The problem with patient Ahn Jeong-mi was identified.
Left Temporal refers to the left temporal lobe of the brain.
AVM is arteriovenous malformation.
In other words, it means a large arteriovenous malformation is seen in the left side of the patient’s head.
In the left temporal lobe, there is the Wernicke’s area, which governs language-related functions, and right now the malformed blood vessels are pressing on it.
“So that was why the language impairment occurred.”
Park Seok-hun’s expression hardened.
“And the level of malformation is more serious than I thought for removal.”
Yeom Dong-gu, who had been observing the monitor beside him, also nodded.
The problematic part of this patient’s blood vessels was not stretched out straight like normal arteries and veins, but twisted like a tangled knot.
And it was a full five centimeters in size.
Five centimeters—isn’t that small, you ask?
Imagine there is a mass larger than an eyeball inside the side of the head.
That mass, which should not originally be there, is pressing down on and compressing the soft brain.
And what if that mass is made of blood vessels twisted and tangled together?
Isn’t it dizzying?
Because the blood vessels are twisted like a clump of hair, the blood flow cannot flow naturally.
Then the blood vessels in the twisted part become blocked, twisted, and weakened, and at some moment—bang!—they might burst.
At that time, not only language ability but even life is in danger.
That is the future of this patient, which may come at any time.
It could be hours later, or weeks, or months later.
“It’s amazing it didn’t burst while growing to this size.”
“It’s large, but this is the first time I’ve seen arteries this severely twisted. It’s truly a miracle the patient is alive.”
The reason such malformed blood vessels form has not yet been clearly elucidated.
It could be a genetic factor, or it could be because the blood vessels grew in the wrong direction.
What is certain is only the fact that such malformed blood vessels settle in the brain and will certainly cause intracerebral hemorrhage someday.
Though no one knows when.
So you can think of it as a kind of time bomb that may explode at any time.
And it is a time bomb attached to the brain, the body’s most important main processor, CPU, and control tower.
“The problem is how to deal with this tangle.”
Park Seok-hun pondered carefully.
There are several methods.
The first is to open the skull with a craniotomy and remove the malformed part of the blood vessels.
The second is to block the problematic part with embolization.
The third is radiation therapy.
These three are representative.
Park Seok-hun asked Yeom Dong-gu.
“What do you think, Dr. Yeom Dong-gu?”
“Wouldn’t it be difficult to proceed with a craniotomy?”
“Why?”
“Because the location is right next to Wernicke’s area, so if we accidentally touch it wrong, the patient’s language ability could be impaired.”
“That possibility is quite sufficient. Good point.”
Right now, the patient’s malformed vascular mass is tightly wedged between the meninges of the temporal lobe and the brain.
If, while cutting out the malformed blood vessels, we touch Wernicke’s area, the region mainly responsible for language comprehension?
Language ability could be permanently damaged.
Fortunately, even if the patient does not lose language ability, they might fluently spout words whose meaning is not connected, or give completely irrelevant answers unrelated to the context of the conversation.
In short, a serious problem in communication occurs.
This is exactly why treating the brain is difficult.
If you touch it wrong, the patient’s life is ruined.
And severely so.
Park Seok-hun asked again.
“What about radiation?”
“Radiation itself carries the risk of exposure, and for the irradiated blood vessels to completely close with radiation would take about two or three years, but there is no guarantee that the blood vessels will endure without bursting during that period.”
“Right. Radiation therapy is not an appropriate answer right now either. Your thoughts are similar to mine.”
Park Seok-hun nodded carefully.
‘Considering the patient’s safety, embolization is the only option after all.’
It was a method befitting Park Seok-hun’s safety-oriented personality.
In fact, he had already concluded on embolization and had asked the junior doctor’s opinion to add confidence to that conclusion.
Yeom Dong-gu, who was helping with the shortage of hands as a pay doctor, was also thinking the same thing.
When it came to safety, there was nothing better than embolization right now.
— Do no harm to the patient.
It is a passage from the Hippocratic Oath.
Park Seok-hun always kept those words engraved in his heart. Because the brain and spine that neurosurgery deals with are especially dangerous areas for patients.
He affirmed to Yeom Dong-gu.
“We’ll treat this patient with embolization.”
“Are you sure we don’t need to transfer her to a large hospital?”
“It’s not right to send a patient who was transferred here to yet another hospital.”
“The machines are old, so the radiation exposure is high and the resolution is low.”
“…….”
Park Seok-hun was silent for a moment.
It was a fact he could not bring himself to refute.
“The situation is poor, but let’s still do our best.”
Suddenly, Choi Moo-gyeol came to mind.
If it were that guy, he would probably manage well even with shabby equipment.
* * *
Embolization is certainly a procedure, but it is heavy to call a procedure and light to call surgery.
It is a treatment method somewhere in the middle ground.
You can think of it as a method that uses embolic material to block the blood flow of malformed blood vessels, thereby blocking or stopping the incorrect flow of blood.
The main surgeon was Park Seok-hun, and the first assistant was Yeom Dong-gu.
Due to Daon General Hospital’s staffing situation, there was no second assistant to assist further.
They brought the old mobile C-arm machine into the operating room and finished preparations for cerebral vascular embolization.
“Anesthesia is finished. Vitals are stable.”
The patient entered general anesthesia.
“Scalpel.”
Park Seok-hun, receiving the scalpel from the nurse, made an incision about 2 cm long in the groin area, slightly below the spot opened during the angiography, and found the femoral artery.
“Inserting the sheath into the CFV.”
Among the blood vessels revealed between the incision, he found the CFV (femoral artery).
After Park Seok-hun skillfully inserted the sheath to secure the entry site.
“Catheter going in.”
He pushed in a catheter only as thick as a couple of strands of hair.
On the monitor, the patient’s blood vessels appeared as an image.
It was noisy and low-resolution, making it a bit difficult, but the catheter controlled by Park Seok-hun finally arrived at its destination after a long journey from the groin to the brain along the femoral artery.
“Huh?”
Park Seok-hun muttered.
“What’s wrong?”
“It has a dangerous structure.”
“Intranidal aneurysm……!”
Yeom Dong-gu’s eyes lingered on the screen.
Ahn Jeong-mi’s malformed blood vessels had another aneurysm inside.
“I’ll move while being as careful as possible about rupture.”
“Yes, Doctor.”
Park Seok-hun carefully inserted a stent.
It serves to support the blood vessels so they do not collapse.
Next, he pushed a coil toward the malformed blood vessels.
It is what actually occludes the malformed blood vessels.
Because a thread-like two-dimensional coil must fill a three-dimensional space, it is a task that takes quite a long time.
He had to pay meticulous attention without gaps from front, back, side, top, and bottom, in all directions.
Thick drops of sweat fell beneath Park Seok-hun’s surgical gown.
The patient’s malformed blood vessels extended so widely, and because of the low quality of the 3D images caused by the old machine, occlusion was especially difficult.
* * *
It was a difficult procedure, but it ended safely.
Ahn Jeong-mi recovered well.
“Take your medicine well, and let’s see each other in a month.”
“Thank you so much. I lived thanks to you, Doctor.”
She returned home smiling.
However, not long after, that patient came to the hospital again due to severe headache.
When Park Seok-hun faced the patient again, she immediately challenged him.
“Didn’t the procedure go well?”
“Did the headache come back?”
“Yes, and people around me say there are times when I can’t understand what they’re saying?”
‘Did the peripheral part burst?’
“……Let’s do an angiography again.”
It was a malformed blood vessel with a structure that could burst in another area even if the problematic site was well blocked with a coil.
Park Seok-hun performed angiography once again.
And the shocking fact he discovered.
‘The blood flow pattern changed……!’
As part of the blood vessels became blocked, the flow of blood changed.
The embolization certainly succeeded, but a new problem had arisen.
‘Then surgery is needed, but if we touch it carelessly, it will be a disaster. It’s too much for our hospital.’
After finishing the angiography, Park Seok-hun said to the patient Ahn Jeong-mi.
“……If you wish, I will transfer you to another hospital.”
“Please do that.”
Park Seok-hun sent the images to nearby large hospitals and made phone calls to check whether there was a hospital that could accept the transfer.
Hospital A’s reply.
—The waiting list is backed up by six months right now. It will be difficult to move up the order.
Hospital B’s reply.
—The earliest first consultation is four months away.
Hospital C’s reply.
—Because it’s a high-grade AVM, a multidisciplinary decision will be needed after outpatient evaluation. You will have to wait at least three months.
No matter how many places he called, there was no hospital that would actually accept her. In the end, Park Seok-hun had to tell the patient difficult news.
“What should we do? They say you have to wait at least three months……”
“It could go wrong within three months, right?”
“No one can guarantee when the blood vessels will burst.”
“Then I need to receive treatment as soon as possible. Is there really no hospital that can accept me?”
Ahn Jeong-mi asked anxiously.
“I will look for more hospitals.”
That was all Park Seok-hun could say.
After the patient left, Park Seok-hun and Yeom Dong-gu of Daon General Hospital’s neurosurgery department put their heads together and began to agonize.
“How about trying the surgery at our hospital at least?”
“At our hospital?”
“Even if the facilities are a bit shabby, surgery isn’t impossible.”
Yeom Dong-gu’s opinion was to perform even a craniotomy at Daon General Hospital, but due to Park Seok-hun’s cautious personality, it was hard to accept.
“A surgical approach is dangerous when we haven’t precisely identified the cause of the recurrence. And if we remove the blood vessels without properly equipped devices, the probability of damaging the patient’s language ability is too high. Is it really right to choose a method that could make the patient mute?”
Park Seok-hun had no confidence.
Confidence that he could cut out only the malformed arteriovenous vessels without causing any damage to the patient’s Wernicke’s area.
Suddenly, one person’s face came to mind.
‘If it were that guy, he might be able to perform this surgery well.’
That guy was none other than Choi Moo-gyeol.
Because he was a human who had become deeply accustomed to opening people’s skulls since his days at Hankook University Hospital.
‘Could we recruit Moo-gyeol to our hospital?’
Park Seok-hun wanted to entrust this patient to Choi Moo-gyeol.
‘If it’s that monster, he could certainly treat even this patient. If only he would come, it would help our department’s operation much more……’
Right now, there are only two doctors in the entire neurosurgery department. Park Seok-hun himself, the head of neurosurgery, and the pay doctor Yeom Dong-gu—that was everyone.
So sometimes the title of department head feels ridiculous. What kind of department head is there when there are only two people?
In this state, if one of the two is not at the hospital on a given day, surgery is completely impossible.
The machines and equipment are aging, and some are handled by outsourcing, so even high-difficulty surgery is not easy.
Even if he had managed to lead things somehow with Park Seok-hun’s ability for the past few years, they could not continue like this forever.
‘If Choi Moo-gyeol comes, and we change some equipment and reinforce manpower……’
Daon General Hospital’s neurosurgery department also needed change.
“Good, I’ve made up my mind.”
Park Seok-hun took something from the drawer and suddenly stood up from his seat.
“Pardon? What decision?”
Yeom Dong-gu asked.
“I’m going to the director’s office for a bit.”
“Ah…… yes.”
‘What is he suddenly going to talk about?’
Leaving Yeom Dong-gu curious, Park Seok-hun went up to the hospital director’s office.
