“Your brutal honesty never ceases to amaze me. Can’t you be a little bit more tactful when speaking to a world-renowned professor?” Su Yun needled Zheng Ren.
“Heh.” Zheng Ren huffed out an unamused chuckle. He made another call to Xie Yiren and Chu Yanran, instructing them to prepare for the surgery.
Once that was done, Zheng Ren called Feng Xuhui again to check on the status of the delivery and remind him of its urgency.
Lastly, he called up Old Chief Physician Pan to provide an update on the situation.
Zheng Ren and Su Yun arrived at the doors of the operating room just as the last call ended.
They changed their outfits in silence.
The patient had yet to be moved, so Zheng Ren did not rush. Seeing that Su Yun had already changed into surgical scrubs, he said, “You go on and help with the setup. I’m gonna light a smoke.”
It was common to have a cigarette to calm one’s nerves before a surgery. Su Yun made a noise of acknowledgment and headed into the operating room.
Zheng Ren went into the tiny smoking room and lit a cigarette. He took a long drag before entering the System.
Without any hesitation, Zheng Ren exchanged all his experience points for training time on top of the time he had been awarded before.
The System’s operating room rose from the ground, fully equipped with simulation mannequins.
Zheng Ren began his intensive training.
Jugular vein catheterization was effortless.
The guide wire traveled down the vein and into the heart, and then the hepatic vein. All was going well.
Journeying through the venous network was easy for someone who could maneuver a guide wire into the smallest arterioles of the prostate.
However, the most difficult step was coming up.
From the hepatic vein, he made an estimate and proceeded with the puncture.
Failure…
He switched positions.
Failure…
Another position.
Failure…
A dozen attempts later, he had still not established a connection between the hepatic and portal veins.
How demanding…
How arduous…
No wonder it was the crown jewel…
After the 42nd failed attempt, Zheng Ren took a break.
Training time was precious but there was no guaranteed success if he continued stabbing in the dark.
The portal vein had a large lumen. Even its branching venules were wider than most other vessels.
It required a lot of luck to accurately pinpoint the position of the portal vein within the liver from the hepatic vein, and more so to successfully puncture it.
What other skills did he require?
Zheng Ren rifled through the library in his mind.
A dozen failed attempts would not lead to the patient’s death.
The liver was a solid organ that could withstand the small-bore punctures of the puncture needle. The pressure within the organ would stem the resulting bleed.
However, there was a limit to the number of failed punctures before the liver became irreversibly damaged.
Zheng Ren ballparked the number at anywhere between 20 to 30 tries.
Hence, each TIPS surgery entailed up to 30 attempts at blind punctures. No wonder the average completion time was 4 hours and 23 minutes. The surgeons were all trying their luck.
Were Zheng Ren handling a real patient and not a simulation mannequin, he would not be as bold in his blind attempts.
He decided to pause practical work in favor of the theoretical.
After all, one ought to sharpen their axe before attempting to chop wood.
Zheng Ren left the System’s training grounds and sifted through the volumes of information stored in his brain.
The memories of medical books and journals came to the forefront of his mind at the snap of a finger.
His Grandmaster rank in interventional surgery was essential for understanding and digesting the copious amount of information that he had once struggled to make any sense of.
Zheng Ren’s proficiency in liver dissection was also a boon in this case.
All knowledge and skill were made possible by countless trials and errors throughout history, and the many lives that were sacrificed in the name of science.
The System had its downsides.
First, it was stringent with time. It counted each second that passed and once his time was up, Zheng Ren would be kicked out of the surgical training room. There was no negotiation.
Secondly, it expected the host to be independent. There was no guidance provided, no wise guru to pass on words of advice.
It was just Zheng Ren alone, fumbling through literature, knowing full well that some experiences were hard to put down in words.
He committed his mind to memorizing the whole TIPS procedure and integrating that knowledge with his experience of liver dissection. Then, he noted down all reported attempts at the procedure.
He called for a new simulation mannequin.
The previous mannequin was unusable after dozens of failed punctures.
Jugular vein puncture, access to the hepatic vein, followed by an attempt at a portal vein puncture.
Failure…
Failure…
Failure…
F*ck!
Zheng Ren almost went crazy.
He thought he had all the information he needed to succeed. The TIPS surgery was a combination of interventional methods and general surgery.
Zheng Ren was a rare two-headed snake, being a Grandmaster in the former and a Master in the latter.
He even had almost a thousand cases worth of experience in liver dissections. Such an experience would not have been possible without the System.
Yet… It was still not enough for the TIPS surgery?
Impossible!
Zheng Ren refused to think that he was incapable.
If he could not do it, there was no way anyone else could.
He had to have taken a wrong turn in the heat of the moment.
Where was his mistake?
Zheng Ren waved and dismissed the training room.
There was a limit on his training time but outside the System, time was even more precious. The patient was already on his way to the operating table.
Zheng Ren sat by the lake. His eyes fell on the realistic fox statue as he recalled his every step during the surgery. What was there to improve upon?
A burning sensation shook him from his quiet reflection.
Exiting the System, he tossed away the cigarette that had burned all the way to his thumb.
He called Su Yun; the doctor was to receive the materials from Feng Xuhui and then only ask for him once the patient was ready for surgery. Zheng Ren wanted some uninterrupted alone time.
Su Yun was perplexed but did not question Zheng Ren’s decisions when it came to emergencies.
The call ended and Zheng Ren cleared his vision before entering the System once again.
What was his mistake?
Zheng Ren went through the steps of the TIPS surgery again. The difficulty was in that single step. The puncture needle was affected by blood flow in the portal vein.
Was the solution in radiology?
CT? MRI?
Suddenly, Zheng Ren remembered the reward from the mission, The First Stage of The Great Beginning. It was a passive ability, Integration.
Perhaps that was it?
It was worth a shot.
The simulation mannequin was a docile and compliant patient that could be maneuvered as he pleased.
Zheng Ren entered the surgical training room. He did not rush to perform the surgery, instead spending some time analyzing CT and MRI scans.
His time was ticking away but he remained calm and focused.
A sharpened axe was what he needed.
A few hours later, Zheng Ren’s eyes ignited with understanding.
