Chapter 179: Heart-Enduring Resolutions

This extracorporeal circulation isn’t an artificial membrane lung—ECMO is a much more complex setup.

It’s only considered when both the heart and breathing have completely ceased.

What Dr. Zhou is establishing for the patient is a life support system that maintains blood flow to tissues and organs during on-pump cardiac surgery.

Its principle involves a series of specialized devices that drain venous blood from the body, manually exchange gases, regulate temperature, and filter it before returning it to the arterial system.

This extracorporeal machine is primarily used when the heart is purposely stopped during surgery or when both heart and respiration need to be halted.

Director Xue’s concern over surgical costs meant that this extracorporeal system wasn’t set up from the start—otherwise, the patient’s life would have been immediately safeguarded.

Had it not been for Dr. Zhou’s lightning-fast operation, the consequences could have been unpredictable.

Dr. Zhou connected the equipment, and once the patient’s nasopharyngeal temperature dropped to around 28°C, he clamped the ascending aorta below the unnamed artery and injected cold cardioplegia at its root to arrest the heart.

At that moment, Dr. Guan was finally able to stop compressing the pericardium.

Next, if the surgery were to run long, roughly every 20 minutes cardioplegia would be continuously perfused through the coronary sinus to keep the heart in deep hypothermia.

Just clamping one aneurysm shouldn’t take that long.

After successfully establishing the extracorporeal circulation, Dr. Zhou let out a deep sigh of relief.

For now, the patient’s life was secure.

“Director Xue, you can now move quickly to deal with that venous aneurysm,”

Dr. Zhou gently reminded.

“Oh, alright!”

She immediately got to work clamping the aneurysm.

The extracorporeal machine only simulates part of the heart’s function; it can temporarily supply tissues with oxygen and blood, but prolonged use would inevitably damage the organs.

In contrast, once an artificial membrane lung is established, it can theoretically replace heart and lung functions long term.

That’s why ECMO is considered more advanced than the extracorporeal machine, with much higher operating costs.

Its setup is even more intricate, requiring several medical staff members to work in unison, all with expert skills.

The risk of mishaps is extremely high if a novice tries to handle this.

With the patient’s life secure, Director Xue’s nerves finally loosened, and the clamping procedure progressed noticeably smoother.

Before long, she successfully clamped the complex cardiac arterial aneurysm.

By cutting off its blood supply, the aneurysm would naturally cease to threaten the vessels.

Some believe that clamping an aneurysm could cause vascular narrowing, but that’s baseless—if done correctly, it won’t affect blood flow.

After clamping the aneurysm, repeated blood-perfusion tests are necessary to confirm that it is completely closed and the arterial flow remains unobstructed before closing the chest.

Only after several careful inspections and confirming everything was in order did she turn to Dr. Guan.

“Dr. Guan, the surgery is finished, but we need a blood perfusion test to verify the outcome. Can you try to get the heart beating again?”

“Alright! Let me give it a try!”

Dr. Guan began warming the heart.

Gradually, the heart resumed beating as blood circulation slowly returned.

Fortunately, the patient’s ventricular fibrillation had already subsided, and the heart was beating normally. The clamping of the aneurysm was a resounding success.

After blood perfusion, it was confirmed that the aneurysm was completely clamped.

It was also verified that the arterial blood flow at that segment was unobstructed and unimpeded.

Everyone exhaled in relief, their anxious hearts finally at ease.

Deputy Director Lu looked as if he’d been reborn, his back already drenched in sweat.

After all, the patient’s heart trouble had been due to two rapid clamping of the brachiocephalic trunk.

“At last, everything’s alright. Let’s close the chest!”

Director Xue was clearly shaken as well.

She probably wouldn’t take such risks in future surgeries.

Doctors tend to be overconfident before any mishap, believing nothing will go wrong.

But once an incident occurs, their confidence wanes.

They become increasingly cautious thereafter.

Deputy Director Lu, along with the Second Assistant, worked together to close the chest.

The sawn-open sternum needed to be re-fixed with steel pins.

Dr. Zhou watched their work with a touch of envy.

Having just weathered a crisis, asking Director Xue for a chance to practice closing the chest might be hard to come by.

But he wasn’t in a rush.

Today, having made a good impression on Director Xue and Deputy Director Lu, he had shown his competence well—future training opportunities wouldn’t be hard to come by.

Once the chest was closed and everything checked, the patient was administered deep anesthesia.

It would be a while before the patient could wake up.

They would be sent to the recovery room, awaiting spontaneous awakening.

Before leaving, Director Xue turned to Dr. Zhou.

“Dr. Zhou, thank you for today! If you’re willing, I’ll assign you to my team starting tomorrow, where you’ll work alongside me and my colleagues.”

Director Xue exuded a considerate, almost maternal, demeanor.

She didn’t take Dr. Zhou with her immediately—a respectful nod to Dr. Zhao.

Although she was the Chief Physician, Dr. Zhao was merely a junior resident, yet she still ensured he received his due respect.

Leaders support each other’s dignity not out of flattery but from genuine professionalism.

Dr. Zhao now effectively became Dr. Zhou’s superior.

He had issued a penalty against Dr. Zhou, and with just a word from Director Xue, Dr. Zhao would follow orders without objection.

But what was going through Dr. Zhao’s mind?

He was undoubtedly uncomfortable.

Perhaps because of this incident, he might harbor resentment towards both Director Xue and Dr. Zhou.

In any case, Director Xue’s approach was as gentle as a spring breeze—remarkably astute.

Working under a Chief Physician was an opportunity Dr. Zhou cherished.

No matter which department he joined, being directly mentored by a Chief Physician meant he’d learn far more than his peers.

This was a key reason why he had outstripped other trainees in just one year.

“I’m willing!”

Dr. Zhou agreed without hesitation.

“Alright, report to my office tomorrow.”

Director Xue was visibly pleased by his affirmative response.

After all, Dr. Zhou’s competence meant that adding him to the team brought in another advanced anesthesiologist capable of providing crucial life support.

Dr. Zhao’s penalty against Dr. Zhou was irreversible; he shot Dr. Zhou a complex glance but ultimately did not revoke his order.

…

The next day, Dr. Zhou reported to Director Xue without delay.

In the large office, Director Xue had already rearranged the team for him.

“Yesterday’s cardiac arterial aneurysm clamping surgery patient has awakened. All vital signs are stable, and the operation was a success,” Director Xue informed, clearly intent on keeping Dr. Zhou updated on the patient’s progress.

As the patient recovered, a cheerful smile naturally spread across her face.

“This morning I have expert clinic rounds and an afternoon study session, so I can’t accompany you today. I’ve arranged for Deputy Director Lu to guide you.”

Director Xue had taken care of everything for Dr. Zhou.

She had put in a great deal of thought.

“Thank you!”

Dr. Zhou was sincerely grateful.

Generally, if a Chief Physician is willing to mentor you, it’s already a great opportunity—it rarely gets this detailed.

Her genuine kindness deeply moved him.

“Since you’re new, start by reviewing our team’s cases. If you have any questions, feel free to ask me or Deputy Director Lu. If neither of us is available, you can also consult Dr. Long or others.”

Not far away, Dr. Long quickly added, “Better ask Dr. Zhou—he’s far better than I am.”

“Don’t be cheeky!”

Director Xue laughed and playfully chided him.

Dr. Long longed to tell her that Dr. Zhou’s skills were exceptionally impressive.

He even felt that Dr. Zhou surpassed him, the attending physician.

He opened his mouth but ultimately said nothing.

After all, even if he spoke up, Director Xue wouldn’t believe it.

“Time’s nearly up. I need to check the orders for a few critical patients and then head to my consultations. Dr. Long, why don’t you show him the routine work of our department?”

With that, Director Xue hurriedly opened her computer to review orders for important patients.

For regular patients, orders are usually managed by the resident in charge, with the attending physician reviewing them during shift changes.

In practice, a junior doctor writes the orders, and then the attending reviews any questionable ones during handover times.

Only critical patient orders are directly handled by the Chief Physician—for instance, in cases of severe illness, post-major surgery, or multiple underlying conditions.

Only for these key patients does the Chief Physician need to get involved.

For other patients, writing orders is much simpler; for key patients, every detail must be considered, leaving little margin for error.

Thus, utmost caution is required.

“Dr. Long, sorry for the trouble!”

Dr. Zhou approached Dr. Long humbly, seeking his advice.

Every department has its own routine and focus—gathering as much information as possible never hurts.

“Don’t be so formal! We’re all on the same team. Let me briefly explain the daily routine in Cardiothoracic Surgery,”

Dr. Long replied very courteously.

“We’re expected to be in the department by about 7:30 in the morning, review our patients’ records, lab reports, treatment plans, and medications via the HIS system, and then prepare accordingly. Unlike me, you currently have no solo surgical tasks. For simpler cases, I draft a surgical plan and have Director Xue or Deputy Director Lu review it. For complex cases, I consult with them to develop a plan together.”

This workflow is similar in most departments—Dr. Zhou had experienced analogous routines during his internships in General Surgery and Orthopedics.

“The anesthesia for the first surgery should be completed before 7:50. For your assigned surgery patients, operations start around 8:00, so you must have them in the operating room by about 7:40.”

A delay in getting patients there might not draw scolding from the anesthesiologist, but the chief surgeon certainly wouldn’t hesitate to let you have it if he was in a bad mood.

“At about 7:50, there’s a ward round. Director Xue leads rounds once a week, and sometimes during departmental rounds led by Dr. Hu Kan, you’ll be expected to join. During rounds, the attending and senior physicians listen carefully to the resident in charge’s report, so make sure you know your patients well. It’s best to have all test results and case files ready beforehand.”

A resident’s crucial daily task is to accurately and promptly present each patient’s condition during rounds.

“Around 8:10, after handover, the doctors exchange shifts. Once handover is complete, you must immediately write orders for your patients, complete discharge summaries, and, if you’re staying in the ward, handle tasks like assisting in operations or changing dressings. In the OR, simply work alongside the chief surgeon to ensure the surgery goes smoothly.”

Dr. Zhou was well aware of these routine tasks.

“It’s worth noting that a typical Cardiothoracic Surgery operation usually lasts a long time—starting around 9:00 in the morning and ending by 1:00 in the afternoon is common. After the first surgery, there’s a brief meal break before proceeding to the next patient. There’s also the handover of ICU patients, or sometimes emergencies in other departments that require ECMO placement or where a CCU patient requests removal of ECMO, and you’ll be called to help.”

ECMO placement is typically a coordinated effort between surgeons and anesthesiologists.

Having worked in the Critical Care Department for three months, Dr. Zhou had mastered the necessary skills for ECMO placement, making him fully capable of assisting the anesthesiologist.

“Given your excellent all-around abilities, if our team gets overwhelmed, you might even be sent to assist in the Internal Medicine or Emergency Departments for consultations.”

This was an early heads-up.

Cardiothoracic Surgery often requires many consultations, and staffing is usually tight.

Outstanding doctors are needed for these consultations.

Even for less challenging consultations, an excellent resident is preferred.

Although Dr. Zhou was just a trainee, his competence was evident—sending him would be as reliable as sending an outstanding resident.

Of course, having just joined Cardiothoracic Surgery and with only a couple of days’ training, they wouldn’t send him on consultations just yet.

Any mistake or embarrassing incident would tarnish the reputation of the department.

After explaining the daily routine, Dr. Long helped Dr. Zhou log into the HIS system and taught him how to review the team’s cases.

…

Dr. Zhou was eager to learn as he thoroughly examined the team’s case files.

This was the fastest way to learn.

Every patient’s symptoms, diagnostic process, tests, treatments, and outcomes were recorded in detail.

Each case he reviewed increased his diagnostic experience by one point.

Deputy Director Lu also had rounds that morning, leaving Dr. Zhou to manage the team’s patients in the ward—the morning passed swiftly.

After lunch, while checking on his patients in the ward, he heard the family of the patient in Bed 19 shouting.

“Nurse! Nurse! My son is in unbearable chest pain after the surgery. Can you administer more painkillers?”

“Didn’t we just use painkillers this morning? You can’t keep using them! Your son is a man—a tough guy. Some pain after the anesthesia wears off is normal. Let him bear it!”

The nurse didn’t have the authority to prescribe; only a licensed doctor could do that.

And as she mentioned, painkillers can’t be overused.

There is a safe dosage, after all.

Even if needed, one must wait until after a metabolic cycle before a doctor can prescribe more painkillers.

She nearly urged them to toughen up their son.

Dr. Zhou listened and gave a sympathetic glance at the family and patient.

It’s normal to feel some pain after the anesthesia wears off, but such severe pain might indicate tissue ischemic necrosis.

This kind of pain is like a slow, deliberate slice—it’s excruciatingly torturous.

The patient’s attractive wife was busy on her phone, constantly checking the case notes.

Dr. Zhou nearly fainted.

She was once again resorting to Baidu to self-diagnose.

Does a busty woman really act so recklessly?

Her methods were both laughable and pitiful.

But perhaps a lesson was needed, so next time she might trust a doctor over Baidu.

When Dr. Zhou finished reviewing the cases and stepped out, the patient in Bed 19 was writhing in pain, throwing a tantrum.

Being an only child from a well-off, pampered family, it wasn’t surprising he acted out in anguish.

Now, suffering such torment, his tantrums were inevitable.

“Doctor! Doctor, my son is in unbearable pain! Please check on him!”

The patient’s mother, seeing Dr. Zhou passing by, clung to him as if he were a lifeline.

Meanwhile, the attractive wife seemed to realize that Baidu couldn’t solve the problem.

She even stood up, for the first time willingly cooperating with the doctors.

Unfortunately, Dr. Zhou was no longer in charge of this patient.

Moreover, this woman was known for frequently complaining, and Dr. Zhou preferred not to get involved.

“I’m sorry, but I’m just a trainee. I’m not qualified to handle this case, and this patient isn’t under my responsibility. I can only notify a nurse for you.”

Dr. Zhou flatly refused.

“What kind of joke is this? Last time you told me to scram and I left. Now you want me to come back? No way—I’m done.”

“If you have a problem, contact the resident in charge or the nurse himself!”

“What kind of attitude is that! My husband is in tremendous pain and you’re just passing the buck. Do you want me to file a complaint right now?”

The patient’s attractive wife exploded in anger.

Her labelling of Dr. Zhou as ‘not professional’ was exactly what she had conveyed to Dr. Zhao.

Now, Dr. Zhou used that as a shield, knowing she wasn’t foolish enough to fall for his retort.

That’s why she was especially furious.

Perhaps this woman, empowered by her influential background and financial means, had grown conceited.

Almost everyone with a bit of power tends to act that way.

When they encounter what they deem ‘unreasonable,’ they’re quick to lose their temper.

Dr. Zhou fixed his gaze on her attractive face, his eyes locking with hers.

“You have every right to complain. I’ve got other patients to attend to. Goodbye!”

At that moment, the situation shifted.

Dr. Zhou had earned Director Xue’s trust and respect, and since the patient wasn’t under his care, his actions were strictly by the book—leaving no one room for reproach.