Chapter 52

Just after leaving Elder Man Zhang’s private ward, a system task was triggered.

“Ding dong! Task: Complete Elder Man Zhang’s surgery, allowing him to regain normal walking ability within 24 hours. Reward: 9000 points, one unknown gift.”

It’s been a long time since the system rewarded a random gift. The surgery isn’t hard, but the tricky part is immediately walking with weight bearing on the second day after surgery. This is a harder challenge than before.

Yang Ping is now discovering the endless wonders of the system — it doesn’t take up real time. That is, no matter how long it takes in the system, it’s just an instant in reality.

This greatest feature can be made full use of. What is more precious than time?

Yang Ping suddenly had an idea, wondering if all his future learning could be done in the system. This is a good idea, and he needs to make good use of the system resources.

Yang Ping went to the office to find Little Five, but he wasn’t there. Zhang Lin was writing a medical record and preparing to sign the informed consent form. Although Professor Zhang is in the same hospital, the process must not be skipped.

Song Zimo was absorbed in viewing a CT reconstruction on an electronic reader and sketching something on a piece of paper, leaning back in his chair.

Yang Ping did not disturb him, only glanced at the paper. Medical Illustrations! This guy can draw medical illustrations, and very good ones too. They’re comparable, if not superior, to the illustrations found in some surgical books.

Yang Ping went to the staff room, where Little Five was downloading some software onto a tablet. Yang Ping was surprised: “How did you know that Professor Zhang wanted to watch his own surgery livestream?”

Little Five said: “Who doesn’t know about Professor Zhang? I just prepared it in advance, in case he asked for it during the surgery and we didn’t have time to prepare.”

Yang Ping said: “You’re right, Professor Zhang did really ask me to prepare a tablet to connect to the operating room’s video system. He wants to watch the live broadcast while undergoing surgery.”

“I’ve already downloaded the connection APP from the video system’s website, and I’ve just confirmed with the operating room. There is a long dedicated data cable that can be fixed to the headrest, and he can watch it lying down.” Little Five said.

Yang Ping was slightly surprised. This kid’s mind was incomparable. He really was a wasted talent not studying medicine. Yang Ping found a bed and lay down, “I’ll rest for a bit. Call me when Elder Man Zhang is ready for surgery.”

“You should eat something. I ordered takeout, it will be here soon.” Little Five said as he was working on his computer.

Yang Ping laid down to rest and entered the library in the system space. Time here required points to use, with each point corresponding to one minute.

Unable to bring images into the space, Yang Ping had to rely on memory to draw diagrams in the space and then study how each bone fragment would be repositioned, focusing on how to build a bone support.

It’s incredibly convenient to consult information in the system. Any publicly published information can be found, no matter the language it will be translated to Chinese. Yang Ping consulted a large number of relevant references, especially on the subject of procedures relating to femoral trochanteric fractures. He read every word of each paper, utilizing his accumulated points to complete the task more efficiently.

After gaining a thorough theoretical understanding, Yang Ping went to the store in the system space. Among the thousands of training packages, he found one for hip fractures. He spent 4000 points to purchase 500 cases, which included a large number of closed reduction and PFNA internal fixation surgeries for femoral trochanteric fractures.

PFNA is an acronym for proximal femoral nail antirotation, which is the best fixation device for this type of fracture in the elderly. “Death Fracture” or “Life’s Final Fracture” is the nickname for hip fracture—acetabular fracture, femoral neck fracture, femoral trochanteric fracture—in the elderly, and has a mortality rate of 68%-70% within two months of conservative home treatment. The survival rate is 50% after one year, meaning that out of 100 patients, 50 will pass away, most of whom received conservative treatment. Therefore, if surgery is possible, it should be performed. It’s not the fracture that’s fatal, but the complications brought on by bed rest: deep vein thrombosis, lung infections, bedsores, urinary tract infections, etc.

Having been an orthopedic surgeon for his entire life, Professor Zhang fully understands the intricacies of the situation, which is why he’s impatient to undergo emergency surgery.

Yang Ping performed 500 surgeries in the system, covering all varieties of comminuted fractures. After completing each procedure, he would evaluate the stability and consider improvements.

He used 3000 points on books, leaving him with 7000 points. He then purchased training packages for femoral shaft and tibiofibular fractures, costing 6000 points. Now, he was left with just 1000 points.

Without delay,Yang Ping completed all the training packages.

The 4-hour water fasting and 8-hour food fasting periods for Professor Zhang were up, so he was pushed to the operating room for surgery. The head nurse from the operating room personally came down to get him.

Yang Ping and a few others followed the gurney into the elevator. The elevator was too crowded with the gurney in there and they had to let Zhang Lin go with the others while they took a different elevator to the operating room.

While dressing, Tian Yuan said, “Doctor Yang, you are pretty influential. This old guy’s prostate has been left unattended for years, and now he has a trochanteric fracture. He insisted that you perform the emergency surgery. This news will spread and from tomorrow, you won’t have to line up in the cafeteria. No one will dare to stop you.”

Yang Ping, while putting on his face mask, laughed and said, “I have no choice but to do this. ‘Life’s Final Fracture’ isn’t just a name. The old guy understands it very well.”

After changing their clothes, they stepped into the operating room. Perhaps because this operation had such high demands or perhaps it was the elderly gentleman’s special status, everyone sat in the attached teaching room quite a while before the start of the operation. Even more people had come as compared with the last time and there were people from other departments as well.

Dean Xia, along with several hospital leaders, all came. Even though he was very busy, he had to find the time to attend. In fact, Dean Xia had visited Professor Zhang in his ward while Yang Ping was resting, but Yang Ping didn’t know about it.

The anesthetic was epidural combined with general anesthesia, and the Director of the Anesthesiology department did the anesthesia himself. However, having been out of direct practice for a while and not wanting to take any chances, he instructed from the side while Liang Fatty actually performed it.

“Yang, I’m passing Elder Zhang into your hands.” Dean Xia patted Yang Ping’s shoulder. He had a good understanding of Yang Ping’s abilities. After all, Elder Zhang had personally chosen Yang Ping, and that wouldn’t be a mistake.

At that time, when Dean Xia learned that Elder Zhang had fractured his bone, he wanted to keep Director Han, but Elder Zhang adamantly disagreed. He also wanted Elder Zhang to move into the Overseas Chinese Building, but again Elder Zhang wasn’t having it. In the end, Dean Xia could only accommodate his wishes. Elder Zhang was very determined, and his decisions couldn’t be changed, not even by 18 strong men.

After the anesthesia took effect, they positioned the body. Zhang Lin and Song Zimo set up the traction frame while Little Five connected the tablet to the video system. After adjusting it and fixing it to the anesthesia frame, Elder Zhang could watch the live broadcast of the surgery while lying down.

The cameras were also adjusted. One was aimed at the screen of the C-arm portable X-ray machine, one at the surgical area, and one at the surgeon.

“This surgery shouldn’t be too hard, right? Using the PFNA should wrap things up in half an hour.”

“Elder Zhang needs to put weight on his leg and walk tomorrow.”

“Really? His bone is shattered into several pieces. How could he possibly walk right after surgery?”

“I don’t know, I heard it from Zhang Lin.”

“This guy is really impressive. He was the one who did the amputation replant last time.”

“The orthopedics department has become an incredible place. Director Han is a top-class figure, Tian Yuan appears to be very competent, Song Zimo is a gifted individual, and this guy is even more impressive than Song Zimo. It seems like Director Han is planning to transform orthopedics into a nationally recognized brand, we need to buck up.”

“Yes, indeed. Director Han is now applying for a research institute in orthopedics, it seems like he’s collaborating with Fudan University. Didn’t you notice he didn’t come tonight? He’s gone to Shanghai.”

“Wow, then our orthopedic department will become very advanced.”

The surgery didn’t start yet, and everyone started chatting.

Dr. Jin came in, a Bluetooth earphone dangling from his ear. He was conducting a surgery last time and missed Yang Ping’s treatment of the comminuted humeral fracture. He had to come to watch this time.

Dean Xia exchanged a few words with Professor Zhang but didn’t stay long. He had a lot of things to do, and it’s quite stressful for doctors to have a dean standing around. So he left promptly.

“Xiao Yang, we specially arranged a table setup for you by Nurse Su. Feel free to bring up any suggestions you may have.” The head nurse, in her forties, was decisive and energetic.

Yang Ping sat in the corner while Su Yixuan had already washed her hands in preparation for the operation.

Yang Ping said, “Nurse Su is truly outstanding. We work together very well.”

The head nurse said, “That’s good. From now on, Xiao Su is with you. You must not ill-treat her, she is a kind and smart girl. She has previously undergone orthopedic specialist equipment nursing training in Shanghai, Hong Kong, and Japan.”

As they were chatting, the traction frame was ready on the other side.

The procedure calls for a traction reduction first for this kind of fracture, followed by disinfection and laying out the towels before starting the surgery.

Traction reduction plays a very critical role and forms roughly half of the surgery. If the reduction is not done well, the subsequent surgery would be challenging or even impossible to complete.

Song Zimo guided Little Five and Zhang Lin to adjust the traction angle and strength. Yang Ping saw it and made some personal adjustments. The originally set adduction was changed to an abduction position, and he also readjusted the tightness of the adjustment rod. After he was satisfied, he said, “Okay! It’s done. Let’s do a fluoroscopy.”

“Senior, this is the abduction position!” Zhang Lin reminded, thinking Yang Ping made a mistake.

During surgery, it’s common for assistants to point out mistakes to the chief surgeon in real-time.

Yang Ping clearly responded, “Correct, it’s in the abduction position.”

But how would they insert the intramedullary nail in an abduction position? Little Five was puzzled.

The neighboring group began their discussion as well.

“Isn’t this kind of surgery usually done in the adduction position? Why is it in abduction? How would they insert the nail later on?”

“Yeah, did he forget?”

“Why isn’t Song Zimo reminding him?”

“Why are you meddling unnecessarily? Just focus on watching.”

A graduate student was responsible for controlling the C-arm X-ray machine. He skillfully maneuvered the machine into position, adjusted its position and angle, and everyone stepped out. He controlled the machine remotely from outside.

The doors and walls of the orthopedic operating room are laced with lead to protect the room from excessive radiation. Once the picture was taken, everyone went back in. The lateral position was completely reduced, and everyone was satisfied.

They did another anteroposterior fluoroscopy. There was still a decently large angulation on the anterior-posterior X-ray, indicating the fracture was not completely reduced. In such a surgery, any angulation renders the surgery unachievable as it would impede the intramedullary nail, and the surgery would be awkwardly stalled.

“It hasn’t been reduced properly, It needs to be done again.” Zhang Lin looked at the screen and commented.

As Little Five prepared to adjust, Yang Ping stopped him: “Leave it as it is, no need to adjust.”

Little Five returned confused. Song Zimo prepared to persuade Yang Ping, “This isn’t reduced properly, we have to–“. But after some thought and looking at the angulation on the screen, he suddenly realized something: “Senior, you are indeed a senior. I am impressed.”

“What happened?” Both Little Five and Zhang Lin were totally confused.

Song Zimo laughed, “You guys stay below the stage. It’s enough with just my senior and me. Watch it closely. Today, my senior is going to perform another of his unique skills for you.”

Yang Ping had already gone out to wash his hands. Song Zimo hurriedly followed him: “Hey! Wait up.”

“Any suggestions?” Yang Ping stood before the sink, the sensor faucet started flowing water, and he began to scrub his hands.

“You’re becoming more and more difficult to understand. Are you really planning to attempt minimally invasive surgery to reposition those fragments, including the one lodged in the muscle? Can the patient really walk tomorrow?” Song Zimo caught up with him.

“What do you think? He said that if it’s not possible, he’ll give me a duck egg.” Yang Ping continued scrubbing his hands.

“I have to admit, Old Sir Zhang is indeed a divine person. How did he know that you would do it?” Song Zimo exclaimed.

“Didn’t you say he’s a divine person? Does a divine person need a reason to do something?” Yang Ping’s retort left Song Zimo speechless.