Chapter 144
“Doc! What about the baby? Is the baby crying?”
Ahn Hyeon-jeong shouted urgently as she packed in the gauze.
“Not good! The baby’s limp and severely cyanotic!”
I shouted as I pressed the stethoscope to the baby’s chest.
I could hear the heartbeat, but it was far too slow.
Bradycardia.
And there was no spontaneous breathing at all.
“What about the mother? Can we control the bleeding?”
“I don’t know! Looks like atony(* uterine atony)! This is crazy, seriously!”
Ahn Hyeon-jeong shouted, biting her lip.
‘They’re not having it easy over there either.’
Who said hell was a place overflowing with demons and lava?
This is hell.
On one side, the bleeding wouldn’t stop, and on the other, the baby couldn’t breathe.
With trembling hands, I grabbed the newborn Ambu bag.
Psshh.
I carefully attempted the first ventilation, and just before the helicopter landed.
That is, while we were rushing to the scene, I quickly logged into the gallery and dredged up the conversation I’d had with PediatricGhost77.
HellJoseonSlave1 : When there’s meconium aspiration, should I suction out the stuff in the nose and mouth first? And since it’s a baby, should I try using a bulb first?
ㄴ PediatricGhost77 : You crazy bastard!!!!!!! Are you trying to kill the kid!!!!!!!! You fucking quack!!!!!!!!! No, not a quack anymore!!!!!!! Either way, that move is quackery!!!!!!!
Hmm, right.
It had been a long time since I’d heard such a sharp, vicious string of curses.
Back in my first-year rookie days, when I knew nothing and spouted nonsense on the gallery every day as if it were my opinion, only to get chewed out by the wraiths with, “You trying to kill a patient? Turn in your license.”
That had been an everyday occurrence back then.
By late in my second year, I hadn’t heard it even once.
Anyway, hearing that kind of cursing in that life-or-death moment, racing out for the mother and newborn, was, how should I put it...
kind of comforting?
No, weirdly reassuring.
That’s how I felt.
ㄴ HellJoseonSlave1 : ??? Why are you suddenly cussing at me? If meconium’s blocking it, you have to suction it out.
ㄴ PediatricGhost77 : NRP
(* neonatal resuscitation)
Routine suction was dropped from the 2015 guidelines! Even if the baby is limp, we’re no longer recommending suctioning out the meconium! Don’t waste time on that—just start positive-pressure ventilation right away!
ㄴ HellJoseonSlave1 : Just Ambu bag it? Just the Ambu bag?
ㄴ PediatricGhost77 : Seal the mask and squeeze it right away. Opening the airway comes first.
ㄴ HellJoseonSlave1 : How long do I squeeze for? How long with no response?
ㄴ PediatricGhost77 : 10 seconds. Watch for exactly 10 seconds, and if the chest doesn’t rise, intubate immediately.
ㄴ HellJoseonSlave1 : ? Don’t you usually watch for 30 seconds and check vitals?
ㄴ PediatricGhost77 : That’s in a normal delivery room, you quack!!!!!!!!! This is a helicopter! There’s no equipment, the space is cramped, and the baby is a 35-week preemie covered in meconium!
ㄴ PediatricGhost77 : Don’t argue. Just trust me and do it. Ten seconds.
Right.
Thinking back on that comment.
Not the textbook 30 seconds, but 10 seconds in the field.
Trust the wraith’s judgment.
Trust the pediatric specialist’s judgment.
And trust myself.
“Phew...”
I wiped the cold sweat from my forehead with my shoulder and squeezed the Ambu bag.
Psshh..
I heard air going in.
1 second, 2 seconds..
My eyes were fixed on the baby’s chest. Rise. Please rise. Lungs, expand.
Psshh..
3 seconds.. 4 seconds..
I felt a strange resistance.
It felt like the air that should have gone in smoothly was bouncing back.
“Pack the gauze tight! Hurry, more! More!”
Ahn Hyeon-jeong’s voice came from just behind my back, across the narrow gap.
It looked like postpartum hemorrhage had broken out because the uterus wasn’t contracting.
That side was a battlefield of its own.
Then this side...
I have to take responsibility for this tiny life.
Hup..
I stared intently at the baby’s chest.
Each time I squeezed the Ambu bag, that tiny ribcage with its thin ribs showing should rise.
That would be the sign that air was getting into the lungs.
But.
Not good.
There was no movement at all.
If anything, only the belly seemed to be puffing out.
Was the air going into the esophagus instead of the airway?
The airway was blocked.
A lump of meconium was definitely blocking the entrance to the bronchi.
8 seconds.. 9 seconds...
Chest.
Still not rising.
The skin was still a deep blue from cyanosis.
There wasn’t even time to check the heart rate.
If oxygen isn’t getting in, there’s no way the heart can beat.
10 seconds.
Time was up.
The deadline set by the wraith.
“Doc! Nurse! Give me the suction tip! Not the one attached to the tube—the separate one I set aside!”
I shouted without looking back.
"Ah, yes! Here!"
I took the thin suction catheter the nurse quickly handed me.
In newborns, routine suction is banned because the vagal reflex can cause bradycardia, but this wasn’t one of those cases.
If something is physically blocking it, you have to clear it before you can put air in, right?
As carefully as possible.
Without injuring the airway mucosa.
“Carefully....”
I opened the baby’s mouth and pushed the catheter deep inside.
Shuuuuuk-
I could see dark green fluid being sucked up through the clear tube.
Meconium.
A huge amount of it.
‘It’s out.’
After confirming the meconium was gone, I grabbed the Ambu bag again.
This time it should go in.
Psshh.
“....”
The chest still wasn’t rising.
Was the meconium stuck too deeply?
Or were the vocal cords themselves swollen?
The baby’s vitality was draining away fast.
At this rate, the baby would die.
We needed a definitive airway.
Endotracheal intubation.
In this shaking helicopter, I’d have to find the tiny vocal cords of a preemie and slip in a 3 mm tube.
I’d done it countless times in adults, but with newborns, the only practice I’d had was on a model during internship.
Right.
PediatricGhost77 : If you ever need to intubate the baby after delivery, absolutely do not try to do it yourself.
ㄴ HellJoseonSlave1 : Then what do I do?
ㄴ PediatricGhost77 : Just call me. Call me, got it?
‘Yeah.’
Got it.
I know my limits.
I took a deep breath.
‘I’ll show you the real world. Come over here and save this kid.’
‘Possession, PediatricGhost77.’
At that moment, my soul was dragged into the darkness, and my consciousness went black in an instant.
And just like that, I became a spectator of my own body again.
No matter how many times I feel it, I can never get used to this sensation.
It’s like playing a first-person VR game while the controller disconnects and you watch the character move on its own.
It feels like my soul has been shoved into the back seat.
Swish.
My right hand, commandeered by PediatricGhost77, smoothly picked up the laryngoscope blade.
The pediatric ghost spoke as soon as he possessed me.
“PPV(* positive-pressure ventilation) failed, so I’ll intubate. I’ll use a Miller 0 blade and a 3.0 mm tube.”
“Ah, yes!”
‘I suppose he can predict the possession situation, but he’s laying it out verbally in advance just in case it turns out to be something else.’
Smart.
Swish.
The left hand gently stabilized the baby’s head, and the right hand naturally slid the Miller blade into the baby’s mouth.
‘Are you crazy?’
The helicopter was jolting up and down because of turbulence.
Even adult intubation is enough to make you swear—now he’s putting a metal rod into a preemie with a mouth the size of a coin?
The tongue was displaced to the left, and the tip of the blade went deep inside.
‘That’s the epiglottis?’
A very blurry, tiny structure the size of a grain of rice came into view.
It was too small.
On top of that, the helicopter’s vibration was shaking my vision like crazy.
The vocal cords would appear and disappear, swaying back and forth dizzyingly like an out-of-focus camera.
‘How am I supposed to put this in? I can’t even see it.’
Despair welled up inside me.
If it were me, I’d have given up here and gone back to squeezing the Ambu bag.
But then.
In that fleeting instant when the vocal cords brushed into the center of my vision.
In.
The wraith didn’t hesitate.
‘The tube has to go in now.. will that even work? If it gets scraped, swelling will start right away, won’t it?’
As if mocking my worry, the tube passed smoothly between the vocal cords and settled into the trachea.
“Haa....”
A deep exhale burst from my mouth.
Success.
“Hang in there, baby. Just a little longer.”
The pediatric ghost, borrowing my mouth, whispered very softly.
At the sound of that voice, the nurse tearing tape beside me paused and looked at me.
“Get the tape ready beforehand.”
“Yes!”
Newborns, especially preemies, have short airways.
If the tube goes in too deep, air will go only into the right lung, collapsing the other lung or causing a pneumothorax.
Depth control is everything.
‘The distance to the bifurcation where the lungs split must be incredibly short. Shouldn’t we auscultate and adjust the depth?’
Before my question even finished, the wraith spoke.
“Yes, 8.5 centimeters at the lips. I’ll tape it down right away.”
The depth was fixed without hesitation.
He’d calculated the proper depth the moment he saw the weight and gestational age.
‘Ah. I was worrying for nothing.’
I decided to just watch quietly.
This guy is a god.
At least when it comes to babies.
“ER doc! We’ve got the mother’s bleeding under control, and BP is up to 110! The baby is...”
Ahn Hyeon-jeong lifted her sweat-soaked face.
Since the urgent fire on the mother’s side was out, now she was worried about the baby.
I was just debating whether to drop the possession and let go of it when...
“Do some chest compressions on the baby. With your thumb. You can see the heart rate is under 60, right?”
The wraith said without even looking at Ahn Hyeon-jeong.
“What? Ah, yes! But what are you going to...”
Though flustered, Ahn Hyeon-jeong saw the [HR 58] on the monitor and quickly began pressing the baby’s chest with two fingers.
The heart still wasn’t beating properly.
We needed to use medication.
But babies don’t have veins.
The arms and legs were too thin to get a line.
The bones were too fragile for intraosseous access.
“UVC(* umbilical venous catheter).”
“Pardon?”
Ahn Hyeon-jeong and the nurse asked at the same time.
UVC.
Umbilical Venous Catheterization.
It’s a procedure in which a tube is inserted through the vessels in the umbilical cord to deliver medication near the heart.
And you want to do that in a shaking helicopter?
Thud, thud.
The helicopter lurched again.
Click.
Instead of answering, the wraith picked up the Kelly clamp and grabbed the umbilical cord we had left long above the belly button.
Scrrrt.
When the end of the cord was cut again, the cross-section was exposed.
“The 3.5 French catheter. You filled it with saline, right?”
“Yes! Here!”
The nurse handed over the slender tube with trembling hands.
Then the wraith gripped the end of the umbilical cord with forceps and began searching for a tiny venous opening, the kind you’d only see under a microscope.
‘Why the fuck is he so fast.’
I couldn’t even see where the opening was, but the wraith’s hand was already moving.
The catheter tip was sucked into the vein on the cut surface of the umbilical cord.
No resistance.
Blood started to backflow.
Entry successful.
“It’s in. We’ve got blood return(* backflow).”
Is that even human?
I couldn’t believe what my own body was doing, even as I watched it.
So that thing is running on the same hardware as me?
Was it any wonder I had questions, since he’d finished a procedure that even the NICU handles cautiously in just 20 seconds on the helicopter floor?
“I’m checking the rhythm. It’s 55. Give epinephrine right away. Flush with normal saline.”
***
Time passed.
Forty seconds that felt like ten minutes passed.
“Checking the rhythm again. Stop compressions.”
When Ahn Hyeon-jeong lifted her hands, everyone’s eyes went to the monitor.
60.
80.
The numbers shot up.
100.
130.
150.
[HR 154 /min]
[SpO2 88 %]
Pink color began to return to the baby’s body, which had been deathly blue, and the chest started rising and falling regularly.
The heart is beating.
It’s alive.
“Ah..!”
Ahn Hyeon-jeong froze.
“Haa....”
Only then did my hand, controlled by the pediatric ghost, begin to tremble slightly.
Was it because the tension had eased, or because of overwhelming emotion?
The pediatric ghost carefully cradled the baby’s tiny hand and said.
“You worked hard, baby.”