Chapter 759: The First Patient
Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
“The patient… should have been anesthetized, right?” Selena the interpreter asked in a low voice, and her worries were very obvious.
“Hmm,” Ling Ran answered, but he did not immediately take any action. Instead, he quietly observed the patient and said, “We’ll use as little time and as few steps as possible to handle the patient’s wound. We’ll focus on keeping him alive.”
He tried to explain it in a clearer manner. The manpower in the operating theater was not enough, and the assistants did not have sufficient experience… In fact, he did not even have an assistant. He had only a nurse and an interpreter who had her hands washed, and he even needed to guide them while he operated on the patient.
Under this situation, performing a complete surgery would be challenging his limits.
Ling Ran did not mind challenging his limits, but he could tell even with his gallstones that the patient would definitely not want to accept any extreme challenges. Besides, the time spent on a complete surgical process would be long, and it was also a disadvantage for the patient’s treatment.
Therefore, even though Ling Ran wanted to perform the complete surgery, he could hear Huo Congjun’s growls in his mind at that time. “We must save the life first, the treatment can come later!”
After staying for such a long time at the Emergency Medical Center in Yun Hua Hospital, Ling Ran agreed with Huo Congjun’s ideals a lot.
Ling Ran moved the patient slightly, then he read the number on the screen and judged the amount of anesthesia he would need before he said, “Also, take note of the urine output during the surgery. If you can notice it, also report the blood loss and douche volume.”
“How much is considered the norm?” Selena wanted to take up the job.
Ling Ran shook his head. “According to the patient’s weight, the normal urine output should be 0.03 ounce every two pounds per hour, but there are other factors, so just report the numbers to me. Pay more focus on decreasing urine output. If it increases, normally, it won’t be a big problem.”
“Alright.” Selena then asked the nurse other questions in a low voice. When she raised her head again, she saw Ling Ran flip the patient as if he was flipping a salted fish.
Selena looked at the patient’s bleeding wound, and she could not help but spoke like a medical professional, “Doctor Ling, aren’t we starting now?”
“Wait for a little longer,” Ling Ran said.
“Why?”
“We’re trying to ensure the depth of anesthesia,” Ling Ran answered.
Selena did not understand the meaning behind his words, so she repeated what Ling Ran in puzzlement, “Depth of anesthesia?”
“Yes, if the anesthesia depth is not enough, awareness with recall (AWR) might happen,” Ling Ran said it lightly, but he was actually telling her the greatest terror of a surgery.
AWR referred to a patient waking up from general anesthesia during surgery.
Imagine a group of people cutting your body, then you woke up. But this was not the scariest point. The scariest point was that nowadays, the anesthesia programs used were all combined anesthesia, therefore, even if the patient experienced AWR, he might not be able to express himself due to the use of medicine like Skelaxin.
In other words, when AWR happened, the patient was conscious and his pain was continuous, but he could not speak, could not shake his head, and could not even tighten his muscle to resist the pain.
If this was not scary enough, the bigger fear of AWR was that after the patients who experienced AWR woke up, most of them did not know that they went through AWR.
Because of the use of anesthetics, when the patient woke up, he might have forgotten all that he suffered over the past two hours.
Meanwhile, AWR was hard to avoid. As everyone had different physiques, the anesthetic also could not be repeatedly administered drugs without any limitations.
For Ling Ran, it was even harder to control the use of anesthetics, since he had just learned it.
Therefore, Ling Ran needed to observe a little more. At the same time, he must try to reduce the surgery time as much as possible. In this situation, this was extremely beneficial.
The operating theater remained slightly quiet for a while.
Soon after, Ling Ran was seen picking up a scalpel and immediately cutting open the patient’s abdominal wound.
“Trauma in intestines,” Ling Ran said before he cleaned and sutured the wound. Then, he cleaned and injected antibiotics before he inserted the drainage tube and started to perform abdominal closure.
This abdominal closure was not a complete abdominal closure. He only did a simple suture that would not allow the abdomen to be opened.
Using a temporary solution within what was considered the inalienable rights of man was also a challenge for Ling Ran.
“We’ll now treat the shoulder,” Ling Ran said, and he started to change the patient’s posture.
Intestines and shoulders were not within Ling Ran’s skill coverage, but the difference when it came to providing simple treatment for wounds in each area of the body was not actually big, especially when it came to the treatment by the Emergency Department. The treatment provided during emergencies was always crude.
Now, Ling Ran also did not pursue any meticulous operations, and he was just like a normal resident doctor in the Emergency Department who just rushed ahead in performing a surgery that he was not very familiar with.
As a result, there was no running away from complications. If the same patient was brought to a big hospital for emergency treatment or thrown to a specialist for surgery, the period of hospitalization, along with other things, would be majorly different from the current arrangement. The patient would also be treated in a much better environment.
In fact, the current patient would definitely have to undergo a second surgery. If he were unlucky, he might need to undergo a third surgery. But it should be fine as long as he could survive.
Just like a newbie, Ling Ran cut open the shoulder with stiff movements and performed anatomical reduction for the patient.
This time, he did not have any skills to help him, and he even did not have any guidance from a senior doctor. Ling Ran could only rely on his previous experience and the knowledge he currently had to treat the patient.
Ling Ran performed rather slowly, but his actions were still skilled.
After all, it was an orthopedic surgery, which he was good at. Even if he rarely performed this sort of surgery, the difficulty of orthopedic surgery was not as complicated as those involving the liver and pancreas.
Most importantly, Ling Ran must complete this surgery. Otherwise, the patient’s shoulder would slowly cause more pain, and in a situation where they did not have sufficient painkillers, this patient would definitely be shouting in pain until his throat was hoarse.
Fortunately, Ling Ran knew how to treat Colles’ fracture, and he owned Perfect Level Colles’ Fracture Treatment. Therefore, performing anatomical reduction was not a problem for him.
He also had a lot of upper limb anatomical dissection experience. The system provided him with more than three thousand EXP points, and he had also dissected a lot of arms during surgery.
Compared with a normal doctor, Ling Ran’s understanding of shoulder anatomy may have been much deeper.
He was just not very familiar with the approach and steps for the surgery.
After all, the aim of the surgery was to repair the patient’s body. He could not act as if he was dissecting a corpse by cutting the body with a scalpel and putting everything together at the end.
Regardless of whether it was an open surgery or endoscopic surgery, they were all complex works to be done in a small space. Doctors needed to treat the patient in a situation where they had to create as small of a wound as possible. Once the wound was cut open, the doctor could not simply cut the patient further for his own convenience, but he needed to find a position that could avoid the important nerves, vessels, and muscles but would still help him achieve his surgery goal.
These kinds of positions and paths were all operative approaches. Generally, an operative approach could only be made after generations of clinicians perfected it over the years. Doctors without any experience basically did not have any other choice but to learn and memorize this kind of operative approaches.
If they wanted to create a new operative approach, it was totally impossible without rich clinical experience that expanded for around eight to ten years. Naturally, many clinicians would still only remember the popular approaches even after they had worked for more than twenty years.
Ling Ran always had a good memory. He slowly operated on the patient based on the operative approach, and finally, he treated the fracture at the shoulder. It was the second time that his head was covered in sweat.
“Selena, wipe my sweat. Nandaman, do the dressing.” Ling Ran did the groundwork for the nurse and started to dress the wound.
Selena and the nurse nodded at the same time, and they both felt sorry for Ling Ran.
“You sweated so much. It must have been really tiring.” Selena wiped off the sweat for Ling Ran, and she could not help but say, “It’s just one arm, don’t tire yourself out… Um, I mean, there are still many patients waiting for you.”
“Yes, it’s only meaningful if we treat one properly before moving on to the next.” Ling Ran nodded.
“With you around, we’ll still feel lucky even if we run into a deluge.” Selena wiped off Ling Ran’s sweat. Then, she lowered her hand reluctantly.
