top student at medical school

Chapter 7 Don't Struggle in Vain (Please add to your favorites and read on)

Time flies, and two more days have passed in the blink of an eye; it's Friday now.

Monday and Friday are Professor Deng Yong's surgery days.

It was 3:42 PM. Of the seven surgeries in this group, four were successfully completed by Professor Deng Yong with his superb skills.

The remaining three relatively minor surgeries were performed separately.

With a large team, Associate Professor Xie Jinyuan can handle any surgery on his own. He can perform almost any type of surgery, and even handle the more difficult surgeries performed by Professor Deng Yong, although his proficiency and skill level are not as high as Deng Yong's.

He took over the last moderately difficult open reduction and internal fixation surgery for a pelvic fracture, called in a PhD and his own master's student, and began the procedure.

Yuan Weihong brought a small segment bone defect surgery, while Qin Geluo, the attending physician, found a simple open reduction and internal fixation fracture surgery and also took his team to find the operating room.

Yuan Weihong and his two apprentices shared the stage!
This is the strength of the surgical teams in top-tier hospitals. When they are together, they are like a dragon; when they are apart, they are like stars in the sky. As long as there are enough operating rooms, they can perform four surgeries at any time.

At this moment, Fang Ziye took the lead in the surgical position, Yuan Weihong was temporarily in the assistant position, and Jie Han was in the second assistant position.

After applying the sterile surgical dressing to the foot, Yuan Weihong used toothed forceps to mark each surgical incision, then drew an arc and tossed the curved plate in front of Fang Ziye.

"Start cutting along this line." Yuan Weihong already knew from his youngest student that Fang Ziye's cutting technique was currently quite advanced, having already mastered the skill of cutting clay in the practice room.

But since he hadn't witnessed it firsthand, he wanted to take a good look at Fang Ziye's current basic skills.

Fang Ziye didn't mince words, muttering, "On the front of the thigh, the subcutaneous fascia layer is about 4mm. If the first incision is made to a depth of about 3mm, you can avoid cutting into the blood vessels in the fascia layer and reduce bleeding."

This is the benefit of practicing strictly according to the standards in the training room. Once applied flexibly in clinical practice, it can be mastered quickly.

Fang Ziye holds the knife like a pen, moves the knife vertically in an arc, and exits vertically.

The cut was swift and clean, without any hesitation or slack.

Yuan Weihong wiped the wound with a dry cotton pad. There was only a very small amount of blood, and the wound was relatively dry.

Yuan Weihong then realized that Fang Ziye's skills were indeed more advanced than before. Previously, when Fang Ziye made incisions, he either misjudged the arc positioning, deviating from the preoperative design, or the depth was uneven, causing local blood vessels to rupture and resulting in a lot of bleeding.

"Electrocautery, electrocoagulation function, cut!" Yuan Weihong gestured to Jie Han to use tweezers to open the external incision on the skin while handing the electrocautery knife to Fang Ziye.

An electrocautery knife has two functions: electrocoagulation and electrocautery. Electrocautery is used for simple hemostasis, while electrocoagulation is used for incision.

Fang Ziye wasn't fooled by Yuan Weihong's tricks. He turned around and said, "Trainee, adjust the electrosurgical current. 40!"

If he were to actually make the cut, that would be unprofessional. Fang Ziye is always cautious and steady, and it's impossible for him to perform a resection under 60mA conditions.

Yuan Weihong sniffed, intending to test whether Fang Ziye's personality had become arrogant after his abilities improved, but he failed to find out.

After the skin is cut open, the subcutaneous fascia layer and fat layer need to be exposed. These two layers are cut with an electrocautery knife, which can stop bleeding during the cutting process. This is a flexible application of electrocoagulation hemostasis.

Fang Ziye stopped one by one, and when he reached the deep fascia layer, he put down the electrocautery and obediently relinquished control.

The next step is to expose the muscles, but Fang Ziye's basic skills are not yet deep enough to go that far, so he will leave it for now. He picked up two S-shaped pull hooks, handed one to his junior brother Jie Han, and kept the other in his own hand, while also reaching for the suction device in Yuan Weihong's hand in perfect unison.

The meaning is self-evident.

Teacher, I can't instruct you to do it, but I'm ready to be your assistant.

Yuan Weihong didn't say anything. He picked up the hemostat, twisted up the deep fascia layer, made a small incision with the scalpel, and then made a blunt incision. After squeezing the muscle layer apart, he changed to a large S-curve.

After exposing the femur, the bone defect segment was visible. Fang Ziye then removed the scar tissue around the bone defect for debridement…

After cutting open the fibula with its vascular pedicle on the same side, it was transplanted and shaped with titanium mesh. The series of operations were complex and exquisite, which greatly impressed Fang Ziye and Jie Han...

But a tall building starts from the ground up, and Yuan Weihong's procedures also began with incision, suturing, and debridement.

"Fang Ziye, you suture the inner layer; Jie Han, you suture the subcutaneous layer. Let me see your suturing skills and what level you're at," Yuan Weihong said, like an old bird feeding its chicks.

Fang Ziye was overjoyed upon hearing this.

I obediently accepted the needle holder and the 3-0 micro-thread, and then began to work steadily and surely.

Besides the technical skills required, a certain level of basic knowledge is necessary for suturing.

The periosteum definitely needs to be sutured. Continuous sutures can be used here, one stitch at a time, resulting in clear layers and excellent apposition of the periosteum. Next is the deep fascia layer. Continuous sutures or simple interrupted sutures can be used for the deep fascia layer, and this requires considerable skill.

A poorly sutured fascia will just bunch up into a lump. A well-fitting suture is like stitching together half a layer of orange peel, achieving a perfect, tight fit.

Fang Ziye has already reached this level.

The muscle layer was not cut open; teacher Yuan Weihong traced the intermuscular space, which requires no further treatment.

Next comes the subcutaneous fat layer, and the suturing of the fat layer requires even more meticulous full-thickness suturing.

It needs to be tight and close together, but not so tight that it will compress the local fat and cause fat liquefaction after the operation. This is similar to suturing tofu.

Fang Ziye performed two injections, a bitter look on his face, and looked at Yuan Weihong.

Yuan Weihong said, "It's alright, it'll do. Keep sewing."

Sometimes, minor local adjustments are not the optimal solution and have little impact on the overall surgery. Fang Ziye's suturing was not very good, but it was not impossible to complete the surgery. However, the difference in skill level is obvious at a glance.

For suturing in more critical locations, such as near the joint capsule, more delicate suturing is required to avoid functional limitations in the patient.

Fang Ziye diligently followed the steps to complete the fat layer, but the level of completion was not high. However, when he got to the subcutaneous fascia layer and the subcutaneous layer, the procedure reverted to the orange peel suture style.

Fang Ziye regained his confidence and finished suturing the subcutaneous layer, resulting in excellent skin alignment. He had the same kind of maternal smile that his senior doctoral students used to give when they finished suturing and looked down on everything with satisfaction at their achievements.

The pressure fell on his junior apprentice, Jie Han.

Jie Han was trembling with fear at this moment. He was a newcomer to the department and the only medical skill he had mastered relatively well was suturing.

The depth control was insufficient; one injection was too deep, and another was too shallow.

After only two stitches, Yuan Weihong couldn't stand it anymore and cut the knot: "Forget it, you should go back to the practice room and stay there for a while longer."

“If this person goes back to the ward, we won’t know how to explain it to the patients and their families.”

Jie Han felt as if he had been granted a pardon. He handed the acupuncture needles back to his senior brother, his eyes filled with curiosity and anticipation, just like Fang Ziye two years ago.

……

After the surgery, my junior colleague Jie Han was responsible for accompanying the patient to the ward.

Fang Ziye took the huge sum of 4 knowledge points and accompanied Yuan Weihong down to the locker room.

Yuan Weihong remained silent the whole way, and Fang Ziye didn't dare to speak either, but his eyes were filled with strange expressions, as if he was expecting something and being afraid at the same time.

However, Yuan Weihong couldn't hold back any longer and turned to say, "Although you have improved your basic skills, it's still a bit too late."

"It's already mid-August, and there are less than six months left until our hospital's doctoral student recruitment."

"If you still have another year or two, you can still give it your all. But if you want to get out of the first training room, even if you are only facing the 'watered-down' requirements that a master's student faces, it's a bit late."

"Go find a good job."

Undeterred, Fang Ziye asked, "Master, what are the actual requirements for us master's students to emerge from the first training room?"

Yuan Weihong glanced at Fang Ziye, feeling particularly reluctant, and decided to let Fang Ziye give up. He then explained all the demanding requirements one by one: "Sew up the tofu properly, and the cutting technique must be able to cut the tofu into an octahedral pyramid shape with clear tiers."

"The debridement technique requires the ability to carve three-dimensional simplified Chinese characters on tofu, while the hemostasis technique requires the rapid and precise capture of the bleeding point in the blood vessel, repeating the process forty times at a single point within twenty seconds, with a standard completion rate of more than thirty-six times."

Upon hearing this, Fang Ziye felt an instinctive sense of despair.

But upon further reflection, he remained silent, yet his eyes were filled with unyielding spirit.

Yuan Weihong turned his head and saw Fang Ziye's eyes. He then leaned over and whispered in Fang Ziye's ear, "Go to the finance department tomorrow to get the publication fee reimbursed. You have a Q1 SCI article, and you need to study its contents carefully."

"You must know it by heart within a month, remember every single detail of the data without a single mistake."

"If anyone asks, you're the author; I'm just the advisor. Then focus on preparing for the doctoral entrance exam in the foreign language department. Do you understand?"

Fang Ziye was stunned for a moment, then felt a warmth in his heart.

(End of this chapter)