The night of 9 April 2015 was cold and rainy.
Vanguard lights shiver in the watery light, drowsy. But for neurosurgeon Chen Xinan, tonight is destined to be another sleepless night.
He had just been squinting when the midnight bell rang on his pillow - the telephone in the duty room was always so loud that it gave people heart attacks.
'Come on, don't go to sleep, come to the lottery!' The one who called was his night shift partner Han Wei.
Chen Xinan and Han Wei are the Black and White Irregulars of the Neurology Department. One is a god outside, the other inside. One white, one black. One is white, the other is black. One is a cat of fortune, the other is a crow's mouth. And as long as the night shift is right, someone is bound to be critically ill that night.
Chen Xinan lifted his wrist and looked at the watch, yawning and asked: "Is it the one admitted from the emergency room in the afternoon. I remember it was a left frontotemporal lobe haemorrhage."
'It's him!' Han Wei has had a cold for the past two days and kept clearing his throat, "I was thinking that the blood pressure was too high in the afternoon, coughing! It's not a good idea to operate the knife. Just now, I took a CT scan, ahem! The bleeding area is much larger."
'Is the blood pressure still high?'
"More than 150, I gave him some sodium nitroprusside drip. You cough! Stop asking questions on the phone and come and have a look."
'Putting on my shoes.' Chen Xinan promised on his lips, thinking that the situation would definitely not stop at "taking a look". As expected, when he arrived at the ward, the patient had already fallen into a coma.
Han Wei was giving medicine at the bedside. He was a dark, strong man, with a white coat that was as tight as a wrap-around skirt on him. A standard M-shaped hairline on his head and two doorways glistened in the light.
Doctors are a profession that is very prone to baldness, but Han Wei can't be considered prematurely bald. After all, he was also 35, a full eight years older than Chen Xinan. However, the two were at the same level, and both were attending physicians.
This is by no means because Han Wei level is not good.
It was well known that the medical path was divided into six levels from bronze to king: regulation, inpatient, attending, deputy director, director, and professor. And each level of promotion, are long and arduous. 3 years of training 5 years inpatient, 35 years old can be independent are considered good.
So Han Wei is normal, Chen Xinan is the exception.
There is a famous saying in physics: there are only two kinds of physicists in the world, the best and the ones who shouldn't have stepped into physics in the first place.
This saying applies to neurosurgery as well. Because it takes so many talents to become a neurosurgeon: a brilliant mind, a maniacal diligence, dexterity, serenity. A little cold-blooded perversion (never more), and then supporting a thumb thick cardiovascular - after all, the brain melon is not a watermelon, cut and can take the cling film hoop.
All of these, Chen Xinan has.
He has had a superb memory since childhood, and at the age of 15 he took the college entrance examination and was admitted to the clinical programme of the Capital Medical University. More outrageous than the brain, is that the same pair of hands: when reading, his two hands together to answer the question; after the practice of medicine, his two hands are able to operate the knife; and more outrageous than these hands, is that he is going to sit down like a stable mood. No matter how urgent the juncture, under how much pressure, he can be calm and collected, his voice is always calm and gentle. The director of the nursing department once said, 'If you give Xiao Chen two reverbs, he can play the Buddha in the Journey to the West'.
Thanks to God's duck-feeding, Chen Xinan was awarded a doctorate at the age of 24 and passed the attending doctor's examination the following year. This could no longer be described as "the proud son of heaven", in Han Wei's words it was "the king of hang-ups".
At this moment, the king of hangers-on had already settled on a treatment plan. He took off his glasses and called the family in to talk.
Selfishly speaking, Chen Xinan didn't like talking to the families of patients with brain haemorrhage. Because if a cerebral haemorrhage went as far as a craniotomy, it meant that the brain nerve cells were already necrotic in a large area. Even if the haematoma is removed by surgery, there is a high risk of hemiplegia, stroke, hydrocephalus, or even aphasia.
To put it bluntly, surgery is "possible to live", and no surgery is "sure to die". And this extreme choice of one or the other usually makes the family lose control of their emotions.
Because of the sudden onset of this patient's illness, the only person guarding the hospital at that moment was his wife. A great-aunt in her fifties with two navy tattooed eyebrows across her head. Her thinning hair was permed into small curls and floated lightly on her scalp like foam.
When she heard that she was going to have a craniotomy, she was stunned on the spot. Her clasped hands were green and red, like an apple with rust spots all over it.
Chen Xinan looked at her sympathetically, but no reflection actually travelled from his retina to his brain. The life of a divine surgeon was busy and exhausting, and underneath the sleep deprivation was his perverted personality holding it together: undaunted by stress and keen to take risks. And most importantly: de-emphasis on empathy.
Patients are living, breathing human beings with their families. There are personalities, thoughts, memories and perceptions. But on the operating table, all of these things disappear, replaced by arteries, veins, nervous systems and brain tissue.
'Doctor, is it okay not to operate?'
Chen Xinan was a bit distracted and smiled perfunctorily, "I can tell you all the various treatment options, as well as the prognostic risks. But the decision-making power is not with me, it is still on your side."
'Then tell me, what are the chances of surviving an operation.'
Chen Xinan's tone was still gentle, but his eyes were empty. The two eyeballs looked like frozen fog, neither of them gathering focus: "Probability is just a number, it can't predict whether anyone will live or die. Even if I say 80%, it doesn't mean much. Because when it falls on an individual, there are only 0% and 100%."
Auntie looked at him fixedly for a moment and flung herself down on her knees. With her hands clasped together, she made a bow and cried out, "Please save my old man! Please, doctor!"
This howling finally let Chen Xinan back to God, kneeling down on one knee to support the sister-in-law's arm: "What are you doing. Since you're here in the hospital, put your heart here. We'll do our best."
--
The hissing of the ventilator, the dripping of the monitor, the buzzing of the electrosurgical knife, and the nicking of the microscope were all around my ears.
The patient's cerebral dura mater had been cut open and flopped skin-like. The surrounding green cloth was soaked with blood, haloed into a large circle of deep purple. The wound was like a mouth in the cold winter, with repeated white vapours.
The microscope hangs above the field of operation, and the lens is a trembling, oily brain. These creepy sights for ordinary people were as normal as a computer desktop in Chen Xinan's eyes. No, it could even be called a magnificent painting.
The folds on the brain intestines were like mountain ranges and canyons, and the microscopic blood vessels and arachnoid membranes were like purple and red starry skies, illuminated by the shadowless lamps with streaming colours.
Curious laymen often ask Chen Xinan, 'What is the human brain like?'
Whenever this happens, Chen Xinan always describes it in an abstract way: "It's like Star Wars in yoghurt. Yoghurt is the kind that is semi-solid and can stand up to a spoon." He even smiled slightly after saying this, enjoying the revulsion on the other's face with interest.
At the moment the yoghurt in front of him was taut and strawberry pink due to the pressure of the blood clot. There was a lot of bleeding, but luckily the blood clot happened to block the broken hole in the blood vessel. Not wanting to risk removing the clot, Chen Xinan carefully searched for the artery that supplied blood to the breach.
'Haemostatic clamp.' He instructed his assistant, using surgical forceps to expose that artery by a few millimetres. Clamping the artery, he rinsed the clot blocking the vessel and allowed it to float outwards. When it floated up, it was then gently sucked away with suction.
The brain tissue loosens up visibly, and then comes the repair. Stitch by stitch, layer by layer, it exits. His hands are steady and deft, each instrument like an extension of his fingers. Blood vessels, dura mater, skull, and finally the skin was sewn on by an assistant.
After an hour or so, the patient was somewhat conscious. However, the function of the higher centres had not yet fully recovered and showed slight agitation.
Chen Xinan had also caught up on a small amount of sleep, and was in a good mood at this moment. Patting his shoulder, he smiled and comforted, 'It's alright ah, just lie down for two more days and you can go home.'
Hippocrates, the father of medicine, once said: doctors have three treasures - language, medicine, and scalpel. Not to mention the false love or false intention, on the comfort of this soft skills, Chen Xinan mastered the perfect.
Han Wei once on this matter sarcastic: 'I just wondered, where do you come so much energy to smile?'
'Don't say it so harshly, it's called the "anticipation effect".' Chen Xinan taboo corrected, 'The desire to live is the best fentanyl.'
Whether Han Wei approved or not, the practical effect was indeed good. The patient gradually stopped swinging his feet when he heard the comforting voice. Woodenly, he raised his hands and clapped silently on his stomach.
Seeing that he was thinking clearly, Chen Xinan inclined his head and explained to the anaesthetist, "Being too irritable will accelerate the oxygen consumption of the brain cells, which will easily lead to secondary bleeding. When the situation is stable, give some sedation." Said took off his glasses and hung them on the V-neck of the brusher suit and walked out of the operating area.
The patient's family members have already rushed to quite a few, are talking in the doorway blocking. As soon as he showed his face, they huddled around him. A pair of eyes balked at his tired face, wanting to find a thirsty answer.
Chen Xinan took off his mask, and there were several strangulation marks across his cheeks. When he smiled and spoke, those strangles pouted up and down like a kitten's moustache: "The blood has been cleared. The person is also awake, the situation is relatively optimistic, first transferred to the NICU for two days of observation. However, because of the amount of intracranial haematoma...'
He hadn't finished speaking when a small doctor from behind the crowd waved at him urgently, 'Doctor Chen! There's a brawler with trauma in the emergency clinic!"