Chapter 121 - 115: Dawn
Outside the operating room.
Jiang He was scrubbing in.
Lifting his head, he could see the tense, battlefield-like atmosphere inside through the glass.
"Blood pressure’s still dropping, 55 over 35!"
"Where are the red cells from the blood bank? Volume expansion isn’t holding it!"
"The runner is on their way up, two more minutes!"
Amidst the chaos,
he finally finished rinsing his arms. Holding his hands up to his chest, he pushed open the door to the operating suite with his back.
The smell of blood instantly flooded his nostrils.
He turned and took the sterile towel Chen Jing offered him to dry off.
Chen Jing deftly helped him into a sterile surgical gown, tying the belt tight.
Jiang He observed the operating table.
The situation on the table was dire.
The patient, Wu Wanning, had her abdominal cavity wide open, and blood was continuously welling up from its depths.
The surgical field was a blurry mess.
The pool of blood had even overflowed the incision’s edge, dripping down the sterile drapes.
"Suction the hepatorenal recess. I can’t see the bleeder."
Yang Xu frowned, his voice sharp.
The person standing in the first assistant’s position was an unfamiliar face—a young resident.
The emergency department was slammed tonight, and all of Affiliated Hospital No. 1’s senior surgeons were tied up in other ORs.
This resident, who had just recently graduated, had been pulled in at the last minute to fill the spot.
He was too nervous.
Faced with a massive trauma rescue involving multiple organ ruptures,
the knowledge from his textbooks felt completely disconnected from reality.
His right hand held the suction, his left a retractor, but both were trembling uncontrollably.
"I’m trying... Director Yang, the bleeding’s too heavy, I can’t clear it..."
The young doctor’s voice was tinged with panic, the tip of the suction tube probing blindly in the pool of blood.
His unsteady retraction was severely interfering with Yang Xu’s next move.
Yang Xu took a deep breath, just about to lose his temper.
Then Jiang He arrived.
He walked straight to the table. "I’ll do it."
His left hand took the handle of the S-shaped retractor, while his right smoothly took the suction from the resident’s hand.
Jiang He said, "Step away from the table. Keep a close eye on the blood gas analysis and coagulation panel."
The young resident froze for a moment...
Then, as if clutching a lifeline, he nodded repeatedly. "Okay, okay."
After stepping back, the young doctor’s hands still wouldn’t stop twitching.
He looked up.
He saw Jiang He take his position across from Yang Xu.
The moment he took over, the rhythm on the table changed instantly.
The retractor was pulled laterally and superiorly with precision.
The intestines and peritoneum were held firmly out of view.
The anatomy of the hepatoduodenal ligament was instantly clear.
Then,
the suction probe delved into the subhepatic space, precisely locating the pooled blood.
Vast swathes of accumulated blood within the field were cleared away.
A huge, irregular laceration running across the right lobe of the liver was starkly exposed under the surgical lights.
Yang Xu felt his field of view abruptly brighten.
He glanced at Jiang He.
A sense of calm settled over him.
"Severe bursting laceration of the right hepatic lobe, involving branches of the hepatic vein."
As he suctioned, Jiang He passed over a non-crushing vascular clamp. "Professor, control the first porta hepatis."
Yang Xu nodded, took it, and in a swift, precise motion, clamped the hepatoduodenal ligament, instantly cutting off inflow to the liver.
The Pringle maneuver (occlusion of the first porta hepatis).
Yang Xu: "Occlusion started. Mark the time."
Jiang He: "00:42."
With the hepatic inflow cut off, though some blood still backflowed from the ruptured hepatic vein branches, Jiang He quickly applied precise pressure with a warm saline-soaked gauze pad.
Lin Peidong let out a long sigh of relief.
The blood pressure reading had finally stopped falling.
The circulating nurse, Chen Jing, also relaxed a bit, turning to increase the drip rate of the infusion pump.
Everyone present had the same feeling:
as long as these two were standing together, this surgery would be fine.
Except... for the young resident who had stepped back from the table.
He was now leaning against the wall, watching the pair’s coordination in a daze.
When Yang Xu needed to ligate, Jiang He’s forceps had already retracted both ends of the vessel, exposing the angle for the needle.
The moment Yang Xu cut the suture, Jiang He was already applying pressure with a warm saline-soaked gauze.
—Seamless.
’What kind of synergy and efficiency is this?’
The young resident swallowed hard, shame and awe welling up inside him at the same time.
’Thank God Jiang He is here.’
’Otherwise... this patient would have definitely died on the table tonight.’
During the suturing, the OR door was flung open, and four units of packed red blood cells finally arrived.
Lin Peidong immediately started the pressure transfusion.
「Ten minutes later.」
Yang Xu had sutured all the major bleeders with deep mattress stitches using large-gauge silk, and the wound surface was packed with gelatin sponge.
"Release the porta hepatis," Yang Xu said.
Jiang He crisply unlatched the non-crushing vascular clamp.
Ten seconds passed.
No active, major bleeding.
The liver was saved.
Yang Xu looked up at the monitor.
Heart rate 110, blood pressure back up to 85 over 55.
Without pausing his needle holder, he started exploring the splenic area and asked, "What’s the situation in the ER?"
"The emergency response team has arrived. The red-tagged critical patients have all been triaged and initially treated. We just need to finish this surgery, and do it well."
Yang Xu breathed a sigh of relief. "Good."
The fatal liver rupture was dealt with.
Next was to address the blunt contusions of the other organs in the abdominal cavity.
Since Jiang He only needed to manage the surgical field and hemostasis,
it gave him enough mental space to observe Wu Wanning’s injuries.
It was a personal habit of his.
To reconstruct the moment of injury by reverse-engineering the fatal wounds on an anatomical level.
His eyes swept over Wu Wanning’s abdomen.
’A very strange pattern of injury.’
When faced with a sudden impact, a person’s instinctive reaction is to cover their head with their hands, curl up, and take the blow with their back or side.
But that wasn’t what Wu Wanning did.
Fractures of the superior and inferior rami of the left pubis, a comminuted fracture of the right iliac wing, and a pubic symphysis separation of over five centimeters.
In orthopedics, this is called an "open book" fracture.