Chapter 188: Won't Die! (Asking for Subscriptions)

The staffing configuration in this operating room clearly couldn't match Operating Room 9 across the way.

There was only one circulating nurse, and only one instrument nurse.

At this moment there were only four lead surgeons: Wu Xuanqi, Hong Du, Huang Kai, and Zhong Xue Gao from Zhang Mingcan's group.

Originally, Director Wu Guonan had arranged for Zhong Xue Gao to perform this surgery with Guo Yunlei.

Liu Linjie's condition appeared relatively simple on the surface — just knife wounds to the thigh and arm, with no damage to major vessels or nerves, requiring only simple debridement and suturing.

An attending physician could have handled it; even bringing Fang Ziye over to do the debridement and suturing would have sufficed.

But unexpectedly, Zhong Xue Gao had barely entered when chest compressions had to begin — the patient had actually gone into shock.

This made everyone realize there was likely hidden cavity bleeding, and as the patient's abdomen grew increasingly distended, pelvic cavity injury was highly suspected.

After Huang Kai, who had been called by Fang Ziye to help, explored and confirmed this was indeed the case, he immediately summoned Old Director Hong Du without hesitation.

However, Old Director Hong Du didn't have much rescue experience in this area, so he immediately called Wu Xuanqi, who rushed over temporarily after stepping down, arriving at the operating room in just over twenty minutes.

In the preceding time, Old Director Hong Du and Huang Kai had only performed hemostatic suturing of explorable vessels within the pelvic cavity.

Now, the pelvic cavity was still a bloody mess, and it was only after Wu Xuanqi arrived that anyone dared attempt to open the retroperitoneal hematoma!

Fang Ziye's sudden entry midway caused many people to raise their heads and look at him.

Nie Mingxian sat steady as a rock at this moment, and after getting the blood pressure under control, said: "Doctor Wu, this is Doctor Fang; the limb-salvage surgery in the operating room next door was done by him, his technique is quite good."

"If needed, you can call someone up to help out."

After Nie Mingxian finished, without waiting for Wu Xuanqi to react, Old Director Hong Du immediately asked: "Still got strength left, Little Fang?"

Fang Ziye was looking for an operating opportunity; even as an assistant he might gain quite a few knowledge points, and he had already rested for nearly an hour — not fully recovered, but seventy to eighty percent.

"Director Hong, I'm going out to scrub in right now." Fang Ziye merely glanced at Wu Xuanqi operating proficiently, then immediately exited the operating room, not standing on ceremony at all.

After Fang Ziye re-scrubbed and gowned up, he first squeezed into the most corner position.

The surgery was in progress; unless it was an extremely critical figure, no one was allowed to occupy key positions — one could only start from the assistant role least affecting the surgical procedure and work up step by step.

At this moment Wu Xuanqi had reached a critical juncture of the surgery; he took a deep breath and didn't deliberately explain to Fang Ziye, but addressed everyone.

"There is definitely active bleeding in the retroperitoneal space, but the exact number of bleeding points and extent of vascular injury are all unknowns."

"Moreover, retroperitoneal pressure is high; once we breach the peritoneal layer, blood may gush out in large volume in a short time, and this gushing process could cause secondary injury to already damaged vessels."

"Therefore, we must locate the bleeding points and achieve temporary hemostasis at the first possible moment."

"I can only clamp two bleeding vessels within a short time at most."

"The patient had no preoperative examination; therefore, no one can determine exactly how many bleeding sites there are — we can only attempt temporary manual hemostasis as best we can, then hand off to assistants for ligation."

"Complete temporary hemostasis as fast as possible."

"However, this process — if there isn't absolute certainty, absolutely do not fight for position or get in each other's way; rather than having several pairs of hands scrambling inside, you'd better stand ready to take over ligation and knot-tying at any moment." Wu Xuanqi said this.

Hong Du nodded upon hearing this: "Xiao Wu, I'll strive to coordinate with you; the others won't put their hands in."

Wu Xuanqi nodded upon hearing this.

With Hong Du making this arrangement, at least no one would interfere.

Looking at Nie Mingxian: "Doctor Nie, the patient's blood pressure will fluctuate rapidly for a while; maintaining vital signs and blood pressure control is up to you."

"During this period, there may be massive fat embolism or flushing into the bloodstream, which could also trigger hemorrhagic shock."

"Good, I'm ready at all times." Nie Mingxian's expression was solemn, not a trace of joking.

Wu Xuanqi spoke again: "Two negative pressure suction devices on standby to clear the field and pooled blood — I'm opening the peritoneum now."

"Large amounts of silk suture are already in position; each of you take one strand — after I achieve temporary hemostasis, you immediately cooperate to complete temporary vascular ligation."

"Know this: a single vessel may have two bleeding points."

Wu Xuanqi finished speaking quickly, then immediately took the pointed knife in hand and cut a small opening.

The moment the peritoneum was breached, the accumulated hematoma inside gushed out like a spring, as if a new spring eye had opened.

But Wu Xuanqi turned the back of the pointed knife toward the assistant position with his right hand, while his left hand unhesitatingly plunged into the blood pool through the opening held open by Zhong Xue Gao and Huang Kai.

With a slight rotation of his palm, he clamped a vessel head writhing like a yellow eel and pulled it out.

At the same time, Old Director Hong Du's hand also reached in and grasped an unnamed artery.

The instrument nurse was quick-eyed and swift-handed, immediately receiving the scalpel on the tray; seeing this, Wu Xuanqi tossed the knife onto the tray, and his right hand instantly squeezed back into the blood pool gap.

"Silk suture—!" Wu Xuanqi called out in a low voice.

Huang Kai pinned one end of the S-retractor with his abdomen, then immediately used both hands to take over the vessel head Hong Du was holding and began ligating.

Zhong Xue Gao, because of Huang Kai's movement, lost his position; his left hand continued pulling hard on the S-retractor, while his other hand took over Huang Kai's original retractor position: "Kai Ye, you let go first."

This left very little operating space for Fang Ziye.

Yet even so, Fang Ziye still manipulated silk suture with both hands, looping it around one of Wu Xuanqi's hands and quickly tying a knot, temporarily ligating a vessel.

After directly tying a quick square knot, Fang Ziye swiftly pulled out another silk strand, looped it onto Wu Xuanqi's other hand, formed a slip knot, and slid it down like a sleeve.

Reaching the vessel, he gave a hard pull — before Wu Xuanqi could even react, Fang Ziye had completed the other knot.

This was a flexible application of knot-tying technique.

Fang Ziye came here to fill gaps, so whatever functional position was lacking, he did that work.

Wu Xuanqi glanced at Fang Ziye, but before he could give any instruction, Fang Ziye had already completed ligation at two sites, then decisively withdrew his hands, picked up the currently unmanned suction device, shoved it straight in, and braced it against the side, yielding his position.

At the same time he shifted his body to give Wu Xuanqi more room.

This is called yielding position.

Although Fang Ziye felt he could also perform manual hemostasis, the division of labor on the operating table was already clear — he could not encroach on anyone else's position!

Let alone crowding out the lead surgeon; even if it contaminated himself, he had to yield the position to the lead surgeon.

One mountain cannot accommodate two tigers; one country cannot have two rulers; on one operating table there can only be one lead surgeon — everyone else is an assistant; this is an iron law!

Fang Ziye had already settled into a practiced oblique horse stance, hips tilted to the side.

Looking at Wu Xuanqi.

Wu Xuanqi merely froze for about two seconds, then continued operating.

When Wu Xuanqi once again caught a vascular stump through the turbulent flow of tactile blood flow, Fang Ziye immediately placed his own suction device into Wu Xuanqi's other palm.

As his eyelids blinked rapidly, he was about to speak a reminder, but Wu Xuanqi seemed to have read his meaning and took the suction device.

Fang Ziye immediately withdrew his half-step backward horse stance, pulled out a silk suture with his left hand, and delivered it to the index finger position of Wu Xuanqi's right hand at this moment.

Both hands quickly circled; in merely two seconds, Fang Ziye completed two knots again!

Immediately after, Fang Ziye moved both hands away without any superfluous words or movements, cleverly shifting the two suture knots with his left hand toward the left abdominal direction, then his right hand once again took the suction device from Wu Xuanqi's hand.

While turning his head: "Instrument Nurse, help me organize the suture knots with vascular clamps."

The previous suture knots, because the situation was urgent, there was no time to organize them, but the current suture knots must be cleaned up, because the situation is no longer that urgent.

And as the four vascular stumps were all ligated one by one, the bleeding speed inside the blood pool had already decreased by more than three-quarters; the bleeding speed could no longer keep up with the negative pressure suction device's suction speed.

The blood pool was descending visibly to the naked eye.

And at this time, Hong Du and Huang Kai, the two of them, only just completed the suture of one vascular end.

Are their movements slow?

Not so; the current time, from Wu Xuanqi's incision, has only passed fifteen seconds.

Old Director Hong Du being able to find the vessel, and Huang Kai cooperating with him to ligate the vessel, took only fifteen seconds — already not slow.

After all, in critical situations, it is not the suture's knot tying, but creating the opportunity to tie the knot, then completing the knot tying, that requires a process.

Not everyone can be like Fang Ziye, possessing Level 4 Knot Tying Technique to perform rapid knot-tying and vessel ligation operations.

Hong Du and Huang Kai, seeing this, knew their cooperation just now had completely dragged down the surgical rhythm; their faces darkened slightly, and they each yielded their positions.

Simultaneously they took the negative pressure suction device from Fang Ziye's hand and the S retractor from Zhong Xue Expert's hand.

Wu Xuanqi at this moment was also not idle; he glanced at Fang Ziye: "For subsequent bleeding points, use vascular clamps."

Wu Xuanqi gave Fang Ziye a covert hint: if Fang Ziye understood, then Fang Ziye could operate; if Fang Ziye did not understand, then Fang Ziye could hand him vascular clamps.

In the flash of a spark, he would not waste even a single extra word.

"Good! ~" Inside the kidney dish, there existed a large amount of vascular clamps — at least the vascular clamps from three instrument packs had all been placed inside.

After Fang Ziye got the vascular clamps, he retreated half a step again, waited until Wu Xuanqi's left and right hands simultaneously extended in with a *kaka* sound, then Fang Ziye sent the vascular clamp in his left hand to the bleeding point at his own favorable visual field position.

Simultaneously, the vascular clamp on his right hand was sent to the bleeding point at the favorable visual field position shared by both him and Fang Ziye.

No conflict; front and back staggered in time, but both could simultaneously temporarily ligate and stop the bleeding points by clamping with vascular clamps.

This is also the general application of hemostasis technique.

Hemostasis technique has many forms of expression; all operations that can stop bleeding can be classified as hemostasis technique — manual hemostasis is merely one form of expression.

Among them, the hemostasis technique of temporary vascular clamp hemostasis is actually content within manual hemostasis methods; it is one of the most simple and unadorned hemostasis surgeries.

Fang Ziye, under visible-to-the-naked-eye conditions, naturally could operate freely.

And every person's standing position has blind spots and favorable visual field positions; whether lead surgeon or assistant, it is all the same.

"You go to the opposite side! ~" After Wu Xuanqi saw Fang Ziye's operational proficiency, his eyes immediately brightened; he had already seen that Fang Ziye's operational level, in this basic skill of hemostasis technique, was quite seasoned.

And this sentence was not Wu Xuanqi driving Fang Ziye away, but letting Fang Ziye become his first assistant, to complete the bleeding point hemostasis operations and subsequent operations within his visual field blind spots.

Lead surgeon and assistant stand on opposite sides precisely to complement each other.

But obviously, Old Director Hong Du, for various reasons, could not reach such a complementary position, so only Fang Ziye could go to the opposite side.

Fang Ziye nodded without hesitation, retreated two steps, turned his back to Wu Xuanqi and left the operating table, then turned again, facing the operating table's direction, and began walking around the operating table.

On the operating table, when exchanging positions with someone, one must stand back-to-back to ensure the sterile principle.

When circling the operating table, turning one's back to the operating table is a major taboo, because you are not looking directly at it, you do not know whether you will contaminate the operating table.

Hong Du shifted one position; Huang Kai, very sensibly, from another direction, facing the operating table, walked toward Fang Ziye's previous assistant position.

Although they did not know why Fang Ziye would be this formidable, on the operating table, it is never the time to ask doubts; now, Fang Ziye and Wu Xuanqi being able to cooperate more perfectly is the most critical thing.

Just as Fang Ziye was switching positions, Wu Xuanqi *kaka* clamped shut three more bleeding points.

The active bleeding behind the peritoneum was already visibly controlled.

At this time, Nie Mingxian at the anesthesia table finally said: "Blood pressure is currently temporarily stable. Circulating Nurse, call for four more blood plasma, 400 Suspended Red Blood Cells to come over."

"Blood bank is critical." The circulating nurse said.

"Blood bank critical, you say the operating room is also critical; think of a way to allocate them over too!" Nie Mingxian ordered, brooking no refusal.

"Okay, I'll make the phone call right away." She dared not argue back.

On the operating table, Fang Ziye, Wu Xuanqi, and the others were completely unaffected by the dialogue; after Fang Ziye stood on Wu Xuanqi's opposite side, only then did he have the chance to again use hemostats to clamp shut several bleeding points Wu Xuanqi could not see.

After this, looking again inside the retroperitoneal hematoma, it had actually recovered a peaceful atmosphere; no more active bleeding appeared.

Even if there was faint oozing, this is no longer bleeding that hemostats can handle; it must rely on subsequent hemostatic materials like hemostatic gelatin sponge to complete hemostasis.

Everyone's mood relaxed at this point.

Wu Xuanqi exhaled a breath: "Forty-odd seconds, completing a hematoma cleanup and hemostasis — this speed counts as timely."

"Director Nie, how is the situation on your end?"

"Director your grandpa." Nie Mingxian had already stood up, starting to draw blood to check electrolytes, cursing under his breath.

Obviously he could not stand Wu Xuanqi calling him Director Nie.

Old Director Hong Du only now narrowed his old eyes and asked back: "Doctor Wu, is it still that cooperating with Doctor Fang makes you feel more comfortable?"

The reason Wu Xuanqi said this was the timely speed was to hint that his cooperation with Huang Kai was a bit amateurish, belonging to the type being carried.

And only Fang Ziye's technique is what can cooperate with him; although he might also be carrying Fang Ziye, at least the gap in distance would not be too far.

The higher the assistant's level, the more comfortable the lead surgeon's operation becomes.

This is also the main reason why in many surgical teachings, high-level people serve as assistants, and low-level people as lead surgeons become exceptionally relaxed.

"Director Hong, I don't have that meaning, but Little Fang's level is truly not bad." Wu Xuanqi finished speaking, then bowed again and began cleaning up the aftermath.

The surgery has reached here; it is only said that vital signs can be temporarily stabilized; the subsequent hemostasis operations also cannot be negligent.

If hemostasis is not done properly, and a hematoma recurs later, or a vessel stump ruptures again, the danger encountered will be higher than the risk of the initial hematoma and blood loss.

After all, people are flesh and blood; they cannot withstand many instances of injury.

Fang Ziye, on the other hand, helped very actively, clearing away blood clots, blood masses, and black blood clots, without saying a word.

Not proud, yet not pretending to be a dead man either, waiting for Wu Xuanqi's instructions.

Wu Xuanqi is the lead surgeon; he does not take Wu Xuanqi's place, does not snatch his operations, but other small operations he can perform freely.

Wu Xuanqi was also silently clearing the debris after the hematoma, saying, "Ziye, when it comes to vessel suturing later, you suture together with me."

"What should be sutured, suture; what cannot be sutured, just ligate directly, do not force suturing."

"Okay, Senior Brother Wu." Fang Ziye nodded, not daring to make any other suggestions on his own.

Wu Xuanqi's level is higher than his own; what he says is the better suggestion, so he should not use his own meager level to guide Wu Xuanqi.

Moreover, Fang Ziye also knew that if he himself were to experience such a hematoma rescue in the future, the level of hematoma evacuation and hemostasis technique must be high enough to stabilize the incision, clearance, and hemostasis of such an active hematoma.

The two cooperated in an orderly manner, finally slowly pushing the surgery into the concluding stage of vessel suturing.

Huang Kai and Hong Du, the two of them, had completely become assistants, helping Fang Ziye and Wu Xuanqi cut sutures.

Then occasionally joking: "Huang Kai, look at them, they're suturing this fast! ~"

Huang Kai, for his part, solemnly upheld his seniority in age: "After all, it's a skill honed through practice, just might be a bit harmful to the body."

When Huang Kai and Hong Du joked like this, Fang Ziye discovered that this Senior Brother Wu Xuanqi was also silently immersed in the operation, not daring to retort much, as if knowing that young people like himself, compared to these 'Directors' in driving, have an inherent deficiency.

"Damn, good thing hypokalemia was discovered."

"These can be rested assured about, should be not dying anymore." Nie Mingxian approached again, using a grumbling tone to say the most reassuring words.

Everyone smiled knowingly, putting their minds at ease.

The anesthesiologist is the patient's life guardian in the operating room; since Nie Mingxian said they won't die, they can operate boldly and decisively.

(Chapter End)