Chapter 2228 - The Tourniquet
Song Junxing emerged from the duty room, donning his white coat as Xie Yao briefed him. After a moment's thought, Song said, "Old Xie, your reasoning on all those points is sound. The remaining blood goes to Wang Chuyi first. Since they're queued and their conditions are equally critical, we follow the first-come-first-served principle. As for the suspected splenic rupture... have the transfusion technician stand by. If necessary, assemble everyone present whose blood type matches—including you and me—to donate."
"Yes!" In truth, these measures were much the same as what Xie Yao was already doing. But he felt such decisions were best not made by him alone—especially when an Elder was on the same shift.
Seeing Xie Yao head toward the emergency room, Song Junxing considered, then followed.
By now, the nurse had helped gather several blood donors—by their attire, stretcher bearers from the Fengchuan Field Hospital rear-transport unit.
Seeing them approach, the nurse rose. "Elder Song, Director Xie."
Song Junxing waved her to skip the formalities. "Can we begin?"
"Well..." The nurse hesitated. "The donors are here, but..."
"Speak up if there's a problem!"
"Um... we're out of citrate and empty bottles. Only enough blood bottles left to collect three units..."
Song Junxing was startled: even that could run out?
But this was the new normal. Transport in semi-pacified areas was nothing like the rear; checkpoints and martial law often created shortages. Even ammunition was sometimes tight; medical supplies were frequently short.
"Collect what we can. We'll deal with the rest later."
"Yes!"
But this was only a stopgap. If an abdominal splenectomy was needed, three units of whole blood might still not be enough. Without citrate bottles, they would have to resort to transfusion surgery. Song Junxing immediately ordered, "Prepare the instruments. Has the transfusion technician been notified?"
"Elder, I just thought of something... about the surgery..." Xie Yao suddenly remembered and sucked air through his teeth.
"What is it?"
"We don't have a transfusion technician today..."
"No transfusion technician? How can that be?" Song Junxing was confused. "Regulations say the Mobile Field Hospital should have at least two transfusion technicians. How can there be none?"
"The regulation is two or more," Xie Yao said helplessly. "But the front is short everywhere—everyone's asking for people. A few days ago, after a reshuffle, Lao Li went back to train new transfusion staff. That left just Xiao Huang on our team, and yesterday he came down with severe malaria..."
"Tsk..." Song Junxing's frown deepened. "What do we do? Old Xie, can you handle it?"
"I've seen it done once in Guangzhou, but I've never done it myself." Xie Yao was at a loss. Privately, he thought: Awkward as this is, saying "What do we do" hardly befits an Elder. The Council claims omniscience; if even the generals are stumped, what about us foot soldiers? This hurts morale. But he kept those thoughts to himself—he had no desire for tea with the Political Security Bureau.
"I've never done it either..." Song Junxing was candid. "My specialty is oral surgery. I've only observed transfusion surgery a few times..."
Well, at least he's not afraid to admit his shortcomings. Xie Yao's impression of him improved slightly. He said, "Elder, there's no help for it—beginners will have to manage. If transfusion becomes absolutely necessary, you take the lead; I'll assist..."
"Doctor Xie!" Before he could finish, Chen Ruihe came running, flustered. "Please come look!"
"What is it?" Xie Yao followed him to Wang Chuyi's bed in the observation room. Blood was being transfused; the wounds looked adequately dressed—the bleeding on both thigh and chest had largely stopped. He had even prepared for possible hemothorax or pneumothorax: closed thoracic drainage was ready. He was puzzled why Chen Ruihe had panicked and brought him here—until he followed Chen Ruihe's pointing finger.
The sight made his pupils contract: Wang Chuyi's left leg had begun to turn black. Faint marks from a tourniquet were visible on the skin.
"The tourniquet wasn't loosened, was it?" Xie Yao asked, suppressing his anger. "Fool! How did you examine him—how did you take his history—and miss this?"
"I... it was already like this when I found out..." Chen Ruihe was crestfallen.
"You..." Xie Yao was about to explode, but Song Junxing, who had followed, stopped him.
"This isn't his fault. The patient was brought in not long ago, yet the limb is already this black. The tourniquet certainly wasn't put on by this young man—it must have been applied by a front-line medic who failed to tell the stretcher bearers that the tourniquet needed to be loosened periodically..."
"Aah!" Xie Yao squatted down in bitter frustration. "Everything's going wrong today! Not one thing has gone right!"
"Old Xie..." Song Junxing did not know what to say. Front-line medics had limited skills; such things were not uncommon. But he understood Xie Yao's frustration.
Having seen what modern medicine under the Council of Elders was truly capable of, "low skill" seemed almost criminal. Wang Chuyi's leg was beyond saving—the tourniquet left on too long had caused classic dry gangrene. Amputation was now unavoidable.
"Old Xie!" Song Junxing seemed to have found his words at last. "Get up! The patient is still waiting to be saved!"
"Yes..." Xie Yao stood, a belly full of grievances, and went to prepare instruments. The transfusion surgery might not take long, but with two novices at the table, who knew? And next door, another patient was waiting for an exploratory laparotomy. In the blink of an eye, the workload had multiplied.
"Old Xie, don't cause trouble," Song Junxing warned, seeing his state.
"I know my limits." Xie Yao nodded and said nothing more.
"Doctor Xie! The abdominal-trauma patient's blood pressure is crashing—pulse weak! Should we do an exploratory laparotomy?" Before the words were out, a shout came from the observation room.
"Take him to the emergency OR! I'll be right there!" Xie Yao shouted back, then turned to Song Junxing. "Elder, the transfusion surgery..."
Song Junxing closed his eyes, looking pained. "I'll do it. You go prep for the laparotomy."
Before citrate could be produced in quantity, the Council's transfusion method was transfusion surgery. But because the Council knew perfectly well that ex-vivo blood collection was the future, they had not bothered with the historical parade of fancy modifications to technique and equipment. They simply threw together some connectors and tubing and called it a day. Once fermentation industry came online, citrate would be cheap. Even in modern times, the ACD preservative for blood collection was nothing more than citric acid plus sodium citrate plus glucose. So for the Council, transfusion technology was either the citrate-plus-cold-storage ex-vivo method or the bare-bones emergency transfusion surgery for expedient situations—skipping all the transitional technologies that had once appeared in transfusion history.
Transfusion surgery meant directly connecting the donor's blood vessel to the recipient's, or indirectly connecting them via tubing. This technique did not require storing blood outside the body, but it did require surgical anastomosis of vessels and/or tubing.
Since the Council had not invested in specialized anastomosis devices or transfusion connectors, field-expedient transfusion surgery relied on pure handiwork: suture one end of the tube to the donor's vessel, the other end to the recipient's vessel. Done. The dangers were obvious. The simple tubing the Council could provide did not prevent clotting well; the tube often had to be changed and re-anastomosed. Since ex-vivo storage solved this problem safely and conveniently, neither Elder nor naturalized physicians much liked transfusion surgery. Ordinarily, it was used only for patients who met two conditions: "immediate transfusion has a high probability of saving them" and "without immediate transfusion they will certainly die"—and even then, only in large-scale emergencies. After an initial vogue, transfusion surgery had cooled off and remained only as a technical reserve.
But the Liangguang Campaign presented new conditions. Unlike Qimu Island or Jeju, Lingao and Guangzhou now had quasi-modern or even modern hospitals. The low-level medical care designed for refugees was obviously unacceptable for the military in the eyes of the field commanders. Yet the logistical system was plainly inadequate to support hospitals at Lingao or Guangzhou standards. Refugees who could not get transfusions—no one would blame the doctors. But with blood stations flourishing in Guangzhou, front-line soldiers denied transfusion technology would give critics ammunition.
In this awkward clash, transfusion surgery made a comeback.
Though transfusion surgery clearly had problems and survival rates were not pretty, there was a difference between technical limitations and having a method but not using it—at least it kept the inspection delegations from complaining.
The Council initially equipped transfusion surgery with improved paraffin-threaded tubes: paraffin somewhat prevented clotting, and the threaded ends fixed sutures, preventing the connectors from shifting inside the vessels. For connectors, they adopted the early-twentieth-century Unger modified transfusion connector: first draw blood from the donor with a syringe while infusing saline into the recipient; then reverse the valve, pushing the syringe's blood into the recipient while redirecting the saline into the donor—partly to prevent clotting.
(End of Chapter)