A Flicker of Hope, Part 2
"I'm starting."
Everyone held their breath. But silence was a luxury a battlefield could never afford. Even in the midst of chaos, the system had to keep running.
Lee Min-jae left everything to the crazy bastard performing the procedure and began checking the system behind him. He whispered to the trembling Park Seong-jeong, "First-year."
"Yes, sir!"
"Record everything. Did you log all the medications, fluid types, and volumes by the minute? From now on, write it down to the second. Every word I say, every move Han Hyeon-jae makes, and every single change in the patient's vitals. What do we have logged so far?"
With a face on the verge of tears, Park Seong-jeong stumbled through the notes he had scribbled on the whiteboard. "U-Uh, arrival time 09:14. At 09:16, we started loading one liter of normal saline, and at 09:18, one gram of tranexamic acid was administered. At the same time, the MTP was activated, and two minutes later, two units of Rh- O-negative pRBCs were transfused. The STAT lab results are still—"
"That's enough." Lee Min-jae nodded as he listened to the concise briefing. Even if the world collapsed, records had to be kept. It was the only lifeline that would save their necks later.
At the center of all the whispering and bustling, the host of my body was focusing every single nerve on a single point: the cross-section of the femoral artery faintly pulsating on the ultrasound monitor, and the layers of skin, fat, and muscle covering it.
The Scalpel God's left hand subtly adjusted the probe to find the optimal angle, while the needle in his right hand trembled faintly. I held my breath. This was it. The exact moment the needle tip would pierce the patient's skin.
"..."
His hand froze in midair. Just before the needle tip touched the skin, he stopped all movement. Why? What's wrong?
The Scalpel God turned his head very slowly. Then, he looked down at his own chest—at the ID badge bearing my name: [Emergency Medicine, Han Hyeon-jae].
"Han... Hyeon-jae," the Scalpel God muttered my name awkwardly. "Right, Hyeon-jae. I'm sorry."
...What? Sorry for what? What the fuck are you sorry for, you crazy ghost bastard?
I could hear the sound of every circuit in my brain frying. Sorry? Now? In this situation? No way. It's not what I think it is, right?
'I'm sorry, Hyeon-jae. Come to think of it, this seems to be beyond my capabilities. I feel like I'll only ruin your medical career if I interfere, so I shall take my leave now.' ...It's not something like that, right?
'I'm sorry, Hyeon-jae. My hand slipped slightly just now, and I think I tore the aorta. This patient will die within thirty seconds, and you will become a murderer.' ...It's definitely not something like that, right?
While the inner me shrieked in terror and rage, the temporary owner of my body revealed his true intentions.
"Y-You there. Quiet down for a second. I need to concentrate."
...Ah. No, you crazy bastard!!!
I realized it then. He wasn't apologizing for a failure or the patient's death. In other words, he was using the absolute maximum amount of social skills the Scalpel God could muster to tell Lee Min-jae and Park Seong-jeong, who were whispering to each other in this critical situation, to 'shut their fucking mouths.'
My medical career is being degraded into a social skills training manual for a ghost with a personality disorder. He was a madman who lacked social skills at a genetic level.
The Scalpel God returned to a state of perfect concentration, focusing every nerve on the monitor and the needle tip. He looked up and stared at the black-and-white fluoroscopic image displayed by the C-arm. The outlines of the patient's pelvis and femur were faintly visible, like ghosts.
"Radiology tech. From now on, keep shooting short pulses. Until I tell you to stop."
"Y-Yes, doctor!" the radiology tech's tense voice rang out.
Beep, beep, beep. Along with the short, staccato sounds, the image on the C-arm monitor began to flicker in real-time.
The Scalpel God aimed the ultrasound probe at the patient's groin again. On the screen, the femoral artery was pulsating as a dark, round circle. He angled the needle at forty-five degrees. Then, with a single, fluid motion, he plunged the needle deep beneath the skin.
There was none of the tedious hesitation or hand-trembling that I experienced every time I drew blood. How could someone have hands like that? It's not that I still can't draw blood... but it's true that my hands are embarrassingly clumsy for a second-year resident.
The subtle resistance as it pierced the skin, passed through the fat layer, and penetrated the fascia. And finally, the moment the needle tip pierced the exact center of the blood vessel on the monitor. Bright red arterial blood spurted out from the back of the needle like a miniature fountain.
A perfect success on the very first try. Seeing this, a low gasp of admiration escaped from the corner of the Resuscitation Room. "Oh..."
The mouths of several young medical staff members hung open in wonder.
"That was... incredibly fast. So smooth."
"He got it in on the first try."
"But... isn't this usually done by trauma surgery professors or interventional radiologists?"
"Shh. Quiet."
A wave of murmurs washed over the room. In the back, Lee Min-jae was holding a phone.
"Yes, Blood Bank? This is Lee Min-jae from Emergency Medicine. The trauma patient currently in Trauma Bay 1—yes, we've activated the MTP, but it's running a bit late. Please keep sending blood products in a 1:1:1 ratio. Packed red blood cells, fresh frozen plasma, and platelets. Yes. Don't stop, just keep sending them up. Yes."
"Vitals: BP 52 palpable, HR 168. It's dropping. Be careful." Han Jae-eon's calm voice echoed.
Without showing the slightest agitation amidst all the noise, the Scalpel God proceeded to the next step. He smoothly slid a thin guide wire with a curved tip into the needle. A slender silver line appeared on the C-arm monitor. The line was gliding forward.
His fingertips twitched continuously. Carefully, with tiny, microscopic movements, his fingers adjusted. It meant he was adjusting the direction of the wire with extreme precision to avoid damaging the vessel walls, as if handling a living creature.
How does anyone do this crazy shit? I could never specialize in something like this. How is this even possible? How can a human being guide this tiny, thread-like wire through a blood vessel? Modern medicine is insane.
Everyone watching held their breath. As the thin silver line traveled up the blood vessel on the C-arm monitor, every single person in the Resuscitation Room fell silent. In the midst of this surreal procedure, with the control of my body completely stripped away, I felt like I was watching the whole thing from a front-row VVIP seat. Do they not sell popcorn here?
Right then, the door to the Resuscitation Room burst open, and a nurse rushed in, practically screaming. In her hand was a freshly printed, still-warm sheet of A4 paper.
"Doctor! The STAT lab results are out!"
At her shout, Lee Min-jae reached out reflexively. He snatched the paper and frantically scanned the numbers written on it.
"pH 7.1, lactate 12, potassium 6.5, hemoglobin 5.8... Oh boy, they're completely shot."
A sigh escaped Lee Min-jae's lips. Without even letting go of the phone in his other hand, he began barking orders at the nurse.
"Push two ampules of bicarbonate through the IV line right now, and let's prep one ampule of calcium gluconate. Tell the Blood Bank to keep sending up platelets and FFP in the correct ratio."
While he poured out orders like a madman, the owner of my body completely ignored all the noise as if it belonged to another world. Where on earth did he get this superhuman concentration? I could only guess. The host of my body didn't budge. His gaze was fixed solely on the guide wire dancing on the C-arm monitor. The wire had now passed the iliac artery and was steadily advancing toward the lower abdominal aorta.
Watching this, Lee Min-jae asked me—no, asked the Scalpel God, "Where are you going to inflate it? You're going below the renal artery, right? Since it's pelvic bleeding. You're almost there."
The question was only natural. At least in the current situation, the biggest problem was the blood pouring from the pelvis. It also had the lowest complication rate and the highest survival rate. In the first place, for a pelvic fracture, a Zone 3 REBOA—inflating the balloon below the kidneys—is considered the standard. This is to preserve blood flow to the kidneys and intestines as much as possible. It was the absolute baseline: even if they blocked the aorta, they had to keep the vital organs alive.
But the words that came out of my mouth from the Scalpel God deviated slightly from common medical knowledge.
"No," he replied nonchalantly, without even taking his eyes off the C-arm monitor. "I'm going to inflate it in Zone 1."