Chapter 2227 - Who Goes First

"You're up now—what's the rush!" Chen Ruihe was not intimidated; he fired right back.

"I'm ordering you one more time—shut your mouth! What are you blathering about!" The officer addressed as "Squadron Commander" was none other than You Ciren. His face was dark as he barked at his subordinate, then turned back to Chen Ruihe with a softened expression. "Young doctor, I'm terribly sorry. This is our vice squadron commander. Normally his temper is fine—he's never like this. It's just that we've had a lot of wounded brothers today. Even I got hit. He's anxious..."

Chen Ruihe could hardly say much to that. He spread out the registration form. "Then let me take a quick look at you first. Treatment may have to wait, though—that last patient was in serious condition. I hope you understand... How were you wounded?"

"Fell into a bandit trap!" The vice squadron commander was still seething, glaring at the unconscious Wang Chuyi. "We've got a lot of casualties, and some got scattered..."

A sharp glare from You Ciren cut him off—he realized he had said too much. Discussing front-line conditions in the rear without authorization was against regulations.

Chen Ruihe did not mind. He examined You Ciren carefully. "Where were you hit?"

"Here!" You Ciren grimaced, turning to show his back and arm. "Took a pellet. Didn't feel it at the time. Now it hurts like hell!"

Chen Ruihe took up scissors and cut away the uniform around the wound. He examined it closely, then probed with a needle. The pain made You Ciren break out in a sweat.

"Ow... ow... it hurts!"

The bleeding was not heavy, but the wound was deep. The projectile could not be extracted with forceps.

"How long ago were you hit?"

"At least an hour. We fought the bandits several times on the road. I don't know which time I got hit."

The skin around the wound showed no bluish discoloration from lead poisoning—meaning it was an iron ball or a stone, not a lead bullet. No risk of heavy-metal poisoning; treatment would be relatively easier.

"Your wound is deep, but it's not a through-and-through. The pellet is lodged inside—possibly against the bone. Lucky it's not lead." Chen Ruihe frowned. If it were a superficial wound, he could treat it on the spot. This one required surgery. "We'll have to wait for Doctor Xie..."

Before Chen Ruihe finished, the vice squadron commander started arguing with someone again.

"What's wrong with you today, you asswipe?" You Ciren was furious now, cursing as he stood up. "Son of a bitch! Making a scene here? Don't you know where you are? Embarrassing the whole unit!"

"What's going on?" Xie Yao heard the commotion and came over. "Why all the noise?"

"This man is being unreasonable, Doctor Xie!" Chen Ruihe jumped up and, together with You Ciren, briefly explained the situation.

Xie Yao frowned. "You said just now—how were you wounded?"

"It was... a command error, you could say. We walked into a bandit trap. Doctor, I have to apologize for him: this fellow is normally even-tempered, steady—I've never seen him fight with anyone. I don't know what's got into him today. Must be seeing so many brothers wounded..."

"Is he himself wounded?" Xie Yao interrupted, pointing at the vice squadron commander, who sat dejected on the ground after being scolded by his superior.

"Him, wounded?" You Ciren laughed. "He didn't bleed, didn't even scrape his skin. Just got bumped on the belly by a log when we broke out..."

Xie Yao listened, studied the officer for a few seconds, then strode over and crouched down. He grabbed the man's wrist and felt his pulse; his expression turned grave. He stood up and said, "Xiao Chen, take this comrade to the observation room too."

Chen Ruihe was startled. "Him?" Xie Yao was clearly not pointing at You Ciren, but at the vice squadron commander who had been making a fuss.

"Doctor Xie, what's...?"

"You could tell the earlier patient was in hypovolemic shock—can't you see what's wrong with this one?"

"Him...? He was jumping around, arguing—what could possibly be wrong...?"

"I've told you: assessing injuries is complicated. You can't dismiss someone just because he's making noise. This man's lips are pale, his hands slightly cold. If I check his pulse, it's probably over ninety... And you didn't even ask about his injury—he was hit in the abdomen by a log and afterward showed marked changes in behavior... Different from his usual self. That's when you need to pay attention!"

"Then what might be wrong with him?" Chen Ruihe was puzzled—and a bit unconvinced.

"Have you considered splenic rupture?" Xie Yao asked as he helped position the patient in shock position.

"Splenic rupture!" Chen Ruihe's eyes lit up; it all made sense now.

"If splenic rupture bleeds slowly and in small amounts, symptoms can be mild and hard to detect. Besides mild pain in the upper left abdomen, the patient usually has few obvious signs..." Xie Yao looked at him as if to say: Do I need to spell out the rest?

The terrifying implications of that diagnosis made Chen Ruihe's hair stand on end: the patient's unusual agitation might well be the restlessness of early shock. Though not yet life-threatening, as bleeding continued and blood volume dropped, he would soon enter the inhibitory phase of shock—at which point rescue would be far more difficult.

"Damn it, if we've got two patients needing massive transfusions at once..." Xie Yao's frown deepened.

Chen Ruihe understood: the Medical Station had nowhere near enough stored blood. One patient needing a large transfusion was a stretch; two at once was a crisis. "Of course, it might not be rupture—that would be best. Let's examine this patient first. If splenic rupture is highly suspected, he'll need an exploratory laparotomy."

"And the shock patient from earlier...?"

"He's clearly in hypovolemic shock, and the bleeding has gone on too long. If we don't act, he'll die... Give him the stored blood first. If you can debride and stop the bleeding, go ahead. I'll handle this one!"

"Yes!" Chen Ruihe could hardly say he was not capable. When hands were short, interns had to be thrown in at the deep end. Better to do something—anything—than stand there helpless.

Xie Yao worked and thought furiously. They had already transfused one patient today. The station had only two or three units of whole blood left—by the Council's standard, "one unit" was 200cc. If the bleeding could be stopped successfully, those two or three units plus IV fluids might just be enough. But if the bleeding could not be controlled—if the suspected splenic-rupture patient needed an emergency splenectomy—it would take several thousand cc of blood to save either.

Now Xie Yao faced the question: which patient to save first?

Wang Chuyi was the County Magistrate. The other was a vice squadron commander in the National Army.

Comparatively speaking, Wang Chuyi was clearly the more important figure. Vice squadron commanders who were sergeants numbered in the hundreds if not thousands. Naturalized cadres who could serve as county magistrates—you could not find more than a handful in all of Lingao. Anyone chosen for such a post was part of the administrative backbone the Elders had cultivated.

"Wang Chuyi may be the County Magistrate, but after all, he arrived first—you can't call it favoritism. And Xiao Chen has already started his transfusion. Besides, this other man might not even have a ruptured spleen..." Xie Yao silently reassured himself. But he knew full well: once the decision was made, it might mean the suspected-splenic-rupture officer would die—and in a sense, Xie Yao would have signed his death warrant.

Though he had seen countless patients die before his eyes and under his hands, Xie Yao still did not like this feeling of holding life and death in his hands.

"Go fetch Elder Song," Xie Yao instructed the medic assisting with the resuscitation. "And see if there are any more blood donors—get as many as you can!"

"What about this one?" The medic pointed at You Ciren, still lying on the examination table.

"He won't die. Move him to the light-casualty holding area. Doctor Xie will operate when he has time." He picked up You Ciren's patient card, filled in the examination details, and said, "Hang it around his neck!"

Song Junxing was the Elder on duty at the Medical Station that day. Though the oral-surgery department had too few maxillofacial casualties to justify a dedicated service, if you drew a front-line assignment, you had to send someone. So Song Junxing rotated through with the other Elders and senior naturalized physicians, accompanying the Mobile Hospital to each county in turn.

This did not count as "practicing outside one's specialty." This era was nothing like the hyper-specialized twenty-first century. Anyone who had worked in a clinic had learned a grab-bag of skills beyond their specialty—things taught in medical school and things never taught, as long as they had anything to do with "medicine." Practitioners of all stripes, regardless of primary discipline, were thrown onto the clinical front line for "training." In the medical sector—whether clinical, pathology, laboratory, epidemic-prevention, nursing, even forensics and veterinary medicine (which were not even under the medical department)—everyone had to be a jack-of-all-trades. No choice: otherwise, the primitive medical-support system could not function. Lin Motian had once joked: "We've all become village-clinic quacks now. There's no part of the body we don't dare cut!"

Though Song Junxing was an oral specialist, under Elder Shi's advocacy and the pressure of reality, he—like all other Elders with any medical background—had rotated through internal medicine, surgery, obstetrics-gynecology, and pediatrics under the Council's technical conditions. He might not be the most skilled, but he understood the shared principles. On the front line, he might not excel at specific tasks, but certain responsibilities could only be fulfilled by him—for example, making the final call in situations like this.

(End of Chapter)