Finally, some peace and quiet, but Chief Physician Old Pan could not but feel helpless.
"Little Zheng, that was a little too big for your boots," said the perturbed Chief Physician Pan.
"Chief Physician Pan, if my skills aren't up to par, we won't be able to carry out our plans for emergency surgery anyway. However, they won't find any mistakes at all if my standard is good enough. Rest assured, I'll complete the task that you assigned to me," Zheng Ren promised, happy that he found a way to live.
Rest assured? How? Chief Physician Old Pan had used a scalpel for more than forty years. Surgeries without any mistakes… they existed, but were very rare.
"Let's go to the general surgery department. When it's time for me to perform surgery, I'd like to request the honor of your presence to prevent them from bending the truth."
The source of Zheng Ren's confidence remained a mystery to Chief Physician Old Pan, but what could he possibly do when the deal was on? Sighing heavily, he instructed all doctors on duty in the emergency department to transfer every acute appendicitis case or similar they had to the ward for consultation.
After that, the duo headed straight toward the first general surgery department in silence.
…
…
Zheng Ren recalled multiple patients with abdominal pain in the first general surgery department, waiting to be examined for educational purposes in live surgical demonstrations.
He went straight to the wards first instead of entering the office upon arrival at the general surgery department.
Whenever Zheng Ren stared at a patient, their relevant diagnostic information would appear at the upper right corner of his vision, which signified that the System was still operational.
However, the words were slightly blurry and seemed faded.
A countdown timer was hovering at the highest point of his vision. Two days and twenty-two hours left.
"Yo? A chief resident from the emergency department is here for a ward round in the general surgery department?" scoffed Cen Meng—a chief resident in the first general surgery department—after witnessing Zheng Ren's patrol around the wards.
Apart from a few experienced senior consultants, no one dared to do ward rounds in other unrelated departments.
This assault of mockery was fired at full power, and Cen Meng had a lot more ammunition waiting to be launched at Zheng Ren.
Pretending as if he heard nothing at all, Zheng Ren continued to walk around and check every patient with abdominal pain to be examined before saying to Cen Meng, "Chief Cen, the patient in bed number three-seven is suffering from an acute appendicitis in the ectopic position and requires immediate surgical intervention."
Cen Meng was stunned momentarily. The ward round he mentioned just now was meant to be a taunt and he had not expected Zheng Ren to take it seriously at all.
Was Zheng Ren looking for a fight?
Cen Meng recalled that the patient in bed three-seven was a forty-year-old male admitted on the first day of the month due to upper right abdominal pain. B-scan ultrasonography findings included an inflammatory mass at the right hypochondrium region with gallbladder wall thickening, which was suggestive of acute cholecystitis.
He diagnosed an acute cholecystitis patient with acute appendicitis? What an idiot…
"Where did you learn surgery from? An appendix lies in the right iliac fossa region, not the right hypochondrium region," sneered Cen Meng.
"I told you, an ectopic appendix." Zheng Ren walked past Cen Meng towards the workstation in front of Chief Physician Old Pan and brought out the patient record of bed three-seven.
"Chief Physician Pan, please take a look at that patient. I think this is a misdiagnosis in the first general surgery department," said Zheng Ren.
Chief Physician Old Pan was at a loss for words.
Misdiagnosis? Damn, that was humiliating. Reconciliation would be impossible from now on.
Whose humiliation it was would be a mystery until later.
How much resentment had he built up to accuse the general surgery department of a misdiagnosis?
An ominous feeling came over Chief Physician Old Pan as he read through the patient record.
Was it possible that he misjudged Zheng Ren when the man was actually a brainless bastard? He took a lifetime to build up a good reputation; was he going to lose it due to this foolish imbecile? There was an inflammatory mass at the anatomical position of the gallbladder. An ectopic appendix was a possibility but honestly, it was at the bottom of the list.
Well, it was alright to proceed for surgical intervention since an incision would be made on the right upper quadrant of the abdomen anyway. Cholecystectomy and appendectomy were just names. The true operation for this patient was an exploratory laparotomy.
However… even Chief Physician Old Pan assumed that this would be a case of acute cholecystitis as well.
Clinically, no one would pay much attention to rare diseases as their chances of occurrence were so small that it would be unwise to hinder a normal medical procedure because of it.
Various investigative reports suggested the patient was most probably suffering from acute cholecystitis.
The patient was currently in the operating theater's elective surgery waiting list after his family members had consented to surgical treatment.
A diagnosis of acute appendicitis in a patient with suspected acute cholecystitis felt unreliable in every aspect.
"Zheng Ren, are you done? Don't forget, you were transferred away…" reprimanded Cen Meng before he was interrupted by Chief Surgeon Liu.
"Isn't the patient prepared for operation? Send him to the operating theater and let Zheng Ren perform the surgery. An acute appendicitis of ectopic position is possible but low on the list. What's the worst that could happen? A misdiagnosis, that's all. We can proceed for an exploratory laparotomy to locate the source when that happens. Cen Meng, tag along and pay attention to the patient's safety."
Then, Chief Surgeon Liu glared at Cen Meng and added. "The patient's surgery is of utmost importance. Negligence is intolerable."
Cen Meng nodded in response.
Cen Meng understood Chief Surgeon Liu's plan instantly as he was involved in the retaliation against the emergency department earlier. Grinning peculiarly and devilishly, he leaned closer to Chief Surgeon Liu and whispered, "Perhaps I can inform the operating theater to arrange a live broadcast in the surgical demonstration classroom. You can inform the upper management of the medical administrative division in the meantime, just in case…"
What a kind and thoughtful lad! The delighted Chief Surgeon Liu patted Cen Meng's shoulder gently. His effort in promoting this chief resident was not in vain after all.
This time, Chief Surgeon Liu will slap Zheng Ren to death and remind Chief Physician Pan that it was foolish to overstep his workplace boundaries!
He winked at Cen Meng, who understood immediately and started making the necessary arrangements.
Chief Surgeon Liu glanced at Zheng Ren coldly and snorted. "Zheng Ren, normally I wouldn't allow you to make nonsense out of this patient's final diagnosis, but I'll give you a chance to prove yourself since whatever you confidently said just now sounded logical too. However, I've to warn you that the operating table isn't someplace where you can fool around as you please. If your diagnosis is wrong, I'll ask Cen Meng to take over and when that happens… Humph!"
…
…
The same anonymous account started a live stream and uploaded the patient's disease condition and various investigation reports to Xinglin Garden.
"Which hospital starts a live broadcast on Xinglin Garden?"
"Perhaps someone who is trying to make a name for himself. Well, it's normal for these people to disappear in the end anyway."
"Hahaha, did you guys read it? A case of acute cholecystitis but treated as an acute appendicitis. How is the surgeon going to broadcast a surgery when he can't even diagnose a patient correctly? Does he want to show u
s the battle between surgeons postoperatively?"
The video livestream attracted the attention of more than a dozen doctors in a very short amount of time.
Those who had the courage to live stream surgery were usually experienced senior consultants.
However, a live broadcast of an appendectomy, sorry… a "misdiagnosed" appendectomy… Was this supposed to be a joke?
The first batch of viewers started inviting their friends or fellow colleagues, and the viewership climbed even further.
The hospital's and patient's name in every medical record and investigative report were pixelated in order to anonymize the location of the live broadcast.
Regardless, none of the viewers cared about those details in the first place. There was only one thing that really caught their eyes—this was a misdiagnosis!
…
…
The surgical demonstration classroom was spacious and bright. A dozen doctors were surrounding Chief Physician Pan just like stars twinkling around a dazzling moon.
This arrangement was Chief Surgeon Liu's idea.
The higher Chief Physician Pan climbed, the harder he would fall ten minutes later.
Yes, only ten minutes were required to expose Zheng Ren as an incompetent and idiotic surgeon. Decades of clinical experience gave Chief Surgeon Liu confidence.
Chief Surgeon Liu could foresee the bright future ahead of him; a future where no one dared to offend him after witnessing the unfortunate outcome of the emergency department.
"Chief Physician Pan, everything was arranged according to your request. The scrub nurse came from the emergency department and Zheng Ren mentioned that he didn't need a surgical assistant. Are you satisfied with this arrangement?" Cen Meng walked into the surgical demonstration classroom and stood in front of Chief Physician Pan courteously, tone and expression flawless.
The deputy division chief from the medical administrative division was sitting beside Chief Physician Pan with a peculiar look on his face.
Chief Physician Pan was really showing his age to allow a mere junior attending surgeon to mess around with such a simple case.
Alas… it was better to go through some trouble this time so that he would not need to handle their disputes in the future.
An eerie silence engulfed the surgical demonstration classroom as everyone became immersed in their own trains of thought.
The anesthesiologist then made a gesture on the screen. The operation had officially begun.
The scalpel was thin and shiny. Without hesitation, the first incision was made.
Chapter 13 - Acute Phlegmonous Appendicitis with An Ectopic Appendix
Zheng Ren used the scalpel to make a five-centimeter incision—the standard incision size in an appendectomy. Xie Yiren—the scrub nurse—watched his hand movements attentively so that she could predict the next procedure and hand over the necessary instrument in advance.
Very professional coordination, it was standard for a surgeon.
Electrocauterization for hemostasis, the small curved forceps for blunt dissection… Slowly but surely, the surgery for the 'misdiagnosed' case began.
In the surgical demonstration classroom, Cen Meng was grinning delightfully while staring at the screen. "That's a small incision. He must be very confident of himself."
"That's true. It's rare to make such a small incision in a standard appendectomy."
"Well, we learned something this time."
The deliberately ambiguous comments were like numerous palms slapping Chief Physician Pan's cheeks with all their might.
Lowering his head shamefully, he prepared himself mentally to lose every bit of dignity he had left.
The only thing supporting Chief Physician Pan's belief in Zheng Ren was the impressive performance of the latter had given with the pancreaticoduodenectomy last time.
Xinglin Garden was livelier than the surgical demonstration classroom at the moment.
None of them knew each other since it was just a live broadcast. There was no conflict of interest, only pure academic discussion.
Thus, their comments were more straightforward and harsh.
[Exploratory laparotomy on the right hypochondrium region with just a five-centimeter incision? What is the surgeon thinking?]
[He figured that the inflammatory stripe in the gallbladder area was actually an abscess in the appendix, hence the diagnosis of acute appendicitis. Just keep quiet and watch the surgery.]
[This is the most ridiculous surgery that I've seen in my entire life. It's a miracle that this surgeon is able to survive until now without getting killed.]
Regardless, no comments—in Xinglin Garden or the surgical demonstration classroom—reached Zheng Ren's ears.
It was quiet inside the operating theater. Zheng Ren used a small gauze to cover the incision and upturned his palm. A medium-sized curved forceps was immediately placed on it.
"Aspirator with suction tube," said Zheng Ren coldly as he put the forceps on the surgical dr.a.p.e while staring attentively at the operative field.
This was the first time Xie Yiren had made a mistake in her judgment. She quickly connected the suction tube to the aspirator and put it on Zheng Ren's outstretched hand.
The hissing sound produced by the aspirator broke the silence in the operating theater.
Zheng Ren held the aspirator in one hand and separated the peritoneum with the blunt end of the curved forceps with the other hand. The aspirator was inserted as soon as the peritoneum was opened.
"Cen Meng, prepare to perform a surgical scrub," instructed Chief Surgeon Liu when he heard Zheng Ren's request for an aspirator before opening the peritoneum.
His voice was soft but loud enough for Chief Physician Pan to hear him very clearly.
Derision. This was undisguised contempt.
Zheng Ren's surgical technique—from making the first incision until now—had been flawless. If anyone attempted to find fault on purpose, their authority would have been questioned.
However, Chief Surgeon Liu was convinced Zheng Ren had made a mistake in his diagnosis. Thus, he had instructed Cen Meng to scrub up and prepare to take over the operation before the peritoneum had even been opened. That was exactly what he had in mind all along to humiliate both Chief Physician Pan and Zheng Ren.
Watching the scene progressed as his script made Chief Surgeon Liu smile in delight.
His presence in the operating theater was not required at all. Even if this was a complicated case of acute cholecystitis, Cen Meng—a chief resident—alone was more than enough to handle it personally.
He just needed to sit there and give Chief Physician Pan a contemptuous gaze.
On the other hand, numerous comments started flooding the live broadcast in Xinglin Garden.
[F*ck! He was really performing the surgery as if it was an appendicitis case. It's rare to find such an awesome doctor nowadays.]
[How confident was he to perform a surgery without an assistant?]
[An aspirator? Is this live broadcast a joke? If he can aspirate any pus out of that incision, I'll start a live stream and drink all the pus myself.]
…
The aspirator was quickly inserted into the small opening in the peritoneum, which fit perfectly without any visible leakage of pus.
Thick yellowish-green pus was drawn into the suction tube as soon as it entered the peritoneal cavity.
There was a huge amount of pus and it took almost thirty-two seconds to complete the drainage.
In the surgical demonstration classroom, Cen Meng, who had been instructed to perform a surgical scrub, merely stood rooted to the spot while the wide smile on Chief Surgeon Liu's face stiffened into a rictus instantly.
Pus? Suppuration was normally absent in acute cholecystitis and the most common clinical case with pus collection was actually acute appendicitis.
This patient was really suffering from acute appendicitis? This was actually a misdiagnosis?
Impossible! Both Cen Meng and Chief S
urgeon Liu desperately tried to recall B-scan ultrasonographic findings for acute phlegmonous appendicitis. There had to be a clue hidden in the B-scan that they missed even if the appendix was in an ectopic position.
Cen Meng stood still at the doorway, caught up in a dilemma between staying or leaving.
His faith was shaken. If he appeared in the operating theater after scrubbing up and the diagnosis of acute appendicitis was proven correct, it would be extremely humiliating, right? How embarrassing it would be if that really happened under the live stream.
In Xinglin Garden, the chat room was completely overwhelmed by comments.
[What the f*ck! He really aspirated pus out of that. That wasn't a gallbladder perforation, right?]
[Is the brother who wanted to start a live broadcast still okay? Was the pus delicious? I'm still waiting for your livestream.]
[Damn… It really was a case of acute appendicitis? Why haven't I encountered such cases before?]
[The surgeon must be very confident to make a five-centimeter incision on a patient with phlegmonous appendicitis. Who is this demon in the live stream?]
Thirty-two seconds later, there was no pus in the suction tube any more.
Zheng Ren placed the aspirator on the sterile gauze Xie Yiren had positioned in advance to prevent contamination to the operating field.
He then continued separating the peritoneum.
Then, a thick, huge, blackish-purple wormlike thing emerged from the three-centimeter opening in the peritoneum.
The peritoneum separation continued to approximately five centimeters when the blackish-purple thing popped out of the opening.
It was engorged, edematous, and had pus collections on it.
No matter what that wormlike thing looked like in the end, every surgeon would recognize it at first glance. That was an appendix.
It could only be an appendix.
It must be an appendix.
Dead silence reigned in the surgical demonstration classroom in that instant.
The smile froze on Chief Surgeon Liu's face and there was an uncontrollable quiver in his orbicularis oculi muscles, as if he was undergoing electrical nerve stimulation.
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