Special Forces Medic

Chapter 1079 - 1050: Pericardial Foreign Body (1)

With a hiss, the operating room door automatically opened. Xiao Lin, feeling that his hands had already been disinfected, walked in. He wasn’t interested in Meisai’s connections and believed that contacting him was out of necessity, so he had no interest in who this person was.

Inside the operating room, the relevant staff were already in place. There was only silent eye contact between them and this newcomer, a familiar atmosphere. Whether in a hospital or a clinic, the sense of exclusion towards outsiders like him was quite apparent. Perhaps it was slightly better abroad if your skills could convince them, and on this point, Xiao Lin had complete confidence and control.

Just recently he learned that the patient was called Jean Lofis, who had been sent to this private clinic by Meisai first. On his way, the doctors here had already treated the wound, but he also received a piece of information—a rather pessimistic piece of information.

On the light board, a film displayed the problem—this person’s heart had obvious defects and issues. At this moment, an unrelated question appeared in Xiao Lin’s mind, not connected with the surgery, but why this person was present at Wang Zhantian’s crime scene. Yelü Shou had tracked him to that bar half an hour earlier, and after the incident, tracing how the two interacted and what triggered his ailment was the ultimate reason. Fighting was a possibility, but the person who instigated the fight wasn’t Yelü Shou.

"Mitral valve issue!" At this moment, someone who appeared to be the lead surgeon walked to the film, describing the information on it in pure English.

"The carotid artery is somewhat abnormally expanded. Is there any obvious sign of bleeding when treating the external injuries? The patient didn’t faint from the external injury."

"Preliminary suspicion is constrictive pericarditis." The lead surgeon changed another film. "However, the patient’s sternum has multiple fractures; currently, their life signs are stable."

"Let’s begin the surgery!" Upon hearing Xiao Lin respond with a "hmm", the lead surgeon already positioned himself as the main surgeon, entirely intending to complete this operation without anyone else’s intervention.

Although roles were exchanged, Xiao Lin cooperated considerably with the work of the main surgeon, skillfully assisting at every step, which greatly satisfied the lead surgeon.

The surgery proceeded without hesitation; the hand rose, the knife fell, completing swiftly. Subcutaneous fat and fascia were instantly cut open with a sharp surgical blade. Xiao Lin wiped away the blood marks on the wound with gauze and immediately clamped it with a hemostatic clamp. "Number four line!" the lead surgeon called out. Quickly taking the number four line, he ligated the bleeding point.

"Retractor!" Xiao Lin called out, extending his hand.

After completing hemostasis with painstaking effort, Xiao Lin installed the retractors. His technique appeared very skilled; he didn’t need any orders from the lead surgeon to know what to do next.

"Next, perform the median sternotomy." After seeing Xiao Lin install the retractors, the lead surgeon calmly instructed the next step of work. As soon as he finished speaking, Xiao Lin had already requested curved pliers and a sternum saw from the Instrument Master!

Curved pliers opened up the muscular tissue at the top of the sternum and separated the loose connective tissue that adhered tightly to the sternum wall. "Sternum saw!"

The lead surgeon took a deep breath. Although the patient was not in immediate life-threatening danger, the first step of the surgery was the simplest yet the most challenging! The sternum saw cut the patient’s sternum down the middle, but the process mustn’t be too forceful to prevent damage to internal organs, requiring extreme boldness and caution.

Three common surgeries for constrictive pericarditis include median sternotomy, bilateral thoracic transverse incision, and left anterior lateral thoracic incision.

The median sternotomy this surgery can fully expose the front and right side of the heart, simplifying the separation of the vena cava and the thickened pericardium at the right heart margin; postoperative respiratory function may affect cases with combined lung disease and respiratory function intersection, often choosing this incision, though the downside is poor exposure of the pericardium behind the left ventricle fat.

The left anterior lateral thoracic incision enters the chest through the fifth intercostal space, requiring cutting and ligating the internal thoracic artery and transecting the sternum on the right side, reaching the axillary midline on the left side. The advantage of this incision is single-sided thoracotomy, affecting respiratory function in patients with poor states. The left heart is well exposed, but the left ventricle and upper and lower vena cava are poorly exposed.

The bilateral anterior thoracic transverse incision advantage is good exposure during surgery, accommodating both sides of the heart. It can thoroughly remove the pericardium, and unexpected events during surgery are easier to handle. The downside is the incision is longer, more traumatic, with greater postoperative impact on lung function.

However, none of these are important. What’s important is the current task of using a sternum saw to cut open the sternum, which unexpectedly fell to him. "You do it!" the lead surgeon glanced at Xiao Lin and coldly instructed.

"Me?" Xiao Lin hesitated as he looked at the lead surgeon, and then he took the sternum saw from his hand, internally feeling a bit of disdain for this person.

The sternum saw wasn’t big, and its weight was average, but the intense vibration upon activation couldn’t be ignored. "Hook!" The lead surgeon received the hook passed from the Instrument Master and maximized the separation of the muscle tissue above the patient’s sternum, instantly revealing the sternum, showcasing it best for Xiao Lin.

Standing opposite the lead surgeon was awkward, the body at a ninety-degree angle, irregularly bent, holding the sternum saw with both hands, gradually cutting into the patient’s sternum. For a moment, the sound of bones tearing echoed in everyone’s eardrums. Two minutes passed, sweat beaded on Xiao Lin’s forehead, and a nearby nurse immediately picked up gauze to wipe the sweat off. This continued for over ten minutes before Xiao Lin finally slowly sawed open Huan Ze’s sternum.

Although the process was simple, Xiao Lin maintained the same posture throughout. When he finally cut open the sternum completely, the back of his gown was soaked through with sweat, and beads of sweat continued to form on his forehead. He handed the sternum saw back to the Instrument Master and reached for ’bone wax’ to carefully apply it to the sawn area of the sternum. "We can officially start now!"

"Bone steps!" The lead surgeon quickly sought the tools needed, with two strips handed over. He took the strips and protected the sternum incision, clearly exposing a corner of the thymus and heart. "Retractor!"

Xiao Lin and the lead surgeon quickly secured the retractor to the surgical table, then placed it onto the patient’s sternum, slowly adjusting it to expand the surgical view and fully expose the patient’s heart.

Xiao Lin instinctively glanced at the patient’s chest. "There’s blood accumulation in the chest cavity!" After speaking, he looked up at the lead surgeon, inquiring with his eyes about the situation.

The lead surgeon seemed puzzled as well. He glanced at the patient’s chest cavity and then turned to look at the nurse responsible for recording. "Report the situation."

"The patient didn’t undergo a blood examination."

"Abdominal radiograph?" Xiao Lin immediately followed up.

"Here!" The nurse quickly retrieved a radiograph, hung it on the lightbox, and simultaneously opened the records to report again. "Emergency radiograph results show the patient has minor fractures on the eighth, ninth, and tenth ribs, with the tenth rib being an open fracture."

Both the lead surgeon and Xiao Lin looked at the abdominal radiograph on the lightbox. Xiao Lin furrowed his brow slightly while the lead surgeon pondered for a moment before saying, "There’s no trace of blood accumulation on the radiograph. Could it be something the patient just developed?"

"Let’s not consider the radiograph for now, suction out the blood for inspection." Xiao Lin glanced at the lead surgeon and then reached out, calling, "Suction tube!"

The Instrument Master handed the suction tube to Xiao Lin while turning on the suction device. "There isn’t much blood accumulation in the patient’s chest cavity. Based on the radiograph, the fractured ribs don’t seem to have damaged any organs," the lead surgeon regained a bit of composure, looking at the suction tube gathering less and less blood, he said.

After finishing suctioning the blood from the patient’s chest cavity, Xiao Lin returned the suction tube to the Instrument Master and looked up at the lead surgeon, saying, "From the scan, it might be the spleen. The report indicates the patient suffered a severe blow."

"Should we first conduct an abdominal exploration?" The lead surgeon, looking at the slowly gathering blood in the patient’s chest cavity, though slow, could still see blood accumulating.

"You’re the lead surgeon!" Xiao Lin coldly tossed the statement to the lead surgeon, leaving him momentarily speechless with anger.

"Monitor all of the patient’s vital signs closely, and report to me immediately if there’s anything." The lead surgeon subsequently gave another order. "Now commence the pericardial dissection, scalpel!"

"Forceps, gauze!" Xiao Lin smiled as he received the necessary tools, then lowered his head first to look at the beating heart inside the patient’s chest cavity.

The lead surgeon cautiously held the patient’s beating heart, while Xiao Lin stood ready to wipe away any bloodstains. Performing surgery on a beating heart requires extreme composure, demanding precision and stability for each incision; the mental exertion is immense, as any slip could leave an irreparable wound on the heart.

The lead surgeon cautiously made a small incision on the pericardium, and Xiao Lin immediately used gauze to wipe away the blood since Xiao Lin needed to ensure the lead surgeon’s surgical view was always clear. Though there was no verbal communication, they worked in such harmony; more precisely, Xiao Lin coordinated in real-time with the lead surgeon’s every move.

After Xiao Lin cleared the surgical view for him, the lead surgeon re-inserted the scalpel into the patient’s chest cavity, carefully holding the heart, following the small incision just made on the pericardium, continuing downward to open it further, cutting just a bit more.

Suddenly, Xiao Lin slightly raised his right hand to signal the lead surgeon to stop the surgery. The lead surgeon, catching a glimpse of Xiao Lin’s raised right hand through the corner of his eye, carefully withdrew the scalpel from the pericardium, pulling his right hand that held the scalpel out of the patient’s chest, then looked at Xiao Lin with confusion.

Xiao Lin only dared to explain after seeing the lead surgeon remove the scalpel from the patient’s pericardium. Because during pericardial dissection, the lead surgeon must not be disturbed by any external forces; otherwise, any slight error is unbearable for the patient lying on the operating table. (To be continued. If you enjoy this work, you are welcome to vote for recommendations and month votes on Qidian.com, your support is my greatest motivation.)