Life is Like a Journey – Chapter 53
by Little PandaVolume 1: Rise
Discussion
I only believe in the scalpel in my hand
“Patient Wu Xinyuan, 21 years old, stage four pancreatic cancer. After two courses of targeted therapy, the staging has improved, but CT still shows the tumor adhering to the abdominal aorta and duodenum, with secondary metastasis in the stomach. Please actively discuss and speak freely.”
The CT scan results were enlarged on the big screen. Lu Qingshi propped up her chin in silence, with Wu Xinyuan’s latest test results placed beside her.
The four coagulation tests showed that her blood clotting function was not good, and unpredictable bleeding and difficulty in hemostasis might occur during the operation.
The surgical plan written overnight was passed around. Everyone in the conference room furrowed their brows. The gastroenterologist stood up and said, “Let’s use an autologous blood recovery machine. This way, there won’t be a problem of not having enough blood.”
The associate chief physician from the hematology department immediately refuted, “No, using an autologous blood recovery machine solves the blood supply problem, but the key issue is that we can’t keep the container hanging without suturing indefinitely.”
Dean Meng put on his glasses, picked up the iPad, and studied it closely, using his fingertips to zoom in on the abdominal vascular scan results.
“This position is truly not good. Look, the tumor is right at the pancreatic head, wrapping around the abdominal aorta, and it’s severely adhered to the lower part of the duodenum. What’s worse is that there’s a shadow in the stomach, meaning the lymph nodes and cutting margins must be cleaned very thoroughly and completely for a radical cure. Otherwise, the prognosis is too poor, and it’s still a dead end.”
Lu Qingshi stood up: “That’s not even the worst part. The worst is that the patient’s blood coagulation function is too poor. Open chest surgery is traumatic and causes a lot of bleeding. It’s very likely we won’t be able to get off the operating table.”
Yu Gui weakly raised her hand: “Um… can we use laparoscopic pancreaticoduodenectomy for radical cure?”
The attending physician from the gastroenterology department let out a sneer: “We’ve already thought of that. It was your Director Lu who proposed it. Unfortunately, with laparoscopy, there’s less bleeding, but the lymph nodes might not be cleaned as thoroughly.”
The organs around the pancreas are densely packed. At the very least, nine nerve plexuses need to be cleared all the way to the superior mesenteric artery, and there are at least twenty lymph nodes. Such a long, major surgery is difficult to control bleeding even with laparoscopy. And if bleeding occurs during laparoscopy, it’s even more troublesome than open chest surgery. After all, in open chest surgery, if there’s bleeding, you can immediately press gauze on it. The laparoscopic space is so small, and the hemostasis speed of the monopolar electrocautery isn’t faster than the bleeding rate. By the time you convert to open chest surgery, it would be too late.1
Yu Gui shrank her neck and gripped the pen in her hand tightly: “What if we mark the nerve plexuses and lymph nodes that need to be cleared in advance? Would that speed up the surgery?”
Lu Qingshi nodded: “Theoretically, yes.”
Yu Gui cast a grateful glance, which the other party ignored, and then a single sentence plunged her into despair: “But that’s only in theory. To prevent further tumor spread and metastasis, we also need aortic artificial vascular replacement. The SPV/PV involvement is too extensive to reconstruct the superior mesenteric artery, and the common hepatic artery is also affected. Therefore, the only feasible option at present is — pancreaticoduodenectomy, portal vein + superior mesenteric artery resection, and aortic artificial vascular replacement, along with biliary-enteric anastomosis to reconstruct the digestive tract.”2
The longer the medical terminology, the more difficult the operation. The string of terms thrown out left Yu Gui dizzy and disoriented. Before the anesthesiologist could speak, she already knew that this surgery was almost an impossible task.
Chen Yi stood up and handed the pre-operative assessment to the dean: “After multiple evaluations and consultations by the anesthesiology department, the patient’s anesthesia tolerance time is within 7 hours. Exceeding this time would pose a life-threatening risk.”
In the silent room, Liu Changsheng used the lid to skim the tea scum in his porcelain cup, and finally slowly put it back on.
“Considering the patient’s family situation comprehensively, we are more inclined towards proposing a chemotherapy and combined medication plan. We suggest the patient return to their local hospital for continued treatment, with our remote guidance and assistance. This way, medical insurance can cover part of it, and the burden on the patient’s family can be lightened a bit.”
The risk for the doctors would also be smaller, which might not necessarily be a bad thing for the patient. Rather than getting on the operating table and not being able to get off, it might be better to make the most of the time with chemotherapy and live one more day at a time.
During the lunch break, everyone dispersed to the cafeteria to eat. Yu Gui snuck into the simulation operating room, but someone was already there. Lu Qingshi, dressed in surgical gown, was standing at the operating table holding a laparoscope.
“This is…” Yu Gui was suddenly stunned. On the operating table was a simulated organ. Judging from the way the tumor was entwined, it was undoubtedly Wu Xinyuan’s digestive organ.
“3D printed organ,” Lu Qingshi said without raising her head. Her fingertips moved slightly, and the buzzing sound of the ultrasonic scalpel started. She stared intently at the computer screen when suddenly a blood mist obscured her vision, and the monitoring equipment began to beep.
Bleeding exceeded 100, operation failed.
Lu Qingshi put down the laparoscope and pressed her lips tightly: “One more time.”
Yu Gui put on her surgical gown and came to help: “I’ll join too.”
“Pancreaticoduodenectomy complete.”
“Next, dissect the portal vein.”
“Forceps.”
Yu Gui handed over the instrument. Lu Qingshi glanced at the screen: “Suction.”
She quickly attached the suction device, her movements much more dexterous than before.
“Good, dissection complete, prepare for resection, ligate the aorta.”
“Yes,” Yu Gui held the laparoscope in her hand and swiftly tied a knot.
“Not right, the ligation needs to be tighter.”
A thin layer of sweat seeped out on Yu Gui’s forehead: “Alright, I understand.”
An observing intern beside them nudged their companion, whispering: “Have you noticed that Yu Gui’s speed is quite fast now?”
The other rolled their eyes: “If you were subjected to Director Lu’s devil training every day, you’d become fast too.”
The intern who spoke first immediately shuddered: “Forget it, I’d rather slack off and wait for death.”
As they were talking, Yu Gui couldn’t keep up with Lu Qingshi’s hand speed over there, and was scolded harshly. Her temper at the operating table was definitely far from good.
“Has your brain been eaten by dogs? The method of resecting the portal vein is wrong! Get off the table, switch people!”
The observing interns on the side felt sympathetic and quickly walked up, but Yu Gui remained motionless in the assistant’s position.
“You…”
She raised her head, staring at the big screen, correcting her mistakes: “She is my patient, I must cure her.”
As soon as she finished speaking, the timer went off. Seven hours had passed unknowingly, the anesthesia critical point had arrived, meaning the surgery was equally unsuccessful. Everyone was dejected.
Lu Qingshi took off her mask and threw it into the trash can: “Alright, let’s stop here for today. Yu Gui, stay behind and continue.”
It was a rule in Lu Qingshi’s surgical team: whoever makes mistakes in the simulated surgery is responsible for staying behind to clean up and propose solutions, required to be placed on her desk within 24 hours.
Everyone looked at her with sympathetic eyes, patted her shoulder and left. Yu Gui could only smile bitterly, but she didn’t seem as resentful as the first time she was left behind.
“One fried noodles, thank you.” Lu Qingshi got her meal from the window and sat down in a corner of the cafeteria. Before her seat had even warmed up, someone sat down opposite her.
She thought it was Qin Xuan and didn’t raise her head: “Go sit over there, don’t stick close to me.”
“It’s been a long time, Director Lu, but you’re still as radiant and enviable as ever.”
It was a slightly deep middle-aged male voice. Lu Qingshi raised her head, her gaze suddenly turning cold: “Get lost.”
The temporary access card on the man’s chest read: Changsheng Biological Pharmaceutical Co., Ltd., South China Regional Sales Representative, Zheng Bin.
He leaned forward slightly, not embarrassed by her cold words, obviously an old hand who had been frequenting various hospitals for years.
“Don’t be like that, Director Lu. I heard you like to eat Fuling sandwich cookies, so I specially brought some from Beijing. They’re from that very authentic shop at Qianmen. Have a taste.”
He placed the wrapped gift on the table and pushed it over. A cold smile appeared on Lu Qingshi’s lips as she put down her chopsticks and stood up to leave. The brief “Get lost” had already exhausted all her patience; she really didn’t want to engage in superficial niceties with people from Changsheng Biological.
The man stood up: “Director Lu, don’t you want to learn about our company’s latest product, the nano-knife? It can directly ablate pancreatic cancer tumors without damaging normal organ tissue…”
Lu Qingshi turned around, hands in her white coat pockets, a hint of frost and a trace of contempt in her eyes. The words she uttered, however, were full of the confidence—or rather, arrogance—of a seasoned surgeon.
“Is there any need for that?”
“I only trust the scalpel in my hand.”
“The 45th marking point,” Yu Gui rubbed her eyes, yawning continuously, and circled another small red dot on the paper with her pen.
Hand-drawing anatomical diagrams of human organs is a basic skill for every surgeon. Yu Gui had good drawing skills. She was marking lymph node and nerve plexus clearance points while referring to the CT scan. Staying up until the wee hours, her eyes were bloodshot. She wished she could prop them open with matchsticks, and went to get half a cup of extra strong coffee to stay alert.
“Team Leader Xiang, the autopsy results are out. The deceased died from □□ class drug poisoning.”
The forensic doctor opened the autopsy report and handed it to her: “The neurotoxin in the body is identical to the one in the Yunnan case. There are needle marks on the veins. It’s preliminarily confirmed to be some kind of new drug, no doubt.”
“Good,” Xiang Nanke carefully looked through it: “Have the people from Yunnan Provincial Public Security Department’s Drug Enforcement Unit arrived?”
Cross-provincial cases are the most complicated. The identity of the deceased who overdosed in Yunnan was confirmed to be from Jinzhou City, and because it involved drugs, both places’ public security took it very seriously. Therefore, the case was also transferred to Jinzhou City Public Security Bureau, vowing to root out the source of the drugs.
Xiang Nanke’s prolonged inaction was also to avoid alerting the enemy. She always felt that Bao Fengnian was just one link, and there was someone else above him.
“They should be arriving soon,” the subordinate glanced at his wristwatch. “Our people are waiting at the train station.”
Before he finished speaking, another criminal police officer pushed open the door, his expression somewhat ominous: “Team Leader Xiang, the Bureau Chief is looking for you.”
Xiang Nanke closed the autopsy report and stood up. Her colleague quickly followed, whispering: “The Bureau Chief’s face doesn’t look good. He’s probably dissatisfied with our delay in closing the net. You should be careful.”
Xiang Nanke paused her steps: “I understand.”
Sure enough, as soon as she knocked and opened the office door, a thick case file came flying towards her. Xiang Nanke caught it steadily, bowed slightly, and placed it on the desk of the half-centenarian in front of her.
“What did Chief Li call me for?”
Chief Li, who had risen step by step from the grassroots to a department-level cadre, was known for his explosive temper. He slammed the desk with a thunderous bang.
“How long has it been since this case was transferred from Yunnan Provincial Public Security Department to Jinzhou City Bureau!!! You can’t even make a tiny splash of progress! Xiang Nanke, what the hell are you good for! Let me tell you, I’ve already made a military pledge with the Provincial Bureau! If we can’t solve the case and find the source of the drugs within a month, we’ll both be kicked out!”
When Xiang Nanke first arrived at the Criminal Investigation Unit of the City Bureau, he actually didn’t think highly of her. Women should just find a logistics position and be content being a vase, he thought. But Xiang Nanke refused, racking her brains to get into the front line as a criminal police officer, matching wits and courage with criminals, repeatedly achieving extraordinary merits. Every step she had taken to get where she is today was exchanged with her own scars and sweat. The harder it was to come by, the more she cherished it.
Xiang Nanke’s throat moved, but she ultimately said nothing: “I understand.”
As she was about to turn and leave, she was called back again: “I understand you’re afraid of alerting the suspects, but you can start with the close relatives of the suspect. You might not get anything out of Bao Fengnian’s wife, but his mistress might be a different story. You understand my meaning, right?”
Chief Li lit a cigarette, and amidst the swirling smoke, he sighed heavily: “Nanke, you’re my most valued criminal police officer. Don’t let me down.”
Xiang Nanke’s nails dug deep into her flesh as she said hoarsely: “I know this. Don’t worry, if I can’t produce solid evidence within a month, I’ll twist my own head off to apologize to the Provincial Public Security Department.”
Footnotes
- Basically: Surgery near the pancreas is really complicated because it’s surrounded by many other organs and important nerves and lymph nodes. During laparoscopic surgery (which uses small cuts and special tools), it can be hard to control bleeding. If bleeding happens, it’s tougher to manage than in open surgery (where there’s a larger incision). In open surgery, you can easily apply pressure to stop bleeding, but in the small laparoscopic space, it’s more difficult and can lead to serious problems before you can switch to open surgery.
- Basically: While there are theoretical options for treating tumors, the situation is more complicated in reality. To stop the tumor from spreading, doctors need to replace part of the aorta (the large blood vessel). Since the cancer has spread too much to fix some key arteries, the best current approach is a major surgery called pancreaticoduodenectomy. This involves removing parts of the pancreas and nearby blood vessels and then connecting the digestive system back together.
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