"Old Shan didn't try to poach you?" Asked Chief Zhang.
"Poach is a nasty word," Professor Shao Shan's voice could be heard from behind.
"Hunters are nasty people," Chief Zhang commented back.
Professor Shao Shan laughed. "Too bad there aren't too many places to hunt."
"So, what did you offer?"
"A fellowship."
"Peh, and I here thought Magic City have more to offer."
Although Chief Zhang didn't sound impressed, it was already a huge deal for a first-year to be offered a fellowship at one of the most prestigious hospitals without completing the usual residency program or even acquiring a higher education degree. The two old men led Li Yun and An Luchang around to meet other visiting surgeons.
After the usual round of handshakes and introductions, Li Yun and An Luchang were both exhausted. It was especially hard for An Luchang who was a bit socially awkward.
"Are you going to take any of the offers?" An Luchang wondered.
"Why? You're going to miss me if I leave?" Li Yun joked.
An Luchang stared blankly back at Li Yun. Quite honestly, it would be difficult without Li Yun around. Although Chief Gao and Lim were excellent mentors, having Li Yun around had helped a lot.
"Life is a series of human interactions," Li Yun patted An Luchang on the shoulder like an old master patting a disciple. "It's common to see people coming in and out."
"So you're really planning to leave."
"I'm not sure yet," Li Yun hadn't decided how he was going to complete the new mission. "And besides, you're in groupchat. It's not like you can't contact me if you have a problem."
After the first day, they attended vendor meetings with Chief Zhang, who negotiated pricing and terms with different companies. They also attended the presentation by Doctor Bao and tried the robotic demos.
An Luchang really liked the new Da Vinci robot. Although he had used the old model at Qinbei, the newer model was more flexible and had better latency. He did the challenge to stitch a grape together, and it only took him less than 2 minutes, outperforming the team that won the anniversary's competition.
"Are you sure you didn't practice?" Li Yun jeered.
"A lot of older surgeons have a tough time even turning on the machine," Chief Zhang commented.
"Yeah, if us old timers don't brush up on our electronic skills, the new kids will surpass us quickly," Professor Shao Shan agreed with a nod.
It was not often said aloud, and despite patients feeling more comfortable with surgeons above the age of fifty, they were not any better than surgeons in their 30s. The reality was, older surgeons lacked dexterity and the ability to keep up with new emerging technology. The 40s were the true golden age of surgeons. It was the reason Chief Zhang focused on administrative work instead of surgery.
The new generation understood that robotics could extend their life as a surgeon well into their 60s. Robots were able to compensate for dexterity as long as the mind was still capable. That was why Chief Zhang wanted a Da Vinci robot for the Emergency Department. However, it was too expensive for his budget. Maybe in another few years.
The following day, Professor Shao Shan invited them to attend a surgical preoperative meeting at Magic City University. During the meetings, the doctors vocalized their displeasure with each other and how poor everyone communicated with each other, a common topic of discussion. After the usual staff meeting and mudslinging from the doctors, the Director stopped the discussion before it escalated into a fight.
"We will leave the topic for next time," the director stated as he flipped open a new file on a high-risk surgery. "Governor Ping's father's heart has developed a severe aortic stenosis. They are looking for a team to perform an aortic valve replacement."
Silence.
"Just earlier everyone was very vocal about wanting to prove themselves. This is an opportunity."
An aortic valve replacement for someone who was eighty-three years of age wasn't an opportunity, it was a death sentence. The likelihood of complications was high. It was likely that Governor Ping had gone to other hospitals, but no one was daring enough to take on the case. Even the doctors at Imperial City would not risk upsetting a governor over the case. The risks far outweighed the benefits.
"All the major hospitals in the country have already turned down the request," the doctors commented. "Our reputation will not be affected if we decline. We should not take the risk."
As everyone discussed the possible complications, Chief Zhang turned to Professor Shao Shan. "This can't possibly be the case you're planning?"
"I wasn't considering it before, but with Doctor Li's ability, I think it may be possible," Professor Shao Shan explained. "We are one of the few hospitals right now capable of transcatheter aortic valve replacement (TAVR)."
Chief Zhang nodded. TAVR was the ideal procedure for high risk patients like Governor Ping's father, but the development of TAVR was not as developed as in other countries.
"Why isn't Imperial City Hospital taking this case?" Chief Zhang wondered. There were four hospitals that were capable of performing TAVR independently.
"They have evaluated that Mr. Ping has a high chance of suffering from acute kidney failure because of his diabetes," Professor Shao Shan explained.
"Oh, I see. Why do you think it will be better for Li Yun to perform the surgery? Don't you have a TAVR specialist?"
"There may be a correlation between the fluoroscopy and angiography triggering kidney failure. During a previous angiogram, he had serious side effects."
Chief Zhang finally understood why Professor Shao Shan needed Li Yun. Fluoroscopy required injecting a dye that contained iodine in order to create clearer imaging. However, iodine should not be used on patients who have kidney problems. If the interventionalists couldn't use the dye, they wouldn't be unable to see and navigate through the arteries, much less placing the valve in the correct position.
"Doctor Li, are you able to assess stroke risk?" asked Professor Shao Shan, stroke was another concern after TAVR.
"I should be," said Li Yun.
"Are you interested in the procedure?"
Li Yun had seen a dozen live procedures done from around the world. Although it was not as invasive as an open heart surgery, there were still risks involved.
"Can I meet with the patients first?" Li Yun requested.
Professor Shao Shan was hoping Li Yun would ask. Any doctor worth their salt would see the patient first before committing to surgery, especially with a case like this.
Although some doctors did not like Professor Shao Shan's proposal, they didn't mind seeing him take such a big risk. They were aware of Li Yun's ability, but being able to navigate into the heart did not mean a successful outcome. TAVR required much more precision, and without any imaging, how would it be possible?
Professor Shao Shan set up a time for them to meet Governor Ping and his father the following morning. They were already in Magic City. Their hope was to find a domestic surgeon, otherwise, they would fly in a foreign doctor to perform the surgery. Most foreigners prefer flying into Magic City.
For a consultation meeting with Governor Ping's father, there were a lot of people in the room. Mr. Ping was being cared for by two doctors, one who was a cardiologist and the other was a TCM doctor.
"Professor Shao, I heard you're proposing to use TAVR on Mr. Ping, can you guarantee that there won't be any complications?" asked Doctor Bing, the cardiologist.
"With any type of surgery, there isn't always a guarantee," Professor Shan Shao stated as he signaled Li Yun to take a seat. "We are here for the purpose of evaluating the risks. Doctor Li is someone who has a profound understanding of the cardiovascular system. We will know better after he takes a look."
Li Yun looked into Mr. Ping's narrow eyes and wrinkled face. It was the eyes of a man who had done a lot wrong in his life. But it was also the eyes of a man trying to repent.
"Old Shan didn't try to poach you?" Asked Chief Zhang.
"Poach is a nasty word," Professor Shao Shan's voice could be heard from behind.
"Hunters are nasty people," Chief Zhang commented back.
Professor Shao Shan laughed. "Too bad there aren't too many places to hunt."
"So, what did you offer?"
"A fellowship."
"Peh, and I here thought Magic City have more to offer."
Although Chief Zhang didn't sound impressed, it was already a huge deal for a first-year to be offered a fellowship at one of the most prestigious hospitals without completing the usual residency program or even acquiring a higher education degree. The two old men led Li Yun and An Luchang around to meet other visiting surgeons.
After the usual round of handshakes and introductions, Li Yun and An Luchang were both exhausted. It was especially hard for An Luchang who was a bit socially awkward.
"Are you going to take any of the offers?" An Luchang wondered.
"Why? You're going to miss me if I leave?" Li Yun joked.
An Luchang stared blankly back at Li Yun. Quite honestly, it would be difficult without Li Yun around. Although Chief Gao and Lim were excellent mentors, having Li Yun around had helped a lot.
"Life is a series of human interactions," Li Yun patted An Luchang on the shoulder like an old master patting a disciple. "It's common to see people coming in and out."
"So you're really planning to leave."
"I'm not sure yet," Li Yun hadn't decided how he was going to complete the new mission. "And besides, you're in groupchat. It's not like you can't contact me if you have a problem."
After the first day, they attended vendor meetings with Chief Zhang, who negotiated pricing and terms with different companies. They also attended the presentation by Doctor Bao and tried the robotic demos.
An Luchang really liked the new Da Vinci robot. Although he had used the old model at Qinbei, the newer model was more flexible and had better latency. He did the challenge to stitch a grape together, and it only took him less than 2 minutes, outperforming the team that won the anniversary's competition.
"Are you sure you didn't practice?" Li Yun jeered.
"A lot of older surgeons have a tough time even turning on the machine," Chief Zhang commented.
"Yeah, if us old timers don't brush up on our electronic skills, the new kids will surpass us quickly," Professor Shao Shan agreed with a nod.
It was not often said aloud, and despite patients feeling more comfortable with surgeons above the age of fifty, they were not any better than surgeons in their 30s. The reality was, older surgeons lacked dexterity and the ability to keep up with new emerging technology. The 40s were the true golden age of surgeons. It was the reason Chief Zhang focused on administrative work instead of surgery.
The new generation understood that robotics could extend their life as a surgeon well into their 60s. Robots were able to compensate for dexterity as long as the mind was still capable. That was why Chief Zhang wanted a Da Vinci robot for the Emergency Department. However, it was too expensive for his budget. Maybe in another few years.
The following day, Professor Shao Shan invited them to attend a surgical preoperative meeting at Magic City University. During the meetings, the doctors vocalized their displeasure with each other and how poor everyone communicated with each other, a common topic of discussion. After the usual staff meeting and mudslinging from the doctors, the Director stopped the discussion before it escalated into a fight.
"We will leave the topic for next time," the director stated as he flipped open a new file on a high-risk surgery. "Governor Ping's father's heart has developed a severe aortic stenosis. They are looking for a team to perform an aortic valve replacement."
Silence.
"Just earlier everyone was very vocal about wanting to prove themselves. This is an opportunity."
An aortic valve replacement for someone who was eighty-three years of age wasn't an opportunity, it was a death sentence. The likelihood of complications was high. It was likely that Governor Ping had gone to other hospitals, but no one was daring enough to take on the case. Even the doctors at Imperial City would not risk upsetting a governor over the case. The risks far outweighed the benefits.
"All the major hospitals in the country have already turned down the request," the doctors commented. "Our reputation will not be affected if we decline. We should not take the risk."
As everyone discussed the possible complications, Chief Zhang turned to Professor Shao Shan. "This can't possibly be the case you're planning?"
"I wasn't considering it before, but with Doctor Li's ability, I think it may be possible," Professor Shao Shan explained. "We are one of the few hospitals right now capable of transcatheter aortic valve replacement (TAVR)."
Chief Zhang nodded. TAVR was the ideal procedure for high risk patients like Governor Ping's father, but the development of TAVR was not as developed as in other countries.
"Why isn't Imperial City Hospital taking this case?" Chief Zhang wondered. There were four hospitals that were capable of performing TAVR independently.
"They have evaluated that Mr. Ping has a high chance of suffering from acute kidney failure because of his diabetes," Professor Shao Shan explained.
"Oh, I see. Why do you think it will be better for Li Yun to perform the surgery? Don't you have a TAVR specialist?"
"There may be a correlation between the fluoroscopy and angiography triggering kidney failure. During a previous angiogram, he had serious side effects."
Chief Zhang finally understood why Professor Shao Shan needed Li Yun. Fluoroscopy required injecting a dye that contained iodine in order to create clearer imaging. However, iodine should not be used on patients who have kidney problems. If the interventionalists couldn't use the dye, they wouldn't be unable to see and navigate through the arteries, much less placing the valve in the correct position.
"Doctor Li, are you able to assess stroke risk?" asked Professor Shao Shan, stroke was another concern after TAVR.
"I should be," said Li Yun.
"Are you interested in the procedure?"
Li Yun had seen a dozen live procedures done from around the world. Although it was not as invasive as an open heart surgery, there were still risks involved.
"Can I meet with the patients first?" Li Yun requested.
Professor Shao Shan was hoping Li Yun would ask. Any doctor worth their salt would see the patient first before committing to surgery, especially with a case like this.
Although some doctors did not like Professor Shao Shan's proposal, they didn't mind seeing him take such a big risk. They were aware of Li Yun's ability, but being able to navigate into the heart did not mean a successful outcome. TAVR required much more precision, and without any imaging, how would it be possible?
Professor Shao Shan set up a time for them to meet Governor Ping and his father the following morning. They were already in Magic City. Their hope was to find a domestic surgeon, otherwise, they would fly in a foreign doctor to perform the surgery. Most foreigners prefer flying into Magic City.
For a consultation meeting with Governor Ping's father, there were a lot of people in the room. Mr. Ping was being cared for by two doctors, one who was a cardiologist and the other was a TCM doctor.
"Professor Shao, I heard you're proposing to use TAVR on Mr. Ping, can you guarantee that there won't be any complications?" asked Doctor Bing, the cardiologist.
"With any type of surgery, there isn't always a guarantee," Professor Shan Shao stated as he signaled Li Yun to take a seat. "We are here for the purpose of evaluating the risks. Doctor Li is someone who has a profound understanding of the cardiovascular system. We will know better after he takes a look."
Li Yun looked into Mr. Ping's narrow eyes and wrinkled face. It was the eyes of a man who had done a lot wrong in his life. But it was also the eyes of a man trying to repent.
