A Desperate Occlusion
Lee Min-jae’s mouth slowly fell open.
Zone 1. It was the uppermost part of the aorta, right below the diaphragm, before the blood vessels branched off to all the major abdominal organs. In other words, blocking it meant cutting off blood flow to the entire abdomen. It meant sacrificing everything—the kidneys, the liver, the intestines. Furthermore, if blood flow to the legs was cut off for too long, it could lead to complications requiring amputation.
"...What?"
A dumbfounded sound escaped Lee Min-jae's lips. He wanted to scream at him to stop this madness immediately, to tell him that he was risking the patient's limbs. But before he could find his voice, the automatic doors of the Resuscitation Room slid open with a sharp hiss. *Swoosh—*
A group of people clad in scrubs rushed in with military precision. It was the trauma surgery team. Leading them was Associate Professor of Trauma Surgery, Jeon Tae-jeong. The moment he stepped into the Resuscitation Room, his eyes swept over the scene: the blood-soaked floor, the flashing numbers on the monitors, and... a mysterious group performing what looked like a bizarre ritual under the eerie glow of the C-arm. His brow furrowed deeply.
"What is going on here? What's the patient's status?"
The first to react was Baek Eun-seo, who was barely holding herself together. Almost reflexively, she began rattling off the trauma patient briefing.
"Y-Yes, Professor! Male in his twenties, involved in a truck-versus-car traffic accident. Found stuporous at the scene. Presenting with an open pelvic fracture and hemoperitoneum. We have activated the MTP and are currently transfusing four packs of pRBCs. The STAT lab results that just came back are—"
"No, wait, I get it. I get it, but..." Professor Jeon Tae-jeong cut off her urgent briefing with a wave of his hand. He was actually stuttering. In his over ten years as a surgeon, he had likely never witnessed a scene like this. His gaze was locked onto the bizarre activity taking place behind Baek Eun-seo, right under the glow of the C-arm. "What on earth are they doing over there?"
The temporary master of my body didn't even look away from the C-arm monitor as he answered nonchalantly, "We are performing a REBOA."
"..."
A look of sheer confusion crossed Professor Jeon's face, as if he were questioning whether he had just heard Korean. "...I mean, who is doing that right now?"
Jeon Tae-jeong's face turned to stone. A REBOA? By the Emergency Medicine department? Without the trauma surgery team even present?
My mouth opened again. "I am."
At that moment, a collective gasp escaped the trauma surgery fellows and surgical residents standing behind Jeon Tae-jeong.
"Ah, P-Professor! You see!" Lee Min-jae desperately intervened, his face twisted in near-tears. He cautiously approached Professor Jeon, trying his best to sugarcoat this utterly unrealistic situation. "Ah, yes, Professor! The patient's condition was so critical that we were trying to buy some time before the trauma team arrived... Uh, yes... Our, well, second-year Emergency Medicine resident, Dr. Han Hyeon-jae, is currently performing the REBOA procedure..."
It was a pathetic, desperate attempt at damage control. However, it did little to help Professor Jeon's brain process the information. Professor Jeon Tae-jeong looked back and forth between Lee Min-jae and me under the C-arm. I could practically see his brain short-circuiting as it struggled to process three terms that should never coexist in a single sentence: [Second-Year], [Emergency Medicine], and [REBOA]. Finally, his mouth opened.
"Are you all insane?!" Professor Jeon Tae-jeong's face flushed a furious crimson. "Do you even know what a REBOA is?! Do you think occluding the aorta with a balloon is some kind of child's play?! Emergency Medicine—no, I'm not looking down on Emergency Medicine, but this! This is a procedure that even in trauma surgery, only fellows in their second year or higher attempt! And you're doing it right here in the Resuscitation Room?!"
Unfortunately, his screaming did not reach the current master of my body. The God of Scalpel completely ignored the shouting, treating it as nothing more than the buzzing of a mosquito. His eyes remained fixed on the C-arm monitor. Under his fingertips, the guidewire was finally advancing toward its target.
"Okay... past the LSA (*left subclavian artery*)... Good. Sheath." An emotionless voice slipped from my mouth, demanding the next piece of equipment.
"I said stop, you son of a bitch, not sheath!" Professor Jeon Tae-jeong finally lost his mind. He looked ready to grab me by the shoulders. "Are you ignoring me right now? You crazy bastards! Stop this instant! I said stop!" He pointed at the C-arm monitor and roared, "And if the bleeding is in the pelvis, why is the wire going all the way up to just below the diaphragm?! Why are you aiming for Zone 1?! Are you out of your mind?!"
Only then did the master of my body turn his head. "If we half-heartedly block Zone 3 and there's an undetected intra-abdominal hemorrhage causing the blood pressure to keep dropping, we won't have time to deflate the balloon and move it up to Zone 1. The patient will die in those few minutes."
"Even if that's true—!"
"Didn't we already confirm hemoperitoneum on the ultrasound? Something has absolutely ruptured inside the abdomen. Just blocking the pelvis is pointless." The logic was flawless. But Jeon Tae-jeong did not back down. "What if it's ACS (*abdominal compartment syndrome*)?! You said the abdomen was rigid!" "Bladder pressure is under 20, so it's fine."
At that, Professor Jeon pointed out the most fundamental contradiction of this absurd situation. "...Fine! Even if all of that is correct! Why on earth are you the one doing the procedure?!"
To that question, "..."
For the first time, the master of my body was speechless. *Hmm...* It seemed the fundamental reality that this body belonged to a lowly second-year resident had finally registered in the God of Scalpel's mind. Even after several seconds, he couldn't find a logical answer to that question. However, his next move was that of a true star—the kind of move that would drive both his fans and haters on the Deceased Doctors Gallery absolutely wild.
"If we keep wasting time, the patient is going to die. Give me the sheath."
Giving up on a logical explanation, the God of Scalpel tried to force his way through by emphasizing the urgency of the situation. Right then, Professor Jeon Tae-jeong made a decision.
"Hey," he said. "Hand it over. I'll do it. I don't know where you watched a seminar on this to think you can try it, but this is a procedure for a specialist. Take your hands off. Give it to me."
"..."
The God of Scalpel looked back and forth between the patient with the inserted guidewire and Professor Jeon Tae-jeong, who was glaring at him with gloved hands. He seemed to be weighing his options. Between himself and this trauma surgery professor, which was the more rational and standard choice in this situation? His calculations likely included evaluating whether this trauma surgeon was actually capable of performing the procedure. Knowing the God of Scalpel's personality, if the professor had seemed incompetent, he would have thrown a fit and insisted on doing it himself.
Without a word, the God of Scalpel offered the end of the guidewire to Professor Jeon Tae-jeong. Professor Jeon took the wire from my hand—or rather, the God of Scalpel's hand.
"Sheath kit." At his command, someone behind him quickly handed over the next instrument. Professor Jeon threaded the dilator and sheath over the wire, pushing them in together. His movements were slightly different from the godlike genius the God of Scalpel had displayed. This was the incredibly seasoned movement of a master craftsman, engraved into his very muscle memory through immense experience and training.
It was right then.
"The angle is too high." Using my mouth, the God of Scalpel began pointing out flaws. Professor Jeon's hand faltered. His brow twitched. "What?"
"I said your angle is too high. If you enter at that angle, the tip of the sheath might scrape the posterior abdominal wall. You need to lower it a bit more and enter parallel to the course of the blood vessel."
"..."
Professor Jeon's face flushed with embarrassment and anger. "Look, you might have picked up a few things from a seminar, but I know what I'm—" He tried to push the sheath in anyway. However, he felt a sudden, stubborn resistance. On the C-arm monitor, the tip of the sheath was blocked by the vessel wall, unable to advance any further.
Watching this, the God of Scalpel spoke again in the exact same tone. "Withdraw the sheath by three millimeters, pull back slightly on the wire, rotate the sheath fifteen degrees counterclockwise, and then push it in again."
Professor Jeon Tae-jeong hesitated for a moment. He was caught between his pride as a surgeon, this utterly absurd situation, and the fading life of the patient before him. In the end, reason triumphed over pride. Without a word, the professor began to manipulate the sheath exactly as the master of my body instructed. A three-millimeter retreat, a gentle pull on the wire, a fifteen-degree rotation. And then, another push forward.
*Slide—*
As if by magic, the sheath glided smoothly into the blood vessel without any resistance. Professor Jeon's mouth parted slightly. He stared back and forth between the C-arm monitor and my face in sheer disbelief.
"Uh... thanks..." A word of gratitude slipped from his lips.
Watching this from within, I was absolutely flabbergasted. *He's instructing a trauma surgery professor and actually getting thanked for it.* After that minor success, the control of the procedure shifted into a bizarre dynamic. The hands belonged to Professor Jeon. The mouth belonged to the God of Scalpel. And the skin of that mouth belonged to Han Hyeon-jae.
"Check the curve at the tip. Don't give it too much of an angle."
"Advance straight up along the wire. If you feel resistance at the bifurcation, don't force it. Pull back slightly and rotate."
"The position is good now. Right below the diaphragm, just above the celiac trunk bifurcation. Stop there."
The God of Scalpel's backseat driving was relentless. Though Professor Jeon frowned at first, he soon realized the instructions were uncannily accurate and began to follow them in silence. Finally, the catheter was perfectly positioned in Zone 1.
"Prepare for ballooning." At Professor Jeon's command, Lee Min-jae handed over a syringe filled with saline that he had prepared in advance. Professor Jeon connected the syringe to the catheter port. "Inflating the balloon now. Watch the blood pressure."
He began to push the syringe plunger very slowly. On the C-arm monitor, the tiny balloon at the tip of the catheter gradually inflated. The moment the balloon completely occluded the young man's aorta from the inside, every eye in the Resuscitation Room locked onto a single target: the vital monitor.
Everyone's heart seemed to stop. Even though the balloon had occluded the aorta, the blood pressure was still scraping the bottom.
"No..." A despairing groan escaped Lee Min-jae's lips.
"Just wait a moment," Professor Jeon said, calming him down.
One second, two seconds, three seconds. In that hellish stretch of time, a miracle occurred. The number 50 changed to 55. And then 60.
"The blood pressure is rising!"