The patient was brought to the emergency ward. There was a series of preparation and documentation before they could start the surgery.
Although an emergency case dictated simpler protocols, everything took around 30 minutes before the patient was wheeled into the operating room.
When the patient was lifted onto the operating table, his systolic pressure was at 90 mmHg.
The decreasing blood pressure suggested that the patient’s condition was not as simple as the diagnosis given.
After the anesthesia, Su Yun repositioned the patient’s body and placed the first layer of surgical drapes. After that, he went to scrub in. Zheng Ren, who was already gowned, entered and started to set up the second layer of drapes.
The surgery was starting.
A pair of hemostatic clamps and some iodoform gauze were placed into Zheng Ren’s open hand.
The clamps were placed beside the patient’s lower body. The surgical site was disinfected, then Zheng Ren asked for a scalpel.
A 20 cm incision was made, followed by a blunt dissection of the layers below. Electrocautery was used to stop any major bleeding.
Cao Guozhen was in the operating room, standing behind Zheng Ren and observing the procedure from the surgeon’s point of view.
The thoracotomy was done perfectly with minimal bleeding.
He was still bitter about their earlier argument and told himself he would have done an equally good job if he was the lead surgeon.
A thoracotomy differed vastly from an abdominal surgery.
In the past, when electrocautery was not yet common in hospitals, a thoracotomy warranted at least 500 ml of blood loss.
Now, with Zheng Ren and Su Yun at the operating table, there was hardly any blood visible. Some of the larger blood vessels were isolated with the hemostatic clamps and quickly sutured.
The electrocauter was employed after the muscle layer was parted.
The whole surgery was performed so cleanly Cao Guozhen felt fear in his heart.
When did the two devils from the emergency department become so good at thoracic surgery? The idea of them stealing surgeries from the cardiothoracic department no longer seemed far-fetched.
Both Zheng Ren and Su Yun went straight for a thoracotomy instead of a fracture fixation procedure.
The severity of the fractures was an excuse to open up the patient’s chest.
They were crossing a line.
If the patient did not recover from the surgery, the family would have the right to sue Zheng Ren and Su Yun.
Of course, the two surgeons had acknowledged the risk when they decided to proceed with the thoracotomy.
A mirthless smile was covered by the surgical mask on Cao Guozhen’s face. These guys from the emergency department were brazen.
They were aware of the hospital procedures, right?
The patient did not carry the last name Zheng or Su. Why were they crossing the line?
Had the two surgeons forgotten their own names?
It was viable to perform the internal fixation surgery after checking the thoracic cavity. The patient’s family would never know and Cao Guozhen would not tell.
However, he would be wary of what happened in the future.
He watched the two surgeons carry on and wondered when disaster would strike.
They were in the process of opening the rib cage. A self-retaining retractor was placed in Zheng Ren’s hands.
The retractor was used to hold the layers apart, giving the surgeon an operative view of approximately 8 cm.
Usually, the operative view was less than 8 cm but due to the patient’s bone fractures, they were able to widen the field.
Su Yun found the silence in the operating room unbearable. “My initial foray in cardiothoracic surgery was because I wanted to perform surgeries like this. You get a clear view of the organs and you don’t have to touch any intestines and fecal matter. Don’t you agree, boss?”
As the gears of the self-retaining retractor turned, the patient’s lungs appeared.
The middle and lower lobes of the right lung each had a huge open wound. The edge of the opening was dark red.
Zheng Ren and Su Yun let out a sigh of relief.
Their instincts were right, there was something unusual about the patient.
Zheng Ren cursed the System for not indicating the severity of the injury.
There was a distinct difference between a 0.5 cm laceration and a 10cm by 10cm open wound.
The hemostatic clamps entered the operative view to investigate the injury. The front section of the clamps disappeared into the wound before its depth could be ascertained.
The middle lobe was almost punctured from front to end.
Behind Zheng Ren, Cao Guozhen was shocked.
What was this?
How did the patient not develop a hemopneumothorax with such an injury? It was impossible!
Impossible!
Cao Guozhen was at a loss.
In his ten years as a medical doctor, he had witnessed countless injuries but this was a first.
What was going on?
As Zheng Ren probed the surgical site, Su Yun was mumbling, “Boss, I think the rebar might have hit him really hard. The fractured ribs stabbed inward like a dagger and damaged the middle and lower lobes of his right lung. Furthermore, the elasticity of the ribs returned it to its original position.
“The impact was so strong that the injury caused was akin to penetrating trauma. During the impact, the bronchial artery was damaged and a large amount of blood filled the lung.”
Zheng Ren’s thought process was similar to Su Yun’s.
“The blood had filled the bronchus and bronchioles, which was why we could not observe the pneumothorax. The scan depicted pulmonary edema because the pressure inside the lung was high as the blood could not escape. Hence, we couldn’t see signs of a hemopneumothorax.”
Su Yun explored the patient’s lung as he continued talking, “The chance of misdiagnosing this case is so high.” He was in a good mood now.
This Su Yun was a different man from the careful and cautious Su Yun an hour ago.
Cao Guozhen stood as stiff as stone behind Zheng Ren.
Su Yun’s explanation made sense. However, if such an idea struck Cao Guozhen, would he risk an exploratory thoracotomy?
No, he would not have the courage to.
Performing a procedure on a patient without any indication or evidence opened oneself to lawsuits and investigations.
These two surgeons were incredibly ballsy.
Nevertheless, Cao Guozhen shuddered to think of what could have happened.
If Zheng Ren and Su Yun had not forced the issue, a few hours of monitoring would have seen the patient expelling blood from his nose and mouth.
The patient would be drowning in his own blood.
This would be more problematic than a typical drowning because coagulated blood led to clogged airways.
The patient would have died in the cardiothoracic department.
He would not have even survived a night in the cardiothoracic department. The truth was a punch to the gut for Cao Guozhen.
Just the thought of what could have happened sent chills down his spine.
His whole body felt clammy as he recalled a patient who came in with rib fractures alongside an aortic dissection. From the CT scan, the dissection appeared minor and went undetected. A few hours after admission, the aorta ruptured and they were unable to resuscitate the patient.
After the patient’s passing, the family came en masse in mourning clothes. They placed the patient’s body at the cardiothoracic department entrance and carried out the mourning ritual.
The thought of the scene made Cao Guozhen’s knees weak.
The fault laid with no one. It was a mistake any doctor could make and the family was not trying to raise a stink, they were just upset at the loss of their family member.
It was not possible for doctors to perform multiple CT scans in the middle of the night to avoid such incidents.
There were a few hundred rib fracture cases taken in by the cardiothoracic department each year. Their department would be rife with lawsuits.
Cao Guozhen’s palms were sweaty as the scenario played in his mind. It was a horrifying thought.
