American Medicine: I survived the death knell thanks to the devil.

Old Hudson sat on the right side of the podium.

He is nearly eighty years old.

Tenured professor of orthopedics at Columbia University and former president of the American Academy of Orthopaedic Surgeons.

His textbook, "Orthopedic Surgery," has been revised to its ninth edition and has been read by every doctor in the United States aspiring to become an orthopedic surgeon.

He doesn't handle administration.

But even the head of surgery has to address him as "Professor".

The old man was wearing a gray suit, no tie, and the top button of his shirt was undone, revealing an old scar from over fifty years ago below his collarbone.

It is said that he was hit by shrapnel at the Saigon Third Field Hospital during the Vietnam War.

He tapped the projection screen with his index finger.

"When this article was published last month, I was fishing in Florida. My wife read it to me; she thought I would be interested."

A few people below laughed.

Hudson's wife was a retired professor of anesthesiology, and the two were notoriously at odds on their tastes in medical literature.

"But this time, she was right."

Old Hudson picked up a printed paper from the table, turned to the third page, and patted it twice.

"Fingertip blunt dissection. Using fingers to penetrate the mediastinum, a deformed bullet is located and removed by touch without visual guidance."

He paused for a moment and looked around the classroom.

"I saw a military doctor doing this in Saigon in 1969."

"John McCord, a trauma surgeon at the Third Field Hospital. A Marine being carried off a helicopter with a steel-core AK-47 bullet lodged in his chest."

"He inserted his right index and middle fingers along the intercostal muscles, felt around for about forty seconds, and then pulled the bullet out."

"For the next fifty-seven years, I never saw a surgeon perform this procedure on a living person again."

He raised his head, his gaze passing over the heads of the resident doctors in the front row, and landing on the middle left.

Lynn sat there with a pen tucked into the pocket of his white coat.

"Until this paper."

Old Hudson put down his paper.

"Modern surgery has evolved to the point where we have so many great technologies: CT scans, ultrasound, intraoperative fluorescence, da Vinci radioscopy, 3D reconstruction, and so on. So great that many young surgeons have forgotten one thing: your finger is your earliest probe."

"Dr. Lin proved something in this case. Under the most extreme conditions, when all other instruments are out of time, a pair of well-trained hands is faster than any equipment."

He turned to the last page of the paper.

"It's well written. The intraoperative decision tree is clearly drawn, the anatomical path is accurately described, and the diagrams are labeled down to each layer of fascia. Dr. Cabot's academic expertise ranks first among the younger generation at Metropolitan Hospital, and I don't think anyone would disagree."

Julian, sitting two rows to Lynn's right and behind him, nodded slightly.

"But most importantly, this article has significance."

Old Hudson took off his reading glasses and wiped them.

The right hand exposed while wiping glasses showed a noticeably thickened radial styloid process, limited thumb abduction, and slight fusiform swelling at the metacarpophalangeal joints.

The signs of active rheumatoid arthritis are that these hands are no longer suitable for surgery.

"Our textbooks contain thousands of surgical techniques, each based on a surgeon's first attempt. The application of blunt finger dissection in modern emergency trauma was previously not systematically documented in the literature. Now it is."

He put his glasses back on.

"This is how surgery should progress. It's not about waiting for someone to invent a new machine, but about someone being willing to put their hand in."

The applause wasn't enthusiastic, but it lasted for about ten seconds.

Hudson signaled for quiet.

He then flipped through several other printed copies one by one.

A study on the accuracy of pedicle screw placement was presented in a beautifully written methodology section, which he summarized in just one sentence: "The data looks very good."

He circled a note on the abstract of a novel prosthesis-controlled study of avascular necrosis of the femoral head, with a follow-up period of less than two years, without saying much.

The comments are brief, each sentence a conclusion.

He pushed all the manuscripts aside, took off his glasses, and placed them on the table.

"I have been practicing medicine for over fifty years and teaching students for over thirty years. Over these decades, I have noticed a change."

"Doctors are getting smarter. Research designs are becoming more sophisticated, statistical methods are becoming more complex, and the impact factors of the journals they publish in are getting higher and higher."

"But sometimes when I sit here, flipping through these papers, I think about a question."

He pointed to the stack of manuscripts with his index finger.

When you choose a research direction, what's your first thought? Is it whether this can save lives? Or what journals can you publish in? Or how much funding can you get after you've succeeded?

"I understand the logic behind obtaining funding. You need an impact factor to get funding, and you need funding to continue research. This chain is not wrong. But as the chain goes on, people forget what doctors are supposed to do."

Hudson put his glasses back on and glanced at the audience.

"When I was young, McCord put his hand in before the helicopter even landed. He didn't have time to think about whether his action was public enough; he was just thinking about whether he could save the patient."

"But if you were in McCormick's situation today, how many of you would reach in?"

No one answered.

The resident doctors in the audience all sat up straight, trying their best to look like they were listening attentively.

Julian's pen stopped on the paper.

Victoria leaned back in her chair, her expression calm.

"Okay, that's enough of the digressions."

Old Hudson turned to the next case file: "Comminuted fracture of the tibial plateau, internal fixation plan."

……

The meeting ended at nine o'clock, and the atmosphere was the same as usual.

The crowd poured out of the lecture hall, and the corridor immediately became noisy.

The doctors, who were sitting upright just a moment ago, are now talking about their own things.

Lynn walked through the crowd and heard two resident doctors behind her speaking in hushed tones.

"What the old man said makes a lot of sense."

"Do you believe it? There were so many opportunities in his time, unlike us now, where the pressure is so great."

"But that Dr. Lin..."

He lowered his voice slightly, "You can get published just by sticking your hand into the mediastinum? I really don't know what the reviewers were thinking."

"Don't you know what the atmosphere is like in the metropolis right now? Whoever the higher-ups support, the lower-ups will pave the way for them. Do you see who the corresponding author is?"

"I really don't understand, how did they end up together?"

"Julian actually said those things at the press conference, could it be that he likes that Asian woman?"

"Doesn't he like Victoria? Does that mean his sexual orientation is fluid?"

……

Lynn did not slow down.

As he turned the corner of the corridor, he heard someone calling his name from behind.

"Dr. Lin."

The visitor was Ryan Prescott.

A specialist in bone tumors, a graduate of Yale School of Medicine, and just returned from a rotation at Sloan Kettering Cancer Center last year.

At 32, he has published nine high-impact SCI papers and his resume includes two clinical trials sponsored by pharmaceutical companies.

His father runs a chain of orthopedic clinics on Long Island; the land alone is worth eight figures.