In Hei Ziqing, time has changed into a big magic in more than 30 years: his family is poor, he lost his heart at the age of 9, he was raised by his mother with hard work, and studied in the clinical medicine major of Chenzhou Medical College (now Chenzhou Xiangnan College) in his hometown. If you use the current popular style, Hei Ziqing may be able to sigh: Why did I grit my teeth and work hard for more than ten years, but I only reached the starting line of others?
But he was as tenacious as a weed, and finally with a heart that did not admit defeat and the persistence of working silently, he stayed in the "national team", and gradually grew into a leading medical talent in Guangdong Province, chairman of the Guangdong Society of Anesthesiology, and served as the vice president of the Third Affiliated Hospital of Sun Yat-sen University in 2021.
Whether it is on the academic achievements in the field of anesthesia or the rare career development path among anesthesiologists, in the public eye, Kuroko Qing carries an atypical story. If you really want to salvage the secret of grassroots youth becoming "koi", he thinks, it should be the word "more real": "Every opportunity is extremely rare, but in fact, I have not taken the initiative to fight for anything." If you do things seriously, you will be seen. ”
The long march of "small town as a subject".
More than 30 years later, speaking of the humble boy in his memory, Hei Ziqing is still a little embarrassed.
Growing up listening to the hero's story, his initial dream was to be a soldier, and he volunteered for the college entrance examination without hesitation to fill in the military academy, only to learn later that his eyesight was not up to standard and he had no chance of getting an admission ticket at all. After accepting the transfer and going to the specialty, he studied clinical medicine for 3 years, and his grades have always been among the best, and he graduated as an anesthesiologist.
"I feel that every step is a little bit less meaningful, and I am still unconvinced. Hei Ziqing recalled that many of the knowledge of anesthesiology was unfamiliar, so after work, he still maintained the state of his time in school, and spent his free time gnawing books and researching information, and soon came up with the idea of studying in graduate school. "At that time, my thinking was relatively simple, and I didn't have very lofty ideals, I just felt that I had to do a good job in any industry. Hei Ziqing added, "And it has been found in clinical practice that anesthesia can solve many problems for patients, so I don't want to change tracks." ”
The results of the exam were announced, and his total score was 379 points, which exceeded the online score of 79 points that year, and he was the first in the anesthesiology major of Sun Yat-sen Medical University. In 1990, 23-year-old Hei Ziqing came to Guangzhou alone with his bags and devoted himself to the outside world for the first time. Previously, the only time he left his hometown was to Yueyang to watch the dragon boat race.
The confidence that came with his results didn't last long, and he soon felt the unevenness of the world. "I don't understand the world, it seems that I only know how to read every day, and I don't fit in with the people around me. Moreover, the foundation laid by the Affiliated Hospital of Chenzhou Medical College, when you first entered the department, is indeed incomparable with the 6-year undergraduate students who have been honed in the First Affiliated Hospital of Sun Yat-sen University for several years, as if no one is more prominent than you, and there are some gaps in the insight and basic clinical skills of discussing problems. Hei Ziqing sighed.
The repression didn't destroy the tenacity, and he held his breath and told himself to catch up.
More than a thousand early mornings and silent nights accompanied the youth of this small town through the long loneliness, over the hills of inferiority and unwillingness. At that time, the commonly used medical equipment was still quite rudimentary, the needle for arterial puncture and the infusion needle were of the same material, failure was commonplace, and intraoperative monitoring of blood pressure still depended on a stethoscope, which had to be kept close to the whole process. The anesthesiologist in the heart group must master arterial puncture, and after each failure, Hei Ziqing will write a diary to summarize the lessons, soak in the dissection room again and again to observe the arterial structure, and consult a doctor who is familiar with the operation.
Hei Ziqing also made a record table, recorded the representative cases and various indicators encountered in detail, and thought repeatedly about the data at night to find a better plan for the clinic.
▲Analyze various indicators and seek better solutions
The common side effects of the anesthesia-inducing drug thiopental are respiratory circulation depression and a continuous drop in blood pressure, the former can be solved by inserting an endotracheal tube to give oxygen, and the latter has no good way to improve. After careful data comparison, it was found that the effect on blood pressure and respiratory depression would be significantly reduced by slowly dividing bolus with the dropping point method, and the use of the dropping point method also helped. There are many similar findings, and a number of clinical research results have also been written into papers and published in the Chinese Journal of Anesthesiology.
These efforts are also seen by the seniors. "This lad will definitely grow up in the future. One day, Hei Ziqing overheard a teacher and a colleague sighing, and instantly felt that his eyes were a little sour.
From grassroots frustration to "koi possession"
When he was about to graduate, his mentor Chen Bingxue suddenly told him, "You don't have to look for a job", and threw a surprise gift package for staying in school and working. That night, Kuroko Kiyoshi had insomnia and looked out the window for a long time, as if he had stumbled through a long and bumpy journey of many years, and luck had smashed him so firmly for the first time.
In 1992, Huang Jiefu, then president of the First Zhongshan Hospital and later chairman of the Chinese Human Organ Donation and Transplantation Committee, formed a liver transplant team.
He also maintained that more serious energy as always. In order to be able to flash in time when his work needs it, he has been living within a few kilometers of the hospital. In the first 10 years of clinical liver transplantation, Hei Ziqing participated in more than 80% of the liver transplantation operations in the hospital, carrying a large white paper full of grids, recording dozens of indicators in detail, and exploring the rules while completing the anesthesia task;
"It's hard to work with thinking, to transform thinking into knowledge, and to continue thinking with knowledge. Kuroko Qing firmly believes in the true knowledge he has comprehended in actual combat.
This is how many miracles of life are created. A patient with a ruptured abdominal aortic aneurysm was bleeding profusely, and with the technology at the time, it was nine deaths. After receiving the call, Hei Ziqing, who was already preparing to go to bed, rushed back to the hospital, boldly abandoned the usual venipuncture needle, and replaced it with a hemodialysis tube with a caliber more than ten times larger, and the flow rate was increased by more than ten times, helping the patient successfully survive the catastrophe of life and death. This practice was later promoted throughout the hospital.
In the process of liver transplantation, after the liver is harvested, it is necessary to transfer the blood of the inferior vena cava back to the superior vena cava through extracorporeal diversion to maintain the stability of the body's circulation. Later, the concept of transfusion of small tubes for large tubes in patients undergoing major bleeding surgery was widely accepted.
"In order to master complex operating techniques better and faster, you have to go the extra mile in addition to what you are used to. Some medical devices may not be prepared for this type of surgery, but they can be borrowed flexibly after understanding the principle. He sighed.
The passers-by who insisted on moving forward finally met the full starlight. In 2002, the 34-year-old Hei Ziqing was promoted to deputy director of the Department of Anesthesiology of the First Sun Yat-sen Hospital, the following year, he graduated from the School of Medicine of Sun Yat-sen University with a doctorate in pathophysiology and was transferred to the Third Sun Yat-sen Hospital as the director of the Surgical Anesthesia Center, in 2009, he went to the University of Florida School of Medicine in the United States to visit and study, in 2017, he served as the secretary of the Party Committee and executive vice president of the Yuedong Hospital of the Third Hospital of Sun Yat-sen, in 2021, he returned to the Third Sun Yat-sen Hospital and was promoted to vice president, and in 2023, he also served as the executive vice president of Zhaoqing Hospital of the Third Hospital of Sun Yat-sen.
"I've just been trying to do the best I can to the best I can. The results made will be seen, and the results will be seen if they are not done well. Recalling the growth of this "koi possession", Kuroko smiled clearly.
Give patients "drunk" intimate protection
For many years, Kuroko Kiyoshi has been thinking about a question: What exactly is anesthesia?
In medicine, it has long been clearly defined as the temporary loss of sensation in whole or in part by drugs or other methods to achieve painless results, and to provide conditions for surgical treatment or other medical examination treatment.
But is that the only thing that is? The damage to the body and the stress response brought about by surgery objectively exist, and should anesthesia minimize the impact on the overall function of the body while pursuing analgesia and life-saving?
"Anesthesia is the science of combating the effects of non-physiological conditions on patients. Anesthesiologists also need to intervene in the perioperative period for key indicators to create a suitable living environment for cells, regulate and maintain body functions to a balanced state, and provide patients with good recovery conditions. With this in mind, he began to study the mechanism of perioperative organ damage.
When he was a young doctor, Hei Ziqing followed the teacher to send patients for examination, and often found that the patient's lungs were white after liver transplantation, indicating that there was fluid accumulation, which was undoubtedly not conducive to recovery. After taking over the Surgical Anesthesia Center, he began to study this phenomenon in depth and found that it was highly correlated with the increased pressure in the pulmonary arteries after the opening of the new liver. Which patients are prone to occur, what is the cause, what method is used, and the questions in his heart are connected with one click, and Hei Ziqing also began to lead the team to make bold assumptions and carefully verify them.
In the end, they found that it had to do with the operating concept: to protect the body, doctors would quickly transfuse large amounts of blood before vena cava blockade, and after the new liver implantation reopened blood vessels, some of the blood quickly flowed back to the lungs, while doctors needed large amounts of fluids to maintain the patient's blood pressure. When fluid rushes in quickly and cannot be drained through the urine, the blood vessels in the lungs become overloaded.
"We switched to restrictive volume transfusion, which is generally only four to five hundred milliliters of volume before vena cava occlusion, unless there is major bleeding, and the volume of fluid is controlled when the new liver is opened. This has significantly reduced the incidence of lung infections in patients, enabling early extubation and rapid recovery. Hei Ziqing introduced that the research results were also published as papers, and the extended project of "Kidney Injury and Protection Strategies in Liver Transplantation" won the second prize of Guangdong Science and Technology Progress Award.
In 2006, he edited and published the first academic monograph "Anesthesiology for Liver Transplantation" that systematically introduced the basic knowledge and clinical skills of liver transplantation anesthesia, and in 2020, the academic influence of anesthesiology in the province ranked in the forefront, and he presided over 8 national scientific research funds (including 1 national key project), 1 doctoral fund of the Ministry of Education, 3 key projects of the provincial scientific research fund, 4 provincial science and technology plan projects, 3 provincial natural science foundations, 1 provincial industry-university-research major project, presided over the project results won the third prize of Chinese medicine, as a backbone member of the project won the first prize of the Ministry of Education and Guangdong Province Science and Technology Progress Award, with 16 utility model patents, 1 invention patent, 1 international patent, and so on.
▲Won the winner of the best paper in the top academic journal in the field of anesthesiology in 2019
He also took the lead in the construction of a rapid rehabilitation system in the whole hospital, providing patients with the best state before surgery, reducing patient trauma during surgery, giving analgesia and nutritional support after surgery, greatly shortening the length of hospitalization, taking several common surgeries as an example, urology bladder cancer, prostate cancer hospitalization reduced from 10 days to 3~4 days, nasal polyps, nasal septum, etc., in the otolaryngology department, to achieve discharge within two days, the total cost of patients is reduced, and the comfort is improved.
At present, he is organizing the hospital to build a perioperative specialty database, which has collected nearly 300,000 medical records, and has jointly edited a perioperative standard dataset through medical enterprises. "We hope to use data to analyze real-world situations, including what kind of organ damage or complications will occur in different surgeries, and use data models to analyze probabilities and risk factors, and find ways to prevent them in advance. He expressed his vision.
The dullness and gentleness of "hard work".
As Secretary of the Party Committee and Executive Vice President of Yuedong Hospital of Zhongshan Third Hospital, Hei Ziqing's first transformation to a hospital administrator is the first time that Hei Ziqing has adapted very well - he continued to work the foundation laid by the former executive vice president Chen Yanming, and led the hospital to successfully create a top three, be selected as a high-level hospital in Guangdong Province, and apply for a national regional medical center. When he was the vice president of the Third Academy of Sun Yat-sen, the results of the "national examination" of the hospital fluctuated, and he took over this hard task and achieved a significant improvement in his grades.
4 years ago, when the reporter of this magazine interviewed the management know-how of Yuedong Hospital, Hei Ziqing once explained the management tools of the balanced scoring method with a smile on his face, and this time, he took out a new weapon - the "national examination" index was dismantled into 56 internal assessment indicators of the hospital, and the corresponding implementation plan was formulated. Taking the use of antimicrobial drugs as an example, after strict management, the 2021 "National Examination" got a full score, and the heart valve interventional surgery followed the homogeneous management model, and the quality control score of a single disease was increased by more than 20 points.
Hei Ziqing mentioned a detail, whether it is the introduction of the balanced scoring method or the management of the "national examination" indicators, the dismantling of each indicator and the formulation of each measure are all typed out by himself word by word.
"As a leader of the hospital, you must understand the policy thoroughly and form a clear idea, if you completely let the clerk draft, let him interpret your thinking mode, the height may be lacking, affecting the final effect. He explained.
Looking at Hei Ziqing's two tough battles in hospital management, you can still see his "true" background - every time before making a move, he will always make a "stupid effort" first, carry out massive learning and thinking, analyze problems, refine indicators, quantify each implementation link, and systematize fragmented ideas. He calls it "management by design."
Some subordinates once lamented that they did everything in detail and did it themselves, and Hei Ziqing described himself as "hard work". This also runs through almost every field of his work.
Chen Chaojin, who was awarded the "Outstanding Communist Youth League Cadre of Guangdong Province" in 2023, recalled two or three things with his mentor Hei Ziqing, saying that he was full of passion when he first came into contact with scientific research, but he was extremely frustrated after 3 months of fierce battles and experiments on 64 mice, but in exchange for zero data. Hei Ziqing not only gave encouragement based on his growth experience, but also carefully helped him find the reasons and put forward suggestions for improvement, and took him to academic conferences to help rekindle his enthusiasm and confidence in scientific research.
"Students should not only rely on their leads, but also on their attention, not just to let them get a degree, but also to consider how much they can contribute to society. Kuroko Qing said.
When he brought Chen Chaojin, he asked him to write a study report every week, organize an exchange every two weeks, and make a list of things to do every month. This style has also continued throughout his teaching career.
The past growth experience made Hei Ziqing obsessed with letting students take fewer detours and achieve success through hard study. "No matter which student it is, you should explain what you should do clearly, don't let them be ignorant, and if you are really ambitious, you will naturally work hard in the direction you want. He is very pleased that the students have maintained a high success rate, and many of them have taken up the position of director of the anesthesiology department of a tertiary hospital.
Towards the end of the interview, the reporter saw a work plan on the computer that Hei Ziqing carried with him - in the first week of this month, the list had 42 items, 8 of which were highlighted in red. "Labor life" is still on the move. He admits that he lacks artistic skills, does not have many hobbies, and his most common pastime is climbing mountains with his family on weekends, and he is sincere but restrained when socializing, but he is glad to have found a career where he has made a living, and he has done his best in everything he does, and has done something and helped many people.
He never thought of himself as a talented player, and he seemed to lack fate with high emotional intelligence, but who said that a weed should not be hungry for spring? Who said that a seed can only grow into a big tree according to a mold?
Welcome to the 2024 edition of The Beginning of Man magazine
Reporter | Yue Chaoqun
Edit | Ye Qin, Zhang Zhiying, editor-in-charge| Zhang Xiuli
Correspondents | Zhou Jin'an, Zhen Xiaozhou
This article was first published in the magazine "The Beginning of Man".
Produced by the Guangdong Health Online all-media team