Chapter 175: Steady Hands & High Stakes

[Pathology Diagnosis EXP +1.]

After earning 1 point in diagnosis experience, Zhou Can became even more convinced that his judgment was correct.

He had to inform his two senior doctors immediately.

[Congratulations! Your Pathology Diagnosis has advanced to Level 4. Current EXP: 1 / Attending-level competence. You can now diagnose several complex illnesses, sometimes detecting hidden conditions, with a small chance of identifying comorbidities.]

Zhou Can hadn’t expected his pathology diagnosis to upgrade at this moment.

Originally, his skills were only average among residents; after eight grueling months in the Emergency, Orthopedics, and General Surgery, he managed to rise from a below-average resident to an average level.

This time, he reached Level 4 largely thanks to successfully diagnosing three super challenging cases and several moderately difficult ones in the Critical Care Department, including some covert cases.

A comorbidity means that under the same symptoms, multiple lesions may coexist.

Diagnosing multiple diseases from one symptom is the toughest challenge.

Even experienced residents can easily miss such cases.

“My pathology diagnosis is finally at the Attending level. By the time the one-year residency ends, I can apply for my practicing physician license,” he thought.

According to regulations, a one-year work experience is required after graduation for the licensing exam.

Zhou Can has now completed eleven months of residency and will likely seize his license during his stint in Cardiothoracic Surgery.

Having reached Level 4 in pathology at this juncture will greatly aid his licensing exam.

And when it comes to the practical skills test, he’ll have no trouble either.

Three months of Critical Care residency, coupled with experience in multiple departments and surgeries, should easily get him through the exam.

For many trainees, getting this license is like scaling a huge barrier.

Many fail, ultimately being forced into other careers or administrative roles.

As the saying goes, what is difficult for some is easy for others.

Suppressing his excitement over the pathology upgrade, Zhou Can turned his gaze toward Dr. Zhao.

“Wait a minute!”

For the sake of the patient’s safety, Zhou Can felt compelled to speak up.

“What’s the matter?”

Dr. Zhao, who had just assumed the chief surgeon’s position and was about to finish, was clearly annoyed by the interruption.

“Your use of electrocautery for hemostasis seems a bit excessive. I worry it might lead to tissue ischemia and necrosis.”

Zhou Can, swallowing his nerves, raised the concern.

At those words, Dr. Zhao’s expression darkened in an instant.

Moments ago his face had been cool; now it was as grim as a stormy sky.

Even Dr. Duan didn’t say much—this trainee had the audacity to challenge a senior’s method, acting outrageously impetuous.

“How did you deduce that ischemia and necrosis would occur? You speak without thinking. Beginners like you tend to fret over the unlikely,” Dr. Zhao snapped, his anger barely contained.

He nearly lost his temper and pointed a finger at Zhou Can’s nose.

Questioning a senior doctor’s critique was extremely dangerous.

If it weren’t for the circumstance, Zhou Can would have stayed out of it entirely.

Dr. Duan didn’t immediately intervene; instead, he examined the patient’s wound carefully.

“Though the electrocautery technique was a bit rough, I see no significant problems. A slight injury to adjacent tissue is normal. The principle behind electrocautery is to use heat to form a scab on the vessel to stop bleeding. Occasional misjudgment is inevitable and may harm surrounding tissues, but our body’s recovery is remarkable. Rest assured.”

Dr. Duan’s tone was surprisingly gentle.

He even patiently explained the electrocautery principle to Zhou Can.

He never imagined that this young trainee’s hemostasis skills could actually surpass his own.

“But the patient has extensive tissue damage. Simply suturing it up risks severe consequences if ischemia sets in,” Zhou Can insisted, his tone growing more forceful.

“Alright, alright. Facts speak for themselves. Once this patient is discharged in a few days, you’ll see. As doctors, we must revere life while being both bold and meticulous. If you hesitate, you won’t make a good physician.”

Dr. Duan cut Zhou Can off, halting the discussion.

“Let’s suture the wound!”

He ordered Dr. Zhao to sew up the incision immediately.

This incident clearly highlighted the varying levels of expertise among doctors and their differing perspectives.

While Zhou Can had pinpointed the issue, Dr. Duan was oblivious to it.

On one hand, he saw Zhou Can as just an inexperienced trainee whose concerns were nothing more than exaggeration; on the other, he was convinced that his established methods were infallible.

Dr. Zhao’s suturing skills were decent—roughly at the average resident level.

Still, he fell short of the excellent resident standard.

After suturing, Dr. Duan inspected the wound, nodding with satisfaction.

“Hmm, well done. Once the patient regains consciousness from anesthesia, send them back to the ward for recovery.”

With the surgery completed, it was time to wrap up.

“Zhou Can, to keep you from raising unnecessary alarms next time, you’re grounded in the Operating Room today to help the nurses clean up. Use this chance to learn how surgeries are really done, so you don’t embarrass yourself in the future,” Dr. Zhao admonished, clearly irritated by the trainee’s interference.

This punishment served a double purpose: it was both corrective and an opportunity for Zhou Can to observe other doctors at work.

Dr. Duan did not comment further and left without a word.

Thus, Zhou Can was left to clean up the Operating Room.

Since there was only one instrument nurse on duty, and no circulating or scrub nurses, cleaning up was entirely his responsibility.

No sooner had he finished than doctors and nurses rushed a patient onto the operating table in an emergency.

“Hey, why is there a male nurse here?”

The chief surgeon was a man in his late thirties with graying hair, exuding an air of refined energy and vitality.

He froze for a moment upon noticing the unfamiliar young man in the room.

“He isn’t a nurse; he seems to be a new trainee. Dr. Zhao assigned him to clean the OR for a day and to observe surgeries—an obvious punishment,” the instrument nurse quickly explained.

The other medical staff exchanged glances, their attitudes shifting immediately.

Everyone knew the drill: when a trainee is sent to clean the OR, it’s clearly a penalty.

Only the anesthesiologist, carrying his toolbox, looked at Zhou Can with a hint of surprise, even nodding slightly in greeting.

“Quick, get the patient onto the operating table! Dr. Guan, please administer anesthesia immediately,” someone ordered.

The patient’s condition was critical.

Zhou Can moved to assist. After all, any extra help in surgery was welcomed; the chief surgeon wouldn’t mind an extra pair of hands.

He recognized the anesthesiologist, Dr. Guan, from many previous major surgeries—when full general anesthesia was involved, Dr. Guan was always there.

Anesthesiologists, much like other doctors, range from residents to attendings to chiefs. Their qualifications vary based on the complexity of the procedure.

They also train their own disciples.

High-risk surgeries with severe cardiac, cerebral, pulmonary, or endocrine complications, or those requiring detailed preoperative evaluation, must be led by a chief or deputy chief anesthesiologist.

Only when the entire perioperative risk is deemed acceptable can the chief surgeon proceed.

Otherwise, even when experts like Wu Baihe or Hu Kan devise the surgical plan, if the anesthesiologist deems the risk too high, the surgery must be postponed until the patient meets the necessary criteria.

Thus, anesthesiologists hold significant status.

They possess deep insights into the human respiratory, nervous, hematologic, and organ systems—true masters operating under the surface.

Their expertise, however, is often overlooked since the anesthesia department’s status pales in comparison to other major departments.

Even the most skilled chief anesthesiologists are known only within the field; patients and their families mainly recognize the chief surgeon’s name.

People rarely concern themselves with who the anesthesiologist is.

Dr. Guan was undoubtedly a senior attending-level anesthesiologist. His personal involvement indicated a high degree of difficulty and risk.

This case was, at the very least, extremely high-risk.

What exactly was wrong with the patient? He appeared pale, agitated, sweating coldly from his forehead, and struggling to breathe—signs of immense distress.

Upon removing the drape, obvious trauma between the ribs was visible.

Zhou Can immediately deduced that the patient was likely suffering from intrathoracic hemorrhage, accompanied by massive pleural effusion.

This condition was extremely dangerous, and an urgent operation to stop the bleeding was essential before shock set in.

Dr. Guan quickly attached the vital sign monitoring leads to the patient.

Ideally, they would also establish central venous pressure monitoring, but given the emergency, they only monitored heart rate, blood pressure, respiration, and temperature.

“Dr. Zhou, could you help intubate and set up the ventilator?”

Dr. Guan, stretched too thin and facing a deteriorating situation, had to call on Zhou Can for assistance.

While others might be unaware of Zhou Can’s talents, Dr. Guan knew them all too well.

Especially considering Zhou Can’s stellar performance in the Critical Care Department—a fact well-known to both critical care staff and many anesthesiologists.

After all, many critical care doctors used to work as anesthesiologists.

For instance, Dr. Shi was once an anesthesiologist before switching to life support research, dedicating himself to saving lives in critical moments.

News of such feats spread quickly among former colleagues in the anesthesia department.

When other staff saw Dr. Guan call on Zhou Can, they all looked on in astonishment.

Clearly, Dr. Guan was quite familiar with the disciplined trainee.

Intubation is not overly difficult, but doing it quickly and accurately requires skill.

Operating a ventilator is relatively easy to learn, but adjusting its parameters tests a doctor’s experience and competence.

Amid the skeptical eyes of everyone present, Zhou Can hurried forward and performed the intubation on the patient.

Intubating an agitated patient under these conditions was a formidable task.

Yet Zhou Can completed the intubation effortlessly.

Intubation involves inserting a specially designed endotracheal tube through the mouth—occasionally through the nose, depending on the situation.

Given the patient’s condition, oral intubation was preferable, as it is somewhat more comfortable than nasal insertion.

The patient was already agitated; getting him to cooperate was no small feat.

Once the tube was in place, Zhou Can deftly adjusted the ventilator settings.

His three months in the Critical Care Department had paid off—he now handled these devices with ease.

His experience shone through as he managed the parameters with precision.

Every step he had taken in his career had led him to this moment.

Those three months in critical care proved invaluable, their lessons applicable in countless scenarios.

Moreover, the heightened alertness required in the critical care unit had forged a resilient spirit in him.

“Alright!”

With a calm demeanor, Zhou Can stepped back to an inconspicuous spot at the periphery of the operating table.

For performing the intubation, he earned 1 point in Device Implantation experience.

Staying in the OR always provided opportunities to gain experience.

“Impressive!”

“That trainee’s maneuver was absolutely slick!”

“I never knew intubation could be so straightforward! I’ve got to try it next time!”

The other staff were left dumbfounded.

Zhou Can’s performance was so striking that it almost made intubation seem deceptively simple.

“Anesthesia is successfully induced. We can now proceed with the surgery.”

As Dr. Guan’s words faded, the chief surgeon moved to his station, making an incision between the patient’s ribs.

Layer by layer, he cut until the pleura was exposed.

Inside, there was an accumulation of blood.

“Let’s aspirate some of the clotted blood first. The bleeding source should be somewhere along the intercostal space,” he explained as he worked.

He hurriedly searched for the bleeding vessel.

However, the complex environment of the thoracic cavity, compounded by residual clots, made it difficult to pinpoint the source.

The chosen incision site had been determined through preoperative examinations to likely harbor the bleeding vessel.

Yet, once the window was opened, it became apparent that finding the exact source was far more challenging than expected.

The chief surgeon was visibly anxious, sweat beading on his forehead.

In what felt like the blink of an eye, the patient’s bleeding quickly led to a massive re-accumulation of blood in the chest cavity.

“The patient’s blood pressure is plummeting! His respiration is deteriorating—we must expedite the surgery!”

The anesthesiologist grew visibly anxious.

Based on the examinations, the bleeding seemed to stem from trauma to the intercostal vessels—arteries, veins, or chest wall vessels.

Due to the high pressure within the systemic circulation, such bleeding tends to be continuous.

Without surgical intervention to stem the flow, spontaneous cessation was nearly impossible.

Dr. Zhou examined the patient’s reports meticulously as everyone around battled to save his life.

The patient had undergone coronary angiography, yet no bleeding point was detected.

A chest X-ray revealed pleural effusion on the injured side, a mediastinal shift towards the healthy side, signs of a pneumothorax with a distinct fluid level, and even signs of lung collapse.

The incision was made on the injured side.

So, where could the bleeding be?

After reviewing the reports, Zhou Can calmly inspected the wound.

Armed with Attending-level hemostasis skills, a 50% boost from life-saving insight, and his newfound Attending-level pathology diagnosis, his diagnostic ability was sharply enhanced and his mind raced.

Even though the bleeding point was invisible, the rising pleural effusion indicated a significant blood loss.

The bleeding was considerable.

“Dr. Long, the patient’s blood type is uncommon and our plasma supply is insufficient. At this rate, the three bags we have won’t be nearly enough for his blood loss.”

An assistant alerted the chief surgeon.

This was truly a devastating turn of events.

Just when you think nothing else can go wrong, fate finds a way.

This relatively controlled procedure suddenly faced an enormous risk of death.

In cases of severe intrathoracic bleeding that cannot be promptly controlled, the patient’s life is in imminent danger.

“Damn it, after so many thoracotomies for bleeding control, today we’ve hit a real wall,” Dr. Long cursed under his breath.

The chief surgeon bore the brunt of the pressure in the operating room.

Sometimes, a chief surgeon turns as sour as if he’d swallowed a firecracker, spending the entire surgery scowling and directing his anger at anyone nearby.

It can’t be entirely their fault.

With the staggering pressure from a crisis, even the smallest mistake from an assistant or nurse is blown out of proportion—sometimes reducing someone to tears.

Many who’ve been part of major surgeries agree that the chief surgeon truly is the weather vane of the OR.

When the chief is in a foul mood, everyone else keeps a low profile to avoid being the target of his ire.

“The bleeding source could be beneath this rib! The blood loss is fierce, suggesting an arterial rupture is most likely,” Zhou Can risked criticism to share his diagnostic conclusion.

“Trainee, don’t make things worse here!”

An assistant shot Zhou Can a warning look, signaling him not to stir the pot.

Meanwhile, the instrument nurse looked at him with sympathetic eyes.

The new doctor was as stubborn as they come—first he got penalized, and now he’s mouthing off again.

Senior doctors don’t appreciate a trainee trying to dictate terms in the OR.

“The patient is hemorrhaging and our plasma supply is insufficient. We could opt for autologous blood transfusion!”

Zhou Can proposed another suggestion.

In major bleeding surgeries, if the blood is uncontaminated, it can be collected and reinfused into the patient.

Tuyu Hospital is certainly equipped with such a system.

A blood salvage machine collects, filters, separates, cleans, and purifies the patient’s lost blood before reinfusing it—autologous transfusion presents far fewer risks compared to allogeneic blood.

Allogeneic blood could lead to hepatitis, HIV, and other infections.

Additionally, allogeneic transfusion can suppress the patient’s immune function, elevating the risk of post-operative wound infections, and hinder healing.

“Get the blood salvage machine here immediately!”

Upon hearing this, Dr. Long made a swift decision.

The patient’s massive bleeding and critical state had clearly disoriented him.

Zhou Can’s words had a wake-up call effect.

“Are you absolutely sure the source is under that rib?” Dr. Long regarded the unassuming trainee with a mix of surprise and skepticism.

After assisting Dr. Guan with the intubation and ventilator, Zhou Can’s extraordinary competence was on full display.

His timely suggestion about autologous transfusion during the crisis proved to be remarkably astute.