Chapter 35: Critical Moments in the ER

As Zhou Can gradually released the hemostat, the previously shrunken blood vessels began to fill. Almost immediately, the patient’s right lower limb started regaining color, no longer so pale.

“The blood flow is smooth; the anastomosis is a success.”

Smiles broke out on everyone’s faces.

For a doctor, nothing is more gratifying than seeing a patient’s condition improve.

Restoring blood flow to the limb significantly increases the chances of saving it. From a medical standpoint, if a limb loses circulation, it can die within 20-30 minutes.

And if the brain suffers from ischemia, it’s even more terrifying.

Brain death can occur in just four to five minutes.

Even if the patient is saved, there is a high probability of ending up in a vegetative state or with severe cognitive impairment.

“Dr. Lin, are you almost finished with the anastomosis?”

Dr. Xu asked.

“Almost there—give it another five or six minutes.”

Dr. Lin focused intently on repairing the severed arterial vessel.

“Given the patient’s trauma, movement is risky. Please have the surgical team come in for a consult. Let’s see if we can complete the operation right here.”

All the ER can do is provide initial resuscitation.

Once the patient’s vital signs stabilize, they’re transferred to specialists for further treatment.

After what felt like an eternity, Dr. Lin finally completed the vascular repair.

“Let’s run a blood flow test!”

After his words, Dr. Lin eagerly examined the repaired vessel and the patient’s left lower limb.

Zhou Can continued to slowly release the hemostat.

He observed how the once-collapsed vessel gradually expanded under the incoming blood, yet the color of the limb remained pale.

After studying it for several tense seconds, Dr. Lin nervously glanced over at Dr. Xu.

“No need to worry; I believe the blood flow is adequate. The slow reperfusion in the left leg is due to two factors: first, the repaired vessel has narrowed, reducing blood supply, and second, excessive blood loss has lowered the patient’s blood pressure, limiting blood flow to the extremities.”

Dr. Xu, however, remained remarkably calm.

Not a trace of panic in him.

Senior doctors not only possess superior technical skills but also maintain exceptional composure under crisis. Their extensive experience allows them to make the right call quickly during emergencies.

In short, the road to becoming a doctor is incredibly tough.

It requires growth in theory, skills, experience, and mental resilience, among many other things.

“Little Zhou, do you pick up any insights from watching us perform the vascular anastomosis?”

Dr. Xu asked him privately.

Other doctors and nurses couldn’t help but look enviously his way. It was obvious to anyone that Dr. Xu held this new trainee in especially high regard.

“I’ve learned a lot—like clearing any air from the vessel at the final stage of the anastomosis, knowing when a damaged vessel needs to be resected, and even methods for harvesting the Great Saphenous Vein. Beyond the technical skills, watching your calm approach in a crisis has been immensely instructive.”

Zhou Can shared his insights in general terms.

“Heh, you managed to absorb even the upper-level doctor’s composure. I’m impressed.”

For once, the usually stern Dr. Xu smiled.

“If you were to repair the femoral artery Dr. Lin just fixed, what would you do?”

Earlier, Dr. Xu had imparted many tips during the vascular anastomosis.

Did Zhou Can truly absorb everything?

Could he put his learning into practice?

These were the questions that preoccupied Dr. Xu.

He had little patience for show-offs.

“If it were me, I’d opt for a triangular anastomosis repair. There are two reasons: first, a circular anastomosis is less secure, while a triangular one is sturdier; and second, the triangular method perfectly isolates the compromised segment of the vessel, removing it, and thus minimizes any potential narrowing or risk of re-rupture.”

Zhou Can offered his perspective.

Dr. Lin listened, a flush of embarrassment on his face.

Although his suturing skills surpassed Zhou Can’s, his surgical strategy was clearly not as flexible.

“Not bad, you earned your keep. Since the surgeons are still on their way, you’ll handle these two small venous anastomoses.”

This was clearly an opportunity for Zhou Can to get some practical experience.

Even if he botched it, the risk was minimal.

Dr. Xu was watching from nearby.

Ready to step in and help if needed.

Zhou Can felt a surge of joy. Who wouldn’t welcome a chance to gain more experience?

After just learning a set of vascular anastomosis techniques and key points, having the opportunity to practice on a live patient was every junior doctor’s dream.

This combination of learning and practice truly maximizes the benefits.

Many only know that great masters produce great students.

But few understand why those students excel so much.

It’s not just because their mentors are highly skilled, but also because they provide ample real-world practice opportunities.

For instance, getting hands-on with venous anastomosis like this is nearly impossible for most trainees.

…

After roughly twenty minutes, an attending from Orthopedics rushed in.

“Dr. Xu, is this the patient?”

He nodded at Dr. Xu in greeting.

Then his eyes fell upon the patient.

“Yes! The victim’s legs were horribly crushed by a vehicle. We managed a temporary reconnection of the femoral artery, but the rest of the surgery will likely need to be handled by your department. I suggest that, once the patient is stabilized here, you have your orthopedic specialists complete the operation before transferring the patient to the ward.”

Dr. Xu briefed him on the situation.

Zhou Can continued diligently with the venous anastomosis.

He worked swiftly, having successfully completed one vessel.

The one he was currently repairing was more complex—it required excising the damaged segment before rejoining.

“Your operating room is rather basic when it comes to intricate bone reconstruction and repair, which likely means we’ll have to perform these procedures in our Orthopedic OR. Also, judging by the damage to the thigh muscles and bones, it’s uncertain if these legs can be saved. As the primary physician on this case, ensure you clearly communicate this to the family. Moreover, treatment won’t come cheap; they must decide between limb salvage or amputation.”

Such crush injuries can rapidly lead to muscle and skin necrosis.

It’s almost impossible to tell with the naked eye.

Only after several days of observation post-surgery can a definitive conclusion be drawn.

“Alright then. After we’ve discussed with the family, we’ll transfer the patient to Orthopedics for further treatment.”

Dr. Xu said no more.

After all, he was only an attending in the ER, with limited authority. Many decisions were beyond his control.

Before leaving, the orthopedic attending glanced at Zhou Can, who was still busy suturing.

“Dr. Xu, are you grooming your successor?”

“What’s the point of having a successor? Being attending is my end goal.”

Dr. Xu’s tone carried a hint of melancholy.

“Allow me to say something you might not like: the environment and conditions in the ER simply cannot produce top-tier talent. You’d be better off leaving some of your attachments behind and focusing on critical and severe cases. With your talent, you truly have the potential to achieve great things.”

The orthopedic attending seemed to know something about Dr. Xu’s past.

Zhou Can couldn’t help but wonder why a doctor with such skill as Dr. Xu was stuck in the worst department—the ER.

What had happened back then?

“What talent do I have? I’ve long been a broken man anyway.”

Dr. Xu chuckled self-deprecatingly.

“But don’t say that. At least in the eyes of many in Surgery, you’re still the legendary ‘Dr. One-Cut’. Enough chatter—I’m off!”

The orthopedic attending waved and quickly departed.

Orthopedics is one of the busiest clinical departments.

Meanwhile, Zhou Can finally completed the second venous anastomosis.

【Suturing EXP +1, Ligature EXP +1, Anastomosis EXP +1】

Earning experience points now was happening at breakneck speed.

Completing two venous anastomoses netted him 30 points in suturing, 4 in ligature, and 2 in anastomosis.

Dr. Xu’s orthopedic colleague had claimed that the ER couldn’t produce top-level doctors, but Zhou Can was far from convinced.

At his current pace, it wouldn’t take him three years to become a master surgeon in the ER.

After finishing the anastomosis, Zhou Can tested the blood flow.

It looked promising.

At the very least, the connection held.

Dr. Xu examined the site carefully, then said, “The anastomosis technique is sound, but your suturing needs improvement. For instance, your stitching here didn’t achieve the optimal caliber, which has narrowed the vessel’s lumen. Also, this should have been your starting point. Pay close attention to these details in the future.”

Being pointed out step-by-step by Dr. Xu was immensely beneficial for Zhou Can.

It’s often hard for one caught up in the moment to see the problems, while a knowledgeable teacher can pinpoint them in an instant.

This guidance saved him from taking the wrong path.

“Dr. Lin, please go back and speak with the family. Tell them that while the massive bleeding in the legs is under control, the patient now needs to be transferred to Orthopedics for further treatment. Limb salvage will cost at least 200,000, with a significant risk of failure. Once you’ve confirmed their decision, we can proceed with the next steps.”

Doctors can only offer treatment recommendations.

The final decision rests with the patient and their family.

Zhou Can had personally witnessed a family opting out of treatment over a mere 20,000 fee.

This patient, around fifty years old with tanned, rough skin and calloused hands, likely came from a modest background. It was uncertain whether his family would agree to spend tens of thousands to save his limbs.

Everyone waited patiently for Dr. Lin’s feedback from the family discussion.