Chapter 88: A Surgeon’s Breaking Point

Everyone watched as Zhou Can demonstrated surgical skills far beyond those expected of a trainee.

He carefully separated the blood vessels from the mass bit by bit.

At last, nearly all of it was detached.

“Doctor, I plan to cut off the capillaries within the mass and then use electrocautery for hemostasis. Finally, I’ll completely separate and excise the mass from the muscle tissue. Is that acceptable?”

Out of respect and caution, Zhou Can didn’t rush to finish.

Instead, he consulted Dr. Xu first.

“That plan is excellent!”

Dr. Xu, in front of the patient, never hesitated to praise him.

With his teacher’s approval, Zhou Can felt confident.

Step by step, he completed the remaining surgical tasks.

He cut off the tiny blood vessels growing into the mass and then used electrocautery to stop the bleeding.

In fact, Dr. Xu had already clamped the main vessel’s root, so when cutting the capillaries the bleeding was minimal.

During surgery, it was crucial to minimize blood loss.

Not just because the sight of blood put psychological pressure on the operator, but also because the flowing blood could obscure the surgical field and cause complications.

The proper method for removing a mass was to cut off its blood supply first, then proceed with further steps.

Dr. Fu, who had long witnessed Zhou Can’s hemostatic techniques, was still amazed at what he saw.

Dr. Lu, Dr. Lin, and Jin Mingxi held similar sentiments.

Seeing Zhou Can’s superb hemostasis, they couldn’t help but feel both envy and pressure.

But that was a good thing.

Pressure breeds motivation!

Traveling with fierce predators sharpens one’s skills, and flying with phoenixes molds a majestic bird.

Only by surrounding yourself with the strong can you become stronger.

After managing the vessels and successfully separating the mass from surrounding tissues, only one step remained.

Excision.

Without hesitation, he decisively removed the mass at its root.

“Xiao Zhou, you excised the mass very well. Remember, whether it’s benign or malignant, it’s okay to remove a bit more normal tissue to ensure complete excision and prevent recurrence.”

“Understood!”

Zhou Can nodded, taking it all in.

An incomplete excision of a malignant tumor could lead to grave consequences.

It might cause cancer cells to spread, eventually robbing the patient of any hope for surgery.

This was a common occurrence.

Whether it was breast cancer, uterine fibroids, stomach cancer… when surgeons with subpar skills operated, incomplete excisions were all too common.

Tumors had one notable trait.

If left undisturbed, they might grow normally.

But once provoked, they escalated to an entirely different, almost insurmountable level.

In its struggle to survive, the tumor would go into a frenzied ‘battle mode’.

Not only would its cell division accelerate, but it would also rapidly invade surrounding tissues.

At that stage, it would be a disaster for the patient.

“Doctor, do you think we can proceed with debridement and suturing now?”

With the mass successfully removed, the patient’s swollen cheek had mostly subsided.

Dr. Xu inspected carefully and found no issues.

He signaled that it was fine to begin debridement and suturing.

Twenty minutes later, Zhou Can successfully completed the debridement and skin suturing.

The patient’s right cheek now looked smooth.

“Everything’s done. The mass under your skin has been successfully removed. If you notice any abnormality at the wound, please inform our staff immediately,”

Dr. Xu advised the patient.

While Zhou Can was suturing, Dr. Xu had already written the orders.

He asked Qiao Yu to take the patient to the IV area for an infusion.

After the patient left, Dr. Xu looked at Zhou Can and then at Dr. Lu, Jin Mingxi, and Dr. Lin.

“Postoperative care for this kind of surgery is vital. If the wound shows signs of infection, it must be managed promptly and decisively. Ideally, antibiotics should be administered via IV, with oral anti-inflammatory drugs. For the first three days, the patient should receive daily infusions so we can monitor the wound closely.”

Dr. Xu imparted his postoperative care expertise to them.

“Xiao Zhou, when you practice independently, make sure you instruct the nurses in the infusion area to keep a close eye on patients with higher postoperative risks. Sometimes, treating them to a milk tea can foster better compliance with your instructions.”

Doctors and nurses are two different systems.

They depend on each other.

While doctors hold a higher status, a strained relationship can backfire on them.

Nurses only perform their duties and no one has the right to criticize them.

When something goes wrong, the unfortunate doctor always bears the brunt.

Among the doctors here, only Zhou Can was a newcomer. Many departmental unspoken rules scared others, so Dr. Xu took it upon himself to mentor him.

“Overall, you did very well with this surgery. But you should be aware of some shortcomings. For instance, your dissection of the mass wasn’t perfectly even, the debridement could have been more thorough, and the suturing was only just above average. These are all areas for improvement.”

Dr. Xu, in front of everyone, pointed out several areas where Zhou Can could improve.

Debridement had become Zhou Can’s weak point.

It was still at a basic trainee level.

It was inevitable, given his short time on the job.

His fundamentals were quite thin.

You can’t expect to become an expert overnight.

Improving surgical skills takes time and practice.

Being able to independently excise the mass without any mishaps was a huge step forward for him.

“I’ll work even harder!”

Zhou Can accepted his teacher’s advice with humility.

He also acknowledged his shortcomings.

At the same time, he noticed that after Dr. Xu publicly critiqued him, the looks from Dr. Lu and the others had become noticeably friendlier.

Only then did Zhou Can understand his teacher’s well-intentioned approach.

Standing out too much may attract unwanted envy.

Excellence can invite envy.

Maintaining a few imperfections allows envious peers to find balance, which in turn protects him.

This strategy could also prevent unnecessary trouble.

“Oh come on, Dr. Xu, your standards for Xiao Zhou are too high! Among trainees, his skills are already exceptional. You can’t expect him to be on par with our seasoned attendings!”

Look at the results.

Dr. Fu began to chime in with praise for Zhou Can.

“Without rigorous training, even the most talented won’t succeed. Higher standards will only make you stronger!”

Dr. Xu had achieved his objective and didn’t delay any further.

“Alright, the Operating Room is all yours. We’re done for today—time to go home.”

…

Days passed, and Dr. Fu never mentioned extra shifts for Zhou Can again.

In the Emergency Department, many colleagues maintained their distance from him.

Meanwhile, Zhou Can clocked in and out punctually every day, independently handling level-one surgeries under Dr. Xu’s oversight.

Since he had demonstrated mid-level incision and dissection skills, Dr. Xu gradually entrusted him with simpler excisions.

However, when the stakes were higher, Dr. Xu always stood by his side for guidance.

Dr. Xu was especially stringent when it came to safety.

Aside from gaining experience in the OR, Zhou Can spent every day practicing on White Mice, buying eight to ten of them and practicing in his apartment.

With each session, his skills in Incision, Tissue Separation, and Ligature improved dramatically.

Every day was a noticeable improvement.

However, this method of practice was very costly.

Just the cost for White Mice ran between 1600 to 2000 yuan daily.

That added up to nearly 60,000 yuan a month.

For most, that expense would be unbearable.

Fortunately, practicing on White Mice was only needed in the early stages. Once most of his skills reached the level of a resident attending, his main training ground would shift entirely to the Operating Room.

Then he could earn experience directly from patient surgeries—faster, cost-free, and even profitable.

However, as a trainee, his salary was quite fixed.

According to national regulations, a trainee earns 10 yuan per case report and 50 yuan per duty shift, but come payday, that money never materialized.

Asking the trainee office was useless.

Approaching the department head was out of the question for the timid. Even the bold ones would ultimately get nowhere.

Since the hospital wouldn’t take money from the department,

the trainees only received a meager monthly stipend for meals, base salary, and some state subsidies, with occasional overtime pay.

Any talk of bonuses, performance commissions, or surgical incentives was unrealistic.

Some doctors participated in training as a form of advanced study. In addition to the aforementioned wages, their original hospitals would pay them an extra salary.

That said, those in advanced training were vastly different from the regular in-house trainees like Zhou Can.

To learn real skills, one had to be a full-scope trainee like Zhou Can.

They were seen as the hospital’s ‘core disciples’.

The hospital groomed them to be future successors.

Apart from that, there were contract trainees whose status was considerably lower than full-scope trainees.

However, they were still nurtured as part of the team.

A few exceptionally talented contract trainees eventually became department leaders, team leaders, senior physicians, or even department heads.

In short, if you wanted to rank the three types of trainees:

Full-scope trainees were the best—highly competitive with limited slots and high demands. Contract trainees were next; departments would recruit a batch based on need and train them rigorously. Some were lucky enough to secure a permanent position post-training, while others would be eliminated.

Advanced training was the least favorable.

It was essentially a stint for doctors from regional or small hospitals to add a touch of prestige.

They might learn a few things, but core surgical skills were hard to master.

Tuyu Hospital estimated they recruited at least 200 trainees a year.

The differences among them could only be experienced firsthand.

…

It was worth noting that during his White Mouse practice sessions, he uncovered a glaring issue.

After his hemostasis skill reached level four, everything was normal.

But when the experience hit 1000/ in level four, the increase suddenly stalled.

While he could still gain 1 point per procedure on a patient,

each practice on a White Mouse only netted him 0.001 point.

He was well aware that this was a punitive measure from the experience system.

A similar problem had occurred when he practiced suturing before.

The only real solution was to earn experience on actual patients.

Other methods were virtually ineffective.

He speculated that perhaps he had reached the peak of what practicing on White Mice could offer for hemostasis.

That’s why further practice was futile.

When you think about it, it made sense.

Below level four, electrocautery was the primary method for hemostasis, but once level four was reached, the methods became more complex—no longer simply electrocautery or ligation.

Hemostasis had evolved in every aspect: diagnosis, medication, strategy, and technique.

At that stage, every hemostatic effort became a formidable challenge.

Zhou Can had a feeling that if the hemostasis system had this flaw, other skills would eventually be affected too.

He had only just started with the experience system, and there was still much to explore.

This system accelerated his learning, not by isolated repetition, but by rewarding the correct methods of practice in varying degrees.

For example, diagnosing a complex, high-difficulty case would earn not only 1 ordinary point but also a bonus of 100 points.

When practice on White Mice no longer fed his hemostasis skill, he didn’t get discouraged.

Instead, he continued to use the mice to quickly gather experience in other surgical skills.

After all, he could afford the expense.

…

In the blink of an eye, sixteen days had passed.

Zhou Can’s days were filled with progress as all his surgical skills advanced rapidly, and he amassed plenty of level-one surgical experience.

Following his hemostasis breakthrough, several other skills were successively promoted to the attending level.

Incision, suturing, ligature, injection, and dissection—all had reached the level of an attending.

Once their experience exceeded 1000/, they, too, encountered the same plateau as seen with hemostasis.

Practice on White Mice no longer yielded gains.

He could only earn experience by performing surgeries on patients in the OR.

Currently, the experience points for these five skills hovered just over 1000, with injection lagging at 252/.

This was mainly because he hadn’t practiced injection on the mice.

Using only his daily procedures in the OR, he managed to elevate his injection skill to its current level.

Now, his injection technique was on par with that of older head nurses—many junior nurses couldn’t even match him.

Of course, injection wasn’t limited to just administering shots.

As he obtained opportunities for more advanced surgeries, its applications would broaden enormously.

Additionally, his debridement skill finally climbed from level two to level three.

His current experience: level three 41/1000.

For a basic resident, this was sufficient for level one and two debridement surgeries.

It was a relief to finally shore up that weak point.

Of course, it would be even better if he could reach a higher level later on.

“All of my four basic surgical skills have reached the attending level. Since practicing on mice isn’t yielding further gains, it’s time to advance Anastomosis, Grasping, and Device Implantation—three higher-level techniques.”

Zhou Can pondered and set a new training plan for himself.

He could practice Anastomosis on mouse tail nerves, vessels, and intestines.

Although the experience gain was slower—only 0.2 points per successful anastomosis—it was still a favorable rate.

He could successfully anastomose a small blood vessel roughly every fifteen minutes.

Practice one evening and he’d gain around 6 to 7 points in anastomosis.

He believed that persisting for about a year would surely elevate his anastomosis skill to the attending level.

Ever since hearing about the stagnation of minimally invasive techniques domestically,

he had secretly added improving his minimally invasive surgery skills to his plan.

In the morning, Zhou Can arrived at the hospital for his shift as usual.

“Good morning, Dr. Zhou!”

“Morning!”

“Wow, Dr. Zhou, you’re getting even more handsome!”

“Hehe, maybe your eyes are just seeing things better!”

Zhou Can smiled as he replied to each one.

His colleagues in the Emergency Department had distanced themselves for a while, but eventually, reason prevailed over rumor.

After nearly half a month, Zhou Can continued to work normally without any hospital superior giving him trouble.

The rumors spread by Dr. Lu eventually fizzle out on their own.

Everyone gradually returned to normal interaction with him.

The workplace was indeed pragmatic.

Though personal relationships were valued, profit remained paramount.

The previous incident had served as a mirror, revealing the true nature of every colleague—a valuable lesson for Zhou Can.

It was a significant step in his growth.

“Xiao Zhou, Jin Mingxi, hold on—you two, come with me to the morning meeting!”

Dr. Xu called out to the two as he beckoned them.

Since becoming a trainee, Zhou Can had never attended any meetings.

Back when he was an intern, meetings were frequent—and missing one would cost you 50 yuan.

“Teacher, could you assign me a more challenging level-one surgery patient today?”

As he walked alongside Dr. Xu, Zhou Can asked cheekily.

Now that several skills had advanced to the attending level, he was no longer content with routine debridement and suturing; he yearned for more challenging operations.