I Am Diagnosed as a Medical Titan

Chapter 254: Chapter 169: Dr. Jiang’s First Surgery

Xu Chen scurried over. ”Teacher, what is it?”

”The ER sent over a patient with migratory right lower quadrant pain. Diagnosis is acute suppurative appendicitis with localized peritonitis. Dr. Zhao is tied up and told me to open him up first. You’ll be my first assistant.”

Xu Chen’s mind went blank for a second.

First assistant?

’Can I even do this? I have no experience.’

He said, ”Sir, I... I’ve never assisted in a surgery like this. I’m afraid I’ll...”

”There’s no one else,” Jiang He cut him off. ”Are you doing it or not?”

”I... I’ll do it!”

Xu Chen hesitated for half a second before gritting his teeth and agreeing.

’Besides, he knew the hospital was short-staffed. If he could be of use, he had to step up.’

Jiang He then saw Tang Pei, who had just returned from delivering some files from the ward.

”Tang Pei,” Jiang He called out.

Tang Pei stopped in her tracks. ”Boss? What’s up?”

”Change your clothes. You’re scrubbing in with me.”

Tang Pei froze. ”Huh? Me too?”

”Yes. Hurry up.”

Meng Shiyu, who had been trailing Jiang He the whole time, immediately rushed forward. ”Teacher, what about me?”

Jiang He glanced at him. ”You’ll be the third assistant. Let’s go. To the locker room.”

Just like that, a team was assembled at lightning speed.

The group of four walked briskly toward the operating room’s changing area.

Once inside the locker room, Jiang He took off his ring and necklace, pressing them against his heart.

’May everything go safely and smoothly, for everyone involved.’

Then, he sent a message to his wife:

[Teacher Shen, I just got pulled into an emergency appendectomy. Have to scrub in now.]

After sending the message, he changed his clothes and went to the scrub sink.

The three rookies had also changed and were standing beside him, looking a bit dazed.

Jiang He squeezed out the disinfectant and began the standard seven-step hand-washing procedure.

As he washed, he naturally slipped into teaching mode:

”Palms together, fingers interlaced, rub...”

Xu Chen stood to Jiang He’s left, while Tang Pei and Meng Shiyu stood to his right.

The three of them copied Jiang He’s movements, scrubbing their hands.

Over the sound of the running water, Xu Chen stole a glance at Jiang He.

’This guy... how is he so calm? Isn’t he nervous at all? This isn’t some school competition, this is a real operation!’

Tang Pei, on the other hand, felt a strange, indescribable emotion.

’She was a fifth-year senior, and Jiang He was supposed to be her junior. But now, being taught by him, it didn’t feel strange at all. It even felt... natural...’

As if she’d already been thoroughly conditioned.

Jiang He said, ”When you rinse, fingertips up. Let the water flow from your fingertips to your elbows. Elbows always lower than your wrists, understand?”

”Understood,” the three said in unison.

After washing their hands, Jiang He held his up, dried them with a sterile towel, then turned and pushed open the automatic door to Operating Room 4 with his back.

Inside the operating room, the shadowless surgical lamp was already on.

Han Yuan had experience assisting in surgeries, so she was acting as the circulating nurse for this operation. She was currently counting the gauze and forceps on the instrument cart.

Next to the anesthesia machine sat a male doctor in his thirties, the anesthesiologist Zhou Li.

Hearing the door, Zhou Li looked up. His brow furrowed instantly when he saw four ridiculously young, unfamiliar faces walk in.

”Who’s the lead surgeon?” Zhou Li asked.

”I am.” Jiang He stepped forward, and Han Yuan immediately handed him a sterile surgical gown.

He slipped his hands into the sleeves, and Han Yuan tied the gown for him from behind.

After putting on sterile gloves, Jiang He walked to the operating table.

Zhou Li paused. ”Jiang He? You’re that new undergraduate student? I’ve heard of you... But where’s Old Zhao?”

”Dr. Zhao isn’t finished in OR 3. The patient shows signs of localized peritonitis. We can’t wait.”

Jiang He’s voice came through his mask. ”Has the anesthesia been checked?”

Zhou Li hesitated.

An appendectomy might be a basic Level 1 surgery, but it could get tricky if you ran into suppurative perforation or an ectopic appendix.

’Letting a brand-new doctor take the lead on this... isn’t that a bit risky?’

Although Zhou Li had his doubts, he reported the situation truthfully:

”Epidural is in. Ropivacaine has been administered and has taken effect. Vitals are stable. But... Jiang He, are you sure you can handle this? The patient’s abdominal muscles are extremely tense. It’s probably a total mess in there. Why don’t we wait twenty minutes for Old Zhao?”

”If a suppurative appendix perforates completely and causes diffuse peritonitis, the difficulty of controlling post-operative infection will increase exponentially.”

Jiang He turned his head to look at Xu Chen and the other two:

”Gown up, glove up, and prepare to drape.”

Seeing his steady tone, Zhou Li opened his mouth, but ultimately swallowed the words of caution.

After all, he had heard some rumors about Jiang He, and combined with that powerful presence... he felt a bit intimidated.

Disinfection, sterile draping.

Jiang He stood at the lead surgeon’s position, with Xu Chen opposite him as the first assistant.

Meng Shiyu was beside Xu Chen, while Tang Pei stood further down, holding the suction tube.

The intense light of the shadowless lamp focused on the patient’s exposed right lower abdomen.

”Scalpel.” Jiang He held out his right hand.

Xu Chen slapped a Number 10 scalpel, blade already loaded, into Jiang He’s palm.

Jiang He gripped the handle and glanced down at McBurney’s point.

With a slight downward press of his wrist, the tip of the blade sliced smoothly inward and downward.

An oblique incision formed in an instant. The subcutaneous fat layer rolled back, and bright red blood seeped out.

”Bovie.”

Xu Chen immediately handed him the electrocautery pen.

”BZZT—”

The faint smell of scorched flesh arose as the bleeder was precisely sealed.

The entire process of incision and hemostasis took less than five seconds.

Sitting behind the anesthesia machine, Zhou Li was astonished.

’That first cut was incredibly masterful. The depth of the incision was perfect, cutting through the skin and subcutaneous fat without nicking the external oblique aponeurosis in the slightest. This kid’s got some real skill.’

”Xu Chen, retractors.”

Xu Chen was still in a daze. Jolted by Jiang He’s shout, he snapped back to reality and quickly inserted two thyroid retractors into the incision.

”Steady hands. Press down, pull out.”

”Expose the external oblique aponeurosis. Use even pressure. Don’t just yank on it. This is living flesh, not a cadaver on the anatomy table.”

Xu Chen’s hands were trembling slightly, but he did his best to adjust the force and angle according to Jiang He’s instructions.

The incision was pulled open to both sides.

Jiang He used his scalpel to make a small nick in the external oblique aponeurosis, then put down the blade and picked up a pair of curved scissors.

”Cut along the direction of the aponeurotic fibers. Meng Shiyu, switch to a curved hemostat to retract the edge of the aponeurosis.”

Meng Shiyu immediately stepped forward and clamped the aponeurosis with a hemostat.

Next were the internal oblique and transversus abdominis muscles.

Jiang He used two hemostats to alternately perform a blunt dissection of the muscle fibers.

”Watch carefully.”

Jiang He said to Xu Chen and Tang Pei as he worked:

”For an appendectomy, avoid cutting muscles that can be bluntly dissected. If you separate along the muscle fibers, the patient will have significantly less post-operative pain and will recover faster.”

The hemostats precisely parted the muscle fibers, exposing the underlying peritoneum.

Tang Pei watched from the side, completely mesmerized.

At the same time, she couldn’t help but feel a surge of emotion.

’Is this really the Boss’s first time as lead surgeon? How is he not nervous at all? He even has the energy to teach?’

Jiang He picked up the peritoneum, confirmed there was no bowel underneath, and then made an incision.

HISS—

The moment the peritoneum was opened, purulent exudate gushed out.

”Tang Pei, suction.”

Tang Pei quickly inserted the tip of the suction tube into the edge of the incision.

The pus was quickly suctioned away.

Jiang He picked up some sterile saline to irrigate the area.

At that moment, the activation pedal for the operating room’s automatic door was stepped on, and the pneumatic door slid open.

Zhao Yumin, already in a sterile surgical gown, walked in.

He had just finished his own surgery and hadn’t even had time for a sip of water, terrified that something would go wrong with Jiang He’s case.

Fortunately, however, everything seemed to be going smoothly so far.

So, Zhao Yumin didn’t make a sound to disturb them, quietly walking up behind Jiang He to look at the surgical field.

The incision was extremely small and neat, with almost negligible bleeding.

The abdominal cavity had been opened successfully, the pus was cleaned up thoroughly, and the surrounding bowel was unharmed.

Zhao Yumin let out a sigh of relief; his heart, which had been in his throat, settled back into his chest.

He looked up at Zhou Li across the room.

Zhou Li gave him a thumbs-up, mouthing the word, ”Impressive.”

Zhao Yumin smiled back and simply stood behind Jiang He, with no intention of taking over.

’Let’s just see how far this kid can really go.’

”Locating the appendix.”

Jiang He, holding a pair of atraumatic forceps and a small sponge stick, gently probed inside the abdominal cavity.

”Follow the taeniae coli down. Their point of convergence is the base of the appendix.”

As he spoke, he gently lifted out the cecum.

But soon, Jiang He’s brows furrowed slightly.

The end of the cecum was tightly wrapped by the greater omentum. Due to the severe suppurative inflammation, the surrounding tissues were clearly edematous and had formed adhesions, looking like a clump of soggy cotton all stuck together.

”The inflammation is worse than expected. The appendix is in a bad position—it’s retrocecal.”

”Xu Chen, large retractor. Retract the cecum up and medially.”

Xu Chen quickly switched retractors, gritting his teeth as he applied force.

He could feel his wrists starting to ache, but he didn’t dare to relax in the slightest.

Jiang He used a piece of wet gauze to slowly push away the enveloping omentum.

This required patience.

Time ticked by, minute by minute.

Finally, the appendix was exposed.

It was stuck fast between the posterior wall of the cecum and the lateral peritoneum, under extremely high tension, looking as if it might rupture at any moment.

”Found it.”

Jiang He gently clamped the body of the appendix with a Babcock forceps.

Behind him, Zhao Yumin nodded to himself in approval.

’Many young attending physicians wouldn’t necessarily be able to dissect out a retrocecal appendix with adhesions like this in one piece.’

”Dissecting the mesoappendix.”

Jiang He switched to a curved hemostat, created a window in the avascular area of the mesoappendix at the base of the appendix, and passed a number 4 silk thread through it.

Meng Shiyu and Tang Pei stared nervously at the thread.

Once the appendiceal artery within the mesoappendix was ligated and the mesoappendix was cut, the surgery would be more than halfway done.

Jiang He’s movements were very gentle.

He gently pulled the ends of the thread, preparing to tie a knot.

But just then—

In a blind spot deep below the base of the appendix, right next to the external iliac artery, an abnormal, partially necrotic network of hyperplastic blood vessels, stressed by the retraction of the cecum and the change in surrounding tension, suddenly ruptured!

It had nothing to do with Jiang He’s actions.

It was a spontaneous rupture, the tissue itself having reached its limit.

In an instant, dark red blood gushed out from the depths of the peritoneum like a spring.

Blood instantly flooded the entire surgical field.

”BEEP BEEP BEEP BEEP—!”

The heart rate monitor alarm blared sharply as the patient’s blood pressure began to drop.

The sudden turn of events made the air in the operating room instantly freeze.

Xu Chen stared at the blood crazily welling up in the surgical field, his pupils contracting. The hand holding the retractor shook violently, nearly losing its grip.

He cried out in alarm, ”Teacher, we have a massive hemorrhage!”

Standing behind them, Zhao Yumin’s expression changed. He was about to step forward and take over, but then he heard Jiang He say:

”Full suction. Retractors, press down two centimeters deeper, right where you are. I’m here. Don’t panic.”

There was no fluctuation in Jiang He’s tone whatsoever.

With that one sentence, he completely suppressed the panic in the operating room.

Even Zhao Yumin was stunned, unable to even react for a moment.