Chapter 157: A Higher Quality

“Ling Ran, continue with the ring finger on the left hand.” It was impossible for Wang Haiyang to not utilize Ling Ran and have other people finish the tasks at hand.

Finger replantation surgeries were one of the operation types that required the surgeon to fight for every second.

Today’s operation was the same.

In order for a five-year-old patient to have eight functional fingers, the surgeon had to complete the stitching process as soon as possible for her.

Being precise and fast was the main requirement for a replanted finger’s postoperative recovery. Blood supply was vital. It was of utmost importance that they recovered the finger’s blood supply as quickly as they could.

No one knew how long it would take before a severed finger suffered too much blood loss and went through necrosis. Perhaps it would be twenty hours, eight hours, or perhaps even twelve hours. The longest-surviving severed finger lacking blood was fifty-six hours, and it was successfully replanted by Wuxi People’s Hospital. However, no one would be willing to take the initiative to challenge that record.

Different people had different situations, but one thing was certain: if you restored the blood supply of the severed finger as soon as possible, it would recover better, and its functionality would be stronger as well.

Group 1, Group 2, and Group 3 were only halfway through with replanting the severed fingers. Everyone had yet to complete the most important anastomosis. There was also the similarly complex nerve anastomosis waiting for them…

With their current speed, they would not be able to finish within one and a half hours.

Under such circumstances, forget about asking Ling Ran to give up his space. There was also no reason for other doctors to take over for him. Ling Ran operated the fastest, plus he was also young and energetic. Allowing him continue was be the best choice.

Regardless of speed or quality, the replacement doctors could not match the chief physicians and associate chief physicians. With that being the case, there was no hope for them to replace Ling Ran.

Wang Haiyang did not even have to weigh the pros and cons. He made his decision in an instant.

He needed to be responsible for the entire operation. He could not be responsible for the dignity of another doctor. To put it in a less flattering manner, surgeons who could not perform a surgery well did not have any sort of dignity to speak of.

This was especially so in provincial tertiary grade A hospitals like Yun Hua Hospital. Most of the surgeons walked down the path of skills. Those who did not have good skills would be looked down upon by the others. That was politically correct, there was no doubt about it.

Wang Haiyang was already a chief physician. He need not care about the dignity of others anymore.

Similarly, Ling Ran did not have to concern himself with another person’s dignity to reject performing a surgery he was familiar with.

Ling Ran only nodded gently and said, “All right. Ma Yanlin, continue to stitch the skin. Nurse Liu, bring me the MRI scan of the ring finger on the left hand.”

Ma Yanlin braced himself and continued to stitch the skin. His actions attracted sidelong glances from all the people around him.

Ma Yanlin was also uneasy. When he picked up the needle-holder, his fingers even quivered a little.

Ma Yanlin could not help but look at Ling Ran.

If a high-ranking, kind-hearted doctor had been in Ling Ran’s place right then, he or she would have likely given a speech of around eight hundred words to comfort Ma Yanlin, so that he would not feel too nervous.

However, Ling Ran did not even look at Ma Yanlin. He just continued with what he usually did. He minded his own business and stared at the MRI scan as his mind wandered. Unlike the minimal details contained in an X-ray scan, the amount of information in an MRI scan was tremendous. So much so that many of the contents in a scan taken by the hospital for a normal patient would be generally summarized.

Doctors who knew how to read an MRI scan would receive much more information from an MRI scan than an X-ray scan.

Ling Ran was focused on reading the scan, and because of that, Ma Yanlin calmed down.

It was impossible for him to not calm down at that moment.

Being doctors meant that they would always encounter all sorts of accidents, and the way they handled those accidents was when they truly showed their skills.

Ma Yanlin was still able to recall all the various things he previously did in the operating theater. Suturing and debridement were operations he did the most. He had also performed incisions several times, which gave him more knowledge about the hand structure of a human body.

Although the finger of a five-year-old was small, Ling Ran had also sutured ten children’s tendons with the M-Tang technique before. The positions may be different, but the problems were similar. The skin, muscle, fat, and sensory signals provided by the other parts were also the same.

Ma Yanlin calmed himself, and he penetrated the young patient’s skin gently with a curved needle.

He sutured seriously, and each stitch reached the standard just like when he was back at the Emergency Department.

If no one had taken note of Ma Yanlin’s face, they would not have been able to tell that the sutures were done by a houseman when they observed his operation.

The doctors watching by the side looked at each other. They did not make a sound.

Suturing was a skill that became better with practice. However, normal doctors did not have a chance to perform any sutures for finger replantation surgeries. If they did not perform a sufficient number of surgeries of this nature, it was only natural that they were not skilled in it.

However, Ma Yanlin was a first assistant who had performed over one hundred cases of surgeries using the M-Tang technique. His familiarity with the surgery was not inferior to that of a senior attending physician. Whenever he performed surgeries with Ling Ran, suturing skin was just a normal part of the operation.

A person’s spirit and focus was, no matter what, limited. A first assistant was valuable because he or she could support the chief surgeon and also take care of trivial matters. Ma Yanlin did not have the chance to show his face previously, but right then, he was remembered by the chief physicians and associate chief physicians in the Hand Surgery Department.

“Doctor Ling, the skin has been sutured.” Ma Yanlin breathed a gentle sigh of relief.

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It would be a lie to say that he did not feel weak when he had to wield a needle in the presence of such a large group of significant people.

To put it bluntly, the chance of a resident doctor being picked out to join a large operation from a large group of residents in a tertiary Grade A hospital such as Yun Hua was as slim as being the ram chosen for tupping among a thousand other rams.

Ma Yanlin obtained the chance while he was still a houseman, and he seized it. He was already so excited that he wanted to be the ram used during tupping season.

“Then… carry out the debridement on the ring finger.” Ling Ran forced his way in and occupied the position of the chief surgeon.

Ma Yanlin could only squeeze his head in. His body was positioned sideways. He managed to grab himself a small space to begin his operation.

The little patient was currently lying on her back with both of her hands splayed opened. There was a group of doctors on each side, and the operating table was very cramped because of it.

Ling Ran and Fei Zhou occupied the position of the chief surgeon on each side. The scrub nurse occupied the space in the middle. The assistants just had to make use of every bit of space they could get as they did their job.

Ling Ran rinsed and cleaned up the wounded part on the patient’s hand. He then pinched the finger’s joint before he observed the finger closely for more than ten seconds. He quietly sighed and said, “The severed part is in the middle section of the finger’s bone. This will require bone shortening surgery.”

After receiving bone shortening, that particular finger would definitely be shorter than other normal fingers. However, at that moment, they no longer needed to think about aesthetics anymore.

Human beings naturally hated to lose. Furthermore, only very few would be willing to admittedly accept sunk cost[1]. That was the time when a doctor’s knowledge and rationality were required to come into play.

After bone shortening and wound recovery, the finger would look terrible. But without bone shortening, the only choice left was to amputate the finger.

That loss did not occur during the bone shortening surgery. It occurred the moment her eight fingers were crushed and severed.

The use of a doctor was to minimize the loss as much as possible, but the chances of having no loss at all were very slim. All in all, the words “recover to its former glory” were merely words that were pleasant to the ears.

Speaking based on probability, the average success rate of finger replantations was approximately 80%. The probability of reaching the “excellent” standard in hand functionality assessments was even lower.

Even if the evaluation on the functionality of the hand was rated “excellent”, that rating would have been obtained based on how well a finger could move after it was severed once. The finger would not function in the same way as a normal finger, much less when compared with the finger of more agile people in the world. Long-term medication and rehabilitation were also indispensable.

It was pitiful for a five-year-old child to be in such a situation. But none of the doctors on the scene would slow down just because they wanted to pursue perfection.

In fact, for the sake of increasing efficiency, all of them implemented the surgical procedure of stitching only one artery and parts of the nerves, including Ling Ran.

Besides Ling Ran, the other chief surgeons were doctors who had stood beside the operating table for around twenty to thirty years. None of them strove for perfection anymore.

All decisions came with a price.

The price of speeding up the surgery may have been a finger or several fingers losing the probability of complete functionality. However, the price of choosing perfection may have been one or even three fingers suffering necrosis. The worst case scenario would be these fingers affecting the other fingers as well.

Weighing risks was what surgeons did at every moment of a surgery.

Perhaps that was the greatest difference between a surgeon and a pilot.

Both surgeons and pilots required strong practical skills as well as a great amount of knowledge, and they all needed to possess the ability to perform timely judgment. The difference was that pilots would try to avoid all risks while surgeons would only choose the risks that they could control the most among various risks.

“Needle-holder.

“Keep it steady.

“Give me a 12-0.”

Ling Ran pushed on step by step. He basically did everything the same as he normally did during his usual operations.

Usually, he just needed around one and a half hours to replant a severed finger.

“The ring finger’s done.” Ling Ran buried himself in his work. He only raised his head and looked at his watch once he completed the operation.

Actually, he did not even need to open his mouth. The others had already noticed Ling Ran’s speed.

Right then, none of the other three teams’ finger replantation surgeries were completed. As they watched Ling Ran complete the steps one by by one, the doctors watching by the side could not describe their emotions.

“Can you still continue?” Wang Haiyang had yet to complete his own sutures as well. He remained calm and inquired.

Ling Ran responded, “Yes.”

“I’ll leave the thumb on the left hand to you.” Wang Haiyang had given Ling Ran the finger that he initially planned to give to Fei Zhou.

Fei Zhou kept his head lowered. He pretended not to know anything. He only comforted himself repeatedly in his mind. ‘The quality of my finger replantation is much higher, the quality of my finger replantation is much higher…’