CHAPTER 458: 458 LIU BANXIA’S TEACHING GUIDANCE

"Feifei, how long has this been going on? Do you have symptoms of painful urination, frequent urination, or urgency?" Liu Banxia asked after pondering for a moment.

"It’s been about half a month," Tang Feifei said, lowering her head. "I don’t have any of the symptoms you mentioned."

"And I’ve noticed that I can control it during the day. It only happens when I sleep at night. Could it be... my condition is part of some disease?"

"What about the amount of urine?" Liu Banxia asked again.

"Not much, just a little bit," Tang Feifei said, gritting her teeth.

Liu Banxia gave it more thought. This indeed doesn’t quite meet the criteria for diabetes insipidus; Xu Hui’s judgment was very accurate, he concluded.

"Let’s do three tests," Liu Banxia said after some consideration. "The first one is a urine test to see if there’s an infection. The second is a blood test, which is routine. The third is an MRI of the head to see if there’s an issue with your cranium."

"Given your situation, you should stay in the VIP ward upstairs. Blood and urine samples can be collected in the ward. Don’t rush for the MRI; do it when there are fewer people or wait until night."

"Your case is somewhat peculiar; technically, we should also consult a gynecologist. Since you came to me, I’ll look after it. I have a few surgeries lined up this afternoon. I’ll visit you in the ward during a break, so just relax, okay?"

"As long as you help me keep this confidential," Tang Feifei nodded, "otherwise... I won’t be able to face anyone."

"Don’t worry, I’ll take care of it," Liu Banxia added. "But the MRI will have to be done a little later, as we have a lot of patients in the Emergency Center at the moment."

"Brother Hui, I have to go to the operating room. Can you and Sister Li help arrange things? Let the nurse buy any necessary items. I won’t feel comfortable if she walks around. She might mess up the Emergency Center."

"Dr. Liu, I don’t have that disease, do I?" Tang Feifei asked again before Xu Hui could say anything.

"Have you had any relevant contact?" Liu Banxia asked with a frown.

"Of course not. I don’t have a boyfriend," Tang Feifei quickly said. "But I know someone who might."

"Then stop speculating," Liu Banxia said. "Brother Hui, conduct an additional test when the time comes. Use ’VIP’ as her name to avoid any future trouble."

Xu Hui nodded with a smile. Personally, he agreed with this approach. If any news leaked, it might land the Emergency Center in a lawsuit. Similar incidents are not uncommon. Handling a celebrity’s hospital stay can be quite difficult. Someone might show off and leak the news, potentially leading to a lawsuit. Moreover, Tang Feifei’s situation is quite unique, so the less information that leaks, the better.

As Liu Banxia walked towards the operating room, he was also pondering Tang Feifei’s condition. Diabetes insipidus can be ruled out, as the urine volume in such cases wouldn’t be this small. Next, I need to determine if it’s a urinary tract infection or an intracranial issue. My guess is that an intracranial issue is more likely. I’ve encountered diabetes insipidus before, in that child. It was a complication of other diseases. Compared to life-threatening conditions, it wasn’t a major concern to leave unaddressed. I can’t make a definitive diagnosis right now; I’ll have to wait for the detailed test results, he mused.

"Teacher Liu, I have confirmed the patient’s information," Liu Yiqing said.

After Liu Banxia scrubbed in and approached the operating table, Liu Yiqing spoke.

"Doctor Li, start the anesthesia," Liu Banxia nodded.

Li Liwei nodded and began.

"Su Wenhao, perform the exploratory laparoscopy. Rectal tumor removal, ostomy, and pelvic exenteration—these are the basic components of rectal cancer surgery," Liu Banxia said after the patient was anesthetized.

"Although certain intraoperative indicators can offer patients significant hope for sphincter preservation, it ultimately comes down to those indicators."

"In the many cases we’ve treated, the chances of sphincter preservation are high only for early-stage patients where the tumor is more than four centimeters from the anus and the base hasn’t been infiltrated."

"Teacher Liu, do you mean we should guide the patient’s expectations somewhat when discussing options?" Su Wenhao asked.

"Not exactly," Liu Banxia said. "For the patient, sphincter preservation is preferable if possible. I’m merely talking about probabilities."

"This is because we often face a challenging dilemma with the patients we treat: attempting sphincter preservation can be somewhat risky and might necessitate a second surgery. Therefore, we must explain this clearly to the patient."

"You should remember the patient with extensive abdominal adhesions, right? If he had been more decisive, the outcome would have been different. We can respect a patient’s choice, but only within medically permissible limits."

"Exploration revealed no obvious ascites, adhesions, or bleeding in the patient’s abdominal cavity," Su Wenhao reported. "The tumor is located below the peritoneal reflection and has not invaded the serosa. There are no obviously enlarged regional lymph nodes. A laparoscopic radical resection of rectal cancer can be performed."

"Huang Bo, you’ll be the chief surgeon. Liu Yiqing, first assistant. Su Wenhao, second assistant," Liu Banxia said calmly.

Huang Bo, who had been preparing to make the second or third trocar insertion, stiffened slightly. He looked at Liu Banxia with a pitiful expression. This is undoubtedly a Level 4 surgery! Although not as complex as liver resection, its difficulty is undeniable, Huang Bo thought.

"What are you nervous about?" Liu Banxia continued. "Is the initial dissection that complex? It’s merely a matter of carefully isolating the rectum and the root of the sigmoid mesocolon, ensuring the ureters and hypogastric nerves aren’t damaged."

"After that, it’s just basic intestinal surgery: ligate the superior and inferior mesenteric vessels, transect the bowel, create an abdominal wall stoma, and bring out the bowel segment to fashion the colostomy at the end. How simple is that?"

Huang Bo shot him an even more resentful look. Simple? Maybe for you, with your skills. For us, it’s not as simple as you make it sound! But could I afford to hesitate now? Absolutely not. If I backed down now, considering Liu Banxia’s usual teaching approach, who knew when I’d get another chance to operate?

"That’s more like it. No need to be so worried," Liu Banxia continued. "The overall difficulty of this surgery is high because it combines various basic maneuvers. Is the dissection here more complex than dealing with an adhered gallbladder? Liu Yiqing, what do you think?"

"No, handling adhesions is much more difficult," Liu Yiqing hastily responded.

"See? Liu Yiqing agrees with me," Liu Banxia stated, clearly pleased. "For the pelvic exenteration, Liu Yiqing will be the chief surgeon, Su Wenhao first assistant, and Huang Bo second assistant."

Liu Yiqing, who had been feeling quite cheerful just a moment ago, tensed up. Suddenly, the pressure of today’s surgery felt heavier than a mountain.

"Pelvic exenteration is also simple," Liu Banxia remarked. "You just operate in the perineal region and resect the unnecessary tissue."

"The main thing to watch out for is protecting the urethra. You’ve all assisted me in at least four similar surgeries. If you still can’t tell what’s what at this stage, you’ll have to go back to basics. Su Wenhao, wouldn’t you agree?"

"Uh... Yes, that’s absolutely correct," Su Wenhao, the honest kid, stammered, unsure what else to say.

"Alright, kids, work hard," Liu Banxia declared. "In the future, for any routine surgery, I’ll break it down as much as possible so each of you can take charge of a component."

"A complete surgery demands high standards and attention to many details. But just performing one component should be manageable, right? I believe you can all handle it."

"These are all individual small tasks that, when combined, make up a major operation. In the future, when we have many surgeries, we’ll use this team approach to tackle them, preventing any single person from becoming too fatigued."

He spoke casually, but to the three listening, his words felt like a volley of tiny throwing knives.

As interns, they were eager for ample hands-on opportunities. However, Liu Banxia provided them so abundantly that they were struggling to keep up. Even though Liu Banxia broke down the entire surgery into more routine steps, it didn’t mean the pressure vanished. Being the chief surgeon for a part of it was entirely different from merely assisting; this was the pressure of command.

Is this irresponsible towards the patient? They requested you for the surgery, and now you’re just standing by while interns operate?

Not quite. Once you’re in the hospital, the medical staff are responsible for every action taken concerning your care.

Although Liu Banxia spoke lightly, his eyes were glued to their actions on the monitor. Letting them operate meant he had to bear the full responsibility. If any mistake occurred, he needed to take over immediately; otherwise, the interns might freeze up.

This was why he dared to give them this much autonomy—only because this patient’s case wasn’t complicated. It was a rare opportunity for hands-on experience and a chance to temper their nerves. Besides, if their usual performance hadn’t earned my approval, who would dare to be so hands-off?

They had been handpicked by Chen Zhenxing, not admitted through connections. Their previous internship experience had provided a solid foundation, and their time in the Emergency Center was for advanced training. For instance, with procedures like today’s small-incision appendectomy, he had to perform it himself. The interns still lacked the necessary skill and finesse for that. However, a laparoscopic cholecystectomy was a good way to assess their capabilities as chief surgeons. The decision always depended on each patient’s specific situation, with the foremost requirement being to alleviate the patient’s suffering and ensure a good prognosis.

This could be considered my special teaching method, and I plan to continue this approach for the next six months of training. Although they’ll feel greater pressure, with proper guidance, it will be immensely beneficial for their growth. Once they grow accustomed to working under such high pressure, their performance will be commendable wherever they go in the future, Liu Banxia considered.

Watching them operate filled Liu Banxia with a deep sense of satisfaction. Perhaps this is the joy of being a mentor, he thought.