Chapter 150: A Critical Operation

Dr. Zou had just mentioned that Traditional Chinese Medicine in China is in decline, barely surviving under market pressures. In contrast, many developed countries abroad are now aggressively developing TCM by recruiting experts, setting up herbal plantations, and conducting in-depth research.

This sparked a sense of crisis in Zhou Can.

It also altered his views on TCM considerably.

In the future, once he attains a higher status, strong financial backing, and advanced surgical skills, his positive stance will undoubtedly benefit the development of TCM.

The surgery proceeded smoothly, and Director Wen was clearly in high spirits.

Sitting back in his chair, he engaged in intermittent chatter about the future direction of medicine.

The atmosphere in the Operating Room was exceptionally upbeat.

At that moment, a graduate student exclaimed, “It seems the patient’s finger just twitched!”

It had been more than 15 minutes since the anesthesia was stopped.

Under normal circumstances, the patient might indeed begin to awaken.

But since this patient had been unconscious before the surgery, his awakening now would be exceedingly good news for both the doctors and his family.

Everyone’s eyes fixated on the patient’s hand.

Just then, the patient’s right middle finger moved again.

“He’s awake! Really awake!”

A delighted smile broke across Director Wen’s face.

“Lin Lizhi, wake up! Lin Lizhi, wake up!”

The anesthesiologist gently patted the patient’s shoulder and whispered into his ear.

In a comatose state, humans resemble a deep sleep; calling their name now often has a high chance of rousing them.

If they don’t respond, it usually indicates severe trauma and a critical condition.

The fact that his finger was moving suggested that his brain was active.

This was a very promising sign.

As the anesthesiologist called him repeatedly, the patient’s eyelids began to flutter, and he slowly opened his eyes.

However, he appeared to be struggling.

His body was still extremely weak—as if merely opening his eyes was a herculean effort after barely clinging to life.

After his eyes opened, his gaze appeared somewhat vacant.

He slowly turned his head, taking in the faces around him.

“Where am I?”

He asked.

“Lin Lizhi, you were in a car accident and are now undergoing surgery at the hospital,” Director Wen explained.

After speaking, Director Wen watched the patient’s reaction intently.

Typically, after surgery, several tests are performed on a waking patient.

Firstly, they assess whether the patient’s consciousness is clear.

Next, they check for any limb paralysis, and finally, they examine overall body functions.

Lin Lizhi fell into a brief silence.

After a moment, he seemed to recall the events before the accident.

“Doctor… is my girlfriend okay?”

He remembered that his girlfriend had also been in the car, which meant his brain hadn’t suffered major damage.

Both his memory and consciousness were intact.

“I’m not exactly sure! Once you recover, ask your family,” replied Director Wen, a chief physician with an overwhelmingly busy schedule.

Matters unrelated to the patient’s condition simply weren’t his concern.

Director Wen then looked up at the anesthesiologist.

“You’re right—he’s not only awake but fully alert. All signs indicate that the surgery was a success.” Turning back to the patient, he added, “Young man, cooperate with the treatment and you’ll be discharged before you know it. Then you can go see your girlfriend.”

“Alright! Thank you all!” the patient managed to say, though his voice was still weak.

His words were indeed somewhat labored.

After awakening, the anesthesiologist observed him for a few minutes and, finding no abnormalities, had him escorted out of the Operating Room.

High-priority patients like him are typically accompanied by both an anesthesiologist and a doctor to prevent any mishaps along the way. Once returned to the ward, a handover is conducted with the assigned bed manager.

“Everyone, take a short break. We’ll start the second surgery in half an hour,” Director Wen announced.

Operating Rooms in the hospital are a scarce resource.

For example, this case was originally planned to last four to eight hours but ended up taking less than two hours.

This left six hours of idle time.

During that window, if another patient needed surgery but was delayed due to room shortages, they could now be accommodated.

Often, particularly with highly complex operations that run overtime, subsequent surgeries are postponed due to a lack of available Operating Rooms.

These freed-up spaces are then put to excellent use.

……

Half an hour later, Zhou Can and the team returned to the Operating Room.

The patient was already lying on the operating table.

It was a young female patient, probably in her twenties. Her hair had been completely shaved, she was prepped and sterilized, and her incision site was clearly marked.

Zhou Can had already reviewed her file.

At just 24 years old, she had been diagnosed with a meningioma.

Typically, malignant transformation in meningiomas is rare. The common types are endothelial, fibrous, and vascular, with mixed types also seen quite often.

Meningiomas usually occur in older patients.

It was extremely rare for someone so young to have one.

According to her account, she had suffered head trauma before.

Medical experts believe that head injuries are a risk factor for meningiomas because, during the repair process, cranial cells are prone to mutations.

She exhibited three symptoms: double vision, numbness on her left face, and in everyday life, some even mockingly called her ‘facially paralyzed.’

They even said her face was asymmetric.

When she smiled, one side of her face expressed emotion while the other remained blank, creating a rather eerie look.

Recently, a new symptom emerged: she kept choking while eating; swallowing food and even drinking water became difficult.

Based on her symptoms alone, a diagnosis of meningioma was almost certain.

A subsequent CT scan confirmed an abnormal tumor at the skull base.

This time, surgery was necessary to remove it.

Among meningioma operations, those at the skull base are among the most challenging.

Skull base meningiomas are intimately associated with normal cranial nerves and blood vessels, and are difficult to expose during surgery, making the procedure extremely challenging.

In truth, no operation overseen by a chief physician is ever simple.

Director Wen, the chief physician of the General Surgery Department, routinely tackles numerous critical and complex cases, bearing pressures far beyond those of ordinary doctors.

The operation soon commenced.

Within the team, Zhou Can had already established himself to some extent. He was currently serving as the third assistant, standing behind two attending physicians and observing the procedure.

Several resident doctors and three graduate students had crowded in behind him.

Positioned as the third assistant, they all respected his skill.

Zhou Can’s surgical abilities were indeed far superior to theirs.

“I’m sure you’ve already reviewed the scans and reports. The patient’s meningioma is a sphenoidal ridge type—the most challenging form of skull base meningioma. Removing it completely without damaging her nerve functions is extremely difficult,” he explained.

While performing the surgery, Director Wen also took the opportunity to teach.

This procedure was graded between Level 3 and Level 4 in difficulty—its complexity even surpassed that of many Level 4 surgeries.

“The incision is typically centered on the pterion, using a frontotemporal approach. Achieve hemostasis!”

Upon incising, bright blood gushed out.

Dr. Zou acted as the first assistant. His hemostatic skills were quite competent, nearly reaching that of an experienced attending physician—after all, he was already a seasoned 40-year-old.

His ability to control bleeding, however, was slightly inferior to Zhou Can’s.

Nonetheless, it was acceptable.

He steadily employed the electrocautery knife to halt the bleeding, while Tang Li worked in seamless coordination, promptly suctioning away the blood.

“Do you know why I stress that the tumor’s diameter should not exceed 2cm?”

Director Wen looked to his two attending physicians.

“If it’s any larger, removal becomes much more difficult.”

Tang Li’s response was somewhat generic.

“I’m concerned about damaging nerves and blood vessels,” added Dr. Zou, whose more precise answer reflected his greater experience.

“Dr. Zou is right. With a tumor any larger, completely removing it is nearly impossible because of the high risk of harming critical nerves and blood vessels. That’s why, going forward, whenever you suspect a meningioma, you must insist on early diagnosis and treatment—the difficulty increases exponentially as the tumor grows.”

Director Wen provided his explanation.

Zhou Can silently took note.

These were invaluable surgical lessons that you could hardly learn from textbooks.

They were passed down orally from veteran doctors to the younger generation.

“Teacher, this patient’s tumor has reached 2.1cm. Why are you still opting for surgery?” asked a graduate student.

“Because she’s young. If we don’t operate, her life might simply fade away. Moreover, her tumor is growing rapidly—a very alarming sign. Typically, only malignant tumors grow this fast, while benign ones progress much more slowly.”

Although Director Wen sometimes cared too much about appearances and engaged in superficial gestures,

his actions—and his willingness to operate on this young woman—clearly demonstrated a spark of brilliance in his mind.

He was truly a doctor worthy of respect.

As layers of skin and subcutaneous tissue were gradually incised, the tumor came into view.

This mass measured over 2cm in diameter.

Zhou Can felt an eager itch to get to work.

His skills in dissection and incision were already at Level 4, essentially at the level of an experienced attending.

Though he wasn’t completely confident about removing such a large tumor, he was willing to take on the challenge.

Director Wen had already begun separating the tumor from the middle cerebral artery. He worked with extreme caution, each cut made with the precision of treading on ice. Yet, in the final stages of separation, he paused.

“This tumor is too tightly adherent to the arterial wall. Forcing it apart will inevitably rupture the vessel. Even if it doesn’t rupture now, problems may arise postoperatively. If necessary, we might have to leave a small portion of the tumor capsule behind.”

After considerable hesitation, Director Wen ultimately abandoned the effort to forcibly separate it.

“Immediately send this excised tumor for urgent pathological analysis. I’ll wait for twenty minutes, and then decide whether to remove the remaining capsule based on the results,” he ordered.

After making the arrangements, Director Wen inspected the surrounding tissue for any additional tumors.

Zhou Can looked at the removed tumor and felt an ominous premonition.

He had seen benign tumors before, which typically appeared more innocuous.

Just like people—their appearance mirroring their inner nature—a kind face often signifies genuine kindness, while a fierce, merciless visage usually hints at malevolence.

Experienced doctors can often gauge a tumor’s nature by both appearance and texture.

Veteran physicians dealing with breast or lymphatic cancers can usually tell by one touch whether a tumor is benign or malignant.

However, the final verdict must always rely on pathological studies.

Intraoperative frozen pathology is the fastest method.

Results can be available within twenty minutes.

Standard pathological examinations require a queue, often taking until the next day.

After about twenty-four or twenty-five minutes, the pathology report returned.

“Malignant!”

Everyone was stunned by the result.

This was the outcome doctors dreaded above all else.

For such a young girl, a diagnosis of a malignant tumor was utterly shocking.

“But there’s a silver lining—the pathology report notes that the tumor’s margins are clear, suggesting it hasn’t invaded surrounding tissues. As long as we excise it completely, the patient should recover well.”

Director Wen looked at the report, clearly troubled.

The final layer of the tumor capsule was far too challenging to remove.

“Everyone, let’s brainstorm. Does anyone have a better method?” he asked.

In surgery, situations can change unpredictably.

Before the procedure, no one can tell whether a tumor is benign or malignant.

Now that the results are in, this is devastating news for the patient.

If the resection isn’t complete, cancer cells will quickly proliferate in her body.

By then, her fate would almost certainly be fatal.

Director Wen was torn, for this decision affected the very fate of this young woman.

He was determined to save her.

But how?

Several doctors offered ideas, yet Director Wen dismissed them one by one.

None of those proposals proved practical.

“What if we prepare two scenarios: harvest a segment of a venous vessel for vascular anastomosis, then attempt to remove the remaining tumor capsule?”

Zhou Can had learned many relevant surgical techniques from Dr. Xu.

A master produces excellent disciples—the suggested plan was one of the more viable options.

He did not propose using an artificial vessel, because the patient is only 24. Even though artificial grafts are advanced, their longevity is uncertain.

Even a 30-year lifespan would pose a huge risk for someone so young.

Using the patient’s own venous vessel, although more laborious, avoids rejection; its success rate is higher.

And there would be no subsequent hazards.

“The plan to harvest a venous vessel for arterial repair faces multiple challenges. First, anastomosing the two ends takes a considerable amount of time—the brain can only tolerate about three minutes of ischemia. Even with my skill, suturing the ends will take at least twenty minutes, assuming the vessel is prepared. Secondly, the central cerebral artery is surrounded by rich nerve tissue, requiring at least 3cm of dissection before anastomosis—the risks during this process are significant.”

Skull base meningioma surgery is renowned as one of the most challenging procedures.

Resecting a sphenoidal ridge meningioma is the toughest among skull base operations.

Excruciatingly difficult—its reputation is well deserved.

The entire operation was fraught with unpredictable, immense risks.

“To tackle the issue of blood supply during the vascular anastomosis, one solution is to establish a bypass,”

Zhou Can proposed another approach.

“Aren’t you just creating extra trouble for yourself?” Director Wen commented with a wry smile, admiring the young man’s boldness.

“I’ve studied it—this branch vessel also supplies blood to the scalp. By diverting flow from it to the target artery, even if the central artery is clamped for one or two hours, it shouldn’t cause major issues.”

Zhou Can’s proposal was designed to maintain blood supply to critical brain tissues during the anastomosis.

Drawing from that branch vessel might induce some hypoperfusion, but it would simply buy time to complete the repair.

Director Wen fell into deep thought.

“Dr. Zhou’s proposal, while complicated and risky, does have merit. It implies setting up all contingencies before launching a full-scale operation.”

For once, Dr. Zou surprisingly supported Zhou Can’s surgical plan. Biquge.

In all honesty, he was quite impressed with Zhou Can.

A trainee with such clear and precise surgical insight—Tuyu probably has only one like him.

If only he knew that Zhou Can’s mentor was the once world-renowned ‘Rapid Surgical Technique’ Xu Yidao, he might have thought otherwise.

A master produces outstanding disciples.

How could Dr. Xu’s pupils be any less?

Dr. Xu imparted everything he knew to Zhou Can wholeheartedly.

Meanwhile, Jin Mingxi enjoyed far fewer privileges.

“This plan is indeed feasible. First, consult with the family—if they agree, we’ll proceed with this approach. If not, we’ll simply clean the surgical wound and suture it closed,”

Director Wen finally made his decision.