Office of the Professor of First Surgery.
The room was laid with thick carpeting, and the rosewood bookcases were filled with all manner of foreign-language original texts and skeletal models.
Nishimura Sumika sat behind a broad rosewood desk.
As the helmswoman of First Surgery, although she rarely took the operating table herself anymore, she still kept a close eye on the department’s difficult cases and special procedures.
In a university hospital, clinical skill was important if one said it was important, and unimportant if one said it was unimportant.
But to sit securely in a professor’s seat, what ultimately mattered was political acumen.
She held the medical chart of Assemblyman Okawara’s son in her hand, nodding repeatedly as she flipped through the surgical record.
The C-clamp had been used in a very timely fashion, and the preperitoneal packing had been a stroke of genius.
It had won First Surgery some face before the board of directors.
After reading it, she picked up the next file underneath.
[Patient: Suzuki Shinya]
[Procedure: Open reduction and internal fixation for C3-type comminuted fracture of the left distal radius]
[Primary surgeon: Imagawa Ori]
[First assistant: Takigawa Takuhei]
[Second assistant: Kiryu Kazusuke]
It was the chart for a routine operation.
By rights, a chart of this level did not need to be submitted to the professor.
But Professor Sato from Radiology had specially called her, saying she would definitely be interested in this patient’s postoperative films.
Professor Nishimura placed the preoperative and postoperative X-rays side by side on the viewing light.
Before surgery: comminuted, collapsed, an utter mess.
After surgery: flat, smooth, fitting together without the slightest gap.
“Interesting.”
Although Professor Nishimura’s own surgical skills could only be described as thoroughly mediocre—even privately called “Professor Butterfingers” by the young doctors under her—her eye was excellent.
“As expected of Doctor Imagawa.”
Professor Nishimura could not help sighing in admiration.
The articular surface was so level it looked as if it had never been fractured at all, and the T-plate was positioned exactly right.
Even the pickiest professor would not be able to find any fault with it.
Imagawa Ori’s surgery truly was beautiful.
That was also why she could tolerate this young doctor doing a few “side jobs” outside.
If her own clinical work was lacking, it was enough that the people under her were capable.
She opened the operative record.
This was the official version written by Takigawa Takuhei, the printed type neat and clear.
But the contents were extremely brief.
[Intraoperative exploration revealed joint instability. Multiple K-wires were used for temporary reinforced fixation. After satisfactory reduction, internal fixation was performed with plate and screws.]
Just that one sentence?
If it had been routine plate fixation, there was no way those tiny bone fragments could have been pieced together so perfectly.
And he had simply glossed over the most important part like that?
Wasn’t this like discovering a gold mine, yet writing only “there are some yellow rocks here” in the report? Wasn’t that a reckless waste of heaven’s gifts?
“Multiple K-wires for temporary reinforced fixation—what does that mean?”
“Simple levering?”
Professor Nishimura’s fingers tapped lightly on the desktop.
Impossible. Simple levering could not resolve severe joint instability. The moment one let go, the bone fragments would collapse.
She keenly sniffed out something unusual.
Surgical failure caused by occult ligament tears had always been a difficult point in treating distal radius fractures.
Yet this operation had been extremely successful.
That meant it was very likely a new surgical concept, a new technique capable of solving the problem of complex wrist fractures.
If that was the case...
If this case could be organized, with the technique behind “multiple K-wires for temporary reinforced fixation” elaborated in detail, then paired with these perfect postoperative images...
This would be a high-quality case report. It might even be published in the Journal of the Japanese Orthopaedic Association!
At her age, money no longer mattered.
If she could publish a few more high-impact papers before retirement, her historical standing would be secured.
“Yumi.”
Professor Nishimura pressed the intercom on her desk.
“Professor, you called for me?”
“Go call Doctor Imagawa Ori here. Immediately.”
“Yes.”
A few minutes later, a knock sounded outside the door.
“Come in.”
Imagawa Ori pushed the door open and entered.
She wore a white coat, both hands in her pockets, her face bearing its usual cool expression.
She had originally been about to make rounds, and afterward she still had to hurry to another private hospital to perform a part-time operation, only to be summoned by the professor with a phone call.
That left her feeling somewhat displeased.
Time could truly be converted into money, but a professor’s nonsense was usually worth nothing.
“Professor, you wanted me?”
“Sit.”
Professor Nishimura pointed at the chair opposite her, a rare kindly smile appearing on her face.
“Imagawa-kun, you were the primary surgeon for Suzuki Shinya’s operation last week, correct?”
“Yes.”
Imagawa Ori sat down, glanced at the chart and films on the desk, and felt somewhat puzzled.
Had something gone wrong with the operation?
Impossible.
The patient was recovering very well. He had already been discharged yesterday, and his family had even brought over some sweets.
Could there have been a mistake in the operative record?
After all, it had been written by Takigawa Takuhei—that trainee doctor who could never pass his specialist exam.
When it had been handed to her for review at the time, she had been rushing off after work to her part-time job, so she really had only skimmed it hastily before signing.
“Have you read it?”
Professor Nishimura pushed the operative record in front of her.
Imagawa Ori picked it up and quickly skimmed it again, but still did not find any problem.
Without changing expression, Imagawa Ori asked, “What is it, Professor?”
Professor Nishimura shook her head, her face wearing an expression of disappointment at wasted potential. “It’s too simple.”
Imagawa Ori froze for a moment.
She had thought the professor had called her over to nitpick. She had not expected it to be because the writing was too simple.
At the time, Takigawa Takuhei had not understood the principle behind Kiryu Kazusuke’s maneuver at all, so he could only write a few vague, repetitive lines to muddle through.
As for herself, although she had understood that it was ligament tension reconstruction, she felt that writing such an unorthodox maneuver into the chart might invite unnecessary controversy, so she had tacitly permitted this ambiguous handling.
The less trouble, the better.
Wasn’t an operative record fine as long as it complied with medical standards and could satisfy insurance inspections and the courts?
But she could not say that outright.
She stood up.
“Professor, the operative situation was relatively complicated at the time. To ensure the chart could be filed promptly, we wrote a general account first.”
“I planned to supplement the details later in the subsequent progress notes or discharge summary.”
“I’m very sorry.”
As she spoke, she bowed slightly in apology.
It was an all-purpose excuse.
Professor Nishimura glanced at her. Imagawa Ori would later supplement the operative record in detail?
Then why had she never seen it?
However, Professor Nishimura had no intention of exposing her on the spot.
What she cared about more were the technical details in this operation that could be used for a paper.
“Imagawa-kun, perfect timing, then. I have a few questions.”
“During the operation, exploration revealed an occult ligament tear combined with joint instability. Such an important finding—why was it brushed over in a single stroke?”
“And the specific placement of these K-wires—the angles, depths, tension control—none of it is described in detail.”
Nishimura Sumika put her glasses back on and took out a notebook.
“Yes.”
Imagawa Ori inwardly cursed that this was troublesome, but on the surface, she respectfully agreed.
She composed herself and began recalling the operation from that day.