The emergency doctor from the ultrasound room recognized Zheng Ren, since most of his patients were from the emergency department.
He laughed. “Chief Zheng, are you planning to do the B-scan yourself?”
“I know a little,” Zheng Ren retrieved the probe from him and moved it around the patient’s abdomen to search for the location he wanted, looking closely at the image on the monitor.
There was obstruction at the far end of the bile duct. Zheng Ren switched between two different positions, lateral and anteroposterior, to confirm that the obstructions were not made of dense calculi but rather decomposing, fermented food debris.
The obstruction point matched complications from side-to-side choledochoduodenostomy and disproved the differential diagnoses of Roux-en-Y choledochojejunostomy and choledochoduodenal fistula.
It was apparent that dilation of the bile duct was the leading cause of the patient’s obstructive jaundice.
There was also gas in the biliary tract as well as cysts in the liver that he strongly suspected to be liver abscesses.
All symptoms pointed to sump syndrome. From her condition, the patient required emergency surgery.
Zheng Ren put the probe back onto the B-scan ultrasound trolley and threw a piece of tissue on the patient as he thought about the procedure. “Wipe her down,” he said casually.
“Chief Zheng, are you sure?” The B-scan doctor was very impressed by Zheng Ren’s skill and was aware that he could never reach the man’s level.
He might not have been able to do exactly as Zheng Ren had done, but the job was done, and he did not even have to lift a finger.
His question came as he wiped off the coupling agent on the patient.
“I’m quite certain of it,” Zheng Ren said, “Chief Xia, if the family members agree, let’s proceed with surgical treatment. Please inform them to seek me out in the emergency ward for preoperative preparations.”
“Alright.” Chief Xia nodded, her expression heavy and serious.
This patient and the one who underwent TIPS surgery the night before were entirely different.
Chief Xia did not know this one personally and could not guarantee for or sign off for the emergency surgery as she had then.
She had to communicate with the patient’s family members and brief them about the condition at hand, but could also hand such duties over to Zheng Ren.
Zheng Ren left the gastroenterology department, still debating between a laparoscopy or laparotomy.
A laparoscopy would leave only a small wound. Patients in the emergency ward who had undergone a laparoscopic cholecystectomy all returned home after the first night of surgery.
However, to treat all the complications in a single surgery, an open cholecystectomy would be the best choice.
Still…
“Boss, the way you threw the tissue on the patient and told the guy to do the wiping made you seem like a f*cking douchebag,” Su Yun chuckled.
At a moment like this, only Su Yun was able to joke around.
Zheng Ren was shocked but immediately understood what Su Yun was implying. Being distracted had let him drop his guard.
Douchebag… tsk tsk.
How fitting. Zheng Ren was amused.
Su Yun followed up with a serious question. “What were you thinking about?”
“I’m deciding between a laparoscopy or a laparotomy.”
“You have to perform a laparotomy. It’s difficult to remove food debris with a laparoscope. You would also need to administer antibiotics after a surgery, which is such a hassle. Most importantly, I don’t want to hold the monitor,” Su Yun said frankly.
Even though Su Yun looked delicate and frail, he preferred a wide, open surgical field, which was why he had chosen thoracic surgery as a research student.
Following the minimization of general surgeries, there was a steep decrease in open thoracotomy. An incision 40 cm long was rarely seen anymore.
Zheng Ren suspected that this was Su Yun’s original intent behind learning heart transplants.
“Let’s opt for laparotomy, then,” Zheng Ren concluded, not because Su Yun did not want to hold a monitor, but because the patient had a very complicated condition. They could require a B-scan ultrasound probe to locate liver abscesses during surgery before puncturing and draining them of pus. Furthermore, they had to treat the obstructive jaundice with all the accompanying procedures.
They both returned to the emergency ward. Old Chief Physician Pan had assigned Yang Lei to the first shift.
Chang Yue had brought the professor around each ward to speak to the patients and discuss how they had violated orders against returning home last night.
After completing the ward rounds, she noticed that patient compliance rates had at least doubled simply from bringing Professor Rudolf Wagner along.
In Sea City, it was common to bring house officers around during ward rounds. However, no one had ever seen a foreign ‘house officer’ before.
The ward was in total order. Zheng Ren informed Yang Lei to prepare for surgery.
Since Yang Lei had made the request that day, Zheng Ren also intended to let him take over part of the surgery to let the man improve.
It was only several months ago that Zheng Ren had to deal with Cen Meng and Chief Liu not allowing him to perform surgery.
He had never expected to now be in a position to allow someone else to do it.
Come to think of it, everything seemed too mystical.
Shortly after, Zheng Ren received a call from Chief Xia to inform him that the patient’s family members had agreed to the surgery and were on their way to the emergency ward. She would send the patient to the operating room after completing preoperative assessment.
Chief Xia was very efficient at her job, which was a trait that Zheng Ren admired.
Zheng Ren did not rely on Yang Lei or Chang Yue to conduct the preoperative briefing.
The family could be unclear about the patient’s medical history. Zheng Ren wanted to clarify if they had withheld it on purpose or out of ignorance.
There was a vast difference between the two.
The family did not take long to reach the emergency room. They were two middle-aged men; the patient’s sons, presumably.
Zheng Ren had seen them before in the ward.
They both looked friendly and positive.
Zheng Ren questioned them about the patient’s past conditions. Their body language conveyed that they lacked the pertinent medical knowledge. In addition, the patient had received her surgery many years ago, when they were still children.
After confirming his speculations, everything went according to plan.
He briefed them on all possible outcomes of the surgery and also updated them about the patient’s current condition. They had no other choice but to proceed with surgery, and even that had a 30% chance of ending in failure.
When he finished, they turned white and broke into a cold sweat.
Su Yun joined Yang Lei for the operating theater after completing preoperative preparations.
The family members signed the surgery consent form, which Zheng Ren passed to Chang Yue before leaving for the operating room.
Professor Rudolf Wagner and Zheng Ren entered the operating room and changed. The professor did not once again try to persuade Zheng Ren to form a research team in Heidelberg University in Germany.
Zheng Ren did not care about the professor’s true intentions, being entirely focused on the upcoming surgery.
Sump syndrome. Hopefully, it was not too serious.
As he changed, he entered the System’s operating room to practice ten related general surgeries.
All the surgeries were successful, as Zheng Ren had a Master rank in general surgery with experience in hepatobiliary anatomy on top of that. Local anatomy was extremely useful.
As long as one had a strong foundation, it would be easy to learn any surgery.
After ten rounds, he was very well-versed.
He had just finished changing and entered the operating room when the sound of the stretcher trolley reached him.
“Chief Zheng, I’m going to start anesthesia. Do you need anything?” Chu Yanzhi asked.
“General anesthesia. Nothing else for now.”
