Path of Medicine With a System-Chapter 214: The female doctor who was convinced to give up!

Zhang Fan was the primary surgeon for the surgery, with Chen Qifa as his surgical assistant. The patient was placed on the operating table, while Zhang Fan and Chen Qifa stood across from each other on opposite sides of the patient. The medical equipment nurse and table were also across from the patient. There was no room for a third doctor!

What could be done then? Tong Lili could only stand to the left of Zhang Fan. There wasn’t even any space for a stool for her to stand on. She would have to stand in order to participate in the surgery.

The anesthesiologist asked Zhang Fan what type of anesthesia to use because this surgery would take quite a long time to complete. Zhang Fan suggested general anesthesia instead of local anesthesia. In surgery, especially orthopedic surgery, cleaning the injury was incredibly important. It was a basic rule of surgery to completely clear away any tissue that had been infected or was dead already. Clearing away tissue couldn’t be done casually.

The surgeon would need to carefully study the patient’s X-ray before the surgery, and then determine how much tissue to clear away and how much to shorten the bone based on the hand’s specific circumstances.

The hand which had been cut off completely seemed just like a flesh-colored lump. It had no color to it due to lacking blood! If you placed it on the ground, it would be difficult to differentiate it from a rubber doll’s hand!

Due to technological advances in surgery, a medical equipment nurse was becoming ever more important. It would take at least one or two years of training for a medical equipment nurse to become skilled enough to help in surgeries. Although surgeons would only work on their specialty type of surgeries, medical equipment nurses would have to work on all types of surgeries. This meant that medical equipment nurses needed to be highly familiar with all the names and usages of every medical equipment type as well as the steps in all types of surgery.

This was because the medical equipment nurse would need to prepare the necessary medical equipment for various steps of the surgery. It would be bad for the nurse if she was unfamiliar with the surgery’s steps and didn’t have the proper medical equipment right away. Some doctors who had a bad temper would even throw the medical equipment onto the ground!

Older and more experienced medical equipment nurses would instantly be able to tell the skill level of the doctor. This was why younger surgeons would always intentionally try to get into the good graces of older nurses. This was because the older nurses might start bad rumors about them otherwise.

Two doctors would need to simultaneously clean the injury for a hand reattachment surgery. This was all in order to save time because time was extremely critical. Cleaning the injury would need to be done at an anatomical level. While cleaning the injury, it would also be necessary to locate the relevant nerves and blood vessels for the next step of the surgery.

The primary surgeon would need to figure out the steps even for something as seemingly simple as cleaning the injury. The order of what you cleaned would be critically important. To make an analogy, this would be as important as having a proper battle formation in war.

The most important muscle structure in the hand was the thenar eminence group. The thenar was a muscle that only humans possessed. While gorillas were the closest genetic relatives to humans, our hairy cousins didn’t have the thenar eminence. The thenar eminence was something that had evolved due to our ancestors’ use of the hands. What was the thenar eminence? In simple terms, that would be the fleshy portion between your thumb and index finger.

After cleaning the muscles, next would be the bones. For the bones inside the hand, the metacarpophalangeal joints were by far the most important. These joints were the biggest priority to preserve.

Zhang Fan had his head lowered as he worked on the surgery together with Chen Qifa. Tong Lili’s work was to maintain clear vision for the surgery. Basically, all she did was hold the surgical retractors and wipe blood. Every surgeon would have to start out like this, only observing the surgery, typically as the third or fourth surgical assistant. After becoming experienced in holding the surgical retractors, wiping blood, using the aspirator to drain blood, and watching a type of surgery several dozen times, the surgeon would then slowly work their way up to secondary surgical assistant, primary surgical assistant, and so on.

During this timeframe, doctors would slowly display differing levels of skill. Surgery was a job that required both talent and hard work. Some doctors would intentionally practice surgery techniques at home. For instance, for laparoscopies, maybe a doctor would continuously practice with two similar-sized bars at home. This doctor would then become far more skilled in one year than another doctor who didn’t do extra practice at home. This was the result of difference in work ethic.

If you paid close attention, many surgeons would commonly have the habit of constantly playing with something in their hands. This wasn’t a habit simply out of boredom. Many of them were actually practicing surgical techniques.

After cleaning the injury, it would be necessary to repair and affix the broken bone. This was something foundational. Only after affixing the bone would it be possible to restore other functions. If the bones weren’t affixed properly, even slight movement would cause a blood vessel which was just repaired to snap again!

After dealing with the bone fracture, next would be repairing the muscles. If some part of the body was accidentally cut off, the best possible scenario that surgeon could hope for was that a very sharp implement had done the cutting, because that would make it much easier to perform limb replantation surgery. But if the body part had instead been cut off due to a crush injury, that would be extremely troublesome. It would be highly likely that reattachment would no longer be possible, and that amputation was the only possible result.

Muscle repair would depend on the blood vessels. Zhang Fan and Chen Qifa began this work under the microscope. The thicker veins needed to match up exactly in order to reestablish a blood cycle. Artery repair would depend on the situation. The radial ulnar artery was one artery that was relatively easier to perform end to end anastomosis on.

Accidentally cutting off one’s hand was a known injury type that would occur around certain types of machinery. The success rate for hand reattachment surgery was the lowest out of all limb replantation surgeries. This was because of how difficult it would be to reestablish the blood cycle.

If the arteria digitalis palmaris communis was shattered near the metacarpophalangeal joints, then that would be really troublesome. The primary surgeon would need to take extra care repairing the arteria digitalis palmaris communis. This was because this vital hand artery could only have arterial anastomosis with only one finger. If the surgeon didn’t repair things properly, it would be possible for one finger to lack blood supply, which would mean an improper blood cycle that would then usually lead to negative aftereffects.

In order to help the cut off hand be restored to its best possible function, it would be vitally important to repair every single broken nerve, no matter if it was located in the wrist or palm.

The surgery proceeded very slowly. Since everything was done under a microscope, Tong Lili found that watching the surgery was incredibly boring. She had no idea what part of the surgery Zhang Fan was performing, because she was unable to see anything. She basically had no clue what was going on.

Additionally, the surgery had been going on for more than two hours by now. Tong Lili was already highly fatigued due to just having finished her final 24-hour work shift in the ICU department. Now, she had just remained standing for more than two hours, so her legs and feet were going numb. She was almost unable to remain standing. She had only stood so long by gritting her teeth and using willpower.

Zhang Fan actually was quite quick at performing surgery. Even so, more than three hours had passed since the surgery’s beginning before he finally finished repairing every nerve. The remaining steps of the surgery would be much simpler. Zhang Fan and Chen Qifa even started talking to each other.

“Pay some extra attention to this patient today, especially the blood circulation in his hand,” Zhang Fan said to Chen Qifa.

“Alright, I will do so, Teacher Zhang.” Chen Qifa nodded in agreement.

“Give the patient the standard antibiotics,” Zhang Fan said next.

“Alright.”

Zhang Fan wanted to see if Tong Lili was still focused on the surgery or not, so he suddenly asked, “Doctor Tong, what is the most common major complication for limb replantation surgery?”

“Um! Infection and necrosis?” Tong Lili answered rather uncertainly. She had been standing for more than three hours now. Due to the fact that she found the surgery to be incredibly boring, she was already beginning to daydream a little. This was because she truly wouldn’t be able to remain standing anymore if she didn’t distract herself. Because of this, she was unable to correctly answer Zhang Fan’s unexpected question.

“It’s actually vascular compromise, which is why surgery patients like this one absolutely can’t be allowed to be in an environment with any smoke or smokers. If vascular compromise occurs, antispasmodic drugs will be required. If antispasmodic drugs are still ineffective, then a second surgery will be required!” Zhang Fan explained to Tong Lili.

Zhang Fan then finally finished the hand reattachment surgery. He bandaged the patient’s hand properly, and then stretched his back.

“Let’s go! It’s finished now,” said Zhang Fan as he saw that Tong Lili was still standing by the operating table.

“My legs are numb! I don’t think I can move!” Tong Lili sounded like she was about to cry. This wasn’t because of the pain in her legs, but rather because she felt like she couldn’t get accustomed to this type of work. Not only did she find surgery to be incredibly boring, she also felt that it took far too long.

She was sad, disappointed, and blaming herself. To be honest, it would truly be difficult for a physically weak woman to perform such a high-level surgery like this one unless she truly loved microsurgery. Wang Yanan was a special exception because she really loved surgery, which gave her a great deal of motivation. However, Tong Lili was someone who had only tried to join a surgical department so that she wouldn’t be assigned to one of the hardest or most unimportant departments to work in.

Life was indeed cruel. If she couldn’t get accustomed to or perform surgical work, then she would only be able to leave the surgical departments. No compromise would be possible. The hospital wasn’t a place where compromises would be permitted for work!

Tong Lili had great difficulty in walking away with the nurse’s support. The moment that she exited the operating room, her tears that she held back for so long finally poured down onto her blue surgeon’s mask.

She far preferred having expectations to this despair! Tong Lili was unable to find any meaning to her working in surgery! She felt truly dejected! She felt as if a knife was stabbing her in the heart with the pain she felt!