Who knows what time it was in the middle of the night.
The duty room was filled with persistent knocking.
"Who is it? Can't a man get some sleep?" Zhang Lin opened the door, bellowed, with sleep deprivation painting the urge to fight someone on his face.
The nurse station has switches; once pressed, the duty room bell rings, enabling intercom communication. Zhang Lin assumed the intern nurse was clueless and had come knocking directly.
"Director Tian?" Oh, what a blunder this was.
Director Tian was slipping on his white gown, his face not just livid, but murderous, "Have you guys completed the surgery?"
Zhang Lin, rubbing his sleepy eyes, responded, 'Yes!'
"You guys are gutsy, so irresponsible. Who behaves like this?" Had it not been for years of higher education, Director Tian was ready to curse aloud.
Zhang Lin was dazed. After completing the surgery, he had planned to call Director Tian from the changing room. But his cell phone battery was low, and he feared it might shut down automatically. So, he decided to charge it once back in the ward and call later. But once in the ward, he fell asleep and forgot about Director Tian.
Getting a hard reprimand, he realized that the surgery was actually supposed to be performed by Director Tian, who had been stuck in traffic.
By now, several hours had passed since the surgery was completed. To come here, banging and clanging at the doors, Zhang Lin was annoyed internally but couldn't express it on his face.
After all, being scolded by superiors was a common occurrence for junior doctors.
After receiving a severe scolding from Director Tian, Zhang Lin was wide awake and quickly woke Yang Ping, who was still asleep.
Hurriedly slipping on his white coat, Director Tian had his mind set on examining the patient's blood flow to the severed finger. Zhang Lin and Yang Ping followed behind him, as silent as the grave, not daring to break wind.
In order to stay awake, Zhang Lin took out a box of essential balm, and began to apply it onto his temples.
Like scolded school children, they followed behind their disciplinarian principal.
As it turns out, the moment Director Tian reached his department, he went straight to the operating room, asking the nurses about the procedure. They told him the surgery was already done and the patient had been back for three hours.
Returning to his department, he found that the nurses had told him that Zhang Lin and Yang Ping were deep asleep.
Calculating quickly, six hours had passed since he received the phone call, the patient had been returned three hours prior, deducting the preparation time, the surgery lasted approximately two hours.
Two hours, with the skill sets of these two blundering fools, couldn't they just do a minor debridement and suture? Or could it be that these two idiots, despite his tardiness, carried out the surgery without linking nerves, blood vessels, or anything, fixed the fractured finger with a Kirschner wire and directly sewed up the skin?
Could something so preposterous happen? If so, this would be a medical malpractice!
This would be a sham surgery.
Tian Yuan's pace became faster, the more he thought, the angrier he got, he could feel the blood rushing to his head.
No longer caring about disturbing the patient's rest, as there's still a few hours left, if they were to return to the operating table now, there is still hope. But if they wait till tomorrow morning, it will be too late and the finger would die.
He could almost picture the sewed up severed finger: pale, shriveled, icy cold, with no blood flow!
With a sudden flick, the sound of a light switch echoed in the ward, and the lights turned on.
The pain relief was well done, the patients were all asleep.
With the sudden turning on of lights and doctors storming towards their bedside, the patient and the person accompanying were jolted awake. They squinted, evading the harsh illumination, completely confused about what was happening.
"We're doing a ward round, checking the blood flow in the finger!" Trembling, Zhang Lin stood by the bedside and explained to the patient as he switched on his portable flashlight.
Tian Yuan pushed Zhang Lin aside, grabbed the flashlight and shone it.
The sewn-up finger was outside, looking plump and red. Tian Yuan carefully touched it; it felt warm! He then lightly squeezed it, the fingertip was full and had elasticity, the capillary refill test appearing normal on the fingernail.
This was impossible and defied all logic.
"Syringe needle!"
At this time, a nurse had pushed over a medical cart, on which were dressing packs, cotton swabs, iodine disinfectant, syringes and more.
The nurse handed over two iodine-soaked cotton swabs, Tian Yuan disinfected twice, and delicately injected three shots at different positions on the fingertip, barely penetrating beneath the skin.
Blood, a vivid red, slowly emerged. At first a drop, then slowly spreading, and finally trickling to one side. Tian Yuan turned to gaze at Yang Ping, then Zhang Lin.
"The blood circulation is very good! I am sorry for the disturbance, we need to check the blood flow every hour," Tian Yuan explained to the patient.
The patient and his family promptly replied: 'No problem, thank you, Doctor.' They seemed a bit taken aback.
Everyone returned to the doctor's office and sat down, creating a somewhat tense atmosphere.
Tian Yuan was stumped. What happened? Did they manage to do the vascular anastomosis? That couldn't be possible. It had only been two hours, and with two segments detached, it would usually take her three to four hours to finish in a good state. It couldn't have been possible for these two to do it in two hours. She wondered where the diagnostic inaccuracies had occurred. Perhaps there had been a time discrepancy.
"What time did the patient arrive at the emergency department? When did he enter the operating room? When did the surgery start? When did it end?" Tian Yuan bombarded them with questions.
"He arrived at the emergency department around eight. Got to the operating room at half-past eight, surgery officially started a little after ten and ended around twelve." Zhang Lin remembered quite clearly. Although he couldn't recount the exact minutes, he recalled the approximate times.
The nurse was also startled by Tian Yuan's expression, believing something severe had occurred. This astute nurse immediately grabbed the patient's file and handed it to Tian Yuan.
"It's okay, go about your work. We will stay here for a while," Tian Yuan gently said to the nurse.
She flipped through the files in detail, locating the anesthesia form and surgery nursing record sheet and compared the times listed with what Zhang Lin remembered. There wasn't much discrepancy.
"They really did the vascular anastomosis?" Tian Yuan asked.
"Two arteries, four veins! Each of the two lacerations was anastomosed this way," Yang Ping soberly explained.
Tian Yuan adjusted her glasses: "Currently, the blood circulation looks good, but the surgery only ended two hours ago. How did it happen so fast? Was it a complete detachment?"
Then it dawned on Tian Yuan; it might not have been a true finger detachment if there had been tissue connecting and one side of the blood vessels was left intact. Whether the vessels were sutured or not wouldn't affect their survival. This was known as an open fracture in diagnostic terms and was distinct from a detachment.
But—-but—-She had seen the picture that Zhang Lin sent. The finger appeared to be clearly detached in two places.
"It was a complete detachment, at two separate planes!" Zhang Lin exhaled as the tension in his nerves slackened and he pulled out the pictures on his phone. He understood Tian Yuan's suspicions: that he and Yang Ping had simply done the suturing and hadn't performed the vascular anastomosis. Now that he got it, there was no reason to be worried. He had watched the entire surgical process, not only did they complete the anastomosis but also the quality was quite high. The revelation gave him quite a fright.
"Director Tian, we recorded the entire surgery. Would you like to watch the video?" Yang Ping suggested.
Zhang Lin also remembered the recording, "Yes, indeed there is a video. I have it copied onto our office computer."
Watching the video appeared to be a good solution. Tian Yuan nodded in agreement.
They all gathered around the computer as Zhang Lin played the recorded footage. As the video played, Tian Yuan occasionally cast perplexed looks at Yang Ping—could it really be this kid performing the surgery in the video?
The instruments under the microscope didn't wobble even slightly, his movements were highly skilled, as smooth as flowing water. His sutures were accurate, light, and nimble, devoid of any superfluous movement—each motion precise, achieving its desired effect in one try. The quality of the anastomosis—whether of blood vessels, nerves, or tendons—was exceptionally good. Even the final skin sutures were near perfect. Such expertise couldn't be achieved without several a hundred or even a thousand surgeries, even if one had talent.
Operating under a microscope required specific training and a certain level of talent—good hand balance and no shaking. Even a slight tremor, when magnified under the microscope, could seriously affect the operation.
The requirements for vascular anastomosis are very high. The tissue outside the vascular stub, including the outer membrane, must be cleaned thoroughly. If even a tiny bit gets inside the vessel during anastomosis, it could cause thrombosis and vascular blockage. The vascular alignment must be precise; any slight misplacement could lead to vascular narrowing or irregularities, causing abnormal blood flow, slowed flow rate or turbulent flow, thus increasing the risk of thrombosis and vascular blockage.
Small blood vessel anastomosis has the highest requirements for suturing technique in surgical operations.
A surgeon needs to practice anastomosis countless times on the tails of mice or rabbit ears under a microscope to achieve such advanced anastomosis skills. This is the pathway taken by Director Han, Director Tian, and Song Zimo.
Tian Yuan reviewed the video once and then replayed it upside down and inside out, paying extra attention to the key steps, fearing she might miss a detail.
Yang Ping understood what Tian Yuan was thinking. He had already thought of a countermeasure and said, "I bought a set of microsurgical instruments online, and even got a second-hand microscope. I practiced on chicken meat every day at home for several years, so I've gotten fairly good at vascular anastomosis."
Tian Yuan reflected for a moment; this explained a lot.
If he dedicatedly learned and practiced microsurgery, it was normal for him to achieve this level with a bit of talent.
This surgery was indeed perfect.
"You should rest, it's been a hard day. The quality of vascular anastomosis is quite high, but we need to be vigilant. Instruct the nurse to monitor the blood flow and address any issues promptly." Tian Yuan instructed.
Tian Yuan wanted to say something else but didn't know what to say.
"You guys go and rest. I'm going by the operating room, Old Jin and team haven't finished yet."