Chapter 23 – Passenger Ship Sinks (2)

“Please prepare enough saline!”

“Yes, I have it ready!”

Ena nodded her head.

“I will begin DCS (Damage Control Surgery). First, we will stop the bleeding and seal the torn areas. Let’s try to block whatever we can for now.”

DCS was originally a nautical term referring to temporarily repairing a ship when a problem arose, and then moving to a port to undergo full-scale repairs.

Considering the patient’s current condition, it was a desperate situation where they had to put out the immediate fire first.

Only then would there be a next step.

If he could just block the blood bursting out like a waterfall in the first stage, it would mean Kim Ji-hyuk had done everything he could.

And Kim Ji-hyuk’s plan was that if they left the rest to Swedish professors, including Professor Olsen, she could be saved.

“Understood!”

“Good. Then let’s begin now. Erika! Scalpel, please!”

“Of course.”

The full-scale surgery began as Erika placed the scalpel in Kim Ji-hyuk’s hand.

A moment later.

Kim Ji-hyuk’s surgical skill was outstanding enough to exceed expectations, and thus the surgery went smoothly.

“Tie!”

The suture line was clean.

It was the result of ligating and cleanly suturing the blood vessels that were torn in multiple directions.

“We must disinfect perfectly! Sepsis could easily occur otherwise!”

“Yes, understood.”

The small intestine was torn, with food and feces leaking out.

If the waste was not properly cleaned up, it could lead to a situation worse than not doing the surgery at all.

Kim Ji-hyuk perfectly sealed the torn areas.

“Ji-hyuk.”

Watching Kim Ji-hyuk, Kim Yun-seok called out in a low voice.

“Even though you are my friend, I respect you.”

“Do not talk nonsense and concentrate on the surgery.”

“No. I mean I respect you as a true doctor.”

“Haha, me too.”

“Huh?”

“I respect you too. Your sincerity toward patients! No one can match you in that aspect. That is why I respect you.”

“…….”

“The surgery is not over yet. Let’s not relax and keep our concentration until the end.”

“Got it!”

In that way, he also perfectly sealed the ruptured duodenum.

Furthermore, the partially damaged liver was resected and packed perfectly to prevent blood from leaking.

On top of that, he drained the urine from the leaking kidney through a tube and even restored a portion of it.

It was a perfect damage control surgery that even reduced the load for the second surgery.

Now, if they transferred her to a ward, monitored her progress for two to three days, and performed the second surgery depending on her recovery, she could definitely revive.

At this point, at least seventy percent of the ridge was crossed.

Right now, Kim Ji-hyuk was grabbing the collar of the Grim Reaper who was trying to take the girl to the underworld and pulling him down.

“It is all done! Now, if we just close…”

It was right at that moment.

“Huh? Th-this shouldn’t be happening?”

The flustered Shin Jung-eun’s voice trembled wildly.

“What is it? What’s wrong, Senior?”

“The patient is strange!”

Shin Jung-eun, whose face had gone pale before they knew it, stammered.

“How is she strange?”

The moment the surgery was nearly finished, a sudden variable popped up.

“The patient’s body temperature is not normal right now! Moreover, her breathing and pulse are also suddenly speeding up!”

Shin Jung-eun’s voice cracked.

“Her temperature? How much is it rising?”

“0.2 degrees per minute. It is continuing to rise right now!”

“W-what? What is the patient’s current temperature?”

“Haa, it went up to forty-two degrees, but it won’t stop. The temperature is continuing to rise! The patient is in danger! What should we do?”

Shin Jung-eun’s face turned white as sheet.

“Forty-two degrees?”

“That’s not the problem, the temperature is continuing to rise. It seems…”

“It seems what?”

“This patient… seems to have malignant hyperthermia!”

“Pardon? Malignant hyperthermia?”

“Yes. I haven’t seen it in person either, but it’s exactly what I saw in the textbook! W-what should we do?”

There was a reason Kim Ji-hyuk was startled.

Malignant hyperthermia.

It was a disease of unknown origin that anesthesiologists never wanted to face.

A disease that causes body temperature to rise as fever suddenly spikes during surgery.

Because of it, the brain takes a heavy blow, and in the worst case, it leads to death.

Although the frequency is not high, occurring in about one in forty thousand adult patients undergoing surgery, it is fatal once it occurs, making it the disease most feared by anesthesiologists.

Furthermore, this was the 1950s.

It was a disease that only appeared in textbooks, and its cause had not even been identified yet, so in reality, someone with Shin Jung-eun’s level of experience would never have seen it.

Therefore, treatment methods were also nonexistent.

“Dr. Shin Jung-eun! You must calm down. What drug did you use on the patient?”

“I used succi.”

‘Damn it, she used succi!’

Kim Ji-hyuk knitted his brows.

Although the cause had not been fully identified, Kim Ji-hyuk knew that succinylcholine could be a trigger for malignant hyperthermia.

“Doctor Kim Ji-hyuk! W-what should we do?”

Shin Jung-eun was on the verge of tears.

‘It’s okay! Since I know it’s malignant hyperthermia, we just need to use the drug! Dantrolene! We need that drug!’

“It is okay. It is not your fault, Senior. First, let’s lower the patient’s temperature as much as possible, and use dantrolene. Dantrolene will be enough to control it.”

Kim Ji-hyuk calmed Shin Jung-eun down as much as possible.

Dantrolene, the sole treatment for malignant hyperthermia, was in the form of a yellow powder.

‘With that, we should be able to control it.’

However.

Shin Jung-eun had a bewildered expression.

“Doctor Kim Ji-hyuk, what is dantrolene?”

The unexpected answer came back.

Shin Jung-eun asked, looking troubled.

‘Ah! There’s no way dantrolene exists right now…’

Kim Ji-hyuk realized his situation which he had momentarily forgotten.

‘It is currently 1953, and dantrolene is still a long way from being released!’

Kim Ji-hyuk had a devastated look on his face.

“…….”

A desperate situation. There was nothing Kim Ji-hyuk could do.

“Doctor Kim Ji-hyuk! The patient’s temperature went up to 42.4 degrees! The patient cannot hold out any longer!”

Shin Jung-eun shouted as if screaming.

“Should we contact the professors?”

At that, Kim Yun-seok stamped his feet.

‘It is currently 1953. Even if they are Swedish professors, there is nothing they can do. Lowering the fever is the urgent priority no matter what. There must be a way.’

“It is useless to contact them.”

“Then what do we do? If we leave her like this, that child is in danger!”

“Doctor Kim Yun-seok is right. We must take action quickly!”

Shin Jung-eun shouted, almost crying.

A situation where the patient’s temperature was soaring and something like dantrolene, the sole treatment, could not even be imagined. What he had to do now was.

‘Let’s stay calm, Kim Ji-hyuk, I just need to do exactly as I learned in school!’

“…….”

Closing his eyes, Kim Ji-hyuk recalled the class time before his regression.

[Everyone, you have heard of malignant hyperthermia, right? Well, it is the disease most feared by anesthesiologists. It is a disease with unknown causes and no proper treatment. In academia, they say genetic causes play a large part. These days, they mention genetics at every turn, don’t they? It seems they just throw it out since it can’t be verified!]

[Hahaha!]

[Anyway, a treatment called dantrolene was released recently, so at least anesthesiologists can breathe a sigh of relief. However, the reality is that not many hospitals actually keep it properly stocked. As a close example, malignant hyperthermia occurred during anesthesia at a certain plastic surgery clinic in Gangnam, but they didn’t have dantrolene.]

[So what happened?]

[What else? They went searching far and wide. But not a single bottle of that drug could be found in any of the numerous hospitals in the middle of Gangnam! It was expensive, and they probably thought it wouldn’t happen. In the end, they managed to get it with difficulty, but the patient had already passed away.]

[Sigh—]

[Then, let me ask a question here. If there is no dantrolene like that, what should we do? Do we just sit back and watch? How did doctors cope with malignant hyperthermia in the era when there was no dantrolene?]

‘Right! One hundred percent oxygen!’

“Senior! Stop the anesthetic right now! Quickly!”

Opening his eyes, Kim Ji-hyuk shouted toward Shin Jung-eun.

“Stop the administration?”

“Yes. Quickly! And place the oxygen mask on and administer only one hundred percent oxygen! We must hurry!”

“Y-yes, I understand.”

Hyperventilation with only one hundred percent oxygen!

This was the first step to control malignant hyperthermia.

There was a need to eliminate carbon dioxide excreted when metabolism occurred due to the increase in aerobic metabolism. In other words, increasing ventilation.

Therefore, it was important to suppress the generation of carbon dioxide from the neutralization of acid by the anesthetic.

“Yun-seok! Go outside right now and bring ice! You must bring as much as possible! We have to lower the patient’s temperature.”

Performing ice massages to lower the patient’s body temperature was the second step.

It was currently 1953, a situation where it was out of the question for medical refrigerators to be equipped. It was not easy to obtain ice, but fortunately, it was now midwinter.

Obtaining ice, which lay everywhere on the ground, was not difficult.

“Got it! I will fetch it right away.”

Now was a situation where they had to unconditionally believe and follow Kim Ji-hyuk’s instructions. Kim Yun-seok hurriedly went out of the operating room.

“Nurse Erika, please go with Yun-seok and help him. The amount of ice must be as large as possible!”

“Nurse? Whom do you mean…”

“Who else but Erika! Quickly.”

“Ah! Yes, I understand. I will do that. Doctor Kim Yun-seok, let’s go together!”

Erika hurriedly followed behind Kim Yun-seok.

‘Good. The next problem is metabolic acidosis! We must control this.’

Kim Ji-hyuk calmly recalled the treatment manual in his head.

[Everyone, the thing you must do immediately to correct metabolic acidosis is to administer bicarbonate intravenously!]

“Bicarbonate! Senior, please administer bicarbonate right now!”

“All right. Administering bicarbonate.”

In that way, Shin Jung-eun swiftly administered the bicarbonate.

“We need to determine the degree of acidosis…”

They had to determine the degree of acidosis through arterial blood gas analysis, but there was no way such a device existed right now.

‘There is no time to blame that right now. If we don’t have teeth, we just have to hold out with our gums!’

“Senior, please keep a close eye on the patient’s breathing from now on. Especially, check the depth and time of the patient’s breathing well!”

“Understood!”

Kussmaul breathing!

A deep and long respiration; when blood becomes acidic, the oxygen-carrying capacity decreases, leading to deep and long breathing. This is called Kussmaul breathing, and it was the most representative symptom of metabolic acidosis.

If this Kussmaul breathing became shallower, it meant that the acidosis was improving.

“How is it now?”

“The Kussmaul breathing has subsided!”

“……!”

‘Ah! Doctor Shin Jung-eun knew about it too!’

“It means the acidosis is decreasing, right?”

“Yes! The breathing is changing to become stable little by little. Shall we administer bicarbonate one more time?”

Just as Shin Jung-eun said, the patient’s metabolic acidosis was improving little by little.

‘We did it! It seems the acidosis is controlled to some extent now.’

However, the problem was the body temperature. If they could not lower the soaring temperature, everything would inevitably be futile.

‘If only we had a pump oxygenator…’

Unfortunately, a pump oxygenator was also out of the question to be equipped. Now, the only solution was the massage using ice ferried in by Kim Yun-seok and Erika.

It was right at that moment.

Slam!

People opening the door and entering.

They were not Kim Yun-seok and Erika, but South Korean soldiers.