System Came When the Doctor was Thirty

”Teacher Chen, thank you for your hard work.” After stepping out of the operating room under the aura of Chen Song, Lu Cheng spoke with respect.

”What’s hard about a ’vacation’?” Chen Song was smoking in the ’fire exit’ leading from the emergency observation ward doctor’s office to the outside corner, the sparse smoke rings obstructing Lu Cheng’s view, making Chen Song appear more profound and unfathomable.

The pace of the emergency department at Long County People’s Hospital was indeed a ’vacation’ compared to the emergency department at Xiangya Second Hospital!

”Teacher Chen, the guidance you just gave on the operating table, I don’t know any of it; I was previously an orthopedic training doctor.”

”I’ll go back and look it up to study.” Lu Cheng replied honestly and specifically.

Chen Song was not surprised: ”That’s why, it would be strange if you knew it.”

”Take your time reading, your previous specialty was orthopedics, so you can only start with the orthopedic diseases...”

”Want one?” Chen Song offered his own with a peaceful demeanor.

Lu Cheng hesitated for a moment, took one, and lit it calmly, but as soon as he took a puff, he started coughing tears: ”Cough cough cough” non-stop.

”Forget it, let’s not waste my supplies on you.”

”Smoking is not good; it easily affects the nerves in the hands; I can’t quit.” Chen Song put away his pack of cigarettes, took a deep puff again, exhaled a ring, stomped out the cigarette butt, and put on his mask again.

”Emergency surgery, in essence, boils down to two points, targeting the control of vital signs.”

”That is, circulatory blood volume and blood pressure. The part we surgeons need to intervene in is the bleeding; if we do this well, the patient’s life is likely to be saved.”

”The acute nature of emergency diseases lies in coming fast, dying fast, and inherently leaving fast, recovering fast, with immediate effect.”

”Thus, in the basic skills of surgical operation, the hemostasis technique is the most fundamental content in our emergency medicine.”

”Once the hemostasis technique is practiced well, other surgeries can be practiced slowly. For example, the first time I did this surgery, it took me a full eleven hours to get off the operating table; my teacher stayed with me outside the operating room the whole day.”

”Surgical techniques are learned bit by bit in this way.” Chen Song’s guidance was very specific.

”Then there’s the diagnosis.”

This time, Chen Song’s guidance didn’t promote any guidelines, yet Lu Cheng still found it extremely beneficial: ”Thank you, Teacher Chen, for your guidance. Currently, I can only focus on improving my tendon suturing skill.”

”Hmm...” Chen Song was very pleased with Lu Cheng’s self-awareness, with his hands behind his back, he walked into the observation ward like a detached and leisurely person.

Lu Cheng, meanwhile, needed to supplement the ’emergency’ medical records, surgical operation records, first course records, and first postoperative ward round records for the emergency patient just now.

Life-saving emergency surgery, where every minute could mean a life.

The law states that in an emergency, a signature can be omitted, with the chief on duty at the hospital authorized to legitimize performing the surgery first, with signatures and medical records to be supplemented later.

Even if the patient dies on the operating table, it is still considered an emergency risk avoidance.

...

At twelve o’clock, Lu Cheng’s lunch in the doctor’s break room smelled enticing as he was tidying disposable masks when a call came from the emergency surgery clinic.

Du Daihua, in front of the patient, was very polite: ”Dr. Lu, this patient has a wrist tendon injury... Director Lin asked you to take a look!~”

The patient was a young man in his thirties, with his wrist temporarily bandaged to stop the bleeding. He thoughtfully looked at Lu Cheng: ”Dr. Du, is this the Dr. Lu? Seems a bit young?”

Du Daihua said, ”Yes, Dr. Lu is a top student from Han City University!~”

”Looks quite handsome, doesn’t he? His surgical skills are just as impressive.”

Du Daihua, being second-tier educated, finished his training, and after witnessing Lu Cheng’s operation, didn’t dare to think of competing with Lu Cheng in ’basic skills.’ Additionally, as Director Peng in orthopedics stumbled on tendon suturing, he avoided it even more so.

The learning period for medicine is extremely lengthy; being a doctor is a super post-late-career profession. The surgery Lu Cheng couldn’t handle, Du Daihua couldn’t either, yet he was willing to wait...

While Du Daihua was communicating with the patient, Lu Cheng had already opened the outer layer of the patient’s gauze, looked at the depth of the wound, and expressed himself quite professionally: ”Bro, this is a carpal tunnel flexor tendon injury, in the professional field, it’s a Zone IV flexor tendon injury.”

”Suturing is definitely necessary, the orthopedic doctor on duty called today saying he couldn’t manage this situation, do you want to go to the State People’s Hospital or?”

”Would you like me to handle it for you?”

The patient’s informed consent not only involves agreeing to Lu Cheng’s operation, but also requires Lu Cheng to provide suitable alternative options.

Allowing Lu Cheng to operate, go to Xiangzhou People’s Hospital, those are the two options.

Chen Song doesn’t perform tendon injuries, the cases are too small for him to bother.

Zone IV flexor tendon injury is relatively the easiest tendon injury to handle; the top recommendation in textbooks is the modified Kessler, which is also one of the simplest tendon suturing techniques.

Lu Cheng’s cautious attitude and tone were reliable upon listening, and his appearance was also somewhat pleasing: ”Dr. Lu, you mean to say, even the orthopedic doctor can’t handle this, but you can?”

Lu Cheng gently shook his head, cautiously replying: ”That’s not my original words, that was stated by the orthopedic doctor on duty today saying he couldn’t handle it.”

”Director Peng from orthopedics has gone to the countryside. Your surgery is a timed procedure; it can’t be delayed too long.”

”If you’re seeking better treatment outcomes, you can head straight to the State People’s Hospital in Ji City, their duty doctors can definitely find someone who can handle your case.”

This tendon injury, Director Peng from orthopedics can perform the surgery, but the previous tendon sutures left him with psychological scars, and he simply prefers not to touch this type of case.

When Director Peng is not on duty, the on-duty doctors certainly won’t take the risk.

Even if the patient mentions ”misunderstanding,” Lu Cheng needs to explain clearly.

Stepping on colleagues to advance or elevating oneself at the expense of others is unethical, even if others can’t suture tendons, they can perform fracture surgery, right? Perform arthroscopy?

Tendon Suturing Skill is just one of the more specialized techniques in the subspecialty of hand surgery, and it’s only in recent years that it’s gained more attention.

Rewind twenty years, you’d suture directly, and as long as there’s no infection, it’s done. Whether it gets stiff or not wasn’t in the medical discussion.

As long as it’s not bleeding or infected, it’s considered treated.

”Well, go ahead... I think you’re quite honest...” The young man agreed.

”Tendon Suturing Skill is a standard surgical procedure; it requires the operating room, and the cost isn’t cheap. Whether it’s me or anyone else performing the surgery, it’ll cost over two thousand yuan.”

”Post-surgery, you must be hospitalized for rehabilitation!”

”This is something I need to make clear to you.” Lu Cheng explained.

”Even if it’s expensive, it’s got to be done; I can’t go back with this ruptured tendon, can I? My fingers can’t bend.” The young man seemed quite helpless.

Though expensive, it needs treatment, given how things have turned out.

Tendon rupture isn’t a joke; he read some educational material and found out it could leave post-surgical stiffness, turning one’s hand into a ’crippled hand’ of sorts.

...

Tendon Suturing Skill isn’t simply debridement and suturing; ordinary local anesthesia won’t suffice, it requires entering the emergency operating room for nerve block anesthesia.

In the County Hospital, the anesthetic drugs and tendon suture materials are domestically produced. The suture used is Tycron (3-0), priced at 195 yuan per piece, with Lu Cheng unsure about the precise reimbursement. Compared to the Johnson & Johnson Ethicon No. 2 (2-0) at Xiangya Second Hospital, priced at 239 yuan each, it’s quite cheaper.

After finishing the conversation and signatures, the patient first went to the emergency operating room, and Lu Cheng said to the on-call Zhang Tiesheng, ”Brother Zhang, this tendon suturing is a secondary surgery, do you think we should write you as the chief or write me as the chief?”

Zhang Tiesheng is a senior attending physician, more experienced than Lu Cheng.

Even Professor Chen Song doesn’t bother being the chief surgeon for this procedure, nor is it ’reliable’ to have him as an assistant. Yet, Professor Chen Song promised he would come by to check after the surgery.

Tendon suturing isn’t something one can handle alone; Zhang Tiesheng came for this surgery backup.

Zhang Tiesheng is of average height, wears black-framed glasses, looking quite cultured, and he chuckled, ”Since it’s you, Xiao Lu, doing the operation, of course, you’re the chief surgeon, and I’m the first assistant!”

How can Zhang Tiesheng take the fall for Lu Cheng? Although emergency medicine requires ’business’, it’s not about sacrificing oneself.

”Alright, Brother Zhang.” Lu Cheng understood.

Entering the operating room, he proceeded with routine formal disinfection and draping.

Then Lu Cheng sat at the main position and started the debridement and suturing, with Zhang Tiesheng seriously watching from the first assistant position.

Although currently only heard that Lu Cheng can suture tendons, based on interactions with Lu Cheng, Zhang Tiesheng confirms that Lu Cheng isn’t someone who brags.

If Lu Cheng says he can do it, then it’s most likely possible.

He can avoid taking the blame, but can’t avoid maintaining a learning mindset to observe the surgery.

Professor Chen Song chose to mentor Lu Cheng and not him; there must be a reason.

”What suturing technique is this?” Zhang Tiesheng asked with slight puzzlement after watching.

The few orthopedic doctors in the hospital familiar with tendon suturing seem not to use this technique; mattress suture, weaving suture are their most commonly used methods.

”Improved Kessler tendon suturing, currently most recommended for suturing technique in IV flexor tendon injuries.” Lu Cheng sutured meticulously, and his answer was equally meticulous.

Zhang Tiesheng’s expression slightly stiffened, remaining silent.

This knowledge is a theoretical dimensional reduction strike; Zhang Tiesheng only knows the high entry requirements for tendon suturing, but doesn’t know how flexor tendons are partitioned; the wrist joint flexor tendon is IV zone, and the most recommended technique for IV zone flexor tendons is improved Kessler...

Academia-style approach, certainly Professor Chen Song’s teachings!~

Just unexpected that Lu Cheng could truly master it!!

Lu Cheng’s work on this tendon suture case, Zhang Tiesheng doesn’t envy or admire at all.

This Lu Cheng, truly worked hard for the surgery.

Zhang Tiesheng’s gaze lingered on Lu Cheng...