“The knot is too tight and there’s too little room for excision.” Department Chief Sun prodded the necrotizing gallbladder with a hemostatic clamp.
“Do not untangle the knot. Necrosis has been going on for too long. If gangrenous tissue enters the hepatic duct, it’ll be problematic,” Zheng Ren said matter-of-factly.
“But…” Department Chief Sun glared in frustration at the twisted knot that held the cystic duct, blood vessels and hepatic duct.
There was no extra space at the base of the gallbladder to perform a resection and suture. If they forced it, the suture would likely unravel. Hence, they could not proceed with the cholecystectomy without untangling the knot.
“May I have a go?” Zheng Ren asked politely.
Department Chief Sun was elated to hear the offer and nodded.
That was why he had called the man here in the first place, after all.
This was a surgical consultation.
The practice of operating without the lead surgeon’s approval was frowned upon. Such a move could soil the relationship between two professionals.
Once the green light had been given, Zheng Ren went to change and scrub in.
When he returned in a surgical gown, Department Chief Sun called out to him. “Little Zheng, come over here.”
Zheng Ren hesitated for a moment before approaching.
The surgeon’s position offered the best view of the surgical site. However, under certain special circumstances, the surgeon’s view was obstructed and the assistant would help from their position.
Department Chief Sun stepped aside and Zheng Ren unabashedly stepped into the lead surgeon’s spot, studying the gallbladder before him.
The chief had started off with a laparoscopic cholecystectomy but switched to a laparotomy when he noticed the atypicality.
However, the problem had remained unsolved even after he opened up the abdomen. This was the first time he had witnessed gallbladder torsion of this severity. It looked like a fried dough twist from 18th Street.
If they had started the surgery before necrosis had set in, the surgery would have been much easier. All he would have had to do was untangle the knotted organs.
Unfortunately, a few hours had been enough for the gallbladder to become gangrenous. It was saturated with fluids, which meant they could not untangle the knot; the slightest movement could tear apart the organ.
The consequences of that were dire.
No one spoke in the operating room, not from Director Xiao’s presence, but the complexity of the patient’s condition.
A lead surgeon would usually be in a bad mood upon encountering such a complicated case. Anyone attempting to joke in the operating room would be on the receiving end of a clamp missile.
Zheng Ren extended his hand and waited. Then, he realized his mistake and softly said, “Hemostatic clamp.”
The tool was passed to him, but the force with which it was pressed into his palm discomfited him.
He started with blunt separation of the swelling surrounding the gallbladder. Department Chief Sun watched with trepidation, as the thin tissue walls were easily perforated.
Being too gentle would accomplish little.
Excessive strength would cause irreversible damage.
“Scissors,” Zheng Ren said a few minutes later, his hand outstretched.
A pair of scissors was given to him.
Zheng Ren looked at them and placed them by the patient’s thigh. “Blunt scissors.”
The scrub nurse jolted and quickly handed him the requested tool.
Zheng Ren sighed internally. He strongly preferred his own scrub nurse.
However, asking for Xie Yiren would be too impudent, so it was best he put up with his lot.
“Move the retractor higher.”
“Pull harder.”
“Here. Hemostatic clamp. Careful with the pressure.”
Zheng Ren constantly coached the assistant throughout the surgery. The time it took for the assistant to shift the retractors seemed longer than the actual surgery itself.
Director Xiao shook his head. Department Chief Sun and his assistant had utterly humiliated themselves in front of a foreign professor.
He would have a word with them after the surgery.
In the operating room, Zheng Ren gave out instructions in his monotonous voice to the assistant, who gritted his teeth.
A fiery anger burned in his chest.
In his opinion, the way he had positioned the retractors was sufficient to provide the lead surgeon a suitable view into the surgical site. He believed Zheng Ren was nitpicking on purpose.
If the surgery went wrong, Zheng Ren could shift the blame, citing subpar assistance during the procedure. That would be 30% of the culpability off Zheng Ren’s shoulders.
“Prep 3#0 atraumatic needle and suture. Smallest size.” Then, Zheng Ren repeated his previous instruction, “Widen the smaller retractor. I need a better visual of the liver area.”
The monster residing within the heart of the second general surgery department chief resident roared.
“Steady your hands. Hold on a little longer if you’re tired.”
The monster grew, almost breathing fire.
“I need a better view to perform blunt dissection of the Glisson’s capsule.”
“Steady the large retractor. Don’t move.”
Manning the retractors was a test of strength for a surgeon’s assistant.
The second general surgery department chief resident could not predict Zheng Ren’s next move, which was why he was always one step behind rather than ahead of the lead surgeon.
As Zheng Ren operated, more instructions were given to the assistant and the scrub nurse.
The atmosphere surrounding the operating table was uneasy and awkward.
The furious beast in the assistant’s heart was beginning to rival Godzilla, but he held his temper. The thought of Zheng Ren blaming him for the surgery’s failure made him persevere.
“Boss, shall I step in?” Su Yun called out from amongst the crowd.
“Has the patient been sent to the ICU?”
“Yes. She is stable. They’re giving her a blood transfusion to mitigate any complications as she bled heavily from her fractures. We couldn’t get fibrinogen, but I’ve told Chief Qian to reach out to others. Not sure if we’ll find some,” Su Yun explained.
“Chief Sun?” Zheng Ren said so softly that only the people next to him—Department Chief Sun and his assistant—could pick up the words.
The assistant understood what was being asked. The vein on his forehead bulged.
“Little Lei, go and take a break. Su Yun, you take over,” Department Chief Sun ordered.
Su Yun went ahead to scrub in.
He came up to the operating table and flinched at the state of the patient’s organs. “How are we doing this?”
“By splitting the liver,” Zheng Ren answered.
The words fell like a bomb onto the heads of every doctor present.
A hepatectomy was usually part of the treatment of a liver cancer patient, when the tumor was between 3 to 5 cm. It was not a common surgery as it required specialization.
The liver was a fragile organ with an abundance of blood vessels. After the wedge resection, reattachment of the remaining tissues to stop the bleeding was a complicated procedure.
Once Su Yun was clear on the procedure, he turned to the nurse, smiled and requested several surgical tools which were then arranged beside the patient’s lower body.
The operating room finally fell silent.
Su Yun matched each move made by Zheng Ren. Be it manipulating the retractors to give Zheng Ren a better view or assisting with the hepatectomy, Su Yun did everything without a word from Zheng Ren.
The surgery was smooth-sailing.
The effortless cooperation between Zheng Ren and Su Yun was a stark contrast to the previous arrangement.
It was a far cry from the second general surgery department chief resident.
A section of the liver was resected, followed by hemostasis. The cystic duct, hepatic duct and relevant blood vessels were cut before the gallbladder was removed. Another round of bleeding control later, the liver sections were reattached with its ducts and vessels.
The rage in the chief resident’s heart immediately subsided as he watched the surgery.
Zheng Ren was in the right.
Their coordination put his own performance to shame; the chief resident slinked away, unable to show his face any longer.
