Surgery Godfather

Chapter 322: Chapter 0306 Are you teasing me?

Yang Ping took Xiao Su to the operating room, and they happened to come out from the respective changing rooms just as they bumped into head nurse Jiang.

Xiao Su immediately greeted her, and head nurse Jiang replied with a warm smile, “Xiao Su, are you back home? Have you suffered any grievances over there?”

Xiao Su laughed and replied, “Not at all. Thank you for your hard work, head nurse. I just came with Doctor Yang to observe the surgery.”

Head nurse Jiang sternly told Doctor Yang, “Don’t dare to bully nurse Su, or else we will not spare you.”

Yang Ping simply smiled and said, “Go on then. There are too many emergency surgeries today. I need to go arrange medical personnel. I will come back to the office later.”

After saying goodbye to the head nurse, Yang Ping brought Xiao Su to the operating room of the spine surgery department. Director Qin and Dr. Wen were discussing the cause of a large free-floating intervertebral disc disappearing mysteriously. It was quite alarming.

“Doctor Yang!” Dr. Wen immediately felt hopeful upon seeing Yang Ping walk in.

Dr. Wen’s impression of Yang Ping had been deep since the time he performed surgery on Professor Zhang. He had also attended Yang’s small lecture and took part in the discussion.

In front of the G-arm machine screen, Director Qin was studying the images of perspective positioning, “Start from the first one, slow down, I haven’t seen clearly yet, don’t flip the images.”

Director Qin was a bit frustrated; his tone was not good. This type of minimally invasive surgery usually involves a preoperative discussion with the patient about potential complications and the possibility of converting to a conventional open surgery.

However, the intervertebral disc had disappeared mysteriously. Even if they proceeded with open surgery and did not find the disc, the patient’s problem would remain unresolved. The patient would still be in pain after the surgery, and not to mention, Director Qin’s reputation would be at stake too.

Director Qin was pacing back and forth between the light box and the G-arm machine screen, comparing the images. The CT and MRI scans clearly showed a half-thumb-sized intervertebral disc, but there was absolutely no sign of it when the camera was inserted.

“Oh, Xiao Yang, could you help us take a look?” Director Qin noticed Yang Ping standing nearby.

Inviting Yang Ping over was Dr. Wen’s suggestion. When the trauma orthopedics department faces difficult questions, it’s common for them to seek Yang Ping’s advice.

However, this was the first time for the spine surgery department. Although both are orthopedics, the specializations are entirely different. The entry standard for chief surgeons in spine surgery is higher than those in trauma orthopedics.

For a straightforward surgery, if you’re not a senior attending physician, you’re not eligible to operate. Major surgery requires an associate professor. After all, the surgery involves the spinal cord and nerve roots. Any small mishap could lead to paralysis or disability.

Yang Ping, who was recently promoted to attending physician, would not normally get a chance to perform spinal surgery. Therefore, it was only natural that Director Qin would have reservations about Yang Ping, unlike Director Gao, who was humble.

Since Dr. Wen suggested inviting Yang Ping while they were in the operating room, rejecting his suggestion would mean that Director Qin was stubborn and obstinate. Therefore, he agreed to invite Yang Ping over.

“Were you having a meal? Sorry to interrupt your meal.” Dr. Wen noticed Xiao Su following along, realizing that it was mealtime.

Yang Ping did not mind at all, “No problem. I had just finished eating when I got your call.”

After Director Qin finished analyzing the imaging pictures, he regretfully suggested, “Let’s pause the surgery for now and redo an MRI to find out where the intervertebral disc is.”

The G arm machine, similar to the C arm machine, is essentially a portable X-ray machine. The only difference is that the C-arm can only produce one-face images, while the G-arm machine can produce both front and side images at the same time.

The intervertebral disc is not visible under X-ray, so under the G arm machine’s perspective, one can only see the vertebra, but not the disc. The position is usually determined by the MRI and CT before the surgery to determine the protruding sections of the intervertebral disc. Once identified, the surgeons will proceed to this section under the G-arm machine’s perspective.

The process was followed without any known mistakes. Possible errors that might typically occur were also repeatedly checked, and no such errors occurred.

“Xiao Yang, I’m sorry to interrupt you, but we need to take the patient downstairs for an MRI.” Director Qin had already removed the instruments. Dr. Wen was in the process of suturing the small incision on the patient’s back, covering the cut with a dressing and removing the sterile coverings.

This type of surgery is usually performed under local anesthesia, but this patient had very noticeable pain symptoms, making it impossible for him to bear the pain during the surgery. Hence, a combined spinal-epidural anesthesia was chosen, numbing the lower part of his body.

The patient was awake, and Director Qin personally explained the complications encountered during surgery. The patient was understanding, as he knew everyone was trying to solve his problem, and no one was intentionally messing with him.

Before Yang Ping had a chance to read the images, everyone quickly transferred the patient to the operating bed as they were preparing to take him to the imaging department for an MRI.

Although this treatment procedure was a bit embarrassing and even cost them their face, Director Qin had to put aside his ego for the safety and effectiveness of the patient’s surgery.

The operating bed was pushed towards the magnetic resonance room of the imaging department. Everyone followed in silence as they didn’t dare to speak, as the director had made a mistake.

After being transferred a few times, they finally arrived at the MRI room. Director Meng gave them face and personally waited in the operating room. A machine was already available. The patient was pushed in, and doctors and nurses were busy checking for contraindications, inspecting for magnetic metals, pacemakers, etc., before finally signing and moving the patient onto the platform.

“Old Qin, what happened? The intraoperative exploration and preoperative imaging are not consistent?” Director Meng let Director Qin sit down, knowing that he had encountered a difficult problem, otherwise there wouldn’t be a situation where the surgery had to be interrupted midway for an MRI.

Director Qin had an unlucky look on his face, “The positioning is accurate, completely flawless, but after the endoscope entered the spinal canal, we couldn’t see the free-falling intervertebral disc.”

“Was there such a thing?” Director Meng was surprised.

The technician and nurse were adjusting the patient’s position, while other doctors waited outside. Only Yang Ping and Dr. Wen followed them in, with Xiao Su tailing Yang Ping. Director Meng, seeing Yang Ping approaching, courteously offered his chair, “Doctor Yang, please sit!”

Director Meng was familiar with Yang Ping, especially after Yang Ping diagnosed the patient’s dural arteriovenous fistula from the MRI. He highly respected Yang Ping and would always invite him when there was a challenging case to be discussed.

The preparations were nearly completed. Director Meng glimpsed into the examination room through the thick glass window. The technician and nurse were already out, and the door to the room was closed.

“Been doing arthroendoscopy for nearly ten years, must have done around two thousand cases. I’ve never encountered such a situation before.” Director Qin still felt a sense of helplessness.

Conversation flowed as the technician expertly adjusted the parameters on the operating platform. The switch was pressed, the table moved, and the patient was slowly sent into the dark tunnel.

The strong magnetic field caused the hydrogen ions in the human body to spin in unison. When the magnetic field was withdraw, the direction of hydrogen ions reverted to a disordered state.

This result, the differing time taken to revert to order, created differentiation, which is the basis of imaging. Only with differentiations could product depiction

It was just like a pencil, creating an image with the density of lines. X-ray images were done with differentials of absorbed rays from objects of different densities. Without these differentials, there was only white or black.

A few doctors from the radiology department were lingering outside the door, reluctant to enter because Director Meng was inside. They were all there to see Yang Ping. Once someone became renowned, many tales would spread. These tales could be amplified and mythicized, causing people to admire and feel distant towards them.

Let’s not talk about those past tales of success, just the most recent one. It was heard that Yang Ping was invited by a Malaysian millionaire to perform a surgery consultation on the 6th day of the first lunar month.

Rumors were that Yang Ping had humbled a well-known expert and that the fee from the cross-country consultation was in millions. Even the minor members who accompanied him received one to two hundred thousand. Although the actual figures weren’t clear, Zhang Lin’s recent attempts to buy a car hinted that the rumors weren’t far off.

With all these tales piling up, Yang Ping slowly became a legendary figure in these people’s minds. Some even began to suspect that the integrated orthopedics department might want radiologists. If luck was on their side, they could join the team and enjoy the fruits of success.

Take Liang Fatty from the anesthesia department – didn’t he get popular via Yang Ping? The story about him flirting with flight attendants on the plane – who on earth spread it? Liang Fatty roamed around trying to find the big mouth, but whenever this was brought up, Zhang Lin would pacify him: “Calm down; famous people don’t have any secrets.”

The speed of high-speed MRI was extraordinarily fast, slowly generating images. Director Meng paused the conversation, as Director Qin leaned over to take a look. They could discern a slipped disc just at first glance, even with their eyes closed.

The object was still there and so clear! Judged by the low signal, it was undoubtedly the extruded nucleus pulposus, and it was still at its original position without any change, located inside the spinal canal, at the back of the L1 vertebrae, and the entry route of arthroendoscopy was precisely facing the slipped disc. There was no positioning error, neither on the sagittal view nor on the transverse view.

“There’s no mistake, the slipped disc is right here!” Director Meng pointed at the image.

Director Qin flipped through the images a few times, assuring there was indeed no mistake. The object was perfectly fine – this was just unbelievable! Could the scope have mistakenly entered some other tissues such that it was separated from the slipped disc? As long as the slipped disc was still there, there could be a solution; they just needed to try one more careful exploration.

“Send to the operating room, sterilize and re-drape for surgery again.” Director Qin finally had a plan.

Despite the trouble, surgeries were still surgeries. Once you’re on the operating stage, you have to proceed until the end, even if there were complications. It’s better to have complications on stage than abandon it halfway through.

“Director Meng, sorry for the trouble, we’ll have to continue the operation.” Director Qin excused himself.

Director Meng got up to see them off, “No worries, let me know if you need anything.”

“Yang, sorry for the bother. Do you want to come back with us?” Director Qin kept a safety net, fearing if there would be problems again, there would at least be an additional hand for help.

The patient was wheeled back to the operating room where they adjusted his body position, used the C-arm for fluoroscopy to confirm the correct segment was there, and re-sterilized and draped him again.

The initial entry route was not a problem, so they entered through the same location after removing the stitches from the small incision. The scope was inserted inside, and the field of vision was clear after a wash of water.

The dura and nerve roots were clear. Having performed such surgeries for ten years, how could they have been mistaken? The lens didn’t enter any other tissue gaps, and it was obviously inside the spinal canal. Where was the slipped disc? Where was it?

“Is this some sort of joke? Is this the MRI we just did?” Director Qin needed a confirmation.

Doctors under the stage verified the date: “Yes, it’s the one just taken, I’ve just hung it up.”

Shit, Director Qin cursed inwardly; today’s situation was ridiculous. The slight confidence that he’d just regained soon deflated, collapsing!

Director Qin reorganized his thoughts, where could the problem be? Where could it be?

“Open the screen, bring out the previous MRI and the one we just take. Zoom in!”

This was a multi-functional operating room with a large screen allowing the chief surgeon to operate the control panel to retrieve necessary medical records through sterile drapes. However, Director Qin was used to looking at films on a lightbox and wasn’t accustomed to this high technology.

Dr. Wen opened the screen through the sterile drape, brought out imaging pictures, found a few characteristic ones, and opened them. By comparing the images side by side, the slipped disc was still at its original position, whether it was on the previous images or the current ones.

But they didn’t mess up with the segments, and the camera was inside the spinal canal, so how come they still couldn’t see the slipped disc nucleus pulpous tissue? They just couldn’t see it no matter how they adjusted it.

“How could this be possible!” Director Qin was flustered again, sweat was breaking out on his forehead.