Patient or "Live", which one do you think is more important?
Withdrawing the cameras according to patient's wishes.
Do you know what you are doing? It's an IMA review!
You'll have to take responsibility for this, Kato-sensei!
To provide the best choice for patients, is what doctors must do.
This is.. Team Dragon.
Sorry to keep you waiting. It's finally here..
Live Demonstration! It's show time!
This is the world's best catheter interventionist, Kuroki Keijiro,
performing Japan's first catheter aortic valve replacement.
Annular diameter of 20 mm.
- Ready? - Soon.
- As planned, 23mm. - Yes.
No way.. using catheter for aortic valve replacement?
Unbelievable.
How is it?
- Are you ready? - Yes.
K-Valve.
The 23mm.
Is that Kuroki-sensei's catheter?
- How do you use it? - K-Valve.
Very cool!
At aortic arch.
Inserting valve tip to central, avoiding contact with aorta.
Amazing!
Reached aortic valve.
This is the crucial part, when approaching valve calcification
the slightest mistake will cause emboli shedding
which can enter the brain. - Cerebral infarction.
This requires superb medical skills and experience.
Sensei! Blood pressure!
- Nakano-sensei, get ready! - Yes.
- Blood pressure is falling. - Will it be OK?
- What's happening? - Not good.
Using catheter for aortic valve replacement is impossible to begin with.
Valve was touched?
- Give me norepinephrine! - Yes.
Blood pressure is stabilized.
OK.
- He stopped. How will he do the replacement? - What now?
Why the syringe? What's happening?
Carotid pulse good.
- Pacing on. - Yes.
Flush.
- What's going on? - Amazing.
- Pacing off. - Yes.
What is it?
By releasing the syringe all at once,
the fluid pressure opens up the tissue valve.
It's commonly used for aortic stenosis in the elderly,
when heart-lung machine cannot be used,
and for patients unsuitable for surgery, such catheterization leaves the valve intact.
For those who can't do surgery, this opens up a bright future.
Pulse pressure variation 10mmHg
No problem.
K-Valve operation.. completed!
Judges, any questions?
(Kato-chan)
The technique we are demonstrating today
is uniquely developed by Kuroki-sensei while in U.S,
named K-Valve.
It has just been approved by Ministry of Health clinical trials,
and this is its first appearance in Japan.
Of course, with the patient's consent.
All operation expenses is borne by Meishin.
Kuroki-sensei, how many such procedures have you done in Texas hospital?
Today is the 13th case.
Kuroki-sensei, what's the reason you return to Japan?
To strengthen Meishin's catheter intervention department
to be America.. No.. World leader in medical profession.
This is a great progress for IMA certification right?
Certainly, it's a solid step towards attainment.
The Live Demonstration is initially
for Ross surgery, isn't it?
- Ross surgery.. - Ross does not matter now!
Ross is indeed planned
as a warm-up to Kuroki's catheter intervention.
Although mechanical failure aborted the live relay,
that operation is also very successful.
But the main event is of course, catheter.
Meishin will be Japan's catheter treatment
hospital centre, accepting all kinds of diseases, all kinds of patients.
IMA review, first hurdle,
high level medical skills, we have just proven.
Then the second hurdle?
Rational management... (TN: rational management principle = economical, not wasteful)
Leave it to me.
This is the management reorganization plan I drafted,
named N-Plan.
Promoting catheter intervention treatments to increase utilization of hospital beds,
resulting in surge of income.
Employing external hygiene and hospital food service personnels,
lowering operating costs by outsourcing.
Turnaround plan is within one year.
The problem is at the last hurdle, quality of health care.
In terms of whether the hospital is providing the best service to patients.
The judges will personally come to the hospital to review.
Yes. Three judges will visit the hospital and observe.
When, whom, what questions, will not disclosed in advance at all.
If any item does not fully meet requirements, it's "OUT".
It's the most difficult hurdle.
- Training for staffs? - Of course, it'll be thorough.
This is our real starting point.
You're still here?
The story earlier..
You have no rights to meddle in here.
Our IMA certification was almost jeopardized.
- But.. - End of story. No more.
What does that mean? We will be in ER from now?
Cardiothoracic surgery will no longer exist?
That's not true. It's just there's no major surgery now.
So we should help out in ER.
Orders from President?
We should be free for some time now, take a holiday.
- Arase-sensei! - Sigh.. I'm here
not to be an ER nurse.
Asada-sensei, what are you doing?
Asada, there's a Bentall surgery at Joyo University next week.
- Can you go help out? - Huh? Then, I..
No. Only surgeons are needed there.
Professor Kojima of Joyo University was IMA judge
George Sato's schoolmate.
Trying to ass-kiss the judge?
This is my orders.
OK.
In order to receive medical tourism patients,
soon, the doctors here must learn foreign languages. Is it true?
Yes we can, of course.
That's first-year junior high level.
Don't be so proud. Do you know any?
Having you as my superior is such a drag.
Yes, we can, of course, thank you.
Ijyuuin.
ER is the best place to study the organic nature of human body,
and for a surgeon to hone his skills and gain valuable experiences.
But I want to study the heart.
Asada-sensei.
Professor Schneider
wants to discuss Ross procedure in details.
Please explain to him.
Yeah? Are you here to dig on us?
It must be hard, to be alone so late.
The junior staff
will always be assigned the most tiring work.
Just like me, before.
IMA final review day
Everyone, today is an IMA review day.
Don't slip up. Thank you.
Yes.
It's finally here.. IMA final review. Wow, I'm so tense.
For a small fry, no.. junior staff, it doesn't matter right?
We don't know who and what will be asked.
It means, all staffs
are being tested.
Then, how about a place to hide?
Yeah, good idea. Where are you hiding? I'm hiding here.
Welcome. Idiot!
The final review is the analysis of our daily work.
But, cardiothoracic surgery has nothing to do.
Yeah, it's basically out of business.
Except for him.
- It hurts! ? It hurts! ? Sensei. - Seems like food poisoning.
- Diarrhea and vomiting after eating wild plants. - Ow! ? It hurts! ?
Hey! I want a diagnosis fast!
- Yes! Right away! - Ouch.. Ouch.
- You OK? - Please.
The judges are coming soon.
The employees had thoroughly studied the guides, right?
We have rehearsed over 10 times.
The expected questions have been distributed to various departments for in-depth studies.
And e-mails have been sent to all heads on behalf of you.
In my first visit to a patient's ward,
I had an orange cosmos. (TN: Cosmos = cosmos bipinnatus(flower))
From then on, orange color is bad luck for me.
- Remember this well. - Yes.
- Ouch Ouch Ouch! - Please calm down!
Oh pain pain ah ah!
- So late. - Relax relax.
It will be a long day.
Translators & QCs: indokid, serene012 KEEP THIS A FREE FANSUB!
HD re-timing by: @ChrHd
Fujiyoshi-sensei, Suzuki-san's chromosome cells 100 times magnification OK?
Magnify 500 times.
No need for the extra explanations.
If there's any doubt, we will ask.
- Just a moment. - Ah, excuse me.
Excuse me.
How many times is this floor being wiped per day, by how many people?
3 times per day. Interval of 5 hours, 3 person shift.
This mop has no cover?
I heard they are asking the smallest details.
Will we be OK..?
I'm out of the loop.
Yokota Tatsuo, 60 years old.
What? Wasn't he brought here by ambulance?
His shoulder hurts.
Shoulder? Huh? So he called the ambulance?
He said it's so that he can be examined quickly.
Hey, over here quick.
The pain is so bad, hey I'm calling you..
What type of detergent is being used?
Commercially-available mild detergent.
This way, please
I'm amazed. Even the type of detergent was asked.
- It's like a raid. - Yes.
We have applied stickers in order of which the highest being red, then yellow then green.
We also put the red-marked items in their own spot.
We asked her.
Let her answer.
Is this the hospital meals? When and where are they made?
Well, outside contractors
will deliver them at 11.30 a.m.
Our aim is to always serve warm food.
- Some people won't eat it, right? - We will check the leftover amounts,
and tell the nurse in charge.
If we ask the patients directly, some will be dishonest.
Tracing method. The judges randomly select a patient,
to view the patient's diagnosis and our health care response.
A thorough investigation whether our health care is appropriate.
We won't know which subject will be selected.
Be cautioned.
It hurts! I told you it hurts!
Is the pain worse now?
I don't know. It's just painful.
No checkup or screening done in the last year?
No, but it has nothing to do with this.
I see.
Then, please go for checkup at the orthopaedic department.
Huh? You are not from orthopaedic department?
No, I'm from the cardiac department.
Bastard! You should have called the other doctor earlier.
This is Yamanaka Takahiro, hospitalized for bacterial enteritis.
With his condition improved, he can already ingest food.
However, there's longer infusion duration. Why is it so?
Because the patient needs fluid replacement, intravenous antibiotics in thus prescribed.
The frequency of diarrhea seems to be increasing.
It's the symptoms of antibiotic itself. Have you checked it?
No, not yet
What is he doing?
The meal delivered to Yamanaka-san of ward 603 yesterday,
where does it come from?
Because it's a specially prepared meal,
I brought it directly from the cafeteria.
Aside from the symptoms of diarrhea from enteritis, when did he recover?
- 4 days ago. - During this time,
you have no doubts that antibiotics may have caused the diarrhea?
Ah.. no, I think the enteritis has not fully disappeared.
President.
Not only unecessarily continuining infusion,
but also failed to confirm if the symptoms are caused by antibiotics.
This is likely be judged as an inappropriate treatment.
- This is bad. - It's not good.
He said he has shoulder pains.
I'm now taking him for an orthopedic examination.
Sure.
I've already asked the orthopedic doctor, Chiba-sensei.
Yeah. Just go ahead. Regards.
I was surprised
that you are assigned to ER.
Such a waste, with your skills.
Why ER? Why only an assistant?
Before Asada arrived, you were the surgeon.
You have to take responsibility for the failure of Live Demonstration?
Huh?
Nothing. There's a rumor going on..
Ridiculous, I did not do anything.
That's good.
There's a man named Inokuchi in my group,
two years younger than you, but already quite familiar with catheterization.
A cardiac surgeon normally starts in his late 30s.
But at the age of 45, he cannot cope physically and visually,
thus cannot do difficult surgeries.
If by then he's a professor, it's great,
otherwise, he would be driven out.
What are you trying to say?
Somehow, I feel that you are being used.
I feel sorry.
Ridiculous. Asada-sensei is a great surgeon.
Even as an assistant, there's much I can learn from him.
We are a team.
Team huh?
It's up to you. Bye.
That man.. Kuroki's skills is indeed amazing.
Yeah, his catheter is stunning.
But, after working with him,
I realized he's not looking at the patient.
- There's only darkness in his eyes. - Darkness?
Yeah, he's engulfed in darkness, a huge darkness.
He's struggling with it.
I should know..
Valve replacement with catheter. I'm surprised.
If you are interested, I can teach you.
I don't mean your skills, but your hate.
No, your resentment towards Ross procedure.
Isn't it time.. to forget the past..?
Don't be too conceited.
It's because of that incident, I became stronger.
I became stronger, Fujiyoshi.
Bones look normal and no swelling at the shoulder.
Oh, really? After hearing that,
My shoulder feels a lot better. Heh heh.
- Then, I'm leaving. - Ah, please wait.
The medical certificate says you should stop by ER again.
What?
3 hours? I have to wait 3 hours? Here?
I'm sorry.
Other symptoms may occur.
Therefore, we have to take your blood again.
Another blood test? How many more?
3 hours later, another re-examination to compare...
Hey! Don't think because I'm old,
how much more blood do you want? You junior staff!
- The re-examination.. - To hell with you!
- You bastard. I'm a very busy man! - Please stop!
- This concerns my livelihood. - Please calm down.
Is there really a meaning to all this?
This is the notes I wrote during my work in ER.
A doctor's job is to save patient. That's everything.
Sorry for hitting you. Can I go back now?
Do you hear me? Hey, glasses!
As expected,
please schedule a consultation with internist Fujiyoshi-sensei.
- Immediately. - Yes.
Yokota-san, please calm down and listen.
You have an acute coronary syndrome, there's possibility of unstable angina.
Immediate hospitalization.
Are you kidding me? My shoulder hurts, why is it angina..?
Ah I see. You are trying to cheat me...
Ah!
Yokota-san!
Yokota-san, are you OK? Yokota-san?
- Oh.. - Can you hear me?
- Yokota-san. - Hey, you.
- President! - What is it?
That violent patient in ER fainted.
Why is it Ijyuuin's patient..?
Of all days, during an important IMA review day..
What a shame, how much more will we fall?
Incredible, I've seen the medical record.
If left unchecked, then this patient is dead now.
Complaining of "sore shoulder",
from ER to orthopedic and back in full circle.
No problem was detected.
The doctor-in-charge deliberately took the time for blood test.
3 hours later, the test report shows
positive Troponin T that is not present initially,
identifying the ACS.
And also, cardiac surgeons occassionally helping out the lack of manpower in ER,
to have such a wonderful arrangement.
This.. This is our Meishin.
Coronary angiography is out.
Stable condition after heparin and NO2 adminstration.
Certainly it's ACS, Acute Coronary Syndrome.
- Yes. - Shoulder pains or toothache,
at first glance it's unrelated to heart, but cardiomyopathy is still possible.
Ijyuuin, it's not simple to recognize this.
At the end, it's catheter treatment?
Yeah, in view of the short-term vascular lesions, it's the best.
It's such a long day.
Indeed.
Discovery of angina pectoris in ER, we scored high on that.
Who is it?
Excuse me.
What?
This time, Ijyuuin's careful diagnosis and prompt action
resulted in significiant points in IMA review, was it not?
So what?
Please give cardiothoracic surgery another chance.
Chance?
- Yes. - On what basis?
IMA just called
from the review of clinical, management and implementation,
Meishin hospital has just been awarded an IMA certification.
- Oh! - Good!
Congratulations, Miss Kito.
Yeah!
- We are promoted to the ranks of world-class hospitals. - That's great!
We owe a debt of gratitude to the cardiothoracic surgery.
This seems to be the key to passing the examination.
- Hey Ijyuuin, nice work! - It's nothing.
Stupid! Thanks to you, our hospital is awarded IMA certification.
- Huh? - That ER patient,
- the ACS was identified by you, right? - Ah..
I heard that it's our winning point.
Let's have a few drinks to celebrate.
Later.. come over.. OK? Hehehe
Kato-sensei.
Good work, Ijyuuin-kun. It's thanks to you.
I've had a similar case.
The patient complained of toothache,
but ACS was diagnosed.
That's why this time I had a bad feeling about this, even though
- I was hit, and.. - Asada!
The Bentall operation,
if you accomplish it, we will have hopes for revival.
This depends entirely on your skills. I've contacted the other party.
I've arranged the CT scans to be sent here in advance.
Meanwhile, do your required preparations.
This is the overview of the patient.
Cardiac surgery is different from the foot, liver or lung.
Cardiac treatment is closely related to the patient's life.
Thus, cardiac surgeons can become very arrogant,
thinking that they can manipulate life and death.
Cardiac surgery is said to team-centric,
but is it really?
In 1957, British doctors,
led by Donald Ross, completed a landmark operation,
and it was named after him, Ross procedure.
But that operation also had an assistant,
just like you.
Likewise for Batista and Norwood procedure.
There are first assistants and other assistants involved.
But their names remain unknown.
Forever.
This is the world of cardiac surgery.
I fully understand your sorrow.
How does an internist like you, Kuroki-sensei, knows?
I was once a cardiac surgeon.
So, I understand. I know.
I know
Meishin's IMA award, we owe it to you.
I've seen your medical record.
(Please head back to ER for checkup, Ijyuuin, Cardiac Department)
You're an excellent doctor.
I know it.
You've worked very hard, all this while.
We have no salary increase after IMA certification?
Don't say that.
Soon, there will be lots of foreign patients.
Then, wouldn't we be more busy?
Ah, yeah. That's right.
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