Chapter 167: Trials in the ICU

Tomorrow at around 3:30 PM, just head to the office and wait for me.

Looks like Director Liu will be on a late shift tomorrow.

“You have WeChat, right? Later, I’ll add you to our work group. Any shift changes or other announcements will be made there.”

Almost every department divides its doctors into several medical teams.

For example, there’s a team for orthopedic trauma—with doctors specializing in that field—another for joint issues, one for microsurgery, one for hand surgery, another for ankle surgery, and yet another for spine surgery.

Zhou Can, who has just joined the Critical Care Department, isn’t very familiar with these team divisions yet.

The Critical Care Department is generally split into three teams.

They primarily cover respiration, multi-organ dysfunction, and cardiovascular plus neurological issues.

Simply put, they manage the systems of external circulation, internal circulation, and the nervous system.

As long as these three systems remain in check, a patient’s life is essentially secure.

External circulation mainly refers to the respiratory system—breathing, oxygen exchange, and synthesis.

Internal circulation deals with blood transport, distributing oxygen, nutrients, and handling waste.

The nervous system needs no elaborate explanation—it centers around the brainstem controlling the entire neural network.

Once you understand these three basic life support pillars, the anesthesiologist’s role starts to seem less mysterious.

To eliminate a patient’s pain, you simply block the nerve signals.

General and spinal anesthesia are the most common methods; local anesthesia is rarely their concern.

Considering surgical costs, the chief surgeon typically handles anesthesia as part of the procedure.

“Dr. Hu, remember to add Dr. Zhou to our work group after your shift,” he instructed.

Director Liu, having finished his instructions, left without waiting for any further comments from Zhou Can.

As soon as Director Liu departed, Dr. Hu visibly relaxed.

“From now on, this is your generation’s world! The youthful tide never stops–each new wave surpassing the last,” Dr. Hu remarked with a complex expression.

Watching Zhou Can’s impressive performance, one couldn’t help but feel a hint of envy.

Now that Zhou Can has earned Director Liu’s favor, he’s truly come into his own.

Dr. Hu had no choice but to accept the reality.

He resolved to keep a good working relationship with Zhou Can, no longer treating him as just a trainee.

At that moment, the alarm for Bed 6 started ringing.

Every machine has its own unique alarm sound.

Having been on duty just for a day, Zhou Can immediately recognized that the sound indicated a blood pressure problem.

He rushed over, and sure enough, the blood pressure was dropping sharply.

It seemed another patient in Bed 6 was about to be lost—when will this curse finally break?

Dr. Hu, accustomed to such crises, remained completely calm.

After a quick examination, he declared, “It’s ventricular fibrillation. Prepare for immediate defibrillation.”

Ventricular fibrillation is marked by rapid, weak, and disorganized contractions of the ventricles, leading to a complete loss of effective blood flow.

This condition causes the heart to stop pumping, erasing both heart sounds and pulses.

Consequently, the heart, brain, and surrounding tissues lose their blood supply.

Think of the heart as a pump—its continuous beat circulates blood through the arteries to vital organs.

When ventricular fibrillation occurs, it’s as if the pump is malfunctioning, leaving blood flow severely compromised.

Within three minutes of brain ischemia, irreversible damage sets in and neurons begin to perish.

Ventricular fibrillation is extremely dangerous.

At this point, the standard rescue method is defibrillation with a defibrillator.

“Zhou Can, you learned how to defibrillate yesterday. You can handle it, right?”

“Yes!”

Zhou Can quickly grabbed the defibrillator without hesitation.

He applied an electric shock to the patient’s chest.

The patient’s body jolted in response.

This is a normal reaction.

[Life-saving Insight +1 EXP]

Zhou Can was a bit taken aback.

He had never been trained in this technique before! How did this life-saving skill suddenly appear?

Pressed by the urgency to save the patient, he couldn’t afford to dwell on the mystery.

His first attempt at defibrillation wasn’t very effective.

“One more time!”

Dr. Hu calmly directed from the sidelines.

Zhou Can delivered another shock to the patient.

[Life-saving Insight +1 EXP]

Gradually, the patient’s heart rate and blood pressure returned to normal—the patient had been temporarily rescued.

Both Zhou Can and Dr. Hu let out relieved breaths.

Earlier, witnessing the patient’s rapidly falling blood pressure had been truly terrifying.

In the ICU, patients often waver near death multiple times a day.

Doctors and nurses work together to pull them back from the brink, employing every life support measure until, through sheer determination, they transfer them out of the ICU.

Or, in some cases, they eventually lose the fight.

Sometimes, certain circumstances necessitate transferring a patient out.

For example, if family members decline further treatment or in cases of malignant tumors and terminal illnesses where recovery is impossible.

In principle, such patients are transferred out.

Some private or small hospitals, mindful of ICU operating costs, might keep patients for a few extra days as a common tactic when numbers are low.

At hospitals like Tuyu, any ICU rescue costing more than 200 yuan in materials requires family consent.

Moreover, ICU operations are extremely expensive and usually run at a loss.

Consider this: daily ICU treatment can cost anywhere from two to three thousand yuan, even running into tens of thousands—so why is it still unprofitable?

For example, a chest or abdominal puncture typically costs about 90 yuan.

A chest puncture requires at least two medical staff.

A senior attending physician plus a supporting nurse.

If the puncture goes smoothly, it lasts no less than half an hour—assuming the physician’s technique is superb, the nurse’s cooperation is precise, and the patient’s condition is stable.

Otherwise, various complications might necessitate using ultrasound guidance to complete the procedure.

Even with two or three people working half an hour on relatively pricey equipment and supplies, the final fee remains around 90 yuan.

Does that sound like the hospital is running at a loss?

Another example is chest compressions—most people know CPR.

Although chest compressions seem simple, anyone who has performed them on an adult knows just how exhausting they are.

For effective CPR, compressions need to be about 5 cm deep, at least 100 times per minute—ideally around 120.

Such high-intensity compressions are manageable for a short duration with two people but are nearly impossible over a long period.

Still, if family members refuse to give up, doctors and nurses, even with tears and gritted teeth, persist until exhaustion.

Typically, this resuscitation process lasts several hours.

Four to five hours is not uncommon.

Family members usually cling to hope for a miracle, urging doctors to save their loved ones no matter what.

They rarely relent until hours have passed.

Even if the compressions last four hours, it often takes four or five medical staff to manage.

Since nurses generally have less strength, doctors are usually the ones performing the compressions.

After four or five doctors laboring for four to five hours, the final charge is only 100 yuan.

Furthermore, the hospital strictly limits this charge to a one-time fee.

Some patients may experience multiple cardiac arrests in a day—as if mocking the doctors—forcing them to continuously perform compressions and resuscitations.

In the end, they only charge 100 yuan.

So, is the hospital losing money or making money?

A doctor’s half-day wage isn’t even covered.

Many family members and patients claim that the ICU overcharges, demanding ten or twenty thousand yuan a day to squeeze out money.

But they rarely consider the cost of the expensive equipment, supplies, and medications used throughout the day.

Many of these supplies are imported.

And why not use domestic products? The discussion only leads to tears—the quality of local products is frankly subpar.

Needless to say, the medication situation is even more worrisome.

At hospitals like Tuyu, don’t complain about the high ICU costs—as long as a life is saved, it’s undoubtedly worth it.

After all, if both life and money are lost, then it’s truly tragic.

After the patient in Bed 6 stabilized a bit, Zhou Can immediately reviewed the newly appeared medical techniques.

To his surprise, he couldn’t help but burst into laughter when he saw them.

He noticed that two new medical skills had mysteriously appeared.

They were likely acquired during his sleep last night.

When he returned to the apartment yesterday, he practiced his Rapid Surgical Technique and checked his personal medical stats—but those skills weren’t there.

[Life-saving Insight EXP: Novice 2/1000. Special Medical Skill: In critical resuscitations, intelligence multiplies—calming the mind and boosting diagnostic clarity by 50%.]

This is the first special medical skill he’s acquired.

It’s fascinating—this skill only activates during patient emergencies.

Boosting diagnostic clarity by 50% significantly aids him in pinpointing a patient’s ailment.

No wonder his mind was so clear when he defibrillated that car accident victim earlier.

Perhaps this skill was already at work.

Clear diagnostic thinking is like having a roadmap to solving problems—the clearer the path, the better the success rate.

Now, let’s examine the other new skill.

[Pharmacological Differentiation EXP: Level 3 1/1000, Hospital Intern Level].

This skill deepens his understanding and application of pharmacology, enabling optimal drug selection for the best treatment outcomes.

It is equivalent to the level of a hospital intern, likely thanks to Zhou Can’s strong pharmaceutical background.

Now with Pharmacological Differentiation, once he obtains his Licensed Physician certificate and prescription rights, he can rapidly advance this skill.

Pathological Diagnosis is about identifying the cause of illness and revealing its underlying mechanisms.

Armed with diagnostic, drug, and surgical skills, Zhou Can now has three strong tools to battle disease.

As he continues to refine these skills, he believes he’ll be able to treat an ever-growing list of conditions.

He was sure these two new skills were a result of saving the patient in Bed 7 last night.

Pharmacological Differentiation came about because his prescription was likely approved by Dr. Shi.

As for Life-saving Insight, it serves as a reward for his active patient resuscitation.

Or perhaps it reflects how, in emergencies, he becomes almost possessed—his diagnostic acumen and brilliance far surpassing his usual state.

In short, these new skills are like treasures to Zhou Can, filling him with secret joy.

“Zhou Can, Zhou Can!”

Dr. Hu, noticing Zhou Can standing there in a daze, repeatedly called his name.

“Ah… you called me?”

Startled, Zhou Can snapped back to attention, feeling a bit embarrassed.

“You can’t afford to daydream here! Always stay alert—a small mistake could delay a rescue and lead to severe consequences,” Dr. Hu warned in a serious tone.

“Understood! I promise to be more careful next time.”

Images of Dr. Zhu’s near-miss—a momentary lapse during a bout of diarrhea—flashed through Zhou Can’s mind.

“Stay focused here while I go help them,” Dr. Hu instructed.

Not far away, at a bedside, five or six doctors and nurses were desperately trying to save a critically ill patient.

Even from afar, the severity of the situation was palpable.

Dr. Hu moved over to assist, which only improved Zhou Can’s opinion of him.

During routine resuscitations, Dr. Hu had always proven himself a reliable and excellent doctor.

He was cautious about administering risky medications due to his own concerns.

Not every doctor is willing to risk their career and hard-earned position over a treatment.

A single mistake could cost them their livelihood or even lead to legal trouble.

While doctors rarely face prison sentences, repercussions such as suspension, loss of prescription rights, or revoked licenses are common for significant errors.

In the worst cases, a doctor can be banned from practicing medicine for life.

Zhou Can picked up the patient records for Bed 6 and began reviewing them.

The report indicated severe intracranial bleeding; the leg fracture was minor in comparison to the brain injury.

“The bleeding is near the brainstem, with extensive hemorrhage accompanied by subarachnoid bleeding. There’s also skull fracture, and the patient is in a deep coma.”

No wonder no doctor dared to operate on this patient.

The risks were simply too high.

The only option was to keep him in the ICU for several days while hoping the bleeding would stop on its own.

Once the patient navigated this critical phase and stabilized, a further treatment plan could be formulated.

“If we can operate to stop the bleeding and clear the intracranial hematoma, we might at least save his life,” Zhou Can considered as he rapidly devised a treatment plan.

After reading the report, he quickly mulled over possible treatment strategies.

He wasn’t sure if his plan would actually be implemented,

but it would help him gain valuable experience and expand his thinking.

The patient’s chest CT showed no major injuries; the earlier ventricular fibrillation was most likely due to a brain issue.

Intracranial bleeding often leads to increased pressure inside the skull.

Sometimes a hematoma forms, compressing critical brain tissue.

In more severe cases, the bleeding occurs right within vital brain areas, usually accompanied by damage to important tissue.

“If the patient’s condition stabilizes even a bit, perhaps we could try an endoscopic surgery—mainly to stop the bleeding, remove the hematoma, and lower intracranial pressure.”

After careful analysis, the only viable treatment Zhou Can could think of was surgery.

Traditional open craniotomy might require a long wait and demand significant patient endurance, while a minimally invasive endoscopic surgery could meet the criteria as early as tomorrow.

Zhou Can realized that his two-month rotation in the General Surgery Department had been tremendously rewarding.

At that moment, diagnosing this patient made him confident enough to propose promising surgical plans.

Having performed numerous advanced surgeries in General Surgery, his experience and judgment regarding the entire perioperative period were unmatched.

“Buddy, if you can hear me, hold on. Once your condition stabilizes, I’ll suggest surgery to the senior physician,” Zhou Can said to the patient.

He had assumed the comatose patient couldn’t hear him.

But then he noticed tears welling up at the corner of the patient’s eyes.

Shortly after, the patient’s heart rate increased and his EEG showed some spikes—it appeared the patient truly heard him and was emotionally responsive.

Realizing this, Zhou Can felt overjoyed.

A patient who seemed critically ill now had a chance at survival—as long as he could endure and undergo endoscopic surgery to stop the bleeding and clear the hematoma.

Zhou Can simultaneously monitored the central venous pressure and urine output of the patient in Bed 6.

For ICU patients, catheterization isn’t just to prevent accidents or frequent trips to the bathroom—it’s crucial for accurate measurements of urine volume and its color.

Any signs of blood in the urine or proteinuria are detected immediately.

If a patient goes more than two days without urine, even if other vital signs seem stable, the prognosis is grim.

Long-term anuria typically indicates that internal circulation is failing.

Such organ failures are often irreversible, beyond the help of dialysis or other supports.

For most, the daily routine of eating, drinking, and the like is exactly what ICU patients need.

Key data is usually recorded every fifteen minutes.

Once Zhou Can finished recording, the patient in Bed 7 began producing louder sputum sounds, prompting him to rush over for suction.

A nurse was turning the patient in Bed 8, checking to see if he’d soiled himself.

ICU nurses are real warriors.

Suctioning sputum, cleaning excreta, washing the perineum and lips, crushing up medications to feed them carefully—these are just the basics.

The overpowering stench from septic patients can make even seasoned young nurses lose their appetite for an entire day.

However, with time, one adapts and builds an unbreakable psychological resilience.

After suctioning the patient in Bed 7, Zhou Can checked his blood pressure, respiration, and urine output—all showing significant improvement.

That outcome filled him with great satisfaction.