Chapter 122: A Test of Surgical Prowess

“You two could be more confident. Your diagnosis is spot on—the patient has a ruptured extensor tendon. As for the early-stage rheumatoid arthritis you mentioned, you can see distinct signs of synovitis and only minor cartilage damage. Can anyone propose a treatment plan?”

Dr. Shan had already gauged the diagnostic skills of these interns.

Zhou Can and another trainee had performed outstandingly, while the others were merely average.

They had identified both the pathology and the cause.

Next came the treatment.

Diagnosis and treatment held equal importance.

The clearer the treatment strategy, the better the treatment plan—and the greater the potential of that trainee.

“I believe we should operate immediately and suture the ruptured tendon,” one intern suggested.

“Besides suturing the tendon, I think we should address the rheumatoid arthritis as well,” another added.

One by one, the interns voiced their opinions on the treatment approach.

Yet Zhou Can remained silent.

A few of his competitors let out a subtle sigh of relief.

Fortunately, the prodigy did have a weakness—in that he seemed less adept when it came to treatment.

Dr. Shan, puzzled, looked at him and asked, “They’ve all offered their treatment ideas. Why aren’t you saying anything? Are you unfamiliar with managing this type of condition?”

Everyone has their own area of expertise.

However, providing a basic treatment plan shouldn’t be too difficult.

“I can’t offer a treatment plan because we have too little information about the patient. Only after considering the patient’s age, constitution, any pre-existing conditions, tolerance, and their own wishes can we devise the optimal plan. Basing it solely on a few reports is too one-sided,” he explained.

Zhou Can had his own perspective.

Medicine requires rigor and caution.

Formulating a treatment plan without fully understanding the patient’s condition is completely irresponsible.

Dr. Shan’s face stiffened as she listened.

She realized this was indeed an oversight on her part.

Being publicly corrected on safety by a trainee did irk her somewhat.

“Dr. Zhou makes a valid point. We should integrate all of the patient’s information to determine the best treatment. But Dr. Shan was only testing your thought process by having you propose a plan based solely on the diagnosis,” Dr. Tang explained to smooth things over.

Dr. Tang defended Dr. Shan’s approach.

With such tact, the young man surely had a promising future ahead.

“Bring the patient into the operating room and get ready for surgery!”

Dr. Shan no longer wished to discuss the matter.

The patient was quickly wheeled into the operating room.

The patient was a woman in her fifties, with deeply tanned skin and a face lined with wrinkles. Her fingers had become deformed from rheumatoid arthritis.

Normally, a person’s fingers can flex and extend freely.

But hers remained permanently bent, refusing to straighten.

Her right hand was even hanging by a bandage around her neck.

Judging by her appearance and demeanor, she was likely a rural woman who had received an initial diagnosis at a local township clinic after tendon rupture.

Township clinics simply aren’t equipped to handle this condition—they must seek treatment at a county-level hospital or a large hospital like Tuyu Hospital.

For the doctors at Tuyu Hospital, this was just a minor surgery.

The difficulty was minimal.

“In cases like this, general anesthesia isn’t usually necessary. A brachial plexus block will suffice,” Dr. Shan explained as she instructed.

While lecturing the interns, she directed Dr. Tang to administer the anesthesia.

Zhou Can watched enviously, regretting the loss of four points of his injection experience.

If he were to inject the anesthesia, he’d have to administer at least four separate injections.

At that moment, the trainee who had been outside applying the plaster returned alongside Dr. He.

Dr. Shan had already instructed Dr. Tang to re-prep the patient’s surgical site.

She then marked the incision line and highlighted the site of the tendon rupture with a red line before carefully incising the skin on the hand.

Blood immediately began to gush out.

“Stop the bleeding!”

She shouted at Dr. Tang.

Zhou Can, rubbing his hands on the side, couldn’t help but feel excited at the prospect of surgery.

After all, he excelled at controlling bleeding.

Dr. Tang’s ability to control bleeding was frankly unimpressive—barely at the level of a junior resident, far below that of a competent attending.

Conversely, Dr. Shan’s surgical skills were remarkably impressive.

Her deliberate yet precise incision of the hand’s skin deftly avoided major blood vessels and nerves.

It was as if she were peeling the bark off a large tree.

Her incision technique had undoubtedly reached the level of a competent attending.

No wonder the Orthopedics Department trusted her with secondary procedures.

Dr. Tang’s hemostasis was indeed a bit slow.

The bleeding had already obscured the subcutaneous tissue.

Zhou Can grabbed the suction device and cleared away the accumulated blood.

Dr. Tang shot him a grateful glance, while Dr. Shan looked on with evident admiration.

The operating room needed proactive individuals like Zhou Can.

The other trainees could only stand by and watch in awe.

“This bleeding point is proving tricky! Why just won’t it stop!”

Dr. Tang had applied the electrocautery knife several times at one bleeding point, but with little effect.

“It must be that the vessel has retracted. I have some experience with this—can I take over?”

Zhou Can had been waiting for this chance for a long time and immediately volunteered.

Seizing the opportunity, he spoke up without delay.

“You… sure you can handle it?”

Dr. Tang hesitated slightly.

This particular bleeding point was notoriously difficult—even he struggled with it. Could a trainee like Zhou Can manage?

Recalling Zhou Can’s impressive performance during a knee joint aspiration, Dr. Tang eventually decided to trust him.

Taking the electrocautery knife, Zhou Can grabbed a fine forceps, cleared away the fatty tissue around the bleeding point, and applied the knife with pinpoint precision.

Sizzle!

His movements were fluid and precise, executed with remarkable efficiency.

At last, the bleeding was successfully controlled.

Everyone in the room was stunned by such a masterful display.

And that was just one of several problematic bleeding points.

There were at least five or six more unresolved sites.

The main issue was Dr. Tang’s unsatisfactory hemostasis speed.

Wielding the electrocautery knife like a legendary acupoint expert, Zhou Can hit every point with unwavering accuracy.

Each pulse was precise.

In just five or six seconds, he had resolved them all.

It was truly both fast and flawless.

“When did trainees from the Emergency Department become this skilled? I always heard they were a poor lot!”

Everyone was stunned, their amazement naturally drawing comparisons to Zhou Can’s background.

He hailed from the Emergency Department.

Though he had only trained in the Emergency Department so far, his skills were already unbelievably advanced.

“Alright!”

Zhou Can handed the electrocautery knife back to Dr. Tang.

This time, Dr. Shan decided to step back.

Her sharp eyes had noted Zhou Can’s excellent hemostatic skills, so she chose to let him continue.

This was to ensure a higher surgical efficiency and reduce the overall operation time.

Moreover, excellent hemostasis improves surgical outcomes; it helps the wound heal faster and minimizes collateral tissue damage during electrocautery.

“Zhou Can, you’ll assist from now on. Dr. Tang, take a break.”

She made an immediate switch in roles.

“Got it!”

Dr. Tang had no objections, though he felt a tinge of disappointment.

Being outperformed by a newcomer couldn’t have felt any better for his pride.

Meanwhile, Dr. He, standing at the operating table, looked at Zhou Can in astonishment and admiration. If Zhou Can had impressed Chief Resident Shen yesterday, his performance in the operating room today was an undeniable display of skill.

Dr. He couldn’t help but exclaim—the trainee was incredibly competent.

He was probably the best among the eighteen trainees this round.

Without any pretension, Zhou Can nodded at Dr. Tang and took the position of First Assistant that Dr. Tang vacated.

Dr. Shan resumed her work, continuing to peel back the subcutaneous tissue in search of the ruptured tendon.

Blood began to flow again, and this time Zhou Can took charge of the hemostasis—completely on another level compared to Dr. Tang.

With precise electrocautery, he controlled the bleeding swiftly and efficiently.

The total blood loss was minimal.

So minimal that even the suction device wasn’t needed.

“The severed tendon seems to have emerged!”

Zhou Can’s keen eyes caught sight of the ruptured tendon.

The situation was relatively ideal.

Without waiting for Dr. Shan’s instruction, he had already fetched a flat retractor from the nurse to retract the incision for a better view.

This provided Dr. Shan with a clear field for the subsequent repair.

“Everyone, look—the patient’s ruptured tendon is right here,” Dr. Shan pointed out to ensure all the trainees could identify it.

“What we need to do is locate both the proximal and distal ends of the severed tendon. For now, we can stabilize them using the tip of a 5ml syringe,” she explained.

Once stabilized, Dr. Shan began suturing the tendon.

“We typically use size 4 absorbable sutures with a cross-stitch technique for added strength,” she instructed.

For subcutaneous suturing, absorbable sutures are now preferred,

as they eliminate the need for a second surgery to remove the stitches.

Her suturing skills were at the competent attending level, though still not as refined as Zhou Can’s.

Before long, she had sutured the ruptured tendon.

“After suturing, we need to continuously reinforce the area around the tendon ends,” she added as she taught the junior doctors.

Once the suturing was completed and the tendon repair confirmed, it was time to finish up.

“Dr. Shan, may I take over the skin suturing?”

Zhou Can wasn’t exactly vying for the chance to suture skin,

but for him, any opportunity to practice suturing in the Emergency Department operating room after hours was a valuable chance to hone his skills.

Grabbing the needle holder and pre-threaded suture, Zhou Can began suturing the skin.

After just two stitches, Dr. Shan’s eyes nearly popped out in amazement.

She had been worried that Zhou Can might falter at this stage.

Instead, he surpassed her expectations—suturing even better than a competent attending.

“Impressive!”

Both Dr. Tang and Dr. He blushed, knowing that compared to Zhou Can, their suturing skills were vastly inferior.

“How can a trainee be this proficient? Did he start practicing suturing back in his freshman year?”

Even the attendings and residents were left in awe.

The other five trainees, feeling both desperate and intimidated, could only think of one word: “Prodigy.”

Zhou Can quickly and neatly finished the skin suturing.

“Dr. Shan, please check my work,” he requested.

“Excellent suturing,” Dr. Shan praised him without reservation.

“Thank you,” he replied, then added, “What about the rheumatoid arthritis? Should we treat it with both anti-inflammatory and antirheumatic medications?”

Zhou Can was well aware that the tendon rupture was merely triggered by the patient lifting something heavy.

The underlying issue was her rheumatoid arthritis.

Suturing the tendon only addressed the symptom.

To truly resolve the problem, medication was necessary to treat the rheumatoid arthritis.

“I’ll include the medications in the orders and move the patient out of the operating room to prepare for the next surgery,” Dr. Shan responded, noticeably softening her tone when speaking to Zhou Can.

Her respectful tone was almost equal to that of a peer.

Strength always earns respect.

Not only was Zhou Can exceptionally skilled in surgery, but he also provided precise treatment recommendations, proving he had no shortcomings in treatment.

At that moment, he was far ahead of the other five trainees.

And this was just the beginning.

Even though this operating room was the least equipped in Orthopedics, the daily surgical volume was astonishing.

The report for the fourth patient appeared on the screen.

It featured examinations of a patient’s knee joint.

Both X-ray and ultrasound images had been taken.

“This is a classic case of septic arthritis of the knee,” declared a notably capable trainee.

“I agree with that diagnosis. We might need to perform an incision, drainage, and lavage,” Zhou Can added, drawing on his rich experience with septic infections in the Emergency Department.

“They’re all really impressive! This patient does have septic arthritis, and as Dr. Zhou suggested, the surgical plan will involve incision and lavage,” Dr. Shan observed as she noted two trainees drawing attention. A trace of satisfaction appeared on her face.

Most senior doctors truly hoped to see capable successors emerge.

Unlike self-centered doctors like Dr. Lu from the Emergency Department, those with genuine talent were few and far between.

The patient was quickly wheeled in once more.

Zhou Can felt an exhilarating rush—another opportunity to shine and gain valuable experience.

In the spirit of competition, he didn’t hold back.

He directly requested treatment authority for procedures including incisions.

Given his superior performance in hemostasis, suturing, and puncture techniques earlier, he had already built a solid foundation of trust with Dr. Shan.

At this point, asking for permission to perform a moderately risky procedure should be acceptable.

“I’ll make the incision myself; you handle the rest,” she decided, unwilling to let Zhou Can take the lead on the incision.

Virtually all senior doctors were cautious about delegating the highest-risk tasks.

Yet Zhou Can remained undeterred.

Simply earning extra practice opportunities was more than enough for him.

Riskier and more complex procedures would come much later—as long as he secured a spot in the operating room, opportunities would abound.

…

By mid-morning, they had completed nearly twelve primary and secondary surgeries.

At lunchtime, Zhou Can once again felt the relentless pace of the operating room. Everyone took turns eating with hardly any time to rest.

“Zhou Can, Dr. He, and Nurse Wang Xiaohong, remain here with me to continue the surgeries. Everyone else, grab your lunch and return to the operating room as soon as possible,” Dr. Shan instructed.

Dr. Shan surprisingly did not keep Dr. Tang, instead choosing Zhou Can.

It was clear she planned to have Zhou Can consistently serve as her First Assistant.

It made sense—having a strong assistant not only eased the lead surgeon’s burden but also significantly increased the surgical efficiency.

Just as Zhou Can loved operating with Qiao Yu, there was no other reason but the seamless teamwork and the professional instrument nurses.

Dr. Shan retained Dr. He, not to serve as an assistant, but to supervise plaster application and assist with miscellaneous tasks in the operating room.

Leaving other trainees to apply the plaster alone was something she wouldn’t trust.

With Dr. He in charge, she felt at ease.

Zhou Can’s status in the operating room was rising rapidly, with more capable tasks coming his way.

Overall, his involvement in surgery was increasing continuously.