Surgery Godfather
Chapter 1301 - 989 Major Bleeding_2

Chapter 1301: Chapter 989 Major Bleeding_2

Director Zhang asked Li Min, as well as the Elderly Director. It was the Chief Surgeon’s consistent practice to consult with everyone when encountering difficulties. Li Min felt that due to the tumor’s abundant blood vessels, performing a complete resection would be safer. If they proceeded with partial resection as per Director Zhang’s suggestion, it would inevitably involve the tumor’s interior. With so many altered blood vessels inside, hemostasis would be a significant problem. The township hospital lacked various emergency equipment and couldn’t handle unexpected outcomes.

Therefore, they had to either give up the surgery now or perform a complete resection of the tumor; that was Li Min’s judgment. The idea of doing a partial resection to alleviate the symptoms of intestinal obstruction was good, but it would be falling into a trap, as it would be very difficult to stop the bleeding during the operation, and a massive hemorrhage could endanger the patient’s life.

"A complete resection is still safer. If we opt for partial resection, we can’t control the bleeding from the tumor’s cut surface. If we’re not planning a complete resection, we might as well give up the surgery now," Li Min offered his advice. Medicine is a science of facts, and human life is paramount; there’s no room for any pretense. Thus, Li Min didn’t agree with Director Zhang’s viewpoint just to please him; he had to speak his own mind.

Director Zhang consulted with everyone, hoping to find a way to step down. He raised the issue, and if everyone agreed, then that was the plan. But now Li Min disagreed.

Director Zhang looked up, pausing his work: "The adhesions inside are too severe, involving major vascular structures. I’m afraid if we accidentally tear a blood vessel, we won’t be able to control the situation. The patient is just over fifty, not too old. Better safe than sorry, let’s be conservative."

"I estimate we can’t be conservative now, unless we stop the surgery and close the abdomen now." Li Min was straightforward; his nature was candid, and the education he received at Sanbo Hospital was just the same. There’s no time for pleasantries at critical moments on the operating table.

Director Zhang hesitated for a moment. Closing up now felt like admitting defeat. Based on his experience, he judged that a partial resection would likely be fine, but still, he decided to be cautious: "Turn on my phone, the unlock code is---, find Director Peng’s number, I’ll talk to him about the situation."

Director Peng was the Head of General Surgery at the regional Sanbo Hospital. His hometown was Nanqiao County, and he was visiting there. Last night, Director Zhang and Director Peng had dinner together. Generally, as a department head, who doesn’t have their own "backing"? County hospitals usually connect with regional hospital experts through further training or pulling in a "big shot" to maintain a steady relationship, in case there’s a need for rescue or clean-up on any issue.

And the "backing" for regional hospitals usually comes from provincial hospitals, and for provincial hospitals, it’s the top national hospitals. Many doctors at provincial hospitals graduated with a master’s or doctorate from these top institutions, where their mentors are their "backing".

The Patrolling Nurse helped to dial Director Peng’s number. Director Zhang briefly explained the patient’s situation over the phone and then instructed the doctors below to take photos of the CT images and medical records and send them to Director Peng’s email.

This practice of seeking guidance from one’s "backing" when encountering difficulties on the operating table and getting advice is quite common, especially in grassroots hospitals. Preoperative diagnosis is one thing; intraoperative conditions can be quite another. Some surgeries cannot be completed due to difficulties, leading to the abdomen being closed up directly. This so-called "switch surgery" is when nothing is actually done, which is regrettably unavoidable. Of course, doctors try their best to prevent such "switch surgeries."

Director Peng responded quickly, calling back in less than fifteen minutes: Avoid partial resection as much as possible. Although there were no angiographic CT images, the tumor’s blood supply seemed abundant, which could cause unstoppable bleeding from the cut surface if resected.

The rationale was simple, like a massive hemorrhage from the uterus during childbirth; if there’s no other option, the only choice might be to perform a total hysterectomy.

Director Zhang thought it over, calculating the next steps in his mind. Nobody took action; everyone’s hands were outside the surgical area. Suddenly, a large amount of blood gushed out from the patient’s abdominal cavity. Director Zhang, with his experience, also known as Zhang Yidao, wasn’t called that for nothing; he quickly grabbed the upper segment of the aorta, while Li Min immediately used the suction device to remove the blood, cleaning the area thoroughly after some time.

"What are you doing? If you don’t understand, don’t mess around." Director Zhang scolded, as everything had been going well, and he had stopped operating. The sudden occurrence made him think Li Min had fiddled with something on his own.

Li Min immediately explained: "I didn’t touch anything just now."

The other assistants and the doctors below had all seen it; everyone stopped working, and Li Min’s hands were resting inside the protective pouch on his chest, not involved in any action. Director Zhang, still holding the blood vessel, didn’t pursue the matter further.

"Major vascular clamps."

Although Director Zhang lacked the theoretical knowledge to block the abdominal aorta, his experience was his trump card. In case of bleeding of unknown origin, he would first turn off the main switch and then look for the cause slowly, rather than foolishly searching everywhere for the bleeding point and wasting time.

Experience is experience, but when experience is combined with theory, it becomes something different. For example, blockade of major vascular structures has its intricacies; where to block, for how long, and how to block are all things that need to be considered. However, Director Zhang didn’t know these details; he only knew that doing so could stop the bleeding.

"Let me see, where is the bleeding? The blood is so bright red, it must be the aorta; no other blood vessels would be this dangerous. But where is the tear?" Director Zhang freed his hand to search for the blood vessels.

By this time, Li Min had already deduced the location of the bleeding based on the signs that had just appeared. He offered his opinion: "The tear is on the posterior side of the spot you just touched, where the cord connects to the aorta. The cord was the blood vessel supplying blood to the tumor directly from the aorta, possibly affected during the separation, and has now partially torn. The bleeding is merely high blood pressure forcing its way through a weak spot."

Director Zhang was somewhat irritated by the young Li Min offering guidance so freely, "Theory is theory, and there’s a big gap between theory and practice."

In such a bloody mess, you can still accurately pinpoint the bleeding site, talking as if it’s the truth. However, Director Zhang still reached out to feel the location indicated by Li Min, but didn’t find anything.

Now dealing with a tear in a major vessel, the situation might be beyond his capabilities. He could have directly handled it before, but now there was no choice but to deal with it head-on. At the very least, he needed to stop the bleeding, otherwise the patient could die from blood loss.

Director Peng called again: "How is it now?"

"There’s major bleeding, and I don’t know the exact location of the bleed, but I’m sure it’s on the aorta. I’m compressing the upper segment of the abdominal aorta to stop the bleeding, trying to locate the site of hemorrhage to repair it." Director Zhang, who usually dreaded the heat, now had sweat continuously forming on his forehead and his back was drenched, with the patrolling nurse constantly wiping his sweat.

"A tear in the aorta?" Director Peng was surprised on the other end, "Old Zhang, I’m still in Nanqiao, not too far from you. Do you need a hand?"

Director Peng was the head of a third-grade provincial hospital in the region, and a good brother to Director Zhang for more than a decade. At this time, he didn’t beat around the bush. If the aorta was injured, it was unclear to what extent. If it were a simple matter of sewing a few stitches, perhaps Director Zhang could manage it somehow. However, if the tear was severe, Director Zhang’s skills were simply insufficient. Handling major vascular surgery wasn’t something just any hospital doctor could do, and even if Director Peng came, if the situation was really severe, he probably couldn’t handle it either.

Director Zhang couldn’t ask for more: "That would be ideal. The patient’s vital signs are still stable; I will wait for you to arrive."

"Don’t panic, young man, a surgeon must have good mental composure," Director Zhang gave Li Min an on-the-spot lesson, although Li Min wasn’t panicking at all; it was Director Zhang himself whose forehead was covered with sweat.

This time it had been an unexpected problem; they thought it was just a common abdominal cavity tumor, remove the tumor, clear the lymph nodes, and call it a day. They hadn’t anticipated such complexity, nor did Director Zhang understand how the aorta could have torn.

"Director Peng from Sanbo Central Hospital is visiting relatives in Nanqiao. Let’s wait for him to take a look, it’s safer. How’s the patient’s blood pressure?" Director Zhang turned his head and spoke as he gestured to the patrolling nurse to wipe his sweat.

The anesthesiologist immediately reported on the blood pressure, which had recently dropped a bit but was still considered normal. Fortunately, Director Zhang had timely blocked the aorta.

"You’ve learned a new trick today, haven’t you? Many people don’t know how to manage this situation. Cutting off the aorta can stop the bleeding—it’s a tried-and-true method." Director Zhang took a break while waiting for reinforcements to arrive. As long as the bleeding didn’t continue, the patient’s vital signs could be maintained at normal levels.

"We can’t exceed half an hour of blocking at this site. If we move the clamping sign down by 5 centimeters, we can extend the blocking time to 45 minutes. We should aim to finish the fight within 45 minutes, otherwise let me have a look," Li Min volunteered proactively.

Director Zhang found his attitude of thinking himself an expert after just a few days of advanced training quite annoying: "You’re going to do this? There’s a human life at stake on this table."

If it weren’t for knowing Dr. Li’s "good doctor" status, Director Zhang would certainly have cursed him out, just trained for a short period, less than a year, and here he was, acting like an expert—utterly ignorant of the broad picture, as if the decades I’ve held a surgical knife were for nothing.

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