Chapter 652: Cooling down and extending the tolerance limit, a new sword technique that combines the strengths of the three schools
Zhou Can always respected Director Lou in his heart, even though Director Lou later sided with Dean Gao. He knew that Director Lou served the thief for the development of the emergency department.
At this moment, looking at Director Lou, whose face was full of anger and who was trying hard to take the credit, Zhou Can felt a little confused.
He didn't even mention arranging staff.
With the assistance of President Gao and Zhou Can's excellent connections among various clinical departments, a super elite surgical team was quickly organized.
It’s a pity that Qiao Yu went abroad to study.
Otherwise, it would definitely be better to let her be the instrument nurse for this operation.
She can also learn a lot of valuable surgical knowledge and accumulate experience.
The preoperative examinations and preparations arranged for Mr. Song are proceeding in full swing.
Zhou Can had already simulated the surgical plan countless times.
After all, Mr. Song is of noble status and cannot afford to make any mistakes.
…
When Zhou Can entered the operating room to change clothes, he found an opportunity to be alone with Director Lou.
"Director Lou, I apologize for not reporting this to you in advance."
"Humph, I think you've grown too powerful. You made the decision on such a big matter all by yourself. Perform the surgery properly. If you mess it up, I won't forgive you."
Director Lou snorted angrily and didn't give Zhou Can any chance to explain.
This was the first time that Director Lou had been so unkind and angry towards Zhou Can since he had joined the emergency department.
Zhou Can sighed slightly.
This matter was kept secret from Director Lou and Doctor Xu in order to prevent them from having the opportunity to stop it.
Dr. Xu is on leave today, so he probably doesn't know about this yet.
Zhou Can's idea was simple: if something went wrong during the operation, he would bear the consequences alone. Dr. Xu was already in a miserable state, so he couldn't be involved.
As for Director Lou jumping out to take credit this time, his behavior is puzzling.
Out of respect, Zhou Can didn't let his imagination run wild.
If everything goes well, Dr. Xu will have a surprise when he comes to work tomorrow.
If something goes wrong during the operation, Dr. Xu will probably be shocked before tomorrow.
In the best No. 1 Class 100 laminar flow operating room in neurosurgery, Zhou Can and his super-luxury elite surgical team officially began to operate on the patient. Director Liu of the Department of Critical Care Medicine personally led his team and Director Feng of the Department of Anesthesiology to protect the patient's life.
In terms of nursing work, the chief director of surgical nursing is the most experienced roving teacher in the neurosurgery operating room.
Jiang Wei served as Zhou Can's instrument nurse and deputy commander-in-chief.
Ma Xiaolan is unlucky. Her due date is approaching and she can only take maternity leave at home.
Missed this opportunity to gild myself.
Of course, the risks are also great. If the operation fails, you may not achieve any success but end up suffering instead.
Having said that, all the necessary signatures before the operation had already been signed by Butler Bian.
If something really happened, even if Mr. Song died on the operating table, at most only the two leading people would suffer. The other people involved in the operation would at most be implicated a little, and there would not be too much risk.
"Director Feng, can we start the operation?"
"All vital signs are stable, general anesthesia was successfully implemented, let's open the skull!"
Since the reform of the Department of Anesthesiology, Director Feng rarely appears in the operating room of the emergency department. He is only seen in major level 4 operations in neurosurgery and cardiothoracic surgery.
He must be the best anesthesiologist in Tuya.
He has a long career, rich experience and first-class professional level.
Although he and Zhou Can were not in name of master and apprentice, they had a master-apprentice relationship. Zhou Can learned a lot of valuable anesthesia knowledge and life-saving methods from him in anesthesiology.
This life-saving means saving the patient's life.
Accidents happen during surgery, and it is common. Every second counts, so life-saving measures are extremely important.
Zhou Can will perform the surgery personally, and he must be the one to perform the surgery.
The Song family does not value those flashy and false reputations, but only values the real ability of the surgeon.
They conducted a very detailed investigation on Zhou Can and felt that Zhou Can had the ability, so they were willing to let Zhou Can perform this operation on Mr. Song.
At this time, the door of the operating room opened automatically and a figure walked in.
Despite wearing a mask and a hood, Zhou Can could still recognize it as Dr. Xu at a glance.
His heart trembled slightly. He didn't expect that the teacher would know about this.
Dr. Xu's arrival did not attract much attention from others.
Because there are quite a lot of medical staff in the operating room.
And they are basically top elites in their respective fields, each with a very broad vision.
What everyone is concerned about now is their own work and trying their best to cooperate with Zhou Can to make this operation a success.
As for the rest, no one cares.
After Dr. Xu came in, he just stood behind Zhou Can and didn't say anything.
But Zhou Can could feel that the teacher's eyes were particularly gentle.
Zhou Can was meticulous and careful with every move during the craniotomy.
Because Mr. Song is very fragile now, the fire of life has become extremely dim, and any rough action may bring about a catastrophic disaster.
Even the extremely experienced Director Feng watched Zhou Can cut the patient's scalp and subcutaneous tissue, drill a hole in the skull, and then use an electric saw to cut the skull flap along the hole...
Every step made him tremble with fear.
Not only him, everyone is the same.
When everyone saw Mr. Song's heart rate suddenly drop, they even held their breath.
"Director Feng, do you want to push Qiangxin?"
"Let's observe first. Zhou Can's skills are very good. It shouldn't affect the patient's vital signs. It is probably related to the recent opening of the skull flap. It will return to normal in a while."
Director Feng sat calmly in the back to protect the patient's life.
His eyes were extremely sharp. Sometimes he stared at the dials and screens of the monitoring equipment, and sometimes he looked at the progress of the patient's surgery.
Zhou Can dissected step by step and was finally able to see the brainstem area.
Even after so many years, you can still see the surgical scars left after the tumor was removed.
Ordinary people cannot see it, but Zhou Can, who has extensive experience in neurosurgery, can spot the damaged areas at a glance.
"Teacher, is this the nerve that was cut?"
Zhou Can asked, pointing to the trigeminal nerve that extends from the brain stem.
"Yes, there was a cut at the pons. The tumor was very large at the time and had infiltrated the brainstem area. If the operation was not done thoroughly, it would definitely recur. There were only two choices at the time: either try your best and take a risk, or close the cranial cavity, sew it up, and tell the family that the operation was too difficult and could not be performed."
Doctor Xu did not say anything else.
He chose the former.
Take a chance.
As a result, his second half of life was ruined, his bright future was gone, and he fell directly into the abyss.
It is really not easy to be a surgeon, and it is even more difficult to be a surgeon with a kind heart and good medical skills.
If Dr. Xu were given another chance to choose, he would probably choose the latter.
The cranial cavity was closed again and surgery was declared impossible.
This kind of thing happens frequently in hospitals. Although it's a bit embarrassing, it's better than getting into trouble.
"After the incision was made, was it sewn up again?"
“It has been repaired, but the results are not satisfactory.”
Dr. Xu admitted it frankly.
"Looking at the situation, we have to cut open the repaired area, clean the wound, and then re-suturing it."
Zhou Can said this after a careful inspection.
Nerve anastomosis is extremely difficult.
And nerve cells are the only cells that cannot regenerate.
It cannot repair and heal itself like other body tissues.
When anastomosing nerves, there are tens of thousands of guide wires inside, and each one must be placed in the correct position to ensure the best effect after nerve anastomosis.
Some guide wires are placed in the wrong place and fail, which is what people often say as "touching the wrong nerve" when insulting others.
The consequences are predictable.
"Director Feng, Director Liu, I am going to perform a brain scan. By then, the patient's vital signs may disappear. How much time can you give me at most?"
Zhou Can took a deep breath, but his eyes remained firm.
"It's safest to do it within three minutes. The shorter the better."
Director Feng said directly.
The brain stem is known as a forbidden zone of life. Not to mention cutting it, few doctors dare to touch even the peripheral areas.
Currently, there are only a few large hospitals in China that dare to claim that the brainstem is no longer a forbidden zone for life.
Tuya barely has the ability in this area.
But to be honest, Wu Baihe would never gamble with his future and tomorrow. As long as the risk was too high, he would give up.
Unless the family members are willing to sign a waiver and Tuya’s legal department signs the document.
If two out of ten brainstem surgeries are successful, that's already pretty good.
Zhou Can's current incision skills are still a little short of level 7. Debridement, anastomosis, suturing, knotting, and pathological diagnosis are all level 7. It can only be said that he has the ability to try, but he is not completely sure.
His steady knife technique and quick knife technique had been stuck at the second level and he had not been able to break through to the third level, which also caused his cutting technique to be stuck at the sixth level.
Debridement and incision are closely related.
Especially for Mr. Song’s brain stem repair area, the difficulty of cutting open and then cleaning the wound can be imagined.
"Three minutes is definitely not enough. I'm not sure at all."
Zhou Can shook his head.
Incision, debridement, and rapid anastomosis. Not to mention three minutes, even if it can be done in thirty minutes, it would be the top level in the field of neurosurgery.
"How long will it take you?"
Director Liu from the Department of Critical Care Medicine asked.
"Conservatively speaking, it will take at least ten minutes."
If Zhou Can could make breakthroughs in his quick and steady knife techniques, this time could be shortened a lot.
Because the quality of the incision is directly related to the difficulty of subsequent debridement.
It also concerns the difficulty and effect of suturing.
After listening to this, Director Liu turned to look at Director Feng.
"Old Feng, how about we try the cooling method? Other than that, I'm afraid there is no better way to extend the time to ten minutes."
“That’s a good idea.”
Director Feng's eyes lit up and he nodded in agreement.
The body's consumption is two different concepts in low temperature and normal temperature environments.
Nowadays, the technology of freezing and preserving life is relatively mature. In science fiction, someone was unfortunately frozen in a snowy mountain avalanche. Then, after N years, the person came back to life through thawing technology.
The temperature in the operating room is generally controlled at around 25 degrees.
Because patients undergo surgery naked, this temperature is the most patient-friendly.
In winter, the temperature of the operating room is generally set to above 20 degrees, and 22 or 23 degrees is the most suitable. In summer, the temperature is controlled below 26 degrees.
Human wisdom is infinite.
For routine surgeries, the temperature in the operating room is controlled within this range. However, for special surgeries, the temperature can be lowered to facilitate the smooth implementation of the surgery.
The most common method is to lower the temperature to around 15 degrees.
At this time, the human body's blood circulation and metabolic rate will slow down accordingly, which is extremely beneficial for bleeding control and prolonging the operation.
"We can extend the time by about three times by lowering the room temperature. It should be safer within 9 minutes. Do you think it's safe?"
"Okay! But I need to go out and put on a coat first."
When Zhou Can heard that the time could be extended three times to 9 minutes, he knew that this was the limit.
Lowering the temperature in the operating room can certainly prolong the patient's extreme tolerance time, but it is extremely unfriendly to the surgeon.
In a low temperature environment, the operator's movements will become slow and clumsy.
This will significantly extend the duration of the surgical procedure.
For example, Zhou Can could sew three stitches per second, which was the fastest speed. But in low temperatures, he might not be able to sew one stitch per second.
In this way, the patient's tolerance for surgery is improved, but the total duration of the operation is also extended several times.
The only way is for the operator to wear a warm coat.
…
Ten minutes later, the main surgical staff had already changed into thermal underwear.
Zhou Can even put on a cotton jacket.
I must point out that when you go out to change clothes, you must change into a new sterile suit, including the hood and gloves.
This is a wasteful act.
However, in order to ensure the smooth implementation of the operation, it is worth it even if it costs a lot, let alone several sets of sterile isolation gowns.
The family would absolutely be happy to pay that money.
As long as the family members are reasonable, they won’t care.
The temperature in the operating room has already begun to be lowered, and both Director Liu and Director Feng are facing a serious enemy.
If the temperature drops, the patient's vital signs will be seriously affected.
Frogs can hibernate, and so can bears, but humans do not have this ability.
Patients in critical condition are even less able to tolerate the damage caused by low temperatures.
Every winter, many elderly people and critically ill patients bedridden have a particularly hard time.
Low temperature itself represents the withering of life.
“Hurry up!”
Director Feng waited until the patient's vital signs stabilized and then said to Zhou Can.
"good!"
Zhou Can held the scalpel, his eyes became firm and focused, and the entire surgical team cooperated with him. The Song family was also looking forward to his success in the operation. Whether Dr. Xu could turn things around and get rid of the shackles of guilt also depended on this operation.
That invisible pressure turned into a burden weighing on him.
After taking several deep breaths, he grabbed the knife and cut.
No hesitation, no fear.
All I have is a sense of responsibility and a kind heart.
As his knife cut down, the clear feeling of the knife was fed back to his fingers and palms and then to his brain.
Under this extremely high-pressure situation, Zhou Can only had the patients in his eyes.
It was as if he could see the beating life.
“Beep, beep…”
The alarms of the monitoring equipment sounded one after another.
The medical staff were busy as the grim reaper hovered over the operating room.
Zhou Can's mind was naturally comprehending the swordsmanship.
Because he has to cut it all off.
"The ultimate of fast knife is to be as fast as lightning, ignoring all difficulties, cutting through the Gordian knot, and completing the task in one stroke. The essence of steady knife method is to win in stability, striving for stability, persistence, and balance... The precise knife method is to pursue only accuracy, without any deviation, with just the right force, just the right position of the knife, and just the right time to cut off the lesion, or just cut the corresponding tissue..."
The three truths of quick knife skills, steady knife skills, and precise knife skills kept emerging in his mind.
I learned fine surgical techniques from Wu Baihe in the neurosurgery operating room.
The three are intertwined and all integrated into the scalpel in his hand.
The area cut was the pons part of the brainstem.
This place had been cut open by Dr. Xu before, but it was an accidental cut.
The subsequent repair was not ideal and now it has to be cut open and repaired again.
Zhou Can knew very well that Mr. Song's life depended on this knife.
When it was cut open, the result was not as ideal as he had expected, and was far from the perfection he had expected.
“Oh no!”
Zhou Can's mind went blank in an instant.
At this moment, he could already feel that a catastrophe was coming, or rather, had already come.
The teacher's kindness, the majestic Song family, his own career, the expectations of so many medical staff...they turned into whips and lashed Zhou Can fiercely.
The more dangerous the situation, the more you need to stay calm.
Zhou Can remembered Director Hu Kan’s advice.
I saw that his hand holding the scalpel slowly became more relaxed and no longer held the scalpel tightly.
Instead, it became a "toy", and the scalpel was no longer the life-saving straw that he held tightly. This was a sublimation of his state of mind.
In the past, the knife controlled the man, but now, he seemed to have grasped the true essence, that man controls the knife.
He held the scalpel in his hand casually, not to throw it away, nor to throw it away, but to give it life and soul. He made it come alive, let it dance on his fingertips and palms, and obey Zhou Can's command at will.
Hit wherever you point.
At this moment, he seemed to be possessed by a demon, and didn't care about anything in the outside world.
Only surgery had long been integrated into his life.
The ideal effect was indeed not achieved during the incision, but after the subsequent debridement, he clearly had the ability to make up for it.
Doctor Xu, who was standing behind him, and Wu Baihe, who was standing opposite him, saw Zhou Can swinging his scalpel quickly to clean the wound.
They all widened their eyes in disbelief.
What kind of swordsmanship ?
Why does it seem like a hodgepodge? The steady knife technique doesn't look like the steady knife technique, the fast knife technique doesn't look like the fast knife technique, and the precise knife technique doesn't look like it. But it seems to have combined the strengths of all three, blending these three contradictions perfectly together.
Doctor Xu couldn’t see anything special about the incision he had just cleaned.
Wu Baihe showed an extremely envious and even somewhat jealous look. This level of nerve incision was the perfect incision he had been pursuing for a lifetime, but he had never achieved it.
Zhou Can has reached it at this moment.
