CHAPTER 482: 482 TEACH ACCORDING TO A STUDENT’S ABILITY

(Thanks to good friends yaoyao0617 and book friend 20190812005747006 for the encouragement with their monthly tickets)

"President Liu, is this surgery very difficult?"

Having just entered the operating room, Li Liwei, the anesthesiologist, asked directly.

Liu Banxia nodded. "There are too many areas that need surgery: the lungs, the abdomen, and fractures in both legs and arms. We’ll need to work on them simultaneously. We’re counting on you."

"Ah... I was hoping to relax a bit during the New Year, and now a major case like this comes in. I heard it was a car accident? How did it get so severe?" Li Liwei asked.

"I’m not entirely sure about that," Liu Banxia replied, then looked at Su Wenhao. "Have you made a preliminary assessment of the patient’s injuries? If so, tell me about it."

"The most common issues from blunt abdominal trauma involve the spleen, kidneys, and intestines. The liver also needs careful examination," Su Wenhao said.

"Teacher Liu, if the patient bleeds significantly after we open the abdomen, we’ll need your help to locate the bleeding points. If multiple organs are damaged simultaneously, we’ll also need you to step in."

Liu Banxia nodded. "That’s no problem, but the initial exploration is your responsibility. The patient’s blood pressure seems relatively stable, so the bleeding might not be too severe."

He said this to boost Su Wenhao’s confidence. Such an emergency surgery places immense pressure on the attending surgeon. While it was routine for veterans like Liu Banxia, Su Wenhao was still an intern, and this was his first time as the lead surgeon in an emergency operation.

Liang Xiaolin, however, was in much better condition. It seemed that all the extra coaching from her brother had paid off.

After a short wait, the nurses wheeled the patient in, and the atmosphere grew tense.

"The patient’s head CT is normal. No signs of bleeding or hematoma," announced the nurse accompanying the patient.

"Considering the complexity of the patient’s injuries, after anesthesia, we’ll perform a median sternotomy. But first, let’s open the abdomen to stabilize blood pressure, then proceed with opening the chest," Liang Xiaolin suggested once the patient was positioned on the operating table.

"Standard midline laparotomy," Su Wenhao stated succinctly.

Even though they were both interns, they were now the lead surgeons. Unless they made a blatant error, Chen Xuehai and Liu Banxia could only observe and not intervene.

Their choices were both sound. In emergency surgery, there’s no room for excessive deliberation.

If Liang Xiaolin had opted for a more conservative approach, she could have made a small left anterolateral thoracotomy. However, this patient had suffered severe impact trauma. Although initial examinations only indicated issues on the left side, other complications could arise during surgery.

Choosing a limited left-sided emergency thoracotomy could necessitate another incision if other problems emerged, which would be far more detrimental to the patient.

"Suction."

As Su Wenhao made the incision into the abdomen, blood welled up. Liu Banxia, without a moment’s delay, began manually removing blood clots.

As the clots were removed and suction cleared the field, revealing the abdominal cavity, everyone present frowned—even Wu Mingyu, who had already started working on the leg fractures.

"Findings upon exploration: two intestinal perforations, a partially ruptured spleen, and a laceration of the left kidney. We can perform an intestinal repair, splenectomy, and a partial left nephrectomy," Su Wenhao announced.

With each injury Su Wenhao identified, Liu Banxia precisely applied hemostatic forceps.

"I’ll handle the intestinal perforation repair. Teacher Liu will be responsible for—"

"I’ll do the splenectomy. Li Hao, you repair the intestines," Liu Banxia interjected, already starting the procedure before Su Wenhao could finish.

"The most critical aspect of emergency surgery is to achieve hemostasis first. Once bleeding is controlled, damaged organs must be removed or repaired with utmost speed and skill."

"The technique for a partial nephrectomy is straightforward: isolate the kidney, identify devitalized tissue, resect it, and achieve hemostasis. The patient’s condition isn’t critical yet, but if you don’t act now, it will become truly dangerous."

Su Wenhao hesitated no longer and began dissecting around the kidney.

Even though he had never performed a nephrectomy, he had to rise to the occasion. He had to give his all to see this surgery through.

This was an opportunity Liu Banxia had given him. While he and Li Hao had assisted in splenectomies and nephrectomies, they had never been the primary surgeon.

"Splenectomy complete. Repairing the mesenteric hematoma near the colon," Liu Banxia announced again, even before Su Wenhao had finished isolating the renal artery and vein.

"Beautiful! Twenty seconds!" Li Liwei couldn’t help but exclaim in admiration from the side.

The initial phase of emergency surgery is a race against time; the shorter the operating time, the less trauma the patient endures. Liu Banxia’s nickname as the "Fastest Scalpel" was certainly not an empty boast. He had just addressed one of the patient’s life-threatening injuries.

"Keep your minds calm and your hands steady. This applies to all of you. Speed comes only after precision," Liu Banxia continued.

"Doctor Liang’s technique is excellent. Currently, her skill level is a cut above yours. Although resection of pulmonary bullae is now considered a routine procedure, her movements are more decisive."

Sweat beaded on Su Wenhao’s forehead. He quickly tilted his head for a nurse to wipe it, then refocused on the surgery.

"Brother Wu, your technique is also very skilled. That’s good speed," Liu Banxia then praised Wu Mingyu.

"If you can finish up in the abdomen quickly, come give me a hand with the right arm fracture. Or are you trying to work me to death?" Wu Mingyu retorted.

"Can’t do that. I need to supervise these two," Liu Banxia replied.

"The key to successful intestinal repair is thorough debridement of the bowel to prevent infection at the anastomosis. Another crucial point is meticulous suturing; every stitch must be precise."

"Li Hao, why do I also need to address the patient’s mesenteric hematoma? Can’t we just leave it for the body to absorb? Wouldn’t the patient recover faster that way?"

"I... I..."

"Don’t stop what you’re doing. You continue suturing. Miao Rui, you answer," Liu Banxia instructed.

"There’s a risk the hematoma could rupture later. Since we’ve already opened the abdomen, repairing it now is the optimal approach," Miao Rui quickly replied.

"Okay! Add a chicken leg for that! My treat, Miao Rui’s paying," Liu Banxia declared.

The previously tense atmosphere in the operating room finally eased somewhat.

Chen Xuehai, who was supervising Liang Xiaolin’s procedure, glanced towards the abdominal team, inwardly impressed by Liu Banxia’s methods.

He had just subjected Li Hao and Su Wenhao to intense pressure, pushing them to perform under duress. Now, a seemingly small joke had managed to momentarily relieve their taut nerves.

It hadn’t disrupted their rhythm; in fact, it seemed to steady their hands.

Liu Banxia understood the personalities of these interns perfectly, almost like they were his own younger siblings. After a few words of praise from Liu Banxia, even Liang Xiaolin’s operating speed had picked up.

This was Liu Banxia’s knack for tailoring his teaching to individual aptitudes.

Chen Xuehai himself knew his younger sister, Linlin, thrived on praise; the more she was complimented, the better she performed in surgery. But as her older brother, he found it difficult to praise her openly, usually managing no more than a curt "not bad."

"Old Wu, don’t worry. Once the thoracic and abdominal procedures are done, we’ll all pitch in to help you with the fractures. We can’t just go off to eat while you’re slaving away in here. Brother Li wouldn’t stand for it, would he?" Liu Banxia added.

"Your attempts at consolation are useless. What are the patient’s vitals?" Wu Mingyu asked.

"They’re quite stable at the moment. Blood pressure started to rise after clamping and hemostasis," Li Liwei reported.

"Thank goodness. Otherwise, I’d be worried about bleeding from the pelvis or somewhere. Let’s get another CT scan post-op, just to be sure," Wu Mingyu said.

"Both intestinal perforations repaired. After the kidney surgery is complete, we’ll irrigate the abdominal cavity thoroughly," Li Hao reported.

"Very good. Your suturing is excellent; even with my meddling, your stitches are neat. We’ll see how it looks post-recovery. If there are no problems, Miao Rui can buy you two chicken legs," Liu Banxia said with a straight face.

"Teacher Liu, I only answered one question. Why am I on the hook for so many chicken legs?" Miao Rui asked, exasperated.

"Well, you don’t have a girlfriend, so what are you saving all that money for? Excellent work—blood supply is good, bowel color is normal, no signs of leakage. Su Wenhao, assist him. You two finish the partial nephrectomy and close the abdomen. If all goes well, Dr. Chen might even treat you to pig’s trotters tomorrow," Liu Banxia said.

"Why are you dragging me into this? Even if I were to treat someone, it would be Linlin," Chen Xuehai protested good-naturedly.

"Don’t be so stingy. We’re all family in the Emergency Center. We should help out Su," Liu Banxia said, picking up a syringe and beginning to inject the kidney.

"The purpose of this injection, of course, is to create a subcapsular bleb, making it easier to incise and dissect the capsule. This is a key difference between a partial and a total nephrectomy. It can be a bit tricky for first-timers."

"But I won’t be helping next time. If you’re not confident, go buy some kidneys and practice on your own. You can’t just opt for a total nephrectomy on every patient. You all need to learn this procedure."

"What are you two still gawking at?" Liu Banxia suddenly addressed Qing Kewa and Miao Rui. "Are you waiting for Doctor Wu to walk you through it step by step? Haven’t you studied this? It’s a simple procedure, are you waiting for Doctor Wu to prompt you? Or do you also want to treat everyone to chicken legs? Booking orders for next year already?"

His last remarks were for Qing Kewa and Miao Rui. They exchanged a glance. Alright, let’s just do it.

Although this particular leg fracture was slightly more complex than a standard one, they felt they could manage it.

Their orthopedic rotation had been no joke; they treasured every surgical case they had been part of. Liu Banxia had fought hard to get them the opportunity to observe Xu Peichen’s surgeries firsthand.

"Oh no, blood pressure is dropping!" Li Liwei suddenly exclaimed.

"Bleeding in the thoracic cavity! Source not yet identified. Suction!" Liang Xiaolin reported urgently.

The operating room tensed up once more. Liu Banxia frowned but remained silent, letting Liang Xiaolin handle it.

"Found it! Rupture at the base of the right pulmonary artery! Clamp for hemostasis, need a patch and sutures!" Liang Xiaolin called out excitedly less than twenty seconds later.

"Blood pressure is recovering! Doctor Liang, impressive!" Li Liwei praised, his eyes fixed on the monitors.

The atmosphere in the operating room eased once more. It appeared the patient was largely out of danger.