Chapter 304: Third option

Zhang Fan worked his hardest during his first 24-hour work shift in orthopedic department #1 for the sake of awing others. Sometimes, it really would be difficult to make comparisons between surgeons, especially when it came to standard surgeries. Everyone would claim that they were the best at performing surgeries. Highly difficult surgeries were of course much rarer and fewer in number, so the difficult surgeries wouldn't be encountered every day. So, Zhang Fan worked on so many surgeries in succession as his way of showing off directly to everyone. He was coarsely announcing to the department that he had arrived!

Doctors were scholars. It would be rare in any department or hospital for there to be vicious infighting to the point where things became incredibly direct, unless there was something critical on the line such as a vacant superintendent or director position. Normally, competition between doctors was more moderate. However, Zhang Fan didn't want to wait. He didn't want to waste his time on such a thing. That was why he used such a coarse method to declare his arrival!

Zhang Fan had worked as the primary surgeon on seven surgeries in a row. He was already working with his third set of anesthesiologist, operating room nurse, and medical equipment nurse. His surgical assistant had been either Wang Yanan or Xue Fei for every surgery. Xue Fei was absolutely exhausted by the end of the last surgery. He immediately collapsed on the ground of the operating room, and was unable to get up again!

"Doctor Zhang, you must be really tired. Hurry and get some rest! Seven surgeries, that's really incredible!" a slightly older nurse exclaimed.

1

Zhang Fan had been waiting for her words. Wang Yanan and Xue Fei had already completely collapsed on the ground as if they had died. They were unwilling to even open their mouths, much less waste energy through speaking.

"It's fine. This is nothing. I haven't performed surgery for so long. I still haven't had enough fun yet!" Zhang Fan said with a laugh. He then helped the nurses to clean up.

Was he actually tired? Yes, he was exhausted, and had only been making things up. Right now, he was forcing himself to go on in order to act cool!

"Hey! Doctor Zhang, don't you move any more. We can clean this up by ourselves." Another nurse hurriedly took away what Zhang Fan was holding.

"I'm really not tired." Zhang Fan smiled.

"Even if you're not tired, immediately get some rest, go to the bathroom, and so on!"

Zhang Fan really wanted to make a snarky comment that nobody capable was here, but nobody would follow up on his joke anymore. The nurses had finished cleaning up and left already. Xue Fei and Wang Yanan were already both fast asleep on the ground!

Although Zhang Fan felt that his pretentiousness hadn't been very effective, everyone in the surgical departments, especially the orthopedic departments, learned by the next day of a new rumor.

"Have you heard? Zhang Fan performed seven surgeries in succession yesterday! He even claimed that he had just begun after he finished the seventh, asking if there were any more for him to do!"

"For real?"

"Did you hear?"

"What?"

"Zhang Fan is intending on dominating the operating rooms!"

"Then what are we supposed to do? Heh! Not only is he skilled, he has as much stamina as a cow used for plowing the fields. Is he gonna let the rest of us make a living?"

...This was a conversation between two orthopedic surgeons.

The next morning, Zhang Fan's medical team reported their work from the previous day at the daily morning meeting for the sake of those taking their shift. Zhang Fan began, "43 patients originally. 11 were discharged, while 12 new patients were hospitalized. 10 surgeries completed yesterday, including..."

He needed to report about all the new patients, discharged patients, surgeries, and the patients' conditions in the morning as well as night.

Did the patients feel any pain? Did they have a fever? How was the pain and fever dealt with? What medicine was used? Did the patients have bleeding? Did the bleeding soak through their gauze? All of this needed to be reported; this was the doctors' daily work.

Maybe many people would think that surgeons would only perform surgeries on a daily basis, with nothing else to do, but that wasn't the case at all. Other than some veteran surgeons who had worked for many years already, surgeons would also have to observe the patients' condition and write medical reports. This would take just as much time as performing surgeries. That was why doctors were busy. They didn't have any choice but to be busy. For instance, medical reports were required to be completed within a certain amount of time, especially now since all medical reports were typed on computers. A major medical report would need to be completed within X hours. After this time passed, the computer system wouldn't even allow you to work on the medical report anymore. The doctor would then only be able to wait for being scolded and fined. The hospital leadership wouldn't care just how many surgeries the doctor had to perform that led to the late medical report.

Zhang Fan reported on all the patients' condition. The other doctors in orthopedic department #1 were so astonished that their mouths were wide open. The other doctors on duty combined had only performed three surgeries, while Zhang Fan had personally performed the other seven. All the other doctors couldn't help but wonder if Zhang Fan was really human!

Normally, if there were too many patients, then the other doctors would share the patients with other medical teams. However, Zhang Fan's medical team performed every single surgery without asking for a single bit of help. Of course the other doctors would be astonished!

Director Gao spoke after Zhang Fan finished reporting. "In the future, if there's a high number of surgery patients, ask for help if at all possible. Don't wear yourself out from fatigue."

"Alright, Director!"

After reporting on yesterday's patients would then be discussion of tomorrow's planned surgeries. Normally, for any surgery which wasn't an emergency surgery, the surgery would always need to be discussed with the entire department. What surgical method, what medical equipment was necessary, and so on would all need to be planned beforehand.

"Tomorrow it's our medical team's patient #16, who has an oblique fracture of the femur. Her checkups will be completed today, and we plan on scheduling her metal plate internal fixation surgery for the femur tomorrow. We will use titanium alloy locking metal plates..." Zhou Chengfu began discussing a patient belonging to his medical team.

Zhang Fan started frowning as he listened to this discussion as he disagreed with the proposed method.

There was much debate in medical society regarding femur fracture surgeries. There were two main schools of thought due to the traits of the femur bone. This was also because the femur bone's nutrition and blood supply had two systems, one being the microcapillaries crawling along the periosteum, and the other being the blood vessels within the bone marrow.

Surgery was for the sake of helping to treat patients. However, any open treatment method would also cause damage to the body. Doctors were constantly trying their best to improve surgery methods in order to reduce the damage done to the body.

For instance, there were two standard treatment methods for femur fractures. They were both internal fixation methods.

The first was to use a metal plate to affix the broken bone. The advantage of this method was that it was simple and direct. The downside was also quite obvious. It would damage a large amount of the periosteum. This fixation method was also overly firm. Bones weren't like wood, where firmer was better. Actually, a bone fracture would heal the best and fastest with a firm fixation that also allowed for the bone fracture to slightly move with less than two millimeters of freedom. Although this sounded contradictory, this was indeed the biological trait of how bone fractures healed.

The other type of internal fixation was intramedullary fixation. A hole would be opened up in the femur so that an intramedullary nail could be inserted into the bone. The fracture would then be affixed at the distant end. The benefit of this was axial fixation. Not only would this barely damage the periosteum, it would even complement the biological trait of how bone fractures healed. The downside to this was also rather obvious. This method would damage the blood supply system inside the bone marrow.

Zhang Fan didn't prefer either method. He preferred to select the most appropriate method based on the patient's overall condition.

Zhou Chengfu finished introducing the patient's condition and the surgery plan. He then looked towards Director Gao. In any surgical department, the primary physician for the patient would first create the surgery plan, and then the director would determine whether to go ahead with the surgery or not, when to do it, and who would perform it. The director was basically the final step of approval for any surgery.

Director Gao glanced at the X-ray from the projector, and then told everyone, "Let's discuss this surgery. Everyone can state their own ideas."

At any hospital, especially the surgical departments, normally everyone would be friendly with each other and all cooperate during any surgery, but it was also common for people to get really angry during debates over surgical plans. This was even more so for different surgical methods with no absolute academic support for one type or the other.

"Then I'll speak up first. I think that intramedullary fixation would be better for this fixation. This patient is a woman in her 60s, so there will be too much damage to the periosteum with metal plate fixation. It will be difficult for the patient to recover afterwards. Having to remove the metal plate will cause a second round of damage to her body," said a second-highest level certification doctor from another medical team.

Currently, a resident doctor from Zhou Chengfu's medical team was recording everything that was discussed for this surgery plan. Everyone's opinions would need to be recorded in the medical report.

"Yes, it will cause damage to the periosteum, but I doubt there will be a second round of damage. This patient is already in her 60s. Nowadays, the titanium alloy metal plates are already the antibacterial type. At her advanced age, there's no need to remove the metal plate. Besides, is there no damage with intramedullary fixation? The patient's not young anymore, and the bone will mainly rely on the bone marrow for blood supply, so metal plate fixation will absolutely be better than intramedullary fixation."

The doctors began to speak their differing opinions, going in turn by highest ranks first. Not all surgeries would have these discussions. However, any surgery type with no established superior surgical method would always spark heated debates about the surgery. This was an academic debate, as well as a fight for benefits. This would determine who had more influence within the department.

By the time that the attending physicians and resident doctors could speak their opinions, all they had to do was support one side or the other. The doctors with either second-highest level certification or highest-level certification would have already expressed the advantages and downsides of both methods quite clearly. The resident doctors didn't need to say anything apart from which side they supported! In this type of situation, if the director wasn't skilled enough to completely suppress everyone, the department would then turn into a battlefield that had a complete lack of unity.

Orthopedic department #1 had five medical teams in total. Two medical teams supported metal plate fixation, while the other two teams supported intramedullary fixation. The last team was Zhang Fan's new medical team. Finally, it was his team's members' turn to speak their opinions.

"Xue Fei." Director Gao called for Xue Fei's opinion directly.

"I think that both will be alright!" Xue Fei was the type who didn't care either way. Still, what he said was technically correct. Indeed, both types of surgery were alright for the patient. There wasn't enough evidence to conclusively determine that one type of surgery was better than the other!

"Zhang Fan." Director Gao gave Xue Fei a sidelong glance before naming Zhang Fan directly.

Everyone turned to look at Zhang Fan in unison.

The veteran doctors who had seen Zhang Fan's accomplishments wanted to hear his opinion. Even though they knew that he wouldn't be able to come up with anything new, they still looked over in his direction. The younger doctors, especially Xu Xian who had recently joined the department, also wanted to hear Zhang Fan's opinion. Xu Xian personally felt that intramedullary fixation was much better in this scenario, and he wanted to see if Zhang Fan would agree with him.

However, Zhang Fan's reply shocked everyone. "I feel that neither of the two surgery types are appropriate!"

"What? You want to try external fixation? Isn't that just ridiculous!?" A second-highest level certification doctor from Zhou Chengfu's medical team immediately became annoyed.

External fixation was yet another fixation method. To explain simply, it would be like constructing a metal support outside a building. Bone fractures could also be affixed by this method. The obvious advantage was that this would give the body very little damage. However, the downsides were also really obvious. This method was highly unadaptable as well as prone to infection. Postoperative care for this method was also really difficult.

Femur bone fractures weren't suitable for external fixation in the first place. It would be impossible to use external fixation in this scenario. That was why this hasty second-highest level certification doctor had interrupted Zhang Fan. Although this was slightly rude, his feelings were understandable.

Zhang Fan didn't mind. He simply smiled, and responded, "Doctor Chen, do you think that external fixation is possible for this surgery?"

Zhang Fan intended to dominate this department now that he was permanently assigned here. He wouldn't be able to dominate by being humble, especially when it came to academic debates. He would have to show his skills. Since this Doctor Chen had interrupted him, then Zhang Fan would remind him to use his brains first before trying to interrupt again in the future!

"Oh! That's obviously impossible." Doctor Chen instantly lost his momentum. He broke out in a cold sweat at Zhang Fan's question. He realized that Zhang Fan hadn't mentioned anything at all about external fixation. 'Oof! I was too reckless,' Doctor Chen warned himself!

"Continue! Talk about the surgery," Director Gao interrupted. He was expressionless, without showing joy or sadness while folding his arms. He also wanted to hear Zhang Fan's thoughts. To be honest, Director Gao also favored intramedullary fixation for this particular surgery.

Zhang Fan got up and lightly adjusted his white doctor's coat. He seemed just like a grandmaster from ancient times who was flinging the laurels of his coat before going up on stage.

A powerful aura seemed to appear around Zhang Fan. *Click!* Zhang Fan opened up a foldable plastic ruler used for measuring bones and walked towards the projector.

"Everyone, please take a look here! The femur was fractured in the middle. This is an oblique fracture as well as an unstable fracture. However, the bone fracture didn't move too much from its original position. This is also a closed fracture. When combining the above factors with the patient's age, my opinion is to use intramedullary fixation."

Right after Zhang Fan finished saying this, he heard many doctors condescendingly saying "tsk". Director Gao also furrowed his eyebrows, but then he thought things over and returned to being expressionless. Xu Xian was also slightly disappointed. He felt that Zhang Fan had displayed a powerful aura but said only meaningless things.

'I suppose that's all he can say!' Xu Xian thought to himself.

Everyone had missed the fact that Zhang Fan's statement didn't fit the two most common methods of surgery for this type of femur fracture. Only Director Gao understood, but this type of surgery's difficulty was extremely hard.

"Closed intramedullary fixation!" Zhang Fan announced.

"Closed intramedullary fixation?" Someone couldn't help but repeat Zhang Fan's words questioningly. This surgical method only had one extra word compared to the normal method. However, the difficulty would be multiplied exponentially! Only the doctors with second-highest level certification or higher would even understand how difficult this surgery was.

The doctors with second-highest level certification all exchanged glances with doubt rather than shock. Meanwhile, the attending physicians and resident doctors who hadn't learned as much yet all had looks of complete confusion. What even was closed intramedullary fixation? For instance, Xue Fei didn't know!

Closed intramedullary fixation was actually quite simple to explain. This was directly affixing the fracture without cutting open the skin to reveal the fracture. The doctor would be doing everything blindly. This had far too high a requirement for the doctor's skill level. Additionally, this method was only normally used for relatively stable fractures. Yet, normal hospitals and doctors still wouldn't choose this method even for stable fractures.

Even though this method would be the least damaging for the patient's body, it would be too dangerous for the doctor because the doctor was doing things blindly. A medical incident or the bone fracture not setting in a proper location would be far more likely to occur. Even a single millimeter's difference could ruin bone fracture fixation. If the fixation wasn't done properly, or if the fixation caused the bone fracture to move at an angle, that would cause the bone fracture to heal in a distorted shape, which would result in a medical incident. Once a medical incident occurred, then nobody would care if the doctor had originally done this for the sake of the patient. Thus, this type of surgery wasn't seen at all in lower-level hospitals. Even in major hospitals, only directors would typically dare to use such a method.

"Bro, this is an oblique unstable fracture, not a stable fracture! Are you absolutely certain that you can guarantee everything would be restored to exact anatomical position?" another second-highest level certification doctor said in a tone which sounded regretful or helpless.

This was the helpless part about being a doctor. Doctors wouldn't dare to attempt something new until their skills were good enough. They wouldn't dare to take the next step.

"Yes, I can!" Zhang Fan stated seriously in front of the projector while holding on to the bone ruler.

"Oh! You can." The other second-highest level certification doctors all fell silent. This was because Zhang Fan's accomplishments were too scary! They both believed and doubted whether Zhang Fan could accomplish this. They felt really conflicted inside!

The original secret whispers discussing the surgery plan had all vanished. Everything became completely silent! The doctors didn't even exchange glances with each other. They all quietly looked at Director Gao, who looked straight at Zhang Fan.

Finally, Director Gao spoke up. "Have you used this method before?" Chasu City Hospital was considered a lower-level hospital. No matter how skilled someone was, the first question to ask for any special surgery was if the doctor had any experience with that method already! Major hospitals would have all sorts of insurance for doctors to dare and try new methods, but lower-level hospitals had to focus on safety first and foremost. What was a lower-level hospital? All hospitals in China which weren't ranked in the top 30 would be considered lower-level hospitals!

That was the difference between lower-level hospitals and top-ranked hospitals. The top-ranked hospitals would have more modern medical equipment and doctors with better academic qualifications, and would be able to learn newer medical treatment methods at a quicker pace. Lower-level hospitals wouldn't even be able to dream about performing high-level research. Lower-level hospitals would only be able to treat more common diseases.

Did you want to take risks with something new? Without even mentioning the patient's family, the hospital would break the doctor's leg first!

There were benefits and downsides to this. There was no right or wrong. However, there was something quite apparent about China's medical system. The heavy responsibility of researching had been left to the top-level hospitals, leading to a slowdown in medical advancements. Still, this really did serve to decrease the number of medical incidents. This awkwardly sounded like it was both good and bad for the patients.

"Yes, I've done it before!" Zhang Fan's face didn't even redden from telling this white lie. Although he had never used this method in real life before, he had practiced it countless times in his System already. He had also practiced orthopedic surgery techniques far more than other types of surgery techniques before. This was what gave him his confidence and a guarantee!

"You're certain?"

"I'm certain!"

Director Gao contemplated and hesitated! It seemed as if several centuries had passed when it only took around a dozen seconds. He then turned around, and said, "Doctor Chen, what do you think?"

Although Director Gao was asking for an opinion, he was actually giving Doctor Chen a way to save face. Director Gao was already intending on letting Zhang Fan try!

Everyone here understood what Director Gao really meant. Even if Doctor Chen disagreed, it wouldn't matter at all. Director Gao would still give the patient to Zhang Fan. If Doctor Chen disagreed, yet Zhang Fan still accomplished the surgery successfully, that would really make things difficult for Doctor Chen in the future!

This was the might of a department director, and the authority that most doctors would want to have for themselves.

"This surgery is really difficult! I wouldn't have any guarantee at all, Director!" Doctor Chen could use a severe or casual tone with Zhang Fan, but Doctor Chen would have to be a lot more respectful with Gao Shijun.

"How about I work on this surgery together with Doctor Zhang?" Director Gao inquired. This way, he could protect Zhang Fan by forcibly taking charge of the surgery. Was there risk to this? Yes, a significant amount. If Zhang Fan was incapable of performing the treatment, or if a medical incident occurred, then Director Gao would have a hard time or even lose his position as director.

Still, Director Gao was willing to trust in Zhang Fan and give the latter an opportunity to improve his skills. This was because doctors cared more about skills than politics. As long as someone could prove their talent in a profession like doctor, then others would give such a doctor development opportunities. The difference would be in the degree of opportunity.

Director Gao was truly helping Zhang Fan with everything possible. Director Gao was the epitome of a great doctor! He was taking on the risks himself so that the younger generation could make progress. There were so many doctors like him in the profession! These doctors would be the foundation of the Chinese medical system!

"Alright, I'll also help out!" Doctor Chen didn't try to add any insults or be a bystander. While academic theories could be debated, once a surgery plan was established, then the rest would be all about cooperation. That was how an excellent hospital department would work!

"Okay! All non-emergency surgeries for tomorrow will be canceled! Everyone shall observe Zhang Fan's surgery!" Director Gao finally smiled. Since things were like this now, he decided to give Zhang Fan an even greater boost which might help the latter to fly even higher and earlier!

All the doctors then turned to look towards Zhang Fan, who was smiling just as much as Director Gao as he made a loud clicking sound with his bone ruler!