Chapter 163: The Grim Routine in the ICU

“Do you know what to do when a patient dies?”

Dr. Hu asked Zhou Can.

“I’ve never handled this before!”

Zhou Can shook his head.

“When a patient dies, immediately inform the family. Stop all long-term orders, reset the computer to zero bed fee, complete the discharge or death registration, and report to the department head right away.”

Dr. Hu explained the general procedures to him.

In the Intensive Care Unit, patients die every day. This is something every ICU doctor must learn.

At that moment, guided by a nurse, the family had already changed into protective gear and entered.

“My husband… *sob*…”

A woman in her mid-thirties began her mournful wailing even before reaching the bedside.

In many regions, it is customary for women to wail like this.

It serves either to express their grief to others or to prove just how heartbroken they are.

Apart from this woman, an elderly woman whose features resembled the patient was also there, leaning over the bed and tenderly stroking the patient’s cheek through tearful eyes.

“Oh my dear, why were you so foolish and heartless? Now that you’re gone, how is your mother supposed to live?”

The old woman’s anguished voice was heart-wrenching.

When the old send off the young, it is one of life’s greatest tragedies.

The mother-in-law and daughter-in-law wept at the bedside. The patient’s wife cried with all her might; although tears were few, her wailing was unmistakable.

Although no one knew what had happened in that family that drove the man to commit suicide by ingesting pesticide,

the man’s family must bear some responsibility.

Had they been guided in time, it might have been avoided.

“Please, calm down, both of you. Make the most of these final moments with him—he’s beyond recovery now.”

Seeing the relatives weeping incessantly, Dr. Hu had no choice but to intervene.

The man on the bed struggled to breathe. He managed to open one eye just enough to see his loved ones gathered at his bedside.

Tears slipped from his eyes.

“Juan…”

He called out his wife’s nickname.

“I’m here!” The woman quickly grasped his hand.

For some reason, Zhou Can couldn’t shake the feeling that the woman wasn’t as grief-stricken over her husband’s death as one might expect.

Regardless, this was a private family matter—he wouldn’t interfere.

Nor would he involve himself in it.

With all his remaining strength, the man managed to say, “Take… care of my mother…” His eyes pleaded with the woman.

“I will. Just rest easy and let go,” she replied through tears.

Next to him, his mother was already inconsolable, her tears and snot mixing as she wept uncontrollably.

Seeing his wife’s promise, the man’s will to fight disappeared completely.

His breathing then ceased abruptly.

Soon after, his blood pressure dropped, brainwaves faded, and his heart stopped.

Monitors began sounding multiple alarms.

The patient’s eyes closed forever.

It is worth noting that after a patient dies, some brain-dead cases do not immediately show a zero heart rate.

However, in medical practice, death does not require the heartbeat to reach zero.

Brain death, dilated pupils, and the cessation of breathing are sufficient to define clinical death.

The heart may continue to beat for anywhere from half an hour to several hours after death.

Standing by the bed, Zhou Can watched the patient’s death with far less terror than at first.

Perhaps he had already come to terms with it mentally.

He was well-prepared psychologically.

Thus, he remained relatively calm about the patient’s passing.

The patient’s mother collapsed into unconsciousness by the bedside, utterly devastated.

The patient’s wife, too, wept bitterly.

Dr. Hu and the nurses methodically followed the protocol.

Dr. Hu removed the ventilator and pronounced clinical death.

Then he instructed the family to settle the hospital fees.

This was crucial.

Without payment, the family would typically not be allowed to remove the body from the hospital.

At Tuyu Hospital, there is a designated morgue, also known as a mortuary.

The body can be stored there for up to twenty-four hours.

Some families might abandon the body.

Though rare, there are occasionally some particularly difficult cases.

In such cases, hospital regulations require a report. A specialized department will handle it.

While the family is busy settling the fees, orderlies usually transfer the body to the morgue.

Most families, however, respect the deceased too much to abandon them.

Soon, an orderly arrived, and two nurses promptly disconnected all monitors and tubes, preparing the body for final processing.

The body was taken away immediately.

The family had already been escorted out of the ICU.

After filling out the death records, Dr. Hu temporarily called in another doctor to help monitor two other patients under his care.

Then he took Zhou Can to the duty room and taught him how to cancel long-term orders on the computer and adjust the bed fee to zero.

These were the crucial details that had to be handled promptly.

Otherwise, disputes between doctors and patients could easily arise.

The family’s emotions are always volatile when a patient dies after treatment.

If they discover that medication is still being administered and fees still incurred despite the patient’s death, conflicts are almost inevitable.

In such cases, the hospital would find itself in an extremely difficult position.

Once Zhou Can had mastered the procedures for handling a death, he followed Dr. Hu back to the ward to continue work.

The empty Bed No.6, once cleaned, would soon welcome the next critically ill patient.

ICU fees are exorbitant, yet beds are always in short supply.

As soon as a bed becomes available, patients waiting outside are immediately admitted.

At a renowned hospital like Tuyu, patients are never in short supply.

Rather, the shortage is always in beds.

…

It was evident that the death of the patient in Bed No.6 had taken an emotional toll on Dr. Hu.

He appeared noticeably downcast.

When Zhou Can returned to care for other patients in the ward, he too was shadowed by lingering apprehension.

He proceeded with utmost caution, fearful of losing another patient in an instant.

Every move was made with extreme care.

Taking advantage of the rare lull, Dr. Hu began instructing him on operating various ICU medical devices.

The defibrillator hardly needed introduction; Zhou Can was already proficient with it.

What remained were infusion pumps, syringe pumps, suction machines, invasive and non-invasive ventilators, hemofilters, fiber bronchoscopes, and more. Dr. Hu explained their uses clearly, one by one.

In the ICU, the most complex operation is on the extracorporeal membrane oxygenation system—ECMO.

No single doctor can operate it alone.

It requires a team of experienced doctors and nurses.

Moreover, the cost to initiate ECMO is exorbitant, so it is rarely used.

Only when both the heartbeat and breathing have ceased will ECMO be considered. Usually, an extracorporeal circulation system must be established within a very short window after cardiac and respiratory arrest.

Otherwise, its benefit is minimal.

Dr. Hu did not try to cram all the ICU equipment lessons into one session.

Instead, he taught in intervals.

This was because various emergencies would intermittently arise that required immediate attention.

Soon, a new patient occupied Bed No.6.

It was a car accident victim with a brain hemorrhage, now in a deep coma.

Shortly after arrival, the patient experienced three episodes of ventricular fibrillation. The situation became extremely perilous. Dr. Hu remained remarkably calm and composed, first personally using the defibrillator to administer electric shocks.

While demonstrating defibrillation techniques and key points to Zhou Can.

“Dr. Hu, why are all our patients in these three beds in such critical condition?” Zhou Can asked in confusion.

Having observed for a while, he noted that patients in some beds had relatively stable conditions.

In others, the patients hardly faced any complications.

Some even had nasal feeding tubes through which food was delivered.

They also had urine bags attached, with little concern for output, and even tracheal intubation was maintained without much issue.

Meanwhile, the excrement was managed by the orderlies.

A nurse would occasionally check in.

In stark contrast, the three beds under Dr. Hu’s care were all critical—each case more serious than the last, with no hint of ease.

Even simple tasks, like turning a patient, sent Zhou Can’s heart racing.

“The greater the ability, the heavier the burden, haven’t you heard?”

Dr. Hu shot back at him.

“Although my three patients are severe, they are not the worst. Look at the one in Bed No.17—now that’s truly frightening.”

The patients under an attending physician naturally present a greater challenge than those under a resident.

That was essentially Dr. Hu’s point.

Zhou Can’s gaze shifted to Bed No.17 where two doctors and two nurses were bustling around the patient with expressions of imminent danger.

They looked as if they were facing a major threat.

For the remainder of the time, Zhou Can frequently stole glances toward Bed No.17.

The two doctors and two nurses there hardly took a break.

He wondered just what kind of case could be so severe.

“Zhou, once a patient is on a ventilator, never skip suctioning. Especially with the patient in Bed No.8—if the sputum isn’t cleared promptly, it could easily block the airway and even trigger choking. Always wear a mask when handling it. Many rookie doctors and nurses end up getting sputum all over their faces.”

After instructing Zhou Can on the basics of equipment operation, Dr. Hu began teaching him how to care for patients.

Most patients have purulent sputum; the very thought of it splattering is repulsive.

Especially since many patients here suffer from sepsis and various infections.

Zhou Can felt his hair stand on end listening.

When suctioning the patient in Bed No.8, he was exceptionally cautious, dreading being splattered with sputum.

Fortunately, nothing like that had happened yet.

After the brain hemorrhage patient’s condition stabilized somewhat, Zhou Can once again rushed to Bed No.7 to study the case file.

This patient, suffering from diffuse intestinal bleeding—could the cause of the hemorrhage not be identified?

He particularly enjoyed puzzling over such challenging, mysterious cases.

If the source of the bleed could be determined, perhaps a treatment could be found, and the patient might improve enough to return to a general ward.

Of course, it was never that simple.

Patients admitted here had already passed evaluations by several gastroenterology specialists and chief physicians.

The fact that even they couldn’t pinpoint the cause indicated just how challenging the case was.

“Zhou, are you still poring over the file for the patient in Bed No.7? Is there something you don’t understand?”

Dr. Hu approached him.

“What do you think is the real cause of this patient’s gastrointestinal bleeding?”

“Who knows! Several chief experts in gastroenterology have already conferred on this. We can at least determine it’s colonic bleeding—ruling out tumors or polyps. The attending even risked performing a colonoscopy and used a hemostatic agent, and even sprayed adrenaline on the bleeding site. But nothing worked. It was like whack-a-mole; stop one bleed and another would start.”

“The final conclusion was diffuse bleeding in the colon. They admitted him to the ICU because his bleeding was chronic, and his intestine hadn’t perforated.”

Dr. Hu explained the patient’s situation in detail.

From their conversation, it was clear that Dr. Hu was an exceptionally competent ICU doctor.

He understood his patients’ conditions thoroughly.

Every possible treatment measure had been meticulously implemented.

“So, the patient must have extensive, multiple bleeding sites along the colon. Normally, wouldn’t widespread bleeding cause ulceration and infection?”

Zhou Can asked curiously.

The colon harbors a vast array of bacteria.

It is here that human waste is formed.

“Strangely enough, the patient had suffered from melena for over six months before admission. One would expect an infection and even perforation by now, yet nothing like that occurred.”

Dr. Hu was equally baffled by this fact.

This patient indeed exhibited many baffling anomalies.

Illnesses in the world are as varied as they are mysterious, with causes and symptoms that often surpass the limits of medical understanding.

They are like the countless unsolved enigmas of our modern world, defying the explanations of current science.

At that moment, an alarm sounded again from the monitor at Bed No.8.

Zhou Can quickly put down the file and rushed over to check.

He saw that the patient’s blood oxygen saturation had dropped to 75%—a very alarming figure.

Moreover, it was continuing to fall rapidly.

The machine kept beeping continuously.

The patient’s face and lips had turned blue—a direct sign of oxygen deprivation.

It was evident there was a problem with the breathing.

Zhou Can hurriedly checked the ventilator to ensure it was properly installed.

The condensate had just been emptied not long ago.

He leaned in to listen and discerned no obvious abnormal sounds.

The pulse oximeter clip showed no signs of dislodgement.

Unable to pinpoint the fault, he turned to call Dr. Hu for assistance.

Before he could, Dr. Hu was standing right behind him.

“In such situations, don’t panic. Let’s first adjust the respiratory parameters and see if that helps,” Dr. Hu said with calm assurance.

Dr. Hu’s composure was unwavering.

After tweaking the respiratory settings, the patient’s oxygen levels stopped dropping and began to rise steadily—and quite rapidly.

Zhou Can exhaled deeply as he watched the blue tint on the patient’s lips gradually disappear.

The crisis had been averted.

“Got it?” Dr. Hu asked.

“So respiratory settings can’t be static! Seems I have a lot more to learn. I look forward to your further guidance,” Zhou Can admitted.

With no prior ICU experience, Zhou Can felt that what he learned that day surpassed everything he had absorbed in an entire year.

Before he knew it, it was time to finish the shift.

Although the shift was officially over at four, the incoming doctor arrived at five for handover.

The handover doctor was a middle-aged man around forty, thin, with a facial expression devoid of emotion and eyes lacking any spark of life. It seemed he had become numb to everything in the world.

This Dr. Shi rarely spoke, and when he did, not a hint of a smile appeared.

After completing the handover, upon leaving the ICU, Zhou Can couldn’t help but remark, “Dr. Shi at handover seems so cold and stern!”

“You’ll get used to it. Dr. Shi is actually a good man. When trouble arises, he’s always ready to help. He used to be an Anesthesiologist before switching to the ICU as an Attending. Barring any surprises, he should be promoted to Associate Chief this year,” Dr. Hu explained.

Dr. Hu added that anesthesiologists tend to be solitary and not very talkative—not because they are aloof, but because their jobs demand constant vigilance on patients’ vital signs. Any slight change requires immediate action or advice to the surgeon.

This constant seriousness eventually becomes their nature.

Not only is the work of an anesthesiologist extremely taxing, their career advancement is also limited and prospects not particularly bright.

At least, that is the case domestically.

In developed countries like Japan and Germany, anesthesiologists are highly regarded, while in the United States, anesthesiologists earn around 190,000 dollars—the highest among physicians.

In China, their status is comparable to that in France, where doctors enjoy high standing.

Actually, specialized doctors in the U.S. are also highly esteemed.

But most American doctors serve as family physicians, similar to community doctors here—albeit with much higher incomes.

In the U.S., true prestige belongs to only two types of doctors: those who lead medical research as PhD professors and those who head specialized departments at major medical centers, often termed super doctors.

Their status is comparable to, or even higher than, top-tier domestic department chiefs.

“Do you know which type of doctor is considered the best in the ICU? It’s the ones who transitioned from anesthesiology,” Director Hu revealed, adding a surprising fact.