Surgery Godfather - Chapter 41:
Chapter 41: Chapter 0040: The Cold Easy Water with the Desolate Wind
After returning from the clinic, Yang Ping hurried to the operating room where Little Five and the interns had already sterilized and laid out the sheets.
One could end up spending half a day in the operating room. He finished work at a little past six in the evening and took a shower in the changing room of the operating room. There was also a bathroom in the ward’s duty room, but with many young doctors present, they all gathered there to shower. Yang Ping, not one for the hustle and bustle, simply took his shower in the changing room of the operating room.
After showering and while resting in the changing room, Yang Ping kept thinking about the surgery Elder Man Zhang had instructed him about. Simple fractures could be treated with Kirschner wire, but for complex fractures like this one, a metal plate was needed. Even ordinary metal plates would not suffice — a locked metal plate was required. Nevertheless, even with a locked plate, the difficulties would be abundant.
Now, Elder Man Zhang was asking Yang Ping to use the Kirschner wire for the surgery, with a budget of three thousand yuan.
Honestly, three thousand yuan, in a top three-tier hospital like this one, could sometimes amount to just a day’s expense. If the cost was concentrated around the surgery period, a day’s expense would fall far short.
Yang Ping initially intended to perform CT three-dimensional reconstruction on the elbow joint. It could show a three-dimensional portrayal of the fractured bone, resulting in intuitive and concrete understanding of the fracture. A CT three-dimensional reconstruction could cost over six hundred yuan, and upon realizing how expensive the procedure was, he quickly abandoned the idea.
For such fractures, many prestigious hospitals make use of virtual reality technology and 3D printing technology to create fracture models. By using this model for preoperative simulation training to understand how to fit the metal plate and where to insert the nails, the success rate of the surgery substantially increases.
Speaking of expenses, the main cost was the anesthesia. The surgery fee was fixed, but the anesthesia was charged by the hour. It meant the surgery needed to be efficient; otherwise, the cost of anesthesia could quickly exceed the budget.
Patients were indeed pitiable, and Yang Ping empathized with them. When he first started working, he only earned two thousand yuan a month. After deductions and paying for rent and utilities, the remaining spending money was tight. It was genuinely hard to make ends meet without cash.
Elder Man Zhang was right, if no solutions were sought, the worker’s elbow joint would be ruined. For a doctor, it might not matter much, but this could change the patient’s life, and possibly even the life of the next generation.
“Ding dong! Mission: Perform a cost-effective surgery on a comminuted fracture at the distal humerus. Reward: 5,000 points.”
A system task was triggered. What did it mean by cost-effective? It meant complete the surgery with three thousand yuan, ensuring good functionality so that the patient could get back to work as usual.
Yang Ping accessed the system to see if there were any solutions. He scanned through the mall and noticed something that caught his attention— “Wire and pin osteosynthesis”.
He hadn’t paid attention to this before, probably because he felt it lacked relevance or the technique was too simple. Anything could be a treasure when it was needed, and be dismissed as a grass when it wasn’t. It only cost him three thousand points, lucky that he still had ten thousand points left, so there were no worries about payment. He immediately bought the wire and pin osteosynthesis technique.
Yang Ping remembered reading a book written by a German doctor — “Steel Cable Bone Connection Surgery”.
This German had a famous quote: “Give me enough steel wire and pins, and I can solve all bone fractures.”
Feeling as if he had seen a glimmer of light in the darkness, Yang Ping immediately found his direction.
He started the wire and pin osteosynthesis technique and entered the training space.
The system prepared numerous pins of different diameters and steel wires of varying thicknesses. It simulated fractures at various locations, some simple, some complex, and some were a mess.
He began practicing puncturing steel pins along a designated path: specifying an entry and exit point, then making sure the pin entered at the designated entry point, and exited at the designated exit point. This seemingly simple task was highly challenging.
It was similar to shooting at two targets set a certain distance apart, with the two targets staggered on parallel lines. You’d have to ensure that the shot went through the heart of both targets.
This was a challenging operation. At first, Yang Ping always failed to puncture correctly. Designating an entry point was easy; seeing the steel pin tip touching the designated point with your naked eye. But as for the exit point, it was impossible to ensure the pin could get out through thick bone tissue. He barely managed to get somewhat close a few times, but the system declared them as failed attempts.
This required spatial imagination. One had to build a three-dimensional concept in mind of the pin’s path in the bone tissue — although it was invisible, they had to use their mind to imagine it.
Yang Ping tried to visualize it repeatedly, and after extensive training, finally managed to successfully puncture the pin through the designated entry and exit points, mastering the technique.
Next, he practiced parallel puncturing, which required multiple pins to be inserted through the bone in perfect parallel. Two pins in parallel, three pins in parallel, four pins in parallel, five pins in parallel — all the way up to ten pins in parallel. The system requirements were stringent; even slightly off would be deemed as a failure, and the procedure had to be restarted.
With this training, you could smoothly pass, but the system wouldn’t offer any rewards. If you failed, the system would harshly deduct points. In other words, it was a situation where you only lose points but never gain. How many points were deducted? It was at least double the amount you had spent to purchase the training, and severe errors could result in all points being deducted.
After mastering parallel puncturing, he learned intersecting puncturing — 15 degrees intersection, 30 degrees intersection, 45 degrees intersection, 60 degrees intersection and 90 degrees intersection.
Lastly, he practiced puncturing fragile, tiny bone fragments — the type that could break upon a single puncture. At first, the bone fragments would break every time, but gradually he learned to control his strength and drilling machine. The pin could go through, leaving the bone fragments untouched.
After mastering puncturing, he learned the technique of steel wire ligation — single-strand, double-strand, multiple-strand, tension band ligation, circular ligation, figure-eight ligation, rectangular ligation etc. Yang Ping practiced everything that existed in orthopedics.
Upon completing the training, he noticed a new feature on the screen — a library.
“The system will release new features according to the upgrade of skills,” the robot’s feminine voice said.
So that’s how it works. But he didn’t know how to use this feature. When Yang Ping opened the library feature, bookshelves, a table and chair suddenly appeared beside him.
“What book would you like to borrow? All worldwide documents are available here, including medical ones. You can provide a book title or keyword for searching,” the system’s female voice said.
Then, a holographic screen appeared in front of him, displaying a catalog of books.
“Steel Cable Bone Connection Surgery,” Yang Ping recited the book’s title.
Immediately, the title of the book showed up on the screen, along with other recommended books of similar nature.
“Reading material consumes one point per minute,” the female voice explained.
Yang Ping clicked on the book’s title, and a physical copy of “Steel Cable Bone Connection Surgery” instantly appeared on the bookshelf.
This feature was beneficial. He no longer needed to buy books, as he could read anytime, anywhere. The deducted points for the service weren’t expensive either. It was a handy learning tool.
Yang Ping read several books on wire and steel pin bone grafting in one go.
For good measure, Yang Ping spent 4,000 points to purchase 500 cases of distal humeral comminuted fracture surgery training.
He was left with only 3000 points.
When he came out of the space, he felt a lot older.
Probably the graduate assistant let the cat out of the bag, the whole department knew that Yang Ping was assigned a challenging task by Elder Man Zhang.
When Yang Ping returned to the department, everyone was busy switching to X-ray films on the electronic film reading screen, wanting to have a discussion. But the patient’s films weren’t in the computer because they were taken in another hospital.
The patient was admitted to a bed managed by Little Five, who hung up the X-ray film.
This was a spontaneous discussion by everyone, there was no official notification for it.
Standing around the film viewing light, Song Zimo patted Yang Ping’s shoulder, “Brother, this is more than just challenging. Did you offend the old man somewhere?”
“This is beyond challenging, it’s practically impossible,” Zhang Lin, with his face full of acne, chimed in.
Director Tian just finished a surgery and was just in the doctor’s office. “Come and have a look, director Tian,” Song Zimo beckoned.
Director Tian was usually steady, with cutting-edge comprehensive skills, and very much respected by everyone.
“An AO plate, huh? The radial side goes to the back, the ulnar side goes to the edge, and then you assist with a countersunk screw. What, are you testing me?” He chuckled.
“No, it’s just that Elder Man Zhang has designated Yang Ping to do it with Kirshner wires.” Little Five explained.
“How can that be possible? What a joke, can he really make a demand like that? If he’s so insisting, then he should do it himself.” Tian Yuan muttered, not daring to say that to his face.
“Tell it to Director Han, let him communicate with the elder man. How can this be done with a Kirschner wire?” Tian Yuan scrutinized the X-ray film.
“Yeah, boss. Director Tian is right, you can’t just listen to him.” Little Five got anxious.
“Let me think about it”, Yang Ping leaned back against the nearest desk.
Director Han came in just then. Seeing everyone gathered together, seemingly in no hurry to go off work, he found the scenario quite lively.
Looking at the X-ray hanging on the viewing light, he glanced at everyone, “Case discussion?”
Everyone kept quiet, while Tian Yuan said, “Director, how would you handle this fracture? Everyone here wants to hear your opinion.”
The director looked closely one more time, “Distal humeral comminuted fracture, intra-articular fracture, needs two plates. Why are we discussing this again?”
“The man Elder Man Zhang admitted could only afford 3,000 RMB and he insisted that Yang Ping has to complete the surgery with Kirschner wires within three days.” Tian Yuan explained in a clear and steady pace.
Director Han was a little confused now, he took another close look at the film: “Oh my, Kirschner wires, really, if it could really be done well, that would be high-level surgery. So Professor Zhang asked for it? When? I’ll pop by and take a look, haha.”
“Yes! And there’s a limit on the cost, it can’t exceed 3000 yuan.” Tian Yuan added.
“That’s indeed a tough one.” Director Han furrowed his brows and turned to leave.
So Director Han made no defense for Yang Ping? His smile seemed rather gloating, strange.
Tian Yuan originally thought Director Han would fight for Yang Ping, going to Elder Man Zhang to discuss a different surgical approach. She didn’t expect this reaction from Director Han.
Tian Yuan was at a loss for words, besides Director Han, who else would dare to confront the old man? Remembering how Director Bai was criticized during the meeting, Tian Yuan shivered at the thought.
“I’ve done my best, you’ll have to figure the rest out on your own. If I have time that day, I’ll come support you, if you need any help, just say the word. I have all the orthopedics books you need.” Tian Yuan shook her head.
“There seems to be a book named ‘Steel Cable Bone Grafting Surgery’ by the Germans, it might be helpful for your reference. I’ll cover your shifts for the next few days.” Song Zimo said.
“I’ll look after the patient, don’t worry. I’ll call you if anything comes up.” Little Five said.
Zhang Lin also moved closer to his side, sitting next to him, “Keep going, the people thank you!”
Everyone took turns to encourage him. It was as if there he stood, against the wind by the banks of the Yi River, about to set off on a daunting journey.
“The wind blows bitterly against the Yi river, brave warriors–” Zhang Lin was reciting a verse, shaking his head, as he swaggered out.
“Brave warriors my foot–” Little Five choked Zhang Lin by the back of his neck.
“Little Five, let me tell you, don’t push me. Us Northeast people don’t back down in fights.”
Zhang Lin wailed.
