godfather of surgery

Chapter 1193 Why is my heart beating so slowly?

Upon arriving at Yang Ping's office, Dean Xia began reporting the phone numbers. About ten minutes later, the leader called.

The leader was very kind and approachable, and showed great concern for Yang Ping. He promised to establish a core technology research and development plan for the pharmaceutical industry, fully support Yang Ping in leading the team to undertake the research and development tasks, and that there was no limit to the support he would give to Yang Ping.

Yang Ping is a talented person who deserves full trust and respect from his superiors.

Yang Ping's efforts alone are not enough. His report also mentioned reforming the current scientific research system. However, such reform is not something that can be accomplished overnight. The leader also mentioned this matter on the phone. He has taken this issue seriously and will gradually promote the reform.

In fact, the leader used the telephone to talk to Yang Ping in order to reduce unnecessary formalities. Sending Yang Ping to the capital for a face-to-face meeting would waste Yang Ping's time. This was a way of talking that the leader specially arranged for him.

After Yang Ping finished his conversation with the leader, Dean Xia smiled broadly. Things were going more and more smoothly for him. It could be said that everything went exceptionally smoothly. All kinds of applications, whether for personnel, money, equipment, or land, were approved quickly without any obstacles.

Now that Dean Xia drinks less alcohol, his stomach problems have miraculously healed themselves. He used to have stomach aches every few days and always carried stomach medicine in his pocket. Now he hasn't had a stomachache for several months and has almost forgotten that he used to have stomach problems.

Whether it was Sanbo Hospital that made Yang Ping successful, or Yang Ping who made Sanbo Hospital successful, perhaps both are true, but the latter carries more weight, that's for sure.

After finishing the phone call, Yang Ping chatted with Dean Xia for a while. Dean Xia was quite ambitious; he was not satisfied with the status quo at all. He wanted to build Sanbo Hospital into a truly top-tier international hospital, injecting it with a culture, heritage, and DNA.

Without Yang Ping, Dean Xia would not have been able to achieve this goal. With Yang Ping's help, he will definitely be able to achieve it. In fact, although Sanbo Hospital is now considered a top international hospital, that is only because of the existence of the research institute and Yang Ping. The other departments, the overall strength of the hospital, and the average quality of all doctors and nurses are still not up to the level of top international hospitals.

Dean Xia was not blinded by victory; he remained keenly aware of the gap between them.

A world-class hospital cannot be built overnight, just like building a university on par with Cambridge and Harvard. It cannot be achieved simply by having money, beautiful buildings, advanced equipment, and a few world-leading professors.

It needs time to mature, it needs a tradition of pursuing truth, a tradition of independent thinking, a tradition of critical thinking, and it needs a cultural core and a gene that values ​​scholarship. At present, Sanbo Hospital is far from possessing these qualities.

It could even be said that Sanbo Hospital's current status was largely due to Yang Ping's personal efforts.

If Yang Ping were to leave Sanbo Hospital one day, the hospital's current status would certainly collapse, and it would no longer be a world-class hospital. So, if we look at it realistically, Sanbo Hospital is not a world-class hospital now, but merely a hospital that has a world-class scholar, Yang Ping.

During the conversation, Yang Ping could sense Dean Xia's ambition and his thoughts on hospital management. He even felt that he had many shortcomings, that his vision was not broad enough, and that he did not yet have the qualities of a world-class hospital creator.

It turns out that Dean Xia also had his own concerns. He also wanted to go out and see the world, but he hadn't had the time. Once he finished this busy period, he also wanted to go out and learn in depth about the management of the world's top hospitals, what those hospitals were really like, what their core was, and how their internal operating mechanisms worked.

At the same time, Dean Xia also believes that he cannot build a world-class hospital by himself; he needs the assistance of a team.

He planned to invite a team of experts with management experience in world-class hospitals to help reform Sanbo Hospital. This was a good idea. Yang Ping wondered if he could talk to the students about it and ask them to help find a professional, top-notch hospital management team to help Dean Xia with the reform.

I chatted with Dean Xia for an hour or two without realizing it, while the case discussion on the other side had already ended.

"The hospital's recruitment interviews are about to begin this year. The interview lists have already been distributed to each department today. Have you seen the list?" Dean Xia suddenly remembered something.

Yang Ping said he hadn't seen it yet. Dean Xia said: "Maybe Dr. Zhang from your department hasn't had a chance to report to you yet. I took a quick look. This time, the personnel department is very efficient. The quality of the people in your department is very high, including the provincial science champion when you entered school."

"I'll take a good look then; we definitely need to bring in some fresh blood," Yang Ping said.

"Professor Yang, what do you think of the idea I just mentioned? If you have time, please keep an eye out for it and help us find a professional team to help us with the reforms." As he was leaving, Dean Xia patted Yang Ping on the shoulder, but he was very careful now, patting him lightly a few times each time.

Yang Ping assured him that he would definitely find a world-class hospital management team to help him reform the management system. This was not difficult; he would delegate it to Robert or Johannesson. Even if Tang Shun were to handle it, he would probably be able to complete the task, as Tang Shun also had experience studying in the United States.

Zhang Lin, Xiao Wu, and several doctors from the research institute were quite happy to return. Perhaps everyone had shared their opinions today, which greatly helped in the diagnosis and treatment of the cases. Confidence can sometimes create a very positive cycle.

Song Ziming, Xu Zhiliang, and Xia Shu were still on the operating table. Yang Ping checked the time. According to the usual speed of surgery, they should have been off the table by now. Why weren't they off yet? Had they encountered some difficulties during the surgery? Although they were all capable of handling things on their own, in Yang Ping's eyes, they still needed to improve. There was no end to improvement.

Yang Ping decided to go to the operating room to take a look. When he arrived at the operating room, he changed his clothes and found that the operating room was bustling with activity.

Looking at the scrub nurses and circulating nurses on stage, Yang Ping thought of Xiao Su and felt deeply moved. Xiao Su had given up her beloved job to support him silently behind the scenes. He secretly resolved to treat her well in the future and make her happy for the rest of her life, and not to do anything to let her down.

The head nurse of the operating room at the research institute is Zhou Can. Many new nurses have been recruited. Sanbo Hospital not only provides overseas training opportunities for doctors, but also for nurses. Nurses will be sent to top hospitals around the world in batches to study, just like doctors, so that they can keep up with international standards.

The head of the anesthesiology department is Fatty Liang. In addition to Dr. Wei, who was recruited early on, several young PhDs have also been added to cope with the increasing number of surgeries at the institute. In fact, the institute has been very restrained, trying to control the number of inpatients admitted, only accepting some difficult and high-risk cases. If the institute were to open up the admission of cases without setting standards, it is estimated that the institute could expand into the world's largest hospital, and increasing the number of beds to tens of thousands would not be difficult.

But that would be pointless. Both the research institute and Sanbo Hospital are pursuing a high-end technological path, which means they cannot expand their scale at will.

"Are you having any difficulties?" Yang Ping asked.

"A cavernous hemangioma with hemorrhage in the right pons, but the blood vessel is problematic, very fragile, and difficult to separate." Song Ziming was separating the cavernous hemangioma. He was quite calm and did not panic when faced with this problem. He probably felt that he could handle it, so he did not call Yang Ping.

Yang Ping stood in front of the X-ray light, carefully reviewing the images: "Didn't you consider this situation before the operation?" "The MRI images showed that the blood vessel wall was not normal. We considered these issues, but we still underestimated the problem. We didn't expect it to be so difficult during the operation. It's easy to tear it if you're not careful, and the malformed blood vessel is also adhered to the surrounding tissues, which is quite difficult to separate." Song Ziming stopped her operation, took a short break, and used the break to explain the situation to Yang Ping.

The brainstem consists of three parts from bottom to top: the medulla oblongata, the pons, and the midbrain.

The pons is part of the brainstem, located between the medulla oblongata and the midbrain. It is divided by a transverse groove at its anterior and posterior margins. The ventral surface of the pons is the pontine base, which contains a large number of transverse fibers that connect to the cerebellar hemispheres. In addition to transverse fibers, there are also some longitudinal nerve fibers.

Many cranial nerves pass through the pons: the trigeminal nerve, abducens nerve, facial nerve, and vestibulocochlear nerve. They control most of the body's sensory and motor functions, especially the regulatory center related to respiration.

Because of the brainstem's unique location, any surgery performed in this area is bound to be a high-risk and complex procedure.

Cavernous hemangiomas are not true tumors, but rather a type of vascular malformation. These malformations can occur in other locations, such as the skin, or even intracranially.

The incidence of cerebrovascular malformations in the general population is relatively low, ranging from approximately 0.1% to 4.0%, and there are four basic types: developmental venous abnormalities, telangiectasia, cavernous malformations, and arteriovenous malformations. In fact, they are all benign. Developmental venous abnormalities and telangiectasia usually have less impact, while cavernous malformations and arteriovenous malformations are more likely to lead to neurological sequelae.

The brain is the most common site of cavernous hemangioma, with a high incidence rate of 70%-90%. According to literature reports, cases have occurred throughout the supratentorial region, but the most common occurrence is in the subcortical region, particularly in the Rolandic and temporal areas.

Most large case studies show that approximately 25% of cavernous hemangioma lesions are located in the posterior fossa, with the majority located in the pons and cerebellar hemispheres. Spinal cavernous hemangiomas are intramedullary lesions, mainly found in the cervical and thoracic segments.

Infratentorial cavernous malformations often present with hemorrhage and progressive neurological dysfunction, while brainstem lesions manifest as cranial neuropathy and long tract signs. Due to the abundance of important nerve nuclei and fiber tracts in this region, progressive neurological decline can occur. Therefore, the natural course of brainstem lesions is worse than that of lesions in other locations. The hemorrhage rate in brainstem lesions is 2%-3% per year, and the rebleeding rate can reach 17%-21%. Progressive neurological decline is observed in 39% of patients.

Cavernous cerebral aneurysms are abnormal vascular clusters composed of numerous thin-walled blood vessels. They are congenital vascular malformations, characterized by cavernous sinuses lacking muscle and elastic layers, often accompanied by calcification and hemosiderin deposition.

These blood vessels are already in poor condition; if they encounter other diseases that can affect the vessel walls, it's like adding insult to injury.

“There’s no other way now but to rely on your basic separation skills. Don’t rush, take it slow. The more difficult the situation, the more patient you need to be. You must not damage the brainstem tissue.” After reviewing the images, Yang Ping had a general understanding of the patient’s condition.

Neurosurgical cases, except for brainstem surgeries, are generally not accepted by research institutes.

This case involves a young American woman, 7 years old, referred by Johns Hopkins Hospital.

Yang Ping stood outside the yellow line, walked to the side of the patient's head and glanced at it. Then he looked at the gauze next to it. It was indeed slightly more bleeding than Song Ziming's usual brainstem surgery. Intracranial surgery should theoretically be done cleanly to minimize bleeding.

This type of surgery isn't necessarily bad if there's a little bit of bleeding. More bleeding means that the separation is more difficult, and difficult separation can easily damage the brainstem tissue. If you encounter an impatient doctor who loses patience and can't stay calm, trouble will ensue, and it can easily lead to serious consequences, ranging from disability to death.

A doctor's psychological qualities are also very important, especially when faced with unforeseen complications during surgery.

Song Ziming is now using a laser scalpel. This high-tech surgical scalpel has many advantages over metal blade surgery, so doctors prefer to use it for these highly precise surgeries.

The circulating nurse brought a stool for Yang Ping to sit on, saying, "You guys continue. Don't worry about me. If you need help, just let me know. If you don't need help, just do it at your own pace. It's impossible for every surgery to go smoothly."

Zhang Lin and Xiao Wu then entered the operating room. He was holding a list in his hand: "Professor, take a look. This is the list of newly recruited doctoral candidates for this year. Please take a look."

Yang Ping took a look. The research institute had already taken shape in terms of structure and system, and the training method for doctors was also mature. So now they were starting to recruit people in stages. However, the threshold for recruitment was extremely high. Basically, all applicants had extremely excellent college entrance examination scores. Yang Ping only recognized the college entrance examination and did not recognize any other methods.

"This is the top science student in the college entrance examination in Beijing that year. He graduated from the eight-year medical program at Beijing Medical University. I heard from his internship supervisor that he is indeed smart, but he is arrogant and difficult to manage. He even had a conflict with his teachers during his internship." Zhang Lin introduced the basic information of the doctoral students on the list.

Yang Ping nodded: "It's normal to have a temper."

The next few were also outstanding in the college entrance examination; none of them were ordinary. Yang Ping was very satisfied.

"They'll be coming for the interviews next Monday, and you'll be attending, Professor." Zhang Lin put away the materials. He also wanted to stay in the operating room to observe the surgery, so he moved to the demonstration room. Due to the aseptic procedure, not too many people could stay in the operating room.

There was also a high-definition screen on the wall. Yang Ping sat in front of the screen and watched. Song Ziming's basic skills in separation were now very mature. Compared with other doctors, he was definitely top-notch. However, in Yang Ping's eyes, there was still room for improvement.

Professor Zhang Zongshun once said something quite insightful: "When it comes to surgery, you can never demand too much skill, since the knife is cutting into a person's body."

During Song Ziming's surgery, Yang Ping would not speak out unless there was a mistake, as this would interfere with the surgery. Even if he wanted to express his opinion, it would be after the surgery.

The anesthesiologist for this surgery was Dr. Wei, while Fatty Liang was in charge of a coronary artery bypass surgery next door.

Anesthesiologist Dr. Wei was a man of few words. No matter how many anesthesias he performed in a day, he was always smiling, his face always bearing a smile, but he just wouldn't say a word. When others chatted, he would listen from the side without speaking, only smiling.

However, he worked very hard, never complained, and always worked diligently without complaint, just like a strong ox.

Why is my heart beating so slowly?

Dr. Wei stared at the heart rate on the electrocardiogram; it was only 40 beats per minute.