I Am Diagnosed as a Medical Titan

Chapter 78: Chapter 78: Massive Hemorrhage

In the operating room.

Yang Xu gave quiet commands.

”Scalpel.”

”Suction.”

The peritoneum was incised.

Liu Jianbang’s brow was tightly furrowed.

Even though he was used to seeing critical cases in the ICU, the absolutely horrendous state of the abdominal cavity still gave him a jolt.

The entire peripancreatic area was a matted mess of infected, necrotic tissue, making it impossible to distinguish any anatomical structures.

”Suction,” Yang Xu said.

The suction tool in Jiang He’s hand delved into the paracolic gutter’s lowest point, methodically drawing out the toxins and fluid.

”Posterolateral approach. Retract the colon, expose the Toldt’s fascia.”

Liu Jianbang gripped the deep retractor with both hands, forcefully pulling the swollen descending colon to the right.

This was the reverse approach Jiang He had proposed.

Since the anterior approach was completely blocked by necrotic tissue and pus, they would incise the posterior peritoneum from the side, lift the entire spleen along with the body and tail of the pancreas like flipping the page of a book, and approach it from the rear.

In the operating room, Yang Xu’s movements were incredibly fast.

Jiang He watched Yang Xu work.

He had to admit, in ’08, Yang Xu’s anatomical knowledge and surgical feel were absolutely at the pinnacle of the nation.

Forcefully dissecting fascia during a state of inflammatory edema could cause massive bleeding with the slightest misstep, but every cut Yang Xu made with his scissors accurately avoided the vascular network.

”Cautery.”

”Wet gauze.”

”Traction.”

Yang Xu’s commands were short and clear.

Jiang He’s assistance was flawless.

This level of synergy gave Liu Jianbang, standing on the opposite side, an illusion: the person at the foot of the bed wasn’t a third-year student, but a senior Attending Physician who had partnered with Yang Xu for a decade.

As the dissection deepened, the splenocolic ligament was severed.

”Prepare for rotation,” Yang Xu said in a low voice.

The most crucial and dangerous step of the surgery had arrived.

They had to lift the entire spleen.

If they pulled too hard, the blood vessels would tear instantly.

Yang Xu put down his instruments and plunged both hands deep into the abdominal cavity.

Liu Jianbang assisted from above, helping to lift.

”One, two, lift,” Yang Xu grunted with effort.

The heavy organ was slowly rotated, opening up the retroperitoneal space.

A large patch of grayish-black necrotic tissue came into view.

Deep within this mud-like tissue, a pulsating, dark-purple mass was faintly visible.

A splenic artery pseudoaneurysm.

”I see it.” Yang Xu’s gaze sharpened. ”Dissector. I’m going to clamp the main arterial trunk first.”

The moment the scrub nurse slapped the dissector into Yang Xu’s hand, disaster struck.

The rotation of the organ had altered the local tension, and after a month of corrosion by the necrotic tissue, the aneurysm wall ruptured under the slight traction.

In the blink of an eye, blood surged madly from the deep space behind the pancreas, instantly flooding the entire surgical field.

”Blood pressure’s dropping! 60 over 40!” The anesthesiologist shot upright, his voice urgent. ”Heart rate 160! Norepinephrine is maxed out! Start pressure bag transfusion!”

Massive hemorrhage.

For a severe pancreatitis patient already on the verge of shock, this level of bleeding could be fatal in under a minute.

Liu Jianbang’s breath hitched. He instinctively reached for gauze to pack the wound, but he couldn’t see the bleeding point at all. Before him was only a rising sea of blood.

”Don’t move.”

Yang Xu’s voice was still frighteningly calm.

He tossed aside the dissector, brought his right hand together, and plunged it deep into the sea of blood.

Relying on his superb anatomical memory and sense of touch, his index and middle fingers blindly found the bottom and pressed down hard on the branch of the abdominal aorta, anterolateral to the spinal column.

The upwelling of blood slowed visibly.

He’d stopped it.

”Suction. Clear out the blood,” Yang Xu commanded.

Jiang He immediately switched to a large-bore suction tip and quickly cleared the pooled blood from the field.

As the blood was suctioned away, the situation became clear—but they were now in a stalemate.

The rupture was in an extremely tricky location.

It was at the base of the aneurysm, right up against the root of the celiac trunk.

The surrounding area was full of hard inflammatory nodules and necrotic tissue that had the consistency of tofu dregs.

Even more critically, it was located in a deep, funnel-shaped cavity.

Yang Xu’s right hand was pressed firmly into the deepest part of the cavity. Looking down from his angle, his own fingers completely blocked his line of sight, making a suturing angle impossible.

To stop the bleeding, the only option was to suture blindly.

And it had to be done within five minutes.

Although the patient’s blood pressure had barely stabilized, the high-dose vasoactive drugs meant his heart could stop at any moment.

Liu Jianbang assessed the situation and said, ”Old Yang, there’s no way to get a needle in at this angle. The incision is too deep, completely blocked by the head of the pancreas. Not unless we clear out all the surrounding necrotic tissue first before suturing.”

Yang Xu replied, ”There’s no time. If we clear it, the patient’s gone.”

Liu Jianbang gritted his teeth. ”Then what do we do? Pressure control isn’t a long-term solution.”

Yang Xu didn’t answer right away.

His mind was racing.

’At this angle, at this depth,’ he thought, ’if I were to do the suturing myself, I’d have to switch to my left hand for compression, then go in with the needle holder in my right hand completely blind.’

’I’d only have a ten percent chance of success.’

’And if the first stitch goes astray and tears the celiac trunk, the patient will die right here on the table.’

’Hand it over to Liu Jianbang? Absolutely not.’

’Old Liu comes from a critical care background. Having an internist’s hands attempt a blind suture on the celiac trunk is no different from just pulling the plug.’

’The hospital is severely short-staffed today. The only reason Old Liu was called in as first assistant is because there isn’t another surgeon in the entire OR department.’

Just then, he recalled a phone call from Wang Xiaoqing of the clinical academy a few hours ago.

On the call, Wang Xiaoqing had told him, half complaining and half in shock, ”Old Yang, that Jiang He is a monster. Blind vascular suturing in a deep, narrow space... that’s a test for attending physicians, and he did it in three minutes and forty-two seconds. Perfectly, without breaking a sweat.”

Blind vascular suturing in a deep, narrow space...

’It’s an uncanny match for the current situation.’

’What’s more, Jiang He was the one who proposed this reverse anatomical approach. Could he be confident he can do this?’

Yang Xu’s gaze slowly shifted from the bloody cavity, across the operating table, and landed on Jiang He’s face.

Jiang He was just standing there quietly.

No panic, no fear. His calmness was chilling.

At that moment, Yang Xu couldn’t help but recall Jiang He’s freakishly good practical skills during the semifinals of the Mind Competition.

Yang Xu was a surgeon, pure and simple.

In his world, rules, ethics, and seniority were worthless in the face of a human life.

As long as the patient could be saved, whoever had the best chance of success would be the one to do it.

”Jiang He,” Yang Xu said suddenly.

”Yes, sir.”

”From your angle, can you feel the tip of my index finger?”

Without hesitating, Jiang He reached his left hand into the abdominal cavity.

His fingertips brushed against Yang Xu’s index finger.

”I can feel it.”

”The rupture is one centimeter below my fingertip. It’s a blind spot. I have to maintain pressure the whole time. You’ll do the suturing.” Yang Xu stared into Jiang He’s eyes. ”Can you do it?”

Jiang He nodded. ”I can.”

At these words, Liu Jianbang, standing to the side, froze for a second, then immediately said, ”Old Yang, this is...”

Without even looking up, Yang Xu said, ”Principle of necessity. A life is on the line. I’m the lead surgeon today. All decisions are mine. If there are any medical disputes, I’ll take full responsibility. It has nothing to do with either of you.”

Yang Xu’s words were delivered with such force and finality that they left Liu Jianbang speechless.

”Switch places,” Yang Xu commanded.

Since his teacher had spoken, Jiang He naturally wasted no time on words.

He was well aware that according to the ’Regulations on the Management of Clinical Practice in Medical Education,’ when medical students participate in clinical practice under the supervision and guidance of a teaching physician, the teaching physician bears the relevant legal responsibility.

Therefore, at this moment, he was, in a legal sense, an extension of the lead surgeon Yang Xu’s hands.

The traceability of all medical decisions and legal liabilities would end with Yang Xu.

He bore no risk.

Jiang He walked directly around the foot of the bed.

With no reason to hold back, it was time to let loose.

Though his brow was beaded with cold sweat, Liu Jianbang could only grit his teeth, take half a step back to make room, and grip the retractor tightly with both hands.

Jiang He glanced down into the abdominal cavity.

He held out his right hand, his voice calm.

”Long needle holder, 4-0 Prolene suture.”

The nurse paused for a beat, then immediately handed over the instruments.

For some reason, she suddenly saw the shadow of a senior attending physician in Jiang He and instantly understood Yang Xu’s decision.

’This man... he’s as calm as a monster. But can he really do it?’

Jiang He took the needle holder. Under the cold, white light of the shadowless lamp, his expression was serene.

For anyone else, this was a near-impossible task with a slim chance of survival.

But for him, it was just another routine day from his past life, one of countless times he had snatched a person from the Grim Reaper’s clutches over the last twenty years.