godfather of surgery

Chapter 1356 Can be done
At 2:17 p.m., Xu Zhiliang was awakened by his phone vibrating.

He opened his eyes and saw the ceiling light on the office ceiling. He was lying on the three-seater sofa in the office. He was so sleepy.

His phone was still vibrating. He picked it up and glanced at it; it was the chief resident calling.

"Director Xu, there's a patient in the emergency room who was transferred from out of town. Their family specifically asked you to see them."

Xu Zhiliang sat up and rubbed his face.

"what's the situation?"

"It's a brainstem glioma, and other hospitals are afraid to operate on it. The family said they looked it up online and found out that you're the best at treating this."

Xu Zhiliang did not hesitate and sat up.

"Have the family members wait in the office, I'll be there soon."

He hung up the phone, stood up, and walked to the sink. Cold water gushed from the tap, and he splashed it on his face, then ran his wet hands through his messy hair. He looked a bit disheveled in the mirror, his eyes were dark, his shirt was wrinkled like a pickled vegetable, and there was a stain from yesterday's coffee splatter on the collar.

He stared at the person in the mirror for a few seconds.

Three years ago, he was an emergency room night shift doctor, treating external injuries, performing gastric lavage, and performing CPR every day. After get off work, he would go home, fall asleep immediately, and then go back to work. At that time, he felt that his life was pretty much set in stone, and that being able to work at a hospital like Sanbo until retirement was already a stroke of good luck.

Later, Yang Ping transferred him from the emergency department to the general surgery department, which wasn't called the research institute back then.

He still can't understand how Yang Ping could have chosen him, an emergency room doctor who is so busy every day and even stutters.

But he didn't ask, and Yang Ping never offered any explanation; asking would have been pointless.

He put on his white coat, buttoned it up, and walked out of the office.

When Zhao Xiaofeng saw Director Xu come out, he immediately followed him.
-
The family member was a woman in her forties, her eyes red and swollen, sitting on a bench in the neurosurgery office. She was clutching a stack of X-ray films so tightly that the edges were wrinkled. When she saw Xu Zhiliang enter, she stood up abruptly, wanting to speak, but her mouth opened and then she swallowed back, leaving only her shoulders trembling.

Xu Zhiliang gestured for her to sit down.

"Let me see the film."

She handed me the film, her hands trembling.

Xu Zhiliang took it, turned around and walked to the film light, inserting the films one by one.

The brainstem glioma was diffuse, located deep within the medulla oblongata. On imaging, the tumor blended seamlessly with normal brain tissue, making the boundaries indistinguishable. This location and type of tumor is a nightmare for any neurosurgeon. He had seen many such cases with Yang Ping, each referred from hospitals across the country, only turning to Sanbo when all other options were exhausted.

He looked at each and every one of the photos for ten minutes, then turned away.

"Where is the patient? Does he...know about his condition?"

"I know! She's under observation in the emergency room." The woman was finally able to speak, her voice hoarse, as if she had been crying for a long time. "Dr. Xu, we've come from Anhui. We've been to several hospitals, but they all said it's not possible. I've looked it up online, and you've performed many of these surgeries. I... I just want to beg you to take a look..."

Xu Zhiliang interrupted her.

How old is the patient?

"nineteen."

"nineteen?"

“My son.” Tears welled up in the woman’s eyes again. “He had just finished the college entrance exam, the day he filled out his college applications, when he suddenly collapsed. They took him to the hospital and found out he had something growing in his brain. We went to several hospitals, in Beijing and Shanghai, but they all said the location was bad and they couldn’t move it. Then a doctor said, ‘Go to Sanbo Hospital, there’s a doctor named Xu who specializes in this…’ Dr. Xu, he has excellent grades, his college entrance exam results this time…”

"Talk about the illness, but don't talk about things unrelated to it!" The ward always interrupted the family members, knowing that Director Xu hated it when family members rambled on.

Xu Zhiliang remained silent.

He recalled that when he was nineteen, he had just been admitted to medical school, full of expectations for the future, and had no idea what a "brainstem glioma" was. At that time, his biggest trouble was that advanced mathematics was too difficult and he couldn't memorize anatomy.

He said, "Let me see the people."
-
The patient lay on the emergency room observation bed. He was very thin, about 1.7 meters tall, but looked to weigh less than 100 pounds. His eyes were sunken, and his lips were pale, but his eyes were bright.

When he saw Xu Zhiliang come in, he tried to sit up, but Xu Zhiliang held him down.

"Lie down...and talk."

“Director Xu,” the boy’s voice was a little weak, but he enunciated clearly, “my mom said you can perform my surgery.”

Xu Zhiliang did not answer. He bent down and began the physical examination.

The finger moves in front of the eyes, and the eyes follow. The pupillary light reflex is normal. Facial sensation is normal. Mouth opening, tongue protrusion, shoulder shrugging, and limb muscle strength are normal. Coordination, finger-to-nose test, and heel-to-shin test are all normal.

He straightened up, pointed at Zhao Xiaofeng, indicating that he would go and ask about his medical history.

Zhao Xiaofeng immediately stepped forward, "How...are you feeling right now?"

The boy thought for a moment.

"It's just...sometimes I feel dizzy, and my vision is a bit blurry. Nothing else. I can eat and sleep well, it's just that my mom cries a lot."

When he said the last sentence, the corner of his mouth twitched slightly, as if he were smiling.

Xu Zhiliang looked at him.

This child has no idea how dangerous his situation is. The tumor has already invaded the medulla oblongata, and if it continues to develop, his respiratory and cardiac centers could malfunction at any moment. The fact that he can still eat, sleep, and make jokes like this is because he's young, has a good constitution, and is also due to luck.

Or perhaps he knew it was dangerous and was using this method to comfort his mother.

"Hospitalize him," he told the family. "Arrange...pre-operative examinations."

The woman's tears welled up again.

"Director Xu, you mean...it can be done?"

Xu Zhiliang looked at her and said, "I can do it."

Zhao Xiaofeng added, "But this surgery cannot guarantee complete removal. Do you know what diffuse glioma means?"

The woman paused for a moment, then shook her head.

"It means that the tumor and normal brain tissue are growing together and cannot be separated. We can remove most of it, but some will always remain. Those that remain may recur later. But if we remove too much, he wouldn't be waking up now."

Zhao Xiaofeng looked at the woman.

"Think it through. To do it, or not to do it?"

The woman stood there, her lips trembling, unable to speak for a long time.

The boy reached out and took his mother's hand.

“Mom,” he said, “I’ll do it.”

The woman looked at him, tears streaming down her face.

"But……"

“I’ll do it,” the boy said, looking at Xu Zhiliang.

"Director Xu, please do it. I'll accept whatever the outcome may be."

Xu Zhiliang remained silent for a few seconds.

Then he nodded.
-
The next day, Xu Zhiliang watched Zhou Yuan's scans more than a dozen times and mentally simulated the surgical procedure countless times. He considered every possible contingency and every possible response. This was the learning method Yang Ping taught him—preoperative simulation and postoperative review. Yang Ping said, "Performing a surgery ten times is not as effective as simulating it a hundred times. If you can't get past the mental stage of the surgery, you can't get past the physical stage either."

At seven o'clock in the morning, there was a knock on the office door.

"Come in."

The door opened, and there stood Zhao Xiaofeng.

“Director Xu,” Zhao Xiaofeng walked in, “I didn’t sleep a wink last night.”

Xu Zhiliang looked at him.

What are you thinking about?

“Think about this surgery.” Zhao Xiaofeng walked over, stood in front of the X-ray light, and looked at Zhou Yuan’s films. “I’ve read about this type of case in the literature. There are no more than ten centers in the world that can do it. And the number of people who can do it well can be counted on one hand.”

He turned his head and looked at Xu Zhiliang.

"Director Xu, are you nervous when facing this kind of surgery?"

Xu Zhiliang remained silent for a few seconds.

“I used to,” he said. “But not anymore. I’m past that period of tension.”

Zhao Xiaofeng was stunned for a moment.

Xu Zhiliang looked at the shadow on the film.

"But not being nervous doesn't mean... being lax. I will think things through... every step. Before each cut, I will plan my escape route."

He looked at Zhao Xiaofeng.

"You are an assistant today."

Zhao Xiaofeng stood up straight.

"Yes."
-
Xu Zhiliang did not wait; the surgery began at nine o'clock in the morning on the third day.

The moment the operating lights came on, Xu Zhiliang sat in the surgeon's position. Zhao Xiaofeng sat in the assistant's position, and Chen Houming remained as an observer. The patient was already anesthetized, lying there with his head fixed in place by a head frame. The surgical area was disinfected and draped, with only a small patch of scalp exposed.

Xu Zhiliang took a deep breath, and the surgery began...

The tumor is deep in the medulla oblongata. Normal tissue is grayish-white and shiny, like a fresh mushroom. The tumor is darker in color and more brittle in texture, like overcooked tofu. But they are mixed together, with indistinguishable boundaries, each containing elements of the other.

Xu Zhiliang stared at the image for a long time before continuing.

Separate, stop the bleeding, separate again, stop the bleeding again. Every twenty minutes, a specimen is sent for frozen section pathology. The nurse runs out and runs back, each time bringing back a report.

First frozen section back: positive margin.

Xu Zhiliang didn't say anything and continued cutting.

Second time: still positive.

Third time: positive.

Fourth time: Positive.

Fifth time: Positive.

The operating room was so quiet that only the sound of the suction machine could be heard. The anesthesiologist stared at the monitor, the nurse handed over instruments, and Zhao Xiaofeng's forehead was covered in sweat. In the corner, Chen Houming stood motionless, like a statue.

When the specimen was sent out for the sixth time, Zhao Xiaofeng finally couldn't hold back anymore.

“Director Xu,” his voice was low but tense, “if you cut any further, you’ll reach the respiratory center.”

Xu Zhiliang remained silent.

He stared at the image under the microscope. The tumor was still a thin layer, clinging tightly to the dorsal side of the medulla oblongata. The color of that area was slightly different from the surrounding tissue, and the distribution of blood vessels also showed subtle differences. Just one millimeter further ahead lay the vital center.

He stared at it for a long time.

“Electrical stimulation,” he said.

Zhao Xiaofeng handed over the stimulator. An electric current gently swept across the area.

On the monitor, the patient's respiratory rate changed. It went from sixteen breaths per minute to fourteen, and then back to sixteen.

Xu Zhiliang's hand stopped.

"Give it another jolt."

It changed again. This time the change was more obvious; the breathing rate dropped from sixteen to twelve breaths, and it took several seconds to recover.

In the corner, Chen Houming took a soft breath.

Xu Zhiliang didn't look up. He stared at the microscope, at the thin layer of tumor tissue, at the distinct nerve fibers.

continue!

"Director Xu!"

"To be a good assistant to Ni."

"Dr. Xu!"

"Don't worry, I know what I'm doing."

Xu Zhiliang ignored Zhao Xiaofeng and Chen Houming's reminders and continued the surgery.

He carefully and meticulously cut off the last thin layer of tissue, then stopped.

“That’s enough,” he said. “Close the skull.”

Zhao Xiaofeng was stunned for a moment. His heart, which had been hanging in suspense, suddenly relaxed. He then realized that his back was covered in sweat, and the monitor screen showed that his breathing was normal.

Xu Zhiliang stood up and gave up his position as the surgeon.

"You come... to close the skull."

Zhao Xiaofeng was stunned.

"I?"

"Would closing the skull work?"

Zhao Xiaofeng nodded.

"Then let's do it."

Zhao Xiaofeng took a deep breath and sat down in the surgeon's seat.

Xu Zhiliang sat beside him, watching him.

One stitch, one stitch, and another.
-
The surgery ended at 2 p.m.

Xu Zhiliang walked out of the operating room and into the rest room. Chen Houming came out from inside and sat down next to him.

"Five hours," Chen Houming said, "faster than I expected."

Xu Zhiliang remained silent.

“Those last few blows,” Chen Houming looked at him, “how did you judge them?”

Xu Zhiliang was silent for a few seconds, then said, "Experience."

Chen Houming nodded.

Zhao Xiaofeng came out and stood next to Xu Zhiliang.

"Director Xu," his voice was weak, "how did you make your judgment regarding those last few blows?"

same question.

Xu Zhiliang looked at him. “Experience,” he said. “Sometimes… you have to trust the instruments, sometimes… you have to trust experience. Ultimately, the choice is also… experience.”

"But what if..."

“There are no ‘what ifs’,” Xu Zhiliang said. “This kind of surgery… has too many ‘what ifs’, which means… we lack experience.”

He looked at Zhao Xiaofeng.

"Got it?"

Zhao Xiaofeng nodded.

"remember."
-
Zhou Yuan woke up the day after the surgery.

His breathing is steady, he can move his limbs, and he can speak. He is just a little weak, and he has to pause and catch his breath before speaking.

When Xu Zhiliang went to check on him, he was leaning against the headboard, and his mother was feeding him porridge. When he saw Xu Zhiliang come in, he tried to sit up, but Xu Zhiliang held him down.

"Lie down."

Zhou Yuan looked at him, his eyes reddening.

"Director Xu, my mother said you worked for five hours."

Xu Zhiliang nodded.

"Thank you." Zhou Yuan's voice trembled slightly.

Xu Zhiliang looked at him.

How are you feeling now?

Zhou Yuan thought for a moment.

"It's okay. It's just a little tiring to talk. I can't breathe properly."

Xu Zhiliang nodded.

"It's normal. The respiratory center... has been slightly affected, but it will recover slowly. It may take... a few months, or even a year. But it will get better."

Zhou Yuan nodded.

“Director Xu,” he said, “I have something to ask you.”

"explain."

Will it recur in the future?

“Yes, life is long or short, and you’re only… nineteen years old,” he said. “Nineteen years old, I think it’s enough for you to live. Even if it’s only… five years, it’s worth it… to live well, to live in the present. As for the relapse, we’ll talk about that later.”

In the end, he only said one sentence:

"First, focus on getting your health back in order. Medical technology might advance in the future, so you don't need to worry about the future at all. What you need to do is make today, the present moment, happy and meaningful."

He turned and walked out of the ward.