Chapter 217: Mastering Hemostasis and the High-Stakes Operation

Zhou Can carefully felt the benefits brought by his hemostasis technique reaching level five.

At level four, its advantages lay in the more precise and flexible electrocoagulation hemostasis, along with an initial ability to analyze the causes of bleeding.

Now he discovered that electrocoagulation had not only become more accurate, but during the process he could clearly sense when the bleeding was controlled.

What seemed like a minor upgrade actually provided an extra layer of safety during electrocoagulation hemostasis on patients.

There was no worry about an overly short coagulation time leaving bleeding unsealed or unstable, only to have rebleeding occur post-surgery.

Nor was there the concern of overcoagulation causing necrosis in vessels or the surrounding tissues.

Both scenarios would inflict harmful secondary effects on the patient.

Tissue necrosis from excessive coagulation was a frequent occurrence – leading to chronic non-healing wounds and infections, which was the lesser evil.

It could directly precipitate multiple postoperative complications, or even septicemia – truly a terrifying prospect.

Everyone had heard that when necrosis sets in a limb, immediate amputation becomes necessary.

Indeed, any significant tissue necrosis should be promptly removed.

Otherwise, the massive absorption of necrotic toxins might impair other organs, with respiratory failure or liver and kidney failures easily claiming a life.

Thus, the enhanced capability of electrocoagulation hemostasis during surgery was extremely beneficial.

It averted the tragedy of tissue ischemia and necrosis due to excessive coagulation.

Moreover, incomplete electrocoagulation that led to rebleeding was another serious hazard.

For instance, consider an open abdominal surgery to excise an intra-abdominal tumor.

Larger blood vessels would be stopped using ligature, while smaller ones were generally managed with electrocoagulation.

During the operation, minor bleeding points in the abdominal cavity were successfully sealed with electrocoagulation.

The doctor then closed the abdominal cavity, and the surgery was deemed a success.

Both the patient and his family were overjoyed.

But after one night, the patient’s condition suddenly worsened. The doctor was baffled – the operation had gone perfectly, and even after thorough checks, nothing seemed amiss.

X-rays revealed that the patient had developed ascites.

An experienced chief surgeon was alarmed. He rushed the patient back into the operating room, and upon reopening the abdomen, found it filled with blood. Investigation revealed that incomplete electrocoagulation had led to unstable hemostasis and postoperative intra-abdominal bleeding.

After strenuous rescue efforts, the patient was finally saved.

All the doctors heaved a long-awaited sigh of relief.

From then on, extra caution was exercised for hemostasis in any abdominal, thoracic, or cranial procedures.

This was just one of the more common examples.

The patient was extremely fortunate to have his life salvaged.

Some patients, unfortunately, die directly from postoperative bleeding.

Others become disabled or lapse into a vegetative state because of bleeding complications.

This is why many high-risk surgeries mandate that the chief surgeon be a deputy or chief attending physician.

Only when a surgeon reaches deputy-level or above can the safety of a level-three operation be assured.

With his hemostasis technique rising to level five, Zhou Can not only enhanced his electrocoagulation skills but also his ability to analyze bleeding causes, make diagnoses, and choose the correct hemostasis methods.

For some bleeding points, a mere glance was enough for him to roughly deduce whether a particular segment of the circulatory system was at fault and how to resolve it.

He possessed a very clear and intuitive understanding.

Some patients might suffer from internal bleeding – be it intracranial, uterine, or abdominal – which Zhou Can previously had to diagnose through examinations.

Now, even without imaging, based on the symptoms, the local skin tone, and signs like bloody stool or hematemesis, he could accurately pinpoint the bleeding source.

He could even roughly determine the underlying cause.

Beyond these improvements in hemostasis, he had gained a more comprehensive and profound understanding of the entire circulatory system.

Where many perplexing issues had once existed, everything now became crystal clear.

This marked a significant upgrade in his theoretical knowledge.

Yet, despite reaching level five in his hemostasis technique, Zhou Can remained humble and continued to focus on his patients.

What appeared to be a mere upgrade of a basic surgical skill made him much more adept and composed during operations.

Surgery inevitably involves cutting into a patient, making the management of bleeding an essential challenge.

A robust mastery of hemostasis was like having a powerful safety net.

It bolstered Zhou Can’s confidence and reinforced his resolve during procedures.

Shortly after this operation, another particularly challenging case was admitted.

It was a 21-year-old young man.

A massive lipoma on his left cheek, left untreated for too long, had grown so large that it triggered a series of severe symptoms.

Not only did the tumor give his face a monstrous appearance, but his left eye was nearly blind.

His teeth were severely damaged, leaving only a few remaining.

According to the patient, even eating had become problematic.

He couldn’t manage foods that were even slightly tough to chew – he dared not eat fish or meat with bones.

The enormous tumor compressed his oral cavity, so much so that sharp food could easily injure his mouth, causing intense pain.

Besides, the tumor would press against his airway during sleep, leading to breathing difficulties.

He could not sleep on his side and had to lie flat.

Even an unconscious turn during the night could be extremely dangerous.

Even in the operating room, the young man wore a mask; the tumor had rendered his appearance grotesque and fearsome, instilling deep-seated self-doubt.

“Doctor, will my face return to normal after the surgery?”

The young man asked Mr. Liu with hopeful eyes.

“It should basically return to normal – or at least be much improved. However, given the enormity of your facial lipoma, the surgery is very high-risk and may bring a series of complications, even endangering your life. You must be mentally prepared for that,”

Mr. Liu said in a serious tone.

Excision of superficial lipomas is usually considered a level-one minor surgery.

Many junior surgical residents relish such opportunities – they’re perfect for practice.

These procedures are relatively simple and low-risk.

Senior doctors are happy to let inexperienced colleagues train on such cases.

However, this operation was a highly challenging level-three surgery, nearly bordering on level four.

Even most deputy attending physicians wouldn’t dare to lead such a procedure.

Mr. Liu, a seasoned deputy attending, had extensive surgical experience and exceptional skills.

Although his title was deputy attending, his surgical prowess was truly on par with a chief physician.

“I’ve lived with this tumor since childhood. My family’s poverty meant I never received treatment. Now, I’ve fallen for a girl who feels the same about me, but her family absolutely opposes our union once they learned of my condition. Over the years, I haven’t earned much – until media coverage and generous donations gave me this chance at surgery. No matter how risky it is, I’m willing to try. Living is pure agony; it’s worse than death,”

The young man’s story moved the doctors and nurses deeply.

So many people only wish to live an ordinary life, like everyone else.

Physical disabilities, deformities, or incurable chronic illnesses force patients to live in pain while facing discrimination, ridicule, and even bullying.

Acquiring an education, finding a job, or even dating becomes exponentially tougher than for others.

With constant advancements in medicine and technology, solutions to these physical challenges are gradually emerging.

For those who lose a leg, a low-level amputation can allow for a prosthetic replacement.

With long-term training, they can eventually walk or handle objects normally using their prostheses.

Not everyone is born into a life of comfort.

In this young man’s case, his impoverished background meant that without media attention and reporting of his plight, he might never have had a chance to change his fate.

“Since you’ve made up your mind, let’s begin the surgery! We doctors will spare no effort to treat you,”

Mr. Liu instructed the patient to lie down on the operating table.

The anesthesiologist prepared to administer general anesthesia.

Zhou Can’s anesthesia technique was just shy of level three – a perfect opportunity – so he immediately went over to help.

Although this was only a level-three surgery, the anesthesiologist was none other than his half-mentor, the silent and stern Dr. Feng.

That alone underscored the danger of this operation.

Any anesthetic procedure that required Dr. Feng to personally oversee it was extremely high-risk.

“Lipomas are never simple. They’re usually closely tied to internal organs. During anesthesia, one must consider numerous risks – from anesthesia mishaps causing respiratory or cardiac arrest, to inadvertent injury to major blood vessels resulting in massive bleeding and life-threatening situations,”

Dr. Feng imparted several very practical insights to him.

A truly brilliant anesthesiologist, like Dr. Feng, not only excels at his primary duties but also anticipates a wide range of potential complications during surgery.

Even Dr. Guan’s level paled in comparison to Dr. Feng’s expertise.

In routine anesthetic procedures, Dr. Guan could only foresee common risks.

He could never match Dr. Feng’s profound insights; in any major surgery, Dr. Feng always had his own unique and penetrating perspective.

He provided numerous practical tips that would help Zhou Can preemptively ward off various surgical risks in future operations.

Zhou Can studied everything very diligently.

He also worked extremely hard during the operations.

Before long, the preparations for intubation and establishing an extracorporeal circulation channel were all completed.

“May I administer the anesthesia to the patient?”

“Yes!”

Dr. Feng gave a slight nod and a grunt of assent.

Zhou Can was long accustomed to his ‘unique’ style of communication.

He then carefully administered inhalation anesthesia to the patient.

Fortunately, no mishaps occurred until the patient lost consciousness – there were no terrifying episodes of respiratory or cardiac arrest during the anesthesia.

【Anesthesia Experience +1.】

【Congratulations! Your anesthesia technique has advanced to level three. You can now independently perform general or spinal anesthesia on ordinary patients, maintaining stable vital signs during anesthesia, and have preliminary capabilities in cardiopulmonary-cerebral resuscitation, mechanical ventilation, and special management of critically ill patients. You are also capable of handling rescue procedures in cases of shock, perioperative acid-base imbalance, acute heart failure, multiple organ dysfunction syndrome, septicemia, acute renal failure, oxygen therapy, defibrillation, rhythm conversion, and pacing.】

Advancing in anesthesia technique is considered one of the most challenging tasks.

The field is simply too vast.

Many anesthesiologists claim that advancing to the attending physician level is nearly hellish.

As for how difficult it is to reach that level, Zhou Can was unsure.

It took him nearly a year to progress from intern to resident level.

Even now, he felt that what he had learned in anesthesia was still very superficial – merely scratching the surface.

Reaching Dr. Feng’s level would likely require another ten or twenty years – a feat hardly achievable.

Fortunately, this was only a secondary skill, not a mandatory advancement.

So he wasn’t in a rush.

Upgrading his anesthesia skills continued to bring him many unexpected benefits,

such as an enhanced ability to foresee intraoperative risks.

At that moment, as he re-assessed the patient’s surgery, he felt an odd chill in his heart.

It was hard to explain – a mysterious blend of mental and emotional pressure.

Before reaching level three in anesthesia, he had been brimming with confidence about this operation.

Now, he couldn’t shake off even a hint of trepidation.

It wasn’t that he had become fearful; upgrading his anesthesia skills had instilled in him a deeper respect for life and a keener intuition for danger.

“If there are no issues, let’s begin the surgery!”

Mr. Liu, clearly unaware of any imminent danger, planned as usual to let Zhou Can gain experience by handling the procedure – intervening only if the risks became unmanageable.

“Mr. Liu…”

But Zhou Can hesitated slightly.

His unease did not escape Wu Ziyu’s notice.

The perceptive woman was particularly sensitive to changes in others’ emotions.

She simply watched Zhou Can with curiosity.

She couldn’t understand why the usually confident Dr. Zhou now seemed as if standing at the edge of a precipice, hesitating to move forward.

It was the first time in all their interactions that she had seen him like this.

“What’s wrong?”

Mr. Liu fixed his gaze on Zhou Can, his eyes filled with questions.

“This surgery is extremely high-risk – please keep a vigilant eye on me. If any part seems too dangerous, you might have to take over immediately.”

Zhou Can said, his voice tinged with anxiety.

“Of course. At any time during the operation, if you feel uncertain, stop immediately and let me take over. Safety always comes first.”

Mr. Liu had repeated those words countless times.

‘Safety first’ was the mantra senior doctors lived by.

Because when complications arose during surgery, it was the primary surgeon – not the subordinate – who was held accountable.

For example, although Zhou Can was the de facto lead on this surgery, Mr. Liu was the nominal lead.

If issues emerged, Zhou Can might share some of the blame, while Mr. Liu would bear the brunt of the fallout.

Opportunities for junior surgeons handed down by senior doctors were precious – one must never recklessly assume that a senior could always cover for any accident.

That trust was truly invaluable.

Many surgeons who had been residents for over three years were never allowed to hold the scalpel; at most they were given minor tasks like applying a retraction hook or practicing suturing.

It wasn’t that the senior doctors held any personal bias –

rather, poor performance in everyday work made them reluctant to delegate responsibility.

Taking a deep breath to steady his slightly nervous heart, Zhou Can asked a nurse to help him put on sterile gloves and began the surgery.

It is worth noting that prior to certain procedures or examinations in surgery, doctors must wear sterile gloves.

If the lead surgeon feels the gloves have been contaminated before the operation starts, they must be replaced immediately.

End.