Chapter 74
Lee Min-jae's mouth slowly fell open.
Zone 1.
It is the uppermost segment of the aorta, just below the diaphragm, before the vessels to all the major abdominal organs branch off.
In other words, blocking it means cutting off blood flow to the entire abdomen.
It means giving up the kidneys, liver, intestines… everything.
What's more, if blood doesn't reach the legs for too long and something goes wrong, the patient may even have to have a leg amputated.
“……What?”
A stunned sound burst from Lee Min-jae's mouth.
Lee Min-jae tried to shout something more.
That this madness had to be stopped right now, that they were trying to amputate a body part.
But before he could get the words out, the automatic door to the resuscitation room opened.
Ziiiiing-
A group in surgical gowns rushed in, perfectly in step. It was the trauma surgery team.
At the very front stood Associate Professor Jeon Tae-jeong of trauma surgery.
The moment he entered the resuscitation room, he looked around everywhere.
The floor turned into a sea of blood, the numbers on the monitor, and… a group of unidentified people carrying out some grotesque ritual under the eerie light of the C-arm.
His brow furrowed.
“What is this? What’s the patient’s condition right now?”
The first to react was Baek Eun-seo, who was barely keeping herself together.
Almost reflexively, she began reciting the trauma patient briefing.
“Yes, sir! Professor! Male in his twenties, found on scene stuporous after a truck-versus-car TA. Under findings of an open pelvic fracture and hemoperitoneum, we activated MTP and are transfusing four packs of pRBCs. The lab results sent out STAT just now are…”
“No, uh, I-I understand. I get it, but….”
Professor Jeon Tae-jeong stopped her urgent briefing with a wave of his hand.
He even stammered. It was probably a sight he'd never seen in more than ten years as a surgeon.
His gaze was fixed behind Baek Eun-seo, on the bizarre procedure taking place under the C-arm’s light.
“What exactly is he doing right now?”
The temporary owner of my body answered very casually without taking his eyes off the C-arm monitor.
“I’m doing REBOA.”
“....”
A look of confusion flashed across Professor Jeon’s face, as if he were thinking, “Am I really hearing Korean right now?”
“So... who is doing that, right now?”
Jeon Tae-jeong’s face hardened like stone.
REBOA.
The emergency medicine department?
Without the trauma surgery team?
My mouth opened again.
“I am.”
At that moment, a gasp of air came from the mouths of the trauma surgery fellows and surgical residents standing behind Jeon Tae-jeong.
“A-ah, Professor! Th-the thing is!”
Lee Min-jae, looking almost on the verge of tears, jumped in first, desperately trying to somehow frame this entire unreal situation as he approached Professor Jeon very carefully.
“Ah, yes, Professor! The patient's condition was so critical that we were trying to buy time before the trauma team arrived... um... yes... our... second-year emergency medicine resident, Dr. Han Hyunjae, is currently performing the REBOA procedure....”
Lee Min-jae's clumsy, desperate attempt to clean things up.
But that explanation did little to help Professor Jeon’s brain turn over.
Professor Jeon Tae-jeong alternated his gaze for a moment between Lee Min-jae and me, the God of the Scalpel, under the C-arm.
It was plain to see that his brain was desperately trying to process the three words [second-year resident] [emergency medicine] [REBOA], words that absolutely could not coexist in the same sentence.
And finally, he opened his mouth.
“Are you all insane?!?!”
Professor Jeon Tae-jeong’s face was blazing red.
“Do you even know what REBOA is? Huh? You think blocking the aorta with a balloon is child's play or something? Emergency medicine—no, I’m not saying this to look down on emergency medicine, but this! This is a procedure that even in our trauma surgery department only fellows in their second year or above attempt! And yet you people are doing it right now in this resuscitation room...!”
Sadly, that cry did not reach the owner of my body.
The God of the Scalpel was completely ignoring all those shouts, as if they were nothing more than mosquito noise.
His gaze remained fixed only on the C-arm monitor.
From the fingertips of the God of the Scalpel, the guidewire was finally advancing toward its target.
“Okay... LSA
(* left subclavian artery)
past it... there. The sheath.”
An emotionless voice flowed from his mouth, requesting the next instrument.
“No, not the sheath, you bastard!”
Professor Jeon Tae-jeong finally lost his reason.
He looked ready to grab my shoulder.
“You’re not listening to me at all, are you? You crazy bastards! Stop right now! I said stop!”
He pointed at the C-arm monitor and shouted.
“And you said the bleeding is from the pelvis, so why is the wire going all the way up there just below the diaphragm? Why are you aiming for Zone 1? Are you crazy?”
Only then did the owner of my body turn his head.
“If we halfheartedly block Zone 3 and there’s some other unconfirmed intra-abdominal bleeding, and the blood pressure still won’t come up, we won’t have time to deflate the balloon and move up to Zone 1 again. This patient will die in those few minutes.”
“No, even if that’s true!”
“On ultrasound, hemoperitoneum
(* blood in the abdomen)
had been confirmed, hadn’t it? There’s definitely bleeding somewhere in the abdomen too. Blocking only the pelvis is pointless.”
The logic was perfect.
But Jeon Tae-jeong did not back down.
“What if it’s ACS! You said the abdomen was rigid!”
“Bladder pressure
(* bladder pressure)
is under 20, so it’s fine.”
Then Professor Jeon pointed out the most fundamental contradiction in all this absurdity.
“...No, even if all of that is right! Why are you the one doing the procedure?!”
At that question,
“....”
For the first time, the owner of my body couldn't get the words out.
Hmm…
It seemed the basic fact that this body’s original owner was a pathetic second-year resident flashed through the God of the Scalpel’s mind.
Even after several seconds, the God of the Scalpel could not find a rational answer to that question.
But what he said next was the star-like move that drove both the fans and haters of the gallery crazy.
“If this keeps up, the patient is going down. Give me the sheath.”
The God of the Scalpel abandoned any logical answer and tried to bulldoze everything through with the urgency of the situation.
Just then, Professor Jeon Tae-jeong made up his mind.
“Hey.”
He said.
“Give it to me. I’ll do it myself instead. I don’t know what kind of training you watched and came back after trying this, but this is something a specialist should do. Step away. Hand it over.”
“....”
For a moment, the God of the Scalpel looked back and forth between the patient with the guidewire inserted and Professor Jeon Tae-jeong, who was staring him down in his gloves.
And apparently he even did something called thinking.
What he was doing, and what that trauma surgery professor was doing.
Which side was the more rational and normal procedure in this situation.
And that calculation would have included whether that trauma surgeon could even perform this procedure.
Knowing the God of the Scalpel’s personality, if that professor hadn't seemed competent, he would have made a huge fuss and insisted on doing it himself.
Without a word, the God of the Scalpel extended the end of the guidewire he was holding toward Professor Jeon Tae-jeong.
Professor Jeon Tae-jeong took the guidewire from my hand—or rather, from the God of the Scalpel’s hand.
Sheath kit.
At that voice, someone behind him quickly handed over the next instrument.
Professor Jeon followed the wire and inserted the dilator
(* vascular dilator)
and the sheath
(* tube)
at once.
His movement looked slightly different from the near-miraculous genius the God of the Scalpel had shown.
The movement of a fiercely skilled craftsman, engraved into the muscles themselves by immense experience and training.
Just then.
“The angle is too high.”
The God of the Scalpel, using my mouth, began pointing out corrections.
Professor Jeon Tae-jeong’s hand faltered. His brow twitched.
“What?”
“I said the angle is too high. If you go in at that angle, the tip of the sheath could scrape the posterior wall. You need to lay it down a bit more and advance parallel to the vessel's course.”
“....”
Professor Jeon Tae-jeong’s face went red with anger.
“No, it sounds like you watched some training somewhere and came back acting like you know things, but I’ll handle it myself...”
Professor Jeon tried to push the sheath in.
But he felt something catch with a hard resistance.
On the C-arm monitor, the tip of the sheath could be seen jammed against the vessel wall, unable to advance any farther.
Seeing that, the God of the Scalpel said in the same tone once more.
“Pull the sheath back by just 3 mm, gently retract the wire a little, rotate the sheath 15 degrees counterclockwise, then push it in again.”
Professor Jeon Tae-jeong hesitated for a moment.
Between his pride as a surgeon, the absurd scene before his eyes, and the patient's fading life.
In the end, reason defeated pride.
Without a word, Professor Jeon began to manipulate the sheath in tiny increments exactly as the owner of my body told him to.
3 mm back, wire retraction, 15-degree rotation.
And advance again.
Swish-
As if it were a lie, the sheath smoothly slid into the vessel with no resistance at all.
Professor Jeon Tae-jeong’s mouth fell open just a little. He looked back and forth between the C-arm monitor and my face in disbelief.
“Uh... thanks....”
Words of thanks leaked from his mouth.
The me inside was horrified watching that scene.
To think he was teaching a trauma surgery professor and even getting thanked for it.
After that small success, the initiative of the procedure began to be reorganized into a strange form.
Hands: Professor Jeon.
Mouth: God of the Scalpel.
Mouth skin: Han Hyunjae.
“Check the curve at the tip. Don’t give it too much angle.”
“Go up along the wire as is. If you feel resistance at the branch point, don’t force it—pull back slightly and rotate.”
“The position is good now. It’s just below the diaphragm, right above the celiac artery branch point. Stop there.”
The God of the Scalpel’s interjections never ceased, and Professor Jeon Tae-jeong initially frowned, but soon realized the instructions were astonishingly accurate and began following them silently.
At last, the catheter was perfectly positioned in Zone 1.
“Prepare for ballooning.”
At Professor Jeon’s words, Lee Min-jae handed over the syringe filled with saline that he had prepared in advance.
Professor Jeon attached the syringe to the catheter port.
“Starting balloon inflation now. Watch the blood pressure closely.”
He began to slowly push the syringe plunger. On the C-arm monitor, the small balloon at the end of the catheter could be seen gradually inflating.
The moment that balloon completely blocked this young man's aorta from the inside.
Every gaze in the resuscitation room turned toward a single target.
The vital monitor.
[BP 50 / 28]
It felt as if everyone's hearts had stopped. Even after the balloon blocked the aorta, the blood pressure was still scraping the bottom.
“No...”
A desperate groan burst from Lee Min-jae's mouth.
“Wait a little longer.”
Professor Jeon calmed Lee Min-jae down.
1 second, 2 seconds, 3 seconds.
Within that hellish stretch of time, a miracle occurred.
The number that had been 50 changed to 55.
And 60.
[BP 75 / 40]
“Blood pressure’s coming up.”