The patient, Muto Yoko san
is under critical MR* *(Mitral Regurgitation)
therefore needs to be operated on immediately
- Alright.. I get it Maruyama-sensei, you perform the operation - What, me?
But you are the specialist in this field, so you should do the operation
Fatal cells are already emerging
The report by Mariyama-sensei explains this case better, therefore it's suitable for him
But...
- Done - Take care of the rest
How amazing... that Kato-sensei
What do you mean?
This patient's operation has a high possibility of failure
That's why instead of operating herself, she's making Maruyama-sensei operate
How cruel
This happens all the time
In this way, she can maintain a good profile for her theseis
That's how she managed to climb up to her current asst. professor position at such a young age
patients are nothing more than her thesis data
she will do anything to be a professor
Kato-sensei is such a cold person
I am sorry.. I have to prepare a patient's out-of-hospital documents
- at ER again? - yes
After finishing this, I have to get back to ER immediately
What kind of operation now?
I'm operating on a patient with a chopped index finger
- index finger? - yes
about that size
Hey!
Don't be so cocky!
No matter how hard you are trying to learn from first-hand experience
You're over once the Batista Operation fails
Fail?
It's going to fail for sure, it's an extremely difficult operation
I will report that to Kato-sensei
What?
I have seen the medical records of the Batista patients
16 year old high school student, Murano Rina and
55 year old housewife, Narahashi Fumiyo
both of them are suffering from dilated cardiomyopathy
NYHA* class IV, severe heart failure condition *(New York Heart Association)
both are candidates of heart transplants, but we are short of suitable donors
if this continues, the housewife has 3 months left
the high school student will survive for half a year at most
Excuse me
What?
I was surprised when I saw the report
That housewife Narahashi Yumiyo is
that Narahashi-san who used to be the head nurse here until eight years ago, right?
Sensei, you should know her too right?
Which one do you think should be operated on?
Murano-san's condition is very stable right now
although the housewife requires the operation more desperately
her physical condition has severely deteriorated
on top of that, she's also suffering from mitral insufficiency
there are higher risks involved
and her stamina has weakened so she may not be able to handle the operation
that means it has been decided, right?
but this is probably the last chance for Narahashi-san to have this operation
she understands the high risks and this being the first Batista operation conducted
yet, she has faith in the department and has requested the operation
if she doesn't do this operation she will have at most 3 months to live
On top of that, we have Asada
with him, the operation chance of success is high
I have decided
So, is it Narahashi-san?
We are performing the operation on.. 16 year old high school student, Murano-san
What?
We are doing the highest-difficulty Batista operation
can you guarantee just relying on Asada's ability will result in 100% success?
This is an obvious choice
Because if you were to fail, everything you had done will go down the drain
Then, tell me the members of the Batista Operation
Head surgeon, Asada Ryutaro
Operation nurse, Satohara Miki
Anaesthetist, Totsuka Zoichi
Clinical engineer, Ichii Shigehari
How about the assistant?
I am considering Maruyama for first surgical assistant
Second surgical assistant is
Ijyuuin Noboru
Who is that?
he's a new doctor who joined the clinic this year
new doctor?
We're talking about Batista Operation, do you understand?
For the last few months, Ijyuuin-kun has been trained under Asada
and has served as an assistant for numerous operations at ER
a doctor in his twenties in university hospitals rarely gets a chance to perform an operation even once a month
so by the university hospital standards, he has an equivalant experience of
years worth of operations with Asada-sensei
- But.. - Of course..
I will test his skills beforehand
If he's not competent, I will consider a replacement
Isn't this a challenge... for you?
But let me remind you
If you fail the first case, there is no second case
- It hurts, let me go ! It hurts! - Stop moving, stay still!
Your elbow is injured
What's wrong?
His right elbow is dislocated from a fight
You
- Shut up! - What are you doing!
I hate hospitals!
Let go of me
How energized you are
in that case there is no need for painkillers
crunch your teeth
Don't bite your tongue
This is the Hippokrates technique to treat dislocation of elbow
Hold him
- fix him on a triangular bandage - yes
You!
Remember this!
3..
4..
5..
6..
7..
ok, he's down
I'm taking a nap now, don't wake me up
What is it, 76kg?
I want to borrow your ability as an anestheologist
What is it?
- is that head hunting? - come and help the Batista team
Hey, my fees are expensive
My anesthesia treatment costs ten thousand each
Pay it
If there is a suitable donor for Narahashi-san, we can still do a heart transplant operation for her
For now, we can sustain her condition with internal medicine treatment
You wouldn't need this anymore, I will keep it
Kato-sensei
For the sake of your thesis, you're only operating on patients with the highest chances of success
you have been abandoning the patients with critical conditions
There have been rumors like that
- What is your point? - I believe that rumor is not true
A doctor shouldn't let a patient suffer because of his own interests
Of course
but I can't fail the Batista operation for the sake of patients
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< Dilated cardiomyopathy >
hey, hey, hey, there's something up
what's wrong?
it's there again, Kato-sensei's black file
Black file?
you don't know?
top secret file that contains list of staffs she doesn't like
sometimes she stares at it with a serious look on her face
then, right after, someone always gets expelled
How can that happen?
I am feeling the uneasiness now too
I've just informed Professor Noguchi
about including Ijyuuin-kun in the Batista team
If it's him, I have been assigning him operations daily
His ability is improving significiantly as compared to other department staffs
how useful could that be?
Although I had tried hard to convince Professor Noguchi this time round
but I still don't trust that he is capable
If he is proven to be incompetent in my test, I won't let him be in the Batista team
Failure is not tolerated for Batista Operation
absolutely not
Alright
do as you like
well, who is the patient for the Batista operation?
the patient is 16 years old high school student
isn't there supposed to be two patients with dilated cardiomyopathy?
the other one is best left treated with internal medicine to prolong his life
- Is that the medical record? - you don't trust my judgement?
No
both you and Fujiyoshi-sensei made this decision
no objection
Sorry for not visiting you earlier
- head nurse Narahashi - wait a moment
I'm not the head nurse anymore
don't be so formal, Kato-sensei
I'm already regretting that I caused so much trouble
to people around me
I am truly sorry
you took care of me back then
oh, that's right
I heard you are the assistant professor now?
yes
I knew you would make it
You tried harder than the others, and cared for the patients
I have nothing to worry about, if you are in charge of me
well..
about your plan for operation
the batista operation..
I will be relying on you
If it's in your hands, if the operation fails... I will be able to give up
For the sake of your thesis, you're only operating on patients with the highest chances of success
and abandoning the patients with critical conditions
A doctor shouldn't let a patient suffer because of his own interests
Narahashi-san has no idea
how I've lived in this department for the past 8 years
As you can see, in cardiac surgery department in Meishin University
We performed 50 cases of MIDCAB* within a year *(minimally invasive direct coronary artery bypass grafting)
casualty is 0
0 casualty?
unbelievable..
the key point is how well you graft the LAD* *(Left Anterior Descending)
Did anything happen while I was away at the conference?
Narita-san from room 821
died from a relapse of myocardium infraction
there was message not to perform MIDCAB operation on her, that's why
I see..
that's fine
in order to maintain the credibility of my thesis data
I had no choice but to sacrifice patients who are hopeless
It's too late to have any regrets now
If the first case were to fail
Both the thesis and the position of professor will disappear into thin air
but you're not going to be involved in the Batista operation directly right?
that's why you brought him
so, there is nothing to worry about even if the operation goes wrong
I am not expecting failure
I will make sure the Batista Operation is a success
for sure
Don't give up ok?
assistant?
for my operation today
CABG, Coronary Artery Bypass Graft operation
you will be the first surgical assistant
Me...? First surgical assistant?
This is a test to gauge if your ability is good enough for Batista operation
- you're the first surgical assistant? - yes
hey, hey, hey.. is this some sort of a joke?
that's my job, why you...?
are you serious?
In that case.. the staff to be expelled must be
ME~
anesthetist is Totsuka-san
clinical engineer is Ichii-san
these are the members who I have presently chosen for the Batista team
- hey - quiet
In order to prepare for Batista
we will perform the CABG, Coronary Artery Bypass Graft operation, with my lead
well, let's start with the operation briefing
the patient is Sakashita Kazuhiro, 65 years old, male
the thrombosis has cut off the blood flow from the middle of the left coronary artery to the tip
and he's not reacting to the anticoagulant medication as well
so there is no choice but to undergo surgery
at the coronary artery with the thrombosis
we will create a bypass with a vessel taken from the inferior epigrastic artery
Hey, are you feeling ok?
you look so pale
I'm pale to begin with
- go prepare now - yes
- You said I can decide my own team members.. - We have no time
we will go with this roster for now
You're going in too?
as long if my schedule permits, I always try to attend my patients' operation
Worrying too much?
The second surgical assistant is Asada-sensei right?
What are you talking about?
- Asada-sensei is the servant nurse today - What!
Is it really?
You're the only assistant
No one is going to help me?
By the way, how is her surgical skills?
what are you talking about.. before you came, she was the "ace" of the cardiac surgery department
We will begin the operation
scalpel
this is the Batista team?
why is the intern with them?
maybe the team members have not been finalised
In order to move around the thrombosis
we create a bypass with another artery
first, they need to obtain the artery that would serve as the new bypass route
we would be obtaining the graft from the inferior epigrastic
Ijyuuin-kun
- your job is to obtain the graft from the inferior epigrastic - Me?
I will be opening up the chest during that time
careful not to damage the artery stems connecting to the abdomen
- tweezer - yes
Is Ijyuuin really ok?
Help him, if anything goes wrong
No.. I won't
Being a member of a team doesn't mean you depend on the help of others
Putting forth your very best and
to try and be of help to other members of the team, that is what a team is
Hey.. servant nurse!
LITA* graft is already done, hurry up and collect the equipments *(left internal thoracic artery)
- don't be lazy - ok, ok
This kid.. is he really alright?
just wait and see
where's the graft?
it's ready
- did you do this? - yes
is something wrong?
nothing
let's begin
- commencing cardioplegeia - yes
- altta clamp.... injecting preservative solution - yes
- he's quite perceptive.. that "little brother" - yes
yeah.. he used a net on the heart, to get a better visual
Lythotome
and also that nurse.. her reflexes are really extraordinary
being in charge of delivering equipments is the same as playing sports, you need great reflexes
You need to adjust to the timing of the surgeon and also keep track of the order when providing equipments
Now I understand why they chose her for the operation nurse
anterior descending branch is opened up
start stitching LITA-LAD 8-0
stitching all at once
amazing
10 stitches in the artery that is only 1.5mm
stiching without any wasteful movements
and impeccable accuracy
She's pretty good
stitching completed
starting blood flow in the graft
declamp
no bleeding at all..
- ok, cease the heart-lung machine - yes
Finally done..
pulmonary artery pressure rising!
PEA 40, pulse 110
- tachycardia is occuring as well - PEA 50 now!
This can't be! The procedure was flawless
Kato-sensei is there need for secondary procedures? or balloon pumping...
Neither is necessary
Inject saline solution on the graft
just do it
yes
- pulmonary artery pressure ceased raising - PEA is now 40, decreasing
..35 now pulse is slowing down to 70
These problems happens often when the heart-lung machine is stopped
you need good judgment skills to assess the seriousness of the situation
this determines the skill level of a cardio-surgeon
remember that
what was the cause then?
It must have been caused by the constriction of left cardial artery
and thus blocking the blood flow
that's why you inject saline solution on the graft to increase the blood pressure and forcing blood flow
that's right
- I will let you handle the final stitching up - Yes!
Take care of the rest then
How is Ijyuuin?
he is highly perceptive and well trained
also very precise in graft trimming
He is meant to do in precision jobs, which fits his personality well
He passed
That was an outstanding team
except for two person
two person?
the clinical engineer and the anaesthesist
clinical engineer could not adapt well to the changes
anaesthesist was off by half a beat
it is permissible for this level of operation
after observing the current team, I understand why Asada wants our anaesthesist Arase, so much
this level of operation?
That means, the level of Batista operation must be....
< Nomura Rina >
I heard from Fujiyoshi
the 55 year old housewife is requesting for Batista operation as well
what's going on, why didn't you tell me?
are you planning not to operate on her for the sake of your Batista thesis?
you can take it that way
show me her medical record
- if I'm operating, I may succeed - true
but, there is also the possibility of failure
I can't risk my Batista thesis on such uncertainties
- patient and thesis are not related - it doesn't work that way
if this operation fails, there is no second chance
Batista thesis is over
my career at the department will be over as well
I want to be a professor
I can't stop here
This girl.... is the patient I had been waiting for a long time
a patient you are waiting for a long time?
don't get it wrong
doctors do not wait for the patients
the patients are the ones who wait for the doctors
the patient has nothing to do with your circumstances
Narahashi-san will
die, if we don't operate on her right away
Are you planning to kill Narahashi-san?
Why did head nurse Narahashi place her faith on a person like me?
- check if you inserted it properly - yes
the first time a patient I'm in charge of died
she was there for me until the next morning
I've finished planning Moriyama-san's operation schedule, please check it
ok, good work
With her encouragement, I gradually became stronger
and I stopped crying
Is there anything wrong, Kato-sensei?
you look as if you're going to cry
do I really look like that?
you really are a crybaby
I only cried once, that time
That was the first and last time
- really? - yes
since I became a nurse, I have seen so many different doctors
but whoever it was, when the patient they care for dies, all of them...
had cried
As a result, they try not to be emotional for the patient
who was about to die
that's how they stop crying
they're humans too
they figured out the way to protect their heart
me too
but you were different
you always faced the patient straight
when patients cry or suffer
you were holding back your tears, trying not to cry
you are a very smart person
you simply changed the way you cried
so... how is the university hospital now?
did it change a bit?
you once said...
"I want to change the university hospital"
- "I will be a professor!" - yes
you're the only one I could talk to about this
there are many patients under my care who have died
patients who were able to be saved if they weren't at this university hospital
I don't want patients do die unecessarily anymore
Kato-san
I will change the university hospitals
that's why you want to be a professor?
you can't change this rotten organization
unless you're at the top of it
just stating it's dirty, or rotten
won't change anything
with that small, thin build of yours... you worked doubly hard
but if it's you, I trust you will one day be able to...
become a professor
I'm so glad I was transferred to this hospital
if it's a doctor like you, even if I die
she'll most certainly keep me in her memories That's how I feel
Excuse me
see... you really are a crybaby
get better quickly ok?
Sensei, I like you so much
Kato-sensei, thank you so much
Sensei, thank you
Thank you, Kato-sensei
If you turn on the lights
I will kill you
I wanted to be a professor to reform this place
but...
I don't know when it happens, I became one of them
I have decided the patient to operate on
why did you choose the patient with the riskier condition?
isn't it common sense to choose the patient with the more favourable condition for the thesis case?
yes
do you understand that this is the first Batista operation in Japan?
if you fail this first case, Meishin's reputation would certainly be damaged
If we don't do the operation on Narahashi-san,
there won't be another chance
isn't it reckless to perform operation in her current condition
are you planning to end her life with your own hands?
I've already considered the risks
for you... thesis or patient, which one is more important?
both
I will save the patient and finish my thesis as well
and I will make you the head professor of Meishin
therefore, in order to be sure
I will assign first surgical assistant position to an excellent surgeon
excellent surgeon, who?
Myself
the position of first surgical assistant will be filled by me
both thesis and patient...
it's so like you
let me make this clear, I didn't decide to operate on Narahashi-san because of my emotions
after considering the patient's condition and your skills
I came to the conclusion that this operation has a higher probability of success
If I wasn't the head surgeon, would you have abandoned Narahashi-san?
Probably
I'm not planning to change the way I live now
I wouldn't give up on my thesis just for a patient
I am a woman who wants to be a professor
even if I have to sell my soul to the devil
but
I wouldn't sell it cheap
as long as you are here
I will not give up
Head surgeon - Asada First assistant - Kato
- hey - yes
are you a doctor from cardiac surgical department?
yes
Is the person named Asada here?
< Narahashi Fumiyo >
- Narahashi? - I was surprised...
to see my mom in her current state
on the day I was brought to this hospital for injuries from a fight
I hate hospitals
my dad passed away when I was young
my mom became a nurse, working at hospital from morning to night like a slave
in the end, she collapsed
you're going to perform the operation, right?
yes
Please
Save her for me
I've always created trouble for her since young
that's why.. I haven't had the chance to do anything good for her yet
Please don't die..
I haven't done anything for her
Please
Save my mom
Please
Narahashi-san's operation is scheduled on the day after tomorrow
first assistant..
so you'll be operating alongside Asada?
the media is paying attention too
failure is not tolerated..
sorry..
I have to go now
hey
can we meet again the day after tomorrow, at night?
sorry, not that day
I will contact you later
I pray for your success
- what! - eighty thousand yen?
wait
Batista is covered under medical insurance, therefore
including the deposit needed, it will amount to around two to three thousand yen
if that's the case, I will pay for it
what are you talking about?
you don't need to
uncle, please let me
this is the only thing that I could do for her now
- I heard that the patient has been decided - yes
if your Batista thesis is recognised
your authority at cardiac surgical department will increase dramatically
you're going to run for professor election right?
is there any problem?
if you do, you have my vote
Japan university hospitals need reformations
we need young and excellent doctors like you
but
if the operation on the day after tomorrow were to fail
Asada-kun would be expelled
you're out of the "mainstream" as well
- what's your point? - when that happens...
I will take Asada-kun into ER
Professor Noguchi has yet to return the favor I had done for him
It's such a waste to lose such a talent
just from one failure of Batista operation
what are you trying to say?
you're saying that the Batista operation won't succeed?
an operation team is like a multiplication
even you have big numbers next to each other
if one zero is included
the result will be zero
Batista operation will fail
Why does Asada-sensei always choose the hardest path?
even for this, it is easier to operate on the 16 year old patient
excellent surgeons
if they were asked to choose either the hard procedure or the easy procedure
they will choose the more difficult procedure
but..
although it is safe and easy, but it is usually just a temporary solution
they will take the one that takes more effort and
best for the patient
in that way, patient won't have to reoperate, and their conditions will be more stable post-operation
isn't selecting the patient the same way?
he doesn't deliberately choose the more difficult path
he simply does not compromise
that is Asada Ryutaro
Day of First Batista Operation
it's today
yeah
is it really a wise decision to perform the operation at this timing?
shouldn't we wait for the patient's condition to get better?
I always think this way before an operation
even if anyone says it's the best condition, you would still have doubts
no one knows if today is the best day
but
we're the one to make today the best
I'll be relying on you, Asada
finally it's the day..
it's starting soon
Excuse me
Second surgical assistant Ijyuuin Noboru
Nurse Murata Mieko
Nurse Kawata Nana
Clinical Engineer Ichii Daikou
Clinical Engineer Maeda Shinji
Anesthetist Kuratuka Kuraichi
Internal Medical Doctor Fujiyoshi Kensuke
Nurse Satohara Miki
Head Surgeon Asada Ryutaro
First surgical assistant Kato Akira
We will start the Batista Operation