Chapter 410: A Test of Nerves in the Operating Room

Still no news had come back.

Dr. Xu returned to the operating room about half an hour after stepping out and picked up the surgery where he left off, never mentioning anything about the patient with gangrene.

A true teacher really knows how to keep his cool. But come on, at least let us know if things worked out!

Zhou Can kept at the surgery inside, not leaving to ask for updates.

Just as the shift was about to end, Ma Xiaolan brought in a new patient—the very man whose leg wound had split open and turned gangrenous.

His skin was dark and you could still see where the sun had left its mark on his forehead and arms.

By all accounts, he should’ve been a robust, healthy middle-aged man with a strong immune system.

But maybe because he hadn’t gotten the nutrition he needed after injuring his leg, and with his illness dragging on, his body had started wasting away. That was a bad sign.

They had to clean up his wound and do all the necessary suturing while he was still in relatively good shape.

Then follow up with professional medical care to help him recover quickly.

Any illness is just as terrifying as a fire.

At first it might be just a tiny spark—if you catch it early, it’s easy to stamp out.

The longer you wait, the worse it gets.

Once the flames start raging, it’s nearly impossible to get them under control.

If you wait until almost the whole house is burned down before fighting the fire, even if you finally put it out there won’t be much house left to save.

Treating a patient follows the same principle.

Stop the disease before the body suffers too much damage.

That’s also the reasoning in traditional medicine: treat symptoms before they worsen.

Right now though, this patient was already teetering on the brink.

“I’ve already assessed his condition. Spinal anesthesia will do. His prognosis isn’t great, but we’re doing everything we can. The family is desperate to save his leg and willing to try anything, no matter the cost. The patient feels the same way.”

Dr. Xu stepped in.

The anesthesiologist followed right after, carrying her trusty ‘toolbox.’

No wonder it took so long to get him into the OR.

After discussing things with the family, Dr. Xu probably consulted with Director Lou or Deputy Director Han. Once they gave the green light, he reached out to Anesthesiology.

Then Anesthesiology had to send someone to evaluate, talk to both patient and family, and get anesthesia consent forms signed.

That’s a whole lot of logistics to run through—getting it all done this quickly was pretty impressive.

Maybe because it was a spinal, the one coming in was a female attending anesthesiologist.

For this kind of anesthesia, there’s no need to call in a deputy chief or even a senior attending.

“Hey, want me to help with the lumbar puncture?”

Zhou Can greeted her with enthusiasm.

“Absolutely! If Director Feng’s star pupil is offering, I’d be crazy to say no!”

The female anesthesiologist gave Zhou Can a grateful smile.

What a rare treat—she’d finally met a normal anesthesiologist.

In Zhou Can’s experience, most in Anesthesiology always looked stone-faced and dead serious—only Dr. Guan seemed somewhat normal.

But ever since Dr. Guan nearly got into trouble with a medical incident, he too had become less cheerful.

There had to be a reason Anesthesiology was always short-handed.

It’s a tough job—lots of work, lots of risks, lots of stress, and only a so-so paycheck.

Why aren’t anesthesiologists paid as much as people imagine? Zhou Can had heard a story from seven or eight years ago when changes to salaries and bonuses were rolled out for medical staff.

Turns out, nurses in a key department were suddenly earning bonuses nearly two thousand yuan more per month than the anesthesiologists.

It left the anesthesiologists feeling resentful, and they staged a collective protest.

Hospital management had no choice but to hold meetings, eventually coming up with a solution that was almost comical: nurses’ bonuses could match anesthesiologists, but not exceed them.

And that’s how the issue was finally put to rest.

If that story’s true, it shows their income really isn’t as high as people might think. If it was, no one would get this upset just because nurses made a couple thousand more.

To be fair, nurses work incredibly hard.

Except for the veterans who duck their duties. Some lazy nurses wouldn’t even hang an IV if they didn’t have to, always making the newbies do it.

Spinal anesthesia is often called a lumbar block.

After prepping the site and disinfecting, you puncture between spinous processes in the patient’s back and inject local anesthetic into the subarachnoid space, causing the lower body to go numb.

Sounds simple, but it’s actually pretty difficult to pull off.

Most rookie anesthesiologists mess it up frequently.

Zhou Can’s injection technique was already at level five—the equivalent of deputy chief physician. Puncture skills were part of that training.

Whether it’s chest, lumbar, or abdominal punctures, Zhou Can could handle them all easily.

Out of the whole anesthesia process, lumbar puncture was often the trickiest part.

Of course, Zhou Can made it look effortless. He finished the lumbar puncture with ease, leaving the female anesthesiologist in awe.

“Can you feel anything in your lower body?”

After a bit—when she figured the anesthesia had kicked in—the female anesthesiologist tested the patient’s response.

“Nothing! Totally numb!”

“Perfect. That means the spinal worked.”

The anesthesiologist admired Zhou Can’s skill even more. What was a tough challenge for her seemed like child’s play to him. She couldn’t help but envy his steady hand.

You only get that kind of confidence when you’ve truly got what it takes.

No wonder Director Feng liked this young doctor so much!

“Let’s get started on the debridement—we still don’t know what we’ll find inside, and with this depth, I’m afraid it’s reached the bone.”

Dr. Xu’s face turned serious.

They took this patient mostly on account of Zhou Can.

Of course, Dr. Xu was also genuinely sympathetic.

Any doctor with a real sense of ethics shares the same basic belief.

Treat every patient like family—it’s rare to find doctors who truly live by that.

Zhou Can’s debridement technique was already level five, which was one reason he dared tackle this gangrene surgery.

You have to have the right chops before you take on a tough job.

Good intentions aren’t enough if you lack the skill.

“Dr. Luo, help the patient by cutting those stitches first.”

Zhou Can decided to give Luo Shishen a chance to practice.

Operating on a gangrene patient takes nerves of steel. Some people even end up vomiting on the spot.

A surgical mask does nothing to block out that rotten stench.

And with the visual shock added in, it’s easy to lose your lunch.

Many rookie doctors struggle after witnessing a dead body, a bloody scene, or something truly revolting. Some can’t even eat for a day or two afterward.

Zhou Can had scrubbed in with plenty of chief surgeons before. On top of that, he’d done loads of surgeries in General Surgery, Cardiothoracic, and Emergency—his mental fortitude had been tempered long ago.

Honestly, the toughest test of nerves might not be the OR, but the ICU in Critical Care.

Some patients there, like severe burn victims, barely had any skin left.

You might even see large patches where the scabs had melted and turned into pus.

It was enough to make your scalp tingle just looking at them.

That melting scab isn’t just excruciating—it’s also extremely dangerous.

Especially when it covers large areas of the body. It has to be stopped right away.

“Uh…”

Luo Shishen’s brows furrowed tightly. Gloved up and holding the scissors Qiao Yu had passed him, he looked like someone being forced to jump into a fire pit.

“Hurry up, quit stalling!”

Zhou Can urged him, impatient.

Since Luo Shishen worked under him, Zhou Can had to keep him on task.

Dr. Xu didn’t bother about these small matters.

Qiao Yu had worked as an ICU nurse, so she could handle the pressure—and all she needed to do was pass instruments. Ma Xiaolan, on the other hand, seemed on the verge of losing it, standing at the foot of the table and barely daring to look at the wound.

The operating room itself wasn’t great either.

If this had been a laminar flow OR—hell, even a basic one—it would’ve sucked out the stink near the table.

But right now, everyone got to enjoy that putrid air up close.

“Geez, there are so many stitches! Isn’t this just torture?” Luo Shishen’s hands quivered. If not for the mask, you’d have seen the disgust on his face.

“Focus.”

Zhou Can barked again.

In moments like this, the attending doctor had to be strict.

That kind of pressure could help Luo Shishen overcome his discomfort.

Normally, you’d cut each knot with one snip when removing stitches.

With continuous suturing, you could get away with just a single cut, but most nurses snipped every segment individually.

It made pulling the thread out of the skin easier.

Under Zhou Can’s scrutiny, Luo Shishen snipped one stitch at a time, clearing them away.

Without the threads holding it shut, the wound gaped wider.

Pus and blood mixed together and dripped down like syrup.

The stench instantly got worse, sharper and thicker.

“Xiaolan, don’t just stand there. Grab the trash can and catch this stuff.”

Zhou Can was purposely giving the new team members some training.

Normally, circulating nurses had more experience than the lead surgeon—they’d need no reminding.

Ma Xiaolan hurried over with the trash can, turning her head away and holding her breath.

“Keep your eye on it—don’t let it spill. If that gets on the floor it’ll be a nightmare to clean up.”

That pus was loaded with bacteria—maybe even viruses.

Washing and disinfecting would not be an easy chore.

“Ugh…”

Ma Xiaolan started gagging and ran to the covered trash can, hand over mouth.

Dr. Xu just shook his head at the sight.

But he didn’t comment.

After all, everyone starts as a rookie.

Emotions really might be contagious—like yawning, where seeing someone else do it makes you want to yawn too.

In that moment, Ma Xiaolan’s retching seemed to set off Luo Shishen.

A grown man, and he followed suit—throwing up as well.

“That kind of nerves need some serious work.”

Not wanting to hold up the operation, Zhou Can took over the stitch removal himself. It was just a small task—if you could overcome your revulsion, it was no big deal.

He quickly finished taking out all the sutures.

“Hand me the suction tip—I need to clear out the blood and pus.”

Zhou Can told Qiao Yu.

“Here!”

Qiao Yu had it ready and passed it over right away.

Technically, suctioning out that stuff should’ve been the assistant’s job.

But seeing how unsettled Luo Shishen was, Zhou Can did it himself.

“Let me handle it.”

As the teacher here, Dr. Xu had seen it all before. He calmly stepped in to assist Zhou Can.

After vomiting, both Luo Shishen and Ma Xiaolan looked embarrassed.

Ma Xiaolan even teared up.

Throwing up really was rough.

“Just watch for now. You need to get used to this and learn to adapt. If you stick with me, you’ll see much worse in the future.”

Zhou Can told them both what was expected.

The patient just looked mortified, shutting his eyes.

If only they’d gone with general anesthesia—maybe that would’ve been kinder.

Once he’d cleared out the pooled blood and pus, Zhou Can started prepping for debridement. Many parts of the tissue had rotted away completely.

“Zhou, walk us through your plan for the debridement.”

Dr. Xu was telling him not to rush in.

“This is a case of wet gangrene with deep and shallow wound surfaces. I plan to clean out the dead tissue in phases—today I’ll focus on the parts that are clearly necrotic. For questionable areas, I’ll leave them for now.”

That was Zhou Can’s approach.

A lot of surgeons think you should cut everything out in one go—even some of the healthy tissue to be safe.

But that’s actually a mistake.

Doing that could make things worse.

For wet gangrene, the best approach is to save as much healthy tissue as possible and never rush.

Trying to eat hot tofu in a hurry only ends up burning your mouth—same goes for surgery.

Cutting away all the bad—and even some good—tissue at once just to ‘clean up’ never works the way rookies hope.

That’s just wishful thinking from fresh-out-of-training doctors.

A truly experienced surgeon would always handle it like Zhou Can did.

“Excellent plan. Go ahead and get started.”

Dr. Xu nodded with satisfaction, trusting Zhou Can to handle it.

Zhou Can first cleaned out all the clearly dead tissue.

Then he gave the wound an initial rinse, carefully inspecting which parts needed cutting and which could be saved.

That process was way tougher than it sounded.

It took limitless patience, attention, and a steady hand. Some bits needed to be cut out with scissors.

…

Over three hours later, Zhou Can looked at the patient’s wound and finally felt satisfied.

Where once there’d only been pus, the wound now looked completely transformed.

Bleeding had been controlled where needed.

It was almost impossible to spot any pus or festering flesh now.