Tokyo, 1994, starting with medical training

Chapter 18 Second Assistant

The question posed by Imagawa Ori is a routine procedure for senior physicians to assess the thought process of junior physicians before surgery.

Takikawa Takuhei pushed up his glasses and stared at the film for a long time.

His lips twitched a few times, as if he were organizing his thoughts, but in the end he could only stammer, "This... the joint surface is severely shattered, it needs... open reduction and internal fixation with a plate..."

His answer was vague, and he clearly hadn't come up with a complete solution.

Although he thought about it very seriously, his mind seemed to be a bit blank. After thinking for a while, he could only come up with the answer from the textbook.

But even a medical student could give this answer.

Imagawa Ori gave him a disapproving look: "Specifically? Entry path selection, reset order, fixed strategy?"

Takikawa Takumi looked troubled: "Approach... uh, we can use the conventional combined anteromedial and anterolateral approach... reduction, let's start with the larger bone fragments..."

As he spoke, his voice grew softer and softer, and his eyes began to dart away.

"Then……"

Then he couldn't continue.

Conventional approaches are insufficient for such complex comminuted fractures, especially when it comes to dealing with collapsed joint surfaces; he had absolutely no clear idea of ​​how to handle them.

The air in the clinic seemed to have stopped flowing, and Takikawa Takuhei even felt a little short of breath.

Kiryu Kazusuke stood to the side, his heart completely unmoved.

The "palm-side prying and back-side support" solution he proposed backstage yesterday is the optimal solution to the current predicament.

He really wanted to speak up and repeat that perfect plan again.

But seeing Imagawa Ori's increasingly impatient expression, he swallowed his words.

"I see."

Imagawa Ori frowned, interrupting Takikawa Takuhei's stammering.

I recalled the surgical plan that Kiryu Kazusuke had mentioned last night; it was clear in its approach and simple to implement.

The difference between the two is immediately apparent.

But she didn't say much, she just turned off the light box, took out the X-ray film, and put it back in the file folder.

"Dr. Imagawa..."

Kiryu Kazusuke was about to speak to her to confirm that he would be her first assistant.

But the pager on Imagawa Ori's waist rang.

She glanced down and said, "I have other patients to see, so I'll stop here for now."

After saying that, she quickly left the clinic.

They didn't even give Kiryu Kazusuke a chance to finish speaking.

"Let's get ready to go to the operating table too."

Takikawa Takuhei came over and patted Kiryu Kazusuke on the shoulder. Although he couldn't answer Imagawa Ori's question, he didn't seem to mind too much.

……

Nine o'clock in the morning.

Kiryu Kazusuke and the nurses handed over Suzuki Shinya's medical records, imaging data, and preoperative preparations.

Then, together with Takikawa Takuhei, they wheeled the patient out of the ward.

Upon entering the operating room area, a strong smell of disinfectant fills the air. White information boards hanging in the corridor display the schedule for all operating rooms for the day in black marker.

Kiryu Kazusuke stopped and took a look.

[Surgery Name: Open Reduction and Internal Fixation (ORIF) for Distal Radius Comminuted Fracture]

[Patient name: Nobuya Suzuki]

[Chief Surgeon: Imagawa Ori]

[First Assistant: Takikawa Takuhei]

[Second Assistant: Kiryu Kazusuke]

what?

Or is he a second assistant?

This arrangement caught Kiryu Kazuya off guard, but he had already obtained the "surgical incision suturing technique," which meant that Imagawa Ori had agreed to let him be Ichisuke.

So what's going on now?

"Kiryu-kun?"

Takikawa Takuhei, who was standing nearby, seemed to notice his unusual behavior and asked a question.

"It's nothing."

Kiryu Kazusuke took a deep breath, suppressing his surging emotions.

Now is not the time for an attack.

Takikawa Takuhei followed his gaze and saw that he was looking at the surgical staff arrangement, so he naturally assumed that he didn't have much confidence in this complicated surgery.

"Dr. Imagawa is the lead surgeon for this operation, I am the first assistant, and you are just the second assistant. Watch carefully and learn from the sidelines."

"You don't need to worry too much, just make sure you're on the hook."

So he patted Kiryu Kazusuke on the shoulder and offered a word of comfort.

Kiryu Kazusuke knew that he had misunderstood something, but he didn't explain further.

The two nurses carefully wheeled the patient into operating room number three and completed the final handover with the circulating nurse and anesthesiologist.

In front of the sink.

The cold water washed over Kiryu Kazusuke's arms as he scrubbed his hands, forearms, and up to three inches above his elbows with a disinfectant brush over and over again.

Imagawa Ori is Imagawa Ori, and the patient is the patient. Whether he is the first assistant or not, this is still an operation.

Medical ethics were his last line of defense.

After washing his hands, he went into the operating room, put on a sterile surgical gown and sterile gloves.

The circulating nurse fastened the straps behind him.

He took the iodine gauze ball handed to him by the nurse and began to disinfect the patient, drape the wound, and apply the surgical film.

It was almost ten o'clock.

Beside the operating table.

Takikawa Takuhei served as the first assistant, standing to the opposite side of the main surgeon's position, while Kiryu Kazusuke served as the second assistant, standing to the right of the main surgeon's position.

The scrub nurse had neatly arranged all the surgical instruments on the instrument table, and the circulating nurse made a final check of the patient's information and the surgical site.

Everything is ready, just waiting for the surgeon.

A few minutes later, the operating room door slid open, and Imagawa Ori walked in.

She had already washed and disinfected her hands, and with her arms raised in front of her chest, the circulating nurse immediately stepped forward to help her put on a sterile surgical gown and sterile gloves.

She walked to the surgeon's position, stood still, and looked around at everyone.

"Let's begin."

Imagawa Ori's voice came through the mask, sounding muffled.

"Scalpel".

She held out her hand, and the scrub nurse immediately slapped a scalpel into her palm.

A clean, crisp cut ripped open the skin.

Imagawa's craftsmanship is indeed impeccable.

Her anatomical structure was clear, and her movements were quick, precise, and ruthless, with almost no unnecessary actions.

The electrosurgical knife made a "buzzing" sound in her hand, separating tissues and coagulating blood vessels wherever it went, keeping the amount of bleeding to a minimum.

She then cut open the subcutaneous tissue to expose the deep fascia.

Takikawa Takuhei, as the first assistant, was responsible for the retractor and suction device. His task was to expose a clear surgical field for Imagawa Ori.

His performance was fairly average, without any major mistakes.

Kiryu Kazusuke stood in the position of the second assistant. His job was simpler, mainly supporting the limbs and occasionally handing over gauze, like an outsider.

The surgery proceeded smoothly.

Imagawa Ori separated the muscles step by step, exposing the periosteum and revealing the shattered distal radius.

The situation was just as bad as the CT 3D reconstruction showed; the joint surface was shattered into more than a dozen pieces, like a piece of broken porcelain.

Reconstructing such joint surfaces is akin to playing an extremely complex 3D jigsaw puzzle within a small space.

After the hematoma and embedded soft tissue at the fracture ends were removed.

"Kirschner wire, 1.2 mm." Imagawa Ori put down the electrosurgical unit. "Prepare for temporary fixation."

The scrub nurse handed a slender steel needle and a hand-cranked drill to her first assistant, Takikawa Takuhei.

This is one of the most crucial steps in the surgery.

Kirschner wires are needed to temporarily fix the main fracture fragments in their reduced positions, creating conditions for subsequent plate and screw fixation.

Takikawa Takuhei took a deep breath and took the equipment.

Following the instructions in the textbook from memory, he found the insertion point of the Kirschner wire at the radial styloid process and placed the tip of the Kirschner wire against the bone surface.

"Wrong angle."

Imagawa Ori gave a cold reminder.

Takikawa Takuhei was taken aback, then quickly adjusted the angle of the needle insertion and began to turn the handle of the hand drill, and the Kirschner wire slowly drilled into the bone.

However, his touch was terrible, and his strength was uneven.

Suddenly, there was a soft "click".

The tip of the Kirschner wire slipped and failed to hold the target bone block in place. Instead, it grazed the edge of the bone block and drilled into the adjacent soft tissue.

First attempt, failed.

(End of this chapter)