Once he had eaten his fill, Ling Ran sat on a chair in the office. He was in a relaxed mode as he reclined against the chair to look outside the window. He saw the corner of a building before him and sank into deep thought.
Sunlight shone on the ground, and it was warm.
To his left was a cup of lemon, kumquat, and passion fruit tea, which was given to him by the nurses at the nurse's station. There were ice cubes in it, and cold steam rose up from it, making it very refreshing. To his right were three sets of dim sum given to him by his patients' family members.
While he was not allowed to receive red packets, gifts of food from the patients and patients' family members were still allowed. However, most of the fruits and snacks that the patients and their family members gifted them were usually for the entire department. The start of the tradition of giving gifts for certain doctors only started after Ling Ran arrived.
"Are you full?" When Huo Congjun returned to the office, he saw that Ling Ran had replenished his strength, and he nodded his head in satisfaction.
Ling Ran hummed as an answer before he asked, "Is the patient here yet?"
"Wang Haiyang is reading the records. He hasn't made his decision yet," Huo Congjun said before he asked, "Did you buy chocolates and other stuff?"
"I bought a bar." Ling Ran whipped out a huge block of Dove chocolate. He bought it at a vending machine.
"That's not enough." When Huo Congjun saw this, he shook his head. He said, "Finger replantation surgeries will last for long stretches of time. What will you do when you're hungry?"
"I've never heard of other doctors eating in operating theaters…"
Huo Congjun pursed his lips and said, "Other doctors are other doctors. We don't have any sort of secret tips for success in the Emergency Department. We just know that we have to eat and drink to our fill before a huge battle. During the battle itself, we have to find time to eat and drink well, and after the battle, we have to eat and drink well to replenish our energy… Hey, you, get two Snickers bars for Ling Ran."
A young resident doctor handed the Snickers bars to Ling Ran.
Ling Ran could only take them. As an exchange, he gave the resident doctor a set of dim sum.
Huo Congjun nodded, "Please listen to Wang Haiyang once you go in. You can take over Chief Physician Wang's part in the surgery when he tells you to. Although they are both microsurgeries, a finger replantation is still quite different from flexor tendon injuries."
*Creak, creak, creak, creak.*
Before Ling Ran even spoke, the chair next to him made strange noises as it was shaken.
Huo Congjun and Ling Ran naturally looked over, and they saw Lu Wenbin, who was sitting in the chair. He was trembling non-stop. He could not stop himself even if he wanted to.
Lu Wenbin felt awkward because there were two people staring at him. He stood up that instant as he smiled in embarrassment and said, "I'm just a little excited."
He was the unofficially designated second assistant surgeon. It would also be his first time participating in the replantation surgery of a severed finger.
"When I asked you to save the patients last time, why weren't you as excited as you are now?" Huo Congjun said in displeasure.
'Is he jealous?' Lu Wenbin spoke happily but also nervously, "I was also excited during that time. I was so much more excited, but I didn't have time to shake in the chair. I didn't realize—"
Huo Congjun hummed before he spoke to Ling Ran, "Don't wander off too far. You're about to enter the operating theater at any moment now."
Once he finished saying all that he wanted to say, Huo Congjun left the office.
Lu Wenbin was so nervous that his legs trembled. "Did I say something wrong? What does Department Director Huo mean by that?"
He subconsciously looked at Ling Ran but found Ling Ran basking under the sun. The light illuminated his face in such a manner that he looked holy.
His fingers moved swiftly.
It was clear that Ling Ran was running a simulation of the finger replantation surgery in his head. Compared to surgeries performed using the M-Tang technique, which focused on tendons, the main point of finger replantation lay in the blood vessels. The flexor tendons of fingers were about the breadth of two or three rubber bands, and blood vessels were usually less than 0.01 inches. This meant that it was the breadth of the tip of a fountain pen. The level of difficulty in this surgery was self-evident.
Small blood vessels would also bring about thrombosis .
Thrombosis was an incredibly dangerous existence. It was considered one of the major causes of death and disabilities in hospitals. To prevent thrombosis, the nurse nursing the patient after the replantation of his or her amputated finger would be required to continuously administer heparin on the wound.
Meanwhile, the surgeon had to insert the needle steadily as the prerequisite of using heparin.
The effect of carelessly sutured blood vessels and blood vessels sutured by unsteady hands on other body parts were not obvious, hence they could be overlooked. However, it was absolutely forbidden for such things to happen in the Hand Surgery Department's finger replantations.
It could be said that keeping the hands stable under a microscope was the hardest part of finger replantation surgeries. Yun Hua Hospital's Hand Surgery Department spent millions of RMB to build their simulation training space and spent millions more on their yearly expenses so that they could train their young doctors on their sutures.
The junior doctors from other departments would just practice on the patients. No one was willing to toy around with the tails of white rats after working hours.
However, the Hand Surgery Department could not do so because the percentage of accidents occurring was too high. Hence, over the course of recent years, hospitals started to build their own simulation training space.
Lu Wenbin knew that when Ling Ran just started his internship, he had completed the test set by the Hand Surgery Department, which allowed doctors to graduate from the simulation training space and enter said department. Therefore, he stared fixedly at Ling Ran's fingers, wanting to see the main points of his operation.
Pulling the retractor was a mindless act. Lu Wenbin wanted to use his head to learn more things.
He watched… and continued to watch...
Lu Wenbin fell quietly asleep. The sun shone on his face, and it was pleasant but also itchy.
[The patient is about to arrive.] Ling Ran's phone rang. It was Chief Physician Wang Haiyang. He sent a text through WeChat.
Ling Ran opened his eyes swiftly. He tore open the chocolate's wrapping and devoured it.
He rushed to the surgical floor and entered the operating theater. When he did, he saw Wang Haiyang looking livid.
"The operation has been canceled." Wang Haiyang directed his gaze to Ling Ran and huffed before he said, "I was just about to send you a text. Go back and rest."
Wang Haiyang snorted, but he did not speak.
The elderly nurse beside him was similarly furious. She said, "The patient's family were so conceited. They first used tobacco and incense ashes to prevent blood flow on the palm, then immersed the severed finger in ice. In the end, the ice melted, and that's the same as immersing the severed finger in water!"
Ling Ran was completely dumbfounded to hear it. The incense ashes would affect the debridement. The nicotine contained in the tobacco shrank the blood vessel, and while it did not pose a problem to small wounds, it was definitely a big problem for finger replantations. Immersing a severed finger in water would also cause the tissues to be damaged the second time.
"He can't achieve the suturing criteria?" Ling Ran still felt a little unwilling to admit this fact.
Wang Haiyang hummed and said, "There's no need for suturing. The finger has decayed."
The criteria for the replantation of severed fingers inside the country was very low. If one still could not achieve the criteria, indeed, there pretty much was no need for suturing anymore.
"Don't the paramedics in the ambulance know about not immersing the severed finger in water?" Ling Ran asked helplessly.
If Wang Haiyang wanted to choose the types of injuries he wanted to treat, he could only choose them from the Emergency Medical Care's ambulance. He would only know the patient's condition by the time he received the patient.
Wang Haiyang took off the gloves he just wore and said, "The finger was sent by the family members. Simple dressing was applied to the patient's finger. The paramedics in the ambulance noticed the incense ashes but did not know there was tobacco."
The scrub nurse also sat down and said, "He just nailed his own coffin for his finger, with a sledgehammer."
"Wait, let me look around for a little while longer." Wang Haiyang was a little embarrassed to face Ling Ran. Ling Ran had brought an entire team to the operating theater, but the Boss had gone missing. As the party leader, Wang Haiyang had to stand up and say a few words to the party.
Ling Ran could only pat his stomach. Right then, he kind of missed Boss Shao.
If Boss Shao's finger was severed, he would have definitely sent it to the hospital with all the appropriate steps taken to ensure it met the criteria for replantation.
He may even have disinfected it.
Ling Ran sighed and said, "Then I'll wait in the waiting room."
The operating theater was a place with a very tense atmosphere. He knew it perfectly well.
Ling Ran sat in the operating theater and opened Kings of Glory. Once he played three rounds, he received a new patient.
"The patient is twenty-three years old. When he caught his wife cheating, the man she cheated with injured his fingers. His index finger and middle finger aren't completely detached from his hand, but they have been contaminated by a large amount of food…" The circulating nurse provided the details while the three doctors changed their clothes.
Wang Haiyang was delighted when he heard it. "This is good. If the fingers aren't completely detached, the level of difficulty will be lower."
As he spoke, he grabbed the patient's fingers and observed them. After a moment, he frowned and said, "There aren't any blood vessels left in the connected skin and muscle tissue. Even if we perform debridement, there won't be much effect. But it's better than nothing."
Ling Ran stared at the finger without uttering a word.
He had done up to hundreds of surgeries using the M-Tang technique, but he did not have much experience for finger replantations.
Wang Haiyang stood at the operating table. When he saw the patient, he felt better. He smiled at Ling Ran and said, "I will perform the first part of the surgery. Let's discuss the subsequent parts, which we will have to perform together later, okay?"
"Okay," Ling Ran answered frankly.
"Then, let's start. The general sequence of finger replantations is as such, we will first debride the cut before we reconnect the bone. Next, we will suture the flexor tendon and perform nerve anastomosis. After that, we will perform blood vessel anastomosis, and finally, suture the skin… Ling Ran, you haven't tried bone reconnection before, have you?" Wang Haiyang explained with a smile, just like a good senior doctor.
"Yes. I've never done any reconnections for bones that are completely detached from the body." Ling Ran fulfilled his duty as Wang Haiyang's first assistant by giving him a helping hand and chatting with him.
"So, later, when we do the bone reconnection, I'll explain the details to you." Wang Haiyang had a feeling that he was going to perform a cool surgery this time.
At the same time, Lu Wenbin dashed down the hallway as he grumbled, "Oh sh*t, oh sh*t! How could I have overslept?"