Chapter 127: Doctor Chi wants to poach people
A broken right thumb and an intact X-ray of the right foot bones.
He couldn't help but be shocked.
Could it be that... when Director Shen said about reconstructing a thumb for the patient, he meant to amputate the big toe of the right foot and transplant it to the thumb position of the patient's right hand?
This ingenious idea of transplanting flowers and trees is really a brain-opening idea.
Only an ordinary person could think of such a trick.
In ancient times, those who built palaces for the emperor were called skilled craftsmen. Modern doctors are actually worthy of this title.
Although this idea is bold and ingenious, it is very difficult to transplant.
At least that's how Zhou Can understood it.
Replanting a severed finger is relatively easy because the size, tissue location, and distribution of the severed finger are consistent with the fracture site.
Blood vessels, tendons, nerves, finger bones, and even skin can all be perfectly connected.
However, there is a big difference between the big toe of the right foot and the big thumb of the hand.
How do I answer this?
If the operation fails, the patient will suffer great loss.
Not only did he lose his right big toe, which disabled his otherwise healthy right foot, but he also had to bear high medical expenses and the pain of surgery.
That would really be asking for trouble.
"Transplanting a toe to a hand toe is extremely difficult and risky. This is the first time I've seen this kind of surgery in my life!"
Doctor He said, rubbing his hands excitedly.
"Toe-to-thumb surgery is a real level 4 surgery. Do you think it can be easy?"
Doctor Shan is not much older than him.
The attending physician is the attending physician, and he has much more knowledge than him.
"We doctors need to be brave enough to take on challenges and be innovative. Toe-to-thumb replacement surgery has been successfully performed in two major hospitals in Shanghai. As long as the operation is done carefully, meticulously and rigorously, the success rate should not be too low. I have already discussed with the patient the risks of a failed operation, and he said he was willing to give it a try."
Director Shen subtly guides the thinking of his doctors.
To establish good medical ethics and medical practice concepts for them.
An excellent chief physician can lead an excellent team. In addition to their excellent technical skills, their noble medical spirit can also influence generations of people.
"This operation has many difficulties that need to be overcome. It is difficult for me to complete it alone. Doctor Shan is good at microsurgery such as vascular anastomosis and nerve anastomosis. The anastomosis of blood vessels and nerves will be left to you. Doctor Chi is an expert in tendon reconstruction and repair, so this will be left to you. I will be responsible for amputating the patient's toes , then making an incision at the missing position of the patient's right thumb, connecting the toe bones with the thumb bones of the hand, and subsequent skin flap repairs."
Director Shen made a division of labor for the surgery.
"During the toe amputation process, a resident is required to stop the patient's bleeding, repair the wound on the foot, and suture it. Which of the residents under you two is qualified for this job?"
Even among doctors in the same group, there is competition.
Dr. Shan and Dr. Chi are both excellent, but it is not enough to just be excellent.
If the residents you supervise are also excellent, you can get a lot of extra points.
"My subordinate Yang Fuhai did a great job in stopping bleeding, and Dr. Gandhi was great in wound repair. It should be very safe for the two of them to undertake this task together."
Dr. Chi acted quickly.
He directly helped his two residents to grab the training opportunity.
"My subordinates, Doctor Tang and Doctor He, are actually quite good. The trainee Doctor Zhou is equally strong." Doctor Shan lags behind Doctor Chi in both qualifications and ability.
She had no way of snatching the opportunity to practice surgery from the other party.
I could only help the doctor weakly and grunt a few times.
"The wound after toe amputation is more complicated to deal with. The two residents under Dr. Chi have more surgical experience. They will handle it this time. The doctors under Dr. Shan will be given other training opportunities later."
Director Shen ultimately chose two residents with more surgical experience.
Doctors Yang and Gan looked at each other and smiled.
Doctor Tang and Doctor He looked gloomy.
The patient was quickly taken to the operating room and given inhalation general anesthesia for safety reasons.
The anesthesiologist monitors the patient's vital signs throughout the process.
The operation began quickly.
Follow the plan.
After Director Shen amputates the patient's toe, he processes it and then refrigerates it.
Then the surgery for the next transplant began at the patient's right thumb.
Doctors Yang and Gan have already been busy.
The patient's foot wounds were treated with a number of procedures including hemostasis, bone grinding, and nerve closure.
Both of them are senior residents who have received a lot of training in the operating room and their surgical skills are quite strong.
Dr. Yang's ability to stop bleeding should have reached the mid-level of a resident doctor.
It seems to be very close to the excellent level of a resident doctor.
But there is still a little bit to go.
Dr. Gan’s debridement skills are also excellent, barely approaching the excellent level of a resident doctor.
No wonder Dr. Chi is so confident in these two men.
Compared with these two, Dr. Tang, who worked under Dr. Shan, was far inferior. As for Dr. He, he was even worse.
At the beginning, Dr. Yang did a very good job of stopping the bleeding, and Dr. Gan also did a good job of debridement.
But problems soon arose.
When Dr. Gan was cleaning the wound, he opened the ligated blood vessels again.
Then I found that nerve closure was not easy to do.
What’s even more terrible is the stitching.
The wound was not deep enough, the wound surface was too wide, and the skin on both sides could not be pulled together.
One wrong step, all wrong.
The two doctors were in a panic and almost got into a fight.
The patient's thumb was cut off but there was an artery inside. Blood was splattered everywhere.
Both Dr. Yang and Dr. Gan had a lot of spray on their clothes.
There were even some bloodstains on Dr. Gan's face.
Director Shen frowned when he saw this scene.
Dr. Chi helped his doctors to smooth things over.
"This may be the first time they have independently treated this type of limb injury, so they are somewhat inexperienced."
"Teacher, can I let Dr. Tang and Dr. Zhou Can take over and give it a try? I think Dr. Yang and Dr. Gan are really inexperienced. Their surgical protective suits are about to be stained with new patterns!"
Dr. Shan took the opportunity to strike again.
A humorous metaphor that vividly points out the embarrassment of the two people.
Dr. Yang and Dr. Gan couldn't help but blush.
They were all experienced senior residents, but because of poor coordination and insufficient foresight, they made a mess of the situation.
"Everyone should be given equal opportunities. Let Doctors Tang and Zhou have a try! Otherwise, Doctor Shan will accuse me of being biased!"
Director Shen couldn't bear to watch this anymore, so he agreed to Dr. Shan's request.
He also wanted to take this opportunity to see Zhou Can's surgical skills.
Rumors are just rumors after all. Only by seeing it with his own eyes can he know for sure.
I witnessed Zhou Can's separation level with my own eyes yesterday, it was truly amazing.
"Dr. Shan asked a resident and a trainee to take over. This is an interesting arrangement!"
Doctor Chi looked at Zhou Can who was walking out.
He had a good understanding of Dr. Tang's abilities.
What made him curious was that Dr. Shan did not let Dr. He, who had poor surgical skills, do the operation, but instead let a resident trainee do it. This arrangement must have a deep meaning.
This shows that she has great confidence in this trainee named Zhou.
Dr. Chi also heard someone say these days that a very strong resident student came to the orthopedic surgery department.
But according to his thinking, how strong can the trainees be?
Soon, Zhou Can showed him how strong the surgical skills of the interns were.
After Zhou Can took over, he immediately bandaged the patient's heel.
The bleeding stops immediately.
Then he calmly used forceps to clamp a severely contracted blood vessel, stretched it, and tied it with one hand at the deep . The whole process was skillful and confident.
After dealing with this blood vessel, deal with the second one.
"Doctor Zhou, why was it that Dr. Yang was able to ligate these blood vessels smoothly at first, but later the debridement caused the blood vessels to become loose, making it very difficult to ligate them again?"
Dr. Tang really doesn't hesitate to ask questions.
Zhou Can's actions left him stunned.
Everyone worked under Dr. Shan, and Zhou Can performed well, so he also benefited from it.
Although Dr. Yang blushed, he was very curious about the answer to this question.
"The human body's blood system has a self-protection mechanism. For example, if this blood vessel is broken or ruptured, it will start bleeding. At this time, the body will control the blood vessel to continue to contract and shrink in order to stop the bleeding. Not to mention such small blood vessels, even some large arteries will be extremely unfavorable for treatment if they are left for too long."
Zhou Can explained the reasons in detail.
Dr. Yang's hemostasis and ligation abilities can only be considered relatively strong.
There may be no problem in treating blood vessels with fresh wounds.
However, when Dr. Gan was cleaning the wound later, the ligature on the blood vessel loosened or the blood vessel was directly severed again.
It will be much more difficult to get a vasectomy.
Because at this time, the blood vessels have retracted and become smaller.
After listening to this, Dr. Yang was greatly enlightened.
At the same time, he saw that the blood vessels that were very difficult for him to handle were like a piece of cake in Zhou Can's hands.
His skills in hemostasis and ligation are obviously much better than his.
This level is not even weaker than Dr. Chi.
A trainee is better than the attending physician?
He subconsciously turned his head to look at Dr. Chi beside him.
Then I saw Dr. Chi's eyes widened, and if he wasn't wearing a mask, his mouth would probably be wide open.
Dr. Chi was probably also shocked by the surgical skills Zhou Can displayed.
Mumble!
He swallowed hard.
"Doctor Shan, where did you find such a talented intern? No wonder you asked him to treat the patient's wound together with Doctor Tang."
"Haha, now you know how powerful he is! Who told you not to take on the trainee students? This time I got a great bargain."
The two residents under Dr. Shan are no match for the doctors under Dr. Chi.
Now with Zhou Can, things are different.
One trainee can beat two.
Zhou Can quickly treated the blood vessels and nerves and looked at Dr. Tang.
"Leave the debridement to me, and you take care of the bone grinding, okay?"
"no problem."
The biggest advantage of Dr. Tang is that he does not fight for credit and is always willing to let newcomers perform.
Zhou Can cleaned the patient's foot wound.
It was really merciless. Some excess meat, tendons and other tissues should be cut off without leaving any part.
Finally, an inward-looking wound shape is formed with a concave middle and the epidermis preserved on all sides.
[Wound cleaning experience +1. ]
It's really not easy to earn this little bit of experience.
[Congratulations on reaching level 4 in debridement. Your current experience value is 1/10000, and your attending physician is of lower level.]
This medical skill has finally been promoted to the level of attending physician.
It's really not easy.
Relatively speaking, debridement is used quite often. For every 1,000 level 1 surgeries, there are about 350 debridement opportunities.
It’s a pity that you can only gain 1 experience point each time you clean the wound.
Unlike medical skills such as injection, hemostasis, suturing, and ligation, one operation can earn more experience points.
After this medical skill was upgraded, he was pleasantly surprised to find that his ability in wound cleaning also improved significantly.
For example, for the same wound, he can now predict how to clean the wound, which is more conducive to suturing and wound healing. He can even predict whether the wound is prone to infection and whether it will have a serious impact on the patient's life after healing.
Everyone can have a clear prediction.
In addition, when dealing with nerves, blood vessels, important organ tissues, and tumors during debridement, we have a more comprehensive understanding.
The handling method will also be more perfect.
For example, for this wound that had already been treated, his debridement skills were upgraded to level four, and his cognition improved.
It was easy to find some areas where we were not doing well.
Some repairs were made to the wound.
Take that nerve for example. Previously, we only considered how to shut it down. We knew almost nothing about the effect of the wound healing on the nerve.
Looking at it now, he could clearly see that after the wound healed, as long as he walked in shoes, the toe bones would continue to compress and stimulate this nerve.
It will definitely have an impact on the patient.
So he improved it and moved it to a proper position, with the protection of an extra layer of fat and a cushion, so there would be no problem.
This is just a processing detail.
But it fully demonstrated that his debridement skills have been greatly improved.
Sometimes, the difference between the level of the director and the attending physician may be just a hair's breadth.
But in surgery, this slight difference may lead to a huge mistake.
For example, in tumor removal surgery, after the tumor was completely removed, there was a small hidden danger left near the nerve. His ability was limited, so he didn't dare to cut it.
The director completely eliminated the hidden danger.
The difference between the two seems to be just a little bit, but the prognosis is worlds apart.
If the main treatment is not completely cleared, the tumor cells will metastasize, which may cause the patient to relapse quickly.
The surgery performed by the owner completely cleaned up the disease. The patient will not have a relapse and will be able to live a healthy life.
The higher the level of medical skills, the smaller the gap.
It is often reflected in the details, just a difference of a millimeter.
Zhou Can was really happy when his debridement skills were promoted to level four.
"Doctor Tang, I'll leave the bone grinding to you! Grind it to about this position. It would be best if you could round the front end of the toe bone a little bit."
This is done so that after the patient's wound heals, the bones will not pierce the skin and flesh due to their sharp edges.
"OK!"
Dr. Tang is a senior resident in orthopedic surgery after all, so he should have no problem grinding bones.
It was polished very quickly.
"Doctor Zhou, how are you? Is there anything else you need fixed?"
“Excellent grinding!”
Zhou Can gave a thumbs up and checked the wound, saying it was fine. He then began to sew up the patient.
He sutured the patient's wound into a duckbill shape.
This is also a common suture method for amputation wounds.
Being able to perform medium-level suturing and medium-level ligation, as well as being able to perform lower-level debridement, and to treat wounds well is enough to give a high score.
After the suturing was completed, he did not report to Dr. Shan or Director Shen.
Instead, he gave Dr. Tang full respect without any arrogance.
"Doctor Tang, is this all right?"
He performed most of the work in the operation, but in the end he asked for instructions from Dr. Tang, who was not as capable as him.
This also won the favor of Dr. Tang.
No one would refuse to deal with someone who is as kind as a spring breeze.
"I think it's stitched very well."
Dr. Tang's face was all smiles.
"Doctor Shan, please help us check if there is anything that needs to be improved in the suture of the patient's foot wound."
Doctor Shan is currently watching Director Shen building the transplant interface.
Hearing this, he came over and checked it carefully.
"You two did a great job of sewing! After the operation is over, I'll ask Director Shen to take a look." She was extremely satisfied with the performance of Zhou Can and Dr. Tang.
It earned her enough face.
Normally, when have his doctors ever defeated Dr. Chi’s doctors?
Today is the only time.
It’s also the first time.
"Damn, the stitches are so perfect, I would never believe he is just a trainee."
After seeing it, Dr. Yang and Dr. Gan were deeply shocked.
Today I have really opened my eyes.
It is true that there is always someone better than you.
Zhou Can surpassed them in not only one medical field, but in multiple fields, almost completely.
This made both of them feel quite frustrated.
"Doctor Shan, let's make a deal. I usually perform a lot of surgeries, so how about letting Doctor Zhou practice with me?" Doctor Chi saw how outstanding Zhou Can was and immediately thought of him.
When it comes to the attending surgeon level, he or she often performs surgery alone with an assistant.
Their income is also linked to the commission from surgery.
In addition, when evaluating deputy directors, academics are a very important factor. The cumulative number of surgeries, the quality of surgeries, and the difficult surgeries that have been completed are all very important evaluation criteria.
Dr. Chi should be considered a senior attending physician and has already begun working towards the title of associate senior professional.
Having a strong assistant will be of great help in his evaluation for the rank of associate senior professor.
