The Returning Doctor Wanted to Live Quietly - Chapter 362



Only Noblemtl

Episode 362. The Poison Miner (6)

Lymph node.

Each doctor had a different name for it.

Lymph nodes, lymph nodes.

Or lymph nodes and lymph glands.

To the lymph nodes.

They all called it differently.

But there was something the same.

You have to be careful.

It was said that you shouldn’t touch it lightly

so.

Knock knock.

Knock knock.

He kept hitting me repeatedly, like a boxer throwing a jab.

A long, laparoscopic cautery device that resembles a shotgun.

It is a process of repeatedly touching and removing tissue using a cautery, over and over again.

Careful hand movements while increasing speed.

The expression ‘Jeongjung-dong’ seemed fitting and yet not fitting.

Again.

Knock knock.

Knock knock.

He continued to touch the soft tissue containing the lymph nodes, peeling off the tissue little by little, very little by little.

From outside to inside.

Again from the inside out.

Sometimes from top to bottom.

Again from bottom to top.

Continue to remove soft tissue along the margins to expose as much of the lymph node as possible.

That’s how Kim Hyun-soo moved.

The professor who came in as the first assistant also did not stay still.

I don’t know much about the esophagus part, but anyway, a cardiovascular specialist.

Kim Hyun-soo was able to maintain concentration as he was able to pull out and tract the blood vessel strands surrounding the lymph node and was excellent at assisting the attending physician.

That soon.

Crunch.

Crunch.

One lymph node was cut out and taken out of the body.

It’s not cancer anyway.

Although there was no need to check for metastasis, everyone’s eyes were turned to the removed lymph node.

Lymph nodes filled with black, clayey material.

It was so hard and hardened that it was indescribable, and its diameter was also so large that there was nothing to say.

All these changes are caused by pneumoconiosis.

No, it was the price I paid for rolling around like a dog in the mine.

but.

“Let’s start again.”

Kim Hyun-soo turned his head back to the monitor, suppressing his emotions.

The surgery started again.

Everyone moved around in silence for a while.

Knock knock.

Knock knock.

Crunch.

Crunch.

Keep kicking it out, and kicking it out again.

However, not all the lymph nodes were removed.

A situation that can be expressed as being ruined overall anyway.

If you kick everything out, your lung function may decline and it may be worse than not doing it at all.

Because it could have been a case of removing a deformed but still functioning lymph node.

For that reason, the selection process was also carried out simultaneously.

Lymph nodes that showed high contrast enhancement.

or calcified tissue.

Voice.

Up to necrotic changes.

I repeated the process of selecting a target and moving in while referring to the histological findings displayed on another monitor.

After a while like that.

This time, a nerve was seen branching into two branches and running parallel to each other in the proximal portion.

hereto.

“Let me check.”

“Please give me a neurostimulator.”

“Here it is.”

Jinhyuk moved after receiving a neurostimulator from the nurse along with a short Q&A.

Stimulating needle connected to a neurostimulator.

In other words, a pointed probe.

Push it in carefully and then apply electrical stimulation.

Jiiing.

Jiiing.

A diaphragm that flinches with stimulation.

Everyone’s expressions hardened.

“It seems to be the phrenic nerve… … .”

“hmm.”

“If you touch it wrong, you could get paralyzed.”

“I know.”

“You know?”

“Yes, unilateral phrenic nerve paralysis due to phrenic nerve damage. A healthy patient is fine, but… … .”

“It is fatal for patients with underlying pulmonary dysfunction.”

“yes.”

Kim Hyun-soo’s expression, which had been briefly answered during a Q&A with the professor, became even more serious.

A situation where the lymph nodes must be dissected while preserving the two branches of the phrenic nerve intact.

Just let it go.

Should I force it?

Kim Hyun-soo was thinking and thinking for a long time.

Anyway, the attending physician is himself.

Although there was a professor to assist the residents and fellows, just like in a typical German operating room, he had to make all the decisions himself.

The responsibility was also his.

Of course, the worries were short-lived.

There is nothing good about the surgery taking so long.

His head turned towards Jinhyuk.

“What do you think this teacher should do?”

“I?”

“Is this okay, Professor? This doctor has worked in pediatric surgery and has become adept at handling microvessels.”

“Well, if you’re confident… … .”

“Then just a moment… … .”

Those who change places in an instant.

When Kim Hyun-soo, who was standing on the patient’s left, suddenly switched seats with Lee Jin-hyeok, everyone watching in the observation room opened their mouths.

* * *

It’s like the surgeon entrusting the surgery to someone else.

As is often the case, the problem was that the target was not the professor who was being criticized, but Lee Jin-hyeok.

Even though I have been working in pediatric surgery for quite some time and am very dexterous, it is still an unpleasant job.

Of course, it would be a blow to the pride of a professor who is standing in front of the fish market.

so.

“Heh heh… … .”

“No, this is… … .”

“My, really… … .”

Everyone was busy clicking their tongues.

Diaphragmatic contraction is known to be controlled solely, or 100%, by the phrenic nerve.

It was a situation where I could have gotten in trouble for touching something wrong.

But soon.

“Uh uh… … .”

Everyone was busy looking surprised.

Jinhyuk Lee handles laparoscopic surgical tools as if they were his own body.

He had no hesitation in moving his hands, and his speed was also unrivaled.

I also thought Kim Hyun-soo was excellent, but this was on a whole other level.

Almost twice the speed?

No, it looked like it was three times as much.

It was to the point where I couldn’t understand why I had been quiet all this time.

A cramped space.

A branch of the phrenic nerve that is closely attached.

Don’t touch it at all.

just.

In the cervical spine.

Back down again.

Peel off.

It peels off again.

Scar tissue caused by inflammation.

Just tear it off.

That’s not all.

The tissue surrounding the lymph node, which had a caseous appearance with holes perforated by necrosis, was also boldly removed.

A situation where the cauterizer also stops bleeding.

At the end of the unstoppable touch, Lee Jin-hyeok’s voice rang out.

“Let me check again.”

The idea is to apply electrical stimulation to check if the nerves are damaged.

Kim Hyun-soo immediately moved his hands.

Jiying.

Jiying.

Neural response to low current.

The diaphragm just contracted.

There was no change in the movement.

It is the same reaction as before the lymph node was dissected.

so.

“There was a reason you left it to Dr. Lee.”

“But was Dr. Lee ambidextrous?”

“Are you ambidextrous?”

“You are blessed.”

Everyone was busy exclaiming in admiration.

But immediately, Max, the hospital director, shook his head.

“I heard you practiced.”

“Huh? Practice?”

“They said you were right-handed.”

“If you’re right-handed… …. Are you saying that you really acquired it through effort?”

“I heard that. I heard it directly from him, so I can’t be lying.”

“Heh heh.”

Once again, others were busy laughing out loud.

It’s like a soccer player whose dominant foot is his right foot deliberately practicing with his left foot to become ambidextrous.

Since they knew that no matter how much they practiced, there were differences in everything from kicking power to accuracy, everyone couldn’t help but stick out their tongues.

It’s easy to say, but it’s extremely difficult to overcome something that is innate through something that is acquired.

No, it was absolutely ridiculous.

While they were admiring each other.

The positions have changed again.

Kim Hyun-soo stands in the doctor’s chair again.

Although his pride should have been hurt, he continued to move his hands with an indifferent expression.

of course.

“What do you think about this?”

“I think that would be difficult for me too.”

“is it so?”

“Yes, I can’t see anything at all.”

“I asked just in case. What about here?”

“Structurally, it’s a bit… … .”

“Then I’ll pass.”

They were the ones who gave up what they had to give up and touched everything they could, with quick Q&A.

They may be pushing themselves too hard for a fellow Korean patient, but they draw clear boundaries and operate accordingly.

A moment where the words selection and focus are perfectly suited.

No, all of this was possible because it wasn’t lung cancer.

If it was lung cancer, there would have been countless cases that would have had to be resected just for the possibility of metastasis, regardless of whether or not it had metastasized.

* * *

Three lymph nodes in the tracheal branch.

Two superior mediastinal lymph nodes.

Three inferior mediastinal lymph nodes.

1 aortopulmonary lymph node.

etc.

The lymph nodes continued to be dissected.

Before we knew it, quite some time had passed since the surgery.

Kim Hyun-soo glanced at his watch and took a deep breath.

Maintaining concentration for long periods of time.

It was never easy.

It was clearly an operating room with the temperature lowered significantly, but sweat was beading on his forehead.

A nurse was constantly wiping away the sweat.

And so the difficult task began again.

As the professor who came in first pulled the detached organ upward, Jinhyeok pulled the right pulmonary artery downward.

Meanwhile, Kim Hyun-soo did not stay still either.

Starting from the anterior aspect of the main bronchial tube, the lymph nodes were removed again by moving the hand along the right pulmonary artery.

Of course, the situation was no different from before.

The inside was filled with a black substance.

It had long since lost its function.

Everyone glanced at this in silence and then started waving their hands again.

This time, the professor pulled the ascending aorta to the left.

Again, Jinhyeok pulled the superior vena cava to the right.

of course.

“The aortic vein must not be damaged.”

It was the first aid that did not forget to pay attention just in case.

I didn’t know about the esophagus part, but he was good at blood vessels like Lee Jin-hyuk.

“I will be careful.”

With a short answer, Kim Hyun-soo moved immediately.

Of course, it is not a situation where you can move both hands freely like Lee Jin-hyeok.

He moved his left and right hands alternately, one at a time, but his movements were extremely delicate.

First, gently pull the lymph node downward with your left hand.

Again, using the right hand, the resection was performed while avoiding the venous veins that flow in the anterior-posterior direction.

At the same time, Kim Hyun-soo said,

“I think I’ve done everything I can do now.”

“hmm…….”

“Let’s take a look first.”

That’s how the camera movement started.

The upper part of the organ.

Bottom.

Jonggyeok-dong.

Even the resected lungs.

I looked at it for a long time and looked at it again.

Is there any part of the sentence that is incorrect?

We went through a thorough check to see if there was any minor bleeding.

This is because if you miss anything, it would be a big problem.

Not long after that.

“I think it might be okay to close it.”

“I think it’s time to stop now.”

“Then I will close it.”

I heard the words signaling the end of the operation.

Now it’s time to turn back what we’ve been doing.

Kim Hyun-soo continued speaking, moving his hands, as it was not a difficult task like lymph node dissection.

“I’m sorry, professor.”

“hmm?”

“Because the patient had suffered so much… … we wanted to end it among ourselves.”

“Ah. That’s… … .”

“I shouldn’t empathize with patients… … but somehow I can’t help but empathize.”

He said that he didn’t ignore himself and leave it to Jinhyuk Lee.

The professor shrugged.

“Well, I thought so.”

A blunt German answer.

The corners of his mouth, hidden by his mask, seemed to be twitching, but everyone was silent and focused on finishing the work.

The plunger was pulled out in an instant.

The suturing process began immediately.

Each stitch is sutured again, including the fascia.

This is done to prevent the possibility of an incisional hernia occurring when abdominal pressure increases.

They were the ones who closed everything from the main incision to the auxiliary incision and then carefully closed the skin with subcutaneous tissue sutures.

After some time like that.

“Thank you for your hard work!”

A voice announcing the end of a long operation filled the operating room.

Now, all we have to do is move him to the recovery room and have his condition checked.

Although I had to go back and forth to the outpatient clinic for over a year for follow-up observation, I was certain that the surgery had been successful.