Department of Anesthesiology.
"We'll try spinal anesthesia first, and if that doesn't work, we'll go straight to general. Her BP is low, so use ketamine for the anesthetic."
Professor Han Seung-hyeon said this to the two residents, then burst through the department office door and headed out first. The third-year resident followed him. The three of them took the elevator straight to the floor housing the MFICU (Maternal-Fetal Intensive Care Unit).
'Damn... the situation is bad...'
Professor Han Seung-hyeon muttered as he stepped off the elevator and started running.
'The lab results I checked right after the call showed an Hb (hemoglobin) of 4.3... I haven't seen a number like that more than a few times in my entire career in anesthesiology...'
Professor Han had almost never seen a hemoglobin level this low. In any other circumstance, the patient wouldn't even be a candidate for surgery; she’d be lying in the ER, receiving blood transfusions. But with obstetric hemorrhage, there was no luxury of waiting around for a transfusion.
'I wonder if the OBGY department can handle this...'
There was only one OBGY professor. They didn't even have many residents. Could this limited staff handle the patient's condition in real-time?
'Probably not.'
With such limited personnel, it would be impossible to arrange the operating room, call the guardians, perform the necessary procedures, and stay by the patient's side for constant observation all at once. There were bound to be gaps.
In the worst-case scenario, the patient could go into cardiac arrest before the surgery even began, leading to the death of both mother and fetus.
'Whew...'
Shaking off the grim thoughts, he arrived in front of the MFICU just as the anesthesiology nurses and operating room nurses arrived as well.
"Professor, we got the call and came as fast as we could..."
"Yes, let's get ready quickly."
Professor Han replied to the nurse and opened the door to the MFICU.
Slide.
As the door opened, the first thing he heard was the voice of a nurse in a state of chaos.
"Code Blue... We need to call a Code Blue!"
Professor Han swallowed a groan at those words.
'As I feared... she's gone into arrest... I had a bad feeling about this...'
His uneasy premonition had been correct.
"What?"
Department Head Kim Seok-hyeong, who had been on the phone with the guardian at the station, shouted as he stood up. At the same time, Professor Han Seung-hyeon ran toward the station and said:
"You don't need to call a Code Blue! The anesthesiology team is here!"
When an emergency situation equivalent to cardiac arrest occurs, there are three departments that can handle it: Internal Medicine if it happens in the ward, Emergency Medicine if it happens in the ER, and... Anesthesiology if it happens in the operating room. Since the anesthesiology team was already on-site, a Code Blue was no longer necessary.
"Please prepare the defibrillator, epi (pressor), and Cordarone (antiarrhythmic)."
Ordering the necessary supplies for resuscitation, Professor Han sprinted toward the source of the alarm.
'Arrest caused by a drop in Hb (hemoglobin) is accompanied by arrhythmia.'
This was different from PEA (pulseless electrical activity), where the heart has stopped completely. This could be reversed with a simple defibrillation to get the heart beating again.
It meant the patient could be saved. Of course,
'If we're too late, even that becomes impossible.'
If they were even a second late, the heart would stop completely, making defibrillation impossible. It was a race against time.
Beep, beep—
As he approached the expectant mother, he saw a man in a white coat standing there.
'What? A man? All the residents are women... who is he?'
The man was holding the defibrillator pads, pressing them against the patient's chest.
"What? What is the situation right now?"
He asked as he approached the patient, glancing at the EKG. At that moment,
Beep, beep—
Click.
Gurgle, gurgle, gurgle.
Suddenly, the EKG waveform began to undulate, forming a W-shape.
'Damn it...! It's cardiac arrest! Quickly, defibrillate...'
Just as Professor Han was rushing toward the patient in a panic,
Thump.
The man holding the defibrillator shocked the patient as if he had been waiting for that exact moment. For an instant, everyone in the MFICU froze.
Beee—
The EKG was a completely flat line.
"..."
While everyone was staring at the EKG,
Beep— Beep— Beep—
A normal EKG rhythm began to appear from the patient.
"...!"
The heart's rhythm had been completely reset and returned to normal.
"Ha..."
A sigh of relief erupted from those around them.
"Whew..."
Professor Han let out a sigh of his own. Hearing the sound, the male doctor turned around and bowed.
"Ah, Professor."
"Oh... um..."
While he was hesitating on how to respond, not knowing who the man was, the man spoke first.
"The patient showed a VF (ventricular fibrillation) rhythm, so I just performed a defib! I'm the intern! Lee! Kang! Woo!"
"Ah, the intern..."
Professor Han nodded, then suddenly jumped in surprise.
'Wait, an intern?'
What kind of existence is an intern? Aren't they the ones who panic when they see a cardiac arrest patient right in front of them, stammering, "Uh... do I do a defibrillation? Really? Me?"
But this intern in front of him had operated the defibrillator as if he had been waiting for the VF rhythm to appear. And he had done it with such skill.
"Um... Intern? You did a calm and excellent job. The VF rhythm appeared at just the right moment."
"Yes! I was waiting because I thought a VF might occur!"
"You... waited?"
Professor Han was flustered again by the intern's words.
"Yes, the lab results showed low Hb, and while observing the EKG, I saw ST-segment depression. I figured if it progressed to VF, a defibrillation would be necessary, so I had the defibrillator ready."
"Uh... so, you anticipated that a VF would occur? Was that your judgment, Intern...?"
"Yes."
Professor Han was shocked by the answer.
'Anticipating that the patient's condition would deteriorate to such an extreme... you can't do that without experience... an intern...?'
This wasn't something you could learn just by reading a textbook. It meant this was a level of response impossible for an intern.
'But how...?'
He had to set that question aside for now. Regardless, the mother was out of cardiac arrest and alive. The top priority now was preparing for surgery.
"Well done. We'll proceed with surgery immediately. Once you're ready, please move the patient into the operating room."
Professor Han said this and entered the operating room along with the anesthesiology resident, the anesthesiology nurse, and the operating room nurses.
***
'Ha...'
I crouched in a corner of the patient waiting room inside the OBGY operating suite and let out a sigh.
'I thought I was going to die.'
But I didn't. That's enough. Have a drink.
[Brooke: That was impressive!]
[Finch_Novel: What is this dopamine rush!!!]
Positive reactions were scrolling through the chat. Sorry, but it's not over yet.
I stared blankly at the bed where the mother was lying.
"I will confirm the patient's information. Patient ID 78884112, Name Kim Yu-mi, surgical site..."
Two anesthesiology nurses were by the patient's side, checking her information and vital signs. The anesthesiology department has it rough, too. As I was muttering that to myself,
Slide.
The operating room door opened.
"...so, she is currently in a state where she requires emergency surgery."
"Ah, yes..."
Professor Kim Seok-hyeong and a young man walked in.
'Hmm... is he the guardian?'
The young man, who appeared to be the husband, was listening to Professor Kim with a bewildered expression.
"Uh... so, you're saying she needs surgery right now? Do I need to stay by her side? I saw that on TV..."
The guardian didn't seem to grasp the gravity of the situation. At that moment,
Whoosh.
Professor Kim pulled back the patient's blanket. What was revealed was a blood-soaked bed.
"Uh... uh?"
Only then did the guardian look flustered.
"Uh... is... is this okay?"
"It is not okay. Honestly, I cannot guarantee anything."
The professor seemed to be giving the guardian a stern warning. The guardian looked like he was falling into an even deeper panic. Watching that, I typed into the chat.
[Me: The professor is really scaring the guardian, isn't he? Is this allowed?]
[Moreau: That's a necessary process. A doctor needs to make the patient and guardian face reality. ㅠ_ㅠ]
Moreau, who had joined at some point, left a message.
[Brooke: Hmm! Obstetric surgery is particularly dangerous.]
[Brooke: Even if a normal delivery is performed without any issues for the patient or the medical staff, there is a 0.5% chance the mother could die.]
I see.
'Well, there are diseases like amniotic fluid embolism... they say if you get that, it's a guaranteed death...'
Childbirth can sometimes lead to unexpected and unpreventable deaths. ...Thinking about it like this, I'm terrified. I'm definitely not going into OBGY.
"So, since this is an emergency, we will receive the consent form from the guardian, and as soon as we receive it, we will enter surgery..."
Watching the professor finish his explanation after showing the patient's condition and walking out of the patient waiting room with the guardian, a message popped up in the chat.
[Moreau: But the mother had cardiac arrest because of low Hb, right?]
[Me: Yeah, we defibrillated and the heart is back, and since some blood packs have gone in, the Hb is up now.]
Since the Hb is up, she probably won't go into cardiac arrest again.
[Moreau: Hmm...]
Moreau seemed suspicious, paused for a moment, and then continued the chat.
[Moreau: Is the fetus okay?]
Is he worried about the fetus again?
[Moreau: No... the mother was in an ischemic state, so isn't it impossible for the fetus to be normal??]
Hmm, is that so?
That's true.
I approached the mother and checked the NST (Non-Stress Test, measuring the fetal heart rate) machine.
Beep.
The machine printed out a graph showing the fetal heart rate at regular intervals.
There...
FHR (Fetal Heart Rate): 130 bpm
The fetal heart rate was indicating a normal range.
[Me: Isn't 120–150 bpm normal? This is normal, right?]
As I typed that into the chat,
Ding.
Once again, the graph printed out right on schedule.
FHR: 112 bpm
Hmm.
Ding.
I waited a moment, and the graph printed out again.
FHR: 89 bpm
"..."
My heart began to pound.
Ding.
The next graph that came out,
FHR: -- bpm
The line representing the fetal heart rate had plummeted vertically, flatlining at the very bottom of the paper.
Fuck...
[Moreau: No...]
Watching the chat scroll by, I gripped the patient's bed.
"Fetal cardiac arrest!"
I shouted as I pulled the bed and rushed out of the preparation room.
"What is it?"
The professor asked, looking surprised at my appearance.
"Professor, the NST isn't picking up a fetal heart rate!"
"What? Ha..."
The professor scratched his head vigorously and ran toward the operating room.
"I'll be scrubbing in, so start the drape!"
"Yes, sir!"
I pushed the patient's bed into the operating room.
"What's going on?"
The anesthesiology professor and the anesthesiology resident looked at me and asked with bewildered expressions.
"Fetal cardiac arrest!"
I repeated the same words.
At that,
Slide.
Clank.
The anesthesiology professor shoved the cart he was using to prepare for spinal anesthesia against the wall and sprinted to the anesthesia machine.
"We're doing general. Dr. Park, help with the prep."
Leaving the anesthesiology professor, who was giving instructions to the resident, I moved the patient onto the operating table.
Then, a chat message popped up.
[Brooke: My! I doubt it's possible for the fetus to survive!]
Is it that difficult?
[Brooke: Unless you deliver the fetus and intubate within five minutes, it's impossible.]
Hmm, I guess it is difficult.
But.
[Me: Five-minute limit. Let's do it.]
Of course, I'm not the one doing it.
The professor has to!
[Lia: You'll need to step up, my boy.]
Hmm.
Why are you calling me?
The lead surgeon is the professor.
[Lia: Because the surgery time depends on the assistant's support.]
What.
[Lia: But no problem.]
[Lia: You've been training for this, haven't you?]
That's true.
I have the time I've spent practicing (though it's only been a month).
[Brooke: Haha! A race against time. I love these kinds of surgeries.]
[Brooke: It doesn't require fancy tricks; it's a battle of pure fundamentals.]
[Brooke: That is the true skill of a surgeon.]
I'm not going to be a surgeon, though.
Anyway.
Just as the disinfection of the patient's surgical site was finished,
Slide.
The operating room door opened, and the professor and Kim Yu-i Senior walked in, water dripping from their hands.
"Intern, go scrub in, too."
"Yes, sir!"
I replied and headed out of the operating room.
Behind me, I heard the professor's voice.
"Scalpel."
The end.
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