Zhang Baigen, Professor of Surgery, former Vice President of Renji Hospital, one of the founders of vascular surgery in China

Introduction

In an era of great change, individuals can feel like small boats adrift on a powerful current. In such times, what is often lacking is not a clever mind, but a focused spirit.

“Although I’m retired, I still participate in medical activities and attend academic conferences. In my free time, I enjoy reading widely, browsing magazines, and taking notes, simply following my interests. To relax, I listen to light music. I’ve always tried to work happily and face life with a smile.”

He believes one must practice “thinking around corners” in life. Whether in medicine or in daily life, challenges are complex, and you must be willing to find new approaches and try different paths.

“Sometimes, we need to deliberately avoid familiar routes and seek new ones, striving to innovate. I believe that as doctors face the future, they must be able to navigate the vast ocean of knowledge; maintain focus amidst the waves of information; and walk with integrity through complex professional relationships.”

The Path to Medicine

Zhang Baigen was born in 1941 to an ordinary family in Shanghai. His grandmother gave him his name, hoping he would grow up strong and healthy. His childhood was not easy, and his family’s simple circumstances taught him a core principle for life: survive, be kind to others, and treat people with sincerity.

“My parents were working-class laborers with no formal education. They had come to Shanghai from Zhejiang province to find work. I remember in junior high, they constantly worried about my tuition. Times were very hard. Sometimes, just having a bowl of white rice felt like a luxury. In that environment, I didn’t have grand ambitions. I just hoped that getting an education would lead to a good job to help support my family.”

Throughout elementary and junior high, Zhang lacked a clear academic focus. That changed in his third year of junior high after he read his first novel, The Gadfly, and met a Chinese teacher who inspired him.

“I still remember the day my teacher gave my essay a surprisingly good grade. I was so happy; it was the first time I felt the joy of being recognized for my work.”

In high school, Zhang developed a love for literature, especially short stories. After graduation, as he and his classmates considered their futures, his parents suggested he study medicine. “Doctors will always have needed, no matter the era,” they advised. Knowing little about the field, he followed their advice. At the time, Shanghai had two main medical colleges. Zhang, unsure which to choose, asked his classmates, who told him the Second Medical College was better. He listed it as his first choice.

While waiting for his acceptance letter, his parents grew worried about the costs and suggested he find a job instead of attending university. Though disappointed, Zhang agreed. Fortunately, a position he applied for at a chemical factory had already been filled, allowing him to pursue his medical path after all.

“When I started at the Second Medical College, I was one of the youngest students—short and quiet. Tuition and housing were free, but we paid about 12.5 yuan a month for food. My family gave me 13 yuan, leaving only 0.5 yuan for everything else. A bus fare was 5 cents, but if I got off early and walked, I could save 2 cents. I went home on weekends to save money and participated in all kinds of campus chores, from cleaning the cafeteria to the latrines. Life was hard, but I found it fulfilling.”

1958, Zhang’s first year, marked the beginning of the “Great Leap Forward.”

“Right after we enrolled, we were sent to the countryside to do farm labor from morning till night. It was grueling work, and injuries were common. Starting in my second year, I studied very hard, began to express my opinions, took detailed notes, and was eager to share my understanding with others.”

This period of hardship forged the resilient spirit of Zhang’s generation of medical professionals.

Entering Renji Hospital with Ambition

In 1963, Zhang graduated and was assigned to Renji Hospital as a surgical resident. He often described those early years as “working like a dog,” though not with a negative connotation. Residents were on call constantly, monitoring patients and responding to emergencies at a moment’s notice.

“Our surgical emergency room operated on two shifts, not three. During a three-month stint in the ER, I barely saw sunlight because I had to sleep during the day. As the doctor on duty, I handled all emergency surgeries and patients alone, without any assistants. At night, the moment we heard a rescue call, we’d throw on our white coats and rush to the ward. With only 2-3 residents per ward, the workload was immense.”

Medical technology was less advanced then, and post-surgical complications were common. With few residents and many senior doctors, young doctors received significant guidance. During rounds, directors and senior physicians would ask questions. If a young doctor couldn’t answer, while they weren’t harshly criticized, the embarrassment was a powerful motivator to study until the knowledge was mastered.

For Zhang, the greatest joy was when senior doctors allowed him to assist in surgery. He learned under a traditional “three-three system” of teaching: the senior doctor performed the procedure three times, then did it three times alongside the young doctor, and finally, observed the young doctor perform it three times independently. This method rapidly accelerated the skills and confidence of young surgeons.

Zhang still recalls learning the “subtotal gastrectomy” procedure. After guiding him just once, his senior doctor felt he was ready to perform it on his own and encouraged him to try. Many believed that true teaching required “hand-in-hand” guidance. Zhang thought differently. He believed surgery, more than other skills, demanded the ability to “learn by observation,” with the core being the mentor’s dedicated instruction, not just physical guidance.

“Much of what our group of doctors has achieved today is thanks to the careful guidance and willingness of senior doctors to share their knowledge.”

In 1969, Zhang’s medical school sent a “small team” into the mountains of Anhui to provide medical support. Zhang was part of this team, treating villagers in Huangtian Commune where poor transportation made timely care nearly impossible. As he traveled from village to village, he came to deeply understand the meaning of “using benevolent skills to benefit the world.”

“The most important quality for a doctor is ‘benevolence’—considering the patient’s vital interests with a compassionate heart.”

Soon after returning from Anhui, Zhang led the first Chinese medical aid team to Morocco. There, his versatility as a specialist with broad skills earned him the respect and trust of the local people and praise from his international colleagues.

Zhang believes that in medicine, difficulties are everywhere, and situations can even be life-threatening. The only way forward, he says, is to patiently identify problems step-by-step. Complaining and fear only waste time and do nothing to solve the problem.

Opening a New Chapter in Vascular Surgery

A popular saying in the early days of vascular surgery in China was, “Wang Zhonggao in the north, Zhang Baigen in the south.” This phrase captured the landscape of the field’s early development.

As the founder of the Department of Vascular Surgery at Renji Hospital, Zhang knew the journey would be challenging.

“Although vascular surgery in China developed relatively late, it has always played a vital role as a major branch of modern surgery.”

He started from scratch, exploring and advancing the field step-by-step, continuously achieving breakthroughs. He focused on introducing advanced foreign technologies and concepts while developing surgical techniques and treatment methods adapted to China’s specific medical needs.

“As early as the 1950s and 60s, Professor Lan Xichun had envisioned establishing a vascular surgery specialty. Unfortunately, due to limited manpower and resources, it never materialized, a fact he always regretted. Later, during the ‘Cultural Revolution,’ the idea resurfaced as part of the ‘teaching revolution,’ but it ultimately did not come to fruition.”

It wasn’t until 1977, after returning from a medical aid mission in Morocco, that Zhang, encouraged by Professor Kuang Yaolin, the then-director of surgery, restarted his pioneering work in vascular surgery.

Director Kuang told Zhang that due to various factors, China was more than a decade behind other countries. It was essential to make up for this lost time to better protect people’s health. These words deeply impacted Zhang and solidified his decision: to start from scratch and establish the “Vascular Surgery Professional Group,” dedicating himself to this then-overlooked specialty for the long haul.

After 16 years as a resident, Zhang was finally promoted to attending physician in 1979.

That same year, Zhang published his first vascular surgery paper on deep vein thrombosis (DVT) of the lower limbs. He detailed effective diagnostic and treatment methods, proposing a comprehensive plan that laid the foundation for the future standardized management of the condition.

Despite this early success, vascular surgery was not a major focus at the time. When the hospital divided into specializations, only two doctors—Sun Jianmin and Zhang—chose vascular surgery. Due to Renji Hospital’s limited resources, Zhang had to conduct his clinical and research work in extremely difficult conditions, operating out of a converted basement ward with basic facilities.

“There, my colleagues and I studied new materials, constantly discussed ideas, and wrote papers. Although it was hard work every day, looking back, that experience was invaluable.”

Soon after, Sun Jianmin left Renji Hospital for a position at Shanghai Ninth People’s Hospital. Other doctors were unwilling to join the new department, and Zhang faced unprecedented difficulties. Fortunately, his work received enthusiastic support from senior experts, including Director Feng Zhuorong of Thoracic Surgery and Director Kuang Yaolin of Surgery. Professor Xu Jingbo, former head of Radiology, provided special support. They often analyzed angiograms together, discussing patient conditions and treatment plans. Professor Xu also offered crucial insights from an imaging perspective and organized radiologists and technicians to conduct “technical research” to improve diagnostic capabilities for vascular diseases. This enabled Zhang’s medical and research work to proceed with greater accuracy and effectiveness.

Gradually, their efforts yielded results. The achievements of Renji’s Vascular Surgery Department began to accumulate, and its influence grew.

“In 1983, a young doctor from Nanjing came to study in Shanghai. He sought out our department and asked if he could observe my clinics, learn angiography techniques, and watch vascular surgeries. I agreed. Before he left, he invited me to an upcoming conference in Xi’an—the inaugural meeting of the Professional Committee of Peripheral Vascular Diseases—and asked me to give a presentation. I happily agreed. Later, I had the honor of being named vice chairman of the committee.”

In 1985, Zhang published a paper on lower limb venous reconstruction surgery. He detailed the surgical steps and postoperative care, proposing a classification-based treatment method that tailored surgical approaches to specific venous conditions. These methods not only effectively treated venous diseases but also improved surgical outcomes and cure rates.

“In 1986, I had the opportunity to study for a year at the Vascular and Organ Transplantation Center in Lyon, France. The trip broadened my horizons and gave me many new ideas I was eager to implement upon returning to China.”

In 1986, Zhang published numerous research findings. He pioneered the classification of peripheral venous diseases in China and demonstrated through research that high-dose anterograde venous angiography of the lower limb, combined with the Valsalva maneuver, was a reliable method for diagnosing deep venous valve insufficiency. These achievements enabled more precise diagnosis and treatment in clinical practice.

Subsequently, Zhang helped establish criteria for assessing the morphology and function of the femoral vein and its valves in Chinese patients and introduced the innovative concept of “relative lower limb venous valve insufficiency.”

In terms of treatment, Zhang used the “femoral vein wall circular narrowing” procedure to treat lower limb venous diseases. This method corrected venous reflux caused by valve insufficiency by reducing the diameter of the femoral vein, thereby alleviating symptoms.

That same year, he also published a paper titled “Progress in Vein Grafting,” which detailed the techniques and advancements in the field and elaborated on its application and advantages in treating lower limb venous diseases.

A year later, the first vascular surgery symposium in China was held in Yantai, where the young Zhang gave one of the four keynote reports: “Diagnosis and Treatment of Cerebral Ischemia Caused by Extracranial Arterial Occlusion.”

“In 1988, Professor Xu Jingbo, Dr. Gu Xiaoping, and I co-wrote the book ‘X-ray Diagnosis and Treatment of Peripheral Vascular Diseases.’ Later, young vascular surgeons told me it was the first book they owned that integrated clinical practice, and they kept it on their desks even when it was worn out. As an author, nothing could make me prouder.”

With his growing reputation, Zhang had more opportunities to participate in academic conferences and sought to conduct more systematic research in vascular surgery.

“At these conferences, I advocated for a discussion style of ‘bold hypothesis, careful verification, and serious response,’ which was approved and recognized by my peers.”

In the 1990s, Zhang developed deeper, more forward-thinking reflections on the state and future of vascular surgery in China.

“At that time, I roughly divided my research into four directions: 1. The mechanism of restenosis after vascular transplantation, exploring it at the cellular and molecular biology levels; 2. The development of artificial blood vessels—we created two generations: the first with endothelial cells, and the second with both endothelial and smooth muscle cells; 3. The application of nanotechnology in vascular surgery; 4. The exploration of gene therapy in vascular surgery.”

Later, in 1993, Zhang participated in establishing the Vascular Surgery Group of the Surgical Branch of the Chinese Medical Association and served as its first deputy leader—a major event for the community. Twenty-five years later, at the National Vascular Surgery Annual Conference celebrating the group’s 25th anniversary, Zhang was presented with its highest honor award in recognition of his outstanding contributions.

As a leader in the field, Zhang began to contemplate the future of vascular surgery in China. In 1998, he published a paper on its current state and future trends, detailing its history, present situation, and future, and discussing strategic plans for its development.

In 2000, Zhang began experimental research on medical nanotechnology. In 2004, he published a paper on the progress and direction of vascular tissue engineering, introducing its basic theories, key technologies, and application prospects.

Facing technological progress and a changing era, Zhang continuously adjusted his strategies. His article, “Exploration·Practice·In-depth Research—The Only Way for Sustainable Development of Vascular Surgery in China,” provided a detailed overview of the innovations and key areas for the field’s future. This article offered important guidance and served as a summary of Zhang’s many years in the field.

“If Chinese vascular surgery and medicine are a grand stage, I am one of its most dedicated actors. The greatness of this discipline will mirror the creativity, vision, and ambition of its doctors. The foundation for a discipline’s development lies in: a solid theoretical base, extensive practical experience, the ability to observe and think, and the perseverance to chase a dream. I believe vascular surgery will be built to even greater heights by the efforts of our younger colleagues. Such efforts have no starting point; a journey of a thousand miles begins with a single step. The pursuit of ideals has no end; the key is persistence.”

Teaching by Example and Ingenuity

To his students, Zhang Baigen is more than a “good teacher”; he is a rigorous and serious mentor with noble medical ethics who has cultivated generations of outstanding vascular surgery talents. He dedicated his life to advancing the field, bringing Chinese vascular surgery to the international stage. He willingly served as a stepping stone, continuously creating opportunities for young doctors on broader academic platforms, ensuring the rich tradition of vascular surgery would be passed down to benefit future generations of patients.

Zhang Baigen placed particular emphasis on his students’ medical ethics, adhering to three basic principles:

“First, in practicing medicine, one must respect and protect life, placing the patient’s well-being above all else. Regardless of a patient’s race, gender, religion, or social status, each person should be treated equally and fairly. Second, respect the dignity and autonomy of patients, protecting their privacy and human rights. Finally, uphold professional ethics and confidentiality. Continuously improve your skills, be conscientious and responsible, and always act with integrity.”

In leading his students, Professor Zhang had his own unique insights.

“Assign responsibility, push them forward, and provide support—this is my basic method.”

Zhang believed that students should be given clear expectations and appropriate pressure to motivate them. At the same time, he would provide support and assistance, like a handrail to steady them as they advance. He encouraged students to bravely shoulder the responsibility of surgical treatment while also teaching them to focus on the fundamentals. As a mentor, he was always there to help them solve problems when they arose.

Today, Zhang Baigen is long retired, yet his days remain busy, and he seizes every opportunity for continued learning.

“I like to say, ‘the past is not like smoke.’ When I retired, I resigned from all my positions, keeping only the identity of a vascular surgeon. I believe being a vascular surgeon is my one true calling and my identity. That identity does not change with retirement.”

For decades, Zhang’s medical career has been like a long poem, chronicling the splendid development of vascular surgery in China. In the story of his life, blood vessels are like intricate paintings or nets. And with the span of his own life, he has healed suffering and composed the masterpiece of vascular surgery in his country.

Message for the 180th Anniversary of Renji Hospital:

"In its 180 years, countless people have found help and healing at Renji Hospital, and we have all witnessed the development and progress of medicine. At this moment, I want to share a few thoughts:

Never forget our founding purpose, and adapt to change as it comes. When facing busy work and various challenges, we must always remember our original mission to serve the health of the people. We must have the courage to take responsibility and uphold medical ethics with the sense of duty befitting a doctor. No matter how the environment changes, we must not stray from the path we have chosen.

Read more, learn more. This is a mission we doctors cannot neglect. In the medical profession, knowledge is our most powerful weapon. A commitment to continuous learning and progress is the attitude we must have. Only by maintaining a pursuit of new knowledge can we keep up with the times and provide better care to our patients.

Honor our legacy and build a solid foundation. As a century-old renowned hospital, Renji has a noble honor and a strong reputation. We must inherit the excellent traditions of our hospital, carry forward the essence of our predecessors’ medical skills, actively promote a spirit of innovation, and drive the progress of medical technology and the improvement of care quality. As a leading hospital in China, we should also actively help lower-level and community hospitals develop and progress.

Remember our mission and our responsibility. As medical professionals, we shoulder the mission of saving lives and alleviating suffering. When facing the test of disease and the choice between life and death, we must prioritize the interests of our patients and always remember our responsibilities and commitments.

No effort in life is ever wasted. In the two vital fields of our medical careers and our family lives, we must give our all and strive for excellence. Whether it is the hard work we dedicate to our jobs or the contributions we make to our families, we must have firm beliefs and perseverance. Only then can we leave truly meaningful and valuable footprints on our life’s journey.

On this 180th anniversary of Renji Hospital, let us join hands in the pursuit of excellence. I wish Renji Hospital even greater brilliance, and may our future be filled with hope and light!"

Editor: Chen Qing @ ShanghaiDoctor.cn

Note: Chinese Sources from “The Path of Benevolent Medicine” which was published in 2024. It records 90 important medical figures in the history of Renji Hospital. Yewen Renyi (ShanghaiDoctor.cn) team was one of the major writers of the book and is authorized by Renji hospital to create English version on the website of ShanghaiDoctor.cn