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24ES | Chapter 6.1
by RAEAs the once-calm afternoon progressed, the emergency cases began pouring in without mercy. It was already the third operation of the day, and before Yesung could even take a breath, his work phone buzzed. The call was from the emergency room. Hastily removing his surgical cap, Yesung picked up the phone.
“What’s the case?”
“A 13-year-old female, TA case! But it’s a pedestrian TA, so the trauma is severe, and the bleeding is heavy! ETA is in 4 minutes, give or take! You need to come right away, Dr. Han!”
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“Understood. Prepare fluids and blood packs immediately. I’ll be there right away.”
“Got it!”
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Yesung hung up and rushed to the emergency room. As he arrived, panting from the sprint, he saw a stretcher being wheeled in by paramedics. He quickly joined the medical team surrounding the patient.
The patient’s condition was far worse than described on the phone. Blood poured profusely from her head, and lacerations and abrasions covered her body. Her ribs were fractured, and her right arm and leg were broken. The medical staff, upon assessing the situation, were momentarily struck speechless. Once inside the resuscitation room, Yesung grabbed gauze and pressed it against the bleeding head wound while barking orders.
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“Call NS1, CS2, and OS3 immediately!”
“Yes, doctor!”
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An emergency medicine resident sprinted out to make the calls while Yesung turned to a nurse.
“What are the patient’s vitals?”
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“Body temperature 34.5°C, pulse 150, BP 70/50—extremely poor! The patient also went into arrest once during the transfer!”
The rib fractures were likely a result of CPR performed during the cardiac arrest. The girl’s breathing was faint and shallow, as if she had barely clung to life to make it to the hospital. Yesung, his expression grim, quickly issued more commands.
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“Stabilize the cervical spine and proceed with intubation! Get a central line in immediately! Where’s the emergency blood I requested earlier?”
“It’ll take a bit longer!”
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“Understood!”
The medical team moved frantically in the resuscitation room.
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“Hand me the IV pack!”
“Yes!”
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“Dr. Han, I’ll stabilize the fractured areas!”
“Please do!”
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“EB! We need elastic bandages—now!”
“More gauze! Dr. Dent, help with hemostasis here! Prepare a 6.5mm pediatric tube!”
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Leaving the hemostasis to a surgical resident, Yesung focused on the intubation. As soon as he inserted the pediatric endotracheal tube, a loud, piercing alarm echoed from the monitors. Everyone froze and turned. A nurse checked the monitor and shouted.
“Doctor! The patient has no pulse! Arrest!”
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“Damn it! Get the defibrillator! Mix 5% D/W4 with 4 amps of norepinephrine5 and administer it intravenously! Dr. Dent, I can’t move because of the intubation—start CPR!”
“Yes!”
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Yesung’s voice rang out, and the surgical resident immediately climbed onto the bed to begin chest compressions.
“Time check!”
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“Noted!”
“Norepinephrine going in now!”
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As Yesung completed the intubation, he moved swiftly to another position.
“Where’s the defibrillator? And the blood? How much longer?”
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“We’ve got the blood packs!”
“And the defibrillator is here, doctor!”
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A nurse carrying blood packs and another wheeling in the defibrillator entered the room simultaneously. Yesung raised a hand to stop the surgical resident’s compressions.
“Good! Start the transfusion immediately. Dr. Dent, step back. Let’s check the rhythm! Vitals?”
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The alarms stopped as soon as Yesung issued the order. A nurse monitoring the patient let out a relieved sigh and reported.
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Yesung exhaled, but he didn’t relax just yet.
“Secure another line immediately and expedite the transfusion!”
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“Yes, doctor!”
“Also, administer tranexamic acid7!”
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“Yes!”
Straightening his back, Yesung asked, “What about the specialists I called?”
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“They’re on their way! Here they come!”
As the nurse spoke, the resuscitation room doors opened to reveal Professor Seok Hoon from Neurosurgery, fellow Lee Siyeon, Orthopedics fellow Jang Kihyun, and Cardiothoracic Surgery resident Seong Yugang. They wasted no time assessing the patient’s condition.
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“This is serious…”
“The humerus and tibia are broken, as well as the ribs. It seems like closed fractures, but we’ll need a CT and X-ray for confirmation. Can we move the patient right now?”
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Professor Seok, positioned at the head, wore a grim expression, while Jang Kihyun remained calm as he inspected the fractures. Seong Yugang quietly checked the patient and nodded in agreement with Jang Kihyun.
“Yesung nodded. “We’ve done almost everything we can here. If her condition remains stable, she should be ready to move.”
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“What about the guardians? Have they arrived?”
“Yes, they’re just outside the resuscitation room.”
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Upon hearing this, Yesung and Jang Kihyun glanced toward the glass walls. Beyond the bloodstained floor, the patient’s parents could be seen anxiously peering in. Yesung turned to Professor Seok.
“I’ll go speak with them. Please take care of the patient for a moment.”
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“Go ahead, Dr. Han.”
With Professor Seok’s approval, Yesung stepped out and addressed the surgical resident on his way out.
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“Finish the remaining procedures and prepare for an emergency CT and X-ray ASAP!”
“Yes, doctor!”
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As the automatic doors opened, the girl’s parents rushed over.
“Doctor! How’s our Areum? Will she survive? Please tell me she’ll make it!”
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“Doctor, I beg you. Save our Areum. Please…”
The mother looked on the verge of fainting, while the father struggled to maintain composure. Yesung hesitated before replying.
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“The situation… is dire. She’s suffered severe head trauma and internal bleeding. Her heart has already stopped twice—once during the transfer and once after arriving at the hospital. I can’t make any guarantees. If her heart stops again…”
Before he could finish, the resuscitation room doors burst open.
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“Doctor! The patient has arrested again!”
“Excuse me.”
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Leaving the distraught parents, Yesung rushed back inside. Under Professor Seok’s direction, Lee Siyeon was already performing CPR.
“Time check! Administer norepinephrine again! Charge the defibrillator to 150 joules—hurry!”
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“Yes!”
“Switch with me, Dr. Lee!”
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Yesung hurried to the patient, switching places with Lee Siyeon. His breath quickened, and sweat trickled down his temples.
“Norepinephrine is in!”
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“Doctor, 150 joules charged!”
Hearing the two nurses’ shouts almost simultaneously, Yesung stepped back and shouted, “Everyone, hands off! Step back! Shock!”
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As the defibrillator delivered the charge, the girl’s upper body jolted violently. Handing the paddles back to the nurse, Yesung leaped onto the bed and began chest compressions again.
“Let’s check the rhythm again!”
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After compressions, he climbed off the bed and checked the monitor himself. Biting his lip, he announced grimly, “No change! We’ll massage again. Charge to 200 joules this time!”
“Doctor, I’ll take over!”
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The surgical resident interrupted as Yesung prepared to climb back onto the bed. Agreeing without hesitation, he passed the position to her while a nurse handed him the paddles.
“Hands off, step back! Shock!”
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Again, the girl’s body jerked from the electrical current. Handing the paddles back, Yesung watched as Jang Kihyun took over chest compressions.
“Let’s check the rhythm!”
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Jang Kihyun stepped off the bed as everyone turned to the monitor. A sharp spike momentarily flashed across the screen, forming a V-shaped peak.
Yesung’s eyes widened. “Check for a pulse!”
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Pressing his fingers against the girl’s neck, his expression darkened.
“PEA8. Continue compressions!”
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Yesung climbed back onto the bed, his movements resolute. Sweat dripped from his chin, soaking his scrubs.
“Check the rhythm again!”
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Despite relentless CPR, the rhythm remained unchanged.
“I’ll take over, Dr. Han!”
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Stepping down, Yesung allowed Lee Siyeon to take his place. Observing the monitor, Seong Yugang asked the nurse beside him, “Is this the first arrest?”
Having arrived after the second arrest was resolved, he was catching up on the situation. The nurse shook her head.
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“No, this is the third time…”
Seong Yugang’s face turned pale, his expression revealing what he didn’t say aloud. But Yesung, focused entirely on the patient, shouted to Lee Siyeon, “Switch with me, Dr. Lee!”
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“Yes!”
Climbing back onto the bed, Yesung continued chest compressions with all his strength. Sweat pooled at his chin and dripped steadily.
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“How much time has passed?”
“It’s been 20 minutes, Doctor.”
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The golden time for resuscitation had long passed. This was the third cardiac arrest, caused by traumatic hemorrhage. While the first two arrests had been resolved relatively quickly, the third had dragged on too long, reducing the likelihood of recovery to near zero.
Yet Yesung refused to stop. His hands pounded the girl’s chest, the resuscitation room enveloped in tense silence. The monitor’s relentless beeping filled the air, underscoring the urgency.
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Finally, Professor Seok Hoon stepped forward, gripping Yesung’s arm. “Dr. Han, that’s enough. It’s been almost 30 minutes. You know as well as I do—if she hasn’t come back by now, there’s no hope.”
The professor’s firm grip caused Yesung’s movements to slow and stop. Logically, Yesung knew the odds of recovery were slim. Even if the heart restarted, the likelihood of brain death was overwhelming due to prolonged oxygen deprivation and blood loss.
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But he couldn’t bear to give up. Officially, there was no fixed deadline for resuscitation. There was always the faint hope, the slim chance that kept him going. However, as a fellow under Professor Seok’s authority, he had no choice but to comply.
Just as Yesung began to step down, someone else climbed onto the bed. The sudden movement caused the bed to shake. Yesung’s eyes widened.
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“It’s not 30 minutes yet, Professor. Just five more minutes. Let me try for five more minutes.”
It was Jung Hageon. Still in his surgical scrubs and panting heavily, he had likely sprinted straight from the operating room.
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Though Cardiothoracic Surgery already had Seong Yugang present, Jung Hageon must have decided to step in after hearing about the critical case. Perhaps he believed it was too much for a resident to handle alone.
With unwavering determination, Jung Hageon began chest compressions. Thankfully, Professor Seok didn’t intervene, allowing Jung Hageon to carry out CPR for the time he requested, switching with other doctors as needed.
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The sound of compressions echoed through the somber room. Time passed. Finally, a nurse muttered, “…It’s been 30 minutes, Dr. Jung.”
In truth, 30 minutes had long since passed. The clock was nearing 50 minutes. At her words, Jung Hageon’s movements slowed and eventually stopped. He stepped down, his breathing labored.
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Everyone in the room had done their best. But nothing had changed. The grim reality sank in, evident to all present.
In the silence, broken only by the monitor’s flatline, Professor Seok turned to Yesung.
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“Dr. Han.”
“…Yes, Professor.”
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“Call the time of death.”
The words cut deeper than any blade. Closing his eyes tightly, Yesung opened them and stepped forward, checking his watch.
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Footnotes
- Neurosurgery
- Cardiothoracic Surgery
- Orthopedic Surgery
- Dextrose in Water
- Norepinephrine injections are used to treat severe, acute hypotension (short-term low blood pressure) and shock.
- Return of Spontaneous Circulation
- Tranexamic acid is a medication used to treat or prevent excessive blood loss from major trauma, postpartum bleeding, surgery, tooth removal, nosebleeds, and heavy menstruation. It is also used for hereditary angioedema.
- Pulseless Electrical Activity