Chapter 267: A Race Against Death in Cardiothoracic Surgery

After arriving at the Cardiothoracic Surgery Department, Zhou Can originally planned to ask around for the operating room.

He quickly realized there was no need.

It was completely unnecessary.

Because staff kept rushing in and out of Operating Room 3, their faces tense and worried.

An outsider might not spot it, but anyone in the field could tell something serious had happened.

Medical staff only get this tense when a patient’s life hangs in the balance.

All sorts of emergency supplies were being ferried inside.

Doctors and nurses from several departments in the hospital rushed over at the first call for help.

Zhou Can followed two nurses into the operating room.

There weren’t enough surgical gowns, so the nurses had set out a pile of disposable protective suits.

Those would have to do in an emergency.

But everyone knew those protective suits were stifling and stuffy. Doing surgery while wearing one was pure misery for the doctor.

Still, saving the patient came first. Zhou Can quickly changed and headed into the main operating theater.

“Director Xue! Director Le!”

Zhou Can saw many familiar faces. He’d spent three months in Cardiothoracic Surgery, so he recognized most of the staff and nurses.

He couldn’t possibly greet everyone, so he just nodded to Director Xueyan and Director Le.

“You’re finally here—help us! Is there any hope for this patient?”

Director Xueyan looked a little more hopeful the moment Zhou Can arrived.

“I’ll start by reviewing the patient’s details.”

He agreed and listened as Director Xueyan explained what had happened.

The patient, a 41-year-old man, had slipped while going downstairs at home and landed on his left side. At the time, he managed to get up and didn’t feel much was wrong.

Around dinnertime, though, he started feeling a heaviness in his chest, his heart was racing, and it was difficult to breathe—like an invisible hand was covering his mouth and nose.

Later, a cough began and to everyone’s alarm he started coughing up blood.

His family immediately realized things were serious and took him to the local clinic.

It was already night when they went. The on-call doctor did a quick check, suggested admitting him, and planned on getting a chest X-ray the next day.

But worried about hospital bills and convinced he’d be fine, the patient refused admission and insisted on going home.

At home, the cough and chest discomfort remained, but there weren’t any other symptoms.

He just kept waiting, hoping he’d get better soon.

That dragged on for twenty-seven days, but his condition didn’t improve—in fact, the chest pain and suffocation grew worse. Sometimes he couldn’t even breathe and was in real pain.

Yesterday, he suddenly collapsed at home. His family, terrified, rushed him to the hospital.

The local clinic was afraid to take such a critical case and suggested transferring him to a bigger hospital.

After a roundabout journey, the family finally got him to Tuyu Hospital.

Emergency doctors at intake realized they couldn’t handle him and passed him along to Cardiothoracic Surgery for further testing.

Dr. Hu Kan received word from a junior doctor: the patient was in bad shape. Chest X-rays showed a right-sided hydro-pneumothorax with over 80% of the right lung collapsed.

A thoracic puncture was done next, and a little non-clotting blood was drawn out.

The preliminary diagnosis: hemopneumothorax.

Given how dire things were, Dr. Hu Kan decided on an emergency thoracotomy.

Experience told him it had to be internal trauma from the fall. Hemopneumothorax like this is hard to manage—especially after such a long delay.

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Normally, checking a fresh injury makes it easy to spot where the bleeding’s coming from.

But after almost a month, it’s much harder—original wounds fade, or new hidden ones appear. Everything becomes more complicated.

A thoracotomy like this needs to be done under deep anesthesia.

About twenty minutes before anesthesia, Dr. Guan gave the patient a scopolamine injection in the muscle.

This helps reduce gut movement and airway secretions.

But just as monitors were hooked up—before anesthesia could even begin—the patient suddenly became agitated, limbs cold and sweaty, lips turning blue.

Dr. Hu Kan stayed calm despite the chaos. He switched to local anesthesia, then made a closed chest drainage on the right side through the sixth intercostal space.

Almost a liter of blood drained into the bottle.

Next, Dr. Hu Kan injected 12ml of 2.5% thiopental and 100mg of succinylcholine into muscle.

Then he inserted the tracheal tube.

About two minutes later, the patient started breathing on his own again.

But the good luck was short-lived. Soon, resistance in the patient’s breathing rose. Dr. Hu Kan and the anesthetist, Dr. Guan, discussed and gave intravenous fentanyl and had him inhale enflurane.

No improvement at all.

After a bit, they noticed no bubbles in the drainage bottle and no shifting in the indicator tubes.

Even manually squeezing the drainage tube gave no bubbles.

The patient’s heart stopped.

Dr. Hu Kan immediately ordered cardiac compressions.

They opened the chest between the ribs. As they cut through the pleura, blood and air gushed out of the incision.

Seeing this, Dr. Hu Kan’s voice trembled with grief—”Keep doing cardiac compressions, prep the IV and intracardiac injections—” and then he collapsed on the spot.

Dr. Hu Kan was known for his steady hand—he’d never lost a patient on the table before.

Well, except for the time he risked surgery on that thymoma patient—it almost cost a life. That incident triggered a heart attack, and it was Zhou Can who rushed around and saved him.

Thanks to that, Dr. Hu Kan and Zhou Can have stayed close ever since.

But less than a year later, Dr. Hu Kan found himself in trouble again.

And this time, it really wasn’t his fault.

The biggest mistake probably lay with the anesthesiologist, Dr. Guan. Dr. Hu Kan just happened to be in the wrong place. He collapsed in the OR because he already knew all hope was lost.

The reputation he spent a lifetime building—his steadiest hand—was shattered in a moment.

The shock was too much. That’s why he fainted.

After Dr. Hu Kan’s collapse, he was rushed out for treatment. Director Xueyan took over as chief surgeon, continuing the rescue effort with Dr. Guan.

Under her leadership, they tried IV and intracardiac adrenaline and lidocaine to revive the heart.

With the help of these heart-stimulating drugs, the patient began to show a pulse again.

Unfortunately it lasted less than a minute—the heartbeat stopped once more.

Since then, they’d been trying desperately to save him.

After hearing all this, Zhou Can quickly pieced together a picture of the patient’s illness and current state.

A quick check—no pulse, body cold and clammy.

There was none of the body warmth a living person should have.

“Where exactly did it all go wrong?”

Zhou Can forced himself to stay calm. The patient had no spontaneous heartbeat or breathing—artificial resuscitation was barely keeping blood oxygen up. Every second mattered.

The patient was already at Death’s door.

All the department chiefs and senior doctors were on site, even Director Liu from Critical Care had been called in.

But faced with such an extreme crisis, everyone felt helpless.

Right now, Zhou Can’s Life-saving Insight came into play in a big way.

His mind was sharp, his thinking clearer and stronger than ever.

“Resect three of the patient’s ribs and enlarge the thoracic opening! The real problem could be a blood clot blocking the drainage tube inside the chest—very likely after all this time!”

Zhou Can shouted out his diagnosis.

He went over it in his mind—this was the only logical explanation.

If something had been wrong with the heart from the beginning, the fall would have killed the patient on the spot—not nearly a month later.

And just because the chest was drained of plenty of liquid blood doesn’t mean no clots had formed.

After the scopolamine injection, the agitation and blue lips could easily point to a major blood clot blocking the already 80% collapsed right lung.

Now that the logic lined up, Zhou Can was even more sure.

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With this surge in experience, Zhou Can’s confidence in his decision only grew.

The rest of the team looked to Director Xueyan to see what she’d say.

“Do as Dr. Zhou Can says. Enlarge the thoracic window immediately.”

Director Xueyan didn’t hesitate—she put full trust in Zhou Can.

With the patient’s life in such jeopardy, there was no room for indecision.

Death already hovered over the patient.

None of these senior doctors had seen a crisis this dire in their careers.

At this point, they were really just fulfilling their medical duty more out of obligation than expectation—that was the true meaning of their efforts now.

In this crucial moment, Zhou Can suggested a course no one else had thought of—or dared try. This was a gamble for a lost cause, giving it one last shot.

But expanding the thoracic window meant cardiac compressions would need to pause.

That’s why even Director Liu from Critical Care hesitated to follow Zhou Can’s suggestion.

Director Liu knew what Zhou Can was capable of after supervising him for almost three months. They were good friends, too.

But in a crisis, friendship didn’t matter—saving the patient’s life came first.

Even so, he was surprised Director Xueyan fully trusted Zhou Can and decisively followed through.

But there just wasn’t time or the right setup for anything else.

If they could, Zhou Can would have preferred to split the sternum down the middle and pry it open—the standard approach.

That’s the usual front-on thoracotomy.

The patient no longer had a heartbeat or breath—doing that now would be far too late.

“Let me!”

Zhou Can noticed the surgeons here had inherited Dr. Hu Kan’s style: steady, painstaking—and slow.

With no time to spare, Zhou Can took over.

Most of the Cardiothoracic staff knew about his skill anyway.

No one objected.

Once he started, the pace skyrocketed—from walking speed to supersonic.

Swish, swish, swish!

His fierce flurry of moves left the entire surgical team dumbfounded.

Watching Dr. Zhou perform surgery was genuinely nerve-racking.

Some people secretly thought—even in cardiac arrest, you shouldn’t treat a patient like livestock, should you?

If the patient died and their family complained, the medical examiner would definitely step in.

And if they saw rough surgical incisions on autopsy, it’d get a bad review for sure.

But when Zhou Can finished enlarging the thoracic window, everyone saw that even at lightning speed his incisions weren’t rough—in fact, they were neater than the careful cuts of the Cardiothoracic staff.

“Use suction to draw out the blood from the chest.”

There was still some pooled blood inside.

Once that was gone, blood clots immediately showed up—not just one, but several.

It was clear the drainage tube in the chest had been blocked by clots.

That blockage had caused both the breathing and heartbeat to fail—a disaster that also explained why the initial attempts at resuscitation only worked for a minute.

“There seems to be a large tumor in the patient’s upper right lung, and it’s ruptured and bleeding.”

Zhou Can said.

“It must have been the mechanical breathing inflating the lung after intubation that moved the clot and blocked the drain, causing a tension hemopneumothorax and heart failure.”

Now that the root of the problem was found, no one thought Zhou Can was out of line.

Instead, they were sincerely impressed by his diagnostic skills and rescue strategy.

To insist on further opening the chest under these conditions took real courage—and a deep, thorough understanding of the situation.

“Start cardiac massage right now! Prepare for a transfusion.”

Zhou Can began directing others once again.

Every second counted—he couldn’t waste time deferring to Director Xueyan for every order, then having her repeat them.

That might keep up appearances, but it would just slow everything down.

And at this point, any delays could mean the difference between life and death.

There’s a saying in medicine: the golden three minutes for cardiac arrest.

They had already run past those three minutes.

Zhou Can quickly cleared the blood clots from the drainage tube.

“In future, after thoracic closed drainage, it’s safer to use a double-lumen endobronchial tube.”

This patient’s crisis was both a freak accident and, in some ways, inevitable.

Back then, Dr. Hu Kan probably just used a single-lumen tube because of the emergency.

But once those clots blocked the tube, it stopped the patient’s heartbeat and breathing, ensuring the first rescue attempt would fail.

One more crucial factor—the ruptured tumor in the lung led to massive internal bleeding.

Fresh bleeding was visible even now.

They’d just cleared the pooled blood, but more kept appearing.

This was where Zhou Can’s all-around expertise really shined.

He quickly identified the source of the lung bleeding, then used a combination of clamping, tying off, and cauterizing to bring it under control.

Ideally, they’d remove the tumor, or even take out the whole right lung if needed.

But nobody here was crazy enough to attempt that now.

Not even if you loaned him three backups for courage.

Otherwise, it would do nothing but bring trouble.

And possibly a mountain of trouble at that.

After a rapid series of rescue efforts, the patient’s heartbeat came back. With a major transfusion, the blood pressure finally started rising.

Once the bleeding was controlled, there was no more worry about losing the transfused blood—the rescue’s results were immediate.

“That was close—we nearly lost him!”

Dr. Guan, usually steady as a rock, was pale as a sheet through the whole thing. He hadn’t said a word.

He was probably scared half to death.

“We managed to save him this time, but he’s got a tumor in his right lung—and it’s likely malignant. What should we do about that?”

Zhou Can asked for Director Xueyan and the others’ thoughts.

With the patient’s vital signs stabilizing at last, the atmosphere in the OR eased a little.

Zhou Can, the humble trainee, was now the undisputed center of the operating room.

That’s just how it goes during surgery—the one who can save the patient, with the best skill and sharpest thinking, calls the shots.

Even if you’re just an intern, the lead surgeon and senior staff will naturally defer to you if you can pull a miracle.

“What are your thoughts?”

Director Xueyan asked him.

Her eyes shone with a special admiration as she looked at Zhou Can. Her little brother really had delivered—he’d turned the tide and brought a patient back from death.

Just moments ago, Director Xueyan had been in despair.

She was sure the patient couldn’t be saved.

Yet a medical miracle happened. After Zhou Can boldly called for a wider thoracic incision, the real problem was found, and the patient’s life pulled back from the brink.