Chapter 577: Neurological Issues? The State of Medicine

Under normal circumstances if the bones of two toes haven’t fused together and each maintains an independent complete structure a simple surgery to separate them down the middle would suffice.

However since this condition is a deformity unexpected complications can arise during the actual procedure.

For instance the blood vessels of the two toes might be intertwined or they might share a single artery for blood supply. In such cases the surgery becomes more complex requiring an artificial bypass to reconstruct an artery.

In reality the anterior tibial artery and the dorsal artery of the foot are the primary sources of blood supply to the toes.

As for venous return it mainly relies on the great and small saphenous veins.

The posterior tibial artery one of the two major terminal branches of the popliteal artery can also serve as a blood source for vascular reconstruction if needed. It typically supplies blood to the sole of the foot though it’s used less often in surgery.

Zhou Can wasn’t clear on the specifics of this patient’s surgery.

One thing was certain though—the surgery shouldn’t be overly difficult. Otherwise it would have been performed by him or perhaps Dr. Xu personally.

After unwrapping the gauze the sutured wound became visible.

The stitching was neat with no skin graft used just a direct closure suture.

For patients with the means they might undergo a period of water inflation to expand the skin before surgery. But since this was a minor procedure and the patient came from various parts within the province preparatory work often couldn’t cover every detail.

Expecting patients to make multiple trips to the hospital wasn’t very realistic either.

Doctors naturally aim to perform surgeries as perfectly as possible but patients often struggle with financial constraints and time costs making it hard for them to accept extensive preparations.

Postoperative direct closure suturing is fairly common.

Skin has remarkable toughness and elasticity. With some rest it can grow back on its own and fully cover the wound.

The only thing to watch out for during this time is preventing infection.

Also postoperative hospital observation typically lasts just one or two days. The remaining recovery involves dispensing medication for the patient to manage at home.

Especially in a major hospital like Tuyu where bed space is tight it’s hard to justify allocating limited resources to a patient undergoing a minor surgery.

This patient chose to have the surgery in Tuyu’s Emergency Department mainly due to Zhou Can’s reputation.

Normally a procedure like separating conjoined toes would be handled by the General Surgery Department.

The Emergency Department Operating Room now functions as a multi-disciplinary surgical unit taking on almost all types of surgeries except for level-four procedures and obstetrics.

Surgery primarily involves two technical aspects.

First is the fundamental surgical skills like incision suturing hemostasis and anastomosis. Second is surgical experience.

Under normal conditions as long as it’s not an exceptionally difficult surgery any surgeon can transform into an all-around expert.

Of course in actual practice such versatile surgeons are incredibly rare.

Ask a surgeon who usually only performs general surgeries to crack open a chest for heart surgery and chances are they’ll lose every patient on the table.

This is also why Cardiac Surgery and Neurosurgery are considered the two pinnacles of surgical fields.

Both domains involve highly specialized and precise procedures.

Only those with exceptional surgical skills and extensive experience in these fields can handle such operations.

Training a surgeon for Cardiac or Neurosurgery takes at least eleven years.

That means from a novice doctor to being able to independently perform a cardiac surgery it takes a minimum of eleven years. In reality this training period is often longer—without fifteen to twenty years of surgical experience senior doctors wouldn’t dare let you lead an operation alone.

After all lives are at stake.

Judging by the suturing technique and neatness of this patient’s toe separation surgery it was likely performed by a fairly experienced surgeon.

The attention to detail in certain aspects was quite impressive.

“Is this the toe that feels numb?”

Zhou Can picked up a sterile cotton swab and touched the patient’s right toe. To be precise it was the third toe.

Typically the second to fifth toes are the most prone to deformities like conjoined toes.

The first toe located on the inner side and the thickest of them all is the leader among toes with a very low likelihood of deformity with the second toe.

This female patient’s issue was primarily with the third and fourth toes of her left foot being conjoined.

“Yes that’s the one.”

The girl nodded.

A family member stood by the hospital bed as her caregiver.

Judging by appearance and age the caregiver was likely the girl’s mother. Yet this woman seemed shy and simple saying little just standing by with a gentle smile as she watched Zhou Can examine her daughter.

The patient’s father had only appeared on the day of the surgery probably returning to work to earn money after seeing his child through the procedure.

In most families the man is often the pillar of support.

The financial backbone too.

“Close your eyes for a moment.”

Zhou Can instructed the patient.

“Can you feel anything?”

He touched the third toe of her left foot again with the cotton swab.

“A little but it’s not very clear.”

“Which toe am I touching now? The left or the right?”

“The right!”

“And now which one?”

“The left!”

“Does the sensation in this left toe feel different from the right one?”

“Yes! It’s very clear. I can tell you’re touching my toe with the holding end of the cotton swab.”

The girl’s responses were precise.

This made Zhou Can’s diagnosis much easier.

The worst kind of patients are those who can’t answer clearly fumbling through questions with vague hesitant replies.

That kind of thing can drive a doctor up the wall.

Now it was almost certain there was an issue with the third toe of the patient’s left foot.

Zhou Can’s expression turned serious.

“You can open your eyes now. Thanks for cooperating.”

With the surgery already completed a visual inspection from the outside revealed nothing unusual.

The patient’s two toes appeared rosy indicating good blood circulation.

It seemed likely that the issue lay with the nerves in the toe.

“Have you ever touched these two toes with your hand before?”

“Yes I have!”

“Did you feel anything when you touched the right toe?”

“Yes! Back when I trimmed my nails or scratched an itch the sensation was very clear. Dr. Zhou is there something wrong with this toe?”

At this point even if she wasn’t the sharpest she could tell the numbness in her third toe wasn’t just the lingering effect of anesthesia.

There was likely a real problem.

“It’s hard to say for sure right now. There’s definitely an issue with the sensation in the third toe. Since the surgery just happened let’s observe it for another day or two. I’ll arrange further tests for you then.”

Zhou Can didn’t jump to conclusions immediately.

Post-surgery factors like local hematoma or wound pain can complicate immediate judgments.

In medicine definitive conclusions are rarely made. Answers given to patients are often vague with a lot of wiggle room.

Even if a doctor knows a patient’s tumor is cancerous and the pathology biopsy supports a malignant diagnosis they won’t outright tell the patient it’s definitely a specific type of cancer. Instead they’ll phrase it conservatively.

Of course when a patient is diagnosed with a malignant tumor or something like uremia considering their emotional capacity the results are often not disclosed to the patient directly.

They’re shared with the family instead.

“I had this surgery so I could dance ballet better in the future. If there’s really a problem with this toe will it affect my dancing?”

The girl looked a bit nervous now.

This was a normal reaction for most patients.

Once they learn of potential issues with their body post-surgery anxiety and tension often set in.

“Don’t worry too much for now. Just focus on resting. If there is a problem we’ll do our best to help you resolve it.”

Zhou Can wasn’t very familiar with ballet. He only knew it involved standing on tiptoes and spinning the entire body like a top requiring significant strength and flexibility in the toes.

The patient underwent this surgery not just for aesthetics but also to improve her dancing.

Each toe has its unique function.

Theoretically the primary role of toes is to stabilize the body.

During human evolution our ancestors needed to run and leap barefoot through forests and mountains even climbing trees to escape predators.

This required the feet to have a certain gripping ability.

Toes were used to grip the ground or tree trunks to steady the body.

Modern humans have evolved to a higher level of civilization mostly wearing shoes while walking. The function of toes has further diminished. Even losing a toe can be adapted to quickly with minimal impact on walking.

However for activities like jumping or dancing there would definitely be an effect.

After finishing his rounds Zhou Can noticed quite a few minor issues.

Patients’ reluctance to have young doctors perform surgeries or treat them wasn’t entirely unfounded.

Among the surgical inpatients in the Emergency Department the proportion of level-one and level-two surgery patients was very low accounting for only about thirty percent of the total surgical inpatients in Emergency Surgery. Most level-one and level-two surgery patients were treated and discharged on the same day.

At most they might return to the outpatient department for a dressing change the next day or come back within a week for suture removal and follow-up.

Level-three surgeries and complex level-two surgeries were mostly handled personally by Zhou Can and Dr. Xu. While the quality wasn’t perfect it at least reached a high standard.

But surgeries performed by others were a bit harder to comment on.

Especially in the past two years the Emergency Department had been recruiting new surgical doctors many of whom were young and inexperienced with subpar surgical skills.

Under such circumstances the quality of surgeries they performed was predictable.

Hospitals tend to be quite lenient when it comes to training new staff.

They allow minor mistakes and issues during the learning and growth process. As long as no major incidents occur the hospital often turns a blind eye.

Expecting every novice surgeon to perform at the level of Zhou Can or Dr. Xu right from the start is simply unrealistic.

“Who performed the surgery for the patient in bed one?”

Zhou Can asked Dr. Jiang Shuangshuang the attending doctor for that bed.

Since she was originally from the Endocrinology Department when she was transferred to the Emergency Department it coincided with the establishment of the inpatient ward there. So she was assigned as an attending doctor in the ward.

Currently the Emergency Department has over a hundred beds and her status here has visibly risen.

If all goes well she should get an opportunity for further training this year. After returning she could take on the role of Chief Resident preparing for promotion to Attending Physician.

Most resident doctors grow through this path.

In departments with fewer doctors each physician is forced to rotate as Chief Resident for a year.

In departments with more doctors it’s a different story.

Being Chief Resident means living in the hospital for an entire year essentially on call twenty-four hours a day without rest.

For married individuals or young doctors in relationships it’s far from ideal.

Even spending a normal night at home with a spouse becomes a luxury.

Many doctors have a love-hate relationship with the Chief Resident position.

Because after serving as Chief Resident one’s skills in various areas including ward management improve significantly. The next step promotion to Attending Physician is almost guaranteed as long as you pass the exam.

In reality the exam for Attending Physician isn’t particularly difficult.

Over eighty percent of doctors pass it.

If you don’t pass you can always retake it the following year.

So the key to becoming an Attending Physician isn’t the exam but the year of training as Chief Resident.

Those with doctoral degrees who haven’t served as Chief Resident and are directly promoted to Attending Physician after a year of work often have certain shortcomings in clinical practice.

Their management skills and ability to handle sudden patient emergencies or worsening conditions might not match those of physicians who rose step by step through hands-on experience. Hospital leaders aren’t blind either. When appointing important management roles in clinical departments they usually don’t hand them directly to untested doctoral graduates.

Besides their career paths are entirely different.

Doctoral graduates focus more on research tirelessly producing high-quality papers to quickly aim for associate or full professorships.

It’s this somewhat detached talent promotion system that leads to many specialized master’s or doctoral students who studied for eight years ending up unable to do much of anything after entering the hospital.

Many renowned doctors might not even be skilled at treating patients.

This is one of the oddities in the current medical field. Relevant authorities have noticed this issue and are working on developing a more scientific and reasonable talent cultivation mechanism.

In the United States medical student exams involve live patients.

Obtaining a medical license abroad is incredibly difficult often requiring a wealthy family to support the training of a doctor or nurse. Doctors in the U.S. belong to a high-income bracket.

In China there’s no shortage of medical students but there’s a lack of medical students who can actually treat patients.

The last time Tuyu Hospital recruited for the Emergency Department there were only two positions and they were for less desirable technical roles. Yet over three hundred master’s graduates applied including a handful of doctoral candidates.

This shows just how competitive the job market for medical students has become.

There’s also a peculiar phenomenon—everyone is scrambling to get into major hospitals. Meanwhile smaller or mid-sized hospitals struggle to attract higher-level talent.

The more prestigious the hospital like Tuyu the more sought-after it is.

When Zhou Can participated in the general training recruitment the hospital initially offered only ten to twelve spots yet thousands applied.

Years later Tuyu’s overall strength and ranking have improved significantly making recruitment even more competitive.

Jiang Shuangshuang has always shown great respect for Zhou Can.

Whenever Zhou Can does his rounds if she’s on duty she usually waits for him early.

Following Zhou Can during rounds allows her to learn a lot.

Zhou Can often offers her guidance which she finds immensely helpful.

“The toe separation surgery for the patient in the first bed was performed by Dr. Fu. Do you need to review the surgical records?”

Jiang Shuangshuang asked.

“You can pull up the surgical records for me. I also need to speak with Dr. Fu to get a better understanding. There’s a good chance something’s wrong with this patient’s toe.”