37. Blood Fell Like Rain

"Go have the pharmacist make a phone call to Wen Youren. Just ask him if he wants the package insert handed to him personally first thing tomorrow morning or given to the doctor on duty tonight."

Luo Hao instructed with a stern expression.

Chen Yong was shrewd enough; as soon as Luo Hao started, he knew why it had to be done this way.

It was to avoid alerting the enemy and to judge whether this fellow was trying to set a trap based on Wen Youren's response.

Chen Yong sighed, "You have to be on guard against this and that just to treat an illness. It's mentally exhausting."

"It's the same everywhere." Luo Hao didn't smile, explaining with a serious expression, "It's still relatively good now. I heard from the teachers that things were even more outrageous back in the chaotic years a few years ago."

"Oh? What happened?" Chen Yong asked casually.

"For example, when an old director of cardiothoracic surgery at a hospital in the Imperial Capital was about to retire, two young competitors fought each other so fiercely that in the end, one of them physically beat the other to a disability."

"Damn! Didn't he get sentenced?" Chen Yong was astonished.

"Why do you have so many questions? Hurry up and go." Luo Hao couldn't be bothered to say much more to Chen Yong.

When talking to him, Chen Yong was like a piece of wood, completely lacking the liveliness he showed when talking to female nurses.

After Chen Yong left, Luo Hao had no mood to eat. He went online, found the drug package insert, and sat pondering while twirling his phone.

Surprisingly, the package insert for iodized oil did not mention its use in interventional treatment for liver cancer. This was simply absurd.

Luo Hao was also newly exposed to interventional surgery. Although his surgical grade had been forcibly upgraded by the system, his detailed knowledge of certain particulars was still somewhat lacking.

However, Luo Hao had been exposed to interventional procedures during his student clinical rotations. Whether in the Imperial Capital, the Magic City, or other hospitals, interventional treatments for liver cancer all used iodized oil.

After thinking for a long time, Luo Hao still couldn't figure out why such an absurd thing could happen. Having straightened out his train of thought, he didn't rush to make the call, but instead quietly waited for Chen Yong to return.

A full half-hour later, Chen Yong made a belated appearance.

This fellow must have been chatting and laughing merrily with the pharmacist, having a wonderful time, Luo Hao thought to himself.

"Luo Hao, Wen Youren said he will pick it up himself first thing tomorrow morning, and didn't have it sent to the department," Chen Yong said upon his return.

Just as expected, Luo Hao confirmed his inner suspicion.

"Luo Hao, what should we do? Should we halt the surgery first?" Chen Yong suggested.

"No rush," Luo Hao shook his head. "I'll try something."

Try something...
That damn phrase again.

This word made Chen Yong recall the moment Luo Hao had acted so superior at the First Affiliated Hospital of the Medical University.

"Can you modify the package insert? Stop talking nonsense. Do you know how troublesome it is to modify a package insert? It's harder than getting a new drug approved for the market." Chen Yong felt uncomfortable all over whenever Luo Hao acted superior, and he directly retorted.

"I said I'd try, I didn't say I was modifying the package insert."

Luo Hao was in a somewhat bad mood, and his tone was harsh.

"Why are you like this? You can't even speak properly when you want to." Chen Yong looked down on him.

Luo Hao suddenly remembered the time Chen Yong was "casting spells" in the corridor of the emergency department at the First Affiliated Hospital.

Chen Yong could practically be considered a formally trained magician!

"Chen Yong, is the cost of your spellcasting high?" Luo Hao immediately softened his tone and asked.

"That... that's not spellcasting! Why do you like portraying ghosts and gods so much? If you really like it, you can go study for a master's degree in magic and mysticism. I refuse to believe a Peking Union Medical College PhD graduate like you can't meet the requirements," Chen Yong replied unhappily.

"Why don't you try again?" Luo Hao said with a smile.

Now Chen Yong could no longer look at the two words "try" straight.

"Try what?"

"See what Director Wen is going to do, or take a peek into the future."

"Are you kidding me! How could I possibly do something like that?" Chen Yong looked at Luo Hao as if he were an idiot.

"Give it a try, so I can feel a bit more at ease. The feeling of being targeted by someone is terrible, my heart feels a bit fluttery." Luo Hao made an exaggerated gesture.

"I couldn't tell that you're feeling fluttery at all," Chen Yong said with zero patience.

His attitude when talking to Luo Hao was completely different from the way he spoke to nurses and pharmacists.

Luo Hao gradually got used to it and took it in stride.

"Just try it, just try it. If you try once, whether it works or not, I'll take you along to perform surgeries. If it's really accurate, I'll take you through ten cases! If you apply yourself, you can be the primary surgeon and I'll assist you."

Luo Hao threw out his ultimate trump card.

Chen Yong couldn't refuse. He gathered his focus, took out his necklace, and began muttering words Luo Hao couldn't understand.

After a few minutes, Chen Yong sighed, "I don't know. I told you my level isn't high enough."

"You're a graduate student after all, a graduate student in magic and mysticism," Luo Hao emphasized.

"A medical graduate student is just a nobody when they hit the clinical floor. Able to perform Level 4 surgeries? Are you kidding me?"

Luo Hao thought about it and realized that was true.

"It's not like I didn't feel anything at all, though. Subconsciously, I felt like you were telling old Director Guohua to go home and hold his grandchildren. Sigh, I already said it's unreliable, but you insisted on making me look."

Knowing his "prediction" was absurd, Chen Yong hurriedly explained.

"!!!" Luo Hao felt that this fellow Chen Yong was truly unreliable.

[They all say men remain youths until the day they die, but where are the youths...]

His phone rang; it was a call from Lin Yuming.

"Director Lin, please give your instructions," Luo Hao answered the phone, saying with a beaming smile.

"Are you in the hospital!" Lin Yuming asked sternly.

"Yes." Luo Hao also turned serious.

"The emergency department. There's an anonymous patient vomiting blood. Go take a look. If they can still be saved, you take charge of leading the rescue."

"You got it!"

The so-called leading the rescue didn't mean Luo Hao would personally perform every hands-on resuscitation measure, but rather that he would issue a waiver of liability for the medical staff in the name of the medical administration department, allowing the clinical side to throw all caution to the wind during resuscitation.

What Luo Hao needed to do included, but was not limited to, handling situations where certain procedures required signatures, but the anonymous patient had no family members present, which could lead to delayed resuscitation, and so on.

The past dozen or so years had been chaotic, and human hearts were no longer pure.

There had been cases where, after a successful emergency resuscitation, family members of the patient came asking for compensation for the clothes that were cut off, or family members of patients who died during resuscitation came crying and making a fuss, demanding someone take responsibility.

Even resuscitation failure was easier to handle; success brought even bigger troubles, especially for patients admitted to the ICU with exorbitant expenses—those situations were extremely prone to accidents.

At times like this, the medical administration department needed to send someone to take charge on the ground.

Of course, not all hospitals were like this. The General Mining Hospital had been declining severely in recent years, and Lin Yuming tried his best to keep the medical staff from feeling disheartened, so many responsibilities were shouldered by the medical administration department.

Most hospitals adopted a laissez-faire attitude, shifting any liability onto the clinical medical staff.

Luo Hao tidied up his white coat and strode out.

"Vomiting blood? Usually, when someone vomits blood, family members are around. Could the medical history be wrong? Luo Hao, do you guess it's trauma?" Chen Yong chattered as he followed alongside Luo Hao.

Young doctors were interested in emergency resuscitation, but anyone who had worked in a hospital for more than two years would stay as far away as possible from an emergency rescue if it had nothing to do with them.

When encountering acute emergencies, Chen Yong noticeably spoke more words to Luo Hao.

"Do you dare to be even more unreliable?"

"I'm just going to see if it's a general surgery patient. How is that unreliable?" Chen Yong was puzzled.

"I'm talking about what you just said—that I told old Director Guohua to go home and hold his grandchildren. Dr. Chen, I respect old Director Guohua very much; I would never say such a thing." Luo Hao emphasized.

"The more you lack something, the more you emphasize it," Chen Yong muttered softly.

"What did you say?"

Chen Yong fell silent, following Luo Hao as they hurried toward the emergency department.

Around the corner, a strange smell hit them head-on.

This was the "signature" scent of the emergency department—disinfectant mixed with vomit and the stench of blood, making one inexplicably irritable.

Looking ahead, a crowd had gathered at the entrance of the emergency resuscitation room. They looked like onlookers rather than family members of a patient.

After all, Lin Yuming had already stated that the patient was anonymous.

Luo Hao strode over, parted the crowd, and before even seeing the patient, he heard a sound of retching coming from inside the room.

The sound arrived first, followed by a thick, pungent smell of blood. The adrenaline in Luo Hao's body instantly surged in large quantities, and he directly entered a tense state of resuscitation.

An elderly male patient was lying on an emergency resuscitation bed, with a nurse "holding" his head tilted to one side.

This was to prevent vomit from entering the airway and causing aspiration in the patient.

The resuscitation bed was covered entirely in dark red blood, a startling sight.

"Little Luo, the patient might not make it," an emergency internal medicine doctor said hastily.

The blood pressure shown on the cardiac monitor had dropped as low as 60/20 mmHg, the heart rate was 160 beats per minute, and the pulse oximeter clip hadn't been attached yet, so the value wasn't visible.

"Why hasn't an IV been started yet?!" Luo Hao frowned and asked.

"Can't get the needle in; the veins had already collapsed when he arrived," the emergency internal medicine doctor said helplessly.

With excessive blood loss and insufficient blood volume, the blood vessels shriveled up like a sheet of paper, making the establishment of a peripheral intravenous line a difficult problem.

In this situation, hitting the vein on the first attempt was extremely difficult; even the most experienced senior nurses couldn't claim they could achieve this one hundred percent of the time.

Luo Hao saw that the patient's limbs were twitching continuously, his face pale, looking as though well over half of his body had already crossed the Bridge of Helplessness.

An elderly nurse was bent over, trying to place an IV line for the patient, but every time the needle pierced the skin, the patient would twitch, increasing the difficulty of line placement by orders of magnitude.

Luo Hao watched as she tried twice within a short period to place the line, both ending in failure.

"I'll place the line, you guys help me hold the patient down." Luo Hao turned, grabbed a pair of sterile gloves, tore open the outer packaging with a "rip" sound, took out the gloves, and put them on.

With a "snap," the elastic band of the glove slapped against Luo Hao's wrist.

Unlike Chen Yong showing off, Luo Hao just wanted to be faster—even if it was only faster by a single second.

He took the puncture needle from the nurse's hand and instructed the nurse and the emergency doctor to hold the patient's arms down.

Luo Hao held his breath and focused, first entering the system's virtual operating room to practice.

Sure enough, the cadaver in the system's operating room was just like the patient before him.

After trying three times with very little surgical training time, Luo Hao felt confident in his mind.

After the infusion needle pierced the skin at a 37-degree angle, the patient suddenly twitched, but the needle in Luo Hao's hand moved imperceptibly with the patient's twitch.

The next second, Luo Hao pressed his left thumb against the infusion needle, "Saline!"

"It went in?!" the elderly nurse asked in astonishment.

What Luo Hao had just done—she understood a little, but didn't quite understand.

Even with people pressing down, the patient's muscles were still twitching.

Coupled with the extremely poor condition of the blood vessels themselves, if it were in a stationary state, trying a few more needles might have succeeded, but any stimulation caused movement and shifted the veins. In the elderly nurse's eyes, hitting it on the first try was simply impossible.

"Saline!!" Luo Hao repeated.

"Oh, oh, oh." The elderly nurse hurriedly connected the infusion tube and turned the pre-hung normal saline drip to maximum speed.

The infusion speed was extremely fast, with no signs of resistance indicating that the needle had pierced through the vessel and fluid was entering the subcutaneous tissue.

Did it really work?
It really worked!

"Connect the three-way stopcock, and prepare a central venous catheterization kit," Luo Hao said in a deep voice.

"Little Luo, the emergency department doesn't have central venous catheterization kits..." the nurse whispered.

Damn it!
Luo Hao cursed inwardly.

High-value consumables had become a restricted zone in the medical field, and central venous catheterization kits also belonged to the category of high-value consumables. They weren't even stocked in the emergency department anymore?!

Though he was cursing inside, Luo Hao remained calm.

This path was blocked, so he would take the next one.

"Prepare a cut-down tray, take the patient's pants off."

Nowadays, attending physicians in their middle years—doctors around the age of Jiang Wenming—basically didn't know how to perform a venous cut-down; it was a surgical technique that existed only in "legends."

Because more than a decade ago, central venous catheterization kits had become available—simple and worry-free, far more convenient and quick than a venous cut-down.

Yet no one expected that one day the emergency department would be unable to find a central venous catheterization kit.

The emergency internal medicine doctor was stunned, "Little Luo, do you know how to do a venous cut-down?"

"Stop talking nonsense, make it quick!" Luo Hao replied bluntly.

The sunshine-like smile that had always hung on his face had long since vanished; Luo Hao looked as stern as a block of stone.

The emergency doctor hurriedly told the nurse to expose the patient's inguinal region. As the nurse turned to get the surgical prep kit, Luo Hao had already assembled the blade, applied local antiseptic, and performed a simple skin prep with the scalpel.

This wasn't standard procedure, but in an emergency, it could save a lot of time.

After the brief skin prep, Luo Hao pressed his hand onto the patient's groin to locate the femoral artery.

He made an incision; there was no blood from the cut, as pale as a sheet of white paper. The patient's blood pressure was extremely low, and the peripheral blood vessels had long since constricted, supplying all available blood to the most vital organs.

Dissecting layer by layer, Luo Hao used his left hand to part the subcutaneous tissue, while his right hand held a hemostat, reached in, and gently lifted.

A piece of "connective tissue" was lifted out by Luo Hao.

Yet the next second, nobody assisted him, and Luo Hao's stern expression increased by one level.

"Chen Yong, what are you doing!" Luo Hao rebuked unhappily.

Chen Yong was still watching the spectacle and hadn't expected to be asked to lend a hand. Scolded by Luo Hao, he frantically searched for gloves.

Luo Hao's stern expression increased by another level.

Without waiting for Chen Yong, Luo Hao released his left hand and picked up the scalpel.

The tip of the blade tapped lightly against the "connective tissue" lifted by the hemostat.

"Infusion tube."

At this moment, even the nurse was somewhat bewildered.

A central venous cut-down was done in under a minute? Was that piece of connective tissue Luo Hao lifted the femoral vein?!

Still receiving no cooperation, Luo Hao took a deep breath, suppressing all his anger.

Outside the door, patients and family members who had come to the emergency department were watching the commotion, and it wouldn't do for him to lose his temper.

Family scandals shouldn't be aired in public, so Luo Hao kept quiet.

The emergency resuscitation at the emergency department really needed an overhaul; this competence was a massive step down from the First Affiliated Hospital.

After repeated urging, the nurse handed over the infusion tube.

Luo Hao had the nurse open the infusion valve, and as normal saline flowed out, Luo Hao unhesitatingly inserted the infusion tube directly into the incised connective tissue.

There was no fluid spilling out, confirming that the infusion tube had entered the femoral vein.

Opening the infusion valve to maximum, Luo Hao continuously fed the infusion tube further inside.

"Did it thread into the inferior vena cava?" Chen Yong finally put on his gloves and came over to help.

"Suture," Luo Hao didn't pay attention to Chen Yong, speaking in a cold voice.

Chen Yong gave a start.

This was the atypical Luo Hao.

Usually, Luo Hao was very gentle; no matter what was said, he wouldn't get angry, acting as if he simply had no temper at all.

This emergency rescue was the first time Chen Yong and Luo Hao had encountered such a scenario together. He hadn't expected Luo Hao to instantly transition into the state of a senior physician, every sentence cracking like a whip across Chen Yong's back.

Securing the infusion tube, Luo Hao carefully anchored it with two stitches, then began suturing the incision site.

Two intravenous lines had been established, and fluids were pouring in. The first step of the rescue was successful.

However, this was only the first step.

"How is the patient?!"

A familiar voice echoed from the corridor—it was Wang Guohua!

Why was he here? Luo Hao felt a slight trace of surprise, but he didn't let his attention wander, focusing intently on the patient's status, ready to perform resuscitation at any moment while contemplating the next treatment plan.

"Director Guohua!" The emergency internal medicine doctor spoke as if he had found a pillar of support, hurriedly saying, "Little Luo established intravenous lines and has started fluid resuscitation, but the situation is not optimistic. The patient might..."

Heavy footsteps entered the room. Without looking, Luo Hao knew it was Wang Guohua.

He strode into the battlefield with booming footsteps, like an ancient behemoth.

It felt as though the entire emergency resuscitation room was trembling.

"Femoral vein cut-down? Little Luo did it?"

"Yes, 1 mg of epinephrine intravenous injection," Luo Hao acknowledged, and then began issuing orders, "200 milligrams of dopamine dissolved in 250 milliliters of normal saline, 30 drops per minute."

"Prepare the defibrillator."

"Suction apparatus, clear the blood from the patient's mouth."

Luo Hao reeled off order after order, directing the resuscitation in an orderly and methodical fashion.

This must have been the greatest cold shoulder and the most profound disregard Wang Guohua had experienced in nearly thirty years.

During every previous major emergency rescue, Wang Guohua had always been the one sitting in command.

Every staff member's feet would feel like they were wearing wind-fire wheels, and if anyone was even slightly slow, Wang Guohua would unleash a torrent of fierce scolding.

So much so that even after retiring for a few years, the medical staff in the operating theatre and emergency department still held Wang Guohua in awe as if he were a tiger.

Yet!

Unawares, Luo Hao had already stepped into the center stage.

Wang Guohua silently watched Luo Hao direct the resuscitation, without insisting on reclaiming the position that originally belonged to him.

Luo Hao's medical orders were rigorous and prompt; at this moment, he didn't look like a young man at all, but rather like a veteran director seasoned through countless battles.

"Director Guohua, why aren't you saying anything? Who is that young doctor, and why is he yapping on and on?" Someone following closely behind Wang Guohua asked in a low voice.

"Shut up," Wang Guohua rebuked.

The person who had followed him started, instinctively clamping his mouth shut.

A dozen minutes later, blood pressure slowly began to recover as fluids poured into the blood vessels. The systolic pressure had returned to 75 mmHg. Although it hadn't reached the lower limit of the normal range, it at least offered a glimpse of dawn.

Yet neither Luo Hao nor Wang Guohua relaxed their expressions in the slightest.

Luo Hao kept his eyes fixed on the cardiac monitor. Seeing the situation improve slightly, he turned his head and asked, "Director Guohua, do you know the patient?"

"I know their village chief. The patient has a thirty-year history of hepatitis B and cirrhosis; the hematemesis is considered to be caused by ruptured gastric varices."

Wang Guohua understood Luo Hao's intent completely without wasting a single word, directly stating the medical history he was aware of.

"A porta-azygos disconnection surgery needs to be done, but you can see the patient's current state," Wang Guohua then said.

This sentence was directed at the village chief standing beside him.

"Director Guohua, can he make it off the operating table alive?"

"Are you blind?" Wang Guohua curled his lip and rebuked unceremoniously.

An old director retained an old director's majesty. Luo Hao and the entire room of medical staff were silenced by Wang Guohua's single sentence.

Was Wang Guohua scolding the patient's family member?!
Such audacity!

"Didn't you see him vomiting blood mouthful after mouthful? In this condition, I estimate he might not even survive the anesthesia," Wang Guohua continued bluntly, "Go to surgery, ninety-nine percent chance of death. Don't go to surgery, one hundred percent chance of death. You choose."

The village chief wore a troubled expression.

"Director Guohua, what does that... porta-whatever surgery mean?"

"If I explain it to you, are you going to go home and burn paper money for his seventh-day post-mortem?" Wang Guohua continued scolding, "Do it or don't do it, give me an answer."

"Do it!" The village chief seemed to respond well to this approach and agreed without hesitation.

Luo Hao knew that the reason Wang Guohua could speak like this was because of whatever connection he shared with this person beside him—that belonged to the annals of history, something others couldn't compare to.

Perhaps Wang Guohua had lived in their village for a few years back in the day.

"Luo Hao, has blood been cross-matched and reserved?" Wang Guohua asked.

"Reserved, Director Guohua," Luo Hao said as he walked over to Wang Guohua's side and whispered, "I have something to discuss. Let's find somewhere empty to talk."

Luo Hao was also growing somewhat anxious; the patient might seem relatively stable right now, but heaven knew when another mouthful of blood would spew out and life would slip away.

Therefore, Luo Hao delivered this sentence rather directly.

Wang Guohua kept a straight face, "This is an emergency rescue, and you are the representative sent by the medical administration department. If you have something to say, say it face to face! I need to prepare for emergency surgery here!"

"Director Guohua, porta-azygos disconnection surgery can indeed treat this, and it used to be the primary choice."

Used to be!

This keyword was captured by Wang Guohua.

"The current first-line procedure is endoscopic variceal ligation."

Wang Guohua knew this procedure existed, but he had never performed it, and moreover, he had never seen Luo Hao perform it either.

In an emergency rescue, every inch of time was worth gold. Wang Guohua would naturally choose the porta-azygos disconnection surgery that he had performed countless times.

"No." Wang Guohua unhesitatingly rejected Luo Hao's suggestion, "I don't agree with your medical administration department's recommendation."

Luo Hao felt somewhat helpless too. Although Wang Guohua was eager to learn minimally invasive surgery, at the most critical and urgent moment, he still chose the surgical method he was most certain of.

As Wang Guohua spoke, he walked over to the patient, reached out, and lifted the patient's eyelids to inspect the conjunctiva.

"Perform preoperative preparations, notify the operating theatre, have the anesthesiologist come down..."

"Blech~~~"

Without any warning, the patient experienced a burst of agitation, spewing a mouthful of fresh blood directly toward the ceiling right in front of Wang Guohua.

A downpour of dark red blood spattered down in heavy drops.

Amidst the rain of blood, the alarm of the monitor sounded, and the electrocardiogram flattened into a straight line.

Cardiac arrest!!