Path of Medicine With a System - Chapter 241: Cutting out the entire anus
After1 Zhang Fan gave the hospital his surgery plan, he wouldn’t actually have to worry about the rest of the preparations. Meanwhile, general surgery director Zhao Quanping was more passionate than anyone about this planned rectal cancer surgery. He checked the patient’s medical information over and over again, and kept making the surgeons in this surgery discuss it many times over. These medical discussions would actually need to be recorded in the medical report as this was the exchange of ideas between the highest-level doctors in the hospital. These types of medical discussions would actually be the best for producing new ideas.
However, for such a high-level medical discussion, even attending physicians weren’t allowed to participate, not to mention any resident doctor apart from Zhang Fan. Who was supposed to record the discussion in the medical report here? Oftentimes, the rules were only followed to the letter, but not to the spirit. Thus, medical reports slowly became filled with copy and paste, not involving the doctors’ thoughts at all. Thus, whenever the surgery departments did weekly patient checkups, the director would usually only look at the patient’s medical information sheets rather than the medical report because the medical report wouldn’t really show anything useful.
The rectal cancer surgery was scheduled for Saturday morning. In China, it was quite commonplace already for most people to be off from work on the weekend. However, doctor was a profession in which they would forever have to go to work on Saturday as well. At most, maybe they would be allowed to end their work shift slightly earlier on Saturday afternoon.
The surgery was intentionally scheduled for Saturday so that the various departments would be able to fully assist. That was because there was too much normal daily work as many surgeries were scheduled at this time of year.
The rectal cancer surgery began. When treating rectal cancer, surgery was currently the only method that could foundationally treat the cancer. Rectal cancer surgery was especially cruel on the body, and even more so if the cancer had already transferred to the pelvic cavity like in this patient’s scenario.
The patient Chen Yun was arranged into the lithotomy position for surgery. That was the medical term for this position. How to describe it in laymen’s terms? Basically, think of the position that you would sit down on a toilet. Then, rotate that position until the patient was on their back. That would be the lithotomy position.
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Zhang Fan was the primary surgeon. General surgery director Zhao Quanping was the primary surgical assistant. Director Li of urology was the secondary surgical assistant. Vice Director Chen of general surgery was the third surgical assistant. This truly was a medical team of elites. For such a highly difficult surgery, a surgical assistant would have to do far more than just hold the surgical retractors and drain blood. The surgical assistant would have to be capable of fixing any problems independently. At a critical moment, it might also be necessary for a surgical assistant to take over the primary surgeon’s position. That was why all of the surgical assistants seriously studied this rectal cancer surgery plan together.
One of the more veteran resident doctor proctologists was in charge of disinfection. Zhang Fan had wanted to personally take care of the disinfection, but Zhao Quanping refused to allow him. “Rectal cancer surgery isn’t a very common surgery. The younger doctors aren’t able to personally participate in such a highly difficult surgery, but at least you should let one watch and learn the steps. You can’t monopolize everything. Here, have a seat for now. You’ll be standing for quite a long period of time afterwards.”
Due to modern technological advances, many surgeries had already been greatly reduced in time. In the 21st century, any surgery which took more than four hours like this one would basically be a mega high difficulty surgery.
Outside the operating room, Chen Yun’s young son was in his mother’s embrace. He was sucking on his own finger and his eyes blinked innocently at his mother’s tear-streaked face. He was far too young to understand anything. However, Chen Yun’s parents had both already collapsed. This was too much of a blow for the two older people to bear. They had originally been healthy, but they soon became bedridden after hearing Chen Yun’s diagnosis of rectal cancer.
“Mommy, don’t cry! I will behave! I won’t ask for candy! Mommy, don’t cry!” Chen Yun’s son exclaimed.
“Yeah! Mommy won’t cry! I won’t cry! Daddy will get well! He will be out soon! Yeah!” Tears still kept streaming out from Chen Yun’s wife’s eyes. Meanwhile, Chen Yan no longer had the mind to cry. Since this surgery was incredibly long, many nurses from different departments would be helping out. Although the nurses wouldn’t be able to help with the actual surgery, this was their way of expressing their desire to help out.
Soon after, Chen Yan received news from within the operating room. “Yan, the disinfection has begun! Don’t worry, Zhang Fan looks incredibly calm. He seems to be really confident!” She learned this from the other nurses in the operating room.
Rectal cancer surgery disinfection would be different from normal disinfection for orthopedic surgery. Most of the time, orthopedic surgeries were clean surgeries. However, rectal cancer surgery was a type of clean-contaminated surgery. Thus, disinfection standards had to be even higher. It would be absolutely correct to say that maintaining a sterile environment for surgery was critical for life. It was only the invention of various antibiotics that greatly helped surgery to develop.
To start a rectal cancer surgery, it would be necessary to first use a large amount of distilled water to wash the rectum and perineal region. Then, merthiolate tincture would be used to disinfect the perineal skin and perineal mucous membrane. There were only a few established surgery techniques, which were all named after westerners.
Why was rectal cancer surgery so cruel? To give a simple explanation, it was cruel because of how much the surgeon would need to cut off. Starting from the sigmoid colon in the abdomen, the entire rectum, inferior mesenteric artery, all of the lymph glands in the area, the levator ani muscles, ischioanal fossa, anus, and a 5-centimeter diameter circle of skin around the anus would all have to be cut off1!
Just reading these words might not be enough to fully experience how cruel this surgery was. So, to explain even further, once this surgery reached the point where the surgeon had cut off all of these portions, if you looked directly at the patient at this time, you would see that there was nothing other than a large hole where the patient’s anus had previously been. This hole would be even larger than a standard bowl that you would eat with. Even scarier was that every single organ within this hole had been removed!
If you looked at the patient from a bird’s-eye view of the abdomen, you would see that everything here had been dug out of the patient!
Zhang Fan made an incision in the center of the side of the abdomen with his scalpel. He entered the patient’s body while dissecting the tissue in order. When entering the abdomen, the doctor would always have to explore the area for themselves first. No matter how advanced modern medical equipment was now, the surgeon’s eyes and hands’ sense of touch was still forever the best firsthand information.
“There are no nodules in the liver,” Zhang Fan informed the other doctors of the situation while exploring the abdomen. Every single doctor would have their own personal style. Although Zhang Fan was pretending to be Bluebird City University Hospital’s Superintendent Lu’s disciple, he had only learned one thing there: slow was quick! He learned that it was critically important to check everything in great detail, and even more so to be as careful as possible with performing surgery.
“There are no evident abnormalities in the upper part of the abdomen for the time being,” Zhang Fan announced as he continued with the next portion of the surgery.
“Saltwater gauze,” Zhang Fan requested in a gentle voice.
The medical equipment nurse working on this surgery was concentrating fully on Zhang Fan. It wasn’t that Zhang Fan was difficult to deal with or that he had a bad temper, but rather because Zhang Fan was also the type to fully concentrate on the surgery. He would avoid speaking whenever it wasn’t necessary. Thus, any nurse who didn’t concentrate fully would easily miss what he said and slow down his tempo.
The medical equipment nurse handed him the requested medical equipment. When handing over medical equipment, it was highly important to make sure that everything followed the proper process. To explain simply, the medical equipment nurse could only let go after confirming for certain that the doctor had grabbed onto the medical equipment properly. How was this supposed to be confirmed? The medical equipment nurse would have to hand the equipment over while her own hand touched the doctor’s so that the sense of touch ensured a smooth delivery!
Zhang Fan slowly cut away and dissected. Time passed by slowly as well. Two hours had now passed since the beginning of the surgery. Zhang Fan had now cleanly separated everything around the cancerous rectum. Primary surgical assistant Zhao Quanping gently held the rectum, while Zhang Fan used an electrotome to slowly cut it out of the body.
Outside the operating room, Chen Yun’s young son had sweetly fallen asleep in his mother’s embrace. He had a smile on his face as he dreamed about his father coming home from work and giving him a lollipop. Chen Yun’s wife had evident tear streaks on her face, but she was already out of tears. She really had worried so much already. She reflexively hugged her son while her eyes listlessly watched the operating room’s “surgery in progress” green-lit sign.
Zhang Fan’s hands were quite steady as he cut away the tumor and cleared all of the connecting lymph nodes.
This was general surgery Vice Director Chen’s first time working on a surgery together with Zhang Fan. Vice Director Chen worked as seriously as he possibly could.
Not only did Zhang Fan’s skills shock him, Vice Director Chen felt as if he had received a flash of sudden inspiration. It was as if he was a window which had been covered by a curtain for a long period of time, and Zhang Fan had suddenly helped to open the curtain for him, allowing him to see far clearer than before. This was the charisma of surgery. A true expert would help you to view another realm. This was also why teachers and disciples were considered to be so important in the field of surgery.
Four hours had now passed since the beginning of the rectal cancer surgery. The nurses were switching with each other in shifts for the surgery so that they could get some food and rest. However, the surgeons all had to remain standing. For this highly difficult surgery, Zhao Quanping had to request some glucose to help keep his energy up. After he finished drinking the glucose, he looked with great envy at Zhang Fan. Zhao Quanping wasn’t envious of Zhang Fan’s outstanding medical skills, but rather of the latter’s youth and lack of fatigue.
Zhang Fan finished cleaning out the entire rectum. Was that the end of the surgery? Not at all. That was only the first step. It would still be necessary to deal with the urology system inside the pelvic cavity slowly step by step. This was why the urology director had been invited to participate in this surgery.
At the urology portion of the surgery, urology Director Li was about to speak up, but Zhang Fan didn’t even slow down as he continued with the surgery. His hands were as steady as ever. He showed no intentions of wanting to step aside from the position of primary surgeon!
Director Li wasn’t unhappy about this at all. This surgery was so difficult that even he was unsure if he would be able to independently finish it. He was only astonished and impressed that Zhang Fan was able to perform the urology portion of this surgery without even having to slow down. This was complete suppression by Zhang Fan’s medical skills. With his medical skills being so overwhelmingly amazing, other doctors who also had great medical abilities would only admire him, and not be jealous.
At such a time, nobody would try and sabotage the surgery. They all did their very best to help out. Even if they weren’t the primary surgeon, they would still do their job properly and full-heartedly. At such a time, the doctors didn’t have their typical clashes, schemes, or conflicts about glory and benefits.
