Chapter 2065: Chapter 1784: The Wrong Concept (2)

Zhaxi nodded and suddenly asked, "Professor Yang, do you still have patients from Tibet here?"

Yang Ping looked at him and said, "I’ve specifically contacted hospitals over there to refer some complex and challenging cases here. The purpose is to let you get in touch with cases that match the characteristics of your region, such as this spinal tuberculosis, which is rare in big cities. There will be another one tomorrow."

Zhaxi was stunned. Professor Yang had gone to such great lengths to train him. He knew that a doctor named Li Min from a township hospital had already learned and returned to make contributions.

That night, Zhaxi wrote in the dormitory until dawn. He thought of Professor Yang’s dedication to him, he remembered the dean’s instructions when he set off from Changdu, and thought of what he had seen and heard in this short week. He knew that these three years would be the most important three years of his life.

The first week of the Sanbo Elite Class ended just like that. Thirty learners, thirty seeds, had just been planted. They didn’t yet know what they would experience, what they would learn, or what kind of people they would become in these three years.

But they knew that starting from today, their paths were different.

The next day, after the shift handover, the doctors dispersed to their own tasks. Zhaxi followed Yang Ping towards the operating room. On the way, Yang Ping walked so fast that Zhaxi had to almost jog to keep up.

"Today’s patient is also referred from Tibet," Yang Ping said as he walked, "Spinal tuberculosis, lumbar segments 2-3, severe vertebral destruction, with a cold abscess forming, compressing the spinal cord. The patient’s muscle strength in both lower limbs is grade three. Without surgery soon, they will be unable to walk."

Zhaxi nodded, took out his notebook, and began to take notes.

"Is this disease common in your Tibet?" Yang Ping asked.

"Yes!" Zhaxi replied, "We have a lot of tuberculosis, including spinal tuberculosis. But many patients are discovered late, and when they are brought in, they are already paralyzed."

Yang Ping stopped, turned back to look at him: "Can your county hospital treat it?"

Zhaxi shook his head: "No, we don’t have a tuberculosis specialty, nor do we have doctors who can perform spinal surgery. Such patients can only be transferred to Lhasa. But Lhasa is too far, and many patients’ families are poor and can’t afford to go, so they just drag it out at home."

Yang Ping was silent for a while and then said, "After you finish learning and return, these people won’t have to drag it out anymore."

Zhaxi nodded vigorously.

The door to the operating room opened, and a nurse came up to them, "Professor Yang, the patient has been brought in, and the anesthesiologist is preparing."

Yang Ping nodded and led Zhaxi into the changing room. While changing into scrubs, Yang Ping suddenly asked, "How late did you stay up taking notes yesterday?"

Zhaxi hesitated for a moment: "Past two o’clock."

"Don’t stay up late! Learn to improve your study and work efficiency. To be a good doctor, you must have a strong body, understand?"

"I understand."

The surgery began.

Today’s surgery was even more complex than yesterday’s. Tuberculosis had destroyed the vertebrae, and the surrounding tissues were a tangled mess, making normal anatomical structures almost unrecognizable. Yang Ping held the electric knife and slowly dissected, moving so deliberately as if it were slow motion in a film.

He usually wouldn’t perform surgery this slowly. Now, by slowing down, he ensured that Zhaxi could clearly see without affecting the surgery’s success.

Zhaxi stood behind him, watching intently without blinking.

"Look here; the normal vertebra and the tuberculosis-damaged vertebra are different in color. The affected vertebra is darker, brittle, and crumbles at a touch."

Zhaxi leaned in a little closer.

"We need to remove all the necrotic vertebrae and clean the intervertebral spaces thoroughly. Not a bit of pus can be left. Leave a little, and the tuberculosis will recur." Yang Ping said as he inserted an instrument and started to scrape bit by bit.

The surgery lasted three hours.

"How much did you understand?" Yang Ping asked again.

Zhaxi thought for a moment: "Sixty percent."

Yang Ping nodded: "Progress from yesterday, continue tomorrow."

The afternoon was for case discussions, with Professor Yang present as an observer, and Dr. Li Guodong presiding.

The case discussion at Sanbo Hospital was completely different from what Zhaxi had seen before. In Changdu, a case discussion would involve the head doctor asking, "What do you all think about this patient?" Everyone would take a turn saying a few words, wrapping up in half an hour. At Sanbo, a single case could be discussed for an entire afternoon.

Today’s case was a seventeen-year-old boy with a 120-degree spinal curvature. As soon as the images were displayed, there were gasps all around the room.

"The patient is from Yunnan," the attending doctor introduced, "His family are farmers and very poor. They noticed the curvature when he was young but couldn’t afford treatment, so it was dragged on until now. Recently, he started having difficulty breathing, and a check at the hospital revealed severely impaired lung function."

The images, one by one, showed the condition: front, side, curvature measurements, 3D reconstruction. Zhaxi looked at these images, feeling a growing tightness in his chest. He had seen patients with spinal curvature in Changdu, but none this severe. This child’s spine was almost in an ’S’ shape, with the heart and lungs pushed to one side.

"How will the surgery be done?" Dr. Li Guodong asked.

There was silence for a few seconds, then someone raised a hand; it was Dr. Lin Yuan.

"Let me share my thoughts," Dr. Lin walked to the front, taking up a laser pointer, "This curvature is mainly in two segments—upper thoracic and lower lumbar. The upper thoracic curve is quite rigid, the lower lumbar is relatively flexible. My suggestion is to do an anterior release first, followed by a posterior correction. From the thoracic cavity, we’ll release the rigid segments, then use a rod and screw system in the back to correct, using Yang’s Osteotomy Technique."

He spoke while marking the surgical approach and fixation segments on the images.

"Where will the rods and screws go?" Dr. Li asked.

"From T2 to L4," said Xiao Lin.

"Sixteen segments?" Dr. Li frowned, "This kid is only seventeen. Fixing so many segments will leave his waist stiff, making it difficult even to bend. You need to relearn Yang’s Osteotomy."

Xiao Lin was taken aback and said nothing.

Another student raised a hand. It was a female doctor, Dr. Chen Xi.

"I think we can reduce the number of segments," Dr. Chen stepped to the front, "Even though the upper thoracic curve is rigid, with adequate release, it might not be necessary to fix so many segments. My suggestion is to fix from T3 to L3 and preserve L4’s range of motion."

"Have you considered the segment from L3 to L4?" Dr. Li Guodong asked, "This area is the apex of the curve and the point of greatest stress. If only fixed to L3, won’t there be long-term decompensation?"

Xiao Chen thought for a moment and said, "We could consider an interbody fusion between L3 and L4, but not fix it, thus increasing stability while keeping some mobility."

Dr. Li Guodong nodded but said nothing, looking toward Yang Ping.

Yang Ping stood up and walked to the front. He didn’t pick up the laser pointer; he just looked at the images. 𝗳𝚛𝚎𝚎𝘄𝕖𝕓𝕟𝕠𝚟𝚎𝕝.𝗰𝕠𝐦

"You all forgot one person," he said, "The patient himself."

The room fell silent.

"This boy is seventeen, still growing. Why is his scoliosis this severe? Because he’s been living in a compensatory posture. When he bends, walks, sleeps, he’s all crooked. His muscles, ligaments, and joints have adapted to this posture." Yang Ping said, "You might straighten the spine, but his muscles remember the old position. Without proper post-operative rehabilitation, he’ll soon curve back."

He paused and looked at Xiao Lin and Xiao Chen: "Your plans only consider bones, not the person."

Xiao Lin and Xiao Chen bowed their heads.

Yang Ping continued, "When designing a treatment plan, we must consider that we are dealing with a human being. Recently, Dr. Li Guodong has been explaining Yang’s Osteotomy to you. This scoliosis correction osteotomy technique that I developed is now widespread worldwide, but you haven’t grasped its essence. Its essence is understanding that the scoliosis belongs to a person’s spine, not just a spine alone. You should pay attention to my words."

"Your speeches earlier revolved entirely around a spine’s scoliosis. The concept was wrong, so the solutions you designed wouldn’t be correct."

"Our clinical doctors encounter many more cases than the doctors in Europe and America. Our surgical proficiency exceeds theirs. But why do we still have a gap? The gap is in the concept. The conceptual gap cannot be bridged by proficient skills alone. I’m not sure if you’ve noticed, but our doctors seldom publish original papers. Most rely on papers with a large number of case samples to prevail."

"Today, I’m not trying to lower our spirits while raising others, but to tell everyone that the concept is extremely important. If the concept is wrong, no matter how skilled you are, it may be futile and sometimes counterproductive."

No one spoke.