Great Doctor Ling Ran Chapter 174
174 Its Easy To Lick A Capable Persons Boots
"Let her use another container later, one with a narrow opening." Unexpectedly, Ling Ran did not scold Yu Yuan. Even though Ling Ran rarely scolded anyone in the operating theater, it was ingrained in everyone's mind that chief surgeons had a penchant for scolding people.
The circulating nurse acknowledged his order but looked as if she had been wronged. If it were another young chief surgeon, the circulating nurse would have likely started a fight right then. When it came to arguments in the operating theaters, young doctors could only gain victory over patients who were under general anesthetics.
It was good that Ling Ran was the one who gave the order because the circulating nurse did not think much of it. However, she began to gaze at Yu Yuan in a less friendly manner.
Panic-stricken, Yu Yuan apologized again. She looked rather dejected.
She had originally hoped to have a good start after she arrived in a new group.
However, there did not seem to be a great change in anything.
She was unable to even hide her carelessness during the first few days she started with this new treatment group of hers.
There were not many changes in Ling Ran's expression. He continued to let Yu Yuan retract the patient's skin. After a while, he said, "Yu Yuan, change your gloves."
"Huh? Change gloves?" Yu Yuan, who was lamenting her own fate while retracing the patient's skin, did not really understand Ling Ran's words.
"There's blood on your gloves," Ma Yanlin explained kindly.
Yu Yuan flipped her hands over and looked at them. Finally, she saw a few spots of blood at the back of her hand, right where the joints of her fingers were. She then felt even more embarrassed.
Microsurgeries had very high requirements when it came to details. It was a basic requirement for the gloves and apparatus to be free of blood because it was easy for blood to get stuck to suturing threads.
Yu Yuan could not remember when she touched blood. When she thought about it, she could not help but become extremely anxious.
Feeling slightly flustered, she quickly left the operating theater. She took off her gloves and changed into a new pair of gloves with the circulating nurse's help. She felt dejected.
"Yu Yuan, get a pair of Bangerter forceps." Ling Ran's order immediately came.
"Oh all right. Umm, give me a pair of Bangerter forceps." Yu Yuan was so panicked that she could not talk properly. She sounded like an intern.
The circulating nurse already had a pair of Bangerter forceps in her hand. The moment Yu Yuan asked for it, she slapped it into her palm immediately.
Even though the pair of Bangerter forcepsalso known as non-traumatic hemostatic forcepsmade her palms cold, Yu Yuan felt slightly calmer.
In her mind, she could immediately recall the Bangerter forceps' origins, and most importantly, its uses. The Bangerter forceps were forceps that were specially invented to hold blood vessels. The forceps' teeth were deliberately made to be uneven, and they were round as well as tiny. This kept the damage to the blood vessels and other fragile tissues caused by pressure at a minimum.
There was no doubt that Ling Ran asked Yu Yuan to get the pair of Bangerter forceps so that she could grip a blood vessel.
Yu Yuan could not help but inhale softly. She felt anxious once again.
"Do you know how to use the Bangerter forceps?" Ling Ran asked Yu Yuan like he was questioning an intern.
However, it was exactly what Yu Yuan needed.
When she was a Master's student, for the sake of writing her thesis, she basically forwent all experience in clinical practice. Once she entered Yun Hua Hospital armed with the high qualifications of a Tier 1 thesis, it was even more impossible for there to be clinicians who wanted to teach her from scratch.
Of course, Yu Yuan was never worried about her theoretical knowledge. She thought for a little while and said, "We must never grip the tunica intima  with forceps. As for the tunica adventitia , we must only grip it when it's absolutely necessary and we have to do so gently."
"Yeah, the Bangerter Forceps you're holding now was chosen from many of its kind after many surgeries. The pressure it exerts isn't too great. You neither have to use any additional force nor worry about the grip being too loose." Ling Ran explained to Yu Yuan as he continued to handle whatever task he had at hand.
His Perfect Level Finger Replantation also included offering guidance to his assistants.
Surgery was never one person's business. The more major a surgery was, the greater the number of doctors involved. Hence, for the surgery to be perfect, the chief surgeon had to have the ability to coordinate and manage his assistants.
With the personality he had, Ling Ran was not skilled in coordinating or managing others.
If a person like Ling Ran were to get a job as an engineer or a product manager, that person would most likely work himself to death.
However, as the chief surgeon in an operating theater, it was a befitting coordinating and managing technique to issue orders confidently.
Ling Ran did not talk about how Yu Yuan was bad with her hands, and neither did he offer any criticisms nor suggestions related to her surgical skills. He explained things step-by-step to her as if she was an intern.
After all, Yu Yuan did have some basics. After familiarizing herself for a while, she was able to fulfill Ling Ran's requirements. Usually, anyone would be able to fulfill the requirements of being a second assistant in the operating theater. When one was exceptionally attentive, and special instructions were given, one could do it even if one was bad with his or her hands.
Very quickly, Ling Ran sutured another blood vessel. He then continued with the next one.
Yu Yuan held the pair of forceps and followed him along the way.
When Ling Ran was suturing the first vein, Yu Yuan's movements were still rather stiff. Slowly, after participating in the suturing of many veins, the stiffness of her movements gradually disappeared.
"Drench the operating field," Ling Ran ordered again.
Yu Yuan confidently picked up the container with a narrow opening.
Splashes occurred again.
"Next, we'll perform perineurium anastomosis," Ling Ran said without even furrowing his eyebrows.
Yu Yuan breathed a sigh of relief, and her spirits were high again.
Ling Ran's rhythm was way too fast.
A few seconds later, Yu Yuan abruptly widened her eyes and asked, "Why is it perineurium? Shouldn't it be epineurium?"
"I'm better at perineurium anastomosis," Ling Ran said, as though it was a given.
"But perineurium anastomosis is much harder and needs a lot more time" Yu Yuan's voice slowly faded away, because Ling Ran was clearly moving faster.
At that point in time, he did not really need a second assistant.
Yu Yuan put down the forceps in her hands. She then asked the nurse to help her put on a pair of surgical magnifying glasses, and she tried her best to acquaint herself with the operating field through the lenses.
She saw that Ling Ran was using a microinstrument to gently separate the severed epineurium of the ulnar nerve. He did so until the normal tip of the nerve appeared before he cut off 0.19 inches of epineurium, where the nerve was severed, in a circular manner. Next, he started to separate the perineuria.
At that point, Yu Yuan's eyes were already wide open.
It could be said that one strand of epineurium was made up of a bundle of perineuria just like a rope, which consisted of many thin threads being twisted together.
It was obviously not an easy task to separate the various functions of those different, thin threads.
However, when Yu Yuan looked at Ling Ran's face, she found that he did not seem to find it difficult at all.
When Ling Ran matched up the perineuria one by one, he basically made it appear as if each of them was labeled.
Yu Yuan could not help but say, "The anatomic structures of different perineuria basically look the same. How do you differentiate them?"
Ling Ran answered without thinking, "Through experience in dissection."
"This How much experience in dissection would you need for that?"
Ling Ran did not answer Yu Yuan.
After obtaining the experience of performing three thousand dissections, Ling Ran was totally at ease when it came to performing surgeries in the Hand Surgery Department.
Every single person's hand was slightly different. But the probability of a hand being completely different from three thousand other people's was extremely low. Besides, nowadays, there were various theoretical papers that spoke of atypical cases.
Nonetheless, Yu Yuan was stunned. She muttered, "Usually, the effect of perineurium anastomosis is better than that of epineurium anastomosis. But it also needs more time, and it isn't usually used in finger replantation surgeries. Additionally, when performing perineurium anastomosis, it's very easy to choose the wrong perineurium. If the wrong perineurium were to be selected... Well, it'd be better to perform epineurium anastomosis if that was the case. Besides, it's more troublesome to suture the perineurium, and it takes more time. It takes at least around half an hour more than epineurium anastomosis. When it comes to finger replantations, the price-performance ratio won't be high if you waste so much time on perineurium anastomosis"
In the operating theater, the nurses, anesthetist, and Ma Yanlin gave Yu Yuan a strange look.
Yu Yuan shook her head violently. "D'Arcy Power once published a paper on the therapeutic effect of epineurium anastomosis and perineurium anastomosis. Even though the results of the paper showed that the resulting nerve conduction velocity of perineurium anastomosis was higher, the compound muscle action potential of patients who received perineurium anastomosis was obviously greater as shown by the wave amplitude, and overall effectiveness was very high, he was using the ulnar nerve for comparison."
Yu Yuan paused for a moment and continued to mutter, "The ulnar nerve is a lot easier to suture compared to the nerves of a severed finger. The time required is lower, and the difficulty level is also lower. It's impossible to suture the nerves of a severed finger in the same time you would an ulnar nerve. So, you can't simply think that perineurium anastomosis is better"
"Mm I'm done suturing." Ling Ran looked away from the microscope and took off his gloves.
Yu Yuan, who had been speaking rather excitedly, was stunned again.
Before she could ask further questions, Ling Ran massaged his own neck and said, "Young Ma, there's no problem with you doing what's left, right? Suture the skin of the patient."
"No problem. You can take a rest." Ma Yanlin got slightly excited. After waiting for so long, even though he only got the opportunity to suture the patient's skin, it still made him very happy.
Ling Ran took off his scrubs and threw it into the cylinder. He then stepped on the automatic door of the operating theater and left.
Nowadays, he took a short rest every time he finished a surgery. Nobody found anything wrong with it.
Ma Yanlin waited for the operating theater door to shut before he sized up Yu Yuan from head to toe and said, "I wouldn't have imagined that you'd be such a good bootlicker. You look so honest from the outside."
Yu Yuan was still in an extremely shocked state. When she heard what Ma Yanlin said, she almost did not react at all. She asked, "What do you mean?"
"Even though you know that Doctor Ling's best known for being extremely well-versed in hand anatomies and that he's amazing in perineurium anastomosis, you deliberately talked about how hard it was. Not bad indeed." As Ma Yanlin spoke, he laughed.
Yu Yuan only realized that Ma Yanlin was making fun of her, and she could not help but lower her head before she said, "I didn't know that I was going to be allocated to Doctor Ling either."
"You'll slowly familiarize yourself with him after this," Ma Yanlin said as he slowly sutured the patient's skin, "Doctor Ling doesn't like to talk when he performs surgeries, and his movements are rather fast. Compared to the other doctors, it's easier to participate in his surgeries. There's only one problem"
Yu Yuan naturally asked, "What problem?"
"Doctor Ling performs surgeries non-stop."
"Non-stop surgeries?" When Yu Yuan thought of her horrible surgical skills, she immediately had a bad feeling. While in an absent-minded state, she recalled a few of Ling Ran's direct orders, but she also remembered that she was of some use under Ling Ran's orders...
After she stood in a daze in the operating theater for a few seconds, Yu Yuan's round face and eyes beamed with a strong desire for knowledge as well as a huge urge to perform surgeries once again.
"Doctor Yu, Doctor Yu" Su Jiafu slowly moved to the front of Yu Yuan. He smiled passionately and asked, "Doctor Yu, you're someone who has published your thesis in a Tier 1 journal. Could you take a look at my paper?"