Chapter 557: Destruction Isn’t Harm: The Soothing Anesthesiologist

After thoroughly assessing the patient’s stomach condition, Zhou Can felt a surge of confidence.

“Could you show me the patient’s preoperative esophageal imaging once more?”

He wanted to seize this chance during the gastroscopy to pinpoint the exact location of the esophageal fistula and, ideally, uncover the root cause. Only then could he ensure the second surgery wouldn’t lead to a recurrence.

“Here’s the esophageal imaging we did today. The fistula opening is over 1cm wide!”

Director Tan’s voice carried a hint of shame as he spoke.

The entire esophageal tear spanned about 6cm, and now a fistula over 1cm had formed. As the chief surgeon, he couldn’t easily escape responsibility.

As Zhou Can maneuvered the endoscope out, he carefully compared the fistula’s position on the imaging. It took considerable effort, but he finally located it.

From the inner wall of the esophagus, the fistula wasn’t immediately obvious.

It sat at the base of the sutured tear, showing signs of infection and suture breakdown.

Drawing on his surgical experience and Level 6 Suturing skills, Zhou Can meticulously examined the area. He confirmed that the rest of the esophageal tear had begun to heal—a promising sign.

There was no need to disturb it further.

Repairing this fistula would definitely require debridement followed by secondary suturing.

First, there was no guarantee that infection or suture breakdown wouldn’t occur again after the repair.

In truth, once the esophageal wall became infected, even without pus formation, the sutures could easily give way a second time.

Even in the best-case scenario, with Zhou Can’s Level 6 Debridement and Suturing skills, the fistula could heal perfectly without reopening. Yet it would still have a massive impact on the patient.

What kind of impact?

The patient’s esophagus was already hardened, brittle, and lacking elasticity and toughness. This meant the maximum size of food it could handle was far below normal.

A few days ago, a 6cm tear in the esophagus had been sutured, significantly narrowing the internal space of that section.

During the gastroscopy just now, Zhou Can could feel it clearly.

The repaired section of the esophagus was noticeably tighter.

This would undoubtedly affect the patient’s ability to eat post-surgery, making choking a real risk.

On top of this already narrowed section, performing debridement and secondary suturing would shrink the space even further.

In the future, the patient might only be able to manage liquid food.

Even then, it would need to be thin liquid—anything too viscous could clog the esophagus entirely.

Plans really couldn’t keep up with changes!

This gastroscopy had proven absolutely necessary.

Without a detailed understanding of the patient’s condition, repairing the esophageal fistula via thoracoscopic surgery might succeed technically but would ultimately be a failed operation.

“May I ask what kind of secondary surgery your hospital has planned for the patient?”

Zhou Can directed the question at Director Tan and Song Qian, seeking their input.

Getting the host hospital’s opinion was crucial.

“We’ve invited Dr. Zhou here to help clean up this mess, so naturally, we defer to your judgment,” Song Qian answered on behalf of Director Tan.

“Since the fistula isn’t large, repairing it based on the existing surgery would be ideal. Before arriving, Dr. Zhou proposed thoracoscopic surgery for the repair. I strongly support this plan as it’s minimally invasive and causes less trauma to the patient.”

Tan Shengli’s surgical approach seemed rather outdated and conservative.

This mindset favored straightforward, step-by-step plans when devising surgical strategies.

The strength was stability, but the downside was a lack of adaptability—very rigid.

“Before coming here, I did think thoracoscopic surgery could work to directly repair the esophageal fistula. However, during the gastroscopy just now, I noticed a problem. The fistula is in the same section as the previous tear. If we perform secondary suturing, I’m worried it will severely impact the patient’s quality of life post-surgery. So, I’m leaning toward a different solution.”

With his Level 6 Pathology Diagnosis skills, Zhou Can had a significant edge in crafting a better surgical plan.

“There’s another option?”

Director Tan’s eyes lit up slightly while Song Qian’s sharp gaze flickered with interest.

“Right now, the patient has an esophageal fistula, making nutritional support an urgent issue. Without proper nutrition, wound recovery will slow dramatically, and the body will face various complications. At that point, the situation becomes extremely dangerous.”

Zhou Can broke down the reasons for everyone.

Currently, whatever the patient ate leaked out, with only a small portion reaching the stomach. The food leaking through the esophagus ended up in the chest cavity. Even with a drainage tube left during surgery, it still posed a major safety risk to the chest.

If it triggered a chest infection, even the most advanced antibiotics might not save the patient’s life.

“Dr. Zhou, if I may interrupt, what do you think caused the esophageal fistula?” Tan Shengli cut in, his surgical thinking seemingly sparked by the discussion.

“During the gastroscopy, I noticed ulcers and redness in the esophagus. I suspect the failure of the esophageal repair surgery stems from swelling and inflammatory necrosis of the esophageal wall, causing the sutures to give way and preventing the wound from healing.”

Zhou Can spoke plainly.

Such cases weren’t uncommon and were somewhat tied to the chief surgeon’s surgical quality. For instance, controlling post-operative swelling—if this had been at Tuyu Hospital, preventive measures could have been taken.

“Alright, please go on with your treatment plan!”

After clarifying the cause of the fistula, Tan Shengli seemed to abandon his own ideas, ready to fully follow Zhou Can’s lead.

“As we all know, spontaneous esophageal rupture, if not treated promptly with surgery, can lead to death from severe infection, malnutrition, and systemic failure. However, even after esophageal repair surgery, re-rupture is very common within three to seven days due to various reasons. If the secondary tear is small, enhancing nutrition, keeping drainage clear, using antibiotics rationally, encouraging lung expansion exercises, and maintaining gastrointestinal decompression can help. With proper care, the fistula may heal on its own.”

Zhou Can proposed a series of treatment measures.

His idea was simple: since repairing the fistula surgically wasn’t feasible, let it heal naturally.

As long as nutrition was adequate and infection strictly controlled, this goal was entirely achievable.

At most, the treatment duration might be a bit longer.

“Dr. Zhou’s measures sound excellent. But with the current esophageal fistula, food leaks into the chest cavity. How can we enhance nutrition?”

Tan Shengli felt that without solving this issue, it was just empty talk.

“Simple. We can perform a jejunostomy to address it.”

Zhou Can answered with confidence.

“Jejunostomy?”

Director Tan’s eyes widened in shock, and the others mirrored his stunned expression.

Dealing with an esophageal fistula was already tricky enough. Artificially creating another opening in the jejunum seemed utterly reckless.

A conservative thinker like Tan Shengli could never have come up with such an idea.

To him, the concept was sheer madness.

Any surgery caused harm to the patient’s body. The patient was already unlucky enough with a post-operative esophageal fistula, and now a doctor wanted to make an opening in the jejunum? What kind of suffering was this?

“Exactly, a jejunostomy. While creating an opening in the jejunum does cause some harm to the patient, the benefits far outweigh the damage. First, after the jejunostomy, food can enter the stomach directly from there, bypassing the esophagus. This reduces continuous infection at the esophageal fistula and prevents it from worsening. It sets the stage for the fistula to heal gradually.”

Wounds feared water and infection.

To survive, the patient had to eat and drink daily, which would continuously infect the esophageal fistula, possibly leading to pus formation.

Antibiotics could control infection, but they weren’t a cure-all.

The best treatment was always prevention.

Preventing infection was far superior to controlling it after the fact.

The former ensured the wound had no chance to deteriorate, while the latter waited for problems to arise before addressing them.

This principle mirrored the idea of a superior physician treating ailments before they manifest, preventing issues before they occur.

An inferior physician only treated diseases after they appeared, scrambling to save the patient.

The difference between the two was stark.

Zhou Can’s surgical thinking already showed traces of a superior physician’s mindset, while Director Tan, unless he changed his approach, might remain an inferior physician for life.

“Secondly, through the jejunal opening, we can directly provide the patient with various foods, ensuring adequate nutrition. With proper nutrition, the patient’s self-healing and immune capabilities will strengthen significantly. As you can see, the patient’s body is already in poor shape due to malnutrition, showing signs of decline.”

The patient’s complexion was awful. Though vital signs were stable, they were in a persistent high fever state.

At this point, the patient’s overall condition was extremely poor.

For an ordinary person, a severe cold with fever and a runny nose could feel like death. For a patient fresh from major surgery, enduring this state was like adding insult to injury.

If not addressed promptly, the patient would die soon.

Clearly, the doctors and leaders at First Hospital had sensed this danger, prompting them to seek urgent help from an external hospital.

“Dr. Zhou’s surgical proposal is highly scientific and reasonable. I believe it’s far better than our initial plan of secondary repair via thoracoscopic surgery. Whether for post-operative recovery or future quality of life, it offers significant benefits. While it seems like a second act of destruction to the patient’s body, it’s akin to scraping the bone to heal the poison, creating favorable conditions for a complete cure.”

At this moment, the anesthesiologist, Director Hei, voiced support for Zhou Can’s new plan.

With the anesthesiologist’s backing, the likelihood of implementing the plan skyrocketed.

No surgery could proceed without the anesthesiologist’s approval.

If she said the surgery could go ahead, it would. If she opposed it, even if the chief surgeon deemed the plan perfect, it couldn’t proceed. At such times, clashes between the chief surgeon and anesthesiologist were common, often leading to heated arguments in the office.

Like a bickering couple, they might quarrel at the head of the bed but reconcile by the foot.

They’d soon make up, so there was no need to worry.

After all, everyone was working toward the same goal, and there was no need to escalate to personal grudges.

“Dr. Zhou’s solution may seem… destructive at first glance, but after careful thought, I also believe this treatment plan is safer and more effective,” Tan Shengli said, stopping short of explicitly agreeing to let Zhou Can perform the surgery.

Since they had invited Zhou Can to take the lead, the decision-making power naturally rested with him.

If they clung to control, it wouldn’t be inviting Zhou Can as the chief surgeon but relegating him to an assistant role.

“Since Director Hei has agreed to Dr. Zhou’s surgical plan, let’s move forward quickly! Whatever you need, we fully support and cooperate.”

Song Qian’s role remained unclear, and she hadn’t introduced herself.

Even Jiang Wei hadn’t mentioned to Zhou Can what position this old classmate held at First Hospital. Just by intuition, her status seemed quite high.

Otherwise, she wouldn’t speak to Tan Shengli and Director Hei, both chief physicians, with such calm authority.

Moreover, in every decision, she acted as a senior leader with the power to finalize matters.

Thus, it was reasonable to assume her position was significant.

“I don’t have any other requests. My colleague can assist as my medical assistant, and Jiang Wei can serve as my instrument nurse.”

Zhou Can had only this small request—to use his own team during surgery.

“That’s perfectly fine.”

Song Qian gave a slight nod to the original instrument nurse and medical assistant, who stepped aside.

The surgery began shortly after.

Zhou Can demonstrated to the First Hospital staff what top-tier surgical skill looked like. The entire procedure took less than forty minutes to complete.

The moment the surgery concluded, he earned a 1000-point reward in Pathology Diagnosis experience.

It was likely tied to his proposal of a new surgical plan.

While not a groundbreaking innovation, it carried a certain novelty. It also showcased a flexible application of various surgical and medical knowledge.

Such expertise was hard to acquire from books alone.

Textbooks taught basic knowledge and theories. Bringing that knowledge to life in clinical practice required constant hands-on experience and accumulation.

Once the surgery wrapped up, Zhou Can carefully rechecked the patient to ensure everything was in order.

Only then did he peel off his gloves and toss them into the trash.

“Alright, move the patient to the recovery room to wake from anesthesia. Observe for about thirty minutes. If there are no issues, they can be sent back to the ward for care. Starting tomorrow, feeding can begin through the jejunal opening. It’s best handled by a more experienced nurse. The patient’s hospital stay will likely be lengthy— healing the esophageal fistula could take over a month.”

Zhou Can briefed Tan Shengli and Song Qian on the situation.

“If there’s nothing else, I’ll take my team and head out.”

“Let me see you off. Thank you for your hard work today, all three of you.”

Song Qian seemed delighted to see the surgery completed successfully.

As they prepared to leave, Zhou Can glanced at Director Hei, the anesthesiologist.

“It was a pleasure working with you. Your intraoperative management was exceptional—one of the most relaxing surgeries I’ve ever performed with an anesthesiologist.”

Zhou Can didn’t say she was the most relaxing anesthesiologist he’d worked with.

He specified it as the most relaxing surgery.

“Thanks for the compliment!”

She offered a subtle smile—the first time Zhou Can had seen her do so.

“See you again!”

He led Jiang Wei and Zhong Ming toward the exit.

Director Hei truly stood out as the most skilled anesthesiologist Zhou Can had encountered. She was professional, meticulous, and her coordination with the chief surgeon was impeccable. She even anticipated Zhou Can’s next moves, providing the necessary life support or preparations accordingly.

Throughout the entire surgery, she made Zhou Can feel as if everything flowed as naturally as water down a stream.

Even Director Feng from Tuyu Hospital had never made Zhou Can feel this at ease during surgery.

It wasn’t that Director Feng’s professional skills were inferior to Director Hei’s, but rather that Director Feng lacked her spirit of complete dedication to supporting the chief surgeon.

Everything she did during the procedure prioritized Zhou Can, offering the best service to the lead surgeon.