Chapter 31
The hours of tedious pressure dragged on. I was just staring blankly at the clock on the station wall.
Time was crawling along brutally slowly. The monitor's vitals were calm, and though the patient was grimacing in discomfort, he was no longer coughing up blood.
'See? It's nothing.'
I let out a sigh of relief to myself.
It was obvious those crazy ghosts had just put me through hell on my day off to scare me.
Reality isn't that dramatic.
Blood gushing like a fountain, turning blue from suffocation—those things only happen in dramas...
Right then.
The patient suddenly jerked with a choking "kek."
A bad feeling, as if something were lurching up from deep in the throat.
The suppressed cough burst out reflexively.
"Kheh! Cough, cough!"
And then.
Puchwaaaaaaak-
The long Kelly in my hand was shoved aside in an instant, and at the same time bright-red blood blasted from the patient's mouth like a fountain.
The vessel I'd barely kept compressed couldn't withstand the force of the cough and burst open completely.
"Aaagh!!!!!"
Red blood splattered everywhere—across the patient's chest, my gown, and the floor.
The patient was coughing up blood in great gushes.
At the same time, the monitor started screaming like crazy.
Beep-beep-beep-beep-!
The oxygen saturation plunged straight from 98% to 90, then 85.
A clot had blocked the airway.
"W-what!?"
My brain froze.
Where had the peace from just a moment ago gone, and why was a hellscape spread out before my eyes?
From the patient's throat, clotted blood kept surging back up.
A horrible gurgling sound rang out.
The patient's face turned blue in an instant.
"Doctor! The patient's sats are dropping! They're in the 70s!"
"Suction! Get the suction ready now!"
I was losing my mind.
My hands were shaking uncontrollably.
ENT still isn't here?
The third-year Han Jae-eon went to see another patient?
Think.
Think.
Think, Hyeon-jae.
'All right! You've got a patient with blood pouring out of his throat!'
'This is airway control. Airway first, you idiot!'
'Use the biggest laryngoscope blade to sweep out the tongue and the clot at once, then get the tube in as fast as possible to secure the airway and inflate the cuff so no blood goes into the lungs!'
Airway, airway!
The ghosts' comments rang in my ears like tinnitus.
"Anesthesia still isn't here yet, right? They're far away?"
"Yes! We still haven't heard back!"
Let's do it.
The decision was over in a second.
I ran to the patient's bedside and shouted,
"The intubation set we prepared earlier! Give it to me now! Blade and 7.5 tube! And the suction tip!"
At my scream, the nurse hurriedly handed over the tray.
With trembling hands, I grabbed the laryngoscope.
'Left hand. The laryngoscope is always in the left hand.'
I switched the laryngoscope to my left hand and pried the patient's jaw open.
And at the sight before me, I sucked in a breath.
Hell.
The inside of the patient's mouth was already a sea of bright-red blood.
The heaving blood and clots were so mixed together I couldn't even tell where the tongue ended and the throat began.
'Suction first! If you can't see, you can't put it in! Use the biggest blade and suck it all out!'
That's what the anesthesiology ghost had said.
I grabbed the thick suction tip with my right hand and shoved it deep into the patient's mouth.
Grrrrrrr-!
The suction machine screamed as it sucked up the clots.
But it was useless.
Blood was surging up from deep in the throat faster than the suction could keep up.
The field of view was still awash in red.
I couldn't see anything.
The oxygen saturation monitor was now counting down toward cardiac arrest.
Fuck.
I can't see.
I can't see anything.
I can't get it in like this.
'If suction alone isn't enough, use the blade like a dam, you moron!'
Right, I definitely remembered seeing a comment like that during gallery training.
'In cases like that, don't hesitate—just shove it in! Use the tip of the blade to push the tongue root and clot all the way to the left and make space, even if it's only for a second! Be aggressive!'
I abandoned reason.
I drove the laryngoscope blade in my left hand deep into the patient's mouth.
Then, in that state, I swept the tongue and the regurgitating mass of clot all the way to the left.
"Keh!"
For a moment, as the blood receded, a tiny opening appeared.
But because the mucosa was swollen and blown up from blood, I couldn't tell where the epiglottis or the vocal cords were.
I was lost.
'Where is it! Where am I supposed to put it!'
The monitor showed 55%.
'If you can't see, press from the outside. Don't you know BURP? Tell the nurse to push the thyroid cartilage back, up, and to the right! Then the vocal cords will come into view!'
I grabbed the fidgeting nurse beside me by the hand.
"Nurse! Here! The patient's neck! This protruding bone here, press it with all your strength! Downward, and toward me!"
The nurse pressed hard on the patient's neck.
That was the moment.
The field of view shifted ever so slightly.
Amid the blood-soaked mess, I could faintly make out the outline of the epiglottis, and beyond it a white, V-shaped structure.
The vocal cords!
Found you, you bastard!
Overjoyed, I pushed the tube in my right hand toward that white gap. Now it was over.
All I had to do was get it in...
Ting.
The end of the tube hit something and stopped.
It wouldn't go in.
"Why won't it go in!"
The worst possible situation.
Laryngospasm.
Oxygen saturation: 50%.
This is it.
'In a situation like that, don't force it. You'll tear something! Just rest the tip of the tube against the vocal cords and wait for the spasm to loosen with steady pressure!'
...Right.
The last hope.
I held the tube steady at the entrance to the vocal cords, neither pushing it in nor pulling it out.
1 second, 2 seconds, 3 seconds....
The monitor's heart rate began to slow.
Please.
Please open.
Please.
And then.
Srrrk.
The resistance at the tube's tip vanished like a lie.
I didn't miss the fleeting moment and pushed the tube all the way in.
Done.
It went in.
"Phew..."
The very moment I let out a sigh of relief and wiped the sweat from my forehead,
"Hey! What are you doing—!"
Third-year Han Jae-eon, who had rushed in frantically after parting the curtain, froze at the sight before her.
A blood-soaked patient, and a first-year resident calmly auscultating with a tube jammed into the patient's mouth.
Han Jae-eon's pupils trembled.
Han Jae-eon's gaze flicked back and forth between the laryngoscope in my hand, the tube lodged in the patient's mouth, and my blood-soaked gown.
"It suddenly started coughing and burst open."
My voice didn't tremble.
"Airway was blocked by massive bleeding, sats dropped into the 70s, so I immediately performed endotracheal intubation at my discretion. A 7.5 tube went in, and I inflated the cuff. I just checked bilateral breath sounds while bagging with the Ambu bag, and there's no issue with the tube position."
Han Jae-eon's expression changed as she listened to my report.
Then she snatched the stethoscope from my hand and pressed it to the patient's chest herself.
Confirmed.
That's what a senior is for.
"Breath sounds on both sides... the tube's in properly."
She muttered briefly, then immediately switched into commander mode.
"Stay glued to the patient and hold the tube so it doesn't come out. I'm going to have the vent
(*ventilator, mechanical ventilator)
hooked up."
And then Han Jae-eon began issuing orders to the nurses.
"Through the line we've got now, dump in normal saline
(*normal saline)
1 liter. We need to fill the volume first."
"Yes, doctor!"
"And check with the blood bank right away to see if the PRBCs that were cross-matched earlier can be brought down now."
"I'll check and let you know right away!"
"Just in case, mix up some norepi amps and leave one line ready on the infusion pump. If the blood pressure drops below 80, we're ready to push it immediately."
"Yes, ma'am!"
"And prepare one A-line
(* arterial line)
kit too. If the blood pressure keeps swinging later, we'll place an arterial line right away."
Han Jae-eon headed toward the station without looking back.
I nodded and wiped the flecks of blood from the corner of my mouth with gauze.
I really just did that.
I shoved a tube down the throat of a person who was bleeding all over.
It didn't feel real.
Before long, Han Jae-eon came back dragging a hefty ventilator.
With the sound of machinery, the screen lit up. Her fingers flew across the touchscreen.
With a whoosh, the machine began forcibly pumping oxygen into the patient's lungs.
The patient's chest rose and fell regularly.
The oxygen saturation slowly climbed back up to 80, 85, 90... and finally 95%.
At least the immediate crisis was over.
Without looking at me, Han Jae-eon shouted to the nurse,
"Nayeon, call anesthesia and ENT again right now and tell them the patient had a massive bleed and the intubation's done! Tell them to come down as fast as possible!"
"Yes, doctor!"
Then she looked back at me again.
What now.
"Han Hyeon-jae."
"Yes."
"Go to the med room and bring me two ampules of midazolam and one ampule of rocuronium. The patient looks like he's about to wake up, so we need to put him back under right away."
Only then did I come to my senses.
I ran to the emergency medication room.
Sedative midazolam, muscle relaxant rocuronium.
Drugs that would sink the patient into deep sleep, paralyze his muscles, and make him perfectly synchronized with the ventilator.
While I was gathering the drugs, the scene from just now flashed through my head like slow motion.
...I really pulled it off.
A hollow laugh escaped me. My hands were still shaking slightly.
When I returned to the patient, Han Jae-eon nodded at the syringe in my hand.
"You got it? Give it all through the IV line."
I connected the syringe to the three-way stopcock on the IV line attached to the patient's arm.
First midazolam. The clear liquid flowed into the bloodstream. Then rocuronium.
"Okay. Let's secure the tube now."
Han Jae-eon cut a long strip of medical tape and brought it over.
We taped around the patient's mouth, securing the tube tightly so it wouldn't come out.
"Now we need to call for a portable X-ray and confirm the tube depth."
Han Jae-eon's orders came without a moment to spare.
I picked up the intercom and contacted Radiology.
A short while later, the radiology tech came in with a portable X-ray machine.
And before long, the imaging was done.
Less than a minute later, the station monitor displayed the X-ray that had just been taken.
"Let's see..."
Han Jae-eon and I stood side by side in front of the monitor, searching for the end of the tube.
The tube tip was in the correct position.
"The depth is just right too."
Han Jae-eon murmured quietly.
I swallowed dryly instead of answering.
Then Han Jae-eon stepped in herself.
Han Jae-eon felt along the patient's wrist radial artery with her fingertips until she found the pulse, then without hesitation drove the syringe in.
Arterial blood gushed up into the syringe.
"Send this straight to the lab!"
The syringe full of blood was grabbed by a nurse and rushed off to the lab.
All that was left was to wait for the results.
As if the commotion had never happened, calm returned to the ER.
Only the sound of the ventilator echoed steadily.
All the initial measures were finished. The patient was stable for now.
My hands were shaking, and my heart was shaking.
I... I...
Was I crazy?
Really.
What is this feeling? This feeling of my heart pounding in a way I can't explain.
Only then did Han Jae-eon shove her hands into her pockets and lean against the wall, looking at me.
I couldn't read her expression.
"Hey."
"...Yes, doctor."
"What you just did."
Han Jae-eon chose her words for a moment.
"You did fucking great."
"...Pardon?"
"How did you do it? Blood was gushing like that, and you didn't even tremble once while putting it in? And you did it all by yourself?"
I couldn't possibly say, 'I was forced to study by ghosts a few days ago.'
What came out of my mouth was the most textbook answer possible.
"I just did it the way I was taught."
Han Jae-eon snorted when she heard my answer.
"Bullshit."
"If doing it the way you were taught was all it took, why would any patient ever die?"