Chapter 205: Tuyu’s Reform and Treatment of Achalasia

Zhou Can couldn’t help but wonder—wasn’t Du Leng supposed to be following Wu Baihe in Neurosurgery? What was he doing in General Surgery?

“I don’t think I need to introduce him—I’m sure many of you already know this talented young doctor standing beside me. His name is Du Leng. He graduated with a doctorate from Johns Hopkins University, spent a year working in our Neurosurgery Department, and is now ready to join General Surgery. Let’s all give Dr. Du a warm welcome.”

Xia Huai’an, the department head, led the applause.

The room erupted in enthusiastic clapping.

Zhou Can was still confused. Sure, Neurosurgery took longer to master, but in terms of prospects, it outshined General Surgery. Was Du Leng just not thinking straight, or was there something more?

“I hope to work well with all of you going forward! Thank you very much!”

Du Leng waited for the applause to die down, then bowed politely to everyone.

He was so well-mannered that he immediately won people over.

“The reason I called this morning meeting is twofold. First, to welcome Dr. Du—the exceptional talent joining our General Surgery team. Second, to officially announce that, starting today, the hospital will, for strategic development, integrate General Surgery, Gastrointestinal Surgery, and Hepatobiliary Surgery. These departments will be divided into several treatment teams, which will compete in diagnosis and treatment. The top-performing team will qualify to establish a sub-department.”

This announcement invigorated all the General Surgery doctors.

In recent years, Tuyu has been relentlessly reforming itself—reshaping its departments, management practices, and talent acquisition systems.

Put simply, Gastrointestinal Surgery split off from General Surgery to focus on digestive conditions.

Hepatobiliary Surgery is also a sub-department.

But neither of these departments has flourished since splitting off.

General Surgery itself desperately needed restructuring.

That’s why they’re now reintegrating and establishing new sub-departments—to boost competitiveness.

The goal is to make Tuyu Hospital a powerhouse, among the top hospitals nationwide.

Right now, they’re stuck in the middle, good at nothing in particular.

The current Director Zhu of Tuyu has big ambitions. He wants to fulfill the dreams set by previous directors and turn Tuyu into a premier, top-tier hospital.

The talent reform is already showing results: most departments have fresh new faces, many with postgraduate degrees or higher.

Those with lower qualifications or mediocre skills have either retired or been shuffled off to secondary and tertiary branches.

Now, Tuyu Main Hospital has a much younger, highly-educated staff.

With this solid base, the next step is optimizing the departments.

To be cautious, they’re leaving key departments as-is for now and picking General Surgery, a weaker performer, as a pilot for the reforms.

In fact, these reforms started seven years ago.

First, they split Gastrointestinal Surgery from General Surgery to focus on digestive tract issues. Then, three years ago, they separated Hepatobiliary Surgery.

But the results have been disappointing.

It turns out, this approach doesn’t work.

Not only did they fail to build strong departments, but it also seriously weakened General Surgery.

This time, the hospital’s reform plan clearly learned a lot from previous failures.

Du Leng obviously picked up on this. At this crucial juncture, he chose to join General Surgery, aiming to compete within the teams and use this opportunity to climb the ladder.

Ordinarily, even with an overseas doctorate, it would take him seven or eight years to become a key leader in any department.

After all, Tuyu Hospital is full of people with doctorates.

Even if some are domestically trained, in terms of credentials, they’re every bit as valid as overseas degrees.

If there’s a difference, it’s just that some organizations prefer foreign backgrounds.

But on a national policy level, there’s no actual distinction.

“Dr. Du, you can pick any treatment team you like—including all teams in General Surgery, Gastrointestinal Surgery, and Hepatobiliary Surgery. Here are the team leaders and their members.”

Altogether, if you include the spinoffs, there’s about 130 doctors across these departments.

Trainees and interns aren’t counted.

There are nearly thirty Chief Physicians, twenty-nine Associate Chief Physicians, and the remainder are Attending Physicians and Residents.

That means almost half are senior-level doctors.

It’s not that it’s easy to become a Chief or Associate Chief Physician—it’s that only those at this level or higher have managed to stay. Attending physicians, residents, trainees, and interns do most of the work.

If these practitioners can’t move up the ladder, or if they lose hope for their futures, they’ll often switch hospitals.

Many have even changed fields or moved to administrative jobs.

Being a doctor really isn’t for everyone.

The pressure is intense, work hours are irregular, and the risks are sky-high. Even if you’re home making babies with your wife at night, if you get a call about an emergency, you’d better throw on your clothes and rush over. Even a minute’s delay could be disastrous.

Because saving lives is a race against time.

Every surgery, diagnosis, and treatment is filled with hidden dangers—one mistake and it could all go wrong.

Dr. Xu is a prime example.

One surgical error, and he went from being a top surgeon to just another attending in Emergency.

If he didn’t have such a strong will, he would’ve abandoned medicine long ago.

That kind of psychological blow isn’t something most people could handle.

“I’ll join Director Yang Qing’s team.”

Du Leng didn’t even check if Director Yang would agree.

He chose the team with total confidence, knowing Yang Qing would welcome him with open arms.

Zhou Can had spent over a month as a General Surgery trainee, so he was somewhat familiar with the teams.

Director Yang Qing was one of the most skilled among the Chief Physicians, excelling in both research and surgery. He was easily in the top three.

By all-around ability, Yang Qing’s team was the strongest in the entire department.

Du Leng merely glanced at the team list before choosing to join—it was clear he’d researched the strengths of every team before coming.

“Welcome to the team, Dr. Du! Glad to have you!”

Yang Qing was in his early fifties—a ‘young’ chief by local standards.

For most doctors at Tuyu, making Chief Physician at forty-five is like winning the lottery. Even making it by fifty-five is considered very lucky.

If you don’t make it by fifty-five, the pressure gets overwhelming.

Most male doctors retire at sixty, though some experts and professors can stretch it to sixty-five.

Yang Qing had already built such strong credentials in his fifties, putting him in prime position to lead the department one day.

According to his profile, his specialties were pancreatic and breast surgery.

He was one of the rare chiefs who specialized in two major fields.

Du Leng strode over to shake Yang Qing’s hand.

With such an outstanding new member joining at this crucial moment for the department, Yang Qing and his teammates were thrilled.

If nothing else, the fact that Du Leng could produce four or five SCI-level papers a year made him a super hot commodity.

General Surgery at Tuyu produced 38 SCI papers last year.

With so many chiefs and associate chiefs, only 38 SCI papers as a group shows how challenging this is.

Many chiefs go a whole year without publishing a single SCI paper.

In his very first working year, Du Leng managed to publish several SCI papers, making his academic credentials stand out even among the elite.

This was his edge—the thing that set him apart.

“Everyone will compete as teams for about a month. We’ll judge you based on outpatient diagnosis rates, inpatient stay length, cure rates, satisfaction scores, incident rates, mortality rates, and other metrics. The top teams will get to form sub-departments.”

Department head Xia Huai’an laid out the rules.

Length of stay is a critical indicator of a team’s treatment abilities. Only by quickly and accurately diagnosing, treating, and properly caring for patients can they be discharged sooner.

If the surgery is sloppy, the meds are off, or there’s a misdiagnosis, the hospital stay drags out.

“Director Xia, some teams see way more patients or have simpler cases thanks to their attending physicians. That’s a big advantage and makes the whole competition unfair.”

Someone raised an objection.

Everyone knew that if you had a big-name doctor in your team, you had a massive advantage. Most patients picked their doctors based on reputation.

For example, Yang Qing specialized in pancreas and breast cases, so most of his outpatients were for those areas.

“It’s not unfair. This competition is meant to see which team excels in what field—and the strongest team will get to set up their own sub-department. That way, doctors can focus their expertise and make our department stronger.”

General Surgery already sees a variety of cases.

At first glance, splitting into multiple sub-departments seems like breaking the department apart.

But in reality, it’s about assigning the right people to the right conditions.

Finer divisions help patients find the right expert and doctors stay in their field of strength.

“Don’t worry about fairness. Even if your team only treats one patient all month, but you cure that patient, you still have a shot at winning. We’ll consider both quantity and quality.”

Hearing this, everyone relaxed.

Every team had its strengths, and everyone was confident in their own group.

“If you don’t think your team has what it takes, you can try to join a stronger team. The point of competition is survival of the fittest—to push weaker teams and slackers to get better. If you don’t improve, you might get left behind.”

The words were a warning to those just going through the motions.

Some chiefs and associate chiefs were guilty of coasting.

Once they got promoted, plenty felt like they’d reached the top and didn’t push themselves anymore.

They started slacking off.

The department’s efficiency dropped in turn.

This reform was meant to weed out the slackers.

Of course, this threatened some people’s interests. That’s why the management was cautious and only tried these reforms in General Surgery first. If successful, they’ll expand them to other departments.

It’s a bit like boiling a frog slowly, gradually easing out the under-performers.

If they went after all the slackers at once, those people would band together in protest, and the reforms wouldn’t stick.

The hospital doesn’t belong to any one person—it’s a fairly democratic place.

“That’s all—meeting adjourned!”

Xia Huai’an concluded the meeting and left the conference room.

The other doctors didn’t rush off. Instead, they gathered in groups, chatting about the new changes and quickly seeking out the alliances they needed.

“Director Liu, our team is tiny. Should we find a stronger team to join?”

Song Ze voiced his worries.

Everyone knew that whoever won would have a shot at leading a sub-department. The rest would get a boost with them.

Dr. Jia was almost sixty and about to retire.

He’d been gunning for senior chief for years, but with little hope these days. No wonder the doctors under him were nervous about their futures.

“I’ve been at this too long—at my age, even if I switch to a better team, there’s no way I’ll be in charge. I’m not going to bother with playing second fiddle. But you all are still young. If you lack faith in our group, feel free to try another.”

Dr. Jia had two attending physicians and three residents. Including himself, there were only six people.

They had more interns and trainees, but those weren’t counted.

“I’m used to following Dr. Jia. Maybe this is the chance to push for that associate chief title. Even if our team finishes last, the hospital isn’t going to fire us.”

He Hansheng was firm in his loyalty.

He was sticking by Deputy Director Liu, come what may.

At this point, Song Ze was just worried he’d lose his chance. If he joined a winning team early, he’d share their glory. Wait too long, and he’d miss out.

“I’m here thanks to Dr. He and Director Liu. I’m not going anywhere.”

A resident made it clear he’d stay loyal.

Song Ze and two other residents stayed quiet.

When big decisions come up, people get very pragmatic.

“Again, if you find a team that will take you, go for it. I won’t mind either way.”

Deputy Director Liu left after that.

Song Ze’s eyes darted around—he was obviously on the hunt for a new group.

Zhou Can was only a trainee in General Surgery and didn’t care much about the reforms. He planned to return to Emergency after training anyway.

All the commotion here had nothing to do with him.

Back in the doctor’s office, he went back to reviewing unfinished case files before making rounds with Attending Physician He Hansheng.

At 9 a.m., Deputy Director Liu began the first surgery of the day.

Zhou Can and an intern wheeled a patient scheduled for cardia reconstruction into the operating room.

This patient suffered severe difficulty swallowing and constant food regurgitation. After several tests, the diagnosis was clear—achalasia of the cardia.

Medical treatment in Internal Medicine hadn’t worked.

So, following medical advice, the patient agreed to try surgery instead. But he refused to undergo esophageal dilation, so Deputy Director Liu recommended reconstructive surgery on the cardia to resolve the issue.

This kind of surgery is rare nowadays.

Most cases are now treated by cutting the muscle of the esophagus.

Cardia reconstruction is generally only used when internal treatment fails, dilation or bending is pronounced, or there are other complications—like diaphragmatic diverticula, hiatal hernia, or suspected cancer.

For Zhou Can, this was his first time assisting with this operation. He was actually looking forward to it.

If he could master it, it would definitely come in handy down the line.