Original subtitles

Was it that necessary to perform the C-section while there was no medical specialist?

As per the text book of Emergency Medicine, in case of a pregnant patient with cardiac arrest,

to save the baby, you should take that baby out within 5 minutes by emergency C-section,

and then, the possibility to bring the mother's heart beat back will be also increased.

That mother didn't only have the cardiac arrest.

There was hemorrhage caused by mesenteric rupture,

and because of the hypovolemic shock,

we could suspect the cardiac arrest was caused.

Doctor Lee Min Woo!

Yes?

Episode 20

Did you only think about the stopped heart?

If you cut open the abdomen and the uterus, without any preparation.

the bleeding would get worse.

Then, wouldn't it have be more harmful to the patient?

I thought about that but,

if I left her alone, I didn't think the heart beat would return to normal.

You just opened it without thinking?

About the situation or the circumstance?

No, that was not the case.

Since her stomach was bloated from pregnancy,

we couldn't distinguish if it was due to the pregnancy or hemorrhage.

Did you verify the baby's condition?

If the baby was already dead, what would have been the medical justification for the laparotomy?

I confirmed it with the stethoscope.

Even though it sounded weak,

I could hear the baby's heart beats.

After hearing the baby's heart beating,

after hearing it...

I couldn't not take the baby out.

Well, I heard about the patient's condition which has progressed to septicemia.

What do you think caused that?

The patient's abdomen isn't opened now.

Well, that's... I think that's because the laparotomy was performed in contamination.

What do you mean "in contamination"?

You said you wanted to save the patient,

but you just opened the abdomen without even basic preparation?

No matter what the reason was, a doctor is supposed to not harm a patient,

but in this case, you gave her the crucial harm.

If she has septicemia, she might not come back.

Well, I thought of using betadine,

couldn't have time to think of sterilized scrub hat, suit and gloves.

I'm sorry.

If you took off your gown at least, it could've caused less infection to the mother.

Yes, he missed that part,

but that doesn't mean he did nothing.

He sterilized the part with betadine,

and if he changed into sterilized scrub suit, it could've delayed the surgery by 2~3 minutes.

In that situation, based on what he did, we can say he tried the minimum sterilization.

That "minimum" isn't meeting the medical standard!

Are we at some field hospital in Africa performing in some tents?

Why on earth were there only interns in ER on that day,

without any specialists?

As we told you before, because of the helicopter conference, we were on the business trip.

On that day, the General Surgery Department was supposed to be on duty.

Well, our General Surgery's fellow was out of the hospital just for a moment.

Chief Na.

How can you forget the innate duty of the Emergency Medicine Department?

Is that the value of the existence of the Emergency Medicine Department?

And General Surgery Department, if you promised to be responsible for being on duty, you should've kept it!

If you can't handle a moment of 5, 10 minutes in ER,

you can have the situation of losing the patient. That is the ER.

If there are only the patients who can wait for 1 or 2 hours,

which hospital would run an ER despite its huge deficit?

Wasn't there any points which can become some legal problems?

Well, the patient's husband took the copies of all her medical chart,

but after that, he didn't mention anything yet.

That's probably because the mother and the baby are alive.

If either one of the two dies,

he might raise the issue then.

Dr. Lee Min Woo!

Dr. Lee Min Woo!!!

Why didn't you pick up your phone?!?

The new mother at the ICU is in a critical condition right now.

The mother's BP is not good and the oxygen saturation is dropping now!

Hurry! Hurry!

Oh. I'm sorry.

I'm sorry, but I'll be leaving now.

I'm sorry!

What on earth is happening?

Why didn't you pick up the phone?!?

How could I answer the phone is that situation?

Well, if the accused runs away like this, then what can we do?

I know, right? What kind of situation is this...

Because the patient is not in a good situation

we did this conference because we did not want to have the situation happening again.

This isn't a trial he should get without helping the patient even though the patient is in a critical situation.

Those guys were involved in that situation, too.

I'm sorry.

While her heartbeat was unstable, her BP suddenly dropped.

Please give her normal saline in full-drip!

Okay.

How is the patient?

Her cardiac rhythm is unstable now!

Give her more IV!

Yes, it's in full-drip now.

Professor!

At this rate, couldn't there be another cardiac arrest?

It may happen.

Give her vasopressin.

Yes.

Even vasopressin?

Vasopressin is a natural hormone and a drug which constricts blood vessels and raises blood pressure.

Doctor, she is in ventricular fibrillation.

Ventricular fibrillation: A severely abnormal heart rhythm which is life threatening.

Start heart compression.

Yes.

Charge the defibrillator to 360 Joules.

Clear.

One, two, three.

Do it again.

Clear!

1, 2, 3!

It came back!

Submit her blood test, and take her arterial blood.

I understand.

The results are out.

The blood pH is 6.9.

Give her some sodium bicarbonate.

As it will be given continuously, please set up the mix.

Yes.

The acidosis is quite serious.

Also her uric acid level is pH 7.0.

How were the blood results in this morning?

Platelet was 32,000 and PT was 42%.

It's definitely DIC.

And other numbers?

Creatinine was 2.8.

The function of kidneys is also very low.

What about yesterday?

Yesterday, it was 2.2.

It's getting worse now.

What about the bilirubin level?

Bilirubin is a product of the metabolism of blood iron. It is a measure of liver function and causes jaundice.

Yes, it is 8.6.

Yesterday, it was 7.2.

Ah.... 8.6...

Nothing is getting better

The problem is not that it is getting better but...

that she already has multiple organ dysfunction syndrome.

Mutliple organ dysfunction syndrome: 2 or more abnormally functioning organ systems.

Then... does that mean there is no hope?

Doctor.

The blood is coming out a lot.

Call the family and..

tell them to come at the visiting hour today.

Please keep doing suction, too.

Yes.

We should prepare ourselves.

Go and find out if the mother is fine.

All right.

As it happened on the day I was supposed to be on duty, I can't stop caring about this.

I'm sorry.

If I were there that day, then it would not have happened.

I am at fault.

Just make sure not to leave your duty if there are only interns.

Only if there were you, Doctor Song Kyeong Hwa,

that kind of accident wouldn't have happened

to perform laparotomy, flapping a contaminated gown without sterilized scrub suit.

That's what I am saying, Professor.

Aigo, it's really frustrating.

Goodbye.

Doctor.

Doctor.

It's nothing special,

but please eat this and strenghten up.

Joon Pyo, I am not a hungry pig.

You eat that.

It's not because you are a pig.

It's only one chocolate bar ...

i gave it so she would cheer up.

Is she in that bad a state?

He said we should prepare ourselves.

Did he say it's because of infection?

Because we didn't wear the sterilized scrub suit?

I thought that too.

I guess the infected part is better than I thought,

but multiple organ dysfunction syndrome...

I guess her heart or lungs wouldn't be well..

Earlier, the heart's rhythm became bad,

so we used the defibrillator.

Is the heart not that well?

What about her liver? Usually the liver endures the longest.

It's okay, right?

Her bilirubin level is 8.

Eight?

Then, it's right before liver failure...

If her lungs are not well, her breathing must not be good, either...

A little later,

Professor Choi..

will have a meeting with her guardian.

Poor baby...

Aigo, my poor baby.

Has all data for the audit of HIRAS been handed over to them?

Yes, it's going smoothly now.

Excuse me for a moment.

Yes, Grandma?

Are you ok? How is the audit going on?

Since the data is prepared well, the audit seems going on well.

All electronic data is also handed over to them.

By the time they find any unjust profits, I will come back there.

There's no need to worry yet.

Yes.

Then, when are you coming back?

I'll come after getting some news about the Trauma Center.

Yes.

Don't be too disappointed by the medical helicopter application.

It seems that there were some other connections of interests tangled too.

What was it?

I don't like having to tell someone so young this kind of news...

One high ranking politician of some party had already one hospital in his mind, so for that,

he even changed the limitation of distance. This is what I heard.

I guess it's like no smoke without fire.

But how did you find that out when other competitors didn't know that?

Our hospital has been admitting Trauma patients and performing surgeries

even without any government's aid,

and our results were good too,

so it seems there was a strong general opinion within the party

that the helicopter needs to be given to Sejung Hospital.

However, since that high ranking politician had already some other hospital in his mind,

other assemblymen left the matter to that politician as it is.

As they didn't have any relationship of common interest with our hospital,

they didn't have any reason to step forward.

But it's still shocking that he even changed the limitation of distance.

It only happened in our region, just forget it quickly.

Is it some kind of connection between that hospital and the relatives or what-not of that high ranking politician?

That kind of people don't touch this kind of trivial 3 billion won.

Wow, look at my grandma, she says 3 billion won is trivial.

Please go back home safely.

Oh, right, when this kind of thing happens,

the audit is something external which will pass by anyway,

but the actual problem will happen inside.

There are always some employees worrying too much unnecessarily

and spreading some exaggerated story of other departments,

calling and manipulating the worries,

and thinking that's all for our hospital

and that's their duty.

That's right. Those people will think of it that way.

Find out quickly which departments or middle managers are like that,

so filter any information from them on your own.

Don't waver, either

All right Grandma. Don't worry.

Yes.

Call the investigation control team and confirm if they received all the data.

All right. I understand.

As all the data is mixed up, tell them to sort them out, too.

Yes.

Hello, yes, is this the Department of Survey and Planning?

We sent the entire electronic data base of Haeundae Sejung Hospital, so please confirm receipt.

Yes. Yes.

It arrived, right?

Yes, all data are mixed now,

among them, you can sort the parts of unauthorized drugs for insurance payment by category.

Yes. Yes. Yes.

Yes, work hard.

Then, we can contact them from our lodging, right?

Yes.

Then, let's finish the rest there.

Yes, Let's do that.

How is the patient Choi Joon Kyu doing?

His body temperature is still high.

Although we change the antibiotics, the body doesn't react to them right away.

It's really frustrating. What on earth would be the cause?

You said it's because of bacterial infection.

So, he's wondering what would be the cause of that bacterial infection.

I wish the infection isn't from those artificial blood vessels...

Dr. Lee Min Woo. What do you think we should do?

Looking at CT scans we took a short while ago,

if the cause is not inside his body, then shouldn't we check the outside?

Right, let's check thoroughly.

Alright.

It's uncomfortable to breath, isn't it?

You can't sleep well either, right?

This machine is a bit hard for the patient. But still, it's better than intubation.

We will examine you now.

His breathing is same as before.

We couldn't find the cause of the infection yet. I hope it's not the infection from artificial blood vessels.

We will check the surface of your body thoroughly. Do you understand?

It's not here... What about there?

It looks fine here too.

It's good here too.

The color of urine is getting better, too.

What about Nitrite?

It didn't come out.

Professor.

Here.

It's festering.

Why is a line needed here?

Last time, central venous catheter wasn't enough,

so we set up one more line...

This is not needed.

Okay.

Can you set up a line again?

As his body is less swollen, I think it can be done.

Then, remove this one and set up two more new lines.

Okay.

Will I remove central venous catheter too?

Yes. Call Microbiology and check about gramstain.

I understand.

He's asking if you found the cause.

I'm suspecting one,

but I can confirm it accurately after having some tests.

Oh, are you done for today?

Yes.

Is it already finished?

We're going to take them to our lodging and keep working. See you tomorrow.

Ah, yes.

Oh, by the way, our team leader is hospitalized in this hospital, right?

Do you mean Team Leader Choi Joon Kyu?

Yes, that's right.

Yes, he's in our ICU now.

He was supposed to come to this hospital for this audit but was replaced because of the accident, right?

Yes.

Yes.

Then, do you want to visit him for a moment?

Is he conscious now?

Although he has some infection, he can communicate with people.

But he would dislike the idea that we visit him during our working hours.

Ah, would he?

Then, we will leave now.

Yes.

How is the condition of the Chairman?

Well, we're trying to reduce the dosage of medicine gradually, but...

You're reducing for now and monitoring the status, right?

If he recovers well by reducing the medicine,

then will he be able to move like before and come back for management work?

I can't guarantee that part.

As you know, for such things like cerebral aneurysm, the most important factor is the patient's mental state when the patient first came to the hospital.

On his way to the hospital, he was conscious, but when he arrived, he was barely conscious.

If he recovers well, it's a good thing,

but in any case, even if he recovers, if he can't come back to his management role...

Then what will happen?

There is the acting Chairwoman.

She has a lack of experience too much...

Well, Director is helping her now, and she has you, too, Leader of Planning and Control.

That's why I'm saying this, but don't you think Doctor Kang Jae In is too young?

Her great aunt, Dean Kang Soo Young, is a professor of Business Administration.

Will Chairman really recover enough to express his opinion?

If he wakes up, the most important thing is what his opinion would be about that.

Anyway, you must have a hard time assisting a young Chairwoman.

Aigo, it's really burdensome.

Oh.

Did you verify Patient Choi Jeong Kyu's Gram staining results?

Ah, yes. The results came out a few minutes ago.

They say the bacteria of gram negative

were found from the blood and phlegm.

Ah, seriously, that's a problem.

When the final test results come out,

It would probably come out as either Pseudomonas Aeruginosa

Or Acinetobacter.

They come out non-stop.

How do you feel?

He says he's feeling a little better.

What is his temperature?

It's 37.4 degrees C.

Then, his fever is going down.

We are going to switch your oxygen mask.

Please change it.

If it's difficult to breathe,

We will help you again with the mask.

Is your breathing better?

Yes.

There are some signs of improvement.

If you're thirsty, please drink a little water.

And even if it's a bit messy here,

Please try to sleep at night.

Yes, I understand.

I have something to tell you regarding the status of the audit from Ministry of Health and Welfare.

At the moment, if the amount of the alleged unjust profit of our hospital

is not higher than 0.5% of the total charged amount,

it will be taken care of by just reimbursement of the amount concerned.

So, in that case, considering its amount and others,

it won't become a big issue.

If it goes over that and it becomes subject to administrative disposition,

then that's the real issue, right?

That's right.

By administrative disposition, if we get the penalty of suspension of business,

in proportion to the relevant time period, the fine can be twice, three times,

four times or even five times more than the actual amount.

If the Administrative disposition comes out,

And the amount of money is too burdensome for us,

I am also thinking of going to court.

You're going to go that far?

It will take a lot of time.

It will cost a lot and there will be court fees to pay.

But keeping in mind our doctor's conviction about their diagnoses,

We must protect them until the end.

So, the doctors won't get disappointed.

And that way, I believe that they can continue to diagnose patients.

I understand.

Solving one issue at a time,

I have decided on the direction in which we face this obstacle.

Were there more results concerning the gram stain test?

Yes, nothing else came out.

How are you feeling?

Compared to yesterday,

I feel more comfortable.

Temperature is 37 degrees C.

It seems that you are crossing the critical stage.

Did you figure out the cause of this problem?

Well, we didn't get the specific bacteria that caused it.

But we see gram negative bacterium from your blood and phlegm.

I think phlebitis is the cause.

Most phlebitis is usually caused by gram positive bacterium.

But for you, a gram negative bacteria...

is probably the cause.

It must be hospital acquired infection, then.

I think so.

Then, you will have to start the treatment based on a hospital acquired infection, right?

You are already getting the treatment.

It would have been better if I didn't have it.

I guess I have some complications.

Yes, that's what happened.

The complication which was caused during the treatment procedure,

I will accept that.

I will also take the cost which will be needed for that.

Based on factual evidence,

I just wanted you to make a medical decision.

Yes, I too...

like factual evidence.

Since a gram negative bacteria was discovered,

You don't need linezolid anymore. I will discontinue it.

This is because of the factual evidence.

And among the gram negative bacterias, we haven't yet discovered the specific bacteria.

Based on the most common bacteria,

we will maintain colistin,

and add amikacin.

This is based on statistics and experience.

Ah then,

Wouldn't there be too much burden to his kidneys?

If it's necessary,

While suppressing the side effects, you should use it then.

Then, does this mean you won't argue anymore?

I think the problems to argue about have been all resolved.

Please contact us if your breathing becomes difficult.

Morning!

Are you back from the rounds?

How is the mother doing?

She is the same as yesterday.

Is it because of you guys that something went wrong with the mother...

Forget it, forget it.

What's the use to scold you guys. It only hurts my mouth.

"Sir Me" is going to endure it for today.

It would be better if we got yelled at.

True.

Yes, this is Sejung Hospital's ER department.

What?

A traffic accident victim?

Where are you now?

This is Yangsam Wooil Hospital.

It's a 44 year-old male patient.

While he was driving 1-ton pickup truck, he hit a large dump truck.

It seems like abdominal hemorrhage. His belly is bloating a lot too.

What's his blood pressure?

With the IV, it's around 70.

I was told to accept all transfer requests.

The Professor is next door.

Yes, send him over.

But, the patient has been in a cardiac arrest before.

After installing the IV and performing a CPR, the blood pressure came back to 70.

What? Cardiac arrest?

Aish, this is crazy. Wait a moment.

I'm going crazy. Why isn't the Professor coming?

Oh, Professor!

It's a truck driver. He had an arrest and about 30 minutes away from here.

Yes, 44 years old.

A male patient?

If you can't perform the surgery there, send him here quickly.

Don't waste time. Send him quickly.

You can't waste time trying to find his ID or what-not!

Yes, I'll have the OR prepared.

As he had an arrest once, it can happen again on his way.

Make a space in resuscitation area.

Quickly, move quickly!

But, will it be okay?

Oh, well...

The patient is 44 years old, so...

I will arrange OR.

Make sure to warm up the IV.

Should I get some type O blood?

Yes, do that.

Do you think that he was injured anywhere else?

I think we should call other departments.

As it's a 1-ton truck, he must have rib fracture.

You didn't hear anything about any leg injury, right?

Yes, he only talked about abdomen bleeding.

For now, call Orthopedics, but if it's not a leg fracture or pelvic fracture,

it's not a super emgency case, got it?

Ah, I understand.

Is this Anesthesiology?

This is a ER Intern, Lee Min Woo.

I'm calling you beause there's an emergency surgery for a TA patient.

How long will it take?

Yes, they say it's Yangsan. So, they should get here in 30 minutes.

He's coming in with IV. If we can keep his BP,

we will send the patient right up without taking a CT scan,

They said that he already had an arrest once at that hospital.

We should hurry up then. Okay.

What's it about?

It's a TA patient.

He's coming from Yangsan and arriving in 30 miniutes.

By the way, he had a cardiac arrest.

I'll go in.

Aren't you going home?

How can I leave a cardiac arrest patient with you?

--Get ready. --Yes.

They need get here quickly.

Even so...

having a Trauma OR,

It's good that we can calmly make preparation.

It is only good?

The other departments won't complain about their surgery schedule being backed up.

That's why there would be a meeting of the committee of Operation Room.

What?

It would happen sometime anyway.

What are you doing? Hurry up and get ready!

Call Nurse Department too.

Yes.

Hi, Hyung!

What's the occasion for coming all this way?

I came to see you as it has been a while.

Wow, you came all the way to Busan?

-Here, sit here. -Yes.

Do you have time on Saturday?

Saturday? Why?

What do you think about taking a yacht out on the ocean to fish?

With some good wine.

I prepared a jet ski, too.

Yacht? Why a yacht?

Sunbaenim, you are under a lot of stress.

Let's go out to the ocean and relieve some stress.

I'm bringing a chef as well.

Bring a few friends and enjoy a nice meal.

Is it okay to bring 2 or 3 more people?

Yes, please do that.

For golf, it's hard to bring friends who don't play but,

on a yacht,

even if you're not interested in fishing, there's still jet skiing.

You can have fun without any worries.

Then, I'll pick you up on Saturday morning.

Why bother coming to the house. We can just meet by the ocean.

Please, it's not far from here to there.

I'll come pick you up.

Let me see, then will I make a team?

Well, then Chief Na Byeong enjoys fishing so he'll like it.

Chief Kim Min Joon is happy if there's alcohol.

If we give him some wine, he will be happy.

It will be fine.

If you or your friends want, I can arrange a lesson for jet skiing.

You don't need to worry about anything and just come.

It sound like it will be fun. This is great.

Please raise the temp of this OR. And please heat about 20 IVs.

Yes.

I'm going to go crazy...

Why aren't they coming? I'm going to go crazy...

They said that he had an arrest, perhaps...

His condition can get worse on his way here.

I specifically told them to send him here without going through any further administrative paperwork.

Please inform me when the patient arrives.

Yes, this is the Sejung hospital ER.

This is Yangsan Wooil Hospital. We were going to transfer over a TA patient earlier.

Why haven't you arrived yet?!

Everything is set up and we're just waiting for him.

The patient...

Yes, you may speak.

The patient is in another arrest while taking a CT scan.

CT?

After we performed CPR and gave him some IV fluids,

Since the blood pressure rose, we wanted to take a CT scan before sending him over.

While we were taking a CT scan, within 30 minutes, he got an arrest.

Why would you take a CT scan during that time?

Maybe it's because the patient is young, but his heart rate came back to normal And his blood pressure came up to about 70.

We will send him right away!

I understand.

The CT scan came out already.

It seems like there's an issue with his abdominal aorta and inferior vena cava.

I will send the CT document with him.

They took a CT scan?

If they take a CT scan at a small hospital, it would take about 30 minutes.

They delayed a cardiac arrest patient to do CT scans?

They said that he got another arrest there.

What?!

Luckily, they said that he came back to normal and they are on their way. So, we'll just have to wait and see.

They said that the abdominal aorta and inferior vena cava are the problem.

Prepare more blood and platelets.

Yes, I understand.

Will he get here alive?

If his abdominal aorta and inferior vena cava are demaged

and he was in an arrest twice.

It won't be surprising

if he had another one on the way.

They probably weren't in their right minds!

Why did they take the CT scan when they don't even have specialized doctors to perform surgery?

Seriously... my goodness!

Our hospital's CT scan is fairly quick.

Even so, we don't send ICU patients there.

That's why...

Is it because they perhaps want to receive monetary compensation for taking a CT scan?

That's probably not their 100% motive.

Since they don't know well enough,

They probably wanted to see his status and while they were doing so, it happened that way.

And if they're not that knowledgeable about trauma patients,

Since they don't know what to do, they sometimes do things like that.

It happens quite often. Almost everytime.

Wow, even though the patient is dying?

They're probably not aware that there is a way to save them if they get here on time.

He's injured a lot and if he dies while performing a CT scan,

They're probably thinking "Oh, a patient that was supposed to die is dead."

Right now, our hospital has a trauma center.

And there are rumors that we are accepting trauma patients.

And we also have a designated OR.

And even though we don't have space in the ICU,

The ER is able to take care of the patients, so we are able to accept more people.

But if we call to send them to another hospital,

"What is the diagnosis? What's wrong with this patient?"

They ask questions and it doesn't get solved.

So, there are many cases where they don't get accepted.

While they make calls to all sort of hospitals,

During that time, they're probably taking a CT scan.

He must arrive here alive.

He came. Oh, he came!

You guys set up the room.

I'm from Yangsan Wooil Hospital. I called you earlier.

- What's his status? - His heart beats are weak, but the it hasn't stopped.

Let's go.

Give me the IV.

Grab it, grab it!

One, two, three!

Set up the IV.

Thank you for your hard work.

Can you get it?

It's weak.

Pulses are barely there in his leg. Connect him to a monitor, quick!

Here,

This is the CT scan. Then, I'll be leaving.

The blood arrived! Give him the blood!

Oh, I'll sign it.

Should I place another central venous catheter, a big one?

Do it as fast as you can.

Yes, I understand.

After you have set up the blood supply, move him to the OR.

I got the CT scan.

Looks like inferior vena cava is severed.

What about the aorta?

Just looking at this, I can't really tell what happened to the aorta.

What can we do?

We'll have to check after we have opened up his abdomen.

If he has an arrest while moving him up to the OR, don't be too surprised.

Stay on guard.

Yes, I understand!

Assisting for surgery is also important.

But whenever you have time, make sure you participate in every surgery.

Recording and verifying the patient's status is even more important.

Yes.

If you come inside and observe the surgery frequently,

Even if you hear about the patient's status and where they got injured,

And if you're really busy, it's possible to hear it from the office.

So, make sure you come in here often and observe what's going on.

Yes, I understand.

And with the patient's cell phone, call the patient's guardian.

Yes.

Isn't the patient's condition too severe?

As soon as you open up his body, I feel like his blood pressure will drop.

There's no other solution. No other solution.

He already had an arrest twice.

- Is the blood ready? - Yes.

Were they late because they were taking a CT scan again?

Yes, they did it again.

Aigoo, my goodness.

Scapel.

Retractors.

Metzenbaum scissors.

Gauze!

We can't secure the view.

The inferior vena cava is severed for about 10 cm.

Aigoo, 10 cm?

Is the aorta okay?

We can't see it clearly.

We must clip the aorta.

I really can't secure the view.

Performing bypass will be hard to do in this condition as well.

Can't we stop to the blood coming out of the aorta?

Yes, then the blood going into the vena cava will decrease too.

Luckily, the blood is circulating to the brain.

Even if we clip the aorta for a moment,

There shouldn't be a problem.

Satinsky clamps.

Still can't secure the view?

Ah, I'm going to go crazy!

I can't secure it at all!

All the neighboring organs are damaged.

So, the anatomy is a mess!

Do we have to approach it from the heart?

Should I call Cardiology?

When do we have time to do that?!

Shouldn't we just go into a bypass?

Do you think that we go into a bypass like a child's game?

Suction please.

Do it well... in this direction.

The aorta is all crushed.

Liver is bruised all over as well.

We can't do it from the abdomen anymore.

We must stop it from the heart.

Anesthesiologist, I'm going to perform an emergency thoracotomy.

Gauze.

You're going to open it from the side?

In most cases of emergency thoracotomy,

you'd access it from a side.

You may do a median incision

in order to approach directly to the heart. You may do a median incision

in order to approach directly to the heart.

Switch spots. Come over here.

Press it down.

Press it.

- Scapel. - It's an arrest.

What?!

Should I massage it?

Hurry up!

Here.

We will access from the abdomen again!

I got it!

Now, blood is only going to the brain.

The hemorrhage of the inferior vena cava is now stopped.

We just need to reconnect it.

Prolene!

Cut!

Cut!

Professor...

You should stop already.

Ever since this patient came in, his heart was rarely beating.

His brain must have been demaged a lot already.

Let's stop here.

Let's wrap it up.

Suture.

Did you get in contact with his guardians?

Yes, they are waiting outside.

Who is the guardian of the patient Yoo Hee Joon?

Here they are, Professor.

Your father...

is hurt a lot.

Did you know that?

Yes..

- Ji Woo, aigo Ji Woo.. - Auntie..

She's their neighbor.

Don't they have any other relatives?

These kids' father is an orphan.

I'm living next door.

At his young age, with these little kids,

he worked hard and lived diligently as a truck peddler,

and as these kids are so pretty, I sometimes took care of them, so they call me Auntie.

What about their mom?

She ran away when these kids were so little.

They don't know where she lives or even whether she's alive or not.

Then, are there any other people to come or to hear my explanation...

No, there is none.

Your father...

is hurt a lot,

and although we tried our best...

we couldn't save him.

I'm sorry.

Doctor Lee Min Woo, you can stop now.

On September 17th, at 10:45PM..

your father passed away.

Let's mark the time of death as 10:45PM.

Yes, Professor.

Your father has scars, so after we clean them up, I will let you meet him again.

Will you come over there?

Let's remove the intubation.

Doctors can't save all patients.

But we should take responsibility until the end.

Until the death, even until issuing the death certificate.

If necessary, even filling out the forms for insurance.

And.. treating the bereaved family with full respect.

All of these... are what doctors must do.

Yes...

Have you been well?

Uh...

- How is Chairman...? - How is ER...?

The position of Chairman is really not easy.

So, hurry to finish your vacation and come back.

The ER will always welcome you.

Speaking of that, as you're not here, Doctor Jae In, everybody is going crazy, including Hyeok Chan and Kang Jin.

Oh, really?

Am I that popular?

No, because there is no one to take over the next shift,

everybody is working hard on a tight schedule.

So, everybody is anxiously waiting for you to come back, that's what I'm saying, Doctor Jae In.

Anyway, that's a relief.

Since I have somewhere to go back to.

What's wrong?

What?

Is it too hard?

You seem to have a really hard time. What, what, what's so difficult?

Is the work of Chairman so hard?

If I tell you, Doctor Min Woo, will you solve that?

Solve what... I can't even solve my own problem.

I think you need a problem solver more than I do.

That pregnant patient... Jo Young Hee...

I heard there was a conference about that case.

Are you alright?

The mother has the problem, not me.

Professor Choi said to prepare myself for the worst case scenario.

And today.. there was one transfer patient from Yangsan.

but he's dead.

But...

his family who came as his guardian

were only two children.

So, you had to inform these children of the death...

I think I couldn't solve anything.

Both for the patient and the guardians, nothing.

Doctor Min Woo.

I think that sometimes, only with trying hard, we can't solve everything.

Anyone wants to have a good result and be worth as much as he or she tried.

But I find that the world... isn't working in that way.

Doctor Jae In, you really had some issue, then?

I'm not sure how I would look if I say it in this way,

but I felt that while working in this position although it was for a short while.

"There are also such things which can't be solved by my sincerity and efforts.."

No, there are too many things like that.

Didn't you know that?

Didn't you know that?

Even sometimes, that sincerity and effort can betray you.

That's right.

But you know that I'm not telling you it's okay for you to live recklessly, right?

After trying my best,

if I do my best as much as I won't regret later..

But whenever I have this kind of situation,

I'm losing the confidence

to face the patient or the guardians..

Cheer up.

We're growing up with all those experiences.

Not being numb?

We're overcoming, more firming up.

From now on, to us,

situations more difficult than now can come to us.

How is his condition now?

As it has been a week since you started triple H therapy,

I heard now is the time to see some progress.

His BP was upto 180, but now it's 150,

so while reducing the dosage of albumin, I will keep monitoring his status.

Then, while reducing the dosage, are we going to wait until any reaction is shown?

That's right.

In the meantime, treating him with triple H therapy,

Is the blood vessels' hemorrhage is completely cleared up, we can say he will recover.

But what if it doesn't work...?

Then?

If there is no reaction, we will take angiography once more,

and if it is as it was the last time, then

I'm considering to use papaverine.

What should we monitor for now?

Whether there is any voluntary movement, or he opens his eyes, or he reacts to any stimulation, you can monitor those things.

Yes, I understand.

Then, I will leave for now.

Have a talk with me.

Is the work enough for you?

Yes, it has been just a few days.

Management looks cool and good if you just look at it from outside,

but to a person who doesn't have any greed toward power, it's just bothersome and tiring.

Your father was like that.

I resemble his appearance only, you know.

And I took after my mother's personality.

I took after my grandmother too.

Great aunt.

You keep mentioning about my deceased father,

so by any chance, is there anything my father did wrong to you?

Because your father was too soft and greedless, ...

So what?

I'm proud of my father.

He wasn't like other people, who are too greedy and show their ugly parts coveting what is not theirs.

Moreover, he passed away a long time ago, so why does he have to hear that kind of comments?

I don't understand well.

What did you say again?

Jae In.

Your great aunt said so

because she's so worried that you, as a young woman, are working in too high a position,

so don't mind that too much.

Yes, I understand.

I will leave first.

The meeting of the committee of the OR will be begun now.

Chief of Anaesthesiology?

Yes, I'm Chief of Anaesthesiology.

Our hospital had been running 18 operation rooms,

but one of them became the designated OR for the Trauma Team since last month.

So, while the schedule of all surgeries remains as they were,

the number of usable ORs is technically decreased.

Well, you must have a big impact as Neurosurgery has more emergency cases.

That's right.

So far, our department has performed all emergency surgeries by adjusting the pre-scheduled surgeries, but there was a limitation,

so we're borrowing the Trauma Team's OR now.

What if you don't consider that OR as a designated OR for Trauma Team,

but as a designated OR for emergency surgeries?

It's not like only Neurosurgery Department has any emergency surgeries.

In my General Surgery Department,

there are cases such as appendicitis or enterobrosia.

The financial impact would be also huge.

As per the data, the turnover from one OR per month was 70 million won..

But if we use one for just the Trauma Team, we will lose that money.

However, at a hospital in this scale,

don't you think we can take that much loss?

That cost is enough for us to consider it as our social responsibility.

If you think it's only 70 million won, you're misunderstanding.

Even if there is a designated OR for the Trauma Team,

is the survival rate of trauma patients increased?

No, it isn't.

That's why the justification for their designated OR is weak.

There was a patient who was transferred from Yang San but died anyway.

What I heard was that the previous hospital was also slow at treating that patient,

and he had cardiac arrest twice before coming to our hospital.

We didn't keep that designated OR empty to have even such patients who have a slim possibility of survival.

If they could save him, maybe we can't say anything.

Then, what are you suggesting should be done?

Anyway, Trauma Team's surgeries are usually performed during nights.

Even if they use other ORs at night, no one would have any reason to interfere with that.

Well, the problem is during daytime...

Since we gathered here to decide it by vote,

I hope we make a decision about that quickly.

Among 23 attendees, 17 were against it,

so the designated OR for Trauma Team can be used only during nights.

Therefore, as of next week, it's decided to run the ORs as was previously done.

Please give some grace period a little more.

Until the end of this year, please let the Trauma Team use their designated OR during days,

and when the next year's budget plan is done, let's talk about this then again.

Since we have this problem right now until the end of this year,

this meeting was called urgenlty, Chairwoman.

For the next 3 months, please run this designated OR during only nights,

and when the next year's budget plan is submitted, you'd better make another plan then.

That's right.

It's regretful to have this result, but at the moment, we don't have any other option.

Then, with this, we will finish the meeting of the Committee of the OR in Haeundae Sejung Hospital.

Thank you, everybody.

Yes, thank you!

Yes, Grandma.

Jae In, have you seen the announcement on the news?

What news?

The Government..

announced the area for Trauma Center support.

What happened?

By any chance....?

Busan area...

is ruled out.

That means...

there is no way to get the government's aid within the next year.

What's this?

What's wrong?

Nurse!

Please come here, quickly!

Yes, Doctor.

What's wrong with this ventilator?

Here, at this intubation tube,

will you do suction, please?

Please give me the gloves quickly.

Here they are.

Uh? Suction tube is not going in.

It worked fine a little while ago.

Huh?

Why not? Give me the Ambu bag, Ambu.

Please bring me the Ambu bag quickly!

Yes.

Quickly.

Plug it quickly.

What's the matter?

Why isn't it squeezed?

Oxygen saturation is 70%.

Her BP is also only 70!

Isn't the airway tube blocked now?

Oh, I'm going crazy.

First, quickly contact Dr. Choi.

Yes.

Get ready for intubation.

Yes.

For now, please push this bed.

Hurry. Hurry.

Please call Professor Choi In Hyeok!

Give me the syringe!

It's blocked with a blood clot!

Blade!

Here.

It's changing a little.

Tube.

It should work at first trial... Ah, I'm going crazy...

Give me the Ambu bag.

Tape, please.