godfather of surgery

Chapter 1452 Opening WeChat Chat

Chapter 1452 Let's chat on WeChat again

Yang Ping pushed open the office door, and a faint aroma of tea wafted out. He paused for a moment, then noticed a thermos on the coffee table with a sticky note on it, written in Xiao Su's handwriting: "New Longjing tea, don't always drink cold tea."

His lips unconsciously curved into a smile. He picked up the cup and took a sip. The tea was still warm, and its fragrance melted on his tongue, dispelling his fatigue.

The computer screen lit up, and a new email appeared in his inbox, with the image data sent by Xu Zhiliang attached. Yang Ping clicked on the first CT scan, and his brows immediately furrowed.

The dorsal medulla oblongata was a more challenging location than he had anticipated. The medulla oblongata is the lowest part of the brainstem, controlling the most basic life functions such as heartbeat, respiration, and blood pressure. The dorsal position meant that he had to enter through the posterior fossa, pass through the thick cerebellum, and navigate through a dense network of cranial nerves to reach that forbidden zone less than two centimeters in diameter.

He flipped through the images one by one. A cavernous hemangioma wasn't a true tumor, but rather a cluster of deformed vascular sinuses, like a bunch of grapes crammed onto the dorsal side of the medulla oblongata. Bleeding was fatal, but surgery was also potentially fatal.

Yang Ping magnified the scan and measured carefully. The lesion was only three millimeters from the floor of the fourth ventricle and less than five millimeters from the occluder—the crucial center controlling respiratory rhythm. If the scalpel had been slightly off-center, the patient might never have woken up again.

He leaned back in his chair, closed his eyes, and mentally constructed a three-dimensional anatomy. Posterior fossa craniotomy, cerebellar vermis incision, fourth ventricle floor opening, and then…

So what do we do then?

The dorsal approach is obstructed by the cerebellum, leaving the operating space as narrow as a slit. The lateral approach involves navigating numerous cranial nerves and blood vessels, posing equally significant risks. The inferior approach, passing through the foramen magnum, is too steep.

There is no perfect approach; every choice is a compromise, and every compromise comes with a price.

Yang Ping opened his eyes again and sent Xu Zhiliang a WeChat message: "I've looked at the scans. Be at the neurosurgery department at 2:30. Call your family members too."

He put down his phone, finished the rest of his Longjing tea, and rested for a while.

2:30 PM, Neurosurgery conference room.

Xu Zhiliang was already waiting there, next to a woman in her forties, her face haggard, her eyes red and swollen, clearly having cried for a long time. She was carrying a bag in her hand, her knuckles white.

“Professor Yang!” Xu Zhiliang stood up. “This is… a patient’s family member, Ms. Wang.”

Yang Ping nodded and sat down across the conference table. He didn't rush to speak, but instead turned on the projector and projected the video onto the screen.

"Let me first share my thoughts." Yang Ping's voice was calm, offering neither comfort nor intimidation, but simply stating the facts. "The patient has a cavernous hemangioma on the dorsal side of the medulla oblongata. He has already bled twice. This coma is due to the third hemorrhage. The hematoma is compressing the vital centers of the medulla oblongata. Fortunately, the bleeding is not excessive, so there is hope for treatment."

He pointed to the image on the screen: "Surgery can be done in this location, and it must be done. The risks are extremely high, but we will do our best."

Ms. Wang's face grew paler and paler. Although she knew the risks were high and many doctors had warned her about them, she was still very scared and nervous to hear it again.

"Then...then what if we don't have surgery?" Ms. Wang's voice trembled.

“No surgery,” Yang Ping said, looking directly into her eyes. “The next bleeding episode might be the last. It’s hard to say when; it could be a few months, a few years, or even tomorrow.”

The meeting room was eerily quiet, with sunlight streaming in through the window and casting dappled shadows on the table.

Xu Zhiliang cleared his throat: "Professor Yang, what is your... opinion?"

Yang Ping was silent for a few seconds before giving a clear answer.

"My opinion is, surgery! Although the surgery is very risky, please trust our expertise; we will minimize the risks as much as possible. Surgery shouldn't be done now. The patient has just had a hemorrhage, and the brain tissue is severely edematous and adhered. If we operate now, the field of vision will be unclear, and it's easy to damage normal tissue. Wait two weeks, until the edema subsides and some of the hematoma is absorbed. The surgical conditions will be much better then. This is also part of reducing the surgical risk."

"But..." Ms. Wang said anxiously, "What if the bleeding starts again in the next two weeks?"

"Therefore, we will not perform elective surgery, but prepare for emergency treatment," Yang Ping said. "The patient will be transferred to our neurosurgical intensive care unit for close monitoring. If there is rebleeding or hydrocephalus, we will perform emergency surgery immediately. If the condition is stable, the surgery will proceed as planned two weeks later. This way, we can achieve the best of both worlds."

Ms. Wang breathed a sigh of relief, because she had also inquired and learned that many people said that Sanbo Hospital's neurosurgery department was extremely strong, especially in brainstem tumor surgery, where it was at a world-class level.

Yang Ping turned to Xu Zhiliang: "These past two weeks, you and your team have been working on the preoperative preparations. The 3D reconstruction, navigation planning, and intraoperative electrophysiological monitoring protocols must all be meticulously prepared. Also, contact the anesthesiology department; this surgery requires intraoperative awakening, and we need to assess the patient's cooperation."

"Intraoperative awakening?" Ms. Wang was startled. "You mean...you mean waking someone up while their head is open?"

“Yes!” Yang Ping explained, “The dorsal side of the medulla oblongata is close to the respiratory center and cranial nerve nuclei. Intraoperative awakening allows us to monitor the patient’s breathing, swallowing, and speech functions in real time, protecting normal tissues to the greatest extent. Of course, if the patient’s cooperation is poor or the psychological pressure is too great, we can also use general anesthesia with electrophysiological monitoring instead. Moreover, we now prefer the latter, as our neurosurgical monitoring technology in this area is world-class.”

Ms. Wang asked nervously, "Professor Yang, will you be performing this surgery yourself?"

Yang Ping glanced at Xu Zhiliang. Xu Zhiliang's eyes held both expectation and pressure. He knew that if Yang Ping performed the surgery himself, the success rate would be much higher. But he also knew that every minute of Yang Ping's time was precious.

“I’ll participate!” Yang Ping said. “I will determine the preoperative plan, I will be the first assistant during the operation, and Director Xu will be the chief surgeon. Please trust Director Xu’s skills. He is a world-class neurosurgeon with extensive surgical experience. On the contrary, I haven’t performed surgery in a long time.”

Xu Zhiliang was taken aback for a moment, then a complex light flashed in his eyes. There was gratitude, pressure, and a feeling of being trusted.

Yang Ping turned to the family: "Go back and discuss it. If you agree, we'll process the transfer today and get him here as soon as possible. Also, I need to know some details about the patient, his occupation, personality, and how he usually copes with stress. Arousal during surgery requires a high degree of cooperation from the patient, and a person with good psychological qualities will have a much higher success rate."

“My husband is a middle school Chinese teacher,” Ms. Wang said, her voice becoming slightly calmer. “He has a very gentle personality, but he’s stubborn at heart. He… he teaches senior high school students. Last year, one of his students had mental health issues and wanted to jump off a building. He insisted on accompanying that student home every day after school for a whole month, and finally persuaded the student to come back. He’s the kind of person who, once he’s made up his mind about something, nothing can change it.”

Yang Ping nodded. This kind of personality is suitable for intraoperative awakening.

“Okay!” He stood up. “Then you go back and discuss it with your family. I have other things to do. Director Xu, please see your family members off.”

After seeing the patient's family off, Xu Zhiliang returned and said, "Thank you, Professor. There are still...a few...questions..."

"Shall we chat on WeChat later?" Yang Ping suggested.

Xu Zhiliang breathed a sigh of relief: "WeChat...let's chat!"

Back in his office, Yang Ping put aside the brainstem surgery data and began dealing with the backlog of emails. Weber's revised paper had arrived; he opened the document and reviewed it line by line.

When Mainstein knocked and entered, Yang Ping was looking at the crucial data analysis section. "Professor, Weber's results are in," Mainstein said, his voice brimming with barely suppressed excitement. "The cross-validation is perfect! The progenitor cells can indeed shift the inflammatory pattern from destructive to restorative!"

Yang Ping looked up at the old German man. Mainstein's eyes were as pure as a child's.

"Congratulations!" Yang Ping said. "This means your paper can be finalized."

“No, it’s not just that.” Mainstein sat down opposite Yang Ping, gesturing wildly. “I was thinking, if we could find the key molecule that regulates inflammation in protocellular cells, could we synthesize it artificially? That way, we wouldn’t need cell therapy; we could just administer the drug directly, which would be simpler, cheaper, and easier to promote.”

Yang Ping put down the mouse and looked at him seriously: "This idea is bold, but the direction is right. The bottleneck of cell therapy lies in the complexity of preparation, high cost, and difficulty in quality control. If we can find small molecule substitutes, it will indeed be a breakthrough, but we must also be clear that regulation is definitely not a single factor. It is a complete mechanism, and what you are observing is only a part of this mechanism."

“You’re right, so I need your support,” Mainstein said. “I want to do joint screening using proteomics and metabolomics, which requires a large platform, and also…”

“We still need money!” Yang Ping finished for him, then smiled. “Write a formal project proposal and submit it to the fund management committee. Also, have Tang Shun coordinate platform resources; whatever technology you need, the research institute will fully cooperate.”

Mannstein stood up and shook Yang Ping's hand firmly: "Professor Yang, do you know? When I was young in Germany, my application for a project at the Max Planck Institute was rejected seven times. The seventh time I was rejected, I sat in my office, looking out the window at the Rhine River, and thought about jumping in."

Yang Ping laughed and said, "Looks like the eighth application was successful?"

"how do you know?"

"Because you're standing here now."

Mainstein laughed and said, "By the way, Weber asked me to tell you that he responded to each of the reviewers' comments, but there is one he is not sure about. One reviewer said that our control group setting is flawed because the original cell culture medium contains serum, and serum itself has anti-inflammatory components. It cannot be ruled out that it is the serum rather than the original cells that are working."

Yang Ping frowned. This was a sharp but reasonable question.

"Tell Weber to add a 'conditioned medium control', taking only the supernatant from the original cell culture, filtering out all cells, and see if the supernatant itself has any effect. If it does, it means that the factors secreted by the cells are working; if not, it means that the cells themselves are required. Once this experiment is done, the reviewers will have nothing to say."

"Brilliant!" Mainstein slapped his thigh. "I'll go tell him right now."

He left in a hurry, and as Yang Ping watched his retreating figure, he suddenly realized that these foreign experts brought not only technology to China, but also a pure love for science. This love, like a spark, was slowly igniting the atmosphere throughout the research institute.

My phone rang; it was Dean Xia.

"Professor Yang, the construction drawings for the new research institute are ready. When would you be free to come and take a look?"

"Tomorrow morning," Yang Ping said. "Today afternoon and evening are fully booked."

“Okay, I’ll have someone deliver the drawings to your office at 10 a.m. tomorrow,” Dean Xia said.

Yang Ping changed his mind again: "You can make the decision yourself, you don't need to show it to me."

Dean Xia insisted on sending the drawings over: "That won't do. The higher-ups have repeatedly instructed that Professor Yang must review them and be satisfied. This procedure cannot be skipped."

"Alright, then it'll be 10 a.m. tomorrow," Yang Ping said helplessly.

After hanging up the phone, Yang Ping rubbed his temples, then stood up and walked into the laboratory.

At six o'clock in the evening, Yang Ping finally finished all his business. He walked out of the research institute building, and the setting sun was dyeing the sky orange-red, with clouds spreading across the horizon like burning cotton.

The phone rang; it was Xiao Su: "Where are you?"

"At the entrance of the research institute."

"Waiting for you on the overpass?"

"it is good!"

He walked towards the overpass, his steps unconsciously becoming lighter. Xiao Su had already arrived, leaning against the railing, watching the traffic below. She had changed into a beige dress, her hair tied in a loose ponytail, swaying gently in the evening breeze.

There weren't many people on the overpass today. The two stalls selling beef offal and sweet potatoes hadn't opened yet; they wouldn't open until 7 p.m. sharp, just like the evening news.

"Shall we take a walk around the hospital?" Yang Ping suggested.

Xiao Su shook her head: "It's windy today, and there aren't many people. We're just standing here enjoying the breeze; it's quite refreshing."

Yang Ping and Xiao Su stood close together, enjoying the breeze. The overpass was in a great location, right at the south wind's mouth, so the breeze felt particularly pleasant.

Xiao Su smiled and secretly grabbed Yang Ping's hand and placed it on her abdomen: "Feel it, it seems to be moving again now."

Yang Ping placed his palm on her abdomen and felt a slight throbbing, like a small fish gently bumping against her. His smile deepened.

"It feels exactly the same as when I was pregnant with my first child," Xiao Su said softly. "I guess it'll be another mischievous boy. What do you hope our children will be like?"

Yang Ping thought for a moment and said, "Anything is fine, whether he's a doctor or not, as long as he's happy and doing what he likes!"

Xiao Su laughed: "That makes sense. All we can do is give him a choice. As for how he chooses, that's his business."

"Let's go home! I made some soup, it'll get cold if we don't go back soon."

"it is good!"

The two walked down the overpass side by side, Yang Ping on the outside, holding Xiao Su's hand. The streetlights cast long shadows of them, overlapping each other like a quiet silhouette.