"Where?" Su Yun's ears perked up.
"Imperial Capital. Chief Kong says they have about a dozen or so liver cancer patients ready."
"Of course I'll go. It's a large-scale clinical research trial. Once you have 100 cases—it probably won't take too long—you can live on the money they pay you for annual conferences," Su Yun said.
Su Yun stopped. He realized Zheng Ren was just bragging to him.
This bastard.
"Do you know why I came to this veterinary hospital?" Su Yun asked.
"Huh? Wasn't it because of Shen Xiaoou?" Zheng Ren raised an eyebrow at Su Yun.
"Hehe," Su Yun let out a dry chuckle that was filled with mirth.
Zheng Ren was sure he was right about the reason. If Su Yun was more reckless… Even if Su Yun was uptight, girls would still flock to him like bees to honey.
In this aspect, Su Yun was a Grandmaster. No, a Legend.
"Are you familiar with ringworms on dogs?" Su Yun asked abruptly.
"I'm not a vet, so no. I don't think I've heard you mention it earlier either."
"Simply put, when a dog has ringworm, its fur will start to come off in circular patches. The end result is a dog with ugly, patchy fur. Many people abandon their dogs because of this condition," Su Yun said.
"And?"
"As a side note, ignore the fact that this surgery costs 10,500 yuan and this family is willing to pay up. They're likely a well-off family. There are many owners who just abandon their pets. Have you seen people abandoning people? There probably are some, but it's rare."
"I see. So you have to seize the opportunity, I know." There was no expression on Zheng Ren's face. He figured sleep deprivation was making Su Yun talk more than usual.
This talkative Su Yun was getting on Zheng Ren's nerves.
"To treat ringworms, there is an animal-specific ivermectin. An injected dose costs less than one yuan and even after some middleman profiting, the price is about one to two yuan." A sneer appeared on Su Yun's face. "Most veterinary hospitals look nice but just like some human hospitals, their intentions are not pure."
"Oh? Intentional misdiagnosis?"
"Of course, what do you think? There are a bunch of divine doctors and cancer experts out there, don't you know?" Su Yun rambled uncharacteristically. The mention of divine doctors was a trigger point.
"I know," Zheng Ren answered exasperatedly.
"They're all scams! Capitalizing on people's despair. Most veterinary hospitals act the same way," Su Yun scolded, then brought the conversation back on topic. "Honestly, I like to treat animals. There are less problems to deal with and the families are very civil, much better compared to human patients."
"You can earn a good amount too."
"I was the rising star of the cardiothoracic department, do you think money is an issue for me?" Su Yun said.
Zheng Ren knew that was true.
He himself was just a budding surgeon but within a short period of time, Department Chief Kong had involved him in research work in Imperial Capital. Money was no longer a worry.
Money was never an issue when one was at the top in their line of work, no matter how niche it was.
Medicine was definitely not a niche job. Needless to say, their financial support was not lacking.
"Back to the topic, I believe any veterinary hospital that administers ivermectin is good and sincere. When I visited, the attitudes of the vets here were average, but the medication they prescribed was on-point. So occasionally, I would come by to perform surgery," Su Yun explained.
"Out of the goodness of your heart?"
"Hours in the hospital watching people live or die can make a man's heart grow cold. Looking after these old dogs, you'd find that they're sometimes more human than us," Su Yun said with a laugh. "I saw Chang Yue's rant in the group. That old man with liver cancer whom Old Chief Physician Pan referred to the hospital, his children are joking around in the hospital."
Zheng Ren thought about his words before sighing.
The anesthesia was complete. Xie Yiren had the surgical tools ready. There were fewer tools here but she spent an equal amount of time making sure everything was perfect.
Zheng Ren and Su Yun scrubbed in.
The old golden retriever was lying on the operating table, anesthetized. The room was sparse, much like a clinic in the rural area.
The surgery was simple. After opening the abdomen, an obstructed intestine appeared before them.
The necessary organ protection was done before a 4cm incision was made at the bulge of the intestine. An undigested sock was pulled out.
Then, an aspirator was used to remove the fecal matter and digestive fluids.
The open intestine was stitched up. The abdominal cavity was rinsed before they sutured the layers back together. The whole surgery took less than 20 minutes.
Zheng Ren and Su Yun removed their gloves and stepped away from the operating table.
Xie Yiren instinctively went to clear the surgical tools but was stopped by Shen Xiaoou with a courteous smile.
The surgery was beyond the veterinary hospital's capabilities but cleaning up after a surgery was not.
They exited the operating room and found the middle-aged man still waiting in the corridor.
"Doctor, did you help him?"
"Huh?" Zheng Ren's mind could not formulate a response in time.
"Hush," Su Yun interjected expertly. "The surgery is complete. In a moment, Director Ou will show you the sock. The sutures can be removed after ten days, depending on the recovery rate. Please be more vigilant next time."
The middle-aged man was shocked.
He had driven to multiple veterinary hospitals around the city and every single one of them had turned him down.
It was all done behind his daughter's back. He had lied to her, saying that he was just taking the dog out to play.
They got the golden retriever when his daughter was born and the two of them had grown up together. He was worried his daughter would be overly saddened by the dog's passing.
The man was willing to pay for the best surgeon to work on him.
However, the surgery was quicker than he expected.
Just a blink of an eye and it was over already?
As they talked, Shen Xiaoou walked out with a plastic bag, the undigested sock within.
"I think you lost a sock," Shen Xiaoou joked.
"Yes, yes." The man's eyes brightened.
"The surgery was successful but Harry will need to be hospitalized for a few days. When he's stable, you can bring your daughter over to visit." Shen Xiaoou added a caution note, "Please be careful next time."
"Thank you, thank you." The middle-aged man bowed deeply.
Zheng Ren thought of the children who treated their father's illness as a joke… Humans were such odd creatures.
"Okay, it's time to go home." Su Yun's eyes were nearly shut as he scrolled through his phone.
"Yeah, I'm leaving soon." Zheng Ren was waiting for Xie Yiren.
"Boss Zheng, come have a look." Su Yun waved his phone at Zheng Ren. It was a snapshot of a lab report.
Chapter 350 - Boss, Did You Get It?
"What's up?" Zheng Ren asked.
"Yang Lili's medical report shows improvement," Su Yun replied with a smile.
Finally, a sincere smile graced Su Yun's face.
Zheng Ren immediately reached for Su Yun's phone. Xie Yiren noticed he was attending to some business and went back into the operating room. She wanted to spend more time with the golden retriever named Harry.
Zheng Ren magnified the test report and read through the details.
The kidney function had returned to normal, and the blood urea nitrogen and creatinine were only slightly above the normal range.
The transaminase levels in the liver had also fallen to 100 units per liter. Her recovery from acute liver damage was impressive.
Most importantly, the coagulation factors in the body were functioning normally.
&nbs
p; The blood gas analysis and other test results indicated Yang Lili was on her way to a full recovery.
"Amazing!" Zheng Ren patted Su Yun's shoulder.
It had been two long and tiring days for Su Yun, working tirelessly like a dog. Dogs nowadays probably had a better life, sock-eating aside.
Finally, Yang Lili was no longer in danger.
"Of course. It has to be perfect," Su Yun said with a smile.
"Shall we try to get the breathing tube out tomorrow?" Zheng Ren asked.
"Yes, we can try. The Acinetobacter baumannii in the ICU are vicious. The earlier we remove the tracheostomy tube, the better."
"Head on home and rest then. The days have been rough on you."
Suddenly, the weariness on Su Yun's face was replaced with a suggestive look.
"Boss, did you get it?" Su Yun whispered.
Zheng Ren wanted to yell at the man.
"Holding hands count." Su Yun's voice was full of hope.
"..."
Su Yun studied Zheng Ren's face and let out a resigned sigh. "Never mind, I know that you're going to be as slow as a tortoise."
"I've moved into her house," Zheng Ren declared.
A wide-eyed expression could be seen from Su Yun.
"But it's in another building."
"Ah…"
"Don't blame me, okay. We went to the movies today but an emergency case interrupted the date," Zheng Ren said, annoyance in his tone.
Hand-holding.
"Take it slow. Don't let a girl this good slip between your fingers." Su Yun let out a yawn before continuing, "I'm gonna head home now."
"We'll drop you off?"
"The traffic is light at this hour. I'll drive slow, don't worry." Su Yun shuffled away. Zheng Ren kept an eye on the retreating figure, worried he might just collapse and pass out in the corridor.
"Oh right, the money for this surgery. I'll give it to you when we're free," Su Yun said as he waved his hand without turning back. He exited the building and disappeared into the night.
"Boss Zheng, you did an amazing job!" Shen Xiaoou said beside him with a smile.
Zheng Ren did not know how to respond. He had only just met this woman.
"Brother Yun's recommendation is truly reliable. Harry had been to all the vets in Provincial Capital but everyone said there was nothing that could be done. Some said the surgery's death rate was as high as 90%."
"Oh, veterinarians don't know how to perform surgery, I guess." Zheng Ren's reckless statement had earned him glares from multiple people.
It was absolutely reckless, given he was in a veterinary hospital.
Shen Xiaoou explained, "This type of surgery is not common for veterinary surgeons. There's little reference for aftercare as well. Veterinary is a new field, so we're all just figuring it out as we go."
Zheng Ren looked uninterested.
"Can you provide your contact details?" Shen Xiaoou tried her luck.
"No need. If the hospital needs me, you can reach me through Su Yun." The rejection was firm, his disinterest fortified.
The smile on She Xiaoou's face froze.
What a merciless rejection.
Zheng Ren went to get Xie Yiren and Chu Yanzhi. It had been a long day.
Before going home, the group grabbed some supper at a restaurant.
Then, the two cars made their way to Xie Yiren's houses.
Chu Yanzhi's presence dashed away any hopes Zheng Ren had of receiving a hug from Xie Yiren. Unlike most girls of this decade, she was a shy person.
They bid each other goodbye. Once inside, Zheng Ren ran a bath as instructed by Xie Yiren.
They texted for nearly an hour before sleep took over.
…
The sun rose the next day, as it did every day.
A new day was before them.
Zheng Ren ran through the tasks he had to do today: ward rounds, patient consultations, and all the essentials.
A trip to the ICU to visit Yang Lili. Her survival was a miracle to behold.
The gastroenterology department patient who underwent the TIPS surgery would be needing a second surgery to remove parts of the stent soon if their blood ammonia level remained low and there were no signs of hepatic encephalopathy.
The removal would smoothen the passage of fluids and widen the lumen. He would also need to check if there was bleeding from the gastric varices.
Zheng Ren would not have the free time to watch the vertebral column resection surgery. He had some interest in orthopedics but his plate was full. He could not just abandon his responsibilities to entertain his interests.
He ate his breakfast before setting out to the hospital.
Old Chief Physician Pan was asking about patients who left the hospital last night. He cursed under his breath, then began assigning tasks to the staff. They did their rounds in the emergency wards.
Once that was done, Zheng Ren left for the gastroenterology department.
Department Chief Xia spotted Zheng Ren and quickly brought a junior doctor to the critical care room.
The junior doctor reported the patient's latest developments. The hematemesis and hepatic encephalopathy had abated. With an elevated but acceptable blood ammonia level, the patient's recovery was on track.
Zheng Ren evaluated the patient's condition and decided a second surgery could be scheduled soon.
Department Chief Xia agreed with Zheng Ren's judgment, and they arranged for the surgery to begin tomorrow morning.
As they exited the patient's room, Department Chief Xia said, "Little Zheng, you did well with the TIPS surgery."
The straightforward compliment caught Zheng Ren off guard.
"I asked a colleague who's a professor in Imperial Capital. He was shocked to hear you performed an emergency TIPS surgery. He said the difficulty of the surgery was well beyond that of an elective TIPS." Department Xia chucked, then continued speaking, "I was wondering if you could have a look at one of our patients who has refractory ascites. If it's fine with you, we can operate tomorrow. It's quite severe and I'm worried the patient will not last the month if we put off surgery."
Zheng Ren cared not for the professor's praise.
Instead, he was interested to hear more about the refractory ascites.
If he wished to further develop his interventional surgery skill, elementary embolization surgeries was not the way to go. It would take a lifetime to make any significant progress.
He had to perform high-difficulty procedures like the TIPS surgery.
They arrived at the patient's room. Zheng Ren saw a thin figure with a bulging belly on the bed.
The large-volume ascites hindered the patient's breathing.
With every laborious breath taken, the man's clavicles and sternum sank deep into his body.
Zheng Ren knew it was not the three-concave sign. The ascites was pushing against the diaphragm and restricting the expansion of the lungs, hence the breathing difficulties.
The System's diagnosis blinked at the right corner of his vision.
Chapter 351 - Postoperative Mental Disorder?
Decompensated cirrhosis, portal hypertension, hypoalbuminemia, electrolyte imbalance, ascites, hydrothorax…
The list of diagnoses was long and blurry.
It looked like this patient had a hepatitis B infection that had progressed to hepatic cirrhosis, splenomegaly, and portal hypertension. This had then led to refractory ascites.
The earlier diagnosis was similar to a disease progression of hepatitis.
Decompensated cirrhosis would lead to two fatal complications—hematemesis and ascites.
When the ascites developed into refractory ascites, the usual diuretic treatment would not work. The ascites would result in hypoalbuminemia, leading to the leakage of fluids, worsening the ascites, and further lowering the albumin levels.
It became a vicious cycle.
The clinical treatment of ascites and hypoalbuminemia were diuretics and an intravenous infusion of human albumin.
<
br /> With the presence of refractory ascites, it did not matter how much human albumin was transfused as it would just leak out as ascites.
This complication was different from hematemesis. Even though hematemesis seemed more urgent than refractory ascites, hematemesis caused by portal hypertension was treatable with general surgery.
Before the emergence of TIPS surgery, patients with refractory ascites could only sit and wait to die. Even now, TIPS surgery was extremely difficult to execute, and only Class Three Grade A Hospitals in cities as big as provincial capitals were equipped enough to perform it.
Without TIPS surgery, patients diagnosed with this disease were pretty much getting sentenced to their deaths.
The patient would be in excruciating pain, suffering slowly while life ran its course.
Zheng Ren performed a simple checkup and questioned the patient about his condition when the labs were back.
The resident beside Chief Xia answered the questions in an orderly manner. The diagnosis by gastroenterology and the System's monitor was similar.
There were no specific contraindications, so the patient was cleared for surgery.
Zheng Ren said, "Chief Xia, the patient did a liver DW-MRI. I've submitted the request for surgery tomorrow."
"DW-MRI?" Chief Xia was stunned.
DW-MRI, diffusion-weighted magnetic resonance imaging in full.
DW-MRI differed from the usual MRI. DW-MRI utilized diffusion of water molecules to generate contrast by mapping the movements of water molecules in biological tissues, such as the brain, to provide clinical information.
It was mostly used for neurological treatment.
It could diagnose acute brain ischemia at a 94% sensitivity rate and 100% specificity. It could also reliably differentiate between an arachnoid cyst and epidermoid cyst, subdural empyema and subdural hygroma, and necrotic abscess and tumor.
Why did Zheng Ren order a DW-MRI for a TIPS surgery?
Chief Xia heard of how the experts from Imperial Capital and Sorcery Capital used DW-MRI to visualize the tumor. However, this patient was suffering from refractory ascites as a result of liver cirrhosis progression, not a tumor.
Little Zheng…
Chief Xia hummed softly.
Zheng Ren did not explain his decision further to Chief Xia. This was a preoperative assessment for TIPS surgery that he devised in the System's operating room after countless practices. He had used it to locate the position of the portal vein and hepatic vein so that his catheterization had a higher rate of success.
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