Chapter 167: Perform in Reverse

Monday.

Ling Ran brought his research paper and went to Yun Hua Hospital in high spirits.

The hospital roused at five in the morning. Dozens of trolleys with breakfasts placed on them occupied the pedestrian sidewalks in the perimeter of Yun Hua Hospital. They headed to the parking lot. The guards had already started collecting fees. The scalpers, who were the most energetic bunch early in the morning, began selling consultation numbers for famous specialists, regardless of whether those specialists were chief physicians or associate chief physicians. The prices of these numbers differed based on how famous the specialists were, and the world was fair in this manner. It was so fair that sometimes, the doctors would use these prices to tease each other.

Long queues had already started forming in front of the consultation counters. The patients’ first choice were the 13 RMB or 17 RMB tickets, which were the prices they had to pay to consult specialists. Only when the numbers for the specialists ran out would the people choose regular consultations, which were priced between 5 RMB or 7 RMB.

The scalpers who were mingled in the crowd could raise the prices of specialist numbers costing only 17 RMB to 60 RMB, 80 RMB, and even 180 RMB.

During the month Pan Hua returned with a Japanese specialist, the specialists’ numbers had soared up to 500 RMB, but that was a sight rarely seen, even in Yun Hua Hospital.

Compared to the tickets scalpers sold for the concerts of superstars, the scalper tickets in hospitals appeared much more lucrative. Specialists provided consultations every week. The scalpers never had to be worried about never selling out, and their source also provided them with a steady flow of tickets. When they formed deals, they would even ask to be paid only in cash…

It was slightly more peaceful in the Emergency Medicine building.

The patients who arrived during the night had been settled, and the patients who would eventually come during the day had not arrived yet. The nurses in the reception area were all nodding away.

“I brought some fruits for all of you.” Ling Ran placed a bag of fruits he brought from home on the reception area.

Two young nurses said in surprise and delight, “Doctor Ling, you’re so courteous.”

“That’s what I should be doing.” Ling Ran had quite a deep understanding on the law of reciprocating gifts. He often received gifts from nurses, female doctors, the sisters of the patients, the sisters of the patients’ family members, or even much more mature ladies, and also from other people. No matter what, he had to reciprocate to their kindness. Fortunately, Ling Ran’s mother, Tao Ping, always prepared return gifts for Ling Ran. His supply of gifts were somewhat adequate.

“Wow, the grapes are so fresh…”

“Ohh you brought apples! I love apples the most…”

The two nurses did not care whether Ling Ran did this out of sincerity or whether it was just a gesture. No matter what, they showed joy towards Ling Ran’s gift.

“The grapes and apples are planted by my friends and relatives in my street. My family will always reserve some every year. When it’s harvesting season, they can send the fruits to my house at any time they want. They might have used chemical fertilizers and pesticides, but they’re all within acceptable standards. It’s easy to clean the fruits,” Ling Ran purposefully said.

The two nurses nodded excitedly. They spoke as one, “Doctor Ling, you’re the best.”

Ling Ran went into the Emergency Department with a smile. He then placed the research paper on Huo Congjun’s desk, put on his white coat, and went into the Operating Area.

He changed into scrubs in the Operating Area, made his way to the waiting room, and, much to the surprise of no one, he smelled the aroma of stewed meat.

Ling Ran walked into the room with a smile and found a plate filled with around ten pork trotters. There was a small plate placed by the bottom right corner of the plate. On it was a QR code, along with a description by the side. [To balance expenditures, each pork trotter will now cost 19.9 RMB. Please pay on your own.]

When he raised his head again, he saw Lu Wenbin standing by the table, all smiles. The more Ling Ran looked at him, the more the white coat made Lu Wenbin look like a chef.

“Are surgery preparations ready?” Ling Ran’s focus was always on the operating theater. As for pork trotters… they were tasty, and naturally, useful in their own sense.

As Ling Ran spoke, he brought out his phone and scanned the QR phone to buy a pork trotter.

Lu Wenbin fished out a big pork trotter from the bottom of the pile. He handed it to Ling Ran with both hands before he said with a smile, “The operating theater is ready. The anesthesiologist is still Su Jiafu. The MRI scan is also placed inside. The patient is a thirty-eight-year-old air conditioning engineer. His hand was stuck when he was installing an air-con. His left index finger suffered an avulsion amputation[1]. The damage to his skin is rather serious. His tendons and blood vessels were both stripped.”

Compared to severed fingers, amputations caused by avulsion amputation were much more severe.

To doctors, the survival rate of the finger after it was replanted would also be much lower.

Ling Ran nodded slowly and asked, “What are the patient and his family members’ expectations towards the surgery? They should know that the possibility of complete recovery is near zero, right?”

“His family members understand,” Lu Wenbin said, “I told them that we will be grafting skin and performing blood vessel transplant. The patient’s finger will also definitely be shortened. His family members show that they can accept this. However, the patient wishes that he can recover hand function as quickly as possible so that he can return to work soon.”

Lu Wenbin paused for a while before he said, “The patient isn’t too well off. They are also quite concerned with medical fees.”

Ling Ran nodded slightly. These were normal requests when it came to finger replantations.

Industrial workers were the group of people who produced the highest number of patients who required finger replantations. Industrial workers cared much less about their appearances compared to other people. They did however, care much more about their ability to survive in the world, as well as medical treatment expenses.

“Let’s go in.” Ling Ran threw away the port trotter’s bone, wiped his mouth clean, and washed his hands clean. He then entered the operating theater. Under the help of the nurse, he donned the scrub that covered his entire body.

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Right then, the operating theater was in a nearly completely sterilized condition.

However, the sterilization standards for the operating theaters of the Emergency Department were never high, and it was the same for the Hand Surgery Department. After all, it was completely impossible to clean the patient up to perfection whenever he or she was sent inside.

The Neurosurgery Department could make their operating theaters completely sterilized when they perform craniocerebral surgeries. The Cardiothoracic Department could also isolate pollutants better than the other departments. But the Emergency Department did not have these conditions, and neither did the Hand Surgery Department.

Another department which could not achieve a high cleanliness rate in their operating theaters was the General Surgery Department. They had piles of feces from the patients shot to the ceiling, and perhaps all the operating theaters who took cleaning very seriously would be suffering from an aneurysm when they saw the cleanliness rate in the operating theater of the General Surgery Department.

As usual, Ling Ran first read the MRI scan. Lu Wenbin and Ma Yanlin unwrapped the towel that had been bound around the hand. They also tried to clean up the grease stains on the patient’s hand. Naturally, they only cleaned up the stains that were not on the spot where the surgery was to be held.

Once Ling Ran returned after reading the scan, they performed debridement.

His waist and neck remained straight, and he stood with his feet apart. His elbows and wrists were steady, and his focus was great…

Lu Wenbin and Ma Yanlin watched and learned.

Microsurgeries was the one surgery where surgeons had to pay attention to their postures the most, because microsurgeries were the embodiment of surgeries that required a lot of physical work. It required the surgeon to remain focused for long periods of time, and the burden on the body was also incredibly great.

Without a good posture, before a surgeon specializing in microsurgery could become famous, he or she would first be sent to the operating table.

“Lower the light,” Ling Ran ordered. The circulating nurse immediately came over and pushed down the lamp over the patient’s injured hand.

The main function of the lamp was to keep the temperature over the patient constant.

One of the most important factors of finger replantations was the hand’s temperature. Once the temperature of the blood dropped below acceptable levels, the chances of the replanted finger surviving would be very low.

At the same time, Su Jiafu the anesthesiologist snapped to attention (but only a little). He kept his eyes on the monitors and was prepared to handle the problems of vascular spasms and blood coagulation.

Besides heparin, surgeons could also use papaverine in the operating theater. The latter’s effect was more potent, because it was an extremely effective miracle drug. Papaverine would not be taken off the list of drugs used in operating theaters for a long time to come.

“Let’s perform the sutures in reverse today.” Once Ling Ran completed the debridement, he made his decision.

Performing the sutures in sequence and in reverse meant the steps required to complete the entire suturing process.

To perform the sutures in sequence for replantation surgeries, the surgeon was to first set the joints of the bone in place, then suture the extensor tendon, followed by the dorsal tendon, and the dorsal skin. Next, the surgeon would suture the flexor tendon, the arteries, and the nerves. The last step was the suturing of the palmar skin for the finger. This could be seen as a progression from the easy tasks to the hard tasks in the surgery.

To perform the sutures in reverse was as its name suggested: the entire surgery was performed in reverse. The surgeon would first handle the hardest task—suturing the arteries, nerves, and flexor tendon. Then, he or she would suture the joints, extensor tendon, and everything else.

Newbies would usually perform the sutures in sequence when it came to surgeries. They would complete the steps one by one and build their own confidence in the process, but to perform the sutures in reverse would mean that the surgeon would need a higher level of control over their skills. Only a handful of doctors would use this method.

If Ling Ran’s Finger Replantation Skill was only at Master Level, perhaps he would only perform the sutures in sequence. It was only because he had Perfect Level Finger Replantation Skill that he could skillfully perform the sutures in reverse.

The results from performing the sutures in reverse would not produce a result that was vastly different from its counterpart. The only difference was on how accustomed the surgeon was to this procedure, how good was the patient’s condition, and the surgeon’s ability to control risks.

Injuries born from avulsion meant that it was easier to fix the joints in place, while the replantation of arteries and tendons were the main task.

Ling Ran and Ma Yanlin stood by the side of the double binocular head compound microscope, while Lu Wenbin used a high power microscope. He retrieved a blood vessel from the upper end of the patient’s right arm so that Ling Ran could perform the transplant.

Both the artery and vein had to be reconnected. A large amount of skin had to be grafted as well.

The trio spent two hours before they finished the hardest part in replanting this one single finger.

“Put another 10-0 thread in the needle.” Ling Ran was slightly exhausted, but he did not allow his eyes to leave the microscope. He could not afford a lapse in focus.

*Hiss.*

The door to the operating theater opened. Nurse Liu entered with a smile. “Remember to take your eggs. Each of you has one box of organic eggs and salted duck eggs. Those who are associate chief physicians or above has a box of four potatoes as well.”

She paused for a moment before Nurse Liu said, “Doctor Ling, Department Director Huo told you to take his share of potatoes.”

“Okay.” Ling Ran still did not raise his head.

It was the same for Lu Wenbin and Ma Yanlin.

Nurse Liu had long since been used to this situation. She went to the operating theater next door to repeat her announcement with a grin.