Chapter 462: Precision and Challenge in Thoracic Surgery

After Zhou Can incised the wall of the abscess cavity, he carefully used a curette to scrape away all the necrotic tissue until only healthy tissue was left. He picked up 11 more experience points in Debridement Technique.

When performing this kind of chest wall tuberculosis lesion removal, the greatest gain is definitely experience in debridement.

Once the cavity was clean, he swapped for a scalpel and started cutting away the abscess wall and necrotic muscle tissue bit by bit.

It might look simple, but in reality it puts both excision and tissue separation skills to the test.

Abscess cavities are irregularly shaped, and removing the dead muscle means you have to carefully search for fistulas and possibly deeper hidden abscesses.

This procedure not only tests the chief surgeon’s skill but also requires a wealth of surgical experience.

It also calls for a lot of flexibility and quick thinking on the fly.

And when excising diseased tissue, you have to be extra careful not to injure any major blood vessels, nerves, or vital organs nearby.

Even associate chief physicians get wobbly-legged at the prospect of performing this level of surgery.

Director Xueyan and Director Le both agreed to let Zhou Can take the lead specifically because the procedure is so complex and demands top-level expertise.

“Well, would you look at that—the fistula is hiding here!”

Modern high-tech scans make life easier for doctors, but you can’t just rely on images to breeze through the real surgery.

Looking at the films, you can tell the size of the abscess and roughly where the fistula is.

If you run a contrast study, you can see the fistula’s path clearly.

But when you’re actually opening the cavity, things rarely go as expected.

There are just too many variables and countless details that could trip you up.

Once Zhou Can found the fistula, he carefully opened and cleared it out bit by bit.

“This fistula is a real pain. Why’s it run all the way behind the rib?”

He figured this had to be one of the most complicated surgeries he’d ever worked on.

“How are you going to handle that?”

Director Le clearly knew some ways to deal with it, but out of respect for Zhou Can, asked him directly.

“No choice but to cut this rib, expose the base of the fistula, and clear the lesion completely. Otherwise, the whole surgery would be for nothing.”

Zhou Can wasn’t just skilled—he was battle-hardened on the operating table.

Taking things as they came, adapting as needed.

Facing a fistula that ran behind the rib, he steeled himself to tackle this hard problem head-on.

This was a core principle drilled into him by Dr. Hu Kan and Dr. Xu: a true doctor treats patients wholeheartedly. When operating, you can’t just go through the motions.

You’ve got to plan every move with the patient’s best interests in mind.

Some doctors with shaky ethics run into major trouble in surgery and immediately think about what’s best for themselves.

Cutting a rib not only adds to the challenge and time, but brings a whole mess of unknown risks.

Try explaining that to the family later—there’s always a chance of disputes or even complaints.

Why do a good deed that only brings you headaches?

Might as well just stitch up the wound and claim the job’s done. If the patient relapses later, that’s just tough luck—they’ll be admitted a second time for another surgery.

There’s no shortage of these “second admission” patients in the operating rooms of big hospitals.

Not all of them are due to shady doctors or incomplete surgery, but at least forty percent are.

Sometimes it’s not about ethics—it’s just that the doctor’s technical limit has been reached.

Let that surgeon do ten of these cases, and all ten patients will end up needing a second operation.

All in all, the tense doctor-patient relationship these days is a huge reason why some doctors stick to defensive medicine.

Zhou Can rarely had to saw bones, especially patient ribs or skulls.

This time, he took it as a chance to brush up on his bone work.

Letting surgical skills sit idle too long makes them rust, and you might end up slipping backward.

Which isn’t good for improving as a surgeon.

Once he carefully sawed through the rib, the fistula was exposed. He opened it all the way to the base, then used a curette to clean it out.

“Sis Yan, can you check if this rib is still healthy?”

For patients where the fistula invades behind the rib, if not treated in time, the rib can easily become necrotic.

“Looks decent to me. I don’t see any sign of necrosis.”

Director Xueyan checked and gave her assessment.

Women are detail-oriented; having a female doctor double-check for subtle changes often pays off.

This patient was lucky to have Zhou Can on their case. He was sparing no effort or expense to cure them.

He began excising the fistula.

Both his Tissue Separation and Excision Technique were gaining steady experience points.

Given the difficulty of the procedure, picking up extra rewards made sense.

“Hey, looks like there’s another abscess here! Hand me a syringe with a tube.” Zhou Can had a hunch there’d be a lot of pus in the newly found deep abscess.

Getting the needle in was almost effortless.

When he tried to draw out the pus, he ended up extracting nearly seventy or eighty milliliters.

This hidden abscess cavity was much bigger than he’d imagined.

“No wonder I always felt something was off in this spot when looking at the CT. Next time I see this kind of patient, I’ll be sure not to trust the scan alone—overlapping abscesses can make scans miss the mark.”

Right then, Director Xueyan had a lightbulb moment.

Not just her—even Zhou Can picked up valuable insight.

That’s the journey of medicine—a slow grind, making progress step by step through real practice.

Thanks to Zhou Can’s efforts, the deep abscess was cleaned out, then separated layer by layer until it was fully excised.

“That was close. Here’s another small fistula! Good thing we caught it, or this patient would’ve been in real danger.”

While removing the deep abscess, Zhou Can uncovered yet another fistula.

It was tiny, but already impressively deep.

When surgeons encounter an abscess during surgery, if at all possible, they try to drain the pus, then operate when the timing is right.

That’s because an abscess can aggressively damage surgical wounds and all sorts of tissues inside the body.

If the abscess isn’t cleared completely, it’s very likely to lead to reinfection or relapse.

Sometimes it can even cause completely unexpected postoperative complications.

…

Nearly an hour later, the surgery was done.

Looking at the array of new experience points, Zhou Can felt satisfied. More importantly, he had wiped out the patient’s disease. With proper care in the ward and no complications, recovery should be smooth.

A lot of patients who suffer a relapse from tuberculosis naturally think it’s just because the disease is tough to cure.

But more often, it’s because the focus of infection wasn’t fully cleaned, or residual cavities were left at closure, or pre-op anti-tuberculosis treatment was insufficient, leading to spread of active tuberculosis or infections by drug-resistant mycobacteria. That’s what causes recurrence.

For these kinds of diseases, mutual trust between doctor and patient is crucial.

There’s also the importance of confidence—the chief surgeon needs it, and so do the patient and their family. With full faith that the disease can be beaten, most people can pull through.

If a relapse triggers suspicion or turns the relationship confrontational,

at that point, it’s best to go to another hospital and find a different doctor.

Returning to your original doctor when there’s no trust left means they’ll treat you with extreme caution—that’s defensive medicine in action.

“Great work, everyone! As usual, I’ve ordered supper—help yourselves before you go, or take it home!”

Director Xueyan was beaming at the success of the surgery.

Under her leadership, Cardiothoracic Surgery was slowly getting back on its feet.

To many people, it seemed nothing short of a miracle.

Back when Dr. Hu Kan died suddenly, Cardiothoracic Surgery was facing a crisis. Plus, with Director Xueyan lacking experience in running a major department, chaos reigned as other hospitals piled on. She took a risky high-difficulty surgery—and the patient died on the table.

At that moment, everyone thought Cardiothoracic Surgery was doomed.

Even Tuyu Hospital’s senior management were preparing for an emergency leadership change.

In that pivotal time, Zhou Can threw all his support behind Director Xueyan and Cardiothoracic Surgery. With regained confidence and tireless effort, together they made the department what it is today.

Vice Director Zhang from Third Hospital even visited the Emergency Department at Tuyu Hospital in person, trying to recruit Zhou Can—speaks volumes about how far Cardiothoracic Surgery has come.

That’s proof the department is back on solid ground.

Even if it’s not at its peak, Third Hospital, Provincial People’s Hospital, and Xinxiang Hospital are all feeling the pressure.

It’s just like in geopolitics—when one neighbor grows stronger, neighboring countries always feel the heat.

You don’t need flashy advertising when your strength speaks for itself.

No matter how low-key you try to be, your rivals can sense your capabilities.

There are only so many cardiothoracic patients in the province. Subtract those handled by smaller hospitals, and the remaining cases are split by the big names.

Last year, when Tuyu Hospital was struggling, Cardiothoracic Surgery lost a lot of patients; other hospitals got a taste of that windfall.

Now that Tuyu Hospital’s department is rising again, more patients are coming back, and it’s easy for those other top hospitals to notice their outpatient and emergency numbers slipping.

Stats like cure rate and admissions are no secret.

Check the numbers and you’ll find out right away.

“Zhou Can, how about stopping by my office for a chat?”

After taking off her gloves and mask, Director Xueyan invited Zhou Can over.

She knew Zhou Can was swamped during the day, and only after surgery did she get a chance to talk with him.

Wanting privacy, she chose her office instead of speaking in public.

“No problem!”

Zhou Can agreed cheerfully.

The two of them headed one after the other to Director Xueyan’s office. She was about to make some tea, but Zhou Can stopped her.

“Come on, Sis Yan, you don’t have to be formal with me. Just say what’s on your mind.”

“All right, but I really won’t treat you like a guest then! I think Cardiothoracic Surgery is doing pretty well—the patient flow’s growing every month, and cure rates are rising. So I want to do a bit of publicity and give our popularity another push. What do you think?”

After a big setback last year, Director Xueyan always consults Zhou Can before making big moves.

It was Zhou Can who once offered her three strategies, one of which was to focus on quietly building up the department, not worrying about reputation or admissions.

That low-profile, “stock up grain, build high walls” approach let Cardiothoracic Surgery shed its burdens and grow at its own pace.

“You’ve been low-key long enough, Sis Yan. Ready to make your move?”

Zhou Can teased with a smile.

“You could say that!”

Director Xueyan nodded slightly.

“I have to say, your ambition is modest! I figured you were aiming to soar like a mighty roc, or at least take off like an eagle. Just aiming for the branches? That’s pretty humble!”

Zhou Can believed Cardiothoracic Surgery could rise much higher.

He had promised Dr. Hu Kan he’d support both the department and Director Xueyan—and he truly believed they could become one of the top ten cardiothoracic departments in the country.

“Oh, now you’re just fishing for compliments! Honestly, you’re way too sly!”

Director Xueyan pretended to scold him.

“On a serious note, a publicity campaign could work just fine. You might even win back a few major cases from other hospitals. But I’d recommend preparing thoroughly. When you publicize, more patients will come—so you’ll get more challenging cases. The real question is can you handle them? If not, you need a plan to back out. Don’t bite off more than you can chew, and never accept patients you know you can’t treat.”

The rest he left unspoken.

But he knew Director Xueyan would catch his meaning.

If you take on a high-difficulty case you can’t handle and a patient dies on the table—or there’s a major complication—you’re just setting yourself up for disaster.

That’s basically shooting yourself in the foot.

“I’ll make sure everything’s in place before we move forward. Any other advice?”

She valued his input greatly.

When it comes to strategy, women aren’t born with the edge.

Men are just wired for logic, decisiveness, and broader vision—which lets them see the big picture.

Historically, those who achieve great things have almost always been men—that’s not just old-fashioned thinking.

Sure, ancient women faced cultural barriers, but that wasn’t the whole story.

There were female emperors—it’s just that they’re rare.

“For the campaign, focus on our strengths. Take me for example—back at Xinxiang Hospital, I once treated a child with a dislocated joint. That case was used in my publicity campaign, and after that, most of my patients were kids with fractures or bone deformities.

So, my point is: choose cases that the department really excels at for the campaign.

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Take tricuspid valve procedures—ours aren’t that strong. Try not to promote those too much.

That way, you pull in patients who really match your expertise.

“I’ve written that down—any other suggestions?”

Director Xueyan was jotting everything down earnestly.

“Nothing for now. If I think of anything, I’ll call or message you.”

Honestly, Zhou Can felt there was no rush.

But he could understand why Director Xueyan, after being held back so long, wanted to finally make a splash. Plus, the rest of the team needed a morale boost.

“For the promo cases, I’m considering including that baby with heart failure transferred from Third Hospital. Do you think that’s wise? Publicizing it might make Third Hospital feel like we’re using their failure to boost ourselves.”

She brought up a very sensitive point.