Chapter 453: Race Against Time in the Operating Room

The very first thing to do was to find the major blood vessel ruptured by the sharp weapon.

One thing’s for sure: when a blood vessel is big enough—artery or vein—it can put a person’s life in grave danger.

It’s just that venous blood vessels have lower pressure, so the bleeding isn’t as fierce as with arteries.

Venous ruptures are relatively easier to stop bleeding from.

This nurse had eight stab wounds in her chest and abdomen. Each wound was savage, every cut driving deep into the cavity.

“Found a rupture in the abdominal aorta!”

After clearing out the blood pooled in the abdomen, the main source of bleeding was finally visible.

This kind of jetting hemorrhage is terrifying—it can send a patient’s blood volume plummeting in minutes, leading to shock and death from blood loss.

“Looks like the superior mesenteric artery in the upper abdomen. We’ll have to ligate it first, then repair it.”

As Zhou Can searched, he muttered to himself, laying out the hemostasis plan.

“Hemostatic forceps!”

“Here!”

Qiao Yu quickly handed him the forceps.

Zhou Can located the blood vessel near the heart and clamped it with the forceps.

“Yang Zhi, hold the forceps for me. Not too hard, not too soft.”

The problem with deep abdominal arteries is that clamping too hard during hemostasis can cause thrombosis or another rupture. Necrosis is a bit less likely, but still on the table.

Staunching bleeding is a real test of a surgeon’s skill.

Zhou Can had just found and clamped the vessel in a matter of seconds. It looked simple, but only because his hemostasis skills were exceptional.

He had deep knowledge of anatomy and rich experience with bleeds—the only way he could move so decisively.

Anyone else might have panicked just at the sight of all that spurting blood, hands and feet shaking uncontrollably.

Once Yang Zhi freed up a hand to hold the clamp, Zhou Can moved fast to begin emergency debridement.

Repairing an artery is much harder than you’d think.

With so many deep wounds in her chest and abdomen, there was no way this patient had just one bleeding point.

But Zhou Can could only take it step by step.

He had to handle the visible, most violently bleeding superior mesenteric artery first.

“Dr. Zhou, her blood pressure’s still dropping. Heart rate’s going down too. She’s frothing blood from her nose when she breathes—could there be a lung injury?” The anesthesiologist called Zhou Can’s attention.

“Got it!”

He’d opened the abdominal cavity, but if they needed to approach the lungs, opening the chest was the only way.

Given her condition, there was no way he dared attempt it.

She’d probably die before he’d even finished opening the chest.

No exaggeration—her condition was precarious now, pushing the limits of life.

“Damn it, the portal vein’s ruptured too! How are we supposed to handle this?”

A quick check turned up another major bleeding point.

The intestine was punctured as well, with contents spilling out and contaminating the abdominal cavity. At moments like this, Zhou Can desperately wished for two or three chief surgeons to help save He Juan.

No matter how skilled or fast he was, he was still just one person.

A heavy sense of helplessness kept crashing over him.

“Get Director Xueyan from Cardiothoracic Surgery over here now with her surgical team. Tell her I need her. The sooner, the better!”

Zhou Can pulled every string he had to save her.

If the Emergency Department requested help from Cardiothoracic, they’d send someone—but it’d be strictly business.

With Zhou Can asking personally, though, they wouldn’t hold back.

The struggle to save her continued.

Blood kept foaming from He Juan’s mouth and nose, her blood pressure refusing to climb.

In just moments, they’d already gone through four blood bags.

At 250ml per bag, that was already a whole liter transfused.

“If the pulmonary artery’s ruptured, we’re in real trouble. I can fix the abdominal vessels and intestines with time, but the lungs are a nightmare. We don’t even know where the blood’s coming from yet.”

As Zhou Can hurriedly repaired vessels, he kept the team updated.

The anesthesiologist stayed focused on keeping her alive while Zhou Can worked to repair vessels and intestine.

He couldn’t worry about the torn intestine right now—there was no time.

Stopping the bleeding was the top priority.

Soon enough, Director Xueyan herself stormed in with her whole surgical team. That was the clout Zhou Can had—just mention his name, and she’d go all-out to help.

“I heard a family member slashed multiple medical staff in your ER with a knife. That’s infuriating.”

Director Xueyan’s first words upon entering were to express her sympathy for the ER team.

“She’s coughing blood foam—is that from a lung injury?”

“Sis Yan, I called you here mainly to see if you think she can survive a chest opening? The wound’s in her right chest, here. From the angle, it looks like an oblique stab.”

Zhou Can pointed out the right side of the patient’s chest.

Her chest had been punctured, though the bra and female anatomy meant it probably wasn’t as deep as it looked.

“If we open her chest, she’ll almost certainly die. My suggestion is to open two small windows for endoscopic surgery—she might have a slim chance that way.”

Associate Director He from Cardiothoracic had also arrived.

He owed Zhou Can plenty of favors, so the moment Zhou called, he rushed over to return one.

When it came to thoracic surgery, Associate Director He was the most experienced person in the room.

“Anesthesia, can she be moved to the endoscopy suite in her state?”

Zhou Can checked with the anesthesiologist.

“Leave her here and she’ll die for sure, but if we risk the move, there’s still a sliver of hope. Let’s go for it.”

The anesthesiologist saw Zhou Can’s determination to save her at any cost and was moved. She resolved to take the risk with him.

There was no choice now—they had to gamble.

“Can I at least repair her portal vein and superior mesenteric artery before we go?”

“That’s probably the best option. We can’t leave those two major vessels clamped off for long.” The anesthesiologist frowned, hesitated, but finally agreed.

Her condition was honestly terrible.

The injuries were simply too severe.

“Sis Yan, can we take her straight to your cardiac surgery endoscopy OR?”

“No problem, I’ll arrange it right now.”

Director Xueyan didn’t hesitate. She threw every possible resource at Zhou Can’s disposal.

Saving a critically injured patient like this took everyone’s focused cooperation.

Zhou Can dove back in to quickly repair the superior mesenteric artery.

Before, he’d only managed debridement and some trimming—now, he had to suture the vessel.

One thing worked in their favor—the vessel only needed a tiny section trimmed, so there was no need to worry about a shortening gap or using an artificial graft. Still, suturing a major artery was a true test of skill.

Especially arteries this size.

In practice, as soon as a blood vessel is cut, it shrinks rapidly.

Medically speaking, that’s called vascular collapse.

If you don’t start suturing quickly, restoring blood flow, the difficulty ramps up fast.

Zhou Can gave it his all, racing to suture the artery.

[Suturing +1, 100 Experience points awarded.]

[Suturing +1, 100 Experience points awarded.]

Level six suturing came in clutch when Zhou Can needed it most. His stitches flew faster and faster.

That familiar, life-affirming sensation appeared again with each stitch.

Every suture netted him 100 experience points.

That meant he was in the same miraculous state as before—totally absorbed, no stray thoughts, belief rock-solid, focus razor sharp.

“Done!”

From start to finish, the arterial anastomosis took just three minutes and six seconds—a new record.

[Anastomosis Skill +1, perfect anastomosis achieved—experience awarded. Benevolent Heart +100 experience.]

Zhou Can was stunned.

Direct experience rewards—this was a first.

He didn’t know what counted as a perfect anastomosis, only that he’d felt on fire during the repair. Every movement felt like he’d drilled it a thousand times—his mind even played out the whole procedure in animation, step by step, as if it was just following a set program.

It was a bizarre, hard-to-explain feeling.

If anything, suturing the vessel now felt as familiar as breathing—a move he’d rehearsed endlessly in his mind.

Zhou Can knew not every vessel or situation was the same. There’s no way to actually rehearse—each time, you have to adapt on the fly.

So for his brain to visualize the steps like a well-rehearsed animation felt almost supernatural—a blend of practiced skill and sudden inspiration. That level of ability had only surfaced during this rescue.

He was racking up a crazy amount of experience rewards this time, with none under 100 points. The highest was even more than that. Could it be due to that unique skill, Benevolent Heart?

Normally, Zhou Can barely thought about that one.

Its growth was slow, too.

Now, all at once, 100 points of experience—his first real big boost.

But there wasn’t time to ponder it. Ideas flashed briefly before his focus snapped tight again as he started repairing and suturing the torn portal vein.

Everything he did was smooth and fast, with near-perfect technique from every angle.

Clot removal and air evacuation before anastomosis—every detail was handled with precision.

Five minutes later, the portal vein was repaired.

But her blood pressure kept falling. They’d already started the sixth bag of plasma. The fluids never stopped.

When he finished the portal vein anastomosis, he was rewarded with a whopping 1,000 experience points.

Not quite as wild as last time’s 10,000, but that kind of payout let his anastomosis skill level rocket up.

He was rapidly closing in on level six anastomosis.

He loosened the ligature on the portal vein to test flow. Blood started running through again.

“Hey, nice! Her blood pressure’s creeping back up. But now she’s going into respiratory failure—we’ve gotta fix the lung injury fast. Biggest worry is fluid building up in the lungs, stopping her breathing altogether.”

Continued bleeding in the lungs doesn’t all drain through the bronchi.

Serious fluid buildup always follows.

Lungs breathe by the constant expansion and contraction of countless alveoli—taking in air, pushing out waste. With too much fluid, it’s as if they’re drowning from the inside.

If it’s just some buildup on one side, she’ll feel tight and short of breath.

But if both lungs flood badly, it’s like being strangled—you can’t breathe at all.

Her respiratory failure was a very ominous sign.

“Let’s drain the chest right away. I doubt she’ll make it to the endoscopy suite otherwise.”

Zhou Can checked her vitals on the monitor.

The alarms were blaring, but there was no quick fix. He could only keep patching up the most urgent torn blood vessels.

This is where a chief surgeon like Zhou Can had to step up.

Any other doctor wouldn’t have the experience or speed to handle this.

“Draining first is definitely the right call.”

Director Xueyan had been by his side the whole time, helping with the rescue, as had Associate Director He.

Having both the chief and associate chief from Cardiothoracic hands-on was a big deal.

They divvied up the work—one ligating the torn bowel to stop the leakage and tidying up to cut down on contamination risks.

The other tackled smaller bleeding points, using electrocoagulation and more ligatures.

Under their teamwork, the patient’s outlook finally started to improve.

A chest drain is also a demanding procedure—high risk and high difficulty.

Many trainees barely even get the basics by the end of their residencies.

For new doctors, things like urinary catheterization and the four types of core punctures are notoriously tough.

Take catheterization—on elderly diabetic patients, it can make rookies cry. Even experienced residents dread those cases.

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Older male patients almost always have enlarged prostates.

That makes catheter placement much harder.

If the patient also has syphilis or severe eczema, it’s enough to break some doctors.

Zhou Can’s injection technique was level five—the equivalent of an associate chief physician.

Thoracentesis was a breeze for him.

He found the site, inserted the needle into the chest, and watched as dark blood flowed quickly from the catheter.

“There’s enough fluid to swamp half the lung.”

His choice of site mattered a lot.

With an experienced eye, you could estimate lung fluid from the drainage speed, tiny shift in location, and puncture depth.

One thing to remember—fluid in the lungs isn’t always blood.

Sometimes it’s also serous fluid, or even sticky pus.

For example, in early COVID cases, the lungs would fill with thick, sticky fluid, turning into stone-like blocks. That’s what killed most of them.

Once the lungs hardened, breathing was impossible.

There was no way to expand or contract anymore.

…

Inside the cardiothoracic endoscopy OR, Zhou Can was now consulting with Associate Director He, Director Xueyan, and others. They pinpointed the likely spot where the pulmonary artery had torn, made three small incisions, and began endoscopic exploration.

“Lobar lung injury, two pulmonary artery ruptures—one of them really serious.”

Zhou Can’s endoscopic skills were as sharp as ever.

Under his hands, they quickly got a clear read on the lung bleeding.

Next came hemostasis and vessel repair. Unlike open abdominal surgery, bleeding control in the lungs had to be done endoscopically, working inside a cramped chest cavity.

“We’re low on blood again—her pressure’s dropping. How many bags of plasma are left?”

“Just one now.”

“Contact the blood bank, tell them to figure something out. If we’re going to finish this whole rescue, we’ll need more blood transfusions.”

Watching her vitals drop, the anesthesiologist was getting more anxious by the minute.

Sweat kept beading on Zhou Can’s forehead, his undershirt already soaked. But all he could think about was saving He Juan, no matter what.

Her toddler was still waiting at home for mom to come back.

Her husband, parents, and family didn’t even know yet—how would they cope when they found out she’d been stabbed like this at work?

Almost half an hour later, Zhou Can finally completed hemostasis, vessel repair, and wound suturing in the lungs.

He gradually restored pulmonary blood flow.

Perfect.

Blood flowed smoothly with no clots or blockages.

“Her breathing’s starting to recover. Blood oxygen is creeping up. Dr. Zhou, that’s incredible!”

For the first time, the anesthesiologist Qu Zi’s brow eased, her eyes shining with relief and excitement.

The patient’s blood pressure nudged upward as well.

But the rescue wasn’t over—eight major stab wounds meant there was still a mountain of work ahead.

So far, they’d only tackled the most life-threatening bleeds. Bowel repair, cleaning the abdominal cavity, and closing numerous other wounds still lay ahead.

Exhausted but undeterred, Zhou Can threw himself back into work alongside Director Xueyan and the rest of the team.

Associate Director He knew his hands were too slow and gave up his spot to Zhou Can.