Chapter 223: Unexpected Post-Op Complications

It wasn’t until Zhou Can finished the surgery and escorted the patient out of the operating room that Mr. Liu spoke gravely, “The Inpatient Unit just called. They say the patient who underwent the lipoma surgery yesterday is now exhibiting multiple unusual symptoms!”

Hearing this, Zhou Can’s heart skipped a beat.

What was bound to happen couldn’t be avoided.

Yesterday, while operating on that patient, he had sensed an indescribable looming crisis.

The fear had Zhou Can performing the entire surgery with trembling caution.

Luckily, the operation went off without a hitch later on.

After work yesterday, still uneasy, Zhou Can made a special trip to the ward. Other than the patient’s pale complexion and a sluggish spirit, all vital signs were normal.

But he never expected a problem to arise today.

Zhou Can couldn’t help but recall Dr. Feng’s warning before leaving, advising him to watch for post-op complications.

Surgeons are quite fearful of post-op complications; all the precautions during surgery and relentless honing of surgical skills aim to minimize such risks.

“It’s already time for lunch break. I’ll go check on that patient,” Zhou Can said to Mr. Liu.

“Let’s go together! The patient is most likely suffering from post-op complications, and dealing with them will be extremely tricky.”

Mr. Liu, with his extensive medical experience, fully understood the dire nature of post-op complications.

He was well aware of how devastating they could be.

“I’ll get some food for both of you, teachers!”

Wu Ziyu now considered Zhou Can a teacher as well.

Having assisted Zhou Can and Mr. Liu in the operating room these past days, Wu Ziyu had received ample guidance that truly earned her the title.

Doctors sometimes get so busy that meal times are easily overlooked.

When you can’t get food, you’re forced to survive on instant noodles.

“Alright! Thanks for handling that. You know I can’t stand spicy food, Mr. Liu.”

That remark from Zhou Can deeply touched Mr. Liu.

A satisfied smile lit up his face, though he said nothing, instead heading into the changing room of the operating suite to change his clothes.

Under normal circumstances, doctors must wear a white coat when working outside the operating room.

Disposable surgical gowns can be worn outside, but regular surgical scrubs are not permitted to leave.

Otherwise, the sterile environment of the operating room cannot be properly maintained.

After changing into his white coat, Zhou Can and Mr. Liu hurried to the inpatient ward.

There, the patient who had undergone the lipoma excision still looked pale, though his spirit had shown slight improvement.

Attending physician Bu Shiren and an intern stood by the bed, their expressions seemingly more anxious than even the patient’s family.

This patient was one Zhou Can had specifically instructed to be closely monitored post-op. Any mishap and Dr. Bu wouldn’t be able to give a proper explanation.

“What’s happening with him?”

Zhou Can asked Bu Shiren.

“From a bit past eight this morning, the patient started experiencing abdominal bloating, nausea, a distaste for fatty foods, and eventually vomiting. Soon after, he developed diarrhea. His temperature, heart rate, and breathing remain relatively normal.”

Bu Shiren promptly handed over the recorded vital signs for Zhou Can to review.

“So, besides what you mentioned, he’s also been very weak overall?”

“Exactly! Ever since the surgery, the patient has been completely drained of energy.”

Bu Shiren’s work was meticulous.

His response was swift.

After familiarizing himself with the patient’s condition, Zhou Can proceeded to systematically rule out potential issues.

Had any crucial nerves or blood vessels been damaged?

He’d been extraordinarily cautious during the surgery, with Mr. Liu double-checking every move. Had there been any injury to essential nerves or vessels, a warning would have been given immediately.

In fact, the surgery had gone flawlessly.

The removal of the facial subcutaneous lipoma had been executed perfectly.

Zhou Can decided to focus on the symptoms of vomiting, distaste for fatty foods, and nausea. Many causes could trigger these symptoms. But since only a single facial lipoma had been removed, even if an accidental injury had occurred, the affected area would be minimal.

With all the key nerves and vessels ruled out, he wondered silently: could the injury have been to the patient’s throat?

The tumor was indeed sizable, but the surgery did not directly involve the throat area.

Direct injury to the throat was highly unlikely.

Only one possibility remained: a hematoma at the surgical site could have pressed on the throat, triggering the patient’s intense nausea, aversion to fatty foods, and vomiting during meals.

Doctors commonly use a tongue depressor to press the base of the tongue as an emetic measure.

They could also use a finger to press the base,

but that carries the risk of being bitten.

When patients reach their limit, they instinctively close their mouths, making it easy for a doctor’s hand to get injured. Hence, doctors avoid risking their fingers.

Thus, the tongue depressor comes in handy.

If yesterday’s surgery had caused even a minor hematoma in the mouth that irritated the throat area, it might explain the persistent nausea and vomiting.

Mr. Liu was currently frowning as he carefully reviewed the post-op vital signs chart.

He was trying to pinpoint the exact cause of the patient’s ailment based on his experience.

Post-op complications are often due to subpar surgical technique, infection, thrombosis, or localized ischemic necrosis.

Diagnosis must rely on piecing together subtle clues and understanding the pathology.

“Open your mouth so I can take a look!”

Zhou Can instructed the patient.

The patient complied, opening his mouth as Zhou Can donned a mask and, almost like a magic trick, pulled a small flashlight from his pocket to inspect the interior.

There were traces of slight bleeding.

However, the degree of hematoma was insufficient to press on the throat or the base of the tongue.

It was safe to rule out the hematoma as the cause of the nausea and vomiting.

The patient’s throat appeared normal; no lesions were observed. Only the side where the lipoma had pressed showed significant dental loss.

The tongue coating was unusually pale with a dull, yellowish tint.

“That’s enough!”

Zhou Can signaled for the patient to close his mouth.

Finding no answers within the oral cavity, he carefully removed the dressing from the surgical site. He had personally performed an invisible suturing technique and even completed a degree of flap repair.

Everything appeared normal.

There were no signs of wound infection like redness or swelling, and the patient’s temperature had not risen, making a post-op infection unlikely.

“This is truly perplexing—no issue at the wound and nothing abnormal in the mouth. So, where does the problem lie?”

Remembering the patient’s additional symptoms of bloating, diarrhea, and overall weakness, Zhou Can began to think beyond the local effects of the surgery, piecing together a comprehensive diagnosis based on all the symptoms.

There are so many potential causes behind these symptoms.

Common conditions like colds or food poisoning can lead to vomiting, nausea, diarrhea, and total body fatigue.

The human body is like a finely tuned machine—if one part malfunctions, it can trigger severe adverse reactions.

“He’s most likely suffering from post-lipoma excision syndrome! This syndrome, which has an incidence rate of up to 30%, can cause tenacious diarrhea, bloating, nausea, vomiting, aversion to fatty foods, alongside signs of malnutrition such as pallor and lethargy. Currently, there’s no effective treatment for it.”

After a long pause, Mr. Liu delivered his diagnosis.

“What could be causing it?”

Zhou Can was encountering this for the first time.

Excision of superficial lipomas wasn’t new to him, and he had never seen post-op syndrome occur before.

However, this was a massive lipoma removal from the head and face—far more complex than previous minor procedures.

“The underlying pathological mechanism isn’t clear. It might be related to the tumor cells themselves. Removing a huge lipoma—or one within the cranial, thoracoabdominal, or adjacent to major organs—can easily trigger numerous adverse reactions. This syndrome is inevitable and only corrective treatments can be offered.”

Mr. Liu immediately issued several medical orders.

He also instructed the nurses to draw blood for a routine investigation to avoid any misdiagnosis.

After leaving the ward, Zhou Can and Mr. Liu went to grab a bite to eat.

It was already nearly time for the meal.

Doctors work incredibly hard, often missing regular meal times—especially those in the operating room and resuscitation area, anesthesiologists included.

Sometimes, in continuous emergency situations, they work for over ten hours straight.

This explains why many doctors, despite studying medicine, sometimes end up diagnosed with cancer in their early forties.

In many cases, these conditions are simply the inevitable result of overwork.

Skipping meals leads to gastrointestinal issues like ulcers. Coupled with late-night work and irregular sleep, the impact on health can be significant.

It’s undeniable that being a doctor is both incredibly demanding and high-risk.

“Mr. Liu, couldn’t that lipoma-related complication have been avoided during surgery?”

Zhou Can asked, a hint of frustration in his tone.

He had reviewed the procedure many times, noting areas for improvement, yet no major mistake had occurred.

So why did the patient develop this syndrome?

Finding the cause and preventing it in future cases was what Zhou Can longed for.

“Based on my surgical experience and both domestic and international case reports, this post-op syndrome is unavoidable. It doesn’t reflect on the surgeon’s skills, but rather the intrinsic effects of the tumor itself.”

Mr. Liu explained to him in a calm tone.

“Wasn’t the tumor completely excised? Could it still cause trouble?”

Zhou Can grew even more puzzled.

His medical knowledge was still shallow, and his clinical experience was a far cry from that of seasoned doctors with decades of practice.

“You’ve heard of the domino effect, right? Remove one tile and a chain reaction ensues, toppling them all.”

Mr. Liu illustrated his point with an example, explaining why some post-op syndromes are unavoidable.

“That lipoma had grown for many years, perhaps even since the patient’s birth. It had established a delicate balance with the patient’s body. Removing it disrupts that balance, leading to a cascade of adverse reactions. Remember, never consider a lesion merely as a redundant body part during surgery.”

“Think of that lipoma as an organ. It grew so large that it essentially became an integral part of the patient’s body.”

Mr. Liu’s explanation was a revelation to Zhou Can.

These insights could only be gleaned through years of clinical practice by veteran experts—knowledge not found in textbooks.

No medical tome or database could ever document such theories.

They defied conventional medical doctrines.

It’s like the difference between official history and unofficial anecdotes.

Unofficial histories can reveal intriguing details that official records omit.

Veteran medical experts are living chronicles of these unofficial accounts.

Many of their theories aren’t written in textbooks, yet they hold undeniable merit.

And they are proven in clinical practice.

“So by that logic, a mole, a tumor, or even an extra finger should be considered an organ unique to that patient?”

A spark of understanding lit within Zhou Can.

As the saying goes, one insightful conversation beats ten years of study.

Mr. Liu’s novel theory opened a new window of understanding for him regarding disease processes.

It was as if a new door had been unlocked.

“Your grasp is impressive—that’s exactly it. An extra finger, a third hand, or even a third leg might be deemed an organ unique to a patient. Yet a tumor or an intradermal mole is often dismissed merely as a lesion. That’s a diagnostic pitfall.”

Mr. Liu smiled and nodded slightly in agreement.

“When you eventually practice independently, always consider these factors. Before excising a tumor, assess its relationship with surrounding organs and its overall impact on the body. For instance, this lipoma patient should be transferred to the Internal Medicine Department in a few days for better management.”

Internal Medicine and Surgery are two entirely different branches of medicine.

In terms of pathology and pharmacology, Internal Medicine far surpasses Surgery. Transferring this post-op syndrome patient to Internal Medicine will benefit his recovery.

Viewing a tumor as an organ is indeed a novel concept.

Zhou Can silently mulled over this new theory.

After lunch, the two took a short break before heading back to the operating room.

The battle was far from over.

They had to quickly clear the backlog of surgical cases in General Surgery.

The frenetic surgical schedule resumed.

Next was a case involving a man in his thirties—a patient with ear discharge and a noticeable mass below the mandibular angle. Pressure on the area increased the secretions in the ear, and following a secondary infection, the patient experienced pain and fever.

This was Zhou Can’s first encounter with such a case.

General Surgery truly is a catch-all department; you never know what pathology you might face.

“This condition is called a parotid fistula. The fistulous tract must be cleared surgically for a complete cure,” Mr. Liu explained to Zhou Can, Wu Ziyu, and the others.

“When diagnosing this condition, aside from the ear discharge and the palpable mass behind the mandibular angle, patients often report a foul taste in their mouths. During surgery, you might find second, third, or even fourth branchial cleft fistulas opening along the anterior border of the sternocleidomastoid muscle.”

This condition is quite rare.

Zhou Can observed the patient carefully, gathering details about his symptoms to build experience for future independent practice.

In fact, before any surgery, Zhou Can always reviewed the patient’s records in detail to understand their condition and underlying causes.

For this parotid fistula patient, he even did extra research to learn more about the condition.

“Sometimes the fistulous openings can be extremely fine—like a pinprick or a small dimple—that are easily overlooked. Even without pressure, there may be minute secretions, which could explain the patient’s complaint of a foul taste.”

Mr. Liu continued his explanation.

Zhou Can remained the primary surgeon, with Mr. Liu offering guidance from the side.

“When performing parotid fistula surgery, be extra cautious not only during the procedure but also post-op. Watch for pharyngeal wall edema and peripharyngeal hematoma, as these can cause airway obstruction. Diligent post-op monitoring and inpatient management are essential. If any issues arise, they must be addressed immediately to avoid irreversible consequences.”

The irreversible consequence, of course, being death.

Doctors often speak in euphemisms in front of patients.

It’s similar across professions.

For instance, if a lawyer hears a case and says there’s a good chance of winning, it usually means victory is likely.

But if the lawyer warns that the litigation might drag on, it’s a subtle hint that success isn’t guaranteed. More often than not, it spells defeat.

Doctors, when speaking to patients, tend to be even more understated than lawyers.

For example, after a physical exam, a doctor might furrow his brow and say, “This case is concerning… it doesn’t look good… really not good.” Often, this implies a malignant tumor or another terminal condition.

If there’s still a chance for surgery or treatment, they urge immediate action.

Delaying further would likely mean a poor outcome.

Meanwhile, Zhou Can was assisting the anesthesiologist with the patient’s anesthesia.

It wasn’t long before the anesthesia was successfully administered.

Zhou Can pocketed another point in anesthesia experience.

Compared to the 100 points awarded for significant experience, earning just 1 point left him a bit dissatisfied. Yet, he knew such opportunities were rare.

Getting one or two such chances in a day was more than decent.

Opportunities to earn 100 points in anesthesia are even scarcer.

Perhaps, if he rotated through the Anesthesiology Department for a month under Dr. Feng’s guidance, those 100-point opportunities might come more frequently.

At the very least, surgeons need to spend a month in the Anesthesiology Department to deeply understand the entire anesthesia process and the necessary precautions.

Especially the hands-on experience anesthesiologists have in supporting patients’ vital signs—a skill truly worth learning.

After all, if you trace the roots of life support, the Anesthesiology Department is the true mentor of Critical Care.