"No, Chief Pan's not around. We have Little Zheng here who's willing to assist," Department Chief Kong objected.
Dr. Pan was the interventional surgery department chief in Union Medical College Hospital and a member of the National Central Health Agency. He was out of the city, being recently involved in the Tibetan Aid Project.
Department Chief Ma was unaware of the circ.u.mstances, hence Department Chief Kong's explanation.
"Little Zheng? Is he your new research graduate?" Department Chief Ma eyed them suspiciously.
Department Chief Kong started introductions. "This here is Boss Zheng from Sea City, L Province. He's skilled in interventional surgery and is here for the new research project we're working on."
Department Chief Ma was surprised but retained the aloofness of a department chief from a top Class Three Grade A hospital. She did not try to shake Zheng Ren's hand.
"I've contacted Chief Meng and he agreed with my assessment. Imaging is needed to make a full diagnosis. We didn't know you would be out drinking, though."
The department chiefs often spoke freely among themselves, hence Department Chief Ma's clear disp.l.e.a.s.u.r.e.
"Sure. Let's get started, then. Boss Zheng will handle it." Department Chief Kong dialed for his chief resident.
During the whole exchange, Zheng Ren had said nothing. He only stared at the System display in the right corner of his vision.
Lin Jiaojiao's diagnosis was simple. There was an obstruction in the vascular system due to the aforementioned biomacromolecule injection. The plug had led to decreased blood supply to the eye and resulted in temporary blindness.
There were a few peripheral arteries but the majority of the eye's blood supply was delivered by the main branch.
They had to clear the obstruction within four hours to salvage the retina. Otherwise, it would suffer permanent damage and result in permanent blindness in Lin Jiaojiao's right eye.
The surgery… The arterial network in the eye was delicate and Zheng Ren could not guarantee success in removing the biomacromolecule obstruction in the artery.
He was an expert in embolization surgery. This was the complete opposite of that.
However, he was willing to try. After all, it was just another procedure.
Su Yun noticed Zheng Ren's silence and shuffled over. "What are you thinking?"
"A buildup of biomacromolecules in the ophthalmic artery is causing temporary blindness," Zheng Ren whispered. "Department Chief Ma's preliminary diagnosis is correct. We'll have to confirm with imaging but I'm hesitant about the subsequent thrombolysis."
"Thrombolysis? Based on your diagnosis, it's a biomacromolecular obstruction in either the capillaries or arterioles, not a blood clot," Su Yun retorted.
Zheng Ren laid his cards on the table. "Two hours have passed since the obstruction. I suspect a blood clot would have formed by now. The surgery should start with lysis, followed by suction removal. It'll be up to fate whether or not her vision can be restored."
Su Yun shook his head; he had low expectations that the surgery would restore Lin Jiaojiao's vision.
"Biomacromolecules?" Department Chief Ma had overheard Zheng Ren's words.
"Yes. I'm guessing there was an error in judgment when she injected hyaluronic acid. The substance must have entered the blood capillaries or arterioles, restricting blood supply to her eye," Zheng Ren said.
His explanation turned Lin Jiaojiao's face green.
A blood clot detected early could be easily resolved. Obstruction by foreign material was much more complicated.
Was she going to be permanently blind in one eye?
Darkness filled her vision as if her sight was disappearing completely.
"Is the diagnosis solid?" Department Chief Kong asked.
"We'll need to confirm it with an angiogram." Zheng Ren asked, "Does the operating room have urokinase?"
"Yes."
"We should start now. It's been two hours since the obstruction. Time is running out," Zheng Ren said firmly.
Department Chief Ma was taken aback by the resolution in his voice, especially from a Sea City junior doctor here on a research visit.
Despite her reservations, she allowed the junior doctor to go about pre-surgery preparations. The patient was transferred to the interventional radiology suite.
The chief resident on call tonight was Dr. Shen. After digesting the patient's condition, Dr. Shen laid down the sterile dr.a.p.es and prepared for the procedure.
Zheng Ren held back from accessing the System to pick up the related training modules. He wanted to have a look at the angiogram first.
The procedure started ten minutes later.
Chapter 225 - Operating Room Bully (Part 2 of 3)
Zheng Ren put on his lead apron and scrubbed in.
When the surgical dr.a.p.es were in place, Dr. Shen took a step back. He was surprised when it was not Department Chief Kong who entered the operating room.
"Little Shen, assist Boss Zheng. Time is of the essence," Department Chief Kong's voice echoed through the speaker.
Dr. Shen did not argue. His boss had spoken.
Nodding in response, he left to wash his hands and put on a surgical gown.
Lin Jiaojiao laid on the operating table. Without a second's hesitation, Zheng Ren performed a radial artery catheterization.
It was successful on the first attempt and the introducer sheath was put in its place. The guide wire was fed into the artery at incredible speed. As the scrub nurse tied the strings of his surgical gown, Dr. Shen heard Zheng Ren urge him, "Hurry up."
Dr. Shen was baffled.
Was the man talking to him?
Who did he think he was? This doctor from a small city was criticizing him for following standard gowning protocols?
Many high-ranking doctors liked to throw their weight around in smaller hospitals and pick on junior doctors. There had been cases where junior doctors resigned en masse, unable to cope with the mental harassment.
However, those were senior doctors from esteemed hospitals.
'This guy is from a small city. Who does he think he is?' Dr. Shen glared spitefully at Zheng Ren.
Bullies were not limited to school grounds. They existed in operating rooms as well.
Some fly-in surgeons had thrown tantrums in operating rooms when they found the surgical tools not to their liking.
However, this was the first time he had encountered someone criticizing his gowning speed.
"Hurry up! We're waiting for you to start up imaging," Department Chief Kong hollered over the speaker. He could not see Dr. Shen's dissatisfaction, only the man's unhurried pace.
Dr. Shen was startled.
He had just washed his hands and imaging was already on its way?
Impossible.
The department chief's orders succeeded in making him speed up. A million questions ran through his mind as he put on his sterile gloves.
Once he was set, he walked up to Zheng Ren's side. The scrub nurse exited the room and the heavy lead door shut soundlessly behind her.
Radial artery catheterization was complete. The guide wire and catheter were all in place. Zheng Ren's crossed arms were still, clearly waiting for Dr. Shen to show up.
'He's already in position?' Dr. Shen was shocked.
Zheng Ren saw the assistant zoning out and said sharply, "Pressure injector."
"Em…" Dr. Shen snapped out of his daze and immediately connected the guide catheter to the injector.
With the device on, Zheng Ren commenced angiography.
The signal from the patient's body was thrown onto the display screen. Dr. Shen was surprised to see the catheter positioned right at the carotid bifurcation.
The ophthalmic artery was branched off the internal carotid artery. Dr. Shen was amazed by Zheng Ren's ability to maneuver the guide wire to the carotid bifurcation without any imaging assistance. His anger faded before such undeniable talent.
He felt guilty for making the surgeon wai
t.
Avoiding eye contact with Zheng Ren, he realized the man was not being insolent; he was.
If it were his own boss standing there, a hemostatic clamp would already be flying at his head.
Dr. Shen vowed not to humiliate himself in front of this outsider.
Department Chief Kong was one of the more mild-tempered supervisors. He did not want to risk failing his residency.
When his senses returned, Zheng Ren was already performing superselection. Onscreen, there was no contrast in the ocular region, indicating a distinct lack of blood reaching it.
'What's the next step? Thrombolysis?'
"30000 units/cc urokinase in 100ml saline solution. Prepare for thrombolysis," Zheng Ren ordered.
Dr. Shen was still deep in thought, one step behind Zheng Ren.
When the assistant doctor did not move, Zheng Ren nudged him with his right shoulder. "Get the nurse to prep the solution."
Dr. Shen startled and mumbled, "...Yes."
Zheng Ren switched off the imaging system as the scrub nurse entered the operating room. "100ml saline, 30000… No, 50000 units/cc urokinase."
The dosage was higher than usual, but Zheng Ren had weighed the risks. Time was of the essence and the patient was not geriartric, so an acute, high dose of urokinase was unlikely to elicit an adverse reaction.
The scrub nurse was quick on her feet and soon, the urokinase solution was fitted into the pressure injector.
Zheng Ren started up the imaging system again and paid close attention to the screen.
"You moved," Zheng Ren pointed out. There was a hint of frustration in his tone.
"Ah?" Dr. Shen had only an unrefined response to give. Had he moved?
At that moment, Department Chief Kong's voice boomed through the speakers again. "Little Shen! What are you doing? Hold the catheter steady!"
Dr. Shen wanted to cry.
Had he made a mistake? No.
He had performed each step according to protocol.
He simply could not keep up with Zheng Ren.
Zheng Ren was like a Ferrari at top speed while Dr. Shen was a 30-year-old Jetta, struggling to keep up. His movement had been an unintentional mistake on his part and had cost them precious minutes as Zheng Ren would need to perform superselection again.
However, Zheng Ren did not make a fuss as he repeated the procedure.
Once it was done, the urokinase solution was administered into the ophthalmic artery.
Zheng Ren handed the guide catheter to Dr. Shen once more and chided him, "Hold it steady. Any movement will require selection again. It's all very tedious."
Dr. Shen wanted to protest his innocence. He understood the intricacies of the procedure but could not explain his earlier mistake.
After all, he had performed interventional surgeries before and was at least an Expert by the System's standards. However, he was insignificant compared to Zheng Ren.
Had this been a routine surgery, Zheng Ren would have done things a few beats slower. Dr. Shen might have been able to keep up.
However, given the emergency nature of Lin Jiaojiao's diagnosis, there was little time left before the damage became irreversible. The unnatural speed at which Zheng Ren operated left Dr. Shen in shambles.
Zheng Ren left Dr. Shen with the catheter and went into the control room. "Department Chief Kong, what's your view on this?"
"The urokinase will help but the large amount of hyaluronic acid might not be so easily removed," Department Chief Kong said with a frown.
The patient's condition would not deteriorate as quickly as that of a simple thrombosis. Zheng Ren's hypothesis was spot-on.
Presumably, blood supply to the eye had been cut off by hyaluronic acid causing an obstruction in the ophthalmic artery.
This was a tricky case, indeed.
Zheng Ren nodded, then turned to Su Yun. "Are you able to assist?"
"No issue, I only had a pound of alcohol1." Su Yun, ever the attractive drama queen, let out a breath of air that made his tousled, black curls twirl.
Without a word, Zheng Ren looked at Department Chief Kong.
The chief took a moment to consider, then he nodded his assent.
"Scrub in," Zheng Ren said to Su Yun. translates directly, as Su Yun is bragging about his alcohol tolerance.
Chapter 226 - Lick the Screen (Part 3 of 3)
When Dr Shen returned to the operating table, Su Yun had taken over his position.
"Pardon me, but the subsequent procedures are rather challenging. I'll be more comfortable with the help of my assistant," Zheng Ren said politely, but that was all he provided before he dove right back into the operation.
The phrase, "my assistant", left Dr. Shen in a daze.
Even Department Chief Kong did not have an assigned assistant. How had this young doctor gotten one of his own?
Dr. Shen left the operating table dejectedly and went into the operator console room, where he stood in place, feeling completely at a loss. He stole a glance at Department Chief Kong from time to time, fearing the man's anger and castigation.
However, a few minutes passed and Department Chief Kong had not looked over at Dr. Shen. His focus was entirely on Zheng Ren and Su Yun operating. Dr. Shen got even more worried.
Could this be the lull before the storm?
"Come over here and observe," Department Chief Kong suddenly said.
"..." Dr. Shen was stunned. Department Chief Kong was not being his usual self.
He had made a serious mistake today; was he not going to be berated for it? Instead of receiving a full-blown lecture from Department Chief Kong, he was being called over to observe the operation?
'How is this possible?' thought Dr. Shen.
"Don't be disappointed," Department Chief Kong said in a benevolent tone, which was a rare thing. "Do you know who the assistant is?"
'The assistant? Isn't he just a handsome-looking chap that looks like a girl? Is he the son of someone important?' thought Dr. Shen.
"I don't know," Dr. Shen answered honestly, not reckless enough to blurt out his speculations.
"He was the one who performed a heart transplant on mice two years ago and published the study in The Lancet," Department Chief Kong said.
"Ah!" Dr. Shen exclaimed, astounded by the mere mention of The Lancet.
In order to earn his doctorate, he had to publish a journal that would be indexed in the Scientific Citation Index (SCI). However, the whole journey from conducting the study itself to getting it published was not an easy task. The only other option was to pay for one.
Dr. Shen's heart dropped when he estimated the cost of a decent quality journal to be at least 50,000 yuan.
That sissy had managed to publish in The Lancet two years ago?
A journal in The Lancet in conjunction with a good impact factor would earn most people their doctoral degrees.
"Look at what they're doing." Department Chief Kong sat directly in front of the operating console room display, his eyes glued to the screen.
Dr. Shen finally regained his composure and began observing the procedure carefully. 'What are they doing?'
The thrombolysis went through fine but was not that effective. Onscreen, the contrast media had moved forward less than 1 centimeter.
What were they doing? What else could be done at this point?
Something was not right. The microcatheter should not be that thick. Was he hallucinating? Dr. Shen adjusted his glasses and leaned forward.
"You don't get it?" Department Chief Kong's tone became much more serious.
Dr. Shen's heart sank. It would be excusable if he could not perform this procedure. However, if he could not even understand what was going on… Department Chief Kong would kick him out of the operating console room then and there.
Beads of sweat suddenly began forming on his forehead. He could feel a chill run down his spine, as if someone was holding a knife against his neck.
"Is that a large catheter?" Dr. Shen had finally figured ou
t what it was after a few seconds.
"Why is he using a large catheter?" he blurted out almost immediately after as if shocked by his own revelation.
"Look for yourself!" Department Chief Kong was very unimpressed with Dr. Shen, irritation growing in his tone.
Tears filled Dr. Shen's face while an ache throbbed in his scarred heart.
'How the hell would I know why he is using a large catheter to navigate through such a thin blood vessel?' thought Dr. Shen.
Nevertheless, his sanity kept him from voicing it out loud in front of Department Chief Kong lest he receive the chief's wrath.
On the screen, the large catheter was inching forward slowly and gradually filling up the blood vessel, each step taken with caution.
This would result in injuries on the inner walls of the blood vessels due to friction. If the walls were punctured, there would be bleeding.
Even though the injury would not be fatal, local hematoma would be inevitable. In more severe cases, the hematoma formed due to deformation of the ophthalmic artery in the posterior cavity would result in compression on the cranial nerves.
'What was Department Chief Kong trying to do, ordering him to observe such a risky procedure?' thought Dr. Shen.
Countless thoughts flashed across his mind. Dr. Shen was considered the cream of the crop, which was why he had been able to obtain a graduate research fellowship under Department Chief Kong. If not for his impeccable memory, he would not have been able to outshine all the other applicants.
He could remember every single book that he had ever read, as well as all the operations he had observed.
Nonetheless, there was not a single procedure he knew that fit the operation that was happening before him.
He subconsciously leaned toward the screen as if it would allow him to have a clearer look, as he had no idea what was going on.
Despite being physically closer to the screen, he still had no clue.
The large catheter maneuvered through the narrow artery carefully and decisively without any signs of stopping.
Were they asking for trouble?
'That can't be the case. If that was his intention, why hadn't Department Chief Kong stopped him from doing it?' thought Dr. Shen.
The Surgeon's Studio c1-799 Page 111
