Chapter 34: Crisis in the Emergency Department

The Emergency Department at Tuyu Hospital is always bustling. It’s not even eight o’clock and the corridor is already jam-packed with patients seeking treatment.

Many patients who should actually be booking a specialist appointment, either to get faster care or because the specialist slots for the day are fully booked, are crowding into the Emergency Department.

This only worsens the staffing shortage in the Emergency Department.

“Dr. Zhou, hurry to the Operating Room! There’s a car accident victim in urgent need of surgery.”

Ye Tingting, upon seeing Zhou Can, immediately called out for his help in the Operating Room.

Judging by her intuition, her rank shouldn’t be too low.

She’s certainly not a junior nurse—at the very least, she’s a junior head nurse.

She seems particularly fond of Zhou Can; just yesterday in the Operating Room she showered him with extra care.

Jin Mingxi, who came into the Emergency Department with Zhou Can, didn’t receive the same treatment.

“Alright, I’m on my way!”

The moment Zhou Can heard there was a surgery to perform, his enthusiasm soared.

After changing into his scrubs and entering the Operating Room, he saw:

Dr. Xu, an unfamiliar resident, an anesthesiologist, and the instrument nurse Tang Ling, four people busy preparing the patient for surgery.

“Good morning, Dr. Xu! You all are early!”

Zhou Can greeted the group cheerfully.

The patient’s upper thighs were a mess of blood and torn tissue; his bloodstained pants had already been cut away.

Likely due to the staffing shortage, the instrument nurse was multitasking, disinfecting the area for the imminent surgery.

While doctors are generally indifferent to gender,

she couldn’t hide her embarrassment as she disinfected the patient’s perineal area.

“Let me handle it!”

Zhou Can quickly snatched the forceps and disinfecting cotton from her, taking over the task.

“Thank you!”

Tang Ling flashed him a grateful smile.

“No problem!”

Having done similar tasks countless times during his internship, Zhou Can was now remarkably adept.

He finished in no time.

“Insert the urinary catheter.”

Dr. Xu ordered.

This was usually a nurse’s job, and Tang Ling looked to Zhou Can for help while holding the catheter.

“From now on, if I’m present, leave this to me.”

Without waiting for her further request, Zhou Can deftly took the catheter and inserted it with practiced skill.

For critically injured patients like this one, inserting a catheter serves multiple purposes:

For instance, collecting urine samples for tests and monitoring post-operative urinary function.

【Congratulations, you’ve acquired the Placement Technique. Current experience level: Level 3 1/1000. You can now implant special instruments or medications such as vascular stents, bone screws, or springs into the designated tissues.】

Zhou Can was stunned for a moment before bursting into elation.

The Placement Technique was considered a premier medical procedure.

Its practice was extremely challenging.

Yet, it was widely applied in high-precision surgeries like cardiac stenting and balloon angioplasty.

Being at Level 3, equivalent to a lower-level resident, filled Zhou Can with immense satisfaction.

If he mastered this technique, returning to the surgical field would undoubtedly leave everyone in awe.

Who would have thought that inserting a urinary catheter could yield such a breakthrough!

It seemed that even these mundane tasks could now be eagerly embraced.

Inserting a catheter earned him 1 experience point in Placement Technique—an exhilarating boost.

It felt just as thrilling as finding a hundred-dollar bill on the street.

He already had three advanced medical techniques; once he elevated them to the attending level, he’d be capable of handling even the most challenging surgeries.

“This patient’s inner thighs are severely fractured. In the Emergency Department, we can only perform initial treatment to stabilize his condition, preserve his life, and do our best to save his legs before transferring him to the Surgery Department.”

Dr. Xu set the tone for the procedure.

The Emergency Department simply isn’t equipped to handle the full scope of such an operation.

Their job is to rescue critically ill patients, doing everything possible to save lives.

“Dr. Lin’s suturing and ligature skills are far superior to Xiao Zhou’s, so Dr. Lin will serve as my first assistant, while Xiao Zhou handles the auxiliary and makes rounds as a nurse.”

After assigning the roles, Dr. Xu and the others took their positions.

“Ouyang, how are the patient’s vital signs?”

“Stable enough for surgery.”

Before proceeding, they had to heed the anesthesiologist’s advice.

The patient’s blood pressure was markedly low, and his heart rate was too fast—clear signs of excessive blood loss.

A severed femoral artery in the thigh could quickly lead to fatal bleeding.

From the looks of it, the femoral artery was likely ruptured.

Many might not grasp the danger of a ruptured femoral artery, though everyone knows that a cut on the neck can be deadly.

In truth, a cut in the trachea doesn’t kill instantly,

but a severed carotid will have blood spurting out immediately.

The femoral artery, like the carotid, leads directly to the heart.

Such massive bleeding is terrifying.

It’s second only to a heart punctured by a sharp instrument.

Ironically, the self-inflicted wrist cuts often shown in TV dramas aren’t nearly as dangerous. In patients with strong coagulation or in low temperatures, bleeding might even stop on its own.

Dr. Xu carefully debrided the crushed sections of the patient’s leg.

A gush of fresh blood burst forth like a spring.

“Hemostatic forceps!”

Before Dr. Xu could finish his order, Zhou Can had already clamped the proximal end of the bleeding vessel with the forceps.

The mid-level resident’s hemostasis wasn’t achieved by chance.

Dr. Lin, serving as first assistant, looked at Zhou Can with mild surprise.

“I heard that the Emergency Department recruited two exceptional talents. I was skeptical at first, but after witnessing Dr. Zhou’s hemostatic skills, I’m a believer.”

When a master performs, it all becomes evident.

Zhou Can’s display of hemostasis immediately earned Dr. Lin’s respect.

Unlike writing academic papers where many attending physicians might pay to boost their credentials through fake research or projects to qualify for deputy senior titles,

surgical skills can’t be faked.

If you’re good, you’re good—if not, your lack will be obvious.

There’s no pretense in surgery.

Excellence is instantly apparent, while shortcomings are revealed in a heartbeat.

“I wouldn’t dare take credit for such skill. Dr. Lin, I’m counting on your guidance in the future.”

Zhou Can downplayed his abilities as much as possible.

As a newcomer, it was best to stay low-key.

Quietly racking up experience would soon put him well ahead of rivals like Dr. Lin and Jin Mingxi.

“Now that we’ve identified the source of bleeding, Dr. Lin, you tackle that wound. I’ll maintain the hemostasis, and then I’ll handle the vascular anastomosis.”

This was a femoral artery anastomosis. Although it wasn’t exceptionally difficult, it demanded careful suturing skills.

Dr. Xu wasn’t comfortable leaving it to Dr. Lin.

He chose to perform the anastomosis himself.

Zhou Can secretly wished he could, but his current suturing skills were still at a lower-level resident’s standard. If he could improve to an excellent resident level, he’d be able to master femoral artery anastomosis.

On the patient’s other leg, the muscle and bone inside were destroyed, though the skin was still attached.

Dr. Lin carefully made an incision in the skin.

Beneath, the subcutaneous muscles had already decayed.

Blood clots and bruises were everywhere.

There was even bone debris.

It was a heartbreaking sight.

This victim had most likely been run over by the rear wheels of a truck on both legs.

On the other side, the femoral artery had a gaping hole.

Blood was spurting out forcefully.

Zhou Can had to multitask, freeing his left hand to clamp the bleeding vessel and control the hemorrhage.

“Thank you!”

Without Zhou Can’s assistance, Dr. Lin would have been unable to proceed.

This ruptured femoral artery needed urgent repair.

“Dr. Xu, the femoral artery on this side is also ruptured. It doesn’t look too bad. May I repair it?”

Dr. Lin’s inquiry allowed Zhou Can to roughly assess his suturing skills.

He deduced that Dr. Lin’s capabilities wouldn’t exceed that of an excellent resident.

It seemed the gap between them wasn’t significant.

Zhou Can’s current suturing skills were at a lower-level resident standard. Just a few more months in the Operating Room and he might even surpass Dr. Lin.

While others progressed slowly along prescribed steps,

most surgical residents took at least five years to elevate their suturing skills from the lower to the excellent level, assuming ample surgical opportunities.

If one only got a chance to suture every three or four days, and practiced only sporadically, it might take seven or eight years to reach excellence.

In comparison, Zhou Can’s potential advantage was quite significant.

“You can give it a try. The suturing gaps must be tight, and you must take arterial pressure into full account.”

Dr. Xu agreed.

On one hand, he was overwhelmed; on the other, whenever the risk was moderate, he preferred to delegate to help his junior doctors grow quickly.

“Understood.”

Dr. Lin nodded and quickly began repairing the ruptured femoral artery.

Luckily, the surrounding soft tissue had somewhat protected the vessel, reducing the severity of the arterial damage.

Otherwise, merely repairing the vessel would have been extremely troublesome.

“Dr. Lin’s suturing skills are about average for a resident,”

Zhou Can noted after reviewing Dr. Lin’s vascular repair.

It wouldn’t take long to surpass him in suturing.

With enough proactive effort, he might best Dr. Lin in ten days to a fortnight.

“Xiao Zhou, for major arterial anastomosis, apart from ensuring a snug suture line, you must also check for any vascular injuries. If you spot one, you need to excise it. If after removal the gap between the two ends is too wide, forcing an anastomosis under tension is not advisable. You can either use a segment of the great saphenous vein or an artificial graft.”

“Generally, if the patient’s own vessel is viable, that’s preferable. Although artificial grafts have become technically mature, they’re still a bit of a gamble—especially in surgeries on young patients who have decades of life ahead. Any substitute must be chosen very carefully.”

As Dr. Xu continued his procedure, he patiently imparted his invaluable surgical experience.

“Remember that.”

Zhou Can nodded, his expression earnest.

His willingness to learn was one of his greatest strengths.

While the surgery was underway, Jin Mingxi and Dr. Lu arrived in succession.

It was time for the shift change.

Dr. Lin was on the night shift, while Dr. Xu and Tang Ling had been called in by the hospital.

Within twenty minutes, Dr. Xu had successfully anastomosed the severed femoral artery.

Dr. Lin was still hard at work.

Differences in skill levels meant significant variations in surgery speed.

An expert surgeon not only works quickly but also maintains top-notch quality.

“Xiao Zhou, release the hemostatic forceps on this side to test the blood flow.”

Zhou Can slowly loosened the forceps,

carefully, not abruptly.

This deliberate approach reflected his impressive command of hemostasis. True mastery isn’t just about flawless technique—it’s about meticulous attention to every detail.

For instance, suddenly releasing forceps on a freshly anastomosed large artery

is akin to opening the floodgates all at once.

Such a move can lead to disastrous consequences.