Chapter 372 - The Soon-To-Be Antiquated Hepatic Lobectomy
Despite knowing the ins and outs of the case, Chang Yue asked Zheng Ren, "Chief Zheng, what are the tests to be scheduled?"
It was a show of respect to the lead surgeon.
More importantly, a second pair of eyes could help spot mistakes. It would not do if the surgery had to be stopped or postponed because of a silly mistake.
"Standard blood work, a coagulation factors test, a liver function test, an electrocardiogram, and a 64-slice CT scan should be sufficient. Call me when you're heading to the CT room, I'll get the doctor to have a look at her lungs," Zheng Ren said.
"She'll be going through another embolization?" Chang Yue asked.
Zheng Ren thought for a moment, then said, "We'll run through the checks first. If everything is good, we can perform a radiofrequency ablation."
His words caught Su Yun's attention.
"Boss, when did you learn that?" Su Yun questioned.
"I saw it once and that was enough," Zheng Ren quoted Su Yun's usual boast.
With the Internet, it was easy to get a hold of surgery footage, especially when one had contacts in larger hospitals.
Su Yun did not doubt Zheng Ren's method, but he was not impressed by the answer.
Professor Rudolf chimed in with his Northeastern Mandarin, "Boss, are you performing a radiofrequency ablation on this big sister?"
The foreign professor's local slang took Zheng Yunxia by surprise.
"Yes." Zheng Ren nodded.
Radiofrequency ablation was a minimally-invasive procedure to treat localized tumors. The procedure was preferred when treating primary liver cancer.
For tumors with a diameter of 3cm of less, radiofrequency ablation had a 70% chance of killing all the cancer cells. The treatment efficiency was on par with that of a surgical excision.
Surgical excisions involving the liver were considered major surgeries. Therefore, as surgical procedures improved alongside technological advancement, doctors aimed to reduce the incision wound and minimize damage to the patient's body.
In radiofrequency ablation, the patient was required to undergo local anesthesia. The CT scan would determine the needle's point of entry and after 15 minutes of ablation, the treatment would be complete.
The patient would feel mild pain during the procedure but, in most cases, it was bearable. An additional dose of intramuscular pain relief could be administered to patients with lower pain tolerance.
The patient can get out of bed after six hours of rest and resume normal activity on the second day. The negative effects on liver function were lesser than an interventional procedure.
Radiofrequency ablation was a way to cure liver cancer.
However, due to its strict criteria, the procedure could only be employed against certain tumors. Nonetheless, the procedure had been tried and tested many times in medical history.
The progress of clinical research brought many changes to the field of medicine and surgery. Improvements were constantly being made to treatments and procedures for the sake of patients.
In the future, hepatic lobectomy would slowly disappear from a hospital's repertoire.
The procedure would only be used in the case of severe liver trauma, but for liver cancer treatment, interventional embolization and radiofrequency ablation would be better suited for the task.
Zheng Ren spent some time thinking. There was only a simple description for Zheng Yunxia's illness in the System's display. Based on his assessment, Zheng Ren believed she would be eligible for radiofrequency ablation treatment this round.
Similar to a lobectomy, they would hope to see a stop in the spread of the metastatic carcinomatosis cirrhosis after the radiofrequency ablation. If there was no relapse, they would have successfully saved Zheng Yunxia's life.
Radiofrequency ablation…
Zheng Ren got his phone out and dialed a number.
"Director Zhang, hello.
"Yes. I have informed Chief Pan of my absence and would like to perform a few procedures in the coming few days. Are your staff free to entertain me?
"About ten or so, I'm sure the Secondary Hospital does not lack patients. We can lower the fee, but I worry about the hospital's capacity for post-surgery care and treatment…
"Okay. Yes, of course. We'll meet soon then."
The call ended.
Su Yun frowned at Zheng Ren. The man's thoughts jumped from one topic to another without any rhyme or reason.
"Lil Fugui, hang back for a while later. We'll be going to the Secondary Hospital to perform some TIPS surgeries tomorrow. They have a courier coming over with the scans," Zheng Ren said to Professor Rudolf Wagner, ignoring the odd look Su Yun was shooting him.
"Aight, sir. How many surgeries?" the professor replied.
"Around ten."
The professor gesticulated wildly.
Ten TIPS surgeries in a day would be considered unimaginable, even in Heidelberg University.
Professor Rudolf never would have thought he would witness such a feat in a small, secluded city in faraway China.
Once all the arrangements were made, Zheng Ren waited in the office for the courier to arrive.
He had a book open on his table, but his mind was occupied with the radiofrequency ablation procedure.
One of the mission rewards offered by the System was a +2 success rate for interventional surgeries. Zheng Ren had no idea what that meant and, without any explanation from the System, he could only make an educated guess.
Radiofrequency ablation was classified as an interventional surgery. Therefore, his Grandmaster rank allowed him to skip the training modules.
Once he completed the mission, the System would grant him the experience of 3,000 radiofrequency ablation procedures. That would give him a significant boost.
The increased success rate was more ambiguous. Zheng Ren tried his best to decipher what it meant.
However, at this rate, he figured he should just wait until he completed the mission and see for himself.
Half an hour later, a knock came from the office door.
Zheng Ren raised his head and saw a plump man at the door. "I'm looking for Chief Zheng."
The man had some printed radiographs tucked underneath his arm. It had to be the courier from the Secondary Hospital.
The courier arrived earlier than Zheng Ren expected. It seemed having the supervisory deputy director of the Secondary Hospital, Director Zhang, on the project made things efficient.
"I'm here," Zheng Ren called out.
The plump courier bowed. He wore a warm smile as he approached.
"Chief Zheng, Director Zhang wanted me to pass you these."
"Yes, thank you for your effort. Have a seat," Zheng Ren bade.
Professor Rudolf inched closer to Zheng Ren's table.
After two whole days of research and study, the professor had a deeper understanding of the TIPS procedure. Hence, he was the only other person who was as excited as Zheng Ren to go to the Secondary Hospital.
The courier did not sit. Instead, he kept his head bowed in respect to Zheng Ren.
The gesture went unnoticed by Zheng Ren as he took the bag and proceeded to look through the scans.
The bag contained the diffusion-weighted scans of the patients and other records and reports.
Director Zhang was generous in his sharing and Zheng Ren was grateful for that.
A brief look through one of the patient's records told him it was a case of decompensated cirrhosis with ascites.
Two months ago, the patient was admitted due to hematemesis. The hospital managed to keep him alive.
However, with symptoms such as hematemesis and ascites, the patient's life was constantly in danger.
One successful emergency rescue did not guarantee a similar result the second time around.
"Lil Fugui, what do you think?" Zheng Ren asked.
Professor Rudolf Wagner studied the scan and reports. "The patient exhib
its clear indications for operative treatment. Their stable condition is optimal for surgery. Boss, we might have rushed it with the previous patient. This one is a better candidate."
The neglected courier tried his best to hold his smile.
Chapter 373 - Faster Than A Rabbit
The golden-haired foreigner spoke a fluent Northeastern Mandarin, which stunned the plump courier.
What was going on?
The courier's presence was negligible to Zheng Ren and Professor Rudolf. The patient's scan was as captivating as a pretty lady.
"The patient's condition is suitable. A better position for entry would be somewhere around here."
"Boss, at this position, there's a possibility we have to patch up the vessel. I suggest angling the needle 15 degrees to the right."
"No. The scan has some artifacts due to hydrography. That position won't do. Here should be adequate."
The courier could not understand a single thing the two men were saying.
Even Su Yun, who was standing behind them, could barely comprehend their ramblings.
Most surgeons had a Graduate-level understanding of radiographs. On the rare occasion, some possess Master-level knowledge.
Su Yun was an exception—he was at Master-level proficiency for both CT and MRI scans.
Nonetheless, he struggled to understand Zheng Ren and Professor Rudolf's discussion.
Godd*mn!
Frustration filled Su Yun's c.h.e.s.t.
'How does a flippin' general surgeon like you have such in-depth knowledge about MRI?'
The plump courier remained where he was.
He had thought the delivery would take an hour at most. Lunchtime was near.
He had hoped to treat Zheng Ren to lunch as a form of relationship building.
It was what the professors often expected.
Some professors even requested for services such as a foot spa or a massage.
This particular doctor was different from the usual professors.
Zheng Ren was young, too young. He looked to be under 30. This was the surgeon who could perform the challenging TIPS procedure?
Perhaps it was the foreigner who was the lead surgeon.
The courier was initially dismissive of Zheng Ren, but held back any untoward comments as he was carrying out orders from Director Zhang.
However…
He definitely did not expect this delivery to take so long.
A single scan and some supplementary information occupied Zheng Ren and Professor Rudolf for an hour.
The courier was tired from standing. His legs were numb from inactivity. If he sat down now, would it be disrespectful to Chief Zheng?
A debate went on in his mind.
It was almost lunchtime. They should leave for lunch soon.
To his chagrin, Zheng Ren and Professor Rudolf did not even notice the passage of time. After going through one patient's scan, the professor had filled a piece of paper with notes in German.
Then, they proceeded to look at another patient's scan.
The courier was tired and hungry. He glanced at the clock which showed it was noon now. It would not do if this kept on. Maybe he should remind them of the time.
"Chief Zheng, look at the time. Perhaps we should go have lunch?" The plump man tried to cut into Zheng Ren and Professor Rudolf's discussion, a big smile on his face.
There was no response from the two men. The man's existence was unperceivable to Zheng Ren. He was utterly immersed in his analysis of the scans, only occasionally diverting his attention to debate with Professor Rudolf.
Su Yun grinned. This plump man looked to be a bureaucratic employee. To a medical doctor, the intriguing scans were more important than a meal.
A clinician would understand.
Those who worked in the wards would agree.
Su Yun watched Zheng Ren and the professor argue and guessed it was about a new methodology that neither were familiar with.
A series of connections were being drawn in his mind.
By the third scan, Su Yun could make out what Zheng Ren and the professor were working on. They did not call him a genius for nothing.
On the fourth patient, Su Yun could contribute some ideas to the discussion.
Although his ideas were constantly shot down unkindly by the professor, Su Yun did not mind.
To determine the entry point for the TIPS procedure using diffusion-weighted MRI was an ingenious approach
As the discussion went on, Su Yun was already drafting the framework for a research paper.
This would be even more promising than the previous articles.
They were advancing too fast… They had returned from Imperial Capital less than a month ago and already a new discovery was before them. The previous articles had yet to even pass peer review.
This speed…
The courier stood for two whole hours before giving in.
While no one was paying attention to him, he slinked away and found a chair to sit.
He rubbed his legs to stimulate blood flow as he pondered about his next plan.
Director Zhang did not give him any special instructions. He only said to bring the scans to Chief Zheng. The courier was aware of Sea City General Hospital's reputation.
They boasted better quality service than the Secondary Hospital, but lost out when it came to Hepatitis B and tuberculosis treatments. After all, the Secondary Hospital was a specialized healthcare center.
In this era where tuberculosis was gradually being eradicated, the Secondary Hospital was switching focus to the liver.
Hence, the courier did not believe Sea City General Hospital could offer better treatments for liver cancer, cirrhosis, or portal hypertension than the Secondary Hospital.
He doubted Sea City General Hospital was equipped to treat patients with both portal hypertension and decompensated cirrhosis. He found it hilarious that the doctors requested a diffusion-weighted MRI scan.
When he went to collect the scans, he could tell the chief of the hepatology ward had had a good laugh at the request.
He also knew the chief was unhappy about Director Zhang inviting an outsider to perform the TIPS surgery.
Hiring a fly-in surgeon was fine, but why did it have to be one from Sea City General Hospital? It was akin to plunging a knife to their pride. How would they face the people from Sea City General Hospital during the annual dinner?
The courier watched Zheng Ren and the foreign professor who were still busy with the scans. He let out a sigh.
He had to admit their zeal for work was admirable.
His lunch plans were clearly in tatters as Chief Zheng only had eyes for the scans.
While the plump man's career was mainly administrative, he had sufficient objectivity to judge a good doctor from the bad. His years in hospital administration have informed him of which doctors to avoid.
This Chief Zheng was one of the good ones.
Suddenly, someone's phone rang on the table. It gave the plump courier a shock.
"Yes?" Su Yun answered the call distractedly. His eyes were still roaming over the current scan in focus.
The speaker on the other end said something which prompted a loud "Sure!" from Su Yun. That was all he said before hanging up the phone.
"Boss, there's a multiple stab wound patient incoming. The heart just stopped! The 120 ambulance is on its way, reaching in two minutes," Su Yun announced before running out of the room.
Zheng Ren, who had to this point been so engrossed in the scans, immediately switched gears and followed Su Yun out of the room. The two doctors ran off faster than a rabbit.
Chapter 374 - Reviving The Dead
Zheng Ren switched modes instantly at the news of an emergency rescue, abandoning his discussion with the professor.
The news of a patient with a stopped heart turned Zheng Ren into an athlete. He chased after Su Yun and the two doctors ran through the hospital corridors.
The elevators were too slow, so they went dow
n the fire escape stairwell.
As they reached the first floor, they heard the sirens of the 120 ambulance approaching.
"You head to the emergency response room, I'll bring the patient," Zheng Ren shouted over the din.
Without saying a word, Su Yun changed course and ran toward the emergency response room.
The 120 ambulance pulled up in front of the emergency entrance. The stretcher trolley was already on the move.
Zheng Ren caught sight of the patient and looked at the System display in the top-right corner of his vision.
Instead of flashing a warning red, it was pale white.
'F*ck!'
Zheng Ren cursed under his breath. Was the patient dead?
Not even a diagnosis! There was no color indication of the patient's vital signs.
This was a first for Zheng Ren.
At this moment, the System notification bell chimed.
[Emergency Mission: Reviving The Dead
[Mission Details: Rescue the multiple stab wound patient undergoing cardiac arrest.
[Mission Reward: One Master-rank emergency rescue skill book and one golden c.h.e.s.t.
[Mission Duration: Three hours.]
There was no time to read the fine print, but the issuance of a mission gave Zheng Ren hope.
It meant the patient still had a fighting chance, or else the System would not have given him a mission.
His past engagements with the System were always fair and balanced. Thus far, he had yet to encounter a mission that was impossible to complete.
A 30-year-old woman came down from the 120 ambulance.
Her hair was a mess as she ran alongside the stretcher trolley. She was shrieking and crying as the emergency response team wheeled the patient into the hospital.
At some point, Zheng Ren joined the foray. He guided the stretcher trolley to the emergency response room. Amidst the chaos, the woman, who was in heels, tripped as she tried to keep up.
No one noticed her fall.
Once the patient was inside the emergency response room, a nurse approached with a pair of scissors. The patient's clothes were removed.
One by one, the stab wounds appeared before Zheng Ren's eyes.
There was one stab wound below the left pectoral.
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