Once they left the second general surgery department, Old Chief Physician Pan commented to Zheng Ren. "That man knows his place."
They were done with the general ward patients and proceeded to the special demands ward.
When they reached the second floor, a shout was heard. "Miss, why are you on your feet?"
Old Chief Physician Pan and Zheng Ren were startled and quickly made their way into the room.
A slender and tall lady stood inside with her hands gripping the hospital bed guardrail.
The lady was seriously 1.8 meters tall. While there were still hints of frailty about her, her elegance shone through.
"Zhou Jinxi?" Zheng Ren asked in a confused tone.
Zheng Ren had never performed an endoscopic transrectal appendectomy in real life prior to this and was therefore unclear about the recovery process. According to existing literature, the patient would be able to stand, pass gas and consume liquid food after a day. Walking would possible be on the second day, and discharge on the third.
However… This Zhou Jinxi lady was on her feet just six hours after surgery.
Both Old Chief Physician Pan and Zheng Ren were shocked.
"Yes. It's you two…" Zhou Jinxi held onto the guardrail and carefully balanced herself. Her big eyes sparkled as she spoke.
"I am the chief surgeon of the emergency department, last name Pan. This man here is my soldier and the one who performed your surgery, Zheng Ren." Old Chief Physician Pan's voice was filled with pride when he mentioned Zheng Ren was his subordinate.
"Ah!" When Zhou Jinxi heard that Zheng Ren was the surgeon, she hopped onto the bed and hid under the blanket like a startled rabbit. Her scarlet face was obscured by the cloth.
"..." Was this shyness?
In the eyes of the stone-faced, unparalleled and godlike doctor, the patients he treated were genderless.
Heh, no wonder he was single to this day.
"Miss Zhou, we are here to check on your recovery," said Old Chief Physician Pan as his tone softened. He was well-versed with people's reactions and knew how to comfort Zhou Jinxi's timid soul.
Her assistant persuaded her for five minutes before she was willing to remove her covers. She answered Zheng Ren's questions with a red face.
Zheng Ren was grateful that her rate of recovery was exceptional. The difficult surgeries that he had to perform had all been on younger patients who stood a better chance when it came to postsurgery healing.
Zhou Jinxi's lower right quadrant of the abdomen showed no signs of pain. A physical check of the surgical site revealed no point tenderness, rebound tenderness or muscle guarding.
Zheng Ren would not be surprised if this lady tried to escape the hospital tomorrow, judging from her buoyant attitude.
His lips curled at the thought. He told the assistant to make sure Zhou Jinxi stayed in bed for a whole day before allowing her to move about.
Old Chief Physician Pan's phone rang as Zheng Ren was about to ask about passing gas.
"Hello. Yes, that's me." Old Chief Physician Pan answered the phone and walked out of the hospital room.
"Yes. I'll head over to the emergency room now!" His tone became awe-inspiring.
He hung up and turned to Zheng Ren, face stern and serious. "Mass poisoning in the city. 120 ambulances dispatched. Let's go."
"How many victims?" Zheng Ren asked.
"As of now, severe cases are in the dozens. We don't have the full numbers yet."
Dozens? This was truly a mass poisoning event.
Chapter 43 - Emergency Rescue!
Old Chief Physician Pan and Zheng Ren jogged in silence to the emergency department.
Once they arrived, Old Chief Physician Pan instructed the department to reject patients that had minor illnesses and to refer them to other hospitals.
He announced that a mass poisoning had happened and the general hospital was limiting their medical resources to only the critically ill. Most patients obeyed the orders and left on their own accord to seek medical attention elsewhere.
Some patients who were not in a rush stayed back to watch the drama unfold.
However, a small portion of patients started making a fuss. They had come all the way to the hospital only to be rejected? Weren't hospitals supposed to save the sick and dying? If they were not tending to the sick, who else was supposed to?
Old Chief Physician Pan gave the protesting uncles, ranting aunties, and raving hoodlums a cold stare. He did not dignify them with a response and headed off to manage the emergency department's clinical decision unit.
The patients who could be discharged were discharged, with the paperwork left for another day. The wards were cleared as much as possible to make room for the coming storm.
Five minutes later, the general hospital's administrative board arrived at the emergency department and got to work. A reshuffling of the rosters was done and more doctors and nurses were brought in to increase the emergency department's capacity.
After all, a big incident like this happened only once every few years. The emergency department did not require such capacity on an average day, and the timely reallocation of resources was expected for emergencies.
Seeing the arrival of the hospital administrative board, a middle-aged female patient ran up and clutched at the sleeves of the prominent Director Xiao.
A tantrum thrown by a middle-aged person was often frowned upon by the public and Director Xiao was no exception.
Seven minutes later, the nearby police force came to provide their assistance.
The national emblem shone under the light. People who were making a fuss quieted down.
Nine minutes later, the sirens of the ambulances could be heard from a distance. All the personnel were at their positions, ready for the battle.
Zheng Ren and the other nurses gathered at the emergency entrance to greet the ambulances. He was not obligated to be there but figured an early diagnosis could save a life.
The ambulances arrived, tires screeching. Wisps of white smoke rose into the sky. There were tire marks where the ambulances pulled up in a hurry.
The stretcher that was pushed out made Zheng Ren stumble.
The patient's exposed skin was greyish blue, very much like an alien from the movie, 'Avatar'.
'This is a bad omen,' Zheng Ren thought. The patient was suffering nitrite poisoning.
Ever since he started training in the System, Zheng Ren's memory had improved by leaps and bounds.
Nitrite poisoning was a rare illness—mentioned in a few sentences in medical textbooks. Once he left medical school and entered the workforce, Zheng Ren had not seen a single case of it.
The few sentences from the textbook stood out in his memory, clear as day.
He concluded that this was a case of nitrite poisoning from the patient diagnosis in the right corner of his view. The patient was currently in a potentially fatal state of circulatory shock.
Zheng Ren grabbed onto the stretcher and started to dash.
Every second was critical in determining the patient's outcome.
"Nitrite poisoning! Prep the methylene blue and the potassium permanganate solution!" Zheng Ren ordered as he pushed the stretcher.
His voice echoed down the hospital corridor.
Little Zhao was hidden in an inconspicuous corner of the emergency department watching a livestream. When he heard Zheng Ren's voice and saw him pushing a stretcher down the corridor, his heart swelled with admiration.
Right now, this normal everyman who had no money, no house and no girlfriend was larger than life.
"Methylene blue, large volumes!" Zheng Ren instructed loudly as he passed Director Xiao.
He sounded like a director, his voice full of authority.
Director Xiao was momentarily surprised. In the background, that unreasonable middle-aged woman was still throwing a tantrum despite the police presence.
Zheng Ren let go of the stretcher and said, "IV line, 250 milliliters 10% glucose with 140 milligra
ms methylene blue. At the same time, flush the stomach with potassium permanganate."
The stretcher trolley left Zheng Ren's hands and the standby nurses at the emergency room took over expertly.
Zheng Ren walked up to Director Xiao and said seriously, "We need more methylene blue. Our usual stock in the emergency department won't be sufficient."
"You're bullying an old lady! I'm not done with you! This is an injustice!" The middle-aged woman grabbed at Director Xiao's collar and screamed like a maniac, ignoring the police officers by her side.
Without a word, Zheng Ren stepped up and flung the woman's arm aside.
He did so without restraint, and the annoying woman lost her footing and stumbled back into the crowd. Startled, she dropped onto the ground and started bawling, her two hands slapping the floor. "These doctors are trying to kill me! The police too!"
"Please take care of this. There will be more patients coming in." Like a king, Zheng Ren gave instructions to the police officers. Then, he turned to Director Xiao and said, "Our stock won't be enough and we need to ask the city council for help. If the city's stock is insufficient, we'll have to seek aid from neighboring districts."
With that, Zheng Ren turned and left, sparing no time to explain the situation.
Every second counted in the emergency room. Director Xiao's countenance was grim as he directed the chief of the medical administration division to stockpile all the methylene blue in the hospital. He did not bother to set his collar before calling up the city council.
Methylene blue, also known as methylthioninium chloride, was typically used for surgical markings. Hence, there was not a large supply of it in the hospital as demand was usually low.
The red blood cells of a healthy human or animal contained substances that could reverse the formation of methemoglobin such as vitamin C and glutathione.
If the concentration of nitrite ingested was enough to overwhelm the body's ability to equilibrate its oxidation, the person or animal would show symptoms of nitrite poisoning.
Methylene blue would be reduced to leucomethylene blue through catalysis by nicotinamide adenine dinucleotide. Leucomethylene blue could then reduce the heme group from methemoglobin to hemoglobin, regenerating the methylene blue. This reversible reaction allowed it to be reused.
This theory was not common knowledge to the emergency medical personnel on scene. Despite that, they were aware of the severity. Cyanosis, shallow breathing and low blood pressure; anyone with clinical experience would know the patient was already in a state of shock.
If they could not improve the patient's condition, the reduced blood perfusion would soon lead to a decrease in kidney function, cerebral edema and ultimately death.
After briefing Director Xiao, Zheng Ren went into the emergency room. At this moment, he never considered if the tone he took with the director would land him in trouble.
The patient laid on the emergency bed with his shirt cut open and thrown aside. His c.h.e.s.t was peppered with countless patches connected to an electrocardiogram. Intricate but orderly cables transmitted electronic signals from the patient's body to the device which produced numbers and graphs.
Blood pressure 50/20, heart rate 40, oxygen saturation not detected!
Normally, such readings on a patient was a lost cause.
The matron was bent over setting up an intravenous line. Three jabs and none of them saw any blood flow. Cold sweat dripped from her forehead and drenched the sterile surgical cap in less than 20 seconds.
The patient's survival was dependent on the intravenous line.
The patient's blood pressure was at 50/20 with a weak pulse. Even the large veins like the jugular and the femoral vein were shrunken and difficult to locate among the muscle tissues.
"Allow me." Old Chief Physician Pan held a surgical kit. He removed the patient's pants and started to search for the femoral vein. A central venous line was a procedure done frequently back in the day but was rarely required now.
The situation was dire. Even after peeling open the skin and muscles of the inguinal area, the femoral vein might have become clear, transparent connective tissue that challenged a physician's eyes and experience.
Furthermore, this method was very slow. Zheng Ren could hear the sirens of the 120 ambulances within his mind.
Without hesitation, Zheng Ren entered the System and shouted, "I want to buy some intensive training time!"
Chapter 44 - Mission: A Buddha to All
The robotic female voice reverberated through space. However, it was not in response to Zheng Ren's shout. It was here to deliver a mission.
[Emergency Mission: A Buddha to All
[Mission Details: Rescue management of mass poisoning cases in the emergency department
[Mission Reward: 300 skill points, 1 silver c.h.e.s.t, 30000 experience points for every 100 patients successfully rescued.
[Mission Duration: 1 day.]
The System was more generous this time around. Zheng Ren was dumbfounded by the mission. Its rewards were unbelievable. He did not know what the silver c.h.e.s.t contained but the 300 skill points and 30000 experience points were enough to entice him.
However… Zheng Ren cursed. The System Shop had no central venous catheterization training.
'Are you f*cking kidding me?' Zheng Ren thought.
Every wasted minute, no, every wasted second could cost the patient's life.
Suddenly, the panicking Zheng Ren was blessed with an idea. Interventional surgeries usually started with an artery cannulation, right?
What he wanted to perform was a central venous catheterization, and while they were not the same procedure, the principles were similar.
Why not give it a try?
There was no time to debate the matter. Zheng Ren selected the interventional surgery training module and out came some options, the first of which was vein and artery cannulation.
Without a second thought, Zheng Ren selected it. He was no longer calculative, expending all 14076 of his experience points on intensive training time.
234.6 minutes; not even four hours. That was all the time Zheng Ren could afford.
The System's operating theater rose from the ground. Zheng Ren entered without further delay. Taking a deep breath to calm himself, he started the intensive training.
…
…
Another patient was brought in from the ambulance, in just as severe a condition as the first patient—circulatory shock due to poisoning.
When the patient was pushed into the emergency room, Old Chief Physician Pan had just opened up the first patient's skin and was separating the subcutaneous tissue to find the semblance of a femoral vein.
"Venous catheterization kit, prepare for disinfection," Zheng Ren said in a scratchy voice, just waking up.
"Bring in a patient, stat!"
The patient was lifted onto the emergency bed as fast as possible and Zheng Ren got to work.
The patient was in supine position with their feet elevated 15 to 25 degrees above their head to increase venous pressure and blood flow.
This was to ensure venous pressure remained higher than atmospheric pressure, minimizing the risk of an air embolism during central venous catheterization.
Zheng Ren tore open the patient's top. His show of strength was nearly animalistic. He placed a 500ml water bottle between the patient's shoulder blades. As they were a tad underweight, Zheng Ren switched the water bottle out with a softer bottle of saline solution.
The aim of the bottle was to open up the c.h.e.s.t area, allowing the shoulders to fall back and elevate the section between the clavicles. It would push the subclavian vein nearer to the clavicle and further away from the apex of the lung.
Then, Zheng Ren turned the patient's head to face him. This placement reduced the angle between the subclavian and jugular veins, making it easier to guide the catheter downward in the direction of the superior vena cava.
"Look here. Make sure the next patient is in the
same position." Zheng Ren wanted to shout the words, but his sore throat made it impossible. The few nurses around him were his only audience.
"Yes!" the nurses replied.
The position was easy, the objective clear. It was not a difficult task.
Gloves went on his hand, a needle at the ready. Once the insertion point was located, Zheng Ren began the procedure.
He did not follow the textbook protocol of subclavian vein catheterization—puncturing one to two centimeters below the midshaft of the clavicle, with the needle angled horizontally and pointed in the direction of the sternoclavicular joint.
Instead, he chose the infraclavicular block as the insertion point, which was below the clavicle and lateral to the midclavicular line.
The nurses had seen subclavian vein insertions before, but the situations had not been as dire and the patients did not have such low blood pressure readings.
Had Zheng Ren lost his senses? Why did he pick the wrong insertion point?
In the midst of the chaos, they did not manage to warn him. Zheng Ren's hands were steady and quick, and the nurses could only watch as he pressed his left hand on the patient's c.h.e.s.t.
He pressed down onto the skin with his left thumb until it was level with the costoclavicular ligament and marked the point, then removed his thumb and proceeded to puncture the skin there.
All this was curated from thousands of books' worth of literature regarding subclavian venipuncture and hands-on practice from the System's intensive training.
During training, all the simulation mannequins had been positioned in the correct way. At first, Zheng Ren completed the procedure in three minutes, which was a bit slow. Toward the end, he could finish with one simulation mannequin in under a minute.
He used 234.6 minutes in the System training to complete 452 venipunctures.
This number might have been lower than some doctors from the emergency departments and intensive care units of larger hospitals, but Zheng Ren had completed them in one go. All the simulations were high-difficulty patients with low blood pressure and low blood volume.
Challenges came with great rewards. Zheng Ren's phlebotomy skills could be considered among the best in the country.
The Surgeon's Studio c1-799 Page 26
