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[Episode 14]
Professor, you told her that you would give some time for her to decide,
but if you make a round visit at this early morning, then...
Didn't you call us to get the consent form for Yoon Mi Joo's surgery?
That's right. Her intestines are perforated.
Even if she's on antibiotics, the surgery is urgently needed.
Patient,
patient, please wake up.
Honey,
doctors are here.
Professor, her temperature is 38.1 degrees .
Well, it seems we need the surgery right away.
Doctor,
I have a pain at my belly....
but it's not unbearable.
My family is coming now, so please wait for a little more.
Bowel perforation...
is not a matter that you can wait as long as you want.
I'm saying that my family is on the way now.
It's possible that the wedding might be cancelled,
so at least, I need to discuss with my family.
The invitations were already sent out...
Well, I understand. Then...
until I finish my round visits and come back to you,
you need to make your decision.
Okay?
Yes.
Even before that, she might need an emergency surgery,
so please don't let her eat anything.
Yes, I understand.
Yes.
Well, it looks difficult to bring the leg back to normal.
For a patient like him who have been lying for a long time, especially when he has atrial fibrillation,
why hasn't he used anticoagulant for this patient?
It hasn't been for a long time since he had a brain surgery for cerebral hemorrhage, so that's why they couldn't use anticoagulant.
At the beginning, only the toes were supposed to be given up, weren't they?
He said he would wait, but why is he hurrying suddenly?
You're right, Chief.
Even if the leg has necrosis, until the border line becomes clearer, we usually wait, don't we?
Otherwise, we might need to amputate twice.
He diagnosed it as septic thrombus.
So, since the blood clots with lots of bacteria were travelling and stuck there,
those need to be removed altogether
to improve the patient's condition.
Is that what he concluded?
Anyway, once the schedule is decided, you perform this surgery.
Yes, Chief.
I need to go to the Chairman's room now,
so wrap it up yourself too.
Yes, we will.
Yes, I understand.
Have you been alright last night?
Wasn't there anything uncomfortable for you?
No, I'm alright.
Make yourself at home.
Oh, Team Leader, what's going on?
As this is so urgent, I'll cut to the quick.
Do you think Park Won Gook will survive?
Ah, yes, you mean the patient Park Won Gook?
During the Cabinet meeting, they were reporting to Mr. President about Trauma Centers,
but all of sudden, Mr.President asked if Park Won Gook would survive or not.
Mr. President did?
The Minister is still attending the Cabinet meeting,
so I need to get back to him before the meeting is over.
What do you think? Will he survive?
Ah, I will check immediately and get back to you.
Yes.
How are you doing?
I'm fine.
Well, Mr.President asked during the Cabinet meeting if Park Won Gook would survive or not.
As they're still in the meeting, the Team leader asked me to give the answer quickly before it ends.
Well, he's in the condition which is getting neither better nor worse.
Considering that septic thrombus occurred at his ankle, ....
Well, regarding to that, for now,
we would be able to confirm a more accurate status after the surgery is done.
Then, are you suggesting to amputate his leg?
Well...
Yes, I think so.
Wouldn't there be any other way to avoid that?
Can't we wait for a little more?
If I can have 100% confidence that it's not septic thrombus,
I would wait longer.
If he gets that surgery, can he survive?
For now, the medical team is thinking that he would recover if he gets the surgery.
I will check the patient's status again,
and if there is any change, I will call you right away.
I will also let you know the post-operative course.
Ah, the surgery's schedule?
Once it's decided, I will send you a text message.
Yes.
Yes, then take care, Team Leader.
Yes, I see.
Wow, Mr. President personally asked his status?
Since he asked suddenly, the secretarial staff fell into a panic and called us.
The result for the Trauma Center.. well, they are finally announcing it anyway.
I thought it wouldn't happen in this year.
I know, right?
Anyway, if they're going to do it, it would be better to do it sooner.
They had postponed it so many times...
Yes, right.
Let's go in.
Of course, the medical decision must be the most important,
but as he's in the center of public attention, it's a bit awkward.
Most of all, the patient needs to get better as soon as possible.
We need to consider what would be the best option for the patient.
Blood culture test.. shouldn't we wait for...
There, you seem to have some opinion, Interns.
Ah, yes...
I'm sorry.
You don't have to be sorry.
It's natural that a doctor has questions and opinions about a patient's status.
I think we'd better wait for the result of blood culture.
I think it wouldn't be late even if we decide about the amputation after getting the test result.
How was the blood culture test?
We submitted it in this morning.
It will take a few days to get its result.
Even if you don't have the blood culture result, you will amputate it first?
If we don't amputate the leg, its delay can make the infection worse,
so the patient's condition can likely become worse.
In the worse case, he can lose his life too.
That intern seems to have a different idea.
Yes. Frankly speaking, I feel bad.
You're his doctor, not his guardian.
If I were his attending physician, I would have had more time to monitor him.
If you want to stop the amputation, try to pursuade Professor Choi with medical grounds.
I'm also wishing not to amputate his leg,
but we can't avoid it only with our wish.
Doctor Jae In.
What?
I mean the Chairman...
I don't know the Chairman well.
When you had an interview for internship, what did the Chairman ask you?
He's very interested in interns.
Ah... To me, he asked why I came to Busan, why this excellent talented person did.
What?
About that patient, Yoon Mi Joo, even if she's not consenting, if the situation turns to an emergency, we need to bring her to OR, so keep monitoring her.
Yes.
Oh, you came.
Well, I have something to discuss with you, so I asked you to come.
Did anything happen to Won Gook?
First, please come this way.
Yes.
Of all times, when the Ministry of Health & Welfare called us, he's under consideration for amputation?
He had an open fracture,
but is it really certain that it's not osteomyelitis?
If it's osteomyelitis, he needs to be treated with medicine,
and if it's not osteomyelitis, you take care of him yourselves.
When it's not my area, I have no intention to interfere.
However, if his overall condition is the problem, isn't that right to amputate?
It's really lucky that the blood clot didn't go to the brain.
If it went to the brain and caused cerebral infarction,
how can we diagnose if it's blocked or not when the patient is unconscious like now?
The brain's color doesn't change unlike the leg.
If the diagnosis were a little late, your Neurosurgery Department would've taken all the blame.
Saying the brain surgery went wrong.
Well, if Chief Kim Min Joon was in charge, wouldn't it have happened?
This is not a matter to happen if someone is in charge and not happen if another is in charge.
This is uncontrollable.
Aigo, what happened to you?
Are you taking the side of Professor Choi In Hyeok?
I'm not taking any side, but talking about a medical fact.
Well, if he was in a bad condition consistently, everybody would think it can't be helped.
But getting worse after getting better, isn't this a bigger problem?
Yes, right.
Wow, Chief Kim Min Joon, you got away at the right timing nicely!
If you're dealing in stocks, you would be really good!
Anyway, his attending physician is Professor Choi, so he will make a decision on his own.
We can just consider how to lead the public's interest to getting approval for the Trauma Center.
Oh, wait.
Hello?
If you amputate the leg...
It would be hard to ride the delivery motorcycle, wouldn't it?
He won't have hard time leading everyday life,
thanks to the advancement in prosthetics.
Since he is not conscious...
If needed,
you should amputate it.
For that...
you could save his life,
you should do it.
He's a positive person.
While living in a tiny dorm room,
he never complained about his life.
He's a type of person
who would say "I'm fine with that",
as long as he could
watch the sponsored kids grow up okay.
I understand.
When the surgery is scheduled,
we will contact you.
Since they told us to look it up, we'll need to look for it.
I'm telling you, it is already decided.
Oh, goodness!
Oh...How are you?
What are you doing here?
I am wondering if we really need to amputate patient Park Won Gook's leg.
Wasn't it already decided this morning that we're amputating it?
I know that. I am just looking to see if there are any other ways.
Hello?
Oh, Team Leader.
I reported it well to Mr. President,
before the Cabinet meeting was adjourned.
The Health & Welfare Minister was very pleased as well.
By the way, is the surgery date fixed for him?
Oh that. I believe it is more than likely going to be this coming Friday.
For that...
Isn't patient Park Won Gook the clear example that the Traumatology is all about?
You could save him because of the care he received during the Golden Hour.
Yes, he is.
What a coincidence that his third surgery date is
on the same day
as the announcement of the sixteen new Trauma Center partnerships!
I was wondering if we could make that announcement at the Haeundae Sejung Hospital.
At my hospital?
He is THE epitome of a preventable death,
a life doctors could save!
The Minister suggested it himself!
It of course is an honor for us.
But...
Is there any problem?
Yes, Team Leader. You know about the amputation of his leg, right?
I was informed that you were going to amputate his toes.
That much...
While regrettable, won't affect too much to the quality of his life.
Well... It seems now that the amputation area will be a bit more.
We can rule that the thrombus is infected if repetitive bacterial culture tests come out positive.
If different bacterium is present after each test,
that means the bacterium is moving around.
So the thrombus at the ankle may not necessarily be the source for the bacteria.
So? If the thrombus at the ankle is not the source...
Do you think the outcome will be any different?
Even if it is not the source,
you cannot avoid the amputation.
If it is infected, you need to amputate it immediately.
Even if it's not,
necrosis will eventually happen because of the thrombus.
If the thrombus is not a source for the bacteria,
wouldn't we be able to save his leg,
once the patient's condition gets better, so that we could reduce the amount of the vasopressors,
as the bood supply will also increase?
If we wait too long, as much as we could keep the shape of his leg,
he may loose most of the functionality.
On top of that, if a thrombus hits the brain, cerebral infarction will happen.
We need to make a decision now.
Is that so?
I see.
Hey, Lee Min Woo.
What on earth are you doing?
Huh? Well...
I'm trying to find another method.
--Dr. Lee Min Woo. --Yes?
Please draw patient Yoo Seung Cheol's blood for arterial blood gas analysis and also redress him.
Yes.
Thank you.
Gloves.
I'll draw some blood.
Did it sting?
I'll change your dressing.
I will do it.
Huh?
Give me a pair of gloves.
Why?
I will do it.
Okay.
Patient Yoo Seung Cheol,
he just drew blood to run a test to see your oxygen and infection level.
Your current condition is that the fever is reduced quite a bit,
and your wounds are healing nicely as well.
We will remove your stitches as early as 10-14 days,
and unless your condition gets worsened unexpectedly,
you'll be moved out of the ICU
to the General Ward this afternoon.
The kid...
had a bit of dehydration at first,
after test came out okay, he was discharged.
Have you got in touch with his family?
I talked to his mother on the phone,
however, as she's old and is having hard time walking around,
she won't be able to come here by herself.
I see.
Did the blood test result come out for the patient on the bed #3?
Not yet.
I have put in the order. OK.
Wait, wait.
Did you hear what's happening with patient Park Won Gook's leg?
Oh I heard that the Ministry of Health & Welfare called about him.
So what is it? Do they not want us to amputate it?
If we amputate it, are they going to award us a Trauma Center?
That type of selection doesn't come that easy.
Ah, you know the patient who were shot with a shotgun...
I wonder why the police deosn't come by for her.
The police?
It's strange that the police doesn't show up for a gun incident.
Should I go ask if they reported it?
If they haven't, should be report it ourselves?
What, what? Where are you going?
I'll go ask if they reported it before shes goes into the surgery.
If they forgot to report, we should report it.
Enter these in for me.
Argh, arrgh, arrrgh!
Excuse me!
Is.. Is there a doctor? The patient is...
Ermm...It's me. I'm here.
Doctor, the patient... the patient is now... Just come with me.
Doctor!
Yes, yes!
I'll go get the surgery.
The pain will stop if I get the surgery, right?
I'll get the surgery!
It will hurt at first then...
It will pass after a while.
It may be a bit hard, but...
Doctor, what's going to happen if she doesn't get the surgery? Will she die?
Ma...Ma... Maybe?
I'll go.... get it. The surgery.
I will!
Wait just a moment!
Yes, she said she'd get it?
I'll be right over there.
Send her up to the OR right away.
The shotgun wound patient?
Yes.
Today's Ms. Seo Hyo Eun's first day.
Isn't it next week?
She insisted coming today as she'd like to say hi and get ready a little bit.
She also wanted to look around the hospital.
Isn't she getting overly excited?
Don't discourage someone with passion!
If you compliment and praise her,
she'd do even better.
Okay. I probably won't have time to see her today.
So you're in charge of the change over.
I understand. I understand.
I understand.
You two, what the hell are you doing?
Come out quickly.
Patient Yoon Mi Joo is going into a surgery now.
Pardon?
Hurry up and go up to the O.R.
Yes, I understand.
Kang Jae in!
You need to go to the ICU.
Patient Yoo Seung Cheol is being transferred to another room.
Hurry! Hurry!
Yes! I'll see you later, Dr. Min Woo.
Come on this side.
Huh?
But...that side...
Hurry and come.
Scalpel.
Give it to him.
Wow, this is a headliner!
"An intern incises the abdomen".
You need to buy a round after this!
Professor....why me?
You've watched me perform surgery many times, right?
Yes.
Let's see what you learned.
Pardon?
Begin.
Yes, I will.
But... How do you hold the scalpel?
Should I hold it like this or should I do it like this?
Whatever is comfortable.
Use the round part of the blade. That is the shapest part.
Forceps.
Get around at the belly button.
Yes.
Bovie.
You see two buttons on the bovie.
The first one is for incision and the second one is for hemostasis.
In an emergency situation, we don't have any choice, but to open up the stomach roughly.
But if that's not the case, you have to do it slowly.
But if that's not the case, you have to do it slowly.
Now, we can see fascia.
Kocher.
You are taking care of everything well.
Bovie.
I opened the fascia. Now I can see her peritoneum.
You can stop from here. Come to this side.
There's a lot of blood that has welled up in the stomach. So that's why you can't continue.
Yes. Thank you very much!
You really have to buy us lunch!
Of course.
You said you would buy us lunch. I wrote it all down you know!
I will buy everyone lunch next time.
Bovie.
Hold it.
Yes.
Well, the abdominal wall is opened in this way.
Yes. I understand.
There's only a little bit of blood that has been welled up.
It seems that the hemorrhage is stopped too.
Retractor.
Irrigation.
The pellet was hidden here.
Let's see... the other one is....
Mixter clamp.
Metz.
You've practiced tieing a lot, haven't you?
Pardon?
Ah, yes, I practiced a lot.
Try it then.
Yes?
You are telling me to do it again?
Is there anywhere else to do the job here?
Wow, you must have a lot of time today... making the intern do even the tie.
Aren't you thinking to finish it quickly and leave?
He said he practiced. This isn't a super emergency surgery either.
He needs to use it in actual surgeries so that the practice can be more effective.
Professor. Why, why are you doing this for me?
Just do it quickly!
Yes. I understand.
Please give me the tie.
Cut?
Cut.
Aish, so frustrating.
You have to tighten it well. Or else it's going to bleed and we're going to have to do surgery again.
Do it slowly. We're not in a hurry.
If my Sunbaes or teachers didn't let me try because they were frustrated by my slow work,
If they just did it themselves, could I have gotten here?
I was able to get here because they gave me a chance even when they were scolding me.
Cut.
You, do you know what it means if a surgeon let the other person do the tie?
I don't really know.
That means he can trust your skills.
I was pretty good when I practice it with my bare hands,
but now, as the suture thread is sticking on my gloves...
Alright, I understand.
I can't really show my skills 100%...
You're doing well.
If you tighten it too much, the tissues can be crushed.
Yes.
If you tighten it too little, then it would be untied.
Yes, I understand.
If you do it wrong you're going to become a star, what with all the blood spewing out!
We're going to have to do a major surgery.
- Cut. - Cut.
Oh, here is one more pellet. Forceps.
Like today, even if I let interns try some of the surgical procedures,
that doesn't mean that it's the right education.
But for Traumatology, it's a different story.
In an emergency case like last time, if you knew how to open the abdomen and find the bleeding spots,
you could've pressed those bleeding spots with gauze
and waited for other doctors who can take care of the next steps.
It can prolong the patient's golden time. Do you understand?
Yes, I understand.
Irrigation.
Wait a second!
Forceps.
What is this! It's been untied!
Oh my goodness.
I'm sorry. I'll do it again.
How do we know where this untied! How are you going to re-do it?
I asked you to do it once. You should have done it well!
You shouldn't have made him do it in the first place.
That's actually right too.
My God.
You're in trouble.
Suction.
Oh, yes.
Stop the suction! Irrigation.
-Look closely. -Yes.
Wait a little more.
Do you see any?
Oh.. yes, wait... no.
Suction.
Hey, Doctor Kang.
Yes.
Are you moving the patient?
Yes, to the isolation ward.
Are you finished with your surgery?
Yes.
You worked hard.
Ah, Doctor Choi In Hyeok.
Say hello.
This is the attending physician of Park Won Gook, Professor Choi In Hyeok.
Ah, I saw you in the TV documentary, Professor Choi In Hyeok.
You are working very hard.
I'm Senator Choi Joon Bae.
I heard about you earlier and I watched the documentary. I'm Senator Choi Joon Bae.
I heard about you earlier and I watched the documentary.
But I thought it might look as if I 'm trying to take advantage of the media's attention.
So I waited until I heard there would be another surgery.
I came here.
Ah, you've thought through that much.
How is the patient, Park Won Gook?
The patient, Park Won Gook is over there.
Oh yes. Is that right.
Explain to him, Professor Choi.
Yes, he was recovering.
He was recovering, but he is not becoming better.
But he is not getting worse either.
Senator, this way.
Well, what is this?
It's to take the patient's body fluid out. We need to monitor well if its color changes.
It's where the patient urinates.
If the patient urinates well, that means the kidney's function is getting better.
Senator, could you try sitting there?
Sitting there like that, you can gaze at that urine container gently.
I didn't know urine could be this important.
Aigo, please take care of him until he gets fully recovered.
Hey, you can stop shooting now.
The patient needs rest.
I'll take one more shot. Senator, you just come here.
Senator and Professor can stand here so both are in the shot.
Professor here, and Director, you too.
Yes, this way.
Chief, you can stand here.
Please move a bit closer to each other. Yes.
Senator, I'd like to discuss with you about the announcement of the Ministry of Health & Welfare,
as well as the condition of Park Won Gook.
We have another schedule that's been pushed.
Well, it would've been good if I could listen more about this patient's status and others, but...
If you have a hard problem with something, tell me.
I will take my time to review it.
Yes, Senator. We'll send you some reports and data,
so please review them. Thank you.
Well, then.
When the media went crazy, you should've told me!
I'm the Senator of his district. What a great chance it was!?
We missed that chance all then, and now rush around after that?
I'm sorry, Senator.
If he gets fully recovered, you can do that,
but if he gets amputated, don't upload those photos on my homepage.
Yes, I understand.
Hello!
Ah, yes. I've heard about you coming.
Where is Nurse Shin?
I saw you right after I came inside.
You must have come out of surgery.
Yes.
The trauma administration office is
right next to the ER.
Ah, yes. I'm aware of that. Then, I'll see you later!
Wait a minute.
Dr. Min Woo,
- Did the surgery end well? - Yes.
Where are you going?
We're moving Patient Yoo Seung Chul to the isolation ward.
The orderlies are going with him. Why are you going?
I'll be right back.
Ah...
Hello.
Ah, yes.
It seems like the family members didn't arrive yet.
Right.
The surgery ended well.
We found the two pellets in her body and took them out.
And we also took care of the perforated intestines.
Excuse me,
Can we move her somewhere else?
Pardon?
I don't think she would want to stay near the person who shot her.
Ah, yes.. well...
she might...
Wait a minute.
Yes.
Did you notify the police?
Truthfully, the patient that just left a few minutes ago,
He's a criminal, so the police always keeps an eye on him.
He shot a person and made him like this... shouldn't the police investigate this issue?
Reporting didn't come across my mind yet.
Then, do you want me call them?
Ah, no.
I will officially notify the police later.
Thank you for your hard work.
Thank you for your hard work.
Please get well soon.
So that you can go back to your family members who are waiting for you.
I will come back for the dressing tomorrow.
He can attempt to commit suicide.
Please watch over him carefully.
It should be fine because we put handcuffs on him.
Professor,
We just moved Patient Yoo Seung Cheol.
It seems that you have a lot of interest in Patient Yoo Seung Cheol.
Patient Yoo Seung Cheol also
has family that's waiting for him.
Are you worried about his family?
Yes.
Provost Kang Su Kyeong came.
I told you that I don't want any visitors.
Oppa!
Why are you here?
I heard that you were hospitalized. How can I just stay still?
What do you mean by hospitalized?
I'm being discharged tomorrow.
- Oh, you came? - Oh, unnie...
Unni, why are you here?
Are you worried about your divorce if he isn't discharged soon?
You... your mouth!
But, oppa, I went out early in the morning to buy this
to help you get your strength back.
You should take that and get your energy back.
I have reviewed and submitted the helicopter request form.
Have you completed the construction yet?
It's in progress. Thanks.
It's not something that will be selected in just within Busan.
You should be mindful of Pohang, Changwon and Masan as well.
Don't expect too much.
Are there any hospitals that pose real competition?
The problem is in Busan.
If they are selecting within Busan, we may actually have a better chance.
But for other regions, there will be a different reason for selection.
What different reasons?
They are bridged to Geoje Island and Gadeok Island.
If there is a patient from there, they can just call for the Ambulance.
It is difficult to be objective when they talk about requirements based on necessity.
There will be a lot of political "give and take".
So, don't put your hopes too high.
Since we are applying for it, we should think like it we should get it, not we wouldn't be getting it!
That is why, I say that you are still naive.
Is he being discharged tomorrow?
Yes, that's correct.
You are still very interested in the hospital management.
It's not that I'm really interested. But since it was so obvious to me,
I could not help telling him about it.
You are a born manager.
Since I'm busy, I'll leave first.
Are you really getting a divorce?
At this age, would we be submitting the divorce paper
and appointing the attorney just for fun?
It's just that my brother's attitude seemed a little different.
That is Mr. Kang Dae Je's prerogative. But I have already made up my mind.
Are you going to see him tomorrow when he gets discharged?
I am busy. I wll be leaving first.
Why don't you take him home since I have no reason to go there.
I'm leaving now.
This is the Emergency Room.
The ICU is over there where you were.
Ah, OK.
You will be spending more time in the ICU than in the office.
Well,
our office is a little small
and shabbier thsn you expected, right?
Oh, not at all!
Rather than being at a place where everything is already there,
I'm actually happier that I can contribute to a developing place.
Oh, earlier today, there was a Senator coming in the ICU.
I had run into the professor unintentionally when I was coming in.
Ah, that's because of the patient, Park Won Gook.
The timing worked out with the government announcement for the Shock Truma Center.
Oh, then, it must be so hectic for him.
Performing surgeries, entertaining those VIPs, giving lectures...
That is right.
It's crazy here.
I will assist him as much as I can!
He seemed so weary earlier.
How does he normally take care of his health?
Does he eat well?
Yes, a little.
He really likes ramyun.
When your body is tired, you get tired of everything.
If he keep going on caffeine or sugar...
Oh my gosh! He may pass away in the OR!
From now on, I'll take good care of him.
Yes,
please do that.
On Monday, when he comes in the morning at 8...
Oh, when I saw the schedule in the office, I swear I read 7 a.m for the book review.
Then, I'll come in before and make him some kimbap.
Yes.
Then, I'll see you on Monday. Please take good care of me.
Young people nowadays...
Are they all so proactive?
Ah.
Oh... don't do that!
Huh?
Wait.
Let me open that up for you.
Hey!
I will do that one, too.
You need to make an incision with the roundest part of the blade.
In this blade,
this area is the sharpest part.
Like this...go around the belly button.
Like this.
Here.
Oh...OK.
Gauze.
With forceps,
slightly tug
the dissected area.
And use the bovie.
between the 2 buttons,
the first one is used for incision and the second one is for hemostasis.
So, are you going to peel this orange or not?
When this Hyung-nim is working on the wonderous art of laparotomy,
all you can think about is food, like pigs? Do you want to all die?
What?
Hey.
Today, this Hyung-nim has
operated on patient Yoon Mi Joo.
And made an incision on her abdomen.
Oh, is that right? So you are going to General Surgery?
What is this? Aren't you envious?
Isn't it amazing?
What's so amazing about? They are enticing you to come to General Surgery.
About enticement...
when I found the central venous catheter, they had already offered me to come.
But we are talking about "Incision" now! The fact that an intern has done the incision means
that they have acknowledged my extraordinary talent.
Since you've made the incision today, shouldn't you buy us dinner?
Since you performed an incision, you wouldn't want to wash your hands and wouldn't be able to sleep?
Would you be able to fall asleep?
Dr. Lee Min Woo.
Ah, hello, Doctor.
Of course, you shouldn't be able to fall asleep.
Excuse me?
I heard that during the irrigation, a tie got untied and floated around.
Oh, how did you...
Hey, you mean "the tie floating around"?
It's been so long since that has happened
that the anesthesiology resident is so amazed that he is telling everyone about it.
So, then Is that really very dangerous?
Professor Choi In Hyeok said it's OK and we closed up the abdomen and got out.
Oh, he must have thought that even if it's bleeding a little
it would probably stop.
Even if it gets untied and starts leaking, it's the responsibility of the doctor in charge,
It's not the Intern's responsibility. Don't worry too much.
Would anything actually...
hmm..could happen! Then there's not much we can do about it.
Hey.
You should have done it well.
You should have done exceptionally well. Isn't that right?
Ah, well.
Thank you.
Coffee... Let's have it later.
- Is anything wrong? - Oh, you scared me!
No.
You don't have anywhere uncomfortable, right?
It's bearable.
Ah, yes. Sleep more.
If you feel uncomfortable,
please make sure to push the button to call a nurse.
Good night, then.
What are you doing?
Oh, what's up?
I couldn't sleep.
What are you studying?
It's because of the patient Park Won Gook's leg.
Here, when atrial fibrillation occurs to a person who didn't have any chronic disease,
that's because of the person's overall body condition.
Of course it is.
He could've had septicemia.
If he's in the state of septicemia, atrial fibillation will occur often,
and since it occurs often, there will be blood clots made,
and then, the bacteria will grow in those clots.
If there is no bacteria found in the next blood culture test,
can't it be ruled out?
What if it is really a septic thrombus?
You're saying you want to cross a stone bridge after checking it.
But while you're checking the bridge, the patient's condition can become worse.
Right now, rather than waiting, running and crossing that stone bridge
might be the best way we have.
I know that too.. but...
by any chance, later,
I'm worried if I would regret for not checking that bridge.
I looked suddenly in the mirror and I knew. I will be taking it hard.
Somehow even though I'm laughing, deep in the light of my eyes it is full of something which is forming.
I really can't remember the expression on my face in that tremulous moment when I first grasped your hands.
Even laughing just like this, I never held back the escaping tears. You know!
They are really running down again as they did before down my two cheeks. I must really hug you.
I love you. I love you. I'm begging you to come back. Come back now to my side.
Ajussi, I'm sorry.
I couldn't find the way to save the leg yet.
I need to find it quickly, though... We don't have much time.
Aish, this drives me crazy...
I'll try harder.
Doctor Min Woo, what are you doing?
Ah, she's my first laparotomy patient, so...
I'm monitoring her status with more special interest.
How is the color of drainage tube?
It's clear. All night, it's clear.
Please don't worry.
Did you find any grounds?
So far, I couldn't find any concrete grounds yet...
We don't have time.
In this situation, making a quick decision is important.
You must really have no work to do. Why are you all coming here in this morning?
You're not often hospitalized,
so if you don't let them come, they would be sad.
- Over there. - Pardon?
Did you find anything for his leg?
Ah, yes...
It's certain that the blood clots went to his ankle.
However, there is no guarantee that the bactrium live in those clots.
Therefore, I'm looking for other causes.
If we amputate his leg and remove the infected area, the number of atrial fibrillation episodes will decrease.
Then, the patient's condition will get better,
and the risk to have other blood clots again blocking other areas will be gone too.
But that's all when we're sure that the clots were the habitat of bacterium.
That point is not clear yet.
What's your grounds to say it's not clear?
First of all, there are too many possible causes of the infection.
Ever since the patient came to the hospital, he had an open fracture,
and his abdomen was also opened too long,
so they all can be the sources of infection.
And now the pancreatin is still leaking,
so the necrotic tissue caused by the pancreatin can easily become the source of infection.
Well, the intern made some effort.
He studied a lot.
Medically, because of septicemia, he often has atrial fibrillation.
As Professor Choi In Hyeok said, if the blood clots caused by atrial fibrillation were infected,
it is the sign of the start of a vicious cycle.
Because of that infection, another problem is occurring.
Then the atrial fibrillation won't get better, right?
Yes, that's right.
Then, if another blood clot is formed and travels to the brain, it will become a major trouble.
Your decision to amputate the leg as his attending physician, is it unchanged?
Yes. I can't give you any medical grounds with test results,
but as per my clinical diagnosis, I'm sure it's septic thrombus.
The patient Park Won Gook had the best treatment which can be claimed by a Trauma Center.
Fortunately,
he was found personally by a Traumatology professor at the accident site,
so he got proper first aid.
And he came into the hospital within the golden time and got the surgery.
Because of all the public attention, he also could get more platelets and blood than is standard with insurance.
So, this patient needs to survive without fail, so that we can say that we prevented the expected death.
But if we amputate his leg...
Tell the guardian that we will amputate his leg.
Yes. I've already told his guardian about that.
Tell the Ministry of Health and Welfare too.
Ah, yes, then maybe...
They will change the place to announce.
All the while, all of you have worked hard.
All the while, all of you have worked hard.
Aigo, look at his hollow eyes. You've worked hard.
You did as much as you can.
The sound of the streets lined with trees standing in a row.
While trying to force a smile by the promised familiarity.
I am like your two winters.
The forgotten times' end is repeated.
Why did you make things complicated!? You said you practiced the tie!
If I give you a chance, you should do it properly!
This is all BECAUSE OF YOU!!!!
-You are coming every night. -Ah, you startled me.
Oh, yes.
Does it hurt a lot?
It hurts more than earlier in the day.
Maybe because it is night.
Oh, yes.
Umm. For just a short while, I'd like to take a look.
What..
Patient,
Can I examine you for a moment?
Does it hurt?
It's a bit painful.
Does it hurt when I take my hands off after pressing it?
Yes.
Please wait a bit.
Nurse, what is patient Yoon Mi Joo's temperature?
Does she have a fever now?
Her temperature is normal.
Oh, really?
But I still think I need to report this.
He is probably sleeping now. What should I do?
OK.
He wouldn't hit me, right?
Since I am reporting a patient's condition.
Hello.
Yes. Professor. It's Intern Lee Min Woo.
What's the matter?
Well, patient Yoon Mi Joo's surgical drainage color
has changed to green.
What?
Since when?
Well, that is, until the evening, it was definitely clear.
But when I check it now...
Is the patient in pain?
She said it hurts when I lift my hand after pressing down.
Okay. I'm coming right away.
Let me examine you a little.
Well...
Does it hurt a lot?
It hurts somewhat.
Wait a little.
How much?
I can endure it.
Wow, this should be very painful!
What is the temperature?
Her temperature is normal.
When did you give her the pain killer?
It's been about 2 hours.
How did you discover it?
I came by to check her surgical drain, early in the morning, just in case.
The color of the drainage is changing with blood mixed in it.
Doctor. Could it be that something is wrong with the tie that I've done?
So that's why you've checked on her so diligently.
Yes.
Do you remember that her intestine was bruised?
Ah, yes.
In most cases, it gets healed naturally.
But there are cases where it gets ruptured.
As the intestine was rupturing,
bile is leaking, it seems.
But her temperature is normal. Also, shouldn't she be in a lot of pain now?
It's because of the pain killer.
It also works as the fever reducer.
That's why her temperature is normal and she is not in as much pain.
She will be in so much pain tomorrow morning.
It's good that you discovered it early.
Ah, I thought, because I messed up the tie... that's why I did it.
Would I have given you a very important tie to do?
Where you have tied, is a place which doesn't bleed.
Excuse me?
Don't over estimate your own value.
Explain well to the patient.
And get the OR ready.
Yes.
Professor.
Do we have any other surgery today, other than patient Yoon Mi Joo's?
No.
Thank you.
Professor.
Oh, you are here.
You've come to work early.
Yes.
Professor, instead of coffee, try this.
Seeing you for a few days, it seems like you drink too much coffee.
This is called, "Chong Myung Tang".
If you drink this,
your concentration and focus will get better.
Cho...
Chong Myung Tang?
--I'll enjoy this. --Yes.
Didn't you give me that to drink?
No.
No?
That's right.
I think it is.
Just drink "Chong Myung Tang".
So you can be "Chong Myung"
I can drink both of them.
What if you need to use the restroom during a surgery.
I will just not bring you a coffee drink anymore.
Here. Drink this, Nurse Shin.
Am I the one who is performing surgery?
She is not very tidy.
She didn't even close the lid.
How long will the surgery take?
About an hour and half.
We will be done at about the same time then.
Today, there is patient Park Won Gook's leg amputation surgery and patient Yoon Mi Joo's surgery.
It will be hard to take both of you in.
So I'd like you each to go into different surgery.
I will scrub in for patient Park Won Gook's surgery.
Alright.
Then, you get ready for patient Yoon Mi Joo's surgery.
Yes.
Can you take Dr. Kang Jae In with you?
Yes, I will do that.
Thank you.
You have to handle it very carefully.
It is worth one year's salary.
Yes, I understand.
What is this called?
It is peritoneoscope.
Is there a problem?
Ah, patient Yoon Mi Joo's surgery is in the next room.
Is the amputation site his ankle?
No, we will have to amputate 15 cm below the knee.
It's his ankle that's blocked. So why so high?
We made a tough decision to save the patient.
Since we are doing this difficult amputation,
we should think about his life as an amputee.
He has chosen a less difficult area for rehabilitation and prosthetics later.
That's right.
If you amputate the ankle that only has bones and flesh,
what can you put around in that area?
When he puts his weight on it later,
we have to put the stump attachment around the bones that could sustain his weight.
The calf muscles are supposed to be the most cushiony.
Have you done some studying?
Yes.
It seems that leg amputation is unavoidable whether it's now or later.
So I've researched what would be the best
to help with rehabilitation.
Hmm. Not bad.
Good work.
While it is necessary for a doctor to find a way to prevent the amputation,
when you had to make the decision that had to be made,
it is right to find out the best thing to do for the patient.
Yes. Then, I'll leave now.
Yes. Work hard.
Work hard.
I will scrub in. So please be ready for the surgery.
Hurry up and prepare for the surgery.
Did you go there?
What?
Yes.
Why didn't you stop me?
It was already decided, regardless of my opinion.
With your eyes getting all red from studying
to find a ground not to amputate the leg.
I was proud of you.
What I am worried about is
that you may
have already decided on the answer
and then tried to find the ground to fit that answer.
To amputate
or not.
The process to find the best solution
and the process of finding after you have already decided what you wanted is
definitely different.
OK.
This is the abdomen that you have already made an incision.
Would you like to open it up again?
Yes.
Come on this side.
Anethesiologist. I'm starting now.
Scissors.
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