25 Cunning and wily beyond measure

"Director Guohua, it is like this." Luo Hao began to explain some of the technical challenges in stone extraction using a basket catheter to Wang Guohua.

Having spent a lifetime performing surgery, Wang Guohua had personally encountered many rare situations. The questions he posed were sharp, piercing, and struck directly at the heart of the matter.

However, this did not stump Luo Hao.

With a surgical proficiency rating of Level 4, equivalent to a vice-provincial level of expertise, there were very few people in the province who could outperform Luo Hao in either general or interventional surgery. Furthermore, with the vast repository of literature available in his system library, combined with his diligent and humble attitude, Luo Hao’s technical skills and theoretical foundation were flawless.

Therefore, the questions posed by Wang Guohua appeared to be nothing more than "simple problems" to Luo Hao.

Wang Guohua immersed himself in the nuances of ERCP surgery, asking questions for nearly two hours before he was finally satisfied.

"Director Guohua, surely you don't intend to perform the surgery yourself?" Luo Hao asked.

"Why not?"

"But the radiation, your health..."

"Let me tell you something," Wang Guohua said.

Luo Hao listened intently.

"You’ve worked in the Department of Obstetrics and Gynecology before. Do you know why they have been shrinking more and more?"

"The decline in birth rates," Luo Hao replied conventionally.

Wang Guohua gave a cold snort. "Tell me the truth."

Luo Hao scratched his head, gave a sheepish laugh, and remained silent.

Wang Guohua did not force an answer out of him, instead saying with disdain, "Years ago, the group bought our mining hospital a DSA machine. Back then, I told the old director of OB/GYN, Director Hu, that their uterine fibroids could be treated with interventional embolization."

"Before that, uterine fibroids required a hysterectomy. Interventional embolization could preserve the organs, and although the cure rate wasn't as high as a total hysterectomy... damn it!"

Wang Guohua cursed. "Once the uterus is removed, what complications could there even be?"

"You're right, Director Guohua," Luo Hao agreed.

Wang Guohua glanced at him and continued, "Director Hu wouldn't even entertain the idea. I know what he was thinking—interventional surgery involves radiation, and the difficulty level is an order or two of magnitude higher than simply removing a uterus."

"He had no intention of learning."

"Every time we meet now, I make sure to mock him. The old man refuses to keep up with the times; he'll end up with dementia sooner or later."

"..." Luo Hao was surprised by Wang Guohua’s harsh tone. The old man’s temper was truly fiery.

The rise of interventional surgery had spread most widely in cardiology, primarily because of the leadership. The pioneers of cardiac intervention were academicians of the Chinese Academy of Engineering, whereas no such figures drove interventional techniques in OB/GYN.

Beyond that, there were financial factors. Many hospital cardiology directors monopolized coronary interventions, and even their spouses began selling stents. These "first-wave" pioneers knew exactly how to profit from every angle.

The cardiac surgery departments that abandoned cardiac intervention in those days suffered greatly. It is said that twenty years ago, cardiac surgery was a top-tier revenue generator, just like abroad. Yet, within a few years, they were completely overwhelmed by cardiology. Outside of provincial hospitals, cardiac surgery departments in prefecture-level hospitals had essentially vanished.

"I’ve done some digging and know that you can perform interventional embolization for hemostasis in cases of cesarean scar pregnancy. If you can handle emergency hemostasis, you can certainly handle uterine fibroids. Aren't you resentful?" Wang Guohua asked, looking at Luo Hao.

"I am just a junior doctor. I just do my job," Luo Hao said calmly. "I don't have the power to change those who remain unmoved by the incoming tide."

Wang Guohua was silent for two seconds before saying, "Now, every time Director Hu sees me, he mocks me for not doing ERCP. The nerve of that bastard! I'm going to perform the surgery myself, just to see where he hides his old face."

"..." Luo Hao was stunned.

*Is this what they mean by 'an old man becomes like a child'?*

He had already retired, yet he was starting to learn ERCP from scratch just because of a few squabbles with an old colleague. Luo Hao found this reason hard to accept; he preferred to believe that ERCP was the lifelong aspiration of the veteran director.

"Director Guohua, the hospital is very pleased that you agreed to be rehired," Lin Yuming said gently. "You can just observe the surgery. If you really put on the lead apron... just in case, I mean, if you get exhausted, the doctors and nurses here will be pointing fingers at me and cursing."

"People these days are so delicate. Can a ten-kilogram lead apron really exhaust someone?" Wang Guohua retorted disdainfully. "Back in my day, bile duct stones were a major headache for surgeons. Whether it was choledochotomy or biliary-enteric anastomosis, the problems were immense."

"I used to think, if only there were a way to reduce trauma to the patient while still achieving 80-90% of the effectiveness of surgery, how wonderful that would be."

"Just like the ovarian cyst puncture and solidification procedure you do, Doctor Luo. Strictly speaking, the recurrence rate is higher than total excision, but the damage is almost negligible."

"If it recurs, just do it again. Unlike surgery, where if you encounter an unexpected situation, the surgeon is screwed."

As Wang Guohua spoke, he seemed to recall something and sighed deeply.

Luo Hao knew very well that an experienced surgeon like Wang Guohua must have encountered countless dilemmas in his lifetime. How does one acquire such rich clinical experience? To put it bluntly, it is built upon the lives of patients and their cries of agony. Heaven knows what Wang Guohua had endured to be so obsessed with ERCP in his twilight years.

"Director Guohua, I understand," Luo Hao said softly. "When I went to the medical records room to look for the surgical notes you wrote yourself 20 years ago, I understood what you meant."

Wang Guohua said nothing, his fingers tapping rhythmically on the desk.

Twenty years had passed in the blink of an eye. An old man and a young man, connected by medical records, were now sitting together.

Lin Yuming watched from the side, a strange sensation rising in his heart. At this moment, although he still doubted Wang Guohua's motives and did not trust the old director, he briefly forgot all his grievances. The scene before him was the romance of a man.

"I'll be seeing outpatients in a few days," Wang Guohua said in an unquestionable tone. "Once we admit the patient, we..."

"Director Guohua, I have a dispute case here. Would you like to take a look and intervene?" Lin Yuming said with a smile.

Wang Guohua raised an eyebrow. "A dispute in our General Surgery department? Did Youren mess up a surgery?"

The old director was rough and bold, but he was also a shrewd person. Lin Yuming had barely started, and he had already guessed the truth.

"Director Guohua, it is like this," Lin Yuming said. "A female patient from a nearby village is complaining to our medical department. Four months ago, she underwent a 'laparoscopic cholecystectomy, common bile duct exploration, and T-tube drainage,' but she has retained stones."

Wang Guohua looked at Lin Yuming, his gaze as sharp as a knife.

"Director Guohua, to be honest, you know the level of our hospital. Director Wen performed the surgery, and from my perspective, he performed to the best of his ability. Retained stones after surgery are, unfortunately, unavoidable. Originally, I had already resolved this—I conceded, admitted our technical limitations, and contacted a superior hospital for the patient."

Wang Guohua snorted.

Seeing that Lin Yuming was being fair and defending Wen Youren without too much blame, the underlying meaning was obvious.

Lin Yuming didn't care about Wang Guohua's attitude; he smiled slightly and continued.

"Director Wen and I both suggested the patient go to the provincial capital for treatment. But the patient's family is very poor; they can't afford to go. She used to come to me every day crying. She hasn't been here in a few days. I suspect they couldn't afford the struggle and took her home to wait for death."

Bile duct stones, taken home to wait for death—Wang Guohua was even more displeased upon hearing this.

"Contact the patient's family and have her brought here," Wang Guohua said. "As for the expenses, you handle it."

"I will apply for the costs from the hospital and process it as a dispute case. Rest assured, it won't come out of the General Surgery department's bonus."

Seeing that Wang Guohua had agreed to clean up the mess for Wen Youren and himself, Lin Yuming said happily. Although he could have bullied the family and used his authority to suppress them, knowing they couldn't make a big scene, compassion is human nature. Since the old director was back, he might as well try; maybe they could save her.