Path of Medicine With a System

Normally, when it came to trying to save an emergency patient, the patient’s specific problem would determine which department was in charge of saving him. However, this patient obviously had multiple trauma. Seeing how the blood was blackening, it was likely that the wooden stake had penetrated through the rectum, entered the pelvic cavity, and damaged a major vein. Well, the patient’s luck could have been worse. If a major artery had been damaged instead, with how long it had taken to transport him to Chasu City Hospital, he would have long since died from acute heart failure and blood loss!

Fluid resuscitation was absolutely necessary for anyone who had suffered major blood loss. However, which type of fluid was best for resuscitation? The academic debates on this would never end! On principle, the fluid’s electrolyte concentration needed to be similar to that of blood plasma’s, the osmotic pressure and osmolality needed to be similar to that of whole blood’s, and it would be best to use the least amount of fluid possible to achieve the greatest amount of dilatation and oxygen transportation. In the recent 20 years, academicians believed that crystalloid solutions were superior to colloid solutions for early fluid resuscitation. Crystalloid solutions included glucose and electrolytes, while colloid solutions included blood plasma, blood plasma substitutes, and whole blood.

To explain quite simply, whenever a patient was in medical shock and needed emergency treatment, should the patient first receive a blood transfusion or equilibration solution infusion? There was much debate on this topic alone, not to mention countless other medical issues.

When it came to treating internal organ bleeding, the doctors would need to simultaneously save the patient from shock while also performing surgery and aggressively searching for the point of bleeding so that the bleeding could be stopped. Only by stopping the bleeding would there be hope of saving the patient’s life.

Since Superintendent Ouyang wasn’t present, there was now controversy on how to proceed with surgery for this patient. Normally, the proctology director wasn’t the type to participate in such things. He was the type who preferred to do as little as he possibly could. Normally, the general surgery director would be happy to take such surgeries, so the proctology director was quite satisfied with only having to deal with hemorrhoids.

But, ever since Zhang Fan performed such a major rectal cancer surgery, the proctology director was no longer able to have things so easy anymore. He had lost almost all of his authority due to Zhang Fan. It would be really difficult for him in the future if he didn’t regain some face. Others were already beginning to say that he was only at the level of cutting some butts!

That was too much for the proctology director to bear. He still hoped for additional income from the lower-ranking proctologists to help him support his new pretty and young wife.

“Prepare for surgery!” announced the proctology director as he looked over the patient in emergency treatment. He had planned it out in his mind already. After entering the abdomen, he would only perform the proctology-related portion of the surgery.

However, the proctology director was left in an awkward position when the general surgery director and urology director didn’t say anything! Nobody was willing to help him with this surgery. The hospital administration director noticed that things weren’t going well, so he hurriedly contacted Superintendent Ouyang. Since the directors were all at the same level, and would often ignore each other, it really wouldn’t be possible to order around the arrogant directors without a powerful higher-ranking leader.

As Chasu City Hospital was doing its best to treat the Hong Kong businessman patient and prepare for surgery, his family members back in Hong Kong were in utter chaos. They were all using every single connection that they could. However, there really was little that they could do since the injured businessman was currently all the way on the other side of China.

The family was large, as was the family business. This meant that there would be many things going on inside. There were those in the family who wanted him to live, those who wanted him to die, and those who wanted him to be in a half-dead state! This wasn’t strange at all. Too much money would tempt people’s hearts towards evil! If this was a smaller family with a regular business, everyone definitely would have tried their best to only use connections to save the patient instead.

The patient’s bodyguards’ cell phones constantly rang. The border province businessman’s cell phone also constantly rang. Things were incredibly messy. The injured Hong Kong businessman’s family members were fighting each other! They were fighting over his surgery and a possible transfer of hospitals! For someone as powerful as this Hong Kong businessman, even his wife might not be able to decide by herself regarding his surgery!

Superintendent Ouyang finished a phone call with her government higher-up. The government higher-up had also talked to her about this businessman. The higher-up didn’t give her any direct order, and simply told her to “do her best”. This was the higher-up’s attitude. Governmental higher-ups would be really specific with their wording depending on the attitude that they wanted to express. The attitude could range from “absolutely”, to “you must”, down to “do your best”, which would each represent differing degrees of how important this issue was to the government higher-up.

When Superintendent Ouyang came into the emergency department, the previously silent department directors finally became willing to speak again.

“What’s the plan? Who will be in charge?” Superintendent Ouyang inquired. Due to the low amount of importance placed on this patient by the government higher-up, she would simply only care about the doctors’ professionalism. She didn’t want to give the doctors any pressure. She hadn’t been told of the patient’s identity yet.

“Superintendent, the patient has anorectal trauma, so allow me to be the primary surgeon! But, when considering the major bleeding, I would like to request assistance from other departments,” said the proctology director.

“Okay!” Superintendent Ouyang glanced at him and agreed. She then told the general surgery director and urology director, “Prepare for surgery.” She was able to decide things quite easily as she was the leader of the entire hospital.

The proctology director wasn’t influential, and his medical skills were only average. He hadn’t been able to convince the general surgery director and urology director to help him. It was likely that they would simply send vice directors to help him. Still, that would be enough. Even though this type of surgery appeared to be really dangerous, as long as the abdomen was opened up and the point of bleeding was swiftly located, the rest wouldn’t be all that difficult. The only requirement was that this be done as quickly as possible. This wasn’t a highly difficult surgery which required cleaning out the lymph nodes, constructing an artificial passage, or so on.

While they were busy discussing the surgery, the cardiology director was quite busy herself with preserving the patient’s life. Only then would surgery be possible, after all. What was preserving this patient’s life about? She would first have to protect his oxygen cycle!

Zhang Fan wasn’t the gossipy type, so he wasn’t at all curious about the competition and infighting between the directors. He only cared about the patient’s condition and how to save him.

Cardiology Director Ren Li was an expert doctor who had previously worked at the provincial hospital, but had come to Chasu City Hospital instead due to infighting at the provincial hospital. Now, she was the undisputed #1 doctor at shock resuscitation in all of Chasu City Hospital. This was how skilled she was!

There were methods and principles for early fluid resuscitation. Basically, be early, be swift, and adequate dilatation were the critical points of saving someone from medical shock.

Ren Li stood calmly in front of the patient’s bed with her arms folded. She issued medical commands without even needing to think about them. “Establish four vein channels for fluid infusion. Swiftly inject 1500 mL of balanced salt solution, 500 mL of medium molecular dextran 70, and use an infusion pump to increase the rate of infusion.”

Director Ren Li then checked the electrocardiogram, and immediately commanded, “Manual blood pressure measurement! Hurry!” The nurse was too busy with all of her work, so Zhang Fan went up and took the sphygmomanometer and immediately began to measure the patient’s blood pressure. At this time, speed was more important than being gentlemanly and polite.

“70/30 mmHg. Pulse is weak,” Zhang Fan reported while taking the patient’s blood pressure measurements.

“Blood transfusion. Swiftly infuse 300 mL of whole blood through the veins. Dexamethasone via IV!” Ren Li continued issuing medical commands. She was doing her best! Her method was actually rather risky! A major medical incident might occur if she didn’t control things well!

This type of patient wouldn’t lack for money! More than 100,000 yuan was deposited on his behalf upon hospitalization! Truly a display of his wealth.

“Blood pressure is rising. His pulse is still weak. The directors can begin surgery!” Zhang Fan told Ren Li.

“Alright. The rest will depend on you surgical departments,” Ren Li declared. Emergency treatment principles were quite simple. To use an analogy, it was like having a bowl with a fish in it, but there was a hole in the bottom of the bowl. In that case, water would need to be added to the bowl at a constant rate in order to maintain the fish’s need for water. The water also couldn’t be added too quickly, as the fish would fall out of the bowl! This balance would need to be maintained until the surgeon was able to treat the patient and stop the bleeding.

This was Ren Li’s medical skill at work!

A nurse swiftly pushed the gurney together with the IV drips out of the emergency department as she swiftly ran towards the surgery-use-only elevator. The proctology director also proudly followed after as he prepared to get on the surgery elevator.

“He’s the primary surgeon?” said a woman in Cantonese as she blocked the proctology director’s path. She appeared to be a personal assistant.

“Eh?” The proctology director didn’t understand Cantonese.

“Who among you is the primary surgeon?” a bodyguard did the translating. In Hong Kong, for the extremely powerful families, the personal assistants weren’t always chosen for the sake of helping with the business. Old Hong Kong families which really favored England often hated speaking Mandarin Chinese.1

They would either speak in English or in Cantonese. They would view speaking English as a way of showing off their status.

“This patient is our CEO. He’s worth more than four billion yuan. Are you certain that you have a guarantee of being able to perform surgery on him?” Who knew what this personal assistant’s intentions were? Her question instantly caused the proctology director to stop in fear! Maybe this woman was working for part of the family that wanted the Hong Kong businessman to die!

Although it was unknown how worried others in the Hong Kong businessman’s party were about his fate, the border province businessman who had organized the hike was extremely worried. He would be held responsible for quite a lot of things here if the Hong Kong businessman were to die.

“Superintendent Ouyang, I’m the secretary-general’s friend. Please, you must help us! We’ll definitely repay the favor!” the local businessman implored with Superintendent Ouyang. He was really scared right now. He knew that anyone who tried to scare the doctors at this time was basically trying to ruin the surgery!

Superintendent Ouyang had been about to erupt, but she suppressed her anger when she looked at the local businessman. He was a tall man who was over 1.8 meters, yet he was bowing deeply with head lowered as he begged the older and shorter Superintendent Ouyang who was only a little more than 1.6 meters tall.

Superintendent Ouyang glanced at the proctology director, who was still standing there frozen. She said, “Say it, loudly tell her your answer!” Superintendent Ouyang couldn’t stand how the proctology director was too afraid to perform surgery after a single woman scared him!

“I! I!” The proctology director was unable to confidently reply that he could perform the surgery! He couldn’t even form a coherent sentence! Superintendent Ouyang was infuriated at his cowardice! So what if this patient was rich!?

People from Superintendent Ouyang’s generation were rather contradictory. Nowadays in China, most of the richest and most powerful individuals were from her generation. However, it was also her generation who looked down on the rich and powerful the most!

Superintendent Ouyang condescendingly glared at the proctology director. She then turned around to look at the other doctors, who had all just exited the emergency department. “Who has a guarantee of being able to perform this surgery? Stand up! Don’t let others look down on us! I won’t stand for losing face like this!”

“Me!” The urology director volunteered!

“Me!” The general surgery director volunteered!

“Me!” The urology vice director volunteered!

“Me!” The general surgery vice director volunteered!

“Superintendent! No need to trouble the directors. I can do it!” Zhang Fan loudly shouted from the edge of the crowd.

“Okay, you can do it then! Let’s have our young doctor perform the surgery!” Superintendent Ouyang declared!

When the border province businessman heard that the youngest doctor here would be performing the surgery, he lost all energy in his body! He collapsed! He felt a stampede of alpacas1 parading through his mind!