Chapter 44: Surgical Training
Early the next morning, Gu Jun woke up in the dormitory building of the Phecda Division for the first time and smelled the crisp aroma of meat in the air.
He rubbed his eyes and got up. Walking out of the spacious bedroom, he saw Cai Zixuan busy working in the kitchen. He was cooking something while reading a book.
Cai Zixuan smiled when he saw him. "Tycoon Jun, you sure woke up early today. Century egg and lean meat porridge coming right up immediately! I called Brother Ma and the others to come over and eat."
"Where did your century eggs and lean meat come from?" Gu Jun was a little dumbfounded, but the cooking was really fragrant. The pressure cooker used in the kitchen was already there at the beginning, while the rat-flavoured rice cooker was left at Eastern University.
"So I say that the welfare here is really excellent," Cai Zixuan couldn't help but admire. "I was just saying that when the receptionist brought us yesterday, ‘Wow such a large kitchen. I would have bought some ingredients if I had known earlier.' The receptionist just asked me what ingredients? I mentioned that some century eggs and lean meat to make porridge would be great for breakfast. As a result, he delivered these ingredients to the door early this morning! He even bought a lot of seasonings."
Gu Jun had already noticed that the kitchen was vastly different from the empty one yesterday. Now, the kitchen cabinet was full of bottles and cans. The figure of an old nanny could also be seen.
"Well, the welfare is indeed great," He already thought about it last night, "but who knows what price we are required to pay for such good welfare."
"That's true." Cai Zixuan also thought about it. "A price is always exacted for what fate bestows."
"That sounds familiar. Is it Shakespeare again?"
Gu Jun ignored Cai Zixuan and walked through the expansive and empty hall. He did not sit down on the sofa. There was no signal when he tried to turn on the TV last night. He came to the balcony and gazed out at the surroundings. This was the twelfth floor. It was very high, and the buildings in front have a panoramic view.
Although it was before seven o'clock, he could already see some people and vehicles moving around. Perhaps it would be more accurate to say that there were people working through the night.
After a while, Gu Jun turned back and headed for the bathroom. After he finished washing up, the porridge was ready, and Brother Ma and Sun Yuheng came out to find the source of the aroma. Cai Zixuan once again proved that if one didn't know how to cook, he wasn't a good doctor. Everyone ravenously devoured two bowls each. The porridge was thick and smooth, incredibly appetizing.
With renewed vigour from the meal, the six went down to the dormitory building, and met with the three girls. They were then led by the receptionist to the training center.
On their way, they learnt of the organization's training arrangements for them, which was divided into three categories: The Clinical Team, the Research Team, and the Errands Team. Other than Cheng Yifeng and Zhou Yi, who were assigned to the Errands Team, looking a little downcasted, everyone else had no opinion regarding these arrangements.
"Student Gu, there are other arrangements for you from above. The contents of your training will be particularly large. For the next few days, you would be training with the Clinical Team first," added the receptionist.
Everyone was not surprised by this arrangement. Gu Jun let out a sigh of relief. Before that, he was afraid that he would be assigned to do irrelevant chores because of his terminal illness. Well, it's good that they placed importance on me.
The training centre was a spacious modern building with nearly ten floors. They walked along with the receptionist. They soon discovered that there were not only rookies like them, but also some young people fulfilling varying roles such as nurses and pharmacists, in the training centre as well. They were also being led by other receptionists. This time the selection was extremely comprehensive.
The group collected the identification documents certifying their internship status and proceeded to different training rooms separately.
Gu Jun and the others who were assigned to the Clinical Team went to the clinical surgery training room. Surgery was the first training programme which they had to carry out. Thinking back to how patients suffering from the Malformation Banyan Disease needed to undergo amputation surgery, the surgical department should be the place where the Ministry of Medicine was mostly lacking in manpower.
The receptionist handed them over to the trainer and reminded them to come to the training centre punctually at 7:30 every day for the entirety of next month, then left.
Obviously, with the current situation, only very few personnel could be spared to serve as trainers. There was only one surgical trainer named Zhou Jiaqiang, looking to be younger than forty years old. He had a robust build with pimple scars marking on his face, looking very much like a bumpy gravel road, but the smile he wore was enthusiastic, very much different from the corpse guides.
"You can just call me Brother Qiang. I will properly guide you all. If you learn properly as well, then it should be simple and there would be no problems."
This training room was not large. It had a podium, blackboard and projection screen above, a dozen training tables, as well as some teaching models and instruments.
At the beginning of this first lesson, Zhou Jiaqiang smiled and encouraged five people to work together. It was indeed effective in making them closer, which made Cai Zixuan and Jiang Banxia particularly excited.
"We are actually still doctors. It's just that the patients we treat are unusual. We should treat them as we would typically do, and there is nothing to be afraid of. You are only scared because you have never encountered them before. But your Brother Qiang here, after going through many cases, no matter the situation, I'll just treat them like ordinary patients. There is nothing to be afraid of!"
"The first rule when performing a surgical operation is to not be afraid. The moment you are afraid, panic will sink in. Once you panic, problems will occur. Your hands must not tremble, and your heart cannot be flustered."
After everyone listened to Qiang Brother's words, they experienced a soothing feeling of being healed. The shadow brought by the Malformed Banyans faded slightly.
Brother Qiang was right. The more they see such cases, the more common would the Malformed Banyans become to them. The pioneers of craniotomy at the beginning of history would also have been terrified, but now, hasn't it become a common thing?
However, Gu Jun constantly had a strange feeling that behind the smile on that face full of acne scars, there seemed to be some intent to ridicule the fresh rookies.
"Oh, Ah Jun," Zhou Jiaqiang was very familiar with their information and smiled as he spoke. "Your anatomy skills are the best, so you must have confidence in yourself! Ruoxiang, Yuheng, Zixuan, you also have high standards. Once you get started, you will quickly pick up the skills. Banxia, you major in TCM, so you are naturally unfamiliar with the anatomical techniques, but it's okay. You can make up for it here."
For the university course of Traditional Chinese Medicine, undergraduates were also required to study human anatomy and Western medicine surgery. Compared with the eight-year clinical course of Western medicine, however, what their course covered was much less in-depth.
"Well, at the very most, I'll wipe your sweat when you guys are performing the surgery." Jiang Banxia was a lively and cheerful character and immediately joked about herself.
Everyone smiled. Cai Zixuan even chortled loudly a few times. There was a need to follow the principle of sterility during surgery. If the surgeon perspires during the operation and becomes sweaty, he can't wipe it himself. Thus, he needs to turn his head and wipe it off with the help of an assistant. Cai Zixuan looked at Jiang Banxia and smilingly said, "Banxia, there's still me as well. Don't fight over sweat with me!"
Gu Jun scrunched his eyebrows in surprise. There seemed to be a sour smell of love in the air?
Wang Ruoxiang nodded at him. The flirting began at the physical examination center yesterday.
"Okay, let's start the class!" Zhou Jiaqiang grew a little more serious, paced about the podium, and started to teach, "The basic operations of surgical operations are generally a few items: tissue incision, tissue separation, hemostasis, ligation, stitching, thread trimming and thread removal, as well as dressing change. There should be no big problem for the first two. You guys are only lacking in experience and skills. For the other items, you should also have some foundation in them. I will talk about them today and strengthen your foundation."
"When performing surgery, of course, hemostasis or curbing of blood flow must be done appropriately. There are several standard methods of hemostasis: compression hemostasis, ligation hemostasis, electrocoagulation hemostasis, using hemostatic items like bandages for hemostasis, and endoscopic clip hemostasis. Among them, the most commonly used and most demanding on technical skills is the ligation hemostasis."
"Ligation." Zhou Jiaqiang purposely placed emphasis on the word and swept a glance over the serious faces of the other five students. "Surgical hemostasis requires a lot of ligation with sutures. After tissue suture, ligation is required as well. Hence, ligation is the most foundational and a very critical step in surgical operation."
"How to complete the ligation safely, reliably, and efficiently? Two key points, one is to choose a suitable suture, and the other is to follow the standard operating procedure. First selecting the right knot according to the situation and completing it. Let me teach you the basic knots first. There are models for knot training in your desk compartments. Take them out."
After Zhou Jiaqiang said that, everyone looked for it from their compartment and took out the models that Brother Qiang indicated. All of them had taken courses in general surgery and affiliated surgical operations, but those were still limited to theories and principles on paper. The specific operations have not been studied in detail yet. For example, the few students from Eastern University initially still had one semester to go for mentoring at the hospital so when they held the models, it felt very foreign.
Gu Jun looked at the knot training model in his hand. It was made from transparent plexiglass material and a delicate design.
"This model uses a magnetic system to simulate tissue tension and parallel elastic ropes to simulate blood vessels," introduced Zhou Jiaqiang. "Three different types of cylinders form a variety of knotting spaces which can simulate various deep structures for knot practice. In short, this is a wondrous treasure for knotting! It's yours now."
Zhou Jiaqiang smiled, but his words were solemn. "Take it back to the dormitory after class and hug it even while you are sleeping. Practice properly."
He also took out a model from the podium. "Overhand knot, as you should know, is the most basic kind of knot." He took a thread and wound a circle around the model. "This is an overhand knot. How about a square knot? This kind of knot is most commonly used in surgery. It is composed of two overhand knots tied in opposite directions. You need to use a square knot when ligating smaller blood vessels and various sutures. As long as it is tied correctly, it will be firm and not easy to fall off."
"What if you add another overhand knot to the square knot and reverse the direction of the third overhand knot and the second overhand knot? Then, it would become a layered knot. When you want to ligate larger blood vessels and suture the tissue with higher tension, the most commonly used knot is the layered knot."
As Zhou Jiaqiang explained, he then used various knotting methods on the model to demonstrate. One hand tie, two hand tie, instrument, tying at depth…
Everyone all stared intently. Gu Jun didn't just watch, the nerves in his hands were also twitching uncontrollably, sensing the speed and strength of Brother Qiang's knotting.
"Please note that when you tie the two overhand knots to tighten the thread, you must cross your hands once. Else it will become a slippery knot. Use both hands to evenly and gently tighten slowly. Otherwise, the thread will be easily broken or even become loose and slip off. This would cause the patient to bleed again or suffer from significant haemorrhage!"
Zhou Jiaqiang demonstrated again and again. "It is not difficult to make a knot by making a few circles, but the difficulty lies in controlling your strength. Look, just like this, slowly…"
They watched Brother Qiang operate. They had a distinct feeling that this pair of hands that clearly belonged to a crude man seemed as gentle as a little girl holding an embroidery needle.
"…" Jiang Banxia was nervous. Brother Qiang made it sound so simple by saying it's not difficult and very easy to do. In actuality, it was like Xu Beihong1 teaching you how to draw a horse. First, draw the outline of the horse, then add the lines of its limbs… There, the horse was painted.
"Okay, do you understand?" Zhou Jiaqiang laughed. "Now you will show me with a one hand tie. The overhand knot first, then square knot, and finally the layered knot."
The five nodded their heads in agreement. No matter what they were thinking, they all got into action.
Cai Zixuan was a little clumsy. He had no problem when tying an overhand knot, but accidentally broke the suture thread when tying the square knot. Seeing that Cai Zixuan had made the mistake of using too much force, Jiang Banxia used evergrowing gentleness to tie her knot. In the end, the knots she tied slipped off.
"It's okay. Pay attention to it next time," Zhou Jiaqiang comforted them while looking at Wang Ruoxiang and Sun Yuheng. Both of them were calm and stable. They didn't hit a bump until tying the layered knot. Due to uneven use of force, their work became slippery knots. For rookies, such a performance was considered pretty decent.
This was consistent with the evaluations given to him by his higher-up. However, he heard that there was a ‘living deity' this time. He was ordered not to spare Gu Jun any courtesy, and must choose the most challenging assignment for Gu Jun.
Zhou Jiaqiang looked at Gu Jun's table. Was he really as ferocious as they say?
Xu Beihong, also known as Ju Péon, was a renowned Chinese painter who hailed from China. He was primarily known for his Chinese ink paintings of horses and birds