Chapter 397: Unexpected Challenges in the Operating Room

“Alright, lie down on the table! Prone position is best for this procedure!”

Zhou Can guided the middle-aged man to lie down properly on the operating table.

The foreign object was conical in shape.

How something like that ended up in an adult’s rectum was truly baffling.

Judging by the scans, the object’s diameter was quite large. Swallowing it was nearly impossible—just its size alone meant it couldn’t possibly pass through the narrow esophagus or small intestine.

So it was definitely pushed in from the outside.

“Doctor… do I need anesthesia for this?”

“If we need to perform surgery to remove the foreign body from the rectum, you’ll definitely need anesthesia. We often use spinal anesthesia, which is also known as subarachnoid or half-body anesthesia. This type of surgery is very complex. It usually requires opening up the abdomen, then cutting into the intestine to take out the object.”

Zhou Can patiently explained everything to the patient.

He also wanted the man to understand the seriousness of the operation.

“Have you tried getting it out by passing stool?” Zhou Can asked.

“I tried, but it didn’t work! I even drank half a bowl of cooking oil on purpose, but it didn’t help at all.” The middle-aged man sounded exhausted. One look at his face, and it was clear he was suffering.

Inside, he was filled with fear.

“You really need to be more careful in the future. You’ve been lucky this time—your intestines didn’t rupture. If they did, waste could leak into your abdomen and cause a life-threatening infection. If the bowel tears and you start bleeding heavily, that’s just as dangerous.”

Since they were both adults, Zhou Can could only offer this gentle warning.

It was a bit of a scare tactic, but he meant well.

A ruptured bowel that leaks its contents into the abdomen can cause severe bacterial infection, even sepsis, which can be fatal. Once intestinal contents enter the abdominal cavity, chemical peritonitis can occur, causing intense pain or even shock.

It’s truly life-threatening.

Even with all the advances in modern medicine, abdominal infections still carry poor outcomes and deaths happen.

In earlier years, accidental leaks of intestinal contents during abdominal surgery resulted in plenty of patient deaths.

Zhou Can first used a dilator to expand the patient’s anus, then used forceps to grab the base of the conical object.

Luckily, the pointed end faced inward. If it had faced the other way, removal would have been a lot harder.

“Qiao Yu, slowly inject some lubricant.”

With a firm but gentle grip, Zhou Can started pulling the object out.

It was extremely tight at first. Any little tug made the man wail in pain. Thankfully, once it loosened up a bit, the lubricant helped and things went smoother.

After quite a struggle, Zhou Can finally managed to pull the object out completely.

He checked and was relieved to find the intestine hadn’t ruptured.

“What on earth is this thing?”

Qiao Yu leaned in, curiosity all over her face.

“Mind your own business, kid.” Zhou Can noticed Qiao Yu was as innocent as a blank sheet of paper.

He helped the middle-aged man pull up his pants and wrote him a prescription—basically just a box of antibiotics.

“Eat more fruits and vegetables when you get home. It’ll help prevent constipation. If anything feels off, come back to see us right away.”

“Alright, thank you, doctor!”

The man looked a bit embarrassed and hurried out of the operating room with Ma Xiaolan leading the way.

“Hey, that was kind of rude just now! Calling someone a kid—she’s twenty-five.” Qiao Yu protested, a little put out.

“Sorry about that! I promise to be more careful with my words next time. Dr. Luo, don’t just stand there—throw that thing in the trash already!”

After apologizing to Qiao Yu, Zhou Can told Luo Shishen to dispose of the medical waste.

With the first patient taken care of, another was brought in.

This next case was also a gastrointestinal emergency—acute pyloric obstruction needing urgent surgery.

Pyloric obstruction mainly causes nausea, burping, loss of appetite, and bloating.

Most regular pyloric obstructions can be treated with medication.

But in cases like this, when the patient had severe reactions—constant vomiting, dehydration, weakness, little urine, constant thirst—and meds from other hospitals failed, they’d come to Tuyu ER yesterday.

After an evaluation, surgery was clearly indicated.

The Emergency Department set up emergency surgery for the patient.

Normally, this would count as major surgery and would usually be scheduled in advance.

This patient also had a stomach ulcer. Any more delays would risk malignant transformation.

As soon as the patient entered the OR, the anesthesiologist followed.

It turned out to be Director Dongfang Luoxue from the Anesthesiology Department.

Recently, Zhou Can didn’t need to study with Dr. Hu Kan in Cardiothoracic Surgery anymore. So ever since Dr. Hu’s passing, he’d been keeping his promise—spending three or four evenings a week after work in Anesthesiology, learning from Director Feng.

Textbook knowledge in anesthesiology is pretty limited, with plenty of overlap with general clinical medicine.

Advancing anesthesiology skills mainly depends on hands-on experience and learning from real cases.

Every surgery Director Feng participates in is a high-risk, level-three or level-four operation. His expertise is beyond question—he’s the best anesthesiologist at Tuyu Hospital.

He’s senior, loaded with experience, and extremely skilled.

Plenty of people think his personality is strange and hard to get along with. Many avoid interacting with him. But to Zhou Can, Director Feng had an intense passion for anesthesia—he’s poured his life into learning, practicing, and improving his skills.

In the old days, people who dedicated their lives to martial arts and ignored worldly affairs were called martial arts fanatics.

Director Feng is, in a sense, a ‘medical fanatic’ for anesthesia.

In this world, there’s nothing scarier than someone who devotes a lifetime to perfecting a single craft. After a decade or more of relentless work, they often reach stunning heights in their field.

At first, Zhou Can wasn’t all that passionate about anesthesiology—he just figured it couldn’t hurt to have another skill, so he started learning from Director Feng.

But as he studied more, especially after serious training with Dr. Hu Kan in cardiothoracic surgery, he started seeing the true value of anesthesiology.

Anesthesiology offers a deeper understanding of the body’s three major circulatory systems, both internal and external. Not only that, but it covers all nine body systems, especially the nervous, respiratory, circulatory, and musculoskeletal systems.

You could say the internal medicine doctors know physiology and pharmacology best.

But anesthesiologists? They’re the ones who truly understand life itself.

When it comes to supporting and safeguarding life, anesthesiologists come second to none.

After learning about anesthesia, Zhou Can felt the benefits in his daily clinical work—even his surgical strategies would change based on anesthesiology.

He also noticed there’s a certain interconnectedness among all branches of medicine.

Medicine is almost like a circle. If you’re missing any piece, the circle just doesn’t close.

Mastering anesthesiology can greatly deepen and unify your grasp of all medicine.

For most people, becoming truly proficient in any one medical field over a lifetime is quite the achievement.

But Zhou Can’s advantage is his Experience Points System. What takes others ten years, he can do in two or three, maybe less. With constant XP gains, quantity soon becomes quality.

With such an edge, he has the time and energy to explore more medical specialties.

Mastering all medical fields is impossible for anyone.

But reaching considerable expertise in several areas? That’s not too much to ask of him.

He’s already obtained strong skills in general surgery, critical care, cardiothoracic surgery, nephrology, and gastroenterology, among others.

Now, as the leader of surgical teams in the Emergency Department, he’s handling nearly every kind of surgery.

As long as he keeps gaining experience, he knows he can keep reaching new milestones across medicine.

Director Dongfang Luoxue was as cold as ever—like an icy beauty from legend.

She was already in her forties, and it showed. Still, there was a hint of lingering elegance in her looks.

“Need any help?”

Zhou Can greeted her with a warm smile.

“Yes.”

She answered with a single word, doing her best to squeeze out a faint smile in return.

Maybe she’d gotten used to wearing a frosty expression, because her smile looked especially stiff.

Still, for her, forcing out any smile was quite an achievement.

“Director Dongfang, you really do look more approachable and beautiful when you smile!”

Zhou Can didn’t hold back with his compliments.

In the past year before Dr. Hu Kan’s passing, Zhou Can would head over to Anesthesiology at least once a week to study with Director Feng. Over time, he’d gotten to know nearly everyone there.

Now, the anesthesiology doctors treated him like one of their own.

Director Dongfang’s friendly attitude toward Zhou Can—even though she was a Chief Physician, she treated him, a Resident, as an equal—was because she’d seen his skill firsthand.

She couldn’t deny it.

She showed little emotion even after Zhou Can’s praise, but her eyes betrayed her joy—she was definitely pleased inside.

While helping administer general anesthesia, Zhou Can asked about the patient’s condition.

Director Dongfang would’ve already done a full workup before having the patient sign the anesthesia consent form. Still, Zhou Can wanted to double-check for his own learning.

It was also about making sure the operation would go smoothly and safely.

“Alright, lie back! For this surgery, you’ll be on your back. Just relax—think of it like taking a nap. When you wake up, your illness will be gone.”

Zhou Can comforted the patient and helped him lie flat.

Pyloric obstruction surgery is usually performed with the patient supine, using either a median upper abdominal incision or a left upper quadrant approach through the rectus abdominis.

Sometimes, patients prefer to lie on their sides due to pain.

The anesthesia went flawlessly, and the patient quickly drifted into sleep with stable vital signs.

“Dr. Luo, when choosing the incision for pyloric surgery, always tailor it to the patient. Don’t just go by the book. Remember: the best incision is the one that makes the surgery easier and leads to better outcomes. If you can’t have both, weigh the pros and cons and decide carefully. If your skills aren’t there yet, pick the approach that lets you operate more safely.”

Zhou Can coached Luo Shishen with impressive care and detail.

It was pretty much hands-on mentoring.

How much Luo actually grasped and remembered was up to him.

Dr. Xu stood by, keeping an eye on things as a supervisor.

Now, he mostly let Zhou Can do his thing.

As long as Zhou Can was up to the job, Dr. Xu didn’t interfere. That level of trust had given Zhou Can invaluable opportunities to hone his skills independently.

“Hemostasis!”

After Zhou Can cut through the abdominal wall, fresh blood welled up.

He’d already taken care to avoid the larger blood vessels.

Bleeding is a part of surgery, especially with major abdominal or chest operations, where the risk of heavy bleeding is always high.

If you lack experience or don’t have solid surgical skills, opening up critical places like the chest or abdomen is simply too risky.

If you aren’t confident and try anyway, you’re asking for trouble.

Luo Shishen fumbled with the cautery, trying to control the bleeding at the incision site.

“Xiao Luo, keep practicing after you go home. Let me handle it!”

Dr. Xu couldn’t watch anymore.

He was strict with his team, and messy technique like this was unacceptable to him.

That’s why interns are never allowed to be first assistants.

For a level one or two procedure, an intern might just manage as an assistant.

But for level three or four surgeries, even senior residents often struggle.

Doctors like Zhou Can, pure geniuses, are rare indeed.

Even someone like Du Leng, a PhD fresh from overseas, can’t compare in surgery. Frankly, he’s not even qualified to carry Zhou Can’s bag.

That’s not arrogance—it’s just the truth.

Choosing surgery as a specialty was the wrong move for Du Leng.

Given his deep medical knowledge, internal medicine might’ve been a better fit.

We all make our own choices, and sometimes luck helps too.

Now, over three years later, Du Leng is an attending in general neurosurgery, and he spent nine months training in general surgery. Zhou Can honestly didn’t know how he was doing these days.

He was definitely not as high-profile as before.

Without true skill, neither the department nor the doctors will give you the spotlight.

The so-called prodigies who joined Tuyu Hospital the same year as Zhou Can are all quietly working hard now. Even Gao Jian, who went into internal medicine, recently started seeing patients in the outpatient clinic.

Still, none of them are on Zhou Can’s level.

Zhou Can has been seeing patients in pediatrics alone for over a year now.

The crowd he draws and the experience he has aren’t something Gao Jian can match. Everything from diagnosis to medication, treatment plans to prognosis—even if Zhou Can stopped improving now, it’d take Gao Jian at least ten years just to catch up.

That’s not an exaggeration.

Being able to diagnose pathology and judge pharmacology at a deputy chief level—many doctors never reach that, no matter how hard they try.

Even among talented doctors, reaching that level often takes at least two decades.

Tuyu Hospital even put Zhou Can, an undergraduate, on the Elite Doctor’s Hall shortlist while he was still just a resident in training—not even certified yet. That says a lot about his abilities.

Decisions like these go through the strictest review process.

With his impressive credentials, Du Leng hasn’t even seen the shadow of that elite shortlist.

That shows just how hard it is to join the Elite Doctor’s Hall.

…

The surgery went off without a hitch. It took less than two hours from start to finish.

But since the two best surgeons in the ER—Zhou Can and Dr. Xu—were both busy with this case, other emergency patients piled up.

In the other operating room, Dr. Cui, who’s competing for a full attending contract, was working hard on his own operation.

His surgical skills were already up to attending standards.

But in terms of speed, he was nowhere near Zhou Can.

It’s worth noting that Dr. Xu isn’t particularly fast with surgeries. Part of it is his caution—he’s careful not to repeat past mistakes, so he no longer chases speed. Plus, he’s just getting older. Endurance and energy aren’t what they used to be.

Once a man hits thirty-five, his stamina drops off compared to his twenties.

After fifty, they call you an old man—and your strength goes too.

That’s why Zhou Can is the real backbone of emergency surgery here.

He operates fast, and he does the job well.

He’s not picky about the cases either—he can handle nearly every type of surgery thrown his way.