Chapter 168: A Glimpse into Life and Death in the ICU

Any disease, once its cause and pathology are identified, can basically be cured with the right treatment.

Unless it’s a malignant disease, in which medicine loses its power.

For instance, most cancers: even if the tumor is located, once metastasis occurs, drugs can only relieve pain and delay death. No medication can precisely kill cancer cells.

However, with the continuous advances in medical science, drugs too are becoming more sophisticated.

The emergence of various anti-cancer drugs has brought hope for curing cancer.

Perhaps one day, cancer will be as easily treated as a mild cold.

After identifying the true cause of the illness in the patient in Bed 7 and applying targeted medication, the treatment results were visibly remarkable.

Unless complications arise, this patient will quickly be transferred out of the ICU.

Zhou Can felt that his medical studies had been profoundly validated. (Biquge)

At that moment, the medical staff around Bed 14, who had been busy with resuscitation, began to disperse, their faces somber. Two young nurses even had tears glistening in their eyes.

It seemed that the patient’s condition was beyond hope.

Soon, family members, dressed in isolation suits, were led in by nurses.

On the bed, they were trying to save an elderly man whose exact ailment was unknown. The family didn’t break into hysterics; the farewell was brief and silent, lasting no more than ten minutes.

After the tube was removed, the patient took his final breath and permanently left this brilliant yet painful world.

Once the nurses had prepared the body, a caregiver hauled the stretcher in, placed the body into a yellow body bag, and took it out through the mortuary door. A life had ended.

This time, an elderly person had passed away, which is far better than the grim image of an old person sending off another old soul.

“Sigh, that old man was in the late stage of lung cancer and had been in our Critical Care Department for almost two months. The attending had long informed the family that treatment was hardly meaningful. Yet, the family insisted on treatment, sparing no expense. Now that he’s gone, it’s a relief for both patient and family.”

After Dr. Hu returned, he took the initiative to recount the story of the patient in Bed 14 to Zhou Can.

Zhou Can listened, his heart filled with mixed emotions.

In the Critical Care Department, one could witness the family’s most genuine side.

Take, for example, yesterday’s patient in Bed 6 who had ingested paraquat—his wife wept more fiercely than anyone, yet it’s hard for an outsider to grasp the true depth of her sorrow.

In contrast, the family of the patient in Bed 14 said goodbye quietly without any outbursts.

Their seemingly indifferent behavior actually concealed deep filial piety.

Even though they knew the old man was frail and terminally ill, they were willing to spend enormous sums to ensure he received the best care in the ICU.

Every penny spent was real money. When faced with certain loss, hardly any family would be willing to pay such a price.

“The patient never knew he had cancer until the end. Otherwise, he might have asked us to remove the tube himself.”

Dr. Hu continued.

“For a patient, knowing it’s a terminal illness might lead them to choose a dignified exit. Although the family’s devotion seems admirable, if it were my parents, I would unhesitatingly request that the doctors remove the tube. Lying in that dark place is daily torture.”

Zhou Can shared his own insights.

“Hey, under the influence of our traditional Chinese values of filial piety, your view might be harshly criticized as unfilial.” Dr. Hu paused, studying Zhou Can as if seeing him anew.

“My parents always told me not to worry about others’ opinions, but to live each day true to oneself. For the sake of filial piety, letting one’s parents suffer on a hospital bed without dignity is far worse than letting them go peacefully.”

Zhou Can’s views indeed diverged from the norm.

He seemed to have grasped life philosophies far beyond his years.

Even if seen as unorthodox by society, he remained undeterred.

In the Critical Care Department, patients rely entirely on caregivers for every need.

Take the patient in Bed 17, also elderly—rumor had it he was a retired official of considerable stature. Now, he depended on a ventilator for breathing, tube feeding for meals, and a catheter for urination.

The man was awake, yet his body was completely immobile.

Eating, drinking, eliminating, turning over, moving his arms or legs—all required constant assistance.

He was no different from a walking corpse.

Yet, the patient was determined to fight on. Having been fiercely independent before retirement, even his family dared not oppose his wishes.

And so, he had languished in the Critical Care Department for nearly half a year.

It was merely a last gasp of life.

One couldn’t help but wonder what he was aiming for. Knowing he was dying, why subject himself to such torment?

“Heh! I wouldn’t have expected such deep insight from someone so young,” Dr. Hu remarked, his tone superficially praising yet his eyes betraying disagreement with Zhou Can’s approach.

Everyone has their own views on life and their own way of living.

“Alright, let’s leave these philosophical musings aside. Today, I’ll continue teaching you how to operate these instruments and administer medication to patients.”

Dr. Hu shifted the focus, begin teaching him more techniques in critical care medicine.

“First, I must tell you that the Critical Care Department isn’t here to cure diseases, but to keep patients alive.

Zhou Can nodded in agreement with this perspective.

The essence of critical care is to do everything possible to save a patient’s life, while treatment is the realm of specialists.

Given the limited time and energy of a doctor, mastering one thing thoroughly is key. Critical care physicians and nurses spend their lives perfecting ways to sustain life.

“Yesterday, you arduously searched for a cure for the patient in Bed 7. From my standpoint as a critical care doctor, I don’t endorse that approach. Professional matters should be handled by professionals. Of course, you succeeded this time, but don’t mistake that as me being bitter or envious of your achievement.”

Dr. Hu’s words were not without reason.

“I’m definitely not saying that. Although our time together has been short, I know you’re a fine doctor,”

Zhou Can’s compliment wasn’t mere flattery; it was heartfelt.

Perhaps everyone’s stance is different, and so are their thoughts.

“Thank you for your acknowledgement. Let me continue to explain why I don’t support your approach. For example, administering what seems like a simple IV drip requires precise calculations of drug ratios, dosages, and infusion rates, along with constant observation and adjustments.”

“For a doctor to master all rescue skills and medication protocols in the ICU without decades of practice is nearly impossible.

Our doctors here need at least two to three years before they can manage a bed independently. Yet, residents often encounter unmanageable problems and consult us, the attending physicians.”

“Even we, the attending physicians, occasionally find ourselves uncertain, at which point we consult the Chief Physicians. In reality, they aren’t infallible either—they too frequently face unprecedented cases and rescue challenges. They must continually learn and deepen their expertise to improve rescue success rates and gradually reduce mortality.”

Dr. Hu spoke candidly to Zhou Can, his words full of genuine goodwill.

“What I want to tell you is that to do something well, even a lifetime of effort might not suffice. Chief Physicians, like Director Liu with his outstanding research in the respiratory field, also never branch out but stick to deepening their expertise in one area.”

“Based on your performance these past two days, you have extraordinary talent in medicine. But such geniuses often risk trying to do everything perfectly and end up achieving nothing remarkable. That would be a real shame.”

Dr. Hu’s counsel was clearly offered with the best intentions.

He earnestly warned Zhou Can against pursuing a generalist career.

Lest he end up achieving nothing at all.

There’s a saying in martial arts: Master one move and you can conquer the world.

It’s better to be an expert in one technique than proficient in a hundred.

“Thank you for your sage advice. When I eventually choose my specialty, I will carefully select one or two fields rather than aim to be an all-around miracle worker.”

After listening to Dr. Hu, Zhou Can sincerely thanked him.

Dr. Xu had also expressed these thoughts to him before.

“Ha ha, if you can absorb all this rambling from an old hand like me, that’s enough. As for your future career choices, I won’t interfere—think of it as sharing the wisdom of someone who’s been there.”

Seeing his earnest attitude, Dr. Hu was satisfied—he knew that some geniuses are too stubborn to heed the advice of their seniors.

Dr. Hu was pleased with his progress.

He only feared that some prodigies would never listen to their mentors’ warnings.

“Alright, let me explain the dosage, pump rate, and other technical details for the patient in Bed 7!”

Dr. Hu then patiently detailed the medication protocols for critically ill patients.

He especially emphasized the medication contraindications.

For instance, the precautions during infusion for a patient with asthma.

Or, in the case of a patient with renal failure, how to adjust the medication and closely monitor vital parameters, among other things.

…

Zhou Can studied intently, even taking copious notes.

There was simply too much to learn—it wasn’t something mastered in a single day.

Now, during his three-month rotation in the Critical Care Department, he deeply appreciated Deputy Director Ye’s foresight.

Even if he doesn’t master everything, achieving a fundamental grasp in three months is a tight schedule.

Today’s lessons with Dr. Hu opened a new window for him.

He’d never imagined that medication management could have so many intricacies.

Time flew by—there’s no such thing as a lunch break in the ICU. Even meals are quickly devoured in just a few minutes.

The workload and pressure on critical care staff are truly overwhelming.

By around 4 p.m., it was time for a shift change, yet the patient in Bed 6 experienced another severe crisis.

Even a fifty-something Deputy Attending jumped in to help with the resuscitation.

They even resorted to using an ice blanket.

After frantic efforts lasting until past five, the patient’s condition finally stabilized once again.

“Judging from the symptoms and the fact that the ice blanket managed to control the situation, we can infer that the intracranial bleeding hasn’t stopped. The recent crisis indicates another bout of severe hemorrhage, and his intracranial pressure is extremely high. Whether he’ll make it through tonight is very doubtful.”

The Deputy Attending’s face was full of worry.

“Dr. Yu, can we increase the supply of clotting factors and platelets to help stop the bleeding?”

Dr. Hu’s face was equally troubled.

Just yesterday, a patient under his care had died, and today another one was lost. It was like hitting the jackpot—in the wrong way.

Despite the staff’s best efforts, some patients just can’t be saved, though the doctors aren’t held accountable.

However, a high mortality rate is certainly detrimental to the physicians in charge.

“At present, the patient’s intracranial pressure remains high. Increasing the dose of clotting factors won’t help and might even cause cerebral thrombosis. Also, his acute brain hemorrhage seems tied to a sudden spike in blood pressure. His systolic pressure has already exceeded 180 mmHg, so I recommend prompt intervention with IV antihypertensives.”

Deputy Director Yu clearly demonstrated expertise far surpassing that of Dr. Hu.

His treatment plan directly addressed the core issues.

“You seem to have something to say—don’t hesitate with suggestions. Don’t worry about your title or seniority.”

Deputy Director Yu noticed Zhou Can’s hesitant expression and encouraged him to speak freely.

“I believe surgery is the most definitive solution.”

A premonition of dread washed over Zhou Can.

This patient might not make it through tomorrow.

For critically ill patients, nights are even harder than days.

Just as many elderly dread winter, many pass away during the cold months. The frigid temperatures can be the final straw for those with weakened circulation.

“Surgery is indeed the best option, but as you can see, this patient simply doesn’t meet the criteria,” Dr. Yu said, with a touch of resignation.

“What about an intracranial endoscopic procedure?”

Zhou Can had already considered it.

Having successfully completed dozens of highly complex surgeries in General Surgery, including several intracranial procedures, he had gained considerable judgment experience.

From the patient’s current signs, an intracranial endoscopic surgery would be walking a tightrope.

It could barely be attempted, but the risks were enormous.

“The risks of endoscopic surgery remain extremely high, and few doctors are willing to attempt it. It would at least require the presence of a Chief Physician from General Surgery, who likely wouldn’t consent. Besides, the significance of performing it tonight is enormous. There are only a few Chief Physicians in General Surgery, and they simply can’t rearrange their schedules on such short notice.”

Deputy Director Yu maintained a humble tone.

He patiently explained the many challenges associated with surgery.

He mentioned that the significance of performing the surgery tonight also hinted at his low confidence that the patient would survive the night.

This was something Deputy Director Yu couldn’t arrange, but Zhou Can could. During his two-month rotation in General Surgery, he had built good relationships with two of the Chief Physicians. With him leading, it should be possible.