Chapter 174: A Busy Day in the Surgical Ward

He was in charge of five beds—three patients awaiting surgery and two in post-operative recovery. Overall, it was a relatively calm day.

Taking advantage of the rare quiet, he reviewed each patient’s examination reports, checking their symptoms and conditions. With considerable experience, he now knew exactly how to communicate with families and patients.

After all, he had been in training for a long time.

Starting conversations with questions the patients or their relatives cared about was an easy way to build rapport and earn their trust.

The patient in Bed 16 had undergone a chest catheter ligation two days ago. His vital signs were stable and his recovery appeared smooth. No complications had arisen.

The patient in Bed 17 was suffering from a cardiac aneurysm.

The examination report showed that the aneurysm was rather large. There are several treatment options, including aneurysm embolization, stenting, vascular replacement, or clamping.

If it were an ascending aortic aneurysm, stenting wouldn’t be an option.

Director Xue had decided on an aneurysm clamp for this patient, likely because the lesion wasn’t suitable for interventional surgery.

“Clamping a major aneurysm isn’t exactly a walk in the park!”

After reviewing the reports, Zhou Can believed the surgery would be extremely challenging.

Although he had never performed a clamping surgery on a cardiac aneurysm, he had experience with intracranial aneurysm clippings.

In fact, he had completed several such procedures.

This rich surgical experience gave him a solid grasp of the technical challenges involved in vascular clamping.

Director Xue, a senior consultant, obviously had thoroughly evaluated the risks before scheduling the surgery. She was clearly confident in the plan.

This wasn’t something that required Zhou Can’s concern.

The most accomplished surgeon in Cardiothoracic Surgery was none other than the ‘Steady Scalpel’ Hu Kan.

Zhou Can was especially looking forward to witnessing Director Hu Kan’s surgical prowess.

“Xiao Zhou, the department has urgently scheduled a surgery for Bed 19. The patient should be in the Operating Room by 9:50! Please follow up!”

Had this favored patient just been admitted and already slated for surgery?

Even though it was only a simple pectoral muscle suture, it was unusual to handle it like this.

Even in the Emergency Department, administering general anesthesia is approached with extreme caution.

“But wasn’t he just admitted? How can he be fasting for 12 hours before surgery?”

Zhou Can inquired.

For adults undergoing general anesthesia, a 12-hour fast and a 4-hour liquid restriction are typically required. Otherwise, if a patient’s stomach contents reflux after anesthesia and are inhaled, it could lead to serious complications.

“The admitting doctor confirmed that the patient hadn’t eaten since 5 PM last night,”

Dr. Zhao explained impatiently.

“Alright!”

Zhou Can then turned his attention to Bed 19’s surgery.

Preoperative evaluations and necessary tests were crucial to prepare the patient in the best possible condition for the procedure.

With the patient scheduled for the Operating Room at 9:50, time was very tight.

Zhou Can had no choice but to act swiftly.

He walked over to Bed 19, where three family members surrounded the patient, fussing over the man in bed.

It was clear that this man had been pampered by his parents since childhood.

Typically, even a man in severe pain wouldn’t wail like a woman.

At that moment, the man lay with his eyes closed, having received a painkiller.

His attractive wife sat on a small plastic stool at the head of the bed, constantly fiddling with her phone.

Zhou Can glanced over—dizzying.

She was actually using Baidu to search for remedies for chest muscle injuries?

The most frustrating patients were those who relied on online medical advice. They loved to scrutinize a doctor’s every move to check for any discrepancies.

“Hello, please show me the patient’s examination reports!”

The report was in her hand, so Zhou Can had to ask for it.

The woman looked up at him, reluctantly retorting,

“Is that absolutely necessary?”

As Zhou Can made his rounds, they had clearly all noticed his presence.

Typically, a patient’s relatives treat the doctor with respect.

But this family of four was anything but ordinary.

They assumed that, knowing one of the senior consultants in Cardiothoracic Surgery and wielding some authority, Zhou Can was just a ‘jack-of-all-trades’.

“The patient’s surgery is at 9:50. We need to start the pre-op preparations immediately. We need your full cooperation,”

Zhou Can said sincerely.

“How exactly are you going to operate on my husband? Who is the chief surgeon? Shouldn’t the chief surgeon personally explain the procedure in pre-op discussions? After all, we’re well acquainted with Director Xue!”

After firing off a series of questions, she even mentioned her relationship with Director Xue.

Dealing with such patients was a headache for medical staff.

They were simply difficult to handle.

Believing they understood hospital protocols and flaunting their superiority at every turn.

Of course, their aim was to secure better medical treatment.

“The chief surgeon will discuss the surgical plan with you at the appropriate time. I’m the ward doctor tasked with pre-op preparations,” Zhou Can explained, his head pounding from her questions.

The patient’s parents stood silently by, allowing their daughter-in-law to show off her skills.

No doubt, she wanted to impress her in-laws with her knowledge and competence.

That was why she was being so difficult.

“Alright, alright. It’s obvious that ward doctors like you know nothing! I insist on discussing this only after the chief surgeon arrives,” the woman said reluctantly as she handed the examination reports to Zhou Can.

Her eyes and tone left no doubt about the disdain she felt for him.

Zhou Can concluded that beauty didn’t necessarily come with grace.

Sometimes, it was just a pretty face.

He carefully reviewed the reports. Pre-op checks, like blood tests, were essential.

He also needed to verify that the patient didn’t have any contagious diseases, infections, and the like.

Following a surgery as a trainee might seem simple, but there was a great deal involved.

Any major oversight could result in censure from senior doctors or the chief surgeon.

He had been scolded many times when he first started his internship.

Almost every doctor had grown up under similar pressures.

Fortunately, the patient’s condition wasn’t a contraindication for surgery.

“You don’t have any cold or fever symptoms now, do you?” Zhou Can began to ask some basic questions about the patient’s condition.

Some patients might find this annoying, but these details were essential.

Before surgery, patients should avoid respiratory issues such as a cold or an infection.

“No, not at all!”

She answered briskly.

“What about coughing?”

“Normal coughs happen, but we’re not talking about the cough of a cold here.”

“Any history of hypertension or diabetes?”

“My husband is so young—you really think he could have those diseases typically seen in the elderly? Why don’t you wait until the chief surgeon arrives? My husband needs to rest now.”

She grew irritated with Zhou Can’s questions.

“Don’t eat or drink before surgery! Make sure to use the restroom beforehand!”

Zhou Can decided not to press further.

If the family didn’t cooperate, insisting further would only invite more insults.

Ultimately, the patient would be the one to suffer if something went wrong.

Sometimes, doctors weren’t overly concerned by such difficulties.

“I already know these basics,”

the woman replied, clearly impatient.

“Quiet down, will you? Let me get some sleep,” the patient grumbled, his mood souring.

Seeing their son’s discomfort, his parents’ faces also darkened.

Zhou Can said no more and moved to tend to other patients.

Before long, the chief surgeon arrived.

He was a short, stocky man in his mid-thirties—about the same age as Jin Mingxi.

Whether he was a resident or an attending wasn’t clear, as pectoral muscle suturing is only a minor procedure.

“I am Dr. Duan Shangqing, the Attending Surgeon from Cardiothoracic Surgery and the chief surgeon for this procedure. How is the pain now—has that painkiller helped?” Dr. Duan approached Bed 19 and gently inquired about the patient’s condition.

His tone was filled with concern.

The patient’s attractive wife, upon hearing the chief surgeon’s arrival, immediately rose with a beaming smile and said, “Thank you, Dr. Duan, for prescribing the painkiller. My husband is feeling much better. But is surgery absolutely necessary?”

The patient’s parents also greeted Dr. Duan warmly, showing utmost courtesy.

“Look at his scans—there’s clearly a tear. Without surgery, there is theoretically a chance for spontaneous healing, but it might result in restricted movement in his left arm along with chest tightness and pain. If the tear worsens, it could even affect his esophagus, heart, or lung function. Moreover, internal bleeding isn’t visible. Fixing the wound promptly, ensuring hemostasis, and suturing is in the patient’s best interest,”

“This is merely a simple suture procedure that sits between first- and second-degree surgeries; the risk is very low. It’s nothing like open chest surgery, which carries a much higher risk.”

Dr. Duan worked to reassure the family, urging them to remain calm.

“After the surgery, my husband’s arm and esophagus won’t be affected, will they?”

She still harbored some concern.

“With a successful operation and ideal recovery, he can return to his preoperative state completely,”

Dr. Duan assured her. The woman then exchanged a look with her in-laws.

“Alright, we’ll go ahead with the surgery. We’ll be counting on you,”

The patient’s father discreetly pulled a red envelope from his pocket and slipped it to Dr. Duan.

“Dr. Duan, I only have this one son. Please take extra good care of him. Consider this small token as a thank-you—like inviting you for tea.”

The envelope made Dr. Duan visibly uneasy.

The hospital strictly forbade accepting kickbacks or gifts.

Accepting this in front of so many people might even land him a meeting with the Medical Department by tomorrow.

“Don’t do that, please! I promise to perform the surgery with utmost diligence. If you keep giving me envelopes, you’re only jeopardizing me,”

Dr. Duan, though small in stature, couldn’t easily refuse the gesture.

The patient’s father sheepishly retrieved the envelope.

“You really are an honorable doctor. Once my son recovers and is discharged, I insist on taking you out for a meal. I hope you’ll join us!”

“We can discuss that later. Now, if you have no further questions, please sign the informed consent and make the prepayment,”

After the family signed, Dr. Duan turned to the patient.

“Wasn’t the ward doctor supposed to coordinate the surgery? Why is nothing ready yet?”

Dr. Duan’s irritation was evident.

“I was following up with the pre-op preparations. They insisted on waiting for the chief surgeon to arrive,”

Zhou Can wasn’t about to take the blame in silence.

Medical staff must ensure all preoperative preparations are complete; if the patient doesn’t cooperate, nothing can be done.

After all, managing illness was ultimately the patient’s own affair.

The emperor may not be in a hurry—but a meddling aide never helps.

“Uh…when I asked that young doctor earlier, he didn’t know a thing. I’m insisting on waiting for you. Look how quickly Dr. Duan finished talking—unlike you, asking useless questions. You really need to study up; you’re not professional at all,”

She proceeded to lecture Zhou Can.

Her words left Zhou Can fuming.

He knew arguing with family members was pointless, so he refrained from any rebuttal.

Instead, he focused on his duties.

Handling preoperative preparations for such patients was truly exhausting.

A nurse came by with a tray to perform the pre-op disinfection and skin preparation; the incision line had already been marked by the chief surgeon.

After some delays, they finally wheeled the patient into the Operating Room.

Chief Surgeon Dr. Duan, Resident Dr. Zhao, a Attending Nurse, and the Anesthesiologist were all in position.

Considering cost constraints, the team for a first- or second-degree surgery was typically kept small.

“Xiao Zhou, the family complains that you’re unprofessional. Learn more and improve,” Dr. Zhao admonished him.

“Yes, doctor!”

Zhou Can felt utterly frustrated—what a miserable day.

Such grievances could only be accepted without quarreling with the family.

The surgery began promptly. The patient was put under general anesthesia, and his vital signs stabilized.

Dr. Duan carefully made a midline incision along the sternum, then proceeded to cut through the skin, subcutaneous tissue, and muscle.

For the incision, besides the midline sternotomy, another option was a horizontal incision in the inframammary fold along the fourth intercostal space, depending on the area needing suturing and the patient’s gender.

If the patient were female, extra care was taken to preserve her figure.

When operating on women, doctors always consider their post-operative quality of life.

For instance, during vaginal delivery, if there’s a tear, the doctor might suture it a bit more to ensure the couple’s intimacy remains undisturbed.

Preserving a woman’s silhouette was of paramount importance.

“Hemostasis!”

Dr. Duan’s command reminded Dr. Zhao to use the electrocautery.

Dr. Zhao efficiently applied the electrocautery, and his hemostasis was at a commendable resident level.

Both Dr. Duan and Dr. Zhao demonstrated surgical skills commensurate with their ranks.

It was clear that while the Cardiothoracic Surgery doctors might be arrogant, their overall competence was impressive.

They certainly had the credentials to back it up.

Once Dr. Zhao completed the hemostasis, Dr. Duan resumed the surgery.

He began separating the skin flap and pectoral muscle.

Zhou Can watched intently—this was a valuable learning opportunity.

He observed as Dr. Duan’s scalpel carefully dissected the pectoral muscle flap slightly off the edge of the sternum.

Both Dr. Duan’s precise incision and Dr. Zhao’s solid hemostasis reflected a steady hand.

Dr. Duan’s incision technique was acceptable for an attending, but his dissection fell short; it required a higher level of tissue separation skill.

Optimistically, even if Dr. Duan’s tissue separation were maximized, it might barely reach a commendable resident level.

Tissue separation was a particularly hard skill to master.

Even Zhou Can had only achieved the lower standard of an attending surgeon.

During the dissection, Dr. Duan may have applied too much force—tiny jets of blood spurted out.

Zhou Can squinted to inspect the area and discovered that a relatively thick arterial vessel had been severed during the separation.

Dr. Zhao immediately and deftly applied electrocautery to control the bleeding.

Sizzle, sizzle, sizzle!

The electrocautery burned through the vessel and surrounding tissues.

However, the hemostasis technique hadn’t reached the level of an attending—it was rather rough and brute force.

Only at an attending level can one balance precision and dexterity.

Dr. Zhao’s current hemostasis was more like using a sledgehammer. Had Zhou Can been in charge, it would have been more like a delicate butterfly landing on a flower—both nimble and precise.

Any surgical technique that reached an attending level was already considered highly skilled.

To progress to a consultant’s level would require a qualitative leap in technique.

For instance, Zhou Can’s suturing and ligating skills were still at the deputy consultant level—vastly inferior to an attending’s abilities.

Zhou Can hesitated, awed by Dr. Zhao’s fierce method of electrocautery.

Too prolonged or aggressive use of electrocautery could severely damage the surrounding tissues.

Dr. Duan said nothing; given his lower rank and recent arrival in the department, it wasn’t wise to question his superiors.

After all, bickering with higher-ups was a recipe for disaster.

Eventually, the bleeding subsided after sustained electrocautery.

Zhou Can leaned in to examine the cauterized area closely—the tissue had already begun to change color.

Perhaps due to his own competency in hemostasis at a mid-attending level, he had a sinking feeling that something was off.

Dr. Duan resumed the surgery.

“Here! Here! Finally, we’ve found the tear! The split in the tissue is quite extensive,”

Dr. Duan exclaimed with relief upon locating the torn muscle layer.

Even though Zhou Can often assisted Director Wen in major third- or fourth-degree surgeries at General Surgery, for many attending surgeons, being the sole operator for a second-degree procedure was a matter of pride.

“Use a thicker absorbable suture—the tension here is higher,”

Dr. Duan instructed. The invention of absorbable sutures had brought relief to patients undergoing surgery.

The technology had matured over time,

and the costs remained reasonable.

Before absorbable sutures were invented, subcutaneous tissue had to be stitched with regular suture material.

Then, once the internal wound had healed sufficiently, the external skin incision would be reopened to remove the sutures before finally re-closing the skin.

One could only imagine the suffering the patient endured.

Such procedures often led to severe scar formation.

After suturing the torn pectoral muscle, Dr. Duan handed the remaining skin closure work over to Dr. Zhao.

Zhou Can’s eyes returned to the slightly discolored cauterized area.

Leaning in for a closer look, he examined it carefully.

“Yes, it’s clearly severe damage. Without proper intervention, necrosis is imminent,”

he confirmed, his mind already drawing grim conclusions.

Dr. Duan hadn’t noticed the issue—either his skills were lacking or he had been too careless.

Chances are his technique was simply not up to par.

Otherwise, Dr. Zhao should have spoken up during electrocautery.