Ling Ran rushed straight to the operating theater.
Lu Wenbin, who had been pretending to be strong all this while, immediately let out a breath of relief. He quickly made his report. "The patient's skin temperature is lower by 36.5 degrees Fahrenheit. There is positive swelling. I used—"
"Did he smoke?" Ling Ran was not surprised.
Nicotine dependence in a smoker was incredibly strong. The difficulty in quitting smoking was as hard as trying to quit opium. A normal person might still fail to quit smoking even if he or she has a strong subjective desire to quit.
A smoker who received finger replantation might not expect his finger to be amputated, and so, was not prepared to quit smoking. There would always be people who would not obey the doctor's requests for them to quit. It was also because of this that many orthopedists in Europe and America refuse to perform finger replantation on smokers.
Lu Wenbin did not expect Ling Ran's reaction to be so mild. He nodded and continued, "I heard that he smoked twice. This time, he only took a puff."
"It doesn't matter how many times he smoked." Ling Ran observed the patient's condition before he asked, "Has the patient's family signed the operation consent form?"
"Yes. I told them the patient is suspected to have an embolism in the anastomosed section, that's why we'll have to sever the anastomosed section and reconnect the artery. I also told them the risks of a second replantation, but the family insists on keeping the finger." Lu Wenbin felt rather disheartened. Even if the second reconnection was successful, there was a possibility that blood circulation would not form. If that was the case, the finger's functionality in the future would never be able to compare to how it had been before.
To a resident doctor who only just began performing finger replantation surgeries, and felt rather accomplished because of them, this kind of problem felt even worse than working for twenty hours straight.
But Ling Ran was never someone who showed his emotions on his face. He did not say much and only said, "Then let's perform the surgery."
Reconnecting the artery was much easier than performing the finger replantation, it was only a matter of cutting a few sections. To him, the process of determining the location of the embolism and reconnecting the blood vessel was merely a simple job that would last for only half an hour—if he intentionally slowed down his pace.
The last time he performed the finger replantation on this patient, Ling Ran had already considered the possibility of the patient ingesting nicotine. Hence, when he sutured the patient, he sutured another blood vessel to increase the rate of blood circulation in the finger.
This time, Ling Ran would also try his best to protect Mao Penghai's blood vessel, and create sufficient blood circulation for him.
It was just a surgery, but none of the medical staff in the operating theater had the mood to talk.
Thrombosis did not happen instantly. When such a severe case of vascular thrombosis occurred, the conditions of the blood vessel in the amputated finger were no longer hopeful. This was like how, in the possibility where multiple trucks are being unloaded on a public road with heavy traffic, no cars can move.
A body that was damaged multiple times might probably provide more blood platelets under the stimulation of nicotine. From the point of view of research papers, if a rat that was about to receive tail replantation surgery smoked, its adsorption of blood platelets would increase by 10%, but in correspondence, the endothelial cells would have a low growth rate—it would only be one-fifth of what a normal rat would have.
Ling Ran could use surgery to get rid of the thrombosis at the anastomosed section, even clean it up properly, but he must use medicine to deal with the inner parts of the amputated finger's blood vessels.
The biggest difference in medicine and surgery was that, while doctors played a leading role in surgeries, the effects of medicine on a person relied on how much that person could adapt to it.
This was just like how people used banned drugs in sports. Some people would swiftly gain huge breakthroughs once they used these drugs; some did not have significant changes; some even start to fall behind on their results. In the end, it all boiled down to how different people had different reactions to drugs.
Take, for another example, heparin, which was used as an anticoagulant. People generally had quite a good reaction towards it, but there would always be some who would react remarkably well to it, and some who would react terribly.
At that moment, if Ling Ran wanted to preserve Mao Penghai's finger, then using drugs that would just lead to normal blood thinning effects would not be enough.
Lu Wenbin saw this as well. Once the surgery ended, he deliberately said, "Why don't I stay in the hospital and watch over Mao Penghai?"
Ling Ran took off his gloves and scrubs before he thought about this for a few seconds. He then said, "Sure."
"I'll try my best to preserve the finger." Lu Wenbin was already used to Ling Ran's personality, so he took the initiative and said, "I won't be joining you for your surgeries tomorrow, by the way."
"Okay. Rest tomorrow. Don't join any surgeries." Ling Ran no longer asked to perform large numbers of surgeries every day. Compared to the M-Tang technique, the energy consumption for finger replantations was much greater. It was equally taxing on the mind and a person's stamina, and it also ate up a large amount of time.
No matter how good Ling Ran's body was, Lu Wenbin and Ma Yanlin's bodies would sooner or later collapse if he kept on performing surgeries at such a rate.
After all, once they reach the stage where they must perform finger replantations, the responsibility of an assistant would also become much greater; they were no longer just supposed to operate the retractor. Furthermore, the two of them still had to perform ward rounds, write medical records, give doctor's advice, and do other miscellaneous things. Even if the two of them alternated shifts, they still did not have time to rest and relax. Once they were through the smoker episode today, even Ling Ran wanted to rest.
As for Lu Wenbin, he had already completely given up on resting. Finger replantations were similar to the other surgeries. The frequency for postoperative complications to happen were the highest at the earliest postoperative stage. If the patient managed to last through it, then there was a high chance for the replanted finger to survive.
Lu Wenbin stayed up all night, constantly ready to give doctor's orders and put together a suitable set of medication for the patient, all because he hoped to raise the success rate of the surgery.
Lu Wenbin continued to stay at Mao Penghai's side throughout the next day and the night. During that period, Lu Wenbin only took short naps. Every single time the slightest disturbance showed, or when his mobile phone vibrated (which it would at a fixed time because he had set it as such), he would wake up.
Lu Wenbin was not unaccustomed to this life. He often did this when he cooked pork trotters. He calculated the time he needed to put the spices and ingredients into the stew, and used whatever free time he had to rest and sleep…
However, compared to pork trotters, waiting for the change in color for a replanted finger was a little too tough.
On the third day...
Ling Ran performed a ward round, as he was wont to.
With disheveled hair, Lu Wenbin stood together with the patient's family beside the bed. Mao Penghai stared ahead expressionlessly. His finger was still grayish-white, and there was even a faint grayish-black hue to it.
"Let me take a look at his medication record." Ling Ran asked for Mao Penghai's medical record and read through it from top to bottom.
Unlike internists, when surgeons administered medicine, they did so in a crude fashion. They only had the thought of curing symptoms in mind as their objective. They did not delve deep into the connection between cause and effect. Yet even so, Ling Ran could still see how much Lu Wenbin tried to help the patient through his medical advice, and also how much effort he had poured into this.
He tried to expand blood vessels, reduce the viscosity of the blood, increase the recovery rate, increase cardiovascular function; Lu Wenbin did everything he could.
Ling Ran put down the medical record and looked at Lu Wenbin. Lu Wenbin's gaze was unfocused. He did not want to meet Ling Ran's gaze.
Ling Ran waited quietly. After a long while, Lu Wenbin finally said in a hoarse voice, "We can't preserve it… We have to amputate."
Mao Penghai's wife was already prepared for it, but when she heard what he said in the end, she still could not help but weep, "Why… Why do we still need to amputate his finger. We used so many drugs, and he even had to suffer through two surgeries…"
The woman wept uneasily, but Ling Ran could only watch in silence. When he searched through his own conscience, he asked himself whether he would have made a different decision if he could predict the future, such as choosing amputation straightaway, or deploy even stricter measures to make Mao Penghai quit smoking. At the very least, he would have given up on the second replantation. He might even refuse Lu Wenbin's request to tend to the patient, because by doing so, they could have saved a large quantity of resources, and omit the need for the patient and his family to pay such a large price for this surgery, be it in terms of their money, energy, or time. They could have even skipped the mental and physical torment they had to go through.
But what if he could not predict the future?
Ling Ran believed that in situations where he could not predict the future, he would mostly likely still perform finger replantation for Mao Penghai.
Nicotine did not necessarily lead to amputation, and he had no way of certainly knowing whether Mao Penghai would smoke…
Ling Ran finally gave a definitive answer, "Amputation is currently the only option."
Tears streamed down the woman's face. She said, "Can't you not amputate him? What is he supposed to do without his finger?"
"A finger that is completely dead will pose a great danger to the other fingers. It's best that we send him to the operating theater right now." Ling Ran took a look at his watch and said, "We'll try to finish it as quickly as possible."
The family members of the patient hesitated for a long time. In the end, they looked towards Lu Wenbin.
"We can only amputate it." Lu Wenbin also felt helpless and resigned.
They advised the family for a little while longer before the family finally agreed to sign a new informed consent form. Mao Penghai was also sent to the operating theater as soon as possible.
Six hours later…
Ling Ran stood in front of Mao Penghai again. Mao Penghai's entire hand was wrapped up. One of his fingers was missing, but he looked a bit more cheerful.
When he saw Ling Ran, Mao Penghai was a little excited. He mumbled out an incoherent "thanks" before he started to cough violently. When he spoke again, his words were a little clearer, "Doctor Ling, I've been a trouble to you all."
"How do you feel?" Ling Ran asked.
"Quite good. Once I stopped thinking about recovery, the pressure became somewhat lesser." Mao Penghai grimaced. It could be said that he had already accepted his fate.
"You still have to go through rehabilitation… Um…" Ling Ran paused for a moment because another Basic Treasure Chest had just appeared in front of him.
[Achievement: A patient's sincere gratitude.]
[Achievement Description: A patient's sincere gratitude is the greatest reward to a doctor.]
[Reward: Basic Treasure Chest]
Ling Ran stared at Mao Penghai in considerable shock. This was the first time he met a patient who would give him two Sincere Gratitudes.
He flicked his wrist and opened the Treasure Chest.
Streams of light flowed out of the chest, and another silver-gray book appeared. Written on its title page were these words. [Interrupted Inverted Horizontal Mattress Suture (Specialist), also known as Halsted Suture. It is largely used for suturing the gastrointestinal tract.]
Ling Ran was taken by surprise again. This was also the first time he hit the jackpot in opening two consecutive chests.
"It's better that I amputated the finger. At least I don't have to be worried about it rotting away in the future," Mao Penghai explained in a tone as if he was talking to himself. His other good hand was placed on the bed sheet, fumbling for something non-stop.