top student at medical school

Chapter 158 Fang Ziye, who plays very clever games (Please subscribe)

"Huh? Something doesn't seem right." At 3:10 p.m., when the third surgery was nearing its end, Fang Ziye stood at the suturing position and was suturing the surgical incision. Wu Guonan, who had just stepped off the operating table, glanced in Fang Ziye's direction while picking up his phone and then let out a soft "Huh."

Then he put his phone behind his back, put his hands behind his back, and moved closer to the operating table again, carefully watching Fang Ziye's suturing process.

The tweezers are used to gently pick and twist the needle, and the insertion and insertion of the needle are decisive and quick. The needle is threaded and passed through the needle without hesitation, and the speed of tying knots is also incredibly fast.

Fang Ziye glanced at Wu Guonan only once before continuing his suturing.

At present, the procedures that Fang Ziye is least worried about causing problems are suturing and manual reduction.

Even with a level 4 proficiency, no matter how bad it is, if I were to suture an incision anywhere, what could you say? It's not like it's the meticulous microsurgical suturing of hand surgery.

Upon hearing Wu Guonan's surprised exclamation, Xue Tao confirmed her suspicions and said, "Right, Director Wu, you noticed it too? I thought I was seeing things."

"Ziye's stitching skills are quite impressive."

Although Enshi Central Hospital does not have a specialized hand surgery subspecialty, Wu Guonan happens to be in the trauma center, which is biased towards the hand surgery subgroup.

Therefore, Wu Guonan's observation of the suturing technique was the most detailed.

In prefecture-level city hospitals, the requirements for suturing are not that high. Basically, as long as the small arteries are sutured, the vascular patency rate is over 90%, the diameter of the blood vessel is reduced by no more than 10%, and no blood turbulence is generated, the operation can be started.

First, save the hand. As for whether the function can be restored to the level of a top-tier hand surgery department, that depends on luck.

In fact, most limb replantation surgeries in hand surgery, no matter how well performed, have very limited functional recovery and cannot fully restore the body to its peak level.

This point is profoundly illustrated by the story of a senior doctor in China who was injured.

Once a doctor's hand is injured, it becomes difficult for them to return to the operating table.

“It should be much better than mine.” Xue Tao looked at it carefully a few more times, and after receiving Wu Guonan’s approval, he said confidently again.

"Haha, hahaha." Wu Guonan laughed wildly after seeing Fang Ziye perform two injections.

Then he looked up and said, "Xue Tao, look, what did I say? You didn't believe me before, but do you believe me now?"

"This is real suturing technique, the kind of suturing skill that can be used in delicate microscopic suturing."

"You're still a little short of perfection." Wu Guonan was very happy.

Goodness, Director Zhang Mingcan sent a PhD who came to "gild his resume" and unexpectedly, he actually suited his tastes.

The hand surgery department at Enshi Central Hospital has always been a weak point.

The orthopedics department at Enshi Central Hospital is strong because of its spinal surgery, joint surgery, and minimally invasive sports medicine. Trauma surgery is somewhat lacking, and hand surgery is even weaker, with only one subgroup.

The strongest trauma surgery department is at Minzu University Hospital, while the strongest hand surgery department is at Enshi People's Hospital. They each have their own strengths!
Xue Tao then fell silent.

However, Fang Ziye had also seen Xue Tao's suturing. His skill level was average, not quite level 4, but it was at least higher than that of a PhD like Luo Tingzhu. He had a skill level of around 300-400, which was about the same as Yang Wenzheng at Zhongnan Hospital.

Xue Tao was much older than Yang Wenzheng, after all, Xue Tao was two or three years older than her teacher.

It's certainly sufficient for trauma surgery, but to venture into hand surgery, it doesn't even meet the baseline of a prefecture-level city hospital.

As for Fang Ziye, he currently wants to reach the baseline level of the hand surgery department at Zhongnan Hospital. He may still lack some proficiency and skill in vascular suturing, but he can be directly employed in a prefecture-level city hospital!

"Very good, not bad." Wu Guonan smiled knowingly and left the operating room first, but at the door of the operating room, he turned back to look at Fang Ziye one last time.

"Very good, very good." He murmured these words in a low voice for a few more times.

After Wu Guonan left, Wang Zhongxing blinked and said, "Brother Tao, what kind of freak is Ziye?"

"When the manual reduction technique is done so well, the suturing technique is also so amazing, and the incision is made so smoothly. Did they start learning this in the womb?"

Wang Zhongxing is around thirty-two or thirty-three years old this year. He has actually been promoted to attending physician for four or five years. However, his academic qualifications are not that high, only a bachelor's degree. Therefore, he needs to be an attending physician for seven years before he can be promoted to associate professor.

Wang Zhongxing greatly admired Fang Ziye's clinical procedures.

In municipal hospitals, academic qualifications are somewhat advantageous, but research skills are not. Technical expertise remains the greatest core competitiveness.

Since everyone's educational background is the same, comparing them is just a matter of shorter people comparing their height.

In the field of scientific research, everyone avoids it like the plague, fearing being targeted.

Technology is the only topic that people frequently discuss.

Fang Ziye then replied, "You flatter me, Brother Xing. I did learn a little from the teachers, but that's about it, nothing to exaggerate."

"If you've ever been to the hand surgery department of Zhongnan Hospital, you'll know that I'm not even qualified to stand on stage."

Fang Ziye had rotated through the hand surgery department. At Zhongnan Hospital, even without mentioning Professor Ni Yaoping, Associate Professor Guan Qiquan could easily outperform the entire trauma surgery department in suturing.

Everyone has their own area of ​​expertise; for a shut-in to want to race Bolt in a sprint, he'd have to be a mutant.

But if Bolt wants to compete with otaku in anime culture, he'd probably be full of questions.

“You can’t calculate it like that. You still have to consider your age. Ziye, how old are you? If you switch to hand surgery, I reckon the professors at Zhongnan Hospital would be very welcoming, right?” Wang Zhongxing was not easy to deal with, and he got to the crucial point.

Fang Ziye responded with a shy smile.

"See, I told you so," Wang Zhongxing said, still a little smug.

But at this moment, Xue Tao looked at Wang Zhongxing, this simpleton, as if he were looking at an idiot. No wonder you're over thirty and still don't have a girlfriend. You deserve it.

Fang Ziye continued suturing.

In fact, by comparing his knowledge points with those from earlier times, Fang Ziye discovered that after his suturing skills were upgraded to level 4, the knowledge points he gained from suturing not only did not increase, but actually decreased slightly.

Although the reduction in the number of sutures is not significant—previously, it took 3 points to complete the suturing of one incision, but now it only takes 2.5 points—this may be related to the difficulty of the disease and the size of the surgery.

However, Fang Ziye knew that, in theory, his improved suturing skills should contribute more to wound healing, right?
What's the underlying principle?

Does this mean that the more advanced one's suturing skills are, the fewer knowledge points one will gain?

What's the point of upgrading skills to a higher level then?

Fang Ziye was just thinking about it casually.

……

After one surgery was completed, Fang Ziye performed a manual reduction under direct vision on the operating table during the fourth surgery.

The treatment principle for fractures is reduction and fixation, which are the key steps in the procedure.

The purpose of surgery is to achieve better reduction and greater stability of the fracture by using plates, screws, or intramedullary nails for internal fixation under open reduction.

Therefore, manual reduction remains effective even after the fracture has been exposed by incision.

For example, in the previous surgeries, Xue Tao and Wu Guonan performed the reduction under open surgery. They reduced the anatomical reduction five or six times and performed fluoroscopy five or six times before achieving the standard of anatomical reduction. In addition, during this process, they also used Kirschner wires for temporary fixation and other reduction tools such as prying.

However, during the fourth surgery, when Fang Ziye was in the position to perform manual reduction, he only reduced the fracture twice and examined it twice with fluoroscopy. The broken ends of the fracture were then put back together.

Upon seeing this, Wu Guonan quickly said, "Don't move, don't move!"

His tone was extremely anxious. As he spoke, he grabbed a drill with a 2.0mm Kirschner wire and rushed onto the stage.

Fortunately, there wasn't a cheap offer like "I'll go buy you some oranges."

After two Kirschner wires were temporarily fixed in place, the circulating nurse pushed the C-arm machine, used for temporary intraoperative X-ray fluoroscopy, to the bedside. Everyone in the operating room left and went to the adjacent isolation room or outside the operating room before preparing to press the shutter button. At this moment, a young, inexperienced nurse from the adjacent operating room, probably in a hurry or something, perhaps an intern who had never seen this before, continued to speed up.

Xue Tao quickly reached out to stop her, saying, "Little sister, don't run away! There's radiation here when you take pictures! Stop for a moment."

The mere mention of radiation startled her so much that she quickly threw her bottom back while pushing the trolley, managing to stop it. Once the trolley was stationary, she turned and ran two more operating room spaces before finally pressing herself tightly against the wall, her eyes filled with terror.

But actually, the camera button was already pressed just as she turned around and ran back.

X-ray machines do emit radiation, but the operating room doors are made of lead to shield them from radiation. The reason for reminding her was to prevent her from facing the operating room directly.

Radiation isn't like a tracking missile.

After the X-ray was completed, the circulating nurse went to the operating room first, while Wu Guonan and other orthopedic surgeons carefully reviewed the images.

The purpose of reviewing the images is to assess the extent of repositioning.

Of course, it's not just one shot. If the repositioning effect is good in the first shot, you need to rotate it 90 degrees and take a side view X-ray to observe the degree of repositioning from more angles.

After all, the displacement after a fracture involves at least two directions: lateral and angular displacement. Only when the fractures are aligned relatively neatly in both directions can it be considered a relatively successful reduction.

The anesthesiologist and circulating nurse were well-versed in the procedures, so they didn't act immediately.

In the distance, the nurse pushing the trolley to another operating room quickly and tiptoed along. Just as she reached the door of the orthopedic operating room, she suddenly accelerated, making a clicking and hissing sound.

The sound of rubber slippers rubbing against the ground was particularly jarring, making people want to chuckle.

However, Wu Guonan and the others did not laugh. Outsiders do not understand orthopedic C-arm machines, so they naturally avoid them.

The circulating nurse quickly adjusted the C-arm machine's angle and, after moving to a safer position, the lateral radiograph taking was completed...

"The reduction was very effective, basically achieving anatomical reduction, and the fracture line was concealed."

"Ziye's skill in repositioning is so good that he could perform full-length fracture surgery, but his professional title is too low and he doesn't have the surgical authority at the moment."

"Right, Xue Tao?" Wu Guonan spoke to Xue Tao in a calm tone.

They treated Fang Ziye as an equal, without making a fuss, as if they thought Fang Ziye deserved to be able to have bone fracture surgery.

In the treatment of fractures, whether it is surgery or manual reduction, reduction is the most crucial step. As long as the reduction is done well, other procedures such as external fixation with plaster casts or internal fixation with internal fixation devices are relatively procedural operations and processes.

"Yes, the most essential point of trauma surgery is manual reduction, just like the most essential point of current bone tumor treatment lies in the precision of the chemotherapy regimen."

"If the technique is good at repositioning, it can handle both large and small cases." Xue Tao finally uttered his usual bawdy joke in front of Fang Ziye.

Speaking of which, recently, since Fang Ziye, a new PhD, just arrived, he and Wu Guonan and others have been pretending to be serious for a few days.

Fang Ziye glanced at Xue Tao a few times, thinking to himself, "Is this something a young man like me should be listening to?"
"What do you mean by 'eating both big and small'?" Wu Guonan was quite mischievous. He seemed serious, but when he started telling jokes, he was probably full of wicked ideas.

The circulating nurse's face flushed red instantly, but the scrub nurse, who looked quite pretty, smiled and said, "Director Wu, I'm going to tell your wife that you're being very promiscuous."

"Have you done this before or what?" The surgery was quick, of high quality, and finished early, making Wu Guonan extremely happy.

This scrub nurse dared to talk back when he was driving and in a bad mood; wasn't she just asking for trouble?
The scrub nurse, being a woman, couldn't openly argue with Wu Guonan, so she lowered her head, crossed her arms, and hurried into the operating room.

Subsequently, Fang Ziye naturally got another opportunity to install screws on a steel plate.

This demonstrates the flexible application of experience in operating orthopedic internal fixation devices.

After the plate is firmly attached to the bone, the fracture line must be checked and spanned across three screw holes. Once the principle of at least three screws for fixation is met, Fang Ziye begins drilling the holes using the formula.

These steps can all be performed in the practice room, except when measuring depth.

Because all the screws in the practice room are custom-made, there is no step of measuring the screw length.

Seeing that Fang Ziye was very unfamiliar with using the depth gauge, Wu Guonan finally found a joke: "It seems that our Ziye is still a bit naive. He doesn't have much experience in measuring the depth of a person."

"It probably wasn't stabbed much."

Fang Ziye cursed inwardly, "Can we please stop making suggestive remarks all the time?"
However, Fang Ziye also knew that the more relaxed Wu Guonan was, the more opportunities he would have.

“That’s right, Director Wu. The holes I usually play in are ones that already existed. They’re not newly opened.” Fang Ziye cleverly used the jokes he had learned at Zhongnan Hospital.

Wu Guonan and the others didn't have an absolute master-disciple relationship with him, so why should he tolerate it?

Even if I admit to being a bit filthy, it's because my teachers taught me bad habits; you become like those you associate with.

Of course, seeing the thoughtful expressions on Wu Guonan's and others' faces, and the incredulous expressions on the faces of the circulating nurse and the scrub nurse after hearing Fang Ziye's words, Fang Ziye also thought, "So this is what it's like to be a comedian."

"Good heavens!" After a long while, Wu Guonan finally calmed down.

"That reaction time is really impressive."

After Fang Ziye finished measuring the depth, he said to the scrub nurse, "54, give me screw #55."

This is mm, I've omitted the unit for easier communication.

After saying that, Fang Ziye said to Wu Guonan, "After all, it's soft."

Fang Ziye learned this phrase from his teacher, and it was that teacher who led him astray.

The original words were from Yuan Weihong to Qin Geluo: "The holes in the clinic are all hard, not as comfortable as the soft ones, so you won't have such a smooth experience, right?"

The atmosphere quickly reached a climax.

A group of people teased Fang Ziye again, saying that Fang Ziye appeared serious on the surface, but was actually full of bad intentions.

Some people say that Fang Ziye must be a womanizer, and he probably has one girlfriend after another.

Fang Ziye neither refused nor explained. He came here to avoid being fed anything. Being a womanizer would actually make some people keep their distance, so such a label was not unreasonable.

After a day of surgeries, Wu Guonan and Xue Tao both invited Fang Ziye to dinner, but it was still early. Today was a big department dinner, and they had to wait for Director Zhang Mingcan's arrangements.

Fang Ziye naturally agreed.

However, Fang Ziye still said, "Director Wu, Director Zhang had something to discuss with me this morning. He asked me to go see him after the surgery. You and Director Xue should go back and rest first."

"I'll write the medical orders downstairs in a bit."

Of the four surgical patients today, the last one is under Fang Ziye's supervision, so Fang Ziye must complete the postoperative medical instructions.

The group nodded in agreement. Fang Ziye's business skills were very mature, and he certainly wouldn't forget such a thing.

Then, Fang Ziye went to the operating room where Director Zhang Mingcan was. The surgeries inside were still in progress, but because he had already given instructions, he was able to continue.

Therefore, Zhang Mingcan's students were waiting for Fang Ziye in the operating room.

Therefore, after Fang Ziye went in, although he met the "outstanding doctoral senior" who was invited by Director Zhang Mingcan, he only watched him perform manual reduction in the operating room and did not stay to have any further contact.

Although Fang Ziye wanted to make contact, time didn't allow it.

After exchanging pleasantries, Fang Ziye followed Guan Hongming, one of Zhang Mingcan's master's students, towards the outside of the operating room.

As he left, Senior Brother Wu Xuanqi smiled at Fang Ziye and said generously, "Ziye, let's keep in touch and exchange ideas more often in the future. Don't be shy."

"Okay, Senior Brother Wu, as long as you don't mind me bothering you." Fang Ziye turned around, waved his hand, and then led Guan Hongming downstairs to the anesthesiology office to write up the medical orders...

(End of this chapter)