Chapter 183: A Crucial Day in the Operating Room

After entering the operating room, he found the patient already lying on the operating table.

Contrary to the usual supine position, the patient was placed in a 90-degree left lateral position.

This position was chosen based on the surgical field, target area, and operation—it wasn’t the standard supine posture. Zhou Can recalled once seeing a manic General Surgery patient being forcibly restrained by several doctors so that a breathing mask could be applied for anesthesia.

Later, after the surgery, that patient was sent back to the ward with his arms and legs bound to the bed using gauze.

This was done to prevent him from turning violent.

Depending on the operation, doctors choose different patient positions.

Inside the operating room were Zhou Can, Dr. Wu, three nurses, and an anesthesiologist.

The anesthesiologist was busy administering anesthesia to the patient.

These preparations were typically made ahead of time. Nurses would enter early to organize equipment, ensure all waste was cleared, and ready the necessary instruments and medications.

“They’re going to give him anesthesia and perform a double-lumen intubation, right?”

Although Zhou Can had never formally studied anesthesia, his extensive exposure allowed him to predict the method with near certainty.

Afterwards, the surgical trainee would spend a month training in the Anesthesiology Department.

During that time, he’d learn advanced anesthesia techniques and specific procedures.

“Exactly!”

The anesthesiologist, a man nearing fifty with a stony, expressionless face, never smiled when he spoke.

“Shall I handle it?”

Zhou Can was eager to gain more experience with intubation.

As his rotation through various departments increased his exposure, he began to grasp the future direction of medicine more clearly.

Minimally invasive endoscopic surgery was evolving from a novelty into the mainstream.

“Preparation is everything; without it, you’re doomed.”

Besides perfecting traditional surgery, Zhou Can seized every opportunity to enhance his advanced medical skills.

“Do it!”

The anesthesiologist, a man of few words with a perpetually unsmiling face, was hard to approach.

Dr. Guan, however, was much more affable.

Zhou Can didn’t hesitate to assist with the intubation and setting up the breathing mask.

Noticing Zhou Can handling the bronchial intubation almost playfully, the anesthesiologist raised his eyes in mild surprise.

Without a word exchanged, the two worked silently to complete all the pre-anesthesia preparations.

Zhou Can then stepped aside.

Before long, Director Xue and Deputy Director Lu arrived with the surgical team.

“Well done; the patient is fully anesthetized!”

Director Xue, ever cheerful, praised with a smile.

She then instructed the scrub nurse to don sterile gloves, verify the surgical markings and vital signs on the patient, and with everything confirmed, the operation commenced.

“Who performed the routine disinfection?”

“I did!”

The Attending Nurse replied.

“Next time, cover a wider area. I suppose you’re usually quite thrifty,” she added.

Though it sounded like criticism, coming from Director Xue, it was easy to accept.

The atmosphere remained relaxed.

The nurse blushed and smiled sheepishly.

“Before the incision, lay out the drapes, then make a right posterior lateral cut,” she instructed.

Director Xue patiently coached her subordinate doctors even as she performed the surgery.

Her movements were as steady as ever.

Zhou Can noted that most Cardiothoracic surgeons, especially those of higher rank, had inherited Dr. Hu Kan’s ‘steady’ style.

Besides steadiness, Director Xue displayed a uniquely delicate finesse typical of a female surgeon.

“When making the incision, don’t rush. Cut through the layers slowly—first the skin, then the subcutaneous tissue, and finally the muscle, until the ribs appear. Clip the fifth posterior rib.”

After speaking, she signaled Deputy Director Lu to cut the rib.

“Then, through the fourth intercostal space, enter the chest cavity to inspect its contents.”

No open-chest surgery is ever simple.

Zhou Can, standing by the table, observed and absorbed every detail.

A strong grasp of the basics is just the foundation; mastering such major surgery requires learning countless additional skills.

Every surgical nuance and warning is essential to study closely.

Even when two operations involve lung lobe removal, the techniques can differ greatly.

This demands that a surgeon be both knowledgeable and adaptable to tailor the approach as needed.

“The key objectives during exploration are three: ensure there are no adhesions between the chest wall and lung, confirm the absence of pleural effusion, and pinpoint the tumor’s exact location within the lung lobe.”

Each of these points is critically important.

In advanced lung cancer, the lung tends to adhere to the chest wall, so any surgery requires meticulous separation.

In fact, by this stage, many patients no longer benefit from surgery.

Most have already experienced cancer cell metastasis.

Ethical doctors explain that once cancer has spread extensively—affecting multiple chest organs and tissues—there’s little point in aggressive treatment; instead, focus shifts to pain relief and quality of life in the advanced stages.

Fortunately, this patient was very fortunate.

There were no adhesions between the lung and the chest wall, no pleural effusion, and a roughly 4cm tumor in the posterior segment of the right upper lobe.

Not particularly large.

No tumors were found in the surrounding organs or tissues.

This was an ideal scenario.

During the surgery, due to pleural contraction and the tumor’s proximity to the lung hilum and upper lobe bronchus, a localized resection wasn’t possible.

Additionally, the superior mediastinal lymph nodes were enlarged, the innominate vein was involved, and notable pericardial effusion was present.

These findings were consistent with the preoperative examination.

Director Xue proceeded with a right upper lobectomy to ensure complete removal of the cancerous cells and prevent recurrence.

Looking at the removed lung lobe with the tumor on it sent a chill down one’s spine.

Even though doctors dealt with blood and pus daily, seeing a cancer mass still naturally evoked fear.

It was a profound testament to their reverence for life.

Only when a knife is held to their neck do ordinary people truly feel fear and grasp the fragility of life.

Doctors, with their vast medical knowledge, understand better than most how delicate life is.

Even now, cancer remains synonymous with death.

In its early stages, cancer often shows no clear symptoms; many Chinese, being frugal, rarely undergo checkups. As a result, diagnoses are usually made in the advanced stages.

Developed countries excel in early detection.

Their lower cancer mortality isn’t due to far superior medical skills, but rather early diagnosis and treatment.

For early-stage cancer, removal combined with chemo and radiotherapy can generally yield satisfactory results.

It’s like extinguishing a burgeoning forest fire—easy to control in the beginning.

But once it spreads into long, raging flames, quelling it becomes a formidable challenge.

Director Xue meticulously committed her lung lobectomy techniques to memory for Zhou Can.

“Lymph nodes act as the body’s loyal guardians. They swell during inflammation or when attacked by cancer cells. The enlarged superior mediastinal lymph nodes must be cleared completely. Before that, manage any pericardial effusion.”

Her movements were deliberate, methodical, and clear.

It was like waging war.

First, eliminate one enemy, then the next, and finally wrap it up—every step with a clear strategy.

She opened the pericardium, excised part of its wall, and skillfully drained out yellow, clear fluid before circumscribing the mediastinal pleura with a circular incision.

Lymph nodes in regions 10 and 11 were revealed.

After clearing them, she dissected the right upper pulmonary vein.

This procedure heavily relied on precise incisions—a technique she expertly demonstrated.

Next, she applied a double ligature at the proximal end of the upper pulmonary vein and then cut it.

She then opened the lung fissure to dissect the right pulmonary artery trunk along with its three branches to the upper lobe, double ligating the proximal segments before transecting them.

The goal was to dissect the right upper lobe bronchus.

Once isolated, she used a stapler to close the bronchial stump.

This operation was extraordinarily complex.

Zhou Can even felt his mind was nearly overwhelmed.

Director Xue, so young yet having risen to a top-ranking position, demonstrated surgical skills that far exceeded Zhou Can’s expectations.

Her academic prowess was likely just as remarkable.

She was an exceptionally outstanding female doctor.

“After removal, proceed to clear lymph nodes in zones 1, 2, 3, 4, 7, and 8, as well as the mediastinal pleura. Finally, excise the affected avascular vein. Cancer cells can spread and hide far more cunningly than one might expect. If any are left behind, the risk of recurrence is high.”

She warned everyone.

“A recurrence means the end of a life. When a patient places their trust in us, we must treat it with utmost responsibility—as if it were our own family.”

At Tuyu, doctors who reach the level of Deputy Director are known for their exemplary ethics.

At least among the chief physicians Zhou Can had encountered, none had ever treated a patient’s life carelessly.

“Finally, open the inferior pulmonary ligament and clear the lymph nodes in zone 9. Once every area is checked, we can conclude the surgery.”

The operation concluded successfully, with Deputy Director Lu taking over the remaining tasks.

She then sat contentedly beside him, a look of satisfaction on her face.

“Deputy Director Lu, may I handle the suturing?”

After watching for so long, Zhou Can’s hands itched to get started.

High-risk dissection wasn’t his domain, but he was more than capable when it came to final suturing.

He was confident he could do it excellently.

“Your suturing skills are just as good as mine—I’ll entrust this to you.”

Deputy Director Lu, having witnessed Zhou Can’s exceptional suturing, knew his talent could rival that of any chief physician.

“Thank you for your trust!”

Zhou Can grinned as he began suturing the patient.

Deputy Director Lu, enjoying a rare moment of ease, offered occasional guidance.

After several hours, this level-four surgery finally came to an end.

It had started just after nine in the morning and concluded at 4:27 in the afternoon.

During this time, no one ate or drank.

Everyone had remained at their stations without a break.

Whether doctor or nurse, the work was exceptionally grueling.

“Alright, everyone, go eat and rest. We’ll regroup in about half an hour to prepare for the next surgery,” Director Xue announced.

Today, Director Xue had two major surgeries scheduled.

Whether it was for the cancer patient or another undergoing a tracheal fistula closure, there could be no delays.

The operations had to begin as soon as possible.

No matter how exhausted she felt, Director Xue gritted her teeth and pressed on.

This is why nurturing capable successors is so critical.

With reliable assistants, the lead surgeon’s workload lightens, and coordinated teamwork keeps everyone energetic.

Earlier, nearly the entire operation had been handled by Director Xue—undoubtedly the busiest of them all.

Perhaps she was eager to amass extensive surgical experience while still young, preparing for future promotion to secondary and primary director ranks.

It’s important to note: the director ranks at top hospitals like Tuyu are internal positions rather than official titles; formal titles remain as Resident, Attending, Deputy Chief, and Chief Physician.

In fact, department heads place even greater value on these internal rankings.

They’re determined internally and theoretically carry more weight.

Why do attending physicians hold a lower status than deputy directors?

It isn’t that their skills differ greatly, but once an attending passes the exams and serves long enough, promotion is automatic.

However, attaining a deputy director rank is far more challenging.

And qualifying for the top chief physician rank is even more arduous, with the trend appearing to get tougher.

This is partly due to intense internal competition and China’s rapid advancements in medical technology.

China has begun matching—and even surpassing—developed nations in many fields. Securing a top chief rank will only become more difficult as time goes on.

Director Xue’s swift promotion to the top rank at such a young age was a testament to her relentless hard work.

This surgery vividly showcased her extraordinary skills.

After everyone changed, they gradually filed out of the operating room.

A group of doctors approached, led by one whose calm and commanding presence was unmistakable.

It was none other than Dr. Hu Kan.

Trailing behind were Director Le and others.

“Dr. Hu Kan, Director Le, are you here for that ultra-complex surgery?” Director Xue asked, as if she already knew their plan.

“Absolutely! This is a rare learning opportunity. Since you’ve finished your operation, why not join us?”

Director Le chimed in eagerly, knowing Dr. Hu Kan was typically reserved.

“I wish I could, but I have another major surgery today. By the time I’m done, it will likely be night,” he said.

Director Xue sighed in resignation.

Every chief physician is burdened with heavy workloads—two major surgeries in a day leave hardly any time for meals.

At her level, teaching and research responsibilities only add to her hectic schedule.

That makes her days even more exhausting.

“It looks like you’re quite busy today. Don’t worry—I’ll record a teaching video on Dr. Hu Kan’s surgical techniques. Even a quick look at it can be a great learning opportunity,” Director Le reassured her.

Director Le’s encouragement was genuine.

Female doctors, especially those who are attractive and exude elegance, remain highly regarded in the department—even past forty.

Director Le clearly intended to flatter her.

Such compliments are instinctive from men and don’t necessarily imply anything more.

“Thanks! See you later!”

She waved goodbye with a smile.

“Your team’s Dr. Zhou is truly remarkable!” Director Le continued, not finishing the conversation immediately.

“What’s up with him? Is he too impulsive or blunt with you or other doctors?”

Director Xue was very protective of her team.

Even though Zhou Can had only joined a few days ago, she was determined to shield him.

“Not at all. This morning, he warned me that the cardiac bypass patient in bed 54 might have taken painkillers with anticoagulant effects. I later confirmed with the patient that he had indeed taken aspirin five days prior—even though preoperative coagulation screening showed no issues.”

Director Le made sure to praise Zhou Can in front of Dr. Hu Kan and Director Xue.

Her gratitude for his careful reminder was evident.

Otherwise, she wouldn’t have mentioned it in this setting.

“Had it not been for his vigilance, neither I nor the bedside or attending doctors would have caught it—a potential safety hazard. For minor surgeries, if there’s no history of coagulation issues, we skip the tests because the drawbacks outweigh the benefits.”

Coagulation tests mainly check platelet count and prothrombin time.

“Thanks to Dr. Zhou’s reminder, and with patient confirmation of recent aspirin use, I prepared for the risk of major bleeding by arranging for fresh platelets—a measure that isn’t typically taken.”

Director Le’s face showed relief as she recounted the incident.

“During the operation, the patient’s bleeding was significantly higher than expected. The fresh platelets and anticoagulants proved invaluable, ensuring the surgery’s smooth completion. Dr. Zhou really did an outstanding job.”

Director Le smiled gratefully at Zhou Can.

Surgery is like warfare—preparation can mean the difference between victory and failure.

Hearing that Zhou Can had done well, Director Xue let out a breath of relief with a smile.

“Is the patient in bed 54 under Dr. Zhou’s care?”

Dr. Hu Kan, who had been silent until now, asked.

“No, he isn’t in charge; he’s one of our team’s patients. His knack for spotting issues and the courage to speak up show that he’s meticulous, responsible, and of excellent character.”

Director Le understood exactly what Dr. Hu Kan was implying.

“Yes, he did exceptionally well! Such a promising young man deserves to be nurtured. In future major surgeries, I’d love to have him along,” Dr. Hu Kan praised him highly.

Working alongside Dr. Hu Kan is a dream come true for many doctors.

The learning opportunities, especially in advanced surgical techniques and methods, are invaluable.

“Thank you, Dr. Hu Kan! Director Le!”

Zhou Can felt a surge of elation—his opportunities in Cardiothoracic Surgery were steadily increasing.

These major surgery experiences would be invaluable when he began performing operations independently.

Rapid growth in surgical skills depends not only on talent and hard work but also on seizing opportunities; watching top experts is far more informative than observing ordinary doctors.