Chapter 381: A Crucial Test in the Emergency Department

The patient who’d just undergone urethral dilation was wheeled off to the recovery room to wake from anesthesia. Hardly a moment passed before the next patient was brought in.

This time it was a woman in her forties. Her face was sallow and she moved painfully slow.

Zhou Can had already reviewed her chart. She’d been admitted with jaundice, weight loss, nausea, and vomiting. Tests revealed a tumor at the head of her duodenum.

The surgery required was the complete removal of the tumor—a Level 3 major operation.

Duodenal surgeries are almost always Level 3 or 4, notoriously difficult and risky.

Compared to the earlier urethral dilation, which was just an appetizer, the Emergency Department’s evaluation of Zhou Can now moved to the real deal.

Dr. Xu, with his seniority as an attending, met the requirements to host Level 3 surgeries. According to the hospital’s surgical safety regulations, higher-level attendings could also supervise these surgeries, while less experienced associate chiefs needed direct oversight to slowly take on Level 4 procedures.

So, this duodenal tumor resection was the toughest surgery Dr. Xu could use to assess Zhou Can.

Anything more advanced would be out of his jurisdiction.

If Zhou Can could successfully finish this operation, the Emergency Department would grant him as many Level 3 and under surgeries as he could handle from then on.

Just like before, the same anesthesiologist guided the patient onto the operating table and started the routine steps of anesthesia.

“Let me know when you’re ready here!”

Dr. Xu headed off to another operating room to conduct a different surgery.

Just to hit their monthly targets, the Emergency Department’s surgeons had to give it their all. With so few hands as skilled as Zhou Can, Dr. Xu had little choice but to pitch in himself.

He really worked himself ragged every day.

And truth be told, Dr. Xu wasn’t young anymore—over fifty, far from matching a young man’s stamina and energy.

Yet here he was, pushing himself, all to strengthen the Emergency Department’s operating rooms little by little.

The hospital only cared about departmental performance and surgical quality.

Less surgeries meant fewer assigned surgeons and a steep decline in hardware resources.

Just look at Cardiothoracic Surgery, Neurosurgery, and General Surgery. They boasted ten-thousand-level clean rooms, top gear, endoscopic and laser scalpels, high-frequency electrosurgical knives, and more. Rumor had it Neurosurgery was even building a state-of-the-art hybrid suite.

Meanwhile, the Emergency Department had only a single operating room to truly call its own.

Their equipment was laughably outdated.

If you wanted better conditions and high-tech tools, you’d only get them through hard work and results.

But what counted as results?

Bring in more revenue for the hospital, do more surgeries, and improve both quality and quantity.

“Qiao Yu, get the prep work started. I’m going to study the patient’s results a bit longer.”

“You got it!”

Qiao Yu responded with practiced efficiency.

She had to juggle multiple roles alone—the job of an instrument nurse wasn’t easy.

Normally, a Level 3 surgery would have at least two scrub nurses.

Fancier surgical teams might have three and nobody would think twice.

With Zhou Can’s team just starting out, it was really only the two of them. The extra workload came with the territory.

About forty minutes later, all the pre-op tasks were finished. Zhou Can understood the patient’s condition inside out, and a detailed surgical plan was mapped out in his head.

“I’ll fetch Dr. Xu!” Qiao Yu volunteered, running out to wait for him to wrap up his procedure, then notified him that they were ready.

Even small details like this showed how thoughtful Qiao Yu was in her work.

Having someone as capable as her on the team was a blessing. She’d make an excellent right-hand, smoothing teamwork and coordination during surgeries.

It meant Zhou Can could avoid lots of needless trouble and made the whole team run more smoothly.

Before starting the surgery, Zhou Can placed a nasogastric tube for the patient.

This should have been done at morning rounds, around seven or eight, as per surgery protocol.

Also, when conditions allowed—especially type B cases—duodenal tumor surgeries nowadays usually favored endoscopy.

But the Emergency Department’s surgical setup was barebones. No endoscope, and lots of newer diagnostic gear was missing.

It was guaranteed to throw obstacles and difficulty into the surgery.

Zhou Can had returned to the ED just to build up a strong surgical team and slowly win new resources by delivering results—aiming to take the emergency OR to the next level.

If the OR thrived, the rest of the department would grow along with it.

Once he’d finished examining the patient, Zhou Can took his spot at the main surgeon’s post and the operation began.

After careful thought, he decided not to use a vertical incision.

Instead, he made a slanted cut beneath the right upper rib, extending laterally to the anterior axillary line and just crossing the midline inside.

Dr. Xu, standing by as assistant, nodded in approval at his choice of incision.

This cut was great for exposure. Though it meant cutting through all the abdominal wall muscles, the wound rarely split open after surgery and—since it avoided the small intestine—hardly ever led to postoperative adhesions or bowel obstruction.

You could see just from these moves how much experience Zhou Can already had.

Three years of honing his craft had transformed him—not just sharpening his surgical skills but boosting medical knowledge, hands-on experience, and quick clinical judgment.

Meanwhile, Dr. Xu was stunned to see Zhou Can combining the Rapid Surgical Technique and the Steady Scalpel Technique into a new hybrid approach.

It even made Dr. Xu rethink his old assumptions about those methods.

He’d always believed the two techniques clashed. Yet now he watched his student blend them—counterbalancing each other but not conflicting, making each incision even more secure.

He was genuinely impressed.

After opening the chest and abdominal cavity, Zhou Can did a full exploration.

He found a metastatic nodule in the liver, and along the hepatoduodenal ligament he discovered a swollen lymph node. This was going to be a tough fight.

With the tumor already spreading, if any was left behind, the patient’s survival time would be short.

Recurrence would be all too likely.

With the situation clear, he felt for the duodenal papilla to assess its size and boundaries—vital for what was next.

Then he made a Kocher incision to the outer side of the duodenum.

The Kocher method was originally a shoulder dislocation reduction technique, but here, the incision was similar in principle.

So the requirements for the incision at this stage mirrored the Kocher approach.

[Rapid Surgical Technique exp +1. Steady Scalpel Technique exp +1.]

[Congratulations, your Rapid Surgical Technique has reached Proficient level.]

After finishing the Kocher incision, Zhou Can sensed a huge leap in his scalpel technique.

His Rapid Surgical Technique, which had always lingered at entry-level, finally leveled up. Not an easy feat.

Really, it should have happened a long time ago.

But a year and a half spent training in Internal Medicine left him few chances for surgery. He could only squeeze in short practice sessions back in the dorm, so progress crept along.

Luckily, the last year spent learning from Dr. Hu Kan in Cardiothoracic Surgery gave plenty of opportunities. Nearly every day brought a surgery or two, and sometimes even the lead role. That’s how he finally built up enough experience for the breakthrough.

[Rapid Surgical Technique — Proficient 1/. Swift cuts fix flaws and expedite procedures. Widely applicable for all sorts of complex surgeries. Can be integrated into all surgical fields requiring scalpel work.]

He steadied himself, forced down the burst of excitement, and moved to the next step: cutting the posterior peritoneum.

The moment the blade touched down, he felt the benefits of the newly improved technique.

He couldn’t quite put it into words. It just felt effortless.

Like the heavy suddenly felt light.

But he quickly noticed the Steady Scalpel Technique had weakened a bit. The scalpel didn’t feel quite as grounded.

To pin it down, it was like the invisible pressure weighing on his hand had lightened.

If the Steady Scalpel was meant to balance out the Rapid Technique, but only the latter had advanced, it naturally threw things off. The risk of slips mid-operation went up.

Put simply, for every clever move, danger grew to match.

The Rapid Technique was intense, and without the Steady Technique’s restraint, Zhou Can could easily fall into the same old bad habits as Dr. Xu.

For a surgeon, a mistake in the OR is terrifying beyond words.

“Hmm?”

Dr. Xu’s eyes lit up with surprise and admiration.

At his level, he instantly noticed Zhou Can’s leap in skill.

But he kept his peace, assisting quietly while Zhou Can worked.

With the posterior peritoneum cut, Zhou Can started dissecting the descending part of the duodenum.

In his hands, the small scalpel felt alive—precise, nimble, almost artistic. The entire process was like witnessing a master’s performance.

……

Nearly ninety minutes later, Zhou Can surveyed the resected nodule, lymph node, and the duodenal tumor. Satisfaction welled up inside him.

The patient had come through seamlessly. The wound was closed and her vitals steady.

“Excellent! Truly outstanding! It’s clear you haven’t wasted these three years—your surgical ability, diagnostic skills, medical knowledge, and judgment have all progressed. Did your Rapid Technique make a big leap just now?”

Only after the operation did Dr. Xu bring it up.

“Yeah, I had a bit of an epiphany. I’ve gained more insights into both the techniques and how to handle the scalpel overall.”

Zhou Can answered honestly.

He knew the Rapid Surgical Technique was Dr. Xu’s legacy and the thing he valued most, always hoping it would be passed on.

“I watched your blend of speed and stability just now. Not bad at all. It shows that what Dr. Hu Kan taught you about the Steady Scalpel Technique really can harmonize with the Rapid Technique. Now that Dr. Hu is gone, of all his protégés, you have the most talent—when you get the chance, you should practice the Steady Technique more.”

Zhou Can almost thought he’d misheard—this was the first time Dr. Xu had ever urged him to practice stability.

A real surprise.

Was this an indirect tribute to Dr. Hu Kan, or recognition of his bold innovations?

It had been Dr. Hu Kan who first suggested merging the two scalpel styles. Zhou Can was just putting it into practice.

Whether Dr. Xu admitted it or not, Dr. Hu had him beat there.

“Your surgery skills are now so advanced, there’s not much left I can teach you. A master shows the way, but only you can walk it. From now on, don’t be afraid to experiment in surgery. If you’re ever unsure, feel free to ask, though my advice is to rely less on me. Each surgeon’s technique and approach is unique—what suits you is always best.”

Seeing how quickly his student had grown, Dr. Xu was both thrilled and relieved.

“Teacher, I still have so much more to learn…”

Zhou Can wasn’t ready to claim mastery yet.

But before he could protest further, Dr. Xu raised a hand to cut him off.

“Don’t worry, I’ll teach you everything I know. You’re my only true successor. I’m not about to take those skills to the grave.”

Left speechless by Dr. Xu’s bluntness, Zhou Can didn’t argue.

“All roads lead to Rome. Everyone has their own surgical path. My job is to give you the basics and some vital experience. The rest is up to you. Actually, we shouldn’t force kids to do everything our way — if we let them explore, they’ll end up going further than us.”

Dr. Xu truly had Zhou Can’s best interests at heart.

He just wanted Zhou Can to soar higher, not get stuck in his teacher’s shadow.

“Understood! Thank you for caring so much about me.”

Zhou Can nodded, relief showing on his face.

“I’m calling in an intern to assist you next. From here on out, use every bit of strength you’ve got, as long as the surgery is safe—don’t hold back. If you’re ever unsure, I’ll be right outside; just call.”

[…]

With that, Dr. Xu gave Zhou Can full authority.

In other words, Zhou Can had passed the assessment.

And he’d done so with flying colors.

After all, just leveling up his Rapid Technique in a high-pressure surgery was more than enough to impress Dr. Xu.

Having spent so much time working together, Dr. Xu knew Zhou Can’s character, style, and work ethic inside and out.

He could trust him wholeheartedly.

Soon after, Dr. Xu sent in an intern.

A 22-year-old guy.

With his head covering and mask, only a rough outline of his features could be made out.

“Hello, Dr. Zhou. My name’s Luo Shishen. I’m majoring in Clinical Medicine—General Practice. I’ve been interning at Tuyu for almost half a year. Please guide me well.” He was clearly respectful.

Before he knew it, Zhou Can had gone from intern, to trainee, to full-fledged resident—and was now a mentor in an intern’s eyes.

Of course, that was mostly courtesy.

“You know how to retract and assist?”

“Yeah, I’ve got the basics of retraction and stitching down. Whatever you need, just say the word.”

“Alright. I’ll tell you what to do as we go.”

Zhou Can nodded, just as Qiao Yu wheeled in the third surgical patient.

This case? Acute appendicitis.

With no endoscopic gear in the Emergency Department, laparoscopic surgery was out. They’d have to do it the old-fashioned way.

All the pre-op consent and prep was obviously handled already—otherwise, the patient wouldn’t be here.

Zhou Can didn’t bother with extra questions, like why the patient hadn’t gone to a specialty department. He double-checked the test results, found no issues, and waited for anesthesia.

Luo Shishen, the new intern, turned out to be pretty reliable. He bustled around, jumping in without being told.

Which pleased Zhou Can quite a bit.

During surgery, though, Luo Shishen proved to be a talker—asking question after question.

At first, Zhou Can patiently answered out of politeness. But even while Zhou Can was in the thick of high-risk procedures, Luo just kept firing away.