Chapter 175
Damn, this is driving me insane.
I was about to absentmindedly touch my forehead, then stopped.
'Can't let it get contaminated.'
I suppressed the urge to clutch my head and forced myself to stay calm.
The empty abdominal cavity and the fully distended heart on the ultrasound screen that Jeong Mu-jin was holding.
The situation had completely gone sideways.
“One more time. Are you absolutely sure there's nothing in the abdomen? What about shadows around the spleen or liver?”
“I told you, there's nothing! Even on sono(* ultrasound), it's clean, and there's absolutely no rebound tenderness when I palpate.”
Jeong Mu-jin shouted in frustration.
“Maybe the field assessment was wrong from the start?”
“This is going to be a disaster...”
I had hurriedly called in the general surgery specialist on duty for the severe trauma team, assuming abdominal trauma was the main cause.
Jeong Mu-jin was an expert at opening bellies, but opening chests was not his specialty.
And then, after additional word from the paramedics that there was jugular venous distention, I belatedly called thoracic surgery, but of all times, the line had gone dead at this critical moment.
Cardiac tamponade.
Blood fills the pericardium around the heart, preventing it from beating and crushing it to death.
There was only one solution.
Either insert a needle into the chest and drain the pooled blood, or open the chest.
But there was no thoracic surgeon.
'Then I'll do it.'
The conclusion was obvious.
I let out a short, steadying breath.
“First, I'm going to intubate.”
I looked at Jeong Mu-jin.
“Doctor, could you place a central line while I handle the airway?”
“Oh, uh, yeah! I'll do it!”
Jeong Mu-jin nodded readily.
“Etomidate 20 and rocuronium 80, please. And prepare norepinephrine too.”
I said to the nurse as I moved to the patient's head.
The syringe was connected to the patient's IV line.
10 seconds.
20 seconds.
The patient's body slackened as the strength left it.
'Blade and a 7.5 tube...'
Click.
I opened the patient's mouth and carefully slipped in the blade.
'See the field...'
The structures inside the throat came into view.
The airway and, beyond it, the vocal cords.
'Right...'
The vocal cords were spread wide open.
Without hesitation, I advanced the tube.
'Remove the stylet...'
Whoosh.
“Yes, it's intubated. I'll auscultate.”
I put the stethoscope in my ears and pressed it to the patient's chest and abdomen.
Right lung.
Shh.
Left lung.
Shh.
The abdomen was quiet.
“Breath sounds are good on both sides, and it didn't go into the GI tract. Secure it.”
I swallowed an exhale of relief.
'At least I can intubate properly.'
“Bag the patient right away. 100% oxygen, and don't hyperventilate—one breath every six seconds.”
“Ah, yes!”
At my words, one of the nurses rushed over and started squeezing the Ambu bag.
But there was still no time to relax.
The numbers on the monitor were still red.
“Blood pressure is dropping further!”
Jeong Mu-jin shouted while jabbing a needle near the clavicle.
If the heart is being crushed, it doesn't matter how much air you push in.
“Let's start MTP for now. The patient's vitals are still getting worse.”
I gave the order without hesitation.
Now there was only one thing left.
Remove the root cause.
Drain out the black blood crushing the heart.
“And get me the sono right now. Squeeze out the gel!”
I grabbed the ultrasound probe without even time to wipe the gel off my gloves.
“I'll do the puncture! Give me an 18-gauge long needle and a 50cc syringe!”
“Y-you're doing it, doctor? Without waiting for CS?!”
The nurse asked with wide eyes.
“Yes. I'll do it.”
'Of course, if this were one of those insane cases where I couldn't use ultrasound right away...'
If the screen were blank and I had to puncture it using only the feel of my hand, I would have invoked the God of Scalpels without hesitation.
But.
'It's not that bad.'
We had ultrasound.
I could see the heart on the screen, and I could see where the blood had pooled.
Something like this, I could handle just fine in my right mind.
No, I had to.
'I need to save that for the real worst-case scenario.'
I calmed my mind.
'Under the xiphoid process...'
Good.
“I'm going in.”
I stared at the ultrasound screen and aimed the long needle below the patient's solar plexus.
A delicate job: drain only the blood inside the pericardium without piercing the heart.
If I failed, the heart would rupture.
I held my breath and began pushing the needle tip forward.
Swoosh.
I felt a heavy resistance in my hand as it pierced the skin.
It was a suffocating moment as I tried to advance the needle slowly and carefully.
“Doctor! It takes a while to thaw that FFP(* fresh frozen plasma)! It hasn't come up from the blood bank yet!”
The nurse's frantic shout broke my concentration.
Then Jeong Mu-jin shouted in frustration beside me.
“Then at least bring the PRBC(* packed red blood cells) first!”
“Uh, then that won't work.”
I blurted it out reflexively.
Of course red cells were urgently needed, but in a situation like this where massive bleeding was suspected, dumping red cells in without coagulation factors would cause dilutional coagulopathy.
The blood could become thin as water, and the patient could end up in the worst possible state, unable to stop the bleeding at all.
“H-hey, doctor! No! Tell them to bring the FFP once it's thawed too! For now, we'll put out the fire with fluids! Give me one more liter of fluids!”
Without taking my eyes off the ultrasound screen, I gave the order without turning back.
“Yes, doctor!”
The nurse ran off again.
Jeong Mu-jin looked at me with a look that said, oh no.
I signaled that it was fine with my eyes and focused again on the sensation at my fingertips.
'All right, now...'
On the screen, the tip of the needle had reached right in front of the pericardial membrane.
Now I only had to break through and draw out that pitch-black blood.
Then the compressed heart would start beating again.
'Now, if I pull it out...?'
Swoosh.
I felt a tiny resistance as the membrane was pierced.
On the screen too, the needle tip was positioned exactly in the middle of the black fluid.
Success.
I pulled back the syringe plunger.
But then.
“…Huh?”
The plunger wouldn't budge.
Even when I pulled hard, nothing came into the syringe.
At most, a few red bubbles.
“Why won't it come out?”
The needle was in the perfect position.
And yet nothing came out.
What got sucked into the syringe wasn't bright, rippling blood. It was a dark, jellylike mass clumped together.
“…A clot?”
The blood had been sitting there long enough to harden like rice cake inside the pericardium.
At this rate, no matter how many times you died and came back, you still wouldn't be able to get it out with a needle.
'I'm screwed.'
A chill ran down my spine.
The puncture had failed.
Now the needle couldn't solve it.
I had to open the chest and scrape out the blood clot.
In other words, surgery was the only way out.
'I have to get it out now.'
Swoosh.
I yanked the needle out without hesitation.
“Did you call the CS nurse station? Do they have a doctor?!”
“Ah, yes! We found one! They'll be coming down soon!”
“Do whatever it takes—broadcast over the hospital PA if you have to—and get them down here as fast as possible! If we don't open this up, the patient will die!”
“Yes, yes! I'll call again!”
“And anesthesia?!”
“They're down here! They're setting up the emergency operating room!”
Fortunately, the operating room was open.
Anesthesia was ready too.
The problem was the surgeon.
The only doctor who could open the chest and handle the heart—the thoracic surgery specialist, or even a resident—still hadn't arrived.
'Should I do an emergency thoracotomy here?'
But this was the ER, not the OR.
The infection risk was huge, and the equipment was lacking.
'Would summoning a ghost even solve this?'
Besides, it was uncertain whether a thoracic surgery resident could operate solo in the first place, and uncertain whether the thoracic on-call doctor would allow me to assist or take over.
Even if I put it nicely and got them to agree, could we finish in 30 minutes?
'I'm losing my mind, seriously.'
Then it happened.
I sensed the automatic doors opening and someone coming in.
I hurriedly turned my head, then froze.
“Chief?”
What came into view was Park Gwang-seok, the center director, entering in a fluster.
'What kind of face is that, like he needs to take a dump. Useless even as help.'
And then, as Park Gwang-seok awkwardly made way, a familiar figure walked in behind him.
“...Director?”
It was Director Lee Jae-yoon.
My mind raced in an instant.
Lee Jae-yoon.
The founding medical center director.
And.
'A cardiothoracic surgery specialist.'
Lee Jae-yoon had been in the field until recently, and even now he was a surgeon who kept his edge by publishing papers at conferences.
Excluding the on-call doctor who wasn't reachable right now, he was the most reliable, most likely, and most authoritative heart-surgery expert in this hospital.
This was my chance.
I looked at Park Se-young, who had finished treating the patient next door and had come rushing over here.
“Professor! Please take over here!”
“Huh? Hey, Hyeonjae, where are you going!”
“Just a second!”
I ran straight toward the director.
Park Gwang-seok looked at me and panicked.
“Hey! What the hell are you—!”
I ignored Park Gwang-seok as if he were invisible and looked at Director Lee Jae-yoon.
“Director!”
Honestly, this was a crazy gamble.
The best-case scenario would be the miracle appearance of the thoracic surgery attending, who'd open the elevator doors and take over while the on-call resident arrived to assist.
The worst-case scenario would be someone, director or not, performing the operation without an assistant and turning the surgery into a mess.
The even worse case was the director ignoring what I said and just walking away.
'The possession time is 30 minutes. If I summon the God of Scalpels, who's double-boarded in CS and GS, the initial assist can last until the CS on-call doctor comes down...'
“Why?”
Director Lee Jae-yoon narrowed his eyes as he recognized me, bloodstained from head to toe.
I skipped the greeting and got straight to the point.
“Could you come with me? It's an urgent situation.”
Then the director gave a slight nod.
'Okay.'
With the director, I headed to the resuscitation room.
Lee Jae-yoon followed without a word and checked the patient's condition.
“It's cardiac tamponade. I tried a puncture, but it's a clot, so I can't drain it that way. We need to open the chest right away, but I don't know when the CS on-call doctor will get here.”
“...Hah.”
Lee Jae-yoon let out a dry chuckle.
He had probably already realized why I was saying this.
“So you're telling me to go into the OR? You're telling me to operate?”
“Yes. Anesthesia has already finished setting up the OR.”
When I answered confidently, Lee Jae-yoon let out a long sigh.
“Fine. Say I do.”
Lee Jae-yoon stared at me intently.
“The assist? You want me to do everything by myself?”
That was the biggest problem.
Heart surgery can't be done alone.
You need someone to hold the field open, suction, and assist.
But right now there was no thoracic surgery resident and no PA nurse.
Then...
“...I think I can do it.”
Director Lee Jae-yoon ran a hand through his hair for a moment.
With a deeply incredulous look.
“You and thoracic surgery... ha, forget it.”
A laugh slipped out of him.
“Can you even go into the OR?”
“Yes, um... in this patient's case, the hemodynamics...”
“Can you do it or not? That's all I'm asking.”
Lee Jae-yoon cut me off.
I swallowed.
An emergency medicine resident assisting in a thoracic surgery operation?
Nonsense.
But now I had to make it make sense.
“I'm not thoracic surgery, but...”
“Do you have it or not? That's all.”
I took a deep breath.
“I can do it.”
The corners of Lee Jae-yoon's mouth lifted.
“What are you waiting for? Move the patient.”
At those words, the nurse and a few interns hurriedly started preparing the transfer.
That was when it happened.
“Director!”
Park Gwang-seok ran into the resuscitation room in a panic, face ashen.
“What on earth is this nonsense—! There's also the issue of a doctor from another department going in by the rules, and the director is at risk. Does it make any sense for an emergency medicine resident to assist in thoracic surgery?!”
With a frantic expression, Park Gwang-seok tried to stop the director.
“The surgical risk is far too high! The director's risk, the hospital's risk... if the highest-ranking executive himself performs emergency surgery and there's even a death on the table, people will tear us apart from every direction! Absolutely not!”
Director Lee Jae-yoon looked down at Park Gwang-seok silently.
As if he were looking at a dog barking its head off.
“Center Director Park Gwang-seok.”
“Yes, Director!”
“Only medical personnel are allowed in the resuscitation room, right?”
“...Huh?”
Park Gwang-seok blinked at the sudden question.
“I'm asking whether only medical personnel can come in.”
“Y-yes, Director.”
As Lee Jae-yoon stepped forward, Park Gwang-seok backed away under the pressure.
“You're medical personnel, right?”
“Pardon?”
“Are you? From the way you're acting, it doesn't look like it.”
Lee Jae-yoon took another step toward Park Gwang-seok.
“Because you're in the way.”
The director pointed toward the exit with a finger.
“Get out.”