top student at medical school

Chapter 161 Give First, Take Later (Please Subscribe)

Chief Physician Hongdu is probably close to sixty years old, about 1.6 meters tall, and has a thin but upright build.

With wispy bangs and white temples, he exudes a reserved and low-key demeanor.

In the few days since Fang Ziye arrived, few people have mentioned Chief Physician Hongdu. However, whenever Chief Physician Hongdu speaks up, even Director Zhang Mingcan readily agrees. Wu Guonan, the newly appointed Chief Physician, shows no intention of refusing.

Fang Ziye stayed behind and approached Director Hongdu to explain: "Director Hong, I can help, but all I can do right now is the routine stuff. As for what to do, I might not understand."

This is similar to the fact that every adult male has the strength to manually reposition a body, and the general procedure is also simple.

But knowing how to reset it, that kind of understanding, is valuable.

If you were to compare a surgeon's absolute strength to that of a fitness enthusiast, they would still be somewhat outmatched.

The team led by Director Hongdu is full of talented people. Among them is Huang Kai, the most senior associate chief physician in the department, and Zhang Jinchuan, whom Fang Ziye had met a few times before. Zhang Jinchuan was the on-call doctor when Fang Ziye first arrived.

Below them are Cao Zhen, a master's student at the Affiliated Hospital of Three Gorges University, and another person undergoing regular residency training. The team has enough personnel.

Fang Ziye spoke with Director Hongdu, and also nodded to Huang Kai and the others, but did not directly call out to them.

Upon hearing Fang Ziye's explanation, Chief Physician Hong Du did not offer an explanation, but Associate Chief Physician Huang Kai laughed.

Huang Kai has a large mouth and speaks with an indescribable softness: "Ziye, you don't know this, do you? The Director Hong standing in front of you is the real pillar of our trauma surgery department."

"The reason why our orthopedics department at Enshi Central Hospital has reached its current scale is entirely due to the efforts of Chief Physician Hong Du."

"Director Hong can perform surgery on the atlas of the cervical spine all the way down to fractures of the little toe. From external fixation braces to intraosseous tumors, all are areas where Director Hong is skilled."

"Director Hong spent the first twelve years specializing in spinal surgery, which was the best in Enshi. He then spent fifteen years working on joint surgery, and now our department is the best in Enshi for joint surgery. And with the opening of the new trauma center, Director Hong..."

While Huang Kai was still exchanging pleasantries, Hong Du patted him on the shoulder and said, "Alright, alright, Huang Kai, do you think Dr. Fang is one of the people you usually meet?"

"You're bringing up things I've done in front of a top orthopedic hospital in Hubei Province like Zhongnan Hospital. Isn't that embarrassing?"

"Xiao Fang, let's go. Let's go down from the operating room first, and then we can talk as we walk."

"After all, I have a certain relationship with Chen, the old Chinese medicine doctor who came from Enshi. We collaborated when he was organizing the manual reduction technique and its application in modern medical clinical practice."

"It's just that I started late and can't keep up with Dr. Chen's level of skill, but I might still have some experience in what kind of fractures can be reduced." Hong Du dropped a bombshell in a rather low-key manner.

An old house where a treasure.

Although it is said that older surgeons are no longer skilled in physical labor, who can ignore the knowledge and experience he has gained through decades of clinical practice?

Upon hearing this, Fang Ziye immediately nodded and followed. He glanced at Director Wu Guonan and the others from afar, and they went about their ward rounds and doing whatever they were supposed to do.

I never even considered that I was no longer in the group.

It is evident that this unassuming old director in Hongdu wields absolute power within the department; at least in terms of status, even Zhang Mingcan would likely have to show him considerable deference.

On the way out of the operating room, Fang Ziye got to know Huang Kai, Cao Zhen, and Zeng Weihang again.

Fang Ziye's deepest impression of Huang Kai was that he had a big mouth, thick lips, and although he wasn't broad, he was muscular and a die-hard fitness fan.

He was nicknamed "Upturned Mouth" both inside and outside the group.

The other Cao Zhen is more low-key, with medium-length hair that usually covers his eyes. Only in the operating room will he tie his hair up and tuck it into a hat to avoid obstructing his vision.

"Wow, Director Huang, you're amazing! I really need to learn a lot from you." In the locker room, when Zhang Jinchuan was explaining things to Fang Ziye, Fang Ziye realized that all the giants of the trauma center were concentrated in Director Hongdu's group.

Although Zhang Mingcan appears to be the administrative director of the ward, the talent under his command is definitely not as good as that here.

Despite his upturned lips and thick lips, Huang Kai, as an associate chief physician at a prefecture-level city hospital, won first prize in the Hubei Provincial Young Physicians' Hand Surgery Skills Competition. There were eight first prizes and three special prizes.

Furthermore, Huang Kai also won the third prize in the National Skills Competition for Minimally Invasive Spinal Surgery. There were only fifty second prizes nationwide, and even including the twenty first prizes and five special prizes.

Huang Kai, who was one of the hundred third-prize winners, must have had a very impressive resume; he must have had something special to earn that award.

Currently, the main focus is on minimally invasive spinal surgery, specifically arthroscopy.

Huang Kai said, "It's all just empty fame, there's no need to take it seriously. It's just the judges' flattery. There's nothing to it about how great or not great."

"Compared to truly skilled people, what am I? Many people wouldn't even bother participating. You don't need to care about that."

Huang Kai's voice is slightly hoarse, but not in an unpleasant way.

After putting on their scrubs, the group arrived one after another at operating room 9.

The operating room is now well-staffed, with two circulating nurses and one scrub nurse. None of the three nurses went on the operating table, presumably because Chief Physician Hongdu had given prior instructions.

After Director Hongdu entered the operating room, one of the older nurses asked, "Director Hong, shall we do a few repositioning surgeries today? If we can't reposition them, then we'll have another surgery?"

"I didn't prepare enough surgical kits right away, but I can disinfect and rotate them at any time."

"Yes, that's fine. I'm very confident in you working with me, Xu Xia." Director Hongdu watched as the anesthesiologist administered the anesthesia, then plopped down on the round steel stool and casually placed his phone on the shelf.

Upon seeing this, several nurses immediately stood up and gave up their seats.

The older nurse said, "Director Hong, you're joking. I was trained by you, and now the hospital has arranged for me to learn from you. It's my good fortune."

The nurse's words were loaded with meaning. It was clear that she was a specialist nurse assigned to Hongdu Hospital and not participating in the hospital's on-call duties.
There must be something there too.

After all, Director Hongdu specializes in three sub-specialties: spine, joints, and trauma. If she can keep up with all of them, her knowledge base is certainly not narrow.

Hong Du chuckled, then looked at the anesthesiologist. His words immediately sent a chill down Fang Ziye's spine.

"Teacher Nie, is the anesthesia easy to administer?" Hong Du's tone was serious and respectful.

Upon hearing this, Fang Ziye turned his gaze, thinking he had misheard.

The person being anesthetized was at most thirty-one or thirty-two years old. At that age, he was more like a junior anesthesiologist. Fang Ziye's first impression was that he had come along to get the medication in advance, and that the chief physician or senior attending physician of the anesthesiology department would be called over when it was time to administer the anesthesia.

Hongdu's address, "Teacher Nie," left him somewhat bewildered.

While administering nerve block anesthesia, he turned around and smiled slightly after he had probably inserted the needle into the correct position: "Almost done, Director Hong. Please wait a few more minutes."

"I've already taken over the next surgery patient, and I'm about to go to the pre-anesthesia room outside for anesthesia."

"It shouldn't take up too much of your time, Director Hong."

Hongdu said, "It's alright, Teacher Nie, you go ahead with your work. We'll wait for you, haha."

The young man turned his head and said, "Director Hong, why don't you change your way of addressing me and call me Mingxian?"

"Don't call me Teacher Nie anymore."

Hongdu shook his head decisively: "That won't do. A top student like you, I have to support you."

"Oh, by the way, Professor Nie, this is Dr. Fang from Zhongnan Hospital, Professor Deng Yong's student, whom your old classmate Dr. Wu mentioned to you yesterday."

For a moment, Fang Ziye felt that the amount of information was a bit too much.

We need to summarize this properly.

In other words, it was Dr. Wu Xuanqi who first came over to greet Director Hongdu and asked Director Hongdu to bring him down today to perform manual reduction. He also made arrangements with the anesthesiologist!
hiss! ~
Why is this?

Is this some kind of tactic?

But it doesn't have to be that bad. Dr. Wu Xuanqi hasn't asked him to do anything. Compared to Zhang Mingcan, Dr. Wu Xuanqi has given him far more than he imagined so far. And all he asked for was some guidance on basic experimental techniques.

Fang Ziye felt a bit confused.

The man named Nie Mingxian turned to look at Fang Ziye, smiled, then slightly withdrew the needle of the nerve block anesthesia, injected a little more medication, and then said, "Director Hong, the anesthesia here is done. I'll go and give the anesthesia to the patient outside now."

"The estimated time is ten minutes after we bring the patient to the operating room, then we transfer the patient back to the ward and the next patient to the pre-anesthesia room before the operating room, and then it will take about twenty minutes."

"They should be about the same."

“You also have time to rest.” Nie Mingxian precisely controlled the time to within ten minutes, speaking clearly.

After saying that, Nie Mingxian glanced at the patient's vital signs on the monitor one last time, then decisively turned around, picked up his medicine basket, and went out.

Fang Ziye was still a little confused, his eyelids twitching rapidly, his face full of doubt.

Seeing this, Director Hongdu stood up and explained to Fang Ziye, "Dr. Fang, this Nie Mingxian used to be a seven-year student at the Third Affiliated Hospital of Kyoto University, and later came to work at our hospital."

"He was originally an emergency room doctor, but because our anesthesiology department was short-staffed and Dr. Nie's anesthesia skills were excellent, the head of the anesthesiology department brought him in. His understanding of anesthesia and the duration of anesthesia was at a very high level."

"Basically, if the anesthesia is to last fifteen minutes, it will not exceed eighteen minutes, with a maximum error of three minutes."

"Currently, we are in the operating room conducting clinical research on the duration of anesthesia, drug dosage, and the location of anesthesia."

"Let's get started. Dr. Nie has already set aside time for us."

"This patient's fracture..." Director Hongdu had a very clear understanding of the patient's fracture; he knew it almost without looking at the X-rays.

Not only did they classify his fractures using the AO and special classification methods from the perspective of modern medicine, but they also quickly presented the corresponding theories and techniques for its reduction to Fang Ziye.

After saying that, Hongdu asked, "So, Ziye, do you know how to do this?"

"In fact, manual reduction technique is all about reduction and fixation, while self-fixation is all about analyzing the clamping point and the point of force."

"Through muscle contraction, impaction of fracture fragments, and embedding, the fracture fragments are self-fixed while simultaneously achieving reduction."

"It's quite complex in theory and difficult to operate."

Upon hearing this, Fang Ziye ignored the matter of Nie Mingxian's deeds. What kind of person Nie Mingxian was was currently none of Fang Ziye's business.

When performing manual reduction on a patient, with knowledgeable techniques readily available and with Senior Chief Physician Hongdu providing a thorough analysis, it's best to focus on the knowledge aspects first.

Upon hearing this, Fang Ziye nodded: "It should be achievable. Director Hong, this patient's fracture is a type B2.3 fracture, which is a double fracture of the tibia and fibula."

As Fang Ziye pointed to the X-ray film hanging on the viewer, he said, "In the understanding of modern medicine, if the fracture ends are aligned by manual reduction, it is still an unstable fracture and requires internal fixation, preferably intramedullary nailing of the tibia and plate screws at the fibular ends for complete fixation."

"Based on your analysis, the stability of the fracture ends can actually be achieved by compressing the midshaft fracture with the fracture stump, and then by using the stretching force of the anterior tibialis muscle group and the passive contraction force of the posterior tibialis muscle group."

"This is very difficult. Please wait a moment while I see how to arrange the repositioning." Fang Ziye was hesitant to agree directly.

He still lacks a deep understanding of how to reposition the object and why it should be done in this way.

Before this, Fang Ziye had never doubted the correctness of the current modern medical guidelines for fracture treatment, nor did he allow himself to question his own abilities.

"No rush." ​​Hongdu shook his head slightly, then went to comfort the patient.

"You're not in a hurry, are you? It definitely won't hurt, right? If it doesn't hurt, just think of it as a rest, close your eyes for a bit, and don't listen to our conversation."

"Leave the professional matters to our professional doctors. This Dr. Fang is the same Dr. Wu from Minzu University Hospital you mentioned, who highly recommended him. You can rest assured that he will handle the procedure. I'm here too." Hong knew exactly what his task was.

Upon hearing this, Fang Ziye felt a slight chill run down his spine.

At this moment, he was thinking about whether his master knew about Chief Physician Hongdu. Although Chief Physician Hongdu was more than ten years older than Deng Yong, with his demeanor, he should know him, right?

Why wasn't it mentioned?
The patient smiled and said, "Director Hong, I trust you and Dr. Wu. I also trust Dr. Fang. Now that I'm here with you, I don't plan to think about anything else."

"You provide the skills, I'll provide the money; you suffer, I'll suffer the pain!" the patient said playfully.

After about two minutes, Fang Ziye finally understood some things and said, "Director Hong, I think it's about time. Let's begin. It may not be successful on the first try, but with your guidance, I think the chances of successful repositioning and self-fixation are very high."

Fang Ziye misappropriated Director Hongdu's statement.

Closed reduction does not require absolute aseptic technique or sterilization. This is because cases that can be closed reduction are definitely not open fractures.

and!
All you need to do is wear sterile gloves to protect your skin from the patient's.

Therefore, Fang Ziye, Hong Du, and Huang Kai each removed a pair of sterile gloves and then began the procedure.

Hongdu personally designed the traction anchor point and provided counter-traction force.

Huang Kai helped with traction, while Fang Ziye controlled the main direction of force and the repositioning process.

As soon as the operation began, Huang Kai's eyes lit up instantly. He looked at Fang Ziye with surprise and foresight: "As expected, it can mobilize the power of muscles."

"This is a perfect combination of modern and traditional medical theories, such an operation."

Director Hongdu didn't speak because many muscles in the lower limbs originate from the medial and lateral condyles of the femur. The position where he applied the counter-traction force was right there, so he naturally felt the number of muscles that Fang Ziye was directing.

She smiled slightly.

When he first came into contact with more advanced reduction techniques, he was already quite old. Although Dr. Chen had asked him if he wanted to learn more, Hongdu himself felt that he couldn't go very far in that area.

"Yeah, Xiao Fang's skills are pretty good."

"He has a style that is somewhat comparable to Dr. Wu's," Hong Du said.

Fang Ziye's heart skipped a beat.

He knew that this senior brother might be slightly better than him in terms of manual repositioning techniques.

But it's okay, it's normal that the senior brother is taller.

If Luo Tingzhu had also been in the medical field for that long, she would probably have reached level 4 or higher. After all, Luo Tingzhu has only been in clinical practice for less than a year, yet she has already reached level 3 or higher.

That's equivalent to gaining 200 proficiency points per year. Reaching level 4 takes about two to three years, and if the opportunity arises, there will be further promotions.

"That's why I've come to learn, Director Hong. I hope you can give me a lot of guidance." Fang Ziye's attitude was upright.

After saying that, he made a slight snap, and after releasing the force, the patient's fracture was corrected and in place.

Unexpectedly, the other two circulating nurses very professionally pushed the C-arm machine closer and, without much guidance, directly to the position for taking pictures.

The level of coordination between them gave Fang Ziye a strange feeling, as if he were still at Zhongnan Hospital.

After reviewing the footage, Hong Du and Fang Ziye were quite satisfied, so Huang Kai naturally didn't dare to have any objections and immediately led Zhang Jinchuan and the others to start applying the cast...

Fang Ziye originally wanted to help, but Huang Kai hinted at him, "Don't you have any questions for Director Hong?"

Fang Ziye then obediently sat down next to Hongdu again.

He asked the question that had been bothering him: "Director Hong, why did this Senior Brother Wu ask you for guidance?"

"Give before you take, give generously and take sparingly, take the seedlings but not the fruit—this is the way of a gentleman," Hongdu explained to Fang Ziye with a smile.

(End of this chapter)