Chapter 148: A Desperate Battle in the OR

‘Not started yet!’

Dr. Zou and Tang Li responded in unison.

Attending rounds usually begin after 7:40, though the time isn’t fixed; they can be flexibly scheduled based on the attending physician’s personal routine.

In principle, rounds should occur once every morning.

At night, only the on-call doctors handle patients.

On one hand, there’s a shortage of staff; on the other, on-call doctors are often junior and lack experience and skill.

This sometimes results in critical emergencies not being managed properly.

Morning rounds allow attending physicians to catch oversights and prevent risks from escalating.

‘Alright then, hurry with the rounds. The first surgery starts promptly at 8:30 AM. There might be no break – you’ll need to complete both surgeries back-to-back today. At 4 in the afternoon, I’m taking three postgraduates for a research experiment, leaving you in charge.’

Many department professors also have teaching duties.

Some even work part-time at the hospital.

Besides managing their own projects and research, they also teach at universities.

They are incredibly busy.

…

The two attending physicians split up during rounds.

Zhou Can accompanied Tang Li along with one resident and three postgraduates as they made their rounds.

Dr. Zou took two more senior residents to check on the beds under his care.

Every bed in the General Surgery Department is assigned to a doctor. Some interns oversee two to three beds, trainees typically cover about five, and dedicated residents manage between ten and fifteen.

Attending physicians keep an even larger caseload – one might be responsible for 25 to 30 beds.

It should be noted that these assignments often overlap.

For example, Zhou Can monitors beds 21–25 while Jiang Xiaohua is in charge of beds 26–31.

Their superior, Cheng Gang, is responsible for beds 21–31.

This shows that while junior doctors cover certain beds, their seniors need to check on them as well.

As a doctor’s rank increases, so does the number of beds they oversee.

At Director Wen’s level, one is often responsible for all patients in the team.

Chief-level doctors conduct rounds only once a week. Some patients nearing discharge might not even see the Chief during rounds.

‘Dr. Zhou, the number of patients in our team isn’t fixed. Since you’re new, you might not be aware of that.’

Tang Li walked ahead while briefing Zhou Can.

They say women have an uncanny sixth sense.

And perhaps that really is the case.

Tang Li clearly believed Zhou Can had a bright future, which is why she lowered her guard to befriend him.

‘Our team has two attending physicians – myself and Dr. Zou. Under normal circumstances, I manage the general ward while Dr. Zou, being more experienced, handles the ICU.’

Dividing responsibilities among the attending physicians ensures clear accountability.

It also allows better patient care by matching duties to each doctor’s skill level.

Dr. Zou is about five years older than Tang Li.

Naturally, his experience is far richer.

ICU patients are all critically ill.

Having a seasoned doctor like Dr. Zou in the ICU ensures more stable care.

‘Good morning, Dr. Tang!’

Cheng Gang had already arrived in his designated ward.

Seeing Tang Li and her team draw near, he greeted them with a smile.

‘Good morning!’

Tang Li responded in a cool, detached manner before beginning to check on her patients.

Cheng Gang’s thoughts grew complicated as he noticed Zhou Can trailing behind Tang Li.

It was obvious that transferring to Director Wen’s team had significantly boosted Zhou Can’s prospects.

That kid really hit the jackpot – why couldn’t I be this lucky?

Cheng Gang felt an undeniable pang of envy.

‘Dr. Zhou, this patient will have surgery this afternoon. Dr. Zou will lead the operation on her depressed skull fracture, though thankfully her brain remains unscathed.’

Tang Li took the initiative to brief Zhou Can about the upcoming surgery.

She wanted him to be fully informed in advance.

Zhou Can noted that the injured woman, in her thirties, had multiple bruises and contusions on her face and hands.

How did she end up like this?

It looked strikingly like a case of domestic abuse.

Her head wound was already bandaged. A nurse was expected to shave her hair two hours before the operation to prepare the incision site and check her basic vitals such as blood pressure.

‘How were you injured?’

Zhou Can couldn’t help but ask.

‘It was just an accidental fall.’

The woman’s eyes darted away evasively.

‘In this context, the fall was a blessing in disguise. Based on the tests, even a slight deterioration could have led to severe brain damage – at best, paralysis or even death.’

Zhou Can didn’t press further; he merely outlined the potential consequences.

Luck doesn’t always shine this brightly.

Domestic abuse tends to be recurring rather than isolated.

Typically, family members like parents or siblings wouldn’t be so ruthless.

It was most likely the work of her husband.

However, when Zhou Can was an intern, he had been falsely implicated in such matters, so he chose not to delve deeper.

He simply mentioned it and moved on.

The woman, already in her thirties and fully an adult, had to make her own decisions.

After checking on the woman with the skull fracture, they continued on to the rest of their assigned patients.

During the rounds, some cases were truly alarming.

However, the car accident victim slated for surgery wasn’t seen.

Presumably, that patient was in the ICU, fighting for survival.

Some injuries were too severe for immediate surgery – these patients might need prolonged ICU support before any operation could be attempted.

Then there were those with extremely complex and critical injuries.

For these, doctors must conduct multi-department consultations to formulate the best surgical plan.

After finishing the rounds, Tang Li issued new orders and adjusted medications for several patients.

Only then did she lead Zhou Can and the team into the Operating Room.

At that moment, the patient had already been transferred onto the operating table.

The Anesthesiologist was meticulously examining the patient.

Meanwhile, Dr. Zou stood by with two residents watching closely.

‘You all are moving pretty fast!’

Tang Li laughed lightly.

‘There are only a few ICU patients. Once we finish rounds, the three of us will bring the patient straight into the Operating Room.’

Dr. Zou simply shrugged.

With only twenty beds in the ICU, their team likely had just a few critical patients.

Moreover, the ICU always has an attending physician on duty, so rounds are more procedural than in-depth.

Zhou Can glanced at the patient on the operating table, noticing multiple tubes inserted everywhere and traces of dried blood.

The head appeared to be the most severely injured area.

The patient was currently in a coma.

Just then, Director Wen finally arrived.

‘How’s the patient holding up? This craniotomy might take at least four to eight hours. Can he endure it?’

Director Wen’s question was clearly aimed at the Anesthesiologist.

‘The patient’s condition is relatively stable for now. His surgical tolerance is low by my assessment, but if we don’t clear the intracranial hematoma, his life may not be saved. Prompt surgery is essential.’

The patient remained comatose, which alone underscored the gravity of his condition.

That fact alone highlighted how serious things were.

The ICU can only offer basic life support – it doesn’t guarantee survival.

Tuyu Hospital’s ICU sees patient deaths frequently.

Sometimes, three or four patients die in a single day, which is all too normal.

Of course, in some cases families insist on extubation.

After all, a day in the ICU is incredibly expensive.

For elderly patients or those with grim prognoses, spending too much on resuscitation may seem futile, prompting families to request extubation.

‘Prepare for a craniotomy to evacuate the hematoma!’

Director Wen commanded.

The accident patient’s reports indicated a severe intracranial hematoma, pointing to extensive bleeding inside the skull.

A craniotomy for hemostasis and hematoma evacuation is an aggressive but necessary treatment.

The patient was very young – just in his twenties.

Rumor had it he was involved in a high-speed crash at night, resulting in catastrophic injuries.

After reviewing the patient’s scans, Zhou Can’s outlook was grim.

The bleeding was subdural.

Typically, supratentorial bleeding of over 30ml requires surgery, and for subdural bleeding, anything above 10ml is a surgical indication.

Under general anesthesia, Director Wen selected the craniotomy site, incised the scalp to expose the skull, and immediately started the electric saw.

Shortly after beginning the incision, the Anesthesiologist urgently called for a pause.

‘Director Wen, the patient’s vital signs are dropping rapidly. If we continue, I’m afraid he won’t survive off the table.’

The patient’s blood pressure, respiration, temperature, heart rate, and oxygen saturation were all falling quickly.

These were very worrisome signs.

During a craniotomy, various complications can further jeopardize the patient’s condition.

At that moment, the patient looked like a candle in the wind.

Even a slight gust could extinguish the flame.

Director Wen’s face was as grim as stone.

Critical patients in Neurosurgery are notoriously difficult to save; not only are complications common, they occur quite frequently.

Doctors always strive to minimize surgical mortality.

This is crucial for evaluations and personal reputation.

Imagine a chief doctor performing a hundred surgeries and losing seven or eight patients – who would trust that doctor to operate again?

Even though the hospital knows those patients were critically ill,

in performance reviews, a high death rate will be publicly criticized by the vice president or even the president, with warnings or reduced surgical privileges imposed.

Excessive mortality impacts not only the doctor and their team, but also the hospital’s overall assessment.

‘It seems the patient’s condition is even more severe than I thought. This case is going to be tough!’

Director Wen watched the rapidly declining vitals on the monitor, a sense of dread rising within him.

Even if the surgery were halted and the patient sent back to the ICU, survival would remain uncertain.

‘We have to evacuate the intracranial hematoma, or he won’t make it. Traditional surgery is undeniably traumatic. I’ve already prepared a backup plan.’

Director Wen had, in fact, prepared for two scenarios.

No wonder he remained so calm even in crisis – his preparation was impressive.

‘Let’s perform a burr-hole endoscopic procedure! It might be our only chance to save him!’

The endoscopic procedure requires only a small drill hole, which minimizes trauma.

However, compared with traditional surgery, the endoscopic approach is technically very demanding.

Tuyu Hospital’s Neurosurgery Department is notably short on experts for this technique.

Director Wen’s own skill in advanced procedures is rather average, which is why he initially favored a traditional craniotomy.

Traditional surgery favors a wide field of view.

The entire process is straightforward and direct.

Endoscopic surgery, on the other hand, tests a surgeon’s dexterity to its limits.

‘Endoscopic surgery… It isn’t our strong suit. Given the patient’s subdural bleeding, this operation is extremely challenging. Could it be…’ Tang Li hesitated.

Both she and Dr. Zou looked worried, their brows furrowed with concern.

‘Even if we’re not experts, we have no choice. If needed, we can always call on Director Zhang from the Obstetrics Department – she’s renowned for her minimally invasive techniques.’

Director Wen had already planned an alternative route.

It’s common practice to seek help from other departments for critical or complex cases.

In this case, they first drilled a 1cm opening in the skull to create a bone flap, then made a cross incision in the dura.

Throughout the procedure, Director Wen proceeded with utmost caution.

Even as the patient’s vitals continued to drop, he dared not stop.

Every second was critical in the race to save his life.

Fortunately, his extensive surgical experience allowed him to accurately pinpoint the hematoma based on CT images.

Next came the most crucial step.

A 6–8mm diameter rigid endoscope had to be inserted directly into the center of the intracerebral hematoma.

This was a true test of the lead surgeon’s skill.

With the brain filled with vital tissue, even a tiny mistake could have disastrous consequences.

Director Wen carefully maneuvered the endoscope as he advanced further.

However, upon reaching the heart of the hematoma, he encountered difficulty.

The area was near the brainstem, which imposed immense pressure on him.

Sweat trickled down his forehead as a nurse helped wipe it away.

His hand trembled uncontrollably.

In those critical moments, every delay increased the risk of death exponentially.

The longer it took, the greater the pressure on Director Wen.

Not only was he under strain, but Tang Li, Dr. Zou, and several residents were also on high alert, barely daring to breathe.

‘Director Wen, may I give it a try? I’m over eighty percent confident I can do it.’

At that moment, Zhou Can refused to stand by idly.

He eagerly volunteered.

Though his action might seem a bit cocky and impolite to outsiders,

‘Are you really that sure?’

Director Wen paused his work and turned to look at him.

‘Absolutely sure!’

Zhou Can’s gaze was resolute, filled with confidence and calm determination.

‘Alright then, give it a try!’

Recognizing Zhou Can’s impressive skill in minimally invasive procedures, Director Wen decided to take the risk in this desperate situation.

He stood nearby, tense and ready to intervene at a moment’s notice.

Taking hold of the endoscope’s control, Zhou Can made slight adjustments before advancing it further.

His movements were steady and deliberate throughout the operation.

They were remarkably precise.

Years of experience with device implantation had given him a significant edge.

‘Alright! We’ve reached the hematoma. Should we start suctioning out the blood?’

Zhou Can asked.

A collective sigh of relief swept through the OR as doctors and nurses exhaled, smiles of joy spreading across their faces.

The toughest hurdle had finally been overcome.

‘Proceed with suction!’

Director Wen was perhaps the most excited of all, his eyes on Zhou Can as if he were a treasured gem.

Zhou Can carefully manipulated the endoscope’s catheter to begin suction, extracting the accumulated blood from the cranial cavity.

Once the intracranial pressure was relieved, the patient’s vital signs improved rapidly.

‘Up, up! The patient’s vitals are rising. Excellent!’

The Anesthesiologist was happier than anyone else.

He promptly announced the good news.