tkworld Chapter 1381 This is what mentoring is all about.
Chapter 1381 This is what mentoring is all about.
Chapter 1381 This is what mentoring is all about.
Yang Ping comes to Peking Union Medical College Hospital in Beijing once a month. There, he has a separate orthopedic ward where he can teach.
The old building at Peking Union Medical College Hospital dates back to the 1950s, its exterior walls covered in ivy. At this time of year, the leaves haven't fully grown in, and some of the plaster on the stairwell walls has peeled off, revealing the mottled bricks underneath. However, the operating rooms are newly renovated, with equipment even newer than that at Sanbo Hospital.
Yang Ping walked into the doctor's office in the ward, which was already full of people.
The young doctors, dressed in white coats, stood neatly in two rows. Some held thick medical records, some held notebooks, and one was nervously rubbing his hands. Professor Yang was a top expert among experts, so it was understandable that the young doctors were a little nervous.
Everyone straightened their backs when they saw Yang Ping enter.
"Hello, Professor Yang!"
The voices were so synchronized, as if they had been rehearsed.
Yang Ping nodded: "Okay, let's begin."
The ward rounds for supervising physicians begin at 8:30.
Song Yun led the way, with Yang Ping beside him, followed by a long line of doctors. Two PhDs pushed a medical record cart at the back, the wheels making a slight creaking sound as they rolled across the ground.
The first ward, we hadn't even entered yet.
Song Yun lowered his voice and said, "Professor, you've seen the scans for this case. The patient with the upper cervical spine tumor is very depressed and pessimistic about the treatment outcome."
Yang Ping nodded: "Does the patient know their true condition?"
“I know!” Song Yun replied, “That’s why he’s extremely pessimistic, and he even had suicidal thoughts before.”
Song Yun pushed open the door, and Yang Ping went in.
Lying on the hospital bed was a young man in his early thirties, wearing a neck brace. He was very thin, with sunken eyes and a vacant gaze, looking extremely unwell. When he saw Yang Ping enter, he struggled to sit up, but Yang Ping gently pressed him down.
"Lie down, don't move!"
Song Yun began her report: "The patient, Mr. Li, a 34-year-old male, was admitted to the hospital due to 'neck pain accompanied by progressive weakness in the limbs for 3 months.' He was treated for cervical spondylosis at the local hospital, but his symptoms continued to worsen. Two weeks ago, he experienced difficulty breathing and was transferred to our hospital via the emergency department. Imaging examination revealed a large mass posterior to the odontoid process of the axis, considered to be a chordoma, measuring approximately 4.2 × 3.8 × 3.5 cm, compressing the medulla oblongata and the junction of the cervical spinal cord, with both vertebral arteries surrounded by the tumor. We have consulted with the interventional radiology department and plan to first perform vertebral artery embolization, followed by posterior tumor resection."
Yang Ping didn't say anything, took the film, and stared at it for a long time in the light from the window.
The office was so quiet that you could hear the rustling of the ivy outside the window being blown by the wind.
He looked at the film for a full three minutes before putting it down, walking to the bedside, and beginning the physical examination. He asked the patient to move his fingers, wrists, and toes, and then used cotton swabs to test the sensation in various skin areas. Finally, he asked the patient to try to grasp his hand; the patient used considerable force, but the grip strength was noticeably weaker.
Yang Ping straightened up and asked a question: "How difficult is it for you to breathe?"
Song Yun said, "The pain worsens when I lie flat, but it is relieved when I lie on my side. Sometimes I wake up at night feeling suffocated and need to sit up to catch my breath for a while."
Yang Ping nodded and then asked, "When should the vertebral artery embolization be performed?"
"Next Mon."
When is the surgery? Who will perform the surgery?
Song Yun paused for a moment and said, "I will be the chief surgeon next Wednesday."
Yang Ping looked at him without saying a word. Song Yun felt a little uncomfortable under his gaze and lowered his head.
After a moment, Yang Ping said, "Tell me your thought process."
Song Yun took a deep breath and began, "I plan to use a posterior midline incision to expose the occipital bone to C4. First, locate both vertebral arteries and dissect them from their normal position towards the tumor, preserving them as much as possible. Then, open the spinal canal from the back and first dissect the relationship between the tumor and the dura mater. If the portion of the vertebral artery encased by the tumor cannot be separated, we will consider removing one vertebral artery, provided that the preoperative balloon occlusion test confirms good compensation on the contralateral side..."
He gestured with his hands as he spoke.
After listening, Yang Ping began to explain on the spot: "Upper cervical spine tumors are the crown jewel of spinal surgery. If not handled properly, the patient will either be paralyzed from the waist down or die on the operating table."
He paused, then said, "I'll come back next Wednesday for this case."
"These next few days, refine the surgical plan further. Think through every step and every possible unexpected event. Call me next Tuesday night, and I'll feel at ease after hearing your explanation."
Yang Ping gave instructions.
The patient felt reassured after hearing this. He wasn't afraid of Professor Yang's straightforward way of speaking. When he heard that Professor Yang would be on stage in person, hope immediately shone in his eyes. He knew that Professor Yang was a doctor who was almost like a demigod.
Song Yun nodded vigorously: "Yes, Professor."
The second ward housed a fifteen-year-old girl.
The girl was very thin, wearing a large hospital gown, and huddled in the corner of the bed, while her mother sat beside her.
Song Yun said softly, "Idiopathic scoliosis, Cobb angle 105 degrees, combined with thoracic kyphosis. Pulmonary function test indicates moderate restrictive ventilatory impairment. He wore a brace at another hospital for three years without effect, and now we are considering surgical correction."
Yang Ping walked to the bedside and asked the girl to stand up with her back to him. The girl stood up timidly, and even her hospital gown couldn't hide the obvious bulge on her back. Her right shoulder was higher than her left, and her right scapula was raised like a wing.
Yang Ping had her bend over and touched the location of each spinous process with his hand, from the cervical spine all the way to the coccyx. Then he had the girl lie back down and picked up the film to look at it against the light.
A 105-degree lateral bend, curving from the thoracic spine all the way to the lumbar spine, the entire spine resembling a large S-shape. The heart was squeezed to the left, and the right lung was compressed to just a thin layer.
He looked at it for a long time, then asked, "What are you planning to do?"
Song Yun said, "We plan to perform posterior scoliosis correction, pedicle screw fixation, and bone grafting fusion, with the planned fusion segments being T2-L4."
"What about osteotomy?"
Song Yun paused for a moment: "We plan to use Professor Yang's osteotomy technique, combined with screw rotation correction."
Yang Ping shook his head: "Mm."
The third ward housed a man in his forties.
The man was very strong; the muscles in his arms bulged out of his hospital gown, but he lay on the bed, too afraid to move. When Song Yun introduced him, he stared at the ceiling, his eyes somewhat vacant.
"A giant osteosarcoma in the pelvic region, involving the right sacroiliac joint and part of the acetabulum. Neoadjuvant chemotherapy has been administered, and the tumor has shrunk somewhat, but it is still progressing. A pelvic rotation osteotomy combined with tumor resection is planned."
Yang Ping took the film, his brows furrowing slightly.
Pelvic tumors are widely recognized as a "no-go zone" in orthopedics. Their complex anatomy, surrounded by major blood vessels, nerve plexuses, and vital organs, results in an extremely high risk of bleeding and numerous postoperative complications. Complete resection is possible in only a handful of hospitals nationwide.
Song Yun continued reporting from the side: "We have asked the interventional radiology department to perform preoperative embolization. The estimated blood loss during the procedure is 2000-3000 ml. Blood preparation is ready, and we plan to use autologous blood transfusion during the procedure."
Yang Ping didn't speak, but walked to the bedside and began the examination. He asked the patient to try raising his legs; the right leg could only be raised a little, while the left leg could be raised to 45 degrees. He pressed on the patient's lower right abdomen, and the patient gasped in pain.
After the physical examination, he returned to the scans and studied them for a long time. "This tumor involves the sacroiliac joint and part of the acetabulum. If we follow the conventional approach and perform a hemipelvic resection, the patient will have a very difficult time walking and will suffer significant functional loss." He pointed to the scans and said to the young doctor behind him, "Look here, at the junction of the tumor and normal bone. If we can cut from here, rotate the entire right iliac bone down, remove the tumor completely, and then rotate the healthy part back and fuse it with the sacrum, the patient's pelvic ring can be preserved, and walking will be much better in the future."
The young doctors stared at the scans, and one of them asked in a low voice, "What about the acetabulum?"
Yang Ping said, "After removing the part of the acetabulum invaded by the tumor, the remaining part can be reconstructed. 3D-printed prostheses or autologous bone grafts can be used. The key is that the plane of rotational osteotomy must be precise, so that it can be cut cleanly while preserving the blood supply."
He turned to Song Yun: "Have you coordinated with the 3D printing center regarding this case?"
Song Yun nodded: "It's done. The customized implants have been delivered."
Yang Ping said, "When designing this kind of prosthesis, several points need to be noted: First, the osteotomy plane should maintain a sufficient safe distance from the tumor boundary; second, the rotated bone block should have sufficient blood supply and should not become necrotic; third, the angle of the reconstructed acetabulum should be appropriate and should not affect joint function."
He spoke slowly, each word seeming to be etched into the minds of the young doctors.
The patient suddenly spoke, his voice hoarse: "Doctor, can I still walk?"
Yang Ping looked at him and said, "Yes, but it's a long road, so you need to be patient."
The patient looked at him, and tears suddenly streamed down his face, but he didn't cry out loud. He just bit his lip and nodded.
……
On Wednesday, Song Yun was the lead surgeon for three surgeries, with Yang Ping assisting him.
The first one was about a pelvic tumor.
The atmosphere in the operating room was more tense than usual. The anesthesiologist repeatedly checked the blood pressure, heart rate, and amount of bleeding. The scrub nurse had the hemostatic materials neatly prepared. Song Yun stood at the surgeon's position, took a deep breath, and then began.
Incision, exposure, separation of blood vessels, finding the tumor boundary... Yang Ping watched every step, occasionally saying a word or two: "Retract it a little lighter." "Dissect that blood vessel two millimeters more." "Move the osteotomy plane outward one degree more."
Four hours later, the tumor was completely removed. The right ilium, along with part of the acetabulum, was rotated down and fixed in its new position. A 3D-printed prosthesis perfectly filled the defect. Blood loss was controlled at 2200 ml, better than expected.
Yang Ping said, "Well done."
The second case was a tumor in the upper cervical spine, and the surgery lasted a full five hours.
First, the bilateral vertebral arteries were exposed, and then the tumor was slowly dissected from its normal position towards the tumor. The tumor tightly wrapped around the blood vessels like an octopus; the slightest mistake could result in massive bleeding. Song Yun's hands were as steady as a machine, peeling away the tumor millimeter by millimeter, slice by slice.
Then, the spinal canal is opened to address the relationship between the tumor and the dura mater. The tumor has already compressed the dura mater, causing it to indent. Extreme care must be taken during dissection to avoid damaging the medulla oblongata and cervical spinal cord below.
Finally, the main body of the tumor was removed. The most difficult part was where the tumor was most tightly adhered to the vertebral artery. Song Yun used micro-scissors to cut it open little by little; each cut felt like walking a tightrope.
For five hours, almost no one spoke in the operating room. Only the beeping of the monitors and the occasional commands: "Suction!" "Gauze!" "Pull a little more!"
Everyone breathed a sigh of relief the moment the tumor was completely removed. The blood loss was 800 ml, but both vertebral arteries remained intact.
The third scoliosis correction procedure.
It was already past six o'clock in the afternoon when the surgery was completed.
Yang Ping took off his gloves and washed his hands. Song Yun chased after him and said, "Professor, Director Liang is waiting for you in his office. He says he must see you."
Yang Ping nodded and followed him to the old building.
Director Liang's office was at the far end of the old building, with an enamel sign from the 1980s still hanging on the door: "Director's Office." Yang Ping knocked on the door, and an old voice came from inside: "Come in."
Pushing open the door, Director Liang coughed a few times and stood up: "Professor Yang is here, please have a seat."
Yang Ping walked over and sat down opposite him: "Professor Liang! How are you feeling?"
"Not bad, not bad." Director Liang waved his hand. "I'm old, my parts aren't what they used to be, but my brain still works."
He looked at Yang Ping and suddenly laughed: "I heard that Song Yun was the chief surgeon for today's cervical spine tumor?"
Yang Ping nodded.
Director Liang was silent for a moment, then said, "Song Yun, what do you think?"
Yang Ping thought for a moment: "Great progress."
How does it compare to before?
"Completely different."
Director Liang smiled, a smile tinged with satisfaction: "I plan to have him take over Hu Guolin's position. I'm truly grateful to you for mentoring him step by step."
After talking with Professor Liang, Yang Ping prepared to return to Southern Metropolis Daily.
Song Yun escorted him to the parking lot. The two walked down the corridor of the old building, their footsteps echoing one after the other. The lights in the old building were dim, and the enamel plaques on the walls gleamed with an old sheen under the lamplight.
As they approached the main gate, Song Yun suddenly said, "Professor, I'd like to talk to you about something."
Yang Ping stopped and looked at him.
Song Yun lowered her head and said, "...Thank you."
Yang Ping didn't say anything.
Song Yun raised her head, her eyes a little red: "I lost to you in the Golden Knife Award back then, and I was really resentful at the time. I felt that I was no worse than you, I was just unlucky. Later, Director Liang scolded me, and that scolded me awake."
He paused, then continued, "He asked me to learn from you. After studying with you for a while, I realized what a truly excellent surgeon is. When you perform surgery, every incision is precisely where it should be, no more, no less, and perfectly balanced. I clearly remember the first cervical spine tumor I performed with you. I stood by and watched, sometimes not daring to even breathe."
Yang Ping looked at him: "Aren't you doing very well now?"
Song Yun thought for a moment and said, "If you hadn't taught me step by step, I wouldn't have improved so quickly."
Yang Ping had already reached the car, and his assistant opened the door. Before starting the engine, he rolled down the window and said to Song Yun, "See you next Wednesday."
Song Yun then came to her senses and said loudly, "See you next Wednesday!"
The car slowly drove out of the hospital gate. Song Yun stood there, watching the car disappear into the night, motionless for a long time.
The gatekeeper, Old Zhang, came over and offered him a cigarette: "Director Song, Professor Yang has left?"
Song Yun took the cigarette and nodded.
Old Zhang said, "Professor Yang is a really good person."
Song Yun looked at the cigarette in his hand and suddenly laughed; he had forgotten that he didn't smoke.
Yes, that's great.