The only consolation Cheng Lixue had was that Zheng Ren's attitude remained well.
"Chief Zheng, I watched your TIPS surgery. It's a world-class performance." Cheng Lixue explained his intentions of visiting him. "I applied to the Secondary Hospital and they sent me here to learn TIPS surgery from you."
Zheng Ren stared blankly at Cheng Lixue who was already in his fifties, not knowing how to respond.
He initially thought that the Secondary Hospital would send a doctor in their thirties, or at least below forty to learn TIPS surgery from him. He did not expect them to send their department chief.
The main worry was that even if he was willing to teach everything he knew, would the man be able to cope?
Chief Cheng Lixue was different from Professor Rudolf Wagner. The professor was a pioneer in interventional surgery. After sharing his idea on liver DW-MRI, the professor was able to provide suggestions and open up more possibilities.
Zheng Ren was certain that Professor Rudolf Wagner had fully grasped the new diagnostic and surgical methods of TIPS surgery.
However, the professor was still not up to his level because unlike him, the professor did not have help from the System.
Could Chief Cheng be up for it?
There was a peculiar expression on Zheng Ren's face, but Cheng Lixue understood his reaction.
He would never have come to learn TIPS surgery in Sea City General Hospital if it was not for the high-pressure working environment in the Secondary Hospital.
Cheng Lixue had to pay quite a price to compete for the chance to learn.
However, it was just a matter of time of facing the realities in order to acquire new skills.
A forty-year-old deputy chief in his department was promoted and took half the staff with him. The interventional department was separated into two and he was only left with administrative authority. He had no say in clinical matters.
He had no choice but to put his pride aside and come to Sea City General Hospital to learn TIPS surgery.
Cheng Lixue's general surgical skills had been deteriorating since long ago. 'Time and tide wait for no man,' was a cold and hard truth for general surgeons, and even more so for interventional doctors.
Nevertheless, he was unwilling to succ.u.mb to fate.
Before coming over, he mentally prepared himself to accept the role of a student and learn as much as he could, leaving behind the department chief attitude.
However, the reaction he received was not what he had expected.
Chief Zheng really needed to work on his emotional intelligence.
Cheng Lixue felt frustrated but had to suppress his emotions.
"Boss, I'm done with the 64-slice CT scan with 3D-image reconstruction." Professor Rudolf Wagner walked in at this moment, breaking the awkwardness between them.
Cheng Lixue stood up subconsciously and made eye contact with the professor.
A few years ago, he went to Heidelberg University for an exchange program. When he first saw the professor, he was wearing a white lab coat and his golden locks swayed in the air. The way he commanded others left a strong impression on Cheng Lixue.
However, the professor was not aware of his presence. He walked straight up to Zheng Ren and said, "Boss, please take a look at the scan and comment on my work."
"Uhm." Zheng Ren clicked on the 64-slice CT scan with 3D-image reconstruction on Zheng Yunxia that the professor had done and slowly went through them slide after slide.
64-slice CT scan with 3D-image reconstruction? By himself?
Cheng Lixue had just arrived moments ago, but he was already learning new things.
These scans were usually done by the CT room technicians with the software. Why did he do them himself?
Judging from the professor's enthusiasm, Cheng Lixue guessed that he probably learned how to do it recently. The way he presented it to Zheng Ren was like a primary school student showing off his homework to his teachers and parents.
Zheng Ren gave an indifferent response. His 'uhm' sounded quite blasé.
Cheng Lixue quickly composed himself. If a top surgeon like Professor Rudolf Wagner could stay behind in Sea City to learn from someone younger than him, who was he to complain!
He inched closer to Zheng Ren and tried to find an angle to look at the computer screen behind the professor's giant figure.
The 64-slice CT scan with 3D-image reconstruction was not new to Cheng Lixue as it was related to radiography.
However, the images he saw were beyond his knowledge.
He was entirely perplexed by the images of intricate arterial networks.
They were images of hepatocellular carcinoma with lipiodol deposition. It should be from a patient who had received multiple surgeries.
After glancing through the images, Zheng Ren extracted one of the earlier ones and compared it with the current scan.
Cheng Lixue's eyes instantly widened.
He had yet to learn about TIPS surgery but he had fifteen years of experience in the treatment of lung cancer using interventional surgery. He certainly understood what those images were indicating.
The tumor was approximately 10cm in the older scans accompanied by vascularization to supply blood, indicating late-stage carcinoma.
Cheng Lixue was not aware of the patient's current condition.
Judging from the scans, the patient would be incredibly lucky to survive for 6 months.
However…
Did all these scans belong to a single patient?
"Chief… Chief Zheng, you performed the surgeries on this patient?" Cheng Lixue felt a little insecure.
He excelled not only in TIPS surgery but also in liver cancer interventional surgery.
"Uhm, the first treatment was 2 months ago, followed up with consolidation therapy. This is the third surgery. The patient should be able to fully recover," Zheng Ren briefly explained to him while he continued to compare the scans.
Fully recover…
Was he being serious or joking?
"Chief Zheng, it's possible to…recover?" Cheng Lixue asked cautiously.
"Who the hell are you?" Professor Rudolf Wagner glared at Cheng Lixue and asked in a strong accent. He hated being interrupted by others when he was in the middle of a discussion about the patient's scans with Zheng Ren.
Chapter 398 - He Could Do It With His Eyes Closed
"You're as irritating as my second aunt," Professor Rudolf Wagner said disdainfully. "Is it so difficult to treat primary liver cancer?"
Cheng Lixue was at a loss for words.
How could he not know?
Also, what was this about his second aunt?
After being an interventional doctor for a few decades, Cheng Lixue had done more than a thousand interventional surgeries on liver cancer. He also had a few dozens of patients who recovered from primary liver cancer.
Even though there were not many, Cheng Lixue was rather experienced in this area.
However, the size of this patient's tumor was enormous… His thought was that it was far too late for the patient to stand a chance of recovering. He could only try his best to prolong the patient's survival.
"Chief Zheng, what do you plan to do after this?" Cheng Lixue was not bothered by the professor's criticism. To him, it was normal to be lectured by one of the top professors in the world.
"We'll use radiofrequency ablation to burn it off," Zheng Ren replied.
"You will need to insert 3 to 4 needles then," Cheng Lixue estimated.
"Uhm, 3 should suffice. Lil Fugui, note down the points of insertion," Zheng Ren said. "The 10th intercostal space on the right, 4 o'clock. 1.5 cm to the right on the midclavicular line in the upper right quadrant of the abdomen. 15 degrees clockwise for the angle of insertion."
"What about the third one?" Professor Rudolf Wagner paid full attention to Zheng Ren and wrote down the points of entry in German.
The professor was considered a linguistical genius considering that he was able to converse in Mandarin
within such a short time frame, but he still needed more time to master the written language.
"I still need to calculate the last position," Zheng Ren said.
The truth was that Zheng Ren thought of going to the Secondary Hospital to perform more TIPS surgery to complete the second stage of The Crown Jewel so that he could get the 3000 cases of radiofrequency ablation experience and the Interventional Surgery Success Rate +2 passive skill.
This would only delay Zheng Yunxia's surgery for a few days but if Zheng Ren could complete the mission, she would gain much more from the surgery.
He decided to wait.
"Chief Cheng, what are those scans you're holding?" Zheng Ren asked after seeing Cheng Lixue was still in a daze after he finished examining Zheng Yunxia's scans. Zheng Ren had to remind him that he was carrying a bag full of scans.
"Uhm…" Cheng Lixue regained his senses and remembered the reason he came here.
"These are the scans and information of patients that meet the requirements for TIPS surgery. Please have a look, Chief Zheng." Cheng Lixue placed them on the table.
Cheng Lixue felt a soreness in his arm as he had carried the bag for a little over half an hour.
Before he had the chance to stretch his sore arms, Zheng Ren already took out the first envelope to view the patient's information.
The professor took the envelope from Zheng Ren and extracted the DW-MRI of the patient's liver and inserted them onto the radiographic film viewer.
Finally, it was his turn. Cheng Lixue quickly gathered himself together and adjusted his position to have a clear view of the scan.
"The patient's condition looks fine," Zheng Ren said in a relaxed manner as he browsed through the diagnosis.
"Boss, this is a typical tumor. We can insert the needle at a 25-degree angle of depression," Professor Rudolf Wagner said.
"Between 24 to 28 degrees should be fine. This way, we can increase the fault tolerance. One thing to note down, align the needle to the left posterior wall of the liver during insertion. Do you have anything else to add on, Lil Fugui?"
Professor Rudolf Wagner quickly wrote down what Zheng Ren mentioned.
When he heard Zheng Ren's question, he answered without lifting his head. "No, boss. This patient has a typical tumor, I think that I can succeed in the first attempt with my eyes closed."
"Uhm, it's quite simple but you shouldn't be too careless," Zheng Ren said. "Let's move on to the next patient."
Hmm? That was all? Cheng Lixue was stunned when he saw the professor start to collect the scans, the patient's information, and his notes before keeping them in the envelope.
What did they say?
It all happened so fast as if they had not mentioned anything at all.
No!
They said…that the needle insertion could be done in the first attempt.
A week ago, if someone told Cheng Lixue that they could succeed in the insertion for TIPS surgery on their first attempt, he would have given them a tough slap to wake him up.
However, Zheng Ren managed to accomplish all that in the TIPS surgery he performed in Secondary Hospital.
Cheng Lixue had no choice but to believe what he saw.
However… What did he learn from this? Nothing!
What should he do?
Cheng Lixue reached out to hold Professor Rudolf Wagner's arm in a panic and said, "Professor, wait."
"What the hell do you think you're doing?" The professor glared at him angrily, causing him to shudder in fear.
Zheng Ren laughed and said, "Lil Fugui, take the scans out."
Professor Rudolf Wagner scowled at Cheng Lixue again before saying, "Boss, this is just a waste of time."
"You didn't say that three days ago," Zheng Ren said smilingly.
"Okay, you're right, Boss." The professor shook his head and continued, "Soon you'll know that you're wrong."
"You're referring to his inexperience on the fundamentals and that he won't be able to learn quickly?" Zheng Ren said.
"Of course, I think there are probably 3 people at most in this world who could master the imageries of MRI scans in one sitting, excluding myself." Professor Rudolf Wagner announced proudly.
Cheng Lixue broke out in a cold sweat.
Why would he start learning TIPS surgery with imaging? This was entirely different from what he had expected.
Should he not start with the basic surgery operation instead of imaging? Furthermore, DW-MRI was never used in interventional surgeries…
Cheng Lixue was completely dumbfounded.
"Chief Cheng, how much do you know about DW-MRI? Zheng Ren asked while he stared into Cheng Lixue's eyes.
"Diffusion-weighted imaging utilizes the Brownian movement of water molecules…" Cheng Lixue stuttered for a bit and failed to elaborate further.
Interventional doctors were more specialized in X-rays.
For instance, interventional embolization surgery was performed under X-rays. After radiofrequency ablation gained popularity in the recent decade, many doctors started to dabble into CT scans but MRI, more specifically DW-MRI, was still…
Cheng Lixue had no clue about it.
"Let's see, what can you infer from this position?" Zheng Ren put up the DW-MRI scan of the first patient on the film viewer and pointed at a specific position while asking his question.
Cheng Lixue was lost.
"The gradient pulse with the same length, amplitude, and position is applied to both sides of the 180b pulse in the spin-echo (SE) sequence. Try subtracting one of the sequence pulses and think along that direction." Zheng Ren tried his best to explain in layman terms.
Nonetheless, Cheng Lixue's expression sold him out.
The Secondary Hospital's interventional department chief was completely lost.
"What about…" Zheng Ren thought for a while before saying regretfully, "Chief Cheng, why not you spend a few days in the CT room to learn?"
"..."
Zheng Ren sighed.
Professor Rudolf Wagner was able to grasp the idea and keep up and even Su Yun did as well, but they were both exceptionally gifted. Cheng Lixue was no match for them.
Chapter 399 - A Surgeon’s Focus
Zheng Ren and Professor Rudolf Wagner went through all the scans for 8 patients within an hour.
Cheng Lixue was still in a blur. He had no clue what Zheng Ren and the Professor were talking about.
After arranging the scans, Zheng Ren asked with a smile, "Chief Cheng, how are the patients' post-operative conditions?"
"They're doing fine. There were no symptoms of hepatic encephalopathy," Cheng Lixue answered blankly. "When we checked the blood ammonia levels this morning, there was only one patient with slightly elevated level but his physical and oral examination did not show signs of hepatic encephalopathy."
"That's great. We can extract the removable stent 3 days after surgery when the patient's body has adapted to it," Zheng Ren said.
"Oh," Cheng Lixue's mind was filled with the DW-MRI imagery.
He felt hurt.
He was totally clueless.
As a medical professional who specialized in imaging and the interventional surgery department chief who majored in liver disease, he could not even understand the scans.
Where should he begin?
Cheng Lixue stood in the office dejectedly.
Zheng Ren was slightly annoyed as he was not in a mood to accommodate Cheng Lixue's inner turmoil.
He sat in his chair and took out his phone to discuss with Xie Yiren about their dinner plans after work.
Zheng Ren was not hungry even though he had skipped lunch. He also did not want to share with Xie Yiren about his day.
Little Yiren seemed to notice Zheng Ren was feeling slightly down. She suggested walking around and just finding something to eat along the way when they felt like it.
Zheng Ren was a little worried when he recalled that his dates with Xie Yiren in the past had always been interrupted by emergency cases from the emer
gency ward, even when they were in the middle of a movie.
He decided to notify Su Yun beforehand by sending him a WeChat message.
[Do you have anything on tonight?]
[Hmm? Are you treating me to dinner or are you planning to go on a date with Little Yiren? Let me guess, you're rather moody today. Surely you're going to meet Little Yiren.]
Zheng Ren was speechless. He could sense Su Yun's mockery through the screen.
[Hey boss, let me tell you a valuable lesson in life. You should never express your negative emotions in front of your girlfriend.]
Zheng Ren thought for a moment before replying to Su Yun.
[Do you have any word of advice?]
[Advice? Why are you still asking for advice? Little Yiren will be yours in no time if you use 10 percent of the focus you have during surgery.]
Ugh… His words were pointless.
[So are you free tonight?]
[Go enjoy your date. Don't worry about the department. Good luck!]
Su Yun did not beat around the bush and simply dismissed him.
Finally, it was time to leave work. Zheng Ren went straight to the bas.e.m.e.nt parking to D zone where he always parked his red Volvo.
This time, Xie Yiren had learned her lesson and met up with Zheng Ren much earlier.
She was wearing a white down jacket but her figure remained slender while still showcasing her beautiful curves. She jumped up and waved to Zheng Ren adorably when she saw him.
Zheng Ren's negative emotions started to rattle and melt away the moment he saw Xie Yiren.
At this moment, life felt good.
When they reached the city center, Xie Yiren started introducing Zheng Ren to different eateries.
The way Xie Yiren described the dishes gave Zheng Ren the impression that she was truly enjoying it.
Even though he was not too enthusiastic about food, Xie Yiren was able to infect him with her happiness.
After parking the car, they both got out.
It was snowing outside. This year, the snowfall was much lighter. It was supposed to be snowing heavily this time of the year, but they could hardly see snow anywhere. Even the weather was warmer than in the past years. There was even a rumor that the influenza outbreak was related to the abnormal weather change.
The Surgeon's Studio c1-799 Page 187
