Chapter 126: Second Chances in the OR

For a severed limb, reattachment within six hours generally offers a good survival rate. With proper storage at a low temperature, there’s still hope even if done within eight hours.

There are even cases where success has been achieved after more than 12 hours.

However, this man’s four replanted fingers, even after over twenty-four hours, remain pale and deeply creased—a very bad sign.

Only fingers devoid of life look like this.

Dr. Shan carefully examined the patient and then inquired about his post-operative symptoms.

For example, are the fingers painful?

Did you make sure to keep them warm?

Did you follow the post-op instructions, and so on?

Zhou Can just stood at the foot of the bed, listening quietly.

During rounds, the order of entry and the placement of doctors is a matter of protocol.

Usually, the patient’s right side is reserved for the Chief and Attending, while the left is for residents. When the Chief makes rounds, several residents gather, with their positions arranged according to seniority.

Those with more experience stand in front, while the less experienced remain behind.

The Head Nurse generally stands at the bedside, ready to attend to the patient at any moment.

The remaining spot at the foot of the bed is for those considered less important.

Such as trainees, interns, graduate students, and fellows—they all have to settle at the bed’s foot.

After finishing the examination, Dr. Shan’s expression turned notably grave.

Everyone else could feel the oppressive atmosphere.

A failed surgery spells disaster for the patient, their family, and all the medical staff.

“Can I see the patient’s records?”

Zhou Can wasn’t trying to steal the spotlight; he simply recalled what his teacher once mentioned about such cases.

He wanted to verify the patient’s basic information before proceeding with further analysis.

The doctor in charge was a greasy young man in his thirties, whose overabundant youth had left him with lingering dark marks from former acne.

He merely shot Zhou Can a disdainful glance, offering no reply.

He was probably thinking, “Does this stupid trainee not realize it’s an attending round? Who does he think he is?”

“Hand over the records!”

Seeing the oily doctor’s lack of response, Dr. Shan’s tone turned exceptionally cold.

Many doctors despise bureaucratic behavior and red tape in the hospital.

Patients can’t wait; delays mean worsening conditions, and there’s no room for half measures.

It’s understandable that doctors and nurses sometimes flatter their superiors—all are eager to advance and secure more resources.

But no doctor enjoys bureaucracy.

Because it often leads to higher mortality and more complications.

The greasy doctor shuddered, not understanding why Dr. Shan was so furious.

He respectfully handed over the medical record book with both hands.

“Please review it!”

After taking it, Dr. Shan immediately passed it to Zhou Can.

“Dr. Zhou, if there’s any information missing from the record that you want to know, feel free to ask.”

By doing so, she was essentially backing Zhou Can up.

“Thank you!”

Zhou Can took the record book and read it carefully.

The patient had lost his four fingers when a coworker mishandled an iron chisel during work.

Immediately after the accident, he was sent to the local social hospital.

Doctors quickly dressed his wounds, provided an ice pack to cool the severed fingers, and advised an immediate transfer to a major hospital for replantation.

Thus, he was rushed over to Tuyu Hospital.

Upon admission, Chief Resident Shen led a team to perform a finger replantation surgery.

To reduce the operation time, Dr. Shan and Chief Resident Shen worked simultaneously on the replantation—one taking on two fingers while Chief Resident Shen handled all the bone fixations for the four fingers.

Dr. Shan mainly performed the tendon, vascular, and nerve anastomoses, along with skin suturing on two of the fingers.

The surgery proceeded very smoothly.

At the time, checks confirmed that blood flow in all four fingers was unimpeded.

After reviewing the records, Zhou Can approached the bedside to carefully examine the patient’s palm and the back of his hand.

He noted several bruises near the wrist and around the base of the thumb on the back of the hand.

“During your talk with Dr. Shan, you mentioned that your thumb feels numb, right?”

“Yes! When the injury first occurred, I thought the pain had numbed it. After the surgery, I assumed the anesthesia wearing off would fix it, but my thumb still remains numb.”

The patient described his sensations honestly.

Zhou Can nodded and picked up a straw from the metal locker by the bedside, then gently touched the proximal part of the patient’s index finger.

“Do you feel anything?”

“A little, but it’s as if there’s a layer of clothing between us.”

Due to limited education, the patient’s description was imprecise.

Yet, his metaphor was quite vivid.

Zhou Can tested his other three fingers in turn, and the responses were almost identical.

They all felt dully numb, with very little sensitivity.

At this point, Zhou Can had a pretty clear idea of the situation.

He then picked up the patient’s X-ray films and scrutinized them carefully.

Dr. Shan waited patiently, while even those doctors slightly annoyed with Zhou Can had no choice but to endure.

“Dr. Shan, does the injury on the back of the hand align with the distribution of the median nerve’s recurrent branch?”

“Yes! The recurrent branch of the median nerve is approximately here.”

She nodded.

Then, her eyes gradually brightened.

A look of sudden realization appeared on her face.

“Are you suggesting that damage to the median nerve has led to poor blood circulation?”

At that moment, Dr. Shan’s expression shed all her customary cool, stern demeanor.

Instead, she looked like a delighted child who had discovered the missing piece of a puzzle.

Her earlier somber expression vanished completely.

“I didn’t say that—you said it,” Zhou Can teased, blinking playfully.

“Heh heh, figuring out the cause of the compromised blood flow is largely your achievement.”

Dr. Shan rarely smiled.

At that moment, Zhou Can graciously let her take all the credit, pleasing her immensely.

“Mr. Gao, we now suspect that the injury in this area may have damaged your nerves. Since nerve cells cannot regenerate, if the damage is severe, we might be powerless. For now, we’ll order two tests—one to check for any interruption in the nerve pathway and another to assess any local hematoma.”

“Once the results are in, we’ll formulate a new treatment plan to do everything possible to save your fingers and hand function.”

She communicated with the patient in a manner that left room for his own decision-making.

This allowed him to choose his own course of action.

Zhou Can silently observed and absorbed these communication techniques.

Besides honing their technical skills, effective patient communication is an essential part of a doctor’s training.

“Dr. Shan, could you explain the connection between nerve damage and compromised blood flow in replanted fingers?”

The oily doctor’s medical knowledge apparently wasn’t very strong.

He was unaware of the relationship between the two.

This connection is rarely documented in textbooks—it’s a hard-earned lesson among doctors.

A mere nod from Zhou Can was enough for Dr. Shan to immediately grasp the cause.

It was clear that she understood the link between nerves and blood circulation.

This only underscored how invaluable a mentor of the chief level can be.

It saves one from many needless detours.

“You can consult Dr. Zhou!”

She seized the opportunity to subtly chide the oily doctor for his earlier arrogance and bureaucratic behavior toward Zhou Can.

The oily doctor looked awkwardly at Zhou Can.

For a senior resident to ask a trainee for advice was somewhat embarrassing.

Especially since not long ago he had acted like a big shot in front of Zhou Can.

Now having to ask for help was truly mortifying!

Not asking would only make it even more awkward.

Everyone understood the situation and would secretly laugh at him.

“Dr.—Dr. Zhou, could you offer some guidance?”

The oily doctor, with no other choice, mustered his courage to ask Zhou Can for help.

“Nerve damage can indeed affect blood flow—didn’t your teacher mention that?” Zhou Can retorted.

“Ahem… maybe he did, perhaps I just forgot.”

The oily doctor’s mentor was, at most, of attending level.

If a teaching doctor dislikes your personality, their guidance might merely be a formality.

So, if your skills are lacking, you must look to your own shortcomings.

Arrogance, rudeness, and bureaucratic habits are traits that can easily displease higher-ups.

“Dr. He, please follow up on this patient. Once his tests are complete, either show me the results or contact Chief Resident Shen. His replantation has already exceeded a day—it cannot be delayed any further.”

Dr. Shan assigned the task to Dr. He.

She then led a group to continue the rounds.

With over a hundred beds to check—even at one minute per bed—the process could take nearly two hours.

So, rounds typically focus on key patients.

Those who had just undergone surgery or were in critical condition received priority, while stable patients were left to residents and trainees.

After about half an hour, they had covered all the open beds in their section.

Dr. Shan then led them into the two patient rooms for further rounds.

Patients admitted to these rooms usually require extra care or have higher expectations for their environment.

Nurses and doctors pay special attention to those in these wards.

Everyone is anxious about potential mishaps.

Zhou Can immediately spotted the male patient who had been transferred from bed 120.

“Hello, Dr. Zhou!”

The male patient greeted Zhou Can warmly as soon as he saw him.

Had it not been for the recent reprimand from a superior—when his issues were highlighted—

it was still uncertain whether his leg could be saved.

Although he never said it aloud, the male patient had long harbored deep gratitude.

Seeing Zhou Can now filled him with excitement and joy.

“Hello! Have you transferred here?”

Zhou Can smiled and approached to chat.

The male patient’s wife, aware of the young doctor’s role as a savior, handed Zhou Can a bottle of Eight Treasure Congee meant for the patient’s breakfast.

“Thanks again! We’re just simple country folk with nothing fancy. Please, have this congee—it’s no trouble at all.”

“Thank you, but hospital regulations prohibit accepting gifts from patients or their families. Please, keep the congee for your husband!”

Zhou Can felt particularly gratified and happy.

Every time a patient is cured or a life is saved, the genuine gratitude they show makes it all worthwhile.

For instance, Mr. Cui, Mr. Wu’s child, or even this humble middle-aged couple—their thankfulness always brightens Zhou Can’s day.

“How is your leg now?”

“After a second surgery, it’s much better. The swelling and pain have subsided.”

The middle-aged man said with a smile.

He appeared much more energetic than the day before.

Zhou Can then lifted the blanket to inspect the man’s foot.

The swelling had disappeared, and the subcutaneous bruises were gone. The skin tone looked fine, though it remained slightly creased—a normal aftermath.

Once the patient is able to walk, he will need rehabilitation exercises for that foot.

In time, it will naturally return to normal.

“After the first surgery, a thrombus formed inside the vessel, likely due to the vascular injury. Later, Chief Resident Shen replaced the damaged segment with a vein graft, which resolved the issue completely.”

Dr. Shan explained from behind.

This was her way of indicating that the thrombus wasn’t due to faulty suturing but rather the patient’s damaged vessels.

Ultimately, it came down to inexperience and insufficient skill.

Had Dr. Xu performed the vascular anastomosis in this surgery, such complications would likely not have occurred.

Soon, they had finished checking all the beds in the two rooms.

The patients there all had various issues and required careful monitoring—many had undergone major surgeries.

For example, the patient from yesterday’s sternal resection led by Chief Resident Shen, whom Zhou Can had the honor to see in the ward.

That surgery was primarily aimed at removing a scapular thyroid tumor.

It was a major open-chest operation.

It was at least a level-three procedure, with extremely high risks.

Sometimes, Orthopedics cannot handle such surgeries alone and must collaborate with Cardiothoracic Surgery.

If the hospital had a dedicated Scapular Thyroid Surgery unit, doctors from that department might have been directly involved.

In today’s era of increasingly specialized medicine, mastering one niche to perfection is truly remarkable.

This brings to mind the Japanese spirit of craftsmanship.

Their lifelong dedication to perfecting even simple tasks—like making sushi—is something we can all learn from.

Who would have thought that such a simple task as making sushi could elevate someone to master status?

After continuous refinement, several different styles of sushi emerged.

It’s another level of specialization.

It epitomizes finesse.

One can imagine that Japan’s achievements in various fields are no accident.

“Let’s head to the Operating Room! You three newcomers need to familiarize yourselves with every surgical patient on our team after your shifts. Their details and surgery schedules are available on the intranet. Also, you are required to keep tabs on any newly admitted surgical patients and those post-op who haven’t yet been discharged.”

Dr. Shan then taught the trio how to log into the intranet.

First, identity verification is required. The hospital’s IT center contacts the trainee’s department; once the department head approves, the corresponding access rights are granted.

It’s actually quite convenient.

Zhou Can logged in to check his team’s surgical patients, which were categorized as unscheduled, upcoming, and post-operative.

For upcoming surgeries, the time, operating room, and the chief surgeon are all clearly listed.

The Emergency Department doesn’t have such details.

They simply treat patients as they come; emergencies that cannot be operated on that day are transferred to specialty departments.

By now, it was past 8 AM, so there was no time left for reviewing their team’s patient data.

Dr. Shan then led them straight into the Operating Room.

Today’s case was in a hundred-level Operating Room—it appeared they were preparing for a major surgery.

Inside, a strange male doctor and two residents had already arrived ahead of schedule.

The male doctor, probably in his late thirties, was tall and burly, exuding a commanding presence as he studied over a dozen X-rays displayed on the screen.

“Good morning, Dr. Chi! As our team’s strongest attending, you never fail to come early to review patient scans.”

Dr. Shan smiled and greeted him.

“Stop flattering me! If it weren’t for you handling rounds, would I have the luxury of reviewing files in the OR so early?” Dr. Chi retorted, then resumed his focus on the images.

Dr. Chi continued to examine the X-rays.

Clearly, being the team’s top attending had its merits.

Not to mention, his unwavering focus was something not many could match.

Dr. Shan joined him as they reviewed the scans side by side.

The images were straightforward—a patient’s right-hand X-ray.

It clearly showed that the patient’s thumb bone was missing.

The proximal phalanx was absent—essentially, the entire thumb was gone.

It was unclear whether this was a congenital defect or the result of an accident.

What sort of surgery could address this?

Zhou Can wondered silently.

Given his low status, he could only stand behind Dr. Tang and Dr. He and observe the scans from afar.

Before long, Chief Resident Shen briskly entered the Operating Room.

One chief, two outstanding attendings, several residents and trainees, and three surgical nurses made up the team.

Just by the assembled force, it was obvious this was a major operation.

Replantation is only a level-two procedure.

There was no need for so many doctors to be involved.

“Everyone’s here! Excellent—your work ethic is impressive.”

Chief Resident Shen looked at Dr. Shan and Dr. Chi as if they were his most trusted lieutenants.

Zhou Can, having only recently joined Orthopedics, wasn’t sure how many teams there were in the department.

He also wasn’t familiar with every member of his team.

Chief Resident Shen was the team leader, with Dr. Shan and Dr. Chi as the two attendings, along with Dr. Tang, Dr. He, and four residents.

These were the staff he was aware of at the time.

“The screen shows the patient’s incomplete right hand—a congenital condition. The thumb accounts for over 50% of hand function and is extremely important. This 21-year-old young man, who works to earn a living, happened to book an appointment with me. He explained that the loss of his right thumb has caused him countless hardships.”

“Writing, handling objects, even simple tasks like wiping—everything is difficult with one hand. And when it comes to finding a partner, his disability drives women away. He hopes we can help create a new thumb for him.”

Chief Resident Shen briefly introduced the patient’s condition.

Faced with such a resilient patient, doctors not only feel sympathy but are deeply moved.

They are determined to do everything possible to help.

Create a new thumb?

How on earth could that be done?

In today’s advanced medical era, we’ve seen artificial hip joints and blood vessels, but never an artificial thumb.

A below-knee amputation can be fitted with a prosthetic to restore much of the leg’s function,

but what about the thumb on the hand?

Chief Resident Shen smiled as he swiped across the display.

“Take a look—here’s the patient’s right foot X-ray.”

Zhou Can examined it carefully—the patient’s right foot bones were intact and well-defined.