Chapter 170: Autistic Fatty Tong!
October 10th, Saturday, a light drizzle.
In the operating room, Tong Yuan’an put on a sterile surgical gown and asked, “Xiao Lu, you’re on clinic duty tonight, right?”
Lu Cheng nodded, “Yes, Teacher Tong. I’m just following the regular shift schedule now.”
“Today’s surgery shift is Tian Zhuang, and it’s a limb replantation, so Han Xiaoping can only call you.”
After Lu Cheng and the circulating nurse finished placing the last drape, he smiled and said, “If you, Teacher Tong, said you were unavailable, the patient would have to be referred elsewhere.”
“Fortunately, you, Teacher Tong, are willing to work overtime.”
Ever since Lu Cheng stayed up for ninety-six hours in the department during the National Day holiday, he no longer dared to disobey the normal schedule and respect the fate of others.
Lu Cheng was even more afraid of burning himself out.
“Alright, I’ll try to finish up quickly later, before you have to go on your shift.”
Tong Yuan’an nodded, “Fortunately, it’s just a forearm amputation, not a finger amputation, so the workload isn’t that heavy.”
A finger amputation could mean multiple finger amputations. The cut surface of a forearm amputation is wider, but it’s a single cut, making it relatively less complex to handle.
“Okay, Teacher Tong.”
Lu Cheng sat down in the assistant’s seat directly opposite Tong Yuan’an, fully prepared, just waiting for Tong Yuan’an to take the chief surgeon’s position.
Once on the operating table, Tong Yuan’an and Lu Cheng worked together to meticulously examine the patient’s stump. “It’s okay. While it’s not the simplest knife cut, it’s also not a crush injury. It’s relatively easier to handle.”
“The patient’s injury time is not long, so the surgery should go smoothly.”
“First, we’ll debride, then fix the bones. During debridement, one of us will handle one side, and the other will handle the other.”
“I’ll take the amputated side,” Tong Yuan’an proactively took on the more difficult part.
“Okay, Tian Zhuang, you and Professor Tong will be responsible for the distal debridement together. I’ll handle the proximal end by myself first.” Lu Cheng assigned Tian Zhuang to assist Tong Yuan’an.
Debridement is a fundamental skill, but since the distal limb has no blood supply, it requires a more meticulous assessment of tissue necrosis and finer manipulation.
The blood supply to the proximal end, during debridement, can be assessed for necrosis through bleeding points.
Lu Cheng’s debridement skill was upgraded during the National Day holiday to 【 Debridement （ Mastery 5/20 ）】.
If he hadn’t leveled up his basic skill in debridement, Lu Cheng might not have wasted skill points on it, as limb replantation surgery couldn’t be upgraded without it.
Basic skills are basic skills, but the overall concept of limb replantation surgery was incorporated into 【 Limb Replantation Surgery 】.
Lu Cheng’s 【 Limb Replantation Surgery 】 was already （ Mastery 20/20 ）, so Lu Cheng handled the stump with ease.
With his focus and steady hands, his operating speed was even faster than Tong Yuan’an, who had an assistant.
Lu Cheng had performed limb replantation surgery as chief surgeon during the National Day holiday, so the scrub nurse Xue Xue was not surprised.
However, Tong Yuan’an, seeing Lu Cheng’s incredibly fast debridement, his fleshy face twitched slightly. He wanted to remind Lu Cheng that there was no need to rush; his teacher, Teacher Tong, would definitely ensure the surgery was completed before Lu Cheng’s evening shift.
After looking back and forth a few times, Tong Yuan’an finally understood Lu Cheng’s ‘trick’!
If tendon suturing is compared to technique, and suturing is basic skill, then debridement and suturing, nerve suturing, and vascular suturing are all basic skills, while the overall surgical procedure for limb replantation is the “technique.”
Basic skills determine the lower limit of surgery quality, while “technique” indicates the upper limit of surgery quality.
Tong Yuan’an couldn’t tell Lu Cheng’s skill level at first glance just by looking at the debridement. But after observing for a few moments, he finally noticed something was not quite right.
Lu Cheng’s movements were too smooth, going far beyond just reciting a procedure by heart.
With this doubt in mind, Tong Yuan’an put down his instruments and patiently continued to watch for another half a minute.
His playful and observant gaze slowly turned solemn and astonished.
If he wasn’t mistaken, and his assessment wasn’t wrong.
Lu Cheng’s current comprehensive skill level in limb replantation surgery had, perhaps, possibly, likely… again and again…
Tong Yuan’an’s own surgical skill was considered quite high at Xiangya Hospital, and even Han Yun Shen, another associate professor, had a broader range of surgical expertise.
However, in terms of surgical depth, he couldn’t match Tong Yuan’an.
Limb replantation surgery is a standard procedure in hand surgery. For a seasoned hand surgeon to call themselves a hand surgeon, this is an essential introductory procedure, a hallmark of a hand surgeon.
However, in reality, not every hand surgeon has achieved profound proficiency in limb replantation surgery.
Knowing a technique, being highly proficient in it, or even being an absolute expert in it are several different concepts.
According to Tong Yuan’an’s understanding, to be able to perform limb replantation surgery normally, one first needs a certain accumulation of basic skills, followed by extensive clinical practice.
For himself, his current skill level was achieved through practicing on hundreds of severed limbs and fingers, which allowed him to surpass a “surgical genius” like Han Yun Shen in terms of specialization.
Therefore, Tong Yuan’an’s current confusion was: Lu Cheng had only recently started engaging in limb replantation, so where did he get so many hands to practice suturing on?
In just one week, how had Lu Cheng’s proficiency reached such a level?
Tong Yuan’an, being a seasoned surgeon, was not so unprofessional as to stop Lu Cheng and question him.
However, precisely because of this professional integrity, Tong Yuan’an felt particularly uncomfortable.
Having a strong suspicion but being unable to confirm its veracity was truly frustrating…
Tong Yuan’an watched for about three minutes before he suppressed his feelings and resumed his debridement.
With the surgery shifting his focus, Tong Yuan’an’s mind finally settled, and he became fully engrossed.
As time passed, about fifteen minutes later, Tong Yuan’an’s thoughts became restless again.
It was because Lu Cheng was looking at him now!
The reason was simple: Lu Cheng’s proximal debridement was completed, and he was now waiting to proceed with bone fixation, which is osteosynthesis.
However, the distal limb was not yet fully debrided, so Lu Cheng had to wait.
While waiting, Lu Cheng could only “watch” as Tong Yuan’an had done before…
Tong Yuan’an noticed Lu Cheng’s gaze, but after a few subtle movements of his Adam’s apple, he glanced again at Lu Cheng’s debrided stump.
If he were to be overly critical, he couldn’t find any fault that would make Lu Cheng stop “watching.”
This, in turn, put Tong Yuan’an under pressure—
Damn it.
What was his identity? A doctor on a rural assignment, here for paired assistance.
In other words, he was here to teach.
But the current reality was that his student’s skill level had surpassed his own. What kind of teaching was he conducting?
How would he manage his extended rural assignment period?
Was it possible that Lu Cheng only had better basic skills in debridement, but his limb replantation surgery was still lacking?
Tong Yuan’an dismissed this thought within seconds, as it was even less likely.
Tong Yuan’an was well aware of his own debridement skill level; it was impossible for Lu Cheng to surpass it. If he could, even with meticulous scrutiny, he might not find any flaws.
Lu Cheng couldn’t possibly have flaws in his handling of details that he could find.
After another seven or eight minutes, Tong Yuan’an finally finished the debridement.
With other thoughts in mind, Tong Yuan’an said in a cold voice, “You’re young and agile, you handle the rest.”
Lu Cheng glanced at Tong Yuan’an upon hearing this. Not detecting any ‘jest’ or ‘doubt’ in Tong Yuan’an’s eyes, he nodded and agreed.
“Okay, Teacher Tong.” After agreeing, Lu Cheng began to rinse the stump with heparin saline.
Immediately, Lu Cheng very rapidly performed manual reduction and alignment of the bone ends of the severed limb.
The hand was completely severed, so during replantation, there should be no directional deviation. This step is crucial…
Otherwise, even if the suturing is done well, if the bone reduction isn’t done properly, the postoperative hand position will be completely different from a normal hand, which would be a huge embarrassment.
Generally speaking, this process is not difficult, but it still requires a certain amount of time to manage all the anatomical structures appropriately.
Lu Cheng addressed each one accordingly, but it was evident that Lu Cheng’s response speed was very agile.
Ulna, radius, nerves, blood vessels, tendons…
Lu Cheng took less than two minutes to align each one, finding the correct orientation for connection.
After aligning them, Lu Cheng instructed Tian Zhuang to insert K-wires for temporary fixation, thereby securing the alignment.
After inserting the two K-wires, Lu Cheng and Tian Zhuang began to apply the steel plate…
The difficulty of performing internal fixation with steel plates and screws for limb replantation is far lower than for non-amputated fractures.
Because there is no soft tissue tension, the distal hand can be rotated 360 degrees, and the entire circumference of the bone is exposed, providing ample visualization.
Applying a steel plate under these conditions is a procedural step.
Locate the fracture line and strip the periosteum.
After placing the steel plate on the bone ends, drill holes according to the screw formula, determine the screw length by measuring depth, and then insert the screws with an electric screwdriver.
In just half an hour, Lu Cheng and Tian Zhuang completed the internal fixation of the ulna and radius with steel plates and screws.
This speed wasn’t breakneck, but it was quite fast. Even Tong Yuan’an estimated his own time to be over forty minutes.
Based on this, Tong Yuan’an became even more convinced that Lu Cheng’s current proficiency in limb replantation surgery was likely higher than his own.
This guy’s talent was simply beyond that of ordinary people.
Talent is something you can’t understand without experiencing it. For example, I’ve never performed the entire procedure of open reduction and internal fixation for fractures, yet I can do such surgery.
But once they’ve operated a few times, one of their operations is equivalent to ten or fifty of others.
They don’t need a large volume of surgeries to push their surgical proficiency to the extreme.
For such individuals, the most important thing is the first few surgeries they perform as the chief surgeon…
Surgery is learned by doing, not by watching.
“Continue,” Tong Yuan’an said before Lu Cheng could even ask with his eyes.
Lu Cheng immediately began to suture the muscles and tendons.
This was even more of Lu Cheng’s forte…
Tong Yuan’an could only envy Lu Cheng’s speed, quality, and choice of techniques.
How many types of tendon suturing techniques did Lu Cheng know? How high was his proficiency level in these techniques?
Tong Yuan’an had the deepest understanding.
For example, in the newly developed Tajima suturing technique, he was even more proficient than the surgical team led by Professor Tajima himself.
In his own team’s original “Tong Method,” he was more skilled than Tong Yuan’an himself, not to mention that Lu Cheng also had his own newly developed ‘suturing technique’!
It’s just that these techniques couldn’t be used arbitrarily. Lu Cheng wasn’t yet an associate senior physician, so he couldn’t create new techniques for fear of being reported. Otherwise, the quality of the vascular bed Lu Cheng could create might even surpass that of the old professors at Xiangya Hospital, which was uncertain.
…
The tendon and muscle suturing were completed by Lu Cheng not only quickly but also with better quality, which Tong Yuan’an naturally recognized.
Of course, Tong Yuan’an had also seen Lu Cheng’s less skilled moments, so he didn’t find Lu Cheng’s current excellent performance to be fake.
Having witnessed Lu Cheng’s journey, he understood even better the exaggerated speed of Lu Cheng’s growth.
After suturing the muscles and soft tissues, the next critical step was vascular suturing.
The diameter of the arteries and veins in a forearm amputation is much larger than that of severed fingers.
In hand surgery, some highly skilled professors have even joked that while arteriovenous anastomosis for severed fingers requires microsurgical instruments, limb replantation at the forearm level and above can be completed without them.
This is where a person’s true operating skill is tested.
Of course, this was just a joke.
The essence of human civilization lies in humans’ flexible application of various tools, not in abandoning better tools and unreasonably pushing their potential.
…
In terms of vascular suturing, Lu Cheng’s operation was satisfactory and not beyond Tong Yuan’an’s comprehension. On the contrary, Tong Yuan’an found many areas for improvement in Lu Cheng’s vascular suturing.
After all, this was Tong Yuan’an’s master operation, the basis of his advantage over his peers, and not something Lu Cheng could casually surpass.
However, in terms of nerve suturing, Tong Yuan’an could only smile and say nothing.
This was a genuine “technique” that Lu Cheng had learned from the advanced training class at Xiehe Hospital. The basic principle was the same: combined suturing of the epineurium and perineurium, but the specific operational mode…
Since Tong Yuan’an had not asked Lu Cheng for the specific details, he couldn’t fully understand.
However, Tong Yuan’an was certain of one thing: the Hand Surgery Department at Huazhong Xiehe Hospital was extremely adept at nerve suturing.
Nerve suturing and handling nerve-related issues are considered the specialty and hallmark of Huazhong Xiehe Hospital, renowned nationwide.
While Xiangya Hospital’s hand surgery department’s strength was not to be underestimated, it lacked such a distinctive “stronghold”!
Considering this, Tong Yuan’an’s scalp went numb.
He glanced at the surgery timer panel.
【16:02:32:14】 4:02 PM.
【03:45:54:32】 Surgery duration: three hours and forty-five minutes.
The remaining subcutaneous tissue and skin suturing would take at most another half an hour. This meant Lu Cheng could finish the surgery around 4:30 PM.
And the quality would be excellent.
The concerns Tong Yuan’an had speculated about had, as expected, come to pass.
As a teacher, he would be teaching in vain in front of Lu Cheng.
For the remaining subcutaneous tissue and skin suturing, Lu Cheng handed it over to Tian Zhuang.
Tian Zhuang wasn’t confused by anything else and diligently and meticulously proceeded with the normal operation.
Lu Cheng, while cutting the sutures, said to Tong Yuan’an, “Teacher Tong, this surgery today can be billed as limb replantation, right?”
The overall fee for limb replantation surgery was higher than billing for individual components.
Lu Cheng was not an aloof person. He believed in receiving fair compensation for his labor.
If he couldn’t operate, it couldn’t be helped, but if there was someone capable on the operating table, the appropriate fees should still be charged.
Tong Yuan’an’s fleshy face twitched for a while, but due to the mask, Lu Cheng couldn’t see it.
He nodded slightly, “Mm…”
Tong Yuan’an spoke sparingly.
Lu Cheng continued, “Teacher Tong, I’m on duty at the emergency clinic tonight, so I won’t have much time in the evening. Please arrange your own dinner later.”
Chen Song was still in Long County, but no one else knew about it. Chen Song didn’t want to be bothered by phone calls during his leave of absence, so he asked Lu Cheng and the others not to publicize it.
He had applied for leave of absence for scientific research at Xiangya Hospital; it had nothing to do with his rural assignment.
The surgeries in Long County were not his responsibility.
“Mm… okay.” This time, Tong Yuan’an responded with a more generous two words.
Lu Cheng: “???”
What was wrong with Tong Yuan’an this time?
Honestly, Lu Cheng preferred the playful Tong Yuan’an to the “Cat Person” Tong Yuan’an who had become like Chen Song.
Tong Yuan’an ended the conversation. Lu Cheng tried to force a casual chat for over a dozen sentences without breaking the ice, so he stopped trying.
It was obvious that Tong Yuan’an didn’t want to talk at the moment.
The surgery concluded smoothly. The patient had received nerve block anesthesia and was directly transferred from the operating room to the observation ward.
Immediately after the surgery, Lu Cheng returned to the doctor’s office in the observation ward of the Emergency Department to write postoperative medical orders and the surgical record.
Chief Surgeon: Tong Yuan’an, First Assistant: Lu Cheng, Attending Physician, Second Assistant: Tian Zhuang, Attending Physician. Proposed Surgery: Limb Replantation Surgery. Actual Surgery Performed: Limb Replantation Surgery…
Long County, Chen Fu Chai Huo Ji.
Chen Song, in a rather bad mood, sat with vacant eyes, hands behind his back. Upon seeing the large, plump Tong Yuan’an enter, he glanced at him sideways without speaking.
He slightly raised his chin, and his shiny forehead reflected the light, piercing Tong Yuan’an’s pupils.
After entering, Tong Yuan’an sat down on Chen Song’s left side, his arms crossed, his well-developed muscles bulging like hills.
After sitting for a while, Tong Yuan’an raised his large right palm, rubbed his thick beard on his left cheek, and showed no inclination to speak.
Chen Song glanced at Tong Yuan’an and jabbed, “Did someone cut your vocal cords today?”
Don’t you see I’m in a bad mood?
Tong Yuan’an’s eyeballs rolled halfway towards Chen Song, and he turned his body halfway, closing his eyes.
As he took deep breaths, his broad pectoral muscles heaved, and his breathing was somewhat heavy. He still didn’t reply…
No one knew the embarrassment Tong Yuan’an was experiencing at that moment.
As an associate professor at Xiangya Hospital, he should have been happy during his rural assignment, as he could show off, be flattered by the local doctors, and earn respect through his skills – a definite sense of accomplishment.
But damn it, just as he extended his training period, Lu Cheng had hit him with a club.
The problem was, this club was a mace. On the left were his original tendon suturing techniques, and on the right were the nerve suturing techniques learned at Xiehe Hospital, trapping him in the middle, unable to break through on either side…
Under the guise of a visiting doctor, he was surpassed in technical skill by someone else.
Now, not only could he not show off, but he also had to be cautious and accommodating. Perhaps, if he wasn’t careful, Lu Cheng might even find fault with him.
Surgery is ultimately a profession where ability comes first and technique is paramount. If you have the ability, you can naturally walk around with impunity.
But a vice professor in Long County had to be so cautious. What was the point of this rural assignment?
The problem was, Tong Yuan’an had already extended his training period. Once the process started, he couldn’t just decide to stop.
Chen Song was smart and had directly taken leave.
Only he, the large, plump Tong Yuan’an, had gotten himself into this predicament.
Tong Yuan’an still remained silent, prompting Chen Song to notice something was wrong: “Bro? What’s up?”
Tong Yuan’an kept his eyes closed, took two deep breaths, and then sighed, “Sigh…”
“Speak up,” Chen Song said.
“I’m fucking stuck,” Tong Yuan’an opened his eyes, tilted his head, his beard on the left cheek almost scratching his cheekbone.
Chen Song shifted slightly, afraid of being misunderstood as returning from advanced studies in Chengdu: “Explain it clearly.”
“That kid Lu Cheng…” Tong Yuan’an then slowly explained the whole story.
He concluded, “So, that’s the situation. Bro, I can’t stay calm anymore. I might have to walk on eggshells from now on.”
The former Tong Yuan’an, during his rural visits, only saw unprofessional aspects. His casual remarks were things beyond others’ comprehension, and he felt very comfortable.
It was equivalent to a graduate student walking into an elementary school classroom; it was quite relaxing.
However, Chen Song did not mock Tong Yuan’an and said with a furrowed brow, “We two brothers are truly suffering together. Our downfall happened at the same time.”
“Don’t be sarcastic,” Tong Yuan’an glared and flexed his biceps, assuming a stance as if ready to fight Chen Song.
“Lu’s girlfriend has put me in a difficult position,” Chen Song said.
Tong Yuan’an raised his upper eyelids and looked at Chen Song with a sharp gaze, not noticing the amusement in Chen Song’s expression.
“How so?” Tong Yuan’an asked.
“This is absolutely not an ordinary young girl. She knows too much about scientific research.”
“From basic cellular experiments to all the processes of clinical trials, she basically has no blind spots.”
“The research accumulation in our hospital’s emergency department is not enough for her to even chew on. In front of her, I feel like half a research novice.”
“Today I gave Mu Nanshu twenty suggestions, and she found twenty-eight immature points,” Chen Song said, scratching his hairline almost bald.
“Cough, cough…” Tong Yuan’an coughed a few times.
“Twenty suggestions, twenty-eight bad points? Chen Song, you’re quite a character!”
Chen Song replied impatiently, “You better believe it. You’ll also have to deal with this young lady, so you’d better pray your research group is up to par.”
“Otherwise, it’ll be your turn for twenty suggestions to be found with thirty flaws.”
Tong Yuan’an extended his hand, his mouth contorted into a pained expression, “Don’t speak yet. Didn’t Lu Cheng say that girl at his home is also delayed graduation?”
