Surgeons Episode 29 Recap
> Surgeons Recap
The hospital received Cai Wei, a severely injured patient who tested positive for HIV. He needed immediate surgery, but the City Infectious Disease Hospital was already full, having admitted 20 hepatitis patients and one HIV patient, and lacked the capability to perform such a complex operation. Zhuang Shu was called to the Emergency Department by Yang Fan to assess the situation.
Yang Fan was deeply concerned about admitting an HIV-positive patient into Renhe Hospital, especially with the current overload of disaster-stricken patients. He feared public panic and potential infections, emphasizing that it would be impossible to keep such a situation confidential given the high patient density. Zhuang Shu, however, insisted that the patient's condition, a lung abscess near major vessels with risk of massive bleeding and sepsis, demanded immediate surgery.
He argued that medical science, not public opinion, should dictate treatment, and that standard safety procedures were in place. When Yang Fan suggested isolating Cai Wei in the Infectious Disease Department, he was informed that those rooms were also full. Yang Fan then tasked his son, Yang Zixuan, who was volunteering at the hospital, with convincing Cai Wei's emotionally unstable wife, Wang Fang, to sign the consent for surgery and to get her own HIV test.
Meanwhile, in another ward, Lin Huan diligently cared for her adoptive father, Lin Hao, who was recovering. Lin Hao expressed regret that her cello-playing hands had to perform such menial tasks for him. Lin Huan playfully retorted, asking if he thought she wasn't his biological daughter. This comment stirred a complex emotion in Lin Hao. He confessed his fondness for a musician's temperament was why he encouraged her to learn cello.
Back in the discussion about Cai Wei, Fu Bowen, after reviewing the case, agreed with Zhuang Shu that immediate surgery was necessary, adhering to clinical treatment processes for HIV patients while strictly protecting privacy. Zhuang Shu further revealed he had already arranged a special operating room. Yang Fan questioned his preemptive actions, but Zhuang Shu explained his extensive experience in performing thoracic surgery on HIV patients from his previous workplace.
Fu Bowen then volunteered to assist Zhuang Shu and share responsibility for the patient's post-operative condition, which reassured Yang Fan enough to give his consent. Zhuang Shu initially expressed concerns about Fu Bowen's health and preferred Zhang Mo Han as his assistant, but Fu Bowen insisted his recovery was complete, and that Zhang Mo Han had already been working for 36 continuous hours. Ultimately, Yang Fan sided with Fu Bowen. Yang Zixuan approached Wang Fang to obtain the surgery consent.
She was distressed, fearing for her own and her child's health after her husband’s extramarital affair. Zhuang Shu intervened, reassuring her that HIV is not spread through casual contact and that the hospital's focus was solely on treating the illness. He then spoke directly to Cai Wei, explaining that his lung abscess, likely a relapse of tuberculosis, had a high cure rate with surgery.
Cai Wei, however, was despairing, believing death was preferable to living with HIV and wishing to forgo the operation. Zhuang Shu patiently explained advancements in HIV treatment, highlighting that with medication, the disease could be controlled for many years, potentially until his 11-year-old child reached university. He appealed to Cai Wei's sense of responsibility towards his child. Moved by Zhuang Shu’s words and his wife’s promise to stay with him for their child’s sake, Cai Wei agreed to the surgery.
He then asked Zhuang Shu if he feared infection, to which Zhuang Shu responded that doctors do not shy away from possibilities, emphasizing the widespread dedication of medical staff, even in more dangerous disaster zones. Before the surgery, Zhuang Shu reminded Fu Bowen to alert him if he felt unable to continue, but Fu Bowen assured him he knew his limits.
Zhuang Shu acknowledged Yang Fan’s valid concerns about public backlash but noted that Fu Bowen’s commitment had now shifted the risk to himself. Fu Bowen, in turn, stated that he had to take that risk for the patient to receive care and thanked Zhuang Shu for the opportunity to participate in the surgery. The operation then commenced with standard sterile procedures. News of the HIV surgery quickly reached the disaster relief team.
Lu Chenxi, speaking with Chen Shaocong, questioned why the Emergency Department hadn't transferred the patient, citing a past incident where families of over thirty patients had blocked the ICU due to an HIV-positive patient. Chen Shaocong explained that the Infectious Disease Hospital was at full capacity and unable to perform such a surgery, and Renhe, while also full with extra beds lining the stairways, couldn't refuse care to those in need.
He downplayed the risk, reminding her HIV is not airborne, but acknowledged the public's widespread fear. He jokingly assured her he would be the first to protect Zhuang Shu should any commotion arise. After the surgery, Cai Wei was placed in the same room as Lin Hao. During a routine check-up, Zhuang Shu learned that Lin Hao was suffering from a lower urinary tract infection, which hadn't responded to initial antibiotics.
While examining Lin Hao, Lin Huan asked her father if he remembered anything from before she was four. Lin Hao said she often got lost as a child and suggested her mother used to scare her about her memory. Lin Huan recalled nightmares from that period involving people in white coats. Lin Hao's wife, overhearing their conversation, quickly interjected, sending Lin Huan to buy food.
She then confronted Lin Hao, who expressed fear of suddenly leaving and felt they couldn't keep Lin Huan's adoption a secret forever. His wife passionately disagreed, arguing that telling Lin Huan now would only cause distress, especially since her original family was unknown. She asserted that they had saved Lin Huan from dying in the mountains and had raised her as their own. Zhuang Shu, still in the room, overheard this entire exchange.
Later, Zhuang Shu was sitting alone on a bench, looking at photos of Lu Chenxi, when Lin Huan approached him, offering him yogurt. They began talking, and Lin Huan learned that Lu Chenxi was Zhuang Shu's girlfriend. Lin Huan observed that Lu Chenxi was straightforward, while Zhuang Shu was a bit "uptight, like a big brother." Zhuang Shu, surprised by the "big brother" comment, mentioned he had no siblings and explained his demeanor as a professional necessity to inspire trust.
Lin Huan recounted her frequent childhood illnesses and persistent nightmares involving people in white coats and a little boy pulling her and running, calling her name. She dismissed them as mere dreams stemming from her hospital visits, but Zhuang Shu seemed relieved that she still remembered them. He revealed that his own parents died when he was young, and he was adopted by a Chinese American father at age ten.
Lin Huan noted her own good fortune in having loving adoptive parents, a stable job, and her father's survival and treatment by a renowned doctor like Zhuang Shu. A new crisis soon gripped the hospital as ten patients across various departments, including General Surgery, Thoracic Surgery, Cardiac Surgery, Urology, and the ER, developed high fevers.
Yang Fan suspected a drug-resistant bacterial infection, noting that eight of the ten cases involved lower urinary tract infections and all had used foley catheters or chest tubes. He called Tang Yunlong, a medical supplies representative with whom he frequently did business, to confirm the quality of the recently delivered foley catheters.
Tang Yunlong vehemently denied any defect, asserting his products were widely used without issue, and instead attributed the infections to the high patient density and relaxed sterilization protocols during the disaster relief efforts. Yang Fan, slightly reassured by Tang Yunlong's denials, initially attributed the infections to the high patient density and relaxed sterilization protocols during the disaster relief efforts, echoing Tang Yunlong's explanation. However, the number of infected patients continued to rise despite intensified disinfection measures.
During a hospital meeting, Zhuang Shu updated everyone on Lin Hao's deteriorating condition, explaining that his urinary tract infection had progressed to a renal abscess, affecting his heart and kidney functions, unresponsive to five different types of antibiotics. Zhuang Shu strongly suspected a drug-resistant organism infection. Fu Bowen highlighted the grim reality: if previously effective combined antibiotics failed, the mortality rate could reach 50%.
With the culture and sensitivity test results taking 9 to 12 days to confirm, such a delay in a densely populated hospital could lead to widespread infection. Yang Fan then turned to the experienced Fu Bowen, asking him to lead the effort to contain the outbreak, affirming his own ultimate responsibility as acting dean. Fu Bowen accepted, identifying retained foley catheters as the most likely source of infection, with E. coli developing resistant strains.
This realization made Yang Fan uneasy, as he was responsible for the procurement of these catheters. Fu Bowen proposed strictly monitoring ICUs, working up all seriously ill patients with invasive catheters, and rushing Lin Hao's culture results to find appropriate antibiotics. Just then, Zhuang Shu received an urgent call: Lin Hao was in critical condition.
He rushed to the ward, where he learned that Lin Hao had suffered from abnormal electrolytes, leading to arrhythmia, and had coded once already, being revived after CPR and defibrillation, but was coding again.
