Practicing Medical Skills in a Small Clinic

"It seems like Director Ru’s most lucrative job right now isn’t being a doctor, but her wood carvings. I heard the cheapest ones sell for 1199 yuan. I really suspect that one day when she’s made enough money, she’ll quit being a doctor and become a sculptor instead."

"You don’t get it! If she stops being a doctor, those wood carvings might not even sell for a hundred yuan each. I’ve seen the description she put up for sale online; they can be pre-ordered, limited editions, and come with her autograph. It’s really just a selling point. At least, I wouldn’t spend that much money on a wood carving."

...

A few doctors had a heated discussion when Director Ru Qingqing was mentioned.

"Xiaoli, let me take over the next procedure! I’ll call you in for hands-on practice later."

Director Zhang said to Li Jingsheng.

The next step was to dissect the lung hilum, a complex and risky procedure that required a seasoned doctor.

Even with his trust in Li Jingsheng, Director Zhang wasn’t going to recklessly assign such a critical task to him.

Although the other doctors were discussing Director Ru’s affairs, their focus remained on the patient’s incision area.

When the operating room atmosphere is relaxed, the lead surgeon doesn’t scold much, and this is generally the state of things.

Everything can be discussed.

This also enhances the understanding among team members.

But when a patient encounters complications or the surgery doesn’t proceed smoothly, it’s a different story.

Everyone works together to assist the lead surgeon in completing the surgery.

Rescue when necessary.

In the event of a major issue, the lead surgeon’s mood is usually quite poor.

The wisest approach at this time is to lower your visibility.

Li Jingsheng stood nearby, attentively watching Director Zhang dissect the patient’s lung hilum. There was so much he needed to learn.

When Director Zhang dissected the lung hilum, his movements were not fast but very steady.

Cardiovascular surgeons, especially those who perform surgeries, generally have this habit.

They strive for stability.

Because thoracic surgery includes cardiac surgeries, even a slight tremor of the hand or a slight misjudgment of force can rupture a major artery.

For mitral or tricuspid valve repair surgeries, it’s needless to say.

They must strive for perfection to ensure the success of the surgery.

"Xiaoli, this is the pericardium. During surgery, you mustn’t cross the line. I once had a student who caused cardiac arrest during a lobectomy. Your incision skills have reached a very high level; it’s like having a very good foundation. What you lack now is surgical experience. In the future, when you have time, you can follow me more often. As long as you have the desire to develop in this area, I’ll teach you wholeheartedly and give you opportunities to train."

Director Zhang guided Li Jingsheng as he performed surgery.

"Our Director Zhang is really partial to you! The training opportunity in today’s surgery should have gone to the other doctors, but instead, you were given precedence."

The scrub nurse was quite young and very beautiful.

Of course, she was wearing a mask and dust cap at the moment, revealing only her smooth forehead, eyebrows, and eyes.

A woman’s beauty can largely be judged by her brows and eyes.

"Thanks to Director Zhang, and to all the teachers for giving way to me. I’m usually busy with outpatient consultations and don’t have much time to come and learn. Being given the chance when I do come makes me feel very fortunate."

Li Jingsheng gently reminded everyone that he wouldn’t be competing for training opportunities every day.

At most, he’d come by occasionally to have a try.

When it comes to interests, no one is easygoing. Snagging a chance once in a while is something they can somewhat tolerate.

"Dr. Li, there’s no need to be so polite. Being able to operate alongside such an excellent young doctor like you is quite nice."

"Exactly, Dr. He’s saying what I wanted to say. Dr. Li, you’re welcome to visit the thoracic surgery department anytime."

Both the first and third assistants warmly welcomed him.

The second assistant remained silent.

"Xiaoli, when handling the upper lobe tip and the anterior segment artery, make sure to first retract the upper lobe posteriorly and downward. Dr. Tang, have Xiaoli temporarily take over your role as the second assistant,"

"Alright! It’s easier to operate from this position."

Dr. Tang nodded kindly towards Li Jingsheng.

So this reserved doctor’s surname was Tang.

His voice was rather soft, and he liked to keep his words concise.

After Li Jingsheng took over, the responsibilities of exposing the view and retracting tissue for cutting were left to him.

"Xiaoli, ligate this distal artery!"

"Temporary ligation?"

"Yes!"

Director Zhang confirmed.

Li Jingsheng gritted his teeth and seamlessly upgraded his slip knot from Minor Achievement to Great Success Level.

With this level of proficiency, ligating such important blood vessels not only minimized damage but also ensured the slip knot wouldn’t suddenly come undone.

Blood vessels are not only very elastic but also exert a strong force due to the heart’s contractions and relaxations.

Slip knots are very prone to loosening.

Especially if the knotting technique is poor, making it more likely to bleed out or come loose.

With Great Success Level slip-knot skills, Li Jingsheng easily tied two slip knots.

When operating, the movements are light and dexterous, even more flexible than a girl’s hand when using forceps.

The chosen ligature position, as well as the tension of the ligature, are impeccable.

"The young man’s knot-tying skills aren’t bad either! Well done!"

Director Zhang couldn’t help but regard him more highly.

Knot-tying seems like a minor operation in surgery, but a variety of problems often arise.

Especially in some special areas, knot-tying is small but crucial, requiring extremely high demands on the doctor’s operation skills.

Sometimes when suturing some severely adhesive internal membranes, or brain tissue, liver lobes, etc., even a slight exertion might directly shatter the tissue being sutured.

It may sound unbelievable to some, but some surgeons, when practicing knot-tying, place a piece of foam on water and practice there.

There’s an even more extreme practice, which involves tying knots on soft tofu pudding.

The requirement is for the knots to be firm and closely adhere to the surface of the tofu.

In the actual operations of clinical surgery, the difficulty only increases. Because sometimes, one must complete knot-tying deep in the thoracic or cranial cavities, where the operating space is extremely narrow. The view might also be obstructed, leaving nothing visible.

It’s conceivable that this level of difficulty is hellish.

However, successfully suturing tissue as delicate as tofu pudding may potentially save a life; this is the value and significance of a doctor.

Li Jingsheng’s method of tying two slip knots is a skill that many more advanced surgeons also possess.

However, there aren’t many surgeons who can tie knots this well.

His current knot-tying skills aren’t particularly formidable yet.

If he reaches a level of perfection in the future, or even higher, there would be great potential.

The surgery continued.

Director Zhang operated slowly, eventually exposing the tumor.

"Everyone, come and take a look at this tumor, primarily observe its location and shape, and then make a preliminary judgment about its nature, whether there’s lymph node metastasis or other metastasis. Also, carefully consider the surgical plan for its removal."

The doctors stepped forward one by one to observe in turn.

Li Jingsheng had seen a small number of tumors, both malignant and benign.

Generally, malignant tumors have apparent characteristics.

Just like some bad people, you can tell from the appearance. They look fierce and malevolent.

"When removing any lesion, you must consider multiple aspects and not blindly pursue a complete removal. If it’s a benign tumor, some won’t enlarge or affect the patient’s bodily functions, then they might not need to be removed. For those that are malignant, or suspected to have a potential for malignancy, it’s best to perform an intraoperative pathology before deciding how to remove it.

Not all tumors suspected of malignancy need expanded resection.

In the past, we encountered a very special case where a patient had a tumor in the lung, and its nature couldn’t be clearly determined. A pathological biopsy suggested a high possibility of malignancy. After discussion, we ended up surgically removing half of the lung.

Later, the patient recovered well post-surgery but experienced wheezing and oppression as aftereffects.

His life and work were greatly affected.

He originally engaged in manual labor, but after removing the right lung, he could no longer do heavy physical work. Even climbing a slope or a few flights of stairs made him short of breath. He lost his job, and his family faced financial difficulties, leading to more frequent fights with his wife, who eventually couldn’t endure such a life and left.

Feeling life was no longer worth living, the patient eventually rushed in front of a large truck while waiting at the roadside and was crushed to death.

After receiving this news during a follow-up, it prompted our reflection.

From the perspective of surgical treatment, removing his right lung helped prevent the recurrence of a malignant tumor. It was a successful surgery.

However, after removing the right lung, the patient’s work and life faced significant disturbances, ultimately leading to choosing suicide. In this sense, our surgery was a failure.

As a result, a special discussion was conducted on whether, at that time, if we hadn’t removed the right lung but only a small part of it, preserving most of the patient’s breathing function, this tragedy might not have happened?"

Director Zhang, when teaching the doctors under him, didn’t rigidly dictate how to do things.

Instead, he shared real cases to make everyone think and understand.

It’s believed that doctors trained this way will be a group of doctors with real compassion.

Before surgery, they will consider the patient’s post-operative life.

Li Jingsheng hadn’t often interacted with Director Zhang, and this was considered a more profound interaction.

He couldn’t help but feel a sense of admiration rise within him.

"Sometimes the lymphatic system, when infiltrated by tumor cells, isn’t noticeable with the naked eye if it’s not severe. Even intraoperative pathological biopsy might not detect it. This requires a surgeon to have rich experience. Checking the surrounding blood vessels is sometimes a good way to tell if metastasis has occurred..."

Director Zhang shared some of his surgical experiences.

Teaching everyone how to judge if cancer cells have spread and metastasized.

In clinical medicine, the commonly used method is to observe the size of the tumor, as well as investigate the surrounding blood vessels, lymph nodes, and other tissues prone to tumor formation.

A malignant tumor may take five or even more than ten years to grow from its inception to maturity.

This is a very long process of carcinogenesis.

Many patients go to the hospital for examination, discover a tumor, but the size is very small.

Based on comprehensive judgment, doctors advise the patients not to be nervous and just to return for a check-up every six months to see if it has grown.

Patients often find this particularly incomprehensible.

Clearly, a tumor was found; why not have surgery to remove it?

Isn’t it like raising a tiger only to court calamity, waiting until it’s bigger to remove it?

What if it metastasizes?