"Hey! I'm not the one with the disorder, alright?"
Su Yun went back to his phone and the conversation died down.
Once both men were rested and ready to leave, Su Yun led them through the fire escape to the general surgery department.
They reached it as a high-pitched wail cut through the air.
A stretcher trolley passed them with a teenager onboard. She was thrashing about, both hands clutching her abdomen. It was an emergency case and they were heading for a check-up.
Something about the patient caught Zheng Ren's eye and he stopped.
Su Yun almost bumped into Zheng Ren. "Hey, move. You're blocking my way."
"Oh."
"What? Was something wrong with the patient?" Su Yun asked jokingly.
"Tell them to prepare for an emergency surgery."
"Dude, just because people call you a boss, you think you're the boss of every hospital department? Do you even know what the patient has? You're gradually becoming a witch doctor. Let me know when you get blacklisted, but please don't let it happen when you're operating," Su Yun instinctively mocked.
"Did you see the patient's mole? By her lips?" Zheng Ren asked.
What did a mole have to do with surgery?
The non-sequitur broke Su Yun's train of thought.
"Did you know that there is a genetic disorder called Peutz–Jeghers syndrome?" Zheng Ren said as he walked.
It was a rare occasion when Su Yun had nothing to say.
"The patient looks to be 14 or 15. Moles by her lips, even her fingers have them."
"Are you gonna perform cosmetic surgery now?" Su Yun knew Zheng Ren was building up a case but could not resist injecting some sarcasm into their conversation.
"PJS is a genetic disorder characterized by polyps in the gastrointestinal tract. The small intestine is the main target. Some have polyps developing in the stomach, colon and rectum," Zheng Ren explained.
"Wait…" Su Yun caught up to Zheng Ren's pace and asked, "What does it have to do with her abdominal pain?"
"Most PJS patients have mole-like features on the hands, feet, and face. Those are actually polyps."
"Okay, so what does it have to do with the abdominal pain?" Su Yu repeated.
He had an angry scowl on his face.
"The size of the polyps varies but most are pedunculated. This increases the risk of intussusception," Zheng Ren explained, then asked, "Have you ever received a case of ovarian torsion due to pedunculated polyps?"
At that moment, Zheng Ren's seniority was indisputable.
All doctors had a competitive streak. Knowing more than one's peers was very much an ego boost.
Su Yun was at a loss.
He had never heard of this P-J syndrome. He was not familiar with rare disorders that almost never appeared in the hospital.
His innate talent could not make up for experience.
Su Yun had previously been a researcher in cardiothoracic surgery. General surgery was not his field of expertise.
"Brother Yun's here," one of the doctors announced when they heard Su Yun's voice.
Zheng Ren's arrival was also greeted warmly. "Boss Zheng, you finally have the free time to visit us."
"Him being free means you're gonna be busy soon," Su Yun muttered.
The line caught the Imperial Capital chief resident by surprise, his outstretched hand faltering midway.
Zheng Ren shook his hand regardless and asked, "And you are?"
"Chief Resident Wang."
Su Yun went straight to the point. "Old Wang, can you get your people to check if that patient has an abnormal number of moles on her soles and palms?"
"Eh…" The chief resident hesitated, then asked, "You suspect it's Peutz–Jeghers syndrome?"
"It's Boss Zheng's hypothesis. What do your people think?" Su Yun said.
"I was suspecting strangulated intestinal obstruction and wanted to do a CT scan to check before operating," Chief Resident Wang said. "If it's PJS, we'll need to operate fast."
Peutz–Jeghers syndrome was a rare occurrence even in an Imperial Capital Class Three Grade A Hospital.
Chief Resident Wang's only exposure to this disorder was through a professor's lecture. As the patient was rushed into the emergency department, he had not noticed the unusual pigments on the patient's face and hands.
"Hello. Can you help check if there are mole-like appearances on the patient's palms and soles?"
It was a simple request that Chief Resident Wang could fulfill.
"Alright. Once the preliminary check is complete, prepare for surgery."
He put down the phone and turned to Zheng Ren, a peculiar expression on his face. "There's hyperpigmentation on her soles."
"Okay. You should get ready for surgery, then."
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Chapter 201 - Disobeying The Powerful Is A Crime (Part 3 of 5)
Chief Resident Wang looked somewhat embarrassed.
The corners of Su Yun's lips curled into a smile, a familiar sight that gave Zheng Ren the urge to slap him, and he asked, "You're not confident because you've never done it before, right?"
Chief Wang rubbed his hands and agreed to Su Yun's statement by smiling awkwardly.
"Boss, have you done it before?" asked Su Yun.
Zheng Ren gave it some thought. It was true that he had never performed such a surgery before. However, he had also completed the one-day mission Together We Stand in only two hours.
He could learn the technique in the System's operating theater, which would not consume too much of his time.
How should he respond to the question: yes or no?
Zheng Ren, who had always been honest, was caught in a dilemma.
Chief Wang also knew that it was one thing to diagnose a rare, intractable disease, as anyone could do so by reading and remembering it.
However, treating the condition was a completely separate issue.
Having the ability to diagnose a disease did not come with the ability to treat it as well.
"It's alright. I'm going to give it a try, and if I fail, I'll look for my boss," said Chief Wang.
Su Yun, who also had no idea what was going through Zheng Ren's mind, gently tapped the man's injured shoulder, inflicting slight pain without actually affecting the wound.
Zheng Ren was puzzled.
"I asked you a question, boss." Su Yun was annoyed.
Chief Wang's eyes widened in disbelief. What the hell was this? He would never have had the courage to speak to his boss in such a derogatory tone; it would certainly get him kicked out of the hospital and mean the end of his career.
Brother Yun was gutsy.
Boss Zheng was also good-mannered.
'Perhaps the title "boss" is just for fun,' Chief Wang thought.
"I knew just a little," Zheng Ren said, "I'll attend the surgery as an observer. If there is any problem, we'll discuss it together."
Chief Wang's impression of Zheng Ren improved significantly.
This boss was young but not imperious. He was worried that both Boss Zheng and Su Yun would have the same attitude and simply take over the surgery.
How shameful would that be?
"I'm sorry for the trouble, Doctor Zheng." Upon noticing Su Yun attempting to speak, he quickly added, "I'm going to call the operating theater and ask them to prepare for surgery."
Chief Wang led Zheng Ren and Su Yun into the office before proceeding with the necessary arrang
ements.
If Zheng Ren's diagnosis was correct, the patient's intestine would have necrotized. In a sense, the diagnosis was almost the same as his own—strangulated intestinal obstruction and intussusception—because a segment of the patient's intestine had to be removed no matter what.
Performing surgery earlier could minimize the extent of necrosis and lead to better postoperative recovery.
Time and tide waited for no man. All of them belonged to the same circle, and no one would kick up a fuss at this critical moment.
Su Yun tapped away on his phone while Zheng Ren enjoyed the view outside the window.
The tall building gave him a clear bird's-eye view.
The classical arcs of the China Zun could be visualized very clearly, a sight which Zheng Ren adored.
"I searched through the internet and found out that the disease actually exists," said Su Yun abruptly.
Zheng Ren nodded.
"You're just a young doctor from Sea City, where did you learn it?" Su Yun's questions were always direct and sharp.
Zheng Ren retaliated without the slightest hesitation. "You and I share the ability to learn something by eye immediately, but I'm just slightly better than you. If you decide to establish a pet medical center in the future, you won't be able to surpass me in your lifetime."
Although Su Yun was aware that Zheng Ren was simply provoking him, the flames of war lit up in his eyes.
Zheng Ren stole a glance at Su Yun, who looked like a bull aggravated by a red cloth, and grinned.
'He is indeed a young man with a hot temper.'
As he thought that, Zheng Ren forgot that he was actually a few months younger than Su Yun.
A few minutes later, Chief Wang had printed the preoperative consent doc.u.ments and called the patient's family to his office for preoperative counseling.
Su Yun noticed that the patient's father also had a black mole near his mouth, but none on his hands.
However, when Chief Wang inquired about the family's history of intussusception, the father denied it.
Was the disease not genetically inherited? What the hell?
Su Yun peeked at Zheng Ren, who was observing the patient's father, and could even feel the heat emitting from the man's body as his mind ran at an incredible speed.
"Boss Zheng, what's going on?" asked Su Yun softly.
"Counsel the family after surgery to undergo colonoscopies in their free time."
Su Yun nodded subconsciously. Perhaps the patient's father had only mild symptoms, which was why he had not suffered intussusception until now.
Even so, there could still be intestinal polyps that risked becoming malignant in the future, so removal at their earliest was recommended to prevent future complications.
After counseling was complete, Chief Wang made a call and was informed that the patient had undergone an abdominal CT scan.
Chief Wang launched the patient management software on his computer and keyed in the patient's ID number to locate his imaging films. At the same time, he instructed medical personnel on the other end of the call to quickly send the patient back for nasogastric tube and urinary catheter insertion for surgery.
The CT films were typical of intussusception, and he could vaguely outline a few polyps scattering along the intestine.
Of course, he had made this deduction after Zheng Ren explained it in advance.
There was no way he could have made such a judgment if he had not known about P-J syndrome in advance.
"Damn, Boss Zheng, you're f*cking awesome!" Chief Wang stared at the films and complimented him. "When I heard that you had performed a needle thoracostomy and emergency laparotomy for hemostasis yesterday, I already thought that you were amazing, but I hadn't expected your ability to diagnose rare diseases to be more f*cking incredible!"
His words sounded rude, but he felt unable to truly express his reverence without vulgarities.
Of course, he would never be so vulgar toward more elderly professors, but Zheng Ren was a few years younger than he was.
Younger, but more knowledgeable; there was nothing he could criticize in the man.
What else could he possibly say other than admit Boss Zheng was awesome? Challenge the man out of jealousy? Chief Wang was not stupid enough to have a death wish yet.
Chief Wang firmly believed that disobeying the powerful was a crime.
"That's kind of you," said Zheng Ren indifferently.
The patient was transferred back in less than ten minutes. The nurse proficiently inserted a nasogastric tube and urinary catheter, then established a venous channel for the patient before quickly wheeling him into the operating theater.
"Boss Zheng, Brother Yun, let's go," said Chief Wang politely.
The woman in charge of the operating theater locker room was dissatisfied with Chief Wang for bringing "outsiders" in for surgery.
However, when she heard that Zheng Ren was the doctor who had saved Fang Lin, she immediately welcomed their arrival with enthusiasm.
"Fang Lin lives a tough life. How did an honest man like him earn such a misfortune?"
The woman in her fifties started talking and threw keys to both Zheng Ren and Su Yun. There were two keys on each keychain, one for the shoe cabinet and another for the locker.
She then opened a small drawer by her side and got another bunch of keys for Zheng Ren.
Chief Wang saw this and laughed. "Boss Zheng, you've earned her respect."
"Huh? How so?" Zheng Ren was puzzled.
Su Yun also glanced at the keys and shook his head. "It's notoriously difficult to persuade her, and they have to put in a good word just to bring hous.e.m.e.n into the operating theater, but now she has given you the keys to the chief consultant-ranked locker."
The so-called chief consultant-ranked locker referred to that at moderate height where one needed not bend down or stand at the tip of one's toes to reach.
As for the professors… They had their own independent lockers.
This was the class division of the operating theater.
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Chapter 202 - I Know Just A Little (Part 4 of 5)
After changing into surgical attire, Zheng Ren and Su Yun stood aside as observers while Chief Wang performed the surgery with a resident doctor as his assistant.
From Chief Wang's proficiency and professionalism, Zheng Ren figured that the man had reached the Master rank in surgery.
Once the peritoneal cavity was exposed, the strangulated intestine was clearly visible within the operative field.
There was a lack of blood supply to a segment of the intestine, causing it to become greyish, a sign of necrosis.
The bowels were released and covered with warm normal saline-soaked gauze first before Chief Wang attentively observed them for over ten minutes. After confirming that the intestine had undergone necrosis due to the absence of blood flow, he began to remove the affected bowel.
Fortunately, the necrotic intestine was merely thirty to forty centimeters long.
Of course, total bowel resection was also an option, but the patient would face physical and economic problems postoperatively.
Many years ago, when lipid emulsion was first introduced to the country, a case that required total bowel resection had been admitted to a hospital. In order to publicize its product, a foreign lipid emulsion manufacturer had allowed lifetime cost exemption for the patient.
The patient had even conceived and ga
ve birth to a child afterward.
However, a few hundred yuan daily for years was beyond an ordinary family's affordability.
It was better to surgically remove the minimum length of the diseased bowel for the patient's sake.
This was precisely why they had to perform the surgery as soon as possible. If the surgeon had performed the laparotomy one minute earlier, one centimeter of the intestine could have been saved.
Chief Wang was obviously a skillful and experienced surgeon.
Once the necrotic bowel was removed, he cut it open out of curiosity.
There were indeed seven to eight polyps residing in the intestine.
Unlike ordinary polyps, these ones had long, twisted pedicles, which had caused the patient's intussusception.
Seeing them, Chief Wang was amazed.
Boss Zheng was indeed an expert. No wonder even the unruly Brother Yun addressed him as his boss.
Once the pathology was confirmed, he began to anastomose the bowel. Everything was done neatly and cleanly, a prerequisite in every surgery, and even Zheng Ren was unable to find flaws in his manipulation.
After anastomosis was complete and the peritoneal cavity irrigated, Chief Wang was prepared to end the surgery.
Suddenly, Zheng Ren said, "Chief Wang, can you check the intestine again? If you find any large polyps with long pedicles, you can surgically remove them now."
"Huh?" Chief Wang was startled.
"This patient has a large number of intestinal polyps. A similar situation might occur after surgery due to its effects and that of postoperative fasting."
Zheng Ren's hypothesis… was too dangerous. Chief Wang's surgical cap was instantly drenched in sweat.
If intussusception recurred after surgery, would it be due to the surgeon's inexperience or relapse of the disease? Chief Wang was immediately aware of this. If the condition recurred, even if it was not the surgeon's fault, a reoperation would take a toll on the patient's health.
Forty centimeters of the intestine had been resected. If he had to remove more intestine and cause postoperative complications such as short bowel syndrome…
"Okay," replied Chief Wang without hesitation.
However, therein laid the next problem. Chief Wang had never performed such an operation, and he lacked the experience to detect the size and number of the polyps, as well as the length of pedicles along the intestine, bare-handed.
The Surgeon's Studio c1-799 Page 100
