In this hospital, there is the best team.
If it's that team, it might be possible.
Kuroki..
There's a patient I want you to operate.
Noguchi Takeo sensei has been appointed as the new President.
Surgeons, should just return to where they belong.
This is the first Russian patient brought by Noguchi.
I hope you can operate.
Asada will be operating on another patient that day.
Two operations on the same day?
We don't have enough members.
It's OK. I've called someone.
The best.. comrades.
- Arase-sensei. - Chronic Myelogenous Leukemia.
There's no possible treatment.
Yes. As scheduled, operation is the day after tomorrow.
Please come and observe, it's an extremely high-level operation.
If the Health Ministry officials personally come to observe,
they will be witnessing Meishin "special medical treatment" hospital.
Haha. Haha. No, no.
No, no. Yes!
They are thoroughly preparing.
You will be healthy after this.
Takase Haruka-san, 39 years old.
Ascending aortic arch aneurysm and AAE, Annuloaortic Ectasia.
For the ascending aortic arch aneurysm,
entire aortic arch is replaced with prosthetic graft, or Total Arch.
For the AAE, the dilated annulus and aortic root are replaced,
Bentall procedure.
Total Arch and Bentall..
During the Total Arch operation, to lessen brain cells damage,
deep hypothermia induced circulatory arrest, (TN: A technique to arrest the flow of blood by lowering body temperature to about 20 degrees Centigrade)
and selective antegrade cerebral perfusion are necessary.
It will be an extremely difficult operation.
The size of aneurysm is already 7cm, could rupture any time.
It's an urgent operation.
The other is Lydia Natalia, 32 years old.
Triple Valve.
Severe mitral and tricuspid regurgitation,
and also Familial Combined Hyperlipidemia,
causing moderate aortic stenosis.
- Triple Valve... - Yes.
Mitral and tricuspid valve reconstruction, and aortic valve replacement.
Need to repair the 3 valves all at once.
It will also be a highest-difficulty operation.
Due to the patient's schedule, the operation is also the day after tomorrow.
Two operations simultaneously..?
- Considerable difficulties are expected. - Yeah.
Two highest-level teams are needed.
Therefore, I invited some members.
Come in.
Toyama-sensei! Nomura-san!
Long time no see, midsplit (hairstyle).
It's been a while.
This is a surgeon from affiliated Hokuyou hospital, Toyama.
His skills as a surgeon, I've seen it, it's the highest level.
Highest level.. Highest, ain't it?
And also Hokuyou's ME, Nomura.
His improvisation to the habits of surgeons is outstanding.
Ah... ah... Pleased to meet you.
- Why are you blushing? - Ouch!
Very.. You are so pretty.. I can't help it..
Pleased to meet you.
Such exciting operations.
Yeah. Bentall and Total Arch will be
me, Ijyuuin, Arase and Kitagawa.
Triple Valve will be Kato, Toyama and Nomura.
- Work hard everyone. - Yes.
First assistant huh? You are promoted, midsplit.
Your bad-mannerism still has not changed?
He can never change.
Pleased to meet you, goblin cat.
Asada.
You had serious injuries? Are you OK?
Are you worried for me?
If anything, I can replace you as the surgeon.
- No need for that. - Is that so?
If required, just tell me. I will.. follow.
Yeah.
Seems like they saved me.
Yeah.
Kuroki!
Out of the way!
Kuroki-sensei!
- Have you known? - Yeah.. CML.
- Chronic Myelogenous Leukemia. - Bone marrow transplant?
No use. Already in blast crisis. (TN: blast crisis = final phase in evolution of CML)
Recently, it has spreaded to the viscera and central nervous system.
At this stage, there is no effective treatment.
As you've known, CML in blast crisis,
I can only live 3 to 6 months.
- When did the blast crisis started? - 6 months before I came to Japan.
Hey!
This matter, don't ever tell Takase.
Yeah.
Asada. No matter what, you must save Takase's wife.
I will surely save her.
Welcome to Meishin.
Nice to meet you.
Haha. Please.
Your checkup begins today.
Don't worry. Our best hospital staffs will take good care of you.
That's great.
Excuse me.
President.
What?
Asada-chan.
Why are you not operating on Lydia?
This is the best arrangement in view of the conditions. I'm operating on another patient.
No way. You will operate on Lydia.
We have decided.
World's top pianist, or an insignificant salaryman's wife.
Which one do you think is more important? Huh?
To me, both are patients.
If it fails, are you going to take responsibility?
It will be OK, old man.
We are operating, there's no better guarantee.
- Why are you guys here? - You are extremely stubborn.
Do you want us to operate on you again? Right?
Yes.
If anything happens, it'll be more than just getting fired.
- Sensei. - Yeah?
What's the probability of success?
Please be honest.
This..
[Laundry instructions]
[Housework instructions]
If anything happens, can you give this to my husband?
This is not needed.
It's certainly a high difficulty surgery.
That is why, we will bring forward our best members.
It will succeed. Surely.
- Mom! - Megu..
Is your surgery tomorrow? I will come.
What are you saying? Don't force yourself.
It's OK. I'll be able to walk soon.
I'm knitting a rug for you, Mom.
I'll bring it tomorrow.
Megumi. This is Asada-sensei. He will be operating on me tomorrow.
My mom, I leave it to you.
Seems like my daughter came.
She's hospitalized in a nearby hospital.
She unwomanly had a fracture from soccer. Yet she insist on coming.
Your family relationship is admirable.
My daughter and wife are not related by blood.
After you left Kouhoku, I had a rough life too.
My ex-wife had enough of me and
left me and my 3 year old daughter.
At that time, I met my current wife.
She treats my daughter as her own, cherishing her.
- Hence, I was able to stand up again. - I see.
Does not want prosthetic valve?
She does not want to take Warfarin for the rest of her life post-operative. (TN: Warfarin = an anticoagulant)
Too much inconvenience.
She wants to use autologous valve, no matter what. (TN: autologous = derived or transferred from the same individual's body)
But, if we use autologous valve, the surgery is significiantly more difficult.
That's your job to make it successful.
Patient's QoL is the priority, go think of something.
With such calcification, to do a valve reconstruction..
Currently, the aortic valve only has moderate stenosis.
Should we just keep it intact for now?
Not possible. The patient has familial hyperlipidemia.
If we ignore it, her aortic valve has to be re-operated within a few years.
It's OK.
I have an idea.
Finally.. tomorrow.
There's so many reporters chasing after Lydia.
Yes of course, that pianist's CDs is selling very well in Japan.
- That's the complete set? - If this operation succeeds,
newly appointed President Noguchi will be so famous.
Ah, it's so exciting.
I'm in the operation too?
You're in.
I understand your fears, after a mistake like that.
Epinephrine connector is off!
But if you don't overcome your fears now,
you will never become a surgeon.
You will be an assistant in Asada-sensei's operation.
Tomorrow's operation.. come and see it.
This is the team you brought back.
The best operation.. I'll show you.
[Day of simultaneous operations]
Has it started?
Ah, not yet, not yet.
Please.
[Second operating room. Lydia Natalia. Triple Valve repair operation]
[ME. Nomura Hirohito]
[First Assistant. Toyama Seiji]
[Surgeon. Kato Akira]
[Internist. Fujiyoshi Keisuke]
[First operating room. Takase Haruka. Bentall and Total Arch Replacement operation]
[Scrub Nurse. Kitagawa Hibiki]
[Anaesthetist. Arase Monji]
[Second Assistant. Magara Fuyumi]
[First Assistant. Ijyuuin Noboru]
[Surgeon. Asada Ryutaro]
You've worked hard. Please enjoy.
It's the first operation since my appointment.
Now, commencing Triple Valve repair operation.
Now, commencing Bentall and Total Arch operation.
- Scalpel. - Yes.
- Tweezer. Gauze. - Yes.
- Electric scalpel. - Yes.
Translators & QCs: indokid, minnie^^ KEEP THIS A FREE FANSUB! Give us a shout at d-addicts forum!
[First operating room]
Aorta clamped. Plegia start. [First operating room]
Yes.
Plegia started. Lowering perfusion temperature.
Start separating aortic root.
- Tweezer. Electric Scalpel - Yes. Yes.
[Second operating room]
Aorta clamped. Plegia start. [Second operating room]
Yes.
Plegia started.
Toyama-sensei, you will be the operating surgeon for the aortic valve.
Yeah. Maintain my operating field, Professor.
Heart has stopped.
- Tweezer. Metzenbaum. - Yes. Yes.
- Aortic hook. - Yes.
There is severe aortic valve calcification.
If not treated carefully, it will be difficult.
- Give me CUSA. - Yes.
CUSA. Harmonic scalpel with a suction device.
Using ultrasound to trim and aspirate the calcified region?
Hey hey hey, a little too fast. Toyama.
Too hasty.
With his technique, what if he cuts a hole?
Just for a second, regrets for entire life.
- Toyama-sensei, you are too hurried. - No problem. Continue like this.
- Toyama! Do it more carefully! - It'll be OK.
Ah!
He punctured the valve!?
What are you doing? Toyama!
- Metzenbaum. - Yes.
- 6-0 Prolene. - Yes.
Using autologous pericardium to patch..
Hole is blocked!
I see. To remove calcification completely,
you will definitely cut a hole.
He had planned to use autogolous pericardium to patch any hole,
- hence his hastiness. - As expected of Toyama.
Hmm... Well done.
- Aortic valve reconstruction.. completed. - It's my small gift to you.
Don't get carried away. Indeed, your speed is fast.
But your handling of left coronary cusp was amateur.
- All right. - Next is the mitral valve.
- Tweezer. - Yes.
- Cooley hook. - Yes.
- Right angle (clamp). - Yes.
- Vessel loop. - Yes.
- Mosquito (clamp). - Yes. [First operating room]
- Rectal Temperature? - 25 degrees. [First operating room]
- Stop the circulation when it drops to 24c. - Yes.
- Right angle. - Yes.
- Vessel loop. - Yes.
Deep hypothermic circulatory arrest for Total Arch.
It's going well here too.
Total disregard of this side. As tunnel-vision as before.
My daughter seems to be heading here,
to bring the rug she woved for her mom.
I see.
After you had left, as a gift for our co-operations,
the Professor wanted to promote us.
But, I was afraid of my daughter.
If I continued staying in that hospital,
she will never see me as a decent human being.
A 3-year old daughter, scared me more than anything else.
Thanks to my wife and daughter, I found myself again. Kuroki.
Circulation stopped.
- Let's go. Metzenbaum. - Yes.
OK. Good, Asada..
What?
- What happened? - Are you Takase-san?
- My wife? How's my wife!? - No.
It's your daughter.
- Contacted ER? - They are waiting.
- Pulse? - 110.
- Keep moving. - Yes.
- Can you hear me? - We are arriving soon.
Pulmonary embolism !?
Blood clots in the blood vessels of leg,
following the vein path, caused a block in the pulmonary artery.
This usually happens in bedridden for a long time or a post-operative patient.
There's a huge blood clot between the main pulmonary artery and right pulmonary artery.
- There's also residual thrombus in the RV. - Kuroki, is thrombus suction possible?
In this magnitude, catheter is impossible.
If not operated immediately, it will be too late.
It's impossible! We need a heart-lung machine.
Both operating rooms are occupied!
There's a pulmonary embolism patient here who needs a heart-lung machine.
how long more?
It seems like it's the daughter of this patient!
- Her daughter has pulmonary embolism? - Not possible.
This operation has just barely started.
- Please wait. - Not possible.
- We still need 2 hours. - No matter what,
heart-lung machine cannot be disconnected.
Heart-lung machine.
Any hospital would only have about two. Dammit!
Can we borrow from a nearby hospital?
Not possible. Borrowing needs 30 minutes, set up another 30 minutes.
1 hour will be too late.
What now? Kuroki-sensei!
Megumi. Megumi! Megumi! Megumi!
They can't find another heart-lung machine.
Circulation has been stopped for 5 minutes.
Bring the patient here.
Currently, Haruka-san
is under deep hypothermic circulatory arrest asphyxia condition,
temporarily detach her heart-lung machine,
create a new circuit to connect to her daughter.
But if you detach her heart-lung machine,
there will be no isolated cerebral circulation.
In 30 minutes, if you can't resume the circulation, would damage the brain..
Let's bet on this 30 minutes!
Leave the arch replacement to me.
You do the thrombectomy surgery, Ijyuuin. (TN: thrombectomy = procedure to remove a blood clot)
You want me to complete thrombectomy in 30 minutes?
Yeah.
- Can only bite the bullet. - Yes.
Really fascinating operations..
- Bring another anesthesia machine. - Yes.
Moving operating table.
Detaching the mother's heart-lung machine for her daughter?
- Yeah. - And also, thrombectomy in 30 minutes?
Asada also needs to finish distal arch and 3 aortic arch branches anastomosis in 30 minutes.
Both are impossible tasks.
Megumi! Hey! Megumi! Megumi!
Please wait here.
Heart-lung machine is prepared.
- Start countdown. - Yes.
Patient is here. Takase Megumi.
Bring her here. Immediate disinfection.
Start disinfection.
- Intern, you are the first assistant. - Yes.
- Expand the field here. - Yes.
Distal trimming completed. Start anastomosis.
- Graft. - Yes.
After thoracotomy, attach heart-lung machine. Scalpel.
VF!
- Prepare DC! - Yes!
- Cardiac massaging! - Yes.
- Charge to 200 Joules! - Yes.
Charge is ready.
No heart rate.
We can't open the chest in this way.
Find the femoral artery vein for cannulation.
- Prepare the tools. - Yes.
Due to the pulmonary artery embolism, cardiac massaging has no effect.
There's not enough time.
If heart-lung machine is not connected immediately,
patient will die.
Ijyuuin!
- Kuroki-sensei! - Continue cardiac massaging.
Femoral artery vein cannulation.
From there, insert PCPS cannulas with catheter, for heart-lung machine connection.
Leave it to me.
- Cooper. - Yes. (TN: Cooper = Catheter set)
- 18 Gauge. - Yes.
With his body shaking like that,
to perform vein cannulation..?
Shit!
OK.
- All right! - Oh!
Heart-lung machine attachment completed.
Pump-ON please.
Yes.
OK.
- I will support. - Kuroki-sensei.
There's no time, Ijyuuin.
Commencing thrombectomy surgery for pulmonary embolism.
- Scalpel. - Yes.
- Tweezer. Gauze. - Yes.
- Electric scalpel. - Yes.
Distal anastomosis completed.
Arch-first for three-branched arch anastomosis. (TN: Arch-first = total arch replacement technique)
- 3-0. - Yes.
Removing right ventricle and main pulmonary artery thrombosis. Tweezer.
- Yes. - Expanding operating field.
- Pull the thread forward a little. - Yes.
Amazing. What is this speed? Asada!
Ijyuuin's pace is fast too.
Right ventricle and main pulmonary artery thrombectomy completed.
- Next is the right pulmonary artery. Metzenbaum. - Yes.
Total arch completed. Cardiopulmonary resumption standby.
- Preparing connector. - Yes.
This is..?
It's not just the right pulmonary artery..
The embolism has spread to the left pulmonary artery.
Why !?
Circulation is stopped for more than 20 minutes.
- With this, it will take more than 30 minutes. - But,
there's not enough time to remove the embolism spread.
I'll do the right pulmonary artery thrombectomy, you do the left.
- Yes. - Directly cut the right pulmonary artery.
- Scalpel. - Yes.
Embolus causing another embolus..
There's no way. If emboli of the daughter is not fully removed,
heart-lung machine cannot be disconnected.
But if the heart-lung machine is not returned to the mother, she will be brain dead.
What will you do? Asada?
Mother or daughter, you have to choose one,
or both will die.
- Mother or.. - Daughter?
Asada.
- Asada. - Asada-sensei.
- Double circulation. - Double circulation?
Stop the sub-pump of heart-lung machine used for myocardial protection.
Then use the spare pump
as the main pump for the mother.
In this way, a single heart-lung machine can be shared for 2 people.
I see, theoretically in this way,
one unit can be shared for 2.
But no one had done it before.
Moreover, the myocardial protection function will be unavailable.
The daughter's thrombectomy will also be more difficult.
Hey hey hey, what are you saying?
Using 1 heart-lung machine for 2 person at the same time?
When you do that, everyone here,
our medical licenses will be revoked.
Are you serious, Asada-chan!
If you do that, this team...
Asada-sensei.
Still, I will do it.
But!
Double circulation
is my idea.
You guys are just following my instructions
I will take full responsibility.
Just say that you guys are forced by me.
Can we do this?
It's impossible with just an average ME, Nomura cannot come over.
I know a ME who can.
Impossible! I've not been in operating room for many years.
I know well how good your skills were.
You've had 2000 cases of cardiopulmonary bypasses, you can do it!
And... you're not alone.
In the operating room, the best team is waiting for you. Quickly!
Save them! Save your own family!
- Prepare suture holder. - Yes.
- 3-0. - Yes.
- Tweezer. - Yes.
Are you out of your mind, Kuro? If you do this,
my special medical treatment plan will be ruined.
This is a big issue. Do you understand?
Absolutely not allowed. Or else..
Go.
Save the patient infront of you, Kuroki-sensei.
- What are you saying? - GO!
You...
If you stop them now, the patient will die.
How can we accept an operation that clearly violates medical ethics?
If the public knows, it will be a big scandal for Meishin.
You are right. I am good in keeping silent.
As a return favor, please leave here.
What?
Their passion for the field far outweigh yours.
It's been a while, let us see your skills.
5 minutes left!
Please.
Can you complete in one plegia, Ijyuuin?
I'll do it.
Build another suction.
Yes. What about the O2 Blender?
- Split into two. - Yes.
Installation completed. Pump-ON.
Toyama.
There's only tricuspid left there, I'll help here.
I won't let you take all the credit.
Let's go. Next is the Bentall.
- Tweezer. - Yes.
- Metzenbaum. - Yes.
- Tricuspid valve reconstruction completed. - Start warm plegia.
Please, closing the right atrium.
- Yes. - 4-0.
- Next. - Yes.
Intern, don't idle, keep up with Asada.
Yes.
OK. Composite graft is done.
You be the first assistant.
- Volume. - Start volume.
Suction up please.
Yes, suction is up.
- Suction up here too. - Yes. Is up.
- Blood gas? - PaO2 300.
Hey, there's a sign of acidosis.
OK. Add bicarbonate.
Hot shot?
One minute before new hot shot.
Triple valve repair completed.
Pulmonary thrombectomy completed.
Bentall and Total Arch completed.
- Flow down. - Flow down.
Back up.
- All right! All right! - All right!
Your skills is incredible.
No, it's thanks to everyone, and also Kuroki. Where's Kuroki?
Kuroki!
Kuroki, pull yourself together.
It worked. The operation was successful.
Mother and daughter are both saved, Kuroki!
Is that so?
We owe it to you.
Asada.
What?
Put me inside this team too.
Please.
What are you saying? You are already part of the team.
Our comrade.
Is that so?
Yeah.
Great team.
Yeah.
If only I can join this team a little earlier..
Asada.
Thank you.
How in such a manner,
we would be losing a comrade.
After Kuroki arrived at Meishin, he ended his tumultuous last few months.
- Is this towel belonging to hospital? - Leave it there.
Hey, in the end, you didn't wear this clothing?
Sorry, it's a present from you after all.
It's OK. Please wear it at home.
- OK. - Dad, are you done?
- So slow. - I'm still packing.
- You're annoying. - Then, we are leaving.
Remember, continue your treatment at home.
- Take it easy. - I understand.
The donor has not been found.
But we will find your treatment.
If you believe, there will be hope.
- Yes. - Thank you.
This, is finally done.
Amazing.
On your next hospital visit, let's play another game.
Will you stay here after your internship?
Yeah. Maybe.. forever.
Here we go.. ready go.
- Pushing. - Mind the step.
- Slowly, slowly. - Yes.
As part of the new national development strategy,
health care is one of the main focus.
The era of internationalization of health care as an emerging industry
has arrived.
I see. Thank you.
Today's guest is
medical critic Noguchi Takeo, former President of Meishin University.
Thank you for coming despite your busy schedule.
No, no.
His character conversion speed is frightening.
Yeah.
But, the way Noguchi voluntarily resigned,
he will definitely be a director somewhere else.
What's your plan now?
With the liberalization in health care, for a University Hospital to survive,
aside from increasing profits, clinical, training and research
must be the three main pillars.
I do not think that I was wrong.
But, I won't completely take off my white coat. (TN: doctor profession)
Would you be holding the scalpel again?
Asada.
Sheesh. The new president's policy to work with Hokuyou isn't bad.
But your Kato-chan keeps ordering us around.
She's a beautiful female doctor.
- Keep quiet. - Ouch!
Hey, are you leaving?
Yeah. With you guys here, no need for me to stay.
No one is sending you off?
I told them not too.
Surgeons are busy. Goodbye.
- I'll see you. - Take care.
- 8-0 Surgipro. - Yes.
Stabilizer set.
- Harmonic. - Yes.
7th area. Head down. Right rotation.
- Sharp-point (scalpel). - Yes.
I will let you see another best team.
[Fictional events disclaimer]