Chapter 154
[W-w-what the hell are you talking about, hell slave? Fuck! This isn't the time for that—do triage! Are you trying to kill the patient?]
The dust clump, no, anonymous user 125.188, leaped up and denied it.
The way they talk and their temper are dead giveaways.
I don't know why they came as a guest instead of logging in.
Either way, there was no point in pressing them about it now.
'Fine, I'll pretend to believe you.'
I was pretty suspicious of that speck of dust, but the situation was urgent, so I decided to trust them for now.
Because their skill was definitely the real deal.
[Hey, you idiot! You can't cut like that! Yeah, like that! Tilt the angle a little more! Go in diagonally so you don't hit the vessel, you moron!]
Scalpel God, no, no... the wandering ghost was flying through the air, pointing out the hand of surgical resident Heo Seung-chan, who was preparing for an escharotomy.
Of course, nothing would reach Heo Seung-chan's ears.
Heo Seung-chan simply held the scalpel and dripped cold sweat in silence.
Maybe I should hold off on lecturing a surgical resident who can't even hear me.
'At this rate, he might get so frustrated he ascends twice.'
Rattle-rattle—!
Then the automatic doors opened again, and a stretcher came into the ER.
The paramedic started briefing us in a hurry.
"Thirty-three-year-old male! Inhaled smoke while escaping the scene! BP is 130 over 80, pulse 110, saturation 96 without oxygen!"
On paper, the numbers were normal.
An oxygen saturation of 96% is pretty good.
For now, I pulled out my stethoscope.
"I'm going to listen to your lungs once. Please take a deep breath."
Haa—haa—
The breath sounds were clear.
No wheezing either.
"What about respiratory rate?"
"It was 24 at the scene!"
24 breaths per minute.
It's a little fast, but given how agitated he is, it's acceptable.
Just a simple smoke inhalation?
"Then this patient..."
I was just about to speak.
When I checked his face, the skin around the nostrils was singed, and the nose hairs were burnt and stuck together.
Facial burns.
Proof that the heat had slammed directly into his face.
In cases like this, the airway mucosa gets burned and swells after a delay.
He can breathe now, but in a little while his airway will narrow to the size of a needle hole.
[Hey! Look at that! His nose hair and eyebrows are all burnt! Can't you see how red his face is?]
The dust clump darted right in front of my eyes and pointed at the patient's face.
[This is a straight shot to swelling! If you get complacent because he looks fine now, his airway will close and he'll suffocate in 30 minutes! Hurry up, hell slave!]
I know that.
I was looking at it too.
"I know, damn it."
I muttered an oath under my breath and checked inside the patient's mouth.
Sure enough.
The inside of his throat was already starting to swell red.
"Could you tell me your name once, please? Loudly."
"Kim... hngh... Ji-in..."
He can't get his voice out.
A hoarse voice.
A clear sign that his vocal cords were swelling.
If we leave it like this, he'll definitely go into airway obstruction.
If we don't open it now, later the only answer will be a tracheostomy.
"Ah, okay. That's enough. Don't speak."
I immediately grabbed a red tag and scribbled on it with a marker.
[Suspected upper airway obstruction : RSI / Crico ready]
"Zone A! Severe airway swelling! Please prep for intubation right away! It's likely going to be hard to secure the airway, so keep the video laryngoscope and cricothyrotomy kit right next to us! If the anesthesiology team is here, hand it over to them!"
"Yes! Moving to Zone A!"
The nurses rushed off with the patient.
Just as I was about to see the next patient.
[Hey! Hell slave! This surgical resident did the initial exam but can't triage! He's just standing there all dazed!]
The ghost pointed to the corner over there.
Surgical resident Seong Joo-on was at a loss, staring at the patient's leg wound.
[He was initially assessed as a simple tibial fracture with no open wound and second-degree burns! Vitals are stable! Why are you just standing there instead of sending him off already?]
"Oh, really?"
I immediately went over to Seong Joo-on.
"Doctor! Right now..."
"I happened to catch a glimpse of the triage a little while ago."
Pretending to check the chart, I recited the destination.
"This patient will go to Zone B. Just splint him and dress the wound there."
"Oh! Yes, sir! Understood!"
Seong Joo-on's face brightened.
The paramedic brought over the stretcher and hauled the patient straight to Zone B.
"Oh, thank you, doctor."
"Not at all. Thank the dust... ah, never mind. Yes. Good luck."
I gave the floating clump of dust a sidelong glance, then headed back to the entrance.
Tap-tap-tap.
Then the connecting corridor inside the emergency center on the other side also grew busy.
People came running with white coats fluttering behind them.
Not interns—faces that clearly showed years of experience.
A trauma surgery fellow and a general surgery chief resident—one of my cohort, basically—had come.
'Maybe a professor...? No, not quite. A fellow-level doctor.'
One was in the final year of surgical training.
The other had finished surgical training and was now handling trauma only.
When they met my eyes, they gave a brief nod and headed straight for the resuscitation room.
'They're going to save that fall patient.'
Lee Minjae must be struggling alone, so that's at least a relief.
Then I should hold the line here.
Rattle-rattle—!
"Patient incoming!"
"Ah, yes!"
This patient was a woman who looked fairly young.
But her condition was anything but normal.
"Twenty-two-year-old female! She was the closest person to the blast site! We gave her 10 liters of oxygen on the way, but her saturation won't rise above around 85! BP 100 over 60, pulse 120, respiratory rate 35—severe hyperventilation!"
"Let me take a quick look!"
I placed the stethoscope on the patient's chest.
Gurgle.
A bubbling sound.
Then the patient opened her mouth.
"I... can't... breathe... cough!"
Thwock.
Blood mixed with pink foam sprayed out of the patient's mouth.
'...Hemoptysis.'
She was coughing up blood.
And not just blood, but bright-red sputum mixed with foam.
The blast pressure must have ruptured the alveoli, causing pulmonary hemorrhage and pulmonary edema at the same time.
"It's blast lung injury! She's progressing into ARDS (* acute respiratory distress syndrome)!"
Without hesitation, I slapped a red tag onto the patient's chest.
And wrote in big letters with a marker.
[Blast Lung / Intubate immediately!!]
"This patient absolutely has to go to Zone A! Tell them to intubate her right away! If they don't do it now, she'll stop breathing!"
"Yes, sir!!"
The stretcher turned toward Zone A.
"Well done, hell slave! You were much, much, much slower than I was, but for a resident, that was pretty fast! If you're late with that one, her lungs will fill with fluid and she'll drown!"
The dust clump spun around me as it praised me.
'Is this even praise?'
Anyway, with that question in mind, I headed back to the entrance.
That was the moment I finally got a brief breather.
Waaah—waaaah—!
Rattle-rattle.
The rough sound of wheels scraping against asphalt came in harshly.
Zzzing—
The automatic doors opened, and the metallic smell of blood rushed out at once.
I reflexively turned my head.
And then.
"Oh."
A sound that was half exclamation, half scream escaped my mouth.
'Fuck.'
Even the dust clump floating beside me flinched and froze for a moment at the sight.
The patient's chest, lying on the stretcher.
Right in the center, something grotesque was jutting up.
"Thirty-year-old female! BP is 110 over 70, pulse 115, saturation 94! She's still alert (* conscious)!"
"Huuhh... uuugh... hahh..."
With her eyes wide open, the patient was gasping in breaths that wouldn't come properly.
Every time she breathed, the enormous steel rod embedded in her chest trembled slightly.
'What the hell... what is that on her chest.'
It's rebar.
"It's a penetrating rebar injury to the right chest. We only cut it at the scene and stabilized it before bringing her in! We didn't touch it because we were worried pulling it out would cause massive bleeding!"
The paramedic's face was pale too.
I couldn't even imagine the fear and vibrations the patient must have felt every time the cutter bit through the rebar.
"Hey! Hell slave, snap out of it! Why are you spacing out!"
The dust clump shouted into my ear.
"You've seen plenty of patients impaled on rebar in the ER! Why are you acting surprised now!"
'You don't see someone with their thorax blatantly pierced like that every day, you lunatic.'
I slapped my cheek once and pulled myself together.
Right, this wasn't the time to be shocked.
"Ah, y-yes! Hey, intern! Come here and check the fixation so the rebar doesn't shift! If it moves, it'll tear the lung apart! Hold it with your hands!"
"Y-yes, sir!"
The intern went pale and grabbed the bundle of gauze wrapped around the rebar.
I immediately put the stethoscope in my ears and placed it on the right chest where the rebar was lodged.
Inhale...
Inhale....
I can't... hear any breath sounds.
'Decreased breath sounds on the right...? No, they're almost nonexistent. Lung collapse?'
Just then.
"Hey, hell slave! I can hear a sucking sound! Air is leaking through the hole!"
Air was being sucked in and out through the gap between the rebar and the skin.
...Ah!
"It's an open pneumothorax (* open chest wound)!"
A hole had been punched through the chest wall, so every time she breathed, air was moving in and out through the chest wound instead of the airway.
That would collapse the lung and keep her from breathing.
We had to seal the hole right away.
"I'm going to do a three-sided dressing! Hurry! Vaseline gauze and plastic wrap!"
I pressed the gauze the nurse handed me tightly against the wound around the rebar.
"Good, hell slave, that's right."
"No, not all sides. If you seal everything, it'll become tension pneumothorax!"
"Yeah. Right. Yes, leave one side open like that."
The dust clump started lecturing me from the side.
"Seal it on inhalation, but let air out when she exhales! Make it a valve! A valve! Okay, that's it!"
"Ugh, shut up already, you're chattering nonstop."
That was how I managed to finish the taping safely, more or less.
This patient needed a chest tube right now and the OR opened immediately.
This was no place to be standing around.
'Wait a second, I think I need to clear out triage.'
I quickly turned my head and looked for Baek Eun-seo.
"Eun-seo! Did anyone else from our department come in? I need to do triage right now..."
"What? I'll handle it! My hands are free right now!"
Baek Eun-seo ran over with bloodstained gloves on.
"You... intubated her?"
"What about that pulmonary hemorrhage patient from earlier? You didn't abandon her, did you?"
"It's done! She's on the ventilator and her vitals are stable!"
"...."
Damn it.
I don't know.
I trust you.
"Eun-seo, guard the entrance! Sort incoming patients and send them where they need to go!"
"Yes, sir! Leave it to me!"
Once Baek Eun-seo ran to the entrance, I could focus on the patients again.
"I'm sending you straight to the resuscitation area! If you see signs of tension pneumothorax on the way, tell us immediately! We'll need to do needle decompression!"
"Yes!"
Then surgical resident Heo Seung-chan, along with the nurses and the intern waiting nearby, rushed in and started pushing the stretcher.
As I ran, I asked the paramedic one last thing.
"How long did the rescue take? How long was she in that condition?"
"It took about 20 minutes just to get her out and cut the material away!"
20 minutes.
That's a long time for the lungs to have been compressed.
I'd have to worry about re-expansion pulmonary edema too, and I couldn't even estimate the blood loss.
"Ah, shit, got it, chief!"
"Yes, good luck!"
Rattle-rattle!
We sprinted down the resuscitation room corridor.
Bang!
When the door opened and we went inside, Lee Minjae turned his head.
His brow twisted sharply.
"What is this?"
He was looking at the rebar.
"What do you mean, what? It's a penetrating injury! It's rebar!"
"Shit... ah, to Resus Bay 3! It's empty!"
"Yes!"
...
"One, two, three!"
We moved the patient onto bed 3 in the resuscitation area.
Then the resuscitation room door opened again, and a trauma surgery fellow in blue scrubs, wearing a gown over them, hurried in, out of breath.
As soon as he came in, he seemed momentarily at a loss for words at the chaos spread out before him.
"What the hell is this? Did a war break out?"
I didn't even have time to greet him before cutting the patient's clothes off with scissors.
"Give me the briefing first!"
The trauma surgery fellow threw on his gloves and rushed in.
While surgical resident Heo Seung-chan stammered out the briefing beside him, I habitually connected the monitor and prepared the chest tube set.
Since I had to put in a tube anyway.
Then it happened.
"Hey, hell slave."
The dust clump blocked my view.
'Be quiet. I'm busy.'
I answered inwardly and spread out the drape.
"Hey, hey, hell slave. Listen to me for a second."
'What.'
I rummaged through the shelf with the chest tubes.
28 French?
32 French?
If it's a hemothorax, I need to put in the big one.
Then the ghost whispered in an extremely serious voice.
[Later, can you give him pointers exactly the way I say? Please? Hm?]
"...."
My hand stopped.
You want me to give him pointers?
To who?
To that trauma surgery fellow over there with his eyes bloodshot?
A terrible premonition swept over me.
This bastard really is the Scalpel God.