godfather of surgery

I'll read Chapter 1355 tomorrow and the day after.

The door to the office of the director of neurosurgery at Sanbo Hospital was open, and Xu Zhiliang was sitting inside with a stack of medical records spread out in front of him.

He had been sitting there for an hour, and hadn't read a single page.

Outside in the corridor, nurses came and went, their footsteps, voices, and carts mingling together—the kind of noise unique to a new department. No one dared to come in and disturb him—the new director, and no one knew his true capabilities yet.

Xu Zhiliang knew what they were thinking.

A 34-year-old PhD who stutters is the head of neurosurgery? Even though he is Professor Yang's apprentice, his qualifications are far too shallow.

He recalled the conversation Yang Ping had with him three days earlier.

Without any preamble or pleasantries, Yang Ping said directly, "The neurosurgery department needs a director. You go there."

Xu Zhiliang was stunned.

"Professor Yang, I—"

How many brainstem surgeries have you performed?

"Three hundred and forty-seven."

"How many doctors in China can perform brainstem tumor surgeries? How many can perform as many surgeries as you? And how many have such a high success rate as you?"

Xu Zhiliang remained silent.

Yang Ping said on his behalf, "You can be counted on one hand, and you're one of those, near the front."

Xu Zhiliang opened his mouth, wanting to say that he had only studied for a few years, what the senior experts in neurosurgery would think of him, and many other things. But Yang Ping didn't give him the chance.

"Report next week," Yang Ping said before leaving.

And so, he arrived.

There was a knock on the door.

Xu Zhiliang looked up and saw Chief Physician Chen Houming standing at the door; he was the former director of this place.

"Director Xu." Director Chen walked in with a smile.

Xu Zhiliang stood up.

"Director Chen, please have a seat."

Chen Houming waved his hand, refusing to sit. He put his hands behind his back, looked around the office, and his gaze lingered on Xu Zhiliang's face a few times.

He walked to the bookshelf and looked at the row of empty shelves.

Where are your notes?

Xu Zhiliang was taken aback.

Chen Houming laughed and said, "Don't pretend. Everyone in the hospital knows that Yang Ping's apprentices all take notes. Secretary Xia filled fifteen notebooks, you filled nineteen, and Song Ziming filled twenty-eight."

Xu Zhiliang paused for a second, then opened the desk drawers and cabinets, where all the notebooks were stacked. He took out a few and handed them over.

Chen Houming took it, pulled out a book, and opened it.

He read very slowly. He turned the pages one by one, pausing occasionally to squint at the messy handwriting and hand-drawn surgical diagrams.

After finishing one book, he picked up another.

Xu Zhiliang stood to the side, not knowing what he was looking for.

When he turned to the third book, Chen Houming stopped.

That page contained a surgical approach diagram for a brainstem tumor, surrounded by dense writing: tumor location, size, boundaries, relationship with surrounding structures, unexpected events encountered during surgery, management methods, and postoperative follow-up results.

Chen Houming stared at it for a long time.

Then he closed the notebook.

“Director Xu,” he said, his tone changing, “I’ve worked in neurosurgery for thirty years, and I’ve only performed forty cases of malignant brainstem tumors. Of those, seventeen survived. Nine of them are able to live normal lives.”

He looked at Xu Zhiliang.

"You made more than 300 units, and all of them survived. More than 270 of them are able to live normal lives."

Chen Houming remained silent for a few seconds.

Then he reached out his hand.

"Welcome. If you don't take this position, I'm afraid no one in the world can do it."

Xu Zhiliang grasped his hand. The hand was thin, with distinct knuckles.

Chen Houming released his grip and turned to walk out. At the door, he stopped, glanced back, and said:
"I'll work for you from now on. As long as you're willing to let me photocopy your notes, I'm fine with being your first, second, or third assistant. I'll even wipe your sweat offstage."
-
At 2 PM, the new head surgeon performed his first surgery.

The patient is a 43-year-old female with a cavernous hemangioma in the brainstem and a history of three hemorrhages. She has already experienced mild paralysis of her left limbs.

This wasn't a patient transferred from Yang Ping. She was an old patient of Chen Houming, who had waited a long time in the neurosurgery department and specifically requested Chen Houming to perform the procedure. Chen Houming referred her to Xu Zhiliang.

The anesthesiologist was a veteran, having worked at Sanbo Hospital for twenty years and seen it all. The scrub nurse was a senior neurosurgeon who had worked with Chen Houming on hundreds of surgeries. Two young resident physicians stood in a corner, barely daring to breathe. Several chief physicians were all present, to see just how capable the new chief physician really was.

The surgery began. Xu Zhiliang worked cleanly and efficiently, cutting open the skin, separating the muscles, and creating a bone window. Under the microscope, the brain tissue was exposed; it was grayish-white, soft, and rose and fell slightly with each breath.

The tumor is deep in the brainstem.

He had watched the videos countless times and simulated the approach in his mind countless times. But once he actually opened it, the situation was never the same.

The tumor was larger than expected. The area of ​​compression was wider than expected. The boundaries were more blurred than expected. But for Xu Zhiliang, it was no big deal.

The anesthesiologist stared at the monitor, the nurse handed over instruments, and the observing doctors held their breath. In the corner, Chen Houming, who had arrived at some point, stood there silently.

Xu Zhiliang didn't look up. His entire attention was focused on that small area of ​​his field of vision.

Separate, stop bleeding, separate again, stop bleeding again.

The tumor was peeled away little by little, and the brainstem gradually returned to its original shape.

In the fourth hour, the final cut was made.

"Stop the bleeding," he said.

After confirming there was no active bleeding, the skull was rinsed with warm saline solution and closed.

Chen Houming walked out from the corner and stood in front of him.

“I watched from the audience for four hours,” he said.

Xu Zhiliang looked at him without saying anything. He didn't like talking to people, especially people he wasn't very familiar with.

Chen Houming remained silent for a long time.

Then he said, "I've worked for thirty years, but I'm not as good as you in three."
-
Two days later, the patient woke up.

When Xu Zhiliang went to check on her, she was leaning against the headboard, eating porridge. When she saw him come in, she put down her spoon and forced a smile.

“Director Xu,” her voice was still a little weak, “they said that you performed the surgery on me.”

Xu Zhiliang nodded.

"how do you feel?"

"It's alright," she said. "My left hand and foot seem to work better than before the surgery."

Xu Zhiliang asked her to raise her hand and foot. The grip strength in her left hand was much stronger than before the surgery, and the muscle strength in her left foot had also recovered.

"The recovery is going well," he said. "If there are no problems after a few more days of observation, I can be discharged."

She nodded, then called out to him again.

"Director Xu."

Xu Zhiliang stopped.

She looked at him, her eyes a little red.

"Thank you."

Xu Zhiliang was taken aback.

“I’ve been sick for three years,” she said. “I went to many places, but they all said it couldn’t be done. Then someone said to go to Sanbo Hospital to see Professor Yang Ping, he could do it. I tried to get an appointment for a long time, but I couldn’t. Then Director Chen said that I didn’t need to get an appointment with Professor Yang anymore, because the new head of his department was Yang Ping’s student and could do it just the same.”

She paused.

“I didn’t believe it at the time. How good could a student be? Later, Director Chen showed me a picture of a patient and said that it was someone I had treated. That person had the same condition as me and was doing well a year after the surgery.”

She looked at Xu Zhiliang, her eyes glistening with tears.

"Director Xu, you're so young, how old are you this year?"

Xu Zhiliang thought for a moment.

Thirty-four.

She nodded.

"Thirty-four, and you're already this amazing. What will you be like in the future?"

Xu Zhiliang didn't know what to say.

"Take good care of yourself," he said. "Contact us anytime if you need anything."

He turned and walked out of the ward.

Sunlight streamed through the windows in the corridor, casting a bright shadow on the floor. He stood in that light for a while.

Thirty-four years old.

I studied neurosurgery for three years.

He has performed more than 300 brainstem surgeries.

All of them survived the surgery, and more than 270 can now live normal lives.

He had never thought that this number was anything special.

Now he realizes that he had unknowingly climbed to the top of the mountain.

These patients might not have survived otherwise.

They're still there. He stood there for a long time.
-
In the afternoon, at the door of Xu Zhiliang's office.

He was a young doctor, around twenty-five or twenty-six years old, wearing a white coat with a name tag that read "Zhao Xiaofeng, Resident Physician." He stood at the door, holding a medical record in his hand, which was trembling slightly.

"Director Xu," his voice was weak, "may I ask you a question?"

Xu Zhiliang looked at him.

"Come in."

Zhao Xiaofeng walked in, stood in front of the desk, and didn't dare to sit down.

Xu Zhiliang pointed to the chair: "Sit."

Zhao Xiaofeng sat down and spread out the medical record.

“This patient,” he pointed to the CT scan, “has a brainstem glioma, a diffuse type. The department discussed it three times, and they all said it’s not feasible. I… I wanted to ask you, is there any possibility?”

Xu Zhiliang took the film and examined it against the light.

It is indeed diffuse, with indistinct borders, extensive infiltration, and mixed with normal tissue. No one in the world dares to touch this type of tumor.

He stared at it for a long time.

Then he put the film down.

"You want to do it?"

Zhao Xiaofeng was stunned for a moment.

"I... I can't do that, I just wanted to ask..."

"You want to...save him?"

Zhao Xiaofeng remained silent for a few seconds.

“I wanted to ask you that,” he said.

Xu Zhiliang looked at him.

"What...is your name?"

"Zhao Xiaofeng".

"How many years have you been working in neurology?"

"Three years."

“Tell the patient and their family that surgery is possible,” Xu Zhiliang said. “You will come and assist them.”

Zhao Xiaofeng was stunned.

"Director Xu, you mean...you want to do it?"

Xu Zhiliang did not answer. He took out the seventh notebook from the drawer, turned to a certain page, and pushed it in front of Zhao Xiaofeng.

"See for yourself."

Zhao Xiaofeng lowered his head.

That page contained a surgical approach diagram for a brainstem glioma, surrounded by dense writing. The course of every blood vessel, the location of every nerve, and every potential risk were clearly marked.

Xu Zhiliang had already mastered many safe surgical approaches for the brainstem from Yang Ping, which was a prerequisite for the success of the surgery.

Zhao Xiaofeng stared at it for a long time.

Then he looked up.

“Director Xu,” he said, “I want to learn from you.”

Xu Zhiliang looked at him.

Do you have a habit of taking notes?

Zhao Xiaofeng paused for a moment, then nodded vigorously.

"remember."

Xu Zhiliang took a blank notebook out of the drawer and tossed it to him.

"From now on, I'll be in the department at 6:30 every day. When I arrive at 7:00, I hope to see your notes on the previous day's cases and surgeries. Please try to communicate with me via WeChat if you need anything. I don't like talking."

Zhao Xiaofeng caught the notebook with both hands, as if it were a precious treasure.

"Okay, thank you, Director Xu!" He stood up, bowed, and ran out.

As Xu Zhiliang watched his retreating figure, he suddenly recalled the first time he entered the operating room with Yang Ping three years ago.

He felt the same way that day—nervous, excited, and afraid of making a mistake.

Yang Ping barely spoke a few words to him from beginning to end. He only handed him a blank notebook after the surgery.

"We must take notes and approach every case and every surgery with a research-oriented attitude," Yang Ping said.

Now he understands.

He stood up and walked to the window.

Outside the window, people were strolling and chatting. In the distance, the research institute building stood quietly; Yang Ping's office was on the fifth floor.

He recalled Yang Ping's words: "You are in that hand."

That hand, now, is to be taken over.

He stood by the window and looked out for a long time.

Then he turned around and walked back to his desk.

Nineteen notebooks were neatly stacked on the bookshelf.
-
The operating room two days later.

Zhao Xiaofeng was already standing there in his surgical gown, waiting for Xu Zhiliang.

Xu Zhiliang walked in and glanced at him.

"Swipe hands".

Zhao Xiaofeng nodded and followed him to the sink.

Xu Zhiliang looked at himself in the mirror.

"First time standing as a first assistant?"

"Yes, this is my first time performing this type of surgery."

Xu Zhiliang nodded and said nothing more.

After washing their hands, they put on surgical gowns and gloves. The two walked to the operating table.

The operating lights came on.

The patient was under anesthesia and lying there with their head fixed in a head frame. The surgical area was disinfected and draped, leaving only a small patch of scalp exposed.

Xu Zhiliang took a deep breath.

"Let's begin."

The scalpel fell.

The skin was cut open, the muscles separated, and a bone window opened. Under the microscope, the brain tissue was exposed; it was grayish-white, soft, and rose and fell slightly with each breath.

The tumor was deep in the brainstem, mixed in with normal tissue, and the boundaries were indistinguishable.

Zhao Xiaofeng sat in the assistant's seat, his hands were steady, but his breathing was a little rapid.

“Slow down, suction device,” Xu Zhiliang said.

"Did you see it clearly?"

Zhao Xiaofeng stared at the microscope, sweat beading on his forehead.

"Look, look clearly."

"See clearly what?"

Zhao Xiaofeng remained silent for a few seconds.

"I've clearly seen the entrance."

Xu Zhiliang nodded.

"Yes, you need to see my approach clearly. The surgical approach is half the battle, and only the first half."

Separate, stop the bleeding, separate again, stop the bleeding again.

Two hours, four hours...

The tumor was peeled away little by little, and the brainstem gradually returned to its original shape.

The last cut was made.

"Stop the bleeding," Xu Zhiliang said.

The old procedure was followed: after confirming there was no active bleeding, the skull was rinsed with warm saline solution and then closed.

After the surgery, Xu Zhiliang walked out of the operating room and sat down to rest in the changing room.

Zhao Xiaofeng followed him out and stood beside him. His surgical gown was soaked with sweat, and his legs were trembling.

“Director Xu,” his voice was weak, “I just… I really saw the entrance clearly just now, it’s different from the one in the book, really different.”

Xu Zhiliang looked at him.

“Go back and write it down,” he said. “Write down what you see today. Look at it again tomorrow, and the day after tomorrow…”

Zhao Xiaofeng nodded.

He took out the notebook, opened it to the first page, and began to write.

My hands were shaking a little, but I wrote very carefully.

Xu Zhiliang stood there, watching him write.