Chapter 143: Critical Decisions in the Operating Room

Zhou Can sneered. For now, Cheng Gang can still afford to scold him.

Once he shows up more frequently in the operating room and climbs the ranks, Cheng Gang might have to start treating him differently.

Accompany Dr. Ou to speak with the family.

The patient and his wife waited anxiously.

After detecting the ruptured brain aneurysm, both the patient and his family were in a state of panic, gripped by fear over the rapid deterioration.

“Dr. Ou, when will the hospital begin treating my husband?”

The patient’s wife fought back tears.

Since yesterday, she had stayed by his side without a break; her hair was a bit messy as she had no time to fix it.

“You must be aware of the test results. No one expected his condition to worsen so rapidly. That ruptured aneurysm poses an immediate life threat, so we had to act fast.”

Almost every doctor first emphasizes the dire consequences when discussing the situation with the family.

It isn’t merely to scare them.

It’s to prepare for the worst.

So that the family can be mentally ready.

If the operation succeeds, the patient will praise the doctor’s skills for saving his life. If it fails, at least the family has been warned, easing the psychological impact.

Moreover, presenting the consequences in a severe light helps the family more readily accept the proposed treatment plan.

Many patients and their families are terrified of surgery, often wavering in their decision.

But in this case, delaying was not an option—a bit of intimidation could avert needless tragedy born from hesitation.

“Doctor, please, you have to save my husband!”

The woman nearly dropped to her knees as she pleaded.

“Please, stop!”

Dr. Ou gently steadied her.

“Saving lives is our duty. Rest assured, we will find a way to treat your husband. The team has just drafted two surgical plans—listen carefully and then choose one.”

Dr. Ou’s conversation with the family was remarkably skillful, providing plenty for Zhou Can to learn.

For instance, although Wu Baihe had already mentioned the two plans to him, he told the family that they emerged from a consultation after the brain hemorrhage was confirmed.

This made it much easier for the family to accept the options.

“Plan One: Open brain surgery. We cut through the scalp, remove a section of the skull, locate the aneurysm through the gaps in the brain tissue, and clip it with a special tool to stop the bleeding. This procedure, however, is highly risky and involves a long recovery.

Plan Two: A modern interventional procedure. We insert a guidewire via the femoral artery, navigate up to the aneurysm, and deploy a spring coil to fill the aneurysm, inducing clot formation to seal the leak. This option is slightly more expensive than open surgery.”

“However, it’s less invasive and allows for a faster recovery. Under ideal conditions, the patient might be discharged in about three days, saving at least ten days of hospitalization. The saved costs can help offset the higher price of the interventional procedure.”

The second option, an interventional procedure, is a development of recent years.

Domestically, our technology is far behind that of foreign institutions.

Compared to traditional surgery, modern interventional and robotic procedures offer distinct advantages.

Interventional surgery is minimally invasive and facilitates a speedy recovery, which is especially beneficial for patients who can barely tolerate major surgery.

For instance, older or severely frail patients who wouldn’t be candidates for open surgery previously had no choice but to opt for conservative treatment,

which often meant waiting for the inevitable.

Now, choosing an interventional approach might just save a life.

“Dr. Ou, how much does the interventional procedure cost for my husband?”

Cost is a major concern for ordinary families.

“His aneurysm is quite large, but luckily he only has one. We estimate the expense at around 120,000 yuan. However, as conditions can change rapidly during surgery, the final cost will be calculated by our finance team after the procedure.”

Dr. Ou’s quote was merely an estimate based on similar cases in the past.

“And what about the cost for traditional surgery?”

The patient’s wife asked again.

“It’s roughly 60,000 to 80,000 yuan.”

Traditional surgery is indeed much cheaper than the interventional option.

But considering the prolonged hospital stay and high risks, if the finances allow it, the interventional procedure is clearly preferable.

The woman whispered her thoughts to her husband.

They weren’t wealthy, yet they weren’t destitute either.

Both appeared well-educated; her style even resembled that of an urban professional.

They were confident they could come up with the necessary funds.

With insurance covering part of the expenses, it was manageable.

“We’ll choose the interventional procedure.”

She had already reached a decision.

“Alright, I’ll arrange it immediately. Before the surgery, the funds need to be deposited into your hospital account. When can we expect the transfer?”

Dr. Ou asked.

Without the deposit, the hospital usually won’t proceed with the surgery.

“I’m going to withdraw the money right now.”

Sure enough, the woman had a decent reserve—accessing over 100,000 yuan was no problem.

……

Half an hour later, she had deposited 120,000 yuan for the surgery.

With the money in place, Dr. Ou called Wu Baihe, who was in the midst of a major surgery expected to last at least six to eight hours.

With no other option, he turned to Director Wen.

After some negotiation, Director Wen finally agreed to perform an emergency interventional procedure on the patient.

On one hand, the situation was indeed critical; on the other, interventional procedures are relatively quick.

In uncomplicated cases, the procedure generally takes only one to two hours.

Next, the anesthesiologist was called in for a preoperative discussion and to secure consent forms, while Dr. Ou had the family sign the surgical consent.

The hospital promptly allocated an operating room.

The surgery proceeded in an orderly fashion.

Zhou Can considered himself extremely fortunate to have the chance to observe and learn in the operating room under Dr. Ou.

Inside the operating room, he finally met Director Wen from the General Surgery Department.

A man in his fifties—probably around 55 or 56—remarkably still flaunted jet-black hair that shone like that of a youth.

Yet age spots and wrinkles had started to mark his face and hands.

Deep lines creased his forehead and the corners of his eyes.

Time had taken its toll—Director Wen’s hair was most likely dyed black.

Still, he exuded an air of refinement. Sporting glasses and speaking unhurriedly, he embodied the charm of mature masculinity.

Achieving a director’s position at 56 at Tuyu Hospital was no small feat.

Just look at Dr. Ou—barely in his fifties and still only an attending physician.

This shows just how difficult it is to secure a higher title.

Even attaining a deputy senior position is equally challenging.

Many outstanding doctors never rise above the level of attending before retirement.

In the operating room, Director Wen led the procedure, assisted by Dr. Ou and two other attending physicians—one male and one female.

The male was in his forties; the female appeared to be around 35 or 36.

The remaining team members were resident doctors and graduate students.

Dr. Ou’s participation in the operation was likely tied to his role as the admitting physician.

After the patient was positioned on the operating table, the anesthesiologist attached multiple monitoring devices, fitted a breathing mask, and initiated inhalation anesthesia.

This method of anesthesia is more acceptable to patients.

After a few deep breaths, the patient’s consciousness faded, and he quickly drifted off into sleep.

There was no pain.

“Anesthesia is successful. All vital signs are stable. We can proceed.”

Those were the words everyone had been waiting for.

Director Wen’s gaze swept over the two attending physicians by his side.

“For this brain aneurysm interventional embolization, we choose the femoral artery at the upper thigh as the entry point. Remember, never opt for convenience by choosing a closer site—using the carotid, for example, is absolutely forbidden.”

The three graduate students quickly took out their notebooks and jotted down the instructions.

Medical students are generally very diligent.

“Also, make sure to study the imaging. If the aneurysm’s neck is too wide, deploying the spring coil won’t achieve the desired result. In such cases, a stent should be used to support the coil and prevent protrusion…”

These surgical insights were both profound and extremely practical.

Zhou Can silently committed them to memory.

His memory was quite good, and since he hadn’t brought any paper, he planned to jot down further notes after his shift.

“Before the operation, our dSA 3D reconstruction provided a clear picture of the aneurysm’s location. Now, let’s begin the femoral artery puncture. Who would like to take the lead?”

Director Wen’s eyes fell on the male and female attending physicians.

As for Dr. Ou, he was relegated to an observer—like a neglected child—with no role beyond learning.

Zhou Can hardly needed mentioning further.

He stood behind Dr. Ou, while the residents and graduate students under Director Wen maintained clear divisions.

“May I take this on?”

The female attending asked in a coquettish tone.

“I believe Tang Li, despite only having performed two coronary punctures, can handle it this time!”

Director Wen approved, leaving the male attending to step back.

“Thank you, Director Wen!”

She flashed a sweet, grateful smile.

In the eyes of the male attending, a capable-looking female doctor clearly had the upper hand.

Opportunities for surgical practice are highly coveted—if you grab one, it’s yours for the taking.

“Let me assist you!”

The male attending, having lost out, didn’t get angry but instead cheerfully offered his help.

Tasks like skin preparation are typically carried out by nurses.

Even secondary disinfection is usually handled by resident doctors.

For an attending doctor, such tasks are beneath his rank.

“Thank you, Dr. Zou!”

She began washing her hands in preparation.

As she administered the injection, the blood drawn was a dark red.

Zhou Can’s lips twitched—this woman seemed adept only at using her charm, with her actual skills being quite limited.

At 35, she had already become an attending, and her educational background was undoubtedly solid.

Combined with her close connections to the department head, that’s how she advanced.

Young doctors at Tuyu Hospital are generally well-qualified.

Nearly ninety percent hold graduate degrees.

The dark red blood from her injection indicated that she had punctured a vein.

When performing a puncture or inserting a catheter, always observe the blood’s color afterward.

Dark red typically signifies venous blood, whereas bright red indicates oxygen-rich arterial blood.

With a bit of experience, it’s easy to tell the difference.

“Oh no, Director Wen, please check—did I puncture the wrong vessel?”

She looked startled.

“Perhaps you hit a vein. Let me handle it!”

Director Wen replied in a gentle tone, without any reproach.

This leniency significantly diminished Zhou Can’s impression of him.

Not every chief is as upright and meticulous.

Only a few, like Dr. Ou, Dr. Xu from the Emergency Department, and Chief Resident Shen from Orthopedics, truly uphold those principles.

Especially with the rapid expansion of Putian-style hospitals in recent years.

Many departments have been taken over by Putian-style doctors—ruthless and profit-driven.

Worse still, these individuals treat patients like cash machines, turning medicine into a money-making scheme and becoming a massive blight in the industry.

Even previously principled doctors have been dragged down and started to imitate them.

Overtreatment, unnecessary diagnoses, and surgeries loaded with expensive consumables—charges that insurance wouldn’t cover.

They even push patients toward buying worthless nutritional products.

These practices have spread throughout the entire medical field.

Countless patients have suffered as a result.

Zhou Can couldn’t be certain that Director Wen was entirely upright, but the fact that the female doctor’s mistake went unpunished was highly abnormal.

Unless that doctor were his own daughter, such leniency would be unthinkable.

Normally, if a subordinate errs, the chief would at least issue a warning.

Director Wen’s gaze swept over Zhou Can.

In the operating room, he was the only unfamiliar young doctor not under his direct supervision—tasks were usually reserved for outsiders.

“Clean the skin on the patient’s other thigh at the puncture site!”

Since the puncture on that femoral artery had failed, it was safer to use the other leg for a new attempt.

Obediently, Zhou Can stepped forward to prepare the skin.

He had performed this procedure countless times with remarkable proficiency.

“Director Wen, it’s done!”

He finished cleaning and stepped away from the operating table.

This task was never assigned to trainees.

Director Wen proceeded with the puncture himself.

With one insertion, he succeeded—but after watching his technique, Zhou Can secretly shook his head.

For a director-level doctor, his puncture should have at least been of deputy director caliber.

Yet that attempt was only at the level of an average attending.

No wonder his female trainee’s performance was so poor—if all mentors operate at this level, how could their students excel?

“Remember, always gauge the depth of the puncture. Too shallow or too deep is unacceptable.”

Director Wen completed the puncture, a hint of satisfaction on his face.

Next, he advanced a catheter from the femoral artery into the abdominal aorta, then the thoracic aorta, followed by the aortic arch, and finally into the aneurysm sac.

Although the process encountered some difficulties, it went smoothly overall.

“Now we come to the critical step—advancing the microcatheter to deploy the spring coil and fill the aneurysm. This step truly tests a doctor’s skill in coil placement.”

With that, he began deploying the first coil.

The entire procedure was clearly visible on the monitor.

However, the coil deployment encountered problems; it stuck at the neck of the aneurysm and refused to settle properly.

Director Wen’s forehead began to sweat.

“Deploying the spring coil is indeed challenging. After practicing for over a decade, I’ve only reached modest proficiency.”

His explanation seemed more like a face-saving gesture than a genuine admission.

Everyone watched in intense silence.

No one dared to speak.

Seconds ticked by as Director Wen’s face grew red.

Tension, embarrassment, and a heavy atmosphere filled the operating room.

Zhou Can observed the entire procedure, convinced that if given a chance, he could successfully deploy the coil into the aneurysm.

However, stepping forward at that moment would only earn him a severe scolding from Director Wen.

After all, if a chief can’t execute the procedure properly, who would tolerate a trainee daring to take over?

Volunteering now would only lead to a torrent of reprimands from Director Wen.

If the chief can’t master the procedure, no director would tolerate a trainee stepping in with, ‘Let me try,’ without incurring his wrath.