Chapter 93: A Critical Case in the Emergency Department

Although the Emergency Department may lack the prestige and strength of other key departments, it enjoys privileges that no other department has when calling for assistance.

When a doctor encounters difficulties, they can summon any doctor from any department for a consultation.

The summoned doctor cannot refuse.

However, there are strict time limits for emergency cases.

This is a hospital regulation.

Furthermore, when a specialist is on call, he cannot back down from a difficult case by saying, ‘I can’t handle this.’ If a lower-level specialist on call finds a case unmanageable, a higher-ranking doctor must be called in.

If, even with the entire hospital’s efforts, the patient cannot be saved, there is nothing more to be done.

The case must then be reported according to procedure.

Though doctors from other departments can also be summoned for consultation on difficult cases, the nature of those consultations is quite different.

For instance, when Orthopedics receives a patient with a fracture suspected of internal bleeding or another serious condition…

The orthopedists, fearing complications, decide they can’t handle it themselves.

So they call in a doctor from Cardiology for a consultation.

The cardiologist, upon receiving the request, is somewhat reluctant. Every doctor is busy—with a mountain of work, who has the time to meddle in another department’s affairs?

But the matter cannot be avoided; the process must run its course.

After all, everyone works for the same hospital—if you help me now, I will help you when you’re in trouble next time.

Unity is essential.

The Internal Medicine doctor arrives.

Upon inspecting the patient, he sighs, ‘Oh dear, the internal bleeding is so severe that the patient is already in shock.’

After reviewing the test reports in detail, he believes the patient is unlikely to make it to the operating table.

While explaining his diagnostic opinion to the orthopedic doctor in charge, he simultaneously reports to his superior—unless he is already a chief physician, in which case reporting isn’t necessary.

In that case, he could express a more definitive opinion right away.

He states, ‘This patient is very hard to save and will likely never make it to surgery. Do as you see fit.’

After saying that, with a casual pat on the back, he leaves.

This is the difference between an emergency consultation and an ordinary one.

……

Not long after, the patient’s blood test results arrive: an abnormally high white blood cell count confirms sepsis.

Doctors from the Emergency Department begin to arrive one after another. A Gastroenterology doctor and a Hepatobiliary Surgery doctor both send their attending physicians.

This level is not to be underestimated.

Both in terms of diagnostic experience and skill, they are top-notch.

“What’s the diagnosis?”

“Acute cholecystitis!”

“This isn’t an overly difficult condition! Didn’t Dr. Xu used to be our department’s chief? He should be able to handle it!” The attending from Hepatobiliary Surgery says with a relaxed air.

Perhaps he did not intend to mock Dr. Xu personally,

but his tone clearly carried an element of condescension.

Judging by his age, he appears to be a recently promoted attending from the Surgical Department.

Still burning with the drive of youth,

success and ambition have perhaps inflated his pride a bit.

Only time and hard lessons can rein that in.

“Dr. Ruan, please take a look at the patient’s condition,” Zhou Can interjects, standing by to back up his mentor.

The Gastroenterology attending has finished reviewing the test reports and is now examining the patient.

The Internal Medicine doctor takes a very meticulous approach—examining the pupils, tongue coating, hands, complexion, and more, while also carefully questioning the patient about details regarding their diet, bowel movements, and the exact nature of the abdominal pain.

Many details aren’t even noted in the medical record.

Typically, those only include basic symptoms, the general condition, and the time of the consultation.

In China, Internal Medicine still retains a trace of traditional Chinese medical practice.

Almost every experienced Internal Medicine doctor knows a bit about the traditional diagnostic method of observation, listening, questioning, and palpation.

Zhou Can watches the Internal Medicine doctor closely as he examines and diagnoses the patient, silently learning from his methods.

Once the Internal Medicine doctor finishes his examination, he does not rush to offer his opinion.

He stands a few steps aside with a slightly grave expression, waiting for Dr. Ruan from Hepatobiliary Surgery to deliver his diagnosis.

Five minutes pass, then eight… Dr. Ruan frowns as he reviews the test reports and re-examines the patient, delaying his diagnostic declaration.

“Dr. Ruan, you must have treated many cases of this kind. You’ve seen the reports and examined the patient. What treatment do you suggest?”

Zhou Can, clearly sensing the difficulty, even goes so far as to put him on a high pedestal—really a rather ‘naughty’ move.

“Uh… well, I need to study it further!”

Dr. Ruan’s face betrays a hint of embarrassment.

“But didn’t you say earlier that this wasn’t a tough case?”

Zhou Can interrupts before Dr. Ruan can finish his thought.

As soon as Dr. Xu had been put on the spot, Zhou Can felt compelled to lightly reprimand him to instill some humility for next time.

He effectively signals that next time, better manners are needed.

“Generally speaking, this type of condition is treatable. However, this patient is a challenge. By the way, what’s the Emergency Department’s treatment recommendation?” Dr. Ruan quickly shifts the topic with impressive responsiveness.

In no time, the conversation is redirected.

After all, to become an attending, one must have honed their skills in countless patient encounters.

Without the ability to adapt on the fly, one would have long been battered by patients and their families.

Zhou Can looks over to his mentor.

This question should be answered by the senior-most doctor present.

As a resident in training, he maintains impeccable decorum.

Never speaking out of turn when it isn’t his place.

“Our recommendation is to perform a gallbladder puncture to drain some bile first, then use imaging to locate and drain the pericholecystic abscess, followed by anti-inflammatory treatment. Once the inflammation subsides, we can schedule an elective surgery.”

Dr. Xu has clearly adopted Zhou Can’s treatment plan.

At that moment, the Anesthesiologist arrives.

After a brief greeting and inquiry, the Anesthesiologist stands by patiently, waiting for the operating doctors to deliver their consultation results.

“Dr. Chi, what are your thoughts?” Dr. Ruan asks the Gastroenterology attending.

“I support the emergency approach. This patient has underlying diseases, is of advanced age, and is quite frail. Coupled with the pericholecystic abscess, the surgical risk is extremely high. Besides, remnants of vomit at the corner of the mouth suggest the patient wasn’t fasting long before entering the OR. I recommend draining the bile and abscess, administering anti-inflammatory treatment, followed by fluid and nutritional support with fasting. Surgery can be delayed until the patient meets the criteria.”

Dr. Chi’s observations are impressively thorough.

“If possible, I would favor a laparoscopic procedure. With its smaller incisions, the trauma is less, and the risks are reduced.”

Minimally invasive surgery has surged in popularity precisely because it significantly reduces trauma, lessening harm and speeding recovery.

Some patients who are too weak for traditional procedures can be accommodated with minimally invasive techniques.

The only drawback is that laparoscopic surgery tends to be considerably more expensive.

On top of that, there are very few doctors who excel in minimally invasive surgery domestically.

“Insufficient fasting time and ongoing vomiting make anesthesia nearly impossible!”

At the mention of recent vomiting, the Anesthesiologist’s face immediately turns grim.

With the hospital cracking down on surgical safety, he cannot take that risk.

All eyes are now on Dr. Ruan, waiting for his verdict.

“Alright then, transfer this patient to the Hepatobiliary ward. I’ll report this to the director; after your department communicates with the family, send the patient over.”

Dr. Ruan has effectively passed this ‘hot potato’ back to the Hepatobiliary department.

For now, the matter is temporarily put to rest.

Before leaving, Dr. Ruan grins at Zhou Can and says, “You really stand up for Dr. Xu, even defending my point!” In doing so, he finds a way to ease the tension.

Had he known that the Emergency Department’s recommendations came from Zhou Can, a resident in training, he might have regarded him even more highly.

“Heh, not at all!”

Zhou Can’s little secret is out, yet he feels no discomfort.

Dr. Xu, who has always looked after him, naturally expects him to repay the favor and defend his mentor.

Dr. Xu listens silently, but his stern face softens just a bit with unmistakable satisfaction.

Clearly, Zhou Can’s actions have greatly pleased him.

They have a far stronger effect than Dr. Lu’s thousand-fold flattery ever could.

While Dr. Lu’s compliments only bring fleeting joy, Zhou Can’s high-level praise touches Dr. Xu on a deeper level, almost like treating him as his own child.

“I’m off now—don’t delay with this patient, or it could get worse!”

Dr. Ruan issues one last reminder.

The patient’s condition is extremely critical, and no one dares to procrastinate.

Dr. Xu personally handles the communication with the family, and negotiations are swiftly finalized.

The family’s demands are modest; as long as the hospital can cure their loved one, they are satisfied.

“Dr. Lu, immediately, along with the nurse, transfer the patient to the Hepatobiliary Surgery Department!”

Dr. Lu’s face shows clear distress.

“Can’t you send Zhou Can instead?” he protests, since Zhou Can is, after all, a senior resident.

Running errands is usually left to those at the lowest rank.

Jin Mingxi is in the middle of surgery, so it’s understandable not to call him.

However, Zhou Can is not in the operating room at this moment.

“You need to be more articulate. Zhou Can’s a bit tongue-tied; he’s more suited for surgery than for talking. Get moving!” Dr. Xu’s words make Dr. Lu want to be hit by a tofu block.

If Zhou Can’s mouth were any less adept, no one would be as quick-witted as he is.

Dr. Xu’s overt support for Zhou Can leaves no doubt; it’s as if he’s shielding his own kin. Dr. Lu, being shrewd, avoids any move that might displease his superiors.

So he obediently escorts the patient.

“Call in the next patient!”

Soon enough, a new surgical patient is wheeled in, his face contorted in pain and sweat beading on his forehead.

This is a case of acute appendicitis.

Taking advantage of the Anesthesiologist’s brief absence,

Dr. Xu reviews the test reports and inquires further about the patient’s condition.

He deems the patient fit for surgery.

“How long has the patient been fasting?” the Anesthesiologist asks the nurse who brought the patient in.

He’s still rattled by the previous chaotic handling by the Emergency Department doctors.

The last surgical patient had clearly not emptied his stomach completely. How could they risk surgery under such conditions?

“It’s been over six hours,” the honest nurse replies.

Acute appendicitis usually occurs at night,

so it’s estimated the patient arrived during the evening.

“I—I had a late snack around 10 p.m. last night and haven’t eaten since,” the patient manages to say, gasping noticeably from the pain.

The pain is excruciating.

Acute appendicitis can truly be agonizing.

“What’s the patient’s name?”

“Huang Weiyuan!”

“Was he received last night?”

“Yes!”

The Anesthesiologist retrieves a stack of consent forms from his case file, swiftly flipping through until he finds the right one.

“I’ll go get the family to sign the anesthesia consent form!”

He leaves the room.

Not long after, he returns.

After a quick examination and confirming everything is in order, he connects the patient to life-monitoring equipment, a non-invasive ventilator, and initiates inhalation anesthesia.

The patient soon drifts into a deep sleep.

“Huang Weiyuan, Huang Weiyuan!” he calls out, receiving no response.

The patient’s vital signs remain stable.

“We can proceed with the surgery now!”

After announcing this, the Anesthesiologist takes a small black stool from beside the wall and sits down, his eyes fixed on the monitoring equipment.

Throughout the procedure, the Anesthesiologist is solely responsible for safeguarding the patient’s life.

However, this is merely a minor Level 2 surgery—not as daunting as major surgeries.

“Zhou Can, are you confident about making the incision?”

“Yes!”

Zhou Can is thrilled.

This is the first time his mentor has allowed him to perform an abdominal incision.

Even though the risk is far lower than opening the chest, it still excites him tremendously.

“Go ahead! Just remember to be both bold and meticulous; safety always comes first. If unsure, do not proceed recklessly.”

“Understood!”

Zhou Can is not one to be careless.

For every surgery he undertakes, he commits with the heart of a lion chasing a rabbit.

“Could Qiao Yu assist as the instrument nurse?”

Zhou Can makes sure to look after Qiao Yu quite attentively.

“Are you trying to recruit a permanent nurse for yourself?” Dr. Xu teases, laughing. “Liu Xia, show the newcomer the ropes.”

This is Dr. Xu’s way of giving his approval.

Liu Xia, a veteran nurse with far more experience than Tang Ling or Nurse Tian Tian, readily agrees.

“No problem!”

Liu Xia is well aware of Dr. Xu’s special favor towards Zhou Can, and also recognizes his extraordinary surgical potential.

In less than a month, Zhou Can has not only been capable of independently performing first-level surgeries,

but he has even acquired the skills to perform abdominal incisions and appendectomies.

It’s truly astounding.

Liu Xia can only imagine how formidable Zhou Can will become if he continues on this path.

A doctor with such potential is someone worth fostering a good relationship with.

Not long ago, Dr. Lu had been spreading rumors that Zhou Can had incurred the wrath of a top hospital official and was doomed—but those times have passed.

Everyone is smart enough to actively mend ties with Zhou Can.

Just look at how many colleagues have been warmly greeting him lately—it’s the trend of the times.

Zhou Can’s care for Qiao Yu is simply contagious.

Once you care for someone, you care for all they hold dear.

Now, Liu Xia’s warm treatment toward Qiao Yu not only earns Qiao Yu’s gratitude but also wins Zhou Can’s favor.

Why wouldn’t she be pleased?

The surgery officially begins.

Liu Xia spares no effort in teaching Qiao Yu the nuances of instrument preparation—each surgery requires its own setup.

Qiao Yu, with a solid foundation as an instrument nurse and her innate talent, quickly masters the techniques.

This endears her even more to Liu Xia, who has a soft spot for high-achieving students.

It’s no wonder teachers favor those who excel—teaching them yields results and is far easier than working with slow learners.

After disinfecting the surgical site, Zhou Can marks the incision line.

Dr. Xu, standing nearby, carefully supervises.

Once everything is confirmed, he grips the scalpel with eyes as sharp as an eagle’s and as fierce as a wolf,

meticulously feeling for the right pressure as he makes the first incision through the outermost abdominal layer.

This layer includes both the epidermis and dermis.

Blood begins to flow, and Dr. Xu promptly suctions it away.

He seems satisfied with Zhou Can’s first incision.

Next, Zhou Can methodically cuts through the thicker subcutaneous tissue, the fascia, and the rectus abdominis. At this point, the peritoneum is exposed.

This is the final barrier before entering the abdominal cavity.

They say that when it comes to cutting precious jade, one misstep can either make you rich or leave you penniless.

A mistake while incising the peritoneum could lead to disaster.

Dr. Xu’s willingness to entrust such a critical task to a resident speaks volumes about his trust in Zhou Can.

Taking a deep breath, Zhou Can strives to remain calm.

Then, trusting his tactile senses, he slowly cuts through the final barrier.

Luckily, no mishaps occur.

It may not be flawless, but it meets the standard.

It’s far superior to what most junior residents could manage.

【Incision Experience +1】

【First Successful Abdominal Incision – Reward: Incision Experience +100】

The system is so generous.

A straight reward of 100 points.

But it’s a one-time bonus. Future incisions won’t grant extra rewards.

For Zhou Can, this marks a significant step forward in the surgical field.

Each successful abdominal incision brings qualitative improvements in his confidence, technique, experience, and nerve.

Typically, only a few skilled senior residents manage to secure one or two such opportunities through persistent effort and negotiation with their superiors.

Zhou Can’s incision skill is currently at Level 4, equivalent to a mid-level attending’s proficiency.

To level up further, he needs to accumulate more experience points.

He just earned 101 incision experience points—this progress is exponentially faster than practicing on a white mouse.

Earning surgical experience on actual patients feels far more rewarding.

As he cuts into the peritoneum, Dr. Xu’s expression is intensely tense.

Now that Zhou Can has successfully completed the procedure, Dr. Xu heaves a sigh of relief.

“Can you locate the appendix?”

“Yes!” Zhou Can replies decisively.

At that moment, Jin Mingxi finishes his current surgery.

Dr. Lu probably won’t return for a while—after all, for a laid-back doctor, this is a perfect excuse to slack off.

He can take a half-hour nap on the way back without repercussions.

“Jin Mingxi, come over here and join us for a promise ritual!”

Jin Mingxi hurries over. Seeing that Zhou Can is already leading an appendectomy, he can’t help but feel a twinge of envy.

He has performed similar surgeries at the County People’s Hospital before.

But given the differences in hospital standards, the approach to surgery is entirely distinct.

At the County People’s Hospital, performing an appendectomy in the operating room is as grand as a festival, with a multitude of doctors involved.

Senior doctors of deputy director rank even operate themselves.

Yet in Tuyu, the most inexperienced Emergency Department seems to treat such surgeries like a game.

An attending merely supervises while a resident leads the operation.

It’s both astonishing and alarming.

There’s no denying that Zhou Can’s talent far surpasses that of a typical resident. As for exactly how strong he really is, even Jin Mingxi can’t be sure.

All he knows is that Zhou Can’s surgical skills are skyrocketing.

Every day it seems he’s a new version of himself.

Despite working together in the same surgeries and training, the difference is striking.

Jin Mingxi gives Zhou Can a thumbs-up, exclaiming, “You rock!”

Then, joining in on the promise ritual.

Qiao Yu, watching Zhou Can’s stellar performance—and benefiting greatly from it—looks at him with eyes full of admiration and a smile that says it all.