Hua Tuo Becomes a Surgeon - Chapter 4

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Bzzzzz…

While they were eating the kimbap for a while, Kim Hyungsun’s phone vibrated.

In fact, Lee Minho’s phone screen also lit up, but Hwabu didn’t know because it was on silent.

“Shit, speaking of [1]…”

Kim Hyungsun hurriedly swallowed the food in his mouth and answered the phone.

“Yes, doctor. Yes! A TA (traffic accident) patient! Yes, I’m almost at the hospital. Anchovy is also with me. Yes, I’ll go straight to the ER (emergency room).”

Unaware that a call had also come to Lee Minho’s phone, Hwabu was focused on savoring the taste of the kimbap. Then, after a while, Kim Hyungsun, who had finished the call, put the remaining kimbap in his mouth and got up from his seat, frowning.

“What are you doing? You’re just going to dawdle when you got a call?”

“Call? I didn’t get one. It seems like they urgently need you, so go first, I’ll finish this and go.”

“There’s no way that only I got the call. Check your phone.”

At Kim Hyungsun’s words, Hwabu took out his phone from his pocket.

“Oh! There was a call.”

“Did you put your phone on silent mode?”

“Uh, yeah.”

“Good job. Go and change it to vibrate. You’re already screwed, but if you miss the call, you’ll be damned to hell.”

Hwabu adjusted his phone to vibrate and put it back in his pocket.

“Let’s go.”

When Kim Hyungsun impatiently urged him, Hwabu reluctantly put the remaining kimbap and drinks into a plastic bag and got up.

As Kim Hyungsun practically ran towards the hospital, Hwabu also ran and took out the kimbap from the bag and ate it.

Kim Hyungsun looked at Lee Minho in disbelief.

“Hey, what are you going to do if you choke while eating like that?”

“I have a lot of experience eating kimbap while running, so I won’t choke on this.”

“What are you talking about? You might really choke, so eat it later.”

“Haha! Don’t worry!”

As Lee Minho continued to eat while running, Kim Hyungsun had no choice but to stop running and walk slowly.

“Damn it, alright, whether we get there early or late, we’re going to get scolded, so let’s go slowly. Eat and drink your soda so you don’t choke.”

“Okay.”

Kim Hyungsun shook his head as he watched Lee Minho eat and drink the last remaining kimbap and drink.

After a while, the two arrived at the hospital and rushed to the locker room to change their clothes before going down to the emergency room.

When they arrived at the emergency room, they could see doctors and nurses administering emergency care to patients who had been brought in by ambulance.

“Dr. Choi, we’re here.”

When Kim Hyungsun greeted Choi Yongsoo, who was performing endotracheal intubation using a scope, Choi Yongsoo yelled.

“It’s been too long since I’ve called you… We’ll talk later. What are you doing? Can’t you see the patient’s vital signs are a mess? Shouldn’t you be securing the central line while I’m intubating?”

[central line – a central venous catheter inserted into a large vein to administer medicines or withdraw blood.]

“Yes, yes!”

“If you make a mistake like last time, I’ll kill you.”

Thump. Thump. Thump……

‘Why is my heart beating so fast?’

Hwabu’s eyes widened as he felt his heart beating rapidly.

When they rushed here a while ago, his heart rate wasn’t this fast. But when he saw the bleeding patients, it started to beat faster.

‘Is the possession about to end? No, it doesn’t seem to be related to the possession… This pounding… W-wait, am I feeling excited right now?’

It was like the feeling of meeting his first love, and he finally understood the reason why his heart was pounding.

“What are you doing, Dr. Lee!”

At that moment, Kim Hyungsun, who was one step ahead, called out to Hwabu.

Hwabu snapped out of it and approached the patient Choi Yongsoo was attending to.

‘Ah, right. This guy asked me to secure the central line a while ago.’

Looking at Choi Yongsoo, who had tormented him the most, a surge of anger rose within him. However, Hwabu took a deep breath and calmed down Lee Minho’s agitated body as he approached the patient.

It was a short distance of less than ten meters, but while walking that distance, he could recall the reasons and methods for securing the central line through Lee Minho’s memories.

The central line needs to be secured when the patient requires a large amount of fluids, when the peripheral veins are not good, when central venous pressure monitoring is needed, when high-calorie parenteral nutrition is needed, when specific drugs that cannot be administered peripherally, or when dialysis is to be performed.

The method of central line insertion depends on the patient’s body type and condition, including internal jugular vein, subclavian vein (‘빗장밑정맥’ in the past), external jugular vein, or femoral vein.

[빗장밑정맥 (bit-jang-mit-jeong-maek) – former Korean term for subclavian vein]

Kim Hyungsun, who moved first, chose the internal jugular vein.

He was hurriedly disinfecting the neck area where the internal jugular vein flows when suddenly a shout erupted from Choi Yongsoo’s mouth.

“Hey, you bastard! Are you trying to secure a C-line with the jugular in the same neck area where I’m intubating?”

“Yes? T-then where should I…”

“Of course, you should secure it with subclavian on the chest.”

“Ah! Got it.”

As Kim Hyungsun quickly disinfected the *clavicle area, Choi Yongsoo continued with an annoyed expression.

[*at the collarbone]

“If your head isn’t just for decoration, use it. Okay, you two switch positions.”

“Yes? D-doctor.”

“I said switch positions.”

“I-I understand.”

As Kim Hyungsun stepped back with a dejected look, Hwabu turned the patient’s head to the left and thoroughly disinfected the entire clavicle area that Kim Hyungsun was working on.

Choi Yongsoo kept a close eye on Lee Minho’s actions while intubating.

While disinfecting, Hwabu reviewed the method for securing the subclavian vein in Lee Minho’s memories. It was not a difficult procedure, but he was a little nervous because it was his first time.

Hwaaaaaaaa…

Suddenly, in his mind, Hwabu’s experiences of cutting open countless people’s bodies and Lee Minho’s knowledge began to merge rapidly.

The three-dimensional structure around the subclavian vein of a patient with a thick neck and ample flesh was drawn in his head as if he could touch it.

‘Somehow, it feels like my soul is getting more and more acclimated to this body. If it’s possession, I should be feeling more detached as time goes on…… but I can’t tell at all.’

Perhaps due to the increased adaptability, finding the subclavian vein and inserting the needle was not that difficult.

Hwabu looked at the three-dimensionally drawn structure surrounding the subclavian vein and held the syringe, aiming the needle at a point 2 cm below the lateral side of the clavicle.

Sssook.

Then, he slowly inserted it.

‘So, this is what it feels like when the needle goes in!’

It was definitely different from when he pierced an acupuncture or drained pus.

As the needle pierced through the skin, Hwabu felt the resistance transmitted to his fingertips. The current direction of the needle was toward the underside of the clavicle and the sternal notch (the concave part of the sternum) of the first rib.

Thung.

As the needle entered the location of the vein he had visualized in his head, Hwabu felt a faint but definite sensation in his fingertips.

‘The needle went in properly!’

He felt confident, but he was still nervous because it was his first time doing this, and he let out a sigh of relief.

‘I was going to give him a hard time if he fumbled like that guy, but surprisingly, he did good.’

Choi Yongsoo, who had been watching Lee Minho’s performance, briefly squinted his eyes and then nodded in approval.

In fact, the subclavian vein is a procedure that is considered somewhat challenging to perform unless you have a complete picture of the anatomical structure of the clavicle in your head, as its location is fixed by surrounding structures.

However, Lee Minho effortlessly executed the procedure like an experienced practitioner.

Shortly after watching Lee Minho confirming the location of the distal end of the central venous catheter, Choi Yongsoo listened to the patient’s chest with a stethoscope, checked the sounds while monitoring the vital signs, and then nodded.

“Fortunately, the vital signs are returning to normal. Dr. Kim Hyungsun.”

As the emergency situation passed, Choi Yongsoo’s tone changed.

“Yes, Dr. Choi.”

“You will secure the endotracheal tube, and Dr. Lee Minho, finish up and bring the portable.”

“Yes.”

Hwabu, upon hearing the word “portable,” recalled that it referred to a portable X-ray machine and glanced around.

Fortunately, the portable was not far away.

After a while, Choi Yongsoo, dressed in protective suit, took a chest X-ray of the patient using the portable.

Hwabu watched it and admired silently.

‘If X-rays can reveal so much of the inside of a person, then what about the CT or MRI?’

Interpreting the screen with only Lee Minho’s memories made it difficult to read the images in black and white shades accurately. However, when combined with Hwabu’s countless clinical experiences, it became possible to interpret it to some extent.

‘It looks like several ribs are fractured…… Is it multiple rib fractures? If that’s the case, flail chest may occur. Judging by the shadow on the sternum, is the sternum fractured as well?’

[flail chest – an injury that occurs typically following a blunt trauma to the chest. When three or more ribs in one area were fractured, it can cause a part of the chest wall to become detached from the rest of the chest wall.]

While Hwabu silently assessed the patient’s condition, Choi Yongsoo, having seen enough, sighed and called someone.

“Damn it, I thought I heard crepitation during auscultation, and it turned out to be right on the mark. Dr. Oh Gook-hwan.”

[crepitation during auscultation – refers to a crackling or grating sound (crepitation), which may be heard using a stethoscope (auscultation)]

“Why.”

The person who answered Choi Yongsoo’s call was Dr. Oh Gook-hwan, a fellow in cardiothoracic surgery. He had inserted a chest tube between the armpit and the side of another patient, who was having difficulty breathing and was wheezing.

“This patient appears to have sternal fracture along with anterior-type flail chest due to multiple rib fractures.”

[sternal fracture – fractured sternum, which is the breastbone.]

“What? This patient is already serious, but that one is even worse?”

After handing over the treatment of the patient to the resident who was with him, Dr. Oh Gook-hwan quickly approached, and Choi Yongsoo stepped aside to give him a better view of the X-ray screen.

“Damn, with this level of injury, there might be myocardial contusion and even pulmonary laceration. Check the electrocardiogram and confirm blood flow with an echocardiogram.”

[myocardial contusion – bruise on the heart muscle.]

[pulmonary laceration – lung tissue is torn or cut.]

[electrocardiogram – records the electrical signals in the heart.]

[echocardiogram – also called as “echo”, basically a heart ultrasound.]

“Shall we skip the CT?”

“The vital signs are barely holding on, and if we waste time getting a CT scan, this patient might not make it. Dr. Kim Hyungsun.”

“Yes, doctor.”

“Judging from the patient’s condition, we’ll have to do a thoracotomy as soon as the tests are done, so Dr. Kim Hyungsun, contact the anesthesiology department in advance and book an OR (operating room).”

[thoracotomy – a surgical procedure that involves making an incision (cut) into the chest wall to gain access to lungs or other organs in the chest.]

“Understood.”

“I’ll have to contact the professor myself.”

Hwabu nodded inwardly as he watched Oh Gook-hwan immediately making a call to the professor.

His own reading was not much different from that of the specialist.

Oh Gook-hwan called the professor on his cell phone, and soon his expression became confused about what he had heard.

“Yes! You want me to do it? But…… Ah, I see. No, I can handle it well enough. Yes. Yes. Yes.”

A little later, Oh Gook-hwan sighed and hung up the phone, and Choi Yongsoo, who was monitoring the electrocardiogram, asked.

“Dr. Oh, what’s wrong?”

“The professor said he needs another hour to finish the surgery. He told me to do it.”

“Why don’t you do it? Procedures like fracture reduction, laceration treatment, and pericardiocentesis are not that difficult for you.”

[pericardiocentesis – a procedure done to remove fluid that has built up in the sac around the heart (pericardium).]

“If I go into the OR, who will take care of things here?”

“Dr. Hong and I will take the interns, and we’ll manage it somehow.”

“What are you going to do if another accident happens like last time?”

“Don’t worry, we’ll only send patients who definitely need surgery to the OR today.”

Hwabu’s expression involuntarily tightened as Choi Yongsoo and Oh Gook-hwan’s gazes turned to him.

With Lee Minho’s memories, he could tell that he was the culprit of the accident these two were talking about.

In an instant, something like a ball of fire erupted in him.

‘What dogshit…… Should I just punch them?’

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Footnotes:

[1] 말이 씨가 된다더니- it’s an idiom that translates to “A word becomes seed.” Meaning, watch what you say or you’ll reap what you said. Anyway, I used “speaking of” ‘cause it sounds more appropriate to Kim Hyunsung’s way of speaking.