Life is Like a Journey – Chapter 16

Volume 1: Rise

Surgery

Death Case

“Dean Meng rarely takes the stage; must record it well for the teaching video.”

In the observation room, the deputy director of the medical office was rubbing his fists, watching the orderly surgery below and praising it.

Director Liu, however, said nothing. With furrowed brows, he glanced at the surgery time, which had already passed four hours.

“Gallbladder removal completed,” Dean Meng placed the dissected tissue into the waste tray. “Send for pathology.”

The operating room nurse nodded and left.

“Next, proceed with the left hemihepatectomy¹ plus caudate lobe resection² using the monopolar electrosurgical knife³.” The instrument nurse calmly handed it over, and Dean Meng firmly grasped it in his hand. Even though he was over sixty, his hand remained steady, calm and composed, bold and meticulous.

“Beep beep——” The operating room bell suddenly rang loudly, and the chief surgeon of hepatobiliary surgery signaled the nurse to answer.

The nurse covered the receiver and relayed, “Chief, the patient in bed fifteen is having massive hemoptysis and needs emergency thoracotomy exploration.”

The hand holding the monopolar electrosurgical knife suddenly paused: “Let Dr. Qian go; I can’t leave at this critical moment.”

“Dr. Qian is on the way back.”

Dean Meng, wearing magnifying glasses, kept his head very low: “You go; I am almost finished here.”

The monopolar electrosurgical knife emitted beeping sounds as it moved over the tissue, releasing pale blue smoke that filled the entire operating room with an aroma resembling roasted meat. Facing the exposed cancerous organ, it could only be considered a dark cuisine, something that would make ordinary people vomit just by seeing it, if not too afraid to look.

“Then…” The chief of hepatobiliary surgery hesitated for a moment, then obediently put down the electrosurgical knife. If the Dean was performing the surgery, he could at most add finishing touches, but what truly needed his crucial help was another patient.

“Which operating room is empty? Push in there first; I will be there shortly.”

The automatic shielding door of the operating room slowly closed, and the second assistant replaced the first assistant, standing opposite Dean Meng.

“Dean, the blood pressure dropped to 60—80⁴,” the anesthetist called out.

“Don’t panic; use vasopressors⁵ to maintain it.”

The operating table is never a one-person battlefield; an excellent team has always been more valuable than a single excellent surgeon. With the departure of a capable assistant, a thin layer of sweat appeared on Dean Meng’s forehead.

“Wipe the sweat; just cut this bit, and it will be done.” The electrosurgical knife was switched to an ultrasonic knife⁶, emitting a beeping sound as Dean Meng carefully separated the healthy tissue from the cancerous cells. The liver area has many blood vessels, and a single careless operation can easily cause massive bleeding.

“Drain, there’s fluid accumulation.” Sweat trickled into his eyes, and he blinked, instructing the assistant, who quickly connected the aspirator.⁷

“Okay… left half liver resection completed,” said Dean Meng, as forceps carefully clamped the black and hard diseased liver from the abdominal cavity, and he breathed a sigh of relief.

“Next, perform caudate lobe resection,” he instructed, picking up the electrosurgical knife again.

The anesthetist stood up and said, “Dean, the blood pressure still hasn’t recovered.”

Dean Meng glanced at the monitor and then focused on his work: “How many milliliters of blood loss?”

“20.”

“Okay, it might be that the surgery is taking too long, causing a burden on the patient’s body. I’ll be quick; use dopamine to maintain it.”

The anesthetist swiftly administered the medication through the catheter into the vein.

“Assistant, expand the surgical field a bit more,” Dean Meng softly instructed, the sweat on his forehead already soaking the surgical cap.

“Okay, nurse, wipe the Dean’s sweat.”

“Liver… caudate lobe resection completed…” Placing the diseased tissue into the waste tray, Dean Meng straightened his back and breathed a big sigh of relief.

“Send pathology.”

The surgery time displayed on the wall had already exceeded six hours.

“Next, proceed with the partial resection and reconstruction of the portal vein.”

The most dangerous part had already been completed, and everyone in the operating room quietly breathed a sigh of relief. The assistant’s face even showed a slight complimentary smile.

“Dean is truly not old; following Dean Meng in surgery is really beneficial.”

“Old, not good. When I was young, doing this kind of surgery…” Dean Meng said while preparing for the vascular resection, “wouldn’t take this long. Give me the vascular clamp.”

He buried himself in work, asking the anesthetist, “The blood pressure still hasn’t come up?”

As soon as he finished speaking, the monitor sharply sounded, and a large amount of fresh blood suddenly rushed into the blood reservoir. The anesthetist also suddenly stood up from his position: “Bleeding reached 50, Dean!”

Dean Meng’s hand holding the electrosurgical knife suddenly paused. He looked at the clear surgical field, the tissue layers distinct, and the recently resected and repaired area perfectly sutured, making it impossible to have bleeding.

“Bring plasma!”

“Open the intravenous access!”

“Replenish the balanced solution!”

“Correct the electrolytes!”

A series of commands were conveyed methodically. Dean Meng, holding forceps, searched for the bleeding point, his heavy surgical gown completely soaked with sweat.

“Where exactly is the bleeding?!” The assistant was as anxious as an ant on a hot pan.

“Bleeding reached 1000 ml!” In a few short minutes that felt like an eternity, the medical director jumped up from the chair, watching helplessly as the blood pressure reading on the cardiac monitor kept dropping, breaking below the minimum value. After a prolonged beep, it fell silent.

“Heartbeat stopped!” The anesthetist announced the final result. Dean Meng’s hand paused, his body swayed slightly, and the surgical knife fell into the tray with a crisp “clang” sound.

“Dean!” Everyone rushed to support him. Dean Meng was on the verge of collapse, his eyes full of unwillingness: “Where exactly is… the bleeding?”

The medical director punched the glass of the observation room, and the deputy director suddenly sat down, too scared to make a sound.

Dean Meng has handled many cases, yet this is the first time a death case has occurred. How… how does one explain this to the patient’s family, and how to explain to the media waiting outside?

Everyone in the operating room looked at each other; fear, dread, worry, and unease appeared on everyone’s faces.

In the deathly silence, steady footsteps were heard. Lu Qingshi, wearing a green scrub suit covered with a radiation-protective lead apron, slowly stepped into the operating room, gesturing to the operating room nurse: “Surgical gown.”

Seeing no response, she repeated more emphatically: “Surgical gown.”

The head nurse was the first to react, quickly helping her put on the surgical gown. As Lu Qingshi walked, the nurse jogged behind her, tying the straps.

“Give me the magnifying glass.” The instrument nurse put the magnifying glass on her.

“Bring the endoscope⁸ over.”

“Disinfect.” She took the scalpel in one hand and made a small incision in Wang Youshi’s pleura.

The assistant stopped her: “What are you, an emergency department person, doing here?! Can’t you see the abdomen still has such a big incision unsewn?! The patient’s heartbeat has already stopped; the urgent task is to quickly think about how to explain to the family, not to do useless work here!”

Lu Qingshi flung him aside and glanced at the open abdominal cavity: “The liver surgery was done very beautifully; the cause of the bleeding is because the patient had an aortic dissection aneurysm rupture⁹.”

She tried to keep it brief, her hands moving quickly, almost dazzlingly.

“I want to perform thoracoscopic root replacement¹⁰ plus total arch replacement¹¹ plus stent elephant trunk procedure¹²; take this.”

A medical micro camera passed through the observation hole she had just cut, displaying the condition inside the patient’s thoracic cavity on the large screen.

The assistant, suddenly ordered around and holding the observation mirror stuffed into his hand, looked incredulous: “Dr. Lu, are you crazy?! The heartbeat has stopped; even if you find the bleeding point, the person cannot be saved, and if saved, there is a possibility of brain death!”

“I see,” Director Meng came to his senses at this moment, shook off the nurse supporting him, and also walked to the operating table, picking up the electric knife: “Dr. Lu intends to operate under hypothermic circulatory arrest¹³. Stop the nonsense and help.”

“Dr. Lu, there is not much time left; circulatory arrest can hold for at most two more minutes,” the anesthetist said, holding the stopwatch.

“OK, found it,” Lu Qingshi, having seen the CT scan in advance and with reduced bleeding under hypothermic circulatory arrest, almost instantly confirmed the location of the aneurysm.

“Vessel clamp,” the micro ultrasonic knife was mounted on the thoracoscope, her hands very steady, exhibiting a fluid beauty under the shadowless lamp.

“Hurry, one minute left!” The stopwatch was rapidly counting down.

“Vessel clamping completed, now placing the stent and performing artificial vessel replacement.”

Lu Qingshi put down one side of the thoracoscope, switched hands, and didn’t bother to wipe the slight sweat beading on her forehead.

“I’ll place the stent, you replace the vessel,” Director Meng said as he picked it up. She slightly breathed a sigh of relief and nodded.

“Fifty seconds”

“Forty seconds”

“Thirty seconds”

“Twenty seconds”

“Ten”

“Nine”

The anesthetist rapidly counted, and Lu Qingshi’s hand movements did not slow, unaffected by the tense atmosphere in the operating room. She was now single-minded, with only one thought in her mind:

Do not give up on any patient.

“Three”

“Two”

“One!”

“Countdown ended”

“Artificial vessel replacement completed”

“Stent placement completed”

Three voices sounded almost simultaneously, and on each person’s face, there was the joy of surviving a calamity.

Lu Qingshi released the hemostat, and the crimson blood slowly flowed through the artificial vessel to the heart. Everyone was intently staring at the screen.

The myocardium¹⁴ suddenly contracted, and the pumped blood flowed through the arteries to the whole body.

“Beep beep——” The once-silent electrocardiogram monitor sounded, and everyone in the operating room erupted into cheers.

The anesthetist and the instrument nurse gave each other a celebratory high-five.

The first assistant breathed a sigh of relief and hugged the third assistant tightly.

Dean Meng’s face, lined with wrinkles, sincerely showed a smile of approval: “Young person, remarkable indeed.”

Lu Qingshi also breathed a sigh of relief, her sweat-soaked clothes heavy. She nodded in acknowledgment as she set down the thoracoscope: “Dean Meng, you overpraise me.”

She stepped back, relinquishing the first assistant’s position, and prepared to remove her gloves: “Well, the surgery is over, I’ll take my leave.”

Just as she was about to step out of the operating room, Dean Meng called her back: “Stop, who said the surgery is over? The portal vein hasn’t been reconstructed yet. Leaving an old guy like me to be the chief surgeon and you all just watching on the side, come over here and be my first assistant!”

Lu Qingshi paused her steps, a hint of a smile appeared at the corner of her lips. She turned and slightly bowed, raising her hand to check her watch: “Sorry, I’m already off duty now. It’s just the portal vein; the assistant next to you can handle it.”

After speaking, she waved her hand and turned to leave.

Dean Meng angrily cursed: “This dead girl! I’ll dock your salary this month!!!”

The director of the medical office wiped the cold sweat from his forehead and sat down heavily: “Scared me to death, docking salary? Add money, add money, give Lu Qingshi a raise!”

1. Left Hemihepatectomy: Left hemihepatectomy is a surgical procedure that involves the removal of the left half of the liver, typically performed to treat liver cancer or other liver conditions affecting that specific region.
2. Caudate Lobe Resection: Caudate lobe resection is a surgical operation to remove the caudate lobe, a small, independent lobe of the liver, often undertaken to remove tumors or lesions located in this specific area.
3. Monopolar Electrosurgical Knife: A monopolar electrosurgical knife is a surgical instrument that uses high-frequency electrical currents to cut tissue or coagulate blood vessels, providing precision and minimizing blood loss during surgery.
4. The blood pressure dropped to 60—80: This indicates a hypotensive condition where the patient’s blood pressure has fallen to a critically low level, with the systolic pressure (maximum blood pressure during contraction of the ventricles) at 60 mmHg and diastolic (minimum pressure recorded just prior to the next contraction) at 80 mmHg, which can compromise blood flow to vital organs.
5. Vasopressors: Vasopressors are medications used to constrict blood vessels and increase blood pressure, typically administered to patients experiencing severe hypotension to stabilize their cardiovascular system.
6. Ultrasonic knife: An ultrasonic knife, also known as an ultrasonic scalpel, is a surgical instrument that uses high-frequency ultrasonic vibrations to cut tissue and coagulate blood, providing precise and minimally invasive surgical interventions.
7. Aspirator: An apparatus for producing suction or moving or collecting materials by suction.
8. Endoscope: A medical instrument used to view the inside of a body cavity or organ. It consists of a flexible tube with a light and camera attached, allowing doctors to diagnose or treat conditions without invasive surgery.
9. Aortic dissection aneurysm rupture: occurs when a tear in the inner layer of the aorta’s wall (the largest artery of the body that carries blood from the heart to the circulatory system) allows blood to flow between the layers, causing the aorta to weaken and potentially rupture.
10. Thoracoscopic root replacement: A minimally invasive surgical procedure to replace the root of the aorta, typically performed using a thoracoscope, which allows the surgeon to operate through small incisions in the chest.
11. Total arch replacement: Involves replacing the entire aortic arch, a section of the aorta that supplies blood to the head and arms, often due to aneurysm or dissection, to restore proper blood flow and prevent complications.
12. Stent elephant trunk procedure: A complex cardiovascular surgery technique used to repair extensive aortic aneurysms and dissections, where a stent graft (a tube made of leakproof polyester with metal mesh underneath) is placed in the descending aorta to provide support and facilitate future surgical interventions.
13. Hypothermic circulatory arrest: A surgical technique that involves cooling the body to significantly lower temperatures to temporarily stop blood circulation, allowing surgeons to perform complex operations on the heart and aorta with reduced risk of brain and organ damage.
14. Myocardium: The muscular tissue of the heart, responsible for contracting and pumping blood throughout the body. It is a central component of the heart’s structure, enabling the heart’s rhythmic contractions that maintain blood circulation.