godfather of surgery

Chapter 1360 Awe

The next day was the weekend. At 6:20 a.m., when Chen Xi pushed open the door of the demonstration room, the lights were already on.

She paused for a moment. There were others in the demonstration room who had arrived even earlier than her. Lin Yuan was sitting in the corner, with three medical records spread out in front of him and a pen in his hand, writing something in his notebook. Hearing the door open, he looked up, glanced at her, nodded, and then lowered his head to continue writing.

Chen Xi walked to her seat, put down her bag, and took out her notebook. She glanced at Lin Yuan, wanting to ask something, but didn't.

At 6:30, people gradually arrived. At 6:50, all twenty people had arrived. No one spoke; only the sound of turning pages and the scratching of pens on paper could be heard.

At seven o'clock sharp, the door was pushed open. Yang Ping walked in, holding another stack of medical records in his hand.

He put the medical record on the table.

"Yesterday's clinical analysis can be submitted now."

Twenty people stood up and handed over their notebooks one by one. Yang Ping took one and flipped through it page by page. When he saw Lin Yuan's notebook, he paused, looked at it a few more times, and then turned the page. When he saw Chen Xi's notebook, he looked at it for a long time, then closed it and put it aside.

"sit!"

Please sit down.

Yang Ping picked up the top notebook and opened it.

"Lin Yuan!"

Lin Yuan stood up.

“Your clinical analysis is very thorough,” Yang Ping said. “The diagnosis, differential diagnosis, and treatment plan are all included. But…”

He paused.

"You wrote 'possible aortic dissection,' why 'possible'? We are doctors now, and the ultimate goal of our analysis is to arrive at a definitive diagnosis, and then develop a treatment plan based on that conclusion... Even if we cannot get a definitive diagnosis, we still need to come up with a solution: whether to conduct further examinations, treat the symptoms, or conduct examinations while treating the condition... Remember, from now on, you must learn to think about problems correctly and completely, instead of in a fragmented, incomplete way, or always thinking that someone will help correct or perfect them... Why did you write 'possible'?"

Yang Ping reiterated this issue.

Lin Yuan was taken aback.

"Because...because there are no confirmed cases..."

What was added to the medical record later?

Lin Yuan thought for a moment.

"...CTA".

What were the CTA results?

"Aortic dissection, Stanford type A."

"Can it be diagnosed yet? Why is it still 'possibly'?"

Lin Yuan's face slowly turned red.

Yang Ping looked at him without saying a word, and the demonstration room was extremely quiet.

A few seconds later, Yang Ping said.

"Attention everyone! We need to learn to monitor patients dynamically, not at any one moment. This is clinical practice, not an exam. Clinical practice is never static like an exam, understand? Sit down!"

Lin Yuan sat down.

Yang Ping picked up another notebook.

"Chen Xi!"

Chen Xi stood up.

"Your clinical analysis is ten pages long," Yang Ping said. "It covers everything from the chief complaint to the present illness, from the physical examination to the auxiliary examinations, from the diagnosis to the differential diagnosis, from the treatment plan to the prognosis, and even the rehabilitation plan. You also wrote a literature review and your reflections. Most importantly, you included the new test results the patient underwent after our discussion yesterday in the analysis. One of the results only came out at 6:05 this morning, which means you reviewed the patient's latest medical records on the computer as soon as you arrived at the department this morning. That's excellent!"

He looked at her.

"From a medical perspective, you have written very well, but if we are to be more critical and look at it from the perspective of the biomedical social model, you have missed something."

Chen Xi was stunned for a moment, then immediately realized: "The patient's psychological state!"

“Yes! This patient, 57 years old, male, aortic dissection,” Yang Ping said. “Do you know what this means?”

Chen Xi thought for a moment.

"It means... he could die suddenly at any time."

"anything else?"

Chen Xi didn't say anything.

"It means he's afraid, terrified," Yang Ping said. "Very afraid. You wrote his blood pressure control plan, his heart rate control plan, his surgical plan, and his postoperative management plan. But have you ever thought about how he'll cope with all of this?"

Chen Xi lowered his head.

“Doctors treat more than just diseases,” Yang Ping said. “They treat people, including their fears, anxieties, and despair. If you only treat the disease and not the person, you’re just a surgeon, not a doctor.”

He paused.

"sit!"

Chen Xi sat down.

Yang Ping put down his notebook and looked at everyone.

“You are all PhDs, and you have enough basic theoretical knowledge. But theory is just theory, and basic theory is just basic theory. People are people. From today onwards, you must learn to diagnose illnesses, but more importantly, you must learn to diagnose people.”

"During rounds today, everyone should ask the patient one question: 'Do you have any questions?' You must answer whatever the patient asks. If you can't answer, write it down, look it up tonight, think it over carefully, and tell the patient tomorrow. In the learning process, it's not shameful not to know; what's shameful is not knowing but not trying to solve the problem."

He stood up: "Li Guodong will lead you later."

After he finished speaking, he left the demonstration room.

The demonstration room was quiet for a moment, then someone whispered, "Ask the patient if they have any other questions? What's so difficult about that?"

No one responded.

Li Guodong walked in and clapped his hands.

"Let's go, ward rounds!"

The inpatient wards are on the second and third floors, with a total of 86 beds, all of which are occupied by patients.

The group split into several smaller groups, and Chen Xi followed the attending physician leading the group into the first ward.

The patient was an elderly man, seventy-two years old, with three-vessel coronary artery disease, and he was scheduled for bypass surgery tomorrow. He was lying in bed when he saw the doctor come in, and immediately sat up to greet him.

The attending physician began taking the patient's history, performing a physical examination, and listening to her heart and lungs. Chen Xi stood to the side, watching and taking notes in her notebook.

After the examination, the attending physician asked, "Do you have any further questions?"

The old man paused for a moment, opened his mouth, then closed it again.

The attending physician waited for a while, and seeing that he didn't speak, turned to leave.

Chen Xi suddenly remembered what Yang Ping had said.

She stepped forward: "Please feel free to ask me any questions, don't hold back."

The old man looked at her, hesitated for a moment, and said, "I...I just want to ask," his voice trembled slightly, "whether I can survive this surgery?"

The ward fell silent for a moment.

The attending physician stopped and turned around.

Chen Xi looked at the old man and saw the fear in his eyes. She remembered what Yang Ping had said: You have to take care of the patient's fear, anxiety, and despair. You have to give the patient confidence, comfort, and hope.

She thought for a moment and said, "Professor Yang will personally perform this surgery. He has performed thousands of bypass surgeries and has not had a single failure so far."

The old man looked at her, and the fear in his eyes had lessened considerably, but a trace remained.

"What if... what if we can't get down?"

Chen Xi didn't know how to answer.

The attending physician walked back and stood by the bed.

“Sir,” he said, “any surgery carries risks, but this one is very small. You have high blood pressure, diabetes, and poor heart function. Not having surgery would be even riskier. With surgery, there is hope. Without it, there is no hope.” The old man listened and slowly nodded.

"Then...then I'll do it."

As Chen Xi left the ward, she was still thinking about the fear in the old man's eyes.

Lin Yuan followed another group and examined another patient.

The patient was a 43-year-old woman with a brainstem tumor who had undergone surgery three days prior. She lay in bed, pale-faced, and stared intently at the doctors as they entered.

After taking the patient's medical history, the attending physician asked, "Do you have any further questions?"

The woman opened her mouth: "I...I just want to ask, will I still be able to work in the future?"

Lin Yuan was taken aback.

What do you do for a living?

"I'm a high school teacher," the woman said. "I teach senior high school students, and they're about to take their graduation exams..."

Lin Yuan thought for a moment.

“You need to rest now,” he said. “At least a month. After a month, if you recover well, you can slowly return to work. But you can’t overwork yourself, you can’t stay up late, and you can’t get emotionally agitated.”

The woman's eyes reddened as she listened.

"Then... what about my students? I've mentored them for three years, and I don't trust anyone else with my knowledge. I know each of their weaknesses..."

Lin Yuan didn't know how to answer.

The attending physician came over, smiling, and said, "Professor Meng! I understand your concern for your students, but don't worry, your students will have other teachers to take care of them." He said, "The most important thing for you now is to recover. If you get better, you can teach many more classes of students in the future. If you don't get better, you won't be able to teach this class either."

He added, “You need to understand one thing: the earth will keep turning no matter who leaves it. Although my words may be harsh, that’s the truth. During this time of rest, your students’ studies will not stop. They will still strive for the college entrance examination. It will not be delayed because you are sick. So your worries are completely unnecessary. You should be more worried about yourself now and make yourself recover faster.”

The woman nodded, tears streaming down her face.

Lin Yuan felt that the attending physician leading the team was being too direct, which was hurtful.

After leaving the ward, the doctor said to him, "Sometimes our words and actions may seem cold and inhumane, but it is precisely this coldness that quickly helps them rebuild their thinking and understand the world, and understand their current real situation."

I did rounds until 10:30.

There were twenty people, each of whom followed four groups and focused on seeing more than a dozen patients. Each person's notebook was full of notes.

At 11 o'clock, Li Guodong called them to the demonstration room.

"Tell me, what did you find during today's ward rounds?"

Someone raised their hand.

"The questions the patient asked were different from what I expected."

"What's the problem?"

“A patient with a cervical spine tumor asked me if she had any questions. She asked if she could eat watermelon. I thought she would ask about her condition, treatment, and prognosis, but she asked if she could eat watermelon.”

Li Guodong nodded.

"How did you answer?"

"I said you can eat it, but eat less, because watermelon contains a lot of water."

"anything else?"

The student thought for a moment.

She seemed very happy.

Li Guodong smiled slightly.

Why is she happy?

The student was taken aback.

"Because...because we can eat watermelon?"

"Because she felt that being able to eat watermelon meant she was still alive and could live a normal life," Li Guodong said. "You must remember, sometimes the questions patients ask aren't the questions themselves. When she asked if she could eat watermelon, she was actually asking: Can I still live like a normal person?"

Li Guodong looked at them.

"When Professor Yang asked, 'Do you have any more questions?' it wasn't just a polite remark. It was a way for you to connect with your patients. You must answer every question they ask seriously. If you can't answer, write it down, look it up, and tell the patient the next day. That's how patients will trust you. When patients trust you, they will listen to you. And when patients listen to you, they will get better."

"I'm going to have surgery tomorrow. We'll go to the surgery center together at 8:30."

Li Guodong told them.

The next day at 8:30, at the surgery center.

Twenty people changed into scrubs and stood in the corridor. The smell of disinfectant was strong, and the light from the operating lights leaked out from under the door.

Li Guodong walked over.

“There are five surgeries today,” he said. “One bypass, one valve replacement, one brainstem tumor, one scoliosis correction, and one laparoscopic radical pancreatectomy. You will be divided into five groups of four, each group will work on one surgery.”

He began taking attendance.

Chen Xi was assigned to the bypass group, and Lin Yuan was assigned to the scoliosis correction group.

The operating room door opened, and they went inside.

The operating table was filled with various surgical instruments. The patient, already anesthetized, lay there covered with a green sheet, only his chest exposed.

Yang Ping was standing at the surgeon's position, washing his hands. A nurse helped him put on his surgical gown and fasten the straps.

Chen Xi stood in the corner, consciously finding a spot with a good view from the safe zone.

"Come here!" Yang Ping said.

She walked over.

"Stand here," Yang Ping pointed to the screen on the wall, "You can only see it clearly by watching the video."

The operation begins.

Yang Ping picked up the scalpel, made an incision in the patient's chest, cutting through the skin, the subcutaneous fat, separating the muscles, opening the ribs, and opening the pericardium—

The heart is exposed.

A beating heart, red and wet, pounding rhythmically.

Chen Xi held her breath.

Yang Ping began taking the blood vessel. The great saphenous vein was taken from the left leg; it was a long, thin vein, like a pink rubber band. He placed the vein in heparinized saline solution and began processing it, removing excess tissue, ligating branches, and checking for any leaks.

Then he started building the bridge.

The ascending aorta was clamped with a side-wall clamp. A hole was drilled, four millimeters in diameter. Then the anastomosis began, with one end of the vein sutured to the hole in the aorta.

Chen Xi stared intently at the screen, not daring to blink. Yang Ping held the needle holder, and the needle went in and out precisely, with a stitch distance of one millimeter and an edge distance of 0.5 millimeters—not a fraction off. Twelve stitches were made, each one on the same plane, with the same spacing between each stitch.

The anastomosis was completed. Yang Ping released the side wall clamps, and blood flowed through. The venous graft bulged and throbbed.

Then came the second anastomosis. The left anterior descending branch of the coronary artery was cut open, and the other end of the vein was sutured in. It was still twelve stitches, with the same one-millimeter stitch spacing and 0.5-millimeter margin.

The anastomosis is complete. The clamp is released, blood flows through, and the color of the myocardium changes from dark red to bright red.

The electrocardiogram has changed; the ST segment has descended.

Yang Ping glanced at the monitor and nodded.

"Close your chest!"

The entire surgery took less than an hour, and the results were clear, smooth, clean, and pleasing to the eye.

After the surgery, Yang Ping took off his surgical gown and washed his hands.

Chen Xi was still standing there, staring at the closed chest. She didn't know why, but when she saw that vibrant heart just now, she felt a strong sense of awe.

She didn't know that this sense of awe was one of the essential qualities of an excellent doctor, a quality she was born with.