- Asada.. sensei. - Only you can save Asada now.
If anyone leaves we can continue running,
- that's a real team. - I am.. the surgeon.
If he can't operate anymore, then he is just an ordinary patient.
- Asada will recover. Surely. - That is.. Asada-sensei.
- Asada. - Asada.
- Let's perform operation together again. - Operation?
Who..?
Do you understand? It's me, Ijyuuin.
He's the one who saved you.
There's evidence of deep cerebral white matter damage.
Axonal injuries resulting in mild diffuse brain injury.
Diffuse brain injury? (TN: A diffuse brain injury is when brain nerve fibers become twisted or otherwise displaced.)
Yeah, if his memory is recovered, it shouldn't be a problem.
How long until he can operate again?
It varies according to individuals, usually in 3 weeks,
- the injury should be healed. - 3 weeks..?
Sato Rie. 34th weeks of pregnancy, operation is scheduled in 3 weeks,
a type of connective tissue disease, SLE,
[SLE patient's C-section and newborn's congenital atrioventricular obstruction pacemaker implementation] or Systemic Lupus Erythematosus.
The SLE leads to the fetus developing a congenital complete atrioventricular block.
As soon as separation from mother's womb,
his pulse will weaken to death. Right after C-section, the newborn
requires immediate pacemaker implantation surgery.
This operation is a race against time, every minute and second counts.
From extraction via C-section,
[Newborn survival time limit: 2:00]
if you cannot recover his pulse in 2 minutes,
the newborn will die.
Operation is 3 weeks away, on 6th December.
Neonatology, obstetric, nursing, cardiothoracic surgery,
will combine efforts. It's an all-out battle.
Simulations will begin today, any questions?
Umm.. what about Asada-sensei?
He's experiencing temporary confusion, but is gradually recovering.
He will be involved in this operation.
- I see, that's good. - Well then, individual briefings.
[Consent form. Patient's name: Sato Rie. Family contact name: Shuichi Sato. Relationship: Husband.]
This is your surgeon, Kato-sensei.
Sato-san is currently 34 weeks pregnant.
We will be preparing with repeated simulations.
At 37 weeks full-term, we'll extract the newborn by C-section,
and surgery simultaneously.
Surgery right after giving birth.
Hang in there.
Akira.
Long time no see.
It's been 10 years?
I heard you returned to Japan.
The previous hospital said the fetus heartbeat is abnormal,
I have to rely on your pediatric cardiac expertise.
My work is to cure patients.
Please help him in any way.
All right.
Ah, why am I involved?
- It's winter now, lots of activities. - Oh you..
There are many things more important than work,isn't it?
Like hobbies and romance.
Well.. Kato-sensei is in love with her job.
- It doesn't seem so. - Huh?
No, I just caught the patient's husband talking to Kato-sensei,
seems like they are connected somehow.
No way..
- Go ask her. - Stupid! No way.
These 2 people seem to be curious
of the relationship between the patient's husband and Kato-sensei.
- Hey you! - What rubbish are you talking
- Kihara-sensei? - Eh?
I was engaged to him 9 years ago, we broke up in the end.
Is that OK?
Operation simulation starts in the afternoon.
focus your concentration on that.
I am a surgeon.
Compared to happy faces of children and husband,
only successful operations can make me happy, maybe I'm this kind of woman.
I see.
Thank you. I've been happy, these 3 years.
You're very strong.
Goodbye.
Can Asada-sensei still perform surgeries?
Certainly, he was badly injured, but the surgery was successful.
It's my fault.
That's not true.
I've been ill since young,
always troubling everyone, and now Asada-sensei too.
That's not true.
Asada-sensei risked his life to save you,
don't let his efforts go to waste.
Asada-sensei.
Who..?
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Asada-sensei. Sensei.
Sensei. Asada-sensei!
It's because of me..
I'll work hard, to battle my disease,
and stand on my feet again.
I'll defeat my disease for you!
Therefore, therefore..
I will save you. Surely!
- Were you safe? - Sensei?
It's all right.
Didn't I say? I will save you, surely.
Asada-sensei.
- I heard you operated on me. - Yeah.
His skills has improved.
Thank you, Ijyuuin.
This.. is for you, Asada-sensei.
He has polished it for you.
- Bring me needle and thread also. - Huh?
Using tissues to practice needling?
The newborn operation is scheduled in 3 weeks.
I see.
[Neonatal pacemaker implantation simulation exercise]
Let's start.
Ready. Go!
Cutting umbilical cord.
[Umbilical cord removal]
Cutting done. [Umbilical cord removal]
- Start countdown. - Yes.
Reaction check. [Receive. Reaction Check]
Yes. [Receive. Reaction Check]
No reaction. Let's go! [Receive. Reaction Check]
No reaction. Let's go!
Wrapped tightly. [Operating room transfer. To operating table]
- Yes. - Open the door! [Operating room transfer. To operating table]
Please. [Operating room transfer. To operating table]
Attaching ECG. [Operating room transfer. To operating table]
What are you doing? [ECG attachment. Disinfection. Arterial line placement]
Sorry. [ECG attachment. Disinfection. Arterial line placement]
Start aspiration. [ECG attachment. Disinfection. Arterial line placement]
- Disinfection. - Yes. - Completed. [ECG attachment. Disinfection. Arterial line placement]
- Peripheral arterial line. - Yes. [ECG attachment. Disinfection. Arterial line placement]
- Switch on monitor. - Inhalational anesthesia. [ECG attachment. Disinfection. Arterial line placement]
- Switch on monitor. - Inhalational anesthesia. [ECG attachment. Anesthesia & Intubation. Disinfection. Arterial line placement]
- Peripheral line placement. - Yes. [ECG attachment. Anesthesia & Intubation. Disinfection. Arterial line placement]
Already 30 seconds. [ECG attachment. Anesthesia & Intubation. Disinfection. Arterial line placement]
- OK, he's down. Intubation. - Disinfection. [ECG attachment. Anesthesia & Intubation. Disinfection. Arterial line placement]
Completed. A-line insertion. [ECG attachment. Anesthesia & Intubation. Disinfection. Arterial line placement]
- Too slow! - Yes. [Anesthesia & Intubation. Disinfection. Arterial line placement]
- A-line please. - Yes. [Anesthesia & Intubation. Disinfection. Arterial line placement]
- Oxygen 100. - Yes. [Disinfection. Arterial line placement]
A-line secured. [Disinfection. Arterial line placement]
A-line secured.
Start disinfection. [Disinfection]
Already 1 minute! [Disinfection]
Disinfection complete [Disinfection]
[Sterilization]
- Let's go. Scalpel - Yes.
- Tweezers. Gauze. - Yes.
- Tweezers. Gauze. - Yes. [Skin incision]
Skin incision completed.
Let's stop here.
1 min 25 sec.
Even if we continue, we cannot recover his pulse in 2 minutes,
the newborn will die.
- Let's try again. - Yes.
Kato-sensei is a little strange today, many mistakes.
But she's amazing.
After all, it's the wife and child of her former fiance.
If it's me, I won't do it.
As expected of "Cold woman".
Ah, sensei.
I'm heading out for some fresh air.
I see. Be careful.
Sensei.
Do you have time to spare?
Sensei, you have any child?
Nope. I'm not married yet.
You're amazing.
As a woman, you're an excellent doctor, and also a university hospital professor.
Don't say that.
Sensei, it's difficult to save this child right?
It's indeed not a simple case.
I've always wanted a child.
My husband too.
Therefore, I resigned my job immediately after marriage.
I finally had this child.
My husband was very delighted.
These
are the names he had chosen after consideration of strokes. (TN: strokes = JP characters strokes)
He's done selecting, but there's over 100.
But my disease,
because of my disease, my child..
Sato-san, it's not your fault at all.
I don't care what happens to me.
This child. As long as this child..
Sato-san.
How's Asada?
He's conscious. He'll be operating in 3 weeks.
- It's thanks to Ijyuuin. - Yeah.
So, the best team has been assembled?
You've grown thinner by 2 kg, too much catheters?
I'm looking forward to the operation.
Sensei, where do you find enjoyment?
I really don't understand.
All alone and gave up being a woman.
Why are you always working so hard?
Even though I am a doctor,
I still want to meet my boyfriend, get married, and give birth.
Is that wrong?
Yeah, you are right.
Those are what most woman wants.
But, I wasn't like this before.
Does it still hurt?
No. I'm OK.
You are recovering pretty well.
Yeah.
Starting suturing?
No, I will start by standing on my feet.
Right.
- Operation preparation? - Currently conducting simulations,
but not quite perfect.
I see.
Yes. Huh?
Anything wrong?
The baby? How's the baby?
Fetal heart rate is declining?
Yeah. 52 now, he'll die if below 50.
We cannot wait 3 weeks for the operation.
When's the limit?
No time to waste, requires surgery tomorrow.
Tomorrow?
Our simulation is not yet perfect.
We don't have time to consider.
- Tomorrow? - Yes.
So, this child. Can this child be saved?
We'll do our best.
Please. This child, you must save this child.
- Please, I beg you. - Rie.
- Sensei, please. I beg you. - Calm down.
- Sato-san. - Sensei. Why?
Calm down.
Can you do it? Without Asada?
It'll be fine.
We absolutely cannot allow intraoperative death of surgical patients,
If any perceived risk, immediately stop,
and transfer to Hokuyou hospital.
That operation. The fetal heart rate is declining close to 50.
He'll die if we don't operate tomorrow.
Are you prepared?
Of course.
If anyone leaves we can continue running, that's a real team.
Right?
Besides, I
have done countless cases of neonatal surgeries.
It'll be fine. If it's you, you can do it.
If it's you, it will succeed for sure.
This, I guarantee.
Who are you talking to? Don't patronize.
[Day of neonatal pacemaker implantation]
So.. I'm going in.
It'll be fine. I'll be waiting for you.
- Please. - Yes.
This is Sato Rie. Please.
See you.
Please!
I leave it to you.
We finally have a child, please save him.
I left you to be a doctor.
I will surely save him.
It'll be fine.
[Operating room A. C-section]
I will surely do it.
[Operating room B. Pacemaker implantation operation]
It will surely succeed.
That.. is our team.
- Removing fetus. - Yes.
Clamp. (TN: umbilical cord)
- Next. - Yes.
- Clamped complete . - Cutting umbilical cord.
- Yes. - Start countdown.
- No reaction. Let's go! - Quick!
- Please. - ECG attachment.
- Start aspiration. - Attachment completed. (TN: aspiration = the process of removing fluids or gases from the body with a suction device)
- Disinfection. - Ready for intubation.
- Yes. - Completed.
- Peripheral line placement. - Yes.
- Peripheral line secured. - Disinfection complete.
Oxygen 100.
- Yes. - Pulse is only 31!
- 30 seconds! - Is the line done? - Hurry!
- What are you doing? - Shallow needle insertion.
Yes.
- A-line secured. - Start disinfection.
Give me! Disinfection completed.
Blood gas analysis?
Acidosis, base excess is minus 25.
- Let's go. Scalpel. - Tweezers. Gauze.
- Incision completed. Electric scalpel. - Yes.
- Tweezers. - Already 1 minute!
- Separation completed. Straight scissors. - Yes.
- Sternotomy completed. Rib spreader. - Yes.
- Fixation completed. Metzenbaum. - Yes.
- Aspiration please. - Yes.
- Emergency pacing. Alligator. - Yes. (TN: Alligator = electrode clip)
- Pacing rate 120. - Yes.
- Pulse has recovered. - ME, how is it?
Acidosis minus 5.
1 min 50 sec.
- They did it in 2 minutes! - Yes.
From now on, it should be fine.
Next is just carefully implant the pacemaker.
Prepared.
Hold on! Oxygen saturation is odd.
- Give me! - Yes.
Acidosis again! Declining. Minus 20!
What is it?
How could it be? Heart rate has recovered. Why?
Arterial duct?
- Echo please. - Yes.
Yes.
Arterial duct is closed.
Because of this, hence the low base excess value.
Check the aortic arch.
This is...?
Aortic arch is narrowing.
Aortic coarctation?
Ductus arteriosus tissue has extended into the aorta.
The ductus arteriosus usually,
with the flow of oxygenated blood from neonatal pulmonary respiration,
will naturally close.
But this child, part of the ductus arteriosus tissue
has extended into the aorta, so when the ductus arteriosus closes,
aorta is pulled in too, causing the coarctation.
The pre-operative fetal examination could not have detected this.
If this continues, the aortic blood flow will stop.
Blood flow cannot circulate to the lower body, will lead to necrosis within 1 hour.
Has entered "ductal shock" state.
- Start countdown. - Yes.
Prepare Prostaglandin E1 300ng.
- Yes. - Lower oxygen to 21.
Yes.
Prostaglandin, one-shot IV.
- How? - Ductus arteriosus did not open.
Another shot.
It's useless.
Overdosing
- may lead to fatal BP decline. - Kato-sensei.
Requires aortic reconstruction emergency operation.
With the cardiopulmonary function of this child, heart-lung machine cannot be used.
Attempting aortic reconstruction without heart-lung machine?
What now? Kato.
- Asada. - Asada.
Kato!
Get a grip on yourself, only you can do it.
In this state, aorta reconstruction..?
Don't give up!
Recall what you learnt while in America.
Blalock-Park procedure.
- Blalock-Park... - Kato-sensei.
Left thoracotomy, prepare to switch positions.
Yes.
Blalock?
Blalock-Park.
Disconnecting the subclavian artery,
to wrap around the aortic arch coarctation.
directly bypass the descending aorta.
This was used in surgical procedures at the time when heart-lung machine has not been established.
In this way, we can operate without the need for heart-lung machine.
Partial clamp.
- Not this. - Huh?
- Give me "Straight". - Yes. (TN: Straight = straight clamp)
- One more. - Yes.
- Jameson (scissors). - Yes.
Kato-sensei. What..?
- The blood vessel was cut!? - What is she doing?
Fold down the subclavian artery,
and suture onto the descending aorta.
- 7-0. - Yes.
That.. is "subclavian flap" procedure. (TN: subclavian flap = Left subclavian patch angioplasty.)
I see. By folding the 2 vessels,
and overlapping them as one.
Indeed, as compared to Blalock-Park,
this method provides better blood flow.
In terms of the baby's post-operative condition, this is the overwhelmingly better treatment.
Amazing!
To use another tissue piece to perform reconstruction,
this is a unique pediatric surgery idea.
But, comparing with Blalock-Park,
subclavian flap requires twice the amount of time,
can the operation be completed in an hour?
If it's them, Kato can do it!
- Time? - 31 min 30 sec left!
12 min 30 sec left!
De-clamp.
SpO2 rising. Blood circulation has reached the foot. Success!
Aortic reconstruction.. completed!
All right!
You are finally born into this world. Thank you.
Thank you.
I know you will surely save him, if it's you..
Your wife is crying.
Yeah.
Kato-sensei, why did she want to be a professor?
Who knows..
Just.. if you are not at the top, you cannot change the organization.
She often said that while in America.
That team... succeed.
President.
Someone sent this to you, President.
Is this in Russian?
[I'll be back]
Why Russia?
- That's good. - Don't slack off.
Get well before the next operation.
Thank you.