The Surgeon’s Studio

Old Chief Physician Pan and Zheng Ren jogged in silence to the emergency department.

Once they arrived, Old Chief Physician Pan instructed the department to reject patients that had minor illnesses and to refer them to other hospitals.

He announced that a mass poisoning had happened and the general hospital was limiting their medical resources to only the critically ill. Most patients obeyed the orders and left on their own accord to seek medical attention elsewhere.

Some patients who were not in a rush stayed back to watch the drama unfold.

However, a small portion of patients started making a fuss. They had come all the way to the hospital only to be rejected? Weren’t hospitals supposed to save the sick and dying? If they were not tending to the sick, who else was supposed to?

Old Chief Physician Pan gave the protesting uncles, ranting aunties, and raving hoodlums a cold stare. He did not dignify them with a response and headed off to manage the emergency department’s clinical decision unit.

The patients who could be discharged were discharged, with the paperwork left for another day. The wards were cleared as much as possible to make room for the coming storm.

Five minutes later, the general hospital’s administrative board arrived at the emergency department and got to work. A reshuffling of the rosters was done and more doctors and nurses were brought in to increase the emergency department’s capacity.

After all, a big incident like this happened only once every few years. The emergency department did not require such capacity on an average day, and the timely reallocation of resources was expected for emergencies.

Seeing the arrival of the hospital administrative board, a middle-aged female patient ran up and clutched at the sleeves of the prominent Director Xiao.

A tantrum thrown by a middle-aged person was often frowned upon by the public and Director Xiao was no exception.

Seven minutes later, the nearby police force came to provide their assistance.

The national emblem shone under the light. People who were making a fuss quieted down.

Nine minutes later, the sirens of the ambulances could be heard from a distance. All the personnel were at their positions, ready for the battle.

Zheng Ren and the other nurses gathered at the emergency entrance to greet the ambulances. He was not obligated to be there but figured an early diagnosis could save a life.

The ambulances arrived, tires screeching. Wisps of white smoke rose into the sky. There were tire marks where the ambulances pulled up in a hurry.

The stretcher that was pushed out made Zheng Ren stumble.

The patient’s exposed skin was greyish blue, very much like an alien from the movie, ‘Avatar’.

‘This is a bad omen,’ Zheng Ren thought. The patient was suffering nitrite poisoning.

Ever since he started training in the System, Zheng Ren’s memory had improved by leaps and bounds.

Nitrite poisoning was a rare illness—mentioned in a few sentences in medical textbooks. Once he left medical school and entered the workforce, Zheng Ren had not seen a single case of it.

The few sentences from the textbook stood out in his memory, clear as day.

He concluded that this was a case of nitrite poisoning from the patient diagnosis in the right corner of his view. The patient was currently in a potentially fatal state of circulatory shock.

Zheng Ren grabbed onto the stretcher and started to dash.

Every second was critical in determining the patient’s outcome.

“Nitrite poisoning! Prep the methylene blue and the potassium permanganate solution!” Zheng Ren ordered as he pushed the stretcher.

His voice echoed down the hospital corridor.

Little Zhao was hidden in an inconspicuous corner of the emergency department watching a livestream. When he heard Zheng Ren’s voice and saw him pushing a stretcher down the corridor, his heart swelled with admiration.

Right now, this normal everyman who had no money, no house and no girlfriend was larger than life.

“Methylene blue, large volumes!” Zheng Ren instructed loudly as he passed Director Xiao.

He sounded like a director, his voice full of authority.

Director Xiao was momentarily surprised. In the background, that unreasonable middle-aged woman was still throwing a tantrum despite the police presence.

Zheng Ren let go of the stretcher and said, “IV line, 250 milliliters 10% glucose with 140 milligrams methylene blue. At the same time, flush the stomach with potassium permanganate.”

The stretcher trolley left Zheng Ren’s hands and the standby nurses at the emergency room took over expertly.

Zheng Ren walked up to Director Xiao and said seriously, “We need more methylene blue. Our usual stock in the emergency department won’t be sufficient.”

“You’re bullying an old lady! I’m not done with you! This is an injustice!” The middle-aged woman grabbed at Director Xiao’s collar and screamed like a maniac, ignoring the police officers by her side.

Without a word, Zheng Ren stepped up and flung the woman’s arm aside.

He did so without restraint, and the annoying woman lost her footing and stumbled back into the crowd. Startled, she dropped onto the ground and started bawling, her two hands slapping the floor. “These doctors are trying to kill me! The police too!”

“Please take care of this. There will be more patients coming in.” Like a king, Zheng Ren gave instructions to the police officers. Then, he turned to Director Xiao and said, “Our stock won’t be enough and we need to ask the city council for help. If the city’s stock is insufficient, we’ll have to seek aid from neighboring districts.”

With that, Zheng Ren turned and left, sparing no time to explain the situation.

Every second counted in the emergency room. Director Xiao’s countenance was grim as he directed the chief of the medical administration division to stockpile all the methylene blue in the hospital. He did not bother to set his collar before calling up the city council.

Methylene blue, also known as methylthioninium chloride, was typically used for surgical markings. Hence, there was not a large supply of it in the hospital as demand was usually low.

The red blood cells of a healthy human or animal contained substances that could reverse the formation of methemoglobin such as vitamin C and glutathione.

If the concentration of nitrite ingested was enough to overwhelm the body’s ability to equilibrate its oxidation, the person or animal would show symptoms of nitrite poisoning.

Methylene blue would be reduced to leucomethylene blue through catalysis by nicotinamide adenine dinucleotide. Leucomethylene blue could then reduce the heme group from methemoglobin to hemoglobin, regenerating the methylene blue. This reversible reaction allowed it to be reused.

This theory was not common knowledge to the emergency medical personnel on scene. Despite that, they were aware of the severity. Cyanosis, shallow breathing and low blood pressure; anyone with clinical experience would know the patient was already in a state of shock.

If they could not improve the patient’s condition, the reduced blood perfusion would soon lead to a decrease in kidney function, cerebral edema and ultimately death.

After briefing Director Xiao, Zheng Ren went into the emergency room. At this moment, he never considered if the tone he took with the director would land him in trouble.

The patient laid on the emergency bed with his shirt cut open and thrown aside. His chest was peppered with countless patches connected to an electrocardiogram. Intricate but orderly cables transmitted electronic signals from the patient’s body to the device which produced numbers and graphs.

Blood pressure 50/20, heart rate 40, oxygen saturation not detected!

Normally, such readings on a patient was a lost cause.

The matron was bent over setting up an intravenous line. Three jabs and none of them saw any blood flow. Cold sweat dripped from her forehead and drenched the sterile surgical cap in less than 20 seconds.

The patient’s survival was dependent on the intravenous line.

The patient’s blood pressure was at 50/20 with a weak pulse. Even the large veins like the jugular and the femoral vein were shrunken and difficult to locate among the muscle tissues.

“Allow me.” Old Chief Physician Pan held a surgical kit. He removed the patient’s pants and started to search for the femoral vein. A central venous line was a procedure done frequently back in the day but was rarely required now.

The situation was dire. Even after peeling open the skin and muscles of the inguinal area, the femoral vein might have become clear, transparent connective tissue that challenged a physician’s eyes and experience.

Furthermore, this method was very slow. Zheng Ren could hear the sirens of the 120 ambulances within his mind.

Without hesitation, Zheng Ren entered the System and shouted, “I want to buy some intensive training time!”