Chapter 2706: with translation of chapter title

2608.2509 In a dilemma

Title line. Translate: "2608.2509 Up and Down in Difficulty"? Actually in a dilemma means "difficulty both up and down" or "in a dilemma". Natural English: "In a Dilemma". But we need to translate faithfully. The phrase in a dilemma literal: "up and down are difficult". Could translate as "Difficulties Above and Below". But we need natural English. The instruction: natural, fluent English prose. So we can translate as "In a Dilemma". But we need to keep the 【N】 indices, no Chinese characters in the output, nothing else.

【2】 "Trouble."

Translation: "Troublesome." or "This is troublesome." Natural: "Troublesome." Keep quotes? The Chinese includes quotation marks. We should keep them? The instruction: output translation, keep punctuation. So we keep the Chinese quotes? Usually we translate to English quotes. We'll output: 「Troublesome. 」 but English uses double quotes. However we should

"Trouble." – none.

After a few seconds of silence, 【Zheng Ren】 and 【Su Yun】 spoke in unison.

It looks simple—just a fish bone stuck in the esophagus; an ordinary person would think removing it would be enough.

But 【Zheng Ren】 and 【Su Yun】 didn't think so, and 【Director Luo】, who called for help on the hotline, didn't think either. If it were simple, 【Director Luo】 wouldn't have called.

That fish bone was like a barbed arrow lodged in the esophageal wall; if one tried to pull it out with brute force, it would surely be a 【Tragedy】.

There's a 1% chance of success, but a 99% chance it will lead to 【Emergency Rescue】, and the likelihood of the patient not surviving is high.

On the way, 【Zheng Ren】 called 【Gao Shaojie】, asking him to wait a bit before sending the patient for surgery, while he himself needed to assess the situation.

"【Boss】, your temper will wear people out." 【Su Yun】 blurted out.

【Zheng Ren】 knew he was criticizing himself for insisting on doing everything personally.

Other things aside, for something like surgery, you definitely need to see it yourself to feel at ease.

Even though 【Gao Shaojie】's skills are improving quickly, he has almost reached 【Rudolf Wagner】's surgical level.

Even if 【Lin Yuan】 can already perform surgery independently, and even if 【Gu Xiao Ran】 can try assisting on stage.

Everyone else in the 【Medical Team】 is growing, but 【Zheng Ren】 still worries like he has OCD. 【Su Yun】 looks down on this about her own 【Boss】, and her words are full of contempt.

However, 【Zheng Ren】 didn't refute 【Su Yun】's words; he silently walked toward the laparoscopy room.

Arriving at the laparoscopy room, after changing shoes and clothes and going in, a doctor was already waiting at the door. He first introduced the condition: "Boss Zheng, Director Luo asked me to pick you up, please go inside. The patient ate fish last night, this morning at 4 a. m. coughed blood and came to our hospital for consultation. Under gastroscopy, there is a 5 cm long fish bone located 8 cm from the cardia in the patient's esophagus, with three fish spines on each side, lodged in the esophageal wall."

He didn't waste words, after a brief greeting he directly began reporting the condition.

Um, the patient's condition is worse than imagined! Zheng Ren's expression turned solemn.

"Director Luo tried, but pulling the spines out would cause them to flush upward, lightly tearing the esophageal mucosa. So he didn't dare move it; please take a look." The young doctor continued.

"Hmm, go check the situation." Zheng Ren strode inside.

Arriving at Director Luo's laparoscopy room, Zheng Ren said: "Director Luo, I'm here."

"Zheng Lao Ban, give it a hand, can't get it out." Director Luo's Sterile Cap was soaked with sweat; he looked a bit tired.

Called from home in the early morning, still dealing with such a difficult patient—anyone would be tired. Zheng Ren smiled and said, "Can't get it out?"

"Hmm, if we force it, I'm afraid the esophageal mucosa will tear from a few centimeters above the cardia all the way to the upper segment." He shook his head. "Otherwise, push it down directly into the stomach."

"That's also an option, but it can't be expelled from the stomach either." Zheng Ren said.

The main component of fish spines is calcium carbonate; gastric acid in the stomach has a pH of 0.9–1.5, so fish spines that reach the stomach only become softer but are not broken down.

Fish spines consist of many components; among them, phosphates can dissolve in acid, and after removing these minerals the spines naturally become softer. However, fish spines also contain a large amount of collagen, which wraps many other large protein molecules and polysaccharides; these macromolecular structures need further breakdown to be digested.

Although gastric pH is very low, once entering the small intestine the pH rises to around 7–8; some proteases effective on fish spine proteins, such as collagenase and pancreatic enzymes, only work under these alkaline conditions, further breaking down food.

In short, everyone present knows that even if a fish bone bearing six spines is pushed into the stomach, it will not be digested.

If the fish bone gets stuck at the pylorus due to gastric peristalsis, causing obstruction or tearing, a larger surgical treatment would be required.

Even procedures like gastrectomy and intestinal anastomosis are no joke.

Director Luo was also left with no choice; he was just speaking offhand.

Zheng Ren put on a pair of sterile gloves, took the gastroscope equipment from Director Luo's hand, and began observing the fish bone's position.

Just as that young doctor described, the fish bone is relatively large and hard. Whether it's from a freshwater or sea fish, Zheng Ren didn't bother to ponder. He also didn't try to pull it out, but instead glanced at the surrounding situation.

The esophageal mucosa shows slight damage, which came from the fish spines puncturing, and part of it is secondary injury from Director Luo's recent maneuver. It's obvious Director Luo was careful, not using brute force to yank the fish bone out.

What should we do about this?

Zheng Ren also felt a bit awkward.

Can't go up, can't go down, and leaving it in place isn't an option either.

"Ding dong~"

A crisp sound rang out, the mission notification sounded. Upon hearing the mission alert, Zheng Ren didn't feel happy; instead, he felt somewhat troubled.

This matter is really hard to resolve, why is Big Pig Trotter showing up now to cause trouble?

【Emergency Mission: Caught between a rock and a hard place.】

Mission Content: Remove the fish bone from the esophagus.

Mission Reward: Skill Points 3000, Experience Points 10000.

Mission Time: 3 hours.

Zheng Ren looked at the mission appearing in the upper right of his field of view, feeling somewhat helpless. Is Big Pig Trotter just playing with him? For such a major surgery, Xiao Shitou doesn't issue missions, yet this fish bone gets a mission.

Moreover, the mission reward bears no proportion to its difficulty.

Looking at the mission panel, Zheng Ren suddenly felt a stir. According to his understanding of Big Pig Trotter, removing the fish bone should be a very simple matter; otherwise, there wouldn't be such a meager reward.

Where is the problem? It must be a blind spot in my thinking.

Countless ideas surfaced in Zheng Ren's mind; he held the gastroscope tube, motionless, staring at the screen. Afterwards, he entered the System Operating Room and began trying various ways to remove the fish bone.

Director Luo waited nearly ten seconds, his unease growing stronger. It wasn't the fish spines that made him uneasy; the greatest anxiety and nervousness came from Zheng Lao Ban's complete stillness.

A troubling thought crossed his mind—could it be that he injured something when he just tried to pull the spines out?

After carefully examining the screen, Director Luo was quite sure nothing was wrong. After again recalling his recent actions, he still felt nothing was amiss.

"Zheng Lao Ban… could it be that you've injured something?" Director Luo didn't dwell on it, but asked tentatively.

"Your maneuver was very gentle, causing no major secondary injury; I'm just thinking about how to extract the fish bone." Zheng Ren smiled and comforted Director Luo.

"Boss, you're overthinking it, you've scared Director Luo." Su Yun smiled and said, "Now do you understand?"

"Hmm, there is indeed a method we can try." Zheng Ren said.

Director Luo's heart leapt with joy—having a method is good, having a method is good!