Chapter 4: Tail Replantation

Lei Beisha was executing the carrot and stick approach in the large room. Once he said those scathing words, he worked on comforting the interns. “In the beginning stage of your internship, all of you should mostly make observation as your priority and pay attention to the methods of learning. Study diligently and train hard. At the same time, you must strive to balance hard work and rest.

“Today, the most important thing we will be doing today is to show all of you a demonstration. After this, you will have plenty of time to shut yourself in the simulation training space. By then, even if you don’t want to be here, you will still find yourselves in this place.”

After seeing that Lei Beisha’s attitude had taken a turn for the better, Wang Zhuangyong quickly raised his white-gloved hand and asked, “Department Director Lei, how difficult is the tail replantation for a white rat and what is the hardest part of it?”

“How difficult is it, you ask…? How do I put this into words…?” Lei Beisha pondered on that thought for a moment and said, “Let me describe it a little to you. Other than you students from the medical academy coming over to do your internships here in Yun Hua Hospital’s Hand Surgery Department, we also accept almost a hundred doctors from other hospitals within the province to come in and do practical learning with us every year. Even when these doctors arrive, the number of those who are capable of completing the tail replantation and meet the requirement of 95% blood flow rate will only be in the single-digits.”

The students simultaneously gasped in shock.

Even if the doctors who were able to come back to work in Yun Hua Hospital lacked skill, they would still be better than the medical students who had never been at the operating table. With this impression in them, the respect that students had in their hearts grew even more towards those who could perform tail replantation for white rats.

A few minutes later, Kang Jiuliang and Ling Ran sat on two sides of the table respectively. The objective lens for both of their double binocular head compound microscope were aimed on the tail of the white rat. At the top side of the machine, Kang Jiuliang and Ling Ran were both provided with a pair of eyepiece lenses.

“Normally, when we are training, we will cut the rat’s tail into approximately sixty to eighty segments. Today is a special case for us; we shall cut it into fewer segments.” At the same moment Kang Jiuliang switched on the microphone on one side of the table, he picked up a scalpel.

“The white mouse is so cute, please don’t cut its tail.” A girl cried out while she hid among the crowd.

Although he supposed that she was just pulling a joke, Kang Jiuliang remained serious as he explained, “Experimental animals are the unsung heroes of our hospitals. Everyone would use them for practice in order to improve their skills and further improve the welfare of humans. In the meantime, everyone should also try their best to utilize every chance for experimentation, but perform your experiments within the limits of your abilities. That way, you can try to minimize the suffering of the animals. So, when you’re practicing, you must remain serious… Student, what are you doing?”

While Kang Jiuliang was talking, he saw that Ling Ran had already cut the tail of the anaesthetized white rat into tens of segments.

“You said that we would cut fewer today, so I’ve cut it into 42 segments. Is that too few?” The scalpel that Ling Ran held in his hand glinted with a silver light across the blade.

The students below watched with both eyes gleaming, that included the girl who just mentioned that the “white mouse is so cute”. She was also extremely excited, to the point that she wished she was the one holding the scalpel.

“You have already made the cuts, leave it there. You must listen to direction after this.” Kang Jiuliang set his eyes on a pile of rat tail pieces. He could not possibly make Ling Ran put all those pieces back together…

Well, that was not too accurate, since they were about to perform tail replantation right then.

“I shall do the demonstration.” Kang Jiuliang held a pair of medical forceps with his left hand while he picked up a needle holder with his right hand and said, “What we are using here is called a medical microscope instrument . Many students have most likely never touched this before. Its main feature is that it is small. For instance, the thickness of the suture thread that we are using right now is only one-tenth of a strand of human hair… By the way, student, how should I address you?”

“Ling Ran,” Ling Ran replied.

“Not much of a talker, eh?”

“Not much.”

“You’ll love talking in the days to come. Surgeons are all chatterboxes when they perform surgeries.” During the surgery, Kang Jiuliang had obviously turned into a completely different person than he was before the surgery.

Ling Ran responded with an “oh”.

Kang Jiuliang could not hold it in anymore and said, “Don’t you feel curious about why?”

“Because of boredom,” Ling Ran replied.

The interns giggled.

Kang Jiuliang was shocked for a moment. He asked, “Is the question I asked too boring?”

“It’s while the surgeons are operating that it gets too boring.”

“Indeed, performing a surgery takes a very long time. It’s true that it is quite boring. Normally, it would already be ten or twenty hours later when we finish a session for hand surgery. The others around you would probably want to talk even if you don’t feel like talking.” Kang Jiuliang no longer bothered himself with the underlying meaning in Ling Ran’s words. While he spoke, he started working with his hands, as if both actions would not affect the other and interfere with each other.

In the eyes of the interns, the rhythm of Kang Jiuliang’s hands as he worked and the speed he used while he spoke was completely different. As the saying went: practice makes perfect. Kang Jiuliang’s exceptional performance even while he spoke was probably what that idiom meant, because he could only do this after a lot of practice.

In the meantime, Ling Ran was also familiarizing himself with the details in Kang Jiuliang’s actions as he operated on the tail. After all, in the end, tail replantation for white rats was just a circulatory anastomosis.

It would require six to eight stitches on the small vascular section in order to stitch each of the severed blood vessels back together, thereby ensuring that blood would circulate smoothly, unobstructed, and without any leakages.

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During the suturing process, the doctors should also be careful of not letting body cavities[1] and dead spaces[2] appear. In all honesty, these specifics and small concerns would be the things that define the skills of a surgeon.

For instance, a doctor of the Hand Surgery Department would require training for two to three years on tail replantation before he or she could reconnect the tail. But the condition of the white rat itself and the skills of the surgeon, which played an even more decisive factor, would determine whether the tail could function as normally as it had before, and whether there would be any pain or even complications after the surgery.

In simpler words, suturing was not easy, and completing the stitch perfectly was even harder.

Kang Jiuliang began to feel bored just talking by himself. He asked Ling Ran directly, “Do you recognize the suturing techniques I am using?”

“It’s a simple interrupted stitch.” Ling Ran did not say much at all.

“Are you familiar with it?” Kang Jiuliang asked another question, but he answered the question himself immediately afterwards. He said, “You should be familiar with it. This is the most common and also the simplest suturing technique. It is otherwise known as the suture and knot-tying technique, isn’t it? One knot right after one stitch. Back when I was training in my school, this is the skill that was practiced the most. How about you?”

Ling Ran remained concise as he replied, “About the same.” He watched the operation performed by Kang Jiuliang. His mind was overflowing with information, he did not want to talk at all.

“Alright, give it a try.” All of a sudden, Kang Jiuliang seemed a little sullen. ‘I’m a very busy person, why can’t you learn how to chat with me a little after I’ve gone through so much trouble to be here to give all of you a demonstration…?’

At first, he wanted to perform a few more anastomoses for a while to allow Ling Ran to familiarize himself with it. After completing just one circulatory anastomosis, he immediately decided to let Ling Ran take over.

Ling Ran was stunned for a moment, but he did not give it much thought. He just said “alright” as he picked up the needle-holder.

All the while, Kang Jiuliang did not move his eyes away from the eyepiece of the microscope. At that moment, he could not help but lift his head up and take a quick peek at Ling Ran.

The saying went that an expert’s skills would be determined once he laid his hands on his craft, and the basic skill required for microsurgeries for experts was for their hands to not shake when they picked up the needle-holder.

In order to put eight stitches on the artery with a mere 0.5 millimeters in diameter, the surgical suture that they were using at the moment was only one-fifth of a hair’s thickness. If an ordinary person picked up the needle-holder, the front tip of the needle would shake indefinitely.

Under the microscope, the magnitude of the tremors would make it seem as if the needle was dancing around.

In actuality, doctors who were never properly trained to perform microsurgery would shake so much that all onlookers would feel dizzy while they watched these doctors pick up the needle-holder under the microscope. These doctors would definitely need to practice holding the needle holder over a long period of time. Some doctors even held the needle holders in their hands until they became swollen just from practice.

As for medical students…

Kang Jiuliang could not help but ask, “Do you still practice microsurgery in Yun Hua Medical Institute?”

“My family runs a small clinic,” Ling Ran said using the lie he made up. The tip of the needle under the microscope went straight for the small artery in the white rat’s tail.

Kang Jiuliang quickly focused his attention, but he only saw that the artery of the white rat’s tail had not moved even by a tiny bit under the microscope. Kang Jiuliang could not help but to raise his eyebrows marginally.

The arteries under the microscope did not tremble at all. That meant that none of them were pulled, not even by a little. This was not a basic requirement in microsurgery. This was, in fact, a very outstanding skill.

In order to train this particular skill, some doctors would put bubbles in a basin of water and perform sutures and knot-tying on top of the bubbles. The goal was for the bubbles to not move even the slightest bit.

It was similar to suturing a broken finger. If the process could be done with that sort of suturing standard, the sutured finger would have much stronger recovery abilities and even mobility in the future than it did in the past.

During that moment of absent-mindedness, one stitch on the anastomosis had already been completed. Kang Jiuliang did not even notice the exact time, the only judgement he could make was that it was at least faster than his.

After contemplating it, Kang Jiuliang quickly looked at the point of the anastomosis under the microscope. He could only see that the knots which were exposed on the outside were fairly consistent. It was pleasing to the eye by the looks of it, there was not even a single mistake like a granny knot[3].

This was practically a textbook example of a vascular suture and vascular knot-tying. There was no mistake at all to be picked out.

‘A small clinic?’

Kang Jiuliang lifted his head and glanced at Ling Ran. Afterwards, he thought to himself, ‘How many fingers had to be chopped off in order to nurture such a high standard of suturing?’

Translator’s Notes:

[1] Body cavity: any fluid-filled space in a multicellular organism other than those of vessels (such as blood vessels and lymphatic vessels).

[2] Dead space: a cavity, potential or real, remaining after the closure of a wound that is not obliterated by the operative technique (Source: Stedman’s Medical Dictionary)

[3] Granny knot: also known as false, lubber’s, calf, and booby knot. It is a varicosity or redundancy of an umbilical vessel (usually the vein)