Chen Junnan was already growing impatient. Liu Zhengliang deliberately maintained a calm expression, though inwardly he had long lost patience. But he cared about his reputation—he was, after all, an expert invited from out of town. Even if ordinary people didn’t understand the status of a medical doctorate in this field, he couldn’t afford to appear overly opportunistic. In this deal, Chen Junnan was the broker, and brokers were supposed to handle all the dirty work.
Chen Junnan read Liu Zhengliang’s expression clearly. It seemed all the undesirable tasks in this charade would fall on him. Well, he was still collecting a commission, so he said, "Nothing in this world is absolutely certain. If you feel uneasy about it, then don’t bother inviting Dr. Liu to perform the surgery. Just use a local doctor from Fushun. That way, you’ll feel more at ease, and as for the old man, just do your best. Filial piety comes first among all virtues—it’s about intention, not actions. If judged by actions alone, no one from a humble background could be called filial."
Liu Zhengliang, of course, nodded in agreement. At that moment, the Filial Son interjected, "My son is young and doesn’t know how to speak properly. We still want the doctor from Beijing to perform the surgery. If there’s a chance to improve the odds, we’ll take it. We’ll sign the informed consent form. Please, operate with peace of mind."
Chapter 4
A few hours later, the patient’s condition had stabilized somewhat, and preparations for the surgery began.
Just as Liu Zhengliang was about to enter the sterilization room, a pretty short-haired girl tilted her chin up and greeted him, "You’re the new doctor, right? Take care of our business in the future. When you have time, give me a call—I’ll treat you to a meal."
Liu Zhengliang didn’t want to emphasize that he was here for a moonlighting surgery, so he nodded perfunctorily and unconsciously accepted the business card she handed him.
Her name was Ai Chen, and she ran a restaurant. The card identified her as the general manager. The restaurant’s name was quite interesting—it shared its name with one of Guo Degang’s crosstalk works: Funeral Association. As the name implied, it wasn’t a place you’d casually visit for a meal. If you invited friends to dine there, they’d probably punch you. It was a restaurant specifically catering to funeral banquets, with more cold dishes than hot ones, and an odd number of dishes per table—never even. Few hosts at funerals were in good spirits, and when people were upset, they tended to be overly particular. This line of work wasn’t easy.
Ai Chen was very pretty—short hair, a loose white top, jeans, kind eyes that smiled, slender eyebrows like crescent moons, cherry-red lips as vibrant as roses, and a slender willow-like waist that accentuated her curvaceous hips. She had that wild streak typical of girls from Fushun: treat her well, and she’d stick to you every day; treat her coldly, and she’d give you the cold shoulder in return. She had experienced both poverty and wealth, and in her first couple of years making money, she had squandered quite a bit. No one had taught her how to apply makeup, so she just piled it on heavily—like her eyebrows, which were clearly tattooed. In Fushun, winter temperatures could drop to over thirty degrees below zero, while indoors it was around twenty degrees. The drastic temperature shifts placed a heavy burden on the cardiovascular systems of many seriously ill elderly people. A sudden gust of cold wind upon stepping outside could be enough to make them collapse. So, this was the peak season for Ai Chen’s family business. Her visit today to scout for opportunities likely meant they were short-handed and she was stepping in to help.
Chen Junnan said with a laugh, "Her father is Ai San, the most famous one-stop funeral service boss in Fushun."
Liu Zhengliang was still watching Ai Chen.
Noticing that Liu Zhengliang kept looking back even after walking some distance away, Chen Junnan chuckled and asked, "Do you know why that young lady wanted to get in touch with you?"
Liu Zhengliang shook his head.Chen Junnan continued, "In other departments like gastroenterology, respiratory, or oncology, critically ill patients basically have a rough timeline. While you're still undergoing treatment, their industry has already factored you into their performance metrics. It's a sure thing, no escaping it. These people have been monitoring hospitals for years, I'm telling you, when it comes to reading fate, they're more accurate than us doctors. As for what kind of urn you'll use, whether you'll buy a north-south or west-east facing burial plot, how many musicians you'll hire, or how many wreaths you'll order—they can estimate your budget just by looking at how you're dressed."
Liu Zhengliang quickly asked, "Then why was she trying to get chummy with me?"
Chen Junnan laughed and said, "She must have mistaken you for a new doctor. Because our Neurosurgery department is highly unpredictable—a perfectly healthy person in the morning could be gone by evening. For them, that's unexpected income. They definitely need to stock up in advance, right? Paper effigies of oxen and horses need to be produced ahead of time, professional mourners need to prepare their emotions in advance. By building good relationships with our department, they get the news first. While others are still waiting in their shops for customers to come arrange services, they come directly to the hospital—washing the body, changing clothes—and the business is secured."
After the casual conversation, the doctors and nurses entered the operating room together.
While the nurse prepared the instruments nearby, the local young doctor read from the medical record: "The patient is sixty-five years old with a history of hypertension. Experienced sudden subarachnoid hemorrhage while conscious, accompanied by severe headache. Angiography shows ruptured aneurysm."
Liu Zhengliang asked, "Was a carotid ultrasound performed?"
The local doctor replied, "Not yet. Should I have them go pay now and get it done quickly?"
Liu Zhengliang paused for a few seconds before saying, "Never mind, let's save the family some money if we can. I'm experienced enough—I should know how to avoid plaque if I encounter it."
The situation was somewhat tricky. They would take it step by step.
Liu Zhengliang calmly instructed the nurse, "Pressurized irrigation with quarter-strength heparin saline."
The surgical nurse carried out the order.
The next steps were lumbar puncture and femoral artery puncture. The lumbar puncture was to drain some cerebrospinal fluid and reduce cerebral edema, while the femoral artery puncture was to thread the guidewire up into the head. After completing the lumbar puncture, Liu Zhengliang worked on the patient's femoral artery—a step no one else could perform for him. Bright red blood flowed from the arterial sheath.
Aortic arch angiography.
A monitor displayed this major artery above the heart—the first T-junction where arterial blood pumped from the heart goes, partly descending to various organs throughout the body and partly ascending to the head. At this moment, Liu Zhengliang recalled the famous saying from Professor Wang Hao, the most humorous instructor at Heping Hospital, which had been passed down through several cohorts of senior students as an inside joke: Wherever there's an intersection, accidents are prone to happen. Here we have professional "crash-for-cash" artists—mural thrombi.
This "crash-for-cash" was a pun.The senior physician from Fushun Central Hospital observing in the control room was instructing the young doctor beside him: "If a clot breaks loose and travels upward with the blood flow to the cranial cavity, blocking any small pathway, it can cause a cerebral embolism. The person on the sickbed would immediately Game Over. In theory, cerebral embolism can be treated with thrombolytic injections, or even enteric-coated aspirin, right? But this patient has cerebral hemorrhage. Administering thrombolytic injections or aspirin to stabilize blood clots in the vessels can easily trigger a sharp rise in blood pressure. While platelets may stop aggregating, it’s like trying to clear silt from a riverbed during a flood by artificially inducing rainfall—this only increases the risk of another cerebral hemorrhage, making it even more critical. This is a damned-if-you-do, damned-if-you-don’t situation. Don’t you think it’s a life-and-death dilemma? Sometimes, being a doctor is harder than being the patient. If you don’t take action, you’re not fulfilling the duty of healing the wounded and rescuing the dying; if you insist on taking action, you’re gambling with life and death, placing yourself in a perilous position to seek survival."
Liu Zhengliang confirmed the next step: bilateral carotid artery angiography.
Liu Zhengliang proceeded further: angiography of the bilateral vertebral artery origins.
The doctors in the control room followed the instructions step by step, providing clear imaging for the chief surgeon, Liu Zhengliang. After 3D rotational angiography, the location of the cerebral aneurysm was fully identified. A daughter aneurysm had grown on top of the main one, like a gourd inside the brain.
Chen Junnan, watching from the side, remarked, "The location is quite tricky."
Liu Zhengliang nodded.
The senior physician observing in the control room whispered again to the young trainee: "This aneurysm is located at the anterior communicating artery, which tests the surgeon’s skill even more. Excessive postoperative fluid accumulation can lead to hemiplegia or other surgical complications. If the surgical bleeding is even slightly excessive, it could bring a host of troubles—incontinence, memory loss, delirium. To put it plainly, it’s like the motherboard or a memory stick burning out. What was once 8GB of memory is now reduced to 4GB. Not only can you no longer play games, but even booting up becomes slow."
The monitor displayed images of the patient’s "blood river" from the lumbar spine to the back of the brain. The guidewire advanced cautiously against the current along the route. It was like Liu Zhengliang’s grandfather in his sixties, riding a bicycle through Fushun’s Happy Garden bird and flower market, one hand on the handlebars and the other steadying a newly purchased fish tank behind him, with a young grandson perched on the front crossbar. He ducked under birdcages hanging from stall awnings, maneuvered around awkwardly spread-out fake antique displays on the ground, and navigated twists and turns through all sorts of clutter. His movements were erratic, but his mind was as steady as Mount Tai. The old man’s feet never touched the ground, much like Liu Zhengliang’s guidewire now advancing like a loach on the monitor.
This "loach" must not touch any thrombus in the patient’s blood vessels. If it does, the person lying there would die.
The guidewire reached the aortic arch. Like a driver looking left and right while slowly turning, Liu Zhengliang took a deep breath in preparation, holding it for the dozens of seconds during the turn. The turn was made—no thrombi attached to the vessel wall were seen. Perfect. Entering the carotid artery was like a car bursting out of Beijing’s South Second Ring Road during evening rush hour and speeding joyfully toward Daxing Airport. This leg of the journey was a triumphant advance, heading straight for the target.Today's surgical plan was embolization. Liu Zhengliang had already explained the treatment principle to the patient's family using his phone and the analogy of Poyang Lake: fill the aneurysm, reclaim land from the lake, and let this quake lake disappear completely, so there would be no need to worry about a dam breach. How does that song go? "Awakening the slumbering mountains, letting the rivers change their form."
Chapter 5
The sand and soil for reclaiming land from the lake were ready, and the heavy machinery was in place.
The stent catheter was positioned—first embolizing the aneurysm, then placing the stent. On the angiographic display, everyone held their breath watching the coils released from the catheter, winding and lingering circle by circle within the aneurysm. The coils gradually filled the aneurysm, and the interlocking arm structure passed through the tip of the microcatheter, with the coils automatically detaching from the catheter.
By now, the several assisting doctors and nurses had completed their tasks and were quietly observing Liu Zhengliang's operation. The coils were only slightly thicker than a strand of hair, but in the narrow, elongated anterior communicating artery hemangioma, they resembled a squirrel burrowing into a tree hollow—there wasn't much room to maneuver, like setting up a ritual arena inside a snail shell.
The aneurysm did not rupture during the surgery, and the coils were positioned perfectly within it, almost completely covering the bleeding point. Liu Zhengliang tilted his head to let Chen Junnan wipe the sweat from his forehead before speaking to him: "Fortunately, we used DSA intervention. If it had been a craniotomy, with such a large fistula, clipping it would have been quite troublesome."
OpenNovel