I'll definitely cure Yuuta.
Heart removal and transplant has to be completed within four hours.
Yuuta-kun's donor has appeared!
Because Dr. Kitou's patient is not able to undergo the heart transplant.
That organ will become...
We'll perform the live liver and heart transplant operation at the same time!
Wait a minute. A patient that has defects in his liver function is definitely unable to receive a heart transplant!
- It's against regulations... - I know it!
Your medical license will be revoked.
It doesn't matter. As long as the patient can be saved.
If Dr. Noguchi knows about Yuuta-kun's heart transplant operation,
the transplant will be forced to stop.
Dr. Noguchi will be going back after he checks the operation schedule for the day.
We can only keep him in the dark and do it.
Come in.
[Time Limit for Donor's Heart]
Heard that you are going to undergo the live liver and heart transplant operation at the same time.
Yes.
And you're actually transplanting an adult's heart in a nine year old child.
That heart was intended for my patient...
Please do it, Asada.
If it is not transplanted into your patient,
a precious life will be wasted.
Go cure the patient before your eyes.
It's a pity for your patient, who was supposed to receive the transplant.
Who? Did you say that “it's a pity”?
It's my patient.
I won't let him die.
Only three hours and twenty-five minutes remaining?
- The liver is here! - Got it.
Complications will arise in the process of the operation.
I'll be in charge of the support for the artificial heart and lungs.
Please be in charge of assisting Asada in the management of the operation process.
The members of the strongest team are going to be assembled soon.
We'll now begin the liver's left leaf removal operation.
- Tweezers. - Yes.
- 6/0. - Yes.
Because of the dilated cardiomyopathy...
we'll now begin the heart transplant.
- Scalpel. - Yes.
- Tweezers, gauze. - Yes.
Let's go!
Pulmonary artery pressure is rising. Internal blood pressure is decreasing now. I'm afraid that because of this condition...
What should we do?
Open his chest immediately, and then change it to artificial heart and lungs management.
- But doing that now... - Do as I say!
Doctor.
To me, nothing is impossible.
- Scalpel! - Yes.
Is there anything?
Congressman Onda seems to be waiting at the venue already.
It seems like he's earlier than we planned.
Is that so?
Isn't it better for you to set off as soon as possible?
I've already asked them to prepare the car.
Got it. Let's go.
Oh yes... I forgot to tell you.
I've already signed the contract...
with the Goldberg Brothers Company.
Thank you for preparing the car.
Please go well.
Bone drill.
Muscle hook.
Backhand.
Giving an adult's heart to a child…
Between an adult and child, there are differences in the size of the blood vessels.
To have to suture the relative blood vessels completely...
In other words, it's like sewing soft tubes of different sizes together.
A large amount of concentration and balance is required.
Also, undergoing transplant at the same time restricts the surgical view. Management of the operation process will become relatively difficult.
In this...
Harmonic.
Transplanting an adult's heart into a child's body?
And it's being done while performing live liver transplant?
Depending on that bunch of rubbish at Hokuyou?
How can it possibly be done right?
I guess so.
- Chest opener. - Yes.
It's that group that was kicked out of Meishin, right?
Impossible, impossible.
This is...
Adhesion!
It has gone across and is stuck to the side walls of the heart.
Although we expected adhesion to occur...
The previous Batista operation
and the chronic heart malfunction is worse than we expected.
It has even developed to the side walls of the heart.
To strip off all the adhered parts will take three hours, even if it's Asada.
If the separation is not completely done...
The heart transplant will not be possible.
Toyama, start stripping the adhesions around the heart.
- But... - Do it with the fastest speed.
Only you and I can do it.
Got it. Internal gauze.
Harmonic.
Kodaka and Nomura, keep up with them.
They're so motivated!
No matter what, it's impossible to strip off all the adhesions within the time limit.
But being able to reach this step is already quite remarkable.
That bunch of rubbish can only think till this step I guess.
Stop the breathing. Pressure check!
Shut down the vent!
No change in blood pressure.
I'll temporary increase the FiO2 to 1 unit. [FiO2: Fraction of Inspired Oxygen necessary to manage enough oxygenation in critically ill patients during surgery.]
Toyama, please take care of the lower side walls.
Got it.
Brilliant.
There's no time.
[Time Limit for Donor's Heart]
I heard that a bunch of doctors from Hokuyou are doing a heart transplant operation.
Can they do it? They are doctors from Hokuyou!
And it's a heart transplant! Will it be alright?
B.O.N F u n S u b s © ~ Band Of Nuts F u n S u b s PRESENTS
Iryu Team Medical Dragon 2 Last Karte
Translator Kyoichi
Lyrics Translators hadmish, motao
Timer dismantle
Editor tenniscalgal13
QC Raspberry Latte
Karaoke SFX zeldAIS
Encoder scarlett0512
Coordinator scarlett0512
[Noguchi Takeo's Encouragement Meeting] [Congratulations on Completion of Meishin's Medical City]
Thank you for coming today.
We'll talk again later. Thank you.
Hi! Thank you.
- You've worked hard! You came from home today? - That's right.
That's great!
Soon, soon. It'll be done soon.
We'll have more time to talk later.
[Time Limit for Donor's Heart]
Asada, please handle the IVC side, too. [IVC: Inferior vena cava.]
Got it.
- Probe. - Yes.
Liver blood vessels suture completed. Next will be the restructure of the gall bladder passageway.
- Tweezers. - Yes.
4/0.
The intestines are starting to get swollen.
- Add more of the muscle relaxant. - Got it.
- Long stent is also prepared too. - Okay, got it.
Even if it's at to this speed,
to have to finish all the stripping is still...
We all know that this is very difficult!
Even so,
we're betting on that little bit of possibility...
to save the patient.
They...
are real doctors.
Perhaps it's hard for you to understand.
My father was a doctor.
He left the university's medical organization to search for his ideal medical ethics.
He opened a clinic in a village with no clinics.
He was working day and night.
Father did not even ask for consultation fees from the poor.
- You don't have to pay. - Thank you for curing my father.
But he was always pushing himself; the result was that he fell sick.
It was due to dilated cardiomyopathy.
Only a heart transplant could cure him.
In Japan, there were few donors.
But to go for a heart transplant operation overseas
was going to cost a lot too.
No one would lend such a huge amount of money to us either.
Even then, we still owed money from when the clinic first started.
The debtors came when my father was still sick.
The medical instruments were all confiscated. The clinic was forced to close down too.
In the midst of depression, my mother died.
Dad also lived a life of desperation.
He was like an idiot, working so hard for others.
In the end,
no one lent him a hand.
Bearing a resentment towards the world
and holding his anger inside, he died.
At that time, I, who got into the medical school with a scholarship...
gave up the path of learning medicine.
I don't wish to walk in my father's path...
and live a pathetic life, where one can't save their own life because they have no money.
But...
Why?
Because they are patients.
If there's a patient suffering in front of me, I have to help him.
That's what a doctor must do.
If there's a patient suffering in front of me,
I have to help him.
That's what a doctor must do.
What?
Ijyuuin, he...
What's wrong?
Fell into a difficult position?
There was a chartered van, right?
If he can't make it to that airport...
What should we do? Time is...
Dr. Ijyuuin...
No matter what, I must send it there!
I'll definitely...
not give up.
Toyama, I'll leave the SVC side to you too. [SVC: Superior vena cava.]
Got it.
Going into suture stage of jejunum. Tweezers. [Jejunum: Middle portion of the small intestine.]
Can you think of something? This concerns a life.
That's why I'm asking you to try your best and...
What do you want to do?
Tell me his exact location.
I will definitely get the heart transported here.
The helicopter is assigned! We'll be receiving it here!
Got it.
Fifty minutes before the heart arrives.
There's no time. Let's both do the stripping at the same time.
- Alright. Harmonic. - Yes.
A little more for the liver.
- Tweezers. - Yes.
- 4/0. - Yes.
[Time Limit for Donor's Heart]
The situation is really crucial. Even if the donor's heart manages to get delivered here...
Only the surroundings of the aorta and the right side of the heart have been stripped off.
- Clipper. - Yes.
Live liver transplant, completed.
As for the rest, we're counting on you.
Next is the stripping of the left ventricle.
Stripping of adhesions, completed.
What do you mean? It's not totally stripped off yet!
We can’t take out this child's heart in this condition!
Yes?
Ijyuuin is arriving soon.
What's wrong?
Has he given up?
As expected.
Didn't you say that you'll hang on until the very end?
Asada!
- Forget it. I'll do it. - You better stop it, 61kg.
Asada.
- Here is the heart! I'll wash my hands and come in right away! - Please!
Donor's heart is here!
What do you plan to do? The stripping is nowhere near completion.
Asada!
Toyama, your speed is indeed remarkable.
But from now on,
the assistant will be changed to Ijyuuin, the one that saw the process of the heart being removed from the donor.
What are you planning to do?
Piggy-back. [Piggy-back: Compound heart transplant.]
Piggy-back?
I've only seen it in medical books.
Piggy-back?
Standard heart transplants
keep the left ventricle, then remove it from the back wall.
Then cut off the recipient's heart and suture on the donor's heart.
Piggy-back is transplanting the donor's heart at the same time
from the recipient's outer right side of the heart.
Which means it is done under a situation where the old heart is being carried.
Two hearts side by side.
This way, instead of changing hearts...
The blood vessels to suture are reduced.
Not just that.
Even if there is a situation where the donor's heart function temporarily reduces...
Keeping the original heart can offer support until its function recovers.
That's what it is.
- Installation of artificial heart and lungs. 4/0. - Yes.
Tourniquet. Toothless artery forceps.
But...
Even if it's Piggy-back,
it cannot be done when the stripping is not completed.
- Artificial heart and lungs installation done. Pump on. - Yes.
Harmonic.
Prepare two 18mm artificial blood vessels.
What?
Piggy-back should be connecting between the pulmonary artery and...
Isn't just one artificial blood vessel for bypass enough?
What is it?
Leaving such a big opening on the right pleural. [Pleura: A thin membrane that envelops each lung and folds back to make a lining for the chest cavity.]
So that's what is it?
The original Piggy-back is
putting the donor's heart on top of the recipient's heart and
suturing the left ventricle's cavity vein and aorta directly.
Only an artificial blood vessel bypass is needed for the pulmonary artery.
But what Asada is going to do is
putting the donor's heart in the chest cavity where there are no adhesions.
To make up for the additional distance compared to the original method,
artificial blood vessels are also sutured onto the aorta.
Unlike the original Piggy-back, the operation can be completed by stripping fewer adhesions.
That's why he stopped the stripping halfway.
There's no time to complete all the stripping.
The condition of the donor's heart, limited space,
everything was considered.
Then he changed the operation method.
Cutting open of pleura, completed.
Donor's heart is prepared.
- Aorta forceps. - Yes.
- Shut down. Inject heart stopping fluid. - Yes.
- Donor's heart. - Yes.
- We'll now begin special Piggy-back operation. - Yes.
- Scissors. - Yes.
The real part begins from here.
Dr. Noguchi.
This is bad!
Beginning left ventricle suture.
- Tweezers. - Yes.
- 4/0. - Yes.
At this rate,
finishing within the time limit will be...
Impossible.
Kirishima.
Donor's heart is a marginal heart that's weak in function...
and the time taken for transportation without blood was too long.
No matter how the operation method is changed, if the donor's heart cannot be revived, then there's no meaning.
Even if blood circulation is revived smoothly, it will not be able to survive.
The possibility of success?
0.1%.
Even that small chance is good.
- Scissors. - Yes.
Left ventricle suture, completed.
Next is the opening of the right ventricle.
- Tweezers. - Yes.
Transplant at the same time?
I thought you knew.
Stop them.
What?
Stop them immediately!
If you do that,
you will no longer have a place in Meishin.
Do you know?
In the past ten years, Japan has performed 49 heart transplants.
Death rate during the operation is zero.
Stopping them now would mean that the heart transplant is a failure.
Plus, what's happening now is a simultaneous live liver and heart transplant.
If stopping it by force causes the operation to fail,
it will be hard for you, as the director, to absolve the guilt.
What did you say?
Please continue your party as it is.
I’m already in the same boat.
After which,
we can only pray that it reaches the shore safely.
But...
if the operation succeeds, it'll be Japan's first simultaneous live liver and heart transplant.
Team Dragon is performing the operation.
It'll definitely succeed.
"Work hard."
Can you pass this message to them?
To Asada and the others.
Undergoing the suture of SVC and right ventricle.
- 4/0. - Yes.
Right rotation.
- Maintain load level after blood drainage. - Yes.
- Internal gauze. - Yes.
- Suction, up! - Yes.
Blood drainage done right away!
Adjust the negative pressure higher.
- Asada, I'll just have to continue to stabilize these two points? - Yes.
- Give me another 4/0. - Yes.
This is Asada's new team?
Yes.
[Time Limit for Donor's Heart]
We'll now begin suturing the far end of the pulmonary artery.
- 4/0. - Yes.
- Tweezers. - Yes.
- Raise the suction a little higher. - Yes.
- Revert the negative pressure. - Yes.
Hypodermic injection 500.
- Add more FFP. - Yes. [FFP: Fresh Frozen Plasma.]
Doctor, it's time to start the speech.
Japan's first simultaneous live liver and heart transplant.
What?
I've become happier.
Dr. Noguchi?
Let's party.
Pulmonary artery suture completed. Begin cutting the aorta open.
The construction of our Meishin Medical City is near to completion.
Time is...
running out.
We'll have to go faster. Aorta suture. 4/0.
- Short handle aspirator. - Leave the retention of suturing to me.
Dig air.
- Scissors. - Yes.
Piggy-back, completed.
- Flow down. - Beginning flow down.
Remove shut down.
Backup. [Backup: Assisting circulation.]
We did it!
It's a success.
It's over.
It's a success!
They managed to do it!
It's a success.
Japan should also learn about America's medical system.
Bring in market mechanism into the medical world.
The more money one pays, the better the treatment one gets.
Isn't this going towards the direction of the medical revolution?
- It's VT. - Ventricular tachycardia? [Ventricular tachycardia: A potentially life-threatening cardiac arrhythmia originating in the ventricles.]
This is bad. It's VT!
Why?
- Set hydrochloric acid Lidocaine to 50mg. - Yes.
- Bring me magnesium! - Yes.
- DC! - Yes.
20 Joules! Charge!
Charging complete!
Get back!
DC!
20 Joules! Charge!
Charging complete!
Get back!
- Open artificial heart and lungs again! - Yes!
Pump start!
VT is too strong.
The time it lacked blood was too long.
This heart can no longer be used.
Let's install a VAD. [VAD: Ventricular Assist Device.]
- Do preparation if the heart cannot be revived. - We're going to use an assisting artificial heart?
- This child cannot take it. - What?
The liver transplant was just completed. The body is already at its limit.
- But... - The donor's heart is still beating.
- Continue blood drainage. - Yes.
What should we do?
Once more DC, 20 Joules.
Shock!
What's wrong?
What are you doing?
Asada!
Stop the heart once more.
Stop the function of the transplanted heart?
Are you serious?
Nomura.
Is the cryostat ready? [Cryostat: A vessel used to maintain cold cryogenic temperatures.]
Yes.
Cryostat?
There is a focus point in the heart.
Cut open the heart after it stops.
Undergo low temperature treatment at the surroundings of the breast muscle.
Cryostat.
Find the spot causing the excessive speed of the heartbeat.
Using freezing techniques to insert the cryostat?
Indeed, if he uses freezing techniques,
he can lock the focal point under a condition so that it causes no harm to the heart.
The problem is how can the focus point be located?
Even the slightest mistake will affect the stimulation conducting system, hindering the conduction.
The heart has stopped.
- Pointed scalpel. - Yes.
- Cryostat. - Yes.
Alright.
Do you know where the focal point is?
When I used my hand to feel the heart contracting, there was only one place that was not right.
Start the freeze treatment.
Freezing treatment complete.
- Begin suturing the heart. - Yes.
- Tweezers. - Yes.
- X/0. - Yes.
- Razor strip. - Yes.
- Tweezers. - Yes.
Flow down.
Remove shut down.
- Backup. - Yes.
Heart rhythm is maintaining!
No VT!
We did it.
It's a success.
We did it.
They did it!
They did it.
It's a miracle.
I forgot...
He's a man that can increase odds from 0.1% into 100%.
Asada Ryutaro.
Operation completed.
You've worked hard.
Kataoka-san, there's a message for you.
Thank you.
I knew they could do it.
Yeah.
Noguchi.
Everyone,
a fantastic piece of news just came in.
Everyone will definitely get a shock after hearing it.
That is...
Goodbye.
Japan's first to reach...
[Noguchi Takeo's Numerous Evil Acts] [Hidden Medical Accidents Exposed!] [Unforgivable Medical Accidents]
Slight defect provision?
According to this slight defect provision,
if you made a huge negligence of duty while doing your job,
the creditor's rights will be transferred unconditionally.
And recognize the change in the representative at the same time.
Isn't this provision in view of my health?
According to this provision,
we made a decision to do a creditor's rights transfer.
There is an enterprise that is willing to purchase our creditor's rights at a high price.
It will be the new owner of Meishin Medical City.
You planned it right from the start.
You deliberately let me sign the agreement with Goldberg?
This is the real...
"Win-Win."
Douglas.
Thank you so much.
It's all thanks to the donor of the heart.
Yamano-san!
His condition is stabilized at the moment.
Why?
Because it's an artificial heart.
Dr. Kirishima!
The next generation's artificial heart
is still in the trial stage in Japan and is not used yet.
It is already certified in America.
It can guarantee medical effectiveness even after the transplant.
Yes.
Asada and I have discussed about taking in the concept of artificial hearts...
Based on their body surface area, it is still extremely difficult for children that have yet to reach 1.
It was instead suitable for Dr. Kitou's patient.
Organ transplant is still very limited in Japan.
The artificial heart transplants now are not covered by medical insurance.
It'll cost a lot of money.
We plan to go into testing and get recognition from the country.
That's why you let Director Yamano...
This is God's field.
Your skills might have already reached that stage.
Dr. Kirishima is also here for that?
Yes.
You're lying, right?
If that's so, you would have come to our operating room a long time ago, right?
Even if I don't enter,
it is already an outstanding team.
Please call me again if there's anything.
I'll fly here anytime.
It's all thanks to you for collecting evidence of Noguchi's evil acts in the dark.
It's nothing. It was all you.
A revolutionary change in the management policy,
reborn again as the large-scale synthesis Medical City.
Taking on the highest position will be Dr. Kitou.
I will present the world's highest standard for everyone to see.
Correspondingly, area medication will be handled by Hokuyou.
Please leave it to me.
But how do you plan to get the investment funds back?
I...
Japan's medical rules have a lot of problems these days.
The patients that place the doctor in the first position don't get the same treatment in return.
This country's ruling also has problems.
So?
So, not just the patients, the country must pay too.
Using Meishin as the center and spreading out to the whole country
to change the medical strategies.
Can you do it?
Oh well, it doesn’t matter who's the boss.
I will always put my medical treatment first.
I will definitely succeed.
He was attacked by some guys, but he was out looking for some guy called Douglas.
Where is this guy from?
He's probably here illegally...
Doesn't look like he has much money.
Just some poor foreigner, no insurance,
no one to help him out.
What can we do?
Well we can't give him any treatment if he hasn’t got the money to pay the insurance.
That is the American way.
No... no...
No...
- Wait a sec! - What is it?
I'll only tell you!
What?
I've already given up on joining Team Dragon.
You wanted to join?
However...
I want to be a supporter!
What?
I'm the 12th member of Team Dragon.
Dr. Kodaka!
Yes?
This is the doctor that I mentioned to you earlier.
Oh, the bald Samurai?
No, it's the frustrated Samurai.
What are you doing?
Go in.
Everyone is waiting.
Yo!
Ready, go!
Merry Christmas!
This is your Christmas present from everyone.
Wow.
Get well soon.
We'll play soccer together.
Thank you!
What is everyone going to do from here?
Return to Hokuyou.
There are also patients who are waiting for us there.
That's right.
But,
call us if there's anything.
We'll rush here whenever it is.
What about you?
If one person was missing,
that child's life would not have been saved.
This team
is the best team!
Is that the heart transplant specialist?
I heard he's phenomenal.
This is really going to be something.