Surgery Godfather
Chapter 506 - 462: The Evil Crystallization of Uric Acid

Chapter 506: Chapter 462: The Evil Crystallization of Uric Acid

After deliberation, the patient’s daughter and son-in-law agreed to the surgery.

However, the patient refused the surgery, insisting on going home, and started arguing with his daughter in the ward, throwing his stainless steel water cup on the floor.

Although the daughter occasionally lost her temper, this only happened rarely. The bottled-up negative emotions needed an outlet.

The complaints she made were merely emotional venting. The couple cared for five elderly family members, and the pressure was immense, leaving them hardly able to catch their breath.

Regardless, she looked after her father immaculately, shaving him every day, cleaning him, washing his hair every few days. The hospital food was not very good, so she made time to go home to cook meals, bringing them to the hospital in a thermal lunch box for her father.

The daughter is like a little cotton-padded jacket, showing her best during these times.

As if coaxing a child, the daughter patiently explained to her father that he needed to cooperate with the doctors for quick recovery and minimal expenses. If he gave up the surgery and went home, future infections could spread throughout his body, causing septicemia. At that point, he would have to be hospitalized in the ICU, bearing costs dozens of times higher than now. Some things can’t be avoided by avoiding expenses now only to spend more later.

The patient verbally refused the surgery, insisting on going home, and giving up treatment because he didn’t want his daughter to bear the financial burden. If the surgery failed this time, he would become a bottomless pit, putting his daughter under a heavy financial burden.

No one wishes to live away from their loved ones with wounds that emit a foul smell.

Even his grandson viewed him as a monster and kept his distance. He could only curl up in his rented room every day, relying on his wife for care.

During this hospital stay, the daughter refused to let her mother care for her father in the hospital, fearing it would overwhelm her. Instead, she asked her mother to stay at home to take care of the children, while she personally took care of her father, handling his toileting needs.

After persuasion from his daughter, the patient agreed to have the surgery, realizing that being stubborn would only cause trouble for his child.

As for amputation, the patient showed little surprise and felt no difficulty in accepting it. Losing a limb seemed insignificant compared to bidding farewell to this miserable life.

If he could really use a prosthetic limb and resume a normal life, he craved it. He yearned to help his daughter with some housework, like buying groceries or looking after her child.

Only those who have lost something can cherish it more. Only those who have experienced illness know how important good health is.

This surgery was not particularly challenging.

The real test was the careful pursuit of perfection in every detail, aiming to maximize the success rate.

The uric acid crystals had a significant impact on the body, which went beyond mere joint discomfort. Joint pain was simply the mildest symptom.

Uric acid crystals could also affect the blood vessels, leading to atherosclerosis and causing problems in major organs like the heart, kidneys, and brain.

Before the surgery, Yang Ping repeatedly studied the patient’s lower body blood circulation. The damage caused by uric acid crystals to the blood vessels resulted in atherosclerosis in the lower limbs and some arteries were narrow. He finally decided to amputate above the knee.

Because the blood circulation in the lower leg was already poor, giant gout nodes were present in both knee joints, and the knee joints had been severely damaged with considerable functional obstruction. Actively amputating above the knee would not only ensure a higher probability of healing at the amputation site, but it would also prevent possible problems that the damaged knee joint could cause in the future.

Many times, surgeons tend to indulge in optimistic fantasies about the outcome, which makes their decision-making more conservative.

For instance, when orthopedic trauma doctors treat some cases of skin avulsion, inexperienced doctors, upon seeing sound skin flaps, always fantasize that they can survive, hence favoring suturing in place. However, contrary to expectations, these skin flaps, having lost their blood supply, will slowly necrotize, resulting in the patient needing a second skin grafting surgery.

Experienced doctors harbor no illusions and decisively handle the skin flaps with reverse skin grafting. Successful after one surgery, they avoid a second surgery for the patient and taking skin from other parts of the body.

The same was true for this patient. Doctors often have fantasies, hoping that the amputation site would be a bit lower to preserve the knee joint, but reality often surpasses the expectations of doctors.

Based on the condition of the blood vessels, Yang Ping thought he should be more proactive, let go of fantasies, and decisively amputate the entire lower leg above the knee, which seemingly appeared healthy.

As for the more than forty gout nodes throughout the body, Yang Ping carefully evaluated each one, and finally decided to remove them all.

During the amputation surgery, Yang Ping did not inflate the tourniquet, keeping it as a spare.

This was because, during the operation, Yang Ping needed to observe the real blood circulation of the limb. His scalpel cut through the skin, subcutaneous layer, deep fascia, and muscle. He needed to observe the bleeding on each layer’s cut surface, which was the most reliable method to assess blood circulation, more reliable than any preoperative vascular imaging examination.

He attempted to cut the skin at the lower segment of the lower leg to verify his judgment, hoping that his judgment was wrong and that the skin would bleed significantly.

However, regardless of whether it was the skin, fascia, or muscle, with no tourniquet, there was hardly any noticeable bleeding. Plenty of pus was still present between the muscles, which had spread from the ankle joint.

The preoperative judgment was correct; amputation from above the knee was necessary.

Yang Ping used a sterile medical film to seal off the cut lower leg, and changed his gloves and scalpel. He made another incision above the knee, at the lower segment of the thigh, and cut the skin into a standard tongue-shaped flap.

Blood began to seep out from the edge of the skin flap, but Yang Ping did not rush to stop it. He had been hoping for this effect.

"The skin’s blood circulation is comparatively good, and the bleeding is noticeable," Song Zimo said as his forceps clamped onto the subcutaneous layer and gently lifted the skin flap.

Yang Ping’s assertive and brave amputation judgment had proven to be very accurate.

"The choice of the amputation site is very appropriate," Yang Ping eased his heart at this time.

At this moment, bleeding was the hope for successful surgery. The faster and more it bled, the higher the hope.

The scalpel continued to cut the deep fascia, severing the muscle group enclosing the femur. Blood vessels were cut and ligated, nerves were incised at the high end with a sharp knife, and finally, it reached the femur at the core.

The electric saw cut through the femur, detaching the thigh just above the knee, removing it from the patient’s body, turning it into a separate, independent object that no longer belonged to the patient.

The detached limb was taken off the operating table, put into a transparent plastic bag, and Zhou Can collected it. It would be sent to the Pathology Department after the surgery. Any tissue or organ cut from a human body must, in principle, undergo pathological examination.

After the residual limb completed the pathological examination, its final destination would be the crematorium for incineration. Everything had a process and could not be handled casually.

Yang Ping used a bone file to smooth the cut surface of the femur, and applied bone wax to stop the bleeding.

At this point, the surgical area was flushed again repeatedly, removing some chalky uric acid crystals. He drilled holes in the bone end, sutured the muscles, wrapped the bone end, and used the holes in the bone end to fix it, forming a good residual muscle pad. This would allow the prosthetic limb to withstand strong impacts and wear in the future.

Finally, the deep fascia and skin were sewn up, a negative pressure drainage tube was placed in, and the amputation of one side was completed.

It’s hard to imagine that a long time ago in Europe, during the medical barbarian era, amputation was extremely simple. Some even directly cut off the limb with a guillotine and pressed the limb into boiling hot oil to stop the bleeding. The bleeding limb was sizzling in boiling oil, and the patient was in unbearable pain. Some even died directly from the shock of the pain.

Even those with strong physical fitness who endured the pain would die from the subsequent infection.

In those days in Europe, it’s unbelievable how crazy and barbaric surgery was to our modern minds.

Meanwhile, traditional Chinese medicine of the same period was much more humane. Hua Tuo’s anesthesia and surgical techniques already had a prototype of modern surgery.

After completing the amputation on one side, Yang Ping continued with the other side. After the double amputation was completed, the remaining limbs were wrapped in sterile dressings and bandages.

The huge gout nodule at the left elbow joint was cut open, and the chalk-like substance inside was revealed. A large curette scraped it out in clumps.

Had this substance been placed somewhere else, it would undoubtedly be mistaken for high-purity lime powder.

It’s hard to imagine that this substance is produced within the human body itself. It’s this "lime", or uric acid crystals, that cause the patient unbearable pain and misery.

From this gout nodule, so much "lime" was dug out that it filled a large metal basin. Even as a surgeon who has seen all sorts of strange diseases, this was still hard to bear.

Liang Fatty was standing a meter away from the operating table, staring at this basin of sinful "lime". He vowed to remember this substance and to stay firm in his fight against gout.

An intern in the corner, pale and sweating, murmured weakly,"Teacher, I can’t hold on anymore."

Then, his body slowly slid down the wall. He tried to endure but was powerless to resist.

"Lay him down!" Nurse Zhou Can, on patrol, was quick and sharp, she threw a surgical gown on the floor, instructing another intern to help him lay down.

For crying out loud, they were in the middle of a surgery and now had to rescue an intern. They had seen people faint at the sight of blood or needles, but never uric acid crystals.

Zhang Lin, who wasn’t on the stage, immediately got involved in the rescue. He quickly and clearly performed a series of operations including laying him flat, opening the airway, auscultating the heart and lungs, oxygen inhalation, and hooking up heart monitoring.

The surgery didn’t stop on this end. Yang Ping continued with Song Zimo and Xu Zhiliang.

"Is he alright?" Yang Ping asked while operating.

They’ve all seen big operations, so they weren’t too concerned about this little hiccup.

"He’s alright, heart and breathing are stable, but blood pressure is a little low." said Zhang Lin, taking off his stethoscope.

"Give him fluids, check his fingertip blood sugar." Song Zimo assisted by cutting the thread.

"2.4!" The blood glucose level was reported by Zhou Can.

"Hypoglycemia. He didn’t eat breakfast, right? Give him an IV of 50% dextrose." Zhang Lin instructed Zhou Can.

Once the diagnosis was confirmed, they stopped interfering with the intern’s rescue, continued with the surgery and let Zhang Lin lead the rescue smoothly and efficiently on the other end.

They were all veterans who had been through many battles. They didn’t even blink at performing rescue operations.

"Who else didn’t eat breakfast or can’t bear the stimulation? Anyone who fits that description, get out." Zhang Lin shouted.

Gradually, the intern woke up. Hypoglycemia can sometimes be deadly.

Liang Fatty was on standby to intubate the trachea. Once the intern was out of danger and woke up, he put away his intubation equipment.

"Has the surgery finished?" The intern’s first sentence when he woke up.

"No!" Zhang Lin took out his stethoscope and auscultated the intern’s heart and lungs again.

"How much was dug out?" The intern asked another question.

Wants to watch? This guy doesn’t know when to quit.

"Close your eyes, lay down and rest for a while, then we’ll check your blood sugar again." Zhang Lin stood up.

Xiao Su had already covered the "lime") - uric acid crystals on the table with a sterile sheet. There were already five metal basins filled, and the sixth was quickly filling up.

After the gout nodules at several major joints were cut open, Yang Ping handed the surgery over to Song Zimo and Xu Zhiliang to continue.

The intern lying on the floor rechecked his blood sugar level and it rose to 6.2, he was out of danger. He got up himself.

"Wow, so much has been dug out. Teacher, I want to take another look." He fixed his eyes on the sterile sheet covering the metal trays on the table, and bored the sweat on his forehead curiously.

"Are you a masochist? Need more drama?" Zhang Lin chided.

While performing the surgery, Song Zimo said, "Let him watch. Consider it desensitization therapy. With so many people here, nothing can go wrong."

The sterile sheet was slowly lifted, revealing the pure white "lime" filling up the metal trays.

"Teacher, I can’t."

The intern quickly averted his gaze and started turning pale again. Someone nearby instantly supported him. It was his first failure at desensitization therapy.

"Take your time, you need to go through desensitization several times." Yang Ping had already taken off his surgical gown and was resting on the side.

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