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# Chapter 3. Status Window (1)
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That same night, in a corner of the emergency room at Korea University Hospital.
I arrived at the hospital while talking to Park Seong-ho, and a familiar ER nurse was waiting to meet me.
Before getting out of the car, I spoke to Kim Ha-yeon, who had driven me here.
"Ms. Kim Ha-yeon, I'm really sorry about today. Since you've already helped me this much, could I ask you for one more favor and have you take care of my car, too?"
"What? What do you mean?"
"As you can see, I'm not exactly in a position to drive you home right now. Take this car home, and I'll contact you tomorrow. If you're okay with it, I'll come pick up the car and properly treat you to another meal. Of course, if you don't want to, you can turn me down. Think it over and let me know. I'm sorry, but I'm in a hurry, so I'll be going now."
I didn't have time to hear what Kim Ha-yeon said in response.
I immediately got out of the car with my coat and bag.
"Doctor."
"Help me get ready to go straight into Operating Room 16."
"Yes, Doctor. This way."
I ran after the ER nurse as she hurried ahead of me.
"How's the patient in Operating Room 16?"
"I just checked on him. His blood pressure has recovered slightly from 60 over 30 to 65 over 35, but he's still unstable. The intra-abdominal bleeding hasn't stopped, so his heart rate is irregular, too."
Listening to the nurse, I tried to assess the situation.
The irregular heart rate was most likely caused by the beta blocker.
If the source of the intra-abdominal bleeding couldn't be controlled and the heart rhythm was becoming irregular as well, that meant the risk of cardiac arrest was increasing.
When his blood pressure had dropped to 60 over 30, I had increased the norepinephrine to its maximum dose and prepared epinephrine. I also needed to adjust the ventilation immediately to maintain his oxygen saturation...
All I could do was hope the resident had managed to hold out until I entered the operating room.
Soon, we reached the changing room.
The nurse took my coat and bag, placed them on the table, and pulled surgical scrubs from a sterile pack.
My coat had cost more than 19 million won, and the bag had cost more than five million, yet I didn't even have time to tell her to handle them carefully as she rolled them up and tossed them onto the table.
I really wanted to complain.
But compared to those material things, saving the patient came first right now.
Fortunately, the nurse was extremely quick and experienced. Holding only the designated handles of the gown, she maintained sterility while helping me put on my surgical attire.
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# Operating Room 16
The moment I entered, I saw the attending surgeon and his staff working with complete concentration.
They were so busy that there wasn't even time for me to exchange a nod with them.
Park Seong-ho, who was standing at the patient's head, immediately saw me and greeted me.
"Dr. Park, give me a report."
"The bleeding site still hasn't been clearly identified. He's currently being maintained on norepinephrine at 0.2 mcg/kg/min, and his oxygen saturation is 88%. His heart rate is fluctuating irregularly between 120 and 140."
The [Status Window] hadn't displayed any warning message indicating that the patient's life was in danger.
His condition wasn't particularly good, but that was still a huge relief.
"Good. You did well. I'll take over from here. Dr. Park, stay beside me and watch carefully."
"Yes, Doctor."
I first checked the monitors quickly, organized the situation in my head, and took control.
"Adjust the alveolar pressure and increase the oxygen supply to the maximum."
"Yes, Doctor."
The resident quickly adjusted the equipment according to my instructions.
"The irregular heart rate seems to be largely due to the beta blocker. Nurse! Prepare 150 milligrams of amiodarone."
While having the nurse beside me prepare the medication, I adjusted the drug administration and tried to stabilize the patient's condition further.
Then suddenly, the ECG monitor began sounding an alarm, signaling an emergency.
I looked at the monitor.
Fast, irregular QRS complexes were appearing, and the heart rate was climbing steadily as the alarm continued to sound.
His blood pressure suddenly dropped to 60 over 30, and his pulse was weak.
His oxygen saturation had fallen to 85%.
Looking at the patient's face, I could see that the drop in blood pressure had already made him pale, and slight cyanosis was beginning to appear.
Meanwhile, the attending surgeon was still frantically searching for and suturing the source of the intra-abdominal bleeding.
"His ventricular tachycardia is getting worse. He's probably going into cardiac arrest soon. All right! Let's prepare quickly."
The resident and nurse waited tensely for my instructions.
"Dr. Park, don't be so nervous! I'm right here. We can control this situation."
"Yes, Doctor."
Park Seong-ho seemed somewhat frozen, so I deliberately acted even more relaxed to lower his tension.
In reality, the situation was extremely urgent...
I gave Park Seong-ho his instructions.
"Administer 1 milligram of epinephrine intravenously, and slowly infuse 150 milligrams of amiodarone over ten minutes."
"Yes, Doctor."
Park Seong-ho followed my instructions perfectly.
There was nothing in particular to criticize.
"Check the alveolar pressure and increase the oxygen supply to the maximum."
"Yes, Doctor."
Following my instructions, Park Seong-ho adjusted the alveolar pressure and set the oxygen supply to its maximum.
"Now prepare the defibrillator. We'll need it if the ECG rhythm isn't maintained, so get it ready in advance."
"Yes, Doctor."
I thought this situation would become a major learning experience for Park Seong-ho.
As expected, the heart rate on the ECG monitor suddenly shot above 170 before faltering, accompanied by another alarm.
Then the heart rate rapidly dropped below 40, and the ECG rhythm became unstable.
Damn it!
It was pulseless cardiac arrest.
"He's transitioned from ventricular tachycardia to ventricular fibrillation! He's in cardiac arrest. Dr. Park, the defibrillator!"
Because the patient was suffering from intra-abdominal bleeding, using a defibrillator would inevitably increase the bleeding.
But that was a problem for later.
Right now, we had to save the patient.
After seeing Park Seong-ho prepare the defibrillator, I spoke to the nurse assisting us.
"Charge it to 200 joules!"
The nurse followed the instruction and responded.
"Charging to 200 joules. Charging complete."
"Everyone, step away from the patient!"
Everyone in the operating room followed my command in perfect unison.
I nodded at Park Seong-ho, who was looking at me, giving him the signal to proceed.
Then, with Park Seong-ho holding the defibrillator, an electric shock was delivered to the patient.
The patient's body jerked and shook for a moment.
Then, thankfully, the nurse spoke.
"Heart rate recovered to 70. Blood pressure is 85 over 50."
The attending surgeon looked at me, silently asking with his eyes.
I nodded.
I calmed my pounding heart.
Then I let out a deep, silent sigh behind my mask.
I didn't want Park Seong-ho, or anyone else in the operating room, to realize how shaken I was.
Damn...
No matter how many times I went through situations like this, I could never get used to them.
The fact that a person's life could end or continue depending on my judgment and actions was an enormous source of stress.
Whew...
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# A Corner of the Intensive Care Unit (ICU)
I explained the condition of Patient 16 to the ICU medical staff and completed the handover.
In particular, I gave them a detailed account of the ventricular tachycardia that had occurred during surgery and instructed them to pay especially close attention to it.
As I was leaving the ICU, Park Seong-ho was standing in the hallway waiting for me.
"Good work, Doctor."
"Yeah. What about the patients in Operating Rooms 8 and 11?"
"They've been transferred to the recovery room, PACU."
"Good. That's a relief. The surgeries went well without any major incidents, even though there were only residents there without an anesthesiology specialist."
"...Yes..."
I couldn't help smiling at Park Seong-ho's somewhat uneasy response.
"What? Are you feeling like you were the one who got stuck with the difficult patient?"
"Ah... No, Doctor. It's not that."
"Then that's good."
"Will the patient be okay?"
"Who knows? Unless I'm God, I can't know. His vitals are stable for now, but no one can guarantee what will happen later."
"Whew..."
Every time I looked at Park Seong-ho, I felt that he was a gentle and sensitive person.
Of course, that was my way of saying that he was warmhearted and compassionate.
He reminded me of myself in the past, which made me feel even more attached to him.
"What matters more is what happens from now on. Don't let your guard down just because the surgery is over."
"Yes."
"This patient is still at high risk of shock from blood loss and cardiac arrhythmia."
"Yes."
"Even in the ICU, his blood pressure needs to be maintained above 90 over 60, so adjust the antihypertensive medication or IV fluid rate as necessary."
"Yes."
"Keep monitoring his ECG so his heart rate remains stable in the 60 to 100 range."
"Yes, Doctor."
"Dr. Park Seong-ho."
"Yes?"
"You held out really well today until I got into the operating room."
"..."
Park Seong-ho looked embarrassed by my sudden praise.
Looking at him, I really felt like I was seeing my younger self.
"It couldn't have been easy. While I was getting ready to enter the operating room and we lost contact for a while, it was thanks to your judgment that the patient had a chance to survive."
"..."
His eyes seemed to be asking whether I really meant it, as though he couldn't believe I was praising him sincerely rather than simply offering empty words.
I nodded to reassure him that I did.
"There are a few things you absolutely need to remember from today's situation. First, when ventricular tachycardia appeared, you checked the pulse before administering medication, right? That was a good decision. When there's a pulse, medication comes first. Electrical shock is the last resort. People often forget this obvious order of priority when they're under pressure."
"Yes."
"It was also good that you monitored and responded to the oxygen saturation, blood pressure, and ECG simultaneously. But when oxygen saturation drops, you need to adjust not only the ventilation but also the alveolar pressure immediately. Always check the patient's lung condition twice!"
"Yes, Doctor."
"And when determining medication dosages, learn to consider the patient's age and medical history more quickly. You need to be especially careful when administering medication to a patient with a history of myocardial infarction, like today's patient."
"Yes, Doctor."
"Never forget this. An anesthesiologist has to manage the patient while communicating with the entire surgical team. Like the conductor of an orchestra. You need to create the perfect environment for the attending surgeon, the lead performer who is the star of that day's performance, to demonstrate all of their skills without holding anything back. At the same time, you have to smoothly coordinate everyone else, from the assistants creating the harmony to the nurses."
"Yes, Doctor."
"Good. You worked hard. Go get some rest now."
Park Seong-ho bowed deeply to me before speaking.
"Doctor, thanks to you, I learned so much today. Thank you."
"Good. I hope this was a valuable experience for you, too, Dr. Park."
"But, Doctor, are you going back in?"
"Yeah. I'd switched my duty shift today, but they said it was an emergency, so I left my blind date and rushed over."
Only then did I remember that Kim Ha-yeon, the woman I'd been on the blind date with, had been about to say something earlier.
I looked at my wristwatch.
It was already past midnight.
Calling her now would probably be rude.
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# Inside a Taxi Heading Home
After spending several hours in the operating rooms in a state of extreme concentration, my mind felt hazy.
I stared blankly out the window.
Then I suddenly wondered how many points I'd earned from the three surgeries I'd performed today.
"Open the Status Window."
I activated the command in my mind, summoning the Status Window before my eyes.
[Status]
[Occupation: Anesthesiology and Pain Medicine Specialist]
[Overall Occupation Level: B]
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[Areas of Expertise: General Anesthesia (B), Emergency Anesthesia (B), Pain Management (B), Intensive Care Unit Management (B)]
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[Main Abilities]
1. Anesthesia Skills: Overall Level B
* General Anesthesia: Ability to perform general anesthesia (Level B, Proficiency 80%)
* Local Anesthesia: Nerve Block (Level B, Proficiency 80%), Epidural Anesthesia (Level B, Proficiency 80%)
* Ultrasound Guidance: Ability to use ultrasound for nerve blocks (Level B, Proficiency 80%)
* Emergency Anesthesia: Ability to administer anesthesia and stabilize patients in critical situations (Level B, Proficiency 80%)
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