CHAPTER 455: A VALUABLE LESSON 455

Auto-brewery syndrome is a very interesting disease, but also a very dangerous one.

It was said that an instance of it had been diagnosed by Liu Banxia in the emergency center, intriguing hospital staff enough that even people from the inpatient department would come over for a look when they had time.

However, the necessary fungal cultures and tests required time, as did observing the patient’s body brew alcohol under natural conditions.

At this point, it was merely Liu Banxia’s speculation. Only when the actual results came out and were verified would it confirm that the patient hadn’t been driving under the influence. Then, they could research how to treat his condition.

Presently, Liu Banxia didn’t have time to concern himself further with this patient. After checking that there wasn’t much else to do in the emergency center and giving some instructions, he rushed towards the operating room.

He needed to observe Xu Peichen’s total hip replacement surgery. This was a procedure only orthopedic surgeons could perform; general surgeons, no matter how urgent the situation, wouldn’t encounter such a case.

"Our President Liu has finally arrived. If you hadn’t shown up any sooner, we would have had to call you," Xu Peichen said with a smile.

Liu Banxia was a bit puzzled because the patient on the operating table hadn’t been anesthetized yet. According to the surgical schedule, this step should have been completed ten minutes ago.

"As soon as he heard you were coming to participate in the surgery, he insisted on waiting for you," Wu Mingyu said with a laugh.

Liu Banxia approached the patient. "That made me a bit nervous," he said to the patient. "But don’t worry. Director Xu is one of the top experts in the country. Besides, a total hip replacement is our last resort. We still need to see the results of the intraoperative frozen section."

The patient nodded with a smile. "To be honest, I’m really scared. I can’t tell my friends or family. You’re all I can count on. Please, I’m entrusting myself to you."

"Rest assured," Liu Banxia said. "Although the surgery is scheduled a bit late, it won’t affect anything. Director Xu specifically squeezed out time for this."

"I’ve also arranged everything in the ward. We always prepare for the worst and hope for the best. Even if you do need a hip replacement, we’ll oversee your entire rehabilitation process."

The patient nodded.

"Alright," Liu Banxia said. "We’ll intubate you shortly and then administer the anesthesia."

Upon hearing this, the patient immediately opened his mouth.

Wu Mingyu had already explained the detailed surgical procedure to him. The patient had also looked up Xu Peichen’s standing in the field of orthopedics online.

Moreover, he hadn’t waited too long. Being diagnosed yesterday and having the surgery today was, in itself, quite fortunate.

Intubation, anesthesia, and positioning the patient in the left lateral decubitus position were completed. The surgery officially began.

As Wu Mingyu performed the initial dissection, Xu Peichen commented, "Liu, you’re very patient with your patients. You need to maintain that patience."

"I just offered some comforting words. Undergoing such a major surgery alone, without being able to tell his family, must be agonizing for him," Liu Banxia replied.

"A good mood can help with a faster, better recovery. He has to bear all of this alone. Director Xu, do you think the chances of it being malignant are high?"

Xu Peichen nodded. "It developed very quickly. It’s fortunate he didn’t delay. I’d dare say if he had waited another month, there probably would have been no saving him."

"Malignant bone tumors progress very rapidly, and they metastasize even faster. We have three such patients in our inpatient department for whom surgery is no longer an option."

"One patient started feeling leg pain when the weather turned cold but dismissed it, thinking it was just the cold. He only came for an examination recently when the pain became unbearable. How long has it been? Just over two months."

"Ming Yu, pause for a moment," Xu Peichen said. "Let Banxia experience the next part. In general surgery, you also perform basic dissections, but you probably haven’t tried to open up such a large surgical field, have you?"

Liu Banxia was startled, looking at Xu Peichen with a helpless expression.

He indeed hadn’t performed such a dissection before. If it were a leg fasciotomy for compartment syndrome, that would be no problem. He was now very experienced in that area and no longer needed anyone’s guidance.

Exploring intra-abdominal organs also wouldn’t be an issue, as most of his training in the dream space focused on that.

Only with a complete understanding of intra-abdominal anatomy could one handle various unexpected surgical situations more easily.

But a total hip replacement? That involved dissecting out the entire hip joint. Where would he have encountered such a large surgical field? This was a proper level-four orthopedic surgery.

Xu Peichen’s suggestion startled not only Liu Banxia but also those watching the surgery on the screen. After all, it was a level-four orthopedic surgery with Xu Peichen himself as the chief surgeon, making it highly educational.

No one had expected Xu Peichen to trust Liu Banxia so much, especially since this involved dissecting different types of tissue, with differing technical points.

"Director Xu, let me ask first," Liu Banxia said. "Now that Doctor Wu has opened the subcutaneous tissue and fascia, should I incise along the fibers of the gluteus maximus, transecting the iliotibial band down to below the greater trochanter?"

Xu Peichen nodded with a smile. "It seems you’ve studied this procedure. Go ahead, give it a try."

Liu Banxia nodded and took the chief surgeon’s position.

Just as Xu Peichen had said, the basic anatomy was similar. Liu Banxia had just stated the key technical points, or rather, the path; he just needed to follow it.

His hands remained as steady and swift as ever. Even though this was his first time dissecting this specific area, countless days and nights of training had given his hands a solid foundation.

Although it was just a simple dissection, those watching on the screen couldn’t help but praise his skill with a "Nice!" Watching Liu Banxia make his incisions was somehow very satisfying.

When Liu Banxia made an incision, his movements were not only fast but also steady and precise. Judging by this current performance, he didn’t seem like someone attempting this for the first time at all. This required strong fundamental skills; the scalpel followed his eyes.

"Director Xu, the rest is up to you. I’m out of my depth now," Liu Banxia said, stepping aside.

"See? I told you, you should come to our Orthopedics Department. Ming Yu, show him how it’s done. Next time you encounter a similar surgery over in your department, you two can manage it together," Xu Peichen said.

Wu Mingyu didn’t hesitate, taking over skillfully.

He was also one of Xu Peichen’s prized pupils; otherwise, he wouldn’t have been sent to the emergency center. If he didn’t have considerable skill, he couldn’t have single-handedly supported orthopedics there.

"Exploration reveals an irregular tumor, approximately 0.5 by 0.3 centimeters. Proceeding with excision and sending for intraoperative frozen section," Wu Mingyu stated.

Xu Peichen nodded. "Excise it. There’s very little chance of it being benign."

Liu Banxia sighed inwardly. If the tumor’s edges were smooth, there might have been some hope. But with a tumor like this, the chances of it being benign were practically zero. Irregular margins are, in fact, a hallmark of malignant tumors.

After a short wait, the phone rang. The nurse answered and then shook her head.

"Proceed with the replacement," Xu Peichen said.

Wu Mingyu nodded and resumed operating.

This time, Xu Peichen didn’t let Liu Banxia assist. The basic dissection he’d done earlier was acceptable, but what followed was critical to the entire surgery’s success or failure.

The surgery itself wasn’t overly complex for Xu Peichen; he had performed it countless times and knew it inside out. He would only intervene at crucial steps, with Wu Mingyu handling many of the basic procedures.

To Liu Banxia, who was observing, orthopedic surgery seemed somewhat "brutal": breaking bones, sawing bones, grinding them down...

He was a surgeon too, but witnessing a joint replacement today was still hard for him to quite accept. It truly validated the saying, "Different fields are like different mountains." Though both were surgical disciplines, orthopedics involved a distinctly different approach.

This wasn’t as simple as replacing parts in a machine; these were human bones, and each individual’s anatomy was different.

Therefore, one needed to test and adjust meticulously. After reducing the hip joint, one had to ensure that flexion, abduction, and external rotation of the hip were unrestricted. When internally rotated to 45 degrees, the knee also had to be pushed posteriorly to check if the joint would dislocate.

The entire process was intricate, not as straightforward as general surgery where a damaged part was simply repaired or removed, prioritizing speed and decisiveness. Joint replacement demanded immense observational skills and patience, as it would affect the patient’s mobility for the rest of their life.

After the drainage tube was placed and the gauze and instruments were checked, the wound was sutured layer by layer.

"Well, what did you think?" Xu Peichen asked Liu Banxia.

Liu Banxia thought for a moment before replying, "It’s certainly changed my perception of orthopedic surgery. It’s very different from our general surgery—a kind of beauty that’s both rough and delicate."

"Especially the joint adjustment. I believe that’s the most critical part of this procedure. Only when the prosthesis achieves a perfect fit after reduction can the surgery be called a success."

Xu Peichen nodded. "Though you’re exaggerating a bit, you’re not far off. Anatomically, orthopedic surgery isn’t overly complex; these approaches are also commonly used in internal fixation procedures."

"However, the reason joint replacement is classified as a level-four surgery is precisely because the adjustment process is so critical. After all, this is a joint the patient will use frequently. We remove the damaged bone to treat the disease."

"And after treating the disease, ensuring the patient has a better prognosis is equally a requirement of the surgery. A surgery’s success isn’t just determined on the operating table, but also by the patient’s outcome afterward."

"Director Zhou must have told you, right? There’s no such thing as a perfect surgery, only the most suitable one. Often, constrained by the location of the lesion, we can only make the most difficult, sometimes seemingly helpless, choices. After making that choice, we then need to consider how to give the patient the best possible prognosis."

"Thank you, Director Xu, for this valuable lesson," Liu Banxia said sincerely.

Those watching the surgery on the screen shared this sentiment. They had all witnessed the meticulous adjustments. There were no one-step solutions, only gradual refinements and shaping until a perfect fit was achieved.