Chapter 326: Spare No Effort
“No.” Zheng Ren handed suction over to Su Yun before opening the peritoneum and performing protective procedures.
The department of thoracic surgery chief’s surname was Zhang. He was rather short and stout, an unpleasant sight even in a face mask.
In the hospital, he was well-known to be stingy and petty. People rarely interacted with him unless it was important.
Chief Zhang felt somewhat awkward in front of the operating table, hesitating.
When Old Chief Physician Pan returned from his call to the blood bank, he saw Chief Zhang standing unmoving and glared at the man.
He did not blame Zhang for lacking the courage to start operating, though, since Yang Lili’s blood pressure was still undetectable. The chances of her surviving both a thoracotomy and laparotomy were very slim.
“Let’s perform a thoracotomy with exploration,” Old Chief Physician Pan said as he watched Chief Zhang mull it over.
Were there fewer directors present in the operating room, Chief Zhang would have rejected the surgery.
He wanted to ask why they were putting in so much effort to save someone who was already dead.
Blood pressure was still not showing up on the monitor. The patient’s heart rate was also extremely high and she had already been tachycardic for a while.
He watched the surgeon perform emergency general surgery at lightning speed. Within only several minutes, the surgeon had already found the ruptured superior mesenteric artery and started a suture.
Chief Zhang let out a sigh and said, “I’ll try my best.”
“Su Yun, help Chief Zhang,” Zheng Ren said without lifting his head. He reached out and received a saline-soaked bandage, which he used to cover the intestines while searching for both necrotization and stab wounds.
Hmm? Chief Zhang was stunned. He glanced at Old Chief Physician Pan out of the corner of his eye, noticing no opposition to Zheng Ren. Many questions arose in his mind.
He was aware that the emergency department had “taken over” emergency general surgeries. Were they going to absorb emergency thoracic surgery as well?
There were few people in the emergency department, but they were definitely ambitious.
Without looking at Chief Zhang, Su Yun turned and left the operating table. He began to disinfect the area for thoracic incision, proceeded to scrub in again and changed into a new surgical gown.
Chief Zhang felt helpless. What the f*ck was happening?
Nonetheless, he could not lash out in front of so many superiors. More importantly, Old Chief Physician Pan was a figure he dared not offend.
If he did… Liu Tianxing was still hospitalized and word was that his depression was so severe his liver was affected.
One had to surrender to fate when the time came. Chief Zhang started by asking the emergency department operating room matron for permission to use a sterile bag from the thoracic department surgery theater.
Su Yun ignored him and started to lay out sheets after scrubbing in and disinfecting the area. He stood beside Zheng Ren and both surgeries commenced.
Xie Yiren became even busier.
For such an unconventional surgery, mutual understanding without verbal communication was impractical.
Zheng Ren and Su Yun continually asked for different tools and Xie Yiren was barely keeping up.
After Chief Zhang had finished briefing the operating room matron about his department’s sterile bag and ordered his own chief resident to retrieve it, he turned to see Su Yun making an incision on the patient’s chest and was instantly angered.
“Stop playing around! You’re going to operate rashly without a retractor? This is a thoracic surgery, not your usual emergency surgery!”
He was right; for the ribs in the chest, special tools were required to retract the chest walls and expose the surgical field. General surgery had self-retaining retractors, but thoracic surgery was different.
Only two decades ago, thoracic surgery required the removal of one rib to expand the surgical field.
Even though his worries were reasonable, every minute and second in an emergency rescue was more precious than gold.
Su Yun was focused entirely on the thoracotomy. He had the confidence and pride of a rising star in cardiothoracic surgery. Why would he bother with complaints from a department chief of Sea City General Hospital?
No one else acknowledged Chief Zhang. Zheng Ren and Su Yun were busy with their respective surgeries. Behind the former stood Director Xiao and Old Chief Physician Pan, fully focused on the surgery and paying no heed to Chief Zhang’s words.
He had no choice but to scrub in. Perhaps he had spoken out of turn.
The operating table was unable to accommodate the usual number of people for both surgeries. In the thoracic surgery department, at least three people were usually required at the table for a thoracotomy. At the moment, only Chief Zhang and Su Yun could fit.
Yang Lei then became the busiest person there as the first assistant.
He had to hold on to the retractor while passing the surgeons their tools.
Zheng Ren was also multitasking, glancing over to Su Yun to check how the man was doing.
Su Yun was executing his part skillfully just like a trained thoracic surgeon, even better than those specializing in general surgery.
Zheng Ren had told Su Yun to assist Chief Zhang due to his experience in heart transplants in Imperial Capital.
Would any emergency case be a challenge to someone who had performed one of the most difficult surgeries?
No way!
To support Su Yun, Zheng Ren selected a Master level skill book without hesitation and added it to the cardiothoracic surgery branch of the skill tree.
Yang Lili had been stabbed twice in her chest when clinging on to the attacker’s arm out of desperation to stop him. After breaking free, he had stabbed her in the torso multiple times.
Fortunately, her liver and spleen were uninjured, but there were between seven to eight perforations in her intestines with some sections pierced right through.
The extent of contamination in her abdominal cavity was critical.
After repeated rinsing and suction with warm saline, he stitched up part of the mesenteric artery and they finally had a clear surgical field.
Repairing the perforated intestines was not a problem. Zheng Ren rapidly performed the suture and managed to fix it in no time.
The main threat was that the patient’s punctured mesenteric artery could lead to mesenteric ischemia and necrosis. After the artery was sutured, the intestines relying on blood supply from the sealed portion would inevitably end up necrotizing.
Cutting and suture of the intestines was now their main task in the abdominal cavity.
Zheng Ren would have preferred an assistant, but he could handle it himself if necessary.
Soon, Yang Lei was helping Su Yun perform other tasks. For Zheng Ren, he only needed to adjust the retractor to help expose the surgical field.
Zheng Ren tied the knot and cut the excess thread on his own. The scissors magically vanished and reappeared at intervals without interrupting his hand movements.
There was about 60 cm of necrotized intestine, which was within an acceptable range. Any more would risk other postoperative complications such as short bowel syndrome.
15 minutes into the laparotomy, Zheng Ren had already removed the necrotized intestine and sutured the healthy parts together.
Right then, fresh frozen red blood cells and plasma finally reached the theater.
“Each of you, take one.” Old Chief Physician Pan began warming a bag of red blood cells by hand.
Director Xiao watched the surgery with a deep frown.
Noticing the arrival of the blood bags, he got Office Director Ding to pass him one.
With the director of the hospital taking the lead, who dared decline?
A phone rang and the emergency room matron answered it. “The blood bank is empty.”
“Office Director Ding, contact the city’s central blood bank,” Director Xiao said, “At least 20 units of red blood cells.”
“Platelets and fibrinogen too.” Su Yun was still perceptive of his surroundings even during a surgery.
Director Xiao was also from clinical surgery; he knew that even if the patient was fit to leave the operating table at that moment, she would face multi-organ ischemia-reperfusion injury and disseminated intravascular coagulation complications.
He nodded.
Officer Director Ding ran out to make the call.
Soon, he returned and whispered into Director Xiao’s ear, “Director, the reserves of B-positive blood in the central blood bank are running low.”
The entire city’s supply depended on the city’s central blood bank. Rarer blood types or those used more often were hard to maintain.
“Contact the blood bank and hospital; get them to find people with the corresponding blood type to donate blood. Hurry up!” Director Xiao continued to watch the surgery, his face grim.
“Yes.” Office Director Ding immediately sprinted out of the operating room to fulfil his duties.
Under normal circumstances, even with an appropriate donor, the central blood bank had a cumbersome list of standard protocols that took up the entire day before any blood could be donated.
However, words from the director of the city’s largest hospital carried some weight.
Zheng Ren felt relieved hearing them.
With the hospital’s support, they did not need to worry about shortages of platelets and fibrinogen.
These two things were essential for the patient’s survival, but it was very difficult to get them nowadays, especially fibrinogen.
Because of the lack of fibrinogen, many porto-azygos disconnection surgeries could not be performed.
After suturing the patient’s intestines, they covered it with bandages soaked in warm saline for five minutes while Zheng Ren checked the abdominal cavity for any unattended injuries. After removing the bandages, he found some light bleeding on the anastomosis.
That was proof that there was no more necrotized tissue and that the anastomosis would not be a problem after surgery.
After several rinses of the abdominal cavity, they began to close it.