Chapter 10: Level-Three Surgery

Words : 2330 Updated : Mar 13th, 2025

The situation immediately took a turn for the worse. The patient developed critical symptoms, leaving everyone, including Thomas and Lennox, completely unprepared. "Get the patient to the emergency room!" The patient was placed on a gurney and quickly moved toward the ER. Thomas thought Walter would be at a loss, ready to back down. However, Walter used every moment during the transfer to conduct an emergency examination on the patient. He missed no detail—whether it was the pain in the chest, the patient's pupils, tongue coating, or cochlea. Saving the patient was of utmost importance. Thomas had no intention of using this situation to make things difficult for Walter. He impatiently remarked, "Walter, the patient's condition is critical. Don't worry about him anymore. You should stay back. "Let me see the examination report!" Walter ignored Thomas' words, focusing entirely on the patient. He had completed his examination and understood the patient's condition well. He needed to see the report to verify his judgment. Before anyone could react, Walter snatched the report from Lennox's arms. Walter confirmed the diagnosis as the gurney was about to enter the emergency room. "It's a cardiac rupture!" The family was stunned upon hearing about the heart rupture. "How could the heart rupture just like that? He gets a check-up every year, and he's always been healthy. There's no history of heart disease in our family." Lennox realized Walter looked unfamiliar and asked curiously, "How did you come to this conclusion?" "There's pericardial effusion at this location," Walter pointed out. Pericardial effusion indicated fluid leakage from the pericardium. Lennox followed Walter's finger to the CT scan, his expression growing serious, saying nothing. "Also, there are high-density areas between the esophagus and the heart. If you don't look closely, you might mistake them for calcified lesions." After Walter's continuous reminders, Lennox finally realized something. "High-density areas? Could it be a foreign bone object?" "Exactly, to be precise, a bone spur. Chest CT scans are extremely difficult to reveal bone spurs. The images of foreign objects are small and can easily be misread as arterial calcification. Even radiologists can overlook this, so the CT report didn't reflect this conclusion." Lennox remained silent. He had missed the diagnosis. "So, the patient's heart rupture was caused by a fish bone or chicken bone piercing the esophagus and entering the heart! Now, a cardiac intervention surgery is needed," Walter quickly explained. He then inquired with the patient's family, confirming his judgment. The patient had eaten spicy chicken for dinner and had choked slightly on a chicken bone, feeling only mild pain, so he didn't pay much attention. In reality, the chicken bone had already pierced the esophagus at that time. Coupled with a ten-kilometer night run, the bone not only pierced the esophagus but also the heart! What seemed impossible had happened. Thomas, who had remained silent, now wore a grim expression. As a chief resident, he was highly experienced. The man had also noticed the pericardial effusion and high-density areas but believed thoracoscopy was necessary to pinpoint the problem. The man thought this would stump the third-year resident and certainly stump Walter, but Walter had figured it out! He wondered, "How could an intern, without extensive medical experience, make such an accurate judgment?" Thomas could never have guessed that Walter relied on sharp instincts honed from practicing medicine on the battlefield to do just that. In the field, there were no sophisticated diagnostic devices. A moment's hesitation could mean the loss of a life. Doctors needed to develop an acute sense of where the problem lay. "Walter, your conclusion is valid! Quickly notify cardiothoracic surgery and prepare for a consultation!" A voice of approval came from behind, belonging to Pablo, who had just changed into his white coat and rushed over. ***** Since it involved the heart, a level three surgery was required. Different levels of surgery had strict requirements for the qualifications of the chief surgeon; an associate chief physician could perform level three to four surgeries. Pablo immediately applied for a multidisciplinary collaboration. The head of cardiothoracic surgery, Rhys Jauncy, quickly arrived, first studying the scans, exclaiming, "Just from the scans, it's hard to identify the bone spur as the culprit." With the help of thoracoscopy, Rhys meticulously searched and finally discovered a chicken bone spur lodged in the patient's right ventricular pericardium. It continuously rubbed against the right ventricle with each heartbeat, leaving a deep scratch and causing the ventricular rupture. "The patient is fortunate. The outer heart has already ruptured; a few minutes' delay could have led to pericardial tamponade due to massive bleeding, and he would be beyond rescue." At this point, Rhys couldn't help but glance again at Walter. He learned from Pablo that this intern diagnosed the patient's condition based on keen observation. "Rhys, Walter deserves a lot of credit. I suggest he be the first assistant in the upcoming surgery," Pablo proposed. Thomas, now merely a bystander, was shocked! Pablo was overly biased towards Walter! Thomas, feeling dissatisfied, tried to intervene, "Cardiac intervention is a level three surgery. Is he qualified?" In the emergency department, they typically encountered level-two surgeries. Thomas wanted to be involved in surgery at this level, even if just as a second assistant. Ignoring Thomas, Pablo continued recommending Walter to Rhys, "Walter successfully performed cardiothoracic surgery before joining us. Besides, he's only participating as an assistant. With you overseeing, what could go wrong? If anything does, I'll take responsibility." Rhys remembered Brayden discussing this. Max had an intern who participated deeply in a cardiac valve repair surgery post-high-speed rail rescue; he and Rhys were both cardiothoracic specialists and long-time friends. So this young man was that intern. Knowing he had to show Pablo some respect, Rhys agreed, "Walter will be the first assistant!" ***** The operating room was enveloped in silence. Everyone performed their duties. The anesthesiologist gestured to activate the autologous blood recovery and reinfusion device, signaling the official start of the surgery. Walter took the lead as the first assistant, confidently making an incision with a thin blade. At the moment of blunt separation, everyone was momentarily frozen. Thomas, the bystander, was the first to recover, almost laughing out loud. He mused, "What is going on? Does he think this is a minimally invasive surgery?" Typical open-heart surgeries required a large 7-inches incision, but Walter's incision was only 4 inches and oddly positioned. Thomas smirked inwardly, "He clearly lacked experience, only making small incisions and lacking the guts for larger ones." Pablo's expression was somber, unable to grasp Walter's intent. Knowing how large an incision should be for open-heart surgery was common knowledge for medical students. Previously, Walter had performed an impressive atypical surgery through a small incision during a gallbladder operation. Could he be trying to apply the same approach here? However, these two surgeries were incomparable. This was a cardiac intervention surgery. The difficulty level of cardiac intervention surgery was between levels 3 and 4, much more perilous than level 2 surgeries. Rhys furrowed his brows, ready to suggest widening the incision. But then, before he could, Walter had already swiftly extracted a 1-inch bone spur with forceps. The speed startled Rhys. Walter extracted it by feel without even needing to locate it visually! A large incision was meant to provide a sufficient surgical field to locate the injury. If a 4-inch incision sufficed, there was no need for a larger one, as smaller incisions cause less harm to the patient. Realization dawned on Pablo. Andy had mentioned that Walter could perform blind maneuvers. This was why he was confident in making a small incision. Raina retrieved the tray, and Walter placed the culprit—the "bone spur"—inside. The woman had gradually adapted to his operational habits since this was not the first time they worked together. His speed in locating lesions was much faster than other surgeons, almost as if he had a scanning and locking function. He would also request instruments at least five seconds earlier than other doctors. Next was the repair of the heart and esophagus. Walter pressed his fingers against the rupture, and the blood obediently ceased to spill. He swiftly suctioned the intracavitary blood with instruments and began repairing the wound. The second assistant beside him anxiously looked at his mentor, eagerly blinking to signal if he could take over. He, too, wanted to handle the knife! Alas, his mentor's attention remained on Walter's operation. Rhys seemed to "forget" to interrupt Walter. He was captivated by the scene before him. Many of Walter's actions appeared reckless, yet the patient's vital signs remained stable. In the domestic field of cardiothoracic surgery, Rhys was a renowned expert, having performed countless level-three surgeries. This was his first time witnessing such an operation. The young man, seemingly gentle and modest, executed each step with wild elegance yet precise efficiency. No wonder Pablo cherished him like a treasure! An impulse surged within Rhys. He wanted to recruit Walter to cardiothoracic surgery at any cost. Such a promising talent was wasted in emergency surgery. He should be transferred to cardiothoracic surgery. With proper training, he would undoubtedly become a valuable asset to the department!

Chapter 10: Level-Three Surgery

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