The Returning Doctor Wanted to Live Quietly - Chapter 375



Only Noblemtl

Episode 375. Decided to Live Quietly (7)

Asin Hospital main building built in 1989.

As they say, history is short.

But there was something that Amilon and Nakamura didn’t know.

That’s right.

‘We started from the fountain!’

They built a hospital from the local area.

That was why he knew he was the 37th generation.

In a time when we were struggling with a medical gap, hospitals were built first in local areas and the main hospital was built later.

But how can you ignore this?

Jang Hyuk-jun’s hand holding the scalpel was tense.

A surgery that must be successful.

Is there any surgery that doesn’t require the word ‘necessary’?

I had to show it to the onlookers.

While you’re waving your hands like that.

The laparotomy was quickly completed from the sigmoid process to the upper part of the umbilicus.

Median sternotomy.

This is a method of abdominal surgery that has been performed hundreds of times.

Immediately afterwards, the second assistant, Amilon, and the third assistant, Nakamura, pulled the retractor.

Jang Hyuk-jun examined the inside of his abdomen.

plural.

Peritoneal seeding.

Even whether the cancer has metastasized.

Put your hand in and touch it.

You can also observe it with your own eyes.

And then.

“Are you okay?”

“It’s okay.”

I even made eye contact with Jinhyeok.

First Aseeman, Jinhyuk Lee.

He was a truly strong supporter.

“First of all, it looks like there is no metastasis. Let’s make an additional incision on the right side. First, let’s secure an additional field of view.”

Jang Hyuk-jun’s instructions.

Amilon reacted late.

“Are you making additional incisions here?”

“Yes, it will ultimately be a Mirrored-L shape. First, give me the scalpel.”

“that…….”

“please.”

“… … .”

As expected of a second assistant, Amilon, who was standing on his right, hesitated without answering.

Jang Hyuk-jun immediately furrowed his brows.

The surgeon is king.

It’s the same in any country.

At least inside the operating room, it is an absolute position.

But there is an assistant who does not follow the king’s instructions.

Something that can’t be happening.

Jang Hyuk-jun shook the hand he had extended strongly.

“I asked for a scalpel.”

“What the patient requested was a median incision.”

“But.”

“I understand the intention of trying to gain additional visibility due to the liver and bile ducts.”

“… … .”

“Making another incision here goes against the patient’s wishes, so let’s just proceed as is.”

At first glance, it could be said to be an expression of opinion, but it crossed the line.

Jang Hyuk-jun shook his head strongly.

“They said that the left side doesn’t need an additional incision, so they’ll just leave it as is and make an additional incision only on the right side.”

“But the patient’s request… … .”

“No. The surgeon’s judgment takes precedence. I can only see half of the field of view. Should we proceed like this?”

“But that really won’t work. Isn’t that different from what the patient agreed to?”

“No. The doctor’s judgment comes first.”

A situation where an argument continues unintentionally.

Jinhyuk handed over the scalpel on behalf of Amilon.

Access to the tray containing surgical instruments was restricted, also due to the third assistant, Nakamura.

From the start, things were not working out.

* * *

Patient’s right to self-choice.

Europe or something.

Whether it’s America or not.

I respect it to the utmost.

A better way.

A better cure.

It clearly exists.

But what if the patient gives up?

Just give up.

It doesn’t even convince me.

This is the exact opposite of Korea.

The Korean medical community was known as the epitome of egoism.

Sometimes, persuading the patient.

Sometimes fighting with the guardians.

It is also true that I am trying to lead you on the right path.

So, Amilon is Amilon.

Jang Hyuk-jun is Jang Hyuk-jun.

We were both feeling frustrated with each other.

Incision direction.

And the German medical world, where patients choose even the length of treatment.

At first glance, it was understandable, but since it wasn’t something to discuss in the operating room, Jinhyuk stepped forward.

“I think it would be better for Amilon to leave.”

“You want me to go out?”

“Yes, you might as well get out.”

“… … .”

“If we just waste time here, it’s not good for the patient. Our hands and feet don’t work together anyway. We’d rather proceed on our own.”

Jinhyuk waved his hand as if he didn’t need your help.

Hand movements that are not normally performed because of the risk of contracting infection.

Without caring about it.

Amilon looked up at the observation room.

A structure where the outside cannot be seen from the inside.

All I could tell was that there were a lot of people there, just shadows in the shape of people.

‘It’s a problem if you drop out, and it’s a problem if you keep going… … .’

Amilon, who had been thinking for a long time, belatedly backed down.

“I don’t want to be responsible for something unnecessary.”

“Yes, that’s right.”

“Okay, that’s it.”

Let him just go out.

Jinhyuk’s head turned towards Nakamura.

“What are you going to do? Are you going to continue to be together?”

“hmm…….”

“If you won’t follow the doctor’s instructions, leave.”

“… … .”

“There is no time.”

“I’ll give up too.”

Nakamura also belatedly took his hands off the retractor.

In the case of Japan, it is common to see behavior similar to that of Korea.

But he is willing to exchange.

It was clear that he felt there was no reason to take the risk.

Let’s get Nakamura out of here.

The vacancy is filled by a scrub nurse.

The formation we always used when there were no doctors coming in as second or third assists.

For the nurses, who were not doctors, it was just like any other surgery.

* * *

The horizontal cut is now complete.

The incision was literally shaped like a capital L.

Jinhyeok asked Jang Hyeokjun, who was examining the refund.

“Are you going to cut the gallbladder first?”

“That’s right.”

“From the top? Or from the bottom? Where are you going to start?”

“Because the field of vision is so poor. Let’s start with the gallbladder head (located between the neck and body of the gallbladder).”

“Should I go for retrograde cholecystectomy?”

“yes.”

This means doing the opposite of how things are usually done.

Ultimately, the bile duct had to be cut open and reconstructed, so the first thing to do was to secure a field of vision.

Once the direction of moderation was decided, Jinhyeok was the first to extend his hand.

“Please give me the Divac forceps.”

“Here it is.”

chuck.

The scrub nurse hands me a pair of Divacy forceps, which are used to grasp blood vessels and fine tissue.

Jinhyuk immediately grabbed the gallbladder tofu.

If you hold it too hard, the tissue will be crushed.

If you hold it too weakly, your grip strength will decrease.

Then grab the tissue with appropriate force.

The remaining hand is also moved to expose the Calot triangle.

Then, Jang Hyuk-jun started to use Bobby to get rid of the surrounding organizations.

Work to clarify the boundaries of the Calot Triangle.

This could be considered preliminary work to confirm the location of the cystic duct and cystic artery connected to it.

Ugh.

Saaak.

After teasing Bobby for a while.

You’re teasing me again.

The act of removing tissue while stopping bleeding.

As Bobby moved, the skin peeled off, as if he was burning a thread sticking out of his clothes with a lighter.

The adipose tissue shrinks.

After a while like that.

When the Calot Triangle is fully exposed.

Jang Hyuk-jun just clipped it.

One in the connected gallbladder duct.

Again, two biliary arteries connected in different directions.

After tying it like that.

“Scissor.”

I started abstinence right away.

Check the clip condition to make sure there are no leaks.

Jang Hyuk-jun, who had handed over the excised part to the nurse, extended his hand again.

“Please give me Bobby again.”

“Here it is.”

“Let’s hurry up a little.”

“yes.”

Like drawing in a sketchbook.

Jang Hyuk-jun scraping tissue along the liver.

This is the procedure of removing the gallbladder.

So, it could be said that it was the work of liberating the tissue that was attached to the liver.

Of course, Jinhyuk didn’t just watch Jang Hyukjun busily waving his hands.

He also does suction.

I stopped the bleeding from time to time.

That’s not all.

Sometimes holding the organization.

And kick it out again.

He moved his hands without hesitation.

A surgery performed by just two people.

It was faster than four people with out-of-sync hands and feet doing it.

* * *

When Jang Hyuk-jun touched the right femoral artery.

Jinhyeok touched the duodenum.

Fat and fascia, which can be considered surrounding connective tissue.

It peels off little by little.

Clear view?

It’s been a long time since we switched to fixed retractors that don’t require the assistants to pull them themselves.

There was no need to worry anymore.

Of course, it didn’t just move quickly.

There were also many cautious movements.

The main blood vessel that supplies nutrients to the liver.

Check for any adhesions to prevent future complications.

I moved my hands to make sure the surrounding lymph tissue was thoroughly removed.

The same was true for Jang Hyuk-jun.

The common bile duct is visible only after removing the surrounding tissues again and again.

The common bile duct containing the tumor had to be removed and then reconstructed, but the procedure was not done right away.

Just check the path the common bile duct takes down towards the pancreas.

Again the hepatic artery next to it.

And the tissues near the common bile duct were simply dissected without touching the portal vein.

Of course, the direction is from top to bottom.

Towards the pancreas.

Keep moving your hands.

As short as 6 hours.

A surgery that can take up to eight hours.

It wasn’t something that could just be ended by cutting it off with a Caesar.

* * *

“This time, you started drinking Kocher.”

Just as the Divac forceps are named after the vascular surgeon Divac.

Kocher technique is also a surgical technique named after Dr. Kocher, who won the Nobel Prize in Medicine.

That also means that it has been verified.

It was a difficult drink.

First, the duodenum and the head of the pancreas.

So, the pancreatic tail had to be gently separated.

It is also not allowed to damage other organs in the middle.

When the onlookers who knew this had very tense expressions on their faces.

Someone said.

“Whew… … I’m so anxious I could die.”

“But aren’t you doing well?”

“That’s true, but in the end, aren’t you an Asian? And you’re Korean, too.”

“But this is Dr. Jang who solved a difficult problem.”

“Theoretical achievement and practical achievement are different.”

“You can’t solve such problems without backing up your field experience!”

“Still, a little… … .”

The opinions of the observers were quite divided.

A difficult problem sent by Amilon and Nakamura.

They also knew what kind of problem they were sending.

I also reviewed the replies myself.

To that extent, being half-believing and half-doubting is also a reality.

It was my first time seeing it with my own eyes, so I was hesitant.

The reality of the German medical community is that no one responded to the invitation. So, the reality of the mass exodus to other countries was just regrettable.

When the onlookers were half in doubt.

The pancreatic parenchyma was exposed.

Lift the duodenum slightly.

This is possible because the 13th lymph node was removed.

The process of liberating the lower part of the common bile duct along the exposed pancreatic parenchyma was repeated.

What followed was traction of the lower common bile duct.

Jang Hyuk-jun ligates the bile duct connected to the head of the pancreas to prevent bile from leaking out, and then resects it.

Now we are proceeding with frozen section examination.

It’s time to check whether the tumor is falsely positive.

Everyone began to wait for the call from the pathology lab.

* * *

A tumor that develops in the bile duct is one that cannot be accurately determined to be cancerous or not without performing an open surgery.

Before the pathology lab could check the specimen and get back to him, Jang Hyuk-jun exhaled.

“Phew… … .”

“I’m doing well.”

“You’re doing well, right?”

“That’s right. What are you going to do now?”

“Let me do a little simulation.”

Jang Hyuk-jun rolled his eyes silently.

When positive.

Or when it is malicious.

He thinks about the method and organizes how to proceed.

Jinhyeok smiled faintly as he looked at Jang Hyukjun.

Jang Hyuk-jun was someone who never seemed to be able to lift a finger in his entire life.

And then there are jokes like, ‘I’m sorry, Earth,’ that no one laughs at.

He was looking for consulting firms and even reading reviews, saying he wanted to open a business.

Now it looks different again.

Of course, no one knew how long this would last.

After a while like that.

I got a call from the pathology lab.

“It’s positive!”

“Okay. Let’s go again!”

“four!”

“Please give me the ball-tip syringe!”

Jang Hyuk-jun started running with an even brighter expression, and Jin-hyeok also started to keep pace.