[Medical Human Story - No. 56] -The Breath of Life: A Record of Crimson Resuscitation(2)

 

 Between the Cold Scalpel and the Burning Heart—The Warning of Emphysematous Pyelonephritis

 

[Part II: A Choice on the Precipice] Between the Cold Metrics and the Burning Pulse

 

The Great Wall of the "System"

The air in the ER hung heavy, as if frozen in time. The word "responsibility," left behind by Chief Park, pierced my heart more sharply than any cold scalpel.

I stood at the station, staring blankly at the patient’s vital signs flickering on the monitor. Her blood pressure read 72/46 mmHg. Despite pushing fluids at a "full drop" and escalating vasopressors to their near-maximum dosage, the numbers refused to defy the laws of gravity.

"Dr. Alice, Professor Kim from Urology says they can't open the OR right now. They want Internal Medicine to 'stabilize' her first. Anesthesia is also in an uproar, saying it’s impossible to even induce anesthesia with a blood pressure this low".

I bit my lip at the intern’s report. A hospital is like a massive machine; if a single cog falls out of alignment, the entire mechanism grinds to a halt.

But inside this patient’s body, demons—E. coli—were devouring glucose, multiplying a thousandfold with every passing second. The carbon dioxide and hydrogen gas they exhaled were bloating her kidney and compressing the renal vein, severing the lifeline of blood flow. Waiting for "stabilization" while harboring a rotting organ was no different from watching a burning fuse and waiting for the bomb to cool down.

The Crossroads of Ethics and Reality

I knocked on Chief Park’s door once more. He was already donning his coat, appearing ready to head home for the day.

"Chief, you have to persuade Urology. There isn't even time to transfer her. If we let go now, she will spiral into multi-organ failure within three hours".

Chief Park turned his head slowly to look at me. His eyes were like a deep swamp, their depths unreadable. He emphasized that a hospital is an organization that must survive, questioning whether the entire staff should risk everything for a patient whose condition deteriorated due to her own negligence. He voiced the very real fears of public condemnation and lawsuits should she die during the procedure.

"A patient’s fault is no reason to abandon their life! " I countered. "A doctor is not a judge presiding over a patient’s morality, are we? We are simply the people who keep them breathing".

A heavy silence filled the room after my protest. I laid the CT scan results on his desk—a map of a kidney that looked as though it had been charred black. It was the undeniable evidence of a human being's agony.

"I will take full responsibility. I will draft everything—from the surgical consent forms to the final reports and even the legal justifications for any contingency. Chief, I just need your 'permission'".

Chief Park stared at the CT image for a long time before finally picking up the receiver with an irritated gesture. He called Professor Kim in Urology and directed him to proceed with the surgery, stating that Internal Medicine would bear all responsibility. Hanging up, he shot me a cold glare, warning me to remember that what I had just begged for might not be the patient's life, but the guillotine for my career as a doctor.

The Consent Form of Destiny

Returning to the ER, I found the patient’s son. He was huddled in a waiting room chair, trembling.

In a voice that was as calm as it was firm, I explained the risks. I told him the truth: that even with surgery, the probability of her passing was very high—but without it, death was certain. I asked him to allow us this 'one final gamble'.

His hand shook violently as he gripped the pen to sign. Tears fell onto the paper, blurring the words "Surgical Consent Form". To me, those tears felt heavier than any medal of honor in the world—they were the weight of a life placed in my hands.

To be continued!

https://medicalhumanstory.blogspot.com/2026/03/medical-human-story-no-56-breath-of_0239424313.html

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