Chapter 161 - 0155: The Last Time

Yang Ping didn’t even have time to eat, he immediately rushed to the Overseas Chinese Building. Director Kong led Yang Ping to the emergency ward, which was already crowded with people.

There has been upper gastrointestinal bleeding, and his hemoglobin level is only 45g/l. Since he is on an artificial liver and magic lung, and continues anticoagulation, it is now massive bleeding. Relying solely on the human body’s own coagulation function, stopping the bleeding is simply impossible. So conservative treatment probably won’t work, he must stop the bleeding through gastroscopy.

Mr. Ning is already being transfused with blood. Director Gan of the gastroenterology department, along with the doctors, nurses, and anesthesiologists, has pushed the endoscopy equipment to the bedside, preparing to perform bedside endoscopy for hemostasis.

Life is fragile, yet it is so persistent. The matter of life, sometimes, is kind of unpredictable.

With such low hemoglobin levels, Mr. Ning is surprisingly conscious, but his face extremely pale, his forehead sweating, all shiny. He lies on one side, his body slightly writhing. One of his hands is held tightly by Miss Ning, and the other hand is gripping the bedsheets hard. He is doing his last resistance himself.

The anesthesiologist wanted to use propofol for general anesthesia, but he refused.

“What time is the flight? Qiqi!” Mr. Ning is very weak and seems to pass out at any moment.

“The flight was at 15:55 yesterday afternoon, Canada time. It should arrive at Nandu Airport at 21:30 tonight, and here around 11 o’clock.” Miss Ning helped her father wipe the sweat off his forehead, which was very greasy.

“I don’t think I can hold on much longer. I know I won’t make it this time! Please help me! Can you help me hold on until tonight? I’m really scared that I won’t wake up after the anesthesia. It will be a great help, Doctor Yang, could you stay aside?” Seeing Yang Ping, Mr. Ning grabbed Yang Ping’s hand.

Every time, Yang Ping was able to pull him back from the brink of death. In his heart, Yang Ping is a god who can guard the flame of life, allowing it to burn a little longer.

“Don’t worry, I’ll stay here!” Yang Ping slapped Mr. Ning’s back of hand with his other hand.

“We can’t skip anesthesia, it’s too painful.”

Director Gan, with his assistant, has put on a disposable sterile suit, a sterile hat, mask, and sterile gloves, quickly preparing the instruments by smearing lubricating oil on the lens.

“I can do it!” Mr. Ning was stubborn.

Tears welled up in Miss Ning’s eyes, seeming this time it was really a goodbye. She suddenly grabbed Yang Ping’s hand: “Doctor Yang, could you please figure out a way.”

She wanted to let her father see his son one last time, to untie her father’s knot of ten years, to fulfill his last wish, so he could leave this world without any regret.

She realized that she was too excited, lost her composure, and immediately let go. Yang Ping nodded his head: “Don’t worry, I’ll figure out a way! Director Gan, don’t use anesthesia. Let’s get started. He can do it.”

What kind of solutions could he find? It’s all about giving him a glimmer of hope, a little comfort in his final moments.

Mr. Ning nodded his head. He lay on his side. His colleagues in the endoscopy room moved swiftly and skillfully. The nurse has laid down a disposable sterile sheet and sat next to him, supporting Mr. Ning’s head.

“Open your mouth!”

Once Mr. Ning opened his mouth, Director Gan skillfully put in the endoscope. The endoscope, like a snake, instantly went deep into his throat, sucked away some phlegm, then went into the esophagus. Probably because of the air stimulus, peristalsis occurred in the esophagus. Director Gan didn’t even wait for the wave of peristalsis to pass, he directly and skillfully pushed the endoscope in, all the way into the stomach.

“This kind of emergency gastroscope, carries a huge risk, especially under no anesthesia, the irritations of gastroscope can cause vomiting, vomiting can cause aspiration!” Director Gan said as he was performing the procedure.

“Don’t worry, his lungs are virtually inactive now, it is being replaced by the magic lung, carry on.” Yang Ping was on the side watching the screen. He, too, had put on a sterile suit, a hat, a mask, and gloves.

Miss Ning also encouraged Director Gan: “We have signed the informed consent form, we are willing to bear any consequences.”

“Can the family member please step outside?” Director Gan heard Miss Ning’s voice and realized there was still a family member in there.

Miss Ning was reluctant to let go, but Yang Ping said, “Let her stay!”

Director Kong had already greeted Director Gan. For this patient, what mattered most was that Yang Ping was present. Any treatment would be much more effective whenever Yang Ping was around.

Director Gan didn’t say anything and continued the endoscope procedure.

“You see the source of the bleeding. It should be a rupture of esophageal varices at the stomach base caused by portal hypertension. Look, there is blood everywhere, still flowing. Very fierce. If we can’t stop it, transfusion is useless. The coagulation factors are consumed quickly, causing disseminated intravascular coagulation which is even more dangerous.” Director Gan showed Yang Ping the screen.

The stomach shown on the screen is full of surging blood. They can’t keep up with suction. It sucks the blood away, more flares up.

“Such a fierce bleeding from esophageal varices at the stomach base, it’s quite rare.” Director Gan was calm and collected. His experience told.

“Ice saline water, wash it with adrenaline!”

The assistant had already prepared. The ice saline water went into the stomach through the forceps channel, which is the instrument channel, normally it could contract the blood vessels. But now it doesn’t seem too effective, same as before.

“Still blind to the bleeding spot. I can’t find the source of the blood.” Director Gan’s operation was very skillful, but under these circumstances, indeed it is hard to find.

“Electrocoagulate for hemostasis. The only thing we can do now is to electrocoagulated at the rough position of anatomy.”

The special cautery for gastroscopy went into the stomach through the instrument channel smoothly, arrived at the base of the stomach. Relying on his rich experience, Director Gan electrocoagulated a few spots at the possible bleeding locations.

Emergency medicine has its own way of thinking. Director Gan had encountered situations like this before. He knew what to do.

After a few electrocoagulations, it seemed a bit better. But instantly, it went back to its original state. Still no use.

“Titanium clip hemostasis!”

This was the last resort, also the most effective. Directly send the titanium clips into the stomach, clamp it to the bleeding spot.

“If that doesn’t work, I’ll send a few more clips into it. Hopefully, it can clamp it and stop the bleeding. Saving his life first is the priority. What’s his blood pressure now?” Having his left hand placed on the operating end of the scope and his right hand holding the applicator’s handle, Director Gan sent the titanium clip into the stomach through the instrument channel.

“82/40mmHg!” Although not under anesthesia, but the anesthesiologist was responsible for the monitoring.

In the room, only the sound of the machine was heard, beep beep.

Estimating the approximate location of the bleeding, one titanium clip clamped it, one squeeze, the titanium clip was in place, the applicator was pulled out.

“Continue, give me another one.” Director Gan was very stable and composed in the face of danger.

The bleeding persisted, even after Director Gan had placed three titanium clips consecutively. It was not working.

“What’s going on today?” Director Gan’s confidence wavered.

That’s how it is with doctors. When their last resort fails to produce the anticipated outcome, their confidence naturally suffers.

Yang Ping was not a specialist in gastroscopy and thus hesitated to interfere. Yet he noted commonalities in the procedure he observed. Every time the blood was suctioned away, he could discern the spot of hemorrhage, demonstrating the keenness honed through his systemic examination training.

“Look, that’s the bleeding point!” Yang Ping pointed it out.

“Where? I can’t see clearly!” Director Gan followed where Yang Ping was pointing.

“May I try?” Yang Ping proposed.

The proposal was somewhat unconventional but unavoidable. He believed he could stem the bleeding. Where the others couldn’t discern clearly, he could.

Director Gan turned to give Yang Ping a look. Being a reasonable man himself, he figured it wouldn’t hurt to let Yang Ping have a go, especially since they had run out of options. His motto was to treat a dying horse like a living horse-doctor. If they weren’t getting anywhere, why not let someone else try? Yang Ping was a respected and trusted doctor – a surgeon. He clearly had experience and confidence in performing gastroscopies. Having him involved would help distribute the risk at hand.

“Come on, Doctor Yang. Give it a try.” Director Gan made room for him.

Yang Ping took the gastroscopy equipment from him. After fiddling with the instruments to familiarize himself with them, he quickly got the hang of it. There were similarities between arthroscopy and gastroscopy; both required disconnected hand-eye operations.

The systematic long-term training not only enhanced Yang Ping’s skills but also helped elevate his innate abilities. His confidence wasn’t blind; he really picked it up quickly.

“Remove the blood. Keep removing the blood!” Director Gan directed from the sidelines. He wanted to make a graceful exit – if Yang Ping succeeded where he failed, these instructions would show that he could still share the credit. For him, it was a matter of saving face.

In the short period when the blood had been suctioned out, Yang Ping immediately clamped the bleeding point. Just one attempt, and he swiftly nailed it. Once the accumulated blood was suctioned out, the bleeding ceased.

He fixed a titanium clip in place, removed the holding device, and solved the problem with a single clip.

“No more bleeding! Doctor Yang, your skills are truly miraculous. Undoubtedly, you are the one who performed the five-segment replantation.” Director Gan was forthright in his praise.

“Where, where. I’m just having some good luck these days. That’s why I wanted to give it a try. Without Director Gan’s guidance, I wouldn’t have been able to do this.” Yang Ping modestly replied, giving Director Gan a face-saving exit.

“Well, there’s that!” Said Director Gan, readily seizing upon the offered respect.

“Take a blood sample, quickly test for complete blood count and DIC panel, and monitor dynamically, every hour.” Director Gan issued the verbal order, which the nurses immediately executed.

Miss Ning wiped away her tears, “Has the bleeding stopped?”

“Yes, it has.” Yang Ping handed over the equipment to Director Gan.

After washing with an ice salt solution, Director Gan performed a thorough check, no other spots of hemorrhage to be found. He suctioned out the gas from the stomach, put in a gastric tube, then withdrew the scope.

Mr. Ning had been grappling with nausea throughout, once the scope was removed, he promptly vomited. Mixed with the blood was saline solution; this mess covered the bed and floor.

The nurses were already accustomed to this and promptly cleaned up the mess. The deft orderly nearby hastened to help.

After Director Gan’s assistant tidied up the equipment and machine, and retreated, the nurses busied themselves cleaning up the waste. The janitorial staff mopped the floor first with a wet mop, then with a dry mop. With the exception of the attending physician and the critical illness management team, everyone else exited the room.

Mr. Ning seemed to want to say something, but due to the taxing ordeal of vomiting and the uncomfortable gastroscopy, he was too overwhelmed to articulate anything momentarily. He just pointed at Yang Ping.

Miss Ning quickly fell in step with Yang Ping, “Doctor Yang, could you please wait a moment?”

Yang Ping paused, “Director Kong, I’ll stay for a while.”

Miss Ning felt a pang of guilt for always imposing on him, “Sorry, Doctor Yang. It seems that my father wants to speak with you.”

This time again, Doctor Yang had helped him through a critical juncture. Both Mr. Ning and Miss Ning had noticed this, and it had touched their hearts.

Yang Ping went to the bedside. At a time like this, he would halt for any patient. In his eyes, there were no billionaires– only patients.

Mr. Ning pointed downward.

“Please sit!” Miss Ning moved a chair over.

Yang Ping sat down. What Mr. Ning needed right now was comfort. At the brink of life, people often desire something for solace. Some turn to God, while Mr. Ning turned to Yang Ping.

“Can you stay with me?” Mr. Ning finally managed to utter this sentence. The next one seemed a long time coming.

Yang Ping nodded, “I will stay right here. Don’t worry.”

Mr. Ning slightly nodded, a smile eerily present on his face.

Miss Ning felt awkward at imposing on a doctor to keep watch. However, seeing her father’s satisfied smile, she said, “Doctor Yang, I apologize for troubling you.”

“No problem! I’ll just stay here.”

Yang Ping knew that the massive blood loss and subsequent blood transfusion would soon likely result in disseminated intravascular coagulation. He wouldn’t survive the night.

Indeed, he wouldn’t make it through this time. What reason could there be to deny a dying man’s simple request?

“What time is it?”

“It’s a little past noon.”

“That’s still quite a long time.”

Mr. Ning squinted his eyes and lay down.