Chapter 272 - 180: For You, I Would Abandon a Half-Lifetime’s Creed

Chapter 272: Chapter 180: For You, I Would Abandon a Half-Lifetime’s Creed

"BEEP—BEEP—BEEP—!"

"Her blood pressure is still dropping! Systolic 75, diastolic 45!" a nurse called out in panic.

Liu Jianbang glanced at the monitor and gave a decisive order, "Start a norepinephrine drip and speed up the IV fluids! Push Ringer’s lactate at full speed for volume expansion, and use a pressure bag!"

"We’re already pushing fluids as fast as we can!"

The head nurse squeezed the IV bag with both hands. "Her blood pressure won’t stabilize!"

This was the most terrifying aspect of a cytokine storm.

Within a very short time, inflammatory mediators had completely destroyed the endothelial cells of capillaries throughout her body, turning her blood vessels into sieves riddled with holes.

The fluids being pumped into her body couldn’t remain in the vessels to maintain blood pressure. Instead, they leaked uncontrollably into the tissue spaces and abdominal cavity.

"Check her intra-abdominal pressure! Now!" Liu Jianbang ordered in a low voice.

A young doctor quickly lifted the manometer connected to the urinary catheter, using the pubic symphysis as the zero point.

The column of fluid climbed up the tube at a visible rate.

"Intra-abdominal pressure... 26 mmHg!"

A normal person’s intra-abdominal pressure is almost zero, or below 5 mmHg.

When this value exceeds 20 mmHg and is accompanied by organ dysfunction, it has a dreaded name in the medical field—

Abdominal Compartment Syndrome (ACS).

Massive amounts of inflammatory exudate and tissue edema were expanding furiously within the confined abdominal cavity, like an ever-inflating balloon. It was mercilessly compressing the inferior vena cava, blocking the channel for blood to return to the heart.

At the same time, it pushed up the diaphragm, compressing both lungs and causing her blood oxygen saturation to plummet.

"Oxygen saturation has dropped to 89%! Should we put her on a ventilator?"

"Don’t intubate yet! Transport her with a bag-valve mask! Get her to the operating room and have Anesthesiology intubate her on the table!"

Zhang Sui stood outside the door, completely at a loss.

His prized rationality, the SOPs and medical guidelines he had adhered to for half his life, had failed to be the amulet that could save his daughter.

If only he had listened to Jiang He’s advice back in the ER, before his daughter’s vitals had deteriorated completely, and started hemofiltration early to clear out the inflammatory mediators...

Perhaps the storm wouldn’t have hit with such ferocity.

But the guidelines didn’t say to.

The SOP didn’t allow for it.

So he had chosen to wait, and in doing so, he had waited for Death to come knocking.

"Dean Zhang!" Zhao Yumin and Jiang He rushed over from the Emergency Department.

Zhang Sui whipped his head around and grabbed Zhao Yumin’s arm. "Old Zhao, what do we do now? Should we start hemofiltration to wash out those toxins...?"

"It’s too late."

Jiang He had already seen the patient’s parameters and cut Zhang Sui off.

"Her intra-abdominal pressure is over 25 mmHg. The inferior vena cava is already compressed, and blood perfusion to the kidneys is almost zero. She’s about to go into acute renal failure. On top of that, the high pressure in her abdomen is causing intestinal ischemia and necrosis."

"Once the intestines become necrotic, bacteria and endotoxins from the gut will breach the barrier and enter the bloodstream. That will lead to irreversible sepsis and MODS—multiple organ dysfunction syndrome."

"Her only chance now is an immediate decompressive laparotomy, followed by the placement of a dual-cannula for continuous lavage and drainage to wash out the toxins. As for the necrotic tissue, we’ll debride whatever loose tissue we can."

Decompressive laparotomy.

Those two words were tantamount to walking a tightrope over a cliff.

Open abdominal surgery on a patient with severe acute pancreatitis during the cytokine storm phase carried an extremely high mortality rate.

The surgical field would be a complete mess, making massive hemorrhage a near certainty.

But... this really did seem to be the only option left.

Zhang Sui’s eyes were bloodshot. "Then do it!" he said urgently. "Can Emergency Surgery handle it? Arrange for an OR immediately!"

Zhao Yumin took half a step back and shook his head bitterly. "Dean Zhang, I can’t do it. Debridement and decompressive laparotomy for SAP... the difficulty is too high. The moment I make the incision, I won’t be able to distinguish the tissue boundaries. If I hit the splenic or gastroduodenal artery, she’ll die right there on the table."

Zhao Yumin wasn’t lying.

He couldn’t perform the procedure, and he wouldn’t pretend otherwise.

It was a matter of being responsible for her life.

"What about Hepatobiliary Surgery? Get the attending on duty to do it!" Zhang Sui looked around desperately.

"Ma Huaide was taken down, and several of the department’s Chief Physicians are under investigation. Director Yang isn’t here. As for the rest... no one would dare touch a pancreatic surgery of this level," Jiang He stated the grim reality.

Just then, the phone in Jiang He’s pocket vibrated.

It was Yang Xu.

Jiang He quickly answered and put the call on speaker.

"Jiang He, it’s bad. There’s major flooding in the city, the underpasses are completely submerged. I got in touch with Old Li from the Municipal People’s Hospital—his car is stuck on West Ring Road. The water is already over his exhaust pipe. It’ll be at least two hours before he can get to Affiliated Hospital No. 1!"

Two hours.

The words were a death sentence.

Given Zhang Jiaqi’s current intra-abdominal pressure of 26 mmHg and her steadily dropping blood pressure, she wouldn’t last forty minutes, let alone two hours.

The call ended.

Zhang Sui swayed, his back hitting the cold wall with a thud.

At that moment, the iron-fisted deputy dean, a man whose hair was always impeccably combed, felt his composure completely shatter.

He buried his face in his hands, his shoulders trembling violently as he let out a desperate, choked sob.

"What do I do... what do I do... This is all my fault..."

Just as everyone was sinking into despair,

Jiang He spoke up. "Dean Zhang, Director Yang has walked me through this surgery before. I have experience. I can do it. If you trust me, get the OR ready. I’ll be the primary surgeon."

Zhang Sui’s head snapped up.

Zhao Yumin also turned in shock, his words tumbling out in a rush.

"Jiang He, what are you talking about? This is a decompressive laparotomy with dual-cannula drainage for severe acute pancreatitis! Even without attempting to forcibly resect necrotic tissue, the moment you open her up, the tissue will be a swollen, adhered mess. It’s almost guaranteed to cause a massive bleed! Not even a Chief Physician at the associate senior level or higher would be confident about this. For a new doctor like you to be the primary surgeon is a 100% violation of protocol! What if something goes wrong?"

Jiang He looked steadily into Zhang Sui’s eyes, his expression calm.

"Dean Zhang, from an SOP standpoint, it’s true I don’t have the authority to be the primary surgeon for this Level 4 Surgery. However, my research focus is SAP. This is the area I’m best at."

"Dean Zhang, trust me. I can save her."

Zhang Sui stared intently at Jiang He.

A fierce struggle played out in his bloodshot eyes.

On one side were the medical rules and regulations ingrained in his very bones.

On the other was his daughter’s life, hanging by a thread.

Which would he choose?

"Dean Zhang, you need to make a decision," Liu Jianbang said, pushing open the ICU door and shouting. "Her blood pressure is still dropping! We can’t wait any longer!"

Zhang Sui took a sharp, deep breath.

He used the wall to push himself upright.

In that instant, all the hesitation, all the dogma in his eyes, vanished into thin air.

"Move her to the OR, prepare blood transfusions, notify Anesthesiology, and get ready to start the surgery immediately!"

"Yes, sir!" The nurses immediately rushed into the ICU and began disconnecting some of the monitor cables, preparing for transport.

...

「In front of the operating room.」

Zhang Jiaqi was rushed over on a gurney.

Due to hypoxia and excruciating pain, she was in a state of semi-conscious delirium.

Tears streamed from the corners of her eyes, washing away the cheap, rebellious eyeliner and thick foundation she had deliberately applied just to anger her father.

Black streaks ran down her cheeks, revealing her true face underneath—pale, delicate, and still bearing a trace of childishness.

As the gurney passed Zhang Sui, it paused for a moment.

With trembling hands, Zhang Sui hurried to her side.

On the gurney, Zhang Jiaqi seemed to sense something.

She reached out a hand, weakly clutching the corner of Zhang Sui’s coat.

"Dad..."

"Dad... it hurts so much..."

Her brow furrowed in agony, tears slipping from the corners of her eyes. "Am I... going to die...?"

"No... you’re not. Don’t be scared, Qiqi. Dad’s here. Dad is right here!" Zhang Sui’s composure shattered, and he broke down in tears, tightly gripping his daughter’s cold hand.

"Let’s get her inside. We can’t waste any more time," Jiang He reminded him softly from the side.

The nurses pushed the gurney, and Zhang Jiaqi’s hand slipped from her father’s grasp, disappearing behind the operating room doors.

Zhang Sui stood outside, staring intently at those cold doors.

At the nurses’ station outside the OR, Chen Jing hurried over with a "Surgical Informed Consent Form" and a "Special (High-Risk/Unauthorized Level) Surgical Approval Form."

"Dean Zhang, we need the preoperative signatures. Because Dr. Jiang is the primary surgeon, which is beyond his authorized level, and the surgery is extremely high-risk, we need special approval signatures from the Medical Affairs Department and the hospital administration. It’s too late to..." Chen Jing looked troubled.

Without a moment’s hesitation, Zhang Sui snatched the pen.

SCRIBBLE, SCRIBBLE, SCRIBBLE...

He signed with such force that the pen tore through the paper.

He signed the family consent form, and then, in the section for hospital administration approval, he heavily signed his own name.

After signing, Zhang Sui turned to face Jiang He.

Their eyes met.

The deputy dean’s face was streaked with tears, his voice hoarse.

"Jiang He... I was wrong before. Terribly wrong."

"I don’t care about the SOP anymore. I just want her to live... Jiang He, as long as she lives, I’m begging you. I’m begging you..."

"I’ll personally handle the paperwork with the Medical Affairs Department. For this surgery, I, Zhang Sui, will bear all the medical risks and administrative responsibility alone. None of it will fall on you! Just save her. Please, just save her..."

By the end, he was so overwhelmed he couldn’t speak, his words choked off.

In that moment, Zhang Sui was not a doctor. He was simply a father who didn’t want to lose his daughter.

Jiang He didn’t waste a single word.

At a time like this, all words of comfort were hollow.

Only the sharp edge of a lancet could sever Death’s chains.

Jiang He gave a slight nod, his gaze as calm as the deep sea.

"Dean, don’t worry. I will do everything in my power."

With that, he turned and strode toward the operating room.

The metal doors slowly closed behind him, shutting out the sorrow in the hallway and the storm raging outside.

In the sterile corridor, the blinding light of a shadowless lamp shone from deeper within.

Jiang He held up his hands, walked to the scrub sink, and skillfully stepped on the pedal to start the water.

Water rushed over his hands and forearms.

This surgery had a slim chance of success.

But Jiang He was confident.

He might not be an expert in everything, but his experience with the pancreas was truly extensive.

He was also grateful that all the preparations had been made in time.

’It should be alright,’ he thought. ’I can save her.’

Droplets of water dripped from his fingertips.

In his mind, Jiang He had a quiet thought:

’Dean, in this life, take your two daughters to visit the zoo together.’

"Prepare the povidone-iodine, get the monopolar cautery ready, and turn the suction to maximum."

Jiang He walked through the door of Operating Room 2, his voice calm as he said:

"Let the surgery begin."