Chapter 176: Surgical Stakes and Unyielding Precision

Can a doctor really have real skills? Patients and relatives might find it hard to tell.

But for doctors, everyone is an insider—just a brief encounter reveals one’s true ability.

The subtle prowess Zhou Can displayed had already earned Dr. Long, the chief surgeon, a new level of respect.

He no longer dared to treat him as a mere trainee.

“I can’t say with 100% certainty—I’m at least 70% sure. If we need full confirmation, we can slide in the endoscope and take a look.”

Zhou Can was careful not to speak too definitively.

It’s always better to leave a little room for error.

Using an endoscope to explore the chest or cranial cavity is far safer than creating a large surgical window.

Adding an endoscopic procedure mid-surgery means extra cost.

There are many types—electronic colonoscopes, enteroscopes, capsule endoscopes, fiber bronchoscopes, etc.—with the capsule endoscope being the priciest.

Moreover, the plan proposed by Zhou Can was, by itself, unconventional.

Using an endoscope after a chest opening could easily raise doubts among the patient’s family.

Dr. Long hesitated, weighing the feasibility of Zhou Can’s suggestion.

“If the bleeding point is really under that rib, we might have to remove it to control the hemorrhage. A quick endoscopic check is both efficient and foolproof.”

Watching the patient’s blood pressure plunge, Zhou Can truly felt for Dr. Long.

An indecisive nature simply wasn’t suited for a surgical career.

In surgery, conditions change in the blink of an eye—crises and emergencies can strike at any moment.

Saving a life might come down to one or two golden minutes. Hesitate too long, and by the time you devise the perfect plan, it may be too late.

One could bet that if the patient reached the afterlife, they’d be cursing their misfortune for ending up with such a slowpoke of a doctor.

“Check the endoscope immediately!”

Under Zhou Can’s insistent urging, Dr. Long finally threw aside his hesitation and made a decisive call.

The two assistants watched all this with conflicted emotions.

It was absurd—a trainee directing the chief surgeon’s actions.

Yet both assistants believed that following the trainee’s advice was the correct move.

The endoscope was slid in.

Once the machine was switched on and preparations completed, it swiftly examined the chest cavity for the bleeding source.

Dr. Long’s technique with the endoscope was noticeably a bit clumsy.

It paled in comparison to Zhou Can’s finesse.

He maneuvered the probe almost like a toddler taking his first tentative steps, carefully exploring the chest.

Zhou Can felt a surge of frustration watching this.

Thankfully, the patient was remarkably resilient; otherwise, it would have been curtains long ago.

“The bleeding seems to be coming from this section!”

With no other option, Zhou Can stepped in to help narrow down the search for Dr. Long.

Dr. Long’s pride surely took a hit.

But with the patient’s life hanging by a thread, Zhou Can’s pinpointing of the bleeding area was like a guiding beacon.

He carefully advanced the endoscope toward the target area.

Inside the chest lie many vital organs—liver, heart, lungs—injure any one of them and the consequences could be irreversible. His caution was well justified.

And it wasn’t solely because of a lack of technical skill.

Whoosh!

A red image filled the screen.

It looked as if blood was drenching the endoscope’s tip.

Dr. Long couldn’t contain his excitement: “Found it! Found it! The bleeding source is right here!”

Other medical staff sighed in relief, their faces breaking into expressions of deep relief.

Only Zhou Can seemed unmoved by the outcome.

He had already diagnosed the issue—this endoscopic check was merely to put Dr. Long’s mind at ease.

“The vessel is torn quite badly. It might need to be reconnected.”

Zhou Can studied the endoscope screen and mentally mapped out a treatment plan.

This artery was thick—it clearly supplied a large region.

A crude, forceful ligation would jeopardize the area’s blood supply, potentially leading to severe malnutrition even without ischemic necrosis.

It would be like severing the main root of a tree—certainly detrimental to its growth.

In reality, the human body is far more complex and fragile than a simple tree.

When it comes to resilience, plants can outlast humans tenfold.

“Damn it, if I’d known the bleed was here and we needed to remove that rib, I shouldn’t have cut here,” Dr. Long muttered, cursing while pinpointing the hemorrhage.

He then quickly enlarged the incision and began sawing off the rib.

Removing the rib was no simple task—detaching it from the surrounding tissue demanded great delicacy.

Dr. Long’s tissue separation skills were just at the level of an attending, and in truth, he had yet to fully master them.

Watching him slowly and carefully separate each tissue made Zhou Can increasingly anxious.

Even with autologous blood transfusions, time was of the essence.

There was no possibility for endless transfusions.

Without prompt hemostasis, the patient’s condition would worsen, and postoperative complications would soar.

The human circulatory system is truly remarkable. Many naïvely think that high blood pressure simply means there’s too much blood in the vessels.

They imagine that cutting a small wound and letting some blood out would restore balance.

If you ever meet a doctor promoting such methods, don’t hesitate—call the police immediately. Chances are you’re dealing with a quack.

In humans, blood makes up about 8% of the body weight.

A 100-jin adult has roughly 4,000 milliliters of blood; a 200-jin person might carry around 8,000 milliliters—it’s not unusual.

Most adults normally have between 5,000 and 6,000 milliliters.

For an adult with 4,000 milliliters, only about 70% is actually circulating—at most 80%.

The remaining 30% is stored within various tissues and cells.

So if our body loses 500 milliliters from an injury, do you think the blood volume in our vessels will shrink by that amount?

No.

The body rapidly mobilizes fluids to compensate for the loss.

After all, we are mostly water.

Newborns may have up to 80% water content, while adults hover around 60%.

Thus, even if 4,000 milliliters were lost gradually, the body could replenish it, maintaining roughly the same total volume.

But since it’s merely fluid replacement, while the total blood volume remains unchanged, its concentration is diluted.

And that dilution can cause serious problems.

Red blood cells, white cells, platelets, albumin, globulins, clotting factors, and electrolytes can’t be swiftly restored by fluids alone.

This inevitably leads to a disruption of the entire circulatory system.

The consequences can be dire.

In theory, donating around 200 milliliters of blood is harmless—even beneficial—but over 400 milliliters at one time could be dangerous.

Frequent, rapid donations are equally risky.

According to science, an adult can safely donate blood roughly once every six months.

The patient on the operating table was bleeding uncontrollably and had already lost a significant amount—his condition was extremely perilous.

Dr. Guan was well aware of this as sweat beaded on his forehead while he separated the tissue around the rib.

Time ticked by; even though Zhou Can could have done the job better and faster, his status as a trainee forced him to remain on standby.

In front of senior doctors, showing off was out of the question—unless you had their approval, it would only stir up trouble.

“How much longer until we stop the bleeding? The patient is about to give out!”

Dr. Guan had remained silent up to that point.

Now, watching the patient’s vital signs fade like a dying lamp, Dr. Guan was truly anxious.

“Separating the rib from the surrounding tissue is incredibly challenging. Rush it and you risk damaging key vessels and nerves. Let me try to hold things together a little longer.”

The chief surgeon and the anesthesiologist worked like comrades in arms—one providing cover while the other took the plunge.

One handled support while the other charged forward.

“Check with the Blood Center—can we get two more units of plasma?”

Dr. Guan asked the Attending Nurse.

“I’ll check right away!”

The nurse dashed off to call for plasma.

Sometimes, with rare blood types, the plasma supply is remarkably limited.

Even at Tuyu—a top provincial hospital—in smaller hospitals they’d probably be scrambling to borrow blood.

After about a minute, Dr. Long’s expression grew grim and his movements nearly halted.

Seeing this, Dr. Long almost stamped his foot in panic.

The surrounding staff also tensed up.

It appeared that Dr. Long had encountered a serious problem.

Under normal circumstances, a slower surgery might be acceptable—after all, good work takes time.

But with massive chest hemorrhage, every second counted, and the patient couldn’t afford any delay.

The entire team held their breath, hoping Dr. Long would overcome this hurdle soon.

“Damn, the more you fear something, the more it seems to show up. This area is riddled with vessels and nerves—the separation is extremely difficult. Normally, I’d take my time, but under this pressure I might have to call in Director Hu for help.”

Dr. Long muttered curses under his breath while trying to ease his way out of the predicament.

Director Hu Kan was the rock for all Cardiothoracic surgeons.

When the going got tough in the OR, they’d immediately think of calling on Director Hu for rescue.

Known as the ‘most steady scalpel,’ he had never disappointed the Cardiothoracic team.

“Director Hu is busy with a joint surgery in the Obstetrics Department; he won’t be able to get here in time,” the scrub nurse reported.

This news sent Dr. Long into a cold panic.

His heart sank further with each passing moment.

The top surgeons in Cardiothoracic Surgery had all inherited Director Hu Kan’s reputation for a steady hand.

But the pursuit of stability could slow down the process.

Nothing in life is perfect—every strength comes with its own flaw.

“I recall that Dr. Zhou’s tissue separation was quite impressive,” Dr. Guan remarked at this critical juncture.

Everyone’s eyes turned to Zhou Can—the trainee once admonished—wondering just who he really was.

The anesthesiologist appeared exceptionally confident in him.

Tissue separation is widely regarded as one of the most challenging surgical skills.

Incision and suturing are standard fare, but tissue separation is elevated to an art form.

Few doctors manage to master it.

“For a trainee, even getting a chance to suture skin is lucky. Do you really believe he can handle separating vital tissues, vessels, and nerves so adeptly?”

Dr. Long’s face was etched with disbelief.

He nearly added, ‘If this trainee manages to safely separate the toughest part of this rib, I’ll twist my head off and use it as a nightstand.’

“I personally witnessed him executing high-difficulty nerve and vessel separations in level-three and level-four surgeries. Even near the brainstem, he performed admirably. Do you think he lacks the skill?”

Dr. Guan had deliberately kept Zhou Can in the background out of respect for Dr. Long.

But now that the surgery had hit a snag, not letting Zhou Can take over would put the patient at immense risk.

They simply couldn’t delay any longer.

“Dr. Guan, you can’t set me up here!”

Dr. Long spoke with a mix of skepticism and hope.

“It’s as if you’re saying that if the patient dies, it’s not my problem. Get him over here quickly—there’s no time to waste.”

Dr. Guan rolled his eyes.

With his status, did he really need to lie?

After all, this was a matter of life and death—no room for games.

“Kid, stop standing around. Get over here now and show me the tissue that’s adhered to the rib.”

Dr. Long gritted his teeth and decided to let Zhou Can take charge.

It was an absurd decision.

Under normal circumstances, one could hardly imagine such a choice.

Zhou Can stepped forward without hesitation, had the nurse fit him with sterile gloves, took the scalpel, and immediately began the separation.

Slice, slice!

In just two swift cuts, Dr. Long’s eyes went wide with astonishment.

Damn, that’s far beyond what one might expect from a trainee—he’s nearly at an attending’s level.

The expressions on the other doctors’ and nurses’ faces grew even more animated.

They’d assumed he was a novice, only to find out he was far more capable. Just as they pegged him as a beginner, Zhou Can unleashed a masterstroke.

The impact was nothing short of astounding.

After witnessing Zhou Can’s extraordinary surgical skill, the nurse recalled a previous case—a patient with a tearing chest wall injury.

Zhou Can had clearly warned that the patient risked widespread tissue ischemic necrosis.

Dr. Duan Shangqing and Dr. Zhao had both ignored his advice.

Dr. Zhao was so infuriated that he punished Zhou Can by making him clean the operating room.

She couldn’t help but worry for that patient. In hindsight, it seemed that Dr. Duan and Dr. Zhao might have been less skilled than Zhou Can—hence, their failure to recognize the problem.

If the patient were to deteriorate, Dr. Duan and Dr. Zhao would have to shoulder the blame entirely.

After all, this would undeniably be a medical mishap.

The involved doctors would be held liable.

“Keep going, keep going! Incredible—who would have thought a trainee could be this capable!”

Dr. Long had long since abandoned concerns about saving face.

Witnessing Zhou Can’s tissue separation skills, all that remained was admiration and respect.

Many believe that true strength garners respect—not only in the wild but also in society.

And Zhou Can did not hold back, given the critical condition of the patient.

With a few swift cuts, he effortlessly separated the tissue that Dr. Long had deemed ‘the major challenge.’

After removing the rib, Zhou Can glanced at the bleeding vessel.

It was a thick artery, still gushing fresh blood.

“Clamp, No. 7 line, fine forceps,” he instructed the nurse.

The nurse’s eyes lit up with admiration.

Without hesitation, she swiftly gathered and handed over the necessary instruments.

Dr. Long made no move to intervene.

Having witnessed Zhou Can’s stunning scalpel technique and exquisite tissue separation, he was well aware of the vast gap between them.

He was now eager to see what Zhou Can would do next.

Such a thick suture thread was clearly not meant for vessel anastomosis.

In surgery, suture threads typically come in sizes 1, 4, and 7—the larger the number, the thicker the thread.

After taking the thread, Zhou Can directly ligated the proximal end of the ruptured artery.

His movements flowed as naturally as drinking water and eating—effortless and precise.

Though his method appeared casual, the ligation was impeccably executed—neither too loose nor too tight, just enough to stanch the bleeding.

Furthermore, the tension on the surrounding tissue was almost negligible.

Zhou Can’s tissue separation skills were so superior that, compared to Dr. Long, his mastery was unmistakable.

Suturing and ligation are fundamental skills every surgeon must master.

Doctors constantly practice ligation and suturing.

Surgery is all about cutting and patching—removing the lesion and then closing the wound.

Once perfected, suturing is a skill that always proves its worth, and when combined with ligation, various tools can be employed for practice.

Many believe their own ligation skills are impressive.

But when measured against Zhou Can’s ability, they were mere amateurs.

The pinnacle of surgical art isn’t about flashy maneuvers, immaculate incisions, or perfectly aligned suture holes.

It’s about precision—getting it just right is the ultimate achievement.

Too much effort is overkill; too little is insufficient.

Perfection lies in balance.

Zhou Can’s choice of ligation site, the tightness of his knots, and the force he applied were all exactly right.

It’s not about flashy moves, neat incisions, or meticulously aligned sutures.

It’s about hitting the precision mark perfectly.

Exceeding or falling short both lead to failure.

Only exactly right will suffice.

Zhou Can executed every detail flawlessly—ligation site, knot tightness, and tension applied were all in perfect harmony.

This is the exact surgical ideal that doctors aspire to—a result that minimizes harm to the patient.

Every element was in perfect balance.

That is the pinnacle of surgical achievement.