"Know what? I don't know anything," Zheng Ren retorted reflexively.
"No, you clearly knew the patient was a drag queen! His getup and act were impeccable. A work of art! If he hadn't asked me to check his t.e.s.t.i.c.l.e.s…"
Zheng Ren could not hold back his laughter. "What are you talking about? All the doctors were busy and it was either you or me. I didn't want to give you the opportunity to smear my name in front of Yiren."
Su Yun thought about it. That was reasonable.
The two doctors walked back to the wards, one grinning joyously while the other scowled.
"I guess an image in the mind's eye is better than nothing," Su Yun said suddenly.
"Huh?"
"I had met some drag queens back in Imperial Capital but none of them were as perfect as this one. Of course, no one wanted me to check their balls then." Su Yun sighed. "If he had not brought up the t.e.s.t.i.c.l.e.s… Honestly, the mention of drag queens and man bits kinda churns my stomach."
"Didn't you just praise his art?" Zheng Ren pointed out.
"If only he had not mentioned his t.e.s.t.i.c.l.e.s," Su Yun repeated.
From the System's display, Zheng Ren had seen that the patient was suffering from acute testicular trauma. He was not interested in its cause.
It was not a major case and he was put off by Su Yun's constant teasing, so he found an opportunity to send the man away.
Chapter 296 - Actions Speak Louder Than Words (Part 4 of 4)
Chang Yue and the other nurses clocked out systematically. The mountain of paperwork had driven her up the wall.
That aside, she still had to interact with patients and their families, a task that required a lot of effort on her part.
She had to keep track of each patient's personality and disposition. Some patients were prone to complications and required more time to double-check their medication and procedure. Some patients were talkative, so Chang Yue would ask them more questions.
Most of the staff had left when Zheng Ren and Su Yun made their rounds. The patients were all stable.
Zheng Ren sat down and picked up a thick tome titled Fundamentals of General Surgery. A few pages in, he felt a disquiet that interfered with his reading.
What was this? It was an odd sensation he had never felt before.
Zheng Ren looked up and ruminated on it. Had he made a mistake on any of the patients today?
A few minutes later, he realized what was bugging him. He had yet to text Xie Yiren…
It was a habit he had developed in Imperial Capital and brought back to Sea City. Even when busy, he could feel a nagging voice in the back of his head reminding him to do it.
Zheng Ren chuckled at his own nature and took out his phone.
"You're only planning to text Little Yiren now?" Su Yun had been waiting for Zheng Ren to make this move the entire time. "Doing so at this hour; I'd say 90% of girls would already be pissed. The younger the girl, the likelier she would be mad."
Su Yun's words succeeded in making Zheng Ren anxious.
His fingers trembled slightly as he typed out his message, something that had not happened even when facing down the knife-wielding criminal back in Imperial Capital.
[Ward rounds completed. All patients stable. What are you doing?]
Zheng Ren kept it neutral.
Xie Yiren did not reply.
The grin on Su Yun's face widened as time passed. After five minutes without Xie Yiren's response, he said, "See, she's mad."
Zheng Ren stayed silent.
"This is why people don't shit where they eat1, yet you chose to do so. Of course, it's convenient, but do you know what its downsides are?" Su Yun said with a smirk.
It was a rhetorical question, one that Su Yun did not expect a straight-faced man like Zheng Ren to answer.
"The convenience is a double-edged sword. See, now that Yiren is upset, would you not have to placate her? If there was an emergency surgery now that required the both of you to work together, wouldn't it be awkward?"
Zheng Ren followed Su Yun's line of thought… and agreed.
"Here's my advice, young man. Girls expect quality time. Why do you think I don't have a girlfriend? I simply don't have the time. Just keep things casual and you'll find life much simpler!" Su Yun continued.
Zheng Ren paid little attention to the narcissistic monologue that followed. Spending so much time with Su Yun had taught him how to tune out the man's shameless self-praise.
The sound of footsteps caught his attention.
Was it Xie Yiren? Zheng Ren could not identify anyone from how they walked, but in his current mood, every shadow in the corner could be her.
"Stop dreaming. The only way forward is for me to take the night shift while you go to her house to make it up to her." Su Yun squeezed Zheng Ren's shoulder. "Think through what you want to say to her."
Right then, a familiar silhouette appeared at the entrance of the office.
Standing there with a food carrier in her hand was Xie Yiren.
With a smile on her face, she called out in a funny accent, "Yoohoo~ It's time for food~"
It was the iconic tagline of the actress Shen Chang in the role of the nanny from I Love My Family, a drama series from years ago.
Being related to food, it had stuck with Xie Yiren since.
Zheng Ren stood up from his seat abruptly. The haze in his heart cleared up instantly upon seeing her.
Huh. Guess I was wrong, Su Yun thought.
"Come on, let's eat," Xie Yiren said as she shook the food carrier and bounded off to the on-call room before Zheng Ren could say a word.
Su Yun patted Zheng Ren's shoulder and muttered grumpily, "You… You're a lucky man."
Zheng Ren laughed and went after Xie Yiren.
When the two men arrived at the on-call room, Xie Yiren was already unloading the contents of the food carrier onto the table.
The carrier was tightly secured and gave off no odor, but the smell of a garlic-based fish dish filled the room as she opened it up.
Even Zheng Ren, who typically viewed meals as a time-consuming affair, felt his mouth water.
"Oh! Little Yiren's cooking is impressive!" Su Yun noticed Zheng Ren's awkwardness and quickly filled the silence.
Xie Yiren looked over her handiwork with pride. "I had this once when traveling with my mother. It was delicious and I begged her to stay for a week; I ate at the restaurant every day and went into their kitchen to learn how to cook this dish. Learned it on my first try."
She truly had an immense love for food.
Zheng Ren took a seat at the table. Once Xie Yiren had everything ready and was seated, they began to eat.
Delicious!
With each bite, Su Yun wondered why he did not have someone like Yiren. How lucky Zheng Ren was.
Not only was Xie Yiren not angry, she had even made food and delivered it to the hospital.
Su Yun cared little about her affluence. This gesture alone was sufficient.
"Hey, come on. Give the girl a review," Su Yun said, tapping his plate with his chopsticks.
The dumb*ss would not even utter a word of praise without Su Yun's prompting. Useless.
Despite that, Zheng Ren continued to remain mum. Instead, he gave Xie Yiren a sincere smile and continued to shovel food into his mouth.
Xie Yiren did not mind it one bit and watched Zheng Ren eat with a smile on her face.
He was quick with emergency rescue and surgery and was equally fast at eating.
They went through the food like a hurricane, leaving only scraps behind.
Seeing Zheng Ren enjoying her home-cooked food brought a newfound happiness to Xie Yiren's heart. Her eyes crinkled as her smile widened.
Was this what was being expressed through action? Su Yun felt confused.
Acts of love seemed to speak louder than words. He ought to put this to test in the future.
As soon as they finished their food, Zheng Ren's phone rang.
He frowned, but it disa
ppeared as soon as he picked it up and saw Old Chief Physician Pan's name.
"Chief Pan.
"Oh. We can try. You know our hospital has no experience with TIPS1, right? And the surgery doesn't really have a high success rate to start with.
"I know. We'll have to pay attention to the post-surgery hepatic encephalopathy. I'll go have a look now."
Although Old Chief Physician Pan was not present in the room, Zheng Ren spoke as if he was, sitting up attentively and smiling. Do not cause trouble in a place where you must be on a regular basis. Often used with workplace romances. The raw text wrote .Transjugular intrahepatic portosystemic shunt surgery.
Chapter 297 - The Crown Jewel (Part 1 of 4)
"An emergency?" Su Yun frowned at the mention of the transjugular intrahepatic portosystemic shunt (TIPS) surgery.
The TIPS surgery was hands down the most difficult type of interventional surgery.
Of course, there were many new surgical methods that required certain medical facilities to pull off; the prostate interventional embolization, for example. These surgeries were already considered difficult, but the TIPS surgery demanded the most skill.
"There is a patient in the gastroenterology department, a friend of Department Chief Xia's, with complications. They had arranged for a surgery in Imperial Capital Hospital but the patient started vomiting blood and is now in critical condition," Zheng Ren explained as he rose from his seat and put on his white coat, shooting Xie Yiren an apologetic look.
Xie Yiren gave him a wave of support. Her brown-eyed gaze softened as she watched Zheng Ren hurriedly dress for duty.
Reassured, Zheng Ren strode confidently out of the on-call room.
"Can you perform the surgery?" Su Yun asked when he caught up.
"I can try." Zheng Ren had never done it before but had some training time saved up in the System. He was willing to spend all his points to save a life.
Postsurgical care was the most complicated part of a TIPS surgery.
To address decompensated cirrhosis and its resulting symptoms, esophageal varices and splenomegaly, there were two methods: the first was a splenectomy and porto-azygos disconnection. The second method was TIPS.
This surgery had barely 30 years of history in a clinical setting.
A German research team, headed by Richter, was the first to perform a transjugular intrahepatic portosystemic shunt surgery in 1988. In 1991, they published a paper detailing 16 successful procedures.
Later, Zemel (1991) and Ring (1992) also reported success.
In 1993, the procedure was introduced to other countries.
The first TIPS surgery locally was performed at the turn of the 21st century by Professor Xu Ke's team from China Medical University.
To this day, the procedure was rarely used in hospitals.
Why?
It was difficult.
Extremely difficult.
Moreover, the post-surgery survival rate was not high.
However, if the patient managed to recover, the benefits of having a shunt in place were huge.
Su Yun had recently started reading up on interventional radiology-assisted procedures and knew that TIPS was the crown jewel of interventional surgery.
Was Zheng Ren going to try it now? Did the hospital even have the necessary instruments and materials?
"Do we have the necessary items?"
"I'll call Manager Feng," Zheng Ren said as he scrolled through his phone contacts.
"Manager Feng, it's Zheng Ren.
"We're starting a TIPS surgery. Please send over the relevant materials immediately.
"Yes. Old Chief Physician Pan will handle the procurement doc.u.mentation tomorrow.
"We need it in an hour!"
He hung up.
"Are you confident with post-surgery care?" He said, his footsteps quickening.
Su Yun recalled the TIPS procedure and its risks. "If we can't prevent hepatic encephalopathy, we can only prescribe amino acids to hopefully control its progression."
The key lay in managing the potential onset of hepatic encephalopathy.
Zheng Ren mulled the risks over as they arrived at the gastroenterology department.
Department Chief Xia felt some embarrassment when she saw him.
Their first meeting had involved the floating gallbladder.
After Zheng Ren was proven correct, Department Chief Xia had been reluctant to cross paths with the emergency department chief resident.
Even for emergency procedures, she called up Old Chief Physician Pan instead… It was the proper channel to go through as favors were traded among department chiefs.
"Good day, Chief Xia. May I know which room the patient is in?" Zheng Ren asked with a neutral expression. There was no pride or sarcasm in his tone. It was as if their previous encounter had never happened.
"Right this way." Department Chief Xia put aside her misgivings for the chief resident and brought the two doctors to the resuscitation room.
It was a male patient in his fifties with jaundice-yellow skin and a deathly miasma surrounding him. He held a basin in his hands to catch the dark venous blood pouring from his mouth.
It was like a scene from hell.
The strong stench of blood filled the room. Zheng Ren glanced at the System's display.
It gleamed a dangerous red.
The System diagnosed hemorrhagic shock, decompensated cirrhosis, refractory ascites, hydrothorax and electrolyte imbalance.
This patient had just recently undergone a splenectomy and porto-azygos disconnection…
Zheng Ren had been deciding between two procedures but was now left with one.
"The vomiting started three days ago. He had just come out of a splenectomy and porto-azygos disconnection surgery, hence the conservative treatment. We managed to control the bleeding with a combination of three hemostatic drugs and epinephrine, but when we were calling the ambulance for a transfer to Imperial Capital, the patient started vomiting large amounts of blood."
A c.o.c.ktail of three hemostatic drugs alongside epinephrine was an extreme measure.
Administering more than three drugs only increased the risk of complications. A cerebral or myocardial infarction could worsen things.
Zheng Ren took a deep breath and calculated his remaining intensive training time.
After all, the TIPS surgery was the toughest procedure in the world of interventional surgery. Zheng Ren was not confident in his current abilities.
Department Chief Xia took note of Zheng Ren's sigh. An anguished smile crossed her face as she said, "I'm sorry it had to be you, but you're the only interventional surgeon we have in the hospital."
Her tone was unexpectedly sympathetic, but her reasoning was sound. Zheng Ren understood her feelings on the matter.
"Even a 10% chance is better than none." Department Chief Xia explained, "The patient was once my classmate, and his wife is also from the same school. Don't worry, Dr. Zheng. No one will hold it against you if you do not succeed."
The last sentence was to reassure Zheng Ren.
Either they performed an emergency TIPS surgery or the patient would vomit blood until he died.
A few more minutes of hematemesis violent enough to paint the floor and ceilings red, and the man would be gone.
If a standard TIPS surgery was a ten out of ten on the scale of difficulty, an emergency TIPS surgery would be an 11.
"Chief Xia, to be honest, I've never performed the procedure. The patient is in critical condition without any viable options. I can try my best, but there's no guarantee," Zheng Ren said.
"Thank you," she said sincerely.
Having a department chief say those words in front of the patient's family was a testament to Zheng Ren's abilities.
Su Yun smirked triumphantly.
In contrast, Zheng Ren's eyebrows creased in worry.
"Do you have the materials needed?" Department Chief Xia cut to the chase.
"I've spoken to the supplier. It should be
here in less than 20 minutes. Let's prep the patient and the consent form…"
"I'll sign for it," Department Chief Xia interjected.
She seemed very close to the patient and his wife.
"Alright. Let's prepare for surgery," Zheng Ren said.
A bell then rang in Zheng Ren's ears.
[Main Mission: The Crown Jewel - First Stage
[Mission Details: Complete the most challenging procedure in the field of interventional surgery: the transjugular intrahepatic portosystemic shunt surgery.
[Mission Reward: The average completion time for the TIPS surgery is 4 hours and 23 minutes. No special reward will be given if the host exceeds it, but if the host completes the procedure in less than that, the reward will be bountiful.
[Rewards include +2 luck points, two gold c.h.e.s.ts, 200000 experience points.
[Mission Duration: 6 hours.]
Zheng Ren had planned to ignore the mission but a quick scan through the details made his eyes pop.
The luck points on top of the experience points reminded Zheng Ren of his time in Imperial Capital, and the System promised even more rewards if he finished the surgery early.
Was the TIPS surgery a main mission?
In the world of interventional surgery, TIPS was the ultimate challenge. Zheng Ren felt that he would have to unlock the entire skill tree before he could even attempt a TIPS surgery.
Main mission… Sure.
He wondered what the main mission was for general surgery.
This would be his first attempt at the procedure. Whether it was to save a life or to accomplish a mission, he would have to plan his approach carefully.
He still had some experience points that could be exchanged for training time. It would have to do.
Zheng Ren went through each step of the procedure in his head.
On the surface, the surgery was simple.
Under local anesthesia, access would be gained through the right jugular vein. The guide wire, guide catheter and angiographic needle would then be maneuvered to the hepatic vein, where the needle would be used to puncture the portal vein for stent placement, building a lasting connection between the portal and hepatic veins.
The difficulty lay in puncturing the portal vein and establishing said connection.
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