Chapter 117: A New Chapter in Orthopedics

Zhou Can reviewed the training schedule – his second rotation would be in Orthopedics for a three-month period.

Orthopedics carries enormous weight in the surgical field – from major operations like open chest or cranial surgery to reattaching a single finger, none can proceed without it.

It is an essential course for surgery.

Zhou Can was full of anticipation for this new department.

During his three-month rotation in the Emergency Department, he had spent most of his time in the Operating Room.

All the knowledge he gained was surgery-related.

In three months in the Emergency’s surgical cases, his experience even surpassed that of others with five years on the job.

Several of his basic surgical skills had already reached an intermediate attending level.

With such competence, his rotation through Orthopedics promised a bright future.

The next day, he and Jin Mingxi arrived early at Orthopedics to report for duty.

For both of them, Orthopedics was the next stop in their training.

Upon entering the Orthopedics department, they saw a long queue outside the clinic – patients in wheelchairs, those using crutches, bandaged with slings, and even some lying in pushed trolleys.

Most of the patients seeking consultation were accident victims.

“Wow, the number of patients here is just as high as in the Emergency Department!”

Jin Mingxi couldn’t help but exclaim.

“Orthopedics and General Surgery are probably the busiest departments. Let’s head to the doctors’ office first.”

Zhou Can’s eyes sparkled as he looked at the patients – all valuable experience points!

“Hello, may I ask who the trainee should report to?”

This time, Zhou Can didn’t ask a nurse.

He hurried over to a middle-aged male doctor in his forties he just happened to see passing by, and inquired immediately.

“Which department are you all coming from?”

“Emergency Department!”

“Follow me!”

“Thank you!”

Zhou Can recalled that Orthopedic doctors usually came off as aloof – this middle-aged doctor was surprisingly approachable.

Just asking for directions, and he personally led them to report.

Along the way, several doctors and nurses greeted the man.

They called him Dr. Yang.

“Come in! Each of you, take a form and sign in.”

Dr. Yang led the two into a relatively spacious office.

Inside, several young doctors were already filling out similar forms.

“Xiao He, how many trainees has the Hospital assigned to the Orthopedics rotation this time?”

Dr. Yang asked one of the young doctors gathering the forms in the office.

“Across all departments, there are thirteen of us, plus five specifically recruited – a total of eighteen trainees.”

Training assignments are generally coordinated by the hospital.

For example, as Zhou Can’s team rotates from the Emergency to Orthopedics, trainees from other departments will be switched into the Emergency.

Only then can the entire hospital function smoothly.

“There are more of us than expected! But that’s a good thing – the more hands, the lighter the workload for everyone.”

Dr. Yang sat at the head of the office.

It appeared that this group of trainees would be under his supervision.

Zhou Can even wondered why Orthopedic doctors seemed so warm – he had clearly approached the right person.

As they filled out their forms, more trainees arrived to report.

“Hurry up and complete your forms. For specialties, just list one or two skills you’re most proficient in. If you’re unsure, just write your originating department.”

Dr. Yang glanced at the clock, perhaps thinking the trainees were dawdling too long.

He then urged them to speed up.

Zhou Can had already finished his form.

In the specialties section, he listed Suturing and Ligature.

These two basic skills had the highest experience points and were nearly at an excellent attending level.

Soon, all eighteen trainees had completed their forms.

“Let me introduce myself. I’m Dr. Yang and I’ll be responsible for your initial arrangement and the overall management throughout your Orthopedics training. First, on behalf of Orthopedics, welcome to you all.”

Dr. Yang’s gaze swept over the eighteen trainees.

“Since the reform at Tuyu, we have adopted a merit-based system – talent rises while mediocrity falls. I care not about your original departments or backgrounds; everyone competes on a level playing field.”

This was his preemptive warning.

It was meant to curb arrogance from prestigious departments and quash any misplaced expectations among the well-connected.

Forget about backdoor favors or gifts.

Clinical departments have always been a battleground where nepotism fails.

Without real ability, even the Hospital Director’s son wouldn’t dare operate on a patient.

What if one slices the patient to pieces?

If something goes wrong, not only will the director be ungrateful, but he’d be furious – like wishing to smash that superior doctor to death. ‘Do you really want to see my son die?’

“First, let me explain the department’s needs for trainees. The Operating Room only has two high-level surgical theaters requiring six trainees for assistance. The outpatient manual reduction room needs one, while the Inpatient Department can use as many as possible.”

Even a fool knows that being in the Operating Room is the best outcome.

Manual reduction in the clinic is also respectable.

The worst assignment is in the Inpatient Department – long hours, heavy workload, and constant berating from family members and patients. Managing beds, on-call duties, writing case reports, miscellaneous tasks – enough to wear anyone out.

“Of course, don’t worry too much. The Hospital’s standardized training covers everything comprehensively. Even if you’re assigned to the Inpatient Department, you’ll still have opportunities in the Operating Room. The focus just shifts accordingly.”

Seeing some nervous looks, Dr. Yang smiled warmly to reassure them all.

Given that Orthopedics had entrusted him with the trainees, he naturally possessed strong managerial and coordinating skills.

“To keep things fair, you’ll be rotating into the Operating Room in batches over the first three days. Those who perform exceptionally well will be retained by the chief surgeons. And if you’re not selected, don’t be disheartened. Surgery isn’t your only path. Even if you end up in the Inpatient Department managing patients, a strong performance could still earn you a chance in the Operating Room.”

For a surgeon, if you can’t operate, the only other option is the far more challenging academic route.

But very few make a name for themselves that way.

A close look at the renowned surgeons in each specialty will reveal that all have mastered surgery, with their academic achievements closely tied to their operative skills.

After all, practice is the root of scholarship.

“Everyone starts on an equal footing. I’ll now distribute your assignments for the first three days.”

Dr. Yang divided the eighteen forms into three groups.

“Xiao He, read out the names of the six trainees scheduled for the Operating Room today.”

He handed the first set of forms to the young doctor.

“Fan Wen, Wang Bin, Jin Mingxi…”

He read aloud the names of six trainees in all.

Zhou Can, having handed in his form a little later, wasn’t in the first batch.

That was actually for the best – it gave him an extra day or two to familiarize himself with the Orthopedics environment.

He knew full well that missing the Operating Room opportunity would set him back considerably.

Even though his surgical skills were exceptionally strong – capable of outclassing everyone – one must give their all to secure a stable position.

“Those six whose names were just called, head to the Operating Room. The remaining twelve, report to the Inpatient Department. Your main task over the next three days is to get to know the entire process from patient admission to discharge. Managing beds, writing case reports, assisting in surgeries, and ward rounds – you all have learned this during your internship.”

The responsibilities during internship and training are indeed very different.

It’s akin to kindergarten, where you learn the rules, recognize letters, and understand numbers 1 to 10. By first grade, children are expected not only to recognize and write letters but also to begin practicing simple characters and basic arithmetic.

Doctors progress similarly.

Step by step, they enhance their professional skills.

Trainees gradually learn to handle tasks with inherent risks independently.

For instance, managing beds.

When an intern sees a patient coughing violently or complaining of severe abdominal pain, they’d call in a senior doctor!

But as a trainee, you must learn to diagnose these matters yourself.

Calling a superior for every minor issue will only get you berated to death.

“Xiao He, please fetch Chief Resident Xiang!”

Dr. Yang instructed.

Chief Resident Xiang wasn’t a business executive – he was the Inpatient Department’s chief.

That’s just how the Hospital referred to him.

Many newcomers assumed the Chief Resident held an extremely high status, but that wasn’t the case.

Despite the Chief Resident often scolding trainees and interns like grandchildren while directing tasks, his rank was significantly lower than that of an attending.

This position was typically rotated, lasting about a year – truly a thankless task.

A doctor needed three years of residency experience to qualify, along with some further training, to be eligible for the role.

It was also a necessary step toward becoming an attending physician.

Usually, one would undergo six months to a year of further training, serve as Chief Resident for a year, and then take the exam for attending certification. Once passed, an attending certificate was issued. If the Hospital had an opening, you’d be hired as an attending.

However, the number of positions was limited. If you weren’t hired within a year, there was no need to panic.

At that stage, as long as no major mistakes occurred, becoming an attending was almost guaranteed.

At worst, you’d just have to wait your turn.

It’s worth noting that passing the attending exam wasn’t very difficult – many managed it on the first attempt.

The real challenge was the licensing exam for practicing physicians after one year of graduation. The pass rate was extremely low – roughly one in five.

If you failed the first year, you could retry the following year.

It wasn’t about dousing the spirits of those who had failed.

First attempt failure, second, third… chances were slim.

The wise move was to switch to administrative roles or change careers altogether.

After all, age waits for no one.

While others might graduate with a bachelor’s at 24 and get certified around 26, those less talented would struggle for years and be nearing 30 – the pressure mounting heavily.

If you’re not cut out for it, cutting your losses is the smartest choice.

Soon, a man in his early thirties, of average build with thick, bushy eyebrows resembling two black brooms above his eyes, rushed in.

According to physiognomy, such men tend to be impatient and hot-tempered.

“Chief Resident Xiang, these twelve trainees are now under your arrangement. Three days later, once the Operating Room has finished selecting candidates, you’ll take charge of their long-term training.”

Dr. Yang said to the man.

“No problem!”

Chief Resident Xiang swept his gaze over Zhou Can and the others and waved his hand.

“Follow me!”

His decisiveness was striking – he didn’t beat around the bush.

Zhou Can and the others followed him to the ward area.

Orthopedics had nine private wards; the rest were open-bed areas. Conservatively, there were over three hundred beds in total.

This scale was intimidating.

Many smaller tertiary hospitals had only around 500 beds in total. Some even had to inflate numbers to qualify as tertiary hospitals.

Tuyu alone, with its single Orthopedics department, held over three hundred beds. With so many departments combined, the total number of beds must be staggering.

In a province, it would be hard to find three Hospitals of this size.

Not to mention, the bed counts of its affiliated Branches One and Two weren’t even included.

“I don’t know your names, so to save time I’ll assign bed areas based directly on the roster. For these three days, your role is solely to assist – you won’t be responsible for managing the beds.”

Chief Resident Xiang read out the names from the roster, assigning each a set of beds.

Each trainee was allocated between eight to twelve beds, varying by number.

The number of beds assigned depended mainly on the individual’s competence in managing them.

Zhou Can was assigned beds 115 through 124.

A total of ten beds.

As Chief Resident Xiang had mentioned, he was only there to assist in management. All ten beds were under the care of a doctor named Dr. Hezhang.

Dr. Hezhang undoubtedly had trainees and interns assisting him.

“Hey, you! Stop standing there – come help set the cast!”

A busy doctor called to Zhou Can.

“I’m talking to you – hurry up!”

Zhou Can quickly made his way over.

He grabbed a scalpel, though he had never used it to apply a plaster cast before.

“The patient fell from a height and severely fractured his right leg. He’s already had surgery. The left foot’s navicular shows a slight crack and fracture. The attending wants us to apply a plaster immobilization.”

It was evident that the patient’s right leg was already mummified in a cast.

The specifics of the surgery were unclear.

For fractures, even after surgery, external fixation is needed to allow the bone to heal.

This process typically takes a relatively long time.

Doctors prioritize treating patients based on the severity of their conditions – life-threatening injuries first, followed by serious and then minor injuries.

There are various types of falls, such as falling from a building, slipping off a cliff, or even a mishap while climbing a tree.

Falls are often accompanied by severe internal injuries.

This patient was particularly lucky to have only fractured a leg.

“You look clueless – you haven’t applied a cast before, have you?”

“I really haven’t!”

Zhou Can crouched down, uncertain how to help.

“I’ll teach you – first, measure the distance from the patient’s foot sole to the ankle. Then measure the width of the sole.”

The doctor, not very tall at about 1.65 meters and around twenty-eight or twenty-nine years old, explained.

Zhou Can didn’t know him, but since Chief Resident Xiang had assigned the trainees, this man was clearly overseeing the process.

“Okay, I got it. Are you Dr. Hezhang?”

The man responded politely – he wasn’t as fierce as one might imagine.

Only then did Zhou Can dare to ask his name.

“Yes! I’m the resident manager here. I’m in charge of beds 115 through 124. Besides you, there are three interns. There was originally another trainee, but he was reassigned today.”

It was indeed Dr. Hezhang.

Even at a large hospital like Tuyu, a trainee’s workload was extremely heavy – almost like being a full-fledged resident.

The handover trainee hadn’t yet been replaced before being reassigned.

This demonstrated just how tight the staffing was in the entire hospital.

“After measuring, note down the length and then prepare a plaster strip of the appropriate length. The width isn’t as critical – for larger limbs you can apply a splint. For these cases, a cast alone will suffice.”

Dr. Hezhang’s movements were swift.

Like most patients, the one before them remained silent.

He quietly watched the doctor work.

“These are the essential materials for applying a cast: plaster, plaster cotton, and bandages.”

One by one, he pointed them out to Zhou Can.

They were easy to distinguish, and Zhou Can nodded, signaling his understanding.

“Once you’ve prepared the plaster strip of the proper length, the next step is to drape it with plaster cotton. Remember, you must get the length and width just right.”

Essentially, you tailor it to the patient’s left foot.

“Go grab half a bucket of hot water – around fifty degrees is ideal. The hot water room is over there.”

Dr. Hezhang was intentionally helping Zhou Can get accustomed to the environment quickly.

Soon, Zhou Can returned with the hot water.

Since the exact temperature couldn’t be measured, he estimated it by feel.

Normal body temperature is around 36–37°C; water that feels slightly hot – about 45 to 50°C – is appropriate.

Dr. Hezhang was pleased to see how quickly he fetched the water.

He tested the temperature with his hand and smiled.

“Good job! What’s your name?”

“My name is Zhou Can! You can call me Xiao Zhou.”

Being new, Zhou Can kept a low profile.

“Dr. Zhou, next you need to soak the plaster strip in the water.”

The plaster strip was immediately covered with copious bubbles as it soaked.

“Remember – wait until the bubbles stop before taking it out.”

After a while, the bubbling ceased.

Dr. Hezhang took the softened plaster strip out and quickly squeezed it by hand.

“Squeeze out as much water as you can, then lay it over the plaster cotton. Do it quickly – if you delay, it will harden too fast.”

Once done, Dr. Hezhang directed Zhou Can to lift the patient’s left leg.

“If the patient is able, they can just step on it.”

With that, Dr. Hezhang looked at the patient.

“Sir, it might hurt a bit – try to bear with it.”

Nearby, two family members watched intently.

Every detail had to be clearly explained to avoid any misunderstanding.

Dr. Hezhang pressed the patient’s foot down with one hand while supporting the plaster against the sole with the other, then quickly wrapped it according to the shape of the foot.

“Dr. Zhou, hold it steady – don’t let the plaster slip!”

Once Zhou Can secured the position, Dr. Hezhang removed the bandage and began wrapping the cast. When one roll of bandage was used up, he took another.

Within minutes, the bandage firmly fixed the cast from the patient’s foot up to the heel.

“Remember, don’t wrap the bandage too tightly or too loosely. If wrapped too tightly, it can cause limb ischemia and necrosis. Once done, adjust the cast so it fits snugly against the foot.”

Throughout, Zhou Can only assisted as a helper.

When the cast was finally applied, a message flashed:

【Congratulations, you have learned the External Fixation for Fractures technique. You can now perform external fixation to help fractures heal quickly.】

【External Fixation for Fractures – Current Experience Level: Level 1/10 (Intern Level)】

Zhou Can was elated to have acquired another orthopedic technique.

Even though it was one of the most basic orthopedic procedures, its application in surgical operations was very frequent.

Especially in trauma cases, many minor fractures can be treated with just a cast.

“Over there, there’s another cast to apply – this time, you take the lead and I’ll guide you,” Dr. Hezhang instructed.

“Alright!”

Zhou Can readily agreed.

Dr. Hezhang clearly hoped he would master the technique quickly so that next time, Zhou Can could perform cast applications on his own.

This time, the patient had a hand fracture that required the cast to be secured around the neck after application.

“Her most severe fracture involves the hip joint. The surgical plan isn’t finalized yet, so for now, immobilize her fractured arm,” he explained.

The patient was a very thin middle-aged woman lying in bed, groaning continuously.

She kept exclaiming that she was dying.

In such cases, Zhou Can was always extra cautious.

Accompanying her was a young man around twenty – likely her son. This unfilial child was busy playing games on his phone.