It was incredibly embarrassing for Cao Guozhen.
However, Cao Guozhen knew what Su Yun said was true. If his department chief found out he lost the c.h.e.s.t treatment, he would never be forgiven.
He exhaled deeply before turning to leave.
"Admit the patient. I'll inform Xie Yiren and the others to prepare for surgery," Zheng Ren said.
"Okay." Su Yun nodded. He watched Zheng Ren's retreating figure and called out, "Thank you, boss!"
"It's nothing. I have faith in you." Zheng Ren waved his hand. This method of Muscosolvan administration was demonstrated by Dr. Chen Houkun 15 years ago. Dr. Chen had used this method to save a few patients who suffered from severe c.h.e.s.t trauma, trauma-induced pulmonary edema, and hypostatic pneumonia. I once had a patient, whom even the ICU had given up on, recovering after 26 days of treatment. The patient even came back to visit me once.
Chapter 402 - Crossing The Line
The patient was brought to the emergency ward. There was a series of preparation and doc.u.mentation before they could start the surgery.
Although an emergency case dictated simpler protocols, everything took around 30 minutes before the patient was wheeled into the operating room.
When the patient was lifted onto the operating table, his systolic pressure was at 90 mmHg.
The decreasing blood pressure suggested that the patient's condition was not as simple as the diagnosis given.
After the anesthesia, Su Yun repositioned the patient's body and placed the first layer of surgical dr.a.p.es. After that, he went to scrub in. Zheng Ren, who was already gowned, entered and started to set up the second layer of dr.a.p.es.
The surgery was starting.
A pair of hemostatic clamps and some iodoform gauze were placed into Zheng Ren's open hand.
The clamps were placed beside the patient's lower body. The surgical site was disinfected, then Zheng Ren asked for a scalpel.
A 20 cm incision was made, followed by a blunt dissection of the layers below. Electrocautery was used to stop any major bleeding.
Cao Guozhen was in the operating room, standing behind Zheng Ren and observing the procedure from the surgeon's point of view.
The thoracotomy was done perfectly with minimal bleeding.
He was still bitter about their earlier argument and told himself he would have done an equally good job if he was the lead surgeon.
A thoracotomy differed vastly from an abdominal surgery.
In the past, when electrocautery was not yet common in hospitals, a thoracotomy warranted at least 500 ml of blood loss.
Now, with Zheng Ren and Su Yun at the operating table, there was hardly any blood visible. Some of the larger blood vessels were isolated with the hemostatic clamps and quickly sutured.
The electrocauter was employed after the muscle layer was parted.
The whole surgery was performed so cleanly Cao Guozhen felt fear in his heart.
When did the two devils from the emergency department become so good at thoracic surgery? The idea of them stealing surgeries from the cardiothoracic department no longer seemed far-fetched.
Both Zheng Ren and Su Yun went straight for a thoracotomy instead of a fracture fixation procedure.
The severity of the fractures was an excuse to open up the patient's c.h.e.s.t.
They were crossing a line.
If the patient did not recover from the surgery, the family would have the right to sue Zheng Ren and Su Yun.
Of course, the two surgeons had acknowledged the risk when they decided to proceed with the thoracotomy.
A mirthless smile was covered by the surgical mask on Cao Guozhen's face. These guys from the emergency department were brazen.
They were aware of the hospital procedures, right?
The patient did not carry the last name Zheng or Su. Why were they crossing the line?
Had the two surgeons forgotten their own names?
It was viable to perform the internal fixation surgery after checking the thoracic cavity. The patient's family would never know and Cao Guozhen would not tell.
However, he would be wary of what happened in the future.
He watched the two surgeons carry on and wondered when disaster would strike.
They were in the process of opening the rib cage. A self-retaining retractor was placed in Zheng Ren's hands.
The retractor was used to hold the layers apart, giving the surgeon an operative view of approximately 8 cm.
Usually, the operative view was less than 8 cm but due to the patient's bone fractures, they were able to widen the field.
Su Yun found the silence in the operating room unbearable. "My initial foray in cardiothoracic surgery was because I wanted to perform surgeries like this. You get a clear view of the organs and you don't have to touch any intestines and fecal matter. Don't you agree, boss?"
As the gears of the self-retaining retractor turned, the patient's lungs appeared.
The middle and lower lobes of the right lung each had a huge open wound. The edge of the opening was dark red.
Zheng Ren and Su Yun let out a sigh of relief.
Their instincts were right, there was something unusual about the patient.
Zheng Ren cursed the System for not indicating the severity of the injury.
There was a distinct difference between a 0.5 cm laceration and a 10cm by 10cm open wound.
The hemostatic clamps entered the operative view to investigate the injury. The front section of the clamps disappeared into the wound before its depth could be ascertained.
The middle lobe was almost punctured from front to end.
Behind Zheng Ren, Cao Guozhen was shocked.
What was this?
How did the patient not develop a hemopneumothorax with such an injury? It was impossible!
Impossible!
Cao Guozhen was at a loss.
In his ten years as a medical doctor, he had witnessed countless injuries but this was a first.
What was going on?
As Zheng Ren probed the surgical site, Su Yun was mumbling, "Boss, I think the rebar might have hit him really hard. The fractured ribs stabbed inward like a dagger and damaged the middle and lower lobes of his right lung. Furthermore, the elasticity of the ribs returned it to its original position.
"The impact was so strong that the injury caused was akin to penetrating trauma. During the impact, the bronchial artery was damaged and a large amount of blood filled the lung."
Zheng Ren's thought process was similar to Su Yun's.
"The blood had filled the bronchus and bronchioles, which was why we could not observe the pneumothorax. The scan depicted pulmonary edema because the pressure inside the lung was high as the blood could not escape. Hence, we couldn't see signs of a hemopneumothorax."
Su Yun explored the patient's lung as he continued talking, "The chance of misdiagnosing this case is so high." He was in a good mood now.
This Su Yun was a different man from the careful and cautious Su Yun an hour ago.
Cao Guozhen stood as stiff as stone behind Zheng Ren.
Su Yun's explanation made sense. However, if such an idea struck Cao Guozhen, would he risk an exploratory thoracotomy?
No, he would not have the courage to.
Performing a procedure on a patient without any indication or evidence opened oneself to lawsuits and investigations.
These two surgeons were incredibly ballsy.
Nevertheless, Cao Guozhen shuddered to think of what could have happened.
If Zheng Ren and Su Yun had not forced the issue, a few hours of monitoring would have seen the patient expelling blood from his nose and mouth.
The patient would be drowning in his own blood.
This would be more problematic than a typical drowning because coagulated blood led to clogged airways.
The patient would have died in the cardiothoracic department.
He would not have even survived a night in the cardiothoracic department. The tr
uth was a punch to the gut for Cao Guozhen.
Just the thought of what could have happened sent chills down his spine.
His whole body felt clammy as he recalled a patient who came in with rib fractures alongside an aortic dissection. From the CT scan, the dissection appeared minor and went undetected. A few hours after admission, the aorta ruptured and they were unable to resuscitate the patient.
After the patient's passing, the family came en masse in mourning clothes. They placed the patient's body at the cardiothoracic department entrance and carried out the mourning ritual.
The thought of the scene made Cao Guozhen's knees weak.
The fault laid with no one. It was a mistake any doctor could make and the family was not trying to raise a stink, they were just upset at the loss of their family member.
It was not possible for doctors to perform multiple CT scans in the middle of the night to avoid such incidents.
There were a few hundred rib fracture cases taken in by the cardiothoracic department each year. Their department would be rife with lawsuits.
Cao Guozhen's palms were sweaty as the scenario played in his mind. It was a horrifying thought.
Chapter 403 - What Else?
Rules and regulations these days forbade the patient's families from taking matters into their own hands.
Nevertheless, Cao Guozhen could picture a horrible fate awaiting him had he taken over the case.
He would be banished to the medical administration division with no contact with his department chief for six months.
He might be served to the medical board to appease the family. Getting his medical license revoked…
His whole career would be gone in an instant.
Cao Guozhen had not even realized how close to the cliff's edge he was.
He wanted to express his gratitude for Zheng Ren but all that came out were mumbles. "Zheng… Chief Zheng… You…"
The words failed to convey his feelings.
Su Yun looked up from the operating table. There was a twinkle in his eye as he said, "Dodged a bullet there, yeah?"
The surgical mask did nothing to hold his chuckle back.
Even two layers of masks would fail to hide his laugh.
Like how it failed to suppress his natural good looks.
The jibe made Cao Guozhen frown.
In this scenario, Su Yun should be showing some kindness and humility.
Su Yun as a character would not last more than three episodes in a drama.
Su Yun glanced at the patient's right lung.
"You must be thinking I won't survive more than three episodes on screen."
Cao Guozhen was surprised. Did he say his thoughts out loud?
"But with your looks, you probably won't even make it on screen."
"..."
Zheng Ren, who had been listening throughout the conversation, wanted to say Su Yun would likely end up as a eunuch in the drama and it was not something worth bragging about. However, he held his tongue as Cao Guozhen was present.
Zheng Ren interrupted Su Yun's jeering and said, "Su Yun, please inform the family about the situation. The damage is too extensive and I need some time to think. Inform them as you would about a lobectomy."
"Understood, boss." Su Yun turned around and took off his surgical gloves. He used his phone to capture a few photos of the patient's damaged lung before leaving the operating room.
Suturing was unlikely to work. The most extreme option was to remove a part of the lung.
It would be a major surgery that required the family's consent.
There was a clause in the rib fracture internal fixation surgery informed consent doc.u.ment which allowed the surgeon to perform procedures outside the scope in the event of an emergency.
However, that was usually limited to minor procedures such as stitching up the lung. A lobectomy would require the family to be informed.
After Su Yun left the operating room, Cao Guozhen let out a relieved sigh.
"Zheng… Chief Zheng, thank you," Cao Guozhen whispered.
The last thing he expected from Zheng Ren was silence. Zheng Ren ignored Cao Guozhen, his eyes focused on the two massive wounds.
A negative reaction from Zheng Ren would have angered Cao Guozhen. This indifference hurt his pride.
Cao Guozhen had extended an olive branch…
The two devils from the emergency department were undoubtedly exceptional surgeons but their social skills left much to be d.e.s.i.r.ed.
…
Cao Guozhen's words did not register in Zheng Ren's mind. Once Su Yun left the table, he entered the System to purchase some surgical training time. He wanted to know if it was possible to suture a wound of this degree.
Zheng Ren had an abundance of points to spend so a few hours of surgery meant nothing.
The System's training room rose from the ground. Simulation mannequins appeared before Zheng Ren.
The simulation mannequin had the same diagnosis as the patient in real life. Zheng Ren proceeded to perform a lobectomy.
The end result was…subpar.
The System gave the treatment a score of 80%.
A lobectomy yielded such a low completion score. Maybe the System could foresee the patient's deteriorating quality of life.
Zheng Ren took some time to think before starting on a new simulation mannequin.
After a few rounds of trial and error, Zheng Ren was surprised to find suturing yielded the best result.
He was speechless.
His surgeon's instinct was to eliminate suturing as a viable option.
The System's judgment…
Looking at the 98% completion score hovering over the simulation mannequin was enough for Zheng Ren to breathe a sigh of relief.
With such a severe injury, a 98% score was more than Zheng Ren could hope for.
The remaining 2% was likely caused by the development of scar tissues at the sutures, leading to decreased lung function.
It was minor compared to losing two lobes of the right lung.
Zheng Ren left the training room. As he walked, he kept an eye on the small fox in front of the thatched cottage.
He had not been in the System for a few days. The fox was more life-like than ever—every strand of white fur was as realistic as the real deal.
Zheng Ren shook the thought out of his mind. He was wasting time, he had to get back to the surgery.
"Large needle, double-stranded No. 7 sutures." Zheng Ren's hand was open and waiting as soon as he was back in the real world.
No. 7 sutures were thick and usually used to sew the skin layer.
Double-stranded would mean even thicker sutures.
Without hesitation, Xie Yiren did as ordered. She got two No. 7 sutures and threaded them through the eye of the largest suture needle.
The needle holder held the suture needle and the sutures. Zheng Ren angled the tool so that the sutures would not get in the way of his movements.
"Chief Zheng, you plan to suture the wound?" Cao Guozhen asked from a few feet away.
"What else?" Zheng Ren said. With a flick of his wrist, the suture needle penetrated the soft lung tissue.
The rhetorical question threw Cao Guozhen off guard.
What else? A lobectomy was the most obvious choice.
It was a straightforward procedure that the family would accept after some explanation.
However, Zheng Ren abandoned the safest method and chose to suture…
If the patient's bleeding continued after the surgery, the outcome would be horrific.
Cao Guozhen swallowed his words before he offended Zheng Ren.
He had nothing of value to contribute so staying quiet was the best thing he could do.
Thinking back to the words he said in the emergency response room made him sweat buckets.
Who gave him the confidence to stand there and lecture Zheng Ren about the ways to save the patient?
Unrestricted Mucosolvan dosage?
Did he think
someone like Chief Zheng would not know these hidden tricks?
Cao Guozhen shut his mouth and watched Zheng Ren forcefully close up the huge wound on the middle lobe.
The final knot was tied so tightly, a single-stranded No. 7 suture would have broken under the force.
No wonder Zheng Ren asked for a double-stranded No. 7 suture.
Was this really the best treatment?
Cao Guozhen mulled over Zheng Ren's tactic. He would track the patient's recovery to observe if this simple but brutal way of suturing had any side effects.
The suturing took a few minutes.
Zheng Ren requested for saline solution to rinse the cavity. After a check for active bleeds yielded no positives, he proceeded to perform the fracture fixation.
The material used for the fixation was shape-memory alloy that contracted when heated and expanded when cooled. The material was placed inside a basin of iced saline solution to achieve the largest expansion before fitting onto the fractures. A warm saline gauze was wrapped around the material to shrink it, fixing the fractures in place.
As Zheng Ren was fixing the fractures, Su Yun returned to the operating room in a flurry. "Boss, I've spoken with the family. I've been thinking on the way in, we might not have to remove the lobes. We could stitch them up! I think it's the best solution. You don't have to worry about the post-surgery, I'll monitor the patient in the ICU."
Chapter 404 - Aspiration Was Key
"Oh," Zheng Ren uttered a monosyllable reply.
Su Yun assessed the operating room and saw the basin of iced saline solution.
This... Zheng Ren was already fixing the ribs?
Su Yun was on his way to wash his hands but when he saw Zheng Ren fixing the ribs, he stopped. He approached the operating table to investigate.
Three rib fractures had been stabilized. The fix was not important because even without it, the fractures would fuse and heal on their own after a few days.
More importantly, Su Yun wanted to know how the patient's lung was dealt with.
The tools used for stabilizing the rib cage were gone. The self-retaining retractors had also been removed. Su Yun could not see what was going on.
The Surgeon's Studio c1-799 Page 189
