Chapter 70

Chapter 4, Episode 70: One Step Further (5)

"I will now begin the dissection."

I spoke in a serious tone.

Even though it was just practice, I had no playful or relaxed attitude.

The deceased on the operating table was a righteous person who willingly sacrificed their body for the advancement of the medical field.

Therefore, my approach to handling the cadaver should also be reverent.

'There were some really strange people.'

I shuddered as I recalled an incident from the distant future.

It was probably the case where a medical school student took photos of the cadaver dissection practice and uploaded them to social media.

They had a cheerful expression, as if they were on a spring outing.

There were also mocking captions about the cadaver.

The medical students who caused the incident showed no respect for the deceased.

I couldn't remember what kind of punishment they received.

But one thing was certain: they were not fit to be doctors.

"Professor, I will assume a rupture of the right diaphragm and proceed with the thoracotomy."

"Go ahead."

I positioned the cadaver to lie on its left side, exposing the right side of the chest.

The moment I confirmed the surgical site, I felt a slight tension.

In my past life as a thoracic surgeon, I had opened the chests of countless patients.

However, the method I used was mostly a bilateral thoracotomy through the sternum.

This type of thoracotomy is the most commonly seen in thoracic surgery dramas.

It involves making a long incision up and down the center of the chest, primarily used for heart surgery.

In contrast, the general thoracic surgery part, where I am being taught by Yang Sun-jae, prefers a lateral thoracotomy.

This is because the organs being operated on are the esophagus, lungs, mediastinum, and diaphragm.

For reference, I had rarely performed a lateral thoracotomy.

While a thoracotomy itself is not a particularly difficult surgery, performing a procedure I had no experience with naturally caused tension.

Before the actual surgery began, I disinfected the surgical site.

I wiped the cadaver's skin with 4% chlorhexidine, applied povidone-iodine, and covered it with a surgical drape.

After completing the disinfection, I felt as if I were really performing a real operation in my past life.

'Then...'

I closed my eyes and bowed my head for a moment.

This was my own ritual before surgery.

Quickly reviewing the entire surgical process from A to Z in my mind.

At the same time, engraving the most tense and careful part of the procedure in my heart.

After performing the ritual, my mind became calm.

"Professor, can you give me a 10-blade?"

"Sure."

Yang Sun-jae inserted a 10-blade into the scalpel handle and handed it to me.

As he handed me the scalpel, Yang Sun-jae glanced at me with a look of doubt.

Sure, you're a genius, so memorizing medical knowledge isn't hard.

But can you apply what you've memorized in a real situation?

Especially in a situation where you're entering the operating room for the first time, and the subject is a cadaver, not a model?

...That's what Yang Sun-jae's eyes were saying.

Now it was my turn to respond to that look.

I boldly placed the scalpel on the right side of the chest and made an incision up to the back.

The cool sensation of the skin splitting was vividly transmitted to my hand.

"Can you give me the Bovie (electrocautery)?"

"Here it is."

Upon receiving the Bovie, I carefully removed the subcutaneous tissue, fascia, and pleura.

Zzzz.

In the quiet operating room, only the sound of the electrocautery burning tissue could be heard.

The smell of burning skin tissue mixed with the sweet aroma of making toffee and the pungent smell of blood.

If we removed the voices of the surgeon giving orders and the assistants following them, it could have been a good ASMR version for the operating room.

The sound of the Bovie.

The clinking sound of surgical instruments as they were moved.

The regular beeping sound of the patient monitoring device.

These sounds had a calming effect on me.

After securing the surgical field with the Bovie, I looked at Yang Sun-jae.

"How about the retractor (retractor)? We will need someone to assist, I think..."

Although the surgical field was secured, the range was too narrow.

To perform the surgery properly, we needed to widen the incision with a retractor.

For that, we needed assistants to pull the retractor.

Just like when I was an intern.

"Don't worry about that."

Zzzz.

As soon as Yang Sun-jae finished speaking, the operating room door opened, and two nurses entered.

Both looked like scrub nurses (nurses who assist the surgeon during surgery).

Looking up at the observation room, I saw Min Dong-geun nodding.

It was a nod that seemed to say he knew exactly what we needed.

"That kid, he's quick on the uptake. Professors, can you help with the retractor?"

"Of course. We came in to help."

"Thank you."

The two nurses took their positions at the operating table.

"Two scrub nurses are helping, and two professors are observing... I feel like I'm being pampered."

"Don't be nervous. Just show off your skills."

"You won't be disappointed."

After saying that, I positioned the retractor at the end of the incised skin.

Click.

Click.

The sound of the pins being tightened was crisp.

"Everything is secured. Please widen the incision."

"Understood."

The two nurses began pulling the retractor from above and below.

As the skin stretched, the surgical field became much wider, and the diaphragm, which needed to be operated on, finally came into view.

"It's my turn again."

Yang Sun-jae held the scalpel and intentionally damaged the right diaphragm.

He was creating the diaphragm rupture scenario for today's practice.

The diaphragm acts as a boundary between the chest and the abdomen.

Above the diaphragm is the heart, and below it are the abdominal organs.

A diaphragm rupture is usually caused by trauma.

If not treated early, it can lead to decreased lung function due to lung compression, abnormal venous circulation, and even herniation of abdominal organs due to increased abdominal pressure.

That's why, when a fellow trained in the esophageal and lung part is called to the emergency room, it's often due to a diaphragm rupture.

"Then, let's proceed with the next step."

"Yes, Professor. I would appreciate it if you could prepare a 1-0 Vicryl."

Vicryl is an absorbable suture, the most commonly used suture in the operating room, regardless of the type of surgery.

The 1-0 indicates the thickness of the suture, with larger numbers meaning thinner sutures.

So, 1-0 is relatively thick, while 5-0 is as thin as a hair.

Squeak.

I used the needle holder in my right hand to extract the needle from the suture packaging that Yang Sun-jae handed me.

This was the beginning of the suture, one of the key indicators of a surgeon's skill.

'I'm confident in suturing.'

I held the torn diaphragm tissue with the forceps in my left hand.

Then, I pierced the diaphragm tissue with the needle of the needle holder in my right hand.

The key here is force control.

If not done correctly, the needle could tear the organ being sutured.

Poke!

The needle cleanly penetrated the torn diaphragm.

I did the same for the opposite side of the torn diaphragm.

The tension I felt as I pulled the suture with the instruments in both hands.

If the tension of the suture is too weak, the wound will open, making the suturing meaningless.

Conversely, if the tension is too strong, the wound may tear.

So, the key to this task was also force control.

I made the suture hold the torn diaphragm taut and tied a simple knot.

Continuing the suturing.

My hands began to dance as if they were possessed.

It felt like my hands were moving me, not the other way around.

This feeling appeared when I was in good condition.

So absorbed in suturing, I even forgot about the surgical nurse, Yang Sun-jae, and Min Dong-geun.

A state of complete immersion.

No one else could understand how long I had waited for this exquisite sensation.

I chose a continuous two-layer suture without hesitation.

A double continuous suture.

Unlike a simple interrupted suture, it involves tying a knot only once per area and continuing the suture without breaking the thread.

A quick suture.

Prevention of blood and fluid leakage.

The double continuous suture had these two advantages.

"Done."

After suturing a 5-centimeter tear in the diaphragm, I put down the surgical instruments with a slight sense of regret.

The taste of being a surgeon, which I hadn't experienced for decades, was intense and captivating.

It was so captivating that I wanted to jump ahead in time and work as a thoracic surgery professor right away.

No matter what, I was the most shining person in the operating room.

"The new surgeon is amazing. The suturing is incredibly neat."

"You look so young for a specialist."

The scrub nurses were busy praising my work.

They didn't seem to know that I was a first-year pre-med student.

Their praise made me both grateful and embarrassed.

After all, I was a 20-year veteran thoracic surgeon masquerading as a first-year pre-med student.

Meanwhile, Yang Sun-jae examined the diaphragm area I had sutured in detail and whistled.

"I knew something was off when you started the thoracotomy, but I didn't expect the suturing to be perfect. There's nothing to criticize."

"Thank you, Professor."

"I think we need to completely redesign the training program. I never imagined you would have the skills and sense of a fellow."

Yang Sun-jae's eyes had a strange light, a mix of surprise and joy.

Seeing Yang Sun-jae's joy made me happy too.

It seemed he felt the satisfaction of setting up this opportunity for me.

"By the way, Eun-ah."

"Yes, Professor."

"I'm curious if you can really reach this level through mental training alone. I've never seen a case like this before."

"I think I can."

I answered calmly, with a poker face.

The concept of being a genius was already out, so there was no point in trying to retract it.

So, I had to push through, no matter what.

But wasn't the current genius concept much better than the old 'I don't know anything, I just heard it somewhere' approach?

It wasn't stifling.

There was no need to hide my abilities.

"Hehe, if you say so, then it must be true. Let's end today's practice here and take a break."

"Yes, thank you, Professor. Thank you, everyone."

I greeted the scrub nurses and left the operating room with Yang Sun-jae.

I took off my surgical gown, cap, and gloves with a sense of relief and stepped out into the hospital corridor.

Only then did I feel like I had returned to my daily life.

My body felt lazy, as if basking in the spring sunshine.

"Professor, can I observe you performing the next surgery?"

I spoke first.

Suddenly, I wanted to see Yang Sun-jae, the master of the esophageal and lung part, in action.

Observing a master's surgery up close would be a great training experience.

"You're eager. Sure, why not. Next time, I'll perform a lung cancer surgery, and you can assist."

"Thank you, Professor."

Yang Sun-jae, seemingly impressed by my enthusiasm, smiled warmly and patted my head.

I didn't mind the affectionate touch from my mentor.

In fact, it made me feel recognized and happy.

"I'm looking forward to what Dong-geun will say after observing your surgery."