Chapter 118 The growth history of qualified doctors, abnormalities of surgical patients
Zhou Can was only concerned with putting a plaster cast on the woman. As for her son, no matter how unfilial he was, it was not the doctor's turn to take care of him.
On the first day of internship at Tuya, the instructor warned them that doctors should only do what they should do.
Don't be too righteous and interfere in the patient's family and private affairs.
I also told them that while doctors save lives, they must also learn how to protect themselves.
Zhou Can didn't understand the advice from his teacher at that time.
I even wonder how such a selfish person could become a teaching instructor?
It was not until later, after his own experience, that he realized that the advice given by his instructor was all good advice. Zhou Can still remembers the first time he meddled in other people's affairs, when a young woman in her twenties was injured and hospitalized.
It was obvious that he was beaten.
But she said it was a fall injury, and the doctors who treated her, the nurses and doctors in charge of her, did not interfere.
Zhou Can just didn't understand why she lied.
There was no attempt to intrude into the patient's privacy.
Until that evening, he was on night shift.
The woman's husband was unexpectedly discovered in the ward, and he slapped her twice and punched her on the head.
She was sitting on the hospital bed crying.
When Zhou Can saw this, he was furious.
I finally understood how the woman got injured.
He rushed into the ward to stop the man from continuing to attack. The man was very arrogant and warned Zhou Can not to meddle in other people's business, saying that this was his family matter. Zhou Can did not tolerate him and angrily accused him of beating his wife, which was illegal.
The man got angry and pushed him.
Zhou Can did not tolerate this man. He had practiced Sanda before, so he knocked the domestic violence man to the ground with one move.
Now the matter has become a big deal.
The woman cried and asked Zhou Can not to hurt her husband.
The man called the police.
The senior doctors in charge of the ward and the heads of hospital departments were all alarmed.
The facts were clear enough. But when the police questioned her, the woman sided with her husband, saying that Zhou Can was meddling in other people's business and was the first to hit her husband. The man even threatened to put Zhou Can in jail.
At that time, Zhou Can's heart was bleeding.
It is clearly about doing good things, upholding justice and helping the weak.
But the woman not only refused to appreciate it, but also turned the tables and framed Zhou Can together with her husband.
When a doctor beats a family member, the impact is extremely bad.
Paying money is a small matter, but you will definitely be punished by the hospital.
Fortunately, a family member in the ward recorded the scene and secretly handed it to the police afterwards, so the truth of the matter was restored.
Zhou Can was not punished and did not have to pay any compensation.
But there is no praise either.
Instead, he was called in for talks by the department director and the teaching teacher, who criticized him.
That incident left Zhou Can with an unforgettable memory.
Since then, he has never meddled in other people's affairs again.
In the process of seeing patients, he learned little by little how to protect himself.
The signature must be made by family members.
Never promise a patient or their family anything that you cannot agree to just because you are overwhelmed with sympathy.
This is a qualified doctor.
…
Under the guidance of Dr. He Zhang, Zhou Can successfully put a plaster on the female patient's left arm.
This was the first time he had completed a cast independently.
Not particularly well done.
Finally it was completed successfully.
He also earns 1 experience point.
According to Dr. He’s instructions, after applying the plaster to the patient, he or she should be observed for about twenty minutes to confirm that there are no abnormalities before leaving.
While waiting, Zhou Can couldn't help but look at the patients in the nearby beds.
There are both male and female patients, and quite a few young people as well.
Some have already had surgery and need to stay in the hospital for a while, while others are waiting for surgery or are lying in traction in agony.
Zhou Can's gaze finally fell on a bed next to him.
The patient was a middle-aged man in his forties, sleeping with his eyes closed. Compared with other patients, he seemed particularly quiet.
A haggard middle-aged woman lay on the bed, looking at her sleeping husband with a sad face.
When disaster strikes, spouses, parents, and children are the three most reliable relatives.
This middle-aged couple has elderly parents and young children.
The pillar of the family.
The sudden collapse of a middle-aged man is almost catastrophic to the family. The woman must be worried about what to do if her husband cannot recover.
Not only can the patient not earn money during hospitalization, but he or she also has to spend a lot of money, which is undoubtedly adding insult to injury for the family.
"He was hospitalized because of a car accident. His lower leg was crushed and fractured. I heard that his tibia was a dislocated fracture and part of the tibia was comminuted. The operation took a full eleven hours. I guess the bones, blood vessels, and nerves all needed to be anastomosed and connected. He was released from surgery at around five this morning."
Dr. He Zhang carefully introduced the patient's condition to Zhou Can.
"Doctor Zhou, there is nothing for you to do right now. How about this, you first check the conditions of the patients in the ten beds. You may need to be on duty tonight."
The exploitation between doctors is just like what happened to Dr. He.
Senior doctors will assign some of the chores, dirty work, and tiring tasks to junior doctors. Night shifts are very hard, and this task is basically done by resident doctors and interns.
For a large department, it is considered good if there is an attending physician on night shift.
The intensive care unit is not included.
If an accident happens to a patient there, someone could die if correct first aid is not given within a few seconds.
For example, some patients’ blood oxygen levels drop sharply, or their heart suddenly stops beating.
This is also why novice nurses and doctors are not qualified to work in the intensive care unit.
Because it really tests the ability of doctors and nurses to deal with various emergencies. This requires rich experience, solid medical knowledge, and skilled rescue skills to support.
The intensive care units of almost all hospitals are staffed by the hospital's elite medical staff.
Faced with Dr. He's exploitation, Zhou Can actually had no room for bargaining.
Just obey.
Zhou Can learned about the condition of the patients in each bed.
Patients and their families generally have a cold attitude towards young doctors like him.
These days, family members and patients are very savvy.
When the director and attending physician made their ward rounds in the morning, they were surrounded by people. They knew that the people in charge had arrived.
Everyone shows a fawning smile and their attitude is very enthusiastic.
Answer whatever you ask.
After Zhou Can checked on the patients in the ten beds, Dr. He, who was in charge of the patients, had already left.
The attending physician needs to prescribe medical instructions for the patients, check the medical records written by interns and residents, write his own summary, report any abnormal conditions of the patients to the senior doctors in a timely manner, etc.
They have a lot of things to do.
Sometimes when a patient has an emergency, the nurse or intern calls him and he immediately has to run over to check and handle the situation properly.
Zhou Can returned to the bedside of the female patient with a plaster cast and checked the plaster.
The plaster has set.
It feels relatively hard.
The female patient was still groaning and shouting that she was going to die.
Her son was only concerned with the games on his phone. He neither asked the doctor when to schedule the surgery nor asked the doctor to give his mother a painkiller injection.
Zhou Can shook his head and looked at the middle-aged man on the bed next to him who had just completed surgery.
At this moment, the middle-aged man was still sleeping with his eyes closed.
Judging from his blinking eyelids and the occasional movement of his head, he was probably not asleep.
"Is he okay? Did he feel any discomfort after the surgery?"
Zhou Can was just asking out of habit.
When he was an intern in charge of the patient's condition, he was equally responsible.
As long as it was a bed he was in charge of, he would go over to check on it from time to time and take the initiative to ask about the patient's condition.
"Everything else is fine, but my husband always complains about a little swelling and pain in his left leg."
She responded to Zhou Can.
"Generally speaking, it is normal to experience swelling, pain, numbness, etc. right after surgery. Don't worry too much."
Zhou Can comforted the family members.
"Doctor, I feel like there's a big bug pushing against my leg. It's really uncomfortable."
The man opened his eyes.
His eyes were bloodshot, probably because of the long period of poor sleep and the injury that had severely damaged his vitality.
The overall mental state of the person is also quite bad.
"Let me check it for you."
Zhou Can lifted the quilt and checked the man's legs. The part that had been crushed had already been operated on and was wrapped in gauze.
This is to prevent the wound from becoming infected.
The specific surgical plan is unclear, but it is certain that the broken bones must be connected. Adding steel plates or steel nails are all possible. Blood vessels, nerves, and tendons all need to be anastomosed and repaired.
Damaged muscle needs to be cleared.
You can imagine how complicated this operation is.
Below the surgical site, the patient's ankles and feet have more wrinkled skin, and the color is much paler than the knees and thighs above the surgical site.
But there is a certain bloodiness.
This means that blood circulation should be fine.
At most, I just had surgery and my blood circulation is a little poor.
Zhou Can touched the patient's right foot and found that the temperature was OK, slightly lower than normal body temperature.
It seems that the operation was successful.
After the operation is completed, if there is no problem with blood circulation and the body temperature of the severed limb can be restored, the patient can basically survive.
"Can you feel it when I touch the back of your foot?"
Zhou Can asked the patient.
"Yes! It's just a little numbness." the patient replied.
Zhou Can nodded and stared at the patient's ankles and other parts carefully.
There are some purple patches, hidden under the skin.
It's a bit like the subcutaneous veins.
That’s what Zhou Can thought at first.
But when he tried to touch the patient's ankle, he felt it was noticeably stiff.
Based on my experience, this is the feeling associated with edema.
"In general, everything is going well. Your ankle seems to be swollen. I will come to check on you every two hours. Please rest assured."
Zhou Can said to the patient.
Postoperative edema is related to many factors.
It can be both normal and abnormal.
Further observation is required depending on the duration of edema.
Zhou Can felt that the patient's condition should be reported to the attending physician.
He walked towards the doctor's office.
Along the way, he was thinking about the middle-aged man's left leg, which had edema near the surgical end and faint purple spots on the inside of his ankle.
What does this indicate?
The operation was obviously successful.
The blood circulation is smooth and the temperature of the feet is also good.
This kind of situation cannot be learned from medical books. You can only diagnose and think for yourself.
During these three months in the emergency operating room, Dr. Xu gave him a lot of guidance.
Plus the accumulated surgical experience.
Zhou Can's diagnostic skills have improved significantly compared to the past.
"The distal limbs have necrosis due to prolonged ischemia?"
It is possible.
The phenomenon of gigantism and livor mortis after death both correspond to the edema and purple spots at the distal part of the patient's left limb.
Moreover, ischemic necrosis is difficult for doctors to detect in a short period of time.
Dr. He is checking the medical records written by the intern.
Whenever he found a problem, he would point it out immediately.
The intern nodded humbly and wrote down the parts that needed to be modified one by one.
At the beginning, Zhou Can was scolded a lot because he didn't write medical records well.
After waiting patiently for Dr. He to finish instructing the intern, Zhou Can said, "Dr. He, I noticed that the patient in bed 120 had some abnormal reactions after surgery."
"What's wrong?"
Dr. He was startled, his face full of tension.
"During the interrogation, I learned that the man kept complaining about leg pain, as if a big bug was crawling around inside him!"
After hearing Zhou Can's reaction, Dr. He's expression calmed down a little and he breathed a sigh of relief.
This new intern was so jumpy and frightened that he was scared to death.
"His leg was run over by a car and was already badly damaged. It's normal to have swelling and pain after surgery. Tell the patient that it will get better in two days."
Dr. He explained.
"When I examined the patient, I found edema and mild purpura proximal to the surgery."
Zhou Can continued to report his findings.
With his diagnostic ability, he was certain that the patient was definitely abnormal.
"I'll go check it out! Is the edema serious?"
Dr. He did not dare to be careless and decided to go and take a look in person.
"The swelling is mild, but I predict this is just the initial stage. It will probably get more swollen later."
Zhou Can has performed two severed finger replantation surgeries.
Although finger replantation cannot be compared with the 120-bed patient, the principle is the same.
Swelling at the site of the severed limb is a very bad sign.
It often indicates failure of the operation.
Out of curiosity and a desire to learn, two interns also went over to check it out.
In order to improve the level of doctors, in addition to reading more books and practicing more skills, they also need to constantly accumulate experience in dealing with these abnormal situations.
The four people came to bed 120, and the patient and his wife saw four doctors coming at once.
He couldn't help but nodded towards Zhou Can with gratitude.
This means that the young doctor reported the situation to his superiors.
Patients and their families like this kind of responsible doctor.
"Are you okay? I heard you reported pain and swelling in your legs?"
Dr. He asked the man on the bed.
"It was swollen and painful, and a little sore, and quite uncomfortable."
The man responded truthfully.
Dr. He nodded, lifted the quilt, and carefully examined the man's leg that .
Tuya's safety mechanism and responsibility mechanism are there, and no doctor dares to neglect his duties or take it lightly.
After all, being a doctor at Tuya Hospital is a very rewarding job. If you mess up, you’ll be destroying your bright future.
"It shouldn't be a big problem. The upper part of the surgery is normal, and there is slight edema near the surgery site at the lower part. As for the subcutaneous purple spots, this is quite common. It is usually mild congestion under the skin. Judging from the flesh color and the temperature of the feet, the possibility of muscle necrosis is small."
Even though Dr. He is just a resident doctor, his skills are really good.
Their experience and diagnostic abilities are even better than those of the attending physicians at municipal hospitals.
The more famous the hospital, the larger its medical volume, and the more knowledge and experience the doctors will have.
A surgeon from a municipal hospital admitted this.
He has mastered liver surgery and is fully capable of performing this type of surgery. However, only a few patients come for liver surgery every year. Some patients even run away from their hospital when they hear that they need liver surgery.
All patients with any serious illness go to big hospitals.
Don't go into their hospital at all.
The scale of the city-level hospital is actually not small, it is already a large hospital. Even this level of hospital has a hard time accepting patients, and the county-level hospitals and district hospitals below it have an even harder time accepting patients who need major surgeries.
Not being able to receive patients means no chance to practice.
Surgical and diagnostic capabilities cannot be improved, and experience cannot be accumulated.
The ultimate result of this vicious cycle is that super-large hospitals become increasingly powerful.
Small and medium-sized hospitals are becoming increasingly weak.
After listening to Dr. He's observations, Zhou Can still felt that it was not that simple.
He frowned, thinking hard.
You only regret not having read enough books when you need them.
He only regretted that his medical knowledge was not profound enough and his diagnostic skills were not strong enough.
You know something is wrong with the patient, but you just can’t figure out what the problem is?
