Translator: EndlessFantasy Translation Editor: EndlessFantasy Translation
At three o’clock in the morning, Ling Ran cranked the engine of his second-hand Volkswagen Jetta—still relatively new— and drove from Lower Groove Clinic to Yun Hua Hospital.
Ling Ran drove with the focus of a race car driver. On the road with a speed limit of fifteen miles per hour, Ling Ran made sure his speedometer was constantly, infinitesimally close to fifteen miles per hour.
He drove to the hospital at a moderate speed. By then, it was a quarter after three.
Ling Ran finally breathed a sigh of relief. After sending away Meng Xue and the others the day before, he worked on his research paper again. Because of it, he could only sleep at ten. He only managed to crawl out of his bed at three. If it was not because the roads being barely populated at dawn, allowing Ling Ran to speed, he would have been late.
As usual, after freshening up in the Operating Area, Ling Ran changed into a fresh pair of underwears and finally felt that he had recovered to full strength.
Ever since he began receiving surgery fees, he had been stocking up on underwear. Moreover, as the time he spent performing surgeries grew longer, the attention to detail required for his surgeries also rose, as did his income. Hence, the underwear Ling Ran bought rose similarly in class; this adhered to economic theories. When a doctor has to stand in the operating theater for ten to twelve hours a day and when he or she did not spend the six hours of their sleep naked, buying anything else other than underwear would be a complete waste.
The air in the Operating Area was fresh, the temperature was constant, and there was a charming, odourless atmosphere.
Ling Ran wore his scrubs and a new, smooth, soft, and close-fitting underwear. His footsteps were light.
When he entered the waiting room, Lu Wenbin brought out a pot of braised meat.
The brownish and slightly yellow braised meat quivered as the aluminium pot bubbled.
The six doctors who worked night shifts along with Ma Yanlin cheered as one. They held a bowl with one hand, and with the other, they opened up their WeChat Pay applications to pay Lu Wenbin. Their actions were neat and well-practised, as if they had done it for a few thousands of times.
“It’s good to have a supper at the end after one whole night of work.” Zheng Pei, a senior resident doctor, repeated himself yet again. He accurately found a pork tail and picked it out directly with his chopsticks. After making sure no one else wanted it, he smiled and put it into his own bowl.
Lu Wenbin put away an extra bowl of rice, pickles and vegetable salad at where Ling Ran usually sat. He laughed, “Today, we will have rice for breakfast. Doctor Ling, what kind of meat do you want?”
“Slice a strip of pork belly for me, and just put it directly on top of the rice.” Under normal circumstances, Ling Ran had to do more than six hours of surgery in the morning before he could eat his second meal. Hence, his appetite during breakfast was excellent.
Lu Wenbin seemed to be able to guess Ling Ran’s choice. He smirked and said, “I have something better for you.”
As he was talking, he took out a steaming pot from the small kitchen and opened it. There was a plate of sliced pork belly cut into pieces with hot steam rolling up from it.
“Steamed pork belly with preserved mustard greens?” The pork tail was in Zheng Pei’s mouth when he spoke, so he was barely comprehensible.
“Strip meat.” Lu Wenbin smiled smugly. He continued, “Shaanxi’s famous dish. The focus is that it’s tender, flavorful, fat, but not greasy. There’s a secret in making it.”
“What’s the secret?” Several doctors looked at the strip meat in Lu Wenbin’s hands. They showed the appropriate amount of curiosity.
Lu Wenbin said mysteriously, “Just put sweet potato. It will absorb the oil.”
The people responded in a perfunctory manner.
Lu Wenbin grunted. He first placed the plate before Ling Ran, took the two largest and best strip meat, and placed them in Ling Ran’s bowl while they were steaming hot. He then put the plate back on the table.
The group of hungry doctors on duty were like vultures. They rubbed their bellies with one hand while they finished the whole plate of strip meat with the other hand.
“Let’s go operate on some flesh.”
“Let’s go, let’s go.”
The resident doctors were satiated. They returned to the treatment room with their hands on their waists, and went to prepare for the debriding and suturing of patients.
In the Emergency Department of a hospital the size of Yun Hua Hospital, there was no shortage of patients in need of debridement and sutures. Slicing up, cutting up, and snipping away flesh was basically a compulsory course for young doctors.
Ling Ran took the pad in the waiting room and read the MRI scans of the first operation of the day while drinking tea.
He would not enter the operating theater with a full stomach. The satiety would affect his judgment and train of thought, and the judgment at the beginning of the operation would affect the whole surgical procedure.
Without a need to give him a reminder, Lu Wenbin called out to another houseman to help him to clean up the pots and pans. He himself quickly brought Ma Yanlin into the operating theater to confirm the various surgical procedures they would be performing later.
After a while, Lu Wenbin returned to the waiting room, gave a brief introduction on the situation of the two patients, and then continued with a slightly troubled expression. “The patient has a history of smoking for fifteen years.”
“He started smoking at the age of sixteen?”
“Yes. I asked the family, and they said that he would smoke at least two packs of cigarettes a day.” Lu Wenbin paused and said, “I think it may be more than that.”
“Does the patient have any intention to quit smoking?” Ling Ran asked. If the patient could not quit smoking, it would not be necessary to perform a finger replantation surgery. One cigarette after surgery, and the finger would turn black and suffer necrosis.
The most important aspect of finger replantations was blood supply, and blood supply was entirely supported by tiny blood vessels, and it was the easiest for small blood vessels to form blood clots. With that in mind, during the early stages of recovery for a patient who just had his or her finger replanted, it would be necessary for the patient to continuously cut the skin so that the hospital could administer heparin to prevent blood coagulation. Nicotine would do the exact opposite, and the quantity of nicotine in cigarettes was too much, which would cause vascular spasms and easily result to thrombosis. At that time, be it amputation or a gradual removal of the necrotic parts, secondary damage could not be avoided. It would make the surgery meaningless, it would be a waste of time and money, and the patient would more likely suffer more. It would then be better to just amputate the finger.
Lu Wenbin pursed his lips and said, “If we tell them to choose between quitting smoking and amputation, they would definitely choose to quit smoking. But people always forget the pain they had to suffer once after they are healed. He smoked for fifteen years, it won’t be easy to quit smoking.”
Ma Yanlin, who was transferred from the Hand Surgery Department due to clinical rotation, said instead, “I have heard of a patient who very firmly said that he would smoke even if he ends up dead.”
Lu Wenbin was amazed, “What happened in the end?”
Ma Yanlin cast him a glance and said, “Naturally, the patient’s wish is the most important thing in the end. If person wants to smoke but you force a limb replantation on him and you amputate it later on, isn’t that equal to scamming them for medical expenses? After repeated confirmation between the chief physician, patient, and the patient’s family, we amputated that patient’s finger.”
“That’s simple.” Lu Wenbin chuckled and said, “It takes three to four hours to replant a broken limb, and it takes half a year for that finger to recover. One cigarette can destroy the entire process. A decision made in advance would be better.”
“Yeah, if the patient can make a decision, it would be easy for us.” Ma Yanlin nodded in agreement. Microsurgery was one of the hardest surgeries. The length of surgery was extremely long, and it was very stressful. After a long period of surgery, doctors would naturally hope to reap the fruits of labor, not only in terms of personal income, but also a sense of acceptance and success.
It would be devastating for a doctor to look at a patient who could not stand the temptation and would rather light a cigarette.
“Doctor Ling, what should we do?” Lu Wenbin looked at Ling Ran.
If the patient could decide whether he wanted replantation or amputation, the doctor could also make a decision conforming to standards.
Many foreign doctors would nowadays refuse to carry out finger replantations for smokers, alcoholics, and others with bad lifestyles. As of the current day, there were similar statements in China itself. Qi Zhenhai from the provincial hospital and Hospital Director Liu from the People’s Liberation Army General Hospital have argued on this before.
Ling Ran remained silent.
To be honest, he really had no such experience.
“Doctor Ling, do you want to see the patient’s family?” Lu Wenbin asked.
For matters of agreement like these, many doctors liked to talk to the patient or the patient’s family before making a decision. Huo Congjun would be one of them. He might be a careless and old military doctor, but he was quite experienced in making judgment.
Ling Ran just thought for a few seconds before he shook his head without hesitation. “There’s no need to meet them again. Has the patient’s family decided to receive finger replantation?”
“Is the informed consent form signed?”
“You could check his documents again and then ask for his family’s opinion. If they still decided on finger replantation, then we shall do it.” Ling Ran’s answer was somewhat unexpected to Lu Wenbin and Ma Yanlin.
Lu Wenbin had to remind Ling Ran, “The patient said that he wanted to quit smoking, but it is difficult to quit smoking, especially for smokers who have smoked for more than ten years. It would not be easy to quit smoking.”
“We can only support his current decision.” Ling Ran paused to look at Lu Wenbin and Ma Yanlin. He said, “What do you think?”
The two thought about it, yet they could not say anything against it.
The patient may quit smoking, or he may not, and no one could guess what would happen in the end, neither could they influence the patient’s actions.
In democratic countries such as Europe and America, doctors may be able to have a say and make a decision to proceed with the surgery or not. As long as they wrote down medical advice that fitted medical standards, there would not be a problem. However, the doctors in China did not necessarily care about their own hours of labor.
Lu Wenbin originally thought that Ling Ran was a doctor who cared about time and efficiency, but found out that when he had to make a decision, he did not hesitate.
Lu Wenbin groaned in his heart and went to the patient’s family to get another confirmation.
Ten minutes later, Ling Ran, Lu Wenbin, and Ma Yanlin went to the battlefield. They dealt with the pollutants and necrotic tissue on the surgical section and trimmed off the wounded parts.