Chapter 200

"Doctor, can we delay the fracture surgery and just stop the bleeding first?" Fang Ziye was only a Junior Doctor, so the task of handing the pen to the patient's family for signatures fell to him.

Looking at the corresponding risks Xue Tao mentioned, as a medical device company staff member, he certainly had some medical background as well.

If an expanding hematoma is mishandled, it can kill; this is not alarmist talk.

"How can that work? Fracture with hematoma — since we're already opening for hemostasis, the open reduction and internal fixation of the fracture must be done at the same time."

"Doing one but not the other violates principle; only someone deliberately trying to keep the patient hospitalized longer to make money would choose that." Fang Ziye answered quite bluntly; naturally it was unacceptable.

What kind of international joke is this? An emergency surgery is about treating whatever can be treated, treating early whatever should be treated; doing one disease type but not another — this isn't car repair.

"I can pay more." The patient replied.

As he spoke, he looked toward Xue Tao, who had made the phone call to summon people.

Three patients arrived simultaneously; at least three full teams were needed, ideally starting at the same time. With just Fang Ziye and Xue Tao, they simply couldn't handle it.

These patients' surgeries — the sooner the better.

After all, the "uncles" outside were waiting to interrogate; Xue Tao didn't even mind seeking help from the neighboring hospital —

Because the disappointment in Xue Tao's heart right now wanted to find an opportunity to fill the void; he had thought the surgery he did for Pang Hong this morning was an act of justice, but never expected there were so many twists and turns inside.

Surgery done, only a sense of unresolved injustice remained in Xue Tao's heart, nothing else.

If these patients also wanted to imitate Pang Hong and stall for time, Xue Tao absolutely would not give them that time.

So when making the calls, he sprayed saliva as he spoke.

"No, this violates the most basic principle; we doctors absolutely cannot do such a thing — it's not a matter of whether you're willing to pay."

"Read carefully: the proposed surgical procedure is exploratory incision, hematoma clearance, hemostasis, and open reduction and internal fixation of the fracture."

"Not simple hemostasis alone." Fang Ziye twirled the pen cap.

Outside, family members seemed to have come to visit, but were stopped by police, only allowed to peek through the doorway.

A young police officer in uniform stood ramrod straight, hand raised to block: "Can't go in; they're signing inside."

"The suspect has an expanding hematoma; don't disturb the signing — without surgery it's not a matter of breaking the law, it's a matter of losing his life."

"You guys were too brutal! I'll file a complaint!" Seeing they couldn't get in, the family tried a roundabout approach.

"He attacked first; we have bodycam footage — if you don't know what assaulting an officer is, we can educate you slowly later."

"We've got injured brothers too, but they're not at Enshi Central Hospital — they went to People's Hospital, to avoid piling up large numbers of wounded."

"If you have questions, talk after the life-saving surgery." That officer was quite rude.

As they spoke, a few more people arrived at the doorway.

Hearing this, Fang Ziye couldn't help but inwardly marvel at his hometown's folkways — truly fierce.

The situation was already exposed, yet during the arrest they still managed to injure trained "uncles" — their combat power is not weak.

Even with combat power not weak, they'll likely be imprisoned for at least some time afterward.

Hearing this, the patients signing inside didn't object at all.

……

Five minutes later, Fang Ziye obtained three Surgical Informed Consent Forms and also had the families sign a Condition Notification Form; then Xue Tao led him, together with the Emergency Department doctors, to send all three patients into the operating rooms simultaneously.

Enshi Central Hospital's scale isn't as large as Zhongnan Hospital's; it has no Emergency Operating Room, so most emergency surgeries are arranged in the general surgery operating rooms.

Xue Tao's prior arrangements were effective; when he brought Fang Ziye to one patient's operating room, everything was already prepared: the preoperative debridement kit, orthopedic internal fixation pack, and sterile towel pack.

An instrument nurse was also assigned, who had already readied the disinfected oval forceps, sterile povidone-iodine, etc., just waiting for Fang Ziye and Xue Tao to disinfect and drape, then immediately start anesthesia and open the case!

General anesthesia was chosen directly, solely to save time.

Fang Ziye voluntarily took the leg-holding position.

These patients all had lower limb fractures!

Xue Tao didn't waste words — straight to surgical scrub, then disinfection, draping, all the way to donning sterile surgical gowns, wrapping the patient's foot, placing the fenestrated drape, then working with the instrument nurse to apply the skin sterile sealing film.

And had the circulating nurse help prepare the electrocautery, suction device, adjust electrocautery current, adjust lower limb tourniquet pressure, and other prep work.

After Fang Ziye reached the table, Xue Tao said: "Right now, most of our department's people are with Huang Kai; I just asked, can't squeeze anyone in."

"But many are helping out, so we can't spare people here either."

"People's Hospital and Min Da Hospital's Trauma Surgery are better, so they handle some police injured on duty; we need to finish these three emergency surgeries as fast as possible!"

"The other two ORs — temporarily called Guang Shenqing and Cao Zhen over for exploration; Guang Shenqing is fine, but Cao Zhen is younger, estimated he can't pull it off."

"Ziye, can you!?" Even though the patient was under general anesthesia and couldn't hear, Xue Tao still spoke very cautiously, stopping halfway.

This kind of thing, he had only been guided through once before by Old Director Hong Du.

That one and only time — a little operation Old Director Hong Du summarized in that special overbearing era of the late 20th, early 21st century, for controlling patient surgery time.

But such things cannot be spoken in front of the patient and family; even under anesthesia, best not to say them.

"Good!" Fang Ziye understood Xue Tao's meaning.

"Brother Tao, after I quickly do exploration and hemostasis here, I'll go help Cao Zhen with hemostasis first. You and this instrument nurse try to handle the rest of the debridement." Fang Ziye replied very decisively.

Actually one point: near the bone, within a certain range, there are no blood vessels or nerves — common knowledge.

Many orthopedic doctors know: once you see bone, operating against the bone won't go badly wrong, as if you've found your way home.

Vascular exploration and hemostasis without any preoperative imaging — if you have no clue, it's truly an extremely troublesome matter.

Xue Tao didn't know how Fang Ziye could do it, but knew Fang Ziye could do it so silently — this closed reduction technique reaches the realm of transformation, far stronger than Old Director Hong Du.

Then, Fang Ziye didn't hesitate either.

Fang Ziye's hemostasis technique, because of Zhang Yu before, had already been leveled up to Level 4.

Hemostasis is just a basic operation; although downstream there are more refined skills like compression hemostasis, electrocoagulation hemostasis, refined specialty skills still originate from basic skills!

It's that the treatment ceiling is higher, not that a basic skill like hemostasis is completely useless.

Then Xue Tao saw Fang Ziye unhesitatingly incise the patient's skin, cutting a three-centimeter opening.

Immediately after, Fang Ziye used his solid basic skills — the incision technique — advancing layer by layer.

Of course, Xue Tao wasn't just watching; he was merely acting as an assistant, on Fang Ziye's opposite side, performing operations like retracting, suctioning blood, or suctioning the smoke produced by the electrocautery.

And just when Xue Tao still hadn't seen things particularly clearly, he saw that Fang Ziye was actually advancing a hemostat deep inside along a certain muscle gap!

He let out a relaxed breath: "Tao Ge, it should be fine now. In a bit, you just debride the hematoma, clean it up completely, and once you can see the vessel, suture it directly."

"If you can't see the vessel, just release this hemostat a bit, once you see the bleeding point, clamp it again and start suturing."

Xue Tao heard this, and the hand holding the suction device trembled slightly: "What are you doing?"

His scalp tingled faintly.

He understood Fang Ziye's meaning; Fang Ziye had directly clamped the proximal end of the ruptured artery, equivalent to finishing the hemostasis technique in advance; the rest was just hematoma cleanup and vascular anastomosis combined with open reduction internal fixation for the fracture.

That is to say, Fang Ziye could not only create surgical indications, but also clearly know exactly which artery's damage the indication pertained to.

What kind of inhuman skill is this?

So, the operation Fang Ziye has now completed is actually not as complex as he imagined; it would normally require finding the hematoma first, then incising it, then finding the bleeding point or even the bleeding artery inside the hematoma.

Then ligate it...

No, no need for that much trouble.

Fang Ziye was equivalent to having dealt with the source of bleeding; now only hematoma cleanup remained; take it slow, completely no need to rush.

Fang Ziye didn't answer directly: "Tao Ge, wait for me to finish handling things over there, then come over to help."

"Okay!" Although Xue Tao found it incredibly inconceivable, at this moment, this seemed like the most scientific arrangement and planning.

Fang Ziye then stepped down from the platform without any hesitation.

However, after Fang Ziye left, the instrument nurse got curious: "Who is this? Doesn't look like he should be your subordinate?"

The instrument nurse was not an orthopedics specialty nurse, but from another department; she just happened to be dispatched over when on duty.

She didn't know Xue Tao, so naturally it was even more impossible for her to know Fang Ziye.

"This is a true divine person; becoming a top expert and professor in the future is a given." Xue Tao took a deep breath, and also couldn't tell the circulating nurse anything else.

"Looks like he's a bit formidable." The instrument nurse couldn't understand the value of the operation Fang Ziye had performed.

Fang Ziye thus arrived at another operating room; when he stepped on the sensor to open the OR's lead-plate sensing door, inside was the "flowing hair" Cao Zhen leading their group's newly arrived resident trainee Li Ruokai, performing disinfection and draping operations.

Li Ruokai was a newly rotated resident trainee, and not from orthopedics, so he knew nothing about most things in the department.

Still complaining: "Zhen Ge, you say what is all this?"

"Today the one on duty is clearly Teacher Zhong Xue Gao; Zhong Xue Gao is from Director Zhang's group; the surgical patient belongs to Director Wu Guo Nan's group; how come our group is neither on duty nor has a surgical patient, yet we still have to come do grunt work?"

This is a very normal mentality.

Clinical work is divided into groups precisely for clear responsibility and tasks.

Each group handles its own matters well.

Cao Zhen heard this, glanced at Li Ruokai, but didn't say much more, still disinfecting carefully.

However, upon seeing Fang Ziye step on the OR's foot-pedal sensing lead-plate door, he turned his head to look at Fang Ziye, with puzzlement: "Doctor Fang, how come you're here? Weren't you doing surgery with Tao Ge?"

Fang Ziye had just finished scrubbing and disinfecting outside, so he reverently held up his hands and walked in, replying in a calm tone: "Doctor Cao, it's like this; the hemostasis on our side has already been handled."

"So Tao Ge had me come over to help; finish the hemostasis here, then go back to help." Fang Ziye walked straight toward the sterile towel pack, his tone neither happy nor angry, with no intention of showing off.

If it were ordinary times, Fang Ziye would still feel a bit happy thinking his technique was good, but today's Fang Ziye truly couldn't bring himself to be happy.

Cao Zhen heard this, and as he was disinfecting, the hand holding the oval forceps trembled slightly.

But the amplitude of the trembling was very, very small.

So Li Ruokai didn't notice at all.

And because of Fang Ziye's arrival, Li Ruokai didn't continue venting sourness.

Fang Ziye was not only a PhD at Zhongnan Hospital, but also someone from Director Wu Guo Nan's group; complaining in front of Fang Ziye would be a bit inappropriate.

Cao Zhen's disinfection soon neared its end.

Fang Ziye then very naturally picked up the middle drape, approached the operating table, and helped with disinfection and draping!

"Towel clamp!" After Fang Ziye finished laying two vertical middle drapes, he called out to the instrument nurse.

The instrument nurse then passed the towel clamp over upside down...

Cao Zhen saw that Fang Ziye had taken over the draping operation, so he again used the hand disinfectant to start re-disinfecting his hands, then began putting on his gown.

Orthopedics disinfection and draping, besides draping, also have wrapping steps for the feet and hands; unless it's foot or hand surgery, both areas need to be wrapped with the middle drape to maintain sterility.

After putting on the sterile surgical gown and sterile gloves, Fang Ziye's side had already completed the middle drape draping operation with the instrument nurse's help.

Cao Zhen immediately took over Fang Ziye's position, folded the middle drape properly, approached the operating table, spread it out underneath, let Li Ruokai slowly put his feet down, then smiled and said: "Ziye, so your hemostasis technique is really fast."

"Not bad."

"Doctor Cao, I'm going to get changed too." Fang Ziye right now just wanted to save as much time as possible.

Since he was already in the OR, after the surgery ended, he still had to go check on Huang Kai.

Fang Ziye and Huang Kai had a good private relationship; he should go take a look. But the reason he didn't go before was because Fang Ziye himself had a surgical task, on the operating table, needing to do work.

Then Master Deng Yong came to Enshi; as a student, hosting the teacher was equally important.

Otherwise, even if he went to see Huang Kai, it would just be a glance; could he really jump on stage, squeeze someone else out of their position, and show off his divine might?

Real-life resuscitation and surgery aren't done like that.

Whoever is in that position does that position's work.

Later, after Professor Deng Yong and the others were called away, Director Wu Guo Nan made other arrangements for Xue Tao and himself.

At any time, in medical practice, finding your correct position is the most critical thing.

Especially the more urgent the moment, every position is extremely important; cannot be vacant, cannot be absent; if there really are special circumstances, it must be reported.

Someone entrusting a position to you is a kind of trust in you!

Fang Ziye had been there for five minutes, all spent on disinfection and draping.

Then he put on the sterile surgical gown, and after applying the sterile skin adhesive drape, Fang Ziye immediately prepared to perform hemostasis together with Cao Zhen.

Cao Zhen placed the kidney dish in front of himself, intending to operate personally.

At this moment, Fang Ziye actively requested: "Doctor Cao, how about I try the hemostasis?"

Upon hearing this, Cao Zhen raised his head slightly, thought for a moment; Fang Ziye had been able to achieve hemostasis so quickly next door, he might really have some skill.

Cao Zhen did not know that Fang Ziye had shown his prowess once during Zhang Yu's surgery; after all, he had not witnessed it with his own eyes.

However, this time Fang Ziye was even faster than when he had performed the hemostasis technique together with Xue Tao before.

Because the course of the popliteal artery is more superficial!

Basically, as long as the skin is incised, advancing two to three centimeters deeper exposes the popliteal artery.

But Fang Ziye did not directly clamp the popliteal artery shut; instead, he snapped the hemostat onto the posterior tibial artery with a click.

Then he thought for a moment and said: "Doctor Cao, I won't meddle in the hematoma cleanup and fracture incision reduction internal fixation afterward; Tao Ge's side still needs people."

After Fang Ziye finished the operation, he carefully glanced at Li Ruokai, who had not yet finished putting on his clothes; feeling that stepping back from the operating table would not contaminate him, he silently withdrew.

Then he began to remove his gloves, untie his gown straps, in one smooth motion, without any hesitation whatsoever.

And at this time, Li Ruokai had not even gotten on the platform.

The motion of putting on clothes froze right there.

Fang Ziye was not showing off for an audience; after throwing his clothes into the linen basket, he walked to the storage table in the operating room and walked out of the operating room very calmly.

There were no carefree steps, only the steady, hurrying footsteps and the squeaking sound of the shoe covers rubbing against the floor.

By the time Fang Ziye reached the operating room doorway, Cao Zhen finally reacted — Fang Ziye was already leaving, and had stepped down.

And this speed was such that from the start of Fang Ziye's operation to its end, only a little over a minute had passed; so fast it was a bit outrageous.

But Cao Zhen still did not say much, nor did he suspect that Fang Ziye had simply come to show off and leave.

Because Fang Ziye originally need not have come; if he were incapable, given Fang Ziye's temper and personality, he certainly would not have come at such a critical moment just to deliberately show off and leave.

He came, and could be this fast, this confident — clearly he had a clear idea in his heart.

And this is what Old Director Hong Du spoke of: the confidence of some people's strength.

"Li Ruokai, get on the platform." Fang Ziye's back view disappeared, the lead door had already closed again, and Cao Zhen still saw Li Ruokai standing there in a daze, and shouted.

Li Ruokai's eyes flickered rapidly a few times, his face full of bewilderment.

And when Cao Zhen reacted and refocused his gaze on the operating table, he discovered that Fang Ziye had silently, unknowingly when, already completed the fracture reduction as well, waiting for him was just the tool person to apply the internal fixation.

Holy crap.

Cao Zhen's mental defenses crumbled.

Can you not be this fast?

(Chapter End)