Xu Qinghe did not sit down. She steadied herself and stood beside him, looking at the medical images on the screen.
All along, she had never allowed her feelings to interfere with her work, especially when she was around him.
“Is the situation complicated?” she asked, since she was not yet familiar with the case.
“Mm.” Shi Wenli handed her all of the patient’s medical records.
Xu Qinghe opened the chart. The patient was a forty-two-year-old man with a lesion in his left temporal lobe that involved the language area of the brain.
The surgery would require the patient to be awakened during the operation to make sure the language area was not accidentally damaged while the lesion was being removed, which would prevent postoperative aphasia.
Shi Wenli continued, “The patient is a mathematics teacher. He’s been very anxious these past few days because he’s afraid he won’t be able to speak after surgery and will never be able to return to teaching normally. He knows he’ll need to be awakened during the operation. I’ve already explained everything to him in detail and helped him with his anxiety. Since the surgery is tomorrow, he’ll inevitably be nervous beforehand. When you visit him later, make sure you reassure him properly.”
Xu Qinghe nodded. “Okay.”
During this kind of surgery, the risk of seizures is relatively high while the patient is awake. Preventing a seizure would therefore be one of the main priorities of tomorrow’s anesthesia management.
After confirming the anesthesia plan, Xu Qinghe picked up her folder and the images.
“I’ll go see the patient first.”
Only then did she notice the two oranges on his desk. They were probably given to him by a colleague.
Shi Wenli stood up as well.
“I’ll go with you.”
As he spoke, he handed the two oranges to her.
“Take these home and eat them later.”
“Thank you.”
Just as she always had, Xu Qinghe accepted them with a smile. She temporarily placed them on the desk before heading to the ward.
The two of them were always extremely thorough during preoperative visits. It was also one of the reasons they had so much in common to talk about.
Shi Wenli was well known around the hospital for being popular with everyone. But among his female friends, the only one he would voluntarily sit with when they happened to meet in the cafeteria was Xu Qinghe.
Over the years since he graduated, she had been the only one.
When they arrived at the ward, the patient and his family were waiting for them.
Xu Qinghe first asked, “Professor Zhang, how are you feeling now?”
Then she introduced herself.
“I’m the anesthesiologist for your surgery tomorrow. My surname is Xu.”
“Dr. Xu, hello. Director Shi already told me that I’ll need to be awakened during the operation. I’m still a little worried. Will it hurt when I wake up tomorrow?”
“You’ll be undergoing intraoperative awakening, not intraoperative awareness.”
Xu Qinghe carefully explained the difference between the two.
“Don’t worry. When we wake you during the surgery, you’ll receive adequate pain medication, so you won’t feel any pain at all. And after the operation, you won’t have much memory of being awake in the middle of it.”
The patient had already heard Shi Wenli explain that even though he would be awakened during the surgery, he would not remember anything that happened during that period after the entire operation was over.
Hearing the anesthesiologist confirm the same thing today made him feel much more at ease.
Xu Qinghe then carefully asked about his medical history and whether he had any allergies.
Because of the special nature of the intraoperative awakening, they needed to rehearse the entire procedure with the patient in advance.
She needed to position the patient’s head as it would be during surgery, so Shi Wenli naturally took the folder and images from her.
The images would be used to have the patient identify different objects. When he was awakened during surgery, they would show him the same images to confirm whether he could name them correctly.
Shi Wenli pulled out the first picture.
“What is this?”
The patient had still been somewhat nervous, but when he saw the animal in the picture, he suddenly smiled.
He remembered buying black-and-white flashcards for his daughter when she was only a few months old.
Now he felt like a child himself.
Shi Wenli explained, “Tomorrow, when we wake you during the operation, we’ll ask you what these pictures show. Just say whatever you see. You’ll also need to repeat things after us. When the doctor says something, repeat it back. I’ll also ask you to count.”
The patient asked, “How far do I have to count? Not all the way from one to a hundred, right?”
Shi Wenli replied, “From one to ten.”
“…That simple?”
His wife immediately said, “If you can say one to ten, I’ll be thanking heaven. You’re going to be awakened while having surgery and lying on an operating table. Do you really expect them to give you a math competition problem to solve?”
Everyone burst out laughing.
After finishing the visit, the two of them left the ward.
Shi Wenli glanced at the electronic clock in the hallway. It was almost eight o’clock.
“Go home early,” he told Xu Qinghe. “You’ll be busy all day again tomorrow.”
Instead of heading toward the elevator, Xu Qinghe followed him back toward his office.
Her voice was quiet.
“…I haven’t taken my orange yet.”
Shi Wenli laughed. He had almost forgotten about it.
Now that they had finished their work, they finally had some time to chat.
“Weren’t you supposed to come back next month?” Xu Qinghe asked curiously.
“The training program finished ahead of schedule.”
Xu Qinghe nodded.
“That explains it.”
Not only had he completed the program early, but he must also have received considerable recognition from the foreign hospital. Otherwise, they would not have issued the approval for him to return early.
She vaguely remembered that he was supposed to have a week of vacation after completing the program.
“Why did you come back to work today?”
Shi Wenli said, “I’m saving those five days for when Shimi gets married.”
Xu Qinghe had been so busy that she had completely forgotten about that.
Shimi was his younger sister. She was also a doctor at the hospital, working in cardiac surgery. Her wedding was scheduled for the ninth of next month.
During the year he had been abroad for training, Shimi had quickly completed one of the major milestones in life. She had gone from being single to getting married in a whirlwind, and even the wedding date had already been set.
“Will five days be enough for you to handle everything for Shimi’s wedding?”
“Things were a little rushed, but my department director gave me another two days off.”
In most families, the parents would handle the arrangements when their daughter got married.
But Shi Wenli’s family was different.
His parents had divorced when he was very young. They later remarried and started new families, leaving the two siblings in the care of their grandparents.
His grandparents passed away when they were still young, so Shi Wenli took on the responsibility of looking after his younger sister.
Xu Qinghe did not know the details of his family situation very well, but she knew that during the Spring Festival, when families normally gathered together, it was always just the two siblings spending the holiday together.
For the two of them, family meant each other.
With his sister getting married, he had essentially taken on the role of a parent, so there were certainly many things he needed to handle.
When they returned to the office, only one orange remained on the desk.
Someone must have passed by and taken the other one.
Shi Wenli smiled.
“I owe you one.”
“It’s fine. One is enough.”
Xu Qinghe casually asked, “Are you going to keep working overtime?”
“Yeah. I still have several medical records to—”
Shi Wenli glanced at the desk and realized the medical records were gone.
Ding Qihang had probably taken them back to make some additions and had casually taken an orange as well.
He smiled and said to Xu Qinghe, “You can get off work now.”
He glanced at her white coat. She still needed to return to her office and change.
“I’ll wait for you in the parking lot.”
He told her where he had parked his car.
They had not seen each other for a year, and it was rare for them to happen to finish work at the same time. Xu Qinghe actually wanted to ride home with him and talk for a while.
But she still had quite a bit of work left.
“I can’t catch a ride with you today. I need to go back to the office and finish the anesthesia records, and I still have two patients to follow up on.”
As she spoke, she held up the orange in her hand.
“Thanks.”
The first thing Xu Qinghe did after returning to her office was wash her hands and peel the orange.
Before meeting him, she had never been particularly fond of oranges.
Whether they were sour or sweet.
Early the next morning, after the shift handover, Xu Qinghe went directly to the neurosurgery hybrid operating room.
Zhang Xun followed her to assist.
After getting a good night’s sleep, he had managed to calm himself down considerably.
His hand had only trembled while drawing up the medication. It wasn’t the end of the world.
“Sister Xu, I’ll draw up the medication again today.”
Xu Qinghe smiled.
“Okay.”
This time, Zhang Xun tried his best to keep his wrist steady and avoid trembling again.
He was a little slow, but fortunately, his movements were steady throughout.
At seven-thirty, the patient was brought into the operating room.
His blood pressure upon entering was 155/88. He had no history of hypertension, and his blood pressure the previous day had been 130/75.
It was clearly caused by preoperative anxiety.
Xu Qinghe distracted him.
“Professor Zhang, I heard you’re a math teacher. Do you teach middle school or high school?”
“I teach second-year high school students, and I’m also their homeroom teacher. Now that I’m sick, I’m worried that my absence will affect my students’ grades.”
Ding Qihang, the doctor in charge of the patient, reassured him.
“It won’t affect your ability to teach them in their final year. If your recovery goes well, you probably won’t miss much of the second semester of your current year either.”
He was just about to relay something the patient’s wife had said when the patient interrupted him.
The patient said helplessly, “There are a few particularly mischievous students in my class. None of the other teachers can control them. They’re only afraid of me. If I’m not at school, who knows what kind of trouble they’ll get into?”
Ding Qihang continued, “Your wife just sent me a voice message. She specifically asked me to tell you before surgery that those students know you’re having surgery today. They asked their Chinese teacher to pass on a message. They said they’ll behave themselves at school, and when they take the college entrance examination, they’ll all get good scores to show you. They want you to have peace of mind during your surgery.”
The patient was filled with an emotion he had never experienced before.
At the most vulnerable moments in life, people were easily moved.
He smiled, but his eyes gradually became moist.
Once all the preparations were complete, Xu Qinghe began inducing anesthesia.
The operating room’s automatic door slowly opened, and Shi Wenli walked in after scrubbing his hands.
Among all the disposable blue surgical caps, Xu Qinghe’s dark-blue cap with a penguin pattern stood out the most.
When the patient saw Shi Wenli, he felt slightly more reassured.
After anesthesia was induced, the patient’s vital signs remained stable. His head was secured in the head frame, and the team began disinfecting and draping the surgical area.
The nurse helped Shi Wenli put on his surgical gown.
He looked toward Xu Qinghe.
“Dr. Xu, how was the patient’s emotional state before anesthesia?”
Xu Qinghe turned her head away from the monitor.
“Pretty good. He’s just waiting to be discharged so he can get back to school as soon as possible. He wasn’t nearly as frightened as he was last night.”
What the students had said had helped distract him from some of his fear.
After putting on his surgical gown, Shi Wenli entered the operating field.
Xu Qinghe turned her attention back to managing the patient’s circulation.
She had often been in the same operating room with him before, but at that time, she had only been the assisting anesthesiologist, and sometimes even the third anesthesiologist.
The surgery began.
Outside the operating room, every minute felt painfully long for the family members waiting in the designated area. It felt as though an entire hour had passed, but when they checked their phones, only ten minutes had gone by.
They kept checking their phones.
The screens lit up and went dark, then lit up again.
Inside the operating room, every second counted.
The patient was awakened, and his breathing remained stable without coughing or choking.
“Director Shi, the patient’s vital signs are stable. He can cooperate with the questions now.”
Shi Wenli and the neurophysiology specialist began electrical stimulation to locate the boundaries of the lesion.
Shi Wenli asked the patient, “What is your surname?”
“Zhang.”
“What’s your full name?”
The patient answered correctly.
Shi Wenli then asked him to count.
“Count from one to ten.”
Xu Qinghe had practiced this with him in the ward the night before.
The patient followed the instructions.
“One, two, three, four, fi… one…”
Shi Wenli was locating the language area at that moment.
The patient had already reached the word “five,” but suddenly his speech became confused. After saying “one,” he could not say anything else, and his face began to twitch.
“Director Shi, stop for a moment. The patient is having a seizure!”
Shi Wenli immediately stopped the electrical stimulation.
The circulating nurse quickly handed over ice-cold saline.
However, irrigating with cold saline did not have much effect. The patient continued to convulse, and the seizure began spreading.
Xu Qinghe glanced at the monitor and immediately administered medication, adjusting the depth of anesthesia.
Very soon, the patient’s seizure was brought under control.
The reason the patient had suddenly been unable to speak was that the electrical stimulation had temporarily disrupted the function of the language cortex.
The purpose of awakening the patient during surgery was to map the location of the language area so that the surgeon could avoid it while removing the lesion and ensure that the patient’s speech would not be affected after surgery.
Before the operation, the patient had constantly worried that the lesion was too large and that he might not make it off the operating table.
He was even more afraid that the surgery might affect his ability to speak.
During his hospital stay, he recorded numerous videos every day for his teenage daughter, telling her how lucky he felt that they had been father and daughter in this life.
The previous night, he had also recorded a long message for the students in his class, wishing them success in the college entrance examination a year later and a bright future.
After the seizure subsided, the patient fell asleep again.
The language area had not yet been completely mapped. Since the seizure had lasted somewhat longer than expected, it was not suitable to awaken the patient again immediately.
Shi Wenli could only pause the mapping and first remove the lesion around the outer safe area.
After nearly an hour and a half, Shi Wenli had removed most of the lesion within the safe area.
The remaining portion was directly adjacent to the language center.
If the language area were damaged during surgery, the consequences could be severe. The patient might permanently lose the ability to speak.
That was why the patient had been under such enormous psychological pressure before surgery.
As Shi Wenli approached the area near the language center, he said, “Dr. Xu, prepare to wake him again.”
“Okay.”
Xu Qinghe immediately reduced the propofol infusion while adjusting the analgesic medication.
A few minutes later, the patient woke up again.
Xu Qinghe held up a picture.
“What is this?”
After a few seconds, the patient answered, “A schoolbag.”
“And this?”
“A fountain pen.”
As Shi Wenli continued mapping the area, Xu Qinghe asked the patient again.
“What is your surname?”
“Zhang.”
“What subject do you teach at school?”
“Mathematics.”
Xu Qinghe said, “Next, repeat after me. ‘May you succeed in the college entrance examination and have a bright future.’”
The patient’s heart rate fluctuated slightly.
“May I… succeed in the college entrance examination… and have a bright future!”
It was obvious how much meaning and hope those words carried for him.
This time, the electrical stimulation did not trigger another seizure, and Shi Wenli successfully mapped the boundaries of the language area.
Once the mapping was complete, Xu Qinghe deepened the patient’s anesthesia.
The medication took effect quickly, and the patient fell deeply asleep again.
The surgery continued.
In the quiet operating room, the only sounds were the faint hum of the ultrasonic aspirator and the electrocautery equipment.
Shi Wenli remained completely focused, carefully separating the abnormal tissue bit by bit.
Xu Qinghe kept her eyes fixed on the monitor. The patient’s heart rate, blood pressure, and oxygen saturation all remained stable.
Just as the instrument in Shi Wenli’s hand reached deeper into the lesion, the patient’s heart rate suddenly dropped, followed by a decrease in blood pressure.
Xu Qinghe immediately alerted him.
“Director Shi, his heart rate is dropping. Pause for a moment!”
At the same time, she administered medication and adjusted the infusion.
Soon, the patient’s vital signs returned to stable levels.
Every time the deeper lesion was separated, it stimulated the patient.
Shi Wenli asked, “Dr. Xu, how are his vital signs?”
“His blood pressure is stable now, 115. His heart rate and oxygen saturation are both within the normal range. You can continue. No need to stop.”
This was the first time Xu Qinghe had worked alongside Shi Wenli as the primary anesthesiologist.
She precisely adjusted the depth of anesthesia throughout the operation, maintaining the patient’s intracranial pressure within the ideal range required for the surgery.
With the intracranial pressure stable and the surgical field clean and clear, Shi Wenli carefully avoided the language area and completely removed the lesion.
At 12:45 p.m., the resection was successfully completed.
Zhang Xun was recording the anesthesia details and finally breathed a sigh of relief.
He considered himself lucky.
His supervising doctor was a top anesthesiologist like Xu Qinghe, who specialized in both neurosurgical and cardiac anesthesia. Every day, he had the opportunity to participate in highly complex surgeries.
The entire operation had lasted nearly four and a half hours.
Shi Wenli left the operating room to get something to eat. He also had another surgery coming up.
Xu Qinghe, however, needed to wait for the patient to wake up so that she could perform the postoperative neurological assessment.
Before leaving, Shi Wenli said to her, “Dr. Xu, thank you for your hard work.”
Xu Qinghe smiled.
“You worked hard too, Director Shi.”
She was happy that the patient’s surgery had gone successfully.
And she was also happy that their first time working together as primary anesthesiologist and surgeon had gone so smoothly.
Shi Wenli glanced at her surgical cap.
Before he left for his training abroad, he did not remember ever seeing this particular design.
“Dr. Xu, exactly how many surgical caps do you have?”
“A lot. I have almost half a wardrobe full at home.”
“You choose one randomly every day?”
“No.”
Xu Qinghe pointed at the clogs on her feet.
“They have to match my shoes.”
“…”
Shi Wenli glanced down at her feet.
She was wearing a pair of sea-blue clogs decorated with penguins.
He could not help laughing.
“You should get back to work.”
He then left the operating room