NovelsAlex Chapter 1384 The Idea Is Wrong
Chapter 1384 The Idea Is Wrong
Chapter 1384 The Idea Is Wrong
The training officially began.
Thirty trainees were assigned to various departments at Sanbo Hospital, each with a mentor. They underwent two years of rotational training at Sanbo Hospital, with the final year spent training at the Sanbo Research Institute. However, Yang Ping placed two doctors in the institute for their entire training: one was Zaxi, from Changdu, Tibet; the other was Ayi, a Miao girl from Qiandongnan, Guizhou, who had worked in general surgery at a county hospital for five years and was capable of performing some simple surgeries independently. Ayi was temporarily mentored by Dr. Li Guodong.
On the first day in the operating room, Zaxi stood behind Yang Ping and watched him perform a spinal tumor resection surgery.
The operating room was quiet, save for the ticking of the monitors and the soft clatter of surgical instruments. Under the operating lights, Yang Ping, wearing a magnifying glass, steadily sliced through the skin with a scalpel, layer by layer. His movements were slow, each step performed clearly; he was intentionally demonstrating to his students.
As he demonstrated, he explained, "The vertebral artery runs through here. Look closely, it's right next to the transverse foramen. If you accidentally touch it, it will cause massive bleeding."
Zaxi moved a little closer, staring intently at him.
"When you make this cut, you have to cut close to the tumor, not too deep, or it will reach the spinal cord. Look, the boundary between the tumor and normal tissue is here. The color is different, and the texture is different too. Feel it." Yang Ping stopped and let Zaxi touch it gently with his finger.
Zaxi's fingers trembled slightly; it was the first time he had ever witnessed the removal of a spinal tumor.
"Now peel off the dura mater. Watch my technique carefully. Use the peeler to push gently, don't pull, or it will tear." Yang Ping's hands were steady, and his movements were gentle and precise.
As Zaxi watched, he memorized everything. He would ask questions whenever he didn't understand something, and Yang Ping would patiently explain each one. Sometimes, one explanation wasn't enough, so he would explain it two or three times until Zaxi nodded in agreement.
Two hours later, the tumor was completely removed, both vertebral arteries were intact, and there was very little bleeding.
As Yang Ping was closing the wound, he glanced at Zaxi and asked, "Did you understand?"
Tashi nodded, then shook his head: "I understand a little, but there's still a lot I don't understand. For example, how did you determine the boundary between the tumor and the spinal cord in that area just now?"
Yang Ping smiled and said, "Then come again tomorrow."
Zaxi was taken aback: "Can you come tomorrow?"
Yang Ping said, "You're here to observe surgeries every day for the next year, until you understand them. I perform eight surgeries a week, and you can't miss a single one."
Tashi nodded vigorously.
That night, Tashi stayed in his dormitory until 2 a.m. He had a thick notebook with the word "Study" written on the cover in Tibetan. He wrote down every step, every detail, and every point he didn't understand during the day's surgery. He drew more than a dozen diagrams, marking every anatomical location and every key point of the procedure.
He wrote more than thirty pages, his hand ached from writing, but his heart was full.
He recalled that before he left Changdu, the hospital director held his hand and said, "Zaxi, you are the only one selected from our hospital. Go there, study hard, and come back. Our hospital is counting on you."
He placed the notebook beside his pillow and closed his eyes. His mind was filled with images of the surgery during the day: Yang Ping's hands, the shape of the tumor, the location of the vertebral artery—every detail was as clear as if etched into his brain.
The next morning at six o'clock, he appeared in the department on time again.
At the same time, Ayi also began her first day of stage practice under the guidance of her mentor, Li Guodong.
During the first week of training, the daily routine of the thirty trainees was almost fixed: they arrived at the hospital at six in the morning and followed the surgeries until the afternoon; from three in the afternoon, they had case discussions and theoretical learning; and after seven in the evening, they had free study time to read books, watch surgical videos, and take notes.
On Friday night of the first week, Yang Ping appeared in the student dormitory. He knocked on Zaxi's door and saw him hunched over his desk taking notes, which was piled high with books and printed papers.
"Still not asleep?" Yang Ping asked.
Zaxi stood up: "Professor Yang, what brings you here?"
Yang Ping walked in and looked at his notebook. It was a thick notebook, densely filled with writing and many hand-drawn anatomical diagrams. He flipped through it and nodded: "Not bad, very diligent."
Zaxi smiled sheepishly: "I was afraid I was too stupid to remember, so I wrote it down several times."
Yang Ping looked at him with a hint of satisfaction in his eyes: "You're not stupid, you're just diligent. Diligent people learn slowly, but they learn thoroughly. In the medical field, what's needed is a solid foundation."
He paused for a moment and then said, "Tomorrow is Saturday, and I have a special emergency surgery. Do you want to come?"
Zaxi's eyes lit up: "I want it!"
At eight o'clock on Saturday morning, Tashi arrived at the operating room. The patient was a herdsman who had been transferred from Tibet. He had spinal tuberculosis, which was compressing his spinal cord, and he was almost unable to walk. The patient did not speak Mandarin, only Tibetan. Tashi acted as a translator, helping him communicate with the doctor.
The surgery lasted two hours. While performing the procedure, Yang Ping explained to Zaxi the characteristics of spinal tuberculosis in high-altitude areas, the key points of the surgery, and postoperative precautions. Zaxi listened attentively and took notes without stopping.
The surgery was over, and the patient's vital signs were stable. Yang Ping took off his gloves and looked at Zaxi: "How much of today's surgery did you understand?"
Zaxi thought for a moment and said, "About half."
Yang Ping laughed: "That's enough. We'll look at the other half tomorrow."
Tashi nodded, then suddenly asked, "Professor Yang, do you have any Tibetan patients here?"
Yang Ping looked at him and said, "I specifically contacted the hospital there and transferred some complex and difficult cases over here. The purpose is to allow you to access cases that are relevant to your area, such as spinal tuberculosis, which is rare in big cities. There's another one tomorrow."
Zaxi was stunned. Professor Yang had gone to such great lengths to train him. He knew that a township hospital doctor named Li Min had already completed his training and returned home to contribute.
That night, Tashi stayed up writing in his dormitory until the early hours of the morning. He thought of Professor Yang's concern for him, the dean's instructions when he left Changdu, and what he had seen and heard in the past week. He knew that these three years would be the most important three years of his life.
The first week of the Sanbo Elite Class has come to an end. Thirty students, thirty seeds, have just been planted. They don't yet know what they will experience, what they will learn, or what kind of people they will become over the next three years.
But they knew that from this day forward, their path would be different.
The next day, after the shift handover, the doctors dispersed to attend to their own tasks. Zaxi followed Yang Ping toward the operating room. Yang Ping walked very fast, and Zaxi almost had to jog to keep up.
"Today's patient is another one transferred from Tibet," Yang Ping said as he walked. "Spinal tuberculosis, L2-L3 segment, severe vertebral body damage, cold abscess formation, compressing the spinal cord. The patient's lower limb muscle strength is grade 3. If surgery is not performed soon, he will soon be unable to walk."
Tashi nodded, took out his notebook, and began to take notes.
"Is this disease common in Tibet?" Yang Ping asked.
“There are many!” Zaxi said. “There are already many tuberculosis cases in our area, and spinal tuberculosis is quite common. But many patients are diagnosed late, and they are already paralyzed when they are brought in.”
Yang Ping stopped and turned to look at him: "Can your county hospital treat this?"
Tashi shook his head: "It can't be cured. We don't have a tuberculosis specialist, and we don't have doctors who can perform spinal surgery. These patients can only be transferred to Lhasa. But Lhasa is too far away, and many patients are too poor to afford it, so they just stay at home and suffer." Yang Ping was silent for a while, then said: "Then after you finish your studies and go back, these people won't have to suffer anymore."
Tashi nodded vigorously.
The operating room door opened, and a nurse came forward: "Professor Yang, the patient has been brought in, and the anesthesiologist is preparing."
Yang Ping nodded and led Zaxi into the locker room. While changing into scrub clothes, Yang Ping suddenly asked, "What time did you finish writing your notes yesterday?"
Zaxi paused for a moment: "A little after two o'clock."
"No more staying up late! Learn to improve your study and work efficiency. To be a good doctor, you must have a strong body, understand?"
"I've got it."
The operation begins.
Today's surgery was even more complex than yesterday's. The tuberculosis had destroyed the vertebral body, and the surrounding tissues were so badly adhered that the normal anatomical structures were almost invisible. Yang Ping held the electrocautery knife and peeled away the tissue bit by bit, his movements as slow as a slow-motion scene in a movie.
He would never take this long to perform surgery normally. The reason he is taking it this long now is to ensure that Zaxi can see the surgery clearly without compromising its effectiveness.
Zaxi stood behind him, staring intently.
"Look, here, the normal vertebral body and the vertebral body damaged by tuberculosis are different colors. The vertebral body damaged by tuberculosis is dark in color, brittle in texture, and will fall off at the slightest touch."
Zaxi moved a little closer.
"We need to remove all the necrotic vertebrae, and then clean the intervertebral space thoroughly, leaving not a single drop of pus. If even a little bit is left, the tuberculosis will recur," Yang Ping said, as he inserted the instruments in his hand and scraped little by little.
The surgery lasted three hours.
"How much did you understand?" Yang Ping asked again.
Zaxi thought for a moment: "Sixty percent."
Yang Ping nodded: "You've improved since yesterday. Let's continue tomorrow."
The afternoon session was a case discussion, with Professor Yang in attendance and Dr. Li Guodong presiding.
The case discussions at Sanbo Hospital were completely different from what Zaxi had seen before. In Changdu, a case discussion would simply involve the head doctor asking, "What do you think of this patient?" and everyone taking turns to say a few words, ending in half an hour. At Sanbo, a single case could be discussed for an entire afternoon.
Today's case is a seventeen-year-old boy with scoliosis at 120 degrees. As soon as the X-ray was played, the whole room was filled with gasps.
"The patient came from Yunnan," the attending physician explained. "His family are farmers with very poor conditions. The child was diagnosed with scoliosis when he was young, but they couldn't afford treatment and kept putting it off until now. Recently, he had trouble breathing, and when he came to the hospital for a checkup, we found that his lung function was severely damaged."
The images were played one by one. Frontal, lateral, curvature measurements, 3D reconstruction. Tashi looked at the images, his heart tightening with each passing moment. He had seen scoliosis patients in Changdu, but never one this severe. This child's spine was almost bent into an "S" shape, and his heart and lungs were squeezed to one side.
"How do we perform the surgery?" Dr. Li Guodong asked.
There was a few seconds of silence in the audience, then someone raised their hand—it was Dr. Lin Yuan.
"Let me share my thoughts." Dr. Lin stepped to the front of the stage and picked up a laser pointer. "This scoliosis is mainly divided into two segments: the upper thoracic curve and the lower lumbar curve. The upper thoracic curve is relatively stiff, while the lower lumbar curve is relatively flexible. My suggestion is to first perform anterior release, and then perform posterior correction. The anterior approach enters through the thoracic cavity to release the stiff segments, and the posterior approach uses a rod and screw system for correction, employing the Yang's osteotomy technique."
As he spoke, he drew the surgical approach and fixation segments on the film.
"Where should the nail be driven?" Dr. Li asked.
“From T2 to L4,” Xiaolin said.
"Sixteen segments?" Dr. Li frowned. "This child is only seventeen years old. If you perform so many segments, his back will become stiff, and he will have difficulty even bending over. You will need to relearn Yang's osteotomy technique."
Xiaolin paused for a moment, then remained silent.
Another student raised her hand; she was a female doctor named Chen Xi.
“I think we can fix fewer segments.” Dr. Chen stepped to the front of the table. “Although the upper thoracic curve is stiff, if we do sufficient release, we may not need to fix so many segments. My suggestion is to fix T3 to L3 and preserve the mobility of L4.”
"Have you considered the L3 to L4 segment?" Li Guodong asked. "This is the apex of the lateral bending, where the stress is greatest. If it's only fixed up to L3, will there be decompensation in the long run?"
After thinking for a moment, Xiao Chen said, "We can consider performing L3-L4 interbody fusion, but without fixation. This will increase stability while preserving mobility."
Li Guodong nodded without saying anything and looked at Yang Ping.
Yang Ping stood up and walked to the front of the stage. He didn't take a laser pointer; he just watched the video.
“You’ve all forgotten one person,” he said, “the patient himself.”
The audience fell silent.
“This child is seventeen years old and still growing. Why is his scoliosis so severe? It’s because he has been living in a compensatory posture. He bends over, walks, and sleeps in a crooked position. His muscles, ligaments, and joints have all adapted to this posture,” Yang Ping said. “Now you have straightened his spine, but his muscles still remember the original posture. If the postoperative rehabilitation is not up to par, he will quickly go back to his crooked position.”
He paused, then looked at Xiaolin and Xiaochen: "Your plans only considered the bones, not the people."
Xiao Lin and Xiao Chen lowered their heads.
Yang Ping added, “When we design a treatment plan, we must consider that we are dealing with a person. Recently, Dr. Li Guodong has been explaining the Yang’s osteotomy technique to you. This scoliosis correction osteotomy technique that I created has become popular all over the world. You have not understood its essence. Its essence is to see the patient’s scoliosis as the scoliosis of a person, rather than the scoliosis of a spine. You should carefully understand what I am saying.”
"Your statements just now all revolved around scoliosis of the spine. The concept is wrong, so the solution you designed will definitely not be right."
"Our clinicians see far more cases than their counterparts in Europe and America, and their surgical skills are far superior. But why do we still lag behind them? The gap lies in their philosophies, and this gap in philosophies cannot be bridged by mere technical proficiency. I don't know if you've noticed, but our doctors rarely publish original papers; the vast majority rely on papers based on a large number of case samples to gain an edge."
"I'm not saying this to boost others' morale and diminish our own, but to tell you that principles are very important. If your principles are wrong, even the most skilled techniques will be useless, and sometimes they will even have the opposite effect."
No one spoke.