Chapter 277 - 183: Dr. Jiang, You’re Amazing

Chapter 277: Chapter 183: Dr. Jiang, You’re Amazing

In a small conference room above the Emergency Department.

Jiang He, Zhang Sui, Zhao Yumin, and Liu Jianbang were discussing the subsequent treatment plan.

Although the rescue operation had ended smoothly,

for a patient with a severe infection complicated by massive hemorrhage, getting off the operating table was just the first hurdle.

"We have the IL-6 results. It’s 780 pg/mL."

Jiang He said, holding a newly printed lab report:

"Even though the open-abdomen Bogota bag coverage provides decompression for the abdominal cavity, and we’ve placed a double-lumen catheter for continuous irrigation and drainage, the absorption of toxins from the necrotic tissue is still ongoing."

Zhao Yumin nodded and said, "I just went to check on the drainage fluid. It’s still a dark reddish color, but the volume is under control. That means the active bleeding in the abdominal cavity has mostly stopped. The core issues now are infection control and organ function support."

"The anti-infection protocol needs to be escalated. I suggest we go straight to Tienam (Imipenem/Cilastatin Sodium) as a last resort, combined with metronidazole to cover anaerobic bacteria."

Jiang He frowned the moment he heard this.

In fact, from a pharmacological perspective of modern antibiotic stewardship,

Tienam (a carbapenem) already possesses extremely potent activity against anaerobic bacteria. Adding metronidazole constitutes dual anaerobic coverage, which is redundant medication.

But in the clinical surgical practice of ’08, because controls on antibiotic abuse were lax and surgeons facing severe intra-abdominal infections were prone to a ’fear of insufficient firepower’...

adding metronidazole was a very common, yet poor, clinical habit.

He began to think.

’How can I, within the framework of current medical logic, reasonably persuade everyone not to engage in this kind of redundant medication?’

After some thought, he decided it was time to bring out the Lancet.

—When in doubt, cite the Lancet!

Jiang He said, "Sirs, I actually read an article in the Lancet that went something like this..."

As they were discussing the medication,

Zhang Sui kept his head down.

As he listened, tears suddenly began to fall.

Then he couldn’t help but start choking back sobs.

Jiang He fell silent.

Zhao Yumin and Liu Jianbang also averted their gazes, silently staring at the cups in their hands.

Everyone understood.

The feeling of facing the potential death of a loved one—you only understand it once you’ve experienced it firsthand.

No matter how strong or rational a person you are, in that moment, all your psychological defenses are torn apart, and you are utterly shattered by a terrifying sense of helplessness.

Zhang Sui struggled to compose himself. "It’s nothing... it’s nothing. Please, continue. If her blood pressure drops, we need to follow up with albumin and plasma immediately. Fluid intake and output must be measured precisely every hour."

"Don’t worry, Dean Zhang. I’ll have the head nurse in the ICU personally monitor her intake and output and report back every half hour."

Zhao Yumin replied in a somber voice.

Once the discussion about the follow-up treatment was complete, Zhao Yumin turned to Jiang He and praised him, "To be honest, with today’s surgery, if it weren’t for Jiang He, we old timers really might not have been able to pull it off."

Liu Jianbang nodded repeatedly. Recalling the scene in the operating room, his heart still raced:

"That spot where the branch of the anterior superior pancreaticoduodenal artery ruptured... the entire field of view was obscured by blood. The aspirator couldn’t keep up at all. Thankfully, Xiaojiang reached in with his left hand to apply pressure and stop the bleeding, while his right hand performed a single-handed blind suture with a 3-0 Prolene... That was a blind suture! He tied the knot in situ, all in one smooth motion. It was simply divine."

"And the use of the Bogota bag! Our hospital encourages learning cutting-edge techniques, but to dare to leave the abdomen open during a life-or-death rescue operation and use an IV bag for temporary coverage and decompression... you wouldn’t find a second person in the entire hospital who would do that. That move directly prevented postoperative abdominal compartment syndrome (ACS) and bought the patient the maximum chance for survival."

Zhao Yumin gave a wry smile. "Working on the same stage as Dr. Jiang really makes me feel like my last ten-plus years in clinical practice were for nothing."

It was a good thing this was 2008, and system-trope novels hadn’t become popular yet.

Otherwise, they would have absolutely suspected that Jiang He had some kind of medical system cheat, maybe even the popular kind where you get three choices after completing a mission...

Jiang He couldn’t be bothered to be modest.

There was no point in being modest this time; his performance was simply too top-tier.

Being modest at a time like this could easily be mistaken for humble-bragging...

’I’ll just have to endure it.’

At that moment, Zhang Sui wasn’t participating in their conversation.

He stared blankly out the window at the dark, rainy night.

Streams of water meandered down the glass, blurring the streetlights outside.

He seemed to be watching the rain, but his mind was replaying the massive car crash on the Ring City Expressway a while back, on a similarly torrential night.

Although he hadn’t been on the front lines of the rescue that night,

he had later reviewed all the rescue records, internal reports, and Jiang He’s operational documentation.

It was enough for him to imagine it...

The situation that night had surely been even more suffocating than today’s.

’Putting myself in his shoes,’ he thought, ’what if the person on that gurney that night had been my own daughter, Jiaqi?’

’What if Jiaqi had been showing symptoms of severe internal bleeding and acute pancreatitis, but the doctors present, for the sake of so-called SOPs, insisted on waiting for all the test results and a signature from a senior doctor before they would act?’

’Could I really have stood by and watched my daughter slowly stop breathing because of delays in the medical process?’

’Would I still have insisted on shouting, "We must follow the SOP! No procedural violations!"?’

Zhang Sui fell silent.

As the saying goes, people tend to take the high ground when the sky isn’t falling on their own heads.

Adhering to rules and respecting the system is, at any time, an absolutely correct thing to do.

However, doing the "correct" thing is often easy, because you don’t have to bear any additional risk.

But as a doctor, when faced with a living, breathing person on the verge of death, perhaps... we sometimes need the courage to break the rules.

Zhang Sui turned his head, his gaze once again falling on Jiang He.

At that moment, he finally and profoundly agreed with Jiang He’s actions that night and recognized his own previous narrow-mindedness.

"Jiang He."

"Yes, Dean Zhang."

"About the early prediction model for SAP... would you be willing to run a pilot program for it here in our hospital?"

"Huh?"

It wasn’t just Jiang He who was taken aback by this statement.

Even Zhao Yumin and Liu Jianbang, who were standing nearby, were stunned.

Jiang He said, "Dean Zhang, my paper on it hasn’t been officially published yet, nor has it undergone extensive peer review. Strictly speaking, it doesn’t yet qualify as a clinical guideline. To use it directly for a pilot program in the hospital... that doesn’t seem to be by the book, does it?"

’This was completely out of character for Zhang Sui.’

Zhang Sui said, "Yes, we certainly can’t write it directly into the hospital-wide mandatory standard operating procedures. However, we can use it as a supplementary reference standard for emergency and general surgery doctors when they admit patients with acute pancreatitis."

Jiang He looked at him with feigned, obedient confusion.

Zhang Sui continued to explain, "Once a patient’s various early indicators trigger your model’s warning, the admitting physician can intervene ahead of schedule. We can communicate with the patient and their family, explain the risks predicted by the model and the pros and cons of early aggressive treatment—like early fluid resuscitation, anticoagulation, or even prophylactic antibiotics. As long as they sign a consent form, we can, within reasonable medical bounds, use your warning system to buy time and try to intercept the severe stage early on."

Jiang He understood.

In other words:

Zhang Sui planned to give the doctors under him a legal, supplementary cheat code.

The data from this prediction model would not be used directly as qualitative medical documentation, nor would it become the official standard for judgment in the event of a medical malpractice incident.

It was like a publicly known game addon.

Once it raised an alarm, the doctor could use an informed consent form to transform an unconventional, aggressive treatment into a personalized plan approved by the family, cleverly bypassing the currently lagging SOPs.

—This was playing in a gray area.

Jiang He couldn’t help but complain inwardly:

’The old hard-head has finally seen the light. It wasn’t easy...’

’This is a good thing for me, too.’

’Promoting the model’s application won’t just save more people; in the future, it will be a major achievement on a national scale.’

So, Jiang He said,

"If we can promote it this way, I have no objections, of course. Early intervention can indeed save many patients who would have otherwise progressed to a severe stage."

"Good. I’ll take the lead on the specific procedures and departmental coordination. You don’t need to worry about it."

As he spoke, Zhang Sui stood up, walked over to Jiang He, and pulled him to his feet, saying,

"We have a handle on Jiaqi’s subsequent treatment plan now. You can’t keep hanging around here. You’ve been working nonstop. Even an iron man would collapse if you don’t get some rest."

Jiang He looked completely baffled.

’Dean, what are you doing? Can’t you just talk? Why are you pulling me?’

Zhang Sui said, "Go home and sleep. Leave the rest to us. If we can’t even handle the postoperative monitoring, we might as well just take off these white coats for good. Your only task right now is to go home and get a good night’s sleep."

Jiang He was speechless. "Dean Zhang, really, you can just say it. You don’t have to get physical..."

Zhang Sui: "Oh, oh, my apologies."

Zhao Yumin chimed in from the side, "Alright, Jiang He, hurry up and go rest. Stop dawdling."

Resigned, Jiang He could only let them shoo him out of the conference room.

...

He walked out of the Emergency Department building.

In the early hours of the morning, the rain had eased up a little.

He got lucky. After waiting less than five minutes, a taxi pulled up in front of him.

Jiang He pulled open the door, slipped into the back seat, gave the driver the address for Southern Medical University, and then slumped back against the seat.

He fished his phone out of his pocket and sent a message to Shen Yu:

[The surgery is over. It was a success. I’m in a taxi on my way back to the university to get some rest.]

He was about to put his phone back in his pocket and close his eyes to rest when, less than ten seconds later, it suddenly rang.

The caller ID read: [Teacher Shen].

Jiang He froze for a second. ’She’s still awake at this hour?’

He immediately hit the answer button, his voice as gentle as possible. "Hello, Teacher Shen, why are you still—?"

"Dr. Jiang..."

Shen Yu cut him off.

Her voice was thick with tears.

Jiang He: "!!!"

Just moments ago, facing a life-and-death situation on the operating table, he had been perfectly calm and composed.

But now, just the sound of Teacher Shen’s tearful voice made his blood run cold.

Jiang He said hurriedly, "What is it? What’s wrong? Don’t cry, just tell me what happened!"

Shen Yu: "Nothing happened..."

Jiang He: "Come on, tell me, what happened?"

Shen Yu: "I just... I had a nightmare..."

Jiang He: "? And?"

Shen Yu: "That’s it. Just a nightmare. A really scary nightmare..."

Jiang He: "..."

After a moment of silence,

he got angry!

A small burst of fury!

But that feeling quickly turned into tender concern. He said,

"It’s okay, it’s okay. Don’t be scared. Tell me, what did you dream about?"

"I don’t want to talk about it..."

"That’s okay. Haven’t you heard that dreams are the opposite of reality? Whatever you dreamed about, it won’t happen."

"Really?"

"Really. Don’t worry. No matter what happens, I’m here."

"...Oh."

After a little while,

Shen Yu really couldn’t hold it in any longer. "Dr. Jiang, I want... I want to eat mung bean cakes. When you come at the end of the month, can you bring me two extra portions?"

She clearly missed Jiang He, but insisted she was craving mung bean cakes.

Jiang He said gently, "Okay, I’ll bring them for you. I’ll bring several extra boxes."

After a pause, he changed the subject. "Since you’re awake, let me tell you about the surgery today. Let me tell you, I was so cool today, so amazing..."

Jiang He bragged to his wifey, and as Shen Yu listened, she started to smile.

’Hehe, I like Dr. Jiang so much. Dr. Jiang is the coolest.’

She took the opportunity to praise him, "Dr. Jiang is so amazing! You’re the best!"

Hearing his wifey’s praise, Jiang He chuckled as well.

Then he suddenly felt like he was that "You’re the best!" kitten that would go viral in a later era.

’Do the right thing, and Teacher Shen will praise you...’

’Hehe, this is pretty good too.’

’I want to be with Teacher Shen forever and ever, and hear her say over and over:’

’Dr. Jiang, you’re the best!’