Chapter 481: Rebuilding the Chest: A Surgeon’s Challenge

Once the chest wound was opened, the remaining sternum was visibly discolored from infection.

As osteomyelitis progresses, the bone can ultimately become necrotic.

This disease is extremely rare.

Hematogenous osteomyelitis is especially uncommon—one of the toughest conditions to treat in orthopedics.

Postoperative sternum infections are among the most common causes for this illness.

Zhou Can carefully removed the infected sternum, completed the debridement, then harvested a rib from each side to reconstruct the chest wall.

Essentially, he set two ribs horizontally across the chest cavity.

[Bone Fixation Technique EXP +1. Reward: Bone Fixation Technique EXP +100.]

Pulling off such a difficult bone fixation only netted a hundred experience points—really not much.

Still, compared to earning just one point per basic case, this was a rocket’s pace.

His Bone Fixation Technique was currently level four—the equivalent of an attending surgeon.

He’d need more effort if he wanted to promote to associate chief.

It’s mostly because orthopedic surgeries are rare around here. The tough cases are often out of reach, while the easier ones barely yield any experience points.

There’s no shortcut—you just have to keep grinding, accumulating a little at a time until you break through.

Pretty much all surgical skills have a major dividing line between level four and five. Before level five, it’s always a slow crawl.

Almost every surgeon makes it to the top this way, one step at a time.

Once you hit level five—the associate chief threshold—you’re finally over the hump. At that point, you can join the biggest surgeries and might even take on some of the complex orthopedics yourself.

Don’t be fooled by the fact that orthopedics mainly deals with a few bones. Orthopedics is known as the most profitable surgical specialty, which tells you everything about its clout.

Even if you only master hand surgery, you can carve out a great career for yourself.

Actually, specialize in any branch of orthopedics—hand, foot, joints, lumbar spine, or trauma—and you’ll be the orthopedic expert every major hospital chases.

The income and status are both outstanding.

In Huaxia, thanks to a long history of traditional Chinese medicine, there’s barely any separation between ancient medicine and martial arts. Especially when it comes to bruises, internal injuries, and trauma—these always went hand in hand with martial artists.

Ordinary people mostly get sick, but those who train in martial arts… getting hurt is almost a daily occurrence.

Broken hands or feet, even fractured ribs, always needed a TCM practitioner to fix them.

As a result, even with modern Western medicine on the rise, Chinese orthopedics still stands tall and proud.

Who’s the true ace in bone-setting and alignment?

It’s got to be traditional Chinese medicine!

For sprains and fractures, nothing beats TCM.

The most common Western orthopedic method for fractures is to use steel pins and plates. A simple splint might need a dozen or twenty steel screws—costs are scary, and the bones end up full of holes.

Of course, these days regardless of TCM or Western medicine, if you can help a patient recover, you’re a good doctor.

Western medicine holds its own in orthopedics too.

When it comes to correcting deformities, TCM traction may help a little, but its results are far inferior to Western surgery.

Take severe scoliosis, for example. TCM can do almost nothing. Western medicine can perform surgery, removing a section or two of the spine and combining it with physical therapy until the patient can stand straight again.

And for things like bone cancer—Western medicine rules there too.

After reconstructing the sternum for this patient, Zhou Can quickly moved to free up both pectoralis major muscle flaps.

What for?

Those muscle flaps were then placed into the area missing chest bone. He brought both sides of the chest muscle together and sutured them, rebuilding the soft tissue.

Once all that was done, a drainage tube was placed at the incision, the cavity was closed up, and the surgery, at last, was complete.

Zhou Can let out a long breath, finally relieved.

This surgery gave him a huge amount of skill experience. Beyond the bone fixation skill, he also racked up points for incision, suturing, hemostasis, and anastomosis.

Whether removing the sternum or grafting the muscle flaps, these were serious skills that required absolute precision.

His surgical skills grew tremendously from the experience.

“All right. As long as the patient gets strong post-op antibiotics, recovery should be quick. But if another infection sets in, things will get ugly—there’ll be almost no solution left.”

Zhou Can added that to remind Director Xueyan about reinforcing the patient’s postoperative care.

For patients coming back a second time, every surgical opportunity becomes more precious.

Even opening the chest once puts a huge strain on the patient.

Now, with the entire sternum removed and two ribs used for reconstruction, the patient had basically exhausted their last bit of ‘capital.’ One more infection and it’d be over—most likely fatal.

If this patient recovers, the case will have a lot of prestige.

He was sure Director Xueyan understood what was at stake.

The second surgery was for a patient with lung cancer.

The patient had a lobectomy three months ago at Fangxin Tumor Hospital.

Now they faced a postoperative recurrence with distant hematogenous metastasis.

Current scans had picked up metastases in the lung hilum and mediastinal lymph nodes.

With such widespread metastasis, there’s little surgery can achieve. Frankly, another operation holds little value now.

But the patient was in their prime, with a wife, kids, and parents all determined to pursue treatment—even if it meant betting everything they had.

Moved by their resolve, Associate Director He decided to take the case.

He admitted his own surgical skill had limits—tackling this would require Zhou Can’s help if they wanted even a slim chance. So after discussing with Zhou Can and Director Xueyan, the surgery was scheduled for tonight.

Here’s something interesting: Last time, Third Hospital poached a bunch of key surgeons and nurses from Tuyu’s cardiothoracic department. Yet, Associate Director He wasn’t lured away.

Both Zhou Can and Director Xueyan were honestly surprised.

You have to know, Associate Director He has always been fiercely self-serving. Even after stepping down to Director Xueyan and giving up the fight for department head, he still acts pretty selfish at work.

Normally, a person like him would jump ship at the first offer.

Yet, oddly, Third Hospital didn’t manage to woo him.

Zhou Can later heard that on the day after multiple cardiothoracic doctors resigned, Associate Director He was raging in the office and smashed several mugs.

Nobody really knew why he lost his temper.

Maybe it was just the stress of losing so many doctors from the department. Or maybe he was fuming that so many staff—including some he personally mentored—chose to leave en masse.

But there’s another rumor.

Supposedly, Third Hospital offered an associate chief under him a salary of 700,000 yuan after tax, with Vice Director Zhang personally recruiting him.

But for Associate Director He, their offer was only 600,000—without mentioning whether it was before or after tax—and they only sent a department-level officer to try to recruit him.

That’s a big step down compared to what the other associate chief got.

That’s basically a slap in the face for Associate Director He.

The rumor is probably true. Otherwise, with his personality, the chance he’d have left was high.

But with no confirmation, who really knows?

Regardless, ever since Tuyu Hospital lost so many key staff, Associate Director He had been working much harder than before—no question. Both the hospital and the cardiothoracic department benefited from it.

“Dr. Zhou, for mediastinal lymph node dissection and right lobectomy, we’ll need you to operate.”

Once the second patient reached the OR, Associate Director He arrived soon after.

Director Xueyan led another team working on a different cardiac surgery. Her surgical skills were pretty strong now, and with Zhou Can in the same OR as backup, it was enough.

For her, Zhou Can’s main role during surgery was cleaning up after emergencies.

If anything went wrong, Zhou Can would jump in to save the day.

Frankly, Zhou Can was doing the job that Director Hu used to handle.

“No problem. You can supervise and guide me. It’s only right for younger colleagues to put in more effort.”

Zhou Can actually got along decently with Associate Director He these days.

But a petty person is still a petty person.

No matter how much Associate Director He tried to act friendly or even fawn over him, Zhou Can’s opinion hadn’t changed. Whenever they worked together, he stayed exceedingly cautious and respectful.

He spoke as little as possible and focused on helping, never giving him a reason to get annoyed.

People all eat the same grains, but every person is different.

A department can be a team of dozens, a hundred, or even more.

You can’t expect everyone to be noble or always warm and friendly.

You meet all kinds.

Learning to unite these people and harness their collective strength is what marks a real leader—someone able to run the department’s business well.

Over the past year or so, Zhou Can’s management skills had improved dramatically.

That laid the groundwork for building a bigger surgical team or even moving up to become department head, deputy director, or director one day.

The surgery kicked off quickly.

Once the patient’s chest was opened, he realized things were worse than what the scans suggested.

Some tumors are just too small for even the best imaging to spot. Only when you physically open up the chest or abdomen and take a look can you find them.

“The cancer has spread way more than I expected!”

Looking at the right lung, surrounding tissue, and mediastinal lymph nodes, Zhou Can’s experience told him—these results only appear with intense cancer cell invasion.

Any surgeon who’s dissected malignant tumors knows they’re often misshapen and have an ugly color. Benign tumors, on the other hand, are well-defined and regular.

Like poisonous mushrooms—often brightly colored, easy to spot.

Of course, some poisonous mushrooms look ordinary and clean, yet are deadly anyway.

Some malignant tumors might resemble benign ones visually, making it hard to judge by eye alone.

That’s why surgeons never rely on experience to judge a tumor’s nature after cutting—it always goes straight to pathology.

Most of the time, it’s sent for instant intraoperative analysis.

You contact the pathology department before the operation, and as you cut, send the specimen over for rapid results. If it’s benign, you can just finish the resection.

But if it’s malignant, you have to extend the resection and may need to clear lymph nodes too.

“Looks like I need to put on magnifying glasses for this.”

The Attending Nurse quickly handed him a pair when she heard.

“How’s the fit? On comfortably?”

She was extra gentle with him.

“Mr. Chang is the master of fitting glasses—not bad. But every time I wear these, it feels weird. Everything looks huge, like I’ve stepped into the land of giants.”

Zhou Can’s remark had everyone laughing.

He meant to lighten up the atmosphere in the OR.

There was a rough battle ahead. If they finished before midnight, it’d be considered a miracle.

Luckily, he was still young—his stamina and energy were at their peak. Otherwise, it would’ve been too much.

No wonder people always say a surgeon’s prime is before thirty-five. After that, they gradually move to teaching and mentoring.

Routine parts of surgeries are done by the pupils; the key parts, the master takes over.

“Scissors!”

Taking them from the instrument nurse, Zhou Can snipped open the mediastinal pleura under the azygos vein arch. Now the phrenic nerve was in view.

He continued cutting alongside the nerve until he reached the hilum.

Then he gently retracted the phrenic nerve with a sling and started dissecting the fatty tissue and lymph nodes from the pericardial side toward the lung.

Sounds easy, but in practice, every step requires intense care.

Even knowing Zhou Can was a brilliant surgeon, Associate Director He couldn’t help but watch nervously from the side—assisting whenever he could.

Whenever the operation neared a vital spot—important organs, nerves, or vessels—Associate Director He would instinctively call out: “Careful, careful!”

The sheer number of metastatic cancer cells was staggering.

Through the magnifying glasses, Zhou Can could spot several papule-like nodules.

Those weren’t just any lumps—they were potentially deadly growths just waiting to explode into massive tumors.

Step by step, Zhou Can steadily cleaned out all the cancerous tissue and lymph nodes.

His Incision and Tissue Separation experience points increased constantly.

Because the operation was near critical structures like the pericardium, the experience rewards kept pouring in.

[Incision Technique EXP +1. High-difficulty excision complete. Reward: Incision Technique EXP +100.]

[Incision Technique EXP +1. High-difficulty excision complete. Reward: Incision Technique EXP +100.]

…

[Congratulations, your Incision Technique has advanced to level six.]

Helping with this ultra-difficult cancer resection really paid off.

He’d especially raked in massive rewards for his Incision and Tissue Separation skills—overflowing, in fact.

Keep in mind, going from level five to six demands a full hundred thousand experience points. Even with Zhou Can racing through surgeries in the ER, he hadn’t seen this kind of leap before.

This time, the unexpected trove of Incision skill rewards finally bumped him to level six—the department chief’s level.

In the surgical arts, Incision is basically advanced anatomy.

Tissue Separation is a higher-level skill within anatomy.

The legendary butcher who could slice up an ox with ease had mastered anatomy to the highest degree—carving a cow with perfect finesse.

Now that Zhou Can’s Incision Technique had reached chief level, his grasp of anatomy was extraordinary. He could dissect any part of the human body as easily as that butcher handled an ox.

More than that, every time he made an incision, the feedback in his hands grew sharper.

It was as if his palms had sprouted countless sensors—he could instantly read the subtle feedback from the scalpel and every instrument with pinpoint sensitivity.

Now, he could slice through a thick stack of A4 paper and choose exactly how many layers to cut, thanks to that precise control.