godfather of surgery

Chapter 1359 Newcomer
Song Ziming, Xu Zhiliang, and Xia Shudu have all left the research institute. Yang Ping has been standing by the office window for almost ten minutes.

On the lawn downstairs, there were twenty young people. They were wearing brand-new white lab coats. Some were talking quietly to the people next to them, some were looking up at the building, and some were looking down at their phones.

There were twenty people, standing not in a very neat row, but all of them were young.

Yang Ping recalled that a few years ago, Song Ziming and Xu Zhiliang followed him to the Sanbo Research Institute. They started from scratch and made progress step by step.

At that time, this building was called the "Institute of General Surgery".

Later, Xia Shu also arrived.

They're not here anymore.

Song Ziming went to the emergency department and created the world's first multidisciplinary emergency department. Xu Zhiliang worked in neurosurgery, performing brainstem surgeries that others dared not attempt; experts from the Mayo Clinic flew in specifically to watch him perform surgeries. Xia Shu worked in cardiac surgery, and together with Li Zehui, made Sanbo Cardiac Surgery a world-class institution.

There was a knock on the door.

"Come in!"

The door opened, and Li Guodong walked in. A few years ago, he was a master's student, but now he has passed the doctoral entrance exam for Yang Ping. He was wearing a white coat, walking with a brisk pace, and holding a list in his hand.

“Professor!” Li Guodong walked to the window, respectfully. “Everyone’s here, twenty people.”

Yang Ping nodded.

What is your educational background?

Li Guodong handed over the list. The first page was a summary of personal information, the second page was a ranking of college entrance examination scores, and the third page was a list of doctoral dissertations. Yang Ping looked at the second page first, as this was what he valued most. College entrance examination scores represent a person's true learning ability; they are difficult to fake and difficult to fabricate. Over the years, countless people have tried to get their children in through various connections and backgrounds, but without passing the college entrance examination hurdle, nothing else matters.

“Eight from Peking Union Medical College Hospital, five from Peking University Health Science Center, three from Fudan University, two from West China Medical Center, and two from Nanjing University,” Li Guodong said. “They are all eight-year programs, and the specialties are evenly distributed: three in cardiac surgery, two in neurosurgery, four in general surgery, two in emergency medicine, two in critical care medicine, two in thoracic surgery, and five in other specialties.”

Yang Ping looked at them one by one. The eight from Peking Union Medical College all ranked within the top 100 in the province in the college entrance examination. The five from Peking University Health Science Center were also top-notch students. None of the students from Fudan University, West China Medical Center, and Nanjing University scored below 680.

He made a simple ranking in his mind.

"Let them in." Yang Ping handed the list back to Li Guodong.

Inside the conference room, twenty people sat neatly in rows. The table was oval-shaped, and they sat around it, each wearing a white lab coat and a brand-new name tag.

When Yang Ping pushed the door open and came in, everyone stood up.

Some people's chairs made a screeching sound, some people nervously crumpled their notebooks, and some people secretly sized up the young two-time Nobel laureate.

Yang Ping waved his hand.

"sit."

They sat down; some took deep breaths, some adjusted their posture, and some lowered their heads, unable to look at him.

Yang Ping sat down in the main seat and looked at them.

Twenty people, twenty young faces, some nervous, some excited, some pretending to be calm, and some unable to hide their curiosity.

Yang Ping said, "You are here because you were once excellent enough."

He paused.

"However, past excellence is history. I hope you will be even more excellent now and in the future."

The meeting room was very quiet.

“From today onwards, you must put in the same effort you did for the college entrance examination back then,” Yang Ping’s voice was not loud, but every word was clear. “Use six years to train yourselves to become world-class doctors. I mean world-class.”

He saw the eyes of several young people light up.

"Like Song Ziming, Xu Zhiliang, and Xia Shu."

Everyone knows these people; they are their idols.

“When they first arrived, they were just like you,” Yang Ping said. “After several years of study…”

He paused for a moment.

"Song Ziming is now the director of the Department of Emergency Medicine. He is a world-class multi-skilled emergency medicine professional and has created the world's first multi-skilled emergency center."

"Xu Zhiliang has performed over 300 brainstem tumor surgeries with a success rate of 92%. He is now the director of neurosurgery, specializing in surgeries that others dare not perform. The Mayo Clinic is planning to send a team to him for a three-month advanced training program."

"Xia Shu, he resigned from Fuwai Hospital and came here with me. He has performed thousands of surgeries. Now he is the deputy director of cardiac surgery, and together with Li Zehui, he has made Sanbo Cardiac Surgery a world-class institution."

He walked back to his seat and sat down.

“You can become like them in the future,” Yang Ping said, “becoming world-class doctors.”

He looked at them, his gaze shifting from one person's face to another.

Why are they growing up so fast?

Someone couldn't help but ask, "Why?"

Yang Ping looked at the young man who had asked the question. He wore glasses, had a round face, and his eyes were filled with curiosity.

“Take notes,” Yang Ping said. “Preview, study, review, and repeat the process repeatedly to hone your theory and practice, and to maintain interest and passion for your profession.”

The young man was stunned.

Yang Ping took a notebook out of the drawer and threw it on the table.

It was a very old notebook with a dark blue cover that had been worn white, frayed edges, and a cracked spine held together with yellowed transparent tape. On the cover were three words written in black pen: Song Ziming.

“This is Song Ziming’s first notebook,” Yang Ping said. “You can take a look.”

No one dared to make a move.

Li Guodong walked over, picked up the notebook, opened it, walked to the first person, paused to let him see clearly, then walked to the second person, the third person, the fourth person...

The notebook pages are yellowed, but the handwriting is still clear. The first page reads: "Coronary artery bypass surgery record (I)".

Behind it was a surgical diagram, showing the ascending aorta, coronary arteries, and anastomosis; every line was drawn meticulously. Next to the diagram were densely packed words, some in black, some in blue, and some in red.

Someone read aloud softly: "Aortic cannulation position: 2.5 cm from the brachiocephalic artery. Venous graft material: Great saphenous vein; be careful not to damage the intima during removal and avoid excessive traction. Anastomosis angle: 45 degrees; not too oblique, otherwise blood flow will form eddies. Anastomosis size: 3-4 mm. Suturing technique: Insert the needle from the inside out and exit from the outside in, with a needle spacing of 1 mm and an edge distance of 0.5 mm..."

The notebook pages were turned one by one.

The second page is the post-operative debriefing: "Today was the second bypass surgery, which went more smoothly than the first. However, the last stitch was a bit tight when suturing the anastomosis. Next time, we should leave enough suture length in advance. Also, when taking the vein, the assistant pulled too much, which may have damaged the intima. We should remind him next time."

The third page is the preoperative preparation: "Tomorrow we'll be performing a bypass surgery on a three-vessel disease, requiring three grafts. The great saphenous vein isn't long enough, so we'll need to use the radial artery. The radial artery is prone to spasm, so we'll need to treat it with papaverine during the surgery. Anastomosis order: do the most difficult one first, and the easiest one last..."

Page four is a surgical diagram, page five is an anatomical atlas for copying, page six is ​​a literature abstract, page seven is...

They looked at the notebook, at the dense handwriting, at the hand-drawn diagrams, at the corrections, at the notes marked in red, and at the "remembered," "pay attention next time," and "be careful" written in the corners.

No one speaks.

Yang Ping stood up.

“Everyone will receive a blank notebook,” he said. “Years later, you will find yourself becoming so powerful.”

After he finished speaking, he walked to the door and stopped.

"By the way, you twenty people, elect a group leader yourselves. If you have any problems, go to Li Guodong first. If Li Guodong can't solve them, come to me."

He pushed open the door and went out.

The meeting room remained quiet for a long time.

Then someone whispered, "That notebook..."

No one responded.

Li Guodong took out a stack of brand-new, thick notebooks from the cabinet. They all had the same dark blue cover and were the same size. He began to distribute them, one to each person.

“Write your names down,” he said. “This is your first notebook.”

Someone took the notebook, opened it to the first page, picked up a pen, and wrote down their name.

Chen Xi took the notebook, opened it, and neatly wrote on the first line: "Chen Xi - Day 1".

Lin Yuan took the notebook, looked at the blank page, and remembered the question he hadn't answered correctly, and the look Yang Ping had given him. He picked up his pen and wrote on the first page: "Day 1, Professor Yang tested me on case studies, and I didn't answer correctly..."

Next, Li Guodong showed them around the area.

The research institute is small, but it has everything it needs. It has two floors of laboratories, three floors of clinical wards, one floor of a surgical center, and one floor of demonstration rooms and conference rooms. From the outside, it looks like an ordinary eight-story building, but once you step inside, you discover a completely different world.

“From now on, this building will be your main area of ​​activity,” Li Guodong said as he walked ahead. He walked quickly, with twenty people following behind. Some were quietly taking notes, while others were looking around.

"The clinical wards are on the first to third floors, with a total of 86 beds. The operating rooms are on the fourth floor, with five operating rooms and two Class 100 laminar flow rooms. The laboratories are on the fifth and sixth floors, including cell biology labs, tumor labs, and so on. The seventh floor is the administrative office area..."

He pushed open a door.

"This is the demonstration room. From now on, we will gather here promptly at seven o'clock every morning."

The demonstration room is large, seating over fifty people. A huge whiteboard hangs on the wall, still bearing notes from the last lecture, highlighting key points of surgical procedures. A projector sits in the corner, and rows of tables and chairs are neatly arranged, their surfaces spotless. "Professor Yang lectures here every Friday morning," Li Guodong says. "What he talks about is unpredictable; it could be a case analysis, a surgical video review, or a complete recap of a particular patient's procedure. Be prepared; you might be called on to ask questions at any time."

Someone asked in a low voice, "What if I can't answer a question?"

Li Guodong looked at him. He was a tall, thin boy wearing glasses, with a slightly apprehensive look in his eyes.

Li Guodong said, "If you can't answer a question, think about why you can't answer it, where your knowledge is lacking, and try to answer it next time. Not being able to answer a question is not a problem, but always being unable to answer a question is a problem."

The person who asked the question shrank back.

Li Guodong continued walking forward. He crossed the corridor and pushed open another door.

"Surgery Center".

The corridor was lined with closed doors, each marked with a sign that read "Clean Area," "Sterile Area," or "In Surgery." Through the glass in the doors, one could see the lights of the operating room lamps, nurses preparing instruments, and the operating table quietly waiting.

“You are already PhDs, and your basic theoretical knowledge is already solid enough,” he said. “Now the focus is on training your clinical thinking, surgical skills, and accumulating clinical knowledge and experience. Simply put, it’s about doing, doing, and doing again, thinking, thinking, and thinking again.”

No one speaks.

Li Guodong glanced at his watch.

“You can familiarize yourselves with the institute’s work environment,” he said. “There is no work scheduled for today. We will meet here at seven o’clock tomorrow morning.”

After saying that, he left.

The twenty people stood still and looked at each other.

Then some people started walking back, some continued walking forward, some took out their phones to check the time, and some whispered to the people next to them.

Chen Xi stood there, staring at the door at the end of the corridor that read "Surgery Center" for a while. Then she took out her brand-new notebook, opened it, and wrote another line below what she had just written:
"Meet in the demonstration room at 7:00 AM tomorrow."

Lin Yuan stood next to her, also writing something in his notebook.

The next morning at 6:30, the demonstration room was already full of people.

Twenty people, not one missing. Some were reviewing the medical records they had studied the night before, some were flipping through anatomical atlases, and some were writing down surgical procedures from memory in their notebooks. No one spoke, only the sound of pages turning.

Yang Ping pushed open the door at exactly seven o'clock. He was holding a stack of medical records in his hand. He walked to the podium and put the medical records on the table.

“We won’t talk about theory today,” he said. “When we see patients today, everyone can speak up boldly.”

He pulled out a medical record and pushed it to Lin Yuan.

"You report the medical records."

Lin Yuan took it and opened it.

"The patient, male, 57 years old, was admitted to the hospital due to 'recurrent chest pain for three months, worsening for two hours.'" His voice was a little nervous, but he tried to remain calm. "He has a ten-year history of hypertension, with a highest recorded blood pressure of 180/110 mmHg, and has not taken medication regularly. He has a five-year history of diabetes, taking oral hypoglycemic agents, with his blood sugar control being average. He has smoked for thirty years, one pack a day. He has drunk alcohol for thirty years, two ounces a day..."

He finished reading.

Yang Ping looked at him and said, "I won't look at the medical records. Give me the report again."

Lin Yuan was taken aback.

“As doctors, we must train our memory,” Yang Ping said. “Being able to review a medical record and ask about the patient’s medical history once is enough to grasp the key information. We absolutely cannot miss anything. Because what you miss may be the most important clue. It may also lead to a fatal oversight.”

Lin Yuan closed the medical record, took a deep breath, and began to recount it.

He finished retelling it, and it was mostly correct.

Yang Ping nodded.

What do you think it is?

Lin Yuan was stunned for a moment.

"Heart...heart attack?"

"why?"

Lin Yuan thought for a moment.

"Chest pain, worsening, history of hypertension and diabetes, smoking..."

"What about the electrocardiogram?"

Lin Yuan flipped through the medical record, which was actually already closed; he just did it subconsciously.

"No...no."

"What about myocardial enzymes?"

"No, not at all." Lin Yuan's voice trailed off. "We should perform a bedside electrocardiogram."

Yang Ping looked at him without saying a word.

Lin Yuan's face slowly turned red.

Yang Ping took back the medical record and pushed it to someone else.

"you say!"

The person took it, flipped through it, and saw it was Chen Xi.

She looked at it for half a minute, then looked up.

"More like aortic dissection."

"why?"

“Chest pain, worsening, and a history of hypertension,” Chen Xi said. “Myocardial infarction requires an electrocardiogram and cardiac enzyme support, which are not available at the moment, so aortic dissection cannot be ruled out. Moreover, his hypertension is not being treated regularly, and his blood pressure is not well controlled, which is a high-risk factor for aortic dissection.”

Yang Ping nodded.

What are you going to do now?

Chen Xi thought for a moment.

"We'll perform a bedside electrocardiogram and bedside ultrasound to check for widening of the ascending aorta and the presence of intimal flaps," she said. "We'll also perform an aortic CTA to confirm the diagnosis. Before a definitive diagnosis, we'll control blood pressure and heart rate to prevent the aortic dissection from progressing."

Yang Ping then took out another film and inserted it into the film viewing lamp.

"This is his CTA."

Everyone looked over.

The ascending aorta is significantly widened, with a diameter of 4.5 centimeters. Inside, there is a thin line extending from the root of the aorta to the aortic arch—the intima-lamella.

Aortic dissection! Stanford type A!
The demonstration room was extremely quiet.

Yang Ping looked at Chen Xi.

What's your name?

"Chen Xi".

Yang Ping nodded.

“You did a good job,” he said. “We can’t be prejudiced, especially with cases that seem very familiar. We must combine medical history, physical examination, and auxiliary examinations, and use this evidence to make rigorous inferences.”

"Everyone is here to familiarize themselves with these medical records, and we will attend the handover at eight o'clock sharp."

"Also, everyone should write a clinical analysis of the medical record you just saw and hand it in to me tomorrow morning."

After saying that, he pushed the door open and went out, then closed it.

The demonstration room remained quiet for a long time.

Then someone whispered, "Chen Xi, you're amazing!"

Lin Yuan sat there, looking at the medical record that had been taken back from his hand, his face still flushed. He remembered what he had just said about "heart attack," the look Yang Ping had given him, and all the details he had overlooked.

Chen Xi sat in the corner, head down, writing something in her notebook.

People nearby crowded around to take a look.

She wrote: "On the first day, Professor Yang tested us on a case: aortic dissection. Key points: chest pain + hypertension, we can't just consider myocardial infarction. Bedside electrocardiogram, rapid ultrasound screening, and CTA confirmed the diagnosis. The patient was a 57-year-old male, with chest pain for 3 months that had worsened for 2 hours, and hypertension for 10 years without regular medication..."

She wrote very carefully.

Lin Yuan looked at her and suddenly understood something.

He took out his blank notebook, opened it to the first page, and wrote another line below the line he had written yesterday.

"On the first day, Professor Yang tested me on case studies. I didn't answer correctly, but Chen Xi did. She said I needed to check the bedside ultrasound, which I remembered. The key points for aortic dissection are: chest pain + hypertension. You can't just consider myocardial infarction. I missed the crucial point of hypertension, so I need to pay attention to it in the future."

After he finished writing, he looked at the few lines of text, and then at the notebook that Chen Xi was writing in.