The room usually used for lectures was now serving as the physicians' office, where all the surgical personnel selected by Qi Yue were assembled, with the exception of Coffin Boy.
Liu Pucheng would administer the anesthetic, while A Ru, Zhang Tong, and Hu San would handle the instruments, concurrently serving as second and third assistants. As for the first assistant, that role could only belong to Coffin Boy.
This operation was unlike any before; a massive thoracotomy was a profound shock to the disciples, and Coffin Boy, who was so often in the company of the dead, was the only one they could truly trust.
“But there is one crucial issue remaining,” Qi Yue stated. “That is the blood transfusion. Although we don't know the exact blood loss from this open-chest procedure, a transfusion will undoubtedly be necessary. I don't have any blood-typing paper right now, so there is only one option: autotransfusion.”
“Autotransfusion?” Liu Pucheng asked. “Is that taking one’s own blood and transfusing it back?”
“Precisely. Normally, this type of transfusion requires dilution, but the extracorporeal circulation blood recovery machine… these things…” Qi Yue trailed off with a sigh.
None of these things were available…
“Then we must take a risk. After opening the chest, I will ligate the artery, allowing his blood to flow back into the circulatory system, and then use suction to draw out the internal bleeding, reintroducing it via intravenous drip,” Qi Yue explained, sketching and scribbling on the blackboard with a piece of charcoal. “This way, we might avoid hemorrhagic shock.”
Liu Pucheng and the others did not grasp the mechanics of it.
“Little Qi, do not be afraid. As physicians, as long as our conscience is clear, we fear nothing,” he said with a faint smile.
Qi Yue nodded.
“Teacher, I am not afraid,” she replied, also smiling. “I simply wish to perform this to the absolute best of my ability.”
She finished speaking and set down the charcoal stick.
“Teacher, Little Coffin is here. Explain today’s surgery to him,” she directed.
Liu Pucheng nodded and said, “Very well.”
“Then everyone, prepare yourselves,” Qi Yue clapped her hands. “Hu San, come with me; we need to gather the tools.”
As Qi Yue and Hu San hurried out of Qianjintang, a horse-drawn cart was approaching the gates of Yongqing Prefecture.
“Is this truly the case?” the Elder Doctor An asked with a grave expression.
“Yes, Father. The rumors have spread throughout the city; it cannot be false,” replied the Younger Doctor An, unable to conceal his excitement. “That woman lacked wifely virtue; the Residence of Marquis Dingxi should have long ago…”
He did not finish his sentence before the Elder Doctor An grabbed a nearby cane and struck him with it.
“Get out! If you show disrespect to the Grand Teacher again, I will forbid you from practicing medicine!” he commanded sternly.
Grand Teacher! Although the Younger Doctor An felt resentful internally, he knew his father meant what he said, so he dared not speak further and sat out of the room.
Coffin Boy arrived just as Qi Yue was entering the doorway, and they met head-on.
“You’ve come; excellent. Hurry, we need to hold a meeting to discuss the surgery,” Qi Yue said immediately.
Coffin Boy’s gaze landed on what she held in her hands.
Chisels, saws, iron forceps, iron wire….
“Take these and boil them,” Qi Yue handed the whole collection over to the two disciples.
The two disciples, their faces pale, took the items and left.
Inside the room, the blackboard, still covered in writing, remained in place. Liu Pucheng guided Coffin Boy to examine everything sequentially, while Qi Yue picked up another piece of charcoal and began her explanation.
“…For this operation, I am employing a median sternotomy, incising the skin…” she explained, making notations on the diagram of the chest cavity, “…then sawing through the sternum from top to bottom…”
Hearing this, Hu San and the others couldn't help but gasp, covering their mouths.
“Th-that…” he stammered.
“This approach minimizes damage to the pleural cavity and offers excellent surgical exposure,” Qi Yue continued, ignoring Hu San. “Then I will explore the mediastinal thymus until I locate the hematoma, remove it, and suture the bleeding point…”
Coffin Boy stared intently at her hands, his eyes shining brightly.
He had only ever seen dead people before; finally, he had the chance to observe a living one….
Opening up a living person….
This was truly exhilarating….
“After clearing the hematoma, I will use iron wire to fix the sternum, followed by a running, full-thickness suture…” Qi Yue went on, rapidly sketching and writing on the blackboard.
Liu Pucheng and the others held their breath. The operation had not yet begun, but just hearing Qi Yue’s planned steps made the hairs on their bodies stand on end.
What kind of skill was this? Heavens, where on earth did she learn this technique!
Having finished the planned exposition and given everyone a preliminary understanding of the surgery, Qi Yue put down the charcoal stick and took a deep breath.
“Now, let us begin,” she announced.
“Yes,” Liu Pucheng and the others responded in unison.
As they spoke, they walked out of the classroom and headed toward the sterilization room. The patient’s family members, squatting in the courtyard, saw them.
“Hey! Hey!” they immediately shouted, pointing their fingers at Coffin Boy. “What is that bringer of bad luck doing here?”
Coffin Boy stopped walking.
“He is my assistant,” Qi Yue stated. “The success of this operation hinges entirely on him.”
These words made the eyes of those men widen; they couldn't process it for a moment as they watched Qi Yue lead Coffin Boy inside.
“Third Brother,” one man recovered and said to the man who seemed to be in charge, “Is this thing reliable? Everyone here seems awfully strange.”
The man addressed as Third Brother looked down at the paper in his hand—the surgical consent form Qi Yue had made him sign.
“Shuanzi, take this and find someone on the street to read what this says,” he said in a low voice.
Shuanzi agreed and took the paper, then went out. The disciples in Qianjintang were busy and paid no attention. Furthermore, the family members were required to stay away during surgery, and once it was done, they would go directly to the intensive care unit; the families were not allowed inside anyway, so their presence or absence made little difference.
Shuanzi left the door but didn't know whom to ask. However, being clever, he realized that asking near Qianjintang might lead people to collude with the establishment and withhold the truth. So, he walked directly away.
Not long after leaving East Street, he spotted a pharmacy. Since they were all practitioners of medicine, an expert should be able to understand what an expert wrote. Shuanzi stepped inside.
He grabbed a young clerk and handed him the document.
“Young man, read this for me and tell me what it says,” he requested.
The clerk saw that this man wasn't there to buy medicine or ask for a consultation and ignored him.
“I’m busy. If you need to read documents, go find a scribe on the street,” the clerk said impatiently, pointing toward the outside.
“Read it when I tell you to! Why are healers protecting each other!” Shuanzi’s patience snapped, and he glared. “Quickly, show me what this Qianjintang has written!”
The clerk flinched in fright, which also drew the attention of people nearby. A stout middle-aged man walked over and took the paper from Shuanzi’s hand.
“You say Qianjintang wrote this for you?” he inquired.
The clerk called out for the proprietor, but the middle-aged man waved him away, and the clerk quickly scurried off.
Shuanzi sized up the man, noticing his attire, and knew he was the proprietor of the pharmacy, so he nodded and explained the situation.
The middle-aged man finished reading the document, a look of surprise mixed with disdain spreading across his face.
“Truly absurd. How can they make someone sign a death waiver like this?” he said, shaking his head.
Seeing him shake his head, Shuanzi immediately panicked.
“What does it say?” he urgently asked.
“It means that they are taking charge of your relative, and whatever happens—life or death—has nothing to do with Qianjintang. How can it have nothing to do with it? If they cure the illness, it’s related; if they fail, it’s unrelated? This is truly…” The middle-aged man shook the paper, clearly displeased. He then looked at Shuanzi, noticing the brute force about him, and a faint smile played on his lips. “Is your family member being treated at Qianjintang?”
Shuanzi nodded and recounted the entire story, even mentioning what the first doctor had said.
The middle-aged man’s eyes narrowed. When he heard that Coffin Boy had also arrived, his eyes suddenly widened.
“What?” he exclaimed, but then quickly composed himself and nodded. “Indeed, indeed…”
Yet, he lapsed back into silence.
That single exclamation and his murmurs of ‘indeed’ made Shuanzi even more frantic.
“Proprietor, what is it?” he asked.
The middle-aged man shook his head and sighed, looking at Shuanzi with a touch of pity.
“Young man, go home and prepare for the funeral,” he murmured quietly.
Shuanzi stood frozen.
“But, but the doctor said there was a fair chance of success…” he protested.
The middle-aged man gave a knowing smile, glanced outside, and pulled Shuanzi closer to the corner of the wall, lowering his voice.
“Silly boy, do you know what Coffin Boy does for a living?” he whispered.
“He works at the mortuary,” Shuanzi replied.
“He does other things besides that,” the middle-aged man whispered. “This, only we physicians know: he plays with human corpses, cutting them open to examine the internal organs…”
Shuanzi’s eyes immediately flew wide open, and he choked, unable to draw a breath.
“We won’t hide this from you either. Many doctors buy bodies from him to practice their surgical skills by studying the organs,” the middle-aged man continued in a low voice. “I take you for a martial artist; do you know how martial arts skills are refined?”
Shuanzi nodded blankly.
“Practice more…” he mumbled vacantly.
“Precisely,” the middle-aged man patted his shoulder, his gaze filled with sympathy and sorrow. “If the people at Qianjintang can open a chest, how do you think they achieved that level of practice?”
Shuanzi stood stock-still for a moment, then let out a long howl and bolted out the door.
This howl startled the middle-aged man momentarily, but he quickly recovered, a look of pleased amusement replacing his solemnity.
He reached into his sleeve, pulled out a letter, shook it slightly, and then tucked it back with a hint of triumph.
“Looks like there’s a show to watch,” he muttered to himself, then began humming a cheerful tune and sauntered away.
Meanwhile, inside Qianjintang, the surgical team, having finished sterilizing, entered the operating room.
This was the second time they had stepped inside, but the tension remained palpable. After all, the last procedure involved only the mouth and nose of a child; this time it was an adult, and the chest cavity at that. Just looking at the hammers, scissors, and saws arrayed on the stand was enough to instill fear.
“Anesthesia complete,” Liu Pucheng announced.
Qi Yue nodded and moved to her position. Seeing her ready, Coffin Boy also took his place. He had already been briefed on his role during the previous procedure. A Ru wheeled the instrument table over, while Zhang Tong and Hu San spread out the drapes and secured them with clamps.
“We are proceeding with emergency thoracotomy. Prepare for sternal splitting,” Qi Yue commanded, extending her hand.
A Ru placed the scalpel precisely into her grasp.
Qi Yue took the blade, made a transverse incision from the center of the sternum up to the left clavicle, and blood slowly began to seep out. Coffin Boy picked up gauze to wipe the area.
The only sound in the operating room was the sound of ragged breathing.
Outside, the disciples observed. When they saw Qi Yue pick up the saw and begin cutting into the patient’s chest, every one of them closed their eyes, the timid ones clutching their hands over their mouths to stifle any sound.
Hu San and Zhang Tong, standing nearby, were clearly at their breaking point. One could barely manage to retract tissue while the other’s hands and feet trembled; the lettering on the surgical record paper continually warped.
“Blood is being collected,” Liu Pucheng said, taking the blood flowing from the siphon. A Ru received the porcelain bottle and placed it on the stand, next to the prepared syringes, needles, and the tubing—originally a single piece, now three plastic lines.
“The mediastinal tension is very high…” Qi Yue noted, ensuring Hu San recorded it.
Coffin Boy watched the opened chest cavity with intense concentration.
“There’s congestion here!” he called out.
Qi Yue nodded.
“This is the thymus, and this is the mediastinum… the hematoma extends down from the superior mediastinum…” Qi Yue said, probing with her hands one by one. “…involving the pericardial pleura on both sides… this is the left innominate vein… posterior side…”
She stopped abruptly mid-sentence.
“Found it! The hematoma is here!” she exclaimed with delight, extending her hand. “Now, we cut, incise the fibrous capsule, and eliminate the blood clots…”
A Ru handed her the surgical knife. Qi Yue inserted it, and at that moment, blood erupted violently—a brilliant, blinding crimson that instantly filled their vision.
“Ah!”
A cry of alarm rose in the room, and even Coffin Boy, standing close by, let out an involuntary gasp.
It was not venous bleeding—it was arterial!
Qi Yue’s mind instantly went blank, the hairs on her body stood erect, and a cold sweat broke out on her back.
(I will request votes when posting updates… RS)