Evening Stars Chapter 21 (Part 2)
Content Note: This chapter contains a graphic description of a surgical procedure following a traumatic injury.
Translated by Q the Panda (ko-fi)
Chapter 21.2
Yang Gao was anxious now and grabbed Fang Shiyou. “Wait, are you sure you want to operate here? What if something goes wrong? We don't even have an anesthesiologist.”
“I don't know if operating here will cause problems, but I know he will definitely die on the way back to the county hospital,” Fang Shiyou said firmly.
Yang Gao clicked his tongue. “Why are you being so stubborn?!”
“Don't you have a judgment?” Fang Shiyou asked. “The pleural adhesion is visually less than two centimeters away from the heart. Think about the road to the county. Unless they bring a helicopter, it's impossible.”
“Even so—” Yang Gao worriedly glanced at Xu Nanheng, then lowered his voice. “Even so, we'd be following regulations. If he dies under your hands, you won't be going back to Beijing. You'll be stuck here as a Tibetan doctor!”
Xu Nanheng roughly understood the situation. It all came down to the most basic issue of liability. To wait for rescue when proper facilities weren't available was reasonable and compliant with regulations.
But for Fang Shiyou, that meant standing by and watching someone die, and he couldn't do that.
“Teacher Xu,” Fang Shiyou said, looking at him.
“Mm,” Xu Nanheng nodded.
“Could you please drive your car along the mountain road toward the county? If you meet 120 along the way, stop them and have their doctors get in your car. Bring them here. The ambulance can't move fast on this road.”
Fang Shiyou added, “But be careful.”
“Got it!” Xu Nanheng nodded, patted his pocket where the car keys were, and ran out of the hospital.
Fang Shiyou adjusted his breathing. “Dr. Yang, I'll be the lead. You assist. You make the calls, and I'll head to the radiology department to look at the patient's scans.”
On the other side, Xu Nanheng swiftly climbed into the vehicle. Without even waiting for the engine to warm up, he put it into gear and set off on a cold start. It was a Mercedes-Benz G63. As the cold engine was suddenly met with a heavy press of the accelerator, it didn't shudder. Instead, it seemed to come alive with excitement. It was as if it sensed its driver's intent, like a half-asleep, sweating warhorse suddenly ignited with fervor upon learning it was about to do something extraordinary.
The pitch-black SUV drove out of the hospital and onto the mountain road toward the county.
Emotions often get eclipsed by greater concerns. That was exactly what Xu Nanheng felt now. All the teaching frustrations and inner struggles had vanished. In the face of life and death, everything else seemed insignificant.
He drove along the mountain road. Not only was it unpaved, but due to frequent landslides, drivers who regularly used this route always kept a shovel in their cars to clear minor debris themselves. As a result, the road was littered with scattered gravel piles, left behind by those who thought, ‘As long as my vehicle can get through, that's good enough.’
But the G-Wagon was different. This car was tall, not just the cabin, but the chassis.
Its cabin was almost cramped, especially its atrocious rear-seat space. This was why people in the know would say, ‘Even a dog wouldn't sit in the back of a G-Wagon.’
As Xu Nanheng had mentioned not long ago, Mercedes-Benz built the G-Wagon with military use in mind. Holding the wheel, the car wobbled over the uneven road, like a drink that had been shaken before being served.
Xu Nanheng's driving skills were solid. Being a rich kid, he had ridden a small motorcycle in England when he was seven or eight. He kept his foot on the accelerator and had his hazard lights on to make himself highly visible. The mountain road was narrow, so he had to drive cautiously.
Subtly, he felt as if he and Fang Shiyou were saving someone together, facing a life-and-death situation side by side.
And he knew that Fang Shiyou was also confronting a dilemma, much like his own. He wasn't sure if he had made the right decision, and neither was Fang Shiyou.
Xu Nanheng clearly understood that if he didn't give the students a heavier workload, it would be extremely difficult for them to pass the exams and get out.
Fang Shiyou also understood that he shouldn't rashly operate on a critically ill patient when objective conditions did not allow for it and an ambulance was already on the way.
But if Xu Nanheng didn't push his students, they might spend the rest of their lives stuck on this mountain.
And if Fang Shiyou didn't act, the patient would slowly die before his eyes.
The mountains of Southern Tibet surrounded him. On the winding uphill road to the county, Xu Nanheng drove around a blind curve. Another mountain came into view under the evening stars, like a giant Buddha gazing down at him.
Because it was a bend, he honked and flashed his lights.
Soon, he saw an ambulance ahead with its emergency lights on. Xu Nanheng immediately continued honking and flashed his high beams a few times.
The ambulance stopped. The nurse at the small hospital had already called ahead to explain the situation. Four people in white coats jumped out quickly. Since they were carrying bags that likely contained medical supplies, Xu Nanheng made a U-turn and got out to open the doors and trunk for them.
“Hurry!” one man shouted. “Lulu, you go in the front. We'll squeeze in the back!”
The female doctor called Lulu quickly went to the passenger seat. Once seated, she pulled on her seatbelt. Xu Nanheng wasted no time. He jumped back into the driver's seat, fastened his belt, and floored it.
The four doctors immediately called the small hospital to report they were in the car. There were no greetings or small talk. They kept the conversation on speakerphone so all doctors could hear updates on the patient's current status.
“The fire department has already sawed off the exposed parts of the rebar. Muscle relaxants have been administered. Currently, there is no pneumothorax, but the upper lobe of the left lung is very tightly adhered to the pleura.”
Lulu in the passenger seat turned and asked, “Should we extend the incision?”
The nurse replied, “Yes. Dr. Fang is still separating the tissue. A piece of the rebar's outer membrane is clamped in the tissue. The patient's heart rate is 131. Did you bring blood? We're running low.”
“Yes, we brought it, we brought it,” another doctor said. “Who's handling anesthesia on your end?”
“……” The nurse was silent for a moment. “Me.”
“……” The car fell silent.
But everyone remained calm. The pause lasted only a moment before one of the doctors spoke. “Okay, it's fine. Check if there are any bleeding blisters at the puncture site.”
The nurse leaned in slightly, peering inside. “There are.”
Then the nurse added, “Blood pressure and oxygen saturation are dropping, and the patient's respiratory circulation is unstable.”
The doctor in the passenger seat asked Xu Nanheng, “Can you go any faster? The ambulance was too slow on the way here. We lost a lot of time.”
“No problem.” Xu Nanheng licked his lips. His memory was quite excellent. He had just driven this road and was now returning along the same route. Physically, he knew it like the back of his hand.
Xu Nanheng drove to the county hospital at the fastest speed he could manage. The massive Mercedes-Benz G-Wagon SUV practically charged through the hospital gate, stopping with its front bumper nearly touching the steps of the outpatient hall.
The doctors instantly unbuckled their seatbelts and sprang out of the car. Xu Nanheng went to open the trunk and helped them carry their bags inside. A nurse immediately came out and led the doctors to scrub in. Since the sink didn't have foot-pedal faucets, the nurse had to turn the water on for them before going to open the emergency room door.
At this point, Xu Nanheng had done all he could.
He exhaled and found a random spot in the outpatient hall to sit.
He looked at the tightly closed emergency room door and suddenly felt that the world was governed by an unseen, predestined order. For instance, the rumor at his Beijing school, about a rich kid who had easily passed the volunteer teaching assessment, was what led him to forgo a plane ticket and instead drive over 3,000 kilometers from Beijing all the way here.
That was why he was able to cross paths with Fang Shiyou on National Highway 109. That was why they had become friends. And that was why he was able to make this emergency trip on the dark mountain road to bring these doctors to save a life.
Not one of these links could have been wrong. The world really was remarkable. Xu Nanheng lowered his head and smiled faintly.
About six or seven minutes later, the ambulance arrived and stopped in the courtyard. Three minutes after that, the patient's family, having been notified, had hurried over.
A woman held two children by the hand, followed by three elderly people, all with faces streaked with tears. As they entered, the workers who had brought the patient quickly stood up, speaking something in Tibetan.
They were all tunnel construction workers. This was exactly what Principal Sonam wanted Xu Nanheng to understand.
It was similar to the situation of his students at their homes. Their parents worked in other places or on construction sites, leaving them to care for the elderly and younger siblings at home. Just like today, even this late, work continued on the construction site.
In the emergency room, the aid doctors had brought blood bags. After the transfusion, they helped Fang Shiyou continue the surgery, and the anesthesiologist took over anesthesia.
Fang Shiyou's side experienced some bleeding. Without a suction device, he relied entirely on gauze, and the view was poor. Fortunately, it was manageable for him.
“Thread.”
The scrub nurse handed it over, and he began suturing. Without a surgical lamp, the other two nurses were using their phones, wrapped in plastic film, for illumination.
One doctor came over, helped locate another bleeding point, and said, “Give two units of suspended red blood cells.”
The anesthesiologist came by to check, and with one look, the experienced doctor knew it was not critical.
After the rebar was removed, further treatment was necessary, but the small hospital lacked sufficient medication and equipment. About an hour later, the emergency room door opened. The patient was pushed out on the bed. The workers and family members stood up simultaneously, anxiously asking about his condition.
A nurse who spoke Tibetan quickly and simply reassured the family that the patient was fine now. Fang Shiyou looked visibly relieved, shook hands briefly with the doctors from the county hospital, and the patient was wheeled into the ambulance, followed by the family.
The entire process felt very unreal to Xu Nanheng.
It wasn't until Fang Shiyou, looking a bit disheveled, stood in front of him that he felt a sense of solid ground beneath his feet.
“You've worked hard,” Xu Nanheng said.
Fang Shiyou forced a smile. “It's fine.”
Emergency surgeries were common in Beijing, but the conditions in Beijing hospitals were far superior, with far fewer worries. The two of them were silent for a moment. Then Yang Gao took off his surgical gown, walked over, and let out a heavy sigh.
Yang Gao: “It's okay now. His vital signs have stabilized. Don't get me wrong, Fang Shiyou, I know you wanted to save him, but…… this fucking place……”
He gestured at the makeshift emergency room. “Think twice next time.”
After saying that, Yang Gao left, probably to the doctors' lounge. Xu Nanheng looked up at him. “Will you be investigated?”
“If……” Fang Shiyou licked his lips. “If the patient has any subsequent complications, then there will be an investigation.”
“Didn't you say his vitals were stable?” Xu Nanheng asked, noticing the thin sweat on the lower half of Fang Shiyou's face under the mask.
Fang Shiyou nodded. They had both been standing, but he sat down next to Xu Nanheng, resting his wrists on his knees. He said, “A rebar pierced his chest. This patient has had prior surgery on the left lung. I don't know the current state of his lungs. I don't even know if he was fit for this surgery. There could be infection, inflammation…… any complications later could be my responsibility.”
Xu Nanheng sat down too and looked at him. “Nonsense. If you hadn't removed the rebar today, he wouldn't have survived.”
Hearing this, Fang Shiyou let out a brief laugh, then lifted his gaze and turned his head to look at him. “But things are rarely black and white, are they?”
Xu Nanheng tensed. Yes.
It was precisely because the world wasn't simply black or white that the human society had developed a complete system of rules, like a massive ‘User Manual,’ clearly outlining how to respond in different situations.
But the ‘User Manual’ wasn't the ‘standard answer.’ If Fang Shiyou had followed it today, he would have just sat there, waiting for the county hospital's ambulance to arrive and take the patient with the rebar still in his left chest away. And that would have been that.
Instead, he sterilized the emergency room and performed surgery on the patient recklessly, like a field doctor in a war zone.