(Thanks to Feng Xingzhu1, Book Friend 20201004112007590, bunkerchina, hlp, and Yiben Zheng Face for the monthly ticket encouragement)

"Tell me about the admission process."

As he put on his white coat and headed out, Liu Banxia said.

"The patient is a 43-year-old male. He drank quite a bit of alcohol in the evening and came home around 9:30 PM, feeling some pain at that time," Su Wenhao said.

"He couldn't hold on any longer, so he came to the hospital. It is now 3:15 AM, and the blood test results confirm pancreatitis. Imaging results suggest it may have developed into hemorrhagic necrotizing type."

Liu Banxia nodded. It seemed genuinely troublesome, but he still needed to see the relevant examination results.

Outside, the patient lay on the bed groaning in pain, with family members anxiously waiting by his side, while Liu Banxia directly examined the test reports.

After reading them, he performed a manual examination on the patient, who now exhibited symptoms of abdominal stiffening.

"Has he had chronic pancreatitis before?" Liu Banxia asked.

"He used to have occasional stomach aches, and it would pass after the pain subsided. Doctor, can you give him some painkillers first? Is it serious?" the patient's wife asked.

"It's no longer just a serious issue; acute peritonitis might have already set in," Liu Banxia said.

"His previous pains indicate a history of pancreatitis, though it wasn't severe back then. Does he often drink alcohol, or does he frequently have irregular meals, eating a lot when there's time?"

The patient's wife nodded.

"Su Wenhao, explain it to them. Surgical intervention is needed. I'll contact the director; this surgery is too major. Liu Yiqing, notify the operating room to prepare," Liu Banxia said.

Regardless of whether the pancreas has progressed to a necrotizing type, even just acute peritonitis is not easy to handle.

Combining the description from the patient's family with the current symptoms, he was confident in Su Wenhao's assessment; the pancreas could not be saved.

Explaining to the patient's family was naturally Su Wenhao's responsibility. As the admitting doctor, he needed training in this area and couldn't pass it on to others.

His words terrified the patient's family, who thought it was just stomach pain from drinking, not expecting surgery would be necessary.

Liu Banxia stepped aside and directly took out his phone to call Zhou Shuwen.

"Banxia, is there an emergency?" After a few rings, Zhou Shuwen answered the call.

"Director, we just admitted a patient with acute pancreatitis. There's also a trend of acute peritonitis, suspected to be hemorrhagic necrotizing pancreatitis; does it require surgical removal?" Liu Banxia asked.

"You guys go ahead and explore on the table. I'm heading to the hospital now. If I haven't arrived and there's necrosis in the pancreas, then you will be the lead surgeon," Zhou Shuwen said before hanging up.

Putting the phone back in his pocket, Liu Banxia rubbed his face.

This surgery had a high difficulty level, and he didn't expect Zhou Shuwen to have such confidence in his abilities.

This was more challenging than the pancreaticoduodenectomy Wang Mingxing had once undergone, as it encompassed this operation and a distal pancreatectomy.

"Did you explain clearly?" Back in the room, Liu Banxia asked.

"Teacher Liu, they still want to pursue conservative treatment," Su Wenhao said with a bitter smile.

Liu Banxia looked at the patient, "We also want to opt for conservative treatment, but your abdominal muscles are stiffening, and there are symptoms of acute peritonitis."

"From the examination, we can confirm there is an issue with the pancreas. With your current acute peritonitis, if we don't handle it now, you might not make it through tonight."

"Although our principle is to observe the pancreas's actual condition once the abdomen is open, I can now diagnose that this pancreas cannot be saved."

"If necrosis is only confined to the head of the pancreas, the surgery would be less challenging. But from the films, there is diffuse enlargement of the entire pancreas with an irregular shape."

"The surgery is highly risky, and many postoperative complications could occur. Even if the surgery is successful, he will need insulin to regulate and manage sugar in the body."

"However, given his situation, surgical intervention is the only means to save his life. Simply put, without surgery, there will be no chance. It could be before dawn or at most until morning."

At this time, he couldn't afford to hold back; everything needed to be explained.

Anyone would resist the idea of such a major surgery, as patients generally believe any inflammation, as long as it's not cancer, can be treated conservatively.

After Liu Banxia finished speaking, he instructed Su Wenhao to continue persuading them and then called Wei Yuan.

"My God, such a major surgery, when will the director arrive?" After listening, Wei Yuan was also taken aback.

"The director is on his way, but he asked us to start with the exploratory laparotomy and related preparations," Liu Banxia said.

"Alright, you take the lead, I'll be your first assistant," Wei Yuan nodded.

"Call everyone else too. Such major surgeries are rare. It gives them an opportunity to observe. Wasn't your first major surgery also a pancreaticoduodenectomy?"

"Sigh... This patient needs a total pancreatectomy. From what the director said, it seems he wants to supervise me doing it." Liu Banxia said with a wry smile.

Wei Yuan glanced at him in surprise, patting him firmly on the shoulder, "The director trusts you so much, what do you have to worry about? Go ahead, I can also learn by following along."

It's the time when people are the most sleepy. The interns and residents were a bit dazed when they were called up, but upon hearing they could observe such a major surgery, they all became highly spirited.

"Everyone, stay sharp. It's a rare learning opportunity. If I didn't have to stay below, I'd want to go in with you to watch," Qi Wentai said.

"Teacher Liu, the patient has agreed and signed the consent," At this moment Su Wenhao ran over.

"Good, let's go straight to the operating table, and send a copy of the relevant materials to the operating room. Are there any additional family medical histories?" Liu Banxia asked.

"No, I've repeatedly asked, just some high blood pressure, possibly caused by frequent drinking," Su Wenhao replied.

"Alright, take the patient for preoperative preparation, I'll head directly to the operating room and wait there," Liu Banxia nodded.

He needs to stay tense because this surgery is really big and highly risky. If it turns out as he thought, when Zhou Shuwen arrives, he would be there as a supervisor, thus the heavy responsibility of the surgery would fall on his shoulders.

It's not easy at all, as one of the most perilous surgeries in general surgery, merely knowing how to do it isn't enough.

He felt quite emotional inside; it was initially due to his performance as an assistant during a pancreaticoduodenectomy that caught Zhou Shuwen's attention. Now, coming full circle to a total pancreatectomy, he wonders if he can perform this surgery beautifully.

Entering the operating room, he scrubbed his hands extra carefully. In his mind, he has already defined this surgery as a milestone surgery.

Even though organ transplants have a high difficulty coefficient, this surgery in Liu Banxia's view is even more challenging.

As long as the technique is precise during an organ transplant, the primary concerns are postoperative rejection and related complications. But this surgery? It involves too many organs and poses significant harm to the patient.

Furthermore, the patient's pancreatitis has been prolonged, presenting symptoms of acute peritonitis. Physically speaking, the patient's condition is already quite poor.

After scrubbing his hands properly, upon entering the operating room, Liu Banxia was a bit surprised to find a group of people already in the operating room's observation deck.

They were all surgeons from other departments of the emergency center, who seemed to have just received the news and came over to observe.

"Not bad, Director Liu, keep it up," Wang Lei said as he walked into the operating room.

"The situation is quite complex, I'll leave the patient to you," Liu Banxia said.

"I can only say I will do my best. I just took a quick look; it's still manageable. If they had come two to three hours earlier, maybe it would have been better," Wang Lei said.

"Sigh... People always procrastinate with illnesses, and if they get sick at night, they think about sleeping it off first. If the pain persists, only then will they see someone during the day," Wei Yuan said.

"Binge eating and heavy drinking are really not advisable. It's better to learn from Banxia—eat smaller meals more frequently. This way, the pancreas can be well-trained, preventing it from overworking in a short period and burdening the body."

"Initially, I was a bit sleepy, but now I'm wide awake. Director Liu, we're counting on you. How much I can learn depends on tonight—no, it's already well past midnight."

"We'll see. I don't even know the state of the patient's pancreas after we open up. I have some confidence with the pancreaticoduodenectomy, but for the total pancreatectomy, we must proceed with caution," Liu Banxia said. 𝒇𝓻𝓮𝓮𝙬𝙚𝒃𝒏𝓸𝙫𝒆𝙡.𝓬𝓸𝒎

This remark sounded a bit reluctant, but no one in the operating room would think so.

That's because they all know how risky this surgery is. Performing surgery for acute hemorrhagic necrotizing pancreatitis complicated by acute peritonitis, is it really that straightforward?

Moreover, it's still unknown how much pancreatic fluid has leaked out, which, if substantial, could also cause some degree of damage to the surrounding organs.

The basic difficulty of this surgery is already very high, and there might be additional complications that may arise, compounding to escalate the difficulty of the surgery linearly.

Otherwise, why would Liu Banxia think of this as a milestone surgery? It's because if he successfully completes it independently, it would be enough to demonstrate his proficiency in surgical techniques to the outside world.

If that happens, the issue of raising his surgical privileges at the emergency center would naturally make sense. Presumably, Zhou Shuwen also has such notions, so he hinted during their call.

Zhou Shuwen is certain to come, but whether he takes over the scalpel depends on Liu Banxia's performance.