Day of First Batista Operation
Batista Operation -Nurse- Satohara Miki
is one of the surgery procedures -Nurse- Murata Mieko
to excise an over-enlarged heart -Nurse- Kawada Nana
it provides the patient an alternative treatment to heart transplant -Clinical Engineer- Ichii Daikou
and was invented to bring back the -Clinical engineer- Maeda Shinji
functionality of heart without transplant -Anesthetist- Totsuka Kuraichi
the operation requires cutting a slice of the heart muscle -Anesthetist- Totsuka Kuraichi
therefore requiring outstanding surgery skills and -Internal Medicine- Fujuyoshi Kensuk
clinical experience -Second Surgical Assistant- Ijyuuin Noboru
-Head Surgeon- Asada Ryutaro
-First Surgical Assistant- Kato Akira
We will begin the Batista Operation
- scalpel - yes
- tweezer - yes
Finally.. Batista Operation is starting
just for today's operation, we have been putting up with that trouble-maker
I hope we can produce good results.. right, Professor Noguchi?
- drill - Yes
here, here come hurry
- can we really come in? - sure, sure come in
I have reserved these seats for you
Excuse me
It has started
- rib spreader - yes
- electric scalpel - yes
It's huge
so this is dilated cardiomyopathy I never expected the heart to be so enlarged
- It's huge - true
but it's pumping slower than usual
heart-lung machine is connected
- start pumping - yes
- install altta clamp and inject cardioplegic solution* - yes *(heart paralysis solution)
- clamp - yes
no
don't stop the heart
we will do this on-beat
with on-beat?
did he say on-beat?
- how stupid - what is he thinking?
with the heart still beating...
the blood circulation is still handled through the heart-lung machine but the heart continues pumping
operating in that condition...
the cells in the heart won't deteriorate
it doesn't stress the patient's body much after the operation
and reduces the risk of using the cardioplegic solution and the problems occuring when restarting the paralyzed heart
but..
operating on an active heart is
100 times harder than operating on a paralyzed heart
there is a higher possibility that the patient may die on the operation bed
he must be furious now
but.. why take this dangerous way?
Asada Ryutaro
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to act so recklessly.. if the operation were to fail
not only the thesis, Professor Noguchi will be forced to take the responsibility too
I can't tolerate his action
What are you thinking, Asada...?
Kato-sensei
- you sure this decision is right? - why are you asking me?
the head surgeon is Asada-sensei
follow his orders
This is Asada-sensei's operation
I'm already prepared for any unexpected situations like this
things have reached this stage.. any mistake will endanger the patient's life
we have to place our trust in Asada
- inserting cast onto venticulus sinister - Yes
- 3-0 - yes
- surgical forceps - yes
why aren't you stopping him, Kato-chan?
recklessly moving on..?
or does he have a plan in mind?
which one
...76kg?
- scalpel - yes
- Kiene scissors - yes
- inserting vent - yes
that "little brother" is able to catch up, just barely though
- Ijyuuin.. hold this - yes
I won't make any mistake today
Batista has already begun
- VENT ON - yes
alright
so fast
from start, to connection of heart-lung machine, to insertion of vent
only taking 10 minutes
unexpected speed
but if you can't even do this, you are not qualified for Batista
the excision procedure is starting
the key point of Batista operation
next, we will perform the excision of the diseased regions
a crucial step is determining the diseased regions
which is locating the diseased cells
diseased regions?
in most cases of dilated cardiomyopathy
the diseased regions are rarely next to one another
there are cases in which the diseased regions are scattered all over
the diseased region on the heart muscle tissue
getting rid of the diseased region only, effectively reducing the left ventricle size
leaving the non-diseased region and stitching it up
in this way, the operation success rate is increased dramatically
but currently there is no fool-proof method to locate the diseased region
Kato-sensei's thesis is to investigate a proper procedure for it
performing this hard of a task without stopping the heart...
how are you going to locate the diseased region?
Asada's movements have ..
stopped
what's going on?
what is he doing?
what are you trying to do.. Asada..?
he can't find the diseased region?
3 minutes have passed
could he be..
by letting the heart to continue beating
- he can feel the movements of the heart muscle tissues - what?
I get it
- It's here - what?
touch and feel it, Kato
you too, Ijyuuin
- what... - what is this?
that's the diseased region
he determined the diseased region without any hesitation
- can't be - how?
Asada figured out the distinction between the diseased and non-diseased regions
from the movements of the heart tissues
that's why he didn't stop the heart
could you really do that?
certainly.... if you observe or touch the moving heart directly
it is easier to locate the disease region
but, on the other hand
it is only possible if you have the confidence of not failing the excision and stitching of a moving heart
that kind of dangerous risk..
if it was me, I wouldn't even consider it
Both of you.. remember this feeling
the disease region
is this?
commencing excision on the disease region
Kato
- lift up the heart apex - yes
- scalpel - yes
here comes..
- Ijyuuin, use the sucker to clean up right ventricle area - yes
- scissors - yes
- Ijyuuin, check for diffusion of cells at the disease region - yes
his technique is very exquisite
how could he excise so quickly?
is he really sure of the accuracy of the disease region?
these old geezers are stupid
if you want a step-by-step commentaries, go watch a telecast baseball game
- hand it to me - please
- Kato, raise it higher - yes
- Ijyuuin, start the sucker - yes
but how is Asada able to grasp the patient's condition so accurately?
in this world, there are two types of surgeons
one who remembers the organs as individual parts as shown in textbooks
and the other one
remembers the organs as one whole unit
as one whole unit?
by grouping the different organs in the human body as one unit
and viewing the human body constituting of connected organs
in his mind, there is a realistic image of a living human body
- Kato, stop the bleeding - yes
as a heart research specialist, Kato-sensei won't understand
only those who has plentiful experience in operating on many different organs
are able to achieve this skill
how much experience do you need in order to acquire such skill?
Asada's proficiency is too outstanding, the rest can't catch up with him
- anesthetist, is the dilater prepared yet? - yes
the anesthetist is slowing Asada down
- get rid of the excess blood - yes
- check the fluid volume - yes
clinical engineer can't catch up with Asada also
an operation team is like a multiplication
no matter how excellent Asada is
if there is one zero included
it all becomes zero
what's wrong?
could you watch this for me?
I'm not feeling well
Excuse me I need to go to the restroom
- hurry - yes
- get into your position quick - yes
please let the operation end without any trouble
- please SET UP - yes
Kato-sensei
the arterial blood is dark
lack of oxygen?
trouble with the heart-lung machine?
if that doesn't get fixed, the heart will stop
the patient will die in operation
- engineer, check the heart-lung machine - what?
Maeda engineer
blood oxygen level is unstable
- increase volume, raise PA - yes
what is that engineer doing?
isn't the one out returning?
this can't happen... dying during operation
instead of dying after the operation
this can never be tolerated
if you could get the patient out alive from the operating room
you could make up stories afterwards,
is she going to last until the end?
do something, Kato-chan!
- do your job, Maeda engineer - yes
- Ijyuuin - yes?
- you can control the heart-lung machine right? - really?
yes, I studied it briefly
then stop what you are doing now
please go take control of heart-lung machine instead
control the heart-lung machine?
- I will cover the rest - hurry
yes
what's the cause?
oxygen controller?
- you, check if the settings are correct - what?
hurry
have courage!
you're the only one available for this job
yes
pressure has returned to 100%
the rest is...
there is no problem, this should be correct
it's back to normal
just now..
I'm sorry
it's ok don't worry about it
excision of diseased region done
now, stitching up the left ventricle
- x-o - yes
Kato, ensure the stitches are secured properly
- tighten the string - yes
after Ijyuuin left his assistant position
Kato-sensei's burden is increased
even with that much commotion, he is still able to perform the operation calmly
what immense concentration Asada must have..
continuing the operation without any signs of disorder
when I realized, we were all absorbed into
this guy's rhythm
alright.. stitching is completed
Batista operation has
finished
- disconnecting heart-lung machine - yes
it has ended
Batista operation has succeeded
- good job, Professor Noguchi - thanks
congratulations
it has ended
you didn't do anything
need to go to washroom
heart-lung machine is disconnected
heart movement has recovered too
we are left with the final stitch on the chest
what's wrong?
look at the heart muscle here
its movement is weaker compared to before the operation
there is blood rejection occuring in the right arterial region
but...
- we have done a detailed examination prior to the operation.. - even if it's examined..
you can't be sure to catch everything
even if Batista is successful
this patient won't survive
continue operation.. we will perform bypass surgery at the right arterial vein
- Kato, you are in charge of the graft procurement - alright
- electric scalpel - yes
< Vital FIB >
ventricular fibrillation
this is bad..
the heart-lung machine has been disconnected..
- prepare the DC - yes
reconnection to heart-lung machine
why is there a ventricular fibrillation?
there may be a clog at the right coronary artery
we need to immediately perform bypass surgery, or else the patient will die
won't work
Ijyuuin has left the operation table, and touched the machine
he can't go back until he has completed the disinfection process again
reconnection of heart-lung machine requires
both Asada and Kato-sensei
shortage of surgery personnel..
Ijyuuin, you will have to do the graft procurement
carry out the disinfection process and return quick
yes
move back, Kato
oxygen saturation is not increasing
blood pressure is decreasing
we need to hurry and perform the bypass surgery, otherwise the heart functionality won't recover
I understand, but without Ijyuin, there is no one to do the graft procurement
- we can't perform the bypass surgery - we don't have time
then who is going to do the graft procurement?
Ijyuuin won't be back for at least 5 minutes
from the inferior vena cava,
retrieve a 15cm graft
Miki..
what did he just say?
he is asking the nurse to retrieve the graft
yes
she won't be able to!
she has retrieved grafts in my operations for hundreds of times
you can rely on her
you.. what are you ordering nurses to do?
this is Japan!
nurse retrieving graft?
this won't do..
this is Asada's decision from NGO where he lacks both equipment and staff
but in a place like Japan with strict restrictions
there can't be a situation where a nurse holds a scalpel
this is ridiculous.. this action won't be tolerated
all of them will be expelled from the hospital
to allow or not to allow.. I am the one to decide
In this place, this is permitted
don't be absurd
we will wait for Ijyuuin to complete his disinfection and return, that how it should be
we have no time for that
do it, Miki
yes
no, stop it!
if you violate this medical law
all of us here would be held responsible for that
when the hospital board carries out an investigation, we would be expelled
we will all lose our jobs
- make them stop! - stop it
what the hell are you doing?
this is an order from the professor, stop her even if you have to tie her up
what are you doing, hurry
I'm ordering you to stop!
I...
don't understand what you are thinking
you are always saying team, team...
but what does a team mean to you?
you don't consider the circumstances of your team members when making decisions
even breaking the medical law through your decisions and doing things as you like
is that really a team?
if you continue, you should what's going to happen to you
not only I will expel you guys
you will also damage Meishin's reputation
do you understand?
stop!
hey!
Meishin is ruined!
hey, stop right now! Listen to me!
please
Kato..
what a team means to me...
is important comrades who are fighting alongside with me
if there is even one who hasn't given up on life
then I will pursue forward, no matter what
as long as there are still comrades who are still fighting with me in here
stop them, Kato!
Kato-chan, stop them!
Hey!
stop them, Kato!
make them stop!
Kato-chan, make them stop!
Hey!
make them stop!
they really did it..
not only they will be expelled from the cardiac surgery department...
if the hospital commitee board decided to take action against them...
I won't be able to get Asada either
Asada Ryutaro..
what a waste.. this talent..
I couldn't keep him for myself..
Miki-san is retrieving the graft?
perfectly retrieved graft...
connection to heart-lung machine done
- start pumping - yes
commencing bypass surgery
- finished retrieval of graft? - yes
- starting the bypass connection stage - yes!
please
let me see my mom one more time
she raised a person like me..
let me have the chance to apologize to her
operation..
is a success
welcome back
I'm sorry..
mother
I'll leave it you to handle the rest
I have to leave to sort out some medical records
me too
everyone's gone
I need to prepare the report for Professor Noguchi, I will excuse myself as well
even Kato-sensei is...
everyone is hurrying to escape from the sinking ship
sinking ship?
because...
our expulsion is inevitable..
I don't think so
huh?
that woman hasn't given up yet
on both the thesis and the patient
now let's close it
myocardium is very fragile
so be very careful to stitch it
- ok - do you think it's alright, Gunji?
let me see
ok well done
the left ventricle is closed
yes
Excuse me
Finished
Well done.. Doctor Kirishima
You are great.. I couldn't have done it without you
But gladly.. I owe my success to you
- Good work Doctor - Thank you
- Well, see you in a minute - Alright.. ok then
is yours doing ok?
Akira..
you created so much trouble for me
I'm very sorry
what was that about?
what are you referring to?
why are you acting ignorant?
of course it's about that operation
making a nurse collect a graft, if she were to fail then there would be police involvement
it's going to be a topic to be discussed at the professors' comittee meeting
it will a subject of interest to the hospital inquiry commission too
if anything were to happen to the patient
I will be ruined as well
What's your excuse, Kato-chan?
Asada's decision of ordering the nurse to collect the graft was right
you should testify like that to the hospital inquiry comission
what?
Asada took appropriate action
in order to save the patient's life
there was trouble with the heart-lung machine, from the patient's condition
he judged that it was an emergency situation
do you think that kind of reasoning will be accepted by the inquiry commission?
a few years ago, my friend
was also called upon by the hospital inquiry commission
it seems to be the case of a nurse ordered to do drip infusion
at that time, nurses were only allowed to do muscle injections
injection into veins were prohibited
the excuse given was that medical action was performed under the strict guidance of the physicians
it is not unusual anymore now
even if it is performed inside the operating room
but
instead of making poor excuses
by disposing all the personnels in the operation room and
and admitting our mistake
would make my situation better if something goes wrong internally
Professor Noguchi
Tomorrow's headline news on the paper would be on
the success of Batista operation
there were a lot of calls from newspaper companies
they asked us for an interview
Meishin's cardiac surgery department will
get the attention of the media
but even if the operation succeeded, if you expel people
and not performing the rest of the scheduled Batista operations
the media will sense that there is something wrong
are you threatening me?
of course not
I just want you to be in the newspaper's headline as the professor who advised
in the success of Batista Operation
you set up the media right?
of course not
they got the rumor from somewhere
Batista operation, performed for first time in Japan
I set the press conference at 6:00pm
necktie...
polka dots ok?
we're saved?
amazing turn of events
starting the press conference first
then the hospital inquiry commission
if that's the case
the hospital wouldn't take any actions against the operation team
well-planned..
she surely deserves to aim for the top, even at such a young age
you could say that..
even you're off the hook now, I still won't give up finding the chance to get you to work for me
whatever..
more importantly..what about my request for Arase?
that request?
sure
but only if you still have the desire to use him, even after knowing what he had done in the past
Arase-sensei's past?
vein injection is ok, but how can a nurse collect the graft
how troublesome
- she's being so cocky, because she's in the team - True
Excuse me
the family of that patient gave this for us
- if you would like, let's have it together? - let's go
excuse me
your graft collection is a big gossip already
I appreciate that Narahashi-san was saved
she took care of me too
not at all
I need to tell you as a head nurse that
the tasks that nurses can carry out are limited
even if the doctor-in-charge is unskilled
I often think that I could do better, but
performing the task for them is not permitted
this graft collection in this case is excusable, since "emergency" was applied to it
from now on, whatever the situation is
promise me that you would never do the same
I can't do that
if it will save the patient's life
I will still do it
I understand
then prepare for the expulsion you deserve
yes
lastly
let me say some personal comments
when I saw you finished retrieving the graft better than most of the doctors...
I felt good
Batista operation for First time in Japan succeeded
- It's me - This is AU answering machine service, connecting to...
when you hear the signal, please leave the message within 3 minutes
This is Akira
Batista operation succeeded without any trouble
call me back when you hear this
good bye
- sensei, preparation for press conference is done so please come join professor Noguchi - I will be there
I can't wait to see tomorrow's headline news
Asada-senei... something terrible happened,
First-time success of Batista operation at North Japan University
first-time Batista successful in Japan, with invitation of the best cardiac surgeons from the US and assistance by North Japan University hospital
Meishin university also performed the Batista operation with success