Surgery Godfather

Chapter 122: Chapter 0119: Difficult Task

“Charge at them, use a sniper rifle, take out the sniper in the opposing forest!”

Professor Zhang shouted in desperation.

Zhang Lin turned his head, froze, dared not move a muscle, held his mobile phone tightly, stuck in a particular motion.

“Professor Zhang—Professor Zhang!”

Sweat seeped from his forehead. If he got caught by Elder man Zhang, the ending would be miserable. Even a poorly buttoned button could get him Scolded, he didn’t know what the outcome of playing a game would be.

“Professor Zhang, you see, we’re just relaxing a bit this afternoon since there’s nothing to do.”

Zhang Lin wanted to cry. Begging pitifully, stuttering, it took all of his courage to squeeze out this sentence.

“Professor Zhang—”

“We’ll never dare to do it again!”

Little Five and Liang Fatty pleaded together, sitting cross-legged on the bed. Their posture was quite awkward, but they dared not move.

“Go on, play it. Why are you looking at me?” Professor Zhang pointed at Zhang Lin’s phone.

Play?

Play what?

Zhang Lin’s thoughts were completely offline.

“It’s already off-duty hours. Come on, let’s play together.” Professor Zhang pulled out his mobile phone and sat down on the chair by the desk.

Was this real or fake? Everyone was completely bewildered, feeling their intelligence was clearly not enough to handle the situation.

“Lock the door, make sure it’s bolted!” Professor Zhang shrewdly pointed his chin towards the door.

Zhang Lin slid down stiffly from the bed, walked a few steps, looked back, waiting for Little Five and Fatty’s thoughts.

Little Five and Fatty were clearly out of ideas at this point, they wondered what Old Zhang was up to.

He locked the door and twisted the handle to confirm.

“Hurry up, let’s team up, before the old lady calls us back for dinner.” Professor Zhang beckoned them.

——

After a busy round, Director Han returned to the office and found Yang Ping still hadn’t left: “You can go off duty and rest, we have someone on duty.”

Yang Ping said: “Professor Zhang just came here.”

“Where is he?” Director Han asked.

Yang Ping went to the door, peered into the corridor, “He was just here a moment ago, but he disappeared when I turned away.”

Director Han also looked out and said: “It’s fine, let him wander around. His leg is completely normal now. I saw him doing Tai Chi in the park this afternoon. He will join us in a few days, help us, and run the clinic. I requested another nurse from the operating room side, Zhou Can! We only have one anesthesiologist for the time being.”

Zhou Can is not bad, diligent and intelligent, quirky. Director Han was good at choosing people.

“That’s enough for now. If we have more surgeries, we can discuss it.” Yang Ping knew it was hard to get people, the operating room was also short staffed. Director Han had significant pull, hence getting people in smoothly.

“There’s a late-stage liver cancer patient at the Overseas Chinese Building. He has metastases all over his body, which have reached the thoracic 1 to thoracic 4 spine. He’s now experiencing severe chest pain, morphine is not working, likely due to a metastatic tumor invading the tension nerve root. Director Kong asked me to go there for a consultation. Do you want to come with me?” Director Han was preparing to go to the consultation.

“Okay, shall we go now?” Yang Ping was very interested.

“Oh, and the Academic Conference is being prepared, you are responsible for the surgeries here. Director Tan hasn’t arranged a specific role for you, but you have their help, you just need to focus on the surgeries here.” They chatted while walking.

When they arrived at the Oncology Department doctor’s office in the Overseas Chinese Building, Director Kong was waiting. He was glowing with excitement and looked very pleased.

“Thank you for your efforts. It’s late-stage liver cancer, metastases all over his body. He has metastatic tumors on his spine, and he’s in severe pain in the chest now. Morphine only relieves the pain in the liver area, but it can’t relieve the pain in his chest. The department of pain management has installed an intravenous pain pump, but it’s not working either. Let’s go see him together.”

In the late stages of liver cancer with metastases all over the body, there is not much that can be done, only pain relief and supportive treatment can be given to improve the patient’s final quality of life.

The patient’s face was yellowish, inhaling oxygen, lying semi-reclined on the bed, the muscles on his face were twitching intermittently, and beads of sweat rolled down his forehead non-stop. It was heartbreaking to watch.

The patient’s family member, his daughter, a tall young woman, appeared mature and capable, sat beside the bed, looking distraught and helpless.

Director Han examined the patient and briefly inquired about his pain.

“I’m begging you all!” His daughter bowed deeply.

“We will discuss this matter.” Director Kong comforted the patient.

After seeing the patient, the group left the ward, washed hands, and returned to the doctor’s office.

“Why isn’t he in the ICU in this situation?” Director Han questioned.

“The patient refuses to stay in the ICU, and refuses intubation and resuscitation once his life is in danger. He already signed an informed consent form, his only request is pain relief.” Director Kong explained.

“We may need to request a consultation with specialists from within the hospital and from elsewhere. His family will probably invite experts from Fuer Hospital and Professor Su Qingyun for the consultation.” Director Kong added.

Professor Su Qingyun, the dean of Fuer Hospital, is a prominent figure in orthopedics in Nandu Province and a popular candidate for academician.

At this time, the patient’s daughter came over and knocked lightly on the office door.

“Come in!” Director Kong motioned for her to sit down.

“This is Miss Ning, Mr. Ning’s daughter,” Director Kong introduced.

Mr. Ning was the patient they had just met. According to Director Kong, Mr. Ning was a well-known tycoon in G City with enterprises that spanned banking, finance, stocks, and insurance.

Miss Ning’s eyes were red and slightly swollen, and she spoke sorrowfully, “My father does not have much time left. I just want him to suffer less and leave this world with dignity.”

As Miss Ning spoke, she wiped away her tears with a tissue, “If it weren’t for my brother, he probably wouldn’t have held on this long. I’m sorry to trouble everyone, please help!”

Miss Ning brought her hands together as if in prayer.

“We will do our best to find a solution,” Director Kong comforted her.

Back at the orthopedic center, Director Han pulled up the patient’s imaging data, “Xiao Yang, take a look. Any good plans?”

“Based on the site of the pain, it is concentrated in his sternal angle. It seems that his thoracic 2 nerve root, has been infringed and strained. Look, both the CT and MRI indicate that the thoracic 2 nerve root is being invaded and strained by a tumor. There’s no way to do intraspinal catheterization in this area. If the plane was below thoracic 4, we could catheterize and anesthetize the area below the plane, but not this one. Once anesthetized, it would seriously affect his breathing and we would need to intubate.” Director Han pointed at the images on the screen of the electronic viewer.

“What about a high selective root nerve block?” Yang Ping suggested.

Director Han shook his head, “Very difficult! Look, the tumor is blocking, puncture is limited; even if there’s no tumor blocking, it’s impossible to be precise and puncture into the sheath of the nerve root. If the anesthesia leaks out, it would have the same effect as intraspinal anesthesia and affect his breathing.”

“We can locate the blood vessels by doing a CT angiography for three-dimensional reconstruction, but we can’t pinpoint the nerves using angiography. If we can determine the spatial orientation of the nerve and its relationship with the tumor, things might be easier.” Yang Ping exclaimed.

“That won’t work either. Even if we know the spatial relationship, how can you ensure that you will be able to puncture into the sheath of the nerve?” Han said.

“Dingdong, mission: End-of-life care! Complete a high-difficulty pain management case, reward sixteen thousand points.”

The long-silent system dingdonged again. Yang Ping thought it stopped issuing single tasks, it turns out the difficulty of the tasks has increased, and the less difficult ones are now counted as daily tasks.

“This patient’s situation cannot be handled by our department alone. There will be a hospital-wide consultation and consultation with external experts soon. Let’s wait for the major consultation. You can go off duty and rest now,” Director Han said as he was about to leave.

Yang Ping didn’t have anything else to do after work anyway, so he opened the patient’s information on the computer using his VIP access that Director Han had helped him secure before becoming a chief doctor. He reviewed the data several times, thinking hard about the situation.

The key issue of this patient was that intraspinal anesthesia for pain relief could not be performed, and if a nerve root block was to be performed, the puncture into the thoracic 2 nerve root sheath must be precise. This degree of difficulty was nearly impossible to achieve—it was theoretically possible, but practically unfeasible.

So what now?

After thinking for a long time, Yang Ping kept coming back to the nerve root block. Without that, there’s no solution to this problem.

—

“How can you be so poor at this?” Elder Man Zhang scolded Zhang Lin.

Zhang Lin scratched his head and chuckled sheepishly.

Elder Man Zhang’s phone rang, “I’m not playing anymore, the old lady is nagging me to have dinner.”

He stood up to leave and turned back, “You can’t play during work hours, but you can play after work!”

He walked a few steps, opened the door and turned back, “Remember! Not during work hours!”