Chapter 380: A Crucial Test in the Operating Room

“So you already knew about this, huh! Looks like you’ve really been keeping tabs on me!”

Qiao Yu’s face lit up with a happy smile.

“Back when I started training in the surgical department, you’re the one who put in a good word for me, aren’t you? The directors from different departments respected you and gave me extra care. Later, I felt like I still had so much more to learn and was worried my skills as an instrument nurse would get rusty if I wasn’t practicing. I didn’t want you thinking less of me. So I asked the chiefs of Cardiothoracic and General Surgery if I could work overtime for free after hours to get more hands-on experience in the OR.”

Where there’s a will, there’s a way.

Only Qiao Yu herself truly understood how much effort she put in behind the scenes for the chance to be Zhou Can’s instrument nurse.

It was her drive and determination that convinced Zhou Can she was someone he could really rely on.

“Comrade Qiao Yu, thank you for all the hard work you’ve put in just to become my trusted assistant in surgery. The first patient of the day will be here soon. I’m looking forward to seeing what you can do.”

Zhou Can gave her the highest praise for her dedication.

“Okay!”

After she answered, maybe because things felt a little too serious, she covered her mouth and let out a shy giggle.

After three years apart, Qiao Yu was clearly even more beautiful and carried herself with newfound confidence. Everything she said and did was sharp and efficient, but her gaze remained as clear and gentle as it was three years ago.

In those three years, they’d barely seen each other a handful of times.

But they still chatted often on WeChat and occasionally caught up over the phone. Usually, Qiao Yu called him first.

“Zhou, get ready—there’s a urethral dilation surgery coming up and you’re the lead!”

Dr. Xu came in, having changed into surgical scrubs.

“I’m fine with it, but this kind of operation needs an assistant.” Zhou Can was genuinely surprised. Dr. Xu had a reputation for being demanding and cautious.

Giving Zhou a urethral dilation right out the gate really wasn’t Xu’s usual style.

“I’ll be your assistant! This is a tough one for a level-two surgery, and it’s your first battle back in the Emergency Department after three years. Don’t mess it up—Director Lou and the others are watching!”

Old habits die hard—Dr. Xu overseeing Zhou Can meant there was nothing to fear if any problems cropped up.

Even though Zhou Can made a name for himself in every department he went to, Director Lou and the others in Emergency hadn’t seen him work personally yet, so they naturally were still a little uneasy.

Yesterday, Zhou Can put a lot of conditions on the table and Director Lou agreed to them all.

If Zhou Can failed to show his true skills today, even if Lou said nothing, Zhou would feel ashamed.

“Doctor, a level-two operation requiring general anesthesia is usually scheduled in advance! There’s pre-op interviews, anesthesia evaluations, lots of prep work… This patient didn’t just show up, did he?”

Zhou Can asked cautiously.

So early in the morning—if the patient had even arrived last night, it still wouldn’t be scheduled this fast.

“If you already know, why still ask? He was admitted yesterday, left for you on purpose.”

Dr. Xu shot him a glance.

Then handed Zhou Can the patient’s chart.

The patient was brought in soon after.

He was a young man in his twenties with a urethral stricture caused by trauma. Right now, he could barely urinate and had started developing complications. It might seem like no big deal, but this “small” problem had turned his life into a living nightmare.

“Doctor, please, I’m begging you—do your best. Since I got hurt, my girlfriend’s always threatening to leave me. Every time I pee, it’s torture. I can’t take it anymore.”

He poured his heart out mostly to Dr. Xu.

“We’ll do everything we can to treat you. For now, please lie down on the operating table.”

After guiding the patient, Dr. Xu gestured for the anesthesiologist to start general anesthesia.

For adults, urethral dilation can typically be done with just local anesthesia.

Doctors usually assess the patient’s overall condition and pick the most suitable anesthesia. General anesthesia carries a bit more risk, but lets you monitor vital signs throughout the procedure. It also prevents the patient from moving or not cooperating.

The main downside is really just the increased cost.

Right now, anesthesia techniques are highly advanced. Despite occasional accidents—even deaths—every year during anesthesia,

the overall risk for general anesthesia remains extremely low.

The idea that local is always safer than general is just a myth. Even a seemingly routine brachial plexus block can end tragically in major hospitals.

And those tragedies happen more often than you’d think.

There’s no such thing as a risk-free anesthesia method. Every surgery, no matter how simple, comes with risks.

And wherever there’s risk, there’s always unpredictability.

While the patient was being anesthetized, Zhou Can continued to study his records and test results.

Once anesthesia succeeded, the anesthesiologist said to Qiao Yu, “Nurse, please insert a catheter and drain his urine first.”

“Understood!”

Qiao Yu replied crisply.

Cleaning up urine and feces, treating infected wounds, changing dressings, inserting catheters—nurses deal with all the messy, exhausting jobs you can think of.

It takes nerves of steel to do this well.

“Let me handle it.”

Zhou Can took the special, ultra-thin catheter himself, sparing Qiao Yu from awkwardness.

Whenever he was present, Zhou tried to look out for the nurses and female doctors whenever possible.

And since Qiao Yu was his confidante, he couldn’t help but take even better care of her.

Inserting a catheter was a breeze for Zhou Can.

But this particular patient was a special case—Zhou ran into unexpected resistance while inserting the catheter.

Good thing he jumped in—otherwise, it would have been even more awkward for Qiao Yu.

Even the most seasoned chief nurse tops out at an attending physician’s level with catheter insertions. For someone like Qiao Yu, with only three years’ experience, matching a junior resident’s skill is already impressive.

After some effort, Zhou finally guided the catheter into the patient’s bladder.

[Catheterization successful. Placement Technique EXP +1. High-difficulty catheterization: bonus EXP +100.]

He was genuinely surprised—a hundred extra experience points out of nowhere.

Maybe this really was a case of good deeds getting rewarded.

[Congratulations, your Placement Technique just reached Level 5. Current EXP: 1 / Junior Associate Chief Physician. Now able to perform high-difficulty internal and intraluminal placements, deep insertion of specialized medical instruments, and select organ placements…]

This might seem like a minor skill, but in practice, it’s incredibly important.

In many procedures, Placement Technique provides the finishing touch that makes all the difference.

For example: placing vascular stents or coils—some doctors start shaking before they even begin. Why? Because malformed aneurysms can be nearly impossible to handle.

And arterial dissections are an even trickier beast.

One careless move and someone’s life is in your hands—wouldn’t you be nervous?

When Zhou’s Placement Technique was still at Level 4, or attending skill, he had to steel himself to attempt deep insertion with special medical devices. The odds of success were low and it took ages.

But now, after hitting Level 5, even if he hasn’t tried yet, he was feeling a lot more confident.

Organ placement might sound absurd.

But in major operations, putting an organ back into its original cavity or tissue space is actually quite common. The risk and technical challenge, though, are sky-high. Success demands incredible skill and experience.

Removing organs is often the easy part—putting them back is a nightmare.

Now, for the first time, Zhou Can truly had that ability.

“The patient’s vitals are stable—we’re ready to begin!”

The anesthesiologist didn’t say much more.

But shot Zhou Can a slightly surprised look. Typically, chief surgeons don’t pay much attention to the nurses in the operating room.

But it was clear to him that Zhou cared a lot about Qiao Yu.

“Let’s get started.”

Dr. Xu gave the order.

He didn’t give Zhou any hints at all—he was purposely using this operation to test Zhou Can’s surgical chops.

He hadn’t even marked out the incision location beforehand.

Zhou would have to handle everything on his own.

“Qiao Yu, do you have all the different-sized dilators ready?”

Zhou glanced over at her.

Her eyes met his with a look that was almost intimate.

“Yes, everything’s set!”

Judging by that, she’d already known what surgery they’d be doing before it started.

“There’s still a surprising amount of urine left!”

Even after the special, slender catheter had been draining the bladder for a while, urine kept pouring out.

Now it was no wonder the patient felt his life was a misery.

When it hurts to pee and you can barely go but your bladder’s about to burst—just imagining that agony is enough to make anyone wince.

Given his condition, it was almost certain he faced some physical issues, so not being able to be with his girlfriend was only natural.

That was probably the real reason she was threatening to leave.

No woman wants to spend her youth as a widow in all but name.

Thinking the word ‘love’ alone can tie a woman down for life… that’s just not realistic.

“Alright, the bladder’s basically empty. Doctor, can I remove the catheter and get started?”

Zhou sought Dr. Xu’s input.

“This surgery is a test for you, so only ask for guidance if you hit a real snag. Otherwise, you’re in charge every step of the way. Remember: the more you need my help, the lower your surgery score—and the fewer tough cases you’ll get in the future.”

Dr. Xu gave him a pointed reminder.

This operation was deliberately arranged to evaluate Zhou Can’s skills. If he performed well, surgeries at this level of difficulty would likely become routine for him.

If not, they’d have to bump him down to easier cases for safety’s sake.

He might even be restricted to only first- and second-grade surgeries.

Right now, Dr. Xu was still working under a cloud from a past medical accident. To this day, he carried that invisible weight. Level-four surgeries were off-limits for him.

Which meant the Emergency Department could offer at most level-three surgeries.

So giving Zhou Can a surgery that was almost level-three right from the start showed just how much hope they were pinning on him.

“Got it!”

Without another word, Zhou removed the special catheter.

Then he picked up the dilator, standing on the patient’s left because the patient was lying flat.

He could have stood on the right as well—it was all down to the surgeon’s preference.

If the patient was in lithotomy position, surgeons typically stand between the legs.

But that setup wasn’t too common.

Steadying a certain organ, Zhou began to advance the dilator into the external urethral opening. That was just step one—the next was advancing the dilator into the bulbar urethra.

This part was no joke. Without solid skills and experience, it was all too easy to injure the urethra.

You had to keep the dilator parallel to the abdomen, sliding it forward. Once it passed through the pendulous urethra, the tip would enter the bulbar urethra.

When the tip reached the bulbar urethra, the surgeon would release his left hand so that the organ could be gently pulled for tension.

Then, with the lightest touch, advance the dilator into the posterior urethra, guiding it from parallel with the abdomen to a vertical angle, so the tip could cross the membranous urethra into the prostatic urethra.

Beads of sweat formed on Zhou’s forehead.

Throughout the operation, he moved with caution at every turn.

After all, this surgery was the Emergency Department’s measure of his personal skill—crucial for building his surgical team.

If all he ever did were first- and second-grade operations, he’d always be replaceable and have limited growth potential.

Only by handling third- and fourth-grade surgeries could he hope to have a real say within the hospital.

Zhou Can was keenly aware of that.

Once the tip of the dilator was past the membranous urethra, Zhou advanced it further while lowering the previously vertical shaft to a parallel position,

“Success!”

Zhou couldn’t help but whisper in delight.

When the dilator was horizontal, that meant its tip had entered the bladder—the operation was done.

It all looked simple, but every step was fraught with risk.

Fortunately, even if you made a mistake in this surgery, the patient’s life wouldn’t be on the line.

At worst, their condition might worsen—and maybe they’d never be a real man again.

The Emergency Department only scheduled this after careful consideration—just to make sure nothing life-threatening could happen.

With the tip in the bladder, Zhou twisted the dilator gently inside the urethra and bladder.

Then, being careful, he pulled it out and repeated the process with a larger-sized dilator.

Dr. Xu watched from the side, a look of satisfaction on his face.

Qiao Yu, being a young woman, spent most of the time pointedly looking elsewhere.

After more than forty minutes, Zhou set the dilator aside and glanced at Dr. Xu.

“Doctor, the operation is finished. Please check my work.”

“Not bad—the whole procedure was solid overall. You passed your first test. But this was only a level-two case, mainly to see your technique. The next surgery will be a real level-three case, so get ready.”

Dr. Xu wasn’t finished testing him yet.

Today, he wanted to see just how much his favorite student had grown after three years away.

Zhou’s Steady Scalpel and Rapid Surgical Technique—the skills Xu was most looking forward to—were the real prize.

Zhou let out a long breath, color returning to his face.

“I need to run to the restroom!”

The pressure during the operation had been intense. He’d stayed tense the whole time.

Now that it was over, he could only think that the next surgery had to be even tougher.

Best to use the restroom now and be in peak shape facing the upcoming level-three case.

Not even attending physicians could lead a level-three surgery.

Only an associate chief physician could do that.

Granting him such a surgery had definitely been approved by Director Lou.