Time was running out! The heart would have stopped beating for at least four minutes now—brain hypoxia would have set in.
There was not enough time!
Zheng Ren put on a pair of sterile gloves and plunged one hand into the stab wound while his other hand reached out. "Scalpel!"
Su Yun had a scalpel in hand and intended on stepping up to the table when he heard the urgency in Zheng Ren's tone. He relinquished the scalpel.
Zheng Ren's fingers probed the wound and came into contact with the heart.
He suspected the patient had a pericardial tamponade!
He recklessly poured some iodophor over the patient's wound and, scalpel in hand, he cut into the patient.
"Ah!" A shriek sounded from outside the room.
Zheng Ren ignored the shout as he pushed the scalpel deeper. There was no time to perform a blunt dissection or address potential issues, like pneumothorax.
"Prep the operating room!" Zheng Ren shouted as he spread open the muscles underneath.
The gory heart sat in the c.h.e.s.t cavity, two fists large.
Zheng Ren made a nick in the pericardium.
The sudden relief of the pent-up pressure caused a spray of red liquid, splattering the room and ceiling.
Blood was everywhere!
The patient's family, bystanders, and even the medical staff on duty were shocked as they watched the events unfold.
Zheng Ren tossed the scalpel aside and put his hand into the patient's c.h.e.s.t cavity. With his fingers, he began to massage the heart.
With the pericardial tamponade resolved, the resistance was lessened and two squeezes were all it took to restart the heart.
At the same moment, Su Yun successfully intubated the patient and was providing breathing assistance with a ventilation bag.
"OR!" Zheng Ren kept his hand on the patient's heart, fearing the worst if he left it unattended.
Su Yun immediately pushed the stretcher trolley and called for a personnel to steer the direction. The team headed for the elevators.
As the stretcher trolley exited the emergency response room, a piercing wail was heard. The 30-year-old woman launched herself at the stretcher and began sobbing uncontrollably.
Her cries were heart-wrenching to hear and even more harrowing to watch. Her agony was on full display in the emergency department.
Despite that, Zheng Ren had no sympathy for the patient's family. The woman was slowing them down in this critical moment.
The patient's c.h.e.s.t cavity was exposed and there was a high risk of open pneumothorax.
They could not maintain this condition for long.
"Let go!" Zheng Ren roared.
The woman was undergoing a mental breakdown as she watched the man's life slip away. She was oblivious to the world around her. Her one and only focus was her lover, who was dying by the second.
"F*ck!" Zheng Ren swore loudly.
There was no time for explanations so he kicked the woman aside and urged the team to move faster.
The bystanders stared wide-eyed at the commotion. Did this count as physical assault? Were doctors allowed to do that?
The other medical personnel were also surprised by Zheng Ren's actions. They were glad that once the patient was rushed to the operating room, they would have washed their hands of this case.
A few nurses approached the fallen woman and made sure she did not cause any further commotion. They agreed with Chief Zheng's decisiveness and found him very manly in the heat of the moment.
The stretcher trolley was wheeled into the operating room. Chu Yanran quickly set up a double-lumen endotracheal tube while Zheng Ren did a deep venous catheterization before changing into his surgical scrubs. Su Yun was already in his scrubs and in the process of washing his hands.
The team in the operating room worked efficiently and cohesively, like a fine-tuned machine. When Zheng Ren returned to the operating table after changing, the surgical dr.a.p.es were laid in place and everything was ready to go.
Sterility was of a lesser concern in an emergency rescue. If there was an infection, it would have been due to the earlier open cardiac massage.
Time was of the essence.
Zheng Ren needed more time.
Time!
Time!
Time!
The ribs spreader held the patient's rib cage open and revealed the wildly beating heart. Relieving the pericardial tamponade seemed to have rejuvenated the organ.
The ventilator got to work as the double-lumen endotracheal tube was set. One lung deflated as Chu Yanran operated the equipment.
This gave Zheng Ren a better view of the heart. There was a 1cm laceration on the left anterior wall of the heart. With each heartbeat, fresh blood oozed from the open wound.
A wound of this size was salvageable. Zheng Ren sighed in relief.
He extended his arm and got a hemostatic forceps.
A deeper probe revealed the wound was approximately 2cm deep.
"A direct suture?" Zheng Ren asked.
"It would work," Su Yun replied. His surgical cap was drenched in sweat. Zheng Ren imagined his usual floppy fringe would be damp and slick against his forehead. Su Yun continued speaking, "Nothing critical. A suture will do."
The heart was not Zheng Ren's forte, but it was Su Yun's.
Su Yun was experienced in heart transplants. This emergency procedure was nothing compared to a heart transplant.
"Sew it up then. Fine sutures," Zheng Ren instructed and handed over the helm. This came as a surprise to Su Yun.
The needle holder was placed into Su Yun's hand: small needle, fine sutures, and a long needle holder.
It was the first time Su Yun received such treatment in the operating room. Even in Imperial Capital, he was never given a chance like this.
Zheng Ren relaxed. He was glad to have someone take over. It would be great if every surgery was as simple.
…
…
This surgery was based on an emergency rescue I had in 2003. The patient survived and we became friends. I kicked the patient's wife aside, but she could not even recall the event.
The scenes described actually happened. The blood splatters really reached the ceiling and we were all covered in blood.
Chapter 375 - Everyone, Shut The F*ck Up!
The wound on the heart was closed with three stitches. The stitching was done perfectly. The tension was just right to hold the two parts together.
As the heart resumed its beating, the wound was no longer leaking blood.
Without the pericardial tamponade, the beating of the heart was no longer hindered.
Zheng Ren and Su Yun continued their exploration in the c.h.e.s.t cavity. They checked the lungs for any damage.
The cardiac tamponade from the stab wound had been their number one priority.
There was a double-walled sac around the heart and the blood from the wound would be trapped in the pericardial space.
A larger wound on the heart would cause a faster bleed. As blood filled the pericardial space, the cardiac output was reduced.
The pressure buildup within the pericardium disrupts the rhythm of the heart. In a severe case, the pressure in the pericardial space overwhelms the pressure in the heart and the organ ceases function.
The simplest solution was to relieve the pressure by making an opening in the pericardium for the blood to flow out. The heart would restart once the high pressure was alleviated.
The biggest factor in this emergency procedure was time.
Time!
If they had adhered to the standard operating procedure for surgeries, by the time they were done with the pre-surgery preparations, the patient would likely be dead.
The patient's best chance of survival was an emergency pericardiotomy.
Aseptic techniques and resuscitation process flow be damned.
Even the risk of an open pneumothorax was acceptable.
The heart was no longer beating and a pneumothorax was
the least of their concerns when the patient could be brain dead soon.
A simple suture could reverse the damage. In this case, the emergency procedure also provided access to the stab wound on the heart.
The pericardiotomy was a last resort procedure—a simple solution to a life-threatening condition.
…
Outside the operating room, emotions were running high.
The patient's family and friends were gathered. They flew into a fury when they saw the big footprint stamped on the patient's lover and the dejected look on her face.
The hospital rumor mill was operating at full speed. There were rumors of the patient being pronounced dead on arrival, yet the emergency doctors insisted on opening up the patient. Understandably, the family and friends did not take kindly to the news.
The sight of the bloody emergency response room was no solace to them.
"There's no need to cut him open if he was already dead!"
"Which doctor killed him?"
"Where's the doctor? Who is responsible here?"
As the news only got out a while ago, there were few family members.
However, their anger at the hospital was palpable.
They were eager to blame someone for the patient's death.
In their minds, cardiopulmonary resuscitation was the go-to procedure when it came to saving lives.
That was what the television and novels depicted.
According to the medical personnel on the 120 ambulance, the victim had died in the ambulance, and yet the hospital doctors cut him open. They were not above mutilating a dead body…
Where was the logic?
The law?
The morals?
The family's rage was fed with dramatic stories by bystanders in the emergency department.
"Yeah, when I saw the patient being wheeled in, he looked like he was dead. When the doctor cut into him, the blood spray was so high, it stained the ceiling. It looked like a bloody rain."
"It was frightening. I think I'm gonna have nightmares after this."
"And the doctor dragged the body off to God knows where. It can't be for organ-harvesting—" Someone shoved the speaker to make him shut up.
It was not something to be said in public.
Was the man searching for death?
The patient's lover was on the floor, her limp body leaning against the wall. Her sobs had subsided into a soundless shuddering of shoulders.
There were no longer tears in her eyes.
Although there were no cries or tears, the sadness she radiated was overwhelming.
The woman said nothing about what had happened. She might have already forgotten the initial incident that had caused the tragedy.
All of this enraged the family and friends of the patient.
"That doctor! Even the dead require a proper burial. What did he do to the corpse?"
"Is Sea City General Hospital involved in some shady business operations? Return the body!"
"F*ck this hospital!"
The family members surrounded the nearest nurse on duty and started shouting at her.
The uproar reached a fever pitch when someone kicked the red plastic bench. They were looking for an outlet for their anger and violence was one of them.
Fan Tianshui, who had been keeping an eye on the situation, ordered, "Everyone, shut the f*ck up!" He was the calm in the eye of the storm. Blood on the ceiling meant nothing to a man who had seen war and witnessed field doctors revive comrades in bloodier settings.
Fan Tianshui fought his way through the crowd. These civilians had little muscle to stop him.
He went to the nurse's defense, uncaring of the public's opinion.
Like a sleeping tiger who had been stirred awake, Fan Tianshui gave the crowd a menacing look. There was a moment of silence as the people took stock of him.
A young man piped up, "Where is my brother's body?"
He only said it to protect his family's reputation.
Fan Tianshui's aura was intimidating and no bystander was willing to get in his way.
"Body? Are you so eager to see him dead?" Fan Tianshui replied.
The words triggered a response somewhere else. "How dare you say that?"
Fan Tianshui side-eyed the person and they immediately shut up.
"Chief Zheng is in charge of the rescue. Your brother is in good hands. Now, all of you, please disperse." Fan Tianshui waved them away. The tension in his arms suggested he would not lose a physical fight.
Since Fan Tianshui became a security guard in the hospital, his diet had improved greatly and his body gradually recovered. While his savings remained meager, he was happy to maintain peace and order for the emergency department.
"Brother, where is the operating room?" the patient's cousin asked, voice cracking. Although there was much anger in him, he knew better than to agitate Fan Tianshui.
"Do not cause a scene here, or else we will report you to the public security bureau," Fan Tianshui warned.
He was built like a bandit from ancient times, so it was odd to hear him threaten them with the public security bureau.
"Direct family members, please follow me," Fan Tianshui ordered. He led them to the waiting area outside the emergency department operating room.
Some families of other patients, and even certain mobile patients, followed the group.
No one could resist an interesting story.
"Please mind your behavior. Chief Zheng is operating inside." Fan Tianshui stood guard at the operating room entrance, his expression stern and unflinching, as everyone waited outside.
Chapter 376 - A Successful Rescue
"Boss, this emergency rescue has proven to me how experienced you really are," Su Yun joked after he sewed the heart and noted a sinus rhythm on the ECG monitor, knowing that the patient would survive.
"I could feel the pericardium with my fingers, but not the myocardium. That meant high pressure. The diagnosis was obvious." Zheng Ren retrieved the warm saline from Little Yiren and poured all of it into the patient's thoracic cavity. He then returned the empty vessel to ask for more.
"It sounds easy to open someone's c.h.e.s.t in the emergency rescue room and give them an open-c.h.e.s.t cardiac massage, but most people don't have the courage to do it," Su Yun said.
He was telling the truth.
Technically speaking, the patient was already dead.
Applying a continuous closed-c.h.e.s.t cardiac massage would not bring the patient back to life. They needed to open the patient's c.h.e.s.t to relieve the cardiac tamponade, where the bleeding could be so intense that it would shoot up the ceiling from the pent-up pressure. An operation like this would deter most doctors.
Why?
Even if they manage to revive the patient, the patient's c.h.e.s.t was exposed to non-sterile conditions. Atelectasis, pulmonary infection, and myocarditis were common postoperative complications.
There would be a long list of complications after surgery.
If they fail to resuscitate…
Haha, congratulations. There was a 50% chance that they would be involved in a medical dispute, which could end their career right then.
"I didn't think it over too much," Zheng Ren answered simply and honestly.
His entire focus was to save the patient.
He gave his best effort no matter what.
He could not just turn his back on the oath to save lives regardless of the final outcome.
"Boss, you seem rather dreary most of the time. Why do you turn into an entirely different person when it comes to an emergency rescue?" Su Yun asked.
"There's no such thing. I'm always cool-headed and organized. Yanran, double-lumen intubation," Zheng Ren ordered Chu Yanran to intubate the patient with a double-lumen endotracheal tube as he talked to Su Yun, checking if there were any leakages in the lung.
"Are you sure about that? You kicked a doctor back in Imperial Capital when you were trying to save Fang Lin. Today you kicked the patient's family
member!"
"We were running out of time and she had a death grip on the gurney. Who would be to blame if the patient dies?" Zheng Ren answered calmly.
At this point, his nerve and enthusiasm from the emergency rescue had subsided.
Zheng Ren replayed the situation in his mind. Given a second chance, he would still kick the patient's family member who was in the way.
The patient's family was grieving; she thought that the patient had died. Her good intentions were hindering the rescue.
"Aren't you worried about medical disputes?" Su Yun asked while he suctioned the excess saline from the c.h.e.s.t with an aspirator.
There were no bubbles after carefully observing the saline in the c.h.e.s.t cavity.
"I was before but Little Six said that he deterred all the medical dispute profiteers from Sea City General Hospital. Normal patient's family members are pretty reasonable. Furthermore, there shouldn't be a problem with Fan Tianshui around." Zheng Ren observed closely for a while more before checking the bright red System monitor in the upper corner of his eye. After seeing that there was no lung rupture, he said, "Close the c.h.e.s.t."
Ding dong~
The mission complete notification sounded in Zheng Ren's ear at that moment.
[Emergency Mission: Reviving The Dead completed.
[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: 45 minutes, 2 hours 15 minutes remaining.]
The rewards were not too bad. Master-rank emergency rescue… Zheng Ren relished for a moment before returning his focus to the surgery.
"There's no technicality required for this type of surgery," Su Yun complained, "Boss, I thought today was finally my time to shine. Are you trying to steal my thoracic surgery?"
"Hmm? Didn't you suture the heart?"
"No one was around to see that," Su Yun said, "When I saw the wound, I knew that the patient was having a cardiac tamponade. I was about to cut it open and administer an open-c.h.e.s.t cardiac massage. Who knew that you would steal that from me. Can't you just be a normal general and interventional surgeon?"
"I was in a hurry and didn't have time to think. I just did it since I know the procedures." Zheng Ren laughed. When he saw that Su Yun finished suctioning the saline from the c.h.e.s.t cavity, he continued, "Prepare antibiotics: eight vials of Cefoperazone-Tazobactam. Do a skin test."
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