Chapter 216: A New Dawn in Surgery

“Thank you! Thank you for letting me feel the warmth of our new department!” Wu Ziyu repeatedly expressed her gratitude to Zhou Can, her words sincere and her eyes genuine. “And thank you, Dr. Zhou, for showing me just how far I have to go to reach the level of an outstanding doctor. I will from now on curb my arrogance and impatience, take you as my role model, and steadily improve both my surgical skills and medical knowledge.”

Today, Zhou Can gave her a very valuable lesson.

Not only was her misunderstanding of Zhou Can cleared up, but her horizons were greatly expanded.

This matter was resolved to perfection.

“Whether it’s Dr. Wu or otherwise, witnessing Dr. Zhou’s surgical prowess left me utterly amazed. I never imagined that a trainee with less than two years of experience could possess such formidable surgical capability. Some of the tissue separation and excision maneuvers in this operation would normally require the skill of an associate chief. Simply phenomenal!”

Director Mo was equally effusive in his praise of Zhou Can’s surgical talent.

“Perhaps it’s because I’m a bit bold, and the mentors have all been very supportive, generously sharing all their knowledge with me. That’s why I’ve made rapid progress! In truth, my surgical skills are still far from associate chief level—if pushed to the limit, they’d only reach attending physician status.”

Zhou Can’s words rang with blunt truth.

Before mastering the Fast Scalpel Technique, his surgical ability was already solid and dependable.

Later, as the Fast Scalpel Technique advanced to the beginner stage, using it to handle tissue separation, incisions, and debridement was like channeling internal power to drive a martial skill—elevating his technique to an entirely new realm.

Though he was only at attending level, he managed to perform with skills common to an associate chief.

And that was precisely what made the Fast Scalpel Technique so captivating.

Whether the “steady scalpel” and “precise incision” techniques possessed a similar magic, Zhou Can was not entirely sure.

All he knew was that he had come to deeply love the allure of the Fast Scalpel Technique.

Every time he operated, an exhilarating sense of satisfaction washed over him.

“Outstanding skills combined with humility—what a promising young man!” Director Mo expressed his heartfelt admiration. He was very optimistic about Zhou Can’s future. “Now that this operation has been successfully completed, I can finally relax. To be honest, not only I but even the other chief physicians were uneasy about handing over patients to you without first confirming your surgical competence.”

Zhou Can managed a bitter smile at those words.

The chief physicians were all composed and dignified, exemplifying impeccable medical ethics.

Here was a trainee who had taken on the surgical cases usually handled by them—even though it was out of goodwill, the chief physicians were still worried that Zhou Can’s skills might not suffice.

To be responsible for their patients, although they didn’t openly object, they sent Director Mo into the operating room to assess Zhou Can’s surgical ability.

With the confirmation that Zhou Can’s surgical prowess was even stronger than they had imagined, Director Mo could confidently report to everyone.

“Director Mo, these next few days I’ll be assisting Zhou Can in surgery. Please keep an eye on the thyroid outpatient cases in Jiaru Surgery. If any complex issues arise, feel free to convene a consultation with the entire department.”

Mr. Liu reminded them.

“Rest assured, Jiaru Surgery is as much your department as it is ours; we will all strive to do our jobs well. No one is going to jeopardize their career here.”

Director Mo waved at Mr. Liu as he, along with Wu Ziyu, prepared to leave.

“Director Mo, Director Liu, may I stay in the operating room to help during surgeries? My surgical skills might not match Dr. Zhou’s yet, but I can certainly assist with retraction, suturing, and hemostasis.”

Seeing Zhou Can’s impressive surgical ability spurred Wu Ziyu to not fall too far behind.

For the next couple of days, Zhou Can’s schedule was packed with surgeries, both large and small.

By assisting as a helper, she was sure to pick up many surgical techniques and insights.

This would significantly benefit the improvement of her own surgical skills.

“I don’t mind at all—it all depends on whether Director Liu agrees!”

Director Mo did his best to look after the junior doctors.

“What assignments does the department have planned for you these next couple of days?” Mr. Liu asked, not rushing to give his approval.

The department had just been established, and there was an overwhelming amount of work.

Staffing was extremely tight.

Even an ordinary resident was saddled with a tremendous workload.

If she were kept in the operating room, some of her regular responsibilities would inevitably have to be reassigned to others.

“I’m tasked with managing the wards, writing case notes, and handling orders. Don’t worry—I won’t let it interfere with our work. I’ll coordinate my shifts with other colleagues and work overtime at night.”

She explained quickly.

“Alright then, but your time in the operating room should not exceed eight hours. Young people, while it’s great to work and learn hard, must also remember to rest. Make sure you get at least six hours of sleep each night.”

Mr. Liu couldn’t bear to refuse the eager look in her eyes.

In the end, he agreed.

She was assigned as Zhou Can’s assistant.

Originally, the more challenging tasks such as retraction and hemostasis were handled by Mr. Liu himself. But due to the manpower shortage, the associate chief had to take on the role of a first assistant.

While serving as the first assistant, Mr. Liu was nominally the lead surgeon, guiding Zhou Can through the operation.

When encountering aspects of the surgery that Zhou Can couldn’t yet handle, he had to step in personally.

Now with an additional resident-level assistant, Mr. Liu found his workload considerably lighter.

After all, in operations like the thyroid tumor resection earlier, two trainees and three interns would never be able to fill in as first assistants.

“Has Dr. Wu ever participated in level-three surgeries?”

“Yes, many times. Usually, I serve as the third assistant. In the parts of the operation I’ve completed, mostly hemostasis and suturing of the capsular tissues.” She was refreshingly candid.

Most residents don’t begin to get hands-on experience with higher-risk surgeries until their third year.

Just like when Zhou Can first started in the Emergency Department—he would get overly excited even when merely draining an abscess.

Surgeons progress incrementally, slowly accumulating experience over time.

“Alright, the next surgery is a thrombosed hemorrhoid excision. You’ll act as the first assistant for Dr. Zhou, okay?”

Mr. Liu decided to test her competence first.

Future opportunities for surgical practice would follow based on her performance.

The patient was quickly brought in.

A woman in her thirties, her gait resembled that of a freshly blossomed girl—limping with her face intermittently contorted in pain.

Hemorrhoids are soft clusters of engorged veins formed by the stagnation, dilation, and twisting of the venous plexus beneath the rectal mucosa and anal skin.

If thrombosed hemorrhoids are not treated promptly, they can inflict extreme pain on the patient, making sitting, lying, and defecation agonizing.

The fact that this woman was limping so noticeably indicated that her condition had progressed to a severe stage.

“Please lie down properly on the operating table!”

Wu Ziyu stepped forward to help position the female patient in the lateral decubitus position.

After all, most doctors in the operating room were male, and a female patient might feel uneasy.

Being a woman herself, Wu Ziyu could more easily earn the patient’s trust and alleviate any embarrassment.

Although Zhou Can was the primary surgeon,

this minor operation did not require a dedicated anesthesiologist.

The operating doctor directly administered local anesthesia.

“Mr. Liu, for her condition, wouldn’t sacral canal anesthesia be more appropriate?”

Zhou Can’s experience with basic level-two general surgery was quite substantial.

Moreover, having learned a lot about anesthesia techniques from Dr. Feng, he could easily manage local anesthesia for such a level-two minor procedure.

With just a brief assessment of the patient’s condition, he could accurately determine the most suitable anesthetic plan.

Hemorrhoid surgeries can generally be performed using local anesthesia, sacral canal anesthesia, or, if necessary, lumbar anesthesia.

“Sacral canal anesthesia is perfect for this situation. Let’s begin!”

Mr. Liu cast an approving glance in his direction.

The ability to flexibly apply the most appropriate anesthetic method indicated that Zhou Can’s proficiency in anesthesia had markedly improved.

Zhou Can took the anesthetic prepared by the instrument nurse and began administering sacral canal anesthesia to the female patient.

This form of anesthesia was more challenging than a simple intramuscular injection for local anesthesia.

It required inserting the local anesthetic through the sacral hiatus into the sacral canal to block the sacral nerves. It is a type of epidural anesthesia, mainly used in rectal, anal, and perineal surgeries.

“Dr. Zhou’s injection technique is incredible!”

Wu Ziyu, watching Zhou Can at work, couldn’t help but be astonished.

If it were her, not only would a single success be hard to come by even with ten attempts, but even one success would be considered a bonus.

She had only witnessed this method two or three times before.

Previously, having assisted Director Mo mainly in thyroid surgeries,

Zhou Can’s administration of sacral canal anesthesia looked almost effortless—a testament to his exceptional skill.

In her quiet comparison, she thought that even if Director Mo performed it himself, it would be hard to match Zhou Can’s ease and finesse.

“It’s nothing; if you practice more, you’ll be able to do it just as easily,”

Zhou Can replied with an unconcerned smile.

“Could you show me a bit more? I’ve seen other doctors attempt it a couple of times, but none have matched your technique. I’ve always wanted to learn, yet never truly mastered it,”

Wu Ziyu, noting his approachable manner, seized the chance to ask for his guidance.

Normally, she wouldn’t dare interrupt a senior doctor in the middle of surgery to ask questions.

“The trickiest part of sacral canal anesthesia is the puncture through the sacral hiatus. You can have the patient lie in either a lateral or prone position, depending on their condition, to minimize discomfort. In the lateral position, the patient arches their lower back and draws both knees close to the abdomen like a curled-up shrimp. In the prone position, place a small pillow under the hips, have the legs slightly apart, with toes inward and heels rotated outward to relax the gluteal muscles.”

Zhou Can diligently explained and demonstrated all the anesthesia techniques and tips he had mastered.

“First, locate the tip of the coccyx—that’s here.” He pointed to the tip of the patient’s coccyx. “Then, move up along the midline about 3 to 4 centimeters until you feel a V-shaped or U-shaped depression. On each side of this depression are two small bony prominences—the sacral cornua. This depression is the sacral hiatus. Once you locate it, you’re essentially ready to puncture.”

What seemed like a simple anesthesia procedure to Zhou Can turned out to be quite an ordeal when he explained it; it made him realize how taxing teaching could be.

He had ended up lecturing her at length.

Recalling how tirelessly his own mentors had explained every surgical nuance to him, he felt a deep sense of gratitude.

Without having been a teacher himself, he hadn’t fully appreciated the hardships his own instructors had endured.

Similarly, without being a parent, one can hardly comprehend the struggles of parenthood.

“I’ve pretty much mastered locating the sacral hiatus. Could you explain the puncture in more detail? I might be a bit slow—don’t mind me,” she said a little bashfully.

Seeing her eager eyes, so reminiscent of how she looked when she sought advice from senior doctors,

Zhou Can said, “You’re very smart. Every doctor learns practical skills just like this; I had to study this anesthesia technique for a long time under my teacher before I got it right.”

He offered her a half-truth with kindness.

After all, when Dr. Xu first taught him this procedure, he supposedly learned it in just one go.

“First, use a small needle to pierce the center of the sacral hiatus. Keep the needle vertical as it passes through the skin and the sacrococcygeal ligament. Once you feel a sudden loss of resistance upon breaching the ligament, adjust the needle so that it forms a 30-degree angle with the skin—this will guide it into the sacral canal.”

Zhou Can then demonstrated the technique again with hand gestures.

However, he refrained from repeating the puncture on the patient.

After all, subjecting the patient to another puncture would have been unacceptable.

“Thank you for being so patient in teaching me,”

she said earnestly while taking detailed notes—certainly intent on studying the method further once back in the office.

Once the anesthesia was successful, the surgery officially commenced.

The patient did not lose consciousness; she remained awake throughout.

Initially, she had been uneasy about having such a young doctor operate on her, but after hearing Zhou Can’s detailed explanations to Wu Ziyu, her apprehensions faded.

If he was capable of mentoring a student, his own skills couldn’t be lacking.

Truly, he was already a master in his own right.

With that reassurance, she comfortably awaited Zhou Can’s surgical procedure.

“Has Dr. Wu ever performed this type of surgery?”

“Not at all! This is even my first time watching something like this,”

she replied with a shy shake of her head.

“Watch every step of my procedure carefully. First, make a radial incision at the site of the thrombus,”

Zhou Can explained as he simultaneously operated.

“After the skin is incised, you’ll see a dark red blood clot. There—those are the clots.”

Zhou Can pointed them out to her.

“Using your thumb and index finger, from the base of the thrombus towards the incision site, squeeze out the entire coagulum. Be mindful of your pressure—it mustn’t be too forceful nor too gentle. Otherwise, you risk failing to expel the clot properly or leave residues that impair treatment. The wound can then be packed with petrolatum gauze or a small cotton ball dipped in hemostatic powder and benzocaine.”

Zhou Can’s surgical speed was remarkable.

Barely had he finished speaking when the procedure was essentially complete.

“Remember, do not suture the wound; let it heal naturally.”

Many wounds are best left unstitched.

Hemorrhoid wounds are a prime example.

There have been instances where novice surgeons made a fool of themselves by attempting to suture such wounds. Similarly, underqualified doctors running private clinics have sometimes incurred medical incidents due to a lack of proper supervision.

This operation was relatively straightforward—once this stage was reached, it was considered complete.

Mr. Liu stood silently by.

He only observed, his eyes softening with a trace of satisfaction as he watched Zhou Can instruct Wu Ziyu.

When a doctor’s skills reach a certain level—especially in later years—they naturally hope to pass on their medical wisdom to others.

Seeing Zhou Can guide Wu Ziyu was a clear sign of the tradition being passed down through generations.

It was this very sight that filled Mr. Liu with deep contentment.

After the female patient was taken out, a new surgical case was quickly wheeled in.

Zhou Can continued to act as the primary force—swiftly and efficiently performing surgeries—while Wu Ziyu assisted him during minor procedures. For more complex, riskier level-two surgeries, she would serve as the second assistant.

In cases like these, Mr. Liu himself would step in as the first assistant for Zhou Can.

By the time Zhou Can completed his fourth surgery of the day, his hemostasis skill had finally advanced to level five.

【Hemostasis Level 5 – Current XP: 1 / Basic Associate Chief Standard】

This marked his fourth level-five surgery.

At this pace, by the end of his three-year residency, he might very well elevate the vast majority of his skills to the level of an associate chief.

That would be truly impressive.

Essentially, he would be able to independently handle all level-three surgeries and even begin tackling the core components of level-four operations.