Chapter 365: Critical Moments in the OR

The chief physicians and associate chief physicians did their best to stay calm, refusing to panic. Everyone was working hard, trying to pinpoint the cause of the ventricular tachycardia.

The risk of death in open-heart surgery is always high.

With a procedure involving atrial resection, ventricular folding, and tricuspid valve replacement, the mortality rate only climbs higher.

The slightest mishap could have irreversible consequences.

“Could it be that the tricuspid valve is just too narrow?”

Director Xueyan was visibly anxious, almost beside herself with worry.

After finally getting the chance to lead such a high-level, difficult surgery—and everything had been going so smoothly—who could have expected such an incident during the intraoperative testing?

First off, it’s clear that the onset of ventricular tachycardia had no direct connection to the water test of the tricuspid valve.

Even if they skipped that test, as soon as the heart started beating again, the ventricular tachycardia would have surfaced anyway.

“I doubt the tricuspid valve is the issue. This is really life or death—so what exactly went wrong?”

Director Hu Kan grew so agitated that he clutched his chest, his heart already under added stress.

His breathing grew heavy and rushed.

Heart patients and those with hypertension are always afraid of emotional shocks.

Especially someone like Director Hu Kan, who had battled serious heart disease multiple times, needed to be extra careful.

“Maybe we should reach out to the Cardiovascular Medicine Department right away. Surgery is our specialty, but diagnosing ventricular tachycardia is really their area of expertise.”

Deputy Director Lu was as straightforward as ever.

Still, he wasn’t wrong. The distinction between surgery and internal medicine was huge.

Even though both Cardiovascular Medicine and Cardiothoracic Surgery dealt with diseases of the chest and heart, each department had its strengths. Cardiothoracic Surgeons specialized in procedures—removing lung tumors, bypass surgery, myocardial infarction, and more.

The Cardiovascular Medicine Department was better at treating heart and vascular conditions without surgery.

For example, dealing with sudden cardiac arrest, ventricular tachycardia, arrhythmias, poor cardiac perfusion, and embolisms. Diagnosing these problems and coming up with drug treatments were exactly the Cardiovascular Medicine Department’s forte.

“Director, what do you think…?” Director Xueyan looked at Hu Kan with concern. She didn’t want to upset him, but they’d run out of options.

“Contact Cardiovascular Medicine Department immediately. Ask them to send over a chief physician for a joint consultation—we need to save this patient right now.”

Director Hu Kan made a swift decision.

A little loss of face was nothing; the patient’s life mattered far more.

“Director Dongfang, could you reach out to the other chief anesthesiologists and see if they have any ideas?”

Director Hu Kan turned to Director Dongfang Luoxue.

As the anesthesiologist, it was her duty to ensure the patient’s safety during surgery.

The heart couldn’t stay exposed to air for long. Otherwise, a host of serious complications could set in and make things even worse.

Even at a time like this, Dongfang Luoxue stayed calm and collected.

Her eyes were cold, her composure unshaken.

She didn’t say a word, but pulled out her phone and dialed someone directly.

Zhou Can could almost guess—she was probably calling Dr. Feng for help.

“Director Feng, we have an emergency. The patient is undergoing atrial folding…”

She briefly explained the patient’s condition.

No one could hear what Dr. Feng said on the other end.

Dongfang Luoxue quickly hung up.

With an emotionless gaze, she looked over at Zhou Can.

“Director Feng is rushing over from home—it’ll take at least half an hour. He asked me to consult with… you in the meantime.”

She seemed almost naturally averse to interacting with anyone.

Even in her forties, whether dealing with Zhou Can or anyone else, her attitude always put people on edge.

The first half of her sentence was for everyone, but then she looked right at Zhou Can—the second half was meant for him alone.

Most people in Cardiothoracic Surgery already knew Zhou Can was close with Director Feng from Anesthesiology; he’d received plenty of guidance. Now that something had gone wrong and Director Feng sent Dongfang to consult with him first, no one was surprised.

Zhou Can didn’t react. He just stared at the patient’s bloody pericardium, puzzled.

“Hey, I’m talking to you—did you hear me?”

Dongfang Luoxue thought he was deliberately ignoring her in retaliation and found Zhou Can annoyingly petty.

Zhou Can still didn’t respond.

Now there was a flash of anger in Dongfang Luoxue’s eyes.

“Dr. Zhou is thinking—don’t interrupt him.”

Director Xueyan, who’d worked with Zhou Can the most, understood him well after all their long hours together.

Hearing Director Xueyan’s explanation, Dongfang said nothing more.

She continued to search for the cause of the ventricular tachycardia.

Right as everyone was searching for answers, the patient’s pericardium began to tremble, almost like a thinly dressed person shivering in a frozen wasteland. “This is bad! It’s ventricular fibrillation—prepare to resuscitate!”

Everyone felt their hearts clench, nerves stretched to the breaking point.

If ventricular fibrillation wasn’t addressed right away, it would progress straight to cardiac arrest.

Surgical danger could strike out of nowhere—that’s exactly why family members had to sign waivers beforehand. If anything happened, doctors and nurses couldn’t keep apologizing through their tears.

All they could do was tell the family they did everything possible.

“Quick! Bring me the mapping probe and mapping ring!”

At this moment, Zhou Can seemed to finally realize what the problem was.

He had a special skill called Life-saving Insight, which worked wonders in critical rescue situations. Now that it had reached the intermediate level, its effect was even better.

In intense rescue attempts, not only did his judgment sharpen and his mind grow incredibly clear, but his diagnostic thinking also improved by 100 percent.

“What mapping probe and mapping ring?”

The three surgical nurses looked completely baffled, having no idea why Dr. Zhou was suddenly asking for these things.

“Zhou, are you planning to do epicardial mapping?”

Director Hu Kan, a true veteran of Cardiothoracic Surgery, instantly caught on to Zhou Can’s intent.

“Exactly!”

Zhou Can nodded vigorously.

“What’s the point of epicardial mapping now?”

Dongfang Luoxue looked at him, full of doubt. The patient was already in ventricular fibrillation and getting worse by the minute—defibrillation seemed like the only way out.

Director Xueyan seemed to catch on to Zhou Can’s reasoning, her elegant brows knitted tight in thought.

The others weren’t quite as skilled—they couldn’t guess why Zhou Can would suggest this.

“If I haven’t misdiagnosed, this patient has Wolff-Parkinson-White Syndrome. Unless we sever the abnormal conduction pathway, no rescue efforts will truly solve the issue. Even after defibrillation, ventricular tachycardia would persist and fibrillation would occur again. I already noticed the ECG was a bit off before surgery, but my experience was lacking so I couldn’t pinpoint the real problem.”

Zhou Can explained this as calmly as possible.

“Earlier, during the final stage of surgery, all we did was a water test. There’s no way that alone could cause such severe arrhythmia. Director Xueyan handled every step perfectly, which means the surgery itself wasn’t the issue. That leaves only one explanation—the problem existed before surgery. It was just hidden too well, or only appeared intermittently, so we missed it.”

Once Zhou Can finished explaining, both Director Xueyan and Director Le nodded in sudden realization.

Deputy Director Lu’s eyes lit up, his gaze on Zhou Can full of admiration.

“We really let this one slip! But it’s not too late—let’s handle this as Wolff-Parkinson-White Syndrome right now.”

Director Hu Kan had already guessed much of this the moment Zhou Can asked for the mapping tools.

After hearing Zhou Can’s explanation, he found it entirely logical and agreed at once to proceed.

To be frank, this should’ve been handled right after opening the chest.

Some WPW cases are easy to spot; others are really well hidden.

Normally, the patient’s ECG would show a much shorter PR interval and a delta wave. But with WPW, since there’s abnormal atrioventricular conduction, sometimes the delta wave doesn’t show up on the ECG and leads to a missed diagnosis.

Zhou Can had noticed the abnormality on the ECG earlier, but he hadn’t thought in this direction at all.

Besides, it was just a slight irregularity—there was no delta wave on that ECG at all.

That’s why even heavyweights like Directors Hu Kan, Xueyan, and Dongfang Luoxue all failed to catch it. Doctors are only human—not gods, after all.

Overlooking something from time to time is only natural.

If a patient with WPW suffers from supraventricular tachycardia, they’ll feel chest tightness, palpitations, and other symptoms.

But in this case, the patient’s heart disease was so severe that even heart stoppage wouldn’t make anyone suspect WPW.

What makes WPW so dangerous are all its possible complications.

Typically, these include fainting, shock, heart failure, or sudden death.

Besides heart rhythm problems, WPW can also lead to shock, heart failure, or death without warning.

Whether this patient could still be saved remained to be seen.

As ‘commander-in-chief,’ Director Hu Kan had acted calm just to steady the team—only pretending things were easy.

“The mapping probe and mapping ring are here!”

The attending nurse came through, quickly finding what Zhou Can needed in the emergency supply cabinet and bringing it over.

“Give it to Director Xueyan. I’m not that experienced…”

“Can you stop with the false modesty and get moving? Now’s not the time to stand on ceremony!” Director Hu Kan scolded, practically glaring.

He thought Zhou Can was great in every way—but sometimes overly modest and a bit slow to act.

Watching him could be exasperating.

“Alright, alright—don’t blame me if I mess this up!”

Having been pushed into the spotlight, Zhou Can had no choice. He’d studied epicardial mapping, but it was still a stretch to call himself an expert.

In truth, this was something best handled by Director Xueyan or Director Le, both far more familiar with the process.

To map the surface of the ventricle, you typically divide it into 53 small regions, each a mapping point.

The entire point is to identify the abnormal conduction area in the atrium.

Using the mapping probe and ring, you record the potentials at every mapping point, compare them with the reference electrode, time the differences in milliseconds, and record those times in each region. You then draw a diagram based on cardiac anatomy—this becomes the epicardial mapping chart.

As you can see, the whole process is incredibly complex. If you want to finish in a hurry, you need full teamwork.

“I’ll handle the diagram!”

Director Xueyan volunteered.

“I’ll assist Dr. Zhou!”

Director Le put aside his pride and gave his full effort.

“I’ll do everything I can to keep the patient stable during this time.” Director Dongfang Luoxue’s tone was still icy, but her willingness to say that showed she recognized Zhou Can’s ability.

It was almost like bowing to a rival after being bested in the ring—a genuine sign of respect.

Director Hu Kan walked over too, personally guiding Zhou Can through the process.

With everyone working together, Director Xueyan finished the epicardial mapping chart.

Epicardial mapping demanded both speed and precision—the team had put the right person at the helm.

If they had left it to the usually unhurried surgeons, the patient might not have survived while they were still drawing.

Director Xueyan, with her vast knowledge and quick calculations, was the perfect person to draw the chart.

Through this unintended teamwork, Cardiothoracic Surgery had just formed a powerful team centered on Zhou Can.

“Zhou, when you’re doing epicardial mapping, remember—since the accessory pathway conducts faster than the AV node, the earliest activation point on the ventricular muscle is where you’ll find the anatomical location of the accessory pathway.”

Director Hu Kan shared everything he knew, pouring all his expertise into Zhou Can.

“We’ve located the abnormal conduction area. Can I go ahead and sever it?”

“Get to it!”

Director Hu Kan was about to start scolding again.

Director Xueyan smiled at Zhou Can, motioning for him to take the lead.

When it came to surgical speed, no one except maybe Dr. Xu could match Zhou Can.

Resolute, Zhou Can cut the abnormal atrioventricular pathway. The patient’s ventricular tachycardia returned to normal.

On top of all that, the experience points he gained were a wonderful surprise.

Still, he wondered why he only got 10 points for the Steady Scalpel Technique.

Was it because he mainly used the Fast Scalpel Technique and only relied on the Steady Scalpel as support?

That must be it.

Usually, the system awarded experience for major breakthroughs or marked improvement—always fair and objective.

After all, an assistant shouldn’t get more credit than the chief surgeon.

It’s like in battle—a foot soldier shouldn’t outrank a general just for being in the right place.

“All right, problem solved. Zhou, you finish closing up. Once you’ve checked everything, seal the chest as fast as possible. We can’t expose the heart for long.”

Director Hu Kan didn’t relax for a second—instead, he hurried Zhou Can, pushing him to finish the surgery promptly.

The last thing he wanted was for success to turn into disaster.

……

Half an hour later, the chest was finally closed.

With Dr. Feng arriving, the patient’s vitals had held steady. Still, anesthesiologists worked miracles only up to a point—they understood the body’s three major circulations better than anyone, but even they couldn’t change fate. If this patient’s WPW hadn’t been resolved, all the skill in the world would’ve been useless.

Even after the surgery, Director Hu didn’t immediately declare it over.

For such a tumultuous heart operation, the danger remained. The patient had to be observed for a while, just in case any postoperative issues arose, before being moved to the ICU.

If, after leaving the OR, something happened, there might not be enough time to wheel the patient back—one mistake could cost it all.

Heart and brain surgeries were always the most dangerous. In hospitals lacking experience, they’d often call in experts from every corner just for a single case—sometimes even assembling top talent from every department.

“Today’s patient almost didn’t make it off the table—a harsh lesson. When you get back, make sure you reflect seriously, and remember this experience.”

During the observation period, Director Hu Kan began his postoperative summary.

“Zhou, you pulled off a lot for us today, but I’ve got to criticize you!”

Zhou Can hadn’t expected that—even with the patient saved and surgery over, his teacher would still scold him.

He didn’t think he’d made any mistakes or slipped up, either.

Mystified, Zhou Can held his tongue and never talked back to Director Hu Kan.

A teacher was a teacher—respect was the bare minimum.