Surgery Godfather

Chapter 125: Chapter 0122: Grand Consultation

I’ve seen quite a few cases of synovial chondromatosis of the knee, and this one is rather rare.

Little Five removed the film to spare the claustrophobic patient any discomfort. He admitted the patient to the hospital and arranged for pre-operative examinations and surgery.

Yang Ping continued his research on the patient from the Overseas Chinese Building, repeatedly simulating the punctures in his mind and adjusting the puncture angles to ensure a hit with every attempt.

Song Zimo didn’t rest at noon, staying in the laboratory to practice arthroscopy. His lunch was brought over from the canteen by Tang Fei. He finished eating during the department’s mealtime then continued practicing in the afternoon.

Apparently, when he was in trauma orthopedics, he would practice until ten every night as long as there were no exceptional circumstances, sometimes even practicing until midnight.

The CT and MRI 3D reconstruction for the patient in the Overseas Chinese Building has been completed. It is a thin-layer scan, and the reconstruction is incredibly clear. Director Han compares Yang Ping’s drawing with the reconstructed image on the electronic reader. The spatial structures hardly differ, and Yang Ping’s drawing is even more expressive.

Checking the time, Director Han noticed it is already half past four. He set aside his work at hand, taking Yang Ping to the Overseas Chinese Building to participate in the grand consultation.

Several directors had already arrived at the meeting room for the Internal Medicine Department in the Overseas Chinese Building, including Director Zhao of the Medical Department. Everyone gathered around the oval table, discussing the patient’s condition privately before the meeting.

Director Kong welcomed Director Han and Yang Ping, inviting them to sit. High-definition tablet computers were placed at each seating position . These were the terminals for the mobile medical record system, where patients’ medical records and auxiliary examination results were accessible. The resolution of the tablets was much higher than average, so that the details of image photos could be seen clearly.

Director Kong hardly had a moment away from his phone, with people continuously walking in. All the major directors of the hospital, several professors from outside the hospital, and Director Zhuang of the Internal Medicine Department had hurried over to help entertain the guest experts.

“This is from the Second Affiliated Hospital…”

“This is from the First Affiliated Hospital…”

“This is from the Tumor Hospital…”

Several directors came over one by one, taking their seats. Director Kong and Director Zhuang handled the arrangements with vigor and were well-prepared without any neglect or omission. These two from the Overseas Chinese Building, they both commanded the room.

Naturally, the consultation had to involve seeing the patient. Someone had already suggested taking a look at the patient. Director Kong led a group to the ward to see the patient while Director Zhuang helped entertain the guests.

Everyone took advantage of this time to catch up. These experts were usually familiar with the heads of relevant disciplines in Sanbo Hospital. They often gathered together at meetings, and some were even in the same circle.

Busy as they usually were, meetings were a rare chance to get together. Aside from academic conferences, large consultations like this were a chance to chat for a while and update each other on recent happenings.

Only Professor Su Qingyun from the First Affiliated Hospital hadn’t arrived yet. He was the primary expert for this meeting. Although the patient had liver cancer, the problem they needed to solve now was caused by spinal metastasis. Su Qingyun was the chairman of orthopedics in Nandu Province and a hot candidate for academician. Naturally, he was the most significant expert for this consultation. The meeting had been deferred from three o’clock to five, specifically to wait for him.

Since Professor Su was also the president of the First Affiliated Hospital and had much important work on his plate, his finding time to come was a token of respect. Everyone privately discussed just how significant the patient must be to warrant Professor Su’s personal involvement. For some consultations at other hospitals, even if they could get Professor Su, he would only send a student to attend.

There were only a few minutes left, and Professor Su had not yet arrived. Yang Ping had seen Professor Su before, at an academic conference held by the People’s Hospital. That was from a distance, not as close as this.

Professor Su had published over a dozen papers in top international orthopedic journals such as AJAM and JBJS. He had an extremely high impact factor and was at the pinnacle of his field domestically, as well as being internationally recognized.

Some people were glancing at their watch, some were looking towards the doorway, others were whispering to each other, but everyone was patiently waiting.

“Speak up during the meeting, don’t be shy. In academic matters, call a spade a spade. There’s no need to be modest,” Director Han quietly instructed Yang Ping.

Exactly at five o’clock, Professor Su, guided by Director Kong, walked in, followed by a young doctor who looked much like him.

As soon as Professor Su entered the room, he smiled and greeted everyone, “Sorry! Thank you all for waiting!”

Actually, he wasn’t late. He arrived precisely on time; it’s just that everyone else had come early.

Professor Su, in his fifties, didn’t look old at all. He wore glasses and a Zhongshan suit with a white shirt underneath. His demeanor was refined, his scholarly bearing evident, and his powerful aura came from his long-standing academic expertise.

Everyone came forward to shake hands with him. When he shook hands with Director Han, he took a little longer. “Brother Han, long time no see,” he said.

Seeing Yang Ping next to Director Han, Professor Su asked, “Who is this?”

“This is Doctor Yang, my student!” Director Han introduced.

Yang Ping shook hands with Professor Su.

“A young man of unique charm. Professor Han’s vision is famously astute. He has not enrolled any doctoral students in many years, adhering to a policy of preferring scarcity to mediocrity. It seems that he has chosen a promising talent,” Professor Su said with a laugh.

“This is Dr. Su!” Director Han introduced the young man beside Professor Su.

“Su Nanchen!” The young man standing next to Professor Su shook hands with Yang Ping.

“Yang Ping!” Yang Ping could feel his confidence and composure.

When Director Han was in Shanghai, both he and Professor Su were outstanding figures among the younger generation in the field of orthopedics. However, when Director Han moved from Shanghai to Sanbo Hospital in Nandu, he had to start all over again, naturally falling behind Professor Su in terms of academic achievements, but his foundations were still solid.

They both recognized each other’s talents, exchanged pleasantries briefly and then took their seats.

“That’s Professor Su’s son, a graduate of the eight-year program at Xiehe, a promising young orthopedist at Fuer, who studied at the Twin Cities Spine Center in Minnesota and the Special Surgery Hospital in New York after graduation. He will be a strong competitor for you in the southern division of the Golden Knife Award; on a national level, he is one of your few exceedingly strong competitors. He is also a well-rounded contender,” Director Han whispered into Yang Ping’s ear.

A case of “like father, like son”, this Dr. Su is not only impressive in appearance but also a graduate of the eight-year program at Xiehe. The difficulty of being admitted to the eight-year program at Xiehe is no less than that of Tsinghua. Those who are able to get in are typically the cream of the crop, ranking among the top in the province’s college entrance examination.

Professor Su undoubtedly had high hopes for his son, otherwise, he wouldn’t bring him along to such conferences. Having him by his side was to let him see the world, encourage interaction, and even help build his reputation and network.

Everyone took their seats, and the consultation started, with Director Zhao presiding and the attending physician presenting the patient’s medical history.

Once the medical history was presented, Director Kong added, “Respected experts and Professor Su, thank you for taking the time out of your busy schedules to consult on this case today. The issue that this patient currently needs to resolve is the severe pain in the chest area. Thank you all very much!”

“Shall we first see the patient? Would that be possible?” Professor Su suggested.

Director Kong led everyone to the ward to see the patient. Professor Su personally asked about the patient’s medical history and performed a physical examination, as did the other professors, based on their own requirements, selectively questioning the patient’s medical history and performing a physical examination.

After seeing the patient, everyone washed their hands and returned to the meeting room.

Director Xu of the Pain Department at Sanbo Hospital was the first to speak: “This patient was admitted the day before yesterday. From the moment of admission until now, the treatment for pain has been under our supervision. According to the principles of pain management for tumors, this patient has been using morphine for three months. For this hospitalization, morphine was used to its maximum dosage, 30 mg per dose, twice a day, but it could only relieve the pain in the liver area. The pain in the chest area remains severe. After a comprehensive examination was conducted after admission, chest pain caused by heart, lung, and aorta were ruled out. Based on neural localization, the range of pain in the thoracic area is within the distribution area of the Thoracic 2 nerve branch. According to the CT and MRI images, the Thoracic 2 nerve root is just being invaded and oppressed. Therefore, we believe it is caused by the Thoracic 2 nerve root. Unfortunately, it is not possible to perform intra-spinal anesthesia for pain relief here. Once respiratory depression occurs, the consequences would be serious, so we encountered difficulties and need everyone’s help.”

“Have you considered using an implanted pain pump, inserted into the spinal canal, with morphine as the main drug in the pump formula, released regularly? This would simultaneously relieve pain without causing anesthesia in that plane, hence not affecting breathing.” The director of the Pain Department at Fuer suggested.

Once the director from Fuer had finished speaking, the director of the Pain Department at Fuyi said: “An implanted intraspinal pain pump is also not feasible. Morphine has already been used to its maximum dosage to suppress the pain in the liver area. This kind of nerve root pain, based on our experience, is almost immune to morphine. In the past when the nerve root was healthy, without any tumor invasion, it worked. But when the nerve root is being invaded and strained by tumor tissues, morphine is ineffective; anesthetics must be used for nerve blockade.”

The director of the Pain Department at Fuer had a different view: “Nerve blockade is too difficult, almost unfeasible. Normally we perform nerve blockade around the sheath, and even if we puncture the sheath, anesthesia will leak. With this kind of blockade, we must guarantee that all anesthetics are in the neural sheath and cannot leak. Otherwise, it would cause anesthesia in that plane and suppress breathing. Mechanical ventilation would be the only option.”

After a brief silence, a professor from the Tumor Hospital spoke: “Has surgical intervention been considered? Without affecting other areas, we can go in from the rear, only removing the tumor tissues that are pressing and invading the nerve root, relieving the pressure and liberating the nerve root, and the pain would naturally disappear.”

“The family refuses surgery, even if it’s targeted!” Director Kong explained.

“They refuse surgery yet want a solution to the problem; this is indeed a challenging issue they have presented us with.” The director of Orthopedics at Fuer commented.

The orthopedics department at Fuer ranks second in Nandu province. A long time ago, Fuer and Fuyi orthopedics were on par with each other, but once Professor Su Qingyun took over as head of orthopedics at Fuyi, they began leaping ahead, from competitive to dominant.

Symbolizing high-risk orthopedic procedures, scoliosis correction surgery is performed more than three hundred times a year at Fuyi, ranking them in the top tier in the country, while Fuer only performs close to a hundred, placing them in the second tier.

For bone tumors, Fuyi has its separate, larger-scale bone tumor ward, whereas Fuer doesn’t yet have a separate bone tumor ward with scale.

Hence, naturally, orthopedics at Fuer accepted its position as second best, considering Fuyi as its older brother.

Neither intra-spinal analgesia nor nerve blockade is applicable, and the family refused surgery.

How can this discussion continue?

The room fell silent once more.

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