Chapter 437: A Test of Skill and Resolve in the Operating Room

“I’m a doctor specializing in anorectal and colorectal surgery. My name is Yang Zhi, and I’ve been working in the operating room for nearly six years.”

The man straightforwardly introduced himself.

“So you’re from General Surgery, huh? I’ve heard that after the reforms, the department’s sub-specialties have made real progress. Plenty of people are fighting for a spot, but you’ve worked in the OR for six years now—that makes you a veteran. So why are you thinking about leaving?”

Zhou Can couldn’t help but feel puzzled.

In terms of seniority, this person was actually Zhou Can’s elder.

But in every workplace, it’s always those with real ability who rise to the top. Mediocre or unambitious folks end up as just another employee, no matter how long they’ve been around. No one’s ever heard of workplace ranks being determined by how many years someone has put in.

Zhou Can’s surgical skills far exceeded most doctors, so his career skyrocketed.

He was already the number two surgeon in the Emergency Department OR at such a young age. If it weren’t for a lack of seniority, he might’ve become number one already.

“Sigh… There are winners and losers, you know. Sure, some of the main sub-specialties have gotten stronger. But our Anorectal and Colorectal Surgery department keeps clashing with Gastrointestinal Surgery—way too much overlap. Our director, Dr. Mi, is honest to a fault and missed every good opportunity during rounds of competition. Now GI Surgery has us squeezed so tight it’s painful to even talk about. I just can’t see any hope here, so I’m looking for a new direction.”

Yang Zhi let out a heavy sigh, his words laced with bitterness.

The chief of a department is like the lead sheep. Whether the whole flock gets to graze on lush grass or is left gnawing on dirt depends on which direction that leader takes them.

Strategy, tactics, competence, the department’s expertise, and its sense of unity… so many factors shape its future.

If leadership keeps making bad calls or can’t pull off effective moves, decline is pretty much inevitable.

Yang Zhi wasn’t lucky—he got stuck with a director who was good with a scalpel but hopeless as a leader.

Looking at his troubled, downcast face now, he probably isn’t even getting scraps.

Gastrointestinal Surgery actually started out as Digestive Surgery—it’s always been a powerhouse.

Trying to compete with GI Surgery from Anorectal and Colorectal Surgery? All you can do is sigh at your own bad luck.

“If I decide not to take you on… what will you do then?”

After getting the full story, Zhou Can threw Yang Zhi a curveball.

“I have a deep affection for Tuyu and real faith in its future, so I’d stay if I could. But for a middle-aged man like me, earning a living matters, too. The Emergency Department is still in its early development and clearly needs talent. Even though Tuyu brings in cohorts of top trainee doctors every year, there’s always a shortage of surgical hands, since it takes so long to train capable surgeons.”

Yang Zhi calmly analyzed the situation.

He was right—surgical doctors are in short supply in every surgical department. Even internal medicine has started fighting for people with a talent for interventions and endoscopic surgery.

They say pilots are hard to train, but surgical talent is even more demanding.

The Emergency Department gets one or two all-round trainees each year lately.

People like Zhou Can—selected from thousands after fierce competition.

Every single one is an elite among elites.

That’s a big reason why Tuyu’s talent pool keeps growing.

Unfortunately, the Emergency Department is broke—it’s got nothing and can’t hold onto people. Most trainees leave as soon as training’s done.

That’s why the shortage of talent just gets worse.

When you’re only picking up doctors other departments have let go, how strong can you expect to get?

You lose a top all-rounder, and patch the hole with a cast-off from a specialty. That’s the Emergency Department’s harsh reality.

“If Dr. Zhou isn’t interested in me, that’s fine. I’ll look around in other departments. If none of them want me either, then I’ll start considering switching to another hospital.”

Yang Zhi had a clear plan for his future.

The guy had definite goals.

“How about this—come help me out tomorrow or the day after. Tomorrow is Wednesday, and I won’t be in the OR until after five thirty. If it’s the day after, I’ll be there from eight in the morning till six at night.”

Zhou Can had always wanted a capable surgical assistant. Since Yang Zhi seemed solid, he decided to put him to the test before deciding anything.

A surgeon’s skill is obvious with just one try in the operating room.

If his surgical ability falls short or his attitude stinks, there’s no way he’ll be accepted.

By now, Zhou Can’s team was pretty solid and stable.

Luo Shishen’s internship was almost over, and soon he’d have to go for specialist training—something every doctor needs if they want to move up.

It’s just as important as the Physician’s Certificate or the medical qualification.

Still, Luo Shishen made it clear from the start—he begged Zhou Can to hold a spot for him. Once he finished his specialist training, he wanted to find a way back on Zhou Can’s team.

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Over the past year, working surgeries with Zhou Can had taught him more than he ever imagined.

At first, he could barely even hold a retractor steady.

When a patient suddenly convulsed, went into ventricular tachycardia, or even suffered cardiac arrest needing emergency resuscitation, he’d freeze up completely. But after a year of Zhou Can’s hands-on instruction, his skills were on a whole new level.

Compared to other interns, he was in a league of his own.

Especially when it came to surgery.

Some interns finish their internships without ever even closing an abdominal cavity or suturing the skin.

But Luo Shishen could already close up an abdomen with ease.

His suturing had improved by leaps and bounds with Zhou Can’s guidance.

After saying goodbye to Yang Zhi, Zhou Can hurried to the break room in the OR to snatch a quick meal—he still had more surgery waiting in Cardiothoracic.

…

Close to eight o’clock, Zhou Can arrived on time at the Cardiothoracic Surgery operating room.

After a year of development, Director Xueyan’s surgical skills had become remarkable. For big procedures, though, she still called in Zhou Can as backup.

Inside the OR, almost everyone was an old acquaintance.

Even the anesthesiologist was someone Zhou Can knew well.

“Dr. Zhou, after this surgery, could you swing by the ICU to check on a patient who just had a lung lobectomy?”

The one asking was none other than Associate Director He.

Usually, Associate Director He rarely operated together with Director Xueyan.

Tonight’s procedure was cardiac surgery, and Associate Director He typically focused on thoracic cases. At his age, he had neither the time nor energy to take on cardiac surgery.

There was only one explanation—he’d waited here just to catch Zhou Can.

“What’s going on with that patient?”

Zhou Can asked.

If a patient needs post-op ICU care, it’s almost always due to a severe condition or major surgery.

It probably meant things weren’t looking good.

Associate Director He was an excellent surgeon and a seasoned diagnostician.

For him to wait this late in the operating room for Zhou Can showed just how complicated the case had become.

Lung lesion resections are a routine part of thoracic surgery.

China has a huge number of smokers, and countless people are forced to breathe secondhand smoke. If the man of the house smokes and doesn’t care about his family’s health, he’ll have the whole household inhaling his smoke.

And secondhand smoke is even more harmful than smoking itself.

Add in the smog, with its sky-high PM2.5 readings, and you’ve got a recipe for rampant lung disease.

PM2.5 refers to fine particulates less than 2.5 microns in diameter—tiny enough to reach deep into the lungs.

It’s a major culprit behind the rise in asthma and lung cancer.

Especially in northern cities, people have to wear masks outdoors. If they can afford it, they’ll install air purifiers at home just to deal with PM2.5.

“The patient’s having persistent alveolar air leaks—not a good sign. When the surgery’s done, I’ll fill you in.”

Associate Director He was tactful; he’d never hold up Director Xueyan’s operation.

A year later, Director Xueyan wasn’t just an ace in the operating room—her department had also transformed under her guidance. It had never been so strong, united, or capable.

She was raising up some real talent, too.

All three strategies Zhou Can had proposed were implemented to the letter.

“Zhou Can, Director He’s been waiting here just for this—you think maybe he could get some rest in the on-call room until you’re done? No need to let him pull an all-nighter with us.”

Director Xueyan and Zhou Can were as close as siblings, so she spoke her mind freely.

No beating around the bush.

“I’m honored—and a bit guilty—to keep Director He waiting just for me.” He added the necessary pleasantries. “Please, go rest in the on-call room. I’ll find you as soon as my surgery wraps up. This one’s going to take at least three hours.”

Zhou Can genuinely admired Associate Director He. The man had his flaws, but his commitment to his patients was impressive.

That was something you couldn’t help but respect.

To be fair, though, he was only responsible for the patients under his direct care.

It wasn’t a matter of medical ethics. Everyone earns their living from this job, and under strict supervision nowadays, Associate Director He took great care because he didn’t want anything to go wrong. That’s the reality for many doctors.

Some patients come into the hospital, questioning everything, following instructions poorly.

Honestly, there’s no need for that.

Unless you run into someone truly unreliable.

Otherwise, no doctor would risk their career just to mess with patients.

In smaller hospitals, doctors sometimes get quotas to meet. Prescribing benign medications and extra tests is part of surviving.

For self-paying patients, doctors usually try to keep the bill down.

For those with insurance, well, you know how it goes.

Given the current environment, if hospitals can’t earn from insurance, most would go bankrupt.

If that happens, it’ll only get harder for regular folks to see a doctor.

Associate Director He, due to his age, just couldn’t pull all-nighters anymore like the younger team. Delighted with Zhou Can’s offer, he left the OR to get some rest.

Meanwhile, Zhou Can grabbed the patient’s file and began scanning through.

“This patient’s case is tricky. I thought it was just a simple congenital heart defect, but turns out it’s Tetralogy of Fallot.”

“If it wasn’t tricky, we wouldn’t call you in. I know you’re swamped in the ER. Anytime we think we can handle it ourselves, we leave you out of it.”

Director Xueyan replied with a smile.

“Whenever you need anything, just call me, Sis Yan. Don’t worry about my workload.”

Zhou Can could sense her genuine concern.

Tetralogy of Fallot is the most common form of cyanotic congenital heart disease.

Without surgery, most patients don’t survive past age seven. Kids with this condition average just twelve years of life.

Symptoms start showing at three to six months—skin, lips, nails, even fingertips can turn blue.

Especially when the child cries, the cyanosis gets worse.

In the past, this was basically incurable. But as doctors invented heart surgery and kept improving their techniques, a solution was finally found.

Tetralogy of Fallot refers to four defects: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricular hypertrophy.

Any one of these could count as a congenital heart disease on its own.

All four together make surgery exponentially more difficult.

Surgery is the only option for this condition.

Without surgical intervention, kids with this disease are at high risk of dying.

Because it’s present from birth, some children are too weak or have poor development to withstand surgery.

In those cases, curing the problem in one go usually isn’t possible.

Experienced surgeons often start with a palliative procedure—save the child’s life first, then go for a full repair once they’re older and stronger.

Zhou Can remembered that, in the past, Director Xueyan never dared attempt this kind of complex surgery.

Now, taking on a Tetralogy of Fallot operation showed just how confident she’d become in her surgical abilities.

“Sis Yan, did you check the patient’s coronary arteries?”

After reading the basics, Zhou Can asked.

“Of course! The patient’s coronary angiogram is right there below.”

Director Xueyan knew Zhou Can never asked questions lightly.

If he brought it up, it must matter.

“Can this surgery even proceed?”

At this point, the patient was only anesthetized—the operation hadn’t started yet.

“Don’t worry. I just want to confirm whether the left anterior descending artery originates from the right coronary. If so, this surgery can’t be done. Plus, if there’s poor development of the left/right pulmonary arteries or nearby vessels, then it’s also a no-go.”

Zhou Can shared his professional judgement.

Director Xueyan listened, smiling with curved eyes. “I knew having you here was the right call. No matter what comes up, you always help us check everything. Relax, I’ve already checked both those issues—no problems.”

Even though she’d already verified it, Zhou Can double-checked to be sure.

Thankfully, none of those contraindications were present.

“How’s the development of his left ventricle?”

Zhou Can followed up.

“It’s not bad—within normal range, though nothing exceptional.”

“Then there shouldn’t be any major issues. Has the patient had proper pre-op fluid intake?”

Zhou Can pressed on the patient’s skin. The elasticity seemed fine.

“All set.”

This time, the Attending Nurse answered.

“Alright then, I’m pretty much good.”

Zhou Can looked at Director Xueyan.

That was his way of waiting for her orders.

“Anesthesia, can we begin?”

In surgery, using job titles like “Anesthesia” isn’t rude—it’s just efficient.

Especially when someone in the OR shares a surname with the anesthesiologist, people prefer to keep things clear.

“The patient’s vital signs are stable. He’s under general anesthesia. Ready for surgery.”

“Let’s get started! Same routine as always—Dr. Zhou Can will take the lead at crucial moments, everyone else, take your positions!”

Director Xueyan brought Zhou Can in not just to double-check things, but because in critical moments, his help was invaluable.

Now, with mastery over several surgical disciplines at associate chief level (or even higher), plus his lightning-quick and steady scalpel techniques, Zhou Can was every bit as skilled as a top-tier chief surgeon.