Chapter 101: A Test of Skills and Consequences

The low level of his initial Orthopedics technique likely stems from the lack of any fundamental background in orthopedics.

Tissue Separation and Anastomosis are both rated at Level 3 from the start because they are advanced techniques developed from the basic surgical methods of incision, suturing, and ligation.

Meanwhile, his Bone Fixation Technique shows no underlying surgical foundation.

Yet, he managed to successfully set a broken bone on his first try. It was due partly to exceptional talent and partly to the interconnected nature of all medical arts. His four core surgical skills were already at an attending level, allowing him to grasp similar techniques by analogy.

His bone-setting skills far surpassed what a true novice could ever achieve.

“Orthopedics is an inescapable branch of surgery with countless applications. Now that I’ve acquired this skill, I’ll gradually work on upgrading it,” he thought.

Zhou Can had always been one to prepare in advance.

Rather than constantly begging for help during surgeries, he decided it better to learn as many techniques as possible.

The field of surgical operations is divided into extremely detailed disciplines, and a truly versatile doctor is almost non-existent.

Complex surgeries typically require multidisciplinary collaboration.

For instance, when a rib is completely fractured and poses a risk of puncturing the heart or other vital organs, a chest-opening fixation surgery might be necessary.

In such cases, cardiovascular surgeons and orthopedists often work in tandem.

For every new skill Zhou Can acquired, the likelihood of needing to rely on others during future operations decreased.

Moreover, the various techniques are intricately interconnected, each complementing the other. Expanding his repertoire greatly enhanced his overall surgical proficiency.

……

“Teacher, do you think the phalangeal fixation is acceptable?”

“Yes, it’s excellent. Hurry up and complete the remaining parts of the surgery!”

Dr. Xu nodded in satisfaction.

Achieving this level on his first try was already impressive.

However, in a replantation surgery, properly aligning the broken finger bones is only the first step.

Next come the challenges of tendon suturing, vascular anastomosis, and nerve anastomosis. Any misstep could doom the surgery.

Fortunately, Zhou Can was fully capable of handling these tasks.

Tendon suturing primarily tests one’s ability in both suturing and ligation, as well as the knowledge of tendon repair.

An average resident could manage this with ease.

Zhou Can’s mastery in these techniques, already at an attending level, allowed him to suture a severed tendon impeccably.

After nearly forty minutes, both the tendons and blood vessels had been successfully connected.

A circulation test showed that within less than thirty seconds, a hint of pink returned to the severed finger.

Perfect.

Dr. Xu, now completely reassured, smiled and returned to his own work.

Zhou Can continued with the nerve anastomosis and skin suturing.

After over an hour of effort, the replantation surgery was finally a success.

He gained additional surgical experience.

And he acquired a new orthopedics technique.

That steady progression felt incredibly rewarding.

The growth of a great physician is measured step by step through countless surgeries, resuscitations, and accumulated diagnostic experience.

One operation led to another.

Throughout, Nurse Tian Tian occasionally chatted with Dr. Lu and Li Shishi.

She had wanted to talk with Zhou Can, but he was so absorbed in his serious work that he barely noticed.

After a few uninteresting attempts at conversation, she shifted her focus.

Around three in the afternoon, a patient requiring trauma suturing arrived—a young boy of only nine and a half, with a cut on his chin from a fall.

Tears still stained his face, barely dry.

At that age, children are naturally mischievous, constantly climbing onto roofs and playing in the mud.

Roughhousing and falling are part and parcel of their daily lives.

Given that the suturing had to be done on his face—and on a child—the precision required was very high.

Dr. Xu then entrusted the case to Zhou Can.

Dr. Lu’s suturing was too careless; leaving an unsightly scar on the child’s chin could affect him for life.

Zhou Can had long studied the Invisible Suturing technique under Dr. Xu.

In the past, his lower suturing skills had prevented him from trying it.

Once his abilities reached an attending level, he began seeking opportunities to apply Invisible Suturing.

Through practice and numerous consultations with Dr. Xu, he mastered it quite well.

After taking on the case, Zhou Can first reviewed the child’s test reports.

There was no bone damage; it was purely a soft tissue injury.

That was a relief.

The bleeding was minimal, indicating no major arterial involvement.

This surgery amounted to a minor debridement.

Meanwhile, Nurse Tian Tian and Li Shishi were happily chatting.

Nobody knew why she was especially cheerful today.

She mentioned that she was on track to pass the intermediate nurse certification with high hopes.

Typically, nurses have a different promotion path than physicians. After one year’s work, they could qualify for the junior nurse certification; four years later, they could aim for the intermediate level.

Her chance to qualify for intermediate certification as early as next year meant she’d already been working for at least five years.

No wonder Qiao Yu always got pushed around by her.

“Local anesthetic, please!”

Zhou Can had to remind her.

“Coming right up!”

Nurse Tian Tian smiled as she quickly prepared the anesthetic and handed it over to Zhou Can, who was meticulously examining the child’s wound.

Because the wound was covered in blood clots, it was impossible to assess the injury clearly.

Only after administering the anesthetic and thoroughly cleaning and disinfecting the wound could the best suturing plan be devised.

Zhou Can casually accepted the pre-mixed anesthetic and injected it around the child’s chin injury.

With his attending-level technique in injections, he executed the local anesthesia far better than most other attendings.

However, shortly after the injection, the bleeding from the wound suddenly increased.

The child cried out with a headache, chest discomfort, and rapid, shallow breathing.

This development truly frightened Zhou Can.

After the previous incident with Jin Mingxi, he was well aware of the consequences of such mishaps.

“Teacher, after the local anesthetic, the child is showing multiple abnormal signs. Could he be allergic to the anesthetic?”

Zhou Can was experiencing such a situation for the first time and became momentarily flustered.

He quickly sought help from Dr. Xu.

“What was the dosage used?”

“About 20mg!”

Zhou Can had injected only a halved dose of the superficial anesthetic for the child.

“Which anesthetic was it?”

Dr. Xu glanced at Nurse Tian Tian.

At this moment, Nurse Tian Tian maintained a calm demeanor. In emergencies, nurses typically bear little blame when doctors are in charge.

Unless negligence on the nurse’s part can be proven, the responsibility always falls on the doctors.

The biggest risk for a scrub nurse in major surgeries is failing to account for materials such as gauze or vascular clamps left in the patient.

In such minor operations, the likelihood of a nurse’s mistake is extremely low.

Thus, Nurse Tian Tian remained cool and detached about the incident.

“It was Dikain! It was strictly diluted with saline at the proper ratio,” she replied.

Almost as she finished speaking, the child’s condition deteriorated rapidly.

Every surgery carries risks.

In dangerous moments, sometimes neither doctors nor nurses have time to react.

The situation had become extremely perilous.

“Dikain almost never causes severe allergic reactions. Procaine, however, requires an allergy test before use,” Dr. Xu said, his brows knitting into a deep frown.

Allowing Zhou Can to conduct the surgery independently technically violated hospital regulations.

But as long as the mentor was willing to take that risk, it could be justified procedurally—at least there was no legal liability.

If nothing went wrong, there would be no issues.

After all, if the public doesn’t speak up, the authorities won’t pursue.

Yet, with the child’s condition this grave, even the experienced Dr. Xu couldn’t immediately pinpoint the problem.

Without knowing the exact cause, precise rescue was impossible.

Time was of the essence.

Every second of delay exponentially increased the risk of the patient’s death.

Beads of sweat formed on Dr. Xu’s forehead as his piercing gaze scrutinized the child’s symptoms.

“The sudden surge in bleeding suggests the patient’s heart is contracting more forcefully, meaning his blood pressure has likely spiked. Take his blood pressure immediately.”

After measuring, it read 190/110 mmHg—an alarmingly high systolic pressure.

Such a sudden spike indicated that his heart was pumping at a pace well above normal.

“Teacher, could it be that the anesthetic is the culprit?”

Zhou Can quickly regained his composure amidst the chaos.

His focus now wasn’t on the potential suspension or even legal repercussions,

but on finding the cause and saving the child by any means.

Zhou Can’s diagnostic acumen was remarkable. After checking the blood pressure and linking the chain of events, he was convinced the abnormality occurred right after the anesthetic was administered.

“Show me the anesthetic bottle.”

Dr. Xu, with his extensive experience, suspected the anesthetic might be at fault.

Nurse Tian Tian immediately bent down to search for the anesthetic bottle.

Her face briefly showed a flicker of anxiety.

Then she produced a bottle.

“Here, this is the bottle,” she said, though her eyes darted evasively and her complexion betrayed her unease.

Having worked with her for so long, Zhou Can knew she was manipulative.

He didn’t trust her words and instead bypassed the operating table to crouch by a small trash bin.

Inside were many discarded bottles, mostly those of local anesthetics.

One bottle, however, was buried beneath the others yet bore slight differences from the rest.

Sensing something was amiss, Zhou Can prepared to retrieve it.

Nurse Tian Tian, though her face turned pale, maintained a facade of concern as she said, “Dr. Zhou, be careful—those glass bottles are broken and could cut you.”

Without a word, Zhou Can used one bottle to carefully pry open the pile and extract the bottle beneath.

At that moment, Nurse Tian Tian’s face went even whiter, though she struggled to remain composed.

“Isoprenaline!”

Zhou Can stared at the label on the bottle and suddenly understood. He nearly wished he could curse Nurse Tian Tian’s entire lineage.

What do you call a venomous, scheming woman?

Nurse Tian Tian was exactly that.

“I never used Isoprenaline in today’s surgery. Where did this bottle come from?”

Zhou Can asked her icily.

Dr. Xu, who had seen his share of tricks and deceptions over the years, locked his icy gaze on her.

“I-I don’t know. Perhaps it was left by the doctor on the night shift yesterday?”

Nurse Tian Tian continued to stammer in her defense.

If it weren’t for her gender, Zhou Can might have slapped her outright for lying at such a critical moment.

At a time like this, she was still trying to cover her tracks instead of addressing the life-threatening situation.

She only feared punishment for admitting her mistake, ignoring the dire risk to the patient’s life.

One could hardly believe there existed a woman so vicious and foolish.

Her once-beautiful face now evoked nothing but disgust.

“Isoprenaline enhances myocardial contractility, accelerates heart rate, and dilates peripheral vessels and smooth muscles. Clinically, it’s used for treating bronchial asthma, cardiac arrest, and shock. It’s a standard emergency drug in the operating room,” Zhou Can coldly explained the drug’s purpose.

It didn’t really need an explanation, as she was a professional and surely knew its use.

Otherwise, she wouldn’t have so deliberately hidden that bottle among the others when searching in the trash bin.

Dr. Xu nearly pieced together the cause of the mishap.

There were many things that couldn’t be said in front of the patient.

He quickly led Zhou Can and Nurse Tian Tian into the changing room outside.

“Nurse Tian Tian, a life hangs in the balance. Did you mistake this drug for the anesthetic?”

Dr. Xu’s face was so grim that it seemed to drip venom, his eyes terrifying.

“I—I didn’t even think that could happen,” she stammered, still evading the truth.

At this point, her evasiveness was inexcusable.

This woman was both stupid and malicious.

For medical professionals, a lapse in ethics spells disaster for both patients and the hospital.

They were like ticking time bombs, liable to explode at any moment.

“I’ll ask you one last time—did you or did you not make a mistake?”

Dr. Xu rarely barked orders at a female nurse, but his fury was now unrestrained.

This idiotic woman had no idea how serious the consequences could be; she might well jeopardize not only Dr. Xu and Zhou Can but also this child’s life.

Even if the child survived, how would the parents ever be satisfied?

To suture a minor wound and then ruin a child’s future—no parent would ever accept that.

They could only draw blood for tests and determine a rescue plan later,

while time slipped away like wilting chrysanthemums.

“Yes! I did make a mistake. I was chatting with Li Shishi and the others, and Dr. Zhou suddenly urged me. In my lapse, I grabbed the wrong bottle,” she finally admitted as Dr. Xu glared menacingly at her.

“What can I say about you?”

Emergency drugs and anesthetics are always stored separately.

I can’t fathom how your mind could have wandered off to commit such a grievous error.

“Immediately administer 100mg of an alpha receptor blocker to mitigate the drug’s toxic effects!”

Upon identifying the cause of the child’s distress, Dr. Xu quickly set forth a rescue plan.

Alpha receptor blockers are especially effective against Isoprenaline. Some patients naturally produce these blockers, rendering Isoprenaline ineffective.

After a series of emergency measures, the child’s condition gradually improved.

Dr. Xu let out a long sigh of relief.

This incident must be reported to higher authorities as per protocol.

“Little Zhou, continue suturing the wound while I make the report,” he instructed.

Dr. Xu, only at the attending level, needed to report the incident to Director Lou, who in turn would notify the relevant departments.

Fortunately, the outcome wasn’t catastrophic. Once the matter reached the Medical Department, it would likely blow over.

Experienced doctors would be assigned to explain the situation to the child’s parents.

Sometimes it’s even better when the family lacks medical knowledge.

For a sudden incident like this, if the explanation was reasonable and the child wasn’t seriously hurt, most parents would accept it.

Of course, they wouldn’t explicitly say that a drug mix-up occurred.

Nurse Tian Tian was immediately removed from surgical duties.

Li Shishi was temporarily called in to assist Zhou Can, while Dr. Lu ceased performing independent surgeries.

……

After suturing, the child’s wound was well managed.

Thanks to the timely rescue following the drug error, the child was out of serious danger.

In the end, the outcome was acceptable.

That was the only comforting aspect.

The incident was not over yet.

A designated person handled discussions with the family, and they eventually accepted the hospital’s explanation before taking the child home.

Inside the Emergency Department office, Director Lou’s face was as grim as ever, and Dr. Xu looked equally dismal.

Zhou Can treaded carefully, while Nurse Tian Tian kept her head down, fiddling with her uniform.

Soon, the supervisory nurse in charge of Nurse Tian Tian and the head nurse of the Emergency Department Nurse Station also arrived.

“Today’s medical incident was completely unacceptable. Due to scrub nurse Tian Tian’s negligence and complacency, we nearly encountered irreparable consequences. Our Emergency Department Operating Room was even in contention for an award this month. Now, not only is recognition out of the question, but we’re also bound to face stern criticism and penalties from higher-ups.”

Director Lou, known for his short temper, pounded the table in anger.

“Director Lou, please calm down. Nurse Tian Tian’s severe mistake is indeed inexcusable. I promise to reinforce her training,” the supervisory nurse said, clearly trying to defend her subordinate.

Doctors, too, were similarly inclined to protect their own.

After all, many in the medical field—both doctors and nurses—make errors.

Without intervention from senior staff, the survival rate of erring nurses was less than ten percent.

Whether it was Director Lou, Director Tan of the Internal Medicine Department, Dr. Xu… all the big shots in the hospital had made countless mistakes.

No one could even recall the exact number.

Because there were simply too many.

Sometimes it was beneficial for interns and residents to be scolded—it only taught them to learn from their mistakes.

“This incident should serve as a warning to every nurse. I will convene a safety meeting as soon as possible and use this case as a model to stress the importance of strict adherence to safety protocols,” the head nurse said, seated—a sign of her high-ranking position.

Being appointed head nurse essentially meant one had reached the level of a senior nurse, a position requiring substantial expertise in both care and management.

Director Lou’s mood eased slightly.

“Nurse Niu Lan, what action should we take regarding Nurse Tian Tian?” Director Lou asked, showing respect for the head nurse.

“Deduct this month’s bonus, cancel her eligibility for the annual award, and have her write a sincere self-criticism. Does that suffice?”

Nurse Niu Lan’s name was indeed unique, as such a name would never be chosen by ordinary parents due to its phonetic similarity to another word.

She spoke steadily, unhurried yet composed, humble yet resolute.

“Yes, I believe these sanctions will thoroughly impress upon her the gravity of her mistake.”

Director Lou expressed his approval of her decision.

With that, the matter was essentially concluded.

Responsibility had been assigned solely to Nurse Tian Tian.

“That’s all for now. Get back to work, everyone,” Director Lou ordered.

Zhou Can deeply felt the art of leadership.

Just moments ago, Director Lou had been like a raging storm, slamming his fists on the table, but now he calmly lifted his hand as if to cool a simmering fire.

It was clear he was setting a stern example for the Emergency Department Nursing Division,

to ensure no further blunders would occur.

“Nurse Niu Lan, please wait. I need to discuss something with you in front of Director Lou and Dr. Xu.”

After waiting for so long, Zhou Can finally had his chance.

Originally, he thought he’d have to wait two or three months until he had mastered most of the primary and secondary surgeries before bringing up the matter.

But Nurse Tian Tian’s reckless act had blown everything up.

It truly lived up to the saying: if fate decrees your downfall, it will come in a spectacular fashion.

Perhaps Nurse Tian Tian was in high spirits after having put Qiao Yu in his place yesterday,

and in her elevated mood she ended up chatting with Li Shishi and Dr. Lu about her prospects for the intermediate nurse certification.

She felt her future was brilliant and everything was going smoothly.

In her overconfidence,

she ultimately made a careless, easily overlooked error.

Zhou Can couldn’t help but worry that if she ever returned to the operating room, he’d once again be saddled with the role of her assistant—a situation he dreaded.

So he decided to seize this opportunity to help Qiao Yu advance, even if it meant stepping on a few toes.