“Yes, that’s me.” Old Chief Physician Pan’s voice was authoritative.
“Right, right. And what do you think it is?
“Let me ask him.”
Old Chief Physician Pan covered the phone receiver and turned to Zheng Ren.
“Zheng Ren, there’s a 72-year-old male patient who has been transferred from the gastroenterology department to the ICU. He came in two weeks ago with bloody stools.
“The bleeding was controlled on the sixth day of admission but his condition warranted a continued stay in the ICU. At 1400 hours today, the bleeding started again. There was more blood this time and antihemorrhagic agents were ineffective. The consensus from the general surgery department was to not opt for surgery,” Old Chief Physician Pan explained.
Zheng Ren knew Old Chief Physician Pan was asking for his medical opinion.
The department had decided to forgo surgery as the patient was elderly and they could not identify the bleed.
The patient’s intestines were a mix of fresh and old blood. An endoscope would not be able to pinpoint the site.
It was not an uncommon case in hospitals.
Such situations often depended on the patient’s luck.
The best-case scenario was for the bleed to stop without external interference. Once the patient was stable, they could proceed with thorough examination and treatment.
However, the worst outcome would be acute uncontrolled bleeding leading to death.
With a standard laparotomy, locating the bleed required some luck.
Although luck was the last thing one wanted to hear in the field of medicine, it was inevitable.
Zheng Ren pondered for a moment then said, “It’s doable.”
His answer was curt. A life was at stake and there was no time for long-winded explanations.
Old Chief Physician Pan had total faith in Zheng Ren. “We’ll be there in 20.”
The call ended.
“Let’s go. How much is the total?” Old Chief Physician Pan stood up swiftly.
The restaurant owner laughed and said, “Chief Pan, we are honored by your patronage here. If we were to take your money, you…”
There was an emergency back in the hospital to attend to; Old Chief Physician Pan could not be bothered with ceremony and threw down a 500 yuan note before turning to leave.
The group, earlier in good humor, immediately snapped to attention like well-trained soldiers.
Unwilling to accept the money, Mr. Sun tried to return it to Old Chief Physician Pan.
However, his approach earned him a glare from the old doctor. He slinked away in fear.
The group got into their car and drove off toward the hospital without another word.
As a surgeon, one had to always be prepared for any emergency surgery. Even though it was a welcome party, Chu Yanran, Zheng Ren and Xie Yiren had not consumed any alcohol.
It was better to err on the side of caution and be prepared for emergencies.
Upon reaching the hospital, each went to attend to their own duties. Old Chief Physician Pan brought Zheng Ren and Su Yun to the ICU.
“Zheng Ren, what’s your plan?” Old Chief Physician Pan asked as they walked.
“We have to perform a radiology imaging: if it’s a standard bleed, we’ll open up the abdomen. If the bleeding site is difficult to find, we’ll perform interventional embolization then cut off the necrotized parts of the intestines,” Zheng Ren answered confidently.
Old Chief Physician Pan had no words.
Zheng Ren was suggesting destructive surgery!
Superselection of the superior mesenteric artery and embolization of the subsequent arterial branch would stop the bleed, but it also meant cutting blood flow to parts of the intestines.
This was a surgical taboo!
Su Yun’s footsteps faltered for a moment before picking up to catch Zheng Ren, whispering, “I think it’s possible.”
“Yeap.” Zheng Ren nodded.
“Zheng Ren, are you confident?” Old Chief Physician Pan asked.
“Yes, as long as the patient’s condition is stable for surgery,” Zheng Ren said reassuringly.
“Alright.” Old Chief Physician Pan said nothing more. The three men walked in silence toward the ICU.
They changed their outfits before entering the ward; its chief, Dr. Qian, was by the patient’s bedside with crossed arms, watching the vital signs monitor and speaking to Chief Sun from the second general surgery department.
Both monitor and ventilator worked with an urgency to keep the patient alive.
How familiar… Zheng Ren studied the scene before him, his comfortable stint in Imperial Capital a distant memory.
“Little Su, you’re back.” Department Chief Qian neglected Old Chief Physician Pan and Zheng Ren in favor of Su Yun.
Su Yun smiled in response.
Old Chief Physician Pan went by the patient’s side and analyzed the man’s vitals: blood pressure at 70/50 mmHg, breathing at 24 breaths per minute, pulse at 121 beats per minute, oxygen saturation 89%.
The patient was going into hypovolemic shock.
“Chief Pan, you’ve arrived. Oh, Zheng Ren, you’re back too,” the second general surgery department chief said.
“What is general surgery’s view on this?” Old Chief Physician Pan asked.
“There’s not much we can do but issue a critical illness notice. Chief Pan, you know that surgery is near impossible.” Department Chief Sun shook his head but his eyes flicked surreptitiously to Zheng Ren.
Chief Qian let out a sigh. “Indeed.”
Old Chief Physician Pan had come to fulfill his responsibility as a doctor, but his presence was of no help to the patient.
At the top right corner of Zheng Ren’s vision, the System display flashed red as it diagnosed the patient: hemorrhagic shock, electrolyte imbalance, lower gastrointestinal tract bleed.
The patient’s condition was deteriorating by the minute. Zheng Ren let out a heavy sigh.
He understood their reluctance to operate as he, too, was once a general surgeon. What could a general surgeon do with a GI tract filled with blood? Cut open the intestine to find the bleed?
In such cases, there was a high chance that opening up the abdominal cavity would lead to the patient dying of blood loss before the bleed could even be identified.
It was either death on the operating table or death in the ICU ward.
From the second phase of the System mission, The First Stage of The Great Beginning, Zheng Ren had been rewarded with the memory of 3,000 gastrointestinal anatomical dissections.
However, his surgical skill was limited to appendicitis and hernias.
This case would require him to spend some time in the System’s intensive training modules.
Recalling the amount of training time he had, he said unhesitatingly, “Let’s give it a try.”
“Oh? Little Zheng, you have a different opinion?” Department Chief Sun responded, evidently waiting for Zheng Ren to speak up.
“We can try an interventional method to search for the bleed.”
Department Chief Qian’s brows furrowed. Interventional radiology was a foreign topic to him, but he was willing to give any proposal a shot.
Department Chief Sun was all smiles. “I knew we could count on you.”
“We have to give it a try at least,” Zheng Ren replied.
“Little Zheng, we’re not familiar with the process, so could you communicate it to the family?” Department Chief Qian asked.
“Sure.” Zheng Ren looked at the patient and asked, “I need at least 10U of RBC [1] and 1L of plasma. Are there signs of coagulation failure?”
“Boss, you head on and talk to the family, I’ll handle the arrangements,” Su Yun interjected, “I’ve just had some drinks so it’s best I don’t meet them.”
Department Chief Qian and Department Chief Sun stared at Su Yun in surprise.
Boss? Was that what he called Zheng Ren?
[1] Red blood cells.
