Chapter 268: A Life on the Table: The Weight of Risk and the Price of Healing

The patient has lung cancer, which was missed during the preoperative workup.

Even though the situation was urgent and the patient’s right lung was 80% collapsed with both hemopneumothorax and severe pleural effusion complicating things, it was still a lapse in our process.

If we’d known about the lung tumor before surgery, we might have been more cautious during the rescue and thought to use a double-lumen intubation.

Every medical incident happens for a whole range of reasons.

Doctors and nurses need to exercise the utmost caution to prevent accidents from happening.

Right now, the patient’s life has been saved, and Zhou Can has successfully defused a medical crisis. But risking their life with an open thoracic exploration wasn’t just about surviving the surgery—it was about actually curing the disease.

If we don’t deal with the lung tumor, the patient’s still as good as dead.

But how to solve it is the big question.

With so many chief and senior physicians here, Zhou Can wouldn’t dare to offer his opinion carelessly!

Earlier when lives were on the line, you could bend the rules out of necessity.

But now that the patient’s stable, there’s no way he’ll put himself in the spotlight again.

“I’m just going to defer to all the chief physicians here—whatever you decide, that’s what we’ll do!”

Zhou Can’s remark drew a burst of laughter from the group.

The tight atmosphere in the operating room once again loosened, and everyone could feel the discussion returning to its usual easy mood.

Zhou Can accomplished something huge yet stayed humble, not boasting or taking credit. Everyone found themselves liking him even more for it.

“Director Le, Director Liu—what are your thoughts?”

Director Xueyan turned to seek everyone else’s opinions.

“This surgery was full of challenges. Managing to save the patient’s life was already a tremendous feat. Let’s each speak freely and do our best to help this patient recover.”

She embodied that warmth and inclusiveness, mobilizing everyone into action.

All joined in the discussion.

“Alright, I’ll break the ice and share some of my initial thoughts,” Director Le said, whose skill—especially in cardiovascular cases—was well recognized.

“Personally, I think our original plan of exploratory thoracotomy was correct. The only reason things got derailed was the anesthesia mishap. But now that the chest is already open and we’ve identified the problem, maybe this is a stroke of luck within misfortune. We might as well take this opportunity to communicate with the family and go ahead with tumor excision, giving the patient a real chance at recovery.”

This plan was the best on paper, but many still had their concerns.

Mainly, everyone remembered how the patient nearly died under general anesthesia before, and they were shaken.

After finally saving the patient, most doctors leaned more toward playing it safe, refusing any unnecessary risks.

They just wanted to protect what they’d achieved so far and send the patient out of the OR safely.

No one wanted any more complications.

“Removing the tumor sounds great and all, but you’ve seen the patient’s state—he nearly died. Can he handle a tumor resection right now?”

An associate chief physician voiced his opposition.

“I also think being cautious is for the best. We could wait until he’s in better shape before doing the surgery.”

“Look at him now—he’s like a candle flickering in the wind. I’m really worried he won’t make it off the table.”

“It’s not about merit, it’s about no mistakes. Steady is best.”

Turns out the conservative camp wasn’t small.

No one wanted to be involved in a medical accident, nor did they want to see the patient die.

“Director Liu, as an expert in critical care, and with your background in anesthesia, you’re kind of the authority on assessing surgical risk here. What do you think?”

Director Xueyan looked to Director Liu.

The question suggested she was leaning toward Director Le’s proposal—she wanted to see the surgery done in one go.

“Uh… I really shouldn’t make the call here. Judging by the tumor situation, we might have to remove the entire right lung. That’s a huge risk.”

Director Liu’s stance was quite neutral.

He’d risen to head of the critical care department in part because of how smoothly he handled difficult situations.

He was only here for the patient’s resuscitation anyway. Now that job was done, he was eager to go back to critical care and not invite further trouble.

“Dr. Guan, what’s your view?”

Director Xue hadn’t asked the actual anesthesiologist until after hearing others’ opinions. It was clear that this whole surgical mishap had knocked Dr. Guan down in the pecking order.

He just didn’t have as much say now; that’s to be expected.

Dr. Guan still looked shaken, clearly out of his element.

After hesitating for a moment, he finally said, “If we’re really going to remove the tumor, I’d like to request another anesthesiologist. We need Director Feng from our department to come over.”

You could tell Dr. Guan’s voice was weak, and he no longer trusted his own skills.

Medical mistakes hit the doctors and nurses involved especially hard.

It can really make them question whether they’re even competent.

Before this, Zhou Can had always thought of Dr. Guan as calm, steady, and level-headed.

Who knows how long it’ll take him to come out from under this shadow?

“Get Director Feng over here, right away,” she said to the attending nurse. Then she turned to Director Le. “Director Le, can you go speak with the patient’s family and get their consent?”

“No problem!”

Director Le agreed immediately.

“Director Xue, Director Le, are you sure you want to go through with this? The risks are enormous!”

A senior associate chief physician urged them, worry written all over his face.

“It’s not that we’re against playing it safe, but this is a fork in the road for the patient. Either we take this chance and remove the tumor, or we close up and go conservative. But if we do that, it’ll be at least six months before we can even think about a second surgery—and by then, the cancer will have spread. There’s no guarantee he’ll survive those six months either.”

Director Le patiently broke down the situation for the senior colleague.

Honestly, the older doctor probably already knew the risks of conservative treatment.

Moments like this tests a doctor’s sense of responsibility.

Taking the risk to remove the tumor could do wonders for the patient—but for the doctors, it comes with huge personal risk.

Even with the informed consent forms, if a patient dies on the table, it’s still a major headache and stains a doctor’s reputation.

Other gains could be affected too.

After Director Le finished explaining, the senior doctor kept quiet.

Soon, Dr. Feng arrived in the operating room.

Zhou Can, being sort of his apprentice, greeted him respectfully right away.

Dr. Feng remained his usual aloof, quiet self.

He just nodded slightly and grunted in reply.

Casting a glance at Dr. Guan, he said, “Accidents happen—there isn’t a single anesthesiologist who’s never lost a patient.” Unexpectedly, Dr. Feng offered comfort and empathy, not even a word of blame.

“Maybe so, but watching a patient nearly die from anesthesia is a psychological blow—it doesn’t go away so easily. I just… I really can’t handle this surgery. I don’t have it in me to take another risk.”

Ashamed, Dr. Guan bowed his head like a child admitting guilt in front of his parent.

“You’ve been an anesthesiologist for years. This isn’t the first time you’ve seen death. Ever since we chose this path, we’ve known it’s filled with thorns, with cliff edges waiting for us at every turn. Making a mistake isn’t the real problem—not learning from it is, and falling in the same pit twice is the only true failure.”

Dr. Feng’s words deeply moved everyone present.

Where was that drive and that purpose we all had when we first started down this path?

Who really studies medicine just for a decent job or to make money? Sure, the good job and status are a part of it—but that’s not everything.

Most people came into this to save lives. To be angels in white for the world.

Saving a life, easing someone’s pain—that’s what every medical person really wants deep down. It’s the most honest wish of every doctor, nurse, and pharmacist.

That’s the love that binds us to medicine.

“I… I’ll reflect and get my head straight. Please allow me a couple days off to recover before coming back.”

Dr. Guan, at least, wasn’t planning to throw in the towel.

He wasn’t ready to quit being an anesthesiologist.

“I can’t approve that leave. You need to get back up, right where you fell. I’ll help you with the anesthesia this time, but I still want you to lead this operation, manage every stage and all the details.” Dr. Feng might have seemed strict and distant, but his way of training people was brilliant.

Whether he was teaching Zhou Can or Dr. Guan, he tailored his approach. Especially in times of setback, unlike other senior doctors who would lash out, he always found a way to help his students out of the darkness.

“Alright.”

Dr. Guan said yes, though he hardly sounded eager. But in the end, he agreed.

With Dr. Feng backing him like this, there’d be no excuse for giving up.

“Director Xue, once you’ve spoken to the family, we can start right away. You don’t need to worry at all about anesthesia—our whole department will be on it.”

After helping Dr. Guan, Dr. Feng reassured Director Xue.

He handled everything with clear order.

“Thank you, really. And thank you to all the anesthesiologists for having our backs in such a high-risk surgery. Director Le is outside speaking with the family now. If they consent, we’ll begin at once.”

Director Xueyan thanked him warmly.

Her gentleness always made others feel at ease, like a breath of spring.

Dr. Feng turned back to Dr. Guan.

“Tell me, what mistakes did you make during this surgery, and what did you learn?”

“There were a couple of errors. Before general anesthesia, I followed routine and injected scopolamine without considering possible risks—that was the first. After the emergency, I worked with Director Hu to resuscitate the patient, but focused only on restoring breathing and heartbeat as fast as possible, and overlooked the risk of blood clots in the pleural effusion. That led to a clot blocking the drainage tube, and the first rescue attempt failed—that was the second error.”

Dr. Guan took a hard look at himself and reflected on two key mistakes.

“If I ever encounter spontaneous hemopneumothorax again and need to do anesthesia after chest drainage, I’ll use a double-lumen endobronchial tube instead of just going for speed or convenience.”

Dr. Guan gave a thorough self-critique.

But after hearing him, Dr. Feng still seemed dissatisfied.

“Anything else?”

“Anything else?” Dr. Guan thought for a moment and shook his head.

He really couldn’t think of more mistakes.

“Zhou Can, what do you think?”

Suddenly Dr. Feng looked over at Zhou Can.

At that moment, Zhou Can was deep in thought about the tumor removal plan.

When Dr. Feng called his name, he turned around.

“Uh… I can just offer a few pointers. For instance, when preoxygenating after intubation, the oxygen flow shouldn’t be set too high. When I joined the rescue, the flow was really cranked up. Also, after intubation, one-lung ventilation should use as low a tidal volume and pressure as possible. Finally, if spontaneous breathing is present but airway resistance rises and there’s no fluctuation in the drainage tube’s water column, you should immediately stop ventilating.”

Zhou Can was modest, but everything he pointed out was what he’d seen personally during the rescue.

These had all been lapses in Dr. Guan’s technique.

Maybe Dr. Guan had completely lost his composure by then, which led to all those mistakes.

If the team had stopped ventilating at the first sign of trouble, the rescue might have gone more smoothly.

Not stopping showed a real gap in professional knowledge.

“Dr. Zhou, you really opened my eyes with that. I had no idea there were so many errors—thank you for pointing them out. If you see increased airway resistance and the water in the drainage tube stops moving, besides stopping ventilation, is there anything else you can do?”

He was genuinely curious, taking the chance to seek advice from Zhou Can.

“You can try compressing the drainage tube. If that doesn’t work, try changing the patient’s position or even performing an open chest intervention.”

Zhou Can was happy to share everything he knew.

Dr. Feng nodded repeatedly, approving what he’d heard.

“I never knew there were so many options. I’m clearly missing knowledge here—I need to learn from Dr. Zhou from now on.” For the first time, Dr. Guan realized just how much Zhou Can had outpaced him.

There was a time when Dr. Guan had been the one teaching Zhou Can about anesthesia.

Now, Zhou Can had definitely surpassed him in some areas.

Realizing Zhou Can’s progress, Dr. Guan felt shocked.

But it also fired up his determination to catch up.

He couldn’t stand to be overtaken by a junior.

Even though the others—like Director Xueyan—weren’t speaking up, their estimation of Zhou Can’s abilities had quietly jumped up several notches.

Everyone here was a medical professional; it was easy to tell who had a higher skill level.

Zhou Can had no idea that his brief exchange with Dr. Guan had earned him even more respect.

Just then, Director Le finished talking with the family and came in.

“When the family learned the patient had lung cancer, they were shocked. Some even thought we were lying. It took all my effort, but I finally got them to believe us. The family agrees to tumor removal surgery.”

Director Le reported this hard-won progress to the team.

Sometimes, it feels impossible being a doctor.

Not only do you have to diagnose and treat the disease, you also have to work tirelessly to communicate with the family.

Take this patient, for example. The doctors could’ve just closed the chest, told the family the risks were too high, and waited another six months before even considering surgery.

The family would’ve had no choice.

They can only follow the doctor’s orders.

Now, the doctors are taking huge risks for the patient’s benefit and still have to endure the family’s suspicion. It’s exhausting.

“Let’s prep for surgery. Director Le, could you take the lead?” Director Xueyan’s surgical skills weren’t bad, but academically she was stronger.

She could remove the tumor, but having Director Le lead made her more confident in their chances.

“I could do it, but this case is unusual. The patient’s condition is poor, so the shorter the surgery, the better. Dr. Zhou works incredibly fast, and his blood loss is the lowest I’ve seen from any surgeon. It’d be safer if he took the lead.”

Director Le nominated Zhou Can as chief surgeon.

Back during his rotation in cardiothoracic surgery, Zhou Can’s skill had already deeply impressed Director Le.

Now, after six more months of growth, Zhou Can’s abilities—shown just recently during the thoracic opening—were even more striking. That’s why Director Le wanted him at the helm.

“Dr. Zhou, are you up for it? Don’t worry, I’ll take responsibility for any risks.”

Director Xueyan looked at Zhou Can.

She secretly hoped he’d take charge of the surgery.

Being too slow really could cost a life.

With the patient already in this dire state, finishing the operation fast was critical.

“I can do it.”

Zhou Can didn’t refuse.

He had deep ties to cardiothoracic surgery and didn’t hesitate to step up when needed.

He never worried about personal gain.

Earlier, he’d already gone over everything and felt completely confident in removing the lung tumor.