Chapter 630: Blood Vessels and Instincts: The Hidden Hand in the Operating Room

There wasn’t much blood pooled inside the cranial cavity.

Typically, bleeding during a craniotomy has two main sources: either the patient had an intracranial bleed before the surgery, forming a collection of blood, or the bleeding occurs during the operation itself, caused by the incision.

Zhou Can’s incision technique was already at a chief surgeon’s level, but his surgical intuition was almost unbelievably sharp.

He could distinguish every blood vessel, nerve and tendon in his way without fail.

This kind of tactile sense isn’t something ordinary surgeons possess. Only those with extreme surgical experience and who have reached the level of chief physician with their skill might have it.

The benefits of this kind of intuition were obvious.

It let the surgeon minimize blood loss during any operation.

Whenever Zhou Can performed major surgeries, his ability to control bleeding always made other doctors green with envy.

Other surgeons might end up with at least 300 milliliters of blood loss during an open-abdomen procedure.

But if Zhou Can held the scalpel, not only did he move with lightning speed, his surgeries left barely a trace of blood. For open-abdominal operations, he could usually keep bleeding below 100 milliliters. In fact, it was often under 50.

And that wasn’t just for simple incisions—he could control bleeding just as well when removing abdominal tumors or even partial organs.

For most doctors, this sort of precision was almost unimaginable.

Because achieving this level of minimal bleeding is nearly impossible.

So, it’s fair to say that surgical skill isn’t just about technique—it’s just as much about real experience.

Before removing any lesion, Zhou Can could clearly anticipate which major vessels would be nearby and made sure to either clamp or ligate them in advance. As for smaller vessels, he’d just cauterize them right on the spot.

“Found the source—it’s a ruptured artery.”

Once the pooled blood was suctioned away, the bleeding point came into clear view.

Of course, for Zhou Can, tracking down the source was second nature. He barely had to try to find it.

Anyone else would have struggled—except maybe a specialist like Wu Baihe, a true chief physician in neurosurgery. Your run-of-the-mill surgeon would be out of their depth here.

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Watching is always easier than doing.

Zhou Can made surgery look effortless, but if any of the other doctors in the room had to step in, they’d likely have faced chaos—a room full of tension and stressful problems.

To have a surgeon like Zhou Can or Wu Baihe as the lead in one of these life-and-death operations? That’s pure luck for the patient.

This time, Zhou Can didn’t even bother to check with Wu Baihe. He just cauterized the bleeding site immediately.

The artery wasn’t large and its pathway could easily be replaced.

After cauterizing this small artery, the blood flow along it was blocked. But there was nothing to worry about—the human body’s massive vascular network meant that other vessels would take over in no time, spreading like roots throughout every corner of the body.

With this artery blocked, nearby smaller arteries would step up and handle the blood supply.

A new route wouldn’t take long to form.

But for the bigger blood vessels, you couldn’t just cauterize or tie them off. Sometimes, you had to find a way to repair them.

Major arteries are like the main roots of a tree—cutting even one can have serious consequences.

It’s tough for the body to develop alternate circulation quickly when a major vessel is lost.

That can lead to ischemia, where organs and tissues are starved of oxygen, risking rapid death or severe loss of function.

“Hmm, this vessel here looks narrowed, almost blocked.”

Zhou Can’s observation caught everyone’s attention.

They all turned to the monitor. All they could see was the blood-red intracranial tissue—the brain itself was visible as white—but the blocked vessel remained hidden.

Wu Baihe never took his eyes off the screen.

He’d been assisting Zhou Can throughout the operation.

His job was mostly to gently retract certain parts of the brain, giving space for Zhou Can to work.

No matter how hard Wu Baihe looked, he just couldn’t spot any problematic vessel.

“Where is it?”

He had to swallow his pride and ask.

Don’t assume top chief physicians don’t care about their reputation—their pride in their field and status means everything, especially in their area of expertise.

After dedicating decades to a profession, anyone would take pride in their achievements.

They were all looking at the same thing with unaided eyes. Zhou Can had far fewer years in medicine than Wu Baihe, but he saw a problem that Wu Baihe missed. Of course, that stung a little.

To make things worse, part of Wu Baihe’s team was right there, too.

Doctors and nurses alike—all of whom normally idolized and revered him—were watching.

To lose face in front of his own people? That was rough.

“Honestly, I’m only guessing here. But does this patch of gray matter look off to you?”

Zhou Can gently moved aside part of the brain to give Wu Baihe a clearer view.

He said this just to help Wu Baihe save face.

What surgeon would really just guess whether a vessel had gone bad mid-surgery?

Frankly, most couldn’t even guess if they tried.

Wu Baihe studied the area of gray matter carefully—soon, he caught on.

“There’s atrophy, maybe even some degeneration… Looks like the area’s not getting enough nourishment. If we analyze from an anatomical perspective, only one main artery supplies this piece of gray matter, and there are two main veins draining it…”

As he spoke, a sudden realization lit up Wu Baihe’s eyes.

Of course—the trouble was with the artery serving that patch of gray matter.

It hit him then: Zhou Can was giving him an out, helping him save face.

“Enlarge the patient’s head scan. In hindsight, running an ultrasound would’ve given us a better look, but a CT will have to do for now.”

The strength of ultrasound was its ability to show blood flow in real time.

When it came to checking blood vessel flow, it was actually more precise and diagnostic than plenty of high-tech equipment.

Some younger doctors put too much stock in the crystal-clear images of MRI, fascinated by the technology.

But honestly, that mindset isn’t exactly practical in clinical settings.

Ultrasound, CT scans, X-rays—each has its purpose; if these have stood the test of time, there’s value to their use.

An ultrasound only costs about a hundred yuan for the patient—but a full MRI can cost what, several hundred at minimum?

The price goes way higher for top-tier scans, sometimes over two thousand yuan.

For checking if a vessel is clear, aside from CT angiography, nothing really beats ultrasound for clear, direct information.

Wu Baihe stared closely at the patient’s CT scan of the head.

“Zoom in here again.”

After enlarging, he stared for a while, but wasn’t confident in his assessment.

“The patient had an MRI done at the external hospital, right? Let’s take a look at that as well.”

He was nothing if not meticulous.

Even after Zhou Can’s tipoff, Wu Baihe still wanted to back his findings with additional data. That sort of caution was second nature to old-school doctors.

In a word: caution.

Why is that?

Because so many senior doctors have been sued by patients and their families. When it comes to court, evidence is everything.

If a doctor stands up and states their case without hard proof, nobody’s going to buy it.

That’s why they need to show scans or tests as the basis for treatment, telling the judge or medical officials, “I made my decision based on clear data and followed proper protocol.”

The administrative higher-ups see that and nod.

Once it’s established there was no negligence, the doctor almost always wins.

Surgery has strict indications for when it’s appropriate.

No surgeon can simply decide to operate based solely on suspicion that a specific artery in the brain has an issue.

That would be completely against the rules.

You have to pinpoint the problem on imaging first, then plan your surgical approach.

Missing the issue before surgery—that’s what we call a missed diagnosis.

But honestly, that’s very common in clinical surgery.

Some lesions are just so well-hidden that even the most experienced doctors struggle to spot them.

That’s why there’s something called intraoperative exploration.

It means probing the target area during surgery to be absolutely sure.

This shows just how much authority a surgeon has once the operation starts. The rules are fairly strict before surgery, but once you’re in, things loosen up a lot.

It’s almost like there’s a strict admissions process, then once you’re through the door, you’re free to act.

That’s basically the implicit rule in today’s operating rooms.

Still, in recent years, stricter oversight has entered the picture. For example, everyone—the nurse, anesthesiologist and surgical assistants—has to sign off at stages, and every part of the procedure must be recorded.

If documentation isn’t up to scratch or there’s cover-up, and it gets discovered, everyone involved—the surgeon, nurses—gets held accountable.

Even the hospital itself can be penalized.

But at the end of the day, hospitals stick up for their own—they tend to handle issues behind closed doors. Real transparency in the operating room? Almost impossible.

It’s like parents wanting live cameras in kindergartens so they can watch the teachers every second. What school would ever agree to that?

“County hospitals really are unreliable. Can’t even manage a proper MRI scan. Their Medical Technology Department doctors need retraining,” Wu Baihe grumbled.

He kept complaining about the poor MRI from the county hospital.

Nobody said a word.

A few people, though, were holding back laughter.

“The scan’s a little fuzzy, but you can still just make out that this vessel really is narrowed—and it’s pretty serious. It’s not a big vessel, just a minor artery, and usually the blood flow demands here are low. Still, issues like this can cause problems. Looks like we overlooked it before the operation. Director Zhou, how do you plan to handle the narrowed artery?”

Now that they’d found the issue, they had to fix it.

There were two options.

Even Zhou Can hesitated for a moment.

“Placing a vascular stent would be safer and quicker, but more expensive. Replacing this section of artery would be cheaper, but far riskier, more complex and harder on the patient. Given how frail the patient is right now, I think the stent is the better bet.”

After deep consideration, he favored the safer, even if costlier, treatment.

That was basically every doctor’s choice—to avoid mishaps at all costs.

After all, nobody ever wants things to go wrong.

“I agree, placing a stent is the way to go. Attending Nurse, please get one ready as Director Zhou requires.”

“On it.”

The Attending Nurse checked with Zhou Can for the specific size and length, then got on the phone to track one down immediately.

“Director Wu, I’ll do a quick check here. If all looks good, I’ll wrap up the endoscopic surgery,” Zhou Can said.

“Okay.”

Wu Baihe nodded.

Zhou Can couldn’t help but feel relieved—thank goodness he hadn’t gone straight to exploring the brainstem.

Who would have guessed? The culprit wasn’t the brainstem, but the grey matter.

The bleeding was in the patient’s hypothalamus, which raised pressure inside the skull and put further stress on an already narrowed artery. That almost completely cut off blood supply to that spot of grey matter—and that, more than anything, was why the patient wouldn’t wake up.

Now the truth was finally out in the open.

Next up was the interventional procedure—placing a stent to open up the nearly blocked artery.

“Director Qu, any changes in the patient’s brainwaves?”

Zhou Can still wanted to make sure before removing the endoscope.

“Brainwaves are a bit livelier, starting to recover, I think,” she replied.

“In patients under general anesthesia, brainwaves are usually pretty calm. But now that we’ve suctioned out the blood and stopped the bleeding, the intracranial pressure is dropping. That’s letting the artery spring back and restoring blood flow.”

The grey matter, which was barely functioning, was coming back online.

“Looks like we were right—the grey matter really was to blame.” Zhou Can finally felt confident.

……

Interventional surgery was where Zhou Can excelled.

The whole stent procedure took less than twenty minutes.

Once it was done, that severely narrowed, almost blocked artery was wide open again and blood flow was restored.

After the anesthesia wore off, the good news arrived.

The patient woke up from the coma.

This high-risk, complicated brain surgery was finally a complete success—and Zhou Can felt he’d gained deeper insight into cranial and neurosurgical operations.

He understood now, more than ever, that medicine was a journey without end—there was always more to learn.

“Director Zhou, can I ask—how did you realize that artery was in trouble during surgery?”

A neurosurgeon in his forties—with more gray than black in his hair and a steady look—came to Zhou Can after the operation, seizing a chance to ask.

Watching Zhou Can operate today had shocked him to his core.

It was the first time he’d seen surgical skills like that in action.

From craniotomy to hemostasis, lesion detection and endoscopic work, Zhou Can’s every move had opened their eyes. But most impressive? The way he spotted that faulty artery.

He recalled—only a small patch of grey matter had been visible at first.

He thought there was a slight possibility of inferring arterial disease from the brain tissue, but barely.

Even their mentor, Wu Baihe, had to personally move the brain tissue and stare at it a long time before coming to a diagnosis.

“What if I said it was just a feeling—would you believe me?”

Zhou Can glanced at the doctor.

Many graying doctors in the clinic—the stress of their studies, research, exams and patient care—took a heavy toll.

Sometimes, when taking on a critically ill patient, it’s not the family who worries most—it’s the doctor.

Every doctor who goes gray by their thirties or forties deserves respect.

They throw themselves into medicine, giving everything they have to help advance the field and humanity, even in the smallest way.

“I believe you! But can you maybe explain it a bit more? I’d love to have that sense too!”

Once he finished speaking, the other doctors—and even the nurses—crowded around, treating Zhou Can like a celebrity.

“Once you’ve had your answers from Director Zhou, head home and get some rest, everyone. Thanks for your hard work today. I’m too old, so I’ll be heading home to sleep first,” Wu Baihe said, unable to hide his embarrassment.

He’d been there as backup for Zhou Can all through the operation.

He’d even brought most of his best team to help out.

But it ended up as Zhou Can’s show.

He wasn’t exactly jealous, but his authority had definitely taken a hit.