Time flowed like water, and two days passed in the blink of an eye. Friday arrived.
Mondays and Fridays were Professor Deng Yong's surgery days.
Friday afternoon, 3:42 PM. Of the seven surgeries scheduled for their group, Professor Deng Yong had already gracefully dispatched four major operations with his exquisite technique.
The remaining three relatively minor surgeries were distributed among the team.
With its numerous members, the group was well-equipped. Associate Professor Xie Jinyuan could handle most surgeries independently. He was capable of performing almost all procedures, even managing to cover the highly complex surgeries typically performed by Professor Deng Yong, albeit with less finesse and technical mastery.
Xie Jinyuan took on the last moderately difficult surgery - an open reduction and internal fixation for a pelvic fracture. He called for a doctoral student and one of his own master's students, then headed to the operating room.
Yuan Weihong took a case involving a small bone defect, while Attending Physician Qin Geluo chose a simple open reduction and internal fixation for a fracture. They each gathered their teams and went to find available operating rooms.
Yuan Weihong's team of three was ready!
This demonstrated the strength of a surgical team in a top-tier hospital. Together they were a formidable force, and individually they were stars. As long as there were enough operating rooms, they could handle four surgeries simultaneously without breaking a sweat.
At this moment, Fang Ziye took the lead surgeon's position, with Yuan Weihong temporarily in the assistant's role and Jie Han as the second assistant.
After applying the sterile drapes to the patient's leg, Yuan Weihong used toothed forceps to mark out the incision points, then drew an arc-shaped line. He tossed the curved tray towards Fang Ziye.
"Cut along this line," Yuan Weihong instructed. He had heard from his youngest student about Fang Ziye's current incision skills, having completed the rubber cutting exercise in the training room.
But he hadn't witnessed it firsthand, so he wanted to see Fang Ziye's current basic skills for himself.
Fang Ziye didn't hesitate. He muttered, "On the anterior thigh, the subcutaneous fascia layer is about 4mm thick. The first cut should be controlled to a depth of about 3mm to avoid cutting into the fascial layer blood vessels and reduce bleeding."
This was the advantage of strict, standardized practice in the training room - it allowed for quick application in clinical settings.
Fang Ziye held the scalpel like a pen, made a vertical incision, followed the arc, and exited vertically.
The cut was clean and decisive, without any hesitation.
Yuan Weihong wiped the wound with a dry cotton pad. There was only a minimal amount of blood, and the wound remained relatively dry.
Yuan Weihong realized that Fang Ziye's skills had indeed improved since before. Previously, when making incisions, Fang Ziye would either deviate from the pre-operative design in arc positioning or make cuts of inconsistent depth, occasionally breaking blood vessels and causing significant bleeding.
"Electric scalpel, coagulation mode, cut!" Yuan Weihong instructed, gesturing for Jie Han to use forceps to open the skin incision while handing the electric scalpel to Fang Ziye.
The electric scalpel had two functions: coagulation and cauterization. Cauterization was used purely for hemostasis, while coagulation was used for cutting.
Fang Ziye wasn't caught off guard by Yuan Weihong's maneuver. He turned his head and said, "Circulating nurse, please adjust the electric scalpel current. 40!"
If he had started cutting immediately, it would have been amateurish. Fang Ziye was always cautious and steady; he wouldn't proceed with cutting at 60mA.
Yuan Weihong sniffed, having intended to test whether Fang Ziye's improved abilities had made him overconfident, but his attempt had failed.
After the skin incision, the subcutaneous fascia and fat layers needed to be exposed. These two layers could be cut with the electric scalpel, allowing for simultaneous cutting and hemostasis - a flexible application of electrocautery.
Fang Ziye completed these steps one by one. When he reached the deep fascia layer, he stopped and put down the electric scalpel, obediently relinquishing control.
The next step involved muscle exposure, a level of basic skill that Fang Ziye hadn't yet mastered, so he refrained from attempting it. He picked up two S-shaped retractors, handed one to his junior, Jie Han, and kept one for himself. With unspoken understanding, he reached for the suction device in Yuan Weihong's hand.
The message was clear without words.
"Master, I can't instruct you to operate, but I'm ready to assist."
Yuan Weihong said nothing. He picked up a hemostat, twisted the deep fascia layer, made a small incision with a sharp knife, then proceeded with blunt dissection. After pushing aside the muscle layer, he switched to a large S-shaped retractor.
After exposing the femur, they could see the bone defect segment. Yuan Weihong then had Fang Ziye remove the scar tissue around the bone defect for debridement...
The fibula from the same side was cut and transplanted with its blood supply intact, shaped with a titanium mesh. The series of complex and exquisite operations left Fang Ziye and Jie Han in awe...
But even the tallest building starts from the ground up. Yuan Weihong's skillful operations had also begun with basic incisions, sutures, and debridement.
"Fang Ziye, you suture the inner layer. Jie Han, you take care of the subcutaneous layer. I want to see your suturing skills and what level you're both at," Yuan Weihong said, like a mother bird feeding her chicks.
Fang Ziye's face lit up instantly.
He obediently took the needle holder and 3-0 Vicryl suture, and began working steadily.
Suturing requires not only technical skill but also a certain level of basic knowledge.
The periosteum layer definitely needs to be sutured. Here, continuous suturing can be used, going all the way through. After suturing, the layers should still be distinct, with the periosteum layer perfectly approximated.
Next is the deep fascia layer. This can be sutured either continuously or with simple interrupted sutures. This is where skill really comes into play.
Poor suturing would bunch the deep fascia into a lump. Good approximation would look like suturing half an orange peel, achieving a perfect, snug fit.
Fang Ziye had reached this level of skill.
The muscle layer hadn't been cut; Yuan Weihong had navigated through the intermuscular planes, so no treatment was needed.
Then came the subcutaneous fat layer. Suturing this layer requires even more finesse with full-thickness sutures.
It needs to be tight and closely approximated, but not so tight that it compresses the local fat, which could lead to fat liquefaction post-surgery. This is similar to the delicate art of suturing tofu.
Fang Ziye made two stitches, then looked at Yuan Weihong with a bitter smile.
Yuan Weihong said, "It's okay, it'll do. Keep going."
Sometimes, perfection in local, minor operations isn't crucial to the overall surgery. Fang Ziye's suturing wasn't ideal, but it was serviceable. The difference in skill level was clear, however.
In more critical areas, such as near joint capsules, more precise suturing would be necessary to avoid limiting the patient's function.
Fang Ziye dutifully completed the fat layer sutures, though the quality was admittedly not high. But when he reached the subcutaneous fascia and subcutaneous layers, he returned to the orange peel-like suturing technique.
Fang Ziye regained his confidence and finished suturing the subcutaneous layer, achieving excellent skin approximation. He had the same proud smile that the senior doctoral students used to have when they finished suturing and admired their handiwork.
The pressure now shifted to his junior, Jie Han.
Jie Han was now trembling with nervousness. As a newcomer to the department, the only medical skill he had relatively mastered was suturing.
His depth control was inadequate; one stitch was too deep, the next too shallow.
After just two stitches, Yuan Weihong couldn't bear to watch anymore. He cut the suture directly and said, "Forget it. You should spend more time in the training room before trying this again."
"We can't explain this incision to the patient and their family when they return to the ward."
Jie Han felt immensely relieved, handing the needle holder back to his senior. His gaze was curious and expectant, identical to how Fang Ziye had been two years ago.
...
After the surgery, junior Jie Han was responsible for accompanying the patient back to the ward.
Fang Ziye, who had gained an enormous 4 Knowledge Points, accompanied Yuan Weihong to the changing room.
Yuan Weihong remained silent the whole way, and Fang Ziye didn't dare to speak. His eyes, however, were filled with conflicting emotions, seemingly both hopeful and fearful.
In the end, it was Yuan Weihong who couldn't hold back. He turned and said, "Although your basic skills have improved slightly, it's still a bit too late."
"It's already mid-August, less than half a year before our hospital's doctoral admissions."
"If we had another year or year and a half, we could give it a shot. But to complete the first training room, even if you're only facing the 'watered-down' requirements for master's students, it's a bit late."
"You should focus on finding a good job."
Fang Ziye, unwilling to give up, asked, "Master, what are the actual requirements for us master's students to complete the first training room?"
Yuan Weihong looked at Fang Ziye, feeling particularly reluctant to crush his hopes. He decided to let Fang Ziye face reality and laid out the stringent requirements: "You need to be able to suture tofu well, and your incision skills should allow you to cut tofu into an octahedral pyramid shape with distinct levels."
"For debridement, you should be able to carve three-dimensional simplified Chinese characters on tofu. As for hemostasis, you're required to quickly locate and pinpoint bleeding vessels, repeating the process 40 times in 20 seconds, with a standard completion rate higher than 36 times."
Upon hearing this, Fang Ziye instinctively felt despair.
But after careful consideration, he remained silent, his eyes filled with determination.
Yuan Weihong turned his head, and seeing the look in Fang Ziye's eyes, he leaned in and whispered, "Tomorrow, go to the finance department to report the page fees. You have a SCI paper in a Q1 journal. You need to study its contents thoroughly."
"You must memorize it inside out within a month, without a single error in the data."
"If anyone asks, you're the author, and I'm just the supervising professor. Then, prepare well for the doctoral entrance exam at another hospital. Do you understand?"
Fang Ziye was stunned at first, then felt a warmth in his heart.