top student at medical school

Chapter 630 A Little Arrogant?!
"Save lives first, then treat illnesses; diagnose first, then treat."

These twelve characters, like an ancient inscription engraved on the hall of medicine, radiate a solemn and unshakable brilliance.

These are not fancy words, but ironclad rules that every doctor must keep in mind!
These twelve-character principles apply under any circumstances and must be given priority at any point in time.

Whether it's a pre-scheduled elective surgery, a race against time for emergency surgery, or a life-threatening emergency rescue, making a clear diagnosis is always the top priority and the most urgent matter.

The more urgent the situation, the more calmly we must follow this principle. Like a lighthouse in a storm, only by adhering to the correct course can we avoid getting lost in chaos and fear.

Otherwise, all efforts will be in vain, like groping in the dark, unable to find the right direction no matter how hard you struggle, because the direction of your efforts has deviated from the right track from the very beginning.

More than 40,000 knowledge points poured out instantly like a flood breaking through a dam. Fang Ziye's physical examination technique, like a butterfly emerging from its cocoon, finally reached level 6.

A crisp bell seemed to ring in his mind, a notification of a system upgrade. However, he didn't have time to carefully experience the changes brought about by the level 6 skill.

He could only instinctively trust his enhanced "instinct," a more acute perception, like the eyes of a hawk, capable of discerning the truth hidden in the smallest details, and a more precise judgment, like the measurement of a high-precision instrument, able to clearly grasp the pulse of life—

The most urgent situation can often be summarized as active arterial rupture and bleeding.

This bleeding is like a volcanic eruption, where blood gushes out at an alarming rate, draining the body of all its blood in a short period of time.

If there are too many bleeding points, densely packed like a honeycomb, or if the artery is ruptured too severely, like a piece of cloth torn by a sharp blade, causing all the blood to be lost in just a few dozen seconds, then even Jesus or Buddha descending would probably be powerless to save it.

Time is like sand slipping through your fingers; once it's gone, it can never be retrieved.

Fang Ziye is neither Jesus nor Buddha. He has no magical powers and cannot create miracles. He is just an ordinary person, an ordinary doctor with two hands.

He cannot transcend life and death, but he can choose to do his best to save every life that can be saved.

He stretched out his hands, not to stir up the blood and make the scene more chaotic, as in the movies, but to "stimulate" the receptors in his palms, the backs of his hands, and even his fingertips.

His hands, like incredibly precise instruments, possessed superhuman sensory abilities. Relying on these receptors, he had to perceive subtle changes in the turbulence within the blood pool through thin medical gloves, as if exploring a pitch-black abyss, relying on his limited senses to search for a faint glimmer of light.

He needs to rely on his sense of touch to feel the direction of blood flow, to judge the speed of blood loss, and to initially locate the bleeding point.

All of this sounds like a slow-motion replay in a movie, but it actually only takes two or three seconds.

Fang Ziye swiftly pulled his right hand away from the pool of blood, his movements as fast as lightning, yet incredibly precise, without the slightest hesitation, like a well-trained soldier carrying out the most important mission on the battlefield.

His gaze was firm and sharp, as if it could pierce through layers of fog and strike at the essence of the problem.

Because it was an emergency, all the instruments were placed in the most easily accessible location. They were neatly arranged on stainless steel trays, gleaming coldly under the operating lights, like silent soldiers...

Regardless of the location of the equipment, it is only for human use.

Fang Ziye did not choose to replace Yao Zhanzhong as the chief surgeon; he only served as the first assistant. In a surgery, regardless of who is the chief surgeon, the first assistant's position is crucial, as it relates to the success or failure of the surgery.

An excellent assistant is like the surgeon's right-hand man; they must not only understand the surgeon's intentions but also provide timely assistance at crucial moments. He remained calm and composed, without a trace of panic, as if he were on a battlefield, fully focused on the fight.

The anesthesiologist's hands were practically smoking from all the work. This was a life-or-death rescue, and he was under immense pressure. It was like walking a tightrope on a cliff; every step had to be taken with extreme care, leaving no room for error.

He needs to perform "various operations," like a skilled pilot operating various instruments to monitor the patient's vital signs in order to maintain the patient's fragile life.

Fine beads of sweat appeared on his forehead, but his gaze dared not wander for even a moment.

Staring intently at the data on the monitor, every second was filled with tense calculations and judgments, because these data determined the patient's life or death.

Instinctively, he urged, "Can you hurry up?!"

He's anxious!
"Snap! Snap!" The sharp snapping sound of the hemostat was particularly jarring in the operating room, like the sound of gunfire on a battlefield, making people feel tense and uneasy.

Yao Zhanzhong did not hear any explanation from Fang Ziye, but only saw him accurately inserting hemostatic forceps into the patient's abdominal cavity.

The action was swift and decisive! Without the slightest hesitation!

Like a skilled carpenter, precisely placing each part in its place.

"Why a carpenter?" Yao Zhanzhong's thoughts began to drift.

It is hard to believe that others can do what I cannot, and my thoughts wander.

There was no explanation, and no one could see what was happening, so those around had no idea what had occurred...

Everyone could only hold their breath and watch quietly, like audience members watching a wonderful performance in a theater, not knowing how the plot would unfold.

But there are only two choices: live or die.

The hospital doesn't actually expect so-called influence, but at this moment they have to.

All they knew was that the blood level, which had been in equilibrium with the suction from the negative pressure device, was now slowly dropping, like the receding tide gradually revealing the rocks on the seabed.

"The bleeding has stopped!" Lan Tianlu shouted, breaking the silence of the operating room, his voice filled with a hint of surprise!
"The bleeding has stopped effectively," Yao Zhanzhong repeated, addressing the anesthesiologist as a reply.

"Anesthesiologist, give me a blood transfusion!"

"Where would we find any blood reserves at this hour? We've all been used up. We can only wait for the blood bank to send some," the anesthesiologist snapped irritably.

He knew that he was like a soldier without ammunition, only able to watch helplessly as the enemy approached, powerless to fight back.

Even the most skilled cook can't cook without rice. Without blood, it's like an army without soldiers; they can only grit their teeth and try their best to maintain the patient's fragile vital signs, hoping for a miracle.

This sanatorium never imagined it would be treating emergency cases!

Today was an accident.

The sanatorium is not obligated to treat emergency surgeries, and blood for elective surgeries is prepared two or three days in advance.

Fang Ziye's movements were swift and precise, like a sophisticated instrument, with each action meticulously calculated and planned.

His fingers were nimble and powerful, like a pianist leaping across the keys, every movement full of rhythm and beauty...

Fang Ziye himself couldn't enjoy these aesthetic pleasures at all. After a while, he relaxed slightly, but he didn't completely let his guard down. Instead, he continued to calmly observe the changes in the blood level...

His eyes, like those of a falcon, could detect any subtle change and leave no stone unturned.

As the blood pool receded, the loops and bite marks of the hemostat gradually became visible. The metal, originally stained red with blood, slowly turned silvery-white, gleaming coldly under the surgical light.

Fang Ziye was still waiting. His physical examination told him that the patient had arterial damage in the retroperitoneum!
If the current pool of blood is like a calm sea surface, then the retroperitoneal hematoma is like a turbulent undercurrent, ready to erupt at any moment.

And it is bound to erupt.

Therefore, after clearing the active bleeding in the peritoneal cavity, he also had to open the retroperitoneal hematoma; he had to open it!

The patient had lost too much blood, and the peritoneal cavity had ruptured. Only part of the bleeding had been stopped, not completely. Incomplete hemostasis was not enough to pull the patient back from the brink of death.

The gates of hell can be summed up in just three words!

For some, going inside meant facing a life-or-death situation.

Pulling someone back from that situation is definitely not as simple as just a few words; it involves details, details...

All miracles must be full of detail to be real; otherwise, they are just fantasies.

He glanced around and noticed that Yao Zhanzhong and the others looked confused. They stared at the area being held by their hemostats as if they were looking at a bunch of incomprehensible symbols. Clearly, they didn't understand the specific situation.

Although they knew that the hemostat had clamped a blood vessel, they did not know which blood vessel it was, nor could they understand the basis of Fang Ziye's judgment.

Fang Ziye still didn't explain, because at this moment, time was life, and every extra word he said would waste another second.

He said firmly, "A knife! A big knife!"

His voice left no room for argument!
No explanation!

Fang Ziye needed no explanation now. He was like a general issuing orders on the battlefield; what he needed was to execute them, not to question them.

He's past the age of explaining and pleading.

"Here's the knife." The scrub nurse immediately handed over a curved tray containing a sharp, round knife, also known as a scalpel. Its blade gleamed with a cold light, like a merciless weapon, yet it was also a life-saving tool in the hands of a healer.

"Team Leader Fang." After understanding Fang Ziye's intentions, Yao Zhanzhong wanted to stop him, but hesitated.

He knew that Fang Ziye must have his reasons for doing this, but he was still somewhat uneasy, worried that Fang Ziye's actions would lead to more serious consequences.

Before he could stop him, Fang Ziye, without any hesitation, widened the opening in the peritoneal cavity, and then made it even larger...

He moved swiftly and without the slightest hesitation, like a seasoned craftsman precisely controlling every detail.

The retroperitoneal space is a closed space, like a sealed container. When it is filled with liquid, it will create relatively large pressure. Once the pressure is out of balance, it will cause a bursting effect.

This is the most basic physical principle, and it is also the basis for Fang Ziye's actions in emergency situations.

This time was no exception. After Fang Ziye completely opened the peritoneal cavity, blood gushed out like a high-pressure water gun, reaching a height of at least twenty centimeters. Some bloodstains unsurprisingly splashed directly onto everyone's masks and hats, and the air was filled with a strong smell of blood, making people feel uncomfortable.

Fang Ziye wasn't wearing glasses, so he could only close his eyes tightly to temporarily avoid the splattering blood and foam.

His brows furrowed, and during the brief pause when he closed his eyes, he began to doubt, to feel uneasy, and to struggle with these feelings, but he had to end them as soon as possible.

The sensation of heat in the blood disappearing and no longer lasting—

Growing up is painful; you have to endure it all.

I'm not wronged!

There's no particular reason; it's simply because others gave you the opportunity, and you want to grow up, so you must take responsibility.

Professor Li Yongjun's trust is definitely not something you can simply enjoy!
Fang Ziye!
Start.

Fang Ziye pressed his lips tightly together, like a resolute warrior, unafraid of any challenge. About two seconds later, the blood splattering stopped, and like the sky after a storm, everything returned to calm.

Fang Ziye opened his eyes.

After the pressure outside the blood vessels was relieved, the retroperitoneal hematoma could be seen running wild like a runaway horse, with blood gushing out like a fountain, as if to vent its previous resentment...

This scene lasted only a few seconds before Fang Ziye's left hand, as if catching a slippery eel, swiftly and precisely extinguished the culprit's bleeding point.

I'm not going to hold back my dissatisfaction either, and you have to shut up too!

His movements were lightning fast, precise and powerful, like a cheetah pouncing on its prey, delivering a fatal blow.

Immediately afterwards, he continued to clamp the proximal and distal ends of the ruptured artery with hemostats, like quickly blocking the enemy's retreat on a battlefield. The metallic clanging of the hemostats was exceptionally clear in the operating room.

After stopping the bleeding, Fang Ziye looked at the patient's monitor again, observing the fluctuating data.

Blood pressure 79/52, blood oxygen 93%!

His blood oxygen and blood pressure were not good, and he was on the verge of shock, but this is the best possible outcome.

He was powerless to do anything more, and the remaining work could only be left to Yao Zhanzhong and his team.

Fang Ziye could certainly stay and save the patient with a 100% success rate, but Li Yongjun's task for him wasn't to save just this one patient. Li Yongjun was greedy!

Quick assessment complete.

Fang Ziye breathed a slight sigh of relief. Although it was only for a moment, his eyes remained calm and showed no sign of relaxation.

"Professor Yao, the extensive bleeding has been stopped. Anesthesiologist, thank you for your hard work in maintaining the vital signs. It would be best to keep the patient's blood pressure stable below the shock threshold to reduce bleeding!" Fang Ziye's tone was calm yet firm.

"Team Leader Fang, where are you going?" Yao Zhanzhong's eyes were fixed on Fang Ziye, still unable to recover from the dazzling series of actions just now.

Although he knew Fang Ziye was very capable, he had no idea how he did it. He had originally hoped that Fang Ziye could stay and complete the entire operation.

"Tianluo and I will go check next door!" Fang Ziye didn't explain further, and simply crossed his arms and backed away!

He knew he couldn't stay there any longer; the patient was not in immediate danger, at least not for the time being.

If Yao Zhanzhong's team were skilled enough, they could have saved the patient's life.

Currently, there are still many patients who need surgery, and time is of the essence; he cannot afford to waste all his time here!
This is irresponsible, but Fang Ziye's current responsibility is not to be responsible for one or two people!
Li Yongjun called him back from Wuhan, not to perform a surgery!
Since Professor Li Yongjun had granted him the right to patrol around the operating room, he would definitely not let go of this good opportunity to save lives.

In the face of an emergency, all actions must be carried out under command. He must act like a loyal soldier, holding the main position in the operating room and protecting every life in need of help.

As Lan Tianluo backed away, he quickly took off his gloves, his tone tinged with anxiety, and suggested, "Senior brother, changing clothes will take up time, at least change your gloves!"

He knew that time was life, and every second wasted could mean the loss of a life. His movements were swift and practiced, as if he had practiced countless times.

“Okay!” Fang Ziye did not refuse. He knew that if he wanted to save more people, he couldn’t waste time.

It is unethical and risky to pass blood-stained gloves to the next patient; the possibility of contamination is too high.

If the next surgery in the operating room wasn't too urgent, Fang Ziye originally planned to go to the next operating room to change into a sterile surgical gown before going on stage, but now, he didn't have time.

At this moment, Fang Ziye's mind was extremely calm, like a sophisticated computer rapidly processing various data.

If his abilities are average, he only needs to perform surgeries on a few patients;

If he were more capable, he would only need to watch over one patient in one operating room.

However, he was confident in his abilities and was recognized by others, so within his capacity, he hoped to save as many people as possible and make a greater contribution during this special time.

At that moment, he didn't care about the good prognosis; he had only one goal: to save as many lives as possible, and to save as many as two lives as possible. He wanted to hold onto every single life firmly.

Changing gloves before sterile surgical gowns is an absolute taboo in surgery, like abandoning one's weapon on the battlefield. However, taboos are relative. Given sufficient preparation time, strict aseptic principles must be followed, and specialized treatment should be provided.

However, in extremely urgent situations, even medical enthusiasts can perform CPR on a person in shock, a right granted by law for emergency avoidance.

In emergency situations, life-saving surgeries can be performed at the accident scene, and interns can also perform surgery. Most importantly, they strive to do their best within limited resources!
"Is this Team Leader Li? You've come at the perfect time." As soon as Fang Ziye stepped into the operating room next door, Professor Fang Zhikuan, the chief surgeon, immediately extended an invitation without turning around. His tone carried a hint of anxiety and a touch of joy.

"Team Leader Li, on stage..." His voice was weary, as if he had been fighting for a long time.

Fang Ziye glanced at the operating table and immediately realized the urgency of the situation. He didn't have time to change his clothes or care about the bloodstains on his body. He strode forward and found an empty spot to stand.

His movements were fluid and natural, as if he had already blended into the operating room environment.

He quickly said, extending his clean, sterile gloved hands, "Professor Fang, Professor Li isn't here, it's me!"

Fang Ziye.

His tone was calm and firm, without any hesitation.

Upon hearing this, Fang Zhikuan was stunned for a moment, a look of disbelief flashing in his eyes, as if he couldn't believe his eyes!
Then, he was overjoyed, his eyes filled with trust and expectation: "Team Leader Fang, you're even better!"

His tone was excited, as if he had seen a savior.

Upon hearing Fang Ziye's voice, Miao Haoyu, who was standing to the side, quickly moved aside to make room. His movement was small, but he didn't hesitate at all.

"This patient has an external iliac crest." Professor Fang Zhikuan said, only realizing halfway through that he hadn't accurately stated the exact location, before Fang Ziye had already inserted hemostats!

His movements were lightning fast and incredibly precise, as if he already knew exactly where the bleeding point was.

After opening the right external iliac artery, he found that the location of the rupture was somewhat difficult to determine, so he could only have Miao Haoyu temporarily cover it and press the skin near the proximal end of the external iliac artery with his hand to temporarily stop the bleeding. He was trying to find a way to expose the bleeding point and then deal with the bleeding together with Gu Yi.

However, he did not expect that Fang Ziye would find a gap from somewhere and directly clamp the external iliac artery with hemostats, his movements quick, accurate and ruthless.

After a "snap," he quickly clamped the distal end of the rupture point of the external iliac artery with a hemostat before beginning to lift up the surrounding soft tissue.

It can be clearly seen that the external iliac artery is not the section before the bifurcation artery, but rather a relatively regular opening, with fresh blood still gushing out.

A ruptured femoral artery can drain the blood from an adult male in less than two minutes. The external iliac artery is larger in diameter than the femoral artery. If the blood is allowed to flow freely like this, the patient will be left with no choice but to talk business with a bull and a horse, discussing when he will die.

This patient suffered a crush injury to the lower right abdomen, including damage to the right external iliac artery, as well as soft tissue and some small arteries, such as the right ureteral artery.

However, in emergency care, treating massive bleeding must be the top priority.

Therefore, Professor Fang Zhikuan and his colleagues simply did not have time to deal with these minor details.

After Fang Ziye took over and dealt with the bleeding in the external iliac artery, he and Lan Tianluo quickly finished dealing with the bleeding in some minor blood vessels.

He glanced at it quickly and said decisively, "Professor Fang, suture the external iliac artery as soon as possible, clean the wound, and end the surgery."

His tone was calm yet firm, full of confidence.

“Okay!” Fang Zhikuan nodded.

"I am leaving."

Fang Ziye took two steps back. He looked at his sterile surgical gown, which was now covered in bloodstains. He didn't care about that now; he just wanted to find a place to change as soon as possible.

"Clothes that are too dirty won't do." He quickly took off his sterile surgical gown and gloves and asked, "Professor Fang, how many people were injured this time?"

His tone was calm, but there was a hint of worry in his eyes.

Fang Zhikuan understood the question, but he didn't answer. He just sighed and said, "Team Leader Fang, let's not discuss this kind of thing. Let's watch the news later."

He knew that discussing these things was pointless; what needed to be done still needed to be done.

Whether the authorities will release the true number of casualties or not, but less news coverage will not reduce their workload; they can only do their best to treat patients.

Fang Ziye agreed, guessing that neither the Fang family nor the professor had ever been exposed to this level of work, so they should focus on getting things done first.

"Senior brother, should I stay here?" Lan Tianluo hesitated. He knew he wasn't as versatile as Fang Ziye. The only thing he could do was stay in an operating room and help out with as many surgeries as possible using his skills.

Because he knew that he had not yet grown up and could not shoulder great responsibilities, he could only do what he could, such as performing manual reduction, cleaning minor wounds outside, and so on.

"You come with me! You'll be my assistant." Fang Ziye refused Lan Tianluo's suggestion without offering any explanation, because he knew that a good assistant would allow him to unleash his full potential more effectively than a good professor.

It's not about needing a highly skilled person as an assistant; more importantly, it's about having someone who understands your intentions and can work well with you.

Just now, Lan Tianlu handed him the equipment at the fastest speed, and he could even roughly guess his operating style.

Asking the scrub nurse or other assistants for instruments on stage would only waste time. At this crucial moment, time is the most valuable resource.

In the third operating room, Fang Ziye and Lan Tianluo came in and came out again. Inside, Nie Mingxian and Wu Xuanqi were holding the fort. Although the wound was large, the two worked together well and should be able to bring the patient back to life as long as the patient was not in absolute shock.

They quickly moved to the fourth operating room.

The surgeon on the stage was Professor Lin Qiaoshan from the Department of Hepatobiliary Surgery. He was also very anxious. When he turned his head, he thought it was Li Yongjun who had arrived.

But after recognizing Fang Ziye, he hesitated for a few seconds before finally asking, "Professor Fang, do you know how to stop bleeding at the porta hepatis and vena cava?"

His tone was anxious, and his eyes were full of expectation.

Fang Ziye had just changed his gloves and clothes, so he was relatively clean. He went straight to the operating table and saw that Lin Qiaoshan was covering his bleeding face with his hands. He asked, "Professor Lin, what's wrong?"

"Liver rupture, inferior vena cava injury, hepatic hilum injury, it's a complete mess." Lin Qiaoshan's tone was full of helplessness.

"We can only..." He didn't finish his sentence because the situation had indeed become uncontrollable.

The inferior vena cava is responsible for blood return. It is the largest venous trunk in the body, and damage to it can have dire consequences, even life-threatening ones.

Fang Ziye did not feign modesty, because he knew that modesty was meaningless at this moment. Seeing that Professor Lin Qiaoshan had already covered the large area of ​​bleeding, what he needed to do was to perform a relatively delicate hemostasis.

He remained calm and composed, without hesitation!
"Tianluo, go to the other side," Fang Ziye said, then explained, "Professor Lin, this is my junior brother. The two of us will have better teamwork."

Lin Qiaoshan saw that Lan Tianluo was already standing in the second assistant position, and he was about to explain the patient's condition.

But as soon as he opened his mouth, he found that Fang Ziye was like a ferocious beast, not listening to his explanation at all, as if he couldn't understand human language, and directly started to violently attack. His movements were so fast that they were dazzling.

The incision in the inferior vena cava was not small, but Fang Ziye quickly performed a temporary suture. Despite his fast suturing speed, the quality of his suture was not low at all. Even after the hemostat was released, the inferior vena cava did not continue to leak.

This skill of temporarily suturing and stopping bleeding is enough for many people to study for years. And this is only Fang Ziye's most fundamental and solid basic skill.

However, given the urgency of the situation, and with the surgery already at this stage, Professor Lin Qiaoshan wouldn't dwell on why Fang Ziye was able to achieve this level of skill; he simply knew that Fang Ziye was capable of it.

So he quickly joined the surgery and put forward all his ideas.

"Team Leader Fang, if you could..."

"Team Leader Fang, if you can still..."

"if……"

Ten minutes later, Lin Qiaoshan's mouth dropped open, and he was completely stunned: "Team Leader Fang, you really can do all of that?"

His tone was filled with shock and admiration; this ability far surpassed that of ordinary doctors.

Fang Ziye calmly stepped back: "It's all thanks to Professor Lin's guidance!" He did not take credit for it, because he knew that he was able to do it because of his mastery of the basics and his ability to turn ideas into reality.

Fang Ziye's current understanding of other surgical specialties is limited to basic anatomy, including some common surgical injuries and procedures.

As for the operational details of some 'major' traumas in hepatobiliary surgery, Fang Ziye did not have the spare time to learn them.

He only knew where the arteries and veins were located in the liver, where the nerves and blood vessels were, and the operating rules of these blood vessels and nerves, etc.

Fang Ziye was familiar with the principles of treating blood vessels and nerves, not the emergency procedures for hepatic hilum injuries. The specific steps of these emergency procedures were explained by Lin Qiaoshan.

However, based on his theories and accumulated knowledge, Lin Qiaoshan broke down the rescue procedures into operational steps, and Fang Ziye was able to execute them perfectly every time. His execution ability was quite outstanding.

"Team Leader Fang, your skills are still the best, I really..." Before Lin Qiaoshan could finish speaking, he found that Fang Ziye had already stepped on the foot-operated induction valve of the operating room and left. He left decisively and quickly.

"Professor Fang is a bit arrogant, isn't he?" Associate Chief Physician Dai Zhongyin muttered beside Lin Qiaoshan, his eyes still showing a hint of resentment.

"In urgent situations, we must act expediently. Professor Fang, do you expect us to exchange pleasantries for seven, eight, or ninety minutes as usual?" Lin Qiaoshan himself didn't realize there was anything wrong with it, so he directly reprimanded Dai Zhongyin.

……

(End of this chapter)