godfather of surgery

Chapter 990: Possessed by the God of Medicine
"Time waits for no one. How about I take a look first? I have received training in this area during my further studies, so I am confident." Li Min proposed again.

Director Zhang rolled his eyes at him and said, "Hold on, young man. Keep calm. Director Peng is fishing in a nearby reservoir. It only takes 20 minutes to drive here. Wait a little longer."

The old dean didn't dare to say anything. Director Zhang was a well-known surgeon in the county with more than 30 years of surgical experience, and Li Mincai had been sent for further training, and he had not yet completed a year of training. I believe it is self-evident that this has nothing to do with feelings.

“We can first——” Li Min actively strived for it.

Director Zhang interrupted him and said, "Why are you so long-winded? It's good for young people to have ideas, but surgery requires experience. There is a big gap between theory and practice. If you have high expectations but poor skills, it will kill you."

Director Zhang has seen many examples of people who are overambitious but lack the skills to perform. A chief surgeon in his department, who was in his thirties, went out for further training for a year and then came back to start performing major surgeries in a big way. As a result, he only performed three operations, two of which required Director Zhang to save the day, and the lawsuit over one has not been concluded yet. Young people can try other things, but surgery is not their thing.

"Can we move the large blood vessel blocking clamp down 5 centimeters?" Li Min still insisted.

Seeing that he was so persistent, Director Zhang thought that this was someone else's territory and it was okay to move the forceps. Director Zhang then ordered a large blood vessel blocking forceps to block the vessel five centimeters below the original position. He then removed the original blood vessel clamp and checked the abdominal cavity. There was still no obvious bleeding, which meant that blocking at this position was feasible.

What does it matter if it’s a little higher or lower, Director Zhang thought to himself. Since the effect is the same, I’ll just listen to him and save him from nagging me.

Li Min looked at the new blocking position. It was fine to maintain this position for 45 minutes, and the maximum time could be extended to 60 minutes. Now Li Min felt a little relieved. If Director Peng could really arrive in less than minutes, then the current situation would not have too much impact on the patient. Otherwise, it would easily cause ischemia and necrosis of some organs.

Just now, Li Min repeatedly asked to take part in the operation. Not only Director Zhang was not happy, but several doctors around him also felt that Li Min was overdoing it, which was totally inconsistent with his usual modesty and prudence. Maybe he was a little arrogant after further training. Is this the kind of operation he can intervene in? His level and rank were not good enough. Even Director Zhang was afraid of this operation, let alone Li Min.

Finally, there was the sound of someone talking outside. The door of the operating room opened and Director Peng came in wearing a surgical gown. Director Zhang immediately said, "Old Peng, wash your hands!"

Director Peng just glanced at the patient's operating area, then briefly understood the situation and followed the leading doctor out to wash his hands. The whole process seemed relaxed and very expert.

"The fish in your reservoir are quite big." Director Peng chatted while putting on his surgical gown.

Director Zhang had Director Peng's support, so he naturally felt much more relaxed: "How was the performance?"

"Three big guys, they will definitely be delicious when we cook firewood fish later." Director Peng said.

Director Peng put on his surgical gown and gloves. Director Zhang gave up his position as the lead surgeon, and Li Min took over as the second assistant. Director Peng reached inside and felt around to find out the situation. "You, Zhang, are experienced. You blocked the aorta in time. Otherwise, the consequences would be disastrous."

After feeling around for a few minutes, Director Peng finally found the tear: "It's not a big tear. It's at the root of a branch of the aorta. It can be repaired."

Director Peng heaved a sigh of relief at this time. Although he seemed calm on the surface when he came, he was still a little nervous. If the tear in the aorta was small and only needed to be repaired, he could handle it. But if the tear was large and a simple repair could not solve the problem, it would become a real large blood vessel surgery, which he could not handle at this time. Surgery is a real thing. If it works, it works. If it doesn't, you can't force it. It's not like management work, where at least you can play it safe and pass the buck.

"Do you have nylon thread? Nylon thread would be better, but silk thread is also OK if you don't have it." Director Peng does not have high requirements, and this easy-going attitude makes him appear more capable.

If the aortic rupture is to be sutured, the blood vessels that supply the tumor must be cut off first, otherwise this part of the blood vessels will block the implementation of the repair work. Therefore, Director Peng began to separate this part of the blood vessels, because the separation work is not easy to do due to severe adhesions.

Director Peng's style is different from Director Zhang's. Director Zhang is a completely unconventional one, while Director Peng uses a conventional academic approach. He holds the forceps in one hand and the tissue scissors in the other, and separates them carefully. This adhesion area is full of dangers, and if you are not careful you may injure blood vessels and cause bleeding.

"Anesthesiologist, report the vital signs!" asked Director Peng.

The anesthesiologist immediately reported the patient's current vital signs. The blood pressure was slightly lower than normal. After all, the loss of so much arterial blood would definitely have a great impact on the blood pressure. It was only because the bleeding was stopped in time that no fatal loss was caused.

"How is the patient's heart function? Is there any problem?" Director Peng asked again.

The attending doctor who was still watching from the audience immediately replied: "It's OK, it's normal."

"Increase the intensity of fluid replacement, use 0.9% saline, fill up the volume quickly, how much blood should be prepared?"

"Six units!"

Six units?

But now it seems to be enough, Director Peng ordered: "First, two units of blood."

Director Peng was calm and composed, and his expert demeanor was admirable. A tertiary hospital is a tertiary hospital, and they are obviously different.

"Old Dean, I heard that your waist has been cured? Where did you have the operation?" Director Peng learned about the old dean from Director Zhang.

The old dean chuckled: "Provincial capital!"

"Which hospital?"

"Sanbo Hospital!"

"Sanbo Hospital? That's the Overseas Chinese Hospital, right?"

"Yes, it is the Overseas Chinese Hospital."

"Xiao Li is currently studying at Sanbo Hospital," Director Zhang added.

"Oh, you are studying in Sanbo. Your Sanbo Hospital is very popular now. I heard that there is a young professor Yang Ping who won the Golden Knife Award and was recently named an outstanding young scientist. This Professor Yang is not even 30 years old. Is he capable? Can he perform surgery? It is said that he is the son-in-law of Academician Su of the First Affiliated Hospital of the People's Republic of China. Is it true?" Director Peng asked while walking through the operating room.

Li Min immediately replied: "Professor Yang is my teacher. His surgical skills are very high, and can be said to be world-class."

Who wouldn't say good things about their teacher? Director Peng did not comment, but just smiled faintly, because not everyone believes in the legend of Yang Ping. Some people still have doubts, and Director Peng is one of them. After all, he is too dazzling and easily attracts criticism. In addition, after the news that Yang Ping is the son-in-law of Academician Su spread, everyone has this idea even more. Whether it is sour grapes or other psychological reasons, there will always be a small number of people who think so, especially since Yang Ping won the Golden Knife Award in orthopedics at the time. Orthopedic doctors generally would not question it because many have watched Yang Ping's live surgery. Some non-orthopedic professionals would question it. Even if there is a surgery video, many people are too lazy to watch it. Anyway, they just question it.

"Your teacher." Director Peng felt that he had to be careful with his words.

In Director Peng's opinion, Yang Ping's story was more or less exaggerated. He was the son-in-law of the Su family, a well-known family in Nandu. In order to get their son-in-law to the top, they would do anything.

"Have you ever performed surgery with him?" Director Peng asked curiously. "I often performed surgery with him. He taught me directly, but now most of the surgeries are performed by his professors. He rarely performs general surgeries, and usually only performs highly difficult and high-risk surgeries." Li Min answered Director Peng's question truthfully.

He is young but has a great demeanor, Director Peng thought to himself. However, some of his thoughts were only in his mind. If Li Min was not present, everyone could talk openly. But with Li Min present, he still had some reservations and did not dare to fully express his opinions.

"They heard they were setting up a research institute. What are they researching?"

Director Peng hadn't finished speaking when suddenly, in an instant, a large amount of blood gushed out of the abdominal cavity that had just been clean. What was going on?

Isn't there an aortic clamp on it? Even aortic clamping doesn't work?
Director Peng remained calm. Judging from the color of the blood, it might be a tear of the inferior vena cava: "Large vessel clamp!"

However, Director Peng didn't know how to start when he took the large blood vessel blocking forceps from the instrument nurse. It was adhesions, all adhesions. Where was the breach? Where should he block? Even if he blocked it upwards, where was the inferior vena cava? Director Peng was stunned.

But experts are experts, and they are not afraid of danger: "Blood pads, lots of blood pads!"

Stuff gauze inside, stuff a large amount of gauze, and use packing pressure to stop bleeding. This is an effective method for emergency abdominal and pelvic bleeding, and it is usually the last resort method.

Li Min judged from the color of the blood and the way of bleeding that there was both arterial blood and venous blood. It was very likely that the aorta had continued to tear upward and downward along the original tear, and the inferior vena cava had also been torn. The tear in the blood vessel was most likely just on the dorsal side, which was difficult to detect. The two tear were estimated to continue to expand actively.

This is a real large vessel surgery, and Director Peng is simply unable to handle it. Only a few hospitals can perform large vessel surgery.

The abdominal cavity was filled with gauze, but the blood pressure was still dropping. It was obvious that the packing was ineffective. A large amount of blood could be seen gushing out from various gaps with the naked eye.

"Blood transfusion! Quick! Blood transfusion!"

When Director Peng saw that filling was useless, his defenses broke down and he became anxious. The calm and composed demeanor of an expert just now was gone. It was too sudden and too dangerous.

"Director Peng, can I take a look? We can't go on like this. Someone might die." Li Min was very rude at this time.

For Li Min, large vessel surgery is at the level of surgery that Yang Ping requires him to "master a batch of". This is because such surgery is rarely seen in township hospitals. However, this type of surgery is a rescue surgery. Once there is such a patient nearby, if he can perform this surgery, he can save a life. Therefore, Yang Ping's plan for Li Min requires him to master this type of surgery.

"Take a look?" Director Peng did not refuse. After all, he had no other choice now. His mind was completely confused and he passively accepted Li Min's suggestion.

Li Min took over and made a rough assessment of the bleeding situation in one or two seconds. He immediately asked the instrument nurse for another clamp, clamped the uppermost part of the abdominal aorta, and then used a few suction devices to suck blood. He explored and separated the aorta all the way down. His surgical ideas were clear and his movements were extremely skillful. He quickly found the extent of the aortic tear, separated the inferior vena cava, and inserted a large blood vessel clamp.

With accurate judgment and extremely fast operation, the bleeding was stopped quickly and the patient was immediately pulled out of danger. Otherwise, if he continued to bleed like he just did, the patient would undoubtedly die.

"Can we find an artificial blood vessel for large blood vessel surgery? It would be even better if we can implant an artificial blood vessel."

Li Min asked Director Peng and Director Zhang.

The two directors thought about it and realized that not only the county hospital, even the city’s central hospital did not perform large blood vessel surgery. Patients could only be sent to the provincial capital. How could they get artificial blood vessels? If they asked suppliers to help arrange the goods, it would probably take more than ten hours for the goods to arrive.

"No, it will probably take more than ten hours to find someone to arrange the goods." Director Zhang was a little scared.

Li Min wondered how the patient could have waited on the operating table for more than ten hours without extracorporeal circulation support. His teacher had taught him about this situation before, because he considered how to save the patient's life in such a special situation.

"The only option is to repair it!" said Li Min.

Through Li Min's examination, the blood vessel tear was very large, but most of the blood vessel wall was still healthy, and only a small part was invaded by the tumor. Most of the tearing was neat, which provided a certain foundation for the repair. Through learning from Yang Ping, Li Min is no longer the young boy he used to be. He has a strong ability to deal with complex problems.

"Do you have nylon thread? For suturing blood vessels?" Li Min asked.

The old director was so frightened that his heart was pounding. He stood on tiptoe to look at the operation and replied, "We have nylon thread, but I don't know if it is suitable for anastomosis of this kind of blood vessel."

"Bring them all to me." Li Min's expression was clear and firm, and his aura as the surgeon was unmistakable.

The circulating nurse immediately took action and took out all the nylon threads in the hospital for Li Min to see. Li Min picked out a few packages that were barely suitable. Anyway, there was nothing to be picky about at this time, so he could only make do with what he had. It was impossible for everything to be standardized and convenient like in a big hospital.

As for the knowledge of various sewing threads, from materials, specifications, craftsmanship, etc., all of these have been trained by Yang Ping, so Li Min is very familiar with how to use some threads crosswise and how to use them in non-normal scenarios.

Li Min began to repair the blood vessels with nylon thread, starting with the longitudinal lacerations, which were the main ones, while the transverse and irregular lacerations were concentrated at the site where the tumor blood vessels branched off from the aorta.

The suturing technique was a bit cool, fast, good and steady. Director Zhang, who was helping cut the threads and tie the knots on the opposite side, was stunned when he saw Li Min's cool suturing. This might be his most intuitive technical understanding of the big hospital, Sanbo Hospital.

Compared with Li Min's suturing skills, Director Zhang felt that his decades of surgical experience were suddenly worthless and that his previous surgeries were shit.

A young doctor who has been training for less than a year can perform large blood vessel surgery. Li Min's current level is unmatched in the entire region. Even Director Peng can't catch up with his level. Is this guy Li Min from Guandu Hospital? Director Peng and Director Zhang had to look up and re-examine Dr. Li in front of them. He even wondered if he was possessed by the God of Medicine.

"Director Peng - cut the thread!" Li Min reminded the distracted Director Peng, who immediately woke up and continued to cut the thread with his head down.

In fact, in Li Min's eyes, Director Peng's thread-cutting movements and results were unqualified. Some were too long, and some were too short. Threads that were too long left more foreign matter, and threads that were too short were prone to loosening. Qualified and standardized movements were not for the sake of looking good, but large sample statistics showed that doing so could guarantee the best results before new methods and standards emerged.

Compared with the neat sutures made by Li Min, the uneven thread ends left by Director Peng were very conspicuous. Director Peng felt very ashamed that decades of surgical experience had been defeated by less than a year of training. Even though he is now in his fifties, Director Peng still has the idea of ​​going out for further training. After all, there is no end to technology.

The whole process was very smooth. The long longitudinal laceration was sutured by Li Min. Now Li Min had to deal with the irregular laceration. He frowned slightly. In fact, he had already made a plan in his mind. Foresight and planning are essential qualities for a surgeon. Even if encountering unexpected dangers, do not be led by the disease. Try to think ahead of the disease so that you can have more initiative.

Li Min's plan was to cut off and discard the invaded part of the blood vessel, and then suture it end to end. This would not only ensure postoperative safety, but also allow the tumor blood vessels to separate from the aorta. Of course, after cutting off a part of it, the aorta could still be anastomosed without tension, which was calculated by Li Min.

The length of a person's abdominal aorta is related to their height. The length of the abdominal aorta can be calculated from the height, and then a few percent of the blood vessel can be removed and it can still be sutured without tension. Li Min not only memorized these data, but also practiced them many times in practice, so he had a clear idea of ​​it.

Director Zhang, who was just stunned by Li Min's surgical skills, couldn't believe that this was Li Min from Guandu Hospital. He was completely possessed by the god of medicine.