They had asked Professor Pei if he would like to make any preparations, and the man requested to meet the patient before the surgery started.
Zheng Ren was glad. Many fly-in surgeons lived a fast-paced life and did not bother meeting the patient.
A short talk with the patient would make a surgeon more cautious during the surgery. Zheng Ren considered the gesture admirable.
Manager Feng's messages kept coming in, keeping them updated of their journey from the airport to the city center.
Zheng Ren thought Manager Feng was too nervous; perhaps it was the first big project of his career.
Careful execution was important. Recklessness could cause everything to fall apart.
At 2:40 pm, Manager Feng sent them another message, stating that they were in sight of the hospital.
"The professor is arriving." Zheng Ren patted down his clothes. He had not put on a shirt and tie for the occasion but did change into a new white coat.
"With your appearance, dressing up would just elicit the opposite response," Su Yun said without batting an eye. Maybe he thought being truthful outweighed tact.
Zheng Ren was already immune to his insults.
Silently, they waited. Ten minutes passed and all was still quiet.
There was no update from Manager Feng.
Chang Yue was getting anxious but Zheng Ren considered that perhaps they were having trouble locating a parking spot around the hospital.
Another five minutes went by and there was still no sign of them.
Zheng Ren sat down and dialed Feng Xuhui's number.
"Manager Feng? Is everything okay?"
Chapter 116 - Minor Accident
Chang Yue looked anxious. Her eyes searched Zheng Ren's for answers.
Su Yun finally asked out loud, "What's wrong?"
"They had an accident at the hospital entrance. Professor Pei is being sent to the emergency department," Zheng Ren said as he rushed downstairs.
Change Yue made to follow, but Zheng Ren ordered her away.
In the emergency room, Zheng Ren saw Manager Feng standing at the door of Chief Physician Pan's office, a look of despair on his face.
He sped up to reach Manager Feng. "How's the professor?"
"A three-wheeled motorcycle collided with the car. Professor Pei's left knee was injured when the emergency brake kicked in. His knee hit the front seat."
Their prudent planning had fallen apart right outside the hospital.
"Where is he now?"
"In the emergency rescue room," Old Chief Physician Pan said.
Zheng Ren immediately rushed in and saw an old man with graying hair on the hospital bed.
The top right corner of his vision brought up his diagnosis: the soft tissue around his left knee joint was injured and the cruciate ligaments were damaged. Zheng Ren had mixed feelings about this.
The injury was not severe, but with his ligaments damaged, the professor needed two to three days of rest before he could even walk properly.
It was not life-threatening or chronic, but today's surgery would have to be delayed.
Old Chief Physician Pan greeted Professor Pei and asked about his injury.
"Nothing serious." Professor Pei's body was fit for his age. He waved his hand and continued, "Just some minor trauma to the soft tissue and cruciate ligaments. Nothing major, really."
"Let's do a scan to make sure," Old Chief Physician Pan said, concerned.
Professor Pei tried to decline the offer but Old Chief Physician Pan insisted. Zheng Ren ended up wheeling the professor to the NMRI room.
The results confirmed the diagnosis made by the System and Professor Pei. It was not a serious injury.
Professor Pei was frustrated. He sighed and asked, "What happens now with the surgery?"
Zheng Ren had been mulling this issue. He thought for a moment and asked, "Professor Pei, if you don't mind, could you guide us through the surgery?"
A guided surgery involved the professor giving step-by-step guidance while junior doctors did the legwork.
"Have you done the procedure before?" Professor Pei asked curiously.
He was under the impression that Sea City General Hospital had state-of-the-art facilities but no interventional surgery experts.
This was why China Changfeng Microinvasive Surgery targeted Sea City for their debut.
"I've done a few cases. Uterine and renal artery embolizations; mainly surgeries to control bleeding," Zheng Ren answered truthfully.
"That's good enough." Professor Pei nodded in approval. "If there's any difficulty, I will step up. My body may not be young anymore, so I can't stand on one leg for too long. Thank you for helping."
"No, thank you for even coming," Zheng Ren said to the old man. He had the utmost respect for the medical practitioner. The old man had strong ethics alongside his superb surgical skill.
Professor Pei was fidgety. Perhaps it was true that every surgeon had minor obsessive compulsive disorder; as long as there was surgery to be done, they would be restless.
At Professor Pei's request, Zheng Ren wheeled him to the emergency ward.
"Ding dong~!" the System chimed.
Oh? A mission?
[Continuous Mission—Doctors with Parental Heart 2: Hope Amidst Despair
Mission Details: Complete the liver cancer tumor embolization.
Mission Reward: 100 skill points and 1000 experience points.
Mission Duration: 4 hours.]
Chang Yue was anxiously waiting for news. When she saw Zheng Ren approaching with a wheelchair, her heart fell.
Professor Pei introduced himself to Zheng Yunxia and they discussed her case. Then, he asked for her CT scans and spent a few minutes analyzing them in an office. FInally, he was satisfied.
The preoperative preparations were complete and Chang Yue brought Zheng Yunxia up to the operating room on the third floor.
They took a while to reach the room as it was Chang Yue's first time transporting a patient there. Normally, Su Yun or Zheng Ren would do the honors.
Professor Pei looked around the interventional suite in the operating room and was very impressed.
Meanwhile, Zheng Ren and Su Yun got down to business.
No one spoke at that point. The only difference in this surgery was its difficulty and the professor's guidance.
Su Yun started disinfection and placed the surgical dr.a.p.es over the patient. Zheng Ren changed into the System's special lead vest, scrubbed in and started femoral artery cannulation.
…
…
The System was humming, but unlike before, the livestream on Xinglin Garden did not begin.
After a moment, the humming disappeared and the System was silent.
There was no livestream this time.
…
Through the thick lead-glass window, Professor Pei watched the two surgeons busying themselves in the operating room. "Where did Little Zheng learn interventional surgery?"
Old Chief Physician Pan, standing beside Professor Pei, answered the s.e.n.s.i.t.i.v.e question. "He must have learned it in his past. I'm not too sure, either, but I watched his past two surgeries and saw nothing amiss."
He was glad that Zheng Ren was not in the room.
If Zheng Ren gave an honest answer, that he once watched it performed during his housemanship, the professor could become angry.
The boy was a good person, but at times, he was too honest.
Old Chief Physician Pan liked that Zheng Ren was good at surgery. Hence, his flaws were balanced out.
"I see. Let's see how it goes then." Professor Pei could only comment as much.
An emergency embolization was not the same as embolization for a liver cancer tumor.
During emergency embolizations, the target blood vessel was usually bigger and easier to access, but for a liver cancer tumor, the embolization of 4th-grade arteries was needed to ensure high efficacy of treatment.
However, the boy only needed to know the basics. Pr
ofessor Pei would scrub in when it was time for arterial superselective catheterization.
As the two old men talked shop, the vascular sheath had already been inserted and the guide wire was slowly entering the femoral artery.
"The pair seem very accustomed to the surgery. Steady hands," Professor Pei said, nodding with approval.
Femoral artery catheterization was a medium-difficulty procedure, but Zheng Ren succeeded on his first attempt. Although the patient did not suffer hypovolemia, it was rare to see a non-specialized doctor in a small city like Sea City perform the procedure with such proficiency.
Old Chief Physician Pan smiled but said nothing. Zheng Ren had always been successful on the first attempt.
However, he did have a few worries as Zheng Ren had never done liver cancer tumor embolization before. Who knew what could go wrong?
The guide wire was in place and Su Yun switched on the imaging system.
In the control room, the live image of the surgery appeared on the 40-inch screen. Professor Pei watched it attentively.
The room was dead silent. The procedure required an administration of chemotherapy drugs into the liver, so Xie Yiren was there to pass them the concoction. This form of targeted delivery minimized side effects.
The Chu sisters, Chang Yue, and Feng Xuhui had nothing to do but remain in the room. No one spoke, afraid to interrupt Professor Pei's thought process.
In the operating room, under X-ray radiation, Zheng Ren slowly maneuvered the thin silhouette of the guide wire into the target vessel.
"Commendable superselection skills," Professor Pei lauded.
Chapter 117 - Major Accident
"He's experienced." The professor's praise made Old Chief Physician Pan incredibly happy.
He shielded Zheng Ren from people's anger but showed humility at the professor's compliments.
Zheng Ren was like his own son. The boy was very talented and deserving.
"The superselection was well-done," Professor Pei said a few minutes later, impressed.
The guide wire moved from the hepatic to the branching artery. The path got narrower as Zheng Ren maneuvered deeper into the network of vessels, each branch requiring him to enter a new vessel. The process was extremely difficult.
Manager Feng's face was tense as he watched the surgery.
This was the first challenge in his field and he had used a lot of resources to bring Professor Pei from Sorcery Capital to ensure the surgery was flawless.
As luck would have it, they had gotten into an accident right outside the hospital gates and now, Professor Pei was not fit to perform surgery.
Although Professor Pei had not suffered any major injuries, Manager Feng expected the surgery to be called off, leaving him to pack his bags and leave Sea City with nothing to show for it.
'A roaring start that ends with a whimper,' Manager Feng had thought as he despaired about his career.
An unexpected blessing had come in the form of a young chief resident from the emergency department.
Manager Feng's worries had been quelled by Professor Pei's assent to a guided surgery.
Five minutes passed and the superselection was done. The guide wire was maneuvered through the femoral artery and into the 4th-grade vessel that was 1cm away from the tumor.
The guide catheter made its entrance, followed by the guide wire, which was established for the catheter—a thick and flexible tube—to follow its path to the tumor.
Zheng Ren's technique was delicate, accurate and flawless in execution.
Professor Pei watched the screen, rapt. Although he said nothing, his look of admiration was evident.
He expected this level of performance from himself, but did not expect to find another surgeon with similar skills in this small city. Clearly, there was hidden talent to be uncovered.
When the catheter reached the tumor site, Su Yun switched off the imaging system. He waved to the control room while his other hand held onto the guide wire and catheter.
Xie Yiren took the cue and went through the heavy lead door. It was time for drug administration.
The chemotherapy drugs had to be prepared on the spot as there was the possibility of a prolonged or failed superselection.
Hepatocellular carcinoma was unlike other forms of cancer with first-line and second-line chemotherapy. For many years, surgical excision of the tumor was the only effective treatment.
In the last decade, the rise of interventional radiology-assisted techniques and the development of targeted medicine such as sorafenib gave hepatocellular carcinoma patients a better chance.
Through clinical studies, doctors realized a combination of chemotherapy drugs and the embolization of the artery supplying nutrients to the tumor produced the best results.
Chemotherapy drugs were known as 'poisons' as their efficacy lay in their cytotoxicity. During surgery, the drug would be delivered to the tumor before the artery was embolized, effectively steeping the tumor in poison. After the artery was embolized, there would be no more nutrients supplied to the tumor.
It was a successful two-pronged strategy.
Xie Yiren was quick with her hands. The drugs were prepared and loaded into the pressure injector. She gave Zheng Ren an encouraging fist pump before closing the heavy lead door behind her.
After the drugs were administered, Zheng Ren performed the iodized oil embolization of the artery.
Once the process was complete, he started up the imaging system.
This step was akin to the saline rinse of normal surgeries. It allowed the surgeon to check for mistakes.
Professor Pei was in a relaxed mood. Jovially, he said, "I had thought that I would need to step up to perform the superselection, but your subordinate managed it admirably."
"Oh, you're being too kind," Old Chief Physician Pan said with a wide smile.
The image was transmitted to the control room screen.
The smile on Professor Pei's face froze as it gazed upon it.
Zheng Yunxia had only one tumor, but it was 8cm big. It was half the height of her liver.
In the image, the bottom half of the tumor was not visible, indicating a successful embolization.
However…
The top half of the tumor was still there.
"Tsk…" Professor Pei's expression darkened.
"Professor Pei, this is…" Old Chief Physician Pan had read up on interventional-radiology assisted surgery earlier, but his 60-year-old brain no longer retained information well. Without any practical knowledge, he could not make out what the situation was.
"The image differs from the CT scans taken prior to the surgery." Professor Pei walked up to the screen and pointed. "The lower half of the tumor is being sustained by the hepatic artery branch but the upper half must be getting nutrients from another artery."
"Which artery could it be?" Old Chief Physician Pan asked.
"I'm not sure. It could be any vessel since tumors can stimulate angiogenesis." Professor Pei shook his head. "The worst case scenario would be a branch from the spinal artery. If that's the case, the embolization procedure has a high risk of causing paralysis."
The room was silent.
Everyone but Xie Yiren looked worried. She, however, seemed to have utmost confidence in Zheng Ren's abilities.
In her opinion, no procedure was out of Zheng Ren's reach.
"Of course, the difficulty lies in locating the blood vessel that supplies nutrients. You need a little bit of luck for that." Professor Pei shook his head.
Soon, Zheng Ren appeared in the control room in his surgical scrubs.
"Professor Pei, what do you think?" Zheng Ren asked.
"If you don't have confidence in it, end the surgery," Professor Pei said grimly as he looked straight into Zheng Ren's lead glasses. "Although it will not be a total success, this surgery would inhibit the lower half of the tumor and extend the patient's life expectancy by three to six months."
Zheng Ren remained silent.
"The other
choice would be to find the artery that supplies blood to the top half of the tumor, but it's not going to be easy."
The Chu sisters and Xie Yiren did not want a slipshod surgery. In their few days of knowing Zheng Yunxia, they had all become good friends. They had a personal stake in this, apart from their professional background.
However!
The surgeon would have to endure prolonged radiation exposure.
Although there was protective gear, it was only helpful against short-term exposure. Prolonged exposure to X-rays would make even Iron Man queasy.
A twelve-hour surgery was vastly different from a twelve-hour interventional surgery.
One was exhausting, but the other could lead to the death of the surgeon.
The room was once again silent.
Should they encourage Zheng Ren to try his best?
Should they ask Zheng Ren to forfeit?
They were all caught in a bind.
"Let me try," Zheng Ren answered with a determined nod.
Chapter 118 - Life And Death Are Fated
"Just try your best and don't be too hard on yourself," said Old Chief Physician Pan after a few moments of hesitation.
However, before he could finish, Zheng Ren had already returned to the interventional radiology suite, closing the lead door behind him and giving the crowd a smile with crinkled eyes.
It was a genuine smile of trustworthiness rather than bravado.
The surgery resumed.
Zheng Ren reinitiated superselective catheterization. Since the hepatic artery had been superselected, his next target would be the renal artery.
His manipulation remained proficient and stable.
Once the micro-guidewire entered the designated artery, he inserted the microcatheter and obtained an angiographic image. Unfortunately, the renal artery was not the culprit.
The process of elimination was their only option.
After excluding the hepatic artery and the renal artery, Zheng Ren began superselecting the superior mesenteric artery.
Fifteen minutes later, the results were once again disappointing.
Professor Pei and Old Chief Physician Pan's expressions gradually darkened. One hour had passed and Zheng Ren had spent most of this time exposed to radiation.
The Surgeon's Studio c1-799 Page 63
