The girls politely thanked him and fled the scene in a hurry.
The bigger the mess, the greater the perpetrators' embarrassment once the truth was revealed.
Zheng Ren smiled and watched them slowly vanish into the distance.
"So that's what happened. My sense of justice is in vain."
"F*ck your sense of justice. I think you were just enjoying yourself."
"That doctor is good. He is patient and explains things very thoroughly."
The crowd gradually dissipated. Zheng Ren then explained the dispute management to the doctor on duty in the internal medicine division and did a simple ward round in the observation units before returning to the emergency ward.
It was already past nine o'clock when he expressed his gratitude to the deputy senior consultant of the second general surgery department before seeing him out.
He took out his phone and asked Chu Yanzhi about the drinking contest via WeChat.
She quickly replied with a short video.
In the video, Su Yun was sweating profusely, sticking his black bangs to his forehead. On the other hand, Chang Yue appeared normal, but Zheng Ren could notice a gleam in her eyes; he was unsure if it was simply his imagination. Both of them shared one thing in common, however—they were still sober.
"Watch them. If either of them drinks excessively, call 120 and send them to the hospital immediately," Zheng Ren advised.
Those who did not require gastric lavage after consuming seven to eight boxes of beers were considered heroes.
"Got it, old man," replied Chu Yanzhi.
Old… Old man…
Shaking his head in response, Zheng Ren prepared to wash up and go to sleep.
Before that, he quickly went for a round in the emergency wards. Lin Yuanshan's father was having slight abdominal pain, but his condition remained stable thus far, so he gave some medical advice and prescribed analgesia for the patient.
Upon returning to the on-call room, Zheng Ren stared at the darkness outside the window. Instead of dramatically going down memory lane, he drew the curtain and lay down on his bed.
Heaven only knew when an emergency case would arrive. If he did not seize what free time he had to get some rest, he would deeply regret it when unforeseen circ.u.mstances came.
Sure enough, Zheng Ren was woken by a phone call at a quarter past five in the morning.
A dreamless sleep was truly satisfying. Then, he glanced at the phone and saw the caller ID—Chang Yue. V4 = c.h.e.s.t lead IV (4), which was why the girl wrongly perceived it as having a flat c.h.e.s.t.
Chapter 87 - Unidentified Patient
"Chief Zheng, I've called an ambulance, but I don't have enough money to pay for it. You have money, right?" Chang Yue's tone sounded cold as usual.
Zheng Ren yawned irritably as he woke up on the wrong side of the bed.
If his sleep was interrupted by an emergency, bad mood notwithstanding, sometimes he would not even have enough time to put on his shoes. However, an early-morning call from Chang Yue, who constantly wore a stony expression on her beautiful face, was indeed very annoying.
Even so, Zheng Ren had always been good-tempered and overcame his irritation.
'Did these guys drink beer the whole night?' The very thought immediately alerted him.
What the f*ck! Did they have a death wish?! They even called an ambulance? Was it possible that they had had acute upper gastrointestinal bleeding due to excessive alcohol consumption?
"Yes," Zheng Ren asked anxiously, "How are you doing? What happened to Su Yun?"
"I'm fine. In fact, I'm quite energetic and I think I can go back to work straight away. Su Yun had too much drink and fell down, but I think he should be alright," answered Chang Yue.
Zheng Ren was slightly at ease and grumbled internally, 'How could these two annoying idiots drink the entire night?'
"Chief Zheng, I picked up a patient on the way as well. He is a middle-aged man with a rigid abdomen. What do you think?" Chang Yue proceeded to the main reason for her call.
"Send him to the emergency department, I'm heading there now." Zheng Ren immediately put on his shoes and white coat before rushing to the emergency department.
Just as he stepped out of the room, he quickly turned around, took 200 yuan out of his wallet and stuffed it into his pocket.
Mobilization of ambulances came with a cost that was calculated based on distance, and there was no discount even if it belonged to Sea City General Hospital. Besides, asking Old Chief Physician Pan for a favor just to save a few hundred yuan would be extremely humiliating.
The crayfish restaurant was not far away from the hospital, so Zheng Ren and the ambulance reached the emergency department at the same time.
Two stretcher trolleys were wheeled in afterward. Su Yun, who was relatively composed despite being plastered, was curled up into a ball and mumbling incoherently on one of them.
Chu Yanzhi followed the trolley with a helpless look on her face.
"I tried to stop them, but they refused to listen," she explained as if it was her fault alone.
"Don't worry about it," Zheng Ren comforted her.
Zheng Ren glanced at Su Yun and checked the diagnosis on the System panel—acute alcohol intoxication… How much did this brat drink?
"Send him to the emergency ward. Start an IV infusion of naloxone, 500mL of glucose solution and two units of vitamin C." Zheng Ren gave simple instructions to Chang Yue.
Chang Yue looked stupefied as she led the paramedic and stretcher trolley upstairs via the elevator with Chu Yanzhi following obediently behind them. Even though the two were almost the same age, Chu Yanzhi looked like a child in every aspect compared to Chang Yue.
When they were further away, only then did Zheng Ren realise that Chang Yue was barefoot with her footprints clearly visible on the floor, presumably due to wetness.
'One has acute alcohol intoxication and the other lost her shoes… What the f*ck!' Zheng Ren thought, annoyed.
However, all of these were inconsequential compared to the patient with a board-like, rigid abdomen.
On another stretcher trolley lay a big-boned but emaciated man.
Zheng Ren read the details on the upper right corner of his vision, printed in bloody red just like the victims of acute nitrite poisoning last time.
Acute gangrenous appendicitis complicated with septic shock.
A life-threatening condition!
He quickly pushed the stretcher trolley into the emergency resuscitation room and shouted at the top of his lungs along the way, "Perform a bedside B-scan ultrasonography, monitor his vitals signs and administer oxygen, stat!"
Upon reaching the resuscitation room, two nurses on duty removed the patient's shirt and started placing ECG leads on him.
In the meantime, Zheng Ren examined him and felt warmth radiating from his body.
Oh, thank God…
Pyrexia was a normal finding in septic shock, but once the extremities were cold, a condition clinically described as cold shock, it could be irreversible and death could be inevitable.
Hyperthermia meant that the patient's immune system was still functional and that the patient was not in as much danger.
Heart rate at 130 beats per minute with oxygen saturation at 93 percent only; the patient's abdomen exhibited spastic rigidity like a hardboard.
This was a typical sign of peritonitis, caused by an involuntary tightening of the abdominal muscles due to peritoneal inflammation, hence the board-like hardness.
Common etiologies included hollow organ perforation leading to leakage of its contents into the peritoneal cavity, or hemorrhage secondary to solid organ rupture, all of which would inflame the peritoneum.
A doctor in charge of ultrasonography hurried over with a portable ultrasound machine cart. He swiftly applied the ultrasonic couplant on the patient's belly and asked, "What is his name?"
It was compulsory to acquire the patient's name as a report had to be issued later. This was a
standard procedure to prevent patient misidentification that could jeopardize their safety, a medicolegal issue.
"A thirty-five-year-old unidentified man," Zheng Ren estimated the patient's age group through his facial features and reported it tersely.
"Lower abdominal mass noted, suspected causations include appendicular abscess or perforated appendix. Other organs cannot be seen clearly due to huge gaseous disruption. Minimal free intr.a.p.eritoneal fluid detected in the pelvic cavity. Otherwise, no other abnormalities are visible," the doctor quickly reported the main ultrasonographic findings to Zheng Ren.
This patient had a severe condition and required immediate surgical intervention.
Zheng Ren picked up his phone while instructing staff to escort the patient to the emergency ward. After a brief moment of hesitation, he pressed the "Call" button.
It was inhumane to disturb Old Chief Physician Pan so early in the morning, but he had to treat this incident seriously and report it to his superior.
It would be fine if the patient was all alone, but if the surgery went haywire or the condition was simply too severe to be treated, family members and friends would often immediately emerge out of nowhere and start tearfully howling injustice.
However, that was not important and Zheng Ren had no time for that. His main issue was the absence of informed consent for surgery.
Old Chief Physician Pan promptly answered the phone, his voice serious.
"Little Zheng, what happened?"
Ever since Zheng Ren first arrived at the emergency department, he had rarely disturbed Old Chief Physician Pan's slumber. Thus, such an unexpected phone call distressed the old man; it was a basic instinct every doctor possessed.
"An unidentified man around thirty-five years old is suspected to have acute gangrenous appendicitis complicated with septic shock. There aren't any contact details of his family members," Zheng Ren reported.
"Start preoperative preparations. I'll contact the medical administration division," replied Old Chief Physician Pan without hesitation.
Zheng Ren hung up and trotted upstairs via the fire escape without wasting time waiting for the elevator.
"Start preoperative preparations," Zheng Ren instructed the nurses and called Chu Yanran and Xie Yiren to prepare for surgery.
After the blood test, electrocardiogram, and various investigative results returned, Zheng Ren took a quick glance at them before pushing the patient, with the nasogastric tube and urinary catheter already inserted, to the operating theater on the third floor.
He handed the patient over to the Chu sisters and rushed back to the emergency ward.
Old Chief Physician Pan was already on his way, and the sleepy medical administrative staff on duty was constantly yawning while bringing video recording equipment to the office in the emergency ward.
The medical administrative staff began recording details for legal purposes once Old Chief Physician Pan reached the office.
Zheng Ren explained everything from the patient's history, status and treatment plans to the reason for his inability to acquire informed consent without family members' contact information.
Subsequently, the medical administrative staff gave authorization to Old Chief Physician Pan and the emergency surgery was greenlighted.
This procedure was mandatory for the self-protection of medical personnel.
After the video was complete, the heavy-eyed medical administrative staff took the equipment and returned to his office.
Zheng Ren was slightly embarrassed and said, "Old Chief Physician Pan, I'm sorry for waking you up so early in the morning."
"Seniors are usually sleep-deprived. I was already awake anyway." Old Chief Physician Pan waved his hand and asked, "Proceed with the surgery. Are you confident about it?"
No one had absolute confidence when treating a patient in septic shock.
Unlike circulatory shock caused by nitrite poisoning, there was no corresponding antidote for septic shock secondary to diffuse peritonitis. The only treatment option was surgical removal of the source of infection and aggressive postoperative antibiotic administration to solve the problem.
Full recovery depended on the patient's physical state as well.
That man… Zheng Ren's expression dimmed after recalling his emaciation and shook his head in response.
"Just do your best." Old Chief Physician Pan gently tapped his shoulder and said, "I'll ask hospital management about treatment expenses during office hours."
Zheng Ren nodded and hurried to the operating theater.
Chapter 88 - It’s a Pity I Can’t Send A Wave of Positive Energy
"Burn my calories!" Zheng Ren, who had changed his attire, heard a childish yell before he walked into the operating theater.
That must be Chu Yanzhi. She only had calories to burn right now, having not slept all night.
When he entered the operating theater, Xie Yiren had already changed and was counting the instruments in front of the instrument table.
Zheng Ren went to perform a surgical scrub and asked during disinfection, "How much did they drink?"
"Eleven boxes each, and that was all the restaurant had." Chu Yanzhi exaggeratedly extended her arms in an attempt to describe the height of the piled-up boxes, which failed.
"They really had a death wish," Zheng Ren cursed as he disinfected.
"It's thanks to Su Yun." Chu Yanzhi was one of the few people who remained ins.e.n.s.i.t.i.v.e to Su Yun's charm and immediately put the blame on him. "I tried to persuade them many times, but he insisted on continuing."
Zheng Ren sighed heavily.
He really hoped that Su Yun would learn his lesson this time and stop assuming that all women were lightweight. If he continued, he could end up having incontinence in the future.
The surgical site was disinfected, the surgical dr.a.p.es applied, surgical gowns worn, and the last layer of surgical dr.a.p.es reapplied… Zheng Ren stood under the surgical lighthead, fully prepared for the operation.
The scalpel in his hand gleamed.
Instead of the standard incision for ordinary appendectomy or a small incision similar to those made during the crazy night of appendectomies, Zheng Ren made a roughly ten-centimeter incision lateral to the right rectus abdominis muscle.
Since the patient was emaciated, he reached the peritoneum shortly after a simple dissection of subcutaneous and fascial layers.
He frowned: the patient's peritoneum had obviously turned black, which meant that the infection had been going on for at least three days.
Damn, this patient was really tough if he could endure the pain building up from simple appendicitis to acute peritonitis. Barely anyone could withstand the agony of a perforated appendix, to begin with.
Zheng Ren extended his hand and an aspirator with a suction tube attached was gently placed on his palm.
The livestream in Xinglin Garden started at the same time.
It was late at night, so there were only a few hundred viewers watching the livestream.
It was only relatively a small viewer count; normally, at least a few thousand viewers would swarm into the live broadcast room as soon as the anonymous account began livestreaming.
[The peritoneum is black. Is treatment even possible for this sort of severe infection?]
[The god will also handle feces? I thought he was a hepatobiliary and pancreatic surgeon.]
[Young man, are you new to this livestream? Have you begun worshipping the god for his miraculous overnight performance of forty-nine appendectomies?]
There was no doubt that the aspirator had to be plunged in immediately after opening the peritoneum. The pus, digestive fluid, and food debris residing in the peritoneal cavity had to be removed to prevent leakage that could lead to secondary infection.
[That's strange. Why isn't there any food residue?]
[Oh, yeah… I treated a gastric perforation case a few days ago and even aspirated a few pieces of meat.]
[The host surgeon is really luck
y. He made it clear that he wanted to dig out some feces, but the insides looked so clean when the peritoneum was opened.]
Lots of pus and exudate were aspirated, but food residue and excrement were nowhere to be seen.
This sight made Zheng Ren feel uneasy. Even though this made the surgery somewhat easier, it also meant that this patient had fasted for three to five days.
No wonder he was big-boned but appeared physically wasted.
After ensuring that all pus and exudate had been fully aspirated, Zheng Ren put protective measures on the peritoneal membranes and carefully exposed the peritoneal cavity.
A large, black appendix emerged in the operative field.
The base of the appendix had perforated and its surrounding areas had become gangrenous.
Zheng Ren cautiously dissected the tissue around the appendix twice as slowly compared to his previous operations.
The gangrenous tissue was particularly brittle and had adhered to the surrounding organs for a few days. Therefore, any accident during dissection could cause irreversible damage to the surrounding tissue.
Although the tissue looked light-colored and unhealthy, gangrene had at least not taken hold, which meant that there was still hope for recovery.
[This is nerve-racking… That must be the appendicular artery. Arterial blood won't gush out, right?]
[Are you a doctor or not? In a gangrenous setting, the appendicular artery will contract and partially close up. Bleeding won't occur as long as the ligation is secure. However, this is the difficult part as there is severe edema on the non-gangrenous base. If it isn't tightly sutured, the thread will automatically fall off once edema subsides.]
[You can put in two sutures, but it's no easy task and any slight overuse of strength will definitely rupture the artery.]
Soon, the doctors in the live broadcast room started discussing the condition animatedly. Exchanging views could widen their horizons, and they had already discussed the challenges of this surgery before Zheng Ren even had even begun ligating the appendicular artery.
The Surgeon's Studio c1-799 Page 49
