top student at medical school

The training rooms in the new hospital area have not yet been repaired, but Fang Ziye funded the construction of a 'skills training room' for the students in the department in a nearby house!
The facilities are not as complete as those in the main campus. There are also senior professors in the practice room, but there are only a few workbenches and a dozen sets of equipment. Students also need to clean the equipment themselves after they finish using it.

A large ultraviolet disinfection cabinet was placed in the room...

The roof lights were specially modified. Fang Ziye spent nearly 100,000 yuan on this alone.

However, now that he's a director, Fang Ziye's income is decent, so he can't be too stingy.

Fang Ziye stood beside an operating table, and opposite him stood his beloved apprentice, Hu Qingyuan, calmly serving as his assistant.

Beneath Fang Ziye's hands lay the tofu that the master's students most wanted to suture. After finishing several stitches, Fang Ziye said to Hu Qingyuan, "Give me the scalpel!"

"Here you go, Master!" Hu Qingyuan immediately and respectfully handed the willow-leaf knife to Fang Ziye.

Fang Ziye roughly assessed the depth of the tofu's side and then sliced ​​it flat without hesitation.

The blade cut through the tofu steadily, slicing it open as if slicing it flat.

At this point, nothing seemed amiss, but after Fang Ziye turned the tofu over, things changed.

A series of gasps of shock filled the room!

The cross-section of the stitched tofu has neatly arranged and uniform stitches, as if measured by a machine.

It is obvious that Fang Ziye meticulously calculated the depth of each stitch when sewing, and the depth and span of each stitch were neat and consistent.

Furthermore, Fang Ziye can precisely control the thickness of the incision during the incision procedure!

This requires not only a steady hand, but also mastery of every detail of the incision and suturing procedure, even down to the point of perfect accuracy in every single data point!
Fang Ziye explained, "If I were to break down for you how to properly sew up the tofu, that would be the standard answer."

"The absolute line to be mastered is very clear: not only must the spacing of each stitch be well controlled, but also the needle entry point, needle insertion point, suture depth, and the position of crossing the cross section must be just right."

"Normally, we sew from the surface layer, but if I just explain it like that, you'll find it hard to understand!"

"I'll cut it open for you to see now, you can all see it, right?"

The first to respond to Fang Ziye was Hu Qingyuan, who was standing opposite him. Hu Qingyuan had an excellent memory: "Master, the basic requirement for our department's master's students to break out of the training room is simply to sew up tofu properly!"

"It doesn't need to be stitched as neatly as you did, Master, does it?"

Hu Qingyuan was certainly clever, so he knew how to praise: "If other teachers could do what you do, Master, they certainly wouldn't hide their talents and be unwilling to show us the details of the stitching."

"But over the years, no teacher has ever cut open the cross-section to show us; they must all be..."

Hu Qingyuan half-concealed his face, cleverly hiding the key words.

They won't.

Fang Ziye chuckled: "Why do you care whether the other teachers can do it or not?"

"I'm teaching you guys here!!!"

"So that you can understand what the different levels of suturing look like."

"At the very basic level, what you need to control is just a few 1cm movements!"

"The suture length is 1cm, and the suture spacing is 1cm. This is visible to the naked eye!"

"However, there are some things that you cannot see directly. You need to practice and constantly feel how to control your suture depth. This is the standard answer."

"Basic suturing doesn't involve many techniques or practice methods; it's all about control—perfect control. Once you achieve that, it will benefit you for life..."

The skills one possesses cannot be lent out. The fundamental skills don't involve many techniques; they are all solid basic skills, or internal strength.

A group of master's students and even doctoral students applauded.

Dr. Xie Zhouzhou, Zeng Duoqin's doctor, asked, "Professor Fang, how does your current cutting technique compare to cutting eight pages of paper in one stroke?"

The fact that only eight pages were cut with one stroke demonstrates the control over the depth of the cut.

But Fang Ziye's current incision technique is equivalent to cutting a cuboid flat with a scalpel!

A scalpel is not a kitchen knife; it doesn't have such a large cutting surface and requires multiple circular cuts.

"A suture is a suture; why are you bothering with the incision?"

"Controlling the depth of the cut and the translation of the cut are two different dimensions. How can you directly compare things from different dimensions?"

"However, do you really want to see the incision?" Fang Ziye had some free time today, and the students wanted to see it, so he didn't mind showing off his skills.

Xie Zhouzhou nodded.

Hu Qingyuan nodded.

Fang Ziye's students, Feng Junfeng and Tian Yao, also nodded, both eagerly anticipating Fang Ziye's surgical procedures, a feat considered the pinnacle of surgical skills.

Fang Ziye picked up the scalpel in his hand, and after thinking for a moment, he lifted it up with a bow-wielding motion.

Immediately afterwards, Fang Ziye very, very slowly brought the scalpel straight down.

Fang Ziye's movements were very slow and lacked any skill.

While everyone was still wondering, about ten seconds later, Fang Ziye let go of her hand.

It was then discovered that the scalpel stood perfectly straight on the surface of the tofu, without any tilting or deviation in any direction.

"Well, if you can do this with tofu, then you can basically go anywhere in surgery," Fang Ziye said, trying to sound mysterious.

After saying that, Fang Ziye left.

The scalpel inserted by Fang Ziye remained unmoved. After everyone else took photos of it, they began to imitate it.

Then the room was filled with gasps of disbelief, exclamations of surprise, and more exclamations of disbelief...

This imitation generated considerable buzz, which lasted for nearly three or four days before dissipating.

Ultimately, no one could do it, so Xie Zhouzhou and the others took the photos to Professor Zeng Duoqin in their department for advice.

Zeng Duoqin glanced at it and laughed, then boldly announced, "Whoever can do this, I guarantee they'll be hospitalized!"

Everyone's mouths were agape, pouting!
This commitment was also relayed back to the main campus.

The allure of staying in the hospital is far greater than the allure of pursuing a doctorate.

……

Tuesday, October 6th.

At 7:40 a.m., as Hu Qingyuan and Fang Ziye walked side by side from the ward to the outpatient clinic, Hu Qingyuan asked curiously, "Master, your scalpel has fallen over."

"Senior Brother Xie Zhouzhou pressed it in less than a millimeter further, and the balance was broken!"

"why is that?"

"Senior Brother Xie originally thought that the deeper it was inserted, the more stable it would be!"

Fang Ziye said, "Qingyuan, your science grades are better than mine, so your understanding of balance should be more thorough than mine, right?"

"The ultimate technique of incision is balance!"

Upon hearing this, Hu Qingyuan asked, puzzled but understanding, "Master, how can that be done?"

Hu Qingyuan emphasized: "I don't want Professor Zeng to keep me in the hospital, I just want to do it!"

Hu Qingyuan felt that with his qualifications and the resources in Fang Ziye's team, if he couldn't stay in the hospital, he should change careers as soon as possible.

In Fang Ziye's team, even a pig could publish a few articles and learn some surgical techniques.

"Then you need to be prepared for a protracted battle, which will take a very long time."

“If it’s a specialized technique, there are skills involved, even in repositioning. But this kind of basic skill has no skills whatsoever.”

"The basic components of surgery are incision, debridement, and suturing."

"Specialized techniques are all combinations of skills and basic skills. Only after special skills are formed are they summarized as specialized techniques!" Fang Ziye said.

Hu Qingyuan had been following Fang Ziye for quite some time and knew that the basics were the hardest to replicate.

Otherwise, no one would have been able to replace Fang Ziye in the treatment of spinal cord injury until now.

"Master, if you can perform an incision like this, what kind of surgeries can you learn?"

"I've been in clinical practice for about six months now, but it seems like I haven't learned any surgeries yet; I've only been learning the basics," Hu Qingyuan said with some anticipation.

The surgeries that Fang Ziye is performing now are something that even Professor Zeng Duoqin cannot replicate, and Hu Qingyuan has even less of a chance to do them.

All he could do was stitch up the skin.

But such a simple operation could not satisfy Hu Qingyuan's curiosity!

"What kind of surgeries can be performed with simple open incision? There are many, such as tendon lengthening, complex tendon release, tumor removal, and malignant tumor debridement," Fang Ziye said. Fang Ziye also knew that Hu Qingyuan's current clinical involvement wasn't very high, so he added a little more "bait" for him!
Sure enough, Hu Qingyuan found these techniques to be exceptionally advanced and very difficult.

"You've learned incision techniques so well that you can do this kind of operation???" Hu Qingyuan asked in surprise.

His mentor was Fang Ziye, so Hu Qingyuan knew that his learning curve was different from others.

For others, the question is what techniques to learn, but for oneself, the question is which part of the operation in the master's group one can complete.

The cases that Fang Ziye currently treats, even if only a portion of the procedures were made available to others, would be extremely difficult surgical procedures.

For example, complex muscle release, tendon lengthening, tendon vascular nerve transfer, and nerve transplantation.

Which one wouldn't be prohibitively expensive in a prefecture-level city hospital?
However, within the Fang Ziye group, these operations are merely components of the surgical procedures!

Fang Ziye laid the foundation first, and could even forcibly support Hu Qingyuan to suture two tendons.

Even for a first-year master's student, especially a highly skilled hand surgeon, suturing tendons is extremely difficult, but Hu Qingyuan had the opportunity.

This is the difference between the platform and the disease!

"It's definitely possible, but learning it won't be easy," Fang Ziye nodded.

"Take your time practicing, Master. I'm still young," Hu Qingyuan said expectantly.

Hu Qingyuan knew that since he had chosen Fang Ziye, he would be embarking on a path different from that of most students.

It's not just that my teacher is special, but also that I am somewhat special myself.

As fellow students of the same master, Hu Qingyuan now senses that his two senior brothers seem rather ordinary.

Therefore, Hu Qingyuan's concerns were different from theirs. While they were frantically thinking about how to stay in the hospital, Hu Qingyuan was considering how to take over Fang Ziye's mantle.

If in the future I could take Fang Ziye's place, allowing Fang Ziye to rest, and I could showcase my prowess in the operating room, with colleagues from all over the country closely observing my surgical techniques, wouldn't that be more fulfilling than a live broadcast?

Hu Qingyuan immediately said, "Master, could you give me a chance to see my first patient of the day?"

"I've been working with you in the outpatient clinic for six months now, and I've almost finished reading all the books I need to read."

Hu Qingyuan has an excellent memory; he has indeed read all the books he was supposed to read, as well as a lot of academic papers.

Moreover, after Fang Ziye's organization, Hu Qingyuan felt that his theoretical level had taken on a systematic prototype, and the next step should be to gain experience in outpatient clinics.

“Sure, I’ll show you the first one later!” Fang Ziye said.

When the two arrived at the entrance of the outpatient clinic, there were still people gathered around, and many of them had not been able to get an appointment.

Upon seeing Fang Ziye, they all gathered around him.

This time, Fang Ziye said very decisively, "No extra appointments. I'm not adding any more appointments today. I have an important mission tonight."

"To the patients and their families who were unable to get an appointment, please understand. Try to book an appointment with another professor, or come back next week."

"The numbers will be released promptly at 8 PM tonight..."

"Professor Fang, it wasn't easy for me to come all the way from Lichuan," a middle-aged man hurriedly explained.

Lichuan is also a county-level city under the jurisdiction of Enshi, and is Fang Ziye's fellow townsman.

Fang Ziye replied, "That's very far, but I have important business to attend to today and can't add you on the phone. I hope you can understand."

"I'm not just playing around. I released seventy accounts today, which is twenty more than usual."

"I can't finish reading it. I'm sorry."

After Fang Ziye finished speaking, he led Hu Qingyuan into the consultation room.

"Professor Fang, it's really not easy for me to come all this way..." The patient tried to push his way to the front.

"Don't cut in line! Professor Fang said they can't add any more numbers. There are only seventy numbers left, and it looks like it'll be a long time..."

"What's it to you? You just got lucky and got an appointment, didn't you?" The middle-aged man's tone was very aggressive.

"Just don't push me." The person who spoke didn't want to argue.

"Professor Fang..." The middle-aged man still tried to rush inside.

The person who spoke was bumped and then fell directly to the ground.

He warned bluntly, "Don't leave, my butt hurts! I told you not to push, my legs are already injured."

He picked up his phone and started calling the police: "..."

"..."

Hu Qingyuan warmly ushered the first outpatient into the ward, smiling as he asked, "Hello, ma'am, what's wrong?"

"This hand used to be very numb, and it was also red and swollen before..." The middle-aged woman raised her left upper limb.

Pigmentation can also be seen on her elbow joint.

Normally, the elbow joint has a certain radial deviation angle, but her radial deviation angle is obviously a bit excessive.

Based on the medical history, Hu Qingyuan immediately suspected an infection: "Have you been hospitalized before? What treatment did you receive? How long has the illness lasted?"

"I was hospitalized. I stayed in the local hospital for a long time. The doctors there said it was an infection, but injections and other treatments didn't help."

"Some doctors say it's gout, some say it's nonspecific inflammation, and others say it's rheumatoid arthritis."

"But no specific cause was found after the blood test."

"This situation has been going on and off for almost two years..." the patient sighed.

"Did the blood test indicate an infection? Did it specify what kind of bacteria it was?" Hu Qingyuan had a vague idea.

Gout and rheumatoid arthritis both have clear specific indicators; if these are not present, infection is a more likely cause to be considered.

"It seems okay, it's just red and swollen, and the doctor didn't say anything special."

Seeing that only Hu Qingyuan was asking questions, the patient looked at Fang Ziye and asked, "Professor Fang, what is the cause of my condition?"

Fang Ziye was drinking water: "Aren't we just doing an examination? I don't have X-ray vision either. Your condition must be a rather rare disease."

Fang Ziye had a rough idea of ​​what was going on, so he gave Hu Qingyuan a hint.

Hu Qingyuan was very clever and immediately understood Fang Ziye's hint, and began to search in the direction of rare diseases!
"Big sister, has your hand been injured before?" Hu Qingyuan asked.

If there was a previous injury, it could be traumatic arthritis.

The middle-aged woman shook her head: "I haven't been injured. My job isn't physically demanding."

That would not be post-traumatic intractable elbow deformity.

"Do you have any other joint pain?" Hu Qingyuan then thought of cystosinemia, a rare disease.

His memory is very vivid; once the rare elbow joint disease was identified, he was able to trace it one by one.

Cystinosis is caused by a defect in lysosomal cystine transport, leading to the deposition of cystine crystals in tissues such as bones and joints. This can cause systemic bone and joint diseases!

The middle-aged woman also shook her head: "Only this joint hurts, no other joints hurt. I've asked doctors before, and they said that rheumatism can affect multiple joints."

Hu Qingyuan temporarily ruled out cystinemia: "Do you have any other illnesses? For example, diabetes?"

Charcot joint disease is often secondary to diabetic peripheral neuropathy. It is caused by repeated microtrauma due to loss of joint sensation, which eventually leads to joint destruction, deformity and dysfunction. It is common in the lower limbs, but Charcot joint of the elbow is very rare.

"My blood sugar has always been normal. I just had a physical exam last month! My fasting blood sugar was 4.2, and my post-meal blood sugar was also normal, less than 6."

If postprandial blood glucose is below 6, there is no glucose tolerance impairment.

Hu Qingyuan glanced at his master, his eyes darting around, thinking to himself, "Master, it doesn't seem to be either of those!"
Is it because I know too few rare diseases?

Hu Qingyuan immediately backed down: "Master, I've finished my consultation. I'll go and do a physical examination for the patient first."

He knew it was time to relinquish the diagnostic authority.

He was very unlucky; this rare disease was too rare for him, and a little too advanced for him.

Upon hearing this, Fang Ziye said, "Then you should have your physical examination done first."

While examining him, Fang Ziye asked, "Are your left hand and both feet numb right now?"

The middle-aged woman thought for a moment and shook her head: "It's not numb anymore. It used to be numb."

Upon hearing this, Fang Ziye immediately understood: "Hu Qingyuan, test the patient's pain and touch sensations."

"This patient is still suspected of having Charcot's arthropathy. However, it's not caused by diabetes; it's more likely due to a spinal cord disease." (End of Chapter)