We can only wait until a suitable donor appears?
If we perform surgery, the risk is too great.
- There's no way. - Will I still be alive by then?
What doctors can do
is only to reach out to patients who want to stand up.
The will to stand up, is from the patient himself.
Asada-sensei risked his life to save you,
don't let his efforts go to waste.
Asada-sensei, I'll work hard to battle my disease.
Asada.. can he still operate after recovery?
- Yes. - If he can't,
then he is just an ordinary patient.
Asada-sensei.
Fully recovered now?
Yeah. Are you OK? Coming all the way here.
I'm feeling good recently.
I see.
Have you started performing surgeries?
Soon.
That..
This new Rubik's cube is given to me by Fujiyoshi-sensei.
But, I can only align this side, it's annoying.
If you persevere, you can do it.
I see. OK.
The purple should be here..
It's indeed PTSD.
Brain function has no problem.
No observable damage in nerve tissues of right hand too.
From the looks of it, it's PTSD, or Post-Traumatic Stress Disorder.
- PTSD. - Your current injury
is triggering a revival of some past trauma.
Thus your right hand will tremble, what are you remembering?
PTSD, or post-traumatic stress disorder.
Its treatment?
There is no established treatment for PTSD.
You need to overcome your past traumatic event.
If you can do this, your right hand would not tremble.
Oh, I can't.
Sensei, you are worse than me. Let me see.
- What color are you aligning? - Orange.
Toru's condition is getting better.
However, in the event his BNP rises...
Toru-kun has congenital rectus diastasis,
he can't use VAD, Ventricular Assist Device.
Should we just wait for a donor for heart transplant?
- Yes. - Sorry, I'm going back to lab.
Rushing for the regenerative medicine society?
Yes, I need to produce research results before that.
In the long run, that can also cure Toru-kun.
- I'll handle the work here. - Sorry.
Sensei, it's your off-time now?
- Huh? - Time.
Oh no! I need to make my rounds.
- Ah, excuse me. - Excuse me.
The doctors here are all really empathetic.
Yeah, that's why I'm feeling so good recently.
- Is it? - I have gained 2 kg.
Mom is so happy for you.
- Right, I'll buy some juice. - OK.
[Dilated Cardiomyopathy (DCM)]
What a surprise, you are studying?
No, not really, I'm just browsing.
Is she looking down on me?
Progression of heart failure.
Worsening heart failure symptoms is pulmonary edema and weight gain.
Pulmonary congestion causing symptoms of coughing.
Try changing the type and amount of serum
to cultivate the cardiac stem cells.
Not working, it's dead.
Don't give up. We are just one step away.
- Try using a different serum. - Yes.
Has Asada started operating?
Soon.
At a catheter seminar in Futaba Central Hospital neurology,
I saw Asada.
Neurology?
With such heavy injuries,
it's not surprising if there's any after-effect.
Apparently, he does not want you guys to know,
does not want his comrades to worry.
Great team.
I'm back.
Toru, is something wrong?
No, I'm fine.
Toru! Toru!
Someone please come! Quick!
What is it? Try again.
No.
Try again. One more time.
- Saturation? - 88.
Raise to 10 liters of oxygen. Ijyuuin-kun, route transfusion.
- Yes. - Cart is here.
- 22 gauge, please. - Yes.
Portable, immediately! And Echo too, hurry!
- Toru.. - It'll sting a little.
PTSD, do you have any leads?
8 years ago, I was seriously injured while in MSAP.
While treating a teenager who stepped on a landmine, my back was severely burnt.
I brought that child to the nearest hospital.
He needed operation from his traumatic cardiac injury.
But
I cannot hold the scalpel because of injury.
Why didn't you operate on him?
Why didn't you save him?
That child died in front of my eyes.
I could not do anything.
Asada-sensei.
Toru, Asada-sensei is here.
Sensei...
Asada... sensei.
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The continued expansion of left ventricle leads to worsening mitral regurgation.
BNP has also exceeded 3000, immediate action required.
Currently, both VAD and transplant are not possible,
operation is the only choice.
- Operation? - Papillary muscle plication surgery.
Papillary muscle plication?
Due to the left ventricle expansion,
the mitral valve chordae tendineae is stretched, causing reflux.
In order to prevent this,
using suture thread to narrow the gap between the isolated papillary muscles,
for the valve to return to normal.
But, with such weak cardiac function,
- can the heart hold up? - It's our only choice now.
Anyways, if the valve reflux is not stopped, Toru-kun cannot survive.
We'll operate the day after tomorrow. Asada, how is it?
It's OK.
No matter what, we must save him.
- Asada will be operating? - Yes.
I see, that's good. Good news indeed, Asada's revival.
- Umm.. that is? - Who knows.
Stent 2.5 - 20.
Sensei, for this vessel diameter.. 2.5 mm?
- Ah, it's 3.0. - Yes.
Recently, is Kuroki-sensei a little strange?
Many mistakes.
Well, is it "overwork"?
- Sensei.. - What happened?
He.. currently, his salt and water intake has been regulated.
Only a few ice worth of volume per day.
So, to speed up the process of melting to water, he has been shaking his cup.
I can't bear to see it.
Are you operating? Just give up.
You will betray the patient's trust on you.
Who are you talking to? I'm unlike you.
Recall the situation of the root injury,
imagine the same situation again and overcome it.
Gather everyone.
- What happened? - Is it confirmation of our roles?
Tomorrow's operation, I cannot be the operating surgeon.
PTSD...
All right. I will be the surgeon.
Ijyuuin is the first assistant. Asada is the second assistant.
Sorry for troubling everyone.
Asada, we are a team.
Tomorrow we will work together for a successful operation.
Should we tell Toru-kun?
Absolutely not.
That child has been fighting till today, it's because you are operating.
If he knew this, he would lose his spirit.
Yeah.
Asada-sensei..
It's... pretty hard.
Lying down.. to sleep.. is hard, I have to sleep while sitting.
Why.. did this happen?
But.. finally..
- Toru-kun. - Finally.. Asada-sensei's.. surgery.
Finally.. I've waited..
I'll do my best.. I..
The battle.. is tomorrow..
- Toru-kun. - Ah.. right.
This.. is.. finally completed..
Next.. is just the surgery.. Sensei..
Please.. Asada.. sensei..
Surely.. It will surely succeed!
...
Therefore, let's fight together.
...
It's been 15 years?
Why are you here?
Ryoko-san was your fiancee,
and she was the first patient I was solely in charge of.
And, maybe it's fated,
my daughter is buried nearby too.
- Daughter? - Yes.
She was born the year you left the hospital.
She died 2 years ago from acute viral myocarditis.
My goal now is, to cure as many children like my daughter.
For this, I will keep fighting for the rest of my life.
It's not only you who has lost a loved one.
Therefore, I am now moving on,
for the sake of my late daughter,
unlike you who is still trapped in the past.
Be strong, Toru.
Please wait here.
Toru, hang in there! It will definitely be OK!
Asada-sensei.
You couldn't save the patient because of burns on your back.
I understand it must be hard.
But, at that time you were alone, it's different now.
Now, there's Kato-sensei, Arase-sensei, Hibiki-san, Fujiyoshi-sensei.
Asada-sensei, you have us on your side.
This, please don't forget.
Surely, our operation will exceed your expectations.
1..2..3..
4..5..6..7..
OK. He's down.
Kato is the surgeon?
You will be witnessing, the strength of Team Dragon.
Now, commencing papillary muscle plication surgery.
- Scalpel. - Yes.
- Tweezers. Gauze. - Yes.
- Electric scalpel. - Yes.
- Pump-ON. - Yes.
- Vascular clamp. - Yes.
Aorta clamped, plegia start. (TN: plegia = cardioplegia)
Yes. Plegia started.
Patient has left ventricular dysfunction, try to reduce the clamped duration.
All right. Ijyuuin-kun.
- I'm counting on you to expand surgical field. - Yes.
- Scalpel. - Cooley hook.
- Sucker. - Yes.
- Next. - Yes.
- Mosquito (clamp). - Yes.
- Pledgets with CV-2. - Yes.
- Mosquito (clamp). - Yes.
- Correction of acidosis. - Yes.
- Next. - Yes.
- Testing reflux. - Yes.
Reflux is stopped.
- Closing left atrium. 4-0. - Yes.
It's smooth-sailing, as expected of Kato-sensei.
Aorta de-clamped.
- Back up. - Yes.
You did it! As expected.
Intern!
- Start epinephrine on count 5. - Yes.
- Pump-OFF. - Yes.
Unplugging IVC cannula.
- Blood recovery. - Starting infusion.
- Bring the next IV. - Yes.
- Ah! - Sorry.
OK. No bleeding. Closing pericardium.
- 4-0. - Yes.
What happened?
- BP is falling! - Is it because the stopped reflux
increases the burden of left ventricle?
But, we have already administered epinephrine!
Epinephrine connector is off!
- Eh? - Dammit!
Left ventricular function is declining fast!
- Start the heart-lung machine again! - Not possible!
- It takes 10 minutes to reassemble! - What!?
- Just re-assemble it! - Yes.
- Bring me another shot of epinephrine. - Yes.
No BP! Heart has stopped!
No time!
I'll do cardiac massaging.
Kato, Ijyuuin! You guys do the blood vessel cannulation!
- All right. 3-0. - Yes.
- Tourniquet. - Yes.
Even if the heart-lung machine is restarted,
nothing can be done afterwards.
Asada, we are a team!
Asada-sensei, you have us on your side.
- Pump-ON. - Yes.
How is it?
Movement is not good. Too much damage.
Kato-sensei, what now?
We can only wait for the recovery of cardiac function.
There is nothing we can do.
I'll do my best, to stand on my feet
I will defeat the disease for you!
Next.. is just the surgery.
Please.. Asada... sensei..
- The trembling.. - has stopped.
Directly cut left ventricle with scalpel.
By "Overlapping", for left ventricle reconstruction.
- "Overlapping"? - In this left ventricle state?
It's too risky! What are you thinking?
We cannot guarantee the recovery of left ventricular function by just waiting.
We have to do what we can!
- But.. - Even if we operate on this heart,
the cardiac function may not recover. It's impossible!
I've already promised him, that it will surely succeed.
If it's this team, we can do it.
- Are you sure we can do it? - Who are you talking to?
I am..
Asada Ryutaro!
OK.
- Metzenbaum. - Yes.
- Vascular clamp. - Yes.
Back up. Plegia start.
Yes.
From now on, fastest speed.
- "One play" is what we have. - Yes.
- 3-0. - Keep moving.
Intern, don't idle! Quickly prepare the next IV!
- Yes. - Keep up!
Asada.
It's way too fast!
Left ventricular closure completed.
- Aorta de-clamped. - Back up.
All right!
Overlapping.. completed.
All right!
Toru.. Toru..
Thank you very much. Thank you very much.
It's successful. Manabe Toru's operation.
I see.. Take a look.
The stem cells are multiplying.
All the cells that were cultivated with serum failed,
but the serum-free stem cells multiplied instead.
They are relying on their own strength to multiply.
Asada..sensei.
Yeah.
Thank you.
Don't thank me.
I owe it to you. You fought well.
- Is that so? - For clinical application,
still need a few months.
But, it's no doubt a big step forward.
- Yeah. - If we can use this
on Toru's heart muscle, hopefully a curative treatment is eventually possible.
Right.
Leave it to me, transplantation is currently not possible,
but I will use my treatment to cure him, surely!
You are not going to Futaba Central Hospital?
No need for that.
Kuroki seems to have visited the cardiology there.
There's no catheter department there.
At a catheter seminar
in Futaba Central Hospital neurology, I saw Asada.
Then.. why?
Catheter patients are declining?
- Do more diagnosis? - Yeah.
For surgery, Asada has returned, they're full of energy. Please.
President! President!
Zdravstvuj! [Hello]