Chapter 128: A Crucial Day in the OR

“You ask me? It’s not my call. We have to follow Dr. Zhou’s and Chief Resident Shen’s opinions,” someone remarked.

Dr. Shan definitely wasn’t willing to let go of a talent like Zhou Can.

A blunt refusal would have offended Dr. Chi.

Cleverly, she tossed the responsibility over to Zhou Can and Chief Resident Shen.

As for a trainee, they rarely get a say in decisions.

Less skilled trainees have to pull strings or give a few bribes to land even a slightly better mentor.

The real decision-makers are the Department Director and the deputy directors or senior attending physicians in the unit.

Some departments, for convenience’s sake, appoint a teaching team leader directly.

That person wields considerable power.

“Thank you, Dr. Chi, for your kindness. As the saying goes, never forget your roots. If I had to choose, I’d stick with Dr. Shan,” she said.

Zhou Can had never been one to forget his roots.

Dr. Shan had taken very good care of him, and he could feel the genuine goodwill behind it.

For him, three months in Orthopedics was a short time; training under a trusted attending provided far more learning opportunities.

At that moment, choosing Dr. Shan over the more renowned Dr. Chi would only deepen that trust.

“Haha, just kidding, Dr. Zhou—don’t take it too seriously. I didn’t expect you to be so grateful,” Dr. Chi teased.

After testing the waters, Dr. Chi could see the matter was unchangeable.

He just laughed it off.

Despite the internal competition, the team remained remarkably united.

Chief Resident Shen had by now nearly finished constructing the skeletal interface at the implant site.

“Everyone, come over and observe carefully! I chose this position for the bone junction. It preserves the patient’s original thumb joint as much as possible, which is crucial for postoperative finger function,” he explained.

Zhou Can edged closer, watching and learning intently.

This kind of microsurgical level-4 operation demanded exceptionally high technical skills from every angle.

There was an abundance of knowledge to be gained.

“With the bone alignment done, we still have numerous challenges: securing the skin flap, tendon, nerve, and reconnecting both arterial and venous vessels. Especially since this patient was born without a thumb, and years later there might be tendon, nerve, or vascular contractures or even absences,” he continued.

Such operations pose even greater unknown risks during the procedure.

The surgical difficulty multiplies accordingly.

It’s a tremendous test for any doctor.

“For bone alignment, you can refer to replantation protocols. We generally use internal fixation for the bone junction,” he advised.

With practiced precision, Chief Resident Shen aligned a toe bone with the phalanx of the patient’s right thumb.

“In future similar surgeries, assess the patient’s phalanges. If the first segment of a thumb is intact, you may consider harvesting the big toe. If there’s severe phalangeal loss, you might even take the second toe next to it (the one resembling a ring finger).”

He patiently explained as he continued aligning the bones.

Different scenarios call for different transplantation methods.

“Dr. Chi, you handle the tendon reconstruction. Feel free to ask me if you’re unsure about anything,” he added.

After confirming the bone alignment was flawless, Chief Resident Shen stepped back from the lead surgeon’s position.

Almost every chief surgeon performs only the most critical parts of an operation, leaving the remaining tasks to the rest of the surgical team.

That’s why department heads favor promising junior doctors.

Generally, the better the talent, the higher their chances of success.

Once a mentor’s protégé proves themselves, the mentor’s workload lightens considerably.

Especially for major surgeries that one person wouldn’t dare to handle completely on their own.

Only physicians at the deputy director level or higher are qualified to lead level-3 or above surgeries.

These doctors are typically older.

Their energy and stamina don’t match those of the younger doctors, so they can’t handle every step of a lengthy operation on their own.

Delegating to trainees is the ideal solution.

Chief Resident Shen deliberately entrusted this tendon reconstruction training opportunity to Dr. Chi,

hoping to hone his abilities in that area.

After taking over, Dr. Chi began locating the tendons, trying different methods for alignment.

When he encountered difficulties, he promptly consulted Chief Resident Shen.

Sometimes Shen even took over personally.

Standing by silently, Zhou Can absorbed every surgical nuance and problem-solving technique – precious skills for his career. Learning from this was a once-in-a-lifetime opportunity.

Jin Mingxi had fought tooth and nail to secure a spot as a trainee at Tuyu, all for the chance to hone his surgical techniques.

……

This operation dragged on for nearly four hours.

The level of difficulty was beyond imagination.

Reconstructing the tendon was painstakingly challenging. The near absence of the flexor tendon almost brought the surgery to a halt.

Later, the nerve anastomosis proved equally daunting.

Dr. Shan excelled in precise surgeries, but reconnecting those nerves nearly broke her.

In the end, it was Zhou Can’s steady hands that successfully linked two nerves.

That was thanks to his natural knack for nerve anastomosis.

Otherwise, Chief Resident Shen would have had to step in personally.

The vascular anastomosis that followed was just as challenging.

Suturing blood vessels just one millimeter in diameter under a microscope was incredibly difficult.

Complicating matters, the vessels to be connected were often mismatched in size.

These issues all demanded innovative solutions.

Lastly, the skin flap coverage was fraught with obstacles.

Fortunately, the entire team pushed through their stumbling efforts and finally completed the surgery.

Next came bandaging and monitoring the blood flow in the transplanted digit.

After reperfusion, a hint of color returned to the nail bed.

Yet overall, the finger still looked a bit shriveled.

This was normal. In a day or two, if the transplant took, the finger would become rosy, turn pale when pressed, then quickly rebound and regain its flush.

That would indicate fresh blood was filling the capillaries.

Otherwise, poor perfusion was a concern.

Like the patient seen during morning rounds with four replanted digits—their fingers were pale and clearly problematic.

It takes about a week to determine if a transplanted finger will survive.

If after a week the digit is rosy, warm, plump, and shows a good capillary refill, it’s a success. But if it turns dark, shriveled, or infected, the transplant has failed.

Immediate intervention would then be required.

It’s often said that the earlier a necrotic limb is amputated, the better.

Otherwise, the dead tissue releases toxins, harmful substances, and bacteria that spread through the bloodstream.

By that point, even saving a life becomes uncertain.

I recall one city hospital that, during a lower limb artificial bypass surgery, had the lead surgeon absent and overall negligence. Patient demands were repeatedly brushed aside, leading to a high-level amputation and ultimately, the patient’s death.

Doctors who treat patient lives as a joke deserve a lifetime ban from practice.

Yet unfortunately, in such cases the patient’s family typically settles for a compensation payout.

Meanwhile, that doctor continues wreaking havoc.

“Alright, let’s wake the patient from anesthesia!”

Chief Resident Shen addressed the anesthesiologist.

“This afternoon I have clinic duty and a class to teach. You two can each lead your teams onward with the surgery. This hundred-level operating room is slated for other procedures later. Let’s pack up and grab a bite to eat—get some rest.”

Watching his two star proteges, Chief Resident Shen laid out the plan.

Department heads are among the busiest doctors around.

Meetings, surgeries, rounds, mentoring, research, lectures, clinics… their schedules are jam-packed.

At Chief Resident Shen’s level, each of them was a gem of Chinese medicine.

“Zhou, you did well today. I specifically checked how you handled the treatment and suturing of the patient’s foot wound. That fish-mouth suture was an excellent choice. By the way, who is your mentor in the Emergency Department?”

Shen’s gaze landed on Zhou Can’s face.

“Dr. Xu!”

In Zhou Can’s eyes, Dr. Xu was his one and only mentor.

Chief Resident Shen nodded. “I had a hunch. Dr. Xu was once one of the top three surgical blades in our department. No wonder your skills are so exceptional. Honestly, while you may lack the experience of an attending, your surgical ability is on par—indeed, some attendings with lesser skills pale in comparison to you.”

That was a rather high compliment.

Yet it was fair and honest.

Zhou Can truly had the potential.

“Zhou, I’m about to say something you might not like, so bear with me,”

Chief Resident Shen said with genuine tone and expression.

“Please, go ahead. I’m all ears!”

Zhou Can knew that at Shen’s level, his words were heartfelt and based on deep experience.

It was only because of his remarkable potential that Shen was willing to share these insights.

“Yesterday, I noticed a bit of Dr. Xu’s style when you were separating vessels. Do you know how Dr. Xu fell from being one of the top three surgical virtuosos to an attending?”

“I know a little. Back then, Dr. Xu had a medical mishap during a surgery and was penalized,” Zhou replied.

Zhou didn’t know many details.

“Dr. Xu’s overly rapid cutting nearly killed his patient. Only after top attendings from multiple departments rallied to save the patient was his life spared, though the patient was left permanently paralyzed, essentially a vegetable,”

Chief Resident Shen recalled, “That patient wasn’t an ordinary case. The incident escalated quickly, and the authorities were ready to hand down a lifetime ban and revoke his license. It was only after several hospital leaders and a high-profile figure Dr. Xu had once saved intervened that he was spared.”

“Your cutting speed worries me deeply. I’m scared you might one day follow in those footsteps,” Shen warned earnestly.

He spoke with heartfelt concern.

“Your talent surpasses any genius I’ve seen. With proper training and continuous self-improvement, there’s no doubt you’ll become a cornerstone of Tuyu. As for your academic background, that’s a hurdle we can overcome. For now, while you’re still experimenting with the rapid cutting style and it hasn’t impacted you much, please rein it in and don’t chase speed recklessly.”

Chief Resident Shen’s earnest counsel showed his sincere care for talented individuals.

He truly didn’t want to see a genius waste his potential on a dangerous path.

“Thank you for your wise words today. I’m still testing the rapid cutting approach—it’s too early to commit. When it comes time to choose a primary specialty after my training year, I’ll weigh the pros and cons carefully,” Zhou Can responded.

Right now, his rapid cutting skills were only in the early stages.

There was still a long way to go before he could claim any real achievement.

He and Dr. Xu had agreed to try it out first.

If Zhou Can later found it unsuitable or too risky when choosing his main focus, he could always abandon it.

“Just listen and learn. From these past two days I’ve observed your abilities, and I’m convinced. From now on, any time I operate, you may join Dr. Shan. And whenever you have any Orthopedics questions, feel free to ask me. Just know that I’m more adept at treating bone trauma and some microsurgeries. I’m not as proficient in joint, spine, bone disease, or foot and ankle surgery,”

Every doctor has their own specialty.

Chief Resident Shen’s expertise, for example, was in bone trauma.

“Thank you for your guidance!”

Zhou Can bowed deeply.

Shen waved him off, “I’m a practical man. Let’s skip the formalities and get some food.”

Today’s surgery had essentially cemented Zhou Can’s standing in the team.

Though nominally a trainee, his role was nearly equivalent to that of an attending.

A quick glance at the special privileges Shen had granted him confirmed this.

As long as Shen was operating, Zhou Can was welcome to participate.

He could seek advice on difficult cases at any time.

These perks were reserved for only the most excellent attendings.

In the days that followed, Zhou Can spent every day shadowing Dr. Shan.

Chief Resident Shen’s operation schedule was unpredictable.

He would only take time for level-3 or level-4 bone trauma surgeries.

Whenever he led a surgery, Dr. Shan always brought Zhou Can along.

Zhou Can particularly enjoyed assisting under Shen because he acquired advanced surgical skills and techniques that few could learn.

Moreover, Shen’s surgeries offered plenty of practical training opportunities.

Time and again, Zhou Can managed to get involved.

Every day his Orthopedics skills improved, and he began forming a comprehensive understanding of bone disorders.

That day, Dr. Shan performed a femoral head bone graft surgery.

This procedure was simpler than the previous one.

It didn’t require harvesting a vascularized bone flap – just drilling into the femoral head, packing in bone chips to relieve intraosseous pressure, and promoting blood flow recovery in the necrotic femoral head.

“Dr. Shan, may I try filling in the bone graft?”

Zhou Can had grown close to Dr. Shan, Dr. Tang, and the rest of the small team, earning a good standing.

He now regularly received important surgical assignments.

It also marked his gradual breaking of the quality control department’s rule that limited him to level-1 surgeries.

Such matters were typically swept under the rug by both the public and officials.

Zhou Can indeed possessed the ability, and senior doctors trusted him enough to give him challenging training.

Technically speaking, even assisting in a level-4 surgery didn’t breach any regulations.

The quality control department’s fuss about surgical quality and safety was nothing but malicious suppression.

Yet there was little he could do – the Emergency Department was a minor player, and he was no match against bigwigs like Director Xie.

“This bone graft carries minimal risk and requires lower technical demand. I want you to operate while I guide you,” Dr. Shan announced, stepping aside.

Zhou Can was overjoyed – sticking with Dr. Shan had proven to be the right choice.

In her surgeries he often got assigned high-risk tasks, such as vessel and nerve separation, bone union in fractures, and internal fixation for fractures.

As he packed in the bone chips,

just as he finished,

【Congratulations! You have acquired the Bone Grafting technique. Transplant the vascularized bone flap to the designated location. This technique repairs deficient bone and salvages necrotic bone by restoring blood supply.】

【Bone Grafting – Current Experience Level 1/10. Insufficient for internship standards.】

Seeing his newly acquired Orthopedics technique, Zhou Can felt a deep sense of satisfaction.

Now, he had mastered all four foundational Orthopedics skills for bone trauma.

With continuous improvement, he could become a competent Orthopedic surgeon.

As for more advanced Orthopedics techniques, he would patiently wait for the right opportunity.

……

Time flew – before he knew it, over two months had passed in his Orthopedics internship.

His understanding of Orthopedic treatment deepened further.

He discovered that Orthopedics and Neurosurgery were like twin siblings.

Many Orthopedic and neurological conditions appeared as mirror images of each other. In numerous major surgeries, Chief Resident Shen alone couldn’t handle everything – neurosurgeons had to join forces.

Zhou Can’s progress in Orthopedics was impressive.

Each of the four foundational Orthopedic techniques saw exponential improvement.

Even the notoriously challenging Bone Grafting technique had advanced to level 2 – a lower-tier trainee standard.

Over two months, he had performed nearly forty Bone Grafting procedures.

The volume was quite commendable.

However, roughly one-third of these surgeries required the implanting of a vascularized bone flap, a far more challenging operation that Dr. Shan usually handled personally.

Zhou Can only got training cases on non-vascularized Bone Grafting procedures.

Moreover, Dr. Shan also had two resident doctors and two trainees – he couldn’t allocate all surgical practice solely to Zhou Can.

On average, over two months Zhou Can managed to participate in sixteen Bone Grafting training sessions, which was already excellent.

From initially packing in bone chips to later learning how to harvest, drill, and execute the entire Bone Grafting process,

it marked very rapid progress for him.

Bone Grafting was, at that point, the least experienced among the four fundamental Orthopedic skills.

Meanwhile, External Fixation for Fractures had reached a level 3, lower-tier resident standard.

This was largely thanks to his diligence.

After shifts, he would dash to the wards, eagerly taking on extra cases.

Whenever someone needed a plaster cast, he cheerfully volunteered.

In just over two months, he had performed External Fixation treatments on more than 170 patients.