Chapter 2113: Chapter 1780: Students Taught by Professor Yang Are Truly Exceptional (Part 2)
Zhang Lin and Little Five rushed to the emergency department.
The rescue room in the emergency department was already a mess. On the stretcher bed lay a man in his thirties, covered in blood, with a neck brace fixed around his head, and his pelvis temporarily bandaged with a sheet, with fresh blood already seeping through the thick fabric layer. The monitor emitted a piercing alarm sound, with a blood pressure of 80/50 and a heart rate of 130.
"What’s the situation?" Zhang Lin asked while putting on a mask.
The emergency department director quickly reported: "Car accident injury, rear-end collision on the highway, steering wheel compressing the chest and abdomen, along with whiplash injury. The local hospital did some basic treatment and transferred him here. Preliminary assessment: cervical spine injury, possibly fracture of the atlas and axis vertebrae; pelvic fracture, hypovolemic shock; multiple rib fractures and hemopneumothorax."
Zhang Lin sucked in a breath of cold air, upper cervical spine injury is the most dangerous area in spinal surgery, surrounding the atlas and axis vertebrae are the medulla, vertebral artery, any slight mishandling might lead to immediate death or high-level paralysis, the fact that this patient made it alive to the hospital is a miracle, most patients with such injuries die on the spot. Pelvic fracture combined with shock is also extremely dangerous. Simultaneous severe injury to these areas increases the complexity of the surgery exponentially.
"How about the imaging?"
"CT is being done, will be out soon."
Dean Chen arrived, looking solemn. He glanced at the patient and then at Zhang Lin and Little Five, "Can our hospital handle this patient?"
Zhang Lin didn’t answer immediately. He walked to the bedside for a rapid physical examination: the patient was unconscious, with significantly decreased muscle strength in all limbs, especially the upper limbs, which was only Grade 2. These are typical signs of upper cervical spine injury, with spinal cord compression, potentially leading to complete paralysis at any moment.
"The upper cervical spine requires decompression and fixation surgery, while the pelvis needs external or internal fixation," Zhang Lin said, "Both surgeries are complex, especially the cervical spine, with extremely high risk."
"Transfer to another hospital?" Dean Chen asked, "To Sanbo?"
"Not enough time," Little Five pointed to the monitor, "Blood pressure is still dropping, the pelvic fracture causes too much bleeding, he might die anytime during transfer, and the unstable cervical spine means any slight bump in transportation could cause complete spinal cord damage, rendering him disabled."
"Then?"
Zhang Lin and Little Five exchanged a look, both seeing the same decision in each other’s eyes.
"We’ll do it," Zhang Lin said, "I’ll be the chief surgeon for the cervical spine, Director Lu will handle the pelvis, we’ll perform both surgeries simultaneously to save time."
Dean Chen was stunned, knowing these two were from Sanbo, but didn’t expect them to dare to undertake such a challenging surgery. The City Hospital neither dared nor could perform upper cervical spine surgery. Pelvic fracture surgeries were more common, but with such severe shock, the risk was also extremely high.
"Can you guarantee success?" Dean Chen asked.
"No absolute guarantee," Zhang Lin replied honestly, "But without doing it, the patient will absolutely die or become paralyzed. If we do it, there’s a chance. Sending him out now might lead to death on the road."
Little Five said, "With pelvic fracture combined with shock, the sooner it’s stabilized to stop bleeding, the better the survival chances. Delay by half an hour more, and even divine intervention can’t save him."
Dean Chen remained silent for a few seconds, then nodded heavily, "Alright! Whatever you need, just speak up, all hospital resources will be at your disposal!"
The CT results came out, and it was worse than expected.
Burst fracture of the atlas, fractured and dislocated odontoid process of the axis, spinal cord compression. The pelvis had a Tile C-type fracture, the most unstable type, with bilateral fracture of the pubic rami, sacroiliac joint separation, complete rupture of the posterior ring, and a large amount of blood accumulation in the pelvic cavity.
"Save the life first, treat the injuries later," Zhang Lin quickly formulated the plan, "Little Five, you handle your side first, set up the external pelvic fixator, stop the bleeding quickly, stabilize the hemodynamics. Meanwhile, I’ll ready the cervical spine surgery, once your side stabilizes, I’ll go to the operating room."
Little Five shook his head, "External pelvic fixation is simple, I’ll have Zhao Quan do it, I’ll assist you with the cervical spine surgery. That surgery is too risky; you need a trustworthy assistant."
Zhang Lin looked at Little Five, feeling a surge of warmth. This was the tacit understanding developed at Sanbo; encountering the most difficult surgeries, the two of them would handle it together, sharing life and death.
"Alright!" Zhang Lin said, "Then Director Zhao will do the external pelvic fixation, and we’ll handle the cervical spine."
The surgeries were immediately scheduled.
Zhang Lin and Little Five went to wash their hands, encountering doctors and nurses along the way who looked at them with unusual gazes. News had already spread that the two new directors would challenge the "death surgery," some admired them, others waited to see the joke.
"Nervous?" Little Five asked.
"A bit," Zhang Lin admitted honestly, "I’ve done quite a few cervical spine surgeries, but that was at Sanbo where the equipment was exhaustive and the team familiar, here..."
"This is our territory now," Little Five interrupted him, "From today onward, this surgery will be a milestone for the City Hospital’s spinal surgery department, succeed, and we establish ourselves; fail..."
"We must succeed even if we fail," Zhang Lin said, "There’s no retreat."
In the operating room, the anesthesia department director personally stepped up. For such a patient, anesthesia was the first hurdle; with the unstable cervical spine, even a slight movement during intubation could cause complete spinal cord damage.
"Director Zhang, how should the intubation be done?" The anesthesia department director asked.
"Awake intubation," Zhang Lin said, "First apply local anesthesia, use a fiber-optic bronchoscope for guidance, maintain neutral position traction on the cervical spine, no backward or forward bending."
This was the standard procedure at Sanbo, but rarely done by the City Hospital’s anesthesia department. The anesthesia department director sweated but nodded, "Okay, I’ll try."
The intubation process was thrilling, with Zhang Lin standing at the head of the bed, even though the patient was under traction, he steadfastly held the patient’s head as if cradling a fragile porcelain. The anesthesia department director cautiously inserted the bronchoscope, each advance accompanied by the beeping of the monitor.
"Blood pressure dropped!"
"Administer dopamine, speed up fluid infusion!"
"Blood oxygen is still falling!"
Zhang Lin’s hands were steady as a rock, eyes fixed on the monitor, directing, "Advance a bit more, yes, see the glottis, good, insert the tube!"
The tube finally got in place, connected to the ventilator, and blood oxygen slowly climbed back up, everyone sighed in relief.
"Director Zhang, we’re ready," the anesthesia department director wiped his sweat.
Zhang Lin said, "In upper cervical spine surgery, the first step is intubation, mess this up and the following steps are all wrong, let’s continue, turn the patient, prone position."
The upper cervical spine surgery began.
Zhang Lin opted for posterior atlantoaxial fusion and fixation. This approach was relatively safe but with limited view and tight operating space, each action had to be extremely precise.
"Suction device," Zhang Lin extended his hand, the instrumental nurse hesitated briefly before realizing what he wanted. The equipment at City Hospital differed from Sanbo, as did the placement, lacking synchronized cooperation.
Zhang Lin didn’t complain, he reached for the suction device himself and started operating. He incised the skin, stripped the muscle, exposing the occipital bone to C3 spinous processes. There was significant bleeding, but within manageable limits.
"Bone rongeur," Zhang Lin said, "I need to open the vertebral canal for decompression."
This was the most dangerous step. Beneath the posterior arch of the atlas lay the medulla, with rich epidural venous plexus, any carelessness could either damage the spinal cord or cause significant bleeding.
Zhang Lin’s hands moved very slowly. With each bone fragment removed, he used a nerve dissector to probe and confirm the location of the dura mater. Under the microscope, his operations were precise to the millimeter.
At Sanbo, recognizing their lack of natural talent, they learned with extraordinary diligence, carrying out surgeries slowly to aim for stability over speed.
Wang Shunye, the second assistant, felt a wave of anxiety.
"This type of surgery can’t be rushed," Zhang Lin didn’t lift his head while explaining to everyone, "Fast means death, slow means life. Look here, the vertebral artery is right beside, rush one millimeter and it’ll cause massive bleeding, and here is the medulla, constantly posing life-threatening risks."
Wang Shunye stayed silent, observing Zhang Lin’s procedure, techniques he’d read about countless times but never seen firsthand, the delicate operations under the microscope, the real-time feedback from neurophysiological monitoring, every step executed steadfastly without any rash decisions.
With Little Five assisting, two hours passed, and decompression was finally accomplished. Zhang Lin began placing screws, atlas lateral mass screws, axis pedicle screws; each screw’s position was verified through fluoroscopy, angle, depth, and length measured with utmost precision.
Wang Shunye and a group of doctors watched in awe; those trained by Professor Yang were indeed different, even the assistants were so competent, undoubtedly representing a first-class level domestically. The legendary two giants must indeed be superb.
