Serena had performed heart repair surgery before, but this time was by far the most difficult.
No proper surgical team, no fully equipped operating room—everything was crude and makeshift. Yet the patient was of the highest status.
Serena took a deep breath and stood at the operating table. Opposite her, Simon Sun’s young face was tense and serious.
"Master." Simon opened the magnifying eyeglasses case, helped Serena put them on, and adjusted them as she requested. Afterward, he pushed all the prepared medicine packs and surgical instruments to the side of the operating table.
Serena had prepared all these in advance—the special instruments and sutures for heart surgery. Before today, only she and Simon had ever seen them.
Dr. Redwater and Dr. Marcus Guile’s eyes lit up at the sight, but they remembered Serena’s earlier warning: No unnecessary noise in the operating room. If you have questions, save them for later. Don’t distract her—if her attention slips for even a moment, the Crown Prince’s life could be in danger.
"Master, we’re ready." While Serena was centering herself, Simon had already administered the necessary drugs to the Crown Prince. Now, all that was left was for Serena to make the first cut.
Actually, Simon didn’t have much left to do. During anesthesia, Serena had already opened a peripheral vein, completed both arterial and venous punctures, and connected the triple infusion lines to ensure smooth delivery of fluids and anesthetics throughout the surgery.
Everything was meticulously prepared. Even without a professional team, Serena had done her utmost.
Serena nodded, signaling Simon to stand opposite her. Dr. Marcus Guile and Dr. Redwater took positions at her sides. Simon would assist with the surgery, while the two legendary doctors essentially acted as nurses. Even so, it was enough to make them both excited.
Standing at the operating table, Serena shut down all emotion, becoming as cold and mechanical as a machine. For a moment, Dr. Redwater and Dr. Marcus Guile were stunned.
Was this really the same Serena they knew—brilliant, humble, and courteous? But then they remembered how Simon Sun changed completely whenever he picked up a scalpel, and it all made sense.
Both master and apprentice were oddities—in that moment of holding the scalpel, they seemed almost divine: rigorous, confident, and devoid of human emotion.
Serena had no time to care what the two were thinking. She was already starting the operation.
Serena picked up a cotton ball, dipped it in iodine solution, and swabbed the heart area. The movement was lightning fast—less than two seconds. Then she grabbed the marking pen and drew the incision line.
A median sternotomy is the standard incision for open-heart surgery with cardiopulmonary bypass. It provides excellent exposure and suits any heart procedure. The incision starts just below the sternal notch and extends about 5cm below the xiphoid process.
Once the incision line was marked, Dr. Redwater handed Serena the surgical scalpel. Her grip was rock-steady, utterly without hesitation. Serena made the first cut, silent and decisive, slicing open the Crown Prince’s chest along the marked line.
The moment Serena made the cut, Dr. Redwater and Dr. Marcus Guile were awestruck. Cutting into a person was nothing like cutting a rabbit—Serena’s move was even cleaner than a top assassin’s strike.
As soon as Serena opened the Crown Prince’s chest, Simon picked up two clamps and placed them at the upper and lower edges of the incision. Serena then took up the electrocautery knife and cut through the periosteum along the midline, reaching the back of the sternum.
There are three ribs over the heart. For lung surgery, you can pull the ribs aside to make space, but for heart surgery, that’s not an option.
For heart surgery, you have to remove these three ribs to avoid obstructing the operation and to fully expose the heart.
Serena first excised the xiphoid process, then separated the posterior sternal space, and used a power saw to split the sternum along the midline.
The harsh grinding sound echoed, blood splattered, staining Serena’s hands red. She didn’t even blink.
Heart surgery is physically demanding—sawing bone requires real strength. That’s why there are so few women in cardiac surgery; many simply can’t manage it.
Sawing through the sternum isn’t elegant at all—it’s even a bit violent. But with the power saw in Serena’s hands, there wasn’t a trace of brutality. Her seriousness made it feel like she was doing something truly great.
In fact, Serena really was doing something extraordinary—something Dr. Redwater and Dr. Marcus Guile had never seen anyone accomplish before.
Cutting open a human chest is nothing like cutting open a rabbit. When Simon operated on rabbits, they were impressed and admiring, but seeing Serena cut into the Crown Prince left them utterly shaken—the scene was almost overwhelming.
So this is what medicine can be—so even violence could become a kind of beauty.
Once the three sections of sternum were sawed off, Serena was drenched in sweat. Fortunately, Dr. Redwater, though stunned, didn’t forget his role and quickly grabbed a clean cloth to wipe her brow.
Serena removed and set aside the three sections of sternum. She used electrocautery to stop bleeding from the periosteum and bone wax to seal the sternum.
Even after removing the sternum, the heart still isn’t visible—you have to open the pericardium to see it.
Serena made a vertical incision along the midline of the pericardium, from the ascending aorta down to the diaphragm. She then made side cuts at the lower end to improve exposure.
Next, she sutured the edges of the pericardium to the soft tissue outside the sternum on both sides and used retractors to open the chest. Only then did the Crown Prince’s heart appear before everyone.
The heart beat gently in full view—nothing blocked it; you could reach out and touch it. But at that moment, no one had time to look.
Serena set down the scalpel and performed an external cardiac survey on the Crown Prince: palpating the aorta, pulmonary artery, left and right atria, left and right ventricles, superior and inferior vena cava, and pulmonary veins, checking size, tension, and for any thrills or malformations.
Imaging was good, but nothing beats opening the heart for direct observation. After repeated checks, Serena confirmed the Crown Prince’s heart had none of these problems and allowed herself a small breath of relief.
No other diseases meant the surgery could proceed as planned. The greatest fear after opening the heart is finding an unexpected problem.
Any surprise would mean a much lower chance of success.
With the checks complete, it was time to establish cardiopulmonary bypass. Open-heart surgery requires stopping the heart’s circulation, opening the heart, and operating inside it without blood.
During bypass, the venous blood is drained outside the body to the artificial heart-lung machine for oxygenation and removal of carbon dioxide, then pumped back into the body to maintain circulation. This method of diverting blood to support the heart and lungs is called cardiopulmonary bypass.
Serena meticulously placed caval tapes, arterial and venous cannulas, cold cardioplegia infusion lines, and left-heart drainage. After confirming all connections to the heart-lung machine were secure, she didn’t start right away—she double-checked every tube and connection for accuracy.
At this stage, even the tiniest error could be fatal. Serena couldn’t afford any carelessness. Only after confirming every channel was unobstructed did she begin cardiopulmonary bypass.
Author’s note: Uh… Heart surgery is extremely complex and specialized. I don’t actually know the details—I’ve been cramming research to write this. If anything doesn’t match reality, please ignore it. After all, I’m not a medical professional.