Chapter 92: A High-Stakes Day in the Operating Room

Sigh~!

A lament echoed from nearby.

Zhou Can turned and saw that Jin Mingxi’s face had contorted into a sour grimace.

The two exchanged a knowing look; Zhou Can understood immediately.

Qiao Yu always served as Zhou Can’s assistant, and today was no exception. That meant the remaining standby nurse from the other operating room would be assigned to Jin Mingxi.

The chance of Nurse Tian Tian showing up was remarkably high.

One wonders if it was her silver tongue that won her the favor of her superiors or if she just had some influential backing.

In one week, she had at least four to five morning shifts.

She didn’t seem to mind it at all.

Ultimately, Zhou Can and Jin Mingxi ended up bearing the brunt.

Anyone who got on her bad side was doomed.

Sure enough, before long, Tian Tian strolled into the operating room with her characteristic pitter-patter. Jin Mingxi let out another dismayed sigh, his expression as bitter as if he had just tasted wormwood.

After changing into her blue scrubs, Qiao Yu was the first to enter the operating room.

“Hello, Dr. Xu!”

“Mm!”

Dr. Xu responded with a serious ‘mm’ in acknowledgment.

“Qiao Yu, you look especially beautiful today!”

Dr. Lu’s eyes were magnetically drawn to Qiao Yu, following her every move.

Even after being turned down countless times, he still treated her like a first love.

“Thanks for the compliment!”

Qiao Yu replied coolly as she briskly made her way to Zhou Can.

“Hey, I’m here!”

She waved sweetly at Zhou Can.

“Finally, it’s your turn for a morning shift?”

Zhou Can was genuinely pleased to see her.

Surgery with her was an absolute joy.

“Not at all! Didn’t you text yesterday? I swapped shifts with Li Shuangshuang—my treat for some grilled lamb skewers,” she explained softly.

She meant Li Shuangshuang when she mentioned ‘Shuangshuang’.

Normally, Li Shuangshuang would be Jin Mingxi’s assistant.

If Qiao Yu hadn’t swapped shifts, Nurse Tian Tian would have been assigned to Zhou Can today.

Today marked his first time requesting a high-difficulty case from our teachers.

If he botched it, winning Dr. Xu’s trust would be a far steeper climb.

The consequences could be long-lasting.

So having Qiao Yu as his assistant was sheer luck.

“Hey, those lamb skewers were originally on you,” she teased gently.

Her tone carried a hint of affectionate reproach.

Probably worried Zhou Can might get the wrong idea, she had specifically arranged the shift swap with Li Shuangshuang.

“Ha ha, no worries at all! As long as you’re my scrub nurse every day, even if I treat you daily, it’s all good,” Zhou Can replied.

He didn’t mind the small expense one bit.

Working with his ideal partner and dodging Nurse Tian Tian—his so-called pig teammate—was absolutely priceless.

“You’re amazing! And I’ll always be your nurse! I even checked the duty roster; next week, I won’t have a single morning shift,” Qiao Yu said, a little indignant.

Her slight complaint brought a smile to Zhou Can’s face.

“Your head nurse really is…” Zhou Can began, but then quickly stopped.

Because he noticed Nurse Tian Tian approaching.

That nurse, with her ever-smiling face and sweet words, was, in Zhou Can’s eyes, nothing more than a calculating schemer.

“Those who make promises lightly seldom follow through, and those who flatter often betray,” he thought.

Be especially cautious around someone who is charming in person but loves to gossip behind your back.

After all, the head nurse wasn’t a minor role.

Her position was almost equal to that of a department head, albeit overseeing nurses.

If Nurse Tian Tian overheard Zhou Can’s remarks about the head nurse and tattled, he’d have unnecessarily made a big enemy.

“Dr. Zhou just mentioned our head nurse, right? Is it because she gave Qiao Yu too few day shifts?”

Nurse Tian Tian asked with a smile.

There it is—proving yet again her backstabbing nature.

Although she knew Zhou Can enjoyed working with Qiao Yu, she never mentioned it when assisting him, instead focusing on promoting herself.

“I mean, your head nurse is so kind and wise, arranging everyone so perfectly. If I were in charge, it’d be utter chaos,” she added.

Zhou Can felt he was talking to one person in one moment and another in the next.

A few days ago, when he first encountered Nurse Tian Tian, he wasn’t so cautious.

But after realizing how scheming she was, he became guarded whenever she was around.

“Hehe, really! Our head nurse is truly impressive—she’s my idol! Dr. Zhou, you just dislike management. You pour all your heart into surgery, and that’s why you’re so good. I’ve heard many nurses and doctors praising you in private!”

Nurse Tian Tian’s silver tongue charmed everyone.

In fact, she and Dr. Lu made quite the pair.

Both were eloquent, though Dr. Lu didn’t return her affections.

Otherwise, they’d be a match made in heaven.

“Ha ha, really?” Zhou Can laughed heartily.

“Of course it’s true! Everyone says Dr. Zhou is young, promising, and destined to become a renowned doctor one day!” Nurse Tian Tian went on without pause.

Her witty remarks flowed unceasingly.

If it were any other rookie, her charm might completely bewilder them.

Zhou Can smiled outwardly, though inwardly he was watching a clown show.

“Alright, let’s get prepped!”

Dr. Xu shot a stern look their way.

As someone who had been through it, he couldn’t let his protégé be undone by Nurse Tian Tian’s flattering tricks.

He would strictly halt anything that might impede Zhou Can’s progress.

Nurse Tian Tian wasn’t afraid of others; she was only terrified of Dr. Xu.

Startled, she shrunk back and obediently moved next to Jin Mingxi, ready to cause him trouble.

The first surgical patient was wheeled in.

It was a patient needing a sutured wound repaired.

“Jin Mingxi, you’re responsible for this patient,” Dr. Xu instructed.

“Got it!”

Ever concise, Jin Mingxi took charge. After a quick examination and brief questioning, he immediately began local anesthesia, debridement, and suturing.

The second patient, a man in his sixties, was pushed in next.

He had been brought in on a wheelchair.

The elderly man could no longer walk.

He clutched his chest, groaning in pain and occasionally retching.

The sight was rather frightening.

In the Emergency Department Operating Room, surgeries are typically prioritized: saving critical patients first, then those with life-threatening conditions, and finally, routine cases.

Almost every patient here presented as an emergency.

Falls, lacerations, assaults, and animal bites were the most common cases.

In the Resuscitation Room, cases were even more complex.

There were cases of pesticide poisoning, mushroom toxin ingestion, sudden bouts of massive bleeding, and more.

If a patient in the Resuscitation Room needed surgery, they’d undergo thorough checks and family consultations before being sent to the Emergency Operating Room. If the procedure exceeded the department’s capacity, they’d be transferred to a specialist unit.

“What’s his condition?”

Dr. Xu asked the nurse who had wheeled the patient in.

“Acute cholecystitis. They did an abdominal X-ray and CT scan; his condition isn’t promising,” the nurse replied, handing over the report.

Dr. Xu scanned the report as the nurse handed it over.

“They only did a urine test? No blood work?” he asked as he frowned while skimming through.

“They did, but time was short. The lab hasn’t produced blood test results yet. Given his urgency, they rushed him over for you to assess,” the nurse explained.

It was common knowledge that the Emergency Department doctors weren’t as skilled as Dr. Xu.

Most staff knew that Dr. Xu had once been a chief, so in serious cases, his opinion prevailed.

“The ultrasound shows there are stones inside the gallbladder!”

Dr. Xu’s frown deepened further.

Acute cholecystitis is considered a Grade II surgery when done as an open procedure, whereas laparoscopic surgery would be Grade III.

For emergency patients, only the traditional open surgery could be performed.

Due to the patient’s advanced age and weak condition, open surgery was unquestionably risky.

Such surgeries are usually scheduled rather than performed immediately.

“Was he admitted today?”

“Yes, I heard he was wheeled in just after 5 a.m.”

“Has he been kept NPO?”

“After he was admitted, the night duty doctor suspected cholecystitis or gallstones and ordered him NPO immediately,” the nurse answered.

The nurses’ job was incredibly demanding.

Even for a simple task of wheeling a patient into the operating room, they had to remember a plethora of details to answer any questions from the surgeons on the fly.

Their role was more like a bridge between the operating surgeon and the attending physician.

“This patient not only has a fever but is very elderly. The surgical risk is extremely high!”

After reviewing all the reports, Dr. Xu’s frown deepened as he pondered.

“Zhou, come over for a consultation!”

Dr. Xu called Zhou Can over.

Dr. Lu stood by silently.

Even if Dr. Xu was uncertain, he should have consulted with a senior resident rather than a rookie.

Calling in a resident felt almost like an insult.

“May I take a look?”

Dr. Lu couldn’t stand it any longer.

With Qiao Yu present, he didn’t want Zhou Can to hog the spotlight.

“Of course,” Dr. Xu said as he handed the files to Dr. Lu.

Dr. Xu passed the documents over to Dr. Lu.

The patient weakly mumbled, “Doc… cough cough… please hurry and operate on me…” Acute cholecystitis was causing him unbearable pain.

Before being wheeled in, the patient had only prayed that once he was inside, the doctors would relieve his suffering.

Doctors could quickly end his torment.

Unexpectedly, once admitted, the doctors didn’t rush him into surgery; instead, they gathered to discuss his case.

“Please don’t worry. The surgical team must ensure the operation is safe before proceeding. The anesthesiologist is on his way,” Dr. Xu reassured him.

An abdominal surgery required a professional anesthesiologist.

It wasn’t something that could be managed with simple local anesthesia.

In fact, even an epidural needed a skilled anesthesiologist.

While doctors had some knowledge of anesthesia, they couldn’t match a specialist’s expertise.

A top-notch surgical team typically consisted of a chief surgeon, two to three assisting doctors, an anesthesiologist, and a scrub nurse. For higher standards, a Attending Nurse was also essential.

In surgery, every role was distinct.

The anesthesiologist’s importance was on par with the chief surgeon’s.

Dr. Lu took the files and examined them one by one.

After a moment, a serious expression crossed his face as he stated, “This gallbladder must be removed!”

That brief declaration left little room for argument.

The patient had already been prepped in the operating room, clearly set for surgery.

If his gallbladder wasn’t removed, how was he going to celebrate the New Year?

“Explain your reasoning in detail!”

Dr. Xu, still cautious about the patient’s condition, wanted more detailed input.

He genuinely sought Dr. Lu’s professional opinion.

“The stones are severe, and with the acute inflammation, removal is the only definitive cure,” Dr. Lu diagnosed.

“Mm, that makes sense,” Dr. Xu nodded slightly, his expression unchanged.

“Zhou, you’ve always had excellent diagnostic skills. Please share your thoughts!”

“Okay!”

After carefully reviewing all the files and examining the patient, Zhou Can declared, “I think it’s not the right time for surgery!”

In recent days, he had learned a great deal about surgical techniques under Dr. Xu’s guidance.

His insights, predictive ability, and risk management had all improved significantly.

The patient grew increasingly anxious.

“Doctors, please hurry with the surgery! I can’t bear the pain any longer. If we don’t operate, I… cough, oh…”

Crackle!

The patient began to vomit. Fortunately, the experienced nurse Liu Xia acted quickly and caught the vomit.

The twelve-hour preoperative fasting was crucial to prevent vomiting under anesthesia and avoid choking.

In such cases, vomiting during anesthesia could be extremely dangerous.

“Do you think the surgery is inadvisable just because he hasn’t fasted?”

Dr. Xu asked.

The substantial amount of vomit was deeply concerning.

“Actually, that’s more for the anesthesiologist to consider. I believe there are two reasons the patient isn’t suitable for immediate surgery. First, the reports suggest that the gallstones have damaged the gallbladder mucosa, causing bile to accumulate and leading to bacterial infection. The severe pain, nausea, and vomiting point to excessive bile pressure.”

Zhou Can calmly elaborated his diagnostic reasoning.

His explanation was far more detailed than Dr. Lu’s brief comments.

Every doctor has a unique diagnostic approach. Some take shortcuts, opting for quick fixes rather than considering all risks or the patient’s prognosis.

It wasn’t that they lacked expertise—it was just laziness.

Such doctors made up roughly ten percent of the team.

Most were simply coasting through their duties.

Fortunately, issues rarely arose because their work was closely supervised.

Senior doctors and department heads were well aware of their habits, so crucial decisions were never entrusted to them.

They were generally assigned tasks that carried lower risks.

“Secondly, the patient’s fragile condition and advanced age already pose significant surgical risks. Moreover, based on the reports, I suspect there is an abscess around the gallbladder. We need to drain it and control the inflammation before scheduling surgery.”

These were opinions Zhou Can himself would have never voiced before.

His practical experience had grown immensely.

Spending nearly a month immersed in the operating room with daily hands-on practice and Dr. Xu’s meticulous guidance, his progress was remarkable.

It reminded him of the time he mocked Du Leng for all talk and no action.

Reading could only provide theory; practical application and experience were entirely different.

True surgical mastery could only come from being in the operating room.

“Now that you’ve seen his condition, the mortality risk with acute cholecystitis isn’t low. Explain your treatment plan and ensure the patient’s safety.”

Acute cholecystitis has a mortality rate exceeding 10%, which is undeniably high.

It often arises as a complication after major surgeries or in patients with multiple underlying illnesses.

Once the condition sets in, the patient’s body simply cannot withstand a cholecystectomy.

In such cases, only symptomatic treatment is feasible.

We stabilize the patient’s condition and wait until he meets the criteria for surgery.

“My treatment plan is to first perform an ultrasound-guided puncture to drain some bile, relieving the gallbladder pressure. At the same time, I’d perform an interventional cholangiography-guided puncture to drain the abscess around the gallbladder. Once the patient’s condition stabilizes and meets surgical criteria, we’ll proceed with surgery,” Zhou Can proposed two treatment options.

“Hurry up with the surgery! If we don’t operate today, I’ll never get out—I’d rather die in here…” the patient groaned, his face contorted in pain.

In severe pain and discomfort, patients tend to be very short-tempered.

Not understanding much about medicine, the patient adamantly refused any delay in surgery.

“Bring in the General Surgery and Internal Medicine doctors for a joint consultation!”

Faced with the patient’s demands, Dr. Xu looked helpless.

Involving authoritative doctors from multiple departments would help alleviate the pressure and convince the patient and family.

This collaborative approach would share the risk among the clinicians.

And that was where the fate of this high-risk case now rested.

The operating room waited with bated breath for the decision.