Path of Medicine With a System
chapter-189

“The patient’s tumor has started spreading!”

“It didn’t show on the CT scan!” Professor Li was so shocked that his hair was beginning to stand on ends.

“The tumor’s membrane has already been broken!” When Zhang Fan cut into the liver, he discovered that there was a small hole in the tumor membrane. This was why tumors would be so disgusting to fight against. As long as there was even a little hole, it would easily transfer to another location. Not to mention, this hole had likely only appeared right after the CT scan was finished!

If the tumor really did transfer itself, then this surgery would become a classical example of having performed a perfect surgery but still ending with the patient’s death!

“Shall we clear the lymph nodes in the area?” Professor Li asked hesitantly. This was what was so scary about cancer. It would be impossible to ascertain if the tumor had transferred itself or not. The only solution would be to cut out all suspicious tissue. That would mean no longer having to worry about tumorous tissue. However, the downside would be that this would also cut away much of the organ’s basic function. If anything unexpected happened, nothing could compensate for the missing liver tissue. Additionally, the liver was an especially complex organ with abundant blood supply connecting everywhere, along with being responsible for its own internal secretions and helping the body to detoxify. Something bad happening to the liver might also cause brain problems!

Zhang Fan considered it for a moment before he gently placed the tumor into the specimen plate, and said, “Let’s clear them all!” He was also quite worried. Nobody would be able to make a guarantee in such a scenario. Having more damage to the patient’s liver was still better than the patient dying!

The doctors observing the surgery in the conference room were somewhat confused. That was because the video feed allowing them to watch the surgery only showed images but no sound, so they weren’t able to hear Zhang Fan and Professor Li’s conversation. Just earlier, Zhang Fan’s surgical techniques had astounded all of the spectating doctors. The patient’s vitals had still remained incredibly stable even as such a gigantic tumor was removed. Everyone had been astonished yet again when they saw the tremendous tumor removed completely.

However, they didn’t know that Zhang Fan and Professor Li were currently grappling with a difficult decision! In the end, Zhang Fan made up his mind to continue with the surgery!

Zhang Fan turned to ask the anesthesiologist, “What’s the patient’s blood pressure and breathing rate?”

“Doctor Zhang, 90/70 mmhg, breathing rate 20!” answered the anesthesiology director.

“Lower the blood pressure! Lower it as much as you possibly can!” Zhang Fan commanded.

“Okay!”

Reducing the blood pressure would lessen the bleeding. However, there would also be obvious downsides to this. All of the major organs might start failing at any moment due to not receiving enough blood. This was just like dancing on top of a thin wire. If one danced well, it would be considered beautiful. If one didn’t dance well, then a life would be lost.

Zhang Fan continued the surgery and began to clear out the lymph nodes. Professor Li no longer worried when he saw that Zhang Fan had decided to continue. Zhang Fan was the primary surgeon for this surgery, after all. His decision was also taking the safest route here.

Almost none of the spectating doctors noticed that a problem had occurred with the surgery. That was because it was unlikely for doctors like them, who typically performed more basic surgeries, to meet with such a complex surgery in their entire life. Zhang Fan cleared out every lymph node that he possibly could around the porta hepatis. He did his very best to clean things as thoroughly as possible so that all possibilities of the tumor transferring itself would be eliminated. After this surgery concluded, Zhang Fan told Professor Li, “When the patient recovers from the surgery, I recommend radiotherapy!”

After the successful removal of a liver tumor, there would always be a large chance of the tumor relapsing within five years. There would be an even larger chance of relapsing in such a situation where it was suspected that the tumor might transfer itself. The success rate for completely eliminating the liver tumor for five years wasn’t that high. This was something that doctors were helpless about. No matter how skilled the doctor, there would always be matters beyond the doctor’s control. This was why the medical field was so difficult. Even if a doctor trained for thousands of times, a specific illness could have more than 10,000 variations. This would test a doctor’s overall skill level. Over the recent few years, China had also discovered that this was a problem with average Chinese doctors. Too many Chinese doctors only knew how to treat illnesses related to their specific department, without being able to look at the bigger overall picture of the patient’s health.

Now that the surgery was finished, Zhang Fan would need to go make a speech at the academic conference. Although a small hole had appeared in the tumor, meaning that there was risk of the tumor transferring itself and causing a relapse, this liver tumor removal surgery would definitely be far more effective than any radiotherapy could. It would also be far better than liver transplant surgery! However, this surgery just lacked perfection.

This was the first time that Zhang Fan had ever given a speech at an academic conference! Of course he would be nervous. Originally, Zhang Fan had wanted to have Professor Li give the speech instead, but Professor Li absolutely refused. Professor Li didn’t want to lose face by stealing someone else’s credit! Professor Li’s two doctorate degree students enviously looked over at Zhang Fan. Not only was Zhang Fan incredibly skilled, Chasu City Hospital’s superintendent had been willing to set up an entire academic conference with him at the center. The two doctorate degree students were truly envious of such preferential treatment!

Only the person giving the speech at the academic conference would become famous. After this academic conference concluded, it was certain that all general surgery departments in Chasu City and the smaller cities under its jurisdiction would treat Zhang Fan as the #1 liver surgeon in the entire area! A doctor’s fame would always start from his reputation being spread by other doctors.

“Leaders, teachers, fellow doctors, thank you all for taking the time to come today despite your busy schedules to attend this liver tumor removal surgery academic conference at our Chasu City Hospital today. Allow me to discuss the specific way of thinking and how to perform this surgery!” Zhang Fan spoke up in quite a humble manner. The conference hall had originally been noisy as the doctors were all discussing with each other, but everyone quieted down. Although the doctors were really astonished with the surgery they just witnessed, very few of them had actually understood it. Now that Zhang Fan was about to explain the surgery to them, all of the general surgeons in the crowd would definitely listen. Even though it wouldn’t be possible to learn how to perform this particular type of large liver tumor removal surgery just by listening to Zhang Fan’s explanation once, it would still help the doctors to really improve at performing liver surgeries.

“The liver is the largest and most important digestive organ in the body. It weighs approximately 1.5 kilograms on average. It’s also the largest organ in the body apart from skin. The majority of the liver is protected by the ribs. Only a small portion of the liver can be touched through the skin under the sternum.” Zhang Fan gave a simple introduction of the liver before starting on the main topic.

“The success rate of patients surviving after liver tumor removal surgery isn’t high. The death rate within five years of such a surgery is as high as 60%. Why is this number so high? Here, I must mention a term known as the hepatic sinusoid!” Zhang Fan then turned around to look for a blackboard, but there was none prepared in the conference room.

The major district manager for the large medical equipment supplier merchant in charge of hosting this academic conference was highly skilled at reading what others wanted. With just a hint of hesitation from Zhang Fan and him turning around to look for something, she immediately discerned that there was a problem. She then secretly came up to him, and asked, “Director Zhang, do you have any requests?”

“Do you have something like a blackboard? I’d like to write some things down.” Zhang Fan wasn’t trying to act pretentious. He really did want to write down and speak about his own experience and way of thinking. Actually, he didn’t realize that this was a sign that his skill level had reached another realm! As the saying went, knowledge should be shared. It would be almost impossible to reach the peak of a medical field without being willing to share with others.

Superintendent Ouyang also heard Zhang Fan’s request for a blackboard. She waved her hand and immediately had some employees of the hospital general affairs department carry over the large blackboard that was typically placed in the hospital’s main hall. How large was this blackboard? It was about seven or eight meters long and two meters tall! It was a gigantic blackboard from a previous generation!

Zhang Fan started drawing on the massive blackboard with a piece of chalk. Sometimes, it would be easier to express medical knowledge with drawings. This was why famous Chinese author Lu Xun wasn’t able to finish studying medicine properly. He was too busy writing, and didn’t know how to draw!

Zhang Fan used red chalk and blue chalk to draw an anatomical model of hepatic lobules. Almost all of the doctors present for the academic conference were surgeons with at least some experience. Zhang Fan’s anatomical drawing immediately made many doctors’ faces redden because Zhang Fan’s drawing was far better than what they could do.

Zhang Fan began to discuss the central venules. “The liver has three main channels: the interlobular artery, interlobular vein, and interlobular bile duct. The interlobular vein and bile duct then enter the hepatic sinusoid and into the inferior vena cava. The main difficulty in performing liver tumor removal surgery is that the liver’s blood vessels are incredibly abundant and spread out in all directions. The tumor is capable of using the bloodstream to enter the brain, intestines, stomach, or even uterus.”

Zhang Fan’s tempo became quicker and quicker as he familiarized himself with speaking about the liver. He was basically reviewing the information he had learned through his System. Speaking about it all helped him to gain an even better understanding of his own knowledge regarding the liver. “The bile duct within Glisson’s capsule is also a potential place that’s easy to miss. I’ve looked through all of the evidence-based medical data on liver tumors from the past 10 years. This location is definitely the single most easily missed spot for us liver surgeons.” This data actually came from his System, which was why Zhang Fan was so confident about it. However, he had just delivered a critical hit to all the doctors in the conference room. Without even mentioning his claim of looking through 10 years of data, even gathering so much data would be difficult. Not to mention, China placed very little emphasis on evidence-based medicine currently.

As Zhang Fan continued talking about the liver tumor removal surgery, the topic became more and more difficult. When he began to discuss the surgical technique used to remove the tumor, only 20% of doctors in the conference room could still understand him. Although Zhang Fan gave a highly detailed and technical explanation about how to perform such a surgery, it really wasn’t easy for the doctors to understand him, as they hadn’t been in classrooms for too long already. Doctors at lower-level hospitals would emphasize clinical experience over foundational knowledge. That was why even though China had a tremendous number of hospitals and doctors, it would be very difficult for any doctor to become highly accomplished at a lower-level hospital. In order to obtain more than just basic medical knowledge, you would need to be at a higher-level hospital with access to more support and higher-level knowledge.

Meanwhile, Professor Li and his two doctorate degree students concentrated fully on listening to Zhang Fan’s every word. Although they’d already known what he was discussing, nobody had ever systematically categorized the knowledge for them to leave only the most practical and best knowledge behind. This was truly elite medical knowledge that actually came from Zhang Fan’s futuristic System!

“When a tumor invades the porta hepatis’s blood supply system, our current treatment method is to use interventional embolism, a type of palliative care! I have an idea. Why not perform liver tumor removal surgery instead? Although there will be great damage to the patient’s body, this will greatly improve the patient’s chances. After the portal vein is cleared, I believe that the five-year patient survival rate for liver tumor removal surgery can be increased by an entire 30%!”

At this point in Zhang Fan’s lecture, Professor Li raised his hand to ask a question. Here at Chasu City Hospital, he acted as if he was still a student in school, properly raising his hand to ask a question because this was his way of respecting and desiring knowledge. This was because Professor Li had never even considered Zhang Fan’s method, or dared to think about it before. Zhang Fan’s method was too difficult!

“Teacher Zhang, may I ask a question? For such a large blood vessel, how would you go about guaranteeing that the organs won’t fail? Also, how do you prevent the liver tumor cells from spreading?” Professor Li asked in a really polite tone.

Zhang Fan was now in thinking mode, so he didn’t pay any attention to Professor Li’s tone. However, the other doctors and medical supply merchants all noticed it. For someone of Professor Li’s status to address another doctor as “teacher”… Zhang Fan was probably the only person in the border province who had such an honor. This was something really incredible!

“First use embolism in a large area, then swiftly replace the portal vein with the radial artery and sew the blood vessel under a microscope. After ensuring that the blood vessel’s function is retained, start the clearing.”

“Do you have experimental data? And, how can you guarantee swift suturing? Fiber sutures take too much time. How long will it take for the embolized liver to begin failing?” Professor Li asked several more questions. These questions were all pointing at the critical points.

Zhang Fan had also personally considered such questions by himself for quite a long period of time. After a tremendous amount of training in his System along with his own knowledge, Zhang Fan now had ideas of his own.

“I don’t have experimental data, but I’m capable of swiftly performing sutures!” Although he didn’t have any data to back him up, Zhang Fan spoke with great confidence. That was the evidence of skill. He managed to shock Professor Li with this one sentence. “I’m capable!”

‘A general surgeon is actually capable of performing fiber sutures on blood vessels, and on top of that, at an extremely high speed?’ Professor Li thought to himself that this was all so inconceivable. He didn’t know that Zhang Fan had actually started out as an orthopedic surgeon, not a general surgeon. Zhang Fan had incredibly high ability for performing liver surgery. With Zhang Fan’s young age, Professor Li surmised that Zhang Fan must have spent all his free time on studying the liver. If that was the case, just how did he also learn how to swiftly perform fiber sutures on blood vessels?!

Zhang Fan continued giving his lecture on liver tumor removal surgery. He became more and more excited as he continued talking.

The major district manager for the host medical equipment supplier merchant began to call her boss. “President Yun, today’s academic conference was a great success. I also discovered an incredibly skilled young doctor today. Not only was he the primary surgeon today, he’s also giving a surgical lecture. Although I don’t understand the lecture, I can sense that he’s already conquered Professor Li! I would like to ask for you to come personally speak with this doctor since he’s still so young.”

“How old is he?” a young-sounding female voice said on the other end of the district manager’s phone.

“He looks to be in his early 20s. At the very most, he can only be 25. I’ll ask more about the specifics!”

“You’re absolutely certain that he’s already conquered Professor Li?”

“Yes. If you don’t feel assured, you can try asking Professor Li yourself in a roundabout manner.”

“Okay, I got it!” The phone call ended here. A young woman surnamed Yun, who was currently far away in Beijing, went deep into thought. She had first entered the market in the border province when the higher-ups of the border province were changed.

There were only certain limited types of medical equipment. Foreign medical equipment supplier merchants were also quite sly. No matter how much money you had, they wouldn’t allow you to represent them unless you had some actual authority. If you had a great deal of authority, they would be willing to make you a major district manager without even requesting a fee for franchising. The district would be drawn quite clearly and switched out once every few years. Many older people would leave, and many new people would join. If you paid close attention to a top-level medical equipment supply merchant’s business movements, you would also be able to see a little bit about politics.

No matter how amazing the medical equipment supplier merchant, they would still need customers. There would only be a limited number of top-level doctors in any province. For a merchant to obtain a strong foothold in the medical equipment market of any province, political support would be the most important, followed by support from the expert doctors. This was a maxim of the trade.

Finally, the academic conference ended. Zhang Fan let out a long and comfortable breath as he said, “This is my meager personal understanding of liver tumors. Please, don’t hesitate to criticize and teach me.”

His words caused the entire conference hall to cool down! Well, of course it would. This was no research laboratory, nor was this a provincial hospital. The great majority of doctors here were from cities even smaller than Chasu City. Most doctors here weren’t able to understand the contents of Zhang Fan’s lecture. It wasn’t that they weren’t hardworking, but that they didn’t have the conditions to even begin to understand such a topic.

After about 20 seconds of complete silence, Professor Li stood up and started leading the applause! Superintendent Ouyang also immediately stood up and started clapping. Although, to be honest, she had no longer been able to understand Zhang Fan’s lecture about halfway through, as she was an internal medicine specialist and not a surgeon, that didn’t affect one bit how proud she was right now!

Everyone started clapping, although most doctors were still rather confused regarding what Zhang Fan had even talked about.

The academic conference thus ended. The medical equipment supplier merchants immediately started busying themselves with inviting the doctors here to banquets afterward. Meanwhile, Professor Li brought Zhang Fan over to a teahouse as the two of them had a talk!