Chapter 139: Turbulence in the Surgical Ward

It must be noted that some people can’t tell the difference between a Head Nurse and a Chief Nurse Practitioner. The head nurse is an administrative role, while the chief nurse practitioner is a professional rank.

Larger departments often have two or more head nurses.

They are responsible for arranging the department’s nursing tasks.

In fact, head nurses are usually chosen from among the chief nurse practitioners.

Zhou Can hadn’t planned on souring his relationship with the nurses in his new department, but when they trampled all over him—acting meekly even after shitting and peeing on him—he steeled himself for two more months of aggravation.

As an old Chinese saying goes, ‘Strike hard with one punch to avoid being hit a hundred times.’

Sometimes, showing a bit of temper is essential to prove you’re not an easy pushover.

They say it’s best to pick on the soft targets.

By targeting this nurse, the worst-case scenario for Zhou Can was simply having to work night shifts without a chance to slack off.

So, he wasn’t afraid at all.

Moreover, knowing human nature well, he figured that if he performed superbly in the coming days, any deputy chief doctor might take notice, and this supervising nurse would likely end up swallowing her pride to mend fences.

At that moment, the supervising nurse glared at him with gleaming green eyes.

Clearly, she hadn’t expected this young doctor to be so defiant.

“I’ll report your work attitude to Dr. Cheng and Liu Yongquan,” she declared.

Then, fuming, she marched off with a tray to disinfect the patient.

This effectively ended their first confrontation with her backing down.

By the time Zhou Can reached the patient’s bedside, she was nearly finished disinfecting.

Jiang Xiaohua stood at a distance, covering her nose and mouth as she watched.

It’s hard to understand why he’s so squeamish about excrement—why choose a career in medicine?

After all, a doctor’s job is to save lives.

It inevitably involves dealing with blood, excrement, and pus.

Some patients’ infected wounds emit odors far more offensive than excrement.

And the smell when a patient’s abdomen is opened can’t be masked, even with a face mask.

If he can’t handle such minor scenes, he’d be better off switching careers.

This supervising nurse, Hu Shuiling, had a notoriously bad temper, was aloof and arrogant, but she worked fast.

She had already skillfully finished disinfecting the patient.

She then picked up a urethral catheter and glanced toward Zhou Can, who stood at the foot of the bed.

If her attitude had been softer earlier, Zhou Can would have eagerly snatched the task.

After all, it would have earned him some valuable catheterization experience.

But now, she was the one handling it.

Hu Shuiling was at least in her thirties and, being married, wasn’t nearly as shy about male patients as the younger nurses.

Men’s bodies didn’t ignite the same embarrassment in her as they did in those young nurses.

Moreover, a nurse with several years under her belt might perform catheterizations only a few hundred times a year—perhaps one or two hundred at best.

Still, most male doctors in the department carried themselves with true gentlemanly grace.

When placing a catheter in a male patient, they usually did it themselves out of consideration for the discomfort young nurses might feel.

Hu Shuiling was aware that she had really pissed off Zhou Can, and she cast a sidelong glance at Jiang Xiaohua, who remained far off.

Sadly, Jiang Xiaohua showed no reaction.

She appeared focused elsewhere, as if she hadn’t noticed the nurse’s pleading look.

Fuming, the nurse decided not to beg for help any longer.

“It’s just a catheterization, isn’t it? I don’t need any help—I can handle it on my own!” she muttered.

With a dark scowl and tightly furrowed brows, she began the catheterization.

“Ow…”

The patient cried out in agony.

Had he not been bedridden, he might have completely lost it.

Sometimes, doctors opt to insert catheters only after the patient is under full anesthesia.

Because the procedure can be genuinely painful.

Especially when the operator is inexperienced or the patient’s anatomy is atypical.

For instance, in older men, an enlarged prostate can compress the urinary tract, causing deformities or shifts in position.

“Please bear with it; it won’t take long,” she coaxed.

While soothing the patient, Hu Shuiling continued her work.

Yet after repeated attempts, she still couldn’t complete the catheterization.

The patient’s cries grew increasingly agonizing.

The female housekeeper watching could bear it no longer.

“Nurse, aren’t you new? Can’t you hear the patient’s screams?”

This middle-aged woman had a tongue as sharp as a knife.

Her venomous words were nearly impossible to withstand.

Already fuming with resentment toward Zhou Can, her mood darkened even further upon being rebuked by the housekeeper.

“I can hear the patient’s cries, but catheterization is a technical skill—it’s not as simple as cooking or bathing, like you housekeepers do!”

When have veteran nurses ever taken a loss?

They never hesitate to put doctors, family members, or patients in their place.

The housekeeper had only meant to offer a friendly reminder, yet Hu Shuiling responded with scornful undertones.

The housekeeper promptly quit her post.

Sometimes, patient disputes are sparked by the smallest disagreement.

“If you can’t handle a catheter properly and it takes forever, then why even bother listening? Have you never seen a man’s body before? Young girls should know better! If you can’t do it, ask a doctor! Deliberately taking advantage of male patients—you’re shameless!”

When it came to insults, few words were as cutting as those from middle-aged women.

Only they could be so vicious.

Cultured, well-mannered ladies were in a league of their own.

In ancient times, Zhuge Liang once verbally crushed Wang Lang in front of two armies. Dare to quarrel with a middle-aged woman, and she’ll have you questioning your very existence.

Now, Hu Shuiling found herself questioning her own life.

“You… you…”

She was so furious that tears nearly welled up.

“Don’t point at me like that! I’m old enough to be your mother. If you dare mistreat a patient, I’ll call the patient’s son—and he’s an official! You’d be out of a job in no time!”

The female housekeeper not only had a barbed tongue but also a formidable presence.

At the mention that the patient’s son was a government official, Hu Shuiling’s unease grew.

A minor incident, fueled by bad moods and uncontrolled temper, had now escalated.

It was heading in a direction she hadn’t anticipated.

If things blew up further, even if she didn’t lose her job, punishment was all but certain.

“Aunt, do not engage with this inexperienced nurse. The patient’s son paid good money to have you care for him—let’s not make a scene that could harm the patient,” the housekeeper advised.

Zhou Can could no longer allow the situation to spiral out of control; otherwise, not only would nurse Hu Shuiling suffer, but Jiang Xiaohua and he might also get involved.

Both he and Jiang Xiaohua would be dragged into it.

Director Xie had been waiting for an opportunity to put him in his place.

This incident was bound to escalate—Director Xie might even laugh at the outcome.

There’s a saying: know when to stop.

A proper punishment for the arrogant nurse should be enough.

“Let me handle this!”

Zhou Can stepped in, swiftly taking the catheter from the nurse and, under her shocked and embarrassed gaze, effortlessly completing the insertion.

A Grade 3 catheterization technique—if you can’t even manage a simple catheter insertion, what’s the point of training?

【Placement XP +1】

【Congratulations! Your catheterization skill has advanced to Grade 4. Current XP: 1. You can now perform complex, high-difficulty procedures.】

After work, Zhou Can kept practicing his catheterization technique.

He was already on the brink of leveling up; this attempt earned him 1 XP and unexpectedly promoted him.

It turned out to be a stroke of luck.

Catheterization is used frequently in the Neurosurgery Department. For example, in aneurysm cases, placing a spring clip into the affected vessel relies on this very skill.

Grade 4 is equivalent to an attending-level technique!

Reaching Grade 4 in advanced medical procedures is no small feat.

It also meant his fundamentals in endoscopic surgery had grown even stronger.

“See that? A skilled doctor gets it done in one go. You should learn a thing or two—you’re not only embarrassing yourself, but also making the patient suffer.”

The housekeeper’s words were as venomous as ever.

This time, Hu Shuiling dared not argue further.

Everyone meets their match eventually.

This nurse, who had acted so high and mighty in front of Zhou Can, was ultimately overpowered by the sharp-tongued housekeeper.

She bore a heavy grievance this time with nowhere to vent—it looked like she’d end up hiding in the restroom to cry.

Zhou Can felt no sympathy for the nurse.

After all, this whole conflict could have been easily avoided.

“Jiang Xiaohua, come help!”

Zhou Can called out to Jiang Xiaohua.

The two of them, along with the housekeeper, managed to roll the patient onto a gurney and rush him to the Operating Room.

Over the past year, the Neurosurgery Department performed roughly 3,000 surgeries.

It has only two dedicated operating rooms—Rooms 3 and 5—with the rest shared with Cardiothoracic Surgery.

Though the Neurosurgery Department has only two ORs, they are all top-tier, hundred-level laminar flow rooms.

And every one of them is equipped with endoscopic capabilities.

This is a testament to the department’s strength.

At that moment, the light in Operating Room 3 was green.

“Oh no!”

A sinking feeling hit Zhou Can; the patient’s delayed arrival was due to fecal incontinence.

He hoped the chief surgeon hadn’t been kept waiting too long inside.

With slight apprehension, they wheeled the patient into the OR, and the recovery room nurse gave them a sympathetic look.

“Why did it take so long? Dr. Ou has been waiting forever.”

She shot them a look that said, ‘Good luck to you.’

Zhou Can hurried into the changing room to don his surgical protective gear.

Jiang Xiaohua, sensing trouble, wore a similarly anxious expression.

The two of them pushed the patient into the operating room.

Inside were two nurses and four doctors, including an anesthesiologist and two resident assistants.

The lead surgeon was a middle-aged man in his fifties.

He was already suited up with a cap, mask, and sterile gloves.

His eyes were cold, his brows furrowed, and his demeanor slightly intimidating.

The atmosphere in the OR was equally grim.

None of the nurses or doctors spoke—a silence heavy with tension.

It was as if even the air was too scared to stir, fearing the chief surgeon’s wrath.

“You took an extra 28 minutes, leaving all of us waiting for you to bring the patient over. Are you lost, or did you fall asleep along the way?”

Dr. Ou exploded in anger.

At least his scolding was somewhat measured.

He worried that if the chief surgeon didn’t yell, things could have been even worse.

“Dr. Ou, I’m sorry. The patient had fecal incontinence before surgery, which caused a delay.”

Zhou Can could only brace himself and explain.

Jiang Xiaohua kept her head down, her expression quiet and compliant.

Everyone has their own way of surviving.

Jiang Xiaohua was far from the naive rookie she appeared to be.

When someone attracts unwanted attention, playing the victim to lower one’s profile is a smart defense.

Despite the scolding, the two managed to get the patient onto the operating table.

Neither the two nurses nor the two resident assistants lent a hand.

They simply watched in cold silence.

Zhou Can could swear that the Neurosurgery Department was the coldest he had ever encountered.

Here, doctors and nurses carried themselves with an air of superiority and deep-seated arrogance.

They didn’t consider new doctors as equals.

It looked like his two-month residency in Neurosurgery was going to be a tough ride.

No wonder people often said that Neurosurgery doctors were difficult to deal with during residency in Orthopedics or the Emergency Department.

“Listen up—since this is your first offense, there’s no punishment this time. But next time, no matter what, you must deliver the patient to the OR ten minutes early.”

Dr. Ou, after hearing Zhou Can’s explanation, softened his expression.

He didn’t scold any further.

The surgery began.

The anesthesiologist examined the patient, confirmed he met the criteria for anesthesia, and began fitting him with a breathing mask and various monitoring devices.

He even opted for the prone position.

“Anesthesia is successful. The patient’s vital signs are stable, although respiratory exchange is slightly weak—surgery can begin.”

Noticing a minor issue, the anesthesiologist alerted the team so they could take extra care during the operation.

Dr. Ou began the surgery.

The two residents provided full assistance.

Zhou Can and Jiang Xiaohua only managed to watch from the sidelines.

There was no chance for them to actively participate or practice.

“The hematoma is here, so we’ll center our incision along this line, starting from the midline of the back.”

The scalpel glided through the patient’s skin like slicing silk, layer by layer.

Dr. Ou’s incision technique was truly skillful.

It reflected an excellent attending-level proficiency.

Training as a surgeon is no easy feat.

It takes at least a decade to develop real skills.

Without twenty or thirty years of practice, major achievements are nearly impossible.

Even if Dr. Ou had finished grad school at 27 and started operating at 28 under the old integrated system, being 50 meant 22 years of experience.

It took a full 22 years for him to develop an outstanding attending-level grasp of anatomy—imagine how long it would take to reach deputy chief level!

Keep in mind, surgical ability isn’t just about anatomy.

“Remember, the incision should be just long enough to expose three vertebrae. Too long, and the patient suffers; too short, and the operation is hindered.”

While working, he explained the nuances to the two residents.

Typically, in the OR, an attending supervises residents, while a deputy chief or chief surgeon oversees the attendings.

These two residents were under Dr. Ou’s guidance.

Zhou Can secretly rejoiced at the first assistant’s hemostatic skill.

If luck held, he might even earn a chance to prove himself.

“Now, separate the paraspinal muscles carefully—be sure not to damage any vital blood vessels or nerves.”

Some young doctors, overconfident from a few successful attempts on murine vessels, think that nicking a few small vessels is no big deal.

They never fathom the horror of slicing a major artery.

The consequences can be dire.

The older the doctor, the more cautious—and timid—they become during surgery.

In contrast, novice doctors are fearless.

“Now, use the retractor to open the wound; the surgical field will then be clear.”

After the assistant widened the view adequately, Dr. Ou frowned; due to the assistant’s poor hemostasis, blood had accumulated at the wound’s base.

“Suction out the blood. Quick, stem the bleeding from these two sources!”

He personally guided the first assistant in achieving hemostasis.

After considerable effort, electrocautery finally succeeded in controlling the bleeding.

Then came the critical step of the surgery.

“When cutting the lamina, exercise caution. Generally, cutting through two segments is enough to clear the hematoma.”

He excised two laminae and inspected the area carefully.

Finding it perhaps insufficient, he cut through another lamina.

“Alright! Next, use the suction device to remove the hematoma until the dura becomes visible.”

The first assistant’s attempt at clearing the hematoma was rather clumsy.

After much struggle, he nearly managed to clear it completely.

At last, the dura beneath the hematoma came into view.

Bleeding typically stems from the dura.

“In the future, remember: if bleeding persists for more than ten days and the body has already absorbed the hematoma, surgery isn’t necessary. As doctors, besides empathizing with a patient’s anxiety, we must insist on operating only when it truly benefits the patient. Performing surgery solely for profit is disgraceful.”

“Also, any surgery is a last resort. If a less invasive procedure can resolve the issue, avoid major surgery at all costs. Every operation inflicts some degree of harm on the patient.”

Dr. Ou sternly admonished his junior colleagues.

After hearing him, Zhou Can’s respect for Dr. Ou grew immensely.

The man had a fierce temper, but his medical ethics were exemplary and his heart righteous.

He was a doctor worthy of respect.

Dr. Xu had once told Zhou Can that a surgery’s purpose was not only to relieve a patient’s pain.

It is also vital that the benefits far outweigh the harm caused.

Only then can a surgery be properly evaluated in terms of safety, performance indicators, and prognosis.

Imagine a patient with mild stomach pain having their stomach removed.

While the pain might vanish, the harm would far exceed any benefit.

“Once the hematoma is cleared, locate the active bleeding point.”

They soon identified a small, active bleeding source.

After electrocautery controlled the bleeding, they continued their exploration.

“Dr. Ou, it seems there’s a mass of clotted blood here that won’t clear away.”

After a careful inspection, Dr. Ou explained,

“Note well: this isn’t mere coagulated blood. It’s an abnormal vessel cluster. When encountered, you must excise it completely.”

After letting the two assistants examine it, Zhou Can and Jiang Xiaohua leaned in, eager to learn more.

But Dr. Ou offered them no further help.

He immediately proceeded to cut out the abnormal vessel cluster.

As soon as it was excised, bright red blood spurted out.

It appeared that a small arterial vessel had been severed, causing moderate bleeding.

The removed abnormal vessel cluster was clamped out and tossed onto a tray.

Zhou Can stepped forward to inspect it closely.

In the OR, if you want to learn something, you must be bold and thick-skinned.

In the eyes of senior doctors, residents, interns, and trainees are treated like nothing more than roadside weeds, and they won’t take the initiative to teach you anything.

It’s rare to get an opportunity to observe the patient’s wound up close during surgery.

When the lead surgeon is operating, there’s no time to babysit junior doctors.

Their focus is on completing the procedure as quickly as possible.

So once the abnormal tissue is excised and thrown onto a tray, no one bats an eye—as long as it doesn’t interfere with the operation.

Dr. Ou calmly instructed the first assistant to control the bleeding.

“It’s not stopping!”

The first assistant appeared panicked and fearful.

Bleeding from the dura is far more frightening than from the skin.

“Get me the electrocautery knife!”

Dr. Ou remained remarkably calm.

But he soon realized that electrocautery wasn’t working.

“Damn it, what’s going on?”

Dr. Ou’s brows furrowed deeply.

Despite his extensive experience, a trace of panic flickered in his eyes.

The unknown is the most terrifying, for no amount of learning can prepare you, nor will it reveal the cause of uncontrollable bleeding.

“It must be bleeding from beneath the dura,” Zhou Can suggested with a glance.

“Mind your own business—stay out of it and stop causing trouble!”

The first assistant glowered at Zhou Can.

“I’m not stirring up trouble—I’m just offering my perspective. Perhaps when Dr. Ou excised that abnormal vessel cluster, he nicked a vessel beneath the dura. Or maybe one of the vessels split into two.”

Blood vessels, much like tree roots, can branch out.

If you cut at a branching intersection, it’s natural that electrocautery might not suffice.

Zhou Can had only acquired such insights after advancing his hemostasis skills to an attending level.

Upon hearing him, Dr. Ou’s eyes brightened as he carefully searched for any subdural bleeding points.

However, the persistent bleeding severely hindered his efforts.

“Hand me the hemostatic forceps!”

Zhou Can looked to the instrument nurse.

“What do you think you’re doing? This is a critical area. You’re just a trainee—you shouldn’t be trying to show off.” The first assistant’s earlier scolding of Zhou Can had done little to stop him.

Zhou Can continued outlining his observations.

This only further ruffled the assistant’s pride.

Resentment grew, but he remained silent out of pride.

Then, this trainee brazenly asked the nurse for hemostatic forceps—clearly trying to get involved!

Wasn’t that overstepping?

“I’m not showing off; I just want to help Dr. Ou,” Zhou Can replied calmly.