What?
Come on! I don't have any hard feeling to my
So, have you learned a lot?
Body!
Where about is your house?
What happened?
Oh, she jumped from the eighth floor and seemed to break his leg.
What?
Are you okay?
Are you alright?
This is really serious hypodermic emphysema.
Nurse! Could you call a portable x-ray. Hurry!
Ok!
Hey, What on earth?
Hey you.
Who are you?
Oxygen.
What the heck! Hey you!
Oh, Doctor Kim! Wow! When did you come back?
Tension pneumothorax.
Did you call the portable?
Yes!
Bring me a tube.
Ok!
He is a respiratory surgeon.
O2 Mask!
Here, Dr. Kim.
What's going on here?
Oh, Dr. Kim, long time no see! What are you doing here?
Did Dr. Kim go home?
No, I think he is still in the hospital. Do you want me to call him?
No, it's ok.
She fell off a building and has right-fumer shaft fracture and right tension fumer thorax.
Get ready for an operation.
What?
Hey, Soo-Young...
what happened to you?
When did you come back?
Just a minute ago.
You bastard!
By the way, what's the condition of the patient?
Oh, yes. She got lots of fractures.
Go bring x-rays.
Did you clamp her before taking a photo?
It's not spreaded yet.
No, Dr. Kim has done a CTD.
Do you think I'm moron?
There was too much tension. Besides, an heart arrest was about to come.
No time for x-ray. So I just did CTD on him.
Nothing's changed
After examination, send her to a room.
Any other problems?
I just came down Any other problems?
I just came down
Dr. Lee, bring me the chart.
I didn't have time to prepare a chart.
What?
She just came in!
And yet, you want to send him up?
No way....Let's open him. Bronchi must have be ruptured.
I parked at the end over there.
I'll catch you soon.
Min-Joo Cha!
You have changed a lot! Min-Joo Cha!
You would have insisted to give me a ride even if I turned it down. Am I wrong?
Am I wrong?
What are you trying to say?
Nothing
I expected more than this...We haven't seen each other for one year
You seemed unfriendly...
Unfriendly?
Me?
Never mind.
See you later.
Should have opened him.
The patient.
I wonder if the operation was started?
OB
Chest spreader.
Oh, my! the rupture is beyond my imagination!
Dr. Kim, lost too much blood, don't you say?
Well...
As it is hard to spread, the lungs must have been torn apart a lot.
But it's better than a head injury. If it were, we would have been in a serious trouble!
Dr. Soo-Young Kim was right.
Intermediate Bronchus has been cut off completely.
Are you going to lobectomy?
I don't know...
How is the vital?
It's ok.
Well, even if I repair the bronchus, it will get even tighter......
What should I do?
So, what's you call?
Well, let's repair first.
If it doesn't go well, we should go back.
Give me some light!
Darnn! It's going to take forever!
I have something to tell you.
What is it?
Not here.
Let's go in somewhere...
I am too tired to drink liquor.
No, not liquor.
Let's have a cup of tea.....
Let's do it some other time.
I'm so tired.
What on earth are you doing now?
Aren't you going ?
Soo-Young, when you left for your study last year...
...you didn't tell me anything about it.
So?
Didn't you know that I would go away to study?
Even when you were there
do you have any idea how many times we talked on the phone?
Only 3 times!
I called you hundreds of times!
Hey! Min-Joo...
And now you were saying that I have changed a lot?
That I was being too harsh on you?
Who made me like this?
You are not in the position to say such things!
Ok. I'm sorry.
However, you are not in the position to criticize, too.
Why should I report every details of my life to you?
Do I have to?
Rittman Cariolgy! You said you wanted to have it, right?
See you tomorrow!
Hello.
Yes?
Dr. Kim!
Hello everyone! Dr. Kim!
Hello everyone!
So, how was the study? Hello everyone!
So, how was the study?
Thanks to all of you.
You did a great job. Good work. Thanks to all of you.
You did a great job. Good work.
Have a seat.
Oh, well....Who doesn't know how to do heart implants?
The problem is that there aren't enough number of donors.
But, still... A skillful doctor like you should do such high-tech surgeries to make our hospital more noticeable.
Are you confident?
Of course I am !
He said the only problem is the number of donors! Of course I am !
He said the only problem is the number of donors!
You can say that again!
Why don't you make one for, chief?
Well... Nothing I can do... Just wait.
Then opportunities will come.
So, did you come here with your brother?
No!
He seems to be sleeping due to an overnight surgery.
I left home shortly after you took off.
He is still sleeping at this time!
Dr. Lee
Yes, sir.
Good morning!
Hi.
About the patient yesterday...
Suk-Jin Oh?
Yes. We should postpone the operation date.
He has too many cavities. It will take a while to treat them all.
Well....Sure...
Are we having lunch together at noon?
Oh, ok.
Oh, by the way, Soo-Young came yesterday.
Oh, really?
He didn't even tell us that he would come.
Typical of him...
So, when is he coming to the hospital?
Oh, he already did one case...
So, I'm off a big hook here.
What do you mean? What did he do ?
Oh well...
I thank him but on the other hand I'm embarrassed as well....
I don't know... I will visit you after I finish a rotation.
So, how are you?
If you get better, we'll switch to chemotherapy. So cheer up!
Lung Cancer!
Stage 3B...T4NOO
Age?
62. Chief Joon-Ki Kim said inoperable, but it's hard to give him up....
Why inoperable?
The right of the bronchus is involved, but it's COPD.
PFT is not good. Is there any other way?
Let me see him first!
Ok! After having lunch together, we'll see him
No! I don't want lunch... You go ahead. Thank You. It was a great help. See you later.
Going now?
Oh, Dr. Kim!
Long time no see. How have you been?
Well I'm okay
By the way, what are you doing here?
Some tea?
No, it's ok. But, I heard that there is a lung cancer patient called Ki-Chul Chang here.....
Oh, him?
I saw him in chest surgery...He is one of the Dr. Cha's patient...
I know. Can I see the C.T.?
You want to see the patient?
No, I don't need to see him. Let me see the chart.
So how is PFT?
He had problem with breathing before.
Let me see his family.
Okay.
Miss Yoo, could you call family of Mr. Jang, please?
Yes! Miss Yoo, could you call family of Mr. Jang, please?
Is the female patient here?
Who? Oh, the one who had surgery yesterday? Yes, right over there.
Let me see the chart. Who? Oh, the one who had surgery yesterday? Yes, right over there.
Let me see the chart.
Oh well. The chart should be.........here.
Huh? Didn't repair it? Only lobectomy!
At the beginning, I heard that they tried to repair it but due to too much blood lose, they have cut it off.
Mr. Jang's family is waiting outside...
Hello? He is a doctor from the respiratory surgery department..
He is a doctor from the respiratory surgery department..
Respiratory surgeon..? I had met him yesterday.....
He's another one. He studied in the US for a year and came back yesterday...
So, you know what's wrong?
Oh, yes.....He knows it too...I heard that the operation is hard..
Yes, you are correct. It's not going to be easy. By just cutting, it's not easy.
But there is other way...
What?
What? Sleeve operation?
Yes. Possible ?
You know we don't have jet ventilator, right ?
A jet ventilator? No need.
Well? I know that you are a great surgeon, but the patient is not so good....
There's a COPD, so that's why I am trying to do a sleeve.
If possible, I am going to do a volume reduction operation as well.
You only have to anesthetize one lung. That's it.
I am not going to touch the other lung.
Isn't it going to be dangerous?
No, it's not.
You went to the US to learn cardio implant... Man, did you do lung surgeries there too?
There is nothing do learn.... Just do it, you know.
Well, you are just like how you were.
Well, what the heck! I will anesthetize, so Just get the permission...Ok?
Don't make any trouble..
Don't worry!
Well, the 30-year-old Valentine wasn't just a gift.
When I got it I felt like it's some kind of bribes.
Come on! Why should I give you a bribe?
It's Just that I thought of you when I bought it.
Ok! Ok. By the way, did you consult Chief. Joon-Ki Kim? It's Just that I thought of you when I bought it.
Ok! Ok. By the way, did you consult Chief. Joon-Ki Kim?
Of course! Don't worry about that!
What?
No way! Too Dangerous!
Why should I ask for anticancer drugs if it is easy to Just take off?
Why is it so hard?
No way.
I can't.
Who asks you to do it, ? I will do it.
Whoever does it, it's just too dangerous.
I don't think you can do it either, even you...
I explained thousands of times.. If we do a sleeve operation......
The pneumonic activity of that patient is worse than you think!
He can't wake up...
Don't worry! If anything goes wrong, i'll do a volume reduction, too..
Ok. According to the theory, it is possible...
...but you haven't done any of this kind!
You never know! It's not you who perform the operation surgery. It's me!! I am confident...I can do it...
Whoever does it, it doesn't matter here.
Then What's the problem?
Whatever you say, I can agree.
Fine! I'm going to do this. I'll talk the rest of this after I finish the operation.
Huh? This CD was still here?
Nurse Joo! You are so stiff. What's wrong?
Since you were away, I had no fun in OP room...
What's that?
This is his music.
Ok! Let's start.
Ok, Let's get started.
Scapel!
Body! Scapel!
Body!
Cut with Body! Suction!
Suction! Cut with Body! Suction!
Suction!
I found the journal.
Ok, thank you. Just leave it there.
What's sleeve operation?
Ok. It's operation which cut the tumor and connect the lung and other organ again....
Then, a patient like Ki-Keul Jang who has COPD can use some of those, right?
Right! But there are many side effects, and it is very hard to stabilize the connected part, so it is very difficult surgery. Not everyone can do it.
Wow! You can dance!
Going to do Ex-Tubation?
Of course! If the condition is like this, we don't even have to have artificial respiration.
Hey, easy on the bag. You are going to burst it....
Don't worry!
Thank you all.
Thank you.
Wow, Soo-Hyung, he is so great!
Yeh. I wasn't sure at the first time.... man, Hey everyone, you should be graceful that you are under his command.. Wow, Soo-Hyung, he is so great!
Yeh. I wasn't sure at the first time.... man, Hey everyone, you should be graceful that you are under his command..
How was the operation?
Yes. It was worse that I thought, but it went ok.. He is going to come out soon.
Thank you, sir. I won't forget this.!!
Thank you!
Thank God!
What?
I should drop you off, right?
You just passed it.
Really? Then why don't you have a date with me? Why, you don't want it?
Sure.
Huh? Why aren't you off?
Then What about you, chief?
Me, You know me. I'm just busy doing nothing. You have been through a lot today? Huh? You know, the patient
who got surgery from Soo-Young today....
I'm sorry, Joon-Ki!
About what?
I agreed on your opinion before, but I couldn't help to
think about it.... So, I asked Soo-Young...
It's ok. If the surgery went ok, it's fine with me.
You have been worried a lot, haven't you?
Well, I was worried alright. I trust Soo-Young, but the surgery is very hard, you know... but the result is good, so everything went ok... Frankly, I feel lucky that I couldn't convince him not to do it. I thank you, too.
Well, Would you have a dinner with me? It's on me.
Oh, well. I already have an appointment....
Really?
Thanks anyway. I don't want to go, but the President's order....so, I have be there ...
You. Where were you! You shouldn't be here. That's why Grandfather keeps reproaching you...
Why is grandfather like that?
What?
Hey, is patient some kind of goods? Why should they lobby him?
No, .... Just having a dinner and drink aren't lobby...
You know better than that...
Hey, you should go home...Ok?
I'm sorry. I think I should go..
Hey! Hey! Joon-Ki! Listen to me. I wasn't going to tell you this, but, Hey, be good to your Grandfather, consider your mother's mind... You are the first son of this family so you should have all the properties but your mom worries...you know..
Uncle!
Grandfather also told me that he should have brought Soo-Young instead of you.
Yeh! That's correct. He is better than me about this matter.
Hey! You! hey!
Did you come to club here?
Underground one?
Yes!
Yes, once. Last Christmas Eve with other people....
Really? Then What should it be? Upstairs, or Downstairs? or Downstairs then Upstairs?
Good night.
Huh! Mom.
What?
What are you doing up so late?
You are late.
Yes! Is grandfather sleeping yet?
He just came in. He had dinner with the Heart Foundation executives.
Didn't he come with brother?
I don't know. Ask yourself.
Huh! You just came?
Yes. What about Min-Uh?
He just went to sleep. Have some rest.
Joon-Ki!
You don't have to do like this? You came in early. We are not some kind of morons, we have ability to do so, that's why we want patients to stay in our hospital...
Then, You are saying that it is ok to buy patients?
Well? I don't know about that, but we are not having surgery on healthy man? They should have surgery, so we can make them better...
You are correct. You only have to surgery... so nothing matters...
Have some drink?
There's a mortality conference tomorrow.
Yes, I know!
At post-operation average over F5 of 0.6, pO2 was 65 and pCO2 was 50. There was hypoxy. On X-ray, the left pulmonal edema was found. We applied directise right away and connected a ventilator. However, the edema became aggravated. After three days of DOP, the patient was expired.
What's the cause of the edema?
I think that during the operation, too much of PO liquid was injected.
By the way, what took so long!
I opened the lower lobe which I thought tumor might have spreaded. But I was mistaken. So we did right lobectomy. Besides, edema was too severe...
So, bled too much?
Yes, a bit.
Then, why didn't you inject blood! Why did you inject water? To kill him.? My! So, he died in just three days. hat about the family?
Yes. There was no problem with that. It was hard operation.... so.
It was the stage 3, why couldn't you do a surgery?
Dr. Cha, how come there were only 1000cc of urine
even though we injected more water?
At first, there was hypervolume shock with sympathetic tone increase too much. Didn't vasoconstriction come? The patient was adenosia, there could have been hormonal impact.
Didn't you think of ECMO?
What's ECMO?
Extra Corporal Membrane Oxygenation. For heart failure or breathing malfunction, ECMO can be very useful.
Oh! Is there a such thing?
I asked for it before I went to the US. If we don't have it, we can use artificial ventilator?
Oh, really? Then why didn't you use it?
Hey, there are interns, too, so explain more! Oh, really? Then why didn't you use it?
Hey, there are interns, too, so explain more!
Yes.
It is natural that the patient would fall into hypoxy.
The theory of ECMO is very simple.
During pulmonary function paralysis, membrane oxygenerator bladder oxygeneration, into the patient systemic circulation.
Then, until pulmonary edema calms down, the patient would be safe.
Of course, in order to carry out ECMO, a skillful MD is a must.
Some hospitals showed 80% of survival rate after ECMO.
I believe that we can have better rate than that.
Min-Joo. Well...
What? What did I do?
Soo-Hyung! Did you really have to do that? What? What did I do?
Soo-Hyung! Did you really have to do that?
Come on! Forget it. He didn't mean to hurt you. Beside, he is your brother! He didn't mean to hurt you. Stop this. You are making fun of yourself. Come on. Drink it up. ...Man, if you are going to be like this, why didn't you tell him then.....?
Soo-Young. I knew that he is a better doctor than I am. I was proud of him today, having him in our hospital....
Then what's the problem?
Well, it's Just that, whenever he looks at the patient or perform a surgery, he seems to be enjoying it, like solving a quiz or something...
That worries me..
Every doctor has some of those points.... Doesn't he?
Well, you are probably right..
But Soo-Young is....
Chief!
Oh, what's up? You were looking for me..
Hey, long time on see.
I'll be damned. How are you?
Hey, Now, you look like a doctor...
Hey, what are you doing here?
Yep. I came here about 2 months ago.
Oh, really? I heard that you are in Seoul.... You should have contacted me.... you again...
Yep... Same here.
Ok! Come on in.... Dr. Cha, is there anything wrong with him?
It's not him but his wife is in the internal department.
Oh, really? Why?
Well, I knew that she was having problem with heart, but I was busy to take a look.... so..
How bad is she?
She has a PDA.
Anything else than PDA
Yes.. We performed a cardiac-ultrasound today, but we didn't find any problem... She has an appointment for CASS tomorrow..
CASS? Do we really have to do that even though there was no problem with Echo.. It's PDA...
But, You never know...
Oh, well. Just do it than.... We are not strangers...so..
What are you talking about.?
I told you before about the cardiac test....
Oh, that? By the way, Can you do the surgery?
Oh... You are calling me that I'm moron.... Can you trust me?
To tell you the truth.. I asked him to get surgery from Dr. Soo-Young Kim
Oh, so, you know that I'm here by my brother's name..
Ok! But since you are here, you should do it.. Will you do it?
Ok.. It's not a hard surgery... so, i'll do it for you....
Then when should we have it?
Ok... I'll tell you tomorrow... The test results are coming out tomorrow.
Oh! By the way?
What, Oh! By the way?
What,
Why didn't you turn down the cardiac test ?
Oh that? That's kind of hard..
These days, the cardiac-ultrasound has been improved a lot... So, if there aren't any major problem, doesn't have to do that painful test..
Ok. I thought that a hospital does every test on patient to get more money.... Well you have a conscience..
It's nothing to do with conscience. I was worried about your financial situation.
You!! By the way, are you still alone?
Yep.. So, your children have been grown up a lot,?
4yrs, 2yrs. So did you son get into school?
No. Next year.
What was the name again?
Min-Woo
Right! Min-U, Min-U, Min-U
But, you should get marry soon for your son.. They need a mom... How long will you leave him with your mom.? Beside, after they get into school......
What are we eating?
Huh? Let's go.
What's up? You are eating alone?
Last day....
Enough! Just eat..
Sorry. Since Joon-Ki is not around,,, I'm kind of upset..
Don't worry. Never mind that. Eat.
Do you know Prosecutor Young-Seop Lee.?
Young-Soep Lee?
A friend of Joon-Ki.. He used to live in Joon-Ki's house........
Oh, I know him..well. But how do you know him?
well, his wife Just came in internal treatment department, but she has PDA.
Really?
I was going to introduce him to you, but when he heard about you, he asked for Dr. Joon-Ki...
How is CASS data?
No, We didn't do that.
Why?
Echo is fine,,, moreover, there are allergy, so he said he is just going to do it.
Who! My Brother?
Hey,
You're going so quick?
Oh, yes. You are not off yet... Well, if you don't have any company why don't you join me for a drink?
Why, is there anything you want to talk about?
No, Just want to drink with you..
Well then.. I have 2 appointments tonight....
Ok!
Why don't you make a date..?
Ok!
But!
What? But!
What?
So, I Just heard that Young-Soep's wife Just came in...
Yes.. PDA.
Do it without CASS?
There are no problems with Echo,, so...
I have no surgery schedule tomorrow... Can I go in too?
No, you don't have to... It's only PDA ligation.
Really, See you tomorrow anyway..
Ok! Soo-Young. Don't drink too much..
Ready.
Ok. let's start..
Dr. Kim!!
Give me a gown...!
Scalpel!
Dr. woo wait outside
Okay. Dr. woo wait outside
Okay.
Come on... let the kids do the opening.?
Late comers should keep quiet here.
I'm sorry. Give me a cloth. Hey, so you guys are singing since you don't have many patients.
Hell, no.
So how many thesis did you write?
Yes, I've already finished one and am preparing one....
Come on! You are a 2nd year and yet wrote only 2 theses? Man! Be careful... I have my eyes on you...
Mosquito Come on! You are a 2nd year and yet wrote only 2 theses? Man! Be careful... I have my eyes on you...
Mosquito
Tie!
Tie? No need! Give me a goby!
Goby Tie? No need! Give me a goby!
Goby
Well, she does have nice skin considering her age... huh? Come on... Just joking... Ok.. let's hurry up..
Hey, what's up with you guys.? Two brothers performing surgery together?
Hey, what is an internal doctor doing here?
How is it going?
We didn't even open it yet
Spreader!
Spreader here.
Hey, Nurse Joo. You should give it to him as closed. man, do I have to tell you everytime?
Hey, get out... I can't stand it any more.
What's this? This is an operation room!! If you want a fight... do it after this....
Nurse. Do you have an aorta-Clamp.?
No, I will get it..
No, don't need it.
Why,? What if it burst? Get it!
I said it's ok..
It should have been ready...! Give me some umbricle tape
Are you going to do it? or me?
No, I don't know for sure, so let's connect it under the duct.
You or Me? No, I don't know for sure, so let's connect it under the duct.
You or Me?
Ok, Ok. I will go out..'
Forcep!
Call Dr. Woo
Right tingle
Call Dr. Woo now!!
Connect here. Call Dr. Woo now!!
Connect here.
Yes..
Call Dr. Woo now!!!!
Get him now.
Suction! suction! Lift! lift! Take it out! Clamp!
Aorta clamp
Dr. Woo
Please call Dr. Woo. please..
Dr. Cha what is going on? What's going on here?
Do it correctly...! Give me some blood
here!
Can you control the bleeding?
The bleeding site is behind the aorta. Wait, wait. I can get it...I got it.
Dr. Kim, do some massage...So little volume. How much is left?
2000cc left..?
Go, and bring some more!
Yes.
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