Chapter 185: Life and Death in the Operating Room

Administer an anesthetic injection to the patient to perform local anesthesia. Alternatively, bring the patient to an unconscious state—what’s commonly known as general anesthesia. This is the most basic and simplest task for an anesthesiologist.

It doesn’t demand high technical sophistication.

Anesthesiologists are revered as life guardians because they provide vital life support.

They can anticipate various crises, ensuring that the entire perioperative period remains under their control.

Should any complications arise during surgery—such as allergic reactions, cardiac arrest, respiratory failure, a sudden drop in blood pressure, or severe oxygen desaturation—they must promptly resolve any issues affecting vital signs.

If the patient’s heart stops, immediate cardiopulmonary resuscitation is required.

If ventricular fibrillation occurs, defibrillation is imperative.

This demonstrates that an anesthesiologist’s role extends beyond anesthesia—they also determine the feasibility of a surgery and ensure the patient’s safety during the operation by meticulously managing vital signs.

Simply administering anesthesia does not make one an anesthesiologist; that title is reserved for those in medical hospitals, not for anesthetists at cosmetic clinics.

Why do cosmetic clinics often face disasters? Fatalities occur all too frequently.

That’s because they employ anesthetists instead of fully qualified anesthesiologists.

Many people mistakenly conflate the two; after this comparison, their differences become clear.

In the future, when considering plastic surgery, you wouldn’t want to entrust your life to someone who only knows how to administer anesthetics.

No matter how polished or boastful those anesthetists appear.

They are technicians, not actual doctors.

Legitimate hospital anesthesiologists have medical licenses and certifications, hold prescribing rights, and actively participate in surgeries.

Anesthesiologists rank far above anesthetists.

Dr. Feng appears to be in his fifties, and he only makes an appearance during extremely challenging Level-4 surgeries. Zhou Can secretly suspects that Dr. Feng is very likely a chief physician.

He assists Dr. Feng without ever expecting anything in return.

So it came as an unexpected delight when Dr. Feng suddenly shared some advanced anesthetic knowledge with him.

It was indeed a welcome surprise.

Zhou Can listened intently to Dr. Feng’s teachings on anesthesia, even jotting down key points in his notebook.

After all, a good memory is no match for a trusty notebook.

Sometimes a surgery requires documenting countless details—even which sutures to use for organs and peritoneum. Zhou Can recorded every detail. In surgery, a single suture can be the difference between success and failure.

This is not meant to be an exaggeration.

Nor is it an overstatement.

For example, selecting a finer suture for stitching tissues under greater tension.

The patient merely sneezed afterwards—is that really too much?

Yet, the stitched area came apart.

If it had been on the body’s surface, it could have been promptly noticed and re-stitched.

But if the rupture occurs within the abdominal or chest cavity, it spells disaster.

“Do you know what disease the patient has?”

Dr. Feng asked.

“Thymoma!”

Zhou Can felt a deep sense of shame for knowing so little about this patient’s condition. The patient was under Director Xueyan’s team, and he was only familiar with his own group’s cases.

He rarely had the opportunity to learn about patients from other teams.

“Before administering anesthesia, we must correlate it with the patient’s illness and overall condition, considering their physical positioning and the anesthesia plan. For instance, this patient with myasthenia gravis requires a supine position with a thin pillow under the shoulder blades. For such patients, an effective dosage of anticholinesterase agents must be predetermined…”

Despite Dr. Feng’s somewhat eccentric personality, the invaluable experience he imparted was pure gold.

Zhou Can absorbed the lessons wholeheartedly, noting the highlights in his notebook.

Shortly after the patient was intubated and placed under general anesthesia, Director Le and Dr. Hu Kan arrived.

When it came to catheterizing the patient, Zhou Can didn’t hesitate to take charge.

He handled it with ease.

And he earned another point for device implantation experience.

“Dr. Feng, is the patient stable?”

Dr. Hu Kan inquired while already instructing the nurse to put on sterile gloves.

“The patient is ready for surgery.”

Dr. Feng truly is a man of few words.

Even when addressing the most distinguished chief surgeons in Cardiothoracic Surgery, his tone remains cool and detached, his face devoid of any smile.

It is said that the longer anesthesiologists work, the more taciturn they become.

Their nerves are perpetually on high alert—the nature of their work leaves little room for casual chatter.

In this sense, an anesthesiologist’s role is as crucial as that of the chief surgeon.

In the United States, anesthesiologists earn as much as surgeons.

Yet in China, anesthesiologists face numerous challenges. Although their income isn’t low—a base salary combined with various bonuses and overtime totaling around 20,000, with annual bonuses pushing it over 30,000—it is a matter of life and death.

They literally risk their lives.

Statistics show that 14 out of 29 doctors who died suddenly were anesthesiologists.

These cases involved robust young men, none over forty.

This data clearly indicates that anesthesiologists are severely overworked.

Receiving late-night calls to rush to the hospital for emergency anesthesia is all too common.

Beyond the fatigue, career advancement in anesthesiology is extremely tough; achieving senior titles is daunting.

Moreover, they are usually behind the scenes. No matter how successful a surgery is, their reputation hardly grows.

They silently bear pressures even greater than those of the chief surgeon; the workload and responsibility are immense, yet their compensation is vastly inadequate.

It’s natural for anyone to feel a sense of injustice.

This unfair treatment has led to a chronic shortage of anesthesiologists.

Some medical schools don’t even offer an anesthesiology program.

This is a thought-provoking issue in the domestic medical community.

Only by improving the status and compensation of anesthesiologists can more medical students be encouraged to specialize in this field.

Otherwise, the shortage of personnel in anesthesiology will only worsen.

Relying on leaders to lure inexperienced recruits into anesthesiology is not a viable long-term solution.

Dr. Hu Kan, after verifying all the marked incision lines and tumor locations on the patient, began the surgery.

He started with a mid-sternum incision to open the chest.

Compared to surgeries led by Director Xueyan, Dr. Hu Kan’s steady and methodical approach exuded an unmistakable sense of safety.

Over the years, Dr. Hu Kan has never encountered a safety incident, which speaks volumes.

After opening the chest, he retracted the pleura on both sides.

At last, the thymus tissue in the anterior mediastinum came into view.

A single glance from Zhou Can filled him with a foreboding sense.

The thymoma had indistinct borders, an abnormal color, and was infiltrating and adhering to the surrounding tissues.

It was clear that the tumor was displacing adjacent organs and tissues.

“This is undoubtedly a malignant tumor!”

A sinking feeling overwhelmed Zhou Can—today’s surgery was going to be exponentially more challenging.

Malignant tumors often alter the normal anatomical relationships.

Their removal carries numerous uncontrollable risks.

Upon examining the thymoma, even Dr. Hu Kan, who had faced countless tough surgeries, couldn’t help but feel a chill.

The disease had ravaged the patient’s body beyond recognition.

Completely removing the tumor would truly test the surgeon’s experience and skill.

“The fibrous connective tissue is so densely adhered and thickened—the surgical risk is immense,”

Director Le observed, shaking his head.

He knew that if he were asked to operate, he would never dare to make the first incision.

“No matter how high the risk, we have to proceed! We evaluated and discussed this beforehand—we can’t just close the chest because things look dire,”

Dr. Hu Kan’s tone was laced with helplessness.

In his decades-long career, he had faced countless high-risk operations.

Which one comes without any risk?

Time after time, he managed to overcome them.

This time, he was confident that the surgery would succeed—confidence born from decades of proven experience and relentless practice.

Every day, rain or shine, he trained in his rapid surgical technique to hone his arm stability, coordination, and focus.

Years of sedentary practice had also granted him an unexpected benefit—inner calm and unwavering focus.

Many assume that Buddhist meditation or Taoist mindfulness are mere superstitions, but they aren’t. Reverence for Buddha or the Tao is not superstition; it’s genuine faith.

Superstition and faith are entirely different.

For an individual, a nation, or even an entire country, the collapse of belief is a terrifying prospect.

Chinese history has seen a flowering of ideas, but over millennia, Taoism has proven to be the foundation for national prosperity. Confucianism and Legalism might govern a country, but they cannot make it thrive.

Even today, the influence of Taoist thought on Chinese culture remains profound.

Why don’t Confucianism and Legalism work? Because Legalism relies on harsh laws devoid of compassion, and Confucianism only speaks in theory. Ultimately, the First Emperor taught people Confucian values—when he suppressed scholars, it was no joke; it was lethal.

Just talking theory without strength—can that build a nation?

Taoism offers a timeless adage still revered in Chinese hospitality: ‘When friends arrive, serve fine wine; when wolves come, arm yourself with swords.’

This principle of courtesy before force still governs interactions today.

Dr. Hu Kan maintained his daily practice of quiet meditation—a practice that could be seen as either Buddhist or Taoist. Over time, his inner calm deepened.

This inner strength provided a crucial foundation for his precise incisions.

It allowed him to remain as steady as an old dog, never losing his composure in a crisis.

As long as he stayed calm, even in emergencies, he could defuse them with clearheaded precision.

“The thymoma is out—now let’s give it everything we’ve got. Director Le, elevate the lower edge of the thymoma,”

This task was assigned to the First Assistant, allowing him to focus on separating the thymoma from the surrounding tissues.

Zhou Can stood beneath the operating table, watching as Dr. Hu Kan skillfully used the high-frequency cauterizer to steadily separate the thymoma from the surrounding fat, working meticulously from the bottom upward.

“What an impressive separation technique—such a steady hand,”

Zhou Can silently admired him, thinking how remarkable it would be if he could master the techniques of separation and incision to that level.

Beyond his superb technique and steady hand, Dr. Hu Kan’s unwavering focus was equally formidable.

Every cut seemed divinely guided—each incision’s depth, width, speed, and the careful avoidance of surrounding blood vessels and nerves was truly awe-inspiring.

Not even the Da Vinci robot could likely match his precision.

Although many doctors revere robotic surgery and manufacturers boast about its merits, the actual outcomes remain debatable.

Manufacturers claim that robotic surgery offers three-dimensional imaging with a 6 to 10 times magnified view and that the robotic arms have high degrees of freedom, rotating up to 540 degrees—almost like Sun Wukong crawling into the chest or abdomen to remove everything that needs cutting.

But in reality, besides being extremely expensive, these robots lack tactile feedback and carry multiple risks of unforeseen complications.

Compared to a skilled surgeon, robotic surgery still has a long way to go.

Perhaps robotic surgery will never replace human surgeons.

On one hand, artificial intelligence is far from perfect; on the other, the fusion of human intuition and emotion adds warmth to surgery, allowing for rapid adjustments in dynamic situations.

Not to mention the importance of tactile feedback.

Human skin and nerves form a remarkably complex and sensitive sensory system.

A master surgeon can feel the subtle differences when cutting different tissues and detect abnormalities instantly.

Robots, in contrast, are cold machines operating on preset programs. Even with remote control, if they cut where they shouldn’t, the operator may not notice right away.

Despite their apparent precision, flexibility, and comparatively few complications, robotic surgeries remain unpopular with patients for reasons beyond cost.

Dr. Hu Kan’s movements were steady and deliberate, his focus unyielding, as Zhou Can watched intently.

He aimed to learn from Dr. Hu Kan’s steady technique and incorporate its merits into his own rapid surgical style.

Zhou Can was a reflective man who constantly pondered and refined his swift techniques. Sometimes his strengths even conflicted with his rapid style, a balance he had to discover through relentless practice.

“Chii!”

A faint, unusual sound emanated from the patient’s chest.

It wasn’t the sound of the high-frequency cauterizer, nor the usual noise of cutting through tissue.

A burst of blood shot out, and Zhou Can’s heart raced.

The closer the incision came to the heart, the higher the pressure in the blood vessels.

If an arterial vessel is breached, it would result in a forceful, water-jet-like spray of blood.

Others in the room grew serious, fixated on the patient’s chest.

They assumed that the revered ‘god’ of surgery had inadvertently injured an arterial vessel.

This wasn’t a surgical failure—just an unexpected mishap.

“The thickened fibrous tissue made it nearly impossible to distinguish from blood vessels, leading to accidental injury. It’s fine—just stop the bleeding quickly,” Dr. Hu Kan said to reassure everyone.

His surgical team was exceptionally competent.

The Second Assistant immediately clamped the ruptured vessel to halt the bleeding.

A spray of blood—like a water gun—indicated that the injured vessel was not a minor one; this was major hemorrhage.

Though Dr. Hu Kan appeared calm, any delay in stopping the bleeding would critically endanger the patient.

“Should we ligate this vessel first and then repair it after the separation is complete, or do something else?”

The Second Assistant’s swift and precise clamp-work displayed his high level of hemostatic skill.

Even though Zhou Can’s own hemostasis skills were at an intermediate level, he couldn’t help feeling inferior.

“Let’s ligate it first!”

Dr. Hu Kan hesitated briefly before replying.

Accidentally cutting such a major arterial vessel would inevitably weigh on him psychologically.

Though he neither spoke nor showed it openly, his inner turmoil was already mounting.

Strong resolve and a deep inner calm don’t guarantee a perfectly unruffled mind in every situation—at best, he managed to remain composed.

Zhou Can glanced at the injured arterial vessel; his lips moved, but he eventually said nothing.

The Second Assistant signaled the Third Assistant, who stepped forward with expert finesse to quickly ligate the proximal end of the arterial vessel, temporarily staunching the bleeding.

Repair of the vessel would have to wait until after the separation and complete removal of the thymoma.

The surgery continued.

Less than twenty minutes later, Dr. Feng, with a puzzled tone, announced, “The oxygen saturation has dropped!”

Sure enough!

Normal oxygen saturation is usually between 95% and 100%, often above 99%.

At that moment, the patient’s oxygen saturation had dropped to 91%, dangerously close to the warning threshold.

Having worked in the Critical Care Department for three months, Zhou Can was extremely alert to oxygen levels.

In the ICU, if a patient goes two days without urinating, it’s almost a death sentence.

Similarly, if oxygen levels remain unstable and keep dropping, the patient is in serious danger.

Thus, with the patient’s oxygen saturation at 91%, he was all too aware of the peril.

Dr. Feng’s vast anesthetic experience undoubtedly alerted him to the danger, hence his grave tone as he warned Dr. Hu Kan.

“Can extra oxygen help raise the saturation a bit? The separation is barely halfway done and will take longer.”

Dr. Hu Kan’s furrowed brows betrayed his dwindling energy.

All he could think of now was to swiftly remove the thymoma and then address the arterial repair.