Chapter 306: Not letting him sew
Zhang Fan slept extremely well. He fell asleep around 1:00 p.m. and reached a deep state of sleep almost instantly. He slept all the way until 8:00 p.m. or so, reaching the point where he felt dizzy after finally waking up. Why had he slept so well? It was because he had performed too many surgeries, and also because his surgical assistants had been Wang Yanan, who was a young woman, or Xue Fei, who was rather unreliable.
Zhang Fan basically did all the work for adjusting the metal plates’ shape, piecing together the bones, operating the electrotome, and putting nails in. All of this work was similar to what a carpenter would do when assembling furniture. This was heavy physical work on top of not being able to walk around at all, so Zhang Fan used up much energy. There was also the problem of the hospital’s food. Both lunch and dinner were boiled lettuce and boiled potatoes. There was no meat at all. There wasn’t even much grease. This food was truly an exemplary example of health food.
However, this food was far too insufficient for doctors like Zhang Fan who had so much physical exertion. The calories gained from such food which had no fat or protein would be used up by adjusting two metal plates’ shapes. Zhang Fan wouldn’t have been so tired if he had more high-quality food, as his System was capable of rapidly absorbing all of the energy from the food. Even the superintendent had been changed several times, yet the cafeteria food supplier couldn’t be changed. This really was rather strange!
Zhang Fan felt slightly better after he shook his head. He then got out of bed and exited the bedroom to see that Shao Hua’s parents and Shao Hua were sitting on the sofa like wooden mannequins who weren’t talking or even watching television.
“How come you guys aren’t watching TV?” Zhang Fan commented as he went to the bathroom.
“Shao Hua was afraid that we would wake you up!” Shao Hua’s father pouted. He was slightly unhappy and acted like a tattling child. When Shao Hua called her parents and asked them to come home late, they had roamed around the farm for an entire afternoon with the food they gathered there until Shao Hua finally got home from work.
When Shao Hua’s parents returned home, Shao Hua’s father wanted to watch the news on TV and said that he would turn the volume down really low. However, Shao Hua wouldn’t agree to this at all. It wasn’t that she was being unreasonable, but rather that she really felt pained about Zhang Fan’s condition today, which was why she rejected her father’s efforts to watch TV so directly. Now that Zhang Fan had woken up, Shao Hua’s father started tattling.
Zhang Fan cleaned himself up and exited the bathroom. He smiled and told Shao Hua’s parents, “I was rather tired today. I wouldn’t have heard anything outside no matter what. Feel free to do what you like in the future if I’m sleeping after working a night shift. It wouldn’t wake me up even if you start singing at home.”
“It’s not like you’ll lose anything if you don’t watch TV for a day. It’s important to get good rest. You’re working a job that affects human lives, so you absolutely must get proper rest. Let’s eat dinner. You must be hungry. Today, we’re having big plate of chicken with noodles, one of your favorites. The chicken is from the farm. It has a great taste!” said Shao Hua’s mother as she glared at her husband.
“Really? I was wondering what the good smell was. Oh! By the way, someone gave me two bottles of Moutai wine. Sir, try it out and see if it’s real or not!”
“Ha! You think he can actually discern if the wine’s real Moutai wine or not?” remarked Shao Hua’s mother as she left. Shao Hua’s father almost fainted out of anger with his proudest skill being looked down upon.
“Of course I can detect the wine’s quality! Let me tell you, I’ve drunk more wine than you have water!”
Shao Hua’s father was about to chase after his wife to argue, so Zhang Fan hurriedly brought out the wine that orthopedic department #1’s medicine supplier merchant had given him a few days ago during a departmental meal. “Sir, check this out, this is the proper brand’s wrapping, right?”
Shao Hua’s father was just like a young child in his old age who needed to be appeased. He acted all serious as he looked over the wine several times over. “Yeah! There’s likely no problem!”
“Teehee!” Shao Hua almost laughed out loud. Zhang Fan rolled his eyes at her, while she covered her mouth and stood up while holding in her laughter. Shao Hua then said towards the kitchen, “Mom, add some onions!” She then immediately went over to the kitchen where she started to secretly laugh together with her mother.
“They have more hair than sense,” commented Shao Hua’s father. He then told Zhang Fan, “You have a great future ahead of you, so you absolutely can’t make a mistake because of alcohol. Actually, it’s fine with me whatever I drink. I’ll be happier than drinking any wine as long as you guys are healthy and safe.”
“Yes, rest assured, Sir, everything is fine.”
“Good, that’s good. Okay, let’s go eat. We’re having a farm chicken today that we especially purchased at the farm. It’s a small and tender chicken that’s not even a year old yet.” He didn’t say anything else, feeling that it was fine to remind Zhang Fan not to get involved with alcohol.
Shao Hua’s family’s cuisine usually trended towards Zhejiang style, which was relatively sweet. They would even put sugar in their sunny-side-up eggs. However, Zhang Fan was from northwestern China, so he couldn’t get accustomed to eating sweet foods at all.
The first time that Shao Hua’s mother cooked sweet sunny-side-up eggs, Zhang Fan had an expression as if he was taking some bitter medicine as he ate the eggs. Ever since then, Shao Hua’s family almost never ate sweet foods anymore. Different types of noodles became the most common meal. Shao Hua’s parents were truly being considerate of Zhang Fan’s food preferences.
The family all sat together and enjoyed a lively meal of big plate of chicken with noodles. Zhang Fan had been starving. He ate more than double the amount of chicken, potatoes, and noodles than the other three people combined. After eating his full, Zhang Fan took a walk together with Shao Hua.
The next morning, Zhang Fan got out of bed to find that Shao Hua’s mother had already prepared his breakfast and set it on the table. Shao Hua’s father treated his wife well, and the two got along well. He wouldn’t allow her to do any heavy physical work at all. However, he absolutely refused to ever enter the kitchen. He also refused to let Zhang Fan enter the kitchen, even over Shao Hua’s objections. Shao Hua’s father claimed, “A man who stays in the kitchen will have his ambitions ground to dust!” Zhang Fan could only respect his chauvinist beliefs!
Zhang Fan had a rather important surgery scheduled for today. Thus, he had told Shao Hua’s mother last night that he wouldn’t be drinking any milk nor eating any soy products or cured products this morning. Zhang Fan was afraid that he would get diarrhea. This was a small yet important detail for surgeons. Every single small detail was important because someone’s life was at stake. Zhang Fan only had some porridge, one egg, and one bun before he went to work.
All the doctors had arrived quite early today. Xue Fei didn’t even go play mahjong last night because of how exhausted he was from the work that Zhang Fan forced on him. He instantly fell asleep when he came home, which made his wife really delighted. If this continued for half a year, maybe Xue Fei could even quit his mahjong addiction!
There was only one difficult part about this surgery: ascertaining whether the bone fracture had reconnected in proper position or not. Not many people performed closed intramedullary fixation surgeries these days. The reasons for this were hard to say. The most common type was still open surgery for fixation. Zhang Fan was quite lucky to have a director who was willing to risk letting him perform this surgery. A different director probably wouldn’t have allowed it.
When performing surgery blindly, one’s sense of touch would be incredibly important. This was no exaggeration. It truly was possible to sense things through the skin. If a bone fracture was properly set in position, well experienced doctors would truly be able to sense it. However, such experience was truly difficult to come by. There wouldn’t be that many patients for a doctor to practice on. Even if there were that many patients, the other doctors in the department wouldn’t let you have that many patients, because more patients equaled more money.
There was a difference between anatomical position and physiological position for bone fractures. The greatest advantage of open internal fixation was that anatomical position could be achieved. Basically, the fracture could be put together accurately as if there hadn’t been a fracture in the first place. However, there would be a large amount of damage done with this method. Just about all of the nearby periosteum would be destroyed.
Meanwhile, physiological position meant that the position wouldn’t return to the exact same as it was before, but the function wouldn’t be affected, and there would be no distortion.
In the past, Chinese doctors had been incredibly skilled in this area. There were numerous orthopedic practitioners of traditional Chinese medicine who had their own family teachings. Several hundred years ago, even more than 1000 years ago, such doctors were already capable of fixing bone fractures to a physiological position with their bare hands through the skin. In modern times, medical advancements were improving every day, yet such techniques became extremely rare. Where did such techniques disappear to? Who knows!
The patient had already been brought to the operating room. After the morning meeting, Director Gao led all of orthopedic department #1’s doctors in an orderly fashion as they went to the operating room. Of course, Zhang Fan was at the very end of the procession. There was no helping it. He was the youngest as well as lowest-ranking doctor.
Plenty of people in the three orthopedic departments learned that Zhang Fan was going to perform a closed internal medullary fixation surgery. Many people gathered around with various different thoughts, such as wanting to improve themselves, curiosity, wanting to watch a show, and so on. Still, the operating room had limited space. Only the relevant personnel for the surgery and one to two doctors for observation could enter. Having too many people would make it impossible to maintain a sterile environment.
Still, this wasn’t a big problem. Chasu City Hospital’s operating rooms had three levels. The lowest level had a monitor room that was specially for watching surgeries in process.
“Director, please allow me to at least raise the patient’s legs and disinfect!” Xu Xian hurriedly asked Director Gao before they entered the operating room. Xu Xian was the type who really wanted to improve himself. Normal graduate students would feel like it was a loss of face to ask like this!
Director Gao saw that Xu Xian had a sincere expression. “Okay, you can participate as the third surgical assistant. Hurry and change into surgical attire.” Xu Xian immediately went over to the changing room. To be honest, he had only heard of closed intramedullary fixation before, but never seen it. It was a surgery seen only in the textbooks.
This surgery was simple to describe and observe. It wouldn’t even look as difficult as open intramedullary fixation. However, this surgery relied far too much on one’s senses and knowledge. Slightly being off by even a little could cause a medical incident. Since the skin wasn’t opened up for this operation, it really was difficult to perform the surgery blindly!
Inside the operating room, the anesthesiologist, medical equipment nurse, and operating room nurse were all prepared for the doctors to arrive. Almost all of the orthopedic surgeons in the three departments were waiting in the monitor room to observe the surgery. Although nobody had especially notified orthopedic department #2 or #3, just about everyone came. Even the hospital administration department sent someone to observe. Although the hospital administration department didn’t know how difficult this surgery was, as long as the surgery succeeded, the hospital administration department would soon issue a report praising the success of this surgical method used for the first time at Chasu City Hospital.
Director Gao had nominally said that he would take the surgery, but in reality, Zhang Fan was still the primary surgeon. Two doctors with highest-level certification, Director Gao and Doctor Chen, were participating as the primary and secondary surgical assistants. There were also two resident doctors, Zhang Fan as the primary surgeon, and Xu Xian as the third surgical assistant. The anesthesiologist finished the anesthesia and indicated to the other doctors that they could begin. Xu Xian swiftly washed his hands and began disinfection. Zhang Fan had carefully reconfirmed the patient’s X-ray right before starting the surgery. He had checked it one last time even though he had already memorized the X-ray.
Director Gao and Doctor Chen silently stood to the side. There was very little that they could do to help out in this type of surgery. Director Gao had also made preparations that they would immediately begin open intramedullary fixation if the blind surgery failed. Director Gao washed his hands and put on his surgical attire. “Don’t worry. Don’t feel any pressure. Even if something happens, we can just open up the leg and perform open intramedullary fixation. It’s nothing at all,” Director Gao said to Zhang Fan after the latter raised his scalpel.
“Yeah!” This was one of Zhang Fan’s bad traits. He didn’t like to say anything unnecessary at all during surgeries. He also didn’t like it when others said anything. Thus, whenever Zhang Fan was the primary surgeon, there would always be a stiffling atmosphere in the operating room. The anesthesiologist and nurses wouldn’t dare to say anything. This was a problem with Zhang Fan’s aura.
“Begin.” Zhang Fan prepared to open up the skin. To explain this surgery, the femur was also known as the thigh bone. This patient’s femur had broken in the middle, and the fracture hadn’t moved too much. Right now, Zhang Fan was about to open up a tiny incision at the very top of the femur. This would be followed by using the electrotome to open up the bone so that a titanium alloy rod could be inserted into the incision. This titanium alloy rod had two holes in the bottom as well as top for placing screws in. Once the fixation was finished and the fracture was in proper position, then four screws would be inserted, ending the bone fracture fixation and surgery.
That was how simple it was. However, 80-90% of orthopedic surgeons would be incapable of performing this simple surgery. Without even mentioning the blind surgery portion, just for the incision and fixation, doctors who were slightly less skilled might not even be able to locate the titanium alloy rod’s holes for the screws!
Zhang Fan opened up a small incision, and then used the electrotome to stop the bleeding. In the past, before electrotomes were invented, silk threads would be used instead to stop the bleeding.
Zhang Fan was the primary surgeon. Director Gao held the aspirator to suction away the electrotome’s smoke. Doctor Chen gently held on to the surgical retractors for opening up the skin. Xu Xian had nothing to do currently, so he just stood there and watched.
ELectrotomes were actually quite simple. An electrotome would be similar to an electric iron. The human body had evolved to an amazing extent, so the surface layer of the skin basically had no major blood vessels at all. When opening up the skin, there wouldn’t be much bleeding at the epidermis. Only when entering the fat layer and muscle layer would there be slightly larger capillaries. The electrotome would immediately cause electrocauterization and stop the bleeding.
It would be more difficult to perform such a surgery due to the electrotome if you were hungry. Not only would this tool burn the blood vessels, it would also burn the fat. This would cause the fat to start smoking. Although the doctors would be wearing masks, there would be the fragrant smell of roasted meat. A doctor who was hungry would really be able to start drooling when smelling this scent.
“Electric drill,” Zhang Fan requested after he opened up a small incision and used his hands to separate the muscles, fascia, stop the bleeding, and expose the bone. The medical equipment nurse had long since prepared the electric drill already. She finished the drill’s adjustments and steadily handed it to Zhang Fan.
The electric drill screeched while piercing through solid bone as if it was tofu. Likely everyone had eaten large bones before with bone marrow inside. This would be the red and soft portion of the bone, shaped like a beehive. When the electric drill broke through the bone, the bone would seem like coffee with milk added as white bone powder would mix together with the dark red of blood and white of bone marrow. This would all swiftly mix together and end up appearing like slightly whitish milk.
Back in the early days, performing this type of surgery had been incredibly cruel as electric drills hadn’t been invented yet. This type of surgery would require bone hammers and bone drills, making the doctor seem just like a butcher. Such tools would be used to forcibly smash an opening in the bone. Intramedullary fixation in the early days was incredibly difficult. The femur bone wasn’t in a clear cavity. There were helixes as well as trabeculae bone. This type of structure made the femur incredibly solid as well as being capable of creating blood.
Thus, a small reamer would be inserted into the femur cavity for fixation. This reamer would be gradually inserted by using a bone hammer to smash it in. How much force was required for this? The patient would have to be tied down, yet their entire body would still shake!
These reamers would be quite similar to triangular bayonets, although the reamers were heavier and duller. There were small, medium, and large reamers which would keep expanding the bone marrow cavity. Just try to imagine using chopsticks to eat bone marrow. The principle was pretty much the same, although chopsticks would be unable to expand the bone marrow cavity. Chopsticks weren’t as good for exerting force with, and there would be no hammer to smash the chopstick deeper into the cavity!
When using a hammer to smash the reamer, that would cause red blood and white bone marrow to fly everywhere. It would be quite troublesome if the patient had a blood-transmitted disease and blood flew into the doctor’s eyes! But now, thanks to modern medical advancements, reamers and hammers were no longer necessary. This type of surgery now seemed far more elegant.
Zhang Fan gently inserted the bone nail after opening up the cavum medullare. This was a slow process. No matter if the surgery portion was performed blindly or not, it would always be necessary to compare to the X-ray to calculate the length. Things couldn’t be long or short. The bone nail gradually descended.
“Rotate the lower portion of the femur outward by 10 degrees,” Zhang Fan told Director Gao and Doctor Chen as he held the bone nail with one hand and supported the femur’s upper portion with his other hand.
An excellent orthopedic surgeon would need to have an excellent sense of 3-D imaging and geometry. Doctors who weren’t good at geometry would typically be forced to give up due to the difficulty of learning anatomy.
Various angles in orthopedic surgery really weren’t easy to control. Without even mentioning the operating table, when normally eating with two chopsticks, it was likely that very few people would be able to make an exact 10 degree angle with their chopsticks without using any measurement tools. Not to mention, this was a scenario with no clear vision.
“Stop! Rotate inward by two degrees and pull down very gently.” Zhang Fan was commanding his surgical assistants for the bone fracture resetting. This surgery would be impossible for Zhang Fan alone if his surgical assistants were incapable. That was why a surgical team would be so important. Director Gao and Doctor Chen slowly rotated while Xu Xian held on to the patient’s leg and slowly pulled downward.
Why was it necessary to pull downward? This was to allow the bone fracture to be slightly separated. This force couldn’t be too great or too small. Too much force would likely result in mispositioning the bone fracture. Too little force wouldn’t separate the bone fracture.
Zhang Fan gently touched the fracture with the bone nail. It was as if the nail was part of his hand. He could clearly envision the fracture’s changes in his mind.
This was his sharp sense gained from countless amounts of practice in his System. Director Gao had worked in orthopedic surgery for all his life, yet even his senses weren’t as good as Zhang Fan’s. This was the best evidence of how much grinding with surgeries Zhang Fan did in his system. *Click!* There was a gentle trembling that came from the sound of the bone being set in the correct place.
“Okay, don’t move, and maintain the patient’s position.” Resetting a bone fracture might be affected by any small movement. Since this was an oblique fracture, a proper angle was required to reset the bone fracture. Right now, the patient’s leg was being held in midair. Luckily, the patient was an old woman whose leg wasn’t very heavy. If the patient was rather fat, then maintaining the leg in midair would make all three surgical assistants’ muscles really sore.
Maintaining a patient’s leg in midair wasn’t as simple as keeping it raised. The position needed to remain fixed throughout the entire surgery. The three surgical assistants needed to all apply a fixed amount of force. To explain simply, if a chopstick snapped and you wanted to tie it up again, in order to ensure that the chopstick’s fracture was reset properly, force would be required to push it back into place before the fracture could be tied. That was the principle behind this.
The three surgical assistants would need to cooperate simultaneously for this while Zhang Fan issued commands. Five minutes, then 10 minutes, and then 20 minutes passed in this position. It really would be difficult to maintain the same position for so long while exerting the same amount of force. Even though the patient was an old woman, her leg would still have some weight to it.
Zhang Fan inserted the nail and aimed it slightly diagonally while slowly sliding it downwards. He dodged the fracture and slowly placed the nail along the bone. This process couldn’t be hurried at all. Rushing would be impossible.
Director Gao and Doctor Chen were both sweating visibly. Originally, there had only been one operating room nurse, but the head nurse sent a second nurse. Both operating room nurses gently wiped away the sweat for the two older doctors.
“Director Gao, should we lower the temperature in the operating room slightly?” the head nurse asked when she came in and saw that both older doctors were sweating profusely.
“N-no! Any lower, the patient, a cold!” Director Gao was unable to speak a complete sentence. He was afraid that speaking too much at once would cause tremors that would ruin the bone fracture reset.
Zhang Fan rotated the bone nail into its final position. “Reset complete. Scalpel!”
The medical equipment nurse immediately handed the scalpel to Zhang Fan while making sure that the scalpel handle faced him and that the scalpel blade faced herself. Zhang Fan took the scalpel and opened up another incision to prepare for inserting the screws. This was also something highly difficult. Even without performing it blindly, doctors with slightly less skill sometimes wouldn’t be able to locate the screw holes even with clear vision.
“I’m opening up an incision. You absolutely must maintain the same position,” Zhang Fan informed the three surgical assistants while holding the electric drill.
“Okay!” Xu Xian replied.
Director Gao and Doctor Chen simply nodded.
Zhang Fan made an incision as the electric drill whirred. His positioning was far too amazing. He opened up the bone to directly reveal the screw hole in the titanium alloy rod without needing to adjust his position even once. This was due to his amazing senses and skills.
Xu Xian was absolutely stunned as he watched. He had figured that Zhang Fan would need to adjust a little to find the proper position of the screw hole since the rod had been inserted blindly. Even if the rod hadn’t been inserted blindly, it was still quite rare to locate the screw hole on the very first attempt according to the surgeries that Xu Xian had watched before.
Zhang Fan then inserted the screw. “Okay, Director, it’s finished!” Zhang Fan already began to rinse in preparation for sewing things up.
Director Gao secretly rubbed his hands which were really numb and sore as he told Zhang Fan, “Should we re-examine things under the C-arm X-ray?”
“Indeed. There’s no worry, and there’s probably no problem, but we should check things out for assurance,” Doctor Chen agreed. They were saying this only because the primary surgeon had been Zhang Fan. If this had been any other resident doctor, the veteran doctors would have said, “Go get the C-arm X-ray!” But with Zhang Fan, the veteran doctors sounded like they were discussing it with him.
Back in the monitoring room, the orthopedic surgeons were really confused about what they had just watched. There wasn’t much to watch for this surgery to begin with. Zhang Fan had only made two small incisions. The rest all depended on the primary surgeon’s senses. Not only that, Zhang Fan was the type who acted like he was almost completely mute whenever he was performing surgery. He would never say anything unnecessary. He hadn’t explained anything at all about what he sensed. Only the other three doctors assisting him would be able to sense anything.
The doctors in the monitoring room felt really conflicted. “It’s over already? What’s with Zhang Fan? He didn’t even mention anything about how he performed fixation or confirmed things, sigh! We wasted our time here! It was like watching a silent movie! I’m leaving. I have medical reports to write.”
“Eh, shouldn’t you wait to see the result from the C-arm X-ray?”
“What use is that? Don’t you see how Zhang Fan is already preparing to start sewing? So what if we see the results? Does that mean you’ll know how to do it? Honestly. I’m leaving!” The doctors all started leaving with such thoughts.
It wasn’t that Zhang Fan was unwilling to explain, but this entire surgery had relied on the senses, something which would seem almost mystical. It would be impossible to describe using words. One could only try and experience it for themselves!
A young nurse pushed over a C-arm X-ray. All the doctors and nurses stood behind the lead sheet and observed the results. When the results came out, the X-ray showed that the bone fracture had been reset in an excellent position.
“Amazing! Your analysis of the angles was so precise,” Doctor Chen said to Zhang Fan with a big thumbs up.
“Teacher Zhang, how did you judge the angles? In that situation, how were you able to determine that a rotation of 10 degrees was necessary?” Xu Xian was astonished as well, but he immediately asked to be taught. This was because he was the type who always strove to improve himself.
“Yes, please do tell us,” Director Gao agreed.
“Um, this, it’s just my senses. Take a look at the original X-ray. Although the angle is slightly large, after a downward rotation, the muscles’ internal rotation corrected the angle slightly. And since the patient is elderly, her muscles have already begun to loosen, so this angle should be around 10 to 12 degrees. When I was using the nail to sense things, I could sense that this point and that point were connected!” Zhang Fan explained while pointing at the original X-ray.
“Oh!” Xu Xian began to break out in a cold sweat. Zhang Fan could even sense such things?
Xu Xian was about to ask another question when the anesthesiologist spoke up first. “Hey! How come you guys are chatting? Are you going to sew the patient up or not? Let me tell you, she’s going to wake up soon as the anesthesia’s wearing off!”
“Haha, let’s talk about this afterwards. Finish the sewing first. Old Chen, let’s get off the surgery now. This little brat ordered us around for so long. My hands are really sore. The rest can be left to them!”
“That’s right. You guys should hurry and go rest. Doctor Xu, you can go now as well. Leave the rest to me,” Zhang Fan stated.
“It’s fine, it’s fine. You should rest instead and leave the rest to me,” Xu Xian answered.
Would Zhang Fan be the type to leave the work to others? That would never happen, as even sewing the sutures counted as surgical experience in his System. Thus, Zhang Fan would forever hog every single part of the surgery that he possibly could. In the end, Xu Xian wasn’t even allowed to do the surgical sutures. He was already holding the needle and prepared to sew, yet Zhang Fan still stole the implements from him by saying, “I think I cut open a small blood vessel when I made my incision. I’ll sew things up. You wouldn’t know the location!”
‘Why is he so insistent on doing everything himself? He’s not even letting me sew the sutures! Besides, damn it, what blood vessels would there even be at that location?’ Xu Xian was really stunned!
The surgery ended!