Chapter 61 - Sudden Reward From The Fickle-Minded
In the emergency resuscitation room, the doctor in charge of B-scan ultrasonography had already started examining the patient.
Before Zheng Ren had time to read the patient's condition in the upper right corner of his vision, a bell rang in his ears. "Ding-dong!"
Huh? A mission? Was this person suffering from a special disease?
[Sudden Mission: The Opponent's Submission.
[Task: Complete surgical treatment for acute obstructive suppurative cholangitis.
[Reward: 200 skill points and 10000 experience points. The higher the surgery completion rate, the greater the reward. If the completion rate reaches 100 percent, additional rewards will be awarded.
[Time: 6 hours.]
What the f*ck… Zheng Ren's eyes nearly popped out of his head.
Even though the System was not stingy, it was not particularly generous either. In the beginning, when the System had been unstable, the surgical intensive training time given to him had been calculated in hours. Once it had stabilized, the System came up with a new gameplay mechanic—experience points—and started calculating training time in seconds.
The System was indeed fickle-minded.
However, this time, the System was actually awarding 10000 experience points for a simple mission named The Opponent's Submission. That could be converted into precious surgical intensive training time!
Moreover, the time given for the completion of this mission was six hours, which meant that any remaining time would be converted to surgical intensive training time.
What in the world was this?
The confused Zheng Ren savored the thought carefully, only to realize the meaning behind the mission's name after a few seconds.
Someone who was hostile toward him had surrendered. That must have been the case.
That made sense!
"Chief Zheng, there is a blockage in the patient's common bile duct," said the doctor in charge of the B-scan ultrasonography.
"He needs emergency surgery. Establish venous access, nasogastric tube insertion, urinary catheterization, and start preoperative preparations. Chang Yue, explain the surgery to the patient's family members."
No matter whose family this patient was related to, judging by the mission name, his condition could not be delayed any further.
"Do you know how to perform preoperative counseling of a jaundiced patient?"
"I'll let you review my doc.u.mentation once I'm done writing," answered Chang Yue.
The nurses and Chang Yue started preparing the patient for surgery without delay.
"I'm going to the operating theater to prepare the equipment. Wheel the patient in as soon as signatures are acquired and preoperative preparations are complete." Zheng Ren scanned through Chang Yue's perfectly written preoperative doc.u.mentation and left in a hurry.
He appreciated Chang Yue very much after getting to know her better these few days.
She was definitely the kind of person who could bring the dead back to life and send the living to heaven through conversation alone. In addition, all of her paperwork was flawless and indisputable, which greatly eased Zheng Ren's workload.
Chang Yue's preoperative counseling offered better results than Zheng Ren's.
Apart from that, Chang Yue's voice seemed to possess a miraculous ability to calm down the patient's family members without them realizing it.
Zheng Ren hurried toward the operating theater to make necessary arrangements for the operation.
Acute obstructive suppurative cholangitis was a tier-three surgical case, and the surgery was far more difficult than laparoscopic cholecystectomy with new technology.
Most importantly, the System had hinted that this patient was not suffering from a simple choledocholithiasis. It was a rare parasitic infestation of the bile duct!
Zheng Ren wanted to achieve perfection in the surgery, which was why he had to find someplace quiet and visit the Shop for some equipment purchase.
He was going to perform an unconventional operation, one that had never been done in the medical field thus far. It was a surgical technique that he inferred from and experimented with on dozens of mannequins in the System's operating theater.
Since it was a new technique, the newly established emergency operating theater definitely did not have suitable instruments. In fact, such instruments did not exist in the world, so he had no choice but to buy them from within the System.
In the operating theater locker room, Zheng Ren changed into surgical attire and went to the smoking area. Then, as usual, he lit up a Ziyun and took a deep drag, allowing the spicy tobacco to stimulate his nervous system before diving into the System.
He had previously spent all of his experience points learning laparoscopic cholecystectomy, so he could not buy the equipment even if he wanted to.
After completing the main quest several times recently, he had managed to save up some points, just enough for him to purchase a few instruments.
He opened the Shop and scrolled down the menu. From his familiarity, it seemed obvious that he had been planning to buy the equipment all along.
Zheng Ren clicked "Purchase" without hesitation and left immediately with the equipment in sterile packaging in his hands.
Pathetically, there were only 200 points in his savings after spending 1800 on his new equipment.
Upon returning to the smoking area, Zheng Ren stubbed out his cigarette, put it back into its pack, and entered the operating theater with the newly purchased equipment.
"Chief Zheng, what's this surgery about?" A slender figure appeared on the other end of the corridor.
Despite having spent two to three days together, Zheng Ren still had trouble distinguishing the twin sisters—Chu Yanran and Chu Yanzhi.
The question was unfathomable and Zheng Ren would likely never get the correct answer in his lifetime.
"Acute obstructive suppurative cholangitis," answered Zheng Ren.
"It's going to be a new surgery, then. Do you need assistants?" asked the twin.
"Hold the retractor if you have time. I'm going to perform an open surgery today."
"I'll assist you if you can accurately identify me," said one of the Chu sisters, who seized every opportunity to criticize Zheng Ren for his face blindness.
They no longer cared that Zheng Ren had absolutely no d.e.s.i.r.e to court beauties.
"Yiren, prepare an automatic retractor holder," yelled Zheng Ren.
Xie Yiren's clear and melodious voice traveled from the storage room.
"Oh, that's boring. Can't you make a guess?" asked one of the sisters.
"The patient is jaundiced and needs immediate surgical treatment." Zheng Ren walked into the operating theater with a blank expression, which was barely visible in the first place behind a surgical cap and mask.
"When will the patient arrive?" the other Chu sister asked.
"It depends on when Chang Yue can get the family member's signature."
"Prep up, then, the patient will arrive soon." The Chu sisters went into the operating theater together and began preparing for general anesthesia.
The twins were definitely better at anesthesia than those undergoing standardized residency training. They claimed that they had anesthetized hundreds of surgical patients during their training in West China Hospital.
The anesthesiologist seconded to the department, who was going to resign soon, had become even lazier after witnessing their standards and would only take part in preoperative anesthesia administration from time to time.
Zheng Ren did not know if the sisters had actually anesthetized that many patients, but after observing several operations, he concluded that they were highly skilled at both general and epidural anesthesia. This was especially obvious during the general anesthesia recovery phase, where they could get the patient to regain consciousness right after he cut the last suture thread.
The patient was wheeled in five minutes later, just a
s the Chu sisters predicted.
Chang Yue and the nurses in the emergency ward had the credit for such a drastic response.
Preoperative preparations had been completed swiftly and Chang Yue had been able to persuade the patient's family members to sign consent forms. These two elements were indispensable.
After the patient was transferred to the operating table, the Chu sisters began intubating and anesthetizing him.
"Burn my calories!" shouted one of the Chu sisters childishly.
'That one is Chu Yanzhi.' This was the only time Zheng Ren could differentiate the two.
The younger twin—Chu Yanzhi—was slightly more active and childish than her older sister. She was also the only one who could say such a shameless and silly statement.
Her statement did not refer to burning calories for weight loss but rather focused her attention on the surgery at hand, like a superhero saving the universe in manga.
What a childish postgraduate student. Had all her studies been in vain and had she actually turned insane after being in the medical field?
Zheng Ren began performing a surgical scrub to decontaminate his hands.
"The anesthesia is complete," announced the Chu sisters in unison like a chorus.
Their lovely eyebrows and soft voices were a feast for the senses.
Zheng Ren put on a sterile surgical gown and a pair of sterile gloves before placing the last layer of surgical dr.a.p.es on the operative field. After that, he took sterile light handle covers from Xie Yiren and installed it on the surgical lighthead.
That way, Zheng Ren could position the surgical lighthead according to his own needs.
The operative site was disinfected with iodophor-soaked cotton and wiped with dry gauze. Xie Yiren then placed the scalpel handle on Zheng Ren's outstretched hand.
Zheng Ren's surgery was again broadcast live in Xinglin Garden during the disinfection process.
[Watching the god performing surgeries is indeed beneficial. I could even feel some improvements in my laparoscopic cholecystectomy skill these past few days.]
[Even a fool can do it after repeated observation. What are you so proud of?]
[Huh? An open surgery today? Let me read the medical record. Wow, this is actually a case of acute obstructive suppurative cholangitis! Finally, I can learn new surgical techniques!]
An incision was made on the right costal margin. The scalpel cut through only the epidermis and dermis without damaging any underlying capillaries.
This was considered a meticulous action.
[It takes more than thirty years to master such incising skills.]
[Is the god planning to perform blunt dissection after making the incision?]
[Isn't this his habit in every surgery? Have you seen the god achieving hemostasis by cauterization? Cauterizing the subcutaneous tissue…]
[Barbeque smell with mushy meat. Your statement made me hungry. I'm going to indulge in some barbeque skewers after this surgery broadcast is over.]
The doctors chatted leisurely; the atmosphere in Xinglin Garden was relaxed and lively as none of them had seen the pathological tissue.
Zheng Ren bluntly separated the subcutaneous and fascial layer and opened the peritoneum. The moment the surgical field was expanded using an automatic retractor holder, the live broadcast room instantly went quiet.
Chapter 62 - Edematous Gallbladder
Intraoperative exploration revealed that there were no abnormal changes in the stomach and small intestine. The liver was normal in size and smooth with no irregularities or nodules commonly seen in cirrhosis.
However, the gallbladder was congested and visibly edematous, and it was slightly larger than half an a.d.u.l.t man's fist.
The swollen gallbladder looked like an inflated balloon. From its appearance alone, any iatrogenic perforation would blow this surgery sky-high.
[Wow, how many gallstones have acc.u.mulated in this gallbladder?]
[It isn't necessarily caused by gallstones. It could be parasites, too.]
[Why do I have a feeling that the gallbladder will rupture at the slightest disturbance, causing bile to flow into the peritoneal cavity and contaminating the operative site? Damn it, I can't watch anymore. I'll probably have a nightmare about a never-ending surgery.]
Despite their claim, the anonymous doctor stayed. In fact, none of the viewers left the broadcast room, and more latecomers continued to come into the livestream to observe the surgery performed by the demon, who had become a legend in Xinglin Garden.
With the tip of his scalpel, Zheng Ren made a small incision 0.5 centimeters away from the liver edge. After that, he began his signature move—blunt dissection.
Most of the viewers were experienced surgeons with hundreds of surgeries under their belt, or they would not dare to even comment on the livestream.
However, none of them could reach Zheng Ren's level of skill at blunt dissection.
After repeated observation of his 49+1 appendectomies, some of them tried to perform a larger range of blunt dissections, but their results had been disappointing and in some cases nearly caused iatrogenic intestinal perforations.
During this period, a new discussion post appeared in Xinglin Garden for those who attempted the host surgeon's technique after watching the live broadcast.
Some of them initially thought that their skills were inferior, but after reading through the post, it seemed everyone was on the same level.
It was likely due to their own perspectives and that the host surgeon had actually performed many surgeries to achieve such expertise in his manipulation.
There was pin-drop silence in the live broadcast room as Zheng Ren bluntly dissected tissue with a pair of hemostatic forceps and his fingers.
Zheng Ren's movements induced slight tremors in many viewers' fingers.
Like a butcher skillfully and effortlessly dismembering an ox, it was obvious that they could only observe this master at work without no hope at imitating his actions.
The edematous gallbladder, half the size of an a.d.u.l.t man's fist, had extremely high surface tension. Even a simple open cholecystectomy would require one to proceed with the utmost vigilance, let alone blunt dissection, as a split-second distraction could rupture the gallbladder.
Even so, the host surgeon seemingly manipulated the instruments without a second thought. The medium curved forceps reached under the incised serous layer of the gallbladder surface and bluntly separated the tissue at a quick pace.
That speed… He must have a death wish.
However, no one would comment that on the livestream.
This was due to the humiliation of every one of the host surgeon's previous critics. To preserve their mortification, many nosy parkers had screenshotted their comments as evidence for the discussion forums.
A few seconds later, the tissue had been bluntly dissected up to the gallbladder neck. The host surgeon then began lysing the messy adhesions caused by inflammation in the Calot triangle.
His finger movements were proficient and slow, but every step was seemingly done without forethought, which frightened the doctors watching the livestream.
The surgeon was walking a tightrope! Generally, professors in Class Three Grade A Hospitals… Why Class Three Grade A Hospitals? Why was he suspected to be a professor? Any hospital below the rank of Class Three Grade A would not dare perform this type of surgery because of the high risk of medical error.
Even in a Class Three Grade A Hospital, ordinary attending surgeons and chief residents would never handle such a troublesome operation.
Only those of lead professor rank and above would possess the confidence to perform such a difficult surgery.
Even so, they would still tackle the situation with extreme care rather than simply using forceps to bluntly dissect tissue without hesitation like this surgeon.
Upon inspection, the host surgeon's movements were not fast but very precise. Then, like a painting, the anatomical structures of the Calot triangle gradua
lly appeared in front of everyone.
This brat must have dissected a few cadavers. No! A few were definitely inadequate; he must have dissected at least dozens of cadavers.
In China, the number of cadavers, also known as silent mentors, was so limited that some medical institutions only had one cadaver per class for studying anatomy.
Few medical institutions had the luxury of providing a cadaver for a group of eight, let alone the mythical four-man team, for dissection.
For example, in a town of strategic importance in the northern frontier, whether it was just an ordinary school or medical institution, countless Kwantung Army1 corpses from decades ago were still preserved for dissection purposes. That was exactly why the doctors from that medical institution did not know what a silent mentor was.
The Kwantung Army corpses were simply unworthy of that title—silent mentors—even though they had been immersed in formalin for decades.
As the number of cadavers was scarce, many doctors actually made up their minds to apply for part-time jobs in the forensics department.
Naturally, such special privileges were provided only to motivated doctors working in tier-three or four cities1 due to a lack of licensed forensic pathologists.
The host surgeon in the livestream had definitely dissected a large number of cadavers. This assumption emerged in every viewer's mind at the same time and was proven during the gradual exposure of the Calot triangle.
The cystic duct and cystic artery were clearly visible. The host surgeon then began to ligate, resect and retrogradely remove the gallbladder.
The removal was just the beginning.
[He is very good at laparoscopic surgery, but I didn't expect him to achieve such a high standard in open cholecystectomy too.]
A dazed doctor expressed his thoughts in Xinglin Garden.
An expert would understand the difficulty behind this surgery. From the cholecystectomy alone, everyone firmly believed that the host surgeon would complete this surgery beautifully.
The Surgeon's Studio c1-799 Page 36
