Faster! Faster!
Zheng Ren kept urging the ambulance driver on.
Sea City General Hospital and No. 9 Elementary School were not that far apart, but the thick metallic scent of blood heightened Zheng Ren's anxiety.
The ambulance would normally be unable to drive at such speed even with its sirens at maximum volume.
However, with a police car clearing its path, the combination of both sirens cut through the traffic between Sea City General Hospital and No. 9 Elementary. No one knew what happened but all gave way to the two vehicles.
Even at traffic lights, cars stopped to let the police car and ambulance by.
Inside the ambulance, Zheng Ren tried to calm himself despite the terrifying vitals on the monitor and the undetectable blood pressure.
He removed his blood-covered gloves and picked up his cellphone.
"I'm Zheng Ren. Prepare for emergency surgery.
"Yes, pre-operative procedures are not done yet.
"There's a blood sample, send someone to take the sample and prepare for transfusion.
"Notify the thoracic surgeon to meet me at the operating table. We'll be operating together.
"Ask Yanran to prepare the double-lumen endotracheal tube."
Upon hanging up, Zheng Ren frowned deeply. Yang Lili's breathing was very weak, with deep breaths taken at intervals.
Such breaths were commonly referred to as "gasping" for air on one's deathbed.
Her condition was very bad. He flushed the dextrose but there were no changes in blood pressure, which remained undetectable.
The police car and the ambulance sped all the way to the emergency department of Sea City General Hospital.
Because the attack had happened in a school, the city council informed Sea City General Hospital that they would be overseeing it closely. Director Xiao was already rushing over with his group. Old Chief Physician Pan stood beside the emergency lane with his hands behind his back, waiting for the ambulance. He did not chat with the hospital's management as his mind was focused on the emergency rescue plan.
Even though Zheng Ren was on the case, Old Chief Physician Pan was not slacking.
If he managed to develop a more comprehensive rescue plan, he could identify possibly overlooked details more easily, allowing him to pull off the emergency rescue.
Finally, the police car and ambulance arrived.
The high-pitched piercing of the police siren sent Old Chief Physician Pan's blood pressure skyrocketing and disrupted his thoughts.
Why were they being escorted by a police car? Why was there damage on the front and side of the ambulance? Old Chief Physician Pan was puzzled but had no time to think about it.
The police car moved aside for the ambulance to come to a halt and park steadily in the emergency lane.
The back door of the ambulance opened as a stretcher trolley reached it. They transferred Yang Lili onto the trolley and Zheng Ren ran towards the operating room with her.
Since this was a high-profile case, many from hospital management were there.
A few of them crowded over to make their presence known.
Zheng Ren pushed them aside as they were blocking the way, not caring who they were.
There was someone standing by at the lift. A dark red trail of blood dripping across the marble floor of the emergency building of Sea City General Hospital like a path of blooming flowers.
The nurse from the 120 ambulance passed several tubes of blood to a doctor who made for the blood bank. Their remaining blood samples would be sent to the lab in the emergency department.
Even though it was an urgent emergency rescue, they still had to go through standard protocol including testing for HIV and syphilis.
Two years ago, National Taiwan University Hospital had missed out on one point during an emergency and infected all their organ transplant patients with HIV.
Some procedures had to be completed, but they would omit steps that were unnecessary.
Zheng Ren ran all the way to the operating room on the third floor with the stretcher trolley.
Su Yun, Yang Lei, Xie Yiren, Chu Yanran, Chu Yanzhi and the operating room nurse were all already on standby. The operating room door was also wide open.
There was complete silence but for the faint sound of the stretcher trolley's wheels rolling against the marble floor.
Zheng Ren handed the trolley over to be delivered to the operating theater while he went straight to the changing room to prepare for emergency surgery.
This was very different from the emergency they had had in Imperial Capital.
When Fang Lin had been injured, he received treatment immediately. This time, however, the golden window for emergency rescue had been lost during the journey to the hospital.
Zheng Ren was not confident that he could save the patient.
Still, regardless of how he felt, he had to save her!
She had used her body to protect the children.
He needed to protect her in return at all costs.
After changing as fast as he could, he strode to the operating room while putting on his surgical cap and mask.
When Zheng Ren arrived, the patient was already on the table.
She was positioned slightly lower. Su Yun had considered the possibility of two concurrent surgeries.
He was in the midst of setting up the closed c.h.e.s.t drainage system and did not choose the second intercostal space along the midclavicular line, instead inserting the tube between the sixth and seventh intercostal space along the midaxillary line.
The former option could remove trapped gases, but the latter could allow the drainage of blood. In the ambulance, Zheng Ren had been wary of draining a lot of blood, if the patient lost too much, it would lower her intrathoracic pressure and lead to even more hemorrhaging.
Things were different in an operating room.
"Where should we start?" Su Yun asked.
"Where's the thoracic surgeon?" Zheng Ren frowned and started scrubbing in.
"Almost here."
"Thoracoabdominal incision at… raise her right side by 45 degrees," Zheng Ren said.
General surgery required the patient be in the supine position, but thoracic surgery needed the patient to be in the lateral position.
Since both surgeries would be performed simultaneously, they had to compromise and choose between the two. Even though their surgical view would be restricted by doing so, it would be worth the time they could save.
Su Yun did not speak, moving the patient into the instructed position after completing the suture to secure the closed c.h.e.s.t drainage tube.
"Double-lumen endotracheal tube." Zheng Ren walked to the operating table after scrubbing in.
"Got it," Chu Yanzhi said.
Chu Yanran also had no time to talk, being busy setting up endotracheal intubation and adjusting the parameters of the ventilator.
Xie Yiren passed him the oval forceps and kidney dish. Zheng Ren picked up several iodophor balls and began disinfecting.
After that, he scrubbed his hands again and put on a sterile surgical gown. As he did so, the thoracic surgeon and other directors of the hospital arrived.
"How's the patient?" Old Chief Physician Pan asked from behind Zheng Ren
"Not good." The latter reached out and the handle of the scalpel was put in his hand.
"Does she require a joined incision?"
"Punctured lung, most likely with vein ruptures that need to be treated. Intestinal punctures in the abdominal cavity while the superior mesenteric artery is also ruptured. I'm not sure the extent of the intestines we'll have to remove." After the incision, he had direct access to the peritoneum without the need for blunt dissection.
He opened its protective layer and removed the slightly colder, dark red blood via suction.
Seeing the continuous flow of blood, Old Chief Physician Pan immediately called to rush the blood bank.
Right then, a continual supply of fresh blood seemed to be the
patient's only hope for survival.
"How's the situation in her c.h.e.s.t? Is there a CT scan of her c.h.e.s.t region?" the department chief of the thoracic department asked at the operating table.
Chapter 326 - Spare No Effort
"No." Zheng Ren handed suction over to Su Yun before opening the peritoneum and performing protective procedures.
The department of thoracic surgery chief's surname was Zhang. He was rather short and stout, an unpleasant sight even in a face mask.
In the hospital, he was well-known to be stingy and petty. People rarely interacted with him unless it was important.
Chief Zhang felt somewhat awkward in front of the operating table, hesitating.
When Old Chief Physician Pan returned from his call to the blood bank, he saw Chief Zhang standing unmoving and glared at the man.
He did not blame Zhang for lacking the courage to start operating, though, since Yang Lili's blood pressure was still undetectable. The chances of her surviving both a thoracotomy and laparotomy were very slim.
"Let's perform a thoracotomy with exploration," Old Chief Physician Pan said as he watched Chief Zhang mull it over.
Were there fewer directors present in the operating room, Chief Zhang would have rejected the surgery.
He wanted to ask why they were putting in so much effort to save someone who was already dead.
Blood pressure was still not showing up on the monitor. The patient's heart rate was also extremely high and she had already been tachycardic for a while.
He watched the surgeon perform emergency general surgery at lightning speed. Within only several minutes, the surgeon had already found the ruptured superior mesenteric artery and started a suture.
Chief Zhang let out a sigh and said, "I'll try my best."
"Su Yun, help Chief Zhang," Zheng Ren said without lifting his head. He reached out and received a saline-soaked bandage, which he used to cover the intestines while searching for both necrotization and stab wounds.
Hmm? Chief Zhang was stunned. He glanced at Old Chief Physician Pan out of the corner of his eye, noticing no opposition to Zheng Ren. Many questions arose in his mind.
He was aware that the emergency department had "taken over" emergency general surgeries. Were they going to absorb emergency thoracic surgery as well?
There were few people in the emergency department, but they were definitely ambitious.
Without looking at Chief Zhang, Su Yun turned and left the operating table. He began to disinfect the area for thoracic incision, proceeded to scrub in again and changed into a new surgical gown.
Chief Zhang felt helpless. What the f*ck was happening?
Nonetheless, he could not lash out in front of so many superiors. More importantly, Old Chief Physician Pan was a figure he dared not offend.
If he did… Liu Tianxing was still hospitalized and word was that his depression was so severe his liver was affected.
One had to surrender to fate when the time came. Chief Zhang started by asking the emergency department operating room matron for permission to use a sterile bag from the thoracic department surgery theater.
Su Yun ignored him and started to lay out sheets after scrubbing in and disinfecting the area. He stood beside Zheng Ren and both surgeries commenced.
Xie Yiren became even busier.
For such an unconventional surgery, mutual understanding without verbal communication was impractical.
Zheng Ren and Su Yun continually asked for different tools and Xie Yiren was barely keeping up.
After Chief Zhang had finished briefing the operating room matron about his department's sterile bag and ordered his own chief resident to retrieve it, he turned to see Su Yun making an incision on the patient's c.h.e.s.t and was instantly angered.
"Stop playing around! You're going to operate rashly without a retractor? This is a thoracic surgery, not your usual emergency surgery!"
He was right; for the ribs in the c.h.e.s.t, special tools were required to retract the c.h.e.s.t walls and expose the surgical field. General surgery had self-retaining retractors, but thoracic surgery was different.
Only two decades ago, thoracic surgery required the removal of one rib to expand the surgical field.
Even though his worries were reasonable, every minute and second in an emergency rescue was more precious than gold.
Su Yun was focused entirely on the thoracotomy. He had the confidence and pride of a rising star in cardiothoracic surgery. Why would he bother with complaints from a department chief of Sea City General Hospital?
No one else acknowledged Chief Zhang. Zheng Ren and Su Yun were busy with their respective surgeries. Behind the former stood Director Xiao and Old Chief Physician Pan, fully focused on the surgery and paying no heed to Chief Zhang's words.
He had no choice but to scrub in. Perhaps he had spoken out of turn.
The operating table was unable to accommodate the usual number of people for both surgeries. In the thoracic surgery department, at least three people were usually required at the table for a thoracotomy. At the moment, only Chief Zhang and Su Yun could fit.
Yang Lei then became the busiest person there as the first assistant.
He had to hold on to the retractor while passing the surgeons their tools.
Zheng Ren was also multitasking, glancing over to Su Yun to check how the man was doing.
Su Yun was executing his part skillfully just like a trained thoracic surgeon, even better than those specializing in general surgery.
Zheng Ren had told Su Yun to assist Chief Zhang due to his experience in heart transplants in Imperial Capital.
Would any emergency case be a challenge to someone who had performed one of the most difficult surgeries?
No way!
To support Su Yun, Zheng Ren selected a Master level skill book without hesitation and added it to the cardiothoracic surgery branch of the skill tree.
Yang Lili had been stabbed twice in her c.h.e.s.t when clinging on to the attacker's arm out of desperation to stop him. After breaking free, he had stabbed her in the torso multiple times.
Fortunately, her liver and spleen were uninjured, but there were between seven to eight perforations in her intestines with some sections pierced right through.
The extent of contamination in her abdominal cavity was critical.
After repeated rinsing and suction with warm saline, he stitched up part of the mesenteric artery and they finally had a clear surgical field.
Repairing the perforated intestines was not a problem. Zheng Ren rapidly performed the suture and managed to fix it in no time.
The main threat was that the patient's punctured mesenteric artery could lead to mesenteric ischemia and necrosis. After the artery was sutured, the intestines relying on blood supply from the sealed portion would inevitably end up necrotizing.
Cutting and suture of the intestines was now their main task in the abdominal cavity.
Zheng Ren would have preferred an assistant, but he could handle it himself if necessary.
Soon, Yang Lei was helping Su Yun perform other tasks. For Zheng Ren, he only needed to adjust the retractor to help expose the surgical field.
Zheng Ren tied the knot and cut the excess thread on his own. The scissors magically vanished and reappeared at intervals without interrupting his hand movements.
There was about 60 cm of necrotized intestine, which was within an acceptable range. Any more would risk other postoperative complications such as short bowel syndrome.
15 minutes into the laparotomy, Zheng Ren had already removed the necrotized intestine and sutured the healthy parts together.
Right then, fresh frozen red blood cells and plasma finally reached the theater.
"Each of you, take one." Old Chief Physician Pan began warming a bag of red blood cells by hand.
Director Xiao watched the surgery with a deep frown.
Noticing the arrival of the blood bags, he got Office Director Ding to pass him one.
&nbs
p; With the director of the hospital taking the lead, who dared decline?
A phone rang and the emergency room matron answered it. "The blood bank is empty."
"Office Director Ding, contact the city's central blood bank," Director Xiao said, "At least 20 units of red blood cells."
"Platelets and fibrinogen too." Su Yun was still perceptive of his surroundings even during a surgery.
Director Xiao was also from clinical surgery; he knew that even if the patient was fit to leave the operating table at that moment, she would face multi-organ ischemia-reperfusion injury and disseminated intravascular coagulation complications.
He nodded.
Officer Director Ding ran out to make the call.
Soon, he returned and whispered into Director Xiao's ear, "Director, the reserves of B-positive blood in the central blood bank are running low."
The entire city's supply depended on the city's central blood bank. Rarer blood types or those used more often were hard to maintain.
"Contact the blood bank and hospital; get them to find people with the corresponding blood type to donate blood. Hurry up!" Director Xiao continued to watch the surgery, his face grim.
"Yes." Office Director Ding immediately sprinted out of the operating room to fulfil his duties.
Under normal circ.u.mstances, even with an appropriate donor, the central blood bank had a c.u.mbersome list of standard protocols that took up the entire day before any blood could be donated.
However, words from the director of the city's largest hospital carried some weight.
Zheng Ren felt relieved hearing them.
With the hospital's support, they did not need to worry about shortages of platelets and fibrinogen.
These two things were essential for the patient's survival, but it was very difficult to get them nowadays, especially fibrinogen.
Because of the lack of fibrinogen, many porto-azygos disconnection surgeries could not be performed.
After suturing the patient's intestines, they covered it with bandages soaked in warm saline for five minutes while Zheng Ren checked the abdominal cavity for any unattended injuries. After removing the bandages, he found some light bleeding on the anastomosis.
The Surgeon's Studio c1-799 Page 155
