At that time, little did we know.
How in such a manner,
we would be losing a comrade.
It all started here...
- Suture holder. - Yes.
- 3-0. - Yes.
Please.
Ijyuuin-sensei, do you want the 21mm or 23mm?
- The 23mm. - Yes.
- Next thread please. - Yes.
UV(Urine Volume) before pump-ON?
What is the UV before pump-ON?
Uhm.. Sorry. UV is around 20ml/h.
20? Was the volume enough?
- Any excretion now? - Eh...excretion is not good!
Inject diuretic to increase excretion.
Nothing wrong with circulatory flow right?
- Ok. Pull out the transfer tube. - Yes.
- Please tie a knot here. - Yes.
Argh.. Aorta is bleeding!
Assess blood lost. Is blood enough?
Stay calm! 4-0.
- Bring 4-0 here! - Yes.
- What's wrong? - We don't have 4-0.
- I'll go get it. - Hurry!
After the Lehman shock, external investments stopped. Plans for medical city were abandoned.
Patients are fewer. The skill levels of surgeons are deteriorating.
I no longer belong here.
University of Chicago has offered me the post of head of ER.
- With a 300 million yen grant. - Wait.
We can't do without you here.
Thank you for everything.
Kito-kun! Certainly, for Meishin to stay in business,
reformation is necessary. - Reformation?
Just changing part of the organization is not enough.
Reality is bitter. - Then what do you suggest?
Everything you say, I will listen. Tell me.
Everything?
Oh damn..
We received another lawsuit. This time is the gastroenterological surgeon Tajima-sensei.
- This is this year's... - 4th case.
We have an unusual amount of lawsuits. - Ouch.
The problem is our outflow of human resources. All the good doctors have resigned.
The bright replacements refused to come.
We are left with staffs who can't do surgeries.
Forget about that. It's all thanks to the negative legacy left by this man.
This hospital is used to be run by this publicly-known unethical professor.
Who would dare to come here?
Patients have all transferred to the neighboring
National Cardiovascular Center.
Even the emergency ambulance will prioritize taking patients there for treatment.
As such, the number of operations here plummeted, we are left to do simple operations.
Anyways, what's up with that person?
Recently, he has not participated in any operation.
That, I don't blame him.
Whatever it is... I can't demonstrate my God-hand capabilities.
I'm already unhappy. More so for the patients.
- Sensei.. this? - I don't need it anymore!
At this time, Kihara-sensei, you can still joke around.
Hey, tell me, what else can I do other than cracking jokes?
Hey, something's going on?
The hospital heads have an important announcement.
- Eh? Let's go. - Yes.
Now, Meishin University Hopital's new President,
Kito Shoko will speak.
- New President? - It's Kito-sensei?
Meishin... will change.
Training. Clinical. Research.
will be the mission of the University Hospital. These three pillars,
we will fundamentally review. First up, training.
Ever since interns have the freedom to choose,
it's regrettable that the brightest
have not been considering Meishin.
To attract young talents,
we have to start by changing the leaders.
Thus I will abolish the old-school tie walls,
and continually bring in bright talents from outside.
Next up is clinical. I believe the key is to strengthen our surgery department.
The guaranteed way is,
to actively attempt difficult operations
to achieve world-wide recognition.
Lastly, for research.
Although I cannot yet reveal specific plans for research,
it's worthy of a Nobel Laureate.
A world-class research.
Your arguments are sound. But do you have a concrete plan?
You mentioned external bright talents.
Who are they?
Translators & QC: indokid, serene012 KEEP THIS A FREE FANSUB!
Finished.
Since the ischemic duration was limited,
cardiotonic should wear quickly.
You did well... you did your best.
Kato-sensei.
We've come to the U.S., just to wait for a donor.
So she can have her transplant operation.
Fujiyoshi-sensei, the patient's here.
- Please let them enter. - Yes.
As expected, Wakakusa hospital said
they cannot do the operation. - I see.
I can't believe this, sensei.
Just a while back, she was still running healthily.
- Sensei. - Hmm?
Can't I... be saved?
40 year old man.
He fell with his bike from 3 metres high into a river.
Immersed in water for 20 to 30 minutes. It's assumed..
Vital..?
Brain and cardiac departments are busy? All right. Other hospitals.
No other choice, we can only bring him to Meishin.
Kihara-sensei, ER has an emergency patient. Should we go?
Go or don't go, under Kito-sensei,
all ER patients are accepted right?
We don't have a choice.
- Traffic accident, seems like chest injury. - Ok.
- Vital? - Blood pressure 84-38.
Pulse 84. Saturation 88. Temperature 32.2c.
- 32.2c? - He was rescued from a river,
but seems he'd drowned for a while.
Any head injury?
- From the looks of it, it's OK. - Please hold his head up.
Yes.
Jugular vein is dilated.
- Echo! (Ultrasound) - Yes. - X-ray scan is here.
Show me!
As I thought.
- Pulse is getting weaker. - Are you OK?
The traumatic heart injuries is causing cardiac tamponade.
OK. Move him to operating room.
Can you hear me? Are you OK?
We are moving.
Incoming stretcher!
Heart may be injured, median sternotomy,
check the heart. - Yes.
OK, opening up pericardium.
- Metzenbaum! - Yes.
Blood pressure is rising! 100-70!
Aortic dissection!
Ijyuuin, you didn't check the flap with Echo?
- Needs aortic replacement! - I know.
- Prepare heart-lung machine. - Yes.
- Ijyuuin, the blood vessels.. - Kihara-sensei!
What! Don't scare me!
- He has Anisocoria. - Huh?
Isn't the head injury OK?
- What are those guys doing!! - The dissociation
has not reached aortic arch yet.
But, high possibility of brain hemorrhage.
The bleeding is still increasing, we can't use the heart-lung machine.
Can't use heart-lung machine? Then what should we do?
We can't do anything about this aortic arch rupturing?
Without stopping the heart, to repair an aortic dissection,
is impossible.
Close up his chest.
After this, the only miracle is from internal medicine.
- Sternal suture.. please. - Yes.
Continue the operation!
- Asada! - Asada-sensei!
- Apparently, his head injury… - I've already heard.
Commencing aortic replacement surgery, inject 3ml heparin.
But, the heart-lung machine cannot be used.
Asada-sensei, there's brain hemorrhage.
- Shut down aorta flow. - But we already said we
can't stop his heart, how do we stop the aorta?
Is this OK?
What? A dry battery?
VF! Ventrical Fibrillation!
What? Are you murdering him?
As expected of Asada.
If we don't stop the heart beat, it's impossible to repair the ascending aorta.
Because of this, the heart-lung machine is needed.
But, if accompanied by brain hemorrhage,
the heart-lung machine increases bleeding and damages brain cells, worst-scenario is brain death.
Thus, using a dry cell battery to send electric shocks to the external heart region.
The heart has no resistance to electric current.
With direct contact, a 9V battery is enough
to deliver electric shock to the heart.
In other words, disrupting the natural electric flow
in the heart to induce a VF.
The heart will temporarily be paralysed, stopping blood circulation.
Then in this short window where bleeding is minimal, repairing the aorta.
From his battlefield experiences with lack of supplies,
only Asada could think of this.
- Long time no see. - I've been waiting.
- Scalpel. - Yes.
- Metzenbaum! - Hold up!
Indeed, in this situation we can repair the ascending aorta.
But with no blood circulation, the brain can only be sustained for 4 minutes.
Only 4 minutes?
- Even if it is you! - Temperature? - 32.3c
I see.. patient's temperature is very low.
If it's 32c, ischemic tolerance time is.. around 10 minutes!
- Hold on tight! Keep up! - Yes.
ME (Mechanic Engineer)! Count down!
-Teflon felt. 4-0 - 26mm graft.
Metzenbaum.
Central region has been sutured, next up peripheral region.
- Understood. - Teflon felt. 4-0.
- Yes. - It's already 3 minutes!
How fast!
As expected of.. Asada Ryutaro.
- DC 20 J. - Yes. Clear.
All right!
- Time left? - 6 min 30 sec. - Amazing!
It's too early to let up, wait till patient's saved.
- Quickly call the brain surgeon. - Yes.
- Insert drain. Scalpel. - Yes.
It was a wonderful operation.
From now on, actively do more difficult surgeries that we can show off to the world.
That's why I called both of you back.
The ultimate goal is Japan's first
pediatric heart transplantation. This would be done by Team Dragon.
This requires your pediatric heart transplant experiences in U.S., Kato-sensei.
And then... you.
Is this for your own glory?
No. It's for the future of health care in Japan.
Japan's Organ Transplant Law has been amended.
In the future, overseas organ transplants will also be regulated.
The only option is to do transplant locally.
But we are now facing a serious shortage of organ donors.
We must make every effort to prolong the lives of those patients awaiting organ donation.
And the only ones who can do it is this team.
Don't you think so?
But, the members are not complete.
- A great doctor? - Yes.
Coming to our hospital?
It's said that he's the best of the best.
Better than Asada-sensei?
No idea. I just know he's coming here.
- Could it be Kirishima-sensei? - No. Someone greater than him.
Who is that?
Probably a guest.
Umm... I'm sorry... but... Who are you?
- Me? - Yes.
Change your tea leaves, it tastes bad.
Do you know the instructor doctor here?
- I want to say hi. - And you are?
- Me? - Yes.
I'm here to intern.
- Huh? - An intern?
This is my new office…?
- The so-called great doctor is... - an intern?
Sensei, you've worked hard.
I'm sorry to hear about your daughter.
Jyuri-san's congenital heart disease
had been cured once.
Two years ago, she was infected with viral myocarditis.
She died while waiting for a heart transplant in this hospital.
I've already checked.
Children with heart disease and awaiting transplant,
there are more than 50 in this entire country. A large number of them
are just waiting in hope of a transplant.
Living their lives worrying.
Are you going to stay here?
- What are you trying to say? - What you should do is
not just holding the hands of children awaiting organ transplant,
but to cure them.
Five years ago, you wrote this paper
"Therapeutic myocardial angiogenesis with bone marrow delivered stem cell."
It's now well-received as a pioneer in regenerative medicine.
But, after you finish the paper,
you joined Team Dragon, and devoted yourself to clinical work.
Saving lives is a doctor's duty!
Although organ transplant law has been amended,
but the number of heart transplants in the country will not immediately increase.
There is a limit to just using surgery to treat patients.
But if by using your own cells for regenerative medicine is achievable.
The number of lives that can be saved will dramatically increase.
In U.S., they've created a complete mouse's heart
from pluripotent stem cells, or even
iPS cells capable of creating cardiomyopathy models.
A global race is about to begin.
Also, this kind of research cannot be done here,
only achievable in university hospital.
Meishin will make every effort for regenerative medicine research,
with a team led by you, Fujiyoshi.
We have prepared a world-class research funding and facilities.
If you do have a mission to save lives, then please complete this research.
Last year, the department was moved here.
How is it? Pretty?
- Good work! - Good work!
And this room
we are free to use as we like.
We are re-forming right? Team Dragon.
Sadly, Miki-san is in Germany and cannot come back.
- How's Arase? - Huh?
I heard Arase was responsible for a patient's death. Is it true?
It's true! Kato-sensei and Asada-sensei are back!
Isn't that amazing! Team Dragon will be resurrected!
Just one year ago.
... replace a diseased mitral valve.
Arase was the doctor-in-charge for
a 16 year old who was admitted for mitral insufficiency.
Can I really still play football next time?
- Blondie! - Hey, watch your words!
You can count on me, kid!
That child was in hospital for quite some time,
and grew close to Arase-sensei.
Tomorrow's the day.
Are you scared?
Nope..
It's just that if anything happens, my parents would be very sad.
Don't think too much.
It's not a major operation. I guarantee.
Please.
Sensei, I leave it to you.
The operation itself is not difficult.
1.. 2.. 3..... 7..
But at that time, there was a shortage of anesthetists.
On that day, Arase alone has to handle four operations.
Got it. How is it?
We just need to close up the chest.
- You must be tired. - Next door operating room,
there's a colorectal cancer patient ready to go, I'll head over.
If anything, call me immediately!
- Scalpel. - Yes.
Soon, trouble happened.
- Where is it? Where? - Gauze.
Hey! Call Arase-sensei back!
Don't need for that!
Anesthetist's not needed! Everything's OK, I will find it!
- Pour warm water! - Yes.
- Drain! - Yes.
- Enough! - Yes.
- Warm water! - Yes.
It was entirely the surgeon's fault, which led to bleeding to death.
If Arase-sensei had been promptly called back, this could have been prevented.
The parents filed a lawsuit, because this operation shouldn't have failed.
Then, the head surgeon pushed
all the blame on Arase-sensei,
claiming it's due to an anesthetic management error.
Also, Arase-sensei had said "I guarantee".
The child was probably delighted
and told it to his parents.
The irony is those words worked against Arase-sensei.
Nowadays to avoid prosecution, medical institutions
avoid making such promises for which they can be sued.
He, he trusted you so much!
But you let him down!
Arase-sensei did not retaliate.
In the end, to minimize damages,
the university hospital paid a huge amount in settlements.
An internal investigation did not indicate negligence by Arase-sensei.
But since then, Arase-sensei has not been in operations.
I have one condition.
What? If you need more research staffs..
In Meishin, I want to continue consultations.
I don't want to research just for the sake of research,
but to research for the sake of patients.
Hence, I still want to conduct consultations. That's my condition.
You haven't changed, still immature.
And, there is a patient I want to bring along.
Patient is Sugaya Yukina. 17 years old.
Last month, she collapsed in a track event.
From test results, she's suffering from a very rare heart disease.
She has been to all established cardiac hospitals.
None is willing to do the operation. The ones left who can do the operation,
is only Team Dragon.
Cardiac function?
Excess catecholamine, left ventricular systolic function is only 30%.
Then she should be undergoing endocrine treatment. Why is cardiac surgery needed?
What's her disease?
Thus far, there are only 100 cases of this cardiac tumor worldwide,
Cardiac Paraganglioma.
The tumor is located at the center of her chest.
Inside the heart, the tumor is surrounded by the aorta and pulmonary arteries,
tumor is secreting noradrenaline hormones, which increases blood pressure,
resulting in cardiac and vascular trauma.
If left alone, will lead to necrosis of central tumor and
a life-threatening rapid decline of blood pressure.
- Current situation? - α-blockers
to temporarily block the release of hormones for 2 weeks.
But, cardiac function can go into a sudden rapid decline.
If the tumor is not completely removed, it may lead to cardiac arrest.
She needs an immediate operation. Do you have any films?
Yeah.
It's huge!
You can say it has completely covered the heart.
We cannot guarantee complete removal,
but any left-over tumors, I'm afraid..
Metastatis will occur, and lead to death.
The tumor cells are located in the chest and can easily spread.
We can only know during surgery the extent of tumor cells,
or if any has entered the tissue cells.
When the operation starts,
if the tumor expands and starts bleeding,
it may lead to death.
Once we start, whatever happens there's no turning back.
This is the hardest surgery for surgeons.
Can you do it? Asada.
Very difficult. - Asada-sensei!
If we make contact with the tumor during surgery, blood pressure will surge.
When we are excising the tumor, blood pressure would rapidly decline.
The anesthetist who can control this.. is only Arase.
So.. ask for Arase's help.
Paraganglioma?
- Yes. The operation.. - It's no use.
We need your strength.
I made a grievous blunder.
I'm.. not a person who is fit to be your comrade.
This is my punishment.
Good luck for the operation!
I used to be like you.
But, that team changed me.
Weren't you the same?
Today I'm your mentor.
Please follow me in my rounds.
Paraganglioma is a rare disease,
you should observe, it helps in your learning. - Yes..
How long will it take? I have a date later.
To prevent intraoperative blood pressure surge,
I will prescribe you this medicine for now
We'll monitor your condition and determine the most appropriate surgery day.
- Do you feel uncomfortable? - I'm all right.
You love track and field?
I still can't believe that I have such serious disease.
You suddenly fell during a track meet, right?
After examination,
I was told that I have this thing inside my heart.
I see.
I was still running actively last month.
I can be cured right, sensei?
From now on concentrate on your treatment, make an effort to recover.
Ijyuuin! Have you contacted Arase?
No. Certainly, it's not possible.
Sensei... this morning's CT shows the
tumor has already penetrated into the heart. - Yeah.
Even if Arase-sensei agrees to join, this operation..
- is very difficult. - Yeah.
That being the case, shouldn't we hurry to inform the patient and her family?
- 14 hospitals. - Huh?
Before coming to our hospital, they have transferred hospitals 14 times.
And that disease came without any warning.
Up to last month, that child was still healthily running.
Do you have the heart to tell her "We can't cure you here"?
I think we should tell.
Unnecessarily clinging on to false hope,
isn't it very cruel to the patients?
Fujiyoshi-sensei, it's inappropriate for me,
but I can understand your inner feelings.
This has nothing to do with my daughter!
Maybe you are right.. But
I still have high hopes for Team Dragon.
Even if it is 1% chance, I'm willing to bet!
Hey, are you OK?
Idiot! Aren't you excited? It's Paraganglioma!
In your lifetime, you'll probably won't even encounter a case!
Ah, I don't want to encounter it either..
How can you say that?
How can you improve? - I don't care.
Just doing general surgery is OK. - You!
Everyone here is so warm-blooded.
saying words like wanting to bet on 1% chance. - No, that's...
If the patient died in operation, I'm ruined for life.
Even if that doesn't happen, giving hope to patients,
If things turns out differently,
who will be responsible?
If you get sued, no one will bother to help.
You are right, but..
On this, Ijyuuin doesn't let his feelings interfere.
will never tell empty promises to patients.
I'll make a move first!
It's been a while, let's go back home year-end!
Ah, that's a good idea!
Mom will be very happy.
When is the operation?
- Blood pressure? - Stable now.
The anesthetist to replace Arase.
If he's suitable, I'll bring him up here.
The operation has to succeed no matter what.
Start from 3 micrograms of dopamine.
Let's use him.
- Quickly bring him here. - Got it.
To what extent the tumor has penetrated the heart,
we won't know until surgery, but we still have a chance.
- Super Junior? - You don't know?
I've heard of them, but I can't differentiate who is who.
Sensei, you are young yet really old-fashioned.
Enough!
Oh, after the surgery,
accompany me to a fan-meeting event, OK?
Huh?
There's one next month, I'm only in Tokyo once in a blue moon.
Please take me, sensei! A junior like you must be free.
Silly. I'm very busy.
Is it you are busy?
Or is it, I cannot be cured?
- Don't talk nonsense. - Sensei, you're bad at hiding feelings.
You look away whenever I ask you something crucial.
- That's not true! - Excuse me.
The surgery has been scheduled.
We will explain the surgical procedure.
The blood circulation is handled by a heart-lung machine,
so the heart can be stopped for some time.
In order to remove the tumor, feeding arteries are ligated
to separate the adhesion.
Whether we can fully remove it, we have to see the extent of tumor erosion.
before we can determine. We'll stop here.
We understand.
Is it OK, Yukina-san?
I guess..
Then, please sign the consent forms.
This one is for the surgery. This one is for the anesthesia.
This is the blood transfusion consent form.
OK. That's all.
Sensei, I leave it to you.
I don't really understand the complex terms.
I.. I can be cured, right?
The operation is very difficult.
In your analysis, what is the success rate?
It's difficult to put in figures...
70%, I believe.
I see. Ah, so it should be all right then.
This is bad!
Objectively speaking, from the state of her cardiac condition,
70% is way too high!
More importantly, if you say something like that,
what if you get sued?
I'm pretty sure, hence I said it. That's it.
Those words would be used as evidence.
I've had enough, I don't want to see another Arase-sensei.
- What if you are the patient? - Huh?
After signing so many consent forms,
the head surgeon replies with ambiguity.
Would you dare to go for the operation?
- But, if we fail.. - There's no absolute certainty in medicine.
There's possible failure, unpredictable things can happen.
That share of risk, that share of responsibility
is for doctors to take. Not patients.
What binds doctors and patients, is not consent forms,
but trust.
The tumor region seems very large.
To what extent, we won't know until surgery.
The only sure thing, failure is not tolerated for this team.
Remember this firmly.
Relax a bit, it's not like you at all.
Sensei, will the operation succeed?
I'm kidding.. you cannot answer this kind of question,
you may get lawsuits.
Let's say, if it succeeds,
you'll accompany me to the fan-meeting event?
I'll phrase it this way. All right?
...?
Don't worry! It will succeed!
Sensei..
I..
guarantee!
Therefore,
hang in there!
There's no reason to be happy about assurance from a junior staff.
Thank you, sensei.
Please. Patient is Sugaya Yukina.
Please.
Don't worry.
- Please. - Yes.
It's finally here. Paraganglioma resection.
This will be a test if Team Dragon can be resurrected.
Now, commencing Paraganglioma resection surgery.
- Transfusion tube. - Yes. - Scalpel. - Yes.
Snare.
- Tube clamp. - Yes.
Heart lung-machine, air cleared.
- Start blood transfusion. - Yes.
- Aortic clamp. Inject cardioplegia solution. - Yes.
The heart has stopped.
Asada's actions are still as fast as ever.
Yeah, Kato-sensei is also outstanding, and the movement of anaesthetist is good too.
But the real problem starts here.
We don't know the degree of tumor's invasion.
Let's hope only the external region is affected.
Assess the tumor. Kato, pull back with Cooley hook.
Eh?
- This is... - What is it? - What happened?
The tumor has already eroded into the left atrium and pulmonary vein.
Left atrium and pulmonary vein?
The degree of invasiveness is much higher than what's shown in the CT.
If the tumor is excised, you won't even have a left atrium.
That tumor is almost covering the heart?
There's no hope, only a heart transplant..
What should we do? Asada-sensei.
Asada.
Excise the tumors, all of it!
But even with all tumors excised,
if cardiac function is not restored, she'll die.
Trust me.
- OK. - Kato, secure the autologous pericardium.
Ijyuuin handles the pulmonary artery and aorta front traction to expand surgical auxillary.
Ijyuuin-kun, switch places.
Yes.
Now, commencing left atrium and both pulmonary veins
total resection of Paraganglioma tumors. Metzenbaum.
Total resection?
Stupid.. There would be no heart left!
I've secured the autologous pericardium.
OK. Ijyuuin, pull the pulmonary vein.
Eh?
What? The vein has disappeared into the lungs!
What is Asada planning to do?
The pulmonary vein has been cut. Now what?
As planned, commencing cardiac reconstruction.
Could it be..? In place of pulmonary vein, making blood vessels from autologous pericardium?
Yeah.
- Kato, do the formation of autologous pericardium to blood vessels. - All right.
I'll continue staying here to help.
Next, excising the tumors.
Firstly, the tumor inside the heart.
Excising the tumors together with the left atrium and pulmonary vein walls.
Next, suturing the blood vessels made from the autologous pericardium onto the atrial wall.
Thus, the pulmonary vein was cut,
to give the heart a more natural shape.
That's right, he is now
attempting to reconstruct the heart!
How could..
If you cannot picture a clear three-dimensional image of the heart in your mind,
and the skill to accurately reproduce it,
it's simply un-doable.
Attempting cardiac reconstruction..
Is this even possible?
Pericardium construction completed.
Ok. Suture it onto the LS (Left Superior) pulmonary vein.
- 5-0. - Yes.
Amazing.. we can do it!
Body temperature too high.
Is the body temperature too high? Is it OK?
..?
[Blondie! Come see my next match!]
Sensei! It's weird, rectal temperature cannot drop!
What? Rectal temperature is 39.2c.
BP 143. It's too high!
- Why did this phenomenon happen? - I think it's because the tumor secreted
hormones when Asada-sensei made contact with it.
Not true, Asada did not touch the tumor during resection.
Asada-sensei!
Why?
Hematuria outflow! PaCO2 is rising!
Acidosis is worsening!
Rectal temperature? 40c.
This.. could it be?
It's Malignant Hyperthermia.
- Malignant hyperthermia. - That's.. an anesthetist's nightmare.
Triggered by onset of general anesthesia.
If this continues, the temperature will rise once every 5 minutes,
leading to destruction of muscle tissues and death.
This cannot be! I thought it was due to hormonal effects.
But then again...
- Treatment? - Discontinue operation of course.
No, we can't stop in this current condition.
Arase-sensei!
DIC.
Disseminated Intravascular Coagulation disorder will occur 1 hour from now.
The operation must end within 1 hour.
One hour! And any bleeding
must be stanched, it's the only way.
Can you do it?
To whom are you talking?
All right, I'll take over intraoperative management.
Dantrolene 5 vials! My standing set..
Yes.
Let's go! Kato, Ijyuuin.
- Got it. - Yes.
- Start timer! - ME! Blood circulation down to 30c. - Yes.
- Dantrolene. - Give it to me. - Yes.
Start countdown!
Stupidity! Cardiac reconstruction under malignant hyperthermia?
It's unheard of anywhere around the world.
Electrolytes and blood pressure management is extremely difficult.
When administering large doses of fluid,
one mistake can cause pulmonary edema or heart failure.
Less than perfect coordination, and it's "OUT".
It's like walking on a tightrope, can they do it?
Arase! Asada!
- Maintain body temperature. - Yes.
Sensei! CK 8000! (TN: CK = Creatine Kinase)
Temperature rising! More dantrolene!
- Metzenbaum. - Yes.
Metzenbaum.
Peripheral LS pulmonary vein suture is completed.
Construction of RS(Right Superior) pulmonary vein from pericardium completed.
Central region visual field expanded.
- 5-0. - Yes. - Tweezer.
- Yes. - Amazing!
Kato-sensei's artificial blood vessel is of perfect size.
Ijyuuin is also keeping up with Asada's speed.
We will surely.. save you!
Install hemodialysis circuit on heart-lung machine!
- Hurry up! - Yes.
40 minutes remaining!
There's not enough time.
Reconstruction of LS pulmonary vein and left atrium almost completed.
But, there's no time to suture RS pulmonary vein.
Two surgeons can suture the peripheral and central regions concurrently.
It's very difficult in this operative field.
Even if AT 3 is administered, time can't be extended. (TN: AT3 = Anti-Thrombin 3)
Pericardium-constructed blood vessel is not needed.
Pull out right pulmonary vein and directly suture!
Indeed, if using pericardium-constructed blood vessel and suturing onto the pulmonary vein,
you need to suture both the peripheral and central regions.
But if you pull out the pulmonary vein,
only central region needs suturing, shortening required time.
Tumor invasion at right pulmonary vein is of a lesser extent
so its length is preserved, all this had been planned?
Very well thought of, Asada.
Please be careful while moving the luggage down.
Hello! Your luggage is here!
Keep your eyes on the operation!
Asada!
Operation.. completed.
All right!
- Finally - Success!
- Wow! - All right!
This team is remarkable.
Surgery is so tiring.
Now, we can go to the fan-meeting event.
Stop making me so worry. 75 kg.
President, a moment.
What?
Please. Sugaya Yukina-san.
Yukina! Yukina! Thank you very much!
Hey, sorry.
I owe it to you. Thank you, kid!
That is..
Thank you for inviting me.
Miss Kito.
I did not invite you.
3 years ago I sat in this seat, all things prosperous must decay.
Thanks to you, Meishin's reputation is down the drain.
Patient numbers are plunging, complaints are soaring.
Physician skills are declining.
Meishin's former prestige was destroyed.
I have already heard.
Reformation program for Meishin that Miss Kito had proposed.
With great enjoyment, I think it's great.
Through acquisition of excellent surgeons, substantially increasing skill level of doctors and interns.
Strengthening the ER department as the basis for organ transplant in future.
Stem cell research that is in line for a Nobel Prize in Medicine.
Very aggresive approach. All of them are admirable.
But, you forgot just one point.
I forgot something? What is that?
That would be me.
After I arrived in U.S, I became a key member of Barack's
medical insurance system reform. Did you know?
Barack? Barack Obama?
Yes.
Then, I travelled around the world,
witnessing the global standard for health care.
I'm sure the level of the Japan health care is by no means world's best.
In terms of health care industry, Japan is behind the world by 10 years.
Health care is also an industry, this is common knowledge.
Soon, health care will extend beyond borders.
But Japan has negative reception towards accepting foreign patients.
Coupled with Japan's low birth rate, how can we increase the patient count?
Contrast this with the malls scattered throughout Japan,
with affluents flocking in from China, Korea, Russia.
If they are also seeking treatment in Japan's medical institutions, what would be the outcome?
Our rival is no longer the neighboring National Cardiovascular Centre.
But India's Apollo Hospital, and Thailand's Bumrungrad Hospital.
This is my proposed idea of Medical Tourism.
Do this step, then it is a real reform.
Miss Kito.
Stop the "Miss".
Apologies.
I heard you called back that "team"?
Yeah.
A world-class operation would soon be done with ease.
Eventually, you will no longer need them.
What do you mean?
My office will be
the vacant room previously occupied by head of the gastroenterological department, OK?
What happened? Reinstatement of Professor Noguchi?
I don't know the specifics.
I'm going to a Society with Kito-sensei today,
I'll go ask her then.
- But.. - Kito-sensei is running a business,
for that you need to be calculative.
But.. like every..
the re-instantement of Noguchi, that final decision still lies with Kito-sensei.
We cannot do anything.
Ijyyuin, aren't you going to So Haji Hospital?
Ah!
See you!
Hello.
Yes.
73-year-old male patient, angina pectoris.
Needs emergency operation, can you do it?
No problem! Call Arase too.
OK. Please bring him here.
- You've decided to go for the surgery? - Yes.
Then we better hurry.
Haa.. such a chore.
Monji Arase?
Goodbye, Team Dragon.
Where are you, Arase?
Umm... I found this.
73-year-old Kai Tanabe complained of chest pain. 20 minutes ago, then he lost consciousness.
Preoperative examination revealed 90% stenosis of left main coronary artery.
This is bad. There's myocardial infarction! Hurry!
Yes.
Arase can't be contacted.
We can't wait, get a replacement.
The operation will start!
I cant... die yet.
Things have become pretty interesting.
What is this?
Left main coronary artery stenosis?
Yeah...
Is this really Arase's?
Commencing acute myocardial infarction from left main coronary artery stenosis
emergency bypass surgery!
- Scalpel. - Yes.
- Tweezer. - Yes.
- Gauze. - Yes.
Can you hear me? Can you open your eyes?
We are heading to the hospital right now.
Arase!
CT. Echo. Confirmed. Probably..
Myocardial infarction from left main coronary artery stenosis!
How did you know? Emergency operation immediately!
Asada is now busy doing the exact same operation!
Kato and Ijyuuin are out, we can't proceed!
Who on earth says it's OK to receive him?
That would be me.
Noguchi! You!?
Yup. Because it's an emergency patient, looks so pitiful.
There's no other hospitals who can receive!
Is he gonna be OK, I wonder? He looks like in pain.
- Tweezer. - Yes.
- Harmonic scalpel. - Yes.
Arase collapsed.
Huh? Exactly like your patient.
Myocardial infarction from left main coronary artery stenosis!
What... Arase-sensei?
No other doctors, can anyone come over!?
Here, we need to secure 4 blood vessels from LITA for bypass! (TN: LITA = Left Internal Thoracic Artery)
At least 2 hours!
- Asada! What to do? - There's no way!
We can't leave here until suture is completed.
- But.. - Try to buy time!
Not possible! IABP is carried out. But ST-segment is still rising! (TN: IABP = Intra-Aortic Balloon Pump)
Cannot last 1 hour!
Asada.
I can't abandon a patient in front of me for another.
But it's Arase!
I can't.
One hour! In one hour, I will complete the suture!
Try to buy time!
OK.
Oh I see.
So, the concept of medical tourism was well-received?
Isn't it good?
It's consistent with the ideals of Meishin's new President. Miss Kito. No, President Kito.
Could not be better.
Oh right, I almost forgotten.
I still have one more souvenir I brought back from U.S.
That is the main event, please look forward to it. Then..
Excuse me.
I got it
-Sensei! -Asada-sensei he..
needs some time to arrive.
- Starting LITA bypass. 2-0. - Yes.
- Stabilizer. - Yes.
- Hurry! - Yes.
Give me!
- Bring another! - Please.
There's no time. Kihara, use tweezer to spread and hold!
Suture like this!
- 8-0. - Yes.
Good work.
Ijyuuin-sensei!
Hello?
Ijyuuin-sensei is returning from So Haji Hospital, but will take some time.
One suture left!
Shit! DC!
Arase!
- Bypass suture, completed. - Now, it's just closing the chest.
- Kihara, I leave it to you. - I got it!
Congratulations on the success of your first meeting.
It's been a while, Kato-chan.
Where's Arase-sensei?
That..
Arase-sensei!
He's saved! How?
- Catheter. - Catheter?
You did the same operation in more than 3 hours.
But he completed in 45 minutes.
The souvenir I brought from U.S, it's unlike others.
The world's best catheter specialist,
Kuroki Keijiro.
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