Plague Doctor

Wu Siyu, who also scrubbed up, stood outside the surgical room. Through the small window on the door, she could look into the room. There were three surgical rooms down this corridor. Two of them were respectively occupied by Gu Jun and Xue Ba. The corridor was adorned with a row of chairs and several monitors hung opposite it. The monitors broadcasted the livefeed of the situation inside the surgical rooms. Several substitute medical workers stood at the ready to change shift. Uncle Dan and Zhang Huohuo sat on the chairs. Their faces turned towards the monitors and their eyes spoke of heavy lethargy. After everything that occurred on the island, they were already very tired. On top of that, the two of them had been taking turns doing CPR non-stop on Gu Jun and Xue Ba. If not for their strong determination, the two victims would have perished already.

"Uncle Dan, Siyu! Is there any update?" At that moment, Lou Xiaoning hurried over from the lobby. The land's travellers trailed behind her. They knew that the ECMO operations were being performed on Gu Jun and Xue Ba while Deng Ximei, who still had a weak heartbeat, was transferred to ICU.

"They're both undergoing endovascular prosthesis now." Uncle Dan answered softly as his eyes stayed transfixed on the monitor. "Opening on Ah Jun's calf has been made and the blood vessel is found… And okay, just like that, perfect… the cannulation insertion is successful!"

A slight cheer went through the people in the corridor. This was a good start. Lou Xiaoning walked to stand beside Wu Siyu. Her left eye looked through the small window and only saw the medical workers bustling around the surgical table. Through the gaps, she caught a glimpse of Gu Jun attached to blood bags, IV bags and other machines like electrocardiogram monitors and anesthesia apparatus. A nurse was conducting chest compression on him while a doctor was bandaging his surface wound. Normally, Gu Jun would be the one doing all these things instead of the other way round.

"Aiz." Lou Xiaoning could not help but sigh. Days ago they were fighting on the battlefield but now…

Suddenly, the main surgeon of the ECMO team, Luo De's voice echoed out from the speakers, "Circulation in preparation." A group of people inside the surgical rooms was there to specifically deal with the ECMO devices. It had many operating factors and those factors could change at any moment. Heart-lung-ECMO inter-circulatory factors and readings could only be understood by trained specialists. These were why ECMO surgery was so hard. After all the preparation was done, Luo De instantly connected the blood vessel transfer tube to the cannulas. The hearts of everyone else inside and outside the room tensed. The ECMO was officially in operation!

There are two main modes of ECMO support, Veno-Venous (VV) and Veno-Arterial (VA).

VV ECMO provides support for the lungs only. One or two cannulas are placed in large vein(s) on the side of the neck or in the groin area at the top of the leg. The patient's heart will continue to work normally. The ECMO machine will drain the blood from the vein through the cannula. Oxygen will be added to the blood, carbon dioxide will be removed, and then the blood is warmed and returned back to the right side of the heart through the cannula. The patient's heart pumps the oxygenated blood to the body, so that the lungs have time to rest and recover.

VA ECMO provides support for both the lungs and the heart. Two cannulas are placed in large vessels on the side of the neck, directly into the chest (while the chest is covered with a sterile protector) or into the groin vessels. The ECMO machine will drain the blood from the vein, add the oxygen and remove the carbon dioxide, warm the blood and then return the blood to the artery and mechanically "pump" the blood through the body. This method allows the blood to "bypass" the heart and lungs, allowing them to rest and get better.

However, if the patient's heart stopped beating after 3 hours, blood clots might form under VA mode, causing thrombus and pulmonary edema. In that case, thoracotomy was required and AAA Mode would be used.

Currently Gu Jun undertook VA mode. Uncle Dan and the rest saw dark red liquid coming out from the transfer tube, that was blood from inside Gu Jun's body… Due to the low oxygen ratio in the venous blood, the blood would be expectedly darker than usual but Gu Jun's blood was so dark that it was almost black and clotting…

The excitement immediately drained from Uncle Dan's face and the man sighed under his breath. As a doctor, he knew what this meant. Gu Jun had 1 percent of surviving. Now he not only had to contend with pulmonary and cerebral problems but also internal organ damage due to anoxic anoxemia… The other medical doctors on the corridor turned their heads away and sighed weakly. The collective sigh blanketed heavily on everyone present.

At the same time, after the blood entered the ECMO machine, it was transferred back into Gu Jun's body through the cannulas and the first circulation was completed. Only then did the chest compression stopped. However, the time needed by patients to resuscitate their heartbeats after being attached to the ECMO machine varied according to the individuals, some reacted instantly, others might take hours… On the electrocardiogram, Gu Jun's heart showed no sign of beating. After the chest compression stopped, he flatlined.

"We have another half an hour." Uncle Dan said, "If Ah Jun can recover some heartbeat, then we can avoid the thoracotomy…"

CT devices were moved into the surgical room earlier. While Gu Jun was in ECMO state, the rescue team conducted a cranial CT on him. The imaging confirmed that he suffered from severe cerebral haemorrhage. Craniotomy had to be conducted instantly because they needed to leave time for possible thoracotomy. After that, there was still bone fraction reduction surgery.

On the other hand, Xue Ba did not suffer from bone fractures and cerebral haemorrhage. His ECMO was also very successful. But his blood condition was more severe than Gu Jun, that meant that he suffered from greater organ damage.

"Aiz, I'm going to spare myself the knowledge. Ignorance is bliss." Uncle Dan stood up and ushered everyone away, "We're not going to be of much help here. We might as well go up to the deck for some fresh air." Mainly, Uncle Dan was worried about Wu Siyu. He didn't think the girl would survive watching the surgeries being conducted on Gu Jun. The young man would be shaved, scalped, and had his skull drilled and saw into…

"Uncle Dan, I'm fine." Wu Siyu replied. "I wish to stay here. I feel like he can sense our presence and staying here will give him the motivation to wake up."

"Alright then." Uncle Dan did not push her. Staying or leaving were neither particularly comfortable options so he'd go along with her decision. Lou Xiaoning and the land's travellers stayed as well. They watched the monitors and chatted aimlessly among themselves. Time was drawing close to the 3 hours limit for Gu Jun. Suddenly a cheer erupted inside the room. It caused everyone outside the room to spring up from their seats.

"There's a heartbeat! The patient has shown signs of autonomous heartbeat!" On the electrocardiograph, it was no longer a strange line. There was a minor fluctuation. Gu Jun's heart had come back online.

"This kid has one powerful heart!" Lou Xiaoning said excitedly, "You gotta give him that."

"There's no need for thoracotomy, this is good, good." Uncle Dan mumbled to himself. Even though this did not mean that Ah Jun was out of the danger zone, it was a good start. "This is good… Captain Xue, Captain Xue, you mustn't lose to your junior, okay…"

"Phew…" Wu Siyu finally sighed as she slumped down in the chair. "And I thought I would have the chance to see what's inside his heart."

"What else could be in there?" Elder Tong's voice came from the communicator, "Are you expecting to find your name carved there?"

The group smiled reservedly. Admittedly the war was not yet over, but now at least there was hope.

…

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