Surgery Godfather
Chapter 505 - 461 Difficult Couple

Chapter 505: Chapter 461 Difficult Couple

Should this gout patient undergo surgery, or not? And if he does, then which type of surgery should be chosen?

The doctors in the department found themselves in quite a dilemma, for the gout had progressed so severely, such that they were devoid of any sound solutions for this patient.

The patient had visited numerous hospitals seeking treatment. Both his ankles were ruptured by massive tophi from the gout, releasing endless quantities of "chalk-like" substances. The wound was becoming increasingly larger and deeper, inhabited by various drug-resistant bacteria. It was persistent and did not show any signs of improvement. The terminations of both his tibia and fibula, talus, and heel bones were all exposed, with some parts necrotic, developing into chronic osteomyelitis.

A wound like this had virtually no chance of healing.

In fact, the wound has been treated by numerous hospitals, employing techniques such as wound debridement, vacuum-assisted closure and so forth, with a host of recently attempted surgeries. Yet, they were all in vain.

The only response the doctors from each hospital gave was to shake their heads: ’Amputation is the only solution!’. They further suggested seeking better hospitals for the surgery.

But, where could they find better hospitals? The patient’s family had no answers.

Because the patient’s both lower limbs were swamped with urate crystals, there would be an extremely high risk of non-healing following an amputation. Once a chronic wound occurred again, the doctors would be driven into a corner, harassed to death, unable to extricate themselves from their predicament.

Therefore, the best strategy seemed to be --- to not touch it!

Keep one’s distance!

In this way, there would be no issues. Over the years, the doctors’ courage had waned. "Other than amputation, are there any other alternatives?" Song Zimo broke the silence.

Yang Ping shook his head: "Amputation is the best course of action for him."

Above the ruptured wound, both of his lower limbs should be amputated at the level of his shins.

Although the stump might not heal, that was only a possibility. As for the current situation, there was absolutely no chance for the chronic wounds at both his ankles to heal.

"Everyone, don’t be so disheartened. For several patients, amputation is a reconstructive surgery, not a destructive one. An amputation could lead the patient from darkness towards the light!"

Because if the stump healed well post-amputation, a prosthetic could be fitted, and the patient could recover his normal walking functionality. In such a case, he would be able to rejoin society.

As lower limb prosthetics are highly developed, the modern medical perspective on lower limb amputations has undergone transformation.

Amputation --- sometimes, it brings hope, it illuminates, it is reconstructive surgery.

In cases of severe lower limb injuries, after prolonged treatments, multiple surgeries, a lot of time, energy and money being used, the salvaged limb often has poor functionality, incomparable to a prosthetic.

Preserving such limbs is a torment to the patient, it is an ineffective treatment plan. At these times, amputation becomes a reconstructive surgery, removing the useless limb, fitting a prosthetic, restoring the normal walking functionality, helping the patient quickly return to a regular, brighter life.

"I agree! Both his ankles have developed chronic osteomyelitis. Continuous treatments would only be futile, wasting time and money. The lower limbs should be amputated at the lower third of the shins. If the stump doesn’t heal, another round of amputations should be conducted, each time increasing the level until the wound heals. The other tophi could be carefully excised. The patient’s goal is to resume a regular civilian’s life. If a prosthetic could put an end to his current terrible life, and turn him back into an ordinary person, why should we perceive amputation as terrifying?" Song Zimo strongly agreed with Yang Ping’s opinion.

His emphasis being particularly on Yang Ping’s statement: Sometimes, an amputation is a reconstructive surgery, not a destructive one. An amputation could lead the patient from darkness towards the light!

It seemed like others didn’t have better solutions and the disease had reached a dead end, leaving not much choice.

Once the treatment plan was decided, when the patient’s daughter heard the news in the meeting room, she was quite disappointed.

She thought coming here could offer some better or unique solutions.

"The most beneficial solution to him is the best one, it doesn’t have to be the latest, or the most expensive, most treatment plans are common ones!" Seeing her disappointment, Yang Ping patiently explained.

"Amputation, if successfully done, can end his currently dark life. Once fitted with a prosthetic, he can walk as he used to."

Yang Ping said with great confidence.

The patient’s daughter was moved. Other hospitals had mentioned it, but none of the doctors were willing to undertake the surgery.

Yang Ping also seemed to perceive the issue. The patient’s daughter had been looking after her father for so long that she had gained some knowledge about the disease. Hence, she would question the treatment details repeatedly and scrutinize every single medication choice.

It easily gave the doctors an impression --- she didn’t trust them.

If there isn’t trust, of course the doctors were unwilling to take unnecessary risks, and wouldn’t perform this operation. Regardless from a legal or ethical standpoint, the doctors wouldn’t have to take the blame for not conducting the surgery. On the other hand, if they did perform the surgery and encountered failure, they would likely have to face never-ending hassles.

"Is the success rate of the surgery high?"

It was the biggest concern of the patient’s daughter.

"It’s hard to say about a specific success rate. His condition is rare, and there’s no similar data to rely on. If we had to estimate, it’s fifty-fifty. If it fails, and the amputation stump doesn’t heal, forming a new difficult-to-heal wound, we would just amputate again, each time increasing the level." Yang Ping explained the contingency plan if the surgery failed.

The patient’s daughter was still undecided: "So, how many times would we have to do it? Wouldn’t there be any assurance?"

Does this mean that doctors always operate without certainty?

"No one can be certain! His current condition has already determined that this will be an uncertain surgery. It’s not because the doctor isn’t confident in his abilities, but because his body has already reached a point where healing is uncertain. The outcome is decided by his body. Whether it will be successful or not, the decision isn’t up to me; it’s up to him. I can only do my best with what I have to do." Yang Ping stated with honesty.

Although these words are unpleasant to hear, they are nevertheless true and candid.

The patient’s daughter’s face was filled with anxiety. She hesitated and then finally asked, "If the surgery fails, do you still charge for the failed surgery? Does it become free?"

Yang Ping hadn’t expected such a question from the patient.

Yang Ping said seriously, "Every surgery, whether successful or not, has to be charged."

"How can you charge for a failed surgery? That’s not fair. If I go to a shop and buy something that’s broken and unusable, I can return it or get a new one. Likewise, I’ve paid for medical services, but if they don’t achieve the desired outcome, why should I still have to pay? Even if things don’t get done, the money is still collected?" The patient’s daughter finally gathered enough courage to speak up.

Yang Ping was not angered by this, "Treating patients can’t be compared to commodity transactions; you’re using the wrong metaphor. If you think this is a commodity transaction, then I can refuse to provide medical services. In other words, I can refuse to sell this commodity. Is that okay with you?"

The patient’s daughter’s face flushed and went pale, and she was momentarily speechless.

"The human body is extremely complex, and all treatment outcomes are statistical. Nothing can guarantee 100% success. That’s the nature of medicine. If your logic holds, then let me be straightforward with you—no doctor would be willing to perform surgery on your father, including me!" Yang Ping had to tell her this harsh reality.

These matters had to be cleared before surgery, otherwise, it would lead to complications afterward.

"To be honest, Dr. Yang, even though my father has medical insurance, our financial burden is quite heavy after such a long treatment period. We have several elders in our family, and we are feeling the strain." The patient’s daughter revealed the truth.

Yang Ping also felt helpless, "I sympathize with you, but I’m just a doctor. I can’t help you out financially. We can only try to help you save as much as possible on hospital fees. If you are truly having financial difficulties, we can try to secure some charitable financial aid for you. If you’re willing to share the surgical risks with me, I will give it my all. But if you’re not willing to take on the risk or think that doctors should bear all the risk, then I’m afraid, regretfully, I can’t bear it all."

In the face of risk, doctors can only share wisdom. If patients and their families insist on not taking risks, no one can force them to make a choice.

The choice lies with the patient; doctors can only help him make it.

"Let me think, are there any other options? More conservative ones?" The patient’s daughter was still hesitant.

Yang Ping shakes his head, "Right now there are only two options. Maintain the status quo or amputate the limb. Face the risk and pursue a normal life."

Many times, money is the deciding factor!

Money isn’t everything, but you can’t do anything without money.

If the patient’s daughter didn’t have to think about money, she wouldn’t have so many worries and she wouldn’t have asked such difficult questions.

Her biggest worry was that the surgery would fail and further surgeries would be needed. In the end, the money would be gone, the disease wouldn’t be cured, and the leg would be lost.

Every family has its difficulties. The patient’s daughter started to call her husband in front of Yang Ping to seek his advice.

Her husband fell silent for a moment. He sounded a bit worn out as he briefly responded, "Go ahead with it. What else can we do?"

His tone was helpless and resigned.

After finishing the call with her husband, the patient’s daughter seemed to be searching her phone’s contacts, as if there was nobody else to discuss this with.

Both husband and wife were only children. Who could they turn to for advice? No one was there to help, and they had to bear everything on their own.

Her phone rang again. It was her husband, "Honey, don’t worry. Let’s go with what the doctor says. Do you need me to come over now? Everything in life carries risks. Even eating can be dangerous if you choke. If it doesn’t work out, we can try again. If it still doesn’t work, we can try yet another time. We can’t carry on like this. In the worst-case scenario, if it doesn’t work out, how bad can it get?"

"What about, what about..." The wife was worried about the money, but she couldn’t bring herself to voice it.

The man on the other end of the call knew what she was thinking. He chuckled, "I’ll advance next month’s salary from my company. Let’s arrange the surgery."

>Not so long ago, an elder member of the family had to be hospitalized due to a stroke. A lot of money was spent. He had just been discharged, and now someone else was admitted.

"Hasn’t next month’s salary already been advanced?"

The wife had a good memory.

She realized she was still in the meeting room. She smiled at Yang Ping and indicated she needed to step out for the call, "Dr. Yang, I’m sorry, we need to discuss this and decide later."

Yang Ping nodded.

"Oh, we haven’t fully advanced it yet, we can still advance some more!"

The husband hemmed and hawed on the other end of the phone.