The Returning Doctor Wanted to Live Quietly - Chapter 332



Only Noblemtl

Episode 332. Giving orders (14)

Esophageal obstruction.

Feeding through the stomach.

21 years is a long time.

Even the name of your attending physician.

I had a vague recollection.

That makes sense.

Not just any patient, but a special case.

This was a patient who had been fed through a tube inserted into his stomach or small intestine for a long period of 21 years.

And I can’t even drink water.

I couldn’t even chew my food.

Patients who received nutrition only through syringes.

So, it was normal to remember that.

Although he did not specialize in esophagus, he was also a thoracic surgeon.

I knew of numerous cases related to CS.

but.

‘I don’t know, I don’t know.’

Whether it was because the patient died and I got to see the case, or because I overheard the professor talking, or because it was just a mistake, or because it was a difficult surgery.

I couldn’t remember the exact circumstances.

This happened when I was R3 at the Correspondence Department.

It was a strange thing to recall.

‘Should I stop the live surgery first? If I continue like this, I’ll die… … No, no. There’s no guarantee that I’ll die, right?’

Jinhyuk continued to frown.

In fact, even remembering it was a problem.

The operating room is already open.

There was no reason to stop it.

Even if you say there were such and such problems.

Because you’ll be treated like a crazy person.

“under…….”

As Jinhyeok let out a long sigh, Han Dongsu, who was checking the presentation materials, shook his head.

“Why? What is it?”

“It happened so long ago… … I don’t remember.”

“What don’t you remember? You said you remember everything once you see it? Is there something you don’t remember?”

“I’m human too.”

“That guy brought a case from 1971?”

“That was prepared in advance… … .”

Jinhyuk answered vaguely, trailing off.

My knowledge of internal medicine is due to continuous testing.

This is what happened because I had to prove that I was a genius.

‘Now is not the time for this… … .’

“Professor, I’m curious as to why you didn’t undergo surgery all this time. If you’re now going to reconstruct your esophagus, then you’re saying that surgery was possible.”

“Why all of a sudden?”

“I don’t know much about the esophagus.”

“You don’t have to know. You have an adult heart anyway. And the lungs? I don’t know either.”

“Still.”

“But still, what? Why? Are you going to the closed-door road?”

I say this because thoracic surgery also has three subspecialties.

It was divided into adult heart, pediatric heart, and pulmonary esophagus.

Han Dong-soo was on the adult heart side.

Dealing with blood vessels.

The future Jinhyuk was also like that.

When Jinhyeok answered with silence, Han Dongsu turned his head and looked at the wall clock.

At this, Jinhyuk also turned his head.

4:28.

The lecture was about to start.

‘I’ll have the surgery after the lecture is over. There’s still time.’

Jinhyuk spoke to Han Dongsu again.

“I have to go to the cardiovascular department. You’re going to brief me anyway. I want to know the history in advance. Is that okay?”

“… …It’s innate.”

“Then you must have done it as soon as you were born.”

“Oh, 4 days after birth. I did it right after I was in the incubator. I had the esophageal fistula (a passage connected to the esophagus) removed. I did an end-to-end anastomosis. I even had a temporary gastrostomy.”

“But it failed.”

“It failed. I was so young. Then, two years later, I had the esophageal anastomosis corrected. Then, it went to the colon too. But it died.”

The colon that was pulled out to reconstruct the esophagus could not hold up.

If that were the case, the necrotic colon would have been removed again and it would have returned to its original state.

Although he had a rough idea of ​​how the surgery would proceed, Jinhyuk shook his head.

“Why is it that when doing esophageal reconstruction, it is usually done towards the stomach?”

“It’s true that you do that because of the complications. But, you, Inma. Why have you become such an idiot?”

“yes?”

“It’s only been two years. Two years. And after birth.”

“ah…….”

Jinhyuk sighed belatedly.

Because I was forcing myself to recall my memories, I missed an important fact.

If you were a very young child, you could do that. And at that moment, the picture is drawn.

A child who suffered from post-operative complications.

Parents cry when they see this.

It was clear that he didn’t come forward for fear of failing again, since he had already failed twice.

Then I barely made up my mind.

It must have been only now, as an adult, that he decided to undergo surgery.

“Esophageal anastomotic stricture. Aspiration pneumonia. Esophageal-colonic anastomotic failure. Intra-abdominal abscess… … .”

“Why the side effects? Check the connection instead. I’ll go first.”

A reminder to check that the video doesn’t cut off.

Without giving me a chance to respond, Han Dong-soo went upstairs.

* * *

It was still a time when the term ‘web conference’ was unfamiliar.

There were only a few operating rooms capable of performing live surgery.

That’s why we had to connect via video conference.

It would often get disconnected.

So, I had to check it right away and do a pre-test, but I intentionally didn’t connect it and checked the EMR first.

Click.

Click.

‘Did you have the surgery at another hospital?’

Since there was no previous surgical record, Jinhyeok looked through the attached files first.

Surgical records sent from Seoundae.

Luckily, it was scanned and uploaded to the EMR.

‘The right colon was moved to the lower part of the sternum. After 5 days, the inflammation level jumped? After 15 days, necrosis was confirmed, so it was removed again… … ‘

Jinhyeok, who was looking at the surgical records, checked his vitals this time.

The patient’s height is 145 cm.

Weight: 39kg.

It was dwarfed.

Because he was unable to eat, he suffered from developmental delays.

The problem is that there is no way to know with just the information given.

As Jinhyeok continued to check the EMR, Jang Hyukjun, who found this suspicious, stepped forward.

“Comrade Vulcan. What are you doing? We need to connect first.”

“Just a moment.”

“I don’t have time. Is it because I don’t know the IP address?”

“No, really, just a moment.”

“… … ? There shouldn’t be any problems. The hospital director is here too.”

Jinhyeok turned his head and looked at Oh Jiho.

He looks with satisfaction at the trainees who don’t even have a medical license yet.

For Oh Ji-ho’s sake, or rather for the sake of the patient, it was necessary to prevent this from happening.

How much time has passed like that?

While Han Dong-soo’s lecture was continuing, Jin-hyeok’s cell phone rang.

The sender is Kim Hyun-soo.

He was the one who entered the esophageal reconstruction surgery as a step.

[It seems like the connection isn’t working. Can’t get a signal?]

“I can’t catch it.”

[Have you tried rebooting? I think turning it off and on again would be good.]

“That’s not important… … Sorry, but what have you decided to do about the surgery?”

[yes?]

“I think the direction was given at the conference.”

[… … .]

Did you think this was a random question?

Kim Hyun-soo, who works in thoracic surgery, remained silent.

The surgery he went into as a first aid.

I should have had an intern check, but since the person I was talking to was Lee Jin-hyeok, I called him directly.

[Now is not the time. Ha… … Did you see the chart?]

“I saw it.”

[You see how severe the scoliosis is? The trachea is displaced to the left. The rib cage is also deformed. It’s sunken in.]

“That has nothing to do with esophageal obstruction.”

[I guess you were always crouching. You couldn’t taste food. It was painful.]

“Then school… … .”

[Because I used to carry a syringe when other people were eating lunch boxes. My depression is severe. My body type is different. My stomach is also curved. I don’t look like a normal person.]

The explanation went on for a long time.

The patient’s situation was extremely pitiful.

Because I have never experienced the pleasure of eating.

“So what are you going to do this time? Are you going to do it with the colon? Didn’t you do it with the right colon before so it won’t work?”

[Some are short and have small diameters, so they can’t be used as colonics.]

“If the colon doesn’t work. What about the stomach? The stomach will also be deformed, so it won’t work.”

[No way. We’ll proceed to the factory.]

“You’re going to the factory?”

[Yes, I will first resect it and then do an esophageal anastomosis. Well, anyway. It’s hard to explain everything now. It’s time for the professor to arrive, so please connect quickly.]

That means you have to go into the operating room.

Jinhyuk was not one to care about this.

“It’s not very common in factories.”

[You recently published a paper in the US called Supercharging. It’s a bit long, though. Anyway, I really don’t have time anymore.]

“Did you announce it recently?”

Jinhyuk’s eyes sparkled as he briefly questioned her.

A patient who underwent esophageal reconstruction with a factory.

I remembered it belatedly.

* * *

Patients with esophageal obstruction.

The most important thing was the prognosis.

The prognosis was not limited to complications.

Whether or not one can eat a certain amount of food.

The improved quality of life after surgery was important, because even chewing has its limits.

So, it was clear that they were trying to use a factory with an internal diameter similar to the esophagus.

It’s a new technology for this era.

but.

‘It became a hot topic because they brought the factory all the way to Gyeongbu. It wasn’t a common surgical method at the time. I don’t know about the future… ‘

The patient died.

He committed suicide at home after surgery, not during the surgery.

The third failure took away the patient’s hope that surgery would be possible if necessary.

so.

“Esophageal reconstruction. Let’s not do that in a factory.”

[Huh? What are you talking about… … .]

“The factory doesn’t have a developed collateral blood flow.”

[I know that. What are you talking about now?]

“I think it would be better to use a different digestive organ.”

[No, that suddenly… … .]

A panicked voice.

Jinhyuk glanced at the stage and lowered his voice.

“If there is insufficient collateral blood flow, the posterior gastric artery may not be able to supply blood properly. Even if you try to reconstruct it, tissue infiltration may occur.”

[under.]

“I would rather use an allograft ureter.”

[That’s the passage used to move urine from the kidneys to the bladder. Oh, Professor. Now, let’s really cut it off.]

The phone suddenly hung up.

Jinhyuk stared blankly at his cell phone.

The intention was conveyed sufficiently, but the problem was that Kim Hyun-soo was not the attending physician.

No, it was a problem even if it was a house surgery.

A patient he had never seen himself.

There was no way I could hear it.

* * *

The lecture ended in an instant.

The live surgery has begun.

Attendance was free.

Because the official ceremony is over.

But no one went out.

The hospital director is already locked up, so where are you going?

When Jinhyuk has a serious face.

Han Dong-soo’s briefing began while looking at the screen displayed on one side.

But no words reached my ears.

I just watch the screen.

A chest injury that was over in an instant.

The thoracotomy results were identical to the CT scan taken before surgery.

The top was curved.

The deformation was so severe that it could not be used for esophageal reconstruction.

While Jinhyuk was just staring at the screen, the surgery progressed quickly.

The surgeon who came in for the collaborative surgery moves his hands to avoid damaging the right gastric artery.

Meanwhile, the professor of pulmonary surgery was not sitting still either.

Using your hand, move your right cervical spine (near the neck) to expose the lower part of the esophageal blind tube.

Peel off the fat layer on the chest wall.

Preliminary work to reconstruct the esophagus.

Jinhyuk muttered while looking at the screen.

“Kim Hyun-soo, you move. Say something. That’s CS. If the surgery is successful, there’s no need for manners.”

While Jinhyuk was muttering to himself.

Even tunnel work has begun.

The task of connecting the cervix and abdomen.

It’s about creating a passage.

Jinhyeok, who was looking at the screen, turned his head and looked around the audience.

A trainee looking at the screen with shining eyes.

Han Dong-soo nods his head with his arms crossed.

Oh Ji-ho, who is always laughing and thinking that the surgical field will also have a good harvest now.

It was a truly helpless moment.

I intentionally didn’t connect to the conference.

Even though he had to drag Hyunsoo Kim into the operating room, he still had to hold on to him.

Everything is about to go down the drain.

But then.

[Hey, should I take a picture here?]

As if it were a lie, Kim Hyun-soo came forward.

* * *

The surgeon is king.

At least that’s how it was in the operating room.

So, you should refrain from meddling, giving advice, or making useless remarks.

Something that breaks the surgeon’s concentration.

It is something that can make you angry and say, ‘How dare you do something like that!’

But Lee Jin-hyeok thought of it as a very high wall.

He’s not a doctor, he’s just a crazy guy who did a cardiac arrest and chest tube insertion in a helicopter.

No, the genius suddenly said something out of the blue.

Don’t use the factory.

I would rather you use another digestive system.

And trembling.

I can’t believe it.

I thought, what the hell is this?

Kim Hyun-soo said with his eyes tightly shut.

“I, the blood flow is good in the stomach, so there aren’t many complications. But the factory. Hmm. Wouldn’t it be good to get a sono (ultrasound) done?”

“What? Now?”

“The cervix is ​​curved. The rib cage is also sunken. This is a bit.”

Kim Hyun-soo, who was speaking, lowered his head.

Because the eyes of the surgeon looking at him were sharp.

It wasn’t a solo surgery, and I came from a surgical department.

It could have been.

But soon.

“What are you worried about?”

“I did that because I thought the prognosis wouldn’t be good later.”

“Then take a picture.”

“yes?”

“Let’s take a picture. Professor Seo, is that okay?”

“Well, I’m fine.”

As the doctor from the surgery department also nodded, Kim Hyun-soo moved like the wind.

It’s already happened.

I just hope Lee Jin-hyeok’s prediction is correct.

* * *

The audience that had been watching quietly became noisy.

Suddenly an ultrasound machine appears.

I can’t help it, since I’m taking pictures of the factory.

Someone immediately started talking.

“What? Is there a problem?”

“Well, I guess I’m trying to see the blood flow.”

“Why are you looking at the blood flow? Factories are not good to begin with.”

“But you never know. It could be worse. Long-term is different for each person.”

The babbling of a trainee talking about something he has heard.

After a while, the surgeon’s voice rang out.

[Isn’t the blood flow weak, but too weak?]

[To this extent, it’s a bit. The factory is like that originally. Hmm.]

[How’s your job? If you have a good view, you can get a job.]

[The colonoscopy results were good, though.]

[Then you should go to work instead.]

The discussion continued for a long time.

Although it was not the use of the small intestine transplant that Jinhyeok had initially proposed, the direction of the surgery was changing.

That too, with just one word from a resident.

No, it was a stroke of genius to do an ultrasound directly on the organs after the thorax was opened.

When Jinhyuk secretly takes a breather.

Han Dong-soo shouted at the noisy trainees.

“Okay, this is CS! Hey! We’re more democratic than anywhere else!!”

It wasn’t a lie.

The shortfall was also the most.

Surgery is also the most CS.

There was no military discipline, as even fellows ran away.

It was almost like the only advantage.

Oh, this is it.

It makes me so sad.

Jinhyuk smiled sadly.