If surgery was a football game

Wang Jianyu, Anesthesiology Center, Beijing Anzhen Hospital

I have several hobbies, such as reading professional materials, listening to books, watching football, and occasionally playing football with my neighbors. In fact, before I entered the medical school, my biggest dream was to be a football commentator or a team doctor, so that I could sit on the bench and watch the Guoan team play. It is a good place to watch football, with a wide view and close to the stadium. The most important thing is that no matter how rich you are, you can't buy a ticket for the seats there.

Later, I went to work in a hospital. I could no longer be a team doctor for a professional team, nor could I be a professional football commentator. I would occasionally play Pro Evolution Soccer at home, turn off the volume, and satisfy my urge to commentate without having to worry about disturbing others.

But I like to compare many things to football games. For example, when I was teaching students in the past and talked about the combination of medications for hypertension, I told them that the combination of antihypertensive drugs are actually the different arrangements and combinations of the forward line in a football lineup, etc. Students who like football listened with great interest, but friends who have never watched football were confused.

In my eyes, in peacetime, there are only two places where wars without gunpowder smoke take place: the football field and the operating table. I have thought about this topic for a long time. Maybe it is time to start playing the league. So, to be appropriate, I will compare the operation to a football game, just to entertain you.

A surgery on a patient is usually performed by a large core surgical team composed of surgeons, operating room instrument nurses (commonly known as "stage nurses" or "hand-washing nurses"), operating room circulating nurses (some hospitals call them "stage nurses"), the chief anesthesiologist and deputy anesthesiologist of the anesthesiology department, and more complicated surgeries also require an extracorporeal circulation perfusion doctor and assistants, instrument and equipment operating engineers, manufacturer's stage engineers, laboratory testing technicians, in-hospital equipment suppliers, logistics support personnel, and pharmacists in the pharmacy.

The patient undergoing surgery is actually equivalent to the chairman of the board of directors of a football club, because at the beginning, the construction, selection and formation of the team are all decided by the chairman. Therefore, as a patient, when you are sick, which hospital to go to and who to see in the hospital, all need to be determined in the composition of the board through constant communication and decision-making. When it comes to treating diseases, doctors and patients are more like a team, working together and helping each other.

The formulation of surgical and anesthesia plans is equivalent to the technical and tactical design on the football field, which requires players with good game reading ability and strong execution of technical and tactical concepts to play. The same is true on the operating table, which requires medical staff with high surgical reading ability, clear thinking, strong skills and professional performance to play.

Football lineup: I choose my favorite "442" formation.

The forward position - the first assistant surgeon. The reason why he can become a first assistant is that he is usually the surgeon who has been working the longest in the surgery. A very important point is that he has rich surgical experience and can cooperate well with the surgeon-in-chief, and sometimes even has the ability to complete the operation independently.

Shadow striker. In the last century, there was a very vivid metaphor for players in this position - "number 9 and a half". Under the cover of the striker, those who can score and create opportunities for other teammates are absolute core players. The chief surgeon is actually the shadow striker on the operating table. Not only does he echo the work of the assistant, but he also has to coordinate the overall situation, independently and stably complete the key steps of the operation, and fully communicate with other colleagues to teach junior doctors the operation and diagnosis and treatment capabilities.

Attacking midfielder: has a wide range of activities on the field, and needs to be clear-headed at all times to deliver high-quality passes to the forwards. On the operating table, he is the instrument nurse. He must always observe the progress of the operation, understand the surgical procedures of the surgeon and the assistant, and know the operating habits of the surgeon and the assistant. I have seen a team with tacit understanding. As soon as the surgeon or the assistant extends his hand, the instrument nurse knows what instrument to pass, without saying much.

Wing forwards: The two people with the largest range of movement on the left and right sides of the court, they are required to be physically strong and tenacious. On the operating table, the circulating nurse and the second assistant can be a perfect match. Good circulating nurses and second assistant doctors are often the type of "ruthless but quiet". "Ruthless" does not refer to attitude, but to the tenacity of work. These two are almost the first to arrive in the operating room every day and the last to leave. Sometimes they also need to help other colleagues to find out the gaps and make up for the shortcomings.

Defensive forward: commonly known as defensive midfielder on the court. The characteristics are relatively young age, large defensive range, no physical effort, tough and simple style of play, mainly as the first barrier on the defensive end, frontal interception, chasing back and interception need to be completed, and modern football also requires certain offensive attributes. I personally think the corresponding position is - assistant anesthesia or anesthesia front line. Colleagues in this position are still a certain gap in age and seniority compared to the main anesthesia, but there are many things to be completed, such as daily inspection of instruments and equipment, extraction of rescue drugs, preparation of anesthesia-related consumables and drugs, monitoring of surgical patients, invasive operations, assistance in mechanical assisted ventilation, extraction of blood for testing, blood transfusion, postoperative follow-up, analgesia observation, etc. An excellent assistant anesthesia can also be a good partner of the main anesthesia, making the main anesthesia work very easy and worry-free, and can also coordinate all communications of the team in the operating room, help other team members to make up for the gaps and work, and give patients the greatest sense of security and protection.

Central defender: As the core player of the team's most important defensive system, this position has very high requirements. The mistakes of the central defender may lead to the team's loss, so the responsibility is heavy. Corresponding to extracorporeal perfusion doctors and engineers. Objectively speaking, these two job positions are two extremely unfamiliar roles for surgical patients. There are few official introductions and not many positive reports. However, for example, for an operation that requires extracorporeal circulation technical support, the level of the perfusion doctor not only affects the effect of myocardial protection, but also affects the patient's prognosis. Similarly, an operation that requires the participation of large equipment engineers is also of high-precision and cutting-edge level, whether it is the three-dimensional reconstruction required for vascular intervention, the electrode implantation required for neurosurgery, or the work of marking potentials in cardiac electrophysiology. Perhaps it is because of the problem of the engineer's business level that some results are happy, and some will fail.

Full-back: The team's full-backs are often required to be able to participate in the offense and complete the defense. In short, modern football has higher and higher requirements for this position. The work content is similar to that of laboratory testers and pharmacists in pharmacies. Not only is it required to be good at the profession, but when necessary, for the interpretation of test results of some difficult cases, or the principles of drug use in special cases, teachers of these two majors will also give enough professional personal insights to assist in the intraoperative management of patients.

Goalkeeper: The only position on the court that requires the lowest presence, the better. When I was training, the coach said: A good goalkeeper will not fly around. If he flies around, it is either because he is not well prepared or he is deliberately performing. So there have always been many compliments about goalkeepers: for example, a good goalkeeper is equal to half a team. There are also words about weak teams having goalkeepers. After all, "the front court is as beautiful as a painting, and the back court is tofu dregs" is something that no one who supports the team wants to see. The chief anesthesiologist is actually the goalkeeper and backbone on our operating table. An excellent chief anesthesiologist rarely rushes around during surgery, because when the surgery is fully prepared, everything is under control, and there is no need to rely on "busy work" to brush the sense of presence. It is precisely because of excellent anesthesiologists that surgeons can fully display their surgical talents and talents on the operating table, and patients are also out of danger during surgery. So I often say that my chief anesthesiologist's words are "the beauty on the operating table is beyond description, and the spring breeze is not as good as having you on the same stage."

Jay Chou of Beijing Zhonghe Guoan Football Club has kept the "No. 12" jersey forever and dedicated it to the fans who support Guoan, calling it "the eternal 12th man". In fact, under the operating table, the logistics support personnel, such as our supply room disinfection teacher, the field staff who receive patients, the big sister who guards the door and distributes surgical gowns, and the cleaning sister who wipes the floor and tidies the room for us during each operation, are all the "12th man" who supports our operations. Without them, the operations will not go smoothly.

Is surgery really like a football match? Of course not, because it is more difficult than a football match. Football matches allow for home and away rounds, and there can be winners and losers in the league, but surgery? It is a game that must be won, because our patients' families are eagerly looking forward to a good result, because our patients trust us immensely, and it is a complete responsibility to entrust their lives to us, because we hope and believe that we can do a good job in surgery. Therefore, we cannot afford to make mistakes.

Wang Jianyu, a native of Beijing city, was born in the 1980s and comes from a medical family. He studied at Peking Union Medical College and currently works at the Anesthesia Center of Beijing Anzhen Hospital.

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