The Surgeon's Studio c1-799

by Black Ursa Prime

  If he were to explain from the very beginning, he would not be able to finish telling him the reasons why even after several days.

  Zheng Ren was also too lazy to deal with other things.

  After briefing Chief Xia about the patient, Zheng Ren took his leave and headed to the ICU.

  He changed and entered the ICU ward. The ward had a strong, depressing atmosphere.

  The chief of the medical administration division was sitting in the ward with deep, furrowed brows.

  Su Yun was seated beside Yang Lili's bed, his fringe swaying in front of his forehead while his head was buried in lab reports.

  "What happened?" Zheng Ren approached Su Yun and asked softly.

  "Boss, there's something wrong," Su Yun said. "We stopped the sedatives this morning but the patient started showing symptoms of mental disorders."

  Mental disorders?

  Zheng Ren was stunned.

  There was no mental disorder shown on the diagnosis on the System's monitor.

  "The routine blood work was mostly normal. The surgery's aseptic environment was maintained well with no obvious signs of infection. Biochemistry analysis: 15.49 mmol/L of glucose, 134 mmol/L of sodium, and 4.15 mmol/L of potassium. Blood gas analysis: pH 7.46, 61 mmHg partial pressure of oxygen, 38 mmol/L of bicarbonate, 3 mmol/L base excess, and keto acids: +++." Su Yun dictated the entire emergency lab report from this morning without even looking at the papers in his hand.

  "How was Yang Lili's mental state?" Zheng Ren asked with a frown.

  "Extreme, intense fear, like phobia," Su Yun said. "It was as if she had seen a ghost. She had an intense episode of emergency agitation and the hand straps couldn't hold her down. Her heart rate shot up from 95 to 156 beats per min after we stopped administering sedatives."

  "That's strange." Zheng Ren recalled the lab results that Su Yun had just told him. The overall results seemed fine. It only had a slight increase in blood glucose, urine glucose, and keto acids. He considered that this was the body's acute stress reaction in response to a traumatic injury.

  Bloody h*ll…

  This would not be easy to explain.

  Could the intense shock from the incident have left her with psychological trauma?

  It was possible. Nonetheless, psychological treatment was still a new branch of science in the country. Zheng Ren did not know any experts in the field.

  More importantly, the psychiatrist would not be able to give Yang Lili counseling in her condition.

  They were going to do a thoracotomy in a few days. If the complications of lung infection began to…

  Zheng Ren had no choice.

  No wonder the ICU's atmosphere was so depressing. A patient with seemingly fine test results had manifested such strange complications.

  Especially when this patient was someone highly regarded in the city. They had to report directly to the health bureau director and the deputy mayor who oversaw the cultural education and health of the patient's condition every day.

  What should they report today? Should they say that she saw ghosts after they stopped her sedatives?

  Zheng Ren frowned deeply while he went through each and every diagnosis shown on the System's monitor.

  They had started her on sedatives again but Yang Lili's heartbeat remained high.

  Postoperative infection? The patient's temperature was slightly elevated, most likely due to postoperative fever. The C-reactive protein had no apparent abnormality, which meant it was unlikely to be an infection.

  Pulmonary embolism? C.h.e.s.t pains and respiratory distress that led to an increased heart rate?

  Zheng Ren listened to Yang Lili's breathing sounds on both sides with a stethoscope. It was not pulmonary embolism…

  Zheng Ren was certain about it without the need to perform CT angiography on the pulmonary artery.

  He should be able to derive a conclusion based on the combinatorial results from the body examination and the System's diagnosis.

  Could it be cardiac insufficiency due to the large volume of postoperative fluid replacement? Zheng Ren pondered. He then asked, "What was her input volume?"

  Su Yun shook his head. Obviously, he had already thought of this.

  "The postoperative fluid output was significantly lesser than the fluid input. On the first day post-surgery, the difference between fluid input-output had decreased. They reached the same volume as of yesterday."

  They administered a larger volume of fluid replacement because Yang Lili had lost a significant amount of blood.

  Besides Yang Lili's young and healthy body, she was able to recover just 2 days after surgery because of Su Yun and the ICU medical staff's hard work.

  Furthermore, Yang Lili had no family history of cardiovascular disease, so he eliminated the possibility of cardiac insufficiency.

  Besides this… What else could it be?

  The last possibility was diabetic ketoacidosis.

  Since Yang Lili presented an increase of blood glucose, ketone in urine, acidosis, and normal levels of β-hydroxybutyrate, the ICU doctor administered a low dose of insulin.

  It was not ketoacidosis either.

  Could it really be a mental disorder… Zheng Ren was stuck.

  After going through each diagnosis on the System's monitor, Zheng Ren's eyes suddenly lit up!

  Could it be that?

  Chapter 352 - Beriberi Is Not A Disease

  "Have you checked her vitamin levels?" Zheng Ren asked.

  "Vitamin?" Su Yun was stunned.

  Their usual routine for emergency rescue in the ICU did not include vitamin tests unless the patient had a specific disease.

  External injuries did not qualify as a specific disease.

  "I'm thinking that it might be vitamin B1 deficiency," Zheng Ren said. "Stop the patient's sedatives."

  "..." Su Yun was still in a daze.

  "I want to see if the patient is presenting symptoms of oculomotor nerve palsy during agitation."

  Paralysis of the extraocular muscle resulting from oculomotor nerve palsy would lead to misalignment of eyes and a loss of pupillary light reflex.

  Right before Su Yun was about to argue, he suddenly recalled the constant trembling of Yang Lili's eyes while she was conscious. That was also why Su Yun felt as if she had seen a ghost.

  He hummed softly for several minutes before abruptly lifting his head, his eyes brightening with realization. "Boss, I think you're right."

  Chief Qian and the other consulting chiefs were baffled.

  Were these two young lads joking?

  The city council was still waiting for their morning report, yet they…

  If it was not for the exceptional emergency rescue abilities that Zheng Ren had demonstrated in the ICU prior to this or his impeccable surgical skills showed in past emergency surgeries, he would be ridiculed and scoffed at.

  Vitamin B1 deficiency?

  What a joke.

  "Little Zheng, Little Su, stop joking around," Chief Qian said in a deep voice to indicate his dissatisfaction.

  "We're not joking, Chief Qian." Su Yun chuckled.

  Zheng Ren's words unveiled the fog and the sky was clear now.

  There were times that a seemingly unsolvable problem could be easily resolved with a simple push.

  "How are the patient's symptoms related to vitamin B1 deficiency!" The medical administration division chief roared. "Beriberi? What nonsense is this!"

  "We all studied pathophysiology before, right?" Su Yun looked around, a sneer hanging on the corners of his mouth. "The common disease of vitamin B1 deficiency is called beriberi, there isn't anything wrong with that."

  While he spoke, his smirk grew larger, attracting many pairs of glistening eyes from the ICU nurses.

  "Vitamin B1, also known as thiamine, is absorbed by the intestine and phosphorylated into thiamine diphosphate.

  "Thiamine diphosphate is an important coenzyme in the decarboxylation of pyruvate and α-Ketoglutaric acid, as well as the coenzyme of erythr
ocyte transketolase."

  The people present were struck with a string of scientific jargon that seemed to appear out of nowhere like thunder and lightning.

  Chief Qian hummed softly. What Little Su said made sense.

  The medical administration division chief had an awkward expression because…he could not understand a single thing.

  His position was quite important, as it required integrating each emergency rescue segment, ensuring the hospital's medical quality was up to standard, and handling medical disputes.

  He had left clinical practice for a long time and lost touch with things like pathophysiology.

  Su Yun could not be bothered about their concerns and continued speaking, "The brain and cardiac tissues have a high metabolic rate. They require sufficient vitamin B in glycolysis to breakdown glucose into pyruvate or otherwise, the lack of thiamine diphosphate will prevent the keto acids from entering the tricarboxylic acid cycle.

  "Acc.u.mulation of keto acids in the blood results in the dilation of surrounding arteries due to the decrease in peripheral resistance. The increased blood flow would then subsequently raise the cardiac output and cardiac workload."

  Hmm? Finally something about the right ventricle output and cardiac preload?

  The medical administration division chief pretended to be in deep thought. He could not risk letting anyone discover his inability to comprehend anything.

  Anyway… This rascal, could he just explain it in simpler terms?

  "Therefore, I…" Su Yun halted midspeech. "My boss said that Yang Lili's agitation and mental distress should be the complications from a vitamin B1 deficiency."

  Su Yun glanced at Zheng Ren after he finished speaking.

  "Am I right, Boss?"

  "That's about it," Zheng Ren said straightforwardly. "I suggest giving her a 100 mg shot of vitamin B1. However, intramuscular injections tend to have a lower rate of absorption. We can try simultaneously injecting 20 mL of saline with 50 mg of vitamin B1 intravenously."

  "It should be fine to administer a higher dosage on the first day," Zheng Ren said.

  The department chiefs and the medical administration division chief stared at each other blankly. They could see the confusion in each other's eyes.

  Even though not everybody agreed with what Zheng Ren and Su Yun were saying, they could not come up with a reasonable rebuttal.

  They had explained their speculations clearly, with detailed elaborations on the biochemical processes.

  Even when the people around them could not follow, their reasoning sounded very professional.

  So?

  What else could they do?

  "Let's try that out since we have no other choices," Chief Qian said.

  He had known Su Yun for the longest time and was well acquainted with him. Usually, if Su Yun had that obnoxious expression on his face, it usually meant he was right.

  They should not argue with him, even if they were a department chief. If not, they might have gotten a slap on the face even when if they backed it up with medical reasoning.

  Moreover, a few milligrams of vitamin B1 would not cause any harm to Yang Lili's condition.

  "Stop the sedatives after half an hour," Zheng Ren said as he stood up, giving the final order.

  "Sure, boss," Su Yun noted down the doctor's order.

  Chief Qian got sentimental as he watched Zheng Ren leaving.

  The young cub had m.a.t.u.r.ed into an a.d.u.l.t.

  Some of the older department chiefs did not even have the strong presence that Zheng Ren exuded.

  Who dared to speak in such conclusively without knowing the medical treatment's guaranteed outcome? If they just spoke without careful consideration, they would be given hell toward the end of it.

  Chief Qian only encountered a handful of professors from the Imperial Capital and Sorcery Capital with a similar aura, but he had never seen someone like this in the…Sea City General Hospital.

  After Su Yun conveyed the doctor's order, the little nurse hurriedly carried out the orders and gave an intravenous injection of vitamin B1 before injecting another dose intramuscularly.

  Su Yun glanced at the time before sitting down beside Yang Lili's bed, his eyes fixated on her.

  There was no problem with the half hour cut-off time that Zheng Ren had mentioned earlier. If they stop the sedatives then, it would take another 2 hours for Yang Lili's body to metabolize the drug.

  If the oculomotor nerve and cardiovascular symptoms were a result of vitamin B1 deficiency, the patient would then be relieved of those symptoms afterward.

  What an interesting diagnosis.

  …

  At the same time, the vertebral resection surgery was ongoing in the major general surgery operating room.

  "Little Zhou, were the embolizations from yesterday done precisely?" Professor Tian from the orthopedics department asked while making an incision.

  Dr. Zhou said, "The embolization took longer than usual because we only have one interventional doctor. I can't really tell if it was successful, but he performed embolizations on a patient with peritoneal hematoma after a pelvic fracture and it went really well."

  "Uhm, interventional doctors are quite rare. You're lucky to have one." Professor Tian started a blunt dissection to separate the muscles, carefully avoiding a location that was richer in capillaries.

  Chapter 353 - A Surgery So Successful That Sends Chills Down The Spine

  Professor Tian had a great technique.

  He made a skin incision, exposing the spinous process and lamina. The 2 lower vertebrae from the pathological vertebra were also fully visible.

  In order to better expose the incision, he needed to cut both sides of the sacrospinalis adjacent to the pathological vertebra and separate them through proximal and distal retraction.

  Under normal circ.u.mstances, the patient would have around 200 mL of bleeding.

  The reason for that was because the surgeon would breach the periosteum in the process of exposing the spinous process and lamina.

  However, the surgery today went surprisingly well.

  The bleeding was maintained well below 50 mL, and the entire surgical field was exceptionally clean.

  Professor Tian was very satisfied with his own technique. He felt that today's surgery would be smooth sailing, and the bleeding volume would probably be capped under 3 liters.

  Because the following steps would cause the bleeding to be heavier, Professor Tian's movements became slower and gentler. He carefully checked each procedure to prevent an accidental hemorrhage.

  He started to gouge out the spinous process and lamina that had been invaded by the tumor with a rongeur.

  "Crack." A small piece of bone was removed.

  The lamellae were not as compact due to the tumor infiltration, producing a cracking sound like a defeated army.

  Even though it was brittle, the tumor angiogenesis allowed the lamellae to receive sufficient blood supply, which usually led to a sudden increase in bleeding.

  The patient would usually bleed profusely starting from this step.

  After removing a piece of the lamina, Professor Tian covered it with a dry gauze out of habit.

  Strange…

  Professor Tian noticed that it took a full 10 seconds for the dry gauze to be soaked in blood.

  Professor Tian was skillful, but he was not at the level of a Legend. Nevertheless, he could be considered to be an orthopedic professor at a higher Master level, approaching the Grandmaster level.

  He had an in-depth understanding of vertebral resection surgery.

  It was still plausible to account for the minimal bleeding prior to this step through his excellent dissection skills.

  However, it was not possible to have such a low amount of bleeding after removing the lamina with a rongeur.

  Normally, the surgery would be continued on in a pool of blood from this step onward.

  This was beyond what the aspirator could manage.

  Moreover, the blee
ding would cloud the surgical field, continuing the vicious cycle.

  Fresh, frozen red blood cells had been prepared, awaiting Professor Tian's orders so that they could start the transfusion.

  This was weird. Could it be a rare tumor? An insufficient blood supply, maybe?

  That would not be the case either. Professor Tian could not fathom the situation in front of his eyes.

  Even if there was insufficient blood supply to the tumor, the lamina should have a rich supply of blood vessels. It would never take at least 10 seconds just to soak the gauze entirely in blood.

  "Professor Tian?" Dr. Zhou noticed Professor Tian drifting away. Not knowing what had happened, he called out to him softly.

  Professor Tian came to his senses from his endless speculations. He set himself back on his feet and proceeded with the surgery.

  He continued to chip the lamina off to expose the spinal nerve roots.

  The tumor invaded the spinal canal. The dura mater was bulging without a pulse, epidural fat absent, and the dural sac was distorted and compressed.

  Professor Tian did not continue covering the gouged lamina with dry gauze because he wanted to see the extent of the bleeding.

  As expected, there was very little blood, only a few millimeters.

  It must have been the interventional surgery!

  Professor Tian quickly identified the reason behind it, but could not accept the truth.

  As a spine surgery specialist and professor in Imperial Capital, he frequently collaborated with interventional doctors to perform vertebral resection surgery.

  Had he encountered a surgery with such minimal bleeding?

  None, not even once.

  With the support of interventional surgery, they were able to reduce a certain amount of bleeding. It was usually in relation to the surgeon's technique, but usually not by that much.

  How difficult could a lumbar artery embolization be?

  If there were no available interventional doctors, Professor Tian could have just put on the lead apron and perform the lumbar artery embolization surgery himself.