Chapter 247: A Surgeon’s Quiet Confidence

“Thank you, thank you!”

A look of surprise crossed Zhou Can’s face, though inwardly he felt pretty unfazed.

After all, having a chief physician ask him to assist in surgery wasn’t anything new.

He’d long since gotten used to this.

He started off by skillfully disinfecting the patient’s abdomen, then marked the spot for the surgical incision.

For an endoscopic operation, only two tiny incisions would do the trick.

The entire process of creating the incisions was handled by Zhou Can alone from start to finish.

Doctors from Internal Medicine, especially chief physicians, generally had some surgical experience. Still, they could never match a chief from Surgery.

Making a small opening in the abdominal cavity? For many, that was already considered a high-risk, high-difficulty move.

But Zhou Can pulled it off with ease.

His surgical technique was so impressive that even Director Shang and Director Shi were left in awe. Watching his steady hands, they both breathed easier.

At least they didn’t need to be on edge like before.

Once the incisions were set, Zhou Can inserted the endoscopic robotic arms. Guided by the camera, he began the procedure with utmost caution.

First up was debriding the fistula and making a partial incision as needed.

Since the fistula had already formed a layer of scarred tissue, direct suturing would do no good.

That’s one of the reasons why fistulas are so tough to repair.

Take catheter-related fistulas, for example. Plenty of surgeons struggle with the procedure, which is why patients often relapse.

Right now, Zhou Can’s debridement technique was at level four—still a step away from level five.

Most debridement jobs he handled were pretty standard, earning him just one point of experience each time.

So naturally, leveling up was a slow slog.

Today was his first time using an endoscopic approach to debride a fistula.

Based on his experience, he figured the new challenge would net him a pretty nice haul of experience points.

Would it be ten? A hundred? Hard to tell—he’d know once he finished.

Working carefully, Zhou Can soon completed the debridement job.

[Debridement Technique EXP +1.]

[First-time completion of a high-difficulty fistula debridement with endoscopy: Reward EXP +100.]

Landing a whopping 100 EXP at once had Zhou Can over the moon.

Payoff matching hard work—that was the kind of result he truly wanted.

Once the wound was clean and the fluids and tissue debris were fully suctioned out, he double-checked the area. Satisfied, he began the suturing phase.

“Wow, that suturing is next-level!”

Director Shang’s eyes nearly popped out. This was his first time witnessing Zhou Can’s suturing skills up close.

Honestly, with suturing ability at sub-chief physician level, Zhou Can would shine in any department within Internal Medicine.

It took him less than twenty minutes to finish the complex suturing of the fistula.

“Director Shang, does this look good to you?”

“It’s absolutely perfect! Kid, I never realized you were this skilled in surgery. Had me worried at first, wondering if you could really handle repairing the fistula!”

Director Shang beamed like he’d just stumbled upon a priceless treasure.

There were so many interventional procedures in Internal Medicine waiting to be done.

Especially in Gastroenterology—polyp and tumor excisions all needed this kind of intervention.

Yet skilled surgical talent was rare in Internal Medicine.

Even among their own chief physicians, surgical prowess was so-so—not exactly remarkable.

They could handle routine issues, sure.

But when trouble popped up or the surgery was high stakes, they’d often need help from the Surgery Department.

Now, seeing Zhou Can’s expertise, Director Shang was already thinking that in the future, maybe they wouldn’t always need to call for backup.

Asking another department for help always felt like swallowing a sword—there was pride and plenty of unspoken tension.

A trainee from his own department, though? He could count on them without a second thought.

The more Director Shang looked at Zhou Can, the happier he felt.

Living up to expectations, Zhou Can also cleaned out the fistula tract, adjusted the drainage tube, then removed the endoscope and closed up the small abdominal wounds.

As for that drainage tube, it would have to stay in until the patient fully recovered post-op, with no sign of ascites or pleural effusion, before it could be taken out.

“Dr. Zhou, I saw you adjust the drainage tube during the surgery. Was there a special reason for that?”

Luo Jingyin watched Zhou Can’s procedure, utterly amazed.

Before this, she’d only known Dr. Zhou as a top-tier diagnostician. Turns out, his surgical talent was downright monstrous.

Such a genius—it was hard not to be awestruck.

Her gaze sparkled with countless tiny stars as she looked at Zhou Can.

The two other grad students, Xie Lin and Qiu Chengyu, were equally blown away by his skills.

They hadn’t even learned the four basic puncture techniques yet, while Zhou Can could open an abdomen on his own and master tough endoscopic procedures. Comparing themselves to him was downright demoralizing.

How could the gap be so wide?

“The drainage tube placement was off. I even suspect that after the patient’s entire stomach was first removed, improper drainage tube setup contributed to this fistula forming at the esophageal anastomosis.”

With tons of surgical experience under his belt, Zhou Can was no stranger to thoracic, abdominal, or cranial drainage procedures.

During the operation, he’d immediately noticed the tube wasn’t done right.

“When I went in endoscopically, I checked the tube’s preset location. The previous doctor placed it too high. If the patient could stand all day, maybe that wouldn’t matter. But after surgery, she stayed in bed all the time, so fluid accumulated in her chest and couldn’t drain properly. The collection soaked the esophageal and jejunal anastomosis, leading to infection and poor healing, and finally resulted in the fistula.”

Zhou Can clearly explained his reasoning.

Director Shang didn’t interrupt during the drainage tube adjustment—instead, he looked on with approval.

Proof that Zhou Can’s operation was spot-on.

“Ah, so that’s it. I understand now!”

Luo Jingyin nodded, having learned something new.

“Zhou Can’s explanation was on point—this is a mistake lots of surgery rookies make. I doubt the chief surgeon messed up the drainage tube—it was probably handed off to an inexperienced assistant who finished up after the main surgeon left. That’s how these tragedies start.”

Director Shang seized the opportunity to teach his three grad students.

All three nodded earnestly, vowing to remember the lesson.

There’s no shortage of cases where the main surgeon handles the tough part great, only for someone else’s misstep in the final stretch to cause major problems.

Plenty of chief surgeons are super busy—they handle the key moments and hand everything else to juniors, then race off to the next case or other tasks.

That leaves the wrap-up work unsupervised and ripe for errors.

“Alright, this surgery was a true success. If the fistula doesn’t reoccur, the patient will be back to normal—that lingering problem these past six months will finally be resolved. Get her to the recovery room. If all looks good, she can be sent straight back to the ward. But make sure the family strictly follows all post-op instructions. We don’t want another incident like what happened to the patient in Bed 73 with the salmonella infection.”

Director Shang gave his orders.

That patient in Bed 73 got lucky. Otherwise, with low reserves and a surgical wound, she might not have made it.

“I’ll be extra careful.”

Zhou Can promised on the spot.

He was responsible for this patient and was determined to ensure smooth post-op management.

“Director Shang, the wife of that patient with cerebral sparganosis asked me when her husband could have the surgery. What should I tell them?”

“I’ll call the neurosurgeons once I’m back in my office, see what they say. Just tell the family we’ll arrange it as soon as possible.”

Since he needed help from another department, Director Shang knew better than to promise an exact time.

“And for the stomach cancer patient in Bed 77—her family arrived at the hospital already. I spoke with them and the patient this morning, and they agreed to surgery. The patient’s mother said she’d pawn everything if it meant saving her daughter.”

Any patient under his care required prompt updates for Director Shang.

There was no room for delay in their treatment.

“That woman has had a rough life. Okay, I’ll schedule her now—if there’s space, she could get surgery as soon as tomorrow morning. With her illness, each day lost means more risk. The sooner she’s treated, the better.”

Director Shang juggled a lot of patients.

Just keeping up with Zhou Can’s cases was enough to leave him frazzled.

Adding clinic duties, teaching, and research, his workload was through the roof.

Plus, as department head, he handled all sorts of internal affairs.

Luckily, he had two deputy chiefs to share the burden—otherwise, he’d be overwhelmed.

…

Back in the office, Zhou Can wrote up charts and reviewed the post-op orders Director Shang set for the patient in Bed 71.

He noticed Internal Medicine’s prescriptions were more precise than Surgery’s.

He learned a lot about medication from comparing them.

Once he finished studying the orders,

[Pharmacological Reasoning EXP +1.]

It wasn’t his first time earning EXP from studying medical orders.

His pharmacological reasoning had reached level three, about the level of a resident. Simple orders? No problem. But for complex post-op care like this, he still couldn’t handle it alone.

With how crucial this skill was, he was determined to raise it soon.

He set himself a new goal: within the year he’d spend in Internal Medicine, he wanted to reach level five in pharmacological reasoning.

With that, he’d have a deputy-level mastery—good enough to lead his own team back in the Emergency Department.

Ambitious? Maybe, but Zhou Can believed in himself.

“Dr. Zhou, Dr. Zhou, the vomiting patient you’re managing just fainted! You need to check on him right away!”

A young nurse rushed into the doctors’ office, waving to get Zhou Can’s attention, panic written all over her face.

“Wasn’t he fine this morning? How’d he suddenly pass out?”

Zhou Can quickly saved his unfinished records and hurried after her.

“How should I know! We just moved him to Bed 11, and right as I was about to check his blood pressure, his eyes rolled back and he lost consciousness.”

This nurse was pretty new on the job.

As she explained what happened, her hands kept shaking—she was clearly rattled.

“Was his temporary bed already taken away?” Zhou Can wondered if switching from a temp bed to an official hospital bed was what triggered this.

Did he get too excited and faint?

“Director Shang gave specific instructions! As soon as the previous patient in Bed 11 was discharged today, the head nurse made sure your patient got the spot right away.”

Director Shang’s word really did carry weight.

Even the head nurse couldn’t refuse.

Unfortunately, the patient didn’t get to enjoy it for long.

“Did he hit his head during the move or anything?”

That was the only possibility Zhou Can could think of.

“No, absolutely not! His wife carried him on her back, and Wang Jie and I helped on either side. We made sure he was settled into Bed 11 safely—he never bumped into anything.”

The nurse was so certain, she almost patted her still-growing chest for emphasis.

Since there was no head trauma, it was unlikely the parasite had caused trouble.

As long as the worm wasn’t burrowing into the patient’s brainstem, they were in the clear.

Still, the incident was a wake-up call for Zhou Can.

This patient was in real danger—they couldn’t afford more delays.

He needed to get surgery to remove the parasite done as soon as possible.

If he could help cure this patient, it’d be a big achievement for Zhou Can.

When he arrived at the ward, he immediately saw the male patient—skin and bones, eyes rolled upward, lying motionless on the bed. His wife was sobbing like the sky had collapsed.

“Ma’am, don’t cry! His vital signs were stable this morning. Even if he’s passed out now, he shouldn’t be in grave danger.”

As he comforted the patient’s wife, Zhou Can rushed to check the man’s condition.

Senior nurse Wang Jie was already there, taking key vitals—heart rate, breathing, the works.

“How’s his blood pressure?”

Zhou Can felt for the man’s pulse. It was weak and thready, as if his strength was all but spent.

He seemed like a candle flickering on its last bit of oil.

Zhou Can could already guess—his blood pressure was dangerously low.

“Systolic 95, diastolic 65. It’s really low.”

Those numbers were lower than the usual red line.

By global standards, anything under 100 for systolic was cause for serious concern.

“How’d his blood pressure drop so much? Did he eat anything this morning?”

“He had a little water, but threw it up. He hasn’t eaten anything since.”

His wife answered, eyes red with tears.

After checking his symptoms, Zhou Can noticed beads of sweat on the man’s forehead and a slight tremor. That clinched his diagnosis.

“Looks like it’s nothing serious—probably just low blood sugar from hunger. Give him 50 milliliters of 50% glucose by IV, stat.”

He gave an immediate verbal order.

Having his medical license made all the difference.

Before this, he’d have needed to bring in a senior doctor.

[Pharmacological Reasoning EXP +1.]

[First time issuing a life-saving medication order: Reward, Pharmacological Reasoning EXP +100.]

Zhou Can felt like a wave of pure happiness had crashed over him.

A windfall that came so suddenly.

With all that new experience in one go, he could truly sense his pharmacological reasoning jumping up a notch.

Checking his stats confirmed it: he’d moved from lower to mid-level resident in pharmacological reasoning.

Just a minor level up, yet the benefits were very real.

He’d reached a whole new tier in understanding and using medicine.

“Just a few more lucky breaks like this and I’ll hit level four soon.”

He was desperate to reach that milestone.

Once he made it to attending-level, handling moderate-difficulty orders solo would be a breeze.

The nurse administered the 50ml glucose IV.

Everyone watched the unconscious patient anxiously.

With someone this frail, every medication prescribed had everyone, nurse and doctor alike, on edge.

The patient’s family was equally tense, wringing their hands tight.

Their hands clenched together unconsciously.

“Nngh…”

The patient let out a faint groan. To the medical team, it was the best news they could hope for.

It meant the glucose treatment was working—he was improving.

He soon regained consciousness.

“Give him another 50ml of glucose.”

Staying calm, Zhou Can nodded to the nurse for further treatment.

[Pharmacological Reasoning EXP +1.]

This time, there was no extra 100-point bonus.

But Zhou Can was still grateful—getting the windfall once was already fantastic.

He kept a close eye on the patient, hanging onto his every movement.

He just hoped the patient would fully wake up.