American Medicine: I survived the death knell thanks to the devil.

The entrance to the trauma room.

Cassie Quinn stood by the door, her back against the wall.

She was recording a patient's information at the triage desk when the announcement of Level 1 trauma activation came on.

As if by reflex, she dropped her pen and rushed over.

She watched as Lynn squeezed through the circle of five attending physicians, tore open the drainage pack, inserted the tube, and connected the negative pressure...

Now, Lynn's voice came through.

"I need an assistant."

Cassie's hands were trembling.

She felt she should rush in.

She was Lynn's assistant when the shrapnel was removed last time.

In that modified ambulance, she was the one who handed over the equipment, pulled the hook, and turned on the lights.

But the person lying here is the Speaker of the New York City Council.

Six armed men were standing outside the door.

None of the five attending physicians dared to touch it.

I still have 280,000 yuan in student loans to repay.

The younger sisters are still in school...

Cassie's right foot, which had just taken half a step, stopped...

She hesitated.

But when she remembered how Lynn had handed her the $800 without hesitation, she was deeply moved.

I remember Lynn pushing the biggest slice of pizza towards me.

do not care!

So what if I have to be an unlicensed doctor for the rest of my life!

She finally made up her mind and walked forward.

"I'll be your assistant."

A woman's voice came from behind her.

It was Victoria Vanderbilt.

Scrub suit, sterile surgical gown, gloves already on, hair tucked into surgical cap.

She was called over the phone. She lived nearby and arrived just in time.

Victoria went straight to the trauma bedside.

He glanced down at Lynn's work.

Location of the chest tube, disinfection area, and skin markings for the left anterior lateral thoracotomy.

Then she looked at Lynn's right hand.

He was not carrying a knife.

The five fingers are stretching. The index and middle fingers repeatedly open and close, while the ring and little fingers alternately flex and extend.

Is this meant to be investigated with bare hands?

He inserted his fingers directly into the chest cavity, using touch to locate the bullet and bleeding points in the pool of blood.

The mediastinum is crowded with the aortic arch, pulmonary trunk, and superior vena cava.

Each one is a major blood vessel that will kill you if you touch it.

But Victoria chose to believe him.

She glanced at Lynn.

Lynn looked back at her.

They didn't say anything.

"Victoria".

It's Julian.

His gaze swept from the trauma bed to Lynn, and finally landed on Victoria.

"You can't be an assistant to a medical intern."

Victoria didn't turn around.

Julian took a step forward, speaking quickly but clearly, "If anything happens to the Speaker, the First Assistant will bear the second-highest responsibility. Your career..."

"You don't need to worry about it."

"Let me finish." Julian did not back down as he had before.

"If you absolutely must operate here, at least follow a reasonable staffing plan. You'll be the lead surgeon, and you have the qualifications to be an attending physician."

"I'll be the first assistant, he'll be the second, and he's qualified to do things like hooking up and sucking blood. The three of us have worked together before, and this is the safest plan."

That makes a lot of sense.

Clear division of responsibilities and dispersed risks.

But Victoria had already spoken.

"No."

"Lynn will be the surgeon. I'll be the first assistant. You either need to be the second assistant, or you can leave."

Julian paused for a second.

He wasn't there to steal the credit.

With Victoria as the lead surgeon and him as the assistant, even if something went wrong, the two senior doctors would share the responsibility, making her situation at least a little better.

He's here to act as a buffer.

He wouldn't allow Victoria to tie herself to an intern.

Julian has known Victoria for almost five years.

When this woman said "no" in the operating room, no one could persuade her otherwise.

It wasn't because she had a bad temper, but because her technical judgments were almost never wrong.

At this moment, she placed all her bets on Lynn.

The liquid level in the drainage bottle has exceeded 1400 ml, and time is running out.

Julian took a deep breath.

I walked to the instrument cabinet, took out a pair of size 7 sterile gloves, and tore open the packaging.

The latex glove made a crisp sound.

"Okay, I'll be your second assistant."

The movements of dressing were clean and efficient.

Only when fastening his surgical gown belt did he whisper one sentence:

"Don't let her regret it."

Lynn didn't turn around.

"Number 10 knife."

……

The door to the trauma room closed.

A sliver of white shadowless light shone through the narrow observation window on the door.

Cassie stood in the corridor.

She loosened her clenched fist.

There are crescent-shaped marks on the palm of my hand, made by four fingernails.

Cassie leaned against the wall, slowly slid down, and sat on the ground.

The tiles were cold, and the February chill seeped through my trousers.

If only it were a little faster.

If only we didn't have to worry about that.

Cassie breathed a long sigh of relief; her hands had stopped trembling.

Trauma room.

Liquid level in the drainage bottle: 1480 ml. Still rising.

Lynn's scalpel fell.

A single, continuous arc-shaped incision was made at the fourth intercostal space on the left side of the chest, from the sternal line to the mid-axillary line.

The blade cuts through the skin, subcutaneous fat, and serratus anterior muscle, running along the upper edge of the fifth rib, avoiding the intercostal nerve and blood vessel bundle.

Dr. Brandon, the head of the anesthesiology department, was already standing at the bedside.

He was the one who rushed down from the operating room upstairs, without even taking off his surgical cap.

He didn't say a word when the five attending physicians were arguing. Anesthesiologists don't participate in surgical decision-making, but they are never absent when it's time to do their job.

"Rapid induction, endotracheal intubation, and connection to ventilator."

He gave medical orders while performing the procedure, which took a total of forty seconds from induction to intubation.

"Your airway is clear, and your blood pressure is being managed with medication. You have a window of opportunity. Do it quickly."

The monitor showed a blood pressure of 58/30, which is lower than before the drainage.

When systolic blood pressure is below 40, the heart loses its ability to perfuse itself.

Myocardial ischemia, conduction system failure, ventricular fibrillation, cardiac arrest.

Irreversible.

Lynn knew what this meant; the drainage released the pressure in the chest cavity and removed the clogging effect on the bleeding point.

It's like pulling out a natural hemostatic plug.

The bleeding rate is increasing.

The window of opportunity is shortening, and the time is decreasing.

The curved clamp penetrates the intercostal muscle, the finocetor retractor is inserted into the intercostal space, the handle is rotated, and the fourth and fifth ribs are slowly opened.

The chest cavity is exposed.

Dark red blood mixed with bubbles almost submerged the entire surgical field.

Victoria held the suction tube in one hand and a gauze pad in the other, quickly clearing away the accumulated blood.

She doesn't inhale indiscriminately, but rather pushes the air from low to high, first exposing the lower edge of the lungs, and then extending it towards the hilum.

This makes locating the source of bleeding more efficient.

here you go.

These three words flashed through Lynn's mind, but he didn't have time to speak.

Brandon's voice came from the bedside:

"Norepinephrine was increased to 0.3, but blood pressure continued to drop. The fourth unit of red blood cells was started, and there were only two units of type O cells left."

The person is bleeding.

The clock is ticking.

In the field of vision cleared by the suction device, there was a penetrating wound on the surface of the upper lobe of the left lung.

After the bullet entered through the anterior chest wall, it tore through the lung parenchyma, and its trajectory was obliquely posteromedially, extending towards the mediastinum.

There is bleeding from the laceration in the lung parenchyma, but this is not the main source of bleeding.

The real trouble lies deeper.

At the end of the trajectory, in the mediastinum.

In that death zone, crowded with aortic arches, pulmonary trunks, and superior vena cava.