Chapter 564: Holding the Fort, A False Alarm

Zhou Can meticulously examined the patient, desperately searching for a way to save this life.

Truth be told, with the lungs in such a dire state, even an extracorporeal membrane oxygenation—ECMO—might not be enough. ECMO isn’t a cure-all; it merely temporarily takes over heart and lung functions to assist with breathing and circulation.

It can’t sustain those functions indefinitely.

Even something as basic as a respirator can’t be used for too long. Otherwise, the patient’s body might grow dependent, drastically raising the risk of infection.

For a patient who’s undergone a unilateral pneumonectomy—complete removal of one lung—their lung capacity is slashed by 50% post-surgery. The respiratory and circulatory systems bear immense strain, like two people carrying a 200-pound load suddenly reduced to one, who’s then crushed under the weight.

Thus, the mortality rate and complications from unilateral pneumonectomy are alarmingly high.

Removing just a lobe of the lung carries far less risk by comparison.

Moreover, the quality of life for such patients takes a severe hit. Where climbing three flights of stairs was once effortless, now even half a flight leaves them gasping and exhausted.

For younger patients, it might even mean they can no longer lead a normal married life.

When Zhou Can devised the surgical plan for this patient, he weighed every option with utmost care. With no other viable choice, he opted for a left lung removal to preserve the patient’s life.

The surgery was performed two days ago; today marked the third day.

Right now, the patient’s face and lips showed cyanosis—a bluish tint—extending even to the fingernails. It was a clear sign of oxygen deprivation.

Breathing was labored, with copious pink, frothy sputum, and the heart rate was alarmingly high at 150 beats per minute, far above normal.

Blood oxygen saturation had plummeted to rock bottom, dipping well below the critical threshold.

When saturation falls under 95%, discomfort becomes evident, alerting doctors to act. This patient’s level had sunk below 80%, even after multiple rescue measures.

Zhou Can’s expression was grim as stone. In the ICU, several chief physicians watched him with tense faces. They were out of ideas and could only pin their hopes on him to find a solution.

“Sis Yan, may I borrow your stethoscope for a moment?”

Zhou Can turned to Director Xueyan with the request.

A reflex hammer and stethoscope are essential tools for any cardiothoracic surgeon, often needed at a moment’s notice.

But this was a sterile environment; items from outside couldn’t be brought in casually.

Director Xueyan’s stethoscope was likely one kept in the ICU for such purposes.

Though each breath the patient took seemed like it could be their last—a terrifying sight—Zhou Can remained steady as a rock. He pressed the stethoscope to the patient’s chest, listening intently to the lung sounds.

“It’s full of wet rales and bubbling sounds. Combined with the current symptoms and signs, there’s no doubt it’s pulmonary edema. The first day post-surgery was stable, which means the lung condition worsened yesterday, or possibly even this morning. Let me see the infusion and medication records.”

Zhou Can’s pharmacological reasoning had now reached level six. When treating critically ill patients like this, he could approach the problem from multiple angles.

This included pharmacology, pathology, and clinical signs, among others.

In the past, when it came to medical orders and complex medication regimens, he often felt powerless to intervene.

The gap between an associate chief physician and a chief physician might seem small, but the difference in skill is vast.

Especially in core areas like pharmacology and pathology, the disparity was stark.

Before his pharmacological reasoning leveled up, Zhou Can lagged behind even Nurse Jiang Wei in several medication domains.

Director Xueyan’s theoretical expertise had always been exceptional. Her pharmacological reasoning was already at level six. Even now, Zhou Can fell slightly short of her prowess.

At best, he could now stand on equal footing and discuss cases with her.

They were at the same tier, though she remained a notch above.

Even though Director Xueyan and Associate Director He had already reviewed the patient’s infusion and medication records, Zhou Can insisted on checking them again. Even if no issues surfaced, it would give him a clearer picture of the treatment and drug administration.

Knowing which drugs were used, in what doses, and their effects provided valuable feedback for Zhou Can.

After reviewing the records, the furrow in his brow eased noticeably.

“The primary rescue measures currently in place are oxygen mask administration and intramuscular injection of sedatives.”

Perhaps due to differing diagnostic opinions, no one dared to administer additional drugs recklessly.

“Zhou Can, judging by your expression, you’ve figured out the cause of the pulmonary edema, haven’t you?”

Having worked with him for so long, Director Xueyan had grown familiar with his habits and tells.

Seeing his brow relax, a wave of relief washed over her as well.

It was a trust built through years of collaboration.

Zhou Can only showed this kind of expression during emergencies when he felt confident in his approach.

“Sort of.”

Zhou Can nodded.

“Actually, after our earlier discussion, we also suspected pulmonary edema. But with the pink sputum and unclear pathological mechanisms, we didn’t dare act rashly. Our rescue measures leaned toward the conservative side.”

Associate Director He’s words carried a hint of saving face.

After all, in the field of thoracic surgery, he was considered a veteran in the department.

For a long time after Dr. Hu Kan’s passing, he had positioned himself as the top authority in thoracic surgery.

There’s no denying that Associate Director He’s skills were solid, backed by extensive experience.

The pink sputum indicated hemorrhagic exudate or bleeding in the lungs.

Aside from Director Xueyan, no one else truly knew the specifics of the surgery. Still, everyone had faith in Zhou Can’s surgical expertise.

“I performed the surgery, so I’m indeed more familiar with the patient’s condition. Calling me in to handle this was a prudent decision on your part, and I appreciate the trust from you and the other chiefs.”

Zhou Can offered a word of praise before continuing.

“I reviewed the medication records for the past three days and found no issues. The sudden onset of pulmonary edema is likely tied to the complete removal of the left lung. Simply put, this kind of post-surgical complication is unavoidable. With one lung entirely gone, the reduction in pulmonary vasculature increases hydrostatic pressure in the blood vessels. Capillary permeability also rises, causing a large amount of fluid to seep from the capillaries into the alveoli, ultimately triggering acute pulmonary edema.”

Zhou Can shared his pathological analysis with the doctors and nurses present.

Rescuing critically ill patients was, in itself, a process of mutual learning and growth.

Each person’s medical knowledge, clinical experience, and approach varied. Listening to others’ perspectives allowed everyone to learn from strengths and address weaknesses. The next time a similar case arose, they’d have a solid reference point.

More skilled doctors could even offer differing diagnostic or treatment opinions during the procedure, pooling their collective wisdom.

This helped prevent misdiagnoses or oversights.

Sometimes, when a patient in a department faced a crisis, a dozen doctors and nurses would swarm in. Family members often misunderstood, thinking it looked like a brawl was about to break out.

But that wasn’t the case at all.

In a hospital, if a situation turned dangerous, doctors wouldn’t confront family members en masse.

Only if a family member became violent—attacking or assaulting staff—would doctors stand together to protect female colleagues and nurses, blocking further aggression.

When rescuing a critically ill patient, having a large group of doctors and nurses rush in was twofold: it showed the value placed on the patient’s life, and it harnessed the group’s collective wisdom and strength to save that life.

This also boosted the chances of a successful rescue.

“So, how do you plan to address this now?”

Director Xueyan felt a flush of embarrassment thinking about how close she’d come to using ECMO on the patient to save their life.

Urgency breeds chaos.

Chaos clouds judgment.

Not long ago, seeing the patient’s condition deteriorate so rapidly—looking as though they might stop breathing at any moment—had genuinely rattled her.

The other chief physicians were just as anxious.

For a typical patient, if an oxygen mask proved ineffective, a respirator could be considered. But this patient’s case was unique, and everyone agreed that ECMO seemed the safest bet.

At least, that’s how it appeared at the time.

Even now, if Zhou Can hadn’t calmly analyzed the situation for everyone, reassuring them that there was no abnormal bleeding in the lungs or heart—just acute pulmonary edema—they’d likely still be as tense and frantic as before.

Every doctor present had extensive experience in emergency rescues.

They knew all too well how fragile a patient’s life could be.

Sometimes, a patient seemed fine one second, only to be gone the next.

“The patient’s heart rate is still too high. Let’s administer another 10mg of morphine intramuscularly for sedation, then use cardiotonic and diuretic drugs to manage the acute pulmonary edema. Also, we must reduce the input of crystalloid fluids—this likely contributed to the sudden onset of edema.”

As Zhou Can spoke, he glanced at the Head Nurse.

While doctors issue medical orders, nurses bear the responsibility and duty to double-check medications.

If during care, they’d been a bit more attentive to this patient and reported any early warning signs to the attending doctor, the acute pulmonary edema might not have escalated so suddenly.

Of course, Zhou Can couldn’t directly blame the nurses.

Such words couldn’t be voiced outright.

“Understood. Moving forward, I’ll pay extra attention to this patient during care.”

The Head Nurse wasn’t clueless; she immediately grasped the implication in Zhou Can’s words.

Rising to the position of Head Nurse meant she had sharp instincts.

“I’ll have to trouble Mr. Chang with this. Once the patient’s condition stabilizes, I’ll treat the sisters at the Nurse Station to some milk tea.”

Zhou Can was pleased with the Head Nurse’s response.

All he wanted was a committed attitude.

With only two head nurses in the ICU, and one stepping up, that was assurance enough.

“Director He, there’s one more thing to note. When turning this patient, we must be extremely cautious. After a unilateral pneumonectomy, mediastinal shift can easily occur over time, especially since this patient’s pulmonary edema is severe, making it even more likely.”

Zhou Can then addressed the ICU’s chief physician with this reminder.

Director He, newly promoted after two previous chief physicians jumped ship, held the title of associate chief physician. He now served as the overall head of the Cardiothoracic Surgery ICU.

He was diligent in his work, though his skills didn’t quite match those of the two directors who’d left.

Those two had since returned, but the role of ICU head no longer belonged to them.

In the adult world, mistakes come with consequences.

After a unilateral pneumonectomy, the positioning for lying on one side requires specific care.

Think of it this way: normally, two lungs fill the chest cavity perfectly. Remove one, and a void is left.

When the remaining lung shifts toward the center, it can cause mediastinal displacement.

This isn’t something to brush off.

Severe mediastinal shift can compress surrounding structures against the healthy bronchus.

For younger patients in their twenties or thirties, whose bronchial walls are softer, this compression can lead to narrowing or deformation, resulting in respiratory distress from airway obstruction.

Experienced doctors often refer to this as post-pneumonectomy syndrome.

Interestingly, this syndrome occurs more frequently after right-sided pneumonectomy.

If it does happen, it’s like curing one ailment only to create another.

In such cases, with the patient struggling to breathe, the ideal solution is often placing a stent in the compressed, deformed bronchus.

Though this patient is older, with harder bronchial walls compared to younger individuals, and the left lung was removed rather than the right, there’s still a chance of post-surgical syndrome.

Especially with acute pulmonary edema causing the remaining right lung’s volume and weight to increase dramatically, inadequate clinical care could trigger a second condition in the patient.

Following Zhou Can’s treatment plan, after a series of administered drugs and rescue efforts, the patient’s condition gradually improved.

Everyone let out a long sigh of relief.

The atmosphere in the ICU lightened considerably.

Whether doctor or nurse, having no life-threatening patients to worry about felt like a small slice of ease and happiness. Especially during night shifts, nurses dreaded both a flood of new patients and crises with those already admitted.

The medical profession is a tough one to swallow.

It’s exhausting, risky, and above all, mentally draining.

“Looks like bringing Dr. Zhou in for a consult was the right call. He performed the surgery, so he knows the patient’s condition best. I was worried it might be a pulmonary embolism!”

Director He chuckled with relief.

“Lao He, don’t feel bad—I was leaning toward pulmonary embolism too. If the family hadn’t objected, I would’ve pushed for ECMO right then. Thankfully, it was just a false alarm.”

Hearing this, others broke into smiles as well.

Seeing a critically ill patient pulled back from the brink filled everyone with a sense of accomplishment and joy.

“Zhou Can, are we still on for those two major surgeries tonight?”

Director Xueyan was more focused on the next task at hand.

With the crisis handled, new challenges awaited her.

For a department to stay strong, it had to tackle tough cases day after day.

To this day, Zhou Can remained the sharpest scalpel in Cardiothoracic Surgery, bar none.

When it came to surgical prowess, he was undeniably the best.

Steady Scalpel Technique, Rapid Surgical Technique—he could wield both with ease.

Blending the two, he handled them with finesse.

Whether it was suturing, hemostasis, ligature, or anatomy, there was hardly a skill he didn’t excel at.

Finding a surgeon with such a comprehensive skill set was near impossible.

The late Dr. Hu Kan had far surpassed Zhou Can in steady scalpel work. But in other areas, he was mostly at a chief physician level, and some of his surgical skills remained at associate chief level until his passing.

“Of course we’re doing them! I’ll be there on time after my shift.”

Zhou Can’s fighting spirit was palpable.

His enthusiasm drew a round of amused smiles from the group.

Right now was a critical moment of quiet competition with Third Hospital. Zhou Can was determined to pile on the pressure. The more high-difficulty surgeries he performed, the better his reputation grew, and the heavier the burden on Third Hospital became.