Saijô no Meii
My Own Rule
-> RTS Page for Saijô no Meii 33
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Chapter 33: My Own Rule
Mikoto: Chest cut complete.
Box: To be honest, I'm not completely confident of what I'm doing.
Box: The procedure for complete transposition of the great arteries is not that simple...
*Complete transposition of the great arteries: An operation to correct the positions of the two major arteries. Mikoto had the same illness in the past.
Mikoto: Cutting the pericardium.
Box: And since I'm currently ill myself, I'm not at my best operating condition.
Mikoto: Removing the pericardium.
Box: But even so...
Mikoto(thought): I will never give up on saving someone.
Mikoto: I will now begin the installation of the artificial heart-lung apparatus.
Box: Yes, ever since that day more than ten years ago---
So Shindou-sensei, you're saying you've operated while drunk before?
Shindou: Yep, I have.
Shindou: Even doctors are humans, so when we're completely off-duty, we do drink you know.
Shindou: It's just that I was unlucky that day, and there were many patients with serious illnesses.
Shindou: So they had no choice but to call on me even though I was off work...
Shindou: And that's all it was.
Mikoto: Th-that's all, you say...
Mikoto: That's the worst! I was mistaken about you, Shindou-sensei!
Shindou: Hey now.
Shindou: So are you saying it would have been better if I just let the patient die?
Shindou: Of course, it would have been easy to turn down the request by saying that I have been drinking.
Shindou: However, when I'm the only one who could save the person...
Shindou: If I give up for a reason like that, then I shouldn't be a doctor.
Shindou: And that's why there is no medical practice law that says "a surgeon cannot operate while intoxicated".
Mikoto: B-but, what if the patient dies from malpractice because of that...
Shindou: who knows.
Shindou: I don't know until that happens...but for me...
Shindou: It's better to kill someone than to let someone die.
Mikoto: That's so messed up!
Shindou: Yeah, it's messed up.
Shindou: When it comes to work that involves dealing with people's lives.
Shindou: Listen up, Mikoto.
Shindou: If you are really serious about becoming a doctor, then you have to clearly define your own rules.
Shindou: Beyond saving people's lives, no one can decide what's good and what's evil.
Mikoto: Installation of artificial heart-lung apparatus complete.
Mikoto: Clamp the aorta using forceps, and inject cardioplegic solution to cause a cardia arrest.
Sadame: ...Nicely done.
Sadame: If I hadn't known about it beforehand...I would not have believed this to be the working speed of someone who's currently ill.
Mikoto: Not at all.
Mikoto: Associate director, you are amazing yourself to have so much blanks between each step.
Sadame: Oh, why thank you.
Maria: B-both of them are so amazing.
Sakamoto: This is out of the ordinary.
Sakamoto: Even though Mikoto is ill, he's not any different from usual, and even the associate director is following him precisely as the first assistant.
Sakamoto: The slowest one is me, the second assistant with no major responsiblities.
Maria: That's somehow so sad.
Sakamoto: Like you can say anything!
Text: You're not helping at all!
Mikoto: Cardiac arrest successful. Now I will proceed to sever the aorta that was clamped earlier.
Diagram: Aorta, Severing the arota/Coronary arteries, Cut away the coronary arteries in button shapes/Pulmonary artery, sever the pulmonary artery
Mikoto: After severing the aorta, cut away the coronary arteries while leaving button-shaped edges, and then sever the pulmonary artery.
Mikoto: Severing the aorta, cutting the coronary arteries, and severing the pulmonary artery complete.
Mikoto: Next, switch places of the two arteries, and perform anastomosis on the aorta.
Mikoto: Aorta anastomosis is complete.
Sadame(thought): S-something is strange.
Sadame: Please wait a moment, Saijou-sensei.
Sadame: In this procedure, before correcting the positions of the great arteries, it's common to practice to first attach the coronary arteries...
Diagram: A heart with complete transposition of the great arteries -> Cut each of the arteries -> First reconnect the coronary arteries to the opposite side, and then switch the position of the great arteries. -> Reconnect the arteries -> Operation complete
Sadame: If you were to reconnect the aorta first, you would have to open up some holes when you reconnect the coronary arteries, so it's more troublesome.
The normal way/Make small openings and connect the coronary arteries./Connect the coronary arteries first.
Mikoto's way/The coronary arteries can't be connected unless holes are made./Connect the aorta first.
Mikoto: Yes, there's that too...
Mikoto: But there is my own rule.
Mikoto: Now then, please remove the clamp on the aorta.
Sadame: Wha-what are you saying, Saijou-sensei.
Sadame: Right now, the heart is stopped, and the artificial heart-lung apparatus is sending blood to the entire body from the aorta... If we were to remove the clamp, then the blood will flow to the heart valve.
Diagram(starting from the heart):
Heart/Blood flowing out/Artificial heart-lung apparatus/Blood flowing in/To the rest of the body/Clamp
Heart/Blood flowing out/Artificial heart-lung apparatus/Blood flowing in/To the rest of the body/Release the clamp/Blood flows to the heart valve/*Because of the valve, blood can't enter the heart itself.
Sadame: If blood were to flow, then it will seep out of where we just performed the anastomosis to say in the least...
Diagram: Blood flowing in/Blood/Blood flowing in/Blood/Blood seeps out of the seams.
Sadame: And if we were to make holes somewhere in the aorta later on in order to connect the coronary arteries, then there should be hemorrhage...
Diagram: If holes were made -> Hemorrhage
Mikoto: There is no need to wory.
Mikoto: The clamp will be reapplied before I open up the holes.
Sadame(thought): Then...then for what purpose...?
Sadame: ...P, please excuse my rudeness, Saijou-sensei...
Sadame: But you are sure that your correct state of mind isn't altered by medications?
What are you saying, associate director.
Mikoto: Medications for the heart have no such side-effects.
Sadame: Is...is that so.
Sadame(thought): Oh, oh well...
Sadame(thought): It may be so for other people, but for him, there must be a reason for it...
Sadame: I-in that case, I will remove the clamp.
Sadame: Th-this is unexpected.
Sadame: Even though the aorta is expanding, virtually no blood is coming out of the seams.
Mikoto: Well, that's the case if the anastomosis is done well.
Mikoto: Now then...
Sadame(thought): J-just what is he thinking?
Sadame(thought): Don't tell me...he just wanted to show off the fact that he can do anastomosis well, and that blood won't seep out even if it flows through?
Mikoto: And now we will determine the locations in which the coronary arteries will be connected.
Mikoto: Using the tip of a hypothermic perfusion apparatus, inject cardioplegic solution. Make the coronary artery swell...
Mikoto: And while both the aorta and the coronary arteries are swelling, determine the locations in which they are to be connected.
Diagram: Search -> Determine!!
Sakamoto: Wh-what's going on?
Sadame: ...I see! So that's what it's about!
Sakamoto: I have absolutely no idea...
Sadame: Sakamoto-sensei, how will you determine the locations in which to attach the coronary arteries?
Sakamoto: We-well, I don't specialize in this area, so I don't really know...
Sakamoto: But I guess I'll just go by feel and pick somewhere that will give the least amount of strain to the aorta.
Sakamoto: For this child, the coronary arteries looks kind of like this from directly above, so probably something like this.
Diagram: This child's coronary arteries/Pulmonary artery/Aorta -> Completion
*Looking from directly above, the aorta is more to the front, so it's slanted.
Sakamoto: Depending on the person, there are unlimited number of ways to do it...
Diagram: The locations in medical books
Sakamoto: And in the medical books, they are shown in this easy-to-understand way...
Sakamoto: But in this case, they should be positioned as such.
Diagram: The locations of this child
Sadame: Well done.
Sadame: However, even if you correctly imagine everything like in the diagram, the coronary arteries in actuality are only 1mm in thickness... The slightest misplacement will cause them to be folded or clogged up...
Correct way of connecting
Mistake while connecting (1)/Bend it too much and it will fold.
Mistake while connecting (2)/Pull it too much and it will become thinner.
Sadame: Even if there are no problems in the short run, in 20, 30 years... The patient may potentially run into problems like what Saijou-sensei is experiencing right now.
Sakamoto: Th-that's true...but there isn't any way of making it perfect that will last into the future...
Sadame: That's why Saijou-sensei is using that method of his.
Sadame: Usually, when coronary arteries are to be connected, both the pulmonary artery and aorta are already cut.
Sadame: In other words, unlike in the diagram, the arteries are limp from without actually having blooding flowing through them.
Sadame: While the vessels are normally swollen with blood flow, if you determine the locations in that limp state, there will for sure be slight miscalculations...
Sakamoto: I, I see!
Sakamoto: Like Mikoto has done, if both the aorta and the coronary arteries are expanded, then they look exactly like how they would normally! That way, he can know for sure!
Sadame: That is correct.
Sadame: And then, as long as he determines the correct locations, the clamp can be reapplied and the procedure can continue on without without too much blood loss...
Sadame: This is the perfect technique.
Sadame: Seriously...how in the world...
Sadame: Do you always think of such terrifying ways of doing things?
Mikoto: Haha, no way... It's not as big of a deal as you make it sound.
Mikoto: All I do is to make simple rules of my own.
Box: Yes, at that time...
Box: I decided on my own rule.
Mikoto: Alright then, I'll make rules that won't lose to yours, Shindou-sensei~~
Shindou: Hahaha, can you really do that?
Mikoto: I definitely can!
Mikoto: I also think it's better to kill than to let someone die, but that's not all.
Shindou: Then, what is it?
Mikoto: Um--- That is...
I'm operating on a child.
But I'm also operating for the future in 20, 30 years, and not just the present.
I have decided on it... That is all.