Old Chief Physician Pan saw the determination in Zheng Ren's eyes. He scanned through the patient's test reports one last time before saying, "I'll go talk to the family."
"Chief, allow me to do it," Zheng Ren said, although he appreciated the gesture.
This was tricky for any doctor. No matter how it ended, there would be a stain on their reputation.
Success would not gain them any commendation as it was expected of their vocation.
Failure… would spell the end for the surgeon.
Old Chief Physician Pan's unstated offer was to shoulder half of that burden.
"Prepare your words. If the family agrees, we'll proceed immediately," Old Chief Physician Pan instructed before leaving the ICU.
Department Chief Qian approached. "Chief Pan really likes you, huh?"
"Yes, I'm aware." Zheng Ren was hashing out the particulars of the consent form on the computer. "It's not an easy procedure."
"Then…"
Department Chief Qian did not continue. His silence said more than he could.
"We can't just watch the patient die," Zheng Ren said.
"Little Zheng, what's your plan? Summarize it for me," Department Chief Qian requested.
"I'll try to find the bleed through radiological imaging. Once we have a clearer picture, we can decide how to proceed."
Department Chief Qian recalled Zheng Ren's words from earlier, but in his opinion, it would be extremely difficult to locate the gastrointestinal bleed.
However, he was not an expert in interventional radiology. He had witnessed Zheng Ren perform a few interventional embolization surgeries but never interacted with any of the patients; internally, he considered contacting colleagues in Provincial Capital.
The doc.u.ment was complete. Zheng Ren printed a copy to bring to Old Chief Physician Pan.
The man was talking to the patient's family. The patient's partner was in her seventies, wiping tears from her eyes as she listened to his briefing.
Behind the old lady stood a few middle-aged a.d.u.l.ts with serious expressions.
Old Chief Physician Pan heard Zheng Ren's footsteps approaching and turned around. "Let's have you sign the doc.u.ments."
The old lady was clearly shaken by Old Chief Physician Pan's words, her hands visibly trembling in the face of cold, hard facts.
Few in this world had the courage to stare death in the face.
Seeing her shaky hands, a middle-aged man walked up, took the pen and signed the doc.u.ments.
The patient's fate was sealed.
Once the formalities were done, Zheng Ren called Su Yun to transfer the patient as he and Old Chief Physician Pan hurried to the emergency department's operating room.
"The patient's family was cooperative and understood the risks. There shouldn't be any issues," Old Chief Physician Pan said once they were out of earshot.
"Okay."
"Do what you can; if it's impossible, we'll just identify the bleed location. Actually, we can even consult the department chief in Provincial Capital," Old Chief Physician Pan advised.
Zheng Ren knew Old Chief Physician Pan worried that he had just come back from Imperial Capital on a surgery high and would thus not back down from a challenge.
He tried to offer some reassurance. "Don't worry, Chief. I'm aware of my limits."
No more words were exchanged as their hurried footsteps echoed down the hallway.
When they arrived outside the operating room, Chu Yanzhi popped out and asked loudly, "What type of surgery are we doing?"
"Hybrid surgery," Zheng Ren answered.
"Okay. I'll let Little Yiren know," Chu Yanzhi replied.
She slipped back into the room. Lively chatter came from inside but soon died down; the figures in the room sped about efficiently as they prepared for the surgery.
Zheng Ren made a call to Yang Lei to ask for his assistance during the operation.
Ten minutes later, Su Yun, Department Chief Qian and Department Chief Sun arrived with the patient.
Department Chief Sun had foregone going home, opting to stay and watch the surgery.
He had seen many similar patients who had not made it, and thus had doubts in Zheng Ren's confidence in treating this one.
However, he knew better than to openly challenge Zheng Ren, especially with Old Chief Physician Pan present. He did not want to end up humiliated like Chief Surgeon Liu.
Zheng Ren was just a junior doctor, albeit a skilled one, with little clout. Old Chief Physician Pan, on the other hand, was a man of importance.
It was why Department Chief Sun had allowed the emergency department to siphon patients from the general surgery department.
If Zheng Ren was successful, he would applaud the man and flatter Old Chief Physician Pan. The emergency department could have the patient.
If the surgery was a failure, well, anything could happen.
The patient was lifted onto the operating table. Zheng Ren turned to Su Yun and tapped his shoulder. "You had some drinks just now. I think you should step back."
Su Yun was taken aback but quickly nodded in agreement.
Yang Lei was a married man and was recently planning for a child, so Zheng Ren did not want him exposed to radiation.
It was strange to stand before the operating table alone.
Going from luxury to modesty was much harder than the reverse.
Just then, the System chimed loudly, signifying a mission notification.
[Emergency Mission: Rescue
[Mission Details: A good doctor has to make many decisions in his life. To rescue or to give up, to hold firm or to back down. Everything is a choice. Please complete one emergency hemostasis surgery to address the lower gastrointestinal bleeding.
[Mission Reward: 200 skill points and 2000 experience points.
[Mission Duration: 5 hours.]
Huh…
Surprise, followed by a bitter smile, colored his face.
When he was in Imperial Capital, the System's mission rewards had been lavish. Now that he was back in Sea City, they paled in comparison.
Did the System take into account the hospital's prestige when handing out rewards? He took a deep breath to center his focus before executing disinfection, femoral artery cannulation and introducer sheath placement.
As the surgery began, a long-dormant livestream began transmitting on Xinglin Garden.
Chapter 267 - Destructive Surgery (Part 1 of 5)
[I'm so happy. I thought the surgeon had stopped livestreaming…]
[Youngster, you will only appreciate the things that you've lost.]
[You guys talk, I'll have a look at the case details. The surgeon no longer allows downloads and honestly, without the patient's details, I'm at a loss.]
Hundreds of people entered the livestream but the numbers were significantly lower than before.
Remembering their previous mistakes, the audience quickly read through the case details before they disappeared.
The surgery began with imaging. With his Grandmaster-level skill, the procedure was easy. By the time the audience had finished reading the case, imaging was already complete.
[Imaging is done? I'd just left to read the patient details. That's some incredible speed.]
[It seems like a tough surgery. I wonder what the surgeon plans to do. An emergency wire-guided hemostasis surgery for a lower GI tract bleed? Is the surgeon trying to do the impossible?]
[Don't spout nonsense when you don't actually know what you're talking about. Using imaging to identify the bleed is common these days, but not a lot of people perform the surgery itself because the risk is high. Even with the imaging data, only about 20% of patients go to surgery.]
Medical opinions flew by in streams and for a moment, the livestream resembled its former glory.
Its audience knew the surgery was difficult.
Among its spectators were experienced doctors from Imperial Capital, Sorcery Capital and Provincial Capital. They had seen patients with similar
conditions before and knew the likely outcome.
The surgery, while doable, was high-risk.
Most doctors would refuse to perform such a surgery.
Knowing the challenge posed, viewer curiosity was at an all-time high.
[The location of the bleed is not obvious from the imaging. There are too many things going on in the abdomen. Any movement will alter the image.]
[The one who called this a common procedure, come out and explain how you would do it.]
[Don't listen to that fellow's nonsense. Didn't you see the patient's test report? In his condition, there's a 90% chance he won't survive a laparotomy.]
Zheng Ren grimly studied the angiographic image.
It was impossible to locate the source of the blood with the intestines spasming everywhere.
His hopes of using interventional radiology to identify the bleed were dashed. He simply could not make sense of the visual data.
There was only one thing left to do.
Zheng Ren entered the System and traded his experience points for training time. The operating theater rose from the ground.
He had faith in his plan, but it was a rare procedure. He needed some practice in the System before attempting it in the outside world.
[Why isn't the surgeon moving? Are they frozen? I can't believe the surgeon dared livestream a case like this, they must be out of their mind.]
[Hold your tongue. Someone once said something similar and had to eat their words minutes later. I can foresee history repeating itself!]
[It's a difficult call to make. I suspect a bleed from one of the mesenteric artery branches. Would embolization be viable? Any experts on interventional or general surgery here?]
[Not an expert, but I can shed some light on the issue. Unlike the uterine artery, the mesenteric artery cannot be embolized without harming the organs. The intestine will necrotize if its blood supply is cut off.]
[The hell, this is a life on the line. What's the surgeon thinking? There's still time to turn back.]
As the comments went wild, Zheng Ren suddenly moved.
From the image, the embolic agent was visibly being administered!
Zheng Ren had decided to perform an embolization!
[I'm speechless. I think this might be a different surgeon.]
[Agreed. The previous surgeon was calm and careful. The embolization of such an important artery will harm the patient. The affected parts of the intestines will necrotize and lead to problems such as peritonitis and gangrene. In three to five hours, the patient will enter septic shock.]
[I'm starting to think this might be a Canadian surgeon. I doubt anyone in this country would perform such a surgery.]
[Are they panicking? This surgeon does not seem calm.]
The viewers on Xinglin Garden were shocked by the unfolding events.
No one had outright accused Zheng Ren of gross negligence out of some semblance of respect for the livestream surgeon.
Those who doubted the surgeon's capability had ultimately been proven wrong and thus the audience withheld their judgment. Even anonymous, humiliation was still humiliation.
Once embolization was done, the imaging system was turned off. The livestream was still ongoing but only the final angiographic image was shown.
[Is the surgeon done? I know rules and regulations overseas are more lax but this is a whole new level. And to have it recorded live, too. I'm almost impressed.]
[Doesn't seem like it. If it's complete, the livestream should be blank.]
[I just thought of something: do you think the surgeon is going to perform a hybrid surgery?]
The viewers chatted away across the frozen background, mostly surgeons with dexterous fingers and incredible typing speed.
Once the chatroom got going, the conversations nearly eclipsed the actual livestream.
In the operating room, Zheng Ren was changing his garments. He repositioned the patient and disinfected the surgical site.
Old Chief Physician Pan asked, "I noticed you embolized one of the branches from the mesenteric artery. Are you sure it won't be a problem?"
"Yes," Zheng Ren replied. "Yang Lei, scrub in."
Su Yun had been paying attention throughout the surgery.
It was a strange operation. He had some qualms about Zheng Ren's decisions but knew they had their reasons. The more he thought about it, the more concerned he became.
"Little Zheng, what are you doing?" Department Chief Sun seemed anxious, but his sincerity was debatable. His tone was gentle, akin to that of a guiding senior hand. "You should know the after-effects of embolizing the mesenteric artery. Why would you do it on purpose?"
Old Chief Physician Pan scowled and shot Department Chief Sun a glare.
The control room was suddenly filled with a murderous intent.
Department Chief Sun desperately wanted to take back his previous words.
Meanwhile, Department Chief Qian was communicating the progression of the surgery to his friend from another hospital. The evaluation from the other side was equally pessimistic.
In Provincial Capital, similar patients were often not recommended for surgery. They would only go ahead at the family's insistence, and from past records, the survival rate was low.
Department Chief Qian shared the same worries as Department Chief Sun.
He wanted to express his views on the matter, but before doing so, he turned to Su Yun and asked, "Su Yun, what's your opinion on this?"
"Hm?" Su Yun had one arm crossed under the other as he observed the ongoing surgery in the operating room. He thought for a moment then said, "Boss Zheng's skills are unquestionable. I'm thinking about the post-surgery arrangements."
Department Chief Qian was speechless. This had to be a fake Su Yun. Where was that high and mighty doctor? He could not believe those words had just come out of Su Yun's mouth.
Chapter 268 - Last Resort (Part 2 of 5)
Zheng Ren disinfected the skin and covered the area with surgical dr.a.p.es, then washed his hands again and placed a second layer of dr.a.p.es.
He did not have to say a word; whenever he extended his hand, the correct tool would be placed in it by Xie Yiren.
Their synchronicity was astounding!
Zheng Ren decided to start with a 15 cm incision on the left side of the rectus abdominis.
Yang Lei and Zheng Ren had experience working together in the general surgery department, although they were dealing with simple appendectomies and hernias back then.
A scalpel was handed to Zheng Ren.
Incision, followed by a blunt dissection. The peritoneum was gently parted to gain access to the peritoneal cavity.
Yang Lei increased retraction to provide a better view for Zheng Ren to begin his work.
As the patient had not been eating or drinking much for the past two weeks, his gut was mainly filled with coagulated blood.
Zheng Ren recalled the imaging post-embolization and identified the part of the intestine that likely contained the bleed, pulling the segment free so that it rested above the body.
"Warm saline gauze." It was his first spoken instruction.
It was an unusual surgery, requiring unusual procedures.
Xie Yiren nodded and got the circulating nurse to obtain gauze soaked in saline solution.
Zheng Ren was not rushing the surgery. He simply covered the segment of the intestine with the gauze and the surgery came to a pause.
The three department chiefs in the control room had their jaws on the floor.
What was this procedure?
Normally, warm saline gauze was used to cover the incision when there was an abnormality observed partway through the surgery, requiring the surgeon to step out to inform the patient's family. It was also used in intraoperative frozen section procedures to stall the surgery as they waited for the test results before proceeding with the next step.
Lastly, saline-soaked gauze was also used in situations where the surgeon had lost control of the procedure and
had to wait for someone else to take over.
Zheng Ren's application of the warm saline gauze did not fall into any of those categories.
The chatroom in Xinglin Garden exploded.
[What is the surgeon doing? Why did the surgery pause again?]
[Maybe there's a switch and they're waiting for another surgeon to assist?]
[Come on, I put down my beer and snuck into the nightclub toilet to watch this. And I'm using mobile data. What's this pause for?]
Dissatisfaction festered in the livestream.
The general consensus was that the current surgeon was not the same one from the previous videos and the surgery was on hold, waiting for assistance.
The intestines were filled with blood and it was impossible to find the source of it all!
How ridiculous!
The audience expressed their anger through their comments, something they could not possibly do were they present in person.
If they judged the situation wrongly online, they could just log off the platform with a stung sense of pride, but that was not possible in real life. They would not offend a surgeon whose methods they could not even understand.
Zheng Ren waited for 30 minutes. This was a slow surgery, a contrast from his usual pace.
The warm saline gauze was replaced three times. Whenever Xie Yiren delivered the new gauze, Zheng Ren's eyes crinkled above the mask and they exchanged a glance of good cheer.
"It's great to have your own scrub nurse back, huh, boss?" Su Yun suddenly muttered from behind him.
Zheng Ren felt his body tense.
"Relax. I think the necrosis is almost done. Resection can start soon, but try to minimise it; I'll look over the patient in the ICU." With that, Su Yun walked out of the operating room without a backwards glance.
Once he had understood what Zheng Ren was doing, he did not bother watching the rest of the surgery.
He knew where the man stood in terms of surgical skill.
A few minutes later, Zheng Ren removed the saline gauze.
There were two distinct colors visible on the segment of intestine.
The pink, fleshy part indicated that the tissues there were still alive and well.
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