In support of application for Deputy Chief Surgeon, 1987
Editor’s Comment: This piece of writing submitted by my father 35 years ago is a review of the achievements and hard work in his first 30 years of medical practice. This stellar and unique report card explains how a doctor in a grass-roots hospital has been tempered into a powerful ‘iron man’, becoming an all-skill expert practicing almost all major medicine areas, extremely rare in a modern society. In helping compile the collection of his own medical papers and in reviewing the 66-year journey, my father feels extremely grateful and proud. Dad said, his growth depends largely on “one book and two mentors”. This book refers to Maingot's Abdominal Surgery, which is a biblical surgical masterpiece. Dad said: At that time, the price of this book was 10 yuan, which was 25% of my monthly salary. It was a treasure of all my belongings! One of the two tutors was Dr. Meixian Min, the surgical authority in Wuhu superior hospital, whose theory, technology, character and demeanor were praised by everyone! The other is Dr. Jingbin Xu, an authoritative professor of orthopaedics in China. My father studied orthopaedics with him at the 127 Hospital of the People's Liberation Army and became his accomplished disciple. About Dr. Min, Dad recalled two episodes he has cherished most. Dad said: Once, he had me preside over an extremely challenging operation. When I came to the operation table ready for the surgery, he said, "Maybe you can't get off the table successfully. Everything off the table is mine!" It means all the aftermath, I do not need to worry about, and he will take care of everything. Who can match this spirit of responsibility! Another thing he said is also very memorable. Before I moved to Wuhu, I came to see him, he said, "Knowing your recent situation, I suggest that you come to join me, in department of either surgery or orthopedics, better in surgery as it has a wider range and would benefit your further development. As long as your current employerNanling agrees to let you leave, I’ll take care of all logistics on the accepting side, including the health bureau, personnel bureau and hospital authority. Ours will be the Second Affiliated Hospital of Anhui Medical University, the provincial level hospital, which should be beneficial to your future promotion! " He was very sincere and his favor was out of pure treasuring for talents. Apart from the career relationship as my mentor, there was not much personal relationship between us. Along the journey of practicing surgery, I always turned to him for advice once I came across challengies, and he acted always as my direct supervisor. It was also his key evaluation that helped my smooth promotion to the title Attending Physician. He was the chief examiner in the promotion committee, and he evaluation was decisive. At that time, he said to me: “you can apply for either surgery or orthopedics for this promotion”. The implication was that I was qualified for both subjects. That was 1981, not long after the Cultural Revolution. The entire Nanling had only seven people promoted to Attending Physicians, that is, less than half of the applicants made it. Your mother and I both succeeded in the promotion list, which caused a stir effect in our community. At that time, professional titles were highly respected in the society. With the title of attending physician, one can enjoy all kinds of preferential treatments.
Mingjie Li, a full-time worker, graduated from the medical class of Wuhu Medical School in 1955. In March 1956, he joined Nanling County Hospital. In 1960, he was sent to study radiology in Wuhu District Hospital for one year, and then returned to the hospital to establish the radiology department. Since 1961, he has been mainly engaged in clinical surgery (during which he had worked concurrently in radiology for two years). Since 1968, he has been the principal surgeon of major surgery in the hospital.
In 1973, he took part in an advanced training course in orthopaedics, and studied orthopaedics for more than one year under the guidance of Professor Jingbin Xu, an expert in orthopaedics at the 127 Hospital of the People’s Liberation Army and editor of the Chinese Journal of Orthopaedics. He obtained a certificate for the completion of the course. Meanwhile, he was selected by the Foreign Affairs Bureau of the province as preparatory personnel for the foreign aid medical team waiting to be sent abroad. On December 1, 1981, he was promoted to the title of Attending Surgeon. At that time, he served as Director of Nanling Branch of Medical Society. In August, 1985, he was transferred to Wuhu Changhang Hospital, where he worked as an attending surgeon and orthopedic surgeon.
Since the medical association resumed its activities after the Cultural Revolution, I have participated in, and submitted papers to, the first, second and third annual conferences of orthopaedics and the first and second annual conferences of surgery in Anhui Province. My papers were printed in the conference proceedings for research exchange. I have also submitted papers to the first academic conference of obstetrics and gynecology in Anhui Province. I have been involved in a variety of academic activities at the prefecture, city and county levels. I have served as a lecturer in the county health school, teaching courses in anatomy, physiology, surgery and orthopedics. I have been supervizing numerous medical college interns for many years. I have been studying professional English for more than 10 years. In 1980, I took part in the correspondence course of “Clinical English Learning” administered by Jiangsu Health Department for one year. Upon graduation, I won the first prize for the National Translation Competition. I have translated a number of professional papers. I can read and translate English books and journals, and write English abstracts for my own papers. I have published numerous papers in medical journals at all levels, and in 1980 I was awarded the title of advanced scientific and technological worker in our county.
In the past two years since I joined Changhang Hospital, according to the limited cases encountered in our hospital, I have performed subtotal thyroidectomy, superficial parotidectomy, radical gastrectomy for gastric cancer, rectal cancer and breast cancer, and numerous cases of gallbladder, biliary tract and intestinal operations. In addition, I have treated cases with spinal canal decompression, spinal cord exploration, myelography (Amipaque), closed penetration of triangular nail under fluorescence of femoral neck fracture and other osteopathy operations in orthopedics. All these cases have achieved good results.
Earlier in my career, I served in Nanling County Hospital surgical department for nearly 30 years as a front line physician of clinical practice. As a principle, all kinds of cases should be solved on the spot. Therefore, my practice covered a wide range, including orthopedics, urology, thoracic surgery, obstetrics and gynecology, ophthalmology and otorhinolaryngology, which are described below.
Surgeries performed include epatectomy, liver repair, ligation of proper hepatic artery, and a large number of biliary surgery and various biliary and intestinal drainage,
Additionally, a comprehensive array of biliary surgeries and assorted drainage techniques for both the biliary system and the intestine have been performed. These techniques include sphincterotomy and plasty of Oddi’s sphincter, as well as various forms of anastomosis involving the common bile duct and duodenum. Procedures such as Roux-en-Y jejunostomy and multiple subsequent operations for recurrent hepatolithiasis are also among the interventions undertaken
such as Oddi’s sphincterotomy and plasty (括约肌切开、成形术), side-to-side and end-to-end anastomosis of common bile and duodenum and its low hole anastomosis, Roux-y jejunostomy, second, third and fourth operations for recurrent hepatolithiasis. Incision and stone removal of liver parenchyma, intrahepatic bile duct stricture plasty, intrahepatic bile duct bypass, a large number of cases for gastrointestinal surgery, radical gastrectomy for gastric cancer (R1R2), total gastrectomy, radical resection for rectal cancer (Miles Bacon Dixon operation), intestinal obstruction, colon cancer, hernia, hemorrhoids, appendix, etc. A case of Hirschsprung’s disease, congenital omphalocele and Pcutz-Jegher Syndrome underwent three operations in 14 years, including hyperthyroidism surgery, radical mastectomy (including super radical mastectomy), splenectomy (including giant brand 含巨牌), splenorenal vein anastomosis, portal azygos disconnection, internal drainage of pancreatic cyst, focus clearance and drainage of abdominal adenitis, PTC and retroperitoneal oxygenation.
Resection of carcinoma in the middle and lower esophagus (including supraarch anastomosis and thoracic roof anastomosis), lung repair, pneumonectomy, septal hernia repair, and closed thoracic drainage.
Surgical procedures on the kidney such as removal of the kidney, stripping of lymphatic vessels in the kidney, removal of stones from the kidney through an incision in the renal parenchyma, removal of tumors in the kidney, removal of stones in the ureter and bladder, realignment of the urethra in case of trauma, vasectomy, transplantation of the ureter, removal of one or both testicles, treatment of cancer on the penis, and repair of a congenital defect of the urethra called hypospadias.///Nephrectomy, renal lymphatic stripping, pyelolithotomy, renal parenchyma incision to remove stones (肾实质切开取石), renal embryonic tumor resection, removal of ureteral and vesical urethral calculi, urethral trauma realignment, vasectomy and anastomosis, ureter transplantation, orchiectomy, penis cancer radical cure, hypospadias repair.
Obstetrics and gynecology:
All operations involved, including Cesarean section (classical, lower segment, extraperitoneal surgery), total hysterectomy (abdominal, vaginal), tubal ligation (abdominal, vaginal), vaginal wall repair, uterine isthmus incision to obtain the fetus, induction of labor, fetal debris, ovarian tumor resection, vesicovaginal fistula repair, cervical cancer pelvic cleaning.
Manipulation and surgical treatment of limbs’ bone, joint and spinal trauma, including reduction steel plate internal fixation and bone grafting for spinal fracture and dislocation, internal fixation (opening and closing) of femoral neck fracture with three-wing nails, and lesion removal of bone and joint tuberculosis, including surgery for tuberculosis of neck, chest, waist, sacral vertebra, hip, knee, ankle, shoulder, elbow and wrist joint, one-time operation for thoracic vertebra tuberculosis through pre-thoracic approach, with lesion clearance, spinal canal decompression and anterior bone grafting, spinal cord tumor extraction, lumbar intervertebral disc extraction, myelography (iodine oil and iodine water), bone tumor (benign and malignant) surgery, meningocele repair and some orthopedic operations.
Ophthalmology and ophthalmology:
Tonsillectomy, radical correction of maxillary sinus, turbinectomy, nasal polypectomy, mastoid incision, cataract, artificial pupil, dacryocystectomy, nasolacrimal duct anastomosis, enucleation and strabismus correction, trichiasis, pterygoid excision and burial, etc.
Professional growth and innovation efforts
The original county hospital where I worked for nearly 30 years is a medical center with a population of 500,000 in the mountainous area of southern Anhui, and its surgery has an exclusive market. Although in the early 1960s, when I entered the early clinical stage of surgery, the conditions and my skill level were both very limited, I had to work hard to face all kinds of diseases related to surgery. There were many surgical opportunities and a wide range of operations. Environment trains people, pressure urges them to advance. I managed to study hard and practice hard, and made rapid progress in practice.
The famous Maingot’s work “Abdominal Surgery” has benefited me a lot with intensive reading and digesting. At that time, the incidences of intestinal obstruction were widespread, especially in the years of famine. There were hundreds of such cases in a year, which laid the foundation for me to break through the basic theory of surgery and practice of lower abdominal surgery. In 1964, I marched into the upper abdomen practice. On the basis of dozens of stomach and gallbladder operations, I was appointed to lead a team for rural roving medical treatment in the countryside in 1965. In 100 days, more than 600 operations of various scales were performed, including 121 laparotomy operations, in which 25 were upper abdomen operations, including stomach, gallbladder and uterus operations. By this time, I had mastered the epidural anesthesia technique in advance, which created favorable conditions for these operations. In the following year, I was sent to lead a team to set up two medical branches in Yijiang and Hewan successively, serving as business leader and continuing to carry out surgical operations. In 1968, I was appointed as the head of the major surgery department of our county hospital, in charge of the treatment of all surgical patients. According to statistics, nearly 100 cases of gastric and biliary operations were performed in our hospital every year in that period. Over the past decades, I have accumulated experience from both positive and negative aspects through a large number of operations, which also involves a process of continuous exploration and innovation.
In 1973, I participated in the restoration and reconstruction of Wuhu District Hospital after the early tubulance of Cultural Revolution. While studying orthopedics, I also helped to perform numerous surgical operations, under the guidance of the director of surgery. Orthopedic specialty was also systematically studied and mastered. I learned the most from Director Meixian Min and Professor Jingbin Xu, who were my two mentors in surgery and orthopedics.
Learn to swim in swimming
The recurrence and reoperation of cholelithiasis prompted me to be eager to update my examination methods and operation methods. Inspired by the literature, I shifted my focus from simply dealing with extrahepatic bile duct problems to paying special attention to the discovery and examination of intrahepatic stones, hence a better understanding of intrahepatic bile duct stenosis. Shortly after the 1980 Provincial Surgical Annual Meeting, I administered PTC, which dramatically improved the blindness in the past practice. The operation methods also expanded to hepatectomy and liver incision for stone removal. Combined with Finster operation plus Oddi sphincterotomy, Roux-en-y operation, posterior duodenal choledochoduodenectomy, hollow anastomosis of distal common bile duct and other internal drainage methods, the curative effect was greatly improved and the re-operation rate was reduced.
In our county, early local schistosomiasis portal hypertension was very common, our treatment ranged from early gastric circle and omentum to liver and kidney, to portal azygos disconnection, and finally to splenorenal venous shunt in 1976. In order to prevent short bowel syndrome after a large number of bowel resection, I performed intestinal anastomosis with interposition of reverse peristalsis segments, resulting in good effect.
I had frequent on-call visits to the countryside to rescue liver and spleen injuries and ectopic pregnancy. In order to solve the critical problem of blood source difficulty, my innovative and careful self-blood transfusion approach played a positive role. For example, in 1969, I was sent 60 miles away to visit a 13-year-old child with rupture of the central liver, which needed to be repaired through the chest. During the 4-5 hour interval while waiting for the ambulance’s return from the county hospital to bring the anesthesia machine, I practiced rein fusion of up to 1000 ml of abdominal liver blood repeatedly for the first time, and finally won the operation opportunity. The postoperative recovery was fairly smooth, but 16 days later, the patient was complicated with massive hemobilia, treated with ligation of inherent hepatic artery, also for the first time. Finally it was cured. Having followed up to now, all is well with the case.
Following the experience reported by provincial hospital in the First Annual Meeting of Obstetrics and Gynecology in 1980, I helped the Department of Obstetrics and Gynecology in our hospital to carry out the first 10 cases of extraperitoneal approach cesarean section and gained practical experience. This became standard operation in our hospital.
After further study in the orthopedics trainee class, I changed the posterior approach of vertebral tuberculosis to the anterior approach for one operation, which greatly shortened the course of treatment, including one-time treatment through chest of thoracic tuberculosis complicated with paraplegia. At the same time, interbody bone grafting was performed. In addition, lumbar tuberculosis was also treated with a trial operation to remove bilateral abscesses, together with bone grafting. It was a success. I also performed cervical tuberculosis surgery. This experience was reported at the first annual meeting of orthopaedics in our province.
Femoral neck fractures are common, complicated to handle and often ineffective. The original open triangular nail fixation led to damage, easy to cause shock to the elderly, and often requiring blood transfusion. After learning the experience from the Tianjin peers in 1979, I changed to closed nailing under fluorescence. The patients had little burden, resulting in less pain, faster recovery and less cost. This experience was reported in the third provincial orthopaedic annual meeting.
I also advanced the spinal cord lipiodol angiography in the past to iodohydrography, which provided the basis for the diagnosis of intervertebral disc surgery, beneficial to the identification and monitoring.
In addition, I assisted the Ear, Nose, and Throat (ENT) department in performing a procedure called subchondral tamponade to help treat a condition called atrophic rhinitis by filling under the mucous membrane of the cartilage nose. My report of this practice received rave reviews at the first annual meeting of the ENT in the province.
In summary, my professional growing process is primarily through improvement in massive practice and advance in technical pursuit. Long-term independent work facing all sorts of clinical practical cases, short of good conditions and nearby mentors, enables me to have developed the habit of independent thinking and turning to books and literature for help and insights. Every time when a new operation is carried out, I feel it necessary to collect extensive information and review all relevant knowledge for contingency. This way, although the road has not been easy, the experience accumulated from practice proves to be fairly profound.
Mingle Li, Attending Surgeon, Wuhu Changhang Hospital, 19??