Chapter 220: A Critical Operation Under Pressure

[My Medical Skills Gain Experience]

Not long after, he hurried to the Resuscitation Room in the Neurosurgery Department.

Inside, a dozen or so doctors and nurses had gathered around a bed.

A cautious, blond man—likely a relative—stood anxiously by the bedside.

“So it’s a foreign guest. No wonder the General Surgery Department is taking this so seriously.”

Let me clarify, this isn’t about blindly admiring foreigners.

We do our best to showcase China’s splendor to our foreign friends—a visionary strategy to attract more investment and talent.

In the past, Zhou Can scoffed at how overly submissive foreign guests appeared when treated preferentially.

He harbored deep contempt for it.

But as his experience grew and his perspective broadened, he gradually understood the profound intent behind favoring foreign guests.

After all, if a foreigner arrives, the ensuing chaos could scare them right back home before they even settle in.

Once home, word would spread about China’s xenophobia and peril—nobody would dare come.

Such outcomes would deter foreigners from visiting.

Without foreign investment, work, and tourism, China’s progress would suffer.

Now, China has risen again as a global powerhouse. We simply welcome foreign guests with an even-handed approach.

“Dr. Zhou is here!”

This nurse was likely the one who had just called Zhou Can.

Zhou Can recalled her vaguely; her name was Shu Qian.

“Director Wen, Director Wu…”

Zhou Can walked over to greet the senior General Surgery doctors.

There were four chief physicians present, along with seven or eight attending and resident doctors—clearly, the hospital regarded this patient with utmost importance.

Otherwise, mobilizing such a vast array of medical resources would have been unthinkable.

“Dr. Zhou, review the scans and case files first. The patient suffered a brain hemorrhage and was just brought in. A head CT has been taken.”

After exchanging a few words, Wu Baihe leaned in to examine the patient more closely.

Zhou Can took the CT scans and inspected them; he noticed multiple white spots, with one particularly large area standing out.

On brain CTs, white spots can signal calcification, hemorrhage, or tumors.

The patient was in a deep coma, unresponsive to calls or even a tap on the shoulder.

When her eyelids fluttered, her eyes appeared vacant and faraway.

This painted a grim picture of her critical condition.

The smaller white spots were likely just normal pineal or choroid plexus calcifications—harmless and not in need of treatment.

The true concern was that large white spot.

Typically, such a high-density area on a CT requires a comprehensive evaluation based on its size, location, CT value, mass effect, and the pressure exerted on surrounding brain tissue.

Having trained in General Surgery for several months, Zhou Can was well-versed in interpreting brain CTs, ultrasounds, and X-rays.

The cause of the patient’s condition was, in fact, straightforward to diagnose.

Her intracranial pressure was soaring, compressing and shifting brain tissue into a herniation—a condition with extremely high mortality and disability rates.

The bleeding site could be roughly localized to the area beneath the falx cerebri.

Herniation in this region is far more dangerous than typical cases—for instance, a foramen magnum herniation usually leads to respiratory failure or arrest, often preceded by neck stiffness, fluctuating pupils, and brainstem hypoxia.

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[My Medical Skills Gain Experience]

In short, most foramen magnum herniations develop gradually, typically affording the doctors some time to act.

But this patient was likely suffering from a severe falx cerebri herniation, where massive displacement or tearing of neural tissue meant most nerves would be irreparably damaged—the window for rescue was extremely fleeting.

Many patients don’t even survive long enough to be trepanned.

“Zhou, what do you think of her condition?”

Director Wen was clearly testing Zhou Can.

With several chief physicians present, diagnosing the cause was hardly a challenge for them.

Besides, this wasn’t a particularly rare condition.

“It appears to be a falx cerebri herniation accompanied by intracranial hemorrhage and elevated pressure. Mild herniations might only cause contralateral leg paralysis and urinary difficulties, but her deep coma indicates severe brain tissue displacement. The optimal solution is an immediate craniotomy. Given her state, conventional surgery might be too slow—it may be wiser to opt for an emergency burr-hole endoscopic procedure.”

In such circumstances, Zhou Can didn’t hold back any of his diagnostic opinions.

He laid out his assessments candidly.

Whether the chief physicians embraced his suggestions was up to them.

“Inviting Dr. Zhou to join the rescue was an exceptionally wise decision! Your diagnosis aligns nearly perfectly with ours.”

Listen carefully: Wu Baihe said “invite”—not that he was summoning him to participate.

For a General Surgery director to be so courteous speaks volumes about Zhou Can’s standing among them.

“Issue the critical condition notice immediately! Then speak with the family—if they consent, have them sign the surgery form and rush her into the Operating Room for emergency surgery.”

Wu Baihe acted decisively, making a series of rapid arrangements.

Every brain herniation is perilous; this patient was nearly at death’s door, and emergency surgery was her only lifeline.

“But we still haven’t pinpointed the bleeding site. Rushing into surgery carries too many uncertainties. This operation is already extremely high-risk—I worry…”

A chief physician voiced his concern, his face etched with worry.

“We simply don’t have time for angiography. After years of intracranial surgeries, I know the brain’s structure inside out. We must rely on experience—let’s act now!”

The famed Peak Scalpel wasn’t just a nickname—Wu Baihe’s mastery of brain anatomy was unparalleled.

Even without the scans, he was confident that his extensive experience would allow him to successfully conduct this high-risk procedure.

Once he finished giving orders, Wu Baihe personally conferred with the foreign guest.

It was impressive to see that Wu Baihe not only carried the prestige of the Peak Scalpel but also spoke fluent English.

Conversations with the family went extremely smoothly.

They quickly agreed to the surgery.

Nurses immediately fetched clippers to shave the patient’s hair and prepared her for surgery.

The patient was soon rushed into the Operating Room.

Tuyu Hospital’s top anesthesiologist, Dr. Feng, was summoned on short notice to assist.

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[My Medical Skills Gain Experience]

Zhou Can assisted with the anesthesia procedure.

Unlike routine cases, this patient’s anesthesia demanded multiple specific techniques and had to be completed in record time.

Dr. Feng and he worked at full throttle, their coordination impeccable, until they successfully induced full-body anesthesia.

[Anesthesia Technique Experience +1]

[For successfully performing your first full-body anesthesia on a brain herniation patient, Anesthesia Technique Experience +100 awarded]

This was Zhou Can’s first reward in anesthesia technique experience—a whopping 100 points.

He was genuinely thrilled.

Yet the anesthesia procedure was fraught with challenges, teaching him many advanced techniques.

Especially in stabilizing vital signs in emergencies and managing pre-op medications—many of these were entirely new to him.

“Dr. Zhou, your surgical speed is impressive. You handle the scalp incision.”

Wu Baihe hadn’t summoned Zhou Can merely to spectate.

Beyond valuing his endoscopic skills as a potential backup primary surgeon, his rapid surgical technique was unmatched.

Tuyu Hospital had only two doctors renowned for their rapid technique.

They were Dr. Xu and Zhou Can.

Dr. Xu would only be roped in under absolute necessity.

Though that incident was long past, Dr. Xu’s identity remained highly sensitive.

With a foreign guest involved, the hospital exercised extreme caution.

If the patient hadn’t been saved and the surgical team’s names were exposed—with Dr. Xu among them—the repercussions would have been severe.

Zhou Can had absorbed Dr. Xu’s rapid technique; though still honing his skill, it was effective.

Positioned as the primary surgeon, Zhou Can executed the scalp incision at breakneck speed, following his pre-planned incision points exactly.

He refrained from handling the cranial drilling.

A poorly executed drill could easily inflict severe damage.

Drilling on a removed bone flap was manageable, but drilling directly into the patient’s skull was an extremely delicate task—even deputy chief physicians would struggle with it.

Beneath the skull lay the dura mater, and under that, vital brain tissue, brainstem, blood vessels, and nerves.

Any misstep could cause unpredictable harm.

It could readily trigger respiratory or cardiac arrest—an unfortunately common outcome.

Thus, cranial drilling must be performed by an extremely experienced General Surgery director.

Wu Baihe himself proceeded to drill the cranial window.

The First Assistant used a mastoid retractor to tension the scalp, facilitating Wu Baihe’s smooth creation of the bone window.

With meticulous care, Wu Baihe drilled the patient’s skull while Zhou Can observed and learned.

Whether drilling or using an electric saw to remove the bone flap, opening the cranial window was incredibly dangerous.

The challenge lay in gauging the precise extent of the cut.

After completing the window, Wu Baihe incised the dura mater and began clearing the brain hematoma with an endoscope.

He methodically removed the intracranial blood, his movements as gentle as if cradling a baby.

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[My Medical Skills Gain Experience]

He feared his aggressive maneuvering might end up harming the ‘baby.’

After all, brain tissue is even more delicate and tender than an infant’s—any slight error could cause irreversible damage.

Zhou Can stood aside, constantly monitoring the endoscope screen while occasionally glancing at how Director Wu handled the instrument.

“Oh no!”

After clearing part of the hematoma, Wu Baihe’s face went pale; tension and gravity shadowed his features.

“Director Wu, what’s wrong?”

The surrounding doctors felt their hearts tighten.

“After removing the clotted blood, fresh blood began gushing out from within the skull. Since there wasn’t time for angiography, locating the bleeding point now is extremely difficult. If this bleeding isn’t promptly stopped, she’ll die soon.”

Wu Baihe had prided himself on his vast experience, expecting to handle any situation.

But the bleeding site was so elusive that even after two rounds of inspection, it hadn’t been found.

With the rescue now stretching beyond three and a half hours, the patient’s chances were rapidly dwindling.

International experience suggests that if emergency surgery for brain herniation exceeds four hours, death is almost inevitable.

Nearly four hours into the rescue, with the bleeding site still unlocated, the brain cells at the fringes of blood supply were dying from ischemia.

The death of these brain cells and tissues is irreversible.

Wu Baihe, admittedly older and depleted from a long night of surgery, was visibly running on empty.

Moreover, none of his deputy or chief assistants were particularly proficient with the endoscope.

“Director Wu, perhaps let Dr. Zhou take over for a while?”

Director Wen, watching anxiously from the sidelines, couldn’t hide his concern.

Although the surgical team was star-studded with chief and deputy physicians, their combined efforts were lacking.

At most, they could only assist the anesthesiologist in stabilizing vital signs.

In reality, the entire operation depended solely on Director Wu.

“Dr. Zhou, are you confident?”

Director Wu paused and turned to ask the ever-ready Zhou Can.

Senior doctors typically ask, “Are you confident? What are your chances?”—not like family members asking for guarantees.

Doctors who have performed surgery understand the inherent hardships and uncertainties.

Families and patients simply can’t grasp that reality.

Pressuring a doctor for a definitive answer is futile.

“Yes!”

Zhou Can’s reply was short and decisive.

“Then go ahead—try to locate the bleeding point! From what I saw on the endoscope earlier, you can exclude most areas. Proceed carefully, and be sure not to injure the brainstem or the critical vessels and nerves in the subarachnoid space.”

After yielding the primary position, Director Wu stayed at the side, closely watching.

Zhou Can silently rejoiced that his Hemostasis Technique had just reached Level 5, giving him the nerve to handle this critical task.

Until now he had merely been a bystander.

If his hunch was correct, the bleeding likely arose from a vascular malformation or a ruptured abnormal vessel.

A larger malformation would have undoubtedly been spotted by Wu Baihe’s extensive experience.

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[My Medical Skills Gain Experience]

If the malformation were small, the bleeding wouldn’t be so heavy.

That left only one possibility: the bleeding was due to a ruptured abnormal vessel.

He deftly maneuvered the endoscope within the cranial cavity,

deliberately leaving the fresh blood unaspirated so it could pool and form a visible reservoir.

“Will this work? It almost seems like he’s just playing around!”

“Letting a trainee handle this is way too reckless.”

“It’s nerve-wracking to watch; if my endoscopic skills were better, I’d have taken over to find the source.”

Many of the doctors in the operating room watched with bated breath.

They thought it absurd that Zhou Can was given such responsibility.

Yet, standing at the operating table, Zhou Can ignored the criticism and focused solely on the endoscope screen; its angle shifted ever so slightly as he moved.

He wasn’t concerned about what other Level 5 Hemostasis experts could do.

After all, he had already mastered tracking the bleeding point by observing blood flow, pooling, and surface ripples once his technique reached Level 4.

Suddenly, his eyes lit up.

“The bleeding point is hidden in the right cerebral hemisphere. No wonder Director Wu couldn’t locate it!”

This spot is easily overlooked.

Even if the endoscope passes nearby, it might quickly retract.

“Hey, hey— the endoscope has advanced too far! This is dangerous!”

“Stop it, quickly!”

Several chief physicians watching Zhou Can’s maneuver were visibly alarmed.

But Zhou Can didn’t stop; he confidently pushed the endoscope directly into the target area within the cerebral sphere.

The procedure was exceptionally challenging.

Fortunately, his Grasping Technique and Transfer Technique had already reached Level 4, proving invaluable for retracting some brain tissue to carve out space.

[Grasping Technique Experience +1]

[For the first successful grasp of critical brain tissue, Grasping Technique Experience +100 awarded]

[Transfer Technique Experience +1]

[For the first successful transfer of retracted brain tissue, Transfer Technique Experience +100 awarded]

High-difficulty surgeries demand equally high rewards.

Zhou Can was overjoyed.

An even greater thrill awaited him as his scope captured a scene that exhilarated him.

“The bleeding point is found! It’s clearly a ruptured abnormal vessel.”

As soon as his scope reached the spot, a torrent of bright blood burst forth, splashing onto the lens.

The bleeding was massive.

It was unmistakably an arterial rupture.

And not from a small artery, but from a relatively large cerebral artery.

No wonder the patient’s own clotting couldn’t staunch the flow.

“Yes! Fantastic! Pinpointing the bleeding point greatly ups her survival chances!”

Wu Baihe was visibly elated.

The doctors who had doubted Zhou Can fell silent, ashamed of their earlier criticism.

No one had expected Zhou Can to actually locate the intracranial bleeding vessel.

And he did it in just nine minutes.

Some even thought that if Zhou Can had taken over earlier, the patient might have had an even better chance.

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[My Medical Skills Gain Experience]

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