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Chapter 413 Teaching and Instruction for Elective Surgery (Please Subscribe)
"Yes!!" Fang Ziye thought carefully for two minutes and nodded solemnly to Nie Mingxian.

He then explained: "In a new technique and an uncertain study, there are basically no two uncertain factors. This is a principle that a mature researcher must adhere to."

The saying "don't bite off more than you can chew" has been taken to its extreme in the field of scientific research.

A study typically explores only one unknown direction.

Limb-sparing surgery for destructive injuries involves using relatively mature surgical techniques, employing highly skilled and common methods, and presenting surgical approaches that are understandable to others, to achieve the possibility of limb preservation in destructive injuries.

Even though there are research findings on this epidermal growth factor, it has not yet been certified through clinical trials, nor has it been made public and subjected to scrutiny by peers.

Do you want to bring it to a new topic?
Upon hearing this, Nie Mingxian frowned slightly, but quickly relaxed.

Researchers are human too. They certainly don't want others to share in the fruits of their labor when they build a team and produce results.

However, Nie Mingxian quickly persuaded Fang Ziye: "Ziye, you should know that surgery has professional limitations, while the limitations of new drug development are much smaller."

"After careful comparison, Ziye, the research project on destructive surgery you've done has less weight in the scientific research field than the development of a new drug."

Treatment for destructive damage, isn't that awesome?

That's absolutely awesome.

However, its professional constraints are too severe. Other peers would need to spend too much time and energy to learn it. Therefore, such originality can only be considered an internal miracle of the team. Its influence in the entire industry needs to stand the test of time.

However, if a new drug is developed and its effects are very good, then its short-term and long-term benefits are incomparable to those of a simple new surgical procedure.

To put it more simply, from the perspective of transmissibility.

The development of a new drug can spread to the surgical departments of county hospitals or even township hospitals within two or three years, but a new surgical procedure may not be able to spread to county hospitals or even township hospitals at all.

No county hospital doctor would be willing to go through the thankless and arduous task of learning limb-sparing surgery, which involves causing serious injury. Amputation is much simpler and more enjoyable.
Many amazing surgical miracles have occurred in the world, but a large number of these surgeries have not been widely disseminated, mainly because they are too difficult and have too many limitations!
After Nie Mingxian and Fang Ziye finished digesting the information, Nie Mingxian rubbed his right thumb and forefinger and said relatively cautiously, "Therefore, for Professor Duan Hong's team to get into this clinical project, it may not be that we take him to the top, but rather that he takes us to the top!"

"Clearly, the next challenge in limb-sparing surgery for traumatic injuries is how to address the issue of unsightly surgical wounds and minimize scarring during healing!"

Nie Mingxian is knowledgeable in his field, in scientific research, and also understands patients and society.

Ask anyone if they would like to have better surgical results and minimal scarring after surgery.

Even if it's an elderly person, without considering any other factors, their answer will always be, "Yes."

The desire for beauty is a basic aspiration for many people after societal development.

Fang Ziye looked down at the nails of his left and right thumbs. The nail beds were a healthy red color and there were no hangnails. After looking at them for a while, he looked up and asked, "Brother Xian, does Brother Wu Xuanqi have a lot of tricks up his sleeve?"

Fang Ziye's impression of Wu Xuanqi was that he was cunning and scheming, and it was best to avoid contact with him unless absolutely necessary.

Wu Xuanqi is the most shameless person Fang Ziye has ever met. Even his teacher, Yuan Weihong, might pale in comparison to him.

This is a very tempting bait.

The development 'achievement' of a relatively mature drug is right in front of us. As long as Fang Ziye agrees, his name can be used in the future, giving him experience and resume in original drug development.

Given Fang Ziye's achievements and surgical skills, his name would be listed very high on the list, and he might even be considered a second author or a co-first author.

This is a piece of fatty meat that's practically in your mouth; just open your mouth and take a bite, and your mouth will be oozing with oil.

"There are indeed many, but at least, I haven't found any reason to refuse."

"Of course, Ziye, you have your own considerations."

Nie Mingxian then stopped rubbing his left thumb and forefinger together and instead made a fist: "Ziye, no matter what, there's bound to be a fight between you and Wu Xuanqi."

"You two are about the same age. If you want to move around within Hubei Province in the future, two tigers cannot share one mountain!"

“Wu Xuanqi’s ten years from his twenties to his thirties were much more unlucky than yours, but during this time, he unexpectedly found a very strong supporter. There was even an original medical device company behind him collaborating with him and cultivating him.”

"Similarly, Lao Wu's qualifications are absolutely not in question."

You need to think this through.

"You probably don't want to spend all your effort developing and creating many ideas, only to have them ignored and end up taking them to your grave, right?"

Fang Ziye turned his head, a grin spreading across his face: "Brother Xian, it's not that scary, is it?"

Nie Mingxian, however, grinned even wider than Fang Ziye, as if he were a well-informed man: "If someone develops a technology that is simpler than yours, even if the effect is only half or even a third of what you developed, you are a loser."

"If you don't want to be isolated, you can only go with the flow and follow the crowd."

"In today's fast-paced society, there are fewer and fewer people who can calm down, seriously learn technology, and focus solely on climbing to new heights."

"Ziye, do you see being a doctor as a job or a career?"

“Ziye, even if you treat being a doctor as a career, others just see it as a job. The essence of a job is to earn money to support your family, not to exhaust yourself physically and mentally…”

Only after saying this did Nie Mingxian realize his rudeness and quickly shut up.

He softened his tone and said, "Let's get back to the topic of damage. I personally believe that cooperation is more important than separation."

Fang Ziye sized Nie Mingxian up and down, his eyes narrowing.

What Nie Mingxian just said is clearly not Fang Ziye's experience, nor Deng Yong's experience, nor Duan Hong's experience.

The competition in Hubei's medical field is far from reaching the level described by Nie Mingxian.

Whether being a doctor is a career, a profession, or a job, in Fang Ziye's consistent education, it's all the same principle.

But Kyoto, where Nie Mingxian had previously lived, was different.

Kyoto and Shanghai are arguably the most economically developed cities; they are truly the battlegrounds for industry giants.

As you can see, among the top three hospitals in any specialty, one is usually from Beijing and the other from Shanghai.

Renowned orthopedic hospitals: Jishuitan Hospital, Beijing Third Hospital, Huashan Hospital, Shanghai Sixth Hospital...

Hospitals in Wuhan, such as Tongji, Xiehe, and Hubei Provincial People's Hospital, are actually not at the top-tier level nationwide.

Cardiovascular surgery – the name Fuwai Hospital encompasses everything, and it's also located in Kyoto.

"Brother Xian, what I mean is that this is my personal opinion, not the opinion of our team. Ultimately, the decision on this matter will be made by Professor Deng and Professor Liu Huanglong. We only have the right to offer suggestions."

“My personal thought is, what if separation is more meaningful than cooperation?” Fang Ziye asked rhetorically.

Fang Ziye dared not speak of other matters.

But in terms of basic skills alone, Fang Ziye dares to say that even if Teacher Duan Hong came, it wouldn't be effective, and even if a teacher from Jishuitan came, it wouldn't be effective.

Under such circumstances, Fang Ziye was unwilling to let more people restrict his thinking and ideas.

With just a few teachers guiding you, giving you ample room to develop your abilities, that's the best approach.

When there are many participants, it becomes necessary to balance various aspects, and to give face to this person and that person, which can eventually distort the original idea beyond recognition...

Developing drugs is certainly a good thing; it can easily lead to lasting fame!

Fang Ziye also thought about it. Regarding Nie Mingxian's question about career, profession, and job, Fang Ziye felt that it didn't matter which one it was. The most important thing was that he was happy.

Right now, I don't have any pressure, I don't have a family to support, I don't need to fight for funding for students, and I don't need to worry about their graduation...

Therefore, during this period, before I start supervising graduate students next year, I should focus on being a good doctor, wholeheartedly and purely.

We'll talk about the future later.

Nie Mingxian leaned back and smiled, "Ziye, you've got quite the nerve. You're turning down an opportunity to have Professor Duan Hong, a leading figure in the field, endorse you."

The phrase "high skill and great courage" perfectly describes you.

The word "莞尔" originally meant "smile," and it was later mostly used to describe a girl's smile. But now, Nie Mingxian's "auntie smile" has that flavor.

Nie Mingxian is not a robot, nor is he a nobody. On the contrary, he has always had a strong plan for his life.

He is more talented than Wu Xuanqi, and is the most talented person Fang Ziye has ever met.

In a horizontal comparison, even Luo Tingzhu is slightly inferior to Nie Mingxian. If a true comparison were to be made, perhaps only Lan Tianluo, with his multidisciplinary high intelligence, could be somewhat comparable to Nie Mingxian.

"Brother Xian, didn't you come here as a mediator?" Fang Ziye's expression was slightly surprised.

Having spent little time with Nie Mingxian, Fang Ziye still couldn't quite figure out what kind of guy he was.

Back in Enshi, Nie Mingxian was a doctor who "worked hard to earn money." He didn't care about anything else. His daily routine was to earn money by relying on his skills and spending time.

After that, Fang Ziye didn't have much contact with Nie Mingxian. When they met again a year later, Fang Ziye was naturally caught off guard...

"I already said that!"

“Wu Xuanqi and I are good friends, but I’ve also heard that Professor Deng Yong and Professor Duan Hong are also close friends!” Nie Mingxian said cryptically.

This "ironclad brotherhood" means that once Professor Deng Yong gets cocky, he'll simply stop hanging out with Duan Hong—at least that's how it appears on the surface...

Fang Ziye would not dare to spread rumors about the teacher's decision and his personal choice.

He quickly changed the subject, forcing a smile and seizing the opportunity: "Brother Xian, what are your plans for the future?"

Nie Mingxian's eyes darted around quickly: "Me? I just take things as they come!"

"We'll go wherever they need us."

"Anyway, following Professor Liu will definitely ensure I can make a living."

"If I follow the teacher, I'll be able to make a living."

This sounds as if it were a pre-arranged choice.

However, Fang Ziye had previously heard Nie Mingxian's "inner thoughts" and knew that there must be another version of the story behind Nie Mingxian's experience.

Seeing through it but not saying it: "Brother Xian, tomorrow is our group's surgery day. There's a patient with a pelvic fracture. Brother Xian, shall we go on stage together?"

Fang Ziye extended an invitation to Nie Mingxian.

Currently, Nie Mingxian's theoretical and practical experience in trauma surgery is still relatively weak.

That's understandable, considering that Nie Mingxian has only recently started working in trauma surgery, and his trip to Zhongnan Hospital with Liu Huanglong was a last-minute decision.

Even if Nie Mingxian were to switch majors, it would require a relatively long period of study.

Furthermore, Nie Mingxian is currently an associate senior anesthesiologist, but his scope of practice is still surgery, so he can still perform surgical work.

"Okay!~"

"Ziye, you didn't even do your rounds, yet you already know about tomorrow's surgery schedule?" Nie Mingxian asked.

“I have some understanding of it. I…” Just as Fang Ziye was about to speak, there was a knock on the door of the consultation room.

"Doctor, hello, the doctor next door told me to come to the trauma center clinic..."

Fang Ziye quickly shut up, and Nie Mingxian also stood up to offer his seat. He turned around and saw a young man clutching his wrist walking in from outside. The cement and lime slurry on his body were quite glaring. He must be a construction worker or someone who had just come from the construction site for treatment.

"Hello, where do you feel unwell? Please come and sit down..." Nie Mingxian sensibly led the patient in.

Then comes the routine process of taking a medical history, conducting a physical examination, and reviewing the images.

Throughout the entire process, Nie Mingxian remained silent, simply watching Fang Ziye complete the task.

……

"That's fine. Your elbow dislocation isn't serious. After reduction, you don't need a cast. If there's no pain in the early stages, you can start functional exercises."

"However, elbow rotation is still prohibited for two weeks!"

"Of course, if you find it difficult to protect your elbow joint in your daily life, we can also put on a cast!" Fang Ziye explained to the young man after treating the dislocation.

The young man looked at his elbow, then at Fang Ziye, then back at his elbow: "Doctor, you just said you were going to reset it for me, but you reset it yourself? I thought you were going to call me 'teacher'."

The young man looked at Nie Mingxian, then at Fang Ziye, and finally stared at Nie Mingxian!

Simply put, Nie Mingxian, who was in his thirties, seemed more convincing and technically superior to Fang Ziye, a 'pretty boy' in his twenties.

Upon hearing this, Nie Mingxian's expression instantly turned awkward, and he reached out to explain, "Big brother, no, no, you've got it wrong. He's a teacher, I just look older. Look, I don't even have a name tag. This is my superior..."

In reality, Nie Mingxian was definitely the superior.

However, when it comes to expertise, Nie Mingxian would never dare to be presumptuous in the field of trauma surgery!
"Really?" The young man looked slightly doubtful.

"What's there to lie about? It's not honorable for a real superior to pretend to be a subordinate. Let's be realistic."

"Just tell me, did Teacher Fang do a good job of repositioning you? Doesn't it hurt anymore?" Nie Mingxian flipped his right hand over, letting the young man experience it for himself.

The young man quickly nodded, relieved: "Thank you, Dr. Fang. I'm so sorry, Dr. Fang."

It was somewhat awkward to directly question Fang Ziye's competence and then ask Nie Mingxian to perform the procedure. After speaking, the young man took the printed outpatient and emergency room medical record from Fang Ziye and left the consultation room.

At the clinic door, the young man muttered with disbelief, "These online guides aren't very useful after all. It seems I should come to the hospital more often and spend less time online..."

After the young man left, Nie Mingxian put on a mask to make himself look more like a newbie, a glint of light flashing in his eyes: "Ziye, is this repositioning technique difficult to learn?"

What is the most fundamental interest of boys? Hands-on activities.

To put it simply, a boy's hands are basically never still.

As children, we always want to hold something; as teenagers, we hold ourselves; and as adults, we still want to hold bowl-shaped objects...

The sense of accomplishment from being able to accomplish something incomprehensible through operation is so great that it makes most people itchy to try it themselves.

In clinical practice, what disease responds to treatment the fastest?
It's very simple, it's a dislocation!

A cure is achieved instantly, and pain is relieved instantly...

"Actually, it's not difficult. You just need to master the basic principles of repositioning. Sufficient traction and timely repositioning are all that's required."

"Take shoulder dislocation, for example, especially anterior shoulder dislocation. You only need to use the external rotation reduction method. Once you master the basic posture and learn how to apply traction, you can learn it very quickly..."

"Brother Xian, first search the basic techniques of external rotation reduction on Baidu, and then if you find a suitable one, I'll let you try it..." Fang Ziye understood and began to tempt him.

Nie Mingxian shook his head: "I don't need to get involved, I'm just curious to take a look."

However, Nie Mingxian couldn't resist using his phone to search on Baidu.

Hey!
With just this one action, Fang Ziye immediately noticed one of Nie Mingxian's 'good habits'.

Is it because they can't stand being alone? Or is it because they see something new and want to learn it?

If you want to learn practical skills, then trauma surgery is perfect. Just the manual reduction technique alone can allow Nie Mingxian to learn little by little over a month, going through all the different techniques...

Time is like water.

The following day, at 2:45 AM.

After watching the patient leave, Nie Mingxian looked at his hands in surprise. His palms were red from the manipulation and still felt warm from the friction.

Every feeling made Nie Mingxian feel both real and fantastical.

After seeing the patient, whose forearm was now in a sling, out of the consultation room, Fang Ziye added, "Remember not to injure your shoulder again, and don't move the affected limb too much, otherwise it's easy for it to dislocate again!"

After saying that, he turned around and looked at Nie Mingxian.

He glanced at the time on his phone and said, "Brother Xian, why don't you go to the break room and rest for a bit? You have to go back to the department for rounds tomorrow."

But Nie Mingxian couldn't sleep at this moment: "Ziye, is this technique for repositioning really that easy to learn?"

"I only studied for one day, and I actually managed to reduce this anterior shoulder dislocation?"

Nie Mingxian could hardly believe it.

The entire process for this patient, from physical examination and review of images to treatment selection and treatment itself, was completed by Nie Mingxian alone.

It hasn't even been a day!
"Brother Xian, you must also take into account all that foundation of medical knowledge you've accumulated before, right?"

"You're a vascular surgeon, so the muscles around the brachial plexus and their corresponding course are etched into your mind. You also know exactly which muscles are involved in the external rotation reduction technique."

"How could you learn this in just one day?" Fang Ziye explained, trying to make Nie Mingxian feel more involved.

If someone is a layman, do you expect them to learn the external rotation reduction technique for the shoulder joint in a day?

The teacher doesn't dare to teach it, and I doubt he'd dare to learn it either.

Even undergraduates with basic skills need to accumulate a few more months of experience and solidify their basic skills in manual repositioning techniques in the practice room.

Why is Nie Mingxian able to do it?

It's still because of their solid basic skills.

Many basic skills may have different forms of expression, but once Fang Ziye's basic skills have reached a certain level, he will know that their principles are the same.

In summary, the initial stage of operation is about practicing control skills.

From controlling the incision technique to controlling the suture depth and angle in suturing...

In the later stages, the focus shifts from control and stability to speed, achieving both speed and quality – this is the expression of highly proficient basic skills.

Having acquired sufficient basic skills, Nie Mingxian had already developed a corresponding foundation.

You can't say that foreign literary scholars, who read foreign books, lack cultural depth...

"Oh, I see."

Nie Mingxian was secretly pleased and disappointed: "I thought it was because I was a bit gifted."

Fang Ziye suddenly looked up.

Does Nie Mingxian really need this kind of commercial hype?

However, after regaining his composure, Nie Mingxian said, "I won't go to sleep yet. Professor Xie said he'll come to relieve you after three o'clock."

"I think you and Professor Xie are truly complementary and mutually beneficial."

“You can definitely take his shifts, and he can give you more rest time, which is better than you being the chief resident all by yourself.”

After a day of observation at the trauma center, Nie Mingxian had a pretty good grasp of Fang Ziye's abilities. In terms of handling emergencies, as long as Fang Ziye was there, Xie Jinyuan basically had nothing to do.

It's understandable, really. Before there was a trauma center, Fang Ziye handled emergency consultations all by himself.

After Associate Professor Xie Jinyuan came to the trauma center, he could hardly sleep soundly if he was only with Wang Yuanqi, as he was always worried.

This is why many of our hospital's physicians need to undergo a period of training before becoming chief residents, because their more than ten years of accumulation from undergraduate, master's, and doctoral studies are still not solid enough.

But Fangziye is different; its foundation is already very mature.

Basically, Fang Ziye can handle anything, from life-threatening to life-threatening situations, and rarely needs to call on others or ask professors to step in. With such comprehensive abilities, many people can sleep very soundly.

"Isn't this a good thing?"

"Brother Xian, if I were just a half-baked amateur, you would have already given up and gone home to sleep," Fang Ziye said with a smile, boasting.

The reason some people dislike those who admire the strong is that they themselves are not the ones who are admired.

In reality, everyone has a relative tendency to admire the strong.

Given that all conditions are right, isn't the better option always the better option?

The answers are mostly the same.

Many emotional relationships are actually based on the psychology of admiring the strong.

She's beautiful, talented, gentle, and considerate—she's won your favor...

"Ziye, you're becoming more and more like a superior." Nie Mingxian nodded and yawned.

Fang Ziye said, "Brother Xian, aren't you also drifting further and further away from being grounded in reality?"

"Think about it, the other PhDs in our department are still at the age where a single dinner party or a few thousand yuan in subsidies can make them happy for a long time."

"But Brother Xian, even if you earn 20,000 a month, it's hard for you to be particularly happy, isn't it?"

Nie Mingxian had long ago reached a monthly income of 20,000 yuan. Back in Enshi, he worked so hard and desperately, even in a highly specialized technical field like anesthesia.

It's impossible not to earn 20,000 yuan a month.

Fang Ziye is the same now, earning nearly 20,000 yuan a month.

If someone told Fang Ziye that his monthly salary was a whopping 20,000, Fang Ziye would be happy, but not particularly happy...

"It's actually quite difficult to find something to have fun," Nie Mingxian said, stretching and yawning.

Fang Ziye said, "Brother Xian, it's not actually that difficult."

"Learning, and actually learning something, and gaining something from learning, always makes people happy, doesn't it?"

Fang Ziye's words suddenly stunned Nie Mingxian!

He turned around abruptly, utterly astonished: "Ziye? You're not kidding, are you? Haven't you learned anything at Zhongnan Hospital in a long time?"

Fang Ziye's ability to say these words represents a kind of 'emotional deficiency' and a kind of need.

I've learned a lot!
It sounds like a simple four-word phrase, but to truly appreciate it, you need to have a certain "gap" in your understanding, which your teacher can then nurture and fill.

Only in this way can one gain a sense of accomplishment and satisfaction.

The fact that Fang Ziye said this so calmly means that he had long since moved beyond the path of independent learning, or even independent exploration.

This means that at least 50% of Fang Ziye's circle of competence is close to the current technological barrier, and if he wants to take even one more step forward, he will need to work hard to explore it.

How is that possible?

This is a feeling that many professors usually have.
Fang Ziye?
Just how much expansion is it going to have?

Is he deliberately trying to get my attention?

Is Fang Ziye deliberately showing off?
Nie Mingxian thought of many things at once, but immediately rejected the idea.

If Fang Ziye wanted to show off, he had plenty of opportunities to do so; there was no need for him to do it at this hour, in the early morning.

Looking for the sun?

Fang Ziye shook his head: "It's not that I haven't learned anything. I can definitely learn if I want to. It's just that there are very few teachers who can guide and mentor me."

"On the contrary, my two masters have already started assigning me teaching tasks."

"That's it for tomorrow's surgery."

"..."

Nie Mingxian frowned.

Tomorrow, Fang Ziye is scheduled to perform an open reduction and internal fixation surgery for a pelvic fracture.

To understand this surgery, Nie Mingxian professionally consulted books, planned the surgical approach, the open reduction and internal fixation technique to be performed, and the basic knowledge of the plates and screws to be used.

Nie Mingxian originally thought that Fang Zizhu would be the main surgeon for this operation, with Professor Deng Yong as the first or second assistant.

It's like giving Fang Ziye a sex change surgery.

Unexpectedly, it turned out that Fang Ziye had led several PhDs to perform the procedure on the pelvic fracture.

Nie Mingxian vaguely remembered that Wu Xuanqi had told him that the time for his pelvic fracture surgery was during his treatment period, and that he was a few years older than Fang Ziye.

The difficulty of pelvic fracture surgery is very close to the high level of difficulty of mature elective trauma surgery.

If Fang Ziye has considerable skill in such surgeries, then it proves that what he just said—that he hasn't felt the joy of learning in a long time—was a heartfelt sentiment.

With these doubts in mind, Nie Mingxian waited until the morning when Fang Ziye and Luo Tingzhu ate breakfast together, only to be forced to eat dog food (a Chinese slang term for witnessing public displays of affection), and then until after the shift ended and the ward rounds were completed.

Afterwards, Deng Yong took Yuan Weihong out of the operating room, while Liu Huanglong, having not performed any surgeries that damaged the equipment, went directly to handle matters in the laboratory. Fang Ziye, on the other hand, took Nie Mingxian, Yan Zhiming, Jie Han, and others to another operating room.

After entering the operating room, the patient had already been anesthetized. Jie Han led Liu Haihua to disinfect and drape the wound, while Fang Ziye was giving Yan Zhiming and Nie Mingxian a brief explanation of the procedure.

"For today's surgery, we will be using the posterior approach to the acetabulum. This approach was originally the Kocher approach and the Langenbeck approach. Letournel and Judet combined the two approaches, mainly to expose the posterior wall and posterior column of the acetabulum."

"Later, some people improved this approach and called it the Gibson approach, which moves the upper part of the incision further forward. Moed further improved the Gibson approach and called it the modified Gibson approach. These surgical incision approaches are very similar."

"The modified Gibson approach can protect the nerves and blood vessels innervating the anterior part of the gluteus maximus, and can better expose the upper part of the acetabulum and the iliac wing. It can be used to treat the posterior wall of the acetabulum, the posterior column, as well as some transverse fractures and T-shaped fractures."

"However, today we will still use the more classic Kocher-Langgenbec approach..."

Teaching elective surgery is quite different from simply performing surgery.

In addition to performing the surgery well, I also need to thoroughly analyze the surgical procedure for my junior colleagues. Analyzing the surgical procedure definitely starts with the surgical approach.

As for why we don't start with diagnosis and surgical indications, it's because these are things that attending physicians and resident physicians need to learn on their own, and Fang Ziye doesn't need to supplement them.

As Fang Ziye spoke, even Nie Mingxian nodded frequently, listening attentively.

Yan Zhiming listened even more attentively, his expression serious. While following Fang Ziye's explanation, his thoughts drifted to local anatomy and orthopedic surgery, as he opened up the patient's local muscle tissue layer by layer.

……

(End of this chapter)