Chapter 195: A Surgeon’s Breakthrough

Zhou Can’s significant progress came from learning a great deal from Dr. Feng on one hand and intensely cramming basic medical knowledge recently, which began to pay off.

Of course, his steady improvement over time played a huge role as well.

Day after day, he absorbed lessons during rounds, patient management, and participation in surgeries, and over time, his skills rapidly advanced.

“Dr. Guan, should we insert a nasogastric tube for him?”

“Of course! You’re even better at this than I am. I’m handing it all over to you!”

Dr. Guan felt completely reassured by Zhou Can’s abilities.

During certain bowel resection surgeries, placing a nasogastric tube for gastrointestinal decompression not only aids exposure during the procedure,

but also helps prevent any catastrophic events like choking during anesthesia in case of vomiting.

Zhou Can considered every detail with impressive thoroughness—techniques and insights that only a professional anesthesiologist would know.

Dr. Guan couldn’t help but express his admiration.

He still hadn’t known that Dr. Feng had already started teaching Zhou Can anesthesiology.

Among the observing doctors, a couple of the more experienced ones had already realized that Zhou Can was no ordinary trainee.

Without genuine competence, no one could offer such precise preoperative suggestions.

After all the instruments were hooked up and the patient was prepped for general anesthesia, Dr. Jia finally arrived in the Operating Room.

“Oh, Zhou Can is taking part in the anesthesia procedure?”

Dr. Jia asked in mild surprise.

“Junior Zhou is acquainted with the anesthesiologist and stepped up to help. He even seems to know a fair bit about anesthesiology—I truly admire him,” Qiu Hong replied with a smile.

“Although anesthesiology is technically a sub-discipline, it involves multiple aspects of life sciences and their integrated application. In the future, when you watch an anesthesiologist at work, feel free to participate more,”

Dr. Jia advised the group of doctors.

His words were almost tantamount to praising and affirming Zhou Can’s actions.

“Let’s prepare for surgery! We’ve got two tough battles lined up today, so we must work quickly.”

Given his age, Dr. Jia could only participate in the core parts of the operation; he couldn’t operate solo on a procedure that could last four to five hours like the young lads can.

Even a partial bowel resection—say, of just the rectum—usually takes around four hours.

And that’s assuming the surgery proceeds smoothly with the operating doctor’s exceptional skills, finishing within the four-hour mark.

Any mishap or complication during the procedure would only extend the operation.

This patient required a section of the colon to be removed.

That meant the surgery would be even more challenging.

Moreover, the diseased bowel was severely adhered, making the separation process a real headache.

No wonder Dr. Jia described it as a tough battle.

“Dr. Guan, how’s the patient’s condition?”

“Not bad at all! We’re ready to start the surgery!”

Anesthesiologists use four rating standards to assess a patient’s condition.

They are: excellent, good, fair, and poor.

When a patient reaches a ‘fair’ level, the surgery is approached with extreme caution.

If, after anesthesia, the patient’s state deteriorates, the anesthesiologist is empowered to halt the operation immediately.

Such occurrences are rare, but they do happen.

For instance, a patient might show normal vital signs before entering the Operating Room, only to start plummeting right after general anesthesia is administered. In that case, the anesthesiologist would stop the anesthesia immediately and, after observation, decide whether to proceed or abort the surgery.

For the sake of safety, the operation would most likely be terminated.

That’s why, in well-regulated hospitals, anesthesiology mishaps are rare.

Conversely, major complications in cosmetic medical institutions occur all too often.

In those clinics, the anesthetists are essentially just technicians, lacking the highly specialized ability to predict a patient’s vital signs.

They simply can’t detect dangers in advance.

And since most cosmetic clinics are private ventures chasing profit,

they dare to let doctors with only a half-month of training perform procedures like breast and nose augmentation, double eyelid surgery, facial slimming, and liposuction. It’s no wonder disasters occur.

“The surgical markings are done. Who’s taking the lead on the laparotomy?”

Dr. Jia looked toward his subordinate associate chief and attending physicians. As for the residents, opportunities to operate were scarce.

“I’ll do it! Is that okay?”

Zhou Can was the first to volunteer eagerly.

The other doctors were momentarily stunned. This kid pounced like a hungry wolf, showing no hesitation at all.

But he hadn’t even checked what kind of operation this really was.

Did he think it was just suturing skin? This was a laparotomy—

an extremely high-risk procedure.

Even seasoned attending physicians wouldn’t claim complete confidence with such an operation.

For a trainee like him to snatch this chance was downright reckless.

“A laparotomy is a procedure that demands high technical expertise. You, as a trainee, can’t handle it. Let me take over!”

The associate chief physician, who was only in his early forties, spoke up.

He was one of the youngest associate chief physicians around.

Speaking calmly and methodically, he exuded the aura of an experienced senior.

“Dr. Jia has said that anyone confident enough can speak up and jump into a surgical task at any time,”

Zhou Can didn’t argue with him directly but instead turned to Dr. Jia.

“Zhou Can, this isn’t a joke. Are you sure you want to take this on? Let me warn you: if you make a surgical mistake during a hands-on procedure under my supervision, your operating privileges will be suspended for at least three months. In severe cases, the Medical Department will take action. So, know your limits and don’t use my words as a free pass to grab surgery opportunities recklessly.”

Dr. Jia spoke plainly,

standing firmly by his words.

His strict penalties were meant to prevent his juniors from overreaching.

With a resolute tone, Zhou Can declared, “Respect for life is my foremost creed. Rest assured, I would never treat surgery like a game.”

His words rang out strongly, exuding unwavering confidence.

When it comes to seizing surgical opportunities, hesitation is not an option.

Otherwise, senior doctors would never entrust you with risky procedures.

If you’re certain of your abilities, then go for it.

For most trainees and residents, even a chance to help suture a wound is a win to celebrate for days.

In practice, a beginner might spend an extra hour or two on opening the abdomen and suturing.

Usually, once the chief surgeon has finished the critical parts of the operation, he exits early, leaving a seasoned attending to keep an eye on things.

That gives the newcomers a chance to claim some suturing opportunities.

Taking a bit more time to suture isn’t a problem.

The key is to keep the senior attending from getting impatient.

Besides, his presence watching you suture might make you nervous.

So you can ask him to leave or sit down until you finish.

After you’re done, invite him for a check.

Just be sure to communicate well and build trust with your senior doctors. Those who stick around usually let you suture as much as you want.

Sometimes they even leave the Operating Room temporarily or step out altogether.

They’re busy, and they too have climbed the ranks from being beginners.

They understand the struggles and challenges all too well.

“Come on, get started! I’m calling a halt—stop immediately if needed. Also, remember not to rush the procedure,” Dr. Jia instructed, though his words barely seemed to faze Zhou Can.

With no other choice, Zhou Can swallowed his apprehension and agreed.

If Dr. Jia had known how headstrong and bold Zhou Can was, he wouldn’t have warned him so sternly.

But there was no turning back now—face-saving was at stake.

He had to let Zhou Can try.

“Dr. Jia, he’s still just a trainee! Laparotomy is too high-risk…”

The associate chief, having lost the chance to assist, looked both discontented and worried.

More from concern than resentment.

“Let him try. I’ll stand by him—risk is controlled,” Dr. Jia asserted, his tone confident though his eyes betrayed a hint of tension.

His gaze was fixed on Zhou Can.

Zhou Can didn’t bother with pleasantries—he stepped up to the chief surgeon’s position, instructed the nurse to don sterile gloves, grabbed the scalpel, and immediately began.

He wasn’t new to laparotomy.

He was fully capable of operating solo, and he performed brilliantly.

The surgical area was already disinfected and marked—the incision was all that was needed.

With flawless, fluid movements, his scalpel cut through the skin.

In one swift stroke, the skin was incised.

Watching him slice through the tissue as if it were pigskin, so casually and at breakneck speed, Dr. Jia clutched his chest, his eyes never daring to blink at the cut.

As soon as Zhou Can finished the first incision, Dr. Jia called a halt, shocked nearly into a heart attack.

“The length and depth of the incision are perfect. Cutting so swiftly and casually—kid, no wonder you’re this confident. You really kept your skills hidden,”

Dr. Jia exclaimed with relief after inspecting the incision.

He had feared Zhou Can might have cut through the subcutaneous tissue—or even the muscle layer—with one stroke.

But after a close look, he realized Zhou Can’s ability far exceeded his expectations.

That single cut, seemingly effortless, was executed with impeccable precision.

The associate chief was so astonished his eyes almost popped out.

He still wore the stunned expression of someone who had just seen a ghost.

Senior Qiu Hong’s eyes were wide with admiration,

and the other doctors—both attendings and residents—stood in awe of Zhou Can’s scalpel skills.

“Shall we proceed?”

Zhou Can was eager to open the patient’s abdomen to inspect the colon.

“Proceed!”

Dr. Jia’s confidence in him had soared.

Next, Zhou Can methodically opened the abdomen layer by layer, much like a skilled butcher dismembering beef.

While incising the muscle layer, he noticed a distinct change in tactile feedback—a very subtle sensation.

It was a feeling he had never experienced before.

Thus far, his incision technique was roughly at the level of a mid-ranking attending—but he hadn’t yet reached that standard.

Normally, such a clear tactile sensation would only be achievable by an associate chief.

Obtaining it ahead of time—what’s often called tactile feedback—brought Zhou Can immense joy.

He guessed that his Rapid Surgical Technique might be blending with the incision process.

When his brain registered the unusual sensation, his hand immediately halted the scalpel.

The biggest drawback of Rapid Surgical Technique is that the hand is often quicker than the brain.

Zhou Can’s ability to stop in time when he sensed a problem was a very encouraging sign—it meant his composure was still strong enough to counteract the haste of the technique.

“There’s a relatively thick blood vessel… Hmm, it’s a vein. Should I cut it through directly?”

After pausing his cut, Zhou Can looked up and asked Dr. Jia.

“Let me check!”

Drawing on his rich surgical experience, Dr. Jia had already secretly validated the incision mark drawn by the assistant. There was no issue.

All major blood vessels and nerves had been safely avoided.

“Indeed! A vein no thicker than two millimeters is safe to transect. And the fact that you noticed it in time shows remarkable tactile feedback. To cut swiftly yet stop instantly—now that’s impressive. Today, I’ve seen true surgical talent,”

Dr. Jia marveled at Zhou Can’s ability to detect the small vein ahead of time.

For a veteran surgeon with over forty years in the field, spotting critical structures with one’s keen tactile sense was commonplace.

For a trainee to reach this level was nothing short of extraordinary.

In the end, Dr. Jia credited this achievement to Zhou Can’s innate talent.

Honestly, Zhou Can’s traditional surgical aptitude was only moderately above average.

But his nerve anastomosis skills and advanced surgical intuition were particularly outstanding.

His display of exceptional conventional surgical prowess was largely a result of blending Rapid Surgical Technique with an experience-based skill system.

“May I ligate it before cutting?”

Eager to show off his surgical finesse and secure more opportunities later, Zhou Can asked.

His fellow assistants, who usually vied for practice opportunities during his General Surgery internship, had been as fierce as wolves.

That was truly intimidating.

“Certainly, go ahead!”

Dr. Jia readily agreed.

This task should have belonged to the first assistant. However, the associate chief, clearly unwilling to assist Zhou Can for fear of diminishing his own stature, had stayed silent.

Quickly, Zhou Can set down his scalpel, collected the needle holder, hook, and suturing thread from the nurse, and ligated the vein.

His entire ligation was not only swift and skillful, but executed with outstanding finesse.

“Click, click—this ligation level is undoubtedly at the associate chief’s standard. It’s almost unbelievable,”

Dr. Jia exclaimed in a series of admiring tones.

The associate chief, who had been too proud to assist earlier, now looked at Zhou Can with a newfound respect.

For someone so young to showcase such precise incision and ligation skills meant it was time to reassess his view of Zhou Can.

Senior Qiu Hong’s beautiful eyes were now sparkling with admiration.

Though she was an attending physician herself, compared to the trainee Zhou Can, her surgical skills paled in comparison.

Her exact educational background was still unclear, though it was known that most were master’s degree holders.

Even doctoral candidates and outstanding master’s students excel in academics,

but in surgery, achievements require hands-on experience.

Seemingly simple ligation actually encompasses numerous surgical techniques.

It’s important to understand that ligation isn’t simply about tying a knot.

Knot tying is just one part of the process.

It’s like being human isn’t limited to just being a man.

Apart from men, there are women, children, and the elderly.

Often, ligation requires a deft use of the hook to pass through tissues,

carefully binding the vessel without damaging important tissues or vessels, and then securing it with a knot.

This process must avoid involving surrounding tissues and ensure the tension and security meet the required standards.

So, ligation is not equivalent to mere knot tying.

In medical terms, knot tying is never considered one of the four basic surgical skills.

After tying the knot on the vein, Zhou Can decisively transected it.

He then took a moment to savor the unique tactile feedback as the scalpel met the vessel.

It was especially marvelous.

This provided a safety measure for future procedures—whenever the scalpel touched a vessel, it would trigger that deep-seated signal, prompting an immediate stop.

At his current level, he could only reliably detect vessels about two millimeters in diameter.

But as his surgical expertise advanced, he might soon be able to catch even subtler signals from smaller vessels.

Thanks to the preemptive ligation, there wasn’t much bleeding from that vessel.

The entire laparotomy was swift and efficient.

Once the peritoneum was opened, the internal organs of the abdomen were revealed.

The associate chief, having witnessed Zhou Can’s surgical prowess, completely changed his attitude.

He began to actively assist by cauterizing minor bleeding points.

“Spread the abdominal incision wide to fully expose the surgical field,”

Dr. Jia instructed the third assistant and a resident.

The third assistant was Qiu Hong.

Currently, her surgical skill only allowed her to hold that position.

In the Operating Room, perhaps it’s the one place where educational background doesn’t matter—

the strongest surgeon naturally takes the lead.

Academics are theoretical, but surgery is all about practical ability.

“Oh dear, the disease in this colon is quite severe! Had he come in sooner for treatment, part of the colon might have been saved. Many illnesses are left unchecked until they become critical. Luckily, his issue is just a bowel obstruction. But if it were an intestinal polyp left too long, it might have turned malignant,”

Dr. Jia examined the diseased segment of the colon in the abdomen and sighed.

“Remember, when you consult with patients in the future, if you notice abnormalities in the colon, address it promptly. Make sure the patient and their family fully understand the risks. Don’t let them think it’s nothing until it escalates into a major problem.”