How could one say it was just good? It was truly exceptional.
Wang Guohua had experienced many such emergency surgeries.
There were cases like the one before him—a rectal foreign object that had perforated the bowel; there were car accidents that ruptured the intestines; there were stab wounds that pierced the gut.
The scenarios were bizarre and varied.
But they all shared one commonality: high intra-abdominal pressure.
The first patient of this kind that Wang Guohua treated in his youth had been crushed by heavy machinery in a mine, resulting in ruptured organs and a bowel perforation. Because of the delay underground, the patient was already at death's door upon arrival.
Wang Guohua still remembered the moment he opened the peritoneum; the feces inside the abdominal cavity shot straight up to the ceiling, much like a detonator being thrown into an outhouse. Everyone in the operating room was sprayed from head to toe.
That experience became a nightmare, one that he could not forget even after his retirement.
Why was the pressure so great? Wang Guohua knew it had to do with the fermentation of the intestinal contents. But he had never studied which patients would develop such extreme pressure or how long it would take for such a condition to manifest.
Knowing the situation existed was enough; why study it?
Wang Guohua had a little trick: do not open the peritoneum directly. He would barely lift the membrane and use a 50ml syringe needle to insert it five millimeters to release the gas.
Only after feeling the tension in the peritoneum decrease would he then open it—this was the only correct approach.
Otherwise, if the operating room were sprayed with fecal matter, never mind how the surgeon, assistant, anesthesiologist, and nurses could continue their work, the infection grade alone would jump a level, and whether the patient could survive the surgery would become a major problem.
Because such patients were rare, Wang Guohua had only mentioned this to Wen Youren twice, but Wen Youren had never paid it any mind.
And yet, right now!
Wang Guohua watched in a daze as Luo Hao used a hook to lift the peritoneum with one hand, while reaching out with the other to ask the nurse for a 50ml syringe needle.
The instrument nurse, unaware of the danger, didn't realize what was happening and asked the circulating nurse to fetch a syringe.
Luo Hao cautiously inserted the 50ml needle a few millimeters.
The action was simple, yet Wang Guohua knew exactly what lay behind it.
It was the accumulation of countless years of clinical experience and the earnest teachings of veteran doctors.
"Luo Hao, what are you doing?" the circulating nurse asked, wearing her goggles.
Because Luo Hao had brought the goggles—which, to some extent, reduced the torture index of the surgery—her tone was slightly gentler.
"Shut up!" Wang Guohua barked.
His voice rang out in the operating room like a thunderclap.
The circulating nurse and the anesthesiologist froze. It had been years since they had seen the old director, Wang Guohua, lose his temper in the operating room.
Now that it was happening again, they didn't feel insulted; instead, they felt an inexplicable sense of dread.
There was a problem!
A big problem!!
Everyone closed their mouths in unison.
"Beep, beep, beep~"
This was the intermittent sound of the monitor.
"Whoosh, whoosh, whoosh~"
This was the intermittent sound of the ventilator.
Mixed in with these sounds was a faint "hissing" noise.
Hmm?
What was that sound?!
So, the reason the old director wouldn't let them talk was to listen to the sound!
They were all experienced clinicians; hearing the hissing, the doctors and nurses immediately connected it to the 50ml syringe needle Luo Hao had requested and Wang Guohua's previous roar.
He was releasing gas!
No explanation was needed; everyone understood what Luo Hao was doing.
But how did Luo Hao know?
The hissing sound gradually weakened. After about 40 seconds, Luo Hao confirmed that no more gas was escaping through the needle, pulled it out, and carefully placed it in the sterile area prepared by the instrument nurse.
Reaching out, a scalpel was slapped into his palm.
Luo Hao carefully used the scalpel to make a small incision in the patient's peritoneum.
As the incision appeared, yellow fecal fluid entered their field of vision.
Luo Hao immediately lifted the peritoneum. Seeing there was no danger of a "volcanic eruption," Wang Guohua calmed down, pushed the question of how Luo Hao knew aside, and inserted the suction tube, which had a protective sleeve.
*Slurp~*
*Slurp~~*
*Slurp~~~*
The feces were sucked out, and that thick, pungent odor began to disperse.
Fortunately, they were wearing goggles. Although they had been in use for a few years, the seal still blocked the infiltration of the irritating gas; at the very least, their eyes were much more comfortable.
After removing a portion of the feces, Wang Guohua assisted Luo Hao in protecting the peritoneum.
Admittedly, doing peritoneal protection in such cases wasn't very useful; the risk of postoperative infection was basically one hundred percent.
But doing it was better than not doing it.
"Prepare warm saline," Luo Hao said softly.
"Dr. Luo, I've prepared 10 bottles of 500ml saline. Is that enough?" the circulating nurse asked, looking at the patient's abdominal cavity with concern.
"Not enough. Bring another 20 bottles," Luo Hao said.
The circulating nurse didn't question him. Looking at the patient's abdominal cavity, she felt that even 30 bottles of warm saline might not be enough to clean it, so it was safer to prepare more.
She didn't want to be scolded by the old director, Wang Guohua, later.
The irrigation began.
Large chunks of feces were removed by hand, and the remainder was washed away with saline and sucked out by the suction device.
"That's a lot of saline," the anesthesiologist noted. "I remember back in 2005, there was an incident at the Second Medical University. The patient's family sued the hospital, saying they had used over 10,000 milliliters of intravenous fluids at once. I was stunned at the time, thinking, 'Has the Second Medical University gone crazy? How could they do such a thing?'"
"I remember that case too. I heard later it was for dialysis," the circulating nurse chatted while she worked.
"People were sloppy back then," Wang Guohua said in a low voice. "Medical records were written carelessly, and there were no detailed logs. 10,000 milliliters of normal saline were just casually entered into the accounts, and then someone found the issue. That's why I tell you, every item must be accounted for precisely to avoid major trouble later."
"Old Director Wang, after being scolded by you so many times, I've kept in mind to be careful, and then be even more careful," the anesthesiologist said with a chuckle.
Wang Guohua kept his head down as he operated, saying casually, "To be a doctor, you need to know how to read people. You guys don't know anything and just learn to be lazy from others."
"Old Director Wang, we're materialists here; we can't believe in that."
"Putting that aside, let's talk about the 2005 dispute. The patient's family were influential people in the provincial capital. They were demanding and could stir up huge waves because they had powerful people behind them. The funny thing is, that patient was originally hospitalized at the Provincial Hospital. The director there felt something was wrong and kept urging the patient to go to a higher-level hospital."
Hearing Wang Guohua start to gossip about old times, everyone leaned in to listen.
Everyone loves a bit of gossip.
Although doing this kind of fecal-removal surgery made even breathing a mistake, being able to distract themselves in such an environment was a good thing.
"Oh, my word. Really?" the anesthesiologist's eyes gleamed.
Old directors are treasure troves of gossip. Unlike nurses, who gossip about who is sleeping with whom, they tell industry secrets.
The anesthesiologist was very interested in the story the old director had mentioned inadvertently.
"Of course, a doctor must know how to read people; that's not just empty talk," Wang Guohua said while scooping feces with Luo Hao. "The director at the Provincial Hospital is my classmate. He told me personally once when he was drunk."
"Tell us more, Director Wang."
"At the time, he anticipated the patient would definitely run into trouble. He went to talk to the family himself, but it was useless; they just wouldn't discharge the patient. Later, when he was pushed to the brink, my classmate almost lived in the dean's office."
"!!!"
"!!!"
The doctors and nurses present truly couldn't imagine what kind of patient one had to encounter for a department director to make such a decision.
Living in the dean's office meant a lot.
But no matter what it meant, that sense of desperate determination could still be felt by everyone in the operating room, even 20 years later.
"The dean was also worn down and pointed at his nose and cursed him for three days. Even then, my classmate held his ground. Later, the dean stepped in to talk to the family. They were all socialites, so they had to give the dean some face. However..."
Wang Guohua dragged out the ending, leaving a cliffhanger.
"However what, Director Wang?"
"The patient was persuaded to discharge, but they left with one of the Provincial Hospital's ventilators. The ventilator belonged to the hospital; as long as they were willing to leave, they gave them a ventilator for free."
"Holy sh*t!" the anesthesiologist was stunned.
A free ventilator upon discharge?! Such a thing actually happened!!
"The patient left the Provincial Hospital and went straight to the Second Medical University Hospital, and the result, you saw it. That incident made a huge fuss. The newly appointed dean of the Second Hospital was really unlucky."
"Tsk, tsk."
Wang Guohua's eyes narrowed behind his goggles, as if he were smiling.
"Speaking of the Second Hospital dean, there's another piece of gossip."
"Director Wang, go on, go on," the anesthesiologist asked happily.
Operating with an old director is great; you get to hear so much gossip that is usually reserved for drinking parties.
"People, no matter how much talent or ability they have, in the end, it still comes down to fate. 'When the time comes, heaven and earth lend their strength; the lucky hero is not free'—that saying isn't for nothing."
"???"
"???"
Hearing Wang Guohua say this, Luo Hao checked his own luck value and felt very comforted.
"Just before that medical accident, the Second Medical University Hospital had an election. Two candidates were at each other's throats, fighting until things got ugly. Later, the one everyone favored failed and went to another hospital. As a result, not long after, they ended up establishing the Third Medical University Hospital, which is now the Cancer Hospital."
"Ah! There's that story too!" the anesthesiologist was surprised.
The famous Third Medical University Hospital in the province focused on cancer treatment; he never expected that before 2005, nobody wanted to go there.
"The one who stayed lost a lot of face in front of the whole country. So, 'fortune and misfortune are interdependent'—that's probably how it is."
As Wang Guohua spoke, he frowned slightly. "Is the ventilation on?"
"It's on, it's on," the circulating nurse replied immediately. "Director Wang, listen, the sound of the exhaust fan is so loud it's deafening."
Wang Guohua shook his head, wanting to hold his breath, but he couldn't stop breathing.
"There's a joke online: a boy had his fortune told as a child, and the fortune teller said he was destined to be a fecal cleaner. Later, to escape the bonds of fate, the boy studied hard, got into a good school, and studied medicine."
When the anesthesiologist reached this point, he didn't care that the story wasn't finished; he asked Wang Guohua for a break and ran out to catch his breath.
The anesthesiologist and the circulating nurse could step out intermittently to breathe, but those on the operating table could not.
After gossiping for a while, Wang Guohua couldn't stand the smell anymore, closed his mouth, and tried to speed up the surgery just a little bit.
But Luo Hao's surgical technique left Wang Guohua with nothing to criticize.
He even felt that if he were the surgeon himself, the operation would not only be no faster than Luo Hao's but would actually be a bit slower.
Damn it!
Wang Guohua hadn't expected this beforehand.
Before the surgery, Wang Guohua had planned to show off his superb surgical skills to make this new generation of doctor, who mastered new technologies, have enough respect for him.
But he never expected that Luo Hao not only mastered new technologies like ERCP but was also "not inferior" to him in traditional open surgery.
12 minutes and 21 seconds later.
"Director Wang, here is the intestinal foreign object." Luo Hao had already "scooped" out all the feces from the patient's abdominal cavity, exposing a "stiff" section of the bowel.
"Open it 5cm first to see the situation."
"Alright." Luo Hao "obeyed the order."
Wang Guohua stared intently at the surgical field; he didn't notice that Luo Hao's attitude had made him feel much better.
Luo Hao cut open the intestine along the rupture point under the diaphragm, and an eggplant appeared before them.
"An eggplant?!" the anesthesiologist was surprised.
Wang Guohua and Luo Hao were fine; they had already deduced it from the imaging.
"Director Wang, the patient's hobby is a bit heavy-handed, isn't it?" Luo Hao said.
"No," Wang Guohua disagreed with Luo Hao's view. "Using an eggplant to treat constipation is a folk remedy."
Another piece of useless knowledge had been added.
Luo Hao said "Ah." His teachers at the Peking Union Medical College hadn't taught him this, and there was no description of it in the system library; Luo Hao had no idea.
"Director Wang, there's such a folk remedy? Isn't that just setting people up for disaster?" Luo Hao said.
"There are many folk remedies, and most are very unreliable," Wang Guohua said. "I've treated two similar patients before, but none as severe as this one. I estimate he inserted the eggplant into his bowel, and because he used too much force, the hard stool pushed a hole in the splenic flexure of the colon."
Luo Hao nodded, honestly memorizing the knowledge point Wang Guohua had shared.
After removing the eggplant, Luo Hao hesitated.
"I'll take it to show the patient's family later," Wang Guohua knew what Luo Hao was thinking, and he said calmly, "It has to be shown. I'll go."
"Okay, Director Wang."
Luo Hao was worried that the fact the patient had inserted an eggplant into his bowel would become known, and the patient would never be able to hold his head up again. But if he kept it a secret from the patient, it would pose a significant hidden danger.
Just as he was weighing the options, his momentary hesitation was spotted by Wang Guohua, who directly took all the responsibility upon himself.
It seemed that what his uncle said wasn't quite right; Old Director Wang and Wen Youren were not the same type of person.
In terms of how they handled things, Wen Youren couldn't even catch up to him.
The anesthesiologist and the nurses didn't notice the conversation between Luo Hao and Wang Guohua; they were marveling at the eggplant and taking photos as a souvenir.
Wang Guohua repeatedly warned them that the photos could only be saved after he had spoken to the patient and their family, and even then, they could only be used as images for academic papers.
His attitude toward the work made Luo Hao approve of him even more, and his favorability grew.
After removing the eggplant, Luo Hao irrigated the abdominal cavity again and carefully rinsed it with hydrogen peroxide.
From the moment Luo Hao started using hydrogen peroxide, Wang Guohua fell silent, his eyes wide as copper bells, staring fixedly at Luo Hao's every move.
Hydrogen peroxide irrigation might look like just another wash, but it was fraught with danger. Wang Guohua knew he was ready to point out any slight oversight Luo Hao might make at any moment.
However, Luo Hao "easily" stepped over all the pitfalls, leaving Wang Guohua with a belly full of clinical experience that he didn't know who to share with.
After the irrigation was finished, Luo Hao painstakingly explored the abdominal cavity three times to check for any missed ruptures.
Watching Luo Hao's technique in handling the intestines, Wang Guohua swallowed back the words he had wanted to say.
Before the surgery, Wang Guohua had prepared thoroughly; he had countless years of accumulated clinical experience that would surely broaden Luo Hao's horizons and let him know how impressive a veteran doctor could be.
Yet!
The surgery was almost finished, and Luo Hao hadn't made a single mistake. Besides gossiping a bit, he hadn't done anything "serious."
Wang Guohua felt a bit depressed.
What was going on?!
Was that dog Lin Yuming trying to embarrass him?!
"Director Wang, I don't see any other ruptures. What do you think?" Luo Hao asked.
"No, suture it," Wang Guohua said gruffly.
Luo Hao used absorbable sutures to sew up the cut part of the bowel, covered it with warm saline gauze while enduring the irritating gas throughout the room, and then observed it meticulously for five minutes.
The anastomotic site was locally ruddy, with no signs of ischemia; the main part of the surgery was declared a smooth success.
They placed sterile drapes again, re-disinfected, and performed one last irrigation.
"Brother Guan, is there any gentamicin?" Luo Hao asked.
"Gentamicin irrigation?" the anesthesiologist looked at the circulating nurse.
Before the circulating nurse could speak, Wang Guohua said, "I brought some; it's on the table under the film viewer."
It was so frustrating! Wang Guohua thought to himself.
It would be one thing if the surgery was just done well, but what young doctor nowadays even has the awareness to use gentamicin for irrigation?
For young doctors, gentamicin was an ancient relic; they might not have even seen it used clinically.
The last "knowledge point" he was going to teach Luo Hao was gone, and Wang Guohua sighed deeply in his heart.
Nowadays, due to reasons like veterinary drug residues and antibiotic abuse, the human body's resistance to antibiotics is very high. High-end antibiotics might not actually be effective; instead, drugs like the old-fashioned gentamicin could work very well.
This was a summary Wang Guohua had reached after decades of surgery, yet he hadn't expected Luo Hao to know it.
If Wen Youren had even half—no, one-third—of Luo Hao's intuition, why would he have to be on the operating table at over sixty years old?
Wang Guohua never expected that he would feel that "someone else's child is better" sentiment while on the operating table.
Gentamicin irrigation was done, and they began to close the abdomen. At the end, Luo Hao moved the greater omentum to cover the top of the bowel suture position.
He even knew such a small detail; Wang Guohua was speechless.
What else did Luo Hao not know?!
If he hadn't known Luo Hao's age, Wang Guohua would have thought that the person standing in the surgeon's position was an octogenarian.
The remaining steps were nothing to talk about. Luo Hao sutured the last stitch, and Wang Guohua used his right pinky finger to hook the needle holder to cut the thread knot. He didn't say anything and walked out of the operating room with the eggplant.
The door to the operating room had been closed the whole time. Walking into the hallway, Wang Guohua took a deep breath, and only then did he feel much better.
It was fortunate that Luo Hao had prepared goggles beforehand; otherwise, a single surgery would have cost him at least half a month of his life.
Wang Guohua held the specimen tray in his hands, with an eggplant inside. The closer he got to the door, the stranger he felt.
He suppressed his strange mood, hid the eggplant first, and called the patient's family who were waiting outside.
Wang Guohua didn't rush to talk about the eggplant. He read the room and determined that the patient's family knew about this—it wasn't some special fetish of the patient, but rather something they had heard from a dance partner while doing square dancing.
Only then did Wang Guohua take out the eggplant and scold the patient's family severely.
An old director has an old director's dignity; he almost cursed them out and nearly shoved the eggplant into their mouths.
Yet, the family took it. They weren't embarrassed into anger; instead, they felt more shame and gratitude.
"Don't do such foolish things again," Wang Guohua said sternly. "If it happens again, you won't even know how you died."
Just as he was speaking, Luo Hao and Chen Yong pushed the patient out.
Wang Guohua took the opportunity to turn back.
Looking back, Wang Guohua saw Lin Yuming.
He handed the specimen to the instrument nurse, and Wang Guohua went with Lin Yuming to change clothes.
"Old Director Wang, it's really fortunate you were there. Otherwise, it would have been hard to complete such a surgery so quickly," Lin Yuming said with a smile.
His smile looked so detestable to Wang Guohua. For a moment, Wang Guohua wanted to use the specimen to plug the mouth of this old man.
"Director Wang, did the surgery go smoothly?"
"Of course it went smoothly!" Wang Guohua glanced sideways at Lin Yuming, his displeasure no longer hidden.
Lin Yuming froze. "Director Wang, I see you're not happy. Was there a problem with the surgery? Or did some little brat offend you? Just say it; whoever offended you, I'll make sure they regret it!"
"You told me to see how Luo Hao's surgery went," Wang Guohua said unhappily and directly.
"???" Lin Yuming was full of question marks.
"You haven't seen Luo Hao perform surgery?" Wang Guohua said with disdain.
"No, I haven't," Lin Yuming replied blankly.
"???" Now it was Wang Guohua's turn to be full of question marks.
"After he graduated with his 8-year doctoral degree, he didn't stay in the capital. After he came back, he was messing around and wanted me to get him intermediate certificates for various disciplines."
"What?" Wang Guohua doubted his ears; he thought he had misheard Lin Yuming.
Lin Yuming could only suppress his doubts and told Wang Guohua about how Luo Hao had asked for intermediate certificates to resolve issues with his professional practice scope.
For the past two years, Luo Hao had been working in the medical affairs office, and he honestly had never seen Luo Hao perform surgery. And Luo Hao hadn't shown off how good his surgical skills were either, just honestly doing his duties in the medical affairs office.
After hearing what Lin Yuming said, Wang Guohua fell into deep thought.
After a long while, Lin Yuming asked tentatively, "Director Wang, is Luo Hao's surgery good?"
"Good?" Wang Guohua looked up and glanced sideways at Lin Yuming, his tone full of displeasure.
"..."
"Can you call that good?! It's extremely good!!"
F*ck!
Lin Yuming never dreamed that Wang Guohua would give such a high evaluation.
Was there a trap?
There must be a trap!
Lin Yuming carefully observed Wang Guohua's expression, trying to find some clues.
"You don't understand surgery; talking to you is a waste of time," Wang Guohua said in a low voice.
"Director Wang, tell me. I can't perform surgery, but I've seen pigs run even if I haven't eaten pork, right?" Lin Yuming pleaded.
"Tsk, let me ask you a simple one: what are the complications of irrigating the abdominal cavity with hydrogen peroxide?"