Chapter 155
“So what exactly are you going to lecture me about.”
I asked while peeling back the plastic wrap.
[How would I know?]
…?
“What the hell, you bastard.”
[I’m just asking in case. If you keep your mouth shut even after I tell you later, then no matter how much I ramble it won’t matter, will it?]
“Uh… sure. Got it.”
Anyway, I grabbed the set, including the thickest 32 French chest tube, and set it on the procedure tray.
If it were only a pneumothorax, a 24 or 28 would do, but with rebar lodged in him like that, he probably had a hemothorax too.
To keep clots from blocking the tube, the straw hole had to be as big as possible.
“We’ve already got one liter of normal saline running wide open! Right now the blood….”
Trauma surgery resident Heo Seung-chan shouted urgently.
“We can’t gauge the blood loss yet, so should we start the MTP (* massive transfusion protocol)….”
Trauma surgery fellow Jin Seon-woo shouted at the monitor.
MTP.
That was when it happened.
[Hey, hey!!! Hell slave!! Stop! Why are you already calling for MTP? You trying to bankrupt the blood bank!]
The dust blob went berserk.
[There are still plenty of other patients! His BP is holding for now! Just get four units of type O packed red cells and some FFP (* fresh frozen plasma)!]
‘Huh?’
Of course MTP would be the sure call, but this was a mass-casualty situation.
Blood is a limited resource.
‘Let’s be efficient.’
If we dumped everything into this patient and a more critical shock patient who came in later died because there was no blood left, whose fault would that be?
“Since his initial vitals are still holding, should we skip the MTP and just bring four units of emergency type O blood first? We should probably conserve the blood bank’s stock!”
At my words, Jin Seon-woo hesitated for a moment, then nodded.
“Oh, right. Run the crossmatch first and bring the type O up. Intern, run!”
“Yes, sir!”
The intern sprinted off at a ridiculous speed.
“Doctor! BP is dropping!”
The nurse on the other side, holding the patient’s arm, screamed.
“What?”
Ding-
Ding-
Ding-
The once steady monitor beeping began to stretch out ominously.
[BP 70/40]
[SpO2 82 %]
The numbers started free-falling.
“BP is 70! Saturation’s dropping into the low 80s!”
“Sir! Sir, stay with me! Can you hear me?!”
Jin Seon-woo patted the patient’s shoulder, but the patient’s eyes were rolling back.
Loss of consciousness.
“The neck! Look at the neck!”
I pointed at the patient’s neck.
The jugular veins were bulging as if they were about to burst, and the trachea had clearly shifted to the left.
Proof that the air trapped in the right chest was compressing the heart and lungs to the other side.
“Looks like he’s got a tension pneumothorax?”
The tension pneumothorax seems to have blown open.
Had air built up beyond what the three-sided dressing we’d applied earlier could handle?
Only a few dozen seconds remained before cardiac arrest.
“Give me a 14-gauge needle! Now!”
Needle decompression.
A rapid treatment for tension pneumothorax: shove a large-bore needle into the chest and let the air out.
“You’re going to decompress right now?”
“Yeah! No time! He’s going to arrest! Then….”
Jin Seon-woo aimed for the second intercostal space along the midclavicular line.
The instant before he drove the needle in without hesitation.
[Hey, hey, hey, hey, hey, hey, Hell slave, fuck, stop that bastard!!!! Hurry!!!]
The dust blob watching beside me suddenly started convulsing and screamed.
[No! Don’t stab him! If you do, we’re fucked!]
I flinched.
Why?
If it’s tension, needle decompression is standard, isn’t it?
Isn’t that even in the ATLS guidelines?
Then why are you stopping me?
[Fuck, just stop him for now! He’ll die!]
There was no time to ask why.
When that insane ghost threw a fit like that, there was definitely a fatal reason.
I shouted on instinct.
“Doctor, wait a second!!!!!!!”
At my shout, Jin Seon-woo’s hand froze in midair.
“Why! What!”
Jin Seon-woo glared at me, scowling hard.
“What, you want to stick the chest tube in right away? We’re not ready yet! Do needle decompression first and…!”
“No, no, doctor, it’s just… it’s just….”
‘Spit it out, you god of scalpels! What’s the reason!’
I screamed inwardly.
I’d just stopped a fellow from performing a procedure.
If I didn’t have a reason, I was dead.
[Needle?!?! Needle?! For a diaphragmatic rupture?]
A diaphragmatic rupture?
[It’s an explosion injury, right? Intra-abdominal pressure must have blown out! That could’ve torn the diaphragm and shoved the organs up into the chest, and you want to stab a needle in blindly? You trying to blow his guts apart!]
Blast injury.
When a powerful shockwave strikes the abdomen, intra-abdominal pressure spikes instantly.
If the diaphragm tears under that pressure, the stomach or intestines that should stay in the abdomen can end up pushed up into the chest.
In this state, if you stick a needle in blindly?
You end up mistaking a gas-filled bowel for a lung and puncturing it—a total disaster.
“Ah, doctor, we strongly suspect a diaphragmatic rupture caused by blast pressure!”
Jin Seon-woo’s eyes widened at my words.
Beep- beep- beep-
The monitor’s beeping urged us on.
“Uh, go on.”
Jin Seon-woo asked.
[Hell slave, in this case!]
“In this case….”
…
“Wouldn’t Finger Thoracostomy be the right move?”
[You mean we should open the pleural space with a finger, you bastard!]
Oh.
Jinx.
Finger Thoracostomy
A procedure in which you cut the skin with a scalpel and insert a finger to directly open the space between the lung and chest wall.
“You said the patient was close to the blast site, and he’s also showing abdominal distension! If the shockwave hit the abdomen, intra-abdominal pressure could rise and push the organs up toward the lower-pressure chest….”
I explained without even pausing for breath.
“The diaphragm can tear too. Because of the herniation risk and a few other reasons, I think opening it with a finger is better than using a needle. The patient’s abdomen is a little firm too!”
Jin Seon-woo quickly palpated the patient’s abdomen.
His expression hardened.
“Right. It’s blast trauma.”
Jin Seon-woo immediately tossed the needle he was holding into the medical waste bin.
“Lidocaine, please. And a No. 10 blade!”
The nurse handed over the equipment quickly.
Jin Seon-woo injected anesthetic between the fifth and sixth ribs and immediately cut the skin open with the scalpel.
Sshhk.
“Kelly, please.”
Then he used the Kelly to spread the muscle apart and shoved his index finger into the wound without hesitation.
***
Fwoooosh-!
The sound of the trapped air rushing out through the gap between his fingers could be heard.
At the same time, the monitor numbers began to stabilize.
[BP 90/60]
[SpO2 92 %]
It was back.
The heart wasn’t being compressed anymore.
“Phew….”
Jin Seon-woo let out a sigh of relief and glanced my way.
His eyes held both gratitude and surprise.
While I managed the vitals from the other side, the procedure progressed quickly.
[Whoa, this bastard’s got some skill? What is this? Quick judgment, huh?]
The ghost watching from the side exclaimed in admiration.
‘Oh, the bastard’s praising him.’
[Of course, he’s still nowhere near me, but for a fellow he’s decent enough! And he picks things up fast!]
‘As expected.’
…
“The initial drainage is… easily over 800 cc. And the color is way too dark.”
The moment the chest tube was connected, dark red blood poured into the drainage canister.
It was a hemothorax.
Jin Seon-woo’s face hardened as he shouted to the nurse.
“Uh… I’ll get you more blood. Not the four units I ordered earlier—just two more. Keep transfusing as they come in!”
He smoothly ordered the blood and then picked up his phone.
“Yes, professor. It’s Jin Seon-woo.”
Probably a call about surgery.
“Yes, yes. We’re in the resuscitation room now. It’s a chest impalement with rebar. Yes. We’ve already hung four units of RBCs. The chest injury is extensive, so I think we’ll need a thoracotomy.”
While the urgent call continued, I quietly double-checked the orders behind the monitor.
The rusty steel had pierced the lung and diaphragm.
He was bound to be vulnerable not just to tetanus, but to anaerobic bacterial infection as well.
“The cefazolin and metronidazole I ordered earlier are in, right?”
“Yes! They’re going in now!”
“Please confirm the tetanus toxoid too.”
“Yes!”
That was when it happened.
Ziiiing-
The resuscitation room’s automatic doors opened once again.
[Cardiothoracic Surgery Professor Han Yi-hyeon]
The embroidered name patch on his chest told us who he was.
‘He looks pretty young.’
If you just looked at his face, he’d pass for a fellow.
As soon as Han Yi-hyeon came in, he paused when he saw the rebar embedded in the patient’s chest.
“…Did I come to the right resuscitation room? This isn’t a battlefield, is it?”
I answered while hanging the IV fluids.
“That’s right. Unfortunately. Welcome, professor.”
“Hah….”
Han Yi-hyeon let out a brief sigh and immediately moved to the patient’s side.
“Brief me.”
“He sustained an impalement injury from rebar at the scene of an explosion. He showed signs of an open pneumothorax on arrival, and during treatment we suspected tension pneumothorax and a diaphragmatic rupture, so we performed a finger thoracostomy and inserted a chest tube. Initial drainage was over 800 cc, and his blood pressure dropped, so we’re transfusing now.”
When Jin Seon-woo finished his report, Han Yi-hyeon nodded and checked the drainage container.
“The diaphragm too? What about the abdomen?”
“Trauma surgery is going to take a look.”
“Tsk….”
The lung was torn, and the diaphragm had ruptured too.
This was a major surgery that required opening both the chest and the abdomen.
“You there, trauma surgery guy.”
Han Yi-hyeon called to Jin Seon-woo.
“Yes, professor!”
“Can trauma surgery take this patient straight to the OR? Do you have a room?”
“Yes, sir. I think so. They said to send him up right away.”
“Anesthesiology?”
“They’re ready.”
“Tsk. Then let’s send him up right away. We’ll take C-arm images upstairs and open him while checking the position.”
Han Yi-hyeon made his decision quickly.
“Ah, yes! We’ll move him!”
“One, two, three!”
The staff swarmed in and began pushing the bed.
Someone held the rebar steady so it wouldn’t wobble, someone carried the IV, and someone else pushed the bed.
And just like that, the patient headed toward the operating room with a massive steel rod lodged in his chest.
Rrrrattle-
Bang.
“Phew….”
My legs were shaking.
[Hell slave, fuck, don’t tell me you’re about to sit down right now?!?]
A familiar shout hit my ear.
The dust blob was bouncing up and down right in front of my face.
[Are you crazy?! Don’t you know what situation you’re in right now! Get out there!]
“Oh crap.”
I snapped to my senses.
[Get up! Take off the plastic gown! Change your gloves! Back to the entrance—now! Run!]
“Argh, fine. I got it.”
I swallowed my curse words and forced myself to stand.
“Haah….”
I let out a deep sigh and, just as I opened the resuscitation room door to head back to the battlefield, someone called out to me.
“Doctor!”
Someone was calling me.
A familiar face.
“…Seong-jeong?”
“Yes! It’s me!”
Park Seong-jeong, now a second-year resident, was standing in front of me.
“Seong-jeong? Weren’t you off today?”
“I got the text while I was at home and ran out right away! I couldn’t catch a taxi, so I had to run here, which made me late!”
Park Seong-jeong reported quickly, gasping for breath.
“On the way here, there was a patient suspected of compartment syndrome, so I called ortho (* orthopedics) right away and did a fasciotomy! And I dressed two burn patients and wrote their admission orders!”
‘Look at this guy.’
He caught another compartment syndrome case?
He was practically a compartment syndrome detection dog now.
“Ah, this bastard.”
My lips curled up before I knew it.
“Good job. Really good job.”
“Not at all.”
Park Seong-jeong gave an awkward smile.
Behind him, the door at the opposite entrance to the ER opened, and people in white coats came pouring in.
More staff from other departments kept joining in one by one.
Reinforcements.
Now we could breathe a little easier.
I clenched my fist tightly.
“Alright….”
I said, patting Park Seong-jeong on the shoulder.
“Let’s go. Until we’ve handled every patient.”
“Yes! Let’s go!”
We headed back into the noise, toward the place where the patients were waiting.
Let’s hold out just a little longer.
‘This hard day will end someday, won’t it.’