Original subtitles

What's wrong with this?

What's wrong with his blood pressure?

Isn't it because of hypovolemia?

It's 70/40.

Please call Dr. Choi In Hyeok!

And the Cardiology department too!

Shouldn't we be using something like medicine?

Call General Surgery. Quickly!

Please call them quickly!

What are you going to do when the doctors didn't even come back?!

It's atrial fibrillation now!

Atrial Fibrillation: Arrhythmia, irregular pulse.

Put the gel.

Quickly!

100 Joules.

Charge.

Clear!

One, Two, Three.

Shock!

Not yet.

Gel.

200 Joules.

Charge.

Clear!

One, Two, Three.

Shock!

HEY!!!

What are you doing right now?!

Can't you get rid of that this instant?!

It came back to normal.

The blood pressure is 160.

What were you doing just now?

His heart rate was turning into atrial fibrillation.

And his blood pressure was suddenly dropping.

Atrial fibrillation?

It's not even ventricular fibrillation?

Yes, so we came him an electrical shock twice. And the results are...

The rhythm is almost back to normal.

And his blood pressure is almost back to normal as well.

What's happening with this hospital that interns are running wild?

The interns don't even notify.

Notify: patient's request, patient's report.

And they continue on with this important procedure?

Did you contact the Cardiology department?

Yes.

What about General Surgery?

We contacted them.

And you couldn't even wait for them?

Well, the patient's blood pressure was suddenly dropping...

There is more than one cause for this.

Did you specifically figure out the cause of this incident?

Tell me the reason why a patient who never had atrial fibrillation suddenly got it now.

Yes...

hypoxia, anemia...

Water-electrolyte imbalance, such as magnesium deficiency...

And insufficient blood plasmas & et cetera.

When there are so many causes...

What happened?

His heart rate turned into atrial fibrillation and his blood pressure suddenly dropped.

After using electrical shock twice, the heart rate came back to normal. And his blood pressure is normal as well.

When the blood pressure dropped,

I thought that the blood flow into the brain and other organs would be too small.

And I thought that it would take too much time to figure out the other causes.

And I wondered why they were like this...

Even though there was an atrial fibrillation, I believe that they treated it well.

And the results are good too.

But, we can just watch over this while giving him medicine.

How can these interns make such important decisions by themselves?

Just look at the patient's condition.

He's in such a critical condition...

These two are also recognized as doctors in this country.

These doctors made the correct decision and went through with the right procedure.

There are cardiologist in this hospital. There is a correct procedure and patients in critical condition.

The sunbaes should be teaching them that. What are you doing right now?

Since the results are fine... even though they did a dangerous thing, it's all good?

If you just say "It's okay, It's okay", What if an accident occurs?

Who will take care of it then?

They just arrived here after they received the notification.

And the cardiologist didn't even arrive yet.

The patient's condition is getting worse in front of your eyes.

And there is an equipment right besides this knowledgeable doctor.

Do they still have to follow the procedures?

Even though it wasn't the right procedure, they didn't bring harm to the patient.

And they made the right decision.

You said that it wasn't ventricular fibrillation, but atrial fibrillation.

Was the patient going to lose his breath?

He wasn't. But you took out the defibrillator haphazardly!

Is he your practice dummy?

I'll be more careful next time.

I was thoughtless.

I'm sorry.

Let's see about that.

While you watch over him,

I'll take them out to eat.

Fine, go do that.

Let's go.

Episode 10

How is the patient's condition right now?

He's in a critical state. You can never be assured of his condition.

He had an atrial fibrillation and we went through with a medical procedure.

Who will be performing the 3rd surgery?

Will it be finished after the 3rd surgery?

I heard that the 1st surgery was done by another person. Will he be the one performing the 3rd surgery?

Well, I guess the person in charge will be doing it.

We are fixing his DIC now. Do you know what a DIC is?

From head to toe, there is nothing normal about this patient.

Can one doctor really save this critically ill patient?

The advice of other departments is neccessary.

Professor, I'm sorry.

You don't need to be sorry.

Your decisions as a doctor were accurate. And you went through with the procedure without any hesitations.

And the patient is fine.

How did you come up with such a quick decision?

Since most of the patients in the ICU go in and out,

Park Won Gook is the only patient that we really have.

So, we decided to memorize every detail related to his case.

But, everything Chief Kim Min Joon said wasn't all wrong.

If his vitals weren't unstable,

Finding out the direct cause

and treatment with medicine comes first.

Yes.

When does your shift starts?

It starts at noon.

Let's go eat.

Yes.

What's the matter?

PURPOSE OF RESEARCH --To establish the trauma patient care system.

RESEARCH --Emergency Medical Center

Hello, this is Public Relations, Kim Min Jung.

Huh, a documentary?

Network medical documentary producers are contacting us to make a film about patient Park Won Gook.

Including the 3rd surgery.

Since it's a touching & warm story...

That will be a big help to the hospital's image.

When we are applying for a trauma center, a hospital and patient which are earning the entire country's attention,

this opportunity to broadcast like this will never come back again.

They are asking to film the surgery procedure?

Yes, that's correct.

Who will be performing the surgery?

Chief Kim, are you going to do it?

Although this is a decision that needs to be made by Chief Kim Min Joon...

However, if Prof. Choi In Hyeok decides to go into surgery,

Will you allow the surgery to be taped?

If they can just save the patient, I don't care who performs the surgery.

However, we should plan ahead in case they fail.

Is there a reason why they should release a video of a failed surgery?

What is the possibility of the patient's survival?

As we have given a big amount of blood plasmas...

The patient is getting closer to the condition neccessary to enter into surgery.

The issue is not whether he can enter the surgery room.

After performing the surgery,

Will you be able to save the patient?

If you try to fix the small intestine and it doesn't work. Let's just say that you can just cut it off.

You said that the Whipple Procedure still needs to be done, right?

You said that the Whipple Procedure still needs to be done, right?

Whipple Procedure--Removal of parts of the stomach, large intestine, pancreas and gallbladder

The patient is in such a critical condition...

So, you don't have the confidence to do it?

Then, the conversation is over.

I'm going to leave first.

I need to stop by the ICU and check up on the patient's condition.

Isn't it a little weird?

About what?

Is he telling us to broadcast it or not?

He's telling us to broadcast it after the patient is saved.

Then, if there is a high possibility that he can die, is he telling us not to do it?

I get an odd feeling...

The fact that they keep asking about who will perform the surgery...

then, are they asking Dr. Kim Min Joon to do it or not?

Well, they are saying that if he can save him, he should do it. If not, he should stay out of it.

But just because Dr. Choi In Hyeok performs it, it doesn't guarantee that the patient will survive either.

But...

If Dr. Choi In Hyeok performs it, I get a feeling that they will accept it even though he fails.

Well, you can never tell what he's thinking...

Well, I guess Chief Kim Min Joon will make the decision.

All media wants Dr. Choi In Hyeok.

All inquiries are also coming in that direction.

Not Dr. Choi In Hyeok, but they probably want something to talk about.

If we release the information about his critical condition to the media, people will understand the situation.

If the patient dies, it's a shame. But if they save him, we will be heroes.

But,

What will happen if they talk about Dr. Choi In Hyeok resigning or transferring to another hospital?

If he fails the surgery and leaves the hospital,

It wouldn't be too weird because they will believe that he is taking responsibility for his actions.

However, if he saves the patient and leaves the hospital, the hospital's image can be ruined.

If that happens, we will take action.

Why? Do you not want them to broadcast it?

Then, I will decline the offer.

Broadcasting and advertisements are all okay.

But, we should at least save the patient that came into our hospital.

We should place a doctor in the surgery room, who has the highest possibility of saving the patient.

I understand.

Professor, I heard you're going to Libya.

Is that true?

Why, You want to go with me?

Well, Yeah I can go too.

But to me, my own countrymen are more important than Libyans.

Speaking of which, there are so many places in this country where people need a surgeon like you.

Need and Want are different.

There is no hospital in our nation which wants a doctor like me.

I would cost hundreds of thousands of dollars. Who would like a doctor like me?

The same situation will happen over and over again,

just at different places.

It is not like we don't want traumatologists in this country.

We want them. However, it is expensive to run trauma centers...

Trauma centers and emergency helicopters... Things you want...

They cost a lot. But if you endure a little more and wait...

Saying "we want to make changes, but they cost a lot",

is the same meaning that they concluded it's better without it.

For economic or whatever reasons maybe...

What if a Trauma Center were created?

Where?

At Sejung Hospital.

It will not happen.

What if it happens?

Even if the Trauma Center were to be established,

if there were no subsequent investments, it will become a dead weight with deficits.

Like right now.

Oh! You came first!

Yes.

How many bags of erythrocytes did he receive today?

He received 5 bags yesterday and he's on the second bag today.

What was his hemoglobin level this morning?

7.3.

How about the platelets?

The count is 40,000.

Wow, it's good to know that he's not receiving as many blood transfusions.

It also means he is not bleeding as much, either.

When he is done with this bag of blood, we should run a bood test

and adjust the transfusion amount accordingly.

Well, there are a considerable number of side effects to transfusion...

now is the time when we need to adjust the amount of transfusion more precisely.

But, it is very hard to decide on exactly when to make the adjustment.

Why?

You can make the call by just looking at the test results, but...

you'll need to look at his body as a whole system.

Don't you know by just looking at him?

Now is...Oh nevermind. The Professor will make the call. Right?

Hello.

Who raised the dobutamine level?

An Internal Medicine doctor came by a while ago and raised the level.

Do you let anyone have access to him like that?

They said they came on a consultation basis and that he's a patient who needs the utmost in care.

We couldn't say no...

Isn't that an EEG machine? Why is that here?

Neurosurgery came by and attached it to him as he hasn't regained consciousness.

Really?

What's wrong with this?

Cardiology came by and checked on his echocardiography.

They said it was okay.

They redressed his legs as well.

Orthopedics redressed them early this morning.

By the way, aren't you the Charge Nurse?

Yes, I am.

Where is his regular nurse that you're attending to him?

There was a direction from the Chief Nursing Officer

that the Charge Nurses attend this patient.

Hello, Professor.

It is good to be a famous person.

All the departments are cooperating to take care of him.

But somehow it feels wrong.

Why is that?

They are trying hard, but all their efforts don't seem to be unified as care for the whole person.

They are only concerned about their specialities,

while Ignoring the overall condition of the patient.

Do you think that's why he's under a lot of stress?

It means there is unnecessary stimulation when he's already on medications.

If the patient is to recover...

sleep and rest are essential.

We plan to have him take CT scans.

You are going to take him to the lab with all these hanging like this?

If his brain condition gets worse,

it will be our fault.

Is the patient's condition that unstable?

What are we going to do if he doesn't gain his consciousness after he's done with other procedures?

We cannot measure his level of consciousness

as he's under soporific medications.

I understand the risk, but

we must take the CT scans.

This is a huge risk in taking him to the CT scan lab in this condition.

Then, what about his brain?

Do you not care if he falls into a vegetative state

as long as he lives?

Get ready.

Yes, I understand.

Professor Choi.

That surgery... can you do it?

You are his attending surgeon.

I'll take care of his condition, so you can operate on him.

Intestines are your specialty.

The patient's condition is more important to the Whipple procedure than the actual procedure itself.

It is possible that I don't know what your plans were

and how you cared for this patient.

You performed the first surgery, you cared for him after the surgery as well.

I would like for you to carry on with the third surgery.

First of all, become his attending surgeon.

Then, you can cut out the disorganized consultations

from all the departments.

It's for the patient's benefit.

I believe you'd do your best.

While Prof. Choi In Hyeok and I are taking care of the same patient at the moment,

we have opposite points of view for the same patient.

However, while Mr. Park is in a critical condition,

even if one doctor were

in complete charge of the patient's care,

whether he'd make it or not is still a question.

For the benefit of the patient...

I'll step aside.

The General Surgery Chief is a bigger man than I thought.

The Chief title doesn't come free, I guess.

Why? What happen to the Chief Kim Min Joon?

He gave the attending surgeon title to Professor Choi In Hyeok.

Really?

Wait a second. Does this mean Prof. Choi will do the media briefing?

Do you think so? I thought it'd be the Chief Medical Officer's job.

I thought Chief Kim enjoyed the media attention. How did he let it go?

It would take a lot of courage.

Or lack thereof....

Then are you going to assist in the 3rd operation?

You too, Dr. Jae In?

Wouldn't it be hard unless we aren't on our shifts?

Patient Park Won Gook is a celebrity.

He'll probably take the General Surgery residents.

That makes sense. Why would he bring in mere interns?

Yeah, but I don't think Min Woo thinks that way.

At this rate, you are going to specialize in General Surgery. Am I correct?

Regardless how many times I look at the books, I cannot picture this in my head...

I understand that you resect the small intestine and connect it to the pancreas, intestines, and bile duct.

But, how do you pull up the small intestine that's under the transverse colon?

If you just pull it forcefully over the large intestine,

wouldn't the intestines gets compressed and obstructed?

For that, you'd open the transverse colon messentry,

then you pull up the small intestine through there.

But, what happens if you tear the blood vessel while opening the mesentery?

Wouldn't intestinal necrosis happen?

That's why you have to do it well.

Have you observed the Whipple procedure?

Yes, when I was in medical school. I even asssisted in the procedure.

Whoa. Was it fun?

I had to stand on my feet all day long. I thought my feel were falling asleep.

From the begining of the procedure, even the Residents were tensed up.

They scared me like that.

What kind of patient was it for?

A pancreatic cancer patient.

If you understand the anatomy, start watching procedure videos.

You would understand it much easier.

You think so?

Ok. Do you want to watch it with me?

What are you going to do, after all this, if you are not allowed in the OR? You'll feel like you're wronged.

Isn't it the most important part of the Whipple that there is no leakage from the anastomosis?

What if pancreatin leaks?

It will dissolve tissue.

What's there behind the pancreas?

An artery that provide the blood to the intestines and .... the PORTAL VEIN!

If there's a leakage during the operation, there's going to be massive bleeding!

Liver and small intestine...

Would go kaput.

Would go kaput.

But my father said that...

He's never seen a patient in this condition surviving a Whipple procedure.

Really?

To put it in a positive way.

He means that there hasn't been anyone in Seoul Sejung Hospital.

Hi,

how is the temparature of the patient today?

It was 36.2 °C just now.

36.2 °C...

It is close to the normal body temperature.

Yes.

How about the blood transfusion?

He didn't receive any today.

Why?

Prof. Choi In Hyeok said he'd decide once the blood test comes back in the afternoon.

I see. He's not receiving as much blood any more.

I got it.

Keep up the good work.

Hi, Professor.

What? You came by again?

I wanted to check up on his blood transfusion amount.

It has gone down quite a bit.

Professor,

When are you going to operate on him?

Well...

If you allow it, I'd like to participate in the operation.

I know the Whipple procedure is difficult...

That's why I've been watching procedure videos and reading anatomy text books.

That's why I've been watching procedure videos and reading anatomy text books.

It IS a difficult procedure.

I am aware of that.

Depending on the condition of the patient,

You may have to be on your feet all day, holding retractors.

You may not be able to go to bathroom.

I am okay with those things.

I won't drink, so I won't have to go to the bathroom.

I'll get a permission from Emergency Medicine Chief Na Byeong Gook. It's tomorrow.

Yes, sir!

I'll make sure that the preparation goes without any glitches.

Practice on locking and releasing the forceps.

I'm already on it. Plenty of times.

Please don't worry about it.

Please don't worry about it.

I'll get going.

Hello, how are you?

How do you feel today?

You look good and I heard you are eating well.

You don't have any concerns, do you?

What on earth is happening?

What do you mean?

Anything wrong?

A lot of things!

Take a look at this.

When did it start happening?

It's been a few days.

The skin got red in this area, then...

starting this morning, feces like stuff is coming out. It smells as well.

What is this?

This is something unheard of!

Since he was getting better, we are trying not to think about the malpractice last time...

How can I trust this hospital if something like this keeps happening?

My apologies. I'll make sure that we treat this right away.

I am sorry.

Consult with the General Surgery right away!

I will, Chief.

A documentary?

Yes. An human interest documentary.

The patient is unconscious. He cannot consent to this.

The Hospital's Legal Department says,

we could assume impsung consent considering the circumstance.

Since he's not a suspect of any wrong doing, but the hero of a moving tale...

He would have consented to the filming.

All the blood you are pouring into him, cost us more than $10,000.

If we need to keep him in the ICU for a long time,

it would cost us tens of thousand dollars or even more than $100,000.

A Medical Emergency Loan and Social Services assistance...

will not be sufficient.

Once it airs,

we are willing to reduce the bills.

If he gets any donations from the viewers,

we'll pass those to the kids he was sponsoring.

Our hospital is not in the social services sector.

The reason you were able to

take care of trauma patients, although with hardships,

is that some other departments were making profits.

Do you know how much deficit you've created while working here?

His employer consented to this.

His distant cousin whom the media found,

also agreed to this.

He is a man with a big heart.

He is alone and doesn't have a family.

Wouldn't people worry about him and wonder about his condition?

That...

I'll think about it.

But. . .

I'm not sure if this is right.

Chief Kim Min Joon handed him over to you,

even when he knew it would be broadcast,

so you could save him.

I hope you'd consent with all these.

Chief, we got a consultation request

from Orthopedics.

Oh, Chief Kim.

Are you done with your rounds?

I'm almost done.

Patient Shin Bok Man...

You know, the founder of Mirae Finance Groups.

Oh, yes.

Feces is coming out from his abdomen.

It is a side effect of an operation for abdominal compartment syndrome.

It's an enterocutaneous fistula.

Please quickly take a look.

Why do I need to look at that nasty thing?

Choi In Hyeok is in the hospital.

What?

Why do I have to clean up after him?

He has to clean after himself.

Side effects like this happen as he cuts open the abdomen all the time.

Chief,

I'll call Professor Choi In Hyeok.

Yes. It's Choi In Hyeok.

Why is this happening to a patient who fell in the bathroom?

We will not let this pass.

Let's hear what the doctor has to say.

Something we worried about has happened.

It's an enterocutaneous fistula, a shunt between the intestines and the skin.

What do you mean by something you worried about?

For a patient who had abdominal compartment syndrome,

this is a possible side effect to the patient whose abdomen was left often for a long period of time.

The intestines are stuck to the skin,

then puncture and leak.

By looking at the discharge,

I'd say this is from the lower small intestine, not from the colon.

What should we do?

Did you have any fever?

A few days...

He had low fever for a few days, but it is normal today.

It seems like the fever went away, as the infected area, which burst under the skin today,

will heal itself naturally as time goes,

as long as the discharge doesn't flow back into the abdomen or the amount is too much.

How long would that take?

It would take up to a year.

What if it doesn't heal naturally?

We will need to have an operation to close it.

It is not that we'll operate on it right away.

I will decide after looking at the condition after a while.

We will hold you accountable for the things

which have happened up to now.

We were going to pass without expressing our concerns,

as my father was getting better and doing better,

I cannot just sit and watch this any more.

If there were any malpractice concerns, I will be responsible for them.

But, for now, I'll treat your father first.

Do you have an ostomy bag?

What is that?

This is an osotomy bag.

Isn't that a bag for patients who had an operation to have an artificial passage for bodily elimination?

Yes, that is correct.

It is to collect the discharge and check the amount.

If the amount decreases over time,

It will heal itslef without an operation. It is very important.

Does he have to have this for a year?

I know this is not comfortable both physically and mentally.

The undesirable side effect appeared,

and I am sorry to inconvenience you like this.

Let's...

have you do a diagnosis first, then we'll talk.

Then,

we'll be back after we get the CT scan results.

I'll take the patient to the CT scan lab.

Guys, guys, guys! Patient Shin Bok Man...

He has fecal leackage in the abdomen!

Professor Choi stopped by as well.

Why?

I don't know why.

But even the Mighty Professor Choi is not a SuperMan.

Then the patient's family must have complained a lot.

No he didn't. I heard he's such a gentleman.

Even when the patient needs to wear the ostomy bag for a year, he said to run the tests first.

Whoa...

Anyway...

What are the things that interns can prepare before an operation?

Why? Are you going on a picnic?

It's not that. We are usually dealing with very urgent ER patients whom we usually have to send up to an OR,

even without taking CT scans, but now when a regular surgery is scheduled...

Is there anything I need to do to prepare properly?

And, he's a good guy with a big heart!

I want to contribute to the effort of saving him!

Then, you should prepare this thing...

Since you may not be able to go to bathroom when the operation goes for a long time.

You know... the... the... Foley catheter!

Gosh. Then what about the Number Two?

Poop tube? Poop tube?

You sound dumb!

Where is the warming blanket?

I have the first surgery this morning, so I want to prepare for it in advance.

It's only one of the three we have in this hospital.

Go check the OR #12.

OR #12? Yes, I understand.

Are you the only ones here?

Yes.

Patient Park Won Gook will have his Whipple surgery this morning.

I need the rapid infusion system.

If it's bothersome, should I prepare it myself?

No, we'll do it.

It's for the OR #2.

Nurse, we also need plenty of suture threads as well.

We're going to need PDS 5-0, prolene 5-0 and 6-0.

Okay, I will prepare a lot for you.

Oh, by the way...

We're also going to need a lot of PDO when we perform pancreas anastomosis.

Yes.

Thanks.

How many irrigations did you prepare?

About 10.

Please prepare 10 more. You heated it up right?

Yes.

We need to prepare for hypothermia.

I think we'll need to prepare more gauzes.

Oh, yes.

Please take care of it.

Hi, is this Facility Services?

This is Operating Room #2.

I think you may need to raise the temperature here.

We're going to start 2 hours later.

This patient will be in great danger if hypothermia occurs.

Don't you know patient Park Won Gook?

We have to keep him alive, so please help me.

Yes. Please help me.

Drink a little.

Oh, yes.

The emergency surgery isn't finished yet.

They said that you can enter the operating room an hour later.

Okay.

I was surprised that they gave you the morning slot.

That's more than expected.

Being a VIP is very good indeed.

Are you not going to drink your coffee?

Ah...Yes.

Are you nervous?

Prior to surgery, I'm always nervous.

Since they will be broadcasting this surgery, it's a little burdensome, right?

Well...

Since I will be wearing a mask...

Only my eyes will be seen.

Well, I guess so.

About...

About Libya.

They say the doctors get injured a lot.

And you might not be able to love ramen which you love so much.

Buy some and mail it to me.

Stop eating it.

What's so good about ramen that you keep looking for it?

Okay, fine. Just don't cause any trouble. And when you're done, come right back.

Ok. I understand.

We'll be leaving then.

Yes Chief

I approved it as Prof. Choi in Hyeok specially asked for you guys.

It's an important surgery so you must not make a mistake. Understood?

Yes, understood!

We'll be back.

Why does he want to bring those interns into the surgery room?

It's such an important surgery!

The surger will take so long...

Who will be on duty in the ER?

Oh, from General Surgery...

Until the surgery is over, the interns and residents are going to be helping out.

Yes.

If several doctors treated the patient.

It may not be beneficial to the patient.

And the one who went on a vacation,

Prof. Choi In Hyeok, a traumatologist came back.

Prof. Choi In Hyeok also performed the 1st surgery.

And I believed that it was the right decision to let him perform the 3rd surgery as well.

Prof. Choi In Hyeok, when you first discovered the patient,

I heard that you performed first aid on him by using your belt.

His popliteal artery was severed.

And if it was worse enough, he could have been in shock. That why I did that.

Uhh... don't you think these doctors are better?

They'd do better at tying up sutures and providing a vantage point.

I think it will be the same because we haven't worked with each other before.

Those two have intuition and passion.

They are good to work with.

But Professor! We are way better than the interns.

If they get tired and can't give me the vantage point, then you can step in for them.

Ok... I understand.

Good luck, Professor Choi.

Let's go.

Yes.

What about the blood?

You don't need to say anything.

When I went to go register for it,

going from place to place, Dr. Lee Min Woo

prepared them all.

He placed 10 orders of platelets, red blood cells and plasmas.

In total, 30.

Aigoo.

It will take some time to prepare it.

I just prepared in advance.

You overdid it since the morning.

What was the goal of the last surgery that we performed?

Speed.

The goal of today's surgery is precision.

Yes.

Professor, are you going to perform both Whipple procedure and intestinal anastomosis?

We are going to start with the Whipple first.

There are also 3 anastomosis areas for the Whipple procedure.

We are going as far as the patient's condition allows us to go.

If it allows for only one, we'll do just one.

If two is possible, we'll go with two.

Anesthesiologist,

Yes.

When it turns into a vicious cycle, please tell me. So, we can stop it.

Okay.

How far we can proceed with the surgery depends on how you guys aid me.

Yes. Understood!

Why do you scare them?

Estimate how long?

The earliest is... three hours.

That fast?

I heard the tissues are stuck together.

The patient's abdomen is already open and his tissue is already damaged.

For a cancer patient in the typical Whipple procedure,

we would need to work on removing cancerous organs and scraping lymph nodules surrounding them,

so it is a lot of work, but for a trauma patient, it's different.

The inflammation has died down.With the drain installed, the condition is better now as well.

It's possible to finish it within 3 to 4 hours.

But...

The tissues are so brittle.

I can't guarantee anything.

The objective is to complete the Whipple surgery within 3 to 4 hours.

Yes.

Well, let's start.

Yes.

Let's get started.

Yes.

Retractor, please.

Hold it.

Grab it.

Weitlaner.

Did you eat breakfast?

Yes. I ate a sandwich and some milk.

Professor, it's bleeding.

Hold it.

Sponge forceps, please.

The tissue is still so brittle.

Touch it.

Yes.

It feels like soggy paper.

It's not enough to say that it's brittle...

You too.

Yes.

It really is.

It's so brittle. Will the tissues stick to each other even though we perform surgery?

Oh, it's bleeding here too.

Suction.

Of course. It may be hard.

It won't be worse than a cancer patient.

Take your hands out.

Yes.

Did you study about Whipple surgery?

Yes.

You loop the small intestine to attach it to the pancreas, bile duct and stomach.

Why

are you givng up on such a good opportunity?

I know.

I thought you'd perform both operations.

You look only on one side of the shield.

What is a Whipple procedure?

It is not a greatly difficult operation, is it?

And you said reconnecting small intestine is so easy that you could do it with your feet.

You need to perform anastomosis of three organs,

through a pancreatic duct thinner than a drinking straw for the Whipple procedure.

What about the artery and vein which flow behind the duct?

If you mess up just one of those, the intestines will rot.

It is a challenging, but doable operation, if you are a surgeon.

But.

That means the patient doesn't have a chance.

Whipple also is one of the procedures that surgeons would like to avoid if possible.

He's a trauma patient.

That means his internal organs which you will need to cut and reconnect are crushed.

So?

On the outside, the tissue looks fine.

However, both pancreas and duodenum are crushed inside.

He doesn't have any organs that are functioning properly.

He's a Grade 5 patient.

That is the highest grade.

You mean the patient is in a very critical condition.

Have you heard of a case of a patient like him surviving the Whipple procedure?

There wasn't any.

Even if Choi In Hyeok does a good job with the operation,

because of the compolications or

the patient's condition, it will be hard for the patient to survive.

If you are not talking about success.

Do you need to broadcast a surgery that will fail?

It will just increase the mortality rate.

He'd become a hero if you save him in a very rare case...

If it fails...

People from all over the country will pity him.

Then even if he leaves the hospital,

it won't be a talk of the town.

Today, we're going to perform a Whipple procedure which is different from what you know.

We're going to place the pancreas on the top.

What?

Usually, when the pancreas is connected to the small intestine,

it'd take a long time time to pull up the intestine.

Therefore, instead of performing anastomosis of the small intestine and pancreas,

you can save about 30 minutes to up to an hour of operation time,

if you do anastomosis of the stomach and pancreas.

Already his pancreas is in a very bad condition.

Therefore, it will be very hard to find the major pancreatic duct.

In a case like this, you can simply connect the end of the pancreas to the stomach.

Well, just hearing it sounds easy...

But will it be ok to do so?

Irrigation.

While it is not used widely as there are disadvantages,

there must be some advantages.

The advantage is that...

The anastomosis will heal quickly as there is a large blood supply in the stomach.

The other advantage is that the stomach is considered sterile unlike intestines.

There won't be any infections and it will heal soon.

What are the disadvantages?

When you connect panceas to intestine,

there is a possiblity of the patient developing ulcers,

and bleeding from them.

Then... the person will throw up blood, right?

Stomach ulcers seems to be trivial disadvantages

compared to the leakage from the anastomosis.

I think so too.

Although he got hurt a lot during the accident,

he is different from a cancer patient.

He was healthy before the accident, working as a delivery person.

I'll have to depend on his body's self-healing ability as he was a healthy person.

Hand me the drainage tube, please.

We're going to install two tubes.

One in the pancreatic duct, and the other in the bile duct.

What kind of tubes are these?

These are surgical drains to remove bile and pancreatin from the gall bladder and pancreas

respectively.

After a few weeks, passages will be formed.

Then even if the anastomosis leaks,

these tubes will act as drains,

and will close natually as he recovers.

How about removal of the tubes later?

You can extract these from outside without opening his abdomen.

In that case, the area will be closed as the abdominal wall heals naturally.

Oh. In that case...

Are you taking preventitive measures in case of the leakage?

Of course I perform anastomosis, wishing there won't be any problems,

however, I also prepare for the possible failure.

There are times that different problems arise,

other than the ones patient brought in when he was first admitted.

For a serious patient like him, it is likely that will happen.

For the things you can prevent, take preventitive measures

and for the things you cannot prevent, you need to figure them out quickly and treat them.

Okay.

Irrigation.

Are you tired?

No, I'm okay.

You said you had breakfast. Are you ok?

But it seems like the kiddos are doing a good job providing you a good vantage point.

The procedure is going well without you complaining.

Yes. You guys are doing well.

It's much better these days with the advancement in retractors, but it used to be done all by by hand.

Don't get me started. You're dead tired, but doctors are yelling at you for doing a poor job.

I lost all my interest

during the internship, so I didn't apply for the General Surgery residency.

Let's rest for a bit.

Do you know the name of this retractor?

I have seen it a lot before.

There are so many differnt types of retractors.

The name of this is...

The Iron Intern.

The Iron Intern?

Correct.

It's an intern like us.

Same Intern?

This tool is more expensive than you!

And this little guy doesn't get nervous in surgery!

Where do you get, "the same Intern," from?

But...

This guy will still be an intern next year,

while I become

a resident next year.

You are going to do a residency as well?

Of course! Is that a question?

Well, we have rested for a bit.

Let's perform anastomosis of the small intestine.

Yes.

Anesthesiologist, how's the patient?

He's still good.

The Whipple procedure got done quicker than I expcted as well.

Retractor.

Hold this.

Now...

Let's check your homework.

What is this area called that we're going to reconnect by the silk threads?

Yes, that area is the jejunum.

That is correct. It is the jejunum which is the second portion of the small intestine.

How about the Vicryl-sutured area?

Yes.

From last time, the area sutured by Vicryl threads is a rather big area of necrosis with

the front area being the jejunum and the back being the ileum.

Good job.

The area that connects jejenum and ileum was cut in length.

However, with this much intestines left,

he won't have trouble leading an everyday life.

Oh, by the way, Professor...

In the text books, they say...

it is much more efficient to provide nutrients directly to the intestines.

That's right.

So, I thought about this...

Even if we provide the nutrients through the nasogastric tube...

If the anastomosis area doesn't get connected well,

would nasogastric tube still work?

It will not, as the nutrients will leak through the anastomosis.

Even if the intestines heal nicely,

the patient won't be able to eat orally, unless he regians his consciousness.

It also won't be ideal to leave the nasogastric tube for too long.

So?

How about installing a feeding tube directly to the intestine at a lower point than the anastomosis spot?

Then we can still use the tube even if the anastomosis leaks.

We can also use it for the long-term.

When he recovers and doesn't need the tube, then we can simply remove it.

I saw it in the text book...

Hey you! It's getting dark outside!

We're almost done here. Why are you trying to give him an idea?

Surgeons are so easily swayed in the OR.

Oh, I'm sorry.

But I think it's a good idea.

You can consider it as an insurance.

It's a good idea.

Let's do it next time,

when we close his abdomen.

Yes.

Instead...

You'll need to do homework on the complications of the procedure of inserting the gastric feeding tube

into the intestine.

Pardon?

I got it. Suture, please.

Professor, we excised quite a bit of pancreas. Do you think he'll be ok?

Would diabetes occur as a complication?

We don't know for now.

We left as much as we could. We have to wait and see.

He will regain his consciousness, right?

Even when a patient didn't hurt the head,

a critically injured patient like him doesn't gain consciousness that easily.

We'll have to wait

while making the best conditions for recovery.

There is no such thing

like a miracle pill for a trauma patient.

While you take care of this patient...

You'll get anxious and panicky

whenever he has a crisis.

You'd like to comfort yourself

thinking

you're doing

something for him by giving him medicine,

running tests and insrerting tubes.

However,

ask yourself.

Is it really for him?

Or...

Are you self-soothing your anxiety?

He needs rest now.

Even if you'd like to do something,

resist that feeling and just wait and see.

That also is...

a critical decision a doctor should make.

-- Yes. -- Yes, I understand.

What we need from now on is

patience.

Hello, Chief Medical Officer.

There's a lot on Prof. Choi In Hyeok's shoulder performing an operation on Mr. Park Won Gook.

You look good on camera!

I have shining eyes.

Too bad I had to wear the surgical mask.

I used to be recruited on the street by modeling agencies.

Of course.

I'm telling you the truth! It happened when I was in the 11th grade!

We get it.

For real!

Why don't you trust me?

Yes, Mom.

Is that you on the TV?

Yes, it's me. You must be watching it.

Whoa, you look smart on the TV!

Your son was always smart.

Doctor,

Mom, I have to go. I'll call you back.

Yes.

Ah, yes. That...

Do you want my autograph?

Where is the treatment room?

Oh, yes. The treatment room.

Over there. Do you see the sign "Emergency Treatment"?

Yes, I do. Thank you.

No problem.

Tsk. He's slow in visual learning. What is this?

You'd recognize me if I do this, right?

-- Doctor! -- Oh, how are you?

What is that?

-- Let's take it quick! -- I'll take it for you.

One, two and three!

Professor Choi became a celebrity.

Aigoo, what is that?

That was a close call.

Expert panel methodology : Research Procedure

Death Preventibility Function : Categories

You bad person...

A nation, at a minimum, should not leave its citizens at the crossroad of life and death

without getting medical treatment.

In that context,

establishing trama centers is an important part of the public medical services.

Where are you?

At my house

I mean Haeundae Hospital...

Must you take that with you?

Then, give up something else.

I was thinking of establishing a trauma center.

You always talked about establishing that.

I thought you didn't like it as it is a money pit that cost a lot but won't make much profits.

Will Jae In be able to manage it well?

Will Jae In be able to manage it well?

I want Jae In... as a beautiful, normal person

I want her to live happily as a woman.

Living an empty life managing the hospital...

I've done that and there's nothing that remains.

Since I was working all the time, I never even gave Young Soo a sibling...

"Why did I live that way?" I only have regrets.

It was because of your preeclampsia, not because of your work.

Anyways, I don't want Jae In to be involved in that kind of business.

Then, should I hand it over to Dae Hyung?

Or to Soo Gyeong?

Or should I hand it to Soo Gyeong's son?

This is the marital asset distribution adjustment petition.

Take a careful look at it.

It has been a long time. Have a seat.

Jae In is an intern in this hospital?

Yes.

Such a busy person, why did you call me?

I heard that you have a special relationship with Dr. Choi In Hyeok.

I was his supervisor for his Master's and doctoral studies. I heard that you have a special relationship with Dr. Choi In Hyeok.

I was his supervisor for his Master's and doctoral studies.

You are the one who sent him to a overseas training.

You even gave him the position at the ER.

Of course.

On that subject...

I need you to persuade him.

I'll ask you one thing.

Just because Dr. Choi In Hyeok is worth something,

Are you going to use him?

If so,

I'm afraid I couldn't help you.

Of course, he does have a prize value.

But, that's not the only reason.

At this time, I'm planning to apply for the Trauma Center.

I need a person like him who will step in and take charge of that place.

Professor Choi In Hyeok?

Yes. I would like to have him to perform a surgery.

No. it can't be done.

Why not?

I watched the show and came all the way here.

You have colon cancer.

That person is a traumatologist.

He doesn't perform cancer surgery.

He can just do it. What is there that he can't do?

Dr. Kim Min Joon and Dr. Lee Sung Hwan...

They are both famous doctors.

Chief, they are acting like that because they don't know anything.

You don't need to worry about a thing.

Chief, aren't you the best?

Have a seat.

All this time,

You have worked hard.

I am not proud of myself.

When other people can't even stay as a traumatologist for 2 years,

If you stayed for 8 years, you have done enough.

I was planning to visit you anyways.

But, you contacted me first.

I should have made it more comfortable for you to work, but I couldn't do that for you.

And I put you in that kind of situation.

It's all because of my lack of capacity.

No, it wasn't.

Because it's Sejung hospital, I was able to do surgeries at the ER.

Well, I've done plenty.

With that violent civil war, why are you trying to go to that country?

It's good to save several lives right away.

But this time, because of Patient Park Won Gook's case,

Traumatology is the hottest topic again since captain Seok Hae-kyun was rescued fom Somali hijackers.

To let that interest die away,

don't you think it's such a good opportunity?

The intersts went after

captain Seok's incident without changing anything.

It really didn't go away all the way.

There are still interests.

Chairman Kang Dae Je wants to use you.

Can't you be used by him just once?

If it's not for the traumalogiy field of this country,

it will be good for this region's traumatology field.

Can't you be used by him?

Besides using your skills alone in Libya,

Even though it's tough,

How about working alongside some hoobae , who want to learn?

Yes, was it manageable working with those interns in the surgery room?

Yes, they have a lot of sense and skills.

Most of all, they know the patient very well.

And they have passion in wanting this patient to live.

They prepared warming blankets,

in order to prevent hypothermia, without me asking first.

They heated up the irrigation solution and registered for more blood.

They are interns who tried their best in any area that they could.

Just 10 years ago, General Surgery juniors would take turns and take care of those patients.

Didn't you do that when you were a resident?

Yes, I did.

But soon after, Cancer centers developed.

Major hospitals which accepted an emergency patient involved in an accident

were almost impossible to find.

Yes.

At this time, I'm planning to apply for a Trauma Center.

And you, who have a lot of experience...

I'm hoping that you would be in charge of that.

I...

Continue listening to what I have to say.

I will give you your own trauma surgery room.

If you keep one of the ORs empty, it would create great amount of deficits.

If the other departments need it,

You can lend it to them under your permission.

We'll be able to recruit paramedics and ER nurses without problems.

Since the General Surgery department is lacking residents, it'll be hard.

Instead, I will give you the interns.

And, how about we create a separate department for Traumatology?

Traumatology as an independant department?

When that happens, you'll be free from

the influence of the General Surgery Chief.

Even if my application for the Trauma Center funding is denied,

I will give you that much.

You don't need to answer right away.

Give it much thought and give me an answer.

Yes. This is Sejung Hospital Emergency Room.

What about his conciousness?

What? A fall victim?

His vitals?

That cannot be. There is no...

Hello? Hello?

Ah seriously. This is driving me crazy.

Is there any empty bed?

Yes, I think we can empty out the #17 bed.

Yes, they said that a fall victim is coming in.

Yes, I got it.

Ah, they are here already.

Is he the fall victim?

-- He has a gunshot wound. -- He got shot?

Make a room already! How's his BP?

Did the night sift nurses come?

What? They are not here yet?

What about the patient's condition?

His BP is 100/60.

There was massive bleeding on the way.

Let's move him first!

Yes, I will.

We have another patient coming in!

Ah, I'm going crazy.

He was fighting that patient over there,

then fell

to the concrete ground.

Did that person shoot this person?

What are their relations?

For severe trauma patients, the treatement will be as follows: