Before writing my debriefing report in support of my application for Chief Surgeon, let me start with three unforgettable orthopedic cases that I experienced in my medical practice. 

In 1970, my old schoolmate and close friend from junior high school, Mr. Gui from Fanchang No.1 Middle School at that time, brought his son’s case to my attention.  His son, aged 16 then, suffered from cervical vertebra 5 tuberculosis with cold abscess, which severely oppressed esophagus and trachea. He was unable to eat, and had difficulty breathing, with hoarseness, dehydration and hypoxia, in a critical condition.  

They had visited Yijishan Hospital, the largest hospital in Wuhu, but the director there Dr. Chen of the Department of Orthopaedics could not admit this case, saying that a few days before, a similar case, died during the operation.  He made the suggestion for the patient to be sent to the provincial Hospital of Hefei, which required 800 yuan then.   However, Mr. Gui’s monthly salary was only 52 yuan, and he had to support a family of six with this income.  How could he afford it?  Besides, nobody knows whether the chief hospital in Hefei could treat him.  In a hurry, Mr. Gui turned to the No. 127 Army’s Hospital located in the suburb of my town Nanling, to try their luck there.  The corresponding department of the hospital was administered by Dr. Xu Jingbin, the nation-wide orthopedic authority, and this military hospital located in a small place long had a tradition of helping the poor.  Unfortunately, Dr. Xu was on a business trip to Nanjing, and several of his subordinates there were too afraid to accept this high-risk patient.   

Feeling helpless, Mr. Gui came to me in Nanling County Hospital (the two hospitals are only 5 miles apart) to discuss possible rescue plans with me.  I was not sure about how best to treat this condition either.  However, I had studied in No. 127 Hospital, with Dr. Xu as my supervisor, familiar with the personnel there.  I immediately called an ambulance. We went back to No.127 Hospital, found doctors in orthopedics and surgery, and asked them to work together for the treatment of this urgent case.  Mr. Gui as patient’s family and I jointly signed the required paper for willing to take the risk of the operation, and discussed the detailed rules.  However, this plan was still not approved by the hospital.  Instead, the hospital asked me to help them out of this embarrassing predicament, and promised a free car to be used for transferring the patient to big city hospitals in Hefei or Nanjing.  The patient’s life was in danger at any time. Far water cannot put out the near fire, so it’s not advisable to transfer to hospital far away. 

I decided to take on the challenge myself.  At that time, I thought, at least I could give pus discharge for saving life first, relieving the oppression of esophagus and trachea, and making it possible for hime to eat and breathe.  So the patient was brought back to the county hospital where I worked.  Without even getting off the stretcher, I ordered to first give fluid replacement and antituberculosis.  At this point in the evening, Mr. Gui didn’t get any food for a whole day, so he was given dinner at my home.  I could not afford the time to have a dinner.  I took the time to review the related literature and anatomy.  Half an hour later, the patient was sent to the operating room under local anesthesia. After my careful dissection, the patient’s pus cavity was cut to release a large amount of pus.  The patient immediately started making sounds, could sip the water, and breath smoothly, indicating him finally put out of immediate danger. 

The operation continued, exposing the focus of cervical vertebra 5 by anterior approach, I removed the dead bone, scraped off the granulation of tuberculosis, flushed the pus cavity, inserted streptomycin and isoniazid, put the drainage piece in, with suture.  The operation was smooth and very effective.  The fever came down 3 days after operation.  The patient went to get a haircut, ate normally and recovered well. 12 days after the operation, he was discharged from hospital, and his medical expenses were 32 yuan.  He continued anti-tuberculosis treatment for half a year and recovered well.  For more than 40 years now, the patient has been working and living normally, now enjoying a family of his numerous children and grandchildren. 

In addition to the complicated anatomy of the neck, such as dense blood vessels, nerves, thyroid gland, trachea, esophagus, etc., this type of cervical tuberculosis debridement operation is of high difficulty also due to the fragility of the cervical spine and the destruction of tuberculosis.  If there is a slight mistake in the cervical spinal cord, it will lead to being paraplegic at a high level or even death.  It’s an orthopedic high risk level 4 operation.  Even in big hospitals, the directors are extremely cautious in treating such cases.  I was still a newcomer in orthopaedics then, but I needed to save lives, knowing that transferring to another hospital at that time was basically a dead end.  The patient was on the verge of an abyss.  But I also had some of my own strength and preparedness for this success.  I had had many years of experience in neck thyroid surgery, familiar with anatomy, and had accumulated specialized knowledge in orthopedics.  This solid foundation finally enabled me successfully complete this rare problem in a grass-roots hospital.  Life threatening symptoms were treated by relieving oppression immediately.  And the disease was cured, with the lesion eradicated.  It proved to be a cure for life.  

Another case, at the end of 1980s, named Xiao Wei, a 14-year-old junior student in Wuhu No.1 Middle School, suffered from right humeral neck tumor.  He had undergone two operations in Yijishan Hospital and Shanghai Zhongshan Hospital respectively.  Now, the disease struck at the right scapula.  The director of orthopaedics in a hospital of our city said, it is malignant tumor recurring and metastasizing, amputation is necessary, and it is challenging to save his life!   The family was in a desperate situation.  The patient’s grandfather, Mr. Wu, was my junior middle school teacher.    Mr.  Wu knew about the case of cervical tuberculosis treated  well by me on Mr. Gui’s son, so he came to me for consultation.  I carefully examined the medical records and the X-ray films before and after, and diagnosed it as a new critical tumor, neither a recurrence nor a metastasis of the original disease.  I personally performed a half-excision of the right scapula in my own hospital, resulting in his full recovery.   More than 20 years have passed, and Xiao Wei has enjoyed good health ever since.  He has become a Dr. Yang in the west later on, and is now a high-end international talent in his field.  From time to time, he and his father still come to visit me with appreciation. 

The third case, in the fall of 1975, a 35-year-old female patient, who had lost 40 kilograms, was admitted to our hospital for tuberculosis of thoracic vertebrae 6 and 7 with paraplegia.  Under general anesthesia, through the chest, the focus was cleared, and the dead bone and the necrotic intervertebral disc were removed.  The tubercle granulation in the spinal canal was 8cm long, which pressed the thoracic spinal cord, resulting in spinal canal obstruction and paraplegia.  After curettage, it could be seen that this segment of spinal cord was throbbing again.  The focus area was thoroughly washed, with antituberculosis drugs added in.     The ribs cut during thoracotomy were trimmed and embedded in the intervertebral defect area, and the anterior bone graft was completed in one single stage. After operation, the patient recovered well and was cured.  The patient’s husband was a blacksmith, who gifted me with  a stainless steel kitchen knife and a spatula of his own craftsmanship, which are still in use in my home today.  In orthopedic surgery, this belongs to the top level-four category.  With thoracic tuberculosis complicated with paraplegia, the cure was one-time lesion clearance and bone grafting through the anterior thoracic approach, definitely having reached the peak in county-level hospitals. 

Such cases have brought me a great sense of pride and accomplishment, and they form the motivation for my lifelong dedication to saving lives and relieving pains for my countless patients.

《李家大院》5: 我的外科生涯

【李名杰从医66年论文专辑（英语电子版）】