Chapter 364: Midnight Surgeons

“It’s not even eight yet and we’ve already finished two surgeries. Looks like if we push a little more, we might not have to stay all night!” Director Xueyan glanced up at the clock on the wall, her eyes crinkling in a smile.

With the mask covering her face, only her eyes gave her away.

“If it were us handling those two surgeries, finishing by ten would already be impressive!”

Deputy Director Lu, in her fifties with a head full of white hair, excelled in both surgery and academia. Unfortunately, her blunt way of speaking could kill any conversation.

Wasn’t that just a roundabout way of saying they were slow in surgery?

Everyone felt a bit awkward, while Dr. Hu Kan stayed silent.

“Ahem… Going a bit slower isn’t a bad thing! Slow and steady wins the race, right?”

Lu was Director Xueyan’s right hand, often taking the role of first assistant—her frequent surgical partner. Xueyan quickly tried to smooth things over.

“Heh, you’re right, Director Xue. I know I move fast, but it’s usually a little careless! Safety comes first in surgery. Slow and steady really is safer.”

Zhou Can jumped in with a self-deprecating joke, hoping to ease the tension.

He had no intention of making enemies with all the doctors in Cardiothoracic Surgery.

“Only one surgery left. Let’s take a short break and come back swinging to finish it off!”

Dr. Hu Kan ended the topic with that.

Don’t let his gentle reputation fool you—these attending surgeons cared a lot about face. The Steady Scalpel Technique was Hu Kan’s lifelong pride. Lu’s offhand criticism about its speed couldn’t have pleased him.

Being in her fifties and fairly senior, Lu got away without a scolding.

If it’d been a young doctor shooting off at the mouth, they’d have been chewed out for sure.

Some people headed for the bathroom, others grabbed some water.

Surgery is physically demanding work. Doctors and nurses alike try to hydrate or gulp down some milk or a protein drink during breaks on long surgeries.

If a doctor’s packed a can of Red Bull, it usually means there’s a tough battle ahead.

Sometimes, a single complex surgery can last over a dozen hours. For doctors and nurses exhausted from a full day, it’s a grueling trial. But to save every second for the patient’s life, they grit their teeth and push through.

A shot of something caffeinated becomes their last resort.

Years ago, many doctors and nurses drank a tonic called Brain Booster.

It helped them stay alert, but came with some nasty side effects.

It kept nerves wired, draining away vitality. In the long run, it just sped up aging for doctors and nurses.

Zhou Can made a quick bathroom run, grabbed a drink and returned to the operating room fired up.

The rest of the surgical staff filed back in too.

The patient was already on the table. The anesthesiologist today wasn’t Dr. Feng, but another chief from anesthesiology: Director Dongfang Luoxue.

Her name suited her—cold as snow, with an air that made it feel like the whole world owed her a debt.

She was every bit as talented as Director Xueyan.

Just over forty, she was strikingly beautiful, with smooth, fair skin that looked more like a college girl’s than a woman her age.

As far as Zhou Can knew, she was anesthesiology’s only female chief physician.

In fact, the youngest one they’d ever had.

There’s a common image of anesthesiologists as men, but there are actually plenty of women in the field.

Overseas, there are even more female anesthesiologists than men.

“Need a hand?”

Zhou Can and Dongfang Luoxue weren’t close, but they knew of each other.

She also knew Zhou Can was sort of Dr. Feng’s protégé.

“Yes.”

She answered with a single frozen word.

“Haven’t seen Dr. Guan in a while. Is he doing okay?” Zhou Can kept his hands busy as he made small talk.

He wasn’t trying to win over this ice-cold anesthesiologist. It was just part of the job.

Good communication meant smoother teamwork.

When emergencies struck, it made all the difference.

If everyone clammed up like her, even minor problems could snowball. That could spell disaster.

She was bent over, meticulously placing the patient’s monitoring electrodes, and didn’t reply.

“Dr. Guan nearly had a scare last time. I’m honestly a little concerned about him, so I wanted to check in.” Zhou Can glanced at her, determined to get a response.

“Work.”

That single word was all he got.

This lady was practically made of ice. Zhou Can had met his share of reserved doctors and nurses, but none this cold.

She wasn’t just reserved—she was glacial.

“They say anesthesiologists are always a little off. Guess it’s true.”

He muttered under his breath.

Of course, he did it on purpose.

He just wanted to see if she’d react.

She pretended not to hear him and didn’t flinch at all.

Zhou Can thought better of pushing her any further and quietly helped prep the anesthesia.

“The patient’s ECG looks a bit off. Should we do any special prep?”

Once the patient had inhaled the anesthetic and drifted off, Zhou Can finally brought it up.

Every anesthesiologist had their own style.

Dr. Feng was the most meticulous Zhou Can had ever seen. Dr. Guan was careful too, but in the end lacked a little clinical experience.

Dongfang Luoxue was extremely detail-oriented, but to Zhou Can she seemed to lack a sense of foresight.

Her prep before surgery was always thorough, but she never seemed prepared for surprises mid-procedure.

“No.”

She replied coldly with a single word.

With that, Zhou Can had nothing more to say.

Honestly, his anesthesia skills were limited; he still had a lot to learn. When he checked the patient’s ECG, he could spot subtle abnormalities.

But he couldn’t tell exactly what those subtle anomalies meant.

Given the patient’s severe heart condition, odd ECG readings were to be expected.

Since Dr. Hu Kan hadn’t raised any concerns, there probably wasn’t much to worry about.

Still, it was a hidden risk. Anesthesiologists are the patient’s guardian angels during surgery. Zhou Can felt obligated to give Dongfang Luoxue a heads-up.

He’d delivered the warning, and since she and Hu Kan were both unconcerned, he dropped it.

“Xueyan, you’ll lead this surgery. Director Le will be your first assistant. Zhou Can and Deputy Director Lu will both serve as second assistants. The rest of you, full support—we need everything to go smoothly.”

Dr. Hu Kan distributed the tasks.

“Please, everyone, help me see this operation through. Thank you!”

With Director Xueyan leading a high-difficulty level 4 surgery, the pressure was on. Before they started, her brows were knit tight and her gaze was laser-sharp.

“Don’t mention it, Director!”

“This surgery’s key to our department’s reputation. The future is on the line. We’ll all give it everything we’ve got!”

Everyone voiced their support.

Right now, they all shared the same boat, and the Cardiothoracic Surgery Department had never been more united.

“Director Dongfang, are we ready to begin?”

Director Xueyan turned to Dongfang Luoxue.

“The patient is stable. Ready for surgery.”

She was just as icy to women as she was to men.

The operation started with a median sternotomy, followed by cannulating the ascending aorta and inserting perfusion lines, then placing venous lines via the superior and inferior vena cava, and a left heart vent through the right superior pulmonary vein. After switching to extracorporeal circulation, cooling, and cardiac arrest, they began the atrial folding procedure.

Nearly all major level 4 surgeries were highly risky.

Stopping the heart took things to a whole new level.

When it got to the cardiac arrest stage, sweat was already beading on Director Xueyan’s forehead.

A nurse came by every so often to dab it away.

Sternotomy wasn’t just technical work—it was physically demanding too.

Even with male doctors assisting, female surgeons still had a tough time with open-chest procedures.

Director Xueyan was half nervous and half exhausted.

She made a new incision parallel to the right atrioventricular groove.

“Hold up—everybody, carefully check the patient’s right atrium. See any problems?”

Dr. Hu Kan seized the moment for some on-the-spot teaching.

“The right atrium looks significantly enlarged,” Deputy Director Lu observed. With years of surgical experience, it came to her almost immediately.

“Good eye, Director Lu! So what should we do when we see this in surgery? Anyone know?”

Dr. Hu Kan always taught with patience, guiding each step.

He tried to make sure students learned as much as possible hands-on.

No one spoke up—maybe the two chiefs had an idea, but didn’t want to risk being wrong.

“When the right atrium is this enlarged, we need to partially resect it. For this patient, we’ll remove a portion of the right atrium.”

Dr. Hu Kan gave the recommendation.

But he didn’t explain the reasoning behind it.

He wanted to leave room for everyone to think it through.

It was Zhou Can’s first time helping with such a tough level 4 heart surgery. At the moment, he was handling retractors—just an extra hand.

Even so, it was an honor.

Even someone like Dr. Long, an attending, hadn’t made the cut for the retractor job in this operation. For Jin Mingxi, watching from below was the best she could hope for.

He had Dr. Hu Kan’s focused mentorship to thank for that.

Jin Mingxi wasn’t lacking in talent, always worked hard, and her skills in the Steady Scalpel Technique weren’t bad at all. That’s what had caught Hu Kan’s eye.

Following Dr. Hu Kan’s guidance, Director Xueyan carefully resected part of the right atrium.

The area was packed with blood vessels. Even moving as carefully as possible, bleeding was heavy.

Director Le tried to slow the bleeding, but struggled.

Blood splattered even onto gowns and masks.

“Dr. Zhou, please, you take over. I just can’t keep up—if I keep going, we might fall behind.”

Director Le handed off the first assistant position.

The role was crucial. If the assistant wasn’t skilled or didn’t sync perfectly with the lead surgeon, the whole operation could suffer.

“But… I’m still junior—are you sure about this?”

Zhou Can put on a humble front, but inside he really wanted that first assistant job.

Compared to being second or third assistant, being first always brought better experience and bigger rewards.

According to surgical admission rules, you had to serve as first assistant in three or four level surgeries to earn proper credentials.

“Zhou, don’t dawdle—get up here and help stop the bleeding! Remember, whoever’s best for the job takes it in surgery. No need for egos or formalities. Our only goal is getting through the operation safely.”

Dr. Hu Kan finally raised his voice.

That settled it. Zhou Can quickly moved up to first assistant, taking over from Director Le.

With his level-five hemostasis technique, he was just as capable as Director Le.

Most young chief surgeons only had one or two core surgical skills at chief-physician level. Not every skill was on par.

Director Le and Director Xueyan were both considered young as chiefs.

In Tuyu’s top hospitals, anyone in their forties with that rank counted as young.

Some even made it by forty-eight or fifty and still felt youthful.

Once Zhou Can took over the bleeding, things ran much more smoothly.

His speed with electrocoagulation hemostasis was unmatched. He even tied off larger vessels with lightning speed.

Within moments, the bleeding was completely under control.

Once all the blood was cleared, they could move on to the next stage.

“Xueyan, check the tricuspid valve and its underlying structures!”

Dr. Hu Kan issued the next orders.

Every step in this surgery had a deeper purpose.

“Doctor, I’ve finished examining the tricuspid valve and its subvalvular structures!”

Xueyan gave her report.

With his vantage point as first assistant, Zhou Can saw it all just as clearly.

“Good. Start the atrioventricular folding procedure now.”

Dr. Hu Kan nodded and continued to guide her through the next steps.

……

More than two hours later, the surgery was almost done.

“Doctor, what’s next?”

Director Xueyan seemed to get more nervous as they reached the end.

She was terrified of making a mistake.

“Let’s do a water test on the tricuspid valve first!”

Dr. Hu Kan stayed in command, managing every part of the operation.

“If the water test reveals small holes on the anterior leaflet, use 5-0 polypropylene suture. Then, after venting air from the left ventricle, open the aortic clamp. Once the heart restarts, check the tricuspid valve again. If there’s no regurgitation, close the right atrium.”

Zhou Can committed these advanced tips to memory.

After the heart started beating again, everything looked normal at first. But within five seconds, the heart began racing far faster than usual.

This kind of ventricular tachycardia could have severe consequences.

Zhou Can’s uncle had suffered from ventricular tachycardia.

It leads to a dangerous arrhythmia.

“What’s happening? Did something go wrong with the surgery?”

Everyone was stunned.

This was a first for many of them with an atrial folding procedure.

They lacked hands-on experience.

“Don’t panic. As long as we find the cause and fix it, we can still make this surgery a success.”

Having things go sideways at the eleventh hour was crushing.

Still, Dr. Hu Kan worked to keep nerves steady.

Judging by his reaction, this was his first time dealing with this, too.