CHAPTER 1: MY SURGICAL CAREER
The Beginning of a Journey
In March 1956, I graduated from the Wuhu Health School and embarked on what would become a 67-year journey in medicine. My early career was diverse – I spent time in schistosomiasis prevention and two years in public health administration before finding my true calling in surgical clinical work in 1961.
The path I've walked spans more than six decades now. I served at Nanling County Hospital for 25 years, Wuhu Changhang Hospital for 22 years, and China Railway Wuhu Hospital for 16 years. Even as I approach my nineties, I haven't fully retired. My vision remains clear, my hearing sharp, and my hands steady. I continue to conduct research, read medical literature, and remain engaged with the latest surgical developments. My mind remains coherent and focused, and I still perform surgeries. As the medical field transitioned to digital documentation, I adapted seamlessly, never falling behind the technological wave.
My life has been devoted to medicine and the art of healing. Throughout more than half a century, I've come to understand the emotional states of patients, monitored their health conditions, and with whatever intellectual capacity, energy, and manual dexterity I possess, I've crafted treatments tailored to individual needs. I've restored health to countless patients, rescued numerous lives from the brink of death, and returned joy to many families shrouded in sorrow.
I worked diligently at the grassroots level of healthcare. Despite only having a diploma from a technical health school and lacking formal professors or mentors to guide me, I forged my own path through self-education. My medical skills were developed through personal insights and countless hours poring over medical texts. Natural aptitude, intelligence, diligence, and unwavering passion paved the way for my medical aspirations. Even in remote and impoverished regions, during an era when intellectuals often faced marginalization, I managed to carve out my own success.
A Surgeon's Breadth and Depth
As I often reflect, "My surgical career has been one of the longest, with numerous operations across a wide spectrum of specialties." Many of the surgeries I performed at the grassroots level presented extraordinary challenges. Some procedures I undertook in county hospitals during the 1960s were considered cutting-edge even in provincial hospitals at that time. Liver and lung surgeries, removal of cervical spine tuberculosis lesions, and repairs of injuries to the retroperitoneal duodenum – I took the initiative to perform these complex operations in modest county facilities, achieving success through careful preparation and determination.
I've always maintained a philosophy about surgery: "Sometimes, you have to pull a tooth from a tiger's mouth. But this isn't about blind risk-taking! It's about calculated risks, advanced skills, and providing high-level treatment." Being brave yet cautious, challenging conventions while prioritizing scientific and pragmatic approaches – these principles have guided my practice.
My surgical experience spans an unusually broad spectrum of medical specialties: abdominal surgery, thoracic surgery, orthopedics, obstetrics and gynecology, neurosurgery, urology, otolaryngology, ophthalmology, radiology, and anesthesiology. In each of these fields, I successfully performed many high-difficulty level-4 surgeries – truly an unusual achievement for a physician without specialized training in each field.
These operations ranged from procedures for acute pancreatitis in abdominal surgery, carotid artery aneurysm resections in head and neck surgery, spinal tumors in neurosurgery, lung malignancies and esophageal cancer in thoracic surgery, to clearing lesions of various forms of osteomyelitis and tuberculosis affecting the cervical, thoracic, lumbar, and sacral vertebrae, along with treating complex fractures in orthopedics.
Academic Contributions
My contribution to medicine extends beyond the operating room. Since the resumption of professional journals and academic activities following the Cultural Revolution in 1979, I have published dozens of papers in journals such as Southern Anhui Medicine, Journal of Bengbu Medical College, Provincial Medical Lectures, Domestic Medicine (Surgery), and Transportation Medicine.
In 1979 and 1980, I participated in the re-establishment of the Anhui Orthopedic Society and Surgical Society respectively, regularly attending their annual meetings. I've been active in numerous academic activities related to surgery both at the national level and within the Ministry of Transportation.
In 1994, I helped plan and organize a symposium on orthopedics in the Yangtze River Basin area, assisting in the compilation of a special issue of Orthopedic Clinic for the Journal of Southern Anhui Medical College. Under the guidance of Professor Jingbin Xu, editor of the Chinese Journal of Orthopedics, we published over 100 papers with contributions from across the country.
In September 1995, I presented two papers at the National Academic Conference on Acute and Severe Surgery in Guilin. My paper "Problems in the Treatment of Liver Trauma" was recognized with a certificate for excellence. I've also published in international forums, including the First International Academic Conference of Chinese Naturopathy held in Chengdu in 1991, with work appearing in the Taiwanese publication "Naturopathy."
Reflections on Spleen Surgery
[Editorial note: The following section reflects Dr. Li's specialized knowledge in a particular surgical field and demonstrates his thoughtful approach to evolving medical practices.]
"The spleen is not essential for life; it can be freely removed." This perspective on splenectomy persisted for two to three hundred years. However, with the advancement of modern medicine and deeper exploration into splenic functions, we've progressively discovered the spleen's significant role in infection resistance, anti-cancer immunity, and other immune functions.
Consequently, selective and effective spleen-preserving surgeries have become the preferred approach in our era. Nevertheless, comprehensively understanding splenic functions and the adverse effects of splenectomy on the body, while correctly mastering the indications for spleen removal, remains crucial to ensuring quality care in splenic surgery.
Pioneering Rural Surgery
The 1960s and 1970s represented the most challenging period of my career, but also the most rewarding. At Nanling County Hospital, we faced severe resource constraints. Modern anesthesia machines were nonexistent; instead, we relied on rudimentary ether and chloroform methods administered through mask inhalation. Monitoring equipment was limited to the most basic blood pressure cuffs and stethoscopes. Antibiotics were in short supply, and blood transfusion capabilities were minimal.
Despite these limitations, we performed surgeries that would intimidate many specialists even in today's well-equipped hospitals. I remember one winter night in 1964 when a young farmer was brought in with severe abdominal trauma following a tractor accident. Upon exploratory laparotomy, I discovered extensive liver lacerations with massive hemorrhaging. Without modern hemostatic tools or sophisticated blood products, I had to rely on basic surgical techniques and improvisation.
Using simple sutures, packing with available materials, and meticulous manual compression, I controlled the bleeding sufficiently to repair the damaged liver tissue. The operation lasted over six hours, performed under the dim light of basic surgical lamps. The patient survived and eventually made a full recovery, a testament to what could be achieved through determination and resourcefulness even in the most challenging settings.
This case, like many others from that period, taught me that successful surgery depends not only on advanced equipment but on fundamental surgical principles, careful technique, and sound judgment. These lessons have stayed with me throughout my career, even as I later gained access to more sophisticated medical technologies.
Surgical Research and Innovation
While my formal education was limited, I maintained a lifelong commitment to learning and medical research. During the 1980s, I conducted several clinical studies on surgical techniques that were particularly relevant to rural healthcare settings.
One area of particular interest was the management of complex fractures with limited resources. I developed modified traction methods using locally available materials that could be implemented in basic hospital settings or even in patients' homes. These techniques significantly improved outcomes for patients unable to access specialized orthopedic care.
I also conducted research on simplified surgical approaches for thyroid disorders, which were common in our region due to iodine deficiency. By refining and standardizing the surgical procedure, I was able to reduce complication rates and operating times, making this surgery more accessible to patients in rural communities.
Between 1985 and 1992, I compiled data on over 200 thyroidectomy cases performed using my modified technique. The results showed a significant reduction in complications such as recurrent laryngeal nerve injury and hypocalcemia compared to previously reported rates from similar settings. This work was eventually published and contributed to improving surgical care beyond our local hospital.
My research philosophy has always been practical rather than theoretical, focused on solving immediate clinical problems rather than pursuing academic recognition. Nevertheless, this approach has led to innovations that benefited countless patients and influenced surgical practice in resource-limited environments throughout our region.
CHAPTER 2: PROFESSIONAL AUTOBIOGRAPHY AND WORK REPORTS
Early Professional Development
My journey into medicine began during a pivotal moment in China's history. Having graduated in 1956 from Wuhu Health School with a specialization in preventive medicine, I entered a healthcare system that was being rebuilt and reformed under the young People's Republic. My initial assignment to schistosomiasis prevention work reflected the national priorities of that era—combating parasitic diseases that had plagued rural China for centuries.
For two years, I traveled to remote villages throughout Anhui Province, conducting screening campaigns, administering treatments, and educating communities about prevention. This work immersed me in the realities of rural healthcare and the challenging living conditions of China's peasantry. The experience instilled in me a deep appreciation for preventive medicine and public health that would inform my approach to surgical practice throughout my career.
In 1958, I was transferred to administrative work in public health, where I gained valuable experience in healthcare organization and policy implementation. While this position offered stability and recognition, I increasingly felt drawn to clinical practice, particularly surgery. The opportunity to intervene directly and immediately in a patient's suffering called to me in a way that administrative work could not.
Transition to Surgical Practice
In 1961, I made the pivotal decision to pursue surgical practice, beginning as a general surgical resident at Nanling County Hospital. Without formal surgical training programs as exist today, my learning was largely self-directed and experiential. I studied whatever surgical textbooks I could obtain, often reading late into the night by oil lamp during the frequent power outages that characterized rural China in that era.
Senior physicians at the hospital provided some guidance, but they themselves had limited specialized training. The shortage of qualified surgeons meant that even as a novice, I was quickly entrusted with increasingly complex procedures. This "learn by doing" approach was fraught with challenges but accelerated my development as a surgeon.
By 1963, just two years into my surgical career, I was performing independent operations across multiple specialties. My surgical logbook from this period reveals a remarkable diversity of procedures: appendectomies, hernia repairs, cholecystectomies, hysterectomies, bone setting, and even emergency craniotomies for traumatic injuries. This breadth of practice, while daunting, provided me with a uniquely comprehensive surgical education.
Professional Achievements and Recognition
My commitment to surgical excellence and continuing education gradually earned recognition beyond our small county hospital. In 1973, I was promoted to Associate Chief Surgeon at Nanling County Hospital, a significant achievement considering my limited formal education. This promotion came after successfully handling a series of complex trauma cases following a major construction accident in our region.
The changing political climate after the Cultural Revolution created new opportunities for professional advancement. In 1979, I presented my first academic paper at the reconstituted Anhui Surgical Society meeting, documenting our hospital's experience with 45 cases of complex abdominal trauma. The paper was well-received and later published in the Provincial Medical Journal, marking my entry into the wider medical academic community.
By 1982, I had been recognized as one of the leading surgeons in Anhui Province's county hospital system. This led to an invitation to join Wuhu Changhang Hospital, a more advanced facility operated by the transportation ministry, where I would serve for the next 22 years. At this institution, I continued to expand my surgical repertoire while mentoring younger physicians and contributing to regional medical education efforts.
Throughout my career, I remained committed to improving surgical standards in rural and underserved communities. Between 1985 and 1990, I participated in a provincial initiative to provide surgical training to township doctors, conducting workshops and demonstrations that helped extend basic surgical care to even more remote areas. This outreach work, conducted alongside my regular clinical duties, represents one of my proudest professional contributions.
Work Report: Surgical Outcomes and Case Series
During my tenure at Nanling County Hospital (1961-1986), I performed over 5,000 major surgeries with a remarkably low mortality rate considering the limited resources available. My case records show an overall surgical mortality of 3.2%, which compared favorably with published rates from similar settings during that period.
Particular areas of surgical focus included:
- Traumatic Injuries: 732 cases of major trauma surgery with a 92.3% survival rate
- Abdominal Surgery: 1,845 procedures including 427 cholecystectomies and 136 gastric resections
- Orthopedic Procedures: 964 major fracture repairs and 43 spinal operations
- Gynecological Surgery: 682 procedures including 213 hysterectomies
- Thoracic Operations: 97 major chest surgeries including 18 lung resections
- Urological Procedures: 346 operations including 85 prostatectomies
- Neurosurgical Interventions: 67 emergency craniotomies and 29 elective procedures
This diverse caseload reflects both the breadth of surgical needs in our community and my development as a multidisciplinary surgeon capable of addressing a wide spectrum of conditions. For many patients, referring to specialized centers in distant cities was simply not feasible due to economic constraints and transportation difficulties. Our hospital represented their only hope for surgical intervention, a responsibility I never took lightly.
My transition to Wuhu Changhang Hospital in 1986 brought access to improved facilities and resources, allowing me to tackle even more complex cases. During my 22 years there, I performed an additional 4,200 major surgeries, increasingly focusing on higher-risk procedures that reflected my growing expertise and the hospital's enhanced capabilities.
Work Report: Teaching and Mentorship
Teaching has been an integral part of my professional identity since the mid-1970s. Without formal academic appointments or teaching titles, my educational contributions occurred primarily through apprenticeship-style mentoring of younger physicians. Over the decades, I have directly supervised the surgical training of 78 physicians who have gone on to serve throughout Anhui Province and beyond.
My teaching philosophy emphasizes the integration of theoretical knowledge with practical skills. I require all trainees to demonstrate both understanding of surgical anatomy and pathophysiology as well as technical competence. My students often note that I place particular emphasis on developing sound clinical judgment—knowing when to operate, when to wait, and when to seek additional assistance.
Documentation and record-keeping form another cornerstone of my teaching approach. I have maintained detailed surgical logs throughout my career, creating an invaluable resource for analyzing outcomes and refining techniques. I instill this same discipline in my students, emphasizing that systematic documentation is essential for continuous improvement.
The most rewarding aspect of teaching has been witnessing the development of surgeons who now lead departments and perform procedures I could only dream of during my early career. Several of my former students have gone on to receive advanced training at provincial and national centers, bringing specialized surgical capabilities back to our region. This multiplication of surgical expertise represents perhaps my most enduring professional legacy.
