Chapter 161: Give First, Take Later (Seeking Subscriptions)

Director Hong Du was probably approaching sixty years old, stood about 1.6 meters tall, with a lean but upright build.

The hair at his temples and the stray strands on his forehead were all white; his whole demeanor was reserved and low-key.

At least in the few days Fang Ziye had been here, few people mentioned Old Director Hong Du, but once Director Hong Du spoke, even Director Zhang Mingcan agreed without hesitation, and Wu Guo Nan, this newly promoted attending physician, showed not the slightest intention of refusing.

So Fang Ziye stayed. After walking up to Director Hong Du, he explained: "Director Hong, I can help, but right now I can only do routine work; as for what exactly should be done and how, I might not understand."

It's like this: the force needed for closed reduction, every adult male has it, and the general routine is simple enough.

But knowing how to reduce, this understanding of how to reduce — that's what's valuable.

If you compare a surgeon's absolute strength against a gym rat's, the surgeon still comes up a bit short.

Director Hong Du's group is brimming with talent: there's Huang Kai, the deputy chief physician with the most seniority in the department, and Zhang Jinchuan, whom Fang Ziye had met a few times before — the duty doctor when Fang Ziye first arrived.

Below them are Cao Zhen, a master's student from Three Gorges University Affiliated Hospital, and an ordinary standardized training resident. The group's manpower is sufficient.

Fang Ziye spoke with Director Hong Du and also nodded in greeting to Huang Kai and the others, but didn't call out to them directly.

Hearing Fang Ziye's explanation, Director Hong Du didn't explain, but Deputy Chief Physician Huang Kai laughed.

Huang Kai has a very large mouth; his speech carries an indescribable soft, sticky quality: "Ziye, you don't know this, do you? The Director Hong standing before you is the true pillar of our Trauma Surgery."

"The reason our Enshi Central Hospital's Orthopedics has its current scale is entirely because Director Hong Du built it single-handedly."

"Director Hong can operate from the atlas of the cervical spine all the way down to a little toe fracture. From external fixators to intraosseous tumors — all are Director Hong Du's specialties."

"Director Hong spent his first twelve years on spine surgery, and spine surgery became Enshi's number one. The middle fifteen years he did joints, and now our department's joint surgery is Enshi's number one. After the new Trauma Center opened, Director Hong Du..."

While Huang Kai was still engaging in commercial mutual flattery, Hong Du patted his shoulder: "Enough, enough, Huang Kai. You think Dr. Fang is like those people you usually see?"

"You cite what I've done in front of a top-tier orthopedics like Zhongnan Hospital — isn't that embarrassing?"

"Little Fang, let's go. We'll head to the OR first, then talk as we walk."

"After all, speaking of it, I have a certain friendship with Old Chinese Doctor Chen who came from our Enshi. When he was organizing the clinical application of manual reduction techniques with modern medicine, we collaborated."

"Just that I started late and couldn't catch up to Old Doctor Chen's powerful operative skill, but on the question of which fractures can be reduced, I might still have a bit of experience." Hong Du dropped a heavy bombshell with remarkable modesty.

A home with an elder is like a home with a treasure.

Although surgeons, when old, no longer rely on sinew and bone for their ability, who can ignore the insight he has soaked up over decades in clinical practice?

Hearing this, Fang Ziye immediately nodded and followed along, glancing back at Director Wu Guo Nan and the others — they went on ward rounds if that's what they should do, did whatever they should do.

They didn't give a thought to the fact that he was no longer in the group.

From this it's clear: this unassuming Old Director Hong Du holds absolute authority in the department; at least in status, even Zhang Mingcan would probably have to yield seven or eight parts.

On the way to the OR, Fang Ziye re-acquainted himself with Huang Kai, Cao Zhen, Ceng Weihang, and the others.

Fang Ziye's deepest impression of Huang Kai: huge mouth, thick lips; though not broad-shouldered, his muscles are wiry and tough — a die-hard gym fanatic.

His nickname in the group is "Cocky Mouth."

The other one, Cao Zhen, is more low-key, wears medium-long hair that usually covers his eyes; only in the OR does he coil his hair up and tuck it into his cap to avoid obstructing his view.

"Holy shit, Director Huang, you're that awesome? Then I really need to learn more from you." In the changing room, while Zhang Jinchuan was briefing Fang Ziye, Fang Ziye learned that the Trauma Center's heavyweights were all concentrated in Director Hong Du's group.

On the surface Zhang Mingcan is the Ward Administrative Director, but the talent under him definitely can't compare to here.

Huang Kai — don't let the cocky mouth and thick lips fool you; with the status of a deputy chief physician at a prefecture-level city hospital, he won First Prize in the Hubei Province Young Physician Hand Surgery Skills Competition — First Prize has eight slots, Special Prize three.

And Huang Kai also won Third Prize in the National Spine Surgery Minimally Invasive Skills Competition — Second Prize nationwide only fifty slots, even adding First Prize's twenty and Special Prize's five.

To become one of a hundred Third Prize winners, Huang Kai's resume is quite substantial; he definitely has the goods to win it.

Currently his main focus is minimally invasive spine surgery, secondarily arthroscopy.

Huang Kai said: "All empty fame, no need to take seriously. It's the judges' favoritism; where's any awesomeness?"

"Compared to truly awesome people, what am I? Many don't even deign to compete. You don't need to mind this."

Huang Kai's voice is slightly hoarse, but not gratingly so.

The group, after changing into scrubs, arrived one after another at Operating Room 9.

The OR now had ample staff: two circulating nurses, one instrument nurse — all three weren't scrubbed in, probably on Director Hong Du's prior orders.

Seeing Director Hong Du enter the OR, a slightly older-looking nurse asked: "Director Hong, are we doing a few reductions first today? If reduction really fails, then surgery?"

"I didn't have enough surgical packs prepared first thing, but they can be sterilized and rotated for standby anytime."

"Mm, that works. Xu Xia, you pair with me; I'm very at ease with you." Director Hong Du watched the anesthesiologist administering anesthesia, then plopped down on a round steel stool and casually set his phone on the storage table.

The nurses stood up at once, yielding the spot.

The older nurse still said: "Director Hong, you jest. I was brought up by you, Teacher Hong; now the hospital arranges for me to only follow you and learn — that's my good fortune."

There's subtext in this nurse's words; clearly she's a specialty nurse assigned specifically to work with Hong Du, not participating in the hospital's general duty roster?

She definitely has some substance.

After all, Director Hong Du covers three sub-specialties — spine, joints, and trauma — and if she can keep up with all of them, her knowledge base certainly isn't narrow.

Hong Du chuckled, then looked at the anesthesiologist; his first words made Fang Ziye's heart skip a beat.

"Teacher Nie, is the anesthesia going smoothly?" Hong Du's tone carried a few parts gravity and respect.

Hearing this, Fang Ziye looked over, thinking he'd misheard.

The one giving anesthesia looked thirty-one or thirty-two at most; at that age, he'd barely count as a junior in Anesthesiology. Fang Ziye's first impression was that he was just tagging along to prep drugs early, waiting for the real anesthesiology chief or senior attending to be called when it was time to induce.

Hong Du's single "Teacher Nie" left him quite bewildered.

He was performing a nerve block; presumably after the needle reached position, he just barely turned his head and smiled: "Almost done, Director Hong. Just wait a few more minutes."

"The next surgical patient, I've already taken them on; going to the pre-anesthesia room outside to induce."

"Shouldn't delay you much, Director Hong."

Hong Du said: "No rush, Teacher Nie. You do your thing. We'll wait for you, hehe."

The young man turned his head and said: "Director Hong, why don't you change what you call me? Call me Mingxian."

"Don't call me Teacher Nie anymore."

Hong Du shook his head decisively: "That won't do. A top-tier talent like you, I have to support and nurture."

"Oh, right, Teacher Nie, this is the Doctor Fang from Zhongnan Hospital that your old classmate Doctor Wu mentioned yesterday, Professor Deng Yong's student."

For a moment, Fang Ziye felt the amount of information was a bit too much.

He needed to properly summarize it.

That is to say, it was Doctor Wu Xuanqi who came over first to greet Old Director Hong Du, had Director Hong Du bring him down today to perform manual reduction, and simultaneously pulled strings with the anesthesiologist!

Hiss—~

Why is this?

Is this another routine?

But it's not to that extent; Doctor Wu Xuanqi hasn't asked him to do anything either. Compared to Zhang Mingcan, up to now, the things Doctor Wu Xuanqi has given him far exceed what he imagined.

And what he asks for is merely that he give him some guidance on basic experiment-related content.

Fang Ziye found it a bit baffling.

The person called Nie Mingxian turned his head to glance at Fang Ziye, smiled again, then slightly withdrew the nerve block anesthesia needle a little, injected a bit more medication, and only then said: "Director Hong, the anesthesia here is done; I'm going to go anesthetize that patient outside."

"Estimated time is ten minutes from now, then bring them into the operating room; then transfer this patient back to the ward and the next patient from the pre-anesthesia room into the operating room; the time to enter the operating room will also be right around twenty minutes."

"Should be about right."

"You'll also have rest time." Nie Mingxian directly controlled the time precisely at the ten-minute level, speaking clearly.

Finished speaking, Nie Mingxian glanced once more at the vital signs on the patient monitor, then decisively turned and left carrying the medicine basket.

Fang Ziye, on the other hand, was still a bit dazed, eyelids fluttering rapidly, face full of puzzlement.

Seeing this, Director Hong Du had already stood up and explained to Fang Ziye: "Doctor Fang, this Nie Mingxian was previously a Seven-Year Program student at Kyoto University Affiliated Third Hospital, later came to work at our hospital."

"He was originally an Emergency Department doctor, but because our Anesthesiology Department was short on manpower, and Doctor Nie's anesthesia technique is very good, he was recruited in by the Anesthesiology Department Chief. His understanding of anesthesia and anesthesia duration has reached a very university level."

"Basically, if he says anesthetize for fifteen minutes, it won't exceed eighteen minutes; at most three minutes of error."

"Currently in the operating room, conducting a clinical project on anesthesia duration, drug dosage, and targeted anesthesia site positioning."

"Let's start work; Doctor Nie has already reserved our time for us."

"This patient's fracture..." Director Hong Du knew the patient's fracture very clearly; basically without looking at the films much, he knew it like the back of his hand.

Not only from the perspective of modern medicine did he classify his fracture with ao and special classification, but in a very short time he also presented the corresponding reduction theories and techniques one by one to Fang Ziye's ears.

Finished speaking, Hong Du asked: "How is it, Ziye, can you do this kind of operation?"

"Actually, manual reduction technique emphasizes reduction and fixation; and self-fixation emphasizes analysis of leverage points and fulcrum points."

"Through muscle contraction, interlocking of fracture fragments, and wedging measures, the fracture ends achieve self-fixation while completing reduction."

"Theoretically relatively complex, operational difficulty not small either."

Hearing this, Fang Ziye first didn't bother with the matter of Nie Mingxian's deeds; what kind of person he ultimately is currently has not a penny's relation to Fang Ziye.

Performing manual reduction for the patient, with knowledge points present and Old Director Hong Du giving him thorough analysis, he might as well handle the knowledge points first.

Hearing this, Fang Ziye nodded: "Should be able to achieve it. Director Hong, this patient's fracture is a B2.3 type fracture within tibial-fibular double fracture."

Fang Ziye pointed at the X-ray plain film hanging on the view box while saying: "In modern medicine's understanding, purely through manual reduction to align fracture ends, it remains an unstable fracture, requiring internal fixation; best is tibial intramedullary nail plus fibular steel plate and screw for thorough fixation."

"According to your analysis, it actually can be done through the fracture fragments' central segment fracture via a clamping form, then utilizing the tibialis anterior muscle group's tensile force and tibialis posterior muscle group's passive contraction force to complete the ends' stability."

"This point has great difficulty; Director Hong, please wait a moment, let me see exactly how to arrange the reduction." Fang Ziye couldn't directly agree.

As of now, in how to reduce and why to reduce this way, he is still a bit too shallow.

Because before this, Fang Ziye fundamentally never doubted the correctness of current modern medicine's fracture treatment guidelines; his capability also didn't allow him to question.

"No rush." Hong Du shook his head slightly, then went to soothe the patient.

"You don't rush either; definitely not painful, right? If not painful, just treat it as resting; squint your eyes a bit; just don't listen to our talk."

"Professional matters leave to us professional doctors; this Doctor Fang is the one your Min Da Hospital's Xiao Wu Doctor strongly recommended. He operates on you, you just rest assured; and there's me too." Hong Du knew what his task was now.

Hearing this, Fang Ziye's heart tightened slightly.

What he was thinking at this moment was: don't know if his Master knows Director Hong Du; although Director Hong Du is ten-plus years older than Deng Yong, with this bearing, presumably he should be acquainted too?

Why never mentioned?

The patient just smiled and said: "Director Hong, I believe both you and Doctor Wu. Doctor Fang I also believe; since I came here, I don't plan to think of anything else."

"You provide technique, I provide money; you endure trouble, I endure pain!" The patient was quite playful.

Roughly after two minutes passed, Fang Ziye then figured out some things, and said: "Director Hong, I feel it's about time; let's start. May not necessarily succeed in one go, but with your guidance, I feel the probability of successful reduction and successful self-fixation is very high."

Fang Ziye misappropriated Director Hong Du's rhetoric.

Manual reduction technique does not require absolute sterile principle, nor disinfection treatment. Because those able to do closed reduction are definitely not open fractures.

And!

Only need to put on sterile gloves, protect self and patient's skin isolation is enough.

Therefore, Fang Ziye, Hong Du, and Huang Kai all each took a pair of sterile gloves. Then began operation.

Hong Du personally did the traction fixed position, providing counter-traction force.

Huang Kai helped do traction; the main force direction and reduction process were overall controlled by Fang Ziye.

Operation just started, Huang Kai's eyes instantly brightened, looking at Fang Ziye with surprise and foreknowledge: "As expected, muscle force can be mobilized."

"This is the perfect combination of modern medicine and traditional medicine theory, this kind of operation."

Director Hong Du didn't speak; because many lower limb muscles originate from the femoral medial and lateral condyles, his counter-traction position is right there; he naturally also felt the quantity of muscles Fang Ziye mobilized.

Corner of mouth curled in a smile.

When he truly contacted relatively high-end manual reduction, he was already older in years; although at that time Old Doctor Chen asked if he wanted to study deeply, Hong Du himself also felt he couldn't go deep much.

"Mm. Little Fang's operation is still very good."

"Has several points that can rival Doctor Wu's demeanor." Hong Du said like this.

Fang Ziye's heart instantly tightened.

He just knew, perhaps this Senior Brother's operational level in manual reduction would be slightly higher than his by a little bit.

But it doesn't matter, Senior Brother is higher, that's a normal thing.

If Luo Tingzhu also walked this long a time in medicine, she'd probably be beyond Level 4 too; after all, Luo Tingzhu has only been in contact with clinical work for less than a year, and has already chased all the way to above Level 3.

Equivalent to one year being two hundred points of Proficiency; to reach Level 4, that is two or three years' time; further on, if the opportunity is suitable, there will still be promotion.

"That's why I came to learn, Director Hong, I hope you can bestow much teaching." Fang Ziye's attitude was proper.

After speaking, he lightly clicked once, and after force dissipation, the patient's fracture was already corrected and in position.

Unexpectedly, the other two circulating nurses, very professionally, directly pushed the C-arm close, and without needing more guidance, could directly reach the photo-taking position.

This coordination proficiency made Fang Ziye involuntarily have an illusion of being inside Zhongnan Hospital.

After viewing the images, Hong Du and Fang Ziye both felt quite satisfied; Huang Kai naturally dared not have an opinion, and directly brought Zhang Jinchuan and several people to start plaster casting...

Fang Ziye originally also wanted to help, but Huang Kai hinted to him: "Don't you have questions to ask Director Hong?"

Only then did Fang Ziye honestly sit back down beside Hong Du.

He asked the doubt in his heart: "Director Hong, this Wu Senior Brother, why would he call for you to guide me?"

"First give then take, thick give thin take, take the seedling but not pick the fruit, that is the gentleman's style." Hong Du, facing Fang Ziye, smilingly explained thus.

(Chapter End)