"Doctor, what’s wrong? I don’t feel any pain now." Seeing their expressions, the patient also began to worry.
"Why didn’t you just tell the truth from the beginning?" Liu Banxia said helplessly.
"I was still feeling pain after eating, so I ca to the hospital. I kept quiet because I wanted you to examine more thoroughly. I should be fine, right?" The patient sat up.
"Fine? The problem is serious," Liu Banxia said.
"Ugh... why did you decide to test the doctors when you’re actually sick?" Xu Hui sighed. "I could still hear your bowel sounds when we first started the consultation, but now I can’t. It’s possible that your intestines have already beco necrotic."
"Before you ca here, you had symptoms of chest pain, which might an that so blood vessels were blocked by blood clots. Then you had abdominal pain, which happens when the blood clot moves into the blood vessels of the intestines."
"But at the ti, the symptoms were mild and didn’t completely block the vessels. So, you didn’t feel terrible pain. When the pain should have beco severe, the ibuprofen began to work."
"The high levels of creatine and lactic acid in your blood also make sense now. You’ve really dug yourself into a hole. If you had told earlier, we could’ve done more targeted examinations."
"A routine thrombectomy or thrombolysis has been delayed to the point of intestinal necrosis. And you definitely didn’t just take one ibuprofen tablet. Even soone who tabolizes drugs very well couldn’t achieve such pain relief with just one pill."
"It’s a good thing we persuaded you to stay. Otherwise, once the necrosis spreads, peritonitis, sepsis—any of them could take your life. You... why are you so foolish?"
By the end, Xu Hui’s voice had risen considerably, truly out of frustration.
Because of standard consultation protocol, doctors always ask about recent dication history to see if the symptoms are drug-induced. But this patient chose to hide it; his reason was actually to test the doctors, to avoid being fooled by them.
He really couldn’t understand why anyone would think like that. In the end, who were they fooling? Aren’t they only fooling themselves?
"You should contact your family now," Liu Banxia said, patting Xu Hui’s shoulder and taking over the conversation. "Although we don’t know which part of your intestines is necrotic, the disappearance of bowel sounds ans there’s a problem with your intestinal peristalsis."
"If you want to live, we must perform surgery imdiately. We will perform an exploratory laparotomy and resect the necrotic bowel segnt. You have half an hour to decide whether or not to contact your family."
"Doctor, no jokes please." The patient’s face turned pale with fear.
"Do you think I’m joking? Playing with your life? Listen for yourself. Compare what a normal person’s bowel sounds are like, then listen to yours." Liu Banxia handed his stethoscope to the patient.
This was the quickest way to prove it. After the patient listened to his own bowel sounds and then to Liu Banxia’s, he fell silent.
Though he was still reluctant to accept it, he knew perfectly well whether he could hear anything or not.
"Don’t hesitate," Liu Banxia said. "We don’t know the extent of the necrosis yet; we’ll only know after an exploratory laparotomy."
"If you agree, I will book the operating room imdiately and get you prepped for surgery. Any delay will only worsen the necrosis."
"Also, because you haven’t fasted or abstained from water preoperatively, there’s a higher chance of postoperative complications. Miao Rui, prepare the consent forms for an exploratory laparotomy and bowel resection."
"Okay, I agree. I’ll call my family first." The patient looked at him, then at Xu Hui, and nodded.
"Prepare for surgery," Liu Banxia said. "Qing Kewa, you’ll be first assistant. Everyone else, scrub in."
Although they knew it wasn’t appropriate to be excited in such a situation, Huang Bo and the others felt a thrill of excitent. This was a Level III surgery, and Teacher Liu was taking all of them.
"Ugh... Banxia, I just don’t get it," Xu Hui sighed.
"Then don’t think about it for now," Liu Banxia said. "It’s easy for a patient to fool a doctor. Even if a departnt director themselves were on call today, they wouldn’t have been able to identify his true condition."
"You stay here and keep an eye on things. I’ll go contact the operating room. Hopefully, the necrotic segnt isn’t too long. Resecting too much will significantly affect his future quality of life."
Xu Hui nodded. He really had done his best. He’d thought it through carefully and tried his utmost to convince the patient to stay. He just couldn’t fathom soone lying like that for no good reason. Thankfully, it hadn’t resulted in a complete disaster yet.
Thanks to their recent experience performing nurous surgeries with Liu Banxia, the preoperative preparations were handled with practiced ease.
This was an ergency surgery. After the anesthesiology departnt and the operating room were notified, those who were eating had to drop their al trays and rush to the OR.
"President Liu, intestinal necrosis?" the anesthesiologist, Li Liwei, asked.
"Most likely," Liu Banxia nodded. "Now we’ll see how severe the necrosis is. I can’t hear any bowel sounds anymore."
"We’re prepping for surgery now. It was a close call; we nearly had a dical incident on our hands. The patient took ibuprofen, didn’t tell Dr. Xu, and wanted to go ho after the pain subsided."
The OR staff didn’t know what to say. Although such incidents were rare, they weren’t unheard of in a hospital.
After a short wait, the patient arrived in the operating room. After identity verification, general anesthesia was administered.
"Qing Kewa, midline abdominal incision. Considering the patient’s height, make it about seven centiters. Xu Yino, you’ll assist with the laparotomy," Liu Banxia instructed.
There wasn’t enough ti to pinpoint which intestinal segnt was affected, so a midline incision was the only choice. Seven centiters—Liu Banxia was confident he could manage with that.
"Abdominal organs appear normal. No ascites or exudate in the abdominal cavity. I’ve found a necrotic section in the small intestine, about thirty centiters long, and it’s black," Qing Kewa reported ticulously after opening the abdominal cavity.
"Alright," Liu Banxia nodded. "I’ll take over from here. Watch carefully."
Standing by the operating table, Liu Banxia exteriorized the necrotic bowel segnt. "Liu Yiqing, what’s the next step?"
"We need to protect the incision with laparotomy pads soaked in warm saline," Liu Yiqing quickly responded. "Then place two dry sterile drapes underneath for complete isolation."
"Why do we do that?" Liu Banxia asked, not yet starting.
"Because... because... the patient’s enteric contents could contaminate the incision," Liu Yiqing said, a bit anxiously.
"Don’t worry, this segnt is only about thirty centiters. It won’t have a major impact on the patient post-surgery," Liu Banxia said with a smile.
"Su Wenhao, tell the next surgical steps, and I’ll proceed according to your instructions. If anything goes wrong, you’ll bear the responsibility."
"Isolate the senteric vessels, resect the bowel, and perform anastomosis," Su Wenhao stated.
"You all should learn from Su," Liu Banxia complinted. "He doesn’t talk much, but he’s concise and to the point."
"Pay close attention to my technique. Ensure full exposure of the vessels during dissection. When transecting, cut close to the distal side, and ligate the distal end first, then the proximal end."
"This patient has a fair amount of adipose tissue. If you’re not confident, you can use transillumination to visualize the vessel pathways before proceeding."
While speaking, Liu Banxia proficiently handled the senteric vessels.
"Miao Rui, for the next step, intestinal resection, tell us about the use and placent of intestinal clamps," Liu Banxia asked unexpectedly.
"Don’t clamp too tightly," Miao Rui quickly replied. "Just enough to occlude the lun and prevent spillage of intestinal contents. The position should be about three to five centiters from the resection margin."
"Correct. Since you know it, I’ll give you the honor. You can resect this necrotic bowel segnt for the patient," Liu Banxia said with a smile.
Even though it was a relatively simple maneuver, Miao Rui was thrilled beyond words.
Liu Banxia wrapped the resected bowel segnt in sterile gauze and placed it on the side instrunt table. He wondered if the patient’s family had arrived yet; they could show it to them after the surgery.
The two bowel stumps were ticulously cleaned and disinfected. If this wasn’t handled properly, an anastomotic leak could occur during the patient’s recovery.
"Next is the end-to-end anastomosis," Liu Banxia said as he began suturing. "I won’t go into detail about this part. If anyone doesn’t know what to pay attention to, look it up in your textbooks on your own ti."
No one had ti to pay attention to his words; they were all intently observing his suturing technique.
Every ti they watched him suture, they were entranced. Liu Banxia’s suturing was fast and steady; they could never get enough of watching it.
"Often, techniques are interrelated," Liu Banxia continued to explain. "Even though this surgery can be classified as a Level III procedure, the crucial part right now is still the suturing."
"It’s best to avoid needing to place additional reinforcing stitches. The tension you apply when suturing is sothing you’ll grasp with more experience. It’s simply basic suturing practice. How profound or difficult can basic suturing practice be?"
"Many major surgical operations are built upon a combination of fundantal operative skills. You need to put effort into anatomy and work on your manual dexterity and coordination. Alright, release the clamps. Let’s check the blood supply."
As he spoke, Liu Banxia completed the suturing. Once the clamps were released, the blood supply appeared normal. He carefully inspected the anastomosis; no leakage was observed. The anastomosis was successful.
"Routine abdominal closure. Job done," Liu Banxia said, stepping back.
DING!
Patient treatnt completed.
Gained 100 experience points, 30 diagnostic skill proficiency points, 200 suturing skill proficiency points, 100 dressing change skill proficiency points, 500 intestinal surgery skill proficiency points.
Task rating: Perfect.
Gained 300 experience points, 50 diagnostic skill proficiency points, 200 suturing skill proficiency points, 100 dressing change skill proficiency points, 800 intestinal surgery skill proficiency points, and 10 Glory Points.
Congratulations, Host! Your Intestinal Surgery skill has increased to Level 2 (6,000/19,999).
Although the rewards weren’t bad, Liu Banxia felt a tinge of regret. It had been a while since he’d experienced the thrill of leveling up.
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