Chapter 186: Critical Moments in the Operating Room

The thymus is located extremely close to the heart. In this patient, the thymic tumor has directly invaded part of the pericardium.

The injured artery has now been ligated, effectively cutting off its blood flow.

In effect, that branch of circulation has been severed.

The entire human blood supply system is incredibly delicate, especially the vessels within the chest.

Both veins and arteries, centered around the heart, form the basis of the whole circulatory system.

From blood reaching the brain to that flowing to the feet, the limbs, bones, and organs all depend on it.

The patient’s oxygen level keeps dropping, and it’s still unclear if the severed vessel is to blame.

But until the thymic tumor is completely separated, there’s no way to perform an anastomosis on that vessel!

Director Hu Kan faced an unprecedented challenge.

“I’ll try increasing the oxygen concentration first, though I doubt it will help much,” he remarked.

Dr. Feng attempted to raise the patient’s oxygen intake.

It’s common in hospitals to see patients on oxygen—pregnant women, those with respiratory failure, COPD, and the like.

Typically, patients receive low-level oxygen; in special cases, the concentration is slightly increased.

However, oxygen levels can’t be raised too high.

Otherwise, the effects could be counterproductive.

Overexposure can lead to issues such as carbon dioxide retention, suppressed lung function, and oxygen toxicity.

Dr. Feng operated with extreme caution.

With the patient’s oxygen already compromised, too high a supply could further suppress lung function and worsen the situation.

Zhou Can watched silently from the side, his heart beating a little faster.

He knew that after nearly two months in Cardiothoracic Surgery, he had little real hands-on experience. Now, his chance had finally arrived.

Cardiothoracic Surgery was undeniably filled with top experts—directors and deputy chief physicians who were masters in their field.

Even the attending physicians were far superior to their peers in other departments.

But they all shared one glaring weakness.

They were slow.

In surgery, timing could mean success or failure.

A slow pace might be acceptable in other operations,

but an accidental arterial injury combined with a sluggish approach was like a leaky roof on a stormy night.

Oxygen isn’t a miracle cure for low blood oxygen levels.

Often, low oxygen levels simply can’t be fixed by giving more oxygen.

As Zhou Can had feared, even with the increased concentration, the patient’s oxygen saturation continued to fall.

It had already dipped below 90.

“Oxygen’s not working!”

Dr. Feng issued a warning.

Director Hu Kan, picking up his surgical pace, looked increasingly pale—the worst was yet to come.

Today’s case was looking extremely problematic.

“Director Le, how long will it take to complete the anastomosis on that ruptured vessel?”

“I’d estimate over three hours,” came the reply.

Director Le was known for his mature technique and quick hands.

Normally, anastomoses on major arteries take anywhere from thirty minutes to three or four hours.

For more complex operations, it could take as long as eight hours.

Under usual circumstances, an arterial anastomosis with an inferior vena cava filter can be done in under thirty minutes, but in particularly challenging cases, additional drugs may extend the procedure considerably.

Even top surgeons like Director Hu Kan couldn’t guarantee a perfect suture on the first try.

If it failed, they’d have to start over.

Numerous risks during surgery made every moment unpredictable.

“Dr. Feng, I think we need to prepare for all outcomes. Start establishing extracorporeal circulation immediately in case of an emergency,” Zhou Can suggested.

“Understood!”

Dr. Feng agreed without hesitation.

“Let me help you set it up!”

Zhou Can received many pointers from Dr. Feng today, and their relationship began to change subtly.

They clearly grew much closer.

The greatest difference between humans and animals is that humans experience complex emotions.

While animals do care for their mates and offspring, their emotions are much simpler.

Human emotions, however, are far more intricate.

In the past, when Zhou Can helped Dr. Feng, he never heard a word of thanks—Dr. Feng was always indifferent and cool.

Until today, when Dr. Feng unexpectedly shared his anesthesia knowledge, techniques, and experience.

It marked a breakthrough in their relationship.

It was like a budding romance—the early stages of dating, like catching a movie, strolling together, exchanging messages, until one day, hands were finally held.

And she didn’t refuse.

That was the true turning point.

Zhou Can had performed extracorporeal circulation many times; he was precise and fast.

【Device Implantation Experience +1 +1……】

When he inserted the catheter into the femoral artery again, he found the procedure noticeably easier than before.

A quiet check of his statistics revealed that his Placement Technique had quietly risen to an attending level, with his experience now at 6001.

While others amassed wealth through hard work, he rapidly gained experience to enhance his surgical skills.

Though it was somewhat like cultivators taking medicinal pills—with its own imperfections—

this meteoric rise, catching up decades of progress in just one year, filled Zhou Can with immense satisfaction.

Experience slowly accumulates.

First, you must improve your technique to earn further opportunities.

While an ordinary surgeon might spend twenty years trying to master suturing to a deputy director’s level, Zhou Can advanced from an intern to that level in just one year.

Not only that, but both his Suturing and Ligature Techniques had soared to level five.

This kind of asymmetric leap was thoroughly exhilarating.

Any minor drawbacks from rapid skill improvement hardly mattered.

Extracorporeal circulation was quickly established.

However, it only serves as a temporary emergency measure, generally lasting about six hours.

Beyond that, it typically transitions to ECMO.

With extracorporeal circulation in place, the surgery continued.

Zhou Can felt a tinge of regret—he’d thought his chance had finally arrived.

But Tuyu Hospital’s top priorities, with their advanced techniques and complete equipment, had temporarily resolved the issue with extracorporeal circulation.

“Phew!”

Director Hu Kan called out to a nurse.

Only then did Zhou Can notice that Hu Kan’s forehead was beaded with sweat.

The near-crisis earlier had undoubtedly put enormous pressure on him, yet as the lead surgeon, he had to remain composed to keep the team’s morale high.

Even after the nurse wiped his sweat, it reappeared shortly.

His complexion looked off—pale and concerning.

Unfortunately, the mask hid much of his face, making it hard to tell.

“Director Hu, something’s not right with you!”

Zhou Can keenly observed that apart from sweat on his forehead, Hu Kan’s hands were moving unusually slowly.

“Wipe that sweat!”

Within less than five minutes, he called out to the nurse once more.

Other doctors at that point began noticing Director Hu’s odd behavior as well.

“Director Hu, why don’t you sit over there and rest? Let me take over the remaining surgical tasks.”

Director Le promptly volunteered to help shoulder the responsibility.

“Good idea! The patient’s fibrous tissue adhesions are severe, so we must be extra careful.”

As Director Hu stepped back, his steps faltered slightly.

Quick on his feet, Zhou Can rushed forward and caught him.

“Director Hu, please be careful!”

These directors were the pillars of Tuyu Hospital—any slip from the operating table could have serious consequences.

After all, they weren’t getting any younger.

“Zhou Can, help me get over there and have a rest!”

Director Hu clearly favored Zhou Can.

Supporting the senior surgeon, Zhou Can realized that Hu Kan appeared far thinner than expected and his body was trembling.

This was far from normal.

“Do you need to step out, drink some water, and grab a bite to regain your strength?”

Zhou Can assumed Hu Kan was simply exhausted.

“I’m fine! I’ll just rest over there. This surgery is extremely challenging. Although Director Le has learned from me for years, there are still areas I worry about.”

Zhou Can had long known that Director Le was one of Hu Kan’s protégés.

In fact, many in Cardiothoracic Surgery were his disciples.

He was never stingy with advice when teaching other doctors.

Originally, Zhou Can was Dr. Xu’s apprentice—a potential rival within Hu Kan’s circle.

Yet, Hu Kan always selflessly nurtured Zhou Can.

Unlike Wu Baihe, who, despite his renown, lacked the same influence and support in the department.

When it came to mentoring, Wu Baihe’s instructions were often brief.

In contrast, Director Hu was patient and meticulous, explaining key points until his students truly understood.

Zhou Can was, in fact, considered one of Hu Kan’s promising disciples.

Without his blessing, how could Director Le dare to call him over for further training?

Zhou Can held a deep, genuine respect for the esteemed and amiable director.

After helping Hu Kan sit on a small round bench by the wall, Zhou Can released his grip.

“I’m fine; you don’t need to worry about me. Go stand at the front of the operating table and observe—as opportunities like this don’t come often,” Director Hu waved him off.

“Okay!”

Zhou Can returned to the operating table, choosing to stand on the opposite side.

Although this angle slightly compromised his view of Director Le’s technique, it allowed him to keep a vigilant eye on Director Hu’s condition.

His intuition told him that what Hu Kan was experiencing was more than mere exhaustion.

At their age, constant high-pressure work could easily trigger cardiovascular issues like high blood pressure or heart disease.

The earlier crisis had undoubtedly rattled him, possibly spiking his blood pressure or quickening his pulse.

Director Le’s surgical skills were clearly inferior to Hu Kan’s.

Still, the separation of the thymic tumor was well within his capabilities.

Time was flying, yet the patient’s condition was far from stable.

The surgery now faced enormous difficulty.

With lead surgeon Hu Kan forced to withdraw due to his health, multiple crises converged to make the operation exceptionally perilous.

The atmosphere in the operating room grew increasingly oppressive.

“Hurry up with the surgery—the patient’s blood pressure is dropping and their breathing is weakening,” Dr. Feng urged Director Le and the team.

Had the patient not been in such dire straits, he wouldn’t have pressured the lead surgeon so hard.

In surgery, nothing is worse than letting nerves take over.

“This tumor is too close to the major cardiac vessels and extremely adhered. I’m worried we may tear them.”

Doctors typically avoid mentioning words like ‘accident’ or ‘disaster’ during operations.

Tearing a major cardiac vessel would immediately cause massive bleeding.

Having already damaged one vessel, another tear would make this the worst surgery ever.

“Director Hu! Director Hu!”

Zhou Can kept glancing at Director Hu, who was seated against the wall.

He noticed that Hu Kan’s body was tilting dangerously to one side.

Rushing over, Zhou Can caught him as he called out.

Hu Kan gasped, “I… feel chest pain and tightness!”

His breathing became rapid, his forehead drenched in sweat, and his body trembled violently.

“Does Director Hu have a heart condition?”

Zhou Can asked Director Le and the others, who had worked with Hu Kan for years and knew him well.

“Director Hu never discusses his health. We really don’t know,” Director Le admitted as he paused the surgery, and all eyes turned to Hu Kan.

“His symptoms resemble a heart attack. The earlier stress likely worsened his condition. I’ll take him for an examination. Director Le, is that okay?”

Director Hu collapsed, and as the highest-ranking surgeon in the operating room, Director Le took charge.

“Hurry up!”

Director Le urged.

“Rest assured, Director Hu, we will complete this surgery perfectly.”

After urging Zhou Can, he also tried to comfort Hu Kan.

Among the Cardiothoracic surgeons present, Director Le excelled in cardiovascular expertise, and upon Zhou Can’s reminder, they all recognized how serious Hu Kan’s condition had become.

Without delay, Zhou Can carried Hu Kan out of the operating room.

Still in his surgical protective gear, Zhou Can rushed toward the Cardiothoracic Outpatient Department.

Along the way, many family members and medical staff watched, bewildered.

Nobody could understand what was happening.

How could a surgeon operating on patients suddenly need saving himself?

“Where’s Director Xue’s clinic?”

Zhou Can asked an information nurse.

“Over there!”

The nurse recognized the man being carried and quickly led the way.

Zhou Can brought him into the clinic, where Director Hu’s condition rapidly worsened.

He was already confused and his complexion had turned alarmingly pale.

“Dr. Zhou!”

Director Xue, who was consulting a patient, was startled by Zhou Can’s sudden entrance carrying the doctor.

“During surgery, Director Hu suddenly had an issue—he seems to have suffered a heart attack. Please take a look!”

Zhou Can quickly apologized to the waiting patients and families, “Sorry for the interruption, but our doctor’s condition is critical. Please bear with us.”

“It’s fine; we’re all chronic patients anyway,” the family replied understandingly.

They hoped that by being accommodating, the doctor would later provide them with better care.

At least, that was what they believed.

“It definitely looks like a heart attack. Quickly register a case for Director Hu—I’ll begin a physical exam and order tests. Given the situation, emergency intervention might be necessary.”

Without a registration, the system can’t process his case.

Without a registered patient, doctors can’t order tests.

In acute myocardial infarction, even a sudden, severe narrowing or blockage in one coronary artery can lead to rapid ischemia, subsequent injury, and necrosis of the heart muscle.

The progression of a heart attack is measured by the minute.

Emergency intervention can significantly reduce the risk of death.

Saving as much heart muscle as possible and preserving cardiac function are key; otherwise, even if the patient survives, their long-term quality of life will suffer.

“I don’t have Director Hu’s ID!”

Zhou Can exclaimed.

“Just write his name. Hurry—I’ll add a number to his case,” came the response.

Director Xue, being an expert, obviously had a fully booked schedule.

Adding a temporary case number was one of the perks of having influential contacts.

Zhou Can dashed to the registration desk, where the attendant, sympathetic to the news about Director Hu, immediately assisted without question.

Armed with the registration number, Zhou Can returned to Director Xue’s clinic.

By then, the physical exam was complete.

Director Xue had already begun ordering test requests.

“First, head to the Chest Pain Center for an urgent ECG, then get a chest X-ray.”

“Got it!”

While carrying Director Hu for the chest X-ray, Zhou Can once again utilized his ‘privilege’ to expedite the process.

When lives are at stake, complaints from other patients or family members can’t slow things down.

Most patients at the clinic had chronic conditions; true emergencies would have been fast-tracked through the Emergency Department.

Zhou Can hadn’t taken Director Hu to the Emergency Department mainly to save time.

Besides, heart attack patients typically return to Cardiothoracic Surgery for interventions, or the Cardiothoracic surgeons are called to handle emergencies in the ED.

Rather than shuffling between departments, it was better to use personal connections and follow a special procedure to save Director Hu’s life.

After examination confirmed that Director Hu had an acute myocardial infarction,

Director Xue immediately arranged for an inpatient bed and held a consultation with other senior physicians to devise a surgical plan.

Meanwhile, Zhou Can notified Director Hu’s family and juggled multiple tasks, essentially acting as a temporary family member.

After discussions, it was decided that Director Hu would undergo an interventional procedure.

This is the standard approach for acute myocardial infarction.

The key to treating a heart attack is to reopen the blocked vessel as quickly as possible.

Once Director Hu’s family arrived, Zhou Can quietly departed and returned to the operating room.

At the same time, the thymic tumor surgery was still in progress.

“Zhou Can, is Director Hu’s condition stable?”

Upon seeing Zhou Can return, they inquired about his status.

“The diagnosis is acute myocardial infarction. An interventional treatment is planned and emergency surgery will begin shortly,” he explained.

For experts in Cardiothoracic Surgery, such interventional procedures are fairly routine.

They believed that if luck was on his side, Director Hu would soon pull through.

They remained hopeful that fate would smile on him in time.

At this moment, the thymic tumor surgery continued under intense pressure.

“Zhou Can, is Director Hu doing okay?”

Seeing Zhou Can return, they once again inquired about his condition.

“The diagnosis remains acute myocardial infarction. We’ve set an interventional treatment plan and will start emergency surgery immediately,” he confirmed.

For Cardiothoracic experts, such procedures are standard practice.

They believed that if fortune favored him, Director Hu would soon turn things around.