Chapter 386 - A Sham of A Surgery
After the phone call ended, Cheng Lixue lit a cigarette.
He took a deep drag to clear his head.
Cheng Lixue was not from the cardiothoracic department. but as a doctor, one had to be familiar with the basics of emergency rescue.
Any experienced doctor would know the criticality of a cardiac tamponade. There had been cases where the patient was successfully rescued, but ended up in a vegetative state.
Was Old Qian trying to prank him?
He sat in the chair in the changing room and took a drag of the cigarette. The smoke lingered in the room.
Cheng Lixue could not wrap his mind around the whole thing.
He glanced at the clock and found that it was close to 9:00 a.m. He had been away for almost 20 minutes. The surgery would have started already. Regardless, he should be present when Director Ren shows up.
As he stepped out of the changing room, Cheng Lixue saw a nurse calling for the next patient.
"Why are you rushing the patient?" Cheng Lixue growled. "The surgery will still take a few hours, there's no point calling the patient in." He glared at the nurse for emphasis.
The fact that Zheng Ren requested eight surgeries to be performed in a day annoyed him and he sought the opportunity to express his dissatisfaction.
"Chief Cheng…"
Cheng Lixue went on the offensive and did not give the nurse a chance to explain herself.
"Did you learn the correct procedure? The patient is elderly and has ascites, and yet you want him to wait out there for hours? Have you no shame?"
The harsh words brought tears to the young nurse's eyes.
Cheng Lixue was a superior who tended to alternate between hot and cold when it came to dealing with his subordinates. As Cheng Lixue was about to speak some gentler words of encouragement, he was rudely interrupted.
The plump man came out of the room.
"What's going on, Chief Cheng? This…" the plump man asked.
"Who allowed the patient to be transported before their turn?" Cheng Lixue asked coldly.
The plump man rolled his eyes and said sharply, "The first surgery's over. He's the second patient." Cheng Lixue's constant bone-picking with Zheng Ren was starting to get irritating. "Chief Cheng, why don't you go celebrate with the first patient while we begin the second surgery? After all, it's the hospital's first successful TIPS surgery. We don't want to keep this elderly patient waiting, right?"
There were hidden barbs in his words. Although the plump man showed Zheng Ren only kindness and hospitality, he was not a pushover.
"Uh…" Cheng Lixue was rooted to the spot.
Completed? Impossible!
'We're talking about a TIPS procedure--a surgery that only the best interventional surgeons could master--and this chief resident completed it within the span of a smoke break?'
"What did you say?" Cheng Lixue asked.
"We're moving on to the next patient and you're in the way. Do you have something against the hospital's decision to invite an external surgeon?" The plump man's tone was curt and his words were merciless.
There were other patients in the process of changing shoes outside the operating room, so they had to keep their volume down.
A low volume did not mean the sting hurt less.
Cheng Lixue was speechless.
'It was really done? He managed to complete a TIPS procedure in 30 minutes?'
Impossible… It was impossible!
A year ago, Director Ren brought the team on an international trip to gain insights on the procedure. Department Chief Cheng observed a few surgeries, but his passion for learning had long since died out.
It was a highly risky procedure, certainly not one he would attempt.
Cheng Lixue would rather keep his shoes dry and wait for his retirement. He doubted he would be able to master the new procedure anyways.
He treated the whole trip to Europe as an all-expense-paid trip from the company and opted out on most of the conferences and demonstrations.
Although he spent most of the trip on leisure activities, he still attended the TIPS demonstration. Even the most skilled surgeon in Europe required two to three hours to complete the procedure.
It must be a botched surgery!
The operating room opened and the first patient was wheeled out. The nurse shot a glare at Cheng Lixue before leaving with the second patient.
The department chief ignored the jab by the plump man and headed straight for the control room. He wanted to review the recording.
The cannula was set up. Then, the puncture was successful on the first attempt and a shunt was left in place… A second shunt was added? Zheng Ren had punctured the portal vein on the first try and had time to leave two shunts?
The speed at which the surgeon completed the surgery was extraordinary.
Cheng Lixue did not believe the young chief resident was responsible for this surgery.
A silhouette caught him by surprise.
"Director Ren, welcome back."
"Director, you must be tired. Please, have a seat."
A string of pleasantries were uttered following Cheng Lixue's queue. The director had made it back from Provincial Capital.
The surgery had proceeded at a breakneck speed. When he had heard Sea City General Hospital wanted eight patients, he wondered how long the surgeon planned to stay in the Secondary Hospital. Forcing the patients to fast for days was against ethical code.
It was inhumane.
However, he was forced to change his mind now. At the rate Zheng Ren was going, eight TIPS procedures would not be a problem.
Damn!
"Professor?" Director Ren asked in a low voice, surprise laced in the question.
'What professor?' Cheng Lixue was trying to figure out who the director was referring to.
There a shuffling of feet as Director Ren parted the crowd to reach the door for the operating room.
"Professor Rudolf, it really is you?" Director Ren said in amazement.
Professor Rudolf Wagner turned his head to the door. "It's me; what's up?"
The thick Northeastern accent shocked Director Ren to his core.
This was the esteemed professor from Heidelberg University. He was rumored to be a stern and aloof professor with great skills.
The professor was disinfecting the skin as he asked, "Yes?"
Director Ren composed himself and bowed at the professor as if he was a pupil. "I brought my team to Heidelberg University in April last year to watch you perform the TIPS surgery."
Professor Rudolf started to place the surgical dr.a.p.es over the patient. "That was nothing. What a sham of a surgery that was."
"..."
The straightforward statement made Director Ren clutch at his c.h.e.s.t. He took a deep breath.
The words hammered straight into the director's heart.
Without a doubt, this was Professor Rudolf Wagner from Heidelberg University. Director Ren could recognize the blond professor. He had a good memory for faces, unlike Zheng Ren.
The professor's mention of TIPS surgery back in April also substantiated Director Ren's guess.
Was the professor tricked into assisting the operation? The director was unsure what had happened.
Tricked into having to be exposed to X-rays?
"Professor, why are you disinfecting the patient yourself?" Director Ren glared at the people around him and instructed, "Go get someone to assist. Zhang Guangzhi, how can you let the professor perform the surgery alone? Why didn't you scrub in? Cheng Lixue?"
The sudden attention on him caught Director Zheng off guard. He could feel sweat starting to form on his forehead.
The plump man waddled up to Director Ren and said with a smile, "Director Ren, we did not invite this professor. We invited the surgeon from Sea City General Hospital. The professor, he…"
Director Ren was suspicious. "The professor?"
"The professor is here as Chief Zheng's a
ssistant."
Chapter 387 - An Up-And-Coming Revolutionist
"What did you say?" Director Ren's expression darkened as he asked.
The plump man noticed the sudden change in Director Ren's expression. Before he could clarify, Professor Rudolf Wagner muttered unhappily, "There's too many people in here. Are you new to the concept of sterility?"
The professor laid the surgical dr.a.p.es over the patient then turned to Zheng Ren and said, "Boss, I'll begin the cannulation."
"Alright." Zheng Ren was wholly-focused on the patient's diffusion-weighted MRI scan as he needed to visualize the procedure in his mind. The appearance of the crowd in the operating room went unnoticed by the occupied chief resident.
"Lil Fugui, remind me to angle the needle 15 degrees later when we're performing the puncture," Zheng Ren ordered before walking away. He was going to scrub in.
"Alrighty," Professor Rudolf Wagner answered before glaring at Director Ren and the others.
The professor held a cannula sheath as he stared down the intruding group. The unflinching look on his face made Director Ren back down, who sheepishly smiled.
Lil Fugui… What a name for the great Professor Rudolf Wagner. Director Ren left the operating room amused.
He was surprised to find Professor Rudolf Wagner performing a TIPS procedure here. He recalled Zhang Guangzhi's explanation: the person they invited over to the Secondary Hospital was a doctor from Sea City General Hospital.
Why was the professor here then? The young doctor in the operating room had the air of a professor studying the scan on the viewer, while Professor Rudolf acted like the junior doctor, fussing over the disinfectant and surgical dr.a.p.es.
Director Ren watched the scene in disbelief. He was confused at the role reversal.
The professor's serious tone and expression reminded him of time he spent in the operating room of Heidelberg University. Professor Rudolf was not a person who made jokes.
Random scenarios ran through Director Ren's mind.
"Director, when I was observing the surgery in Sea City General Hospital, Dr. Zheng was the lead surgeon while the professor assisted," Director Zhang whispered in Director Ren's ear.
"..."
Director Ren was speechless. The truth was hard to digest when he had such a high opinion of Professor Rudolf Wagner.
"The first TIPS surgery in Secondary Hospital was also successfully completed by Dr. Zheng. He managed to puncture the portal vein on the first attempt with the professor assisting."
"..."
Director Ren's silence continued.
The second TIPS surgery was ongoing now. Cheng Lixue muscled his way to the front of the crowd to get a good view of the screen.
The cannula was in position and the guide wire was fed into the jugular vein. It was the usual procedure to gain central venous access.
Everything was moving smoothly thus far.
The key highlight of the TIPS procedure was the puncture of the hepatic vein to the portal vein, as it was a literal stab in the dark. There was a low rate of success due to the lack of visual guidance.
Cheng Lixue kept his full attention on the screen. He was curious about the young doctor's methods.
What was he going to do?
The puncture kit was delivered to the two surgeons inside.
Cheng Lixue's eyes were wide as he stared unblinking at the screen. Zheng Ren was probably just lucky the first surgery went so smoothly.
It would not happen a second time.
Cheng Lixue had always been a principled doctor, but he found himself wishing for the surgery to encounter some complications.
Perhaps it was the organizational change in the hospital that incited the professor's irrational anger toward young doctors.
He used to be able to say young doctors these days were daring and full of energy, but lacked the skills and experience; yet here he was witnessing a young doctor from Sea City General Hospital, who did not look over 30, perform a TIPS surgery: a procedure Cheng Lixue himself could not execute.
It was a blow to his pride.
Should he step down and let the young take over?
No, that was not an option.
The whole control room was unusually quiet. Anyone who knew the procedure was paying close attention to the screen, waiting for the most important step. The others, who only knew the procedure's name, kept their mouths shut in the presence of Director Ren and Director Zhang.
No one dared to interrupt the tense silence in the control room. Anyone who spoke up unnecessarily was likely to earn Director Ren's ire, as he was captivated by the ongoing surgery.
Through the radiation shielding glass, they could see Zheng Ren and Professor Rudolf were in the middle of a discussion. The puncture needle shifted slightly, then was held in position.
'Seems like they aren't proficient either,' Cheng Lixue thought to himself, grinning as if he had won the battle.
If they had it down to a T, they would not be having a discussion partway through the surgery.
His victory lasted less than 20 seconds. On the screen, the shunt was inserted via the wire guide.
A success?
With Cheng Lixue's level of understanding, he could not make out what had happened. His interventional skills were limited to liver cancer treatments such as radiofrequency ablation. He did not bother to expand his skillset and the TIPS surgery was undoubtedly beyond his capabilities.
'No way… No way…' Cheng Lixue chanted in his mind.
He was going to be disappointed.
The shunt reached the target site and was deployed, connecting the hepatic vein and the portal vein.
Cheng Lixue had witnessed this surgery from start to end.
Despite that, he had no idea how Zheng Ren succeeded. even Director Ren was at a loss.
At this point, Director Ren realized age was catching up to him.
The world belonged to the next generation, to doctors like this young chief resident from Sea City General Hospital.
The TIPS procedure was viewed as one of the most difficult surgeries, and yet he successfully performed the puncture on the first attempt. No wonder the Heidelberg University professor flew all the way to China to be his assistant.
In modern day speech, this was known as an intellectual exchange. In the past, it would be said the professor was learning a trade.
Whether it was Lil Fugui or a random doctor, they would be considered a world-class surgeon after learning this skill.
This young doctor… He was an up-and-coming revolutionist.
While Director Ren was caught up in his thoughts, the second shunt was set in place.
Once he got over his surprise, Director Ren turned to Director Zhang. "Old Zhang, is this second shunt to prevent hepatic encephalopathy?"
"Uh, yes, Director Ren. Usually a second shunt isn't placed as during the removal process, it could potentially cause a major bleed."
Director Zhang got straight to the point. There was no point speaking in riddles with the director; it would only irritate him.
"At Sea City General Hospital, Chief Zheng performed two TIPS procedures. One of them was an emergency case to stop the bleeding. In both surgeries, they set removable shunts. They already successfully removed one of the shunts and the patient was discharged today."
"Amazing!" Director Ren exclaimed.
"Yes. Hence why I was so adamant that we invite him over to perform the surgery. We might never get another chance if he becomes a bigshot."
"How much does one surgery cost?"
"5,000 yuan. For the financially needy, the hospital will cover 3,000 yuan," Director Zhang said.
Director Ren frowned and turned to stare at the busy pair in the operating room. "Nonsense! That price is a slap to the professor's face and ours!"
Chapter 388 - You Can Brag But Don’t Exaggerate
"Director, we were considering the patient's financial background when we settled for 5,000 yuan—," Zhang Guangzhi said.
> His words were cut off.
Director Ren asked as he watched the screen, "What does Dr. Zheng think of the offer?"
The second removable shunt overlapped with the first shunt graft perfectly. The surgery was coming to an end.
"Chief Zheng agreed to the offer. His only request was for us to get eight to ten patients within the month."
"Oh?" Director Ren made a surprised sound.
"I believe Chief Zheng and Professor Rudolf Wagner are developing a new method and require sufficient cases to back them," Director Zhang whispered his suspicion to Director Ren.
Director Zhang knew the implications of such a project.
Director Ren thought for a moment, then said, "The volume is insufficient. We need at least 30 samples. Money is not an issue; the hospital will provide a discount."
"Then…"
"Get Dr. Zheng to train someone from our hospital. Most of the patients who require TIPS surgery are definitely from our hospital. Let him know he will have his supply of patients."
"Understood."
It was at this point of the conversation Zheng Ren exited the operating room. Professor Rudolf Wagner had taken over the procedure.
Director Ren still could not wrap his mind around the situation. He wondered if he had missed any signs that this was a prank.
"Chief Zheng, you're terribly familiar with the TIPS procedure." Director Zhang approached Zheng Ren with a big smile on his face.
"I'm alright."
"Where did you learn the method?" Director Zhang asked.
Where indeed? Even the world's best hospital would have trouble completing the TIPS surgery in such a short time.
"My first TIPS procedure was because of Chief Xia's emergency patient. It was a forced, rushed job, but the procedure was less difficult than I'd thought. Then, with the professor's help, we did a few days of research and developed this new approach," Zheng Ren said with a chuckle as he searched around for the third patient's scan.
Director Zhang rushed to Zheng Ren's aid and the words made him trip, nearly hitting his head on the table's corner.
The plump man managed to get a hold of Director Zhang before he fell.
Forced to perform an emergency TIPS surgery?
Was this an exaggeration?
The Surgeon's Studio c1-799 Page 182