Chapter 59: Practice

Tendon repair was meticulous work. One could spend a long period of time meddling with the flexor tendons in one pig’s hindfoot.

Ling Ran was not in a hurry as well. He was just going through his steps in the operation at a leisurely pace. It was an opportunity for him to practice, and also an opportunity for him to explain the M-Tang technique to the other two.

The Master Level M-Tang Technique was great indeed. But it was still far from Perfect Level. The main difference lay in the success rate of the surgery and the recovery of the hand’s capability after surgery.

Of course, a typical flexor tendon injury was not that different to anyone with Master Level or Perfect Level M-Tang Technique. The probability of failure for both was extremely low if one just performed the surgery using the fixed procedure. Besides, even if one failed to follow procedure, the surgery itself would still be a success. It was just that, the degree of recovery would not be ideal. It could be 20% or 30% lower than the expected rate of recovery. However, the degree of recovery would still be higher than most doctors’ successful cases.

But then again, Ling Ran could not hope for all of the cases that he engaged in to be typical cases of flexor tendon injuries.

Most failed cases happened in atypical situations.

The atypical cases were also the greatest challenge to doctors. The development of clinical medicine could be seen as a process that gradually introduced people with atypical medical illnesses, atypical anatomical structures, atypical physical conditions, and atypical injuries into typical medical cases.

Take, for example, appendicitis, which was known to be the simplest laparoscopic surgery by modern standards. The mortality rate due to this medical condition over the past hundred to one thousand years was more than poets who had their poems published. Modern medicine was capable of conquering appendicitis due to a step-by-step accumulation of experience from the doctors who performed this surgery over time. For instance, Colins collected the data of 50,000 cases regarding appendicitis back in 1995, making a summary about the position of where the appendix would be in the human body. This confirmed that the appendixes of 95.48% people were located at their lower right abdomen. Only 0.58% of people had their appendixes located at their upper right abdomen. That gave surgeons the idea to cut the lower right part first for the appendix. If they could not locate the appendix there, they would look for it at the upper right. If they still could not find it, they would just move on to the lower left. They did not need to look through the intestines in the whole stomach blindly…

Surgeons now knew that there were eight abnormal positions for the appendix, six different cases of dysplasia[1], four types of deformities, and also four types of ectopic tissues[2]. From there, these cases, which were once classified as atypical cases were categorized as typical situations.

The incision required to remove the appendix in a laparotomy had also improved from being as long as the length of an arm, to being as long as the length of a finger. Later on, it was improved to the surgeon only requiring three holes underneath the laparoscopy…

It was the same for the M-Tang technique.

Since its appearance back in the 90s, the technique had been used to target typical flexor tendon injuries. It was later improved slowly.

Ling Ran estimated that the Perfect Level M-Tang technique should be able to target most of the flexor tendon injuries in Zone II. The range for Master Level should not differ much as well. However, the success rate and effectiveness of some atypical cases, which would appear on rare occasions would show poorer results.

Anyway, doctors could not guarantee what sort of patients they would meet.

Since Department Director Huo hoped to snatch business from the Hand Surgery Department, a great number of patients with flexor tendon injuries would definitely be sent over there in the foreseeable future. Once the number of patients increased, atypical cases would definitely appear as well, and they would even need to see just how far away these atypical cases were from typical cases.

Ling Ran did not hope for the system to just send a Perfect Level M-Tang Technique to him as a gift.

Up to the present moment, he was only able to obtain a Level 1 Skill Book from opening the Intermediate Treasure Chest and acquire a Perfect Level Skill upgrade. The range of choices for the upgrade was also limited to basic skills.

The Master Level M-Tang Technique was acquired through activating a single Skill Book. It was a type of surgical method. However, Ling Ran did not even have the slightest assurance on whether he could obtain the Perfect Level M-Tang Technique or other tendon repair techniques from similar Skill Books.

Truth be told, even if the system gave him a new Skill Book, the best possible scenario was only him expanding his personal skill library. He could not upgrade his M-Tang technique—which was already at Master Level—to Perfect Level.

The value for it was too low. He would only make that sort of decision if he was stupid, and he was not stupid. Ling Ran had already tested his IQ level before.

He got the answer to what he should do once he analyzed the situation seriously. The best way for Ling Ran to become better was to actually improve the standards of his skills.

He was already the best doctor in Yun Hua in terms of the M-Tang technique. If he continued to perform the surgeries, it was only obvious that he would improve.

The gist of an article would come to you after you read it over a hundred times. The same went for performing surgeries.

If one could perform the same surgical method over a hundred times, even weaklings would be capable of reaching above average standards sooner or later.

If a doctor could perform the same surgical method over a thousand times, that doctor would definitely become excellent in that field.

Ling Ran was stitching up the flexor tendons that he cut in the hindfoot, and he was doing so in an orderly manner. He would also speak once in a while.

“After you penetrate the tendon with the needle horizontally, insert the needle on the opposite side of the tendon just enough to vertically penetrate the needle back into the tendon…

“Tie the knot near the end.

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“Lock the second loop of the thread into the knot of the first loop of thread, then penetrate the tendon again with the needle.

“You can tie another knot at the very end of the tendon. It’ll be better if you did it at the center of the palm.”

Ling Ran was wearing a pair of magnifying glasses. He was focusing on the middle of his field of vision. He did not turn his head back.

But Lu Wenbin knew that Ling Ran was speaking to him.

Lu Wenbin’s hands were also quietly moving on their own. He did not even realize it.

He was still a long way from mastering the M-Tang technique. It could even be said that he was still not very clear about what Ling Ran was doing and why he was doing those things. This was despite the fact that Ling Ran had explained the entire procedure once to him.

However, one would need to learn it step-by-step like this in order to grasp and master a surgical method.

The process of stitching was not some martial arts technique from some secret scripture. Those who wanted to learn it could easily find information about it.

However, only very few could get the opportunity to personally witness the process itself, much less be able to act as an assistant. It was the fastest way one could learn the true essence of a certain method.

Lu Wenbin was suddenly a little excited. If he could really master the M-Tang technique, how would everything turn out for him?

Since the Emergency Department was really going to snatch business from the Hand Surgery Department, the department could not possibly rely on Ling Ran alone. Ling Ran was the person who fired the first shot. People deemed him the flag bearer who stood at the front in battle. Hence, Huo Congjun would definitely search for a way to recruit new forces to fill in the gaps after Ling Ran left.

By that time, he may do things such as get doctors from other hospitals, transfer manpower from the Hand Surgery Department, or even conduct training within the Emergency Department itself for the technique.

And regardless of whichever method Huo Congjun decided to use, it presented endless opportunities for resident doctors like Lu Wenbin himself.

The most important thing was, Lu Wenbin discovered that Ling Ran was willing to teach him.

Although he was unlike some doctors who guided them orally and required them to perform the steps themselves, Lu Wenbin still had quite the opportunity, especially since Ling Ran’s own skills were excellent. It was easy for Lu Wenbin to raise his expectations in this regard.

In comparison to that, the awkwardness of having to be an assistant for an intern seemed to have reduced. It was no longer as strong as it was in the beginning.

It was basically required of young doctors to be shameless in order to learn something.

“Doctor Ling.” Wang Jia returned after she received a phone call. “Department Director Huo is preparing to return. It’s estimated that he’ll need four hours to come back.”

“Oh, it should be about time to get off work by then.” Ling Ran pondered for a moment and said, “We’ll have to think about our dinner.”

Lu Wenbin lifted his head up for the nth time and looked at the pig’s foot, which was hanging in the air before he blurted, “I know how to cook pig trotters.”

Ling Ran and Wang Jia both looked at Lu Wenbin.

“During my time as a houseman, I brought meals along with me quite often. Sometimes, I would also buy pig’s hindfeet to cook them…” Lu Wenbin felt a little abashed while he spoke.

“Remember to remove the threads when you cook.” Ling Ran smiled for a moment, causing the department hunk to feel as if he had just breathed in fresh air. He also became more enthusiastic.

Wang Jia quickly assisted him in removing the pig’s hind feet. She was removing the threads when she asked, a little unsure, “Would the patients and their families turn around and run if they ever see us chewing on pig trotters?”

Ling Ran stood behind them as he languidly said, “The patients won’t be running fast since they’re hurt. We can catch them back.”

The light from the setting sun was strong and glaring.

In the old storeroom with white walls and white ceilings, pig feet swayed freely. It cast a strange shadow in the room.

Translator’s Notes:

1. Dysplasia: A term used in pathology to refer to an abnormality of development or an epithelial anomaly of growth and differentiation (Source: Wikipedia).

2. Ectopic tissue: Ectopic is a word used with a prefix, ecto, meaning “out of place.”. Here it means tissues that are situated in a place remote from the usual location. (Source: Wikipedia)