Chapter 128 Director Shen's Advice, Growth in Orthopedics
"It's no use asking me about this. We need to listen to Dr. Zhou's opinion and Director Shen's opinion."
Dr. Shan certainly doesn't want to give up Zhou Can, a talent like him.
If I flatly refuse, I will offend Dr. Chi.
She cleverly passed the ball to Zhou Can and Director Shen.
Generally speaking, the trainees themselves do not have much say in who they follow.
Trainee students with less ability have to use backdoors and give gifts in order to be assigned to a slightly better teacher.
The people who really have the decision-making power are the department director and the deputy director and chief physician within the department.
In order to save trouble, some departments will directly appoint a teaching team leader.
That person has a lot of power.
"Thank you, Dr. Chi, for your kindness to me. A tree never forgets its roots, and a person never forgets his origins. If I have to choose, I'd rather follow Dr. Shan."
Zhou Can has never been a person who forgets his roots.
Dr. Shan took great care of him and he could feel the kindness.
For him, three months of orthopedic surgery training was too short. Following a chief physician with whom he had a certain level of trust, he would have more opportunities to practice.
At this moment, if he did not choose the more powerful Dr. Chi but Dr. Shan, it would definitely deepen this trust.
"Haha, it's just a joke, Dr. Zhou, don't take it seriously. I didn't expect you to be so grateful."
After trying it out, Dr. Chi saw that this was not possible.
Just laugh it off.
It can be seen that although there is competition within the group, it is generally united.
At this time, Director Shen has preliminarily completed the construction of the bone interface at the implant site.
"Come and watch carefully and learn! I chose this position for the bone connection. It preserves his original thumb joint to the greatest extent. This will be very beneficial for the recovery of finger function after the successful operation."
Zhou Can also came forward to watch and learn carefully.
This type of level 4 microsurgery has extremely high technical requirements in all aspects.
There is a lot to learn.
"We have solved the problem of bone tissue docking. We also need to solve many problems such as flap coverage, tendon, nerve, arteriovenous blood vessel connection. In particular, this patient has congenital malformation and thumb is missing. Because it has been many years, there may be tendon, nerve, blood vessel contracture or missing. "
This type of surgery has greater unknown risks during intraoperative exploration.
The difficulty of the operation also increases exponentially.
It is a great test for doctors.
"For bone connection, you can refer to the replantation of severed fingers. Generally, bone connection and internal fixation are used."
Director Shen skillfully connected the toe bone with the phalanx of the patient's right thumb.
"In the future, when you encounter similar surgeries, you can make a judgment based on the patient's hand phalanges. In this case, if the first phalanx of the thumb is intact, then you can amputate the big toe of the right foot. If the phalanges are severely missing, you can consider amputating the second finger next to the big toe (ring finger?)."
Director Shen patiently explained while setting the bone.
There are different transplantation methods for different situations.
"Doctor Chi, you will be the one to do the tendon reconstruction! Feel free to ask me if you have any questions."
After Director Shen completed the bone setting and checked that everything was correct, he gave up his position as the surgeon.
Almost all surgeons only perform the most critical part of the operation, and the rest of the operation is left to other members of the surgical team.
This is why directors like to bring in talented junior doctors.
Generally speaking, the better the talent, the higher the success rate.
After bringing up the apprentice, being a master can be much more relaxed.
Especially for a major operation, it is almost unimaginable that the surgeon has to complete it all by himself.
A physician who is qualified to perform level three or above surgery must be at least deputy director level.
The age is generally older.
Their energy and physical strength are no longer as good as those of young men. They no longer have enough energy and physical strength to complete all the steps of the operation.
Letting apprentices share the worries is the most ideal way.
Director Shen specifically gave Dr. Chi this opportunity to exercise and reconstruct the tendon.
We also intend to cultivate Dr. Chi’s surgical capabilities in this area.
After Dr. Chi took over, he began to look for the tendon and then tried to find a way to connect it.
When he encountered something he didn't understand, he would ask Director Shen for advice in a timely manner.
It was even operated by Director Shen himself.
Zhou Can stood by and learned silently. Some surgical techniques and how to deal with various problems were very valuable core technologies. It was a great opportunity for him to be able to learn from him.
Jin Mingxi worked hard to get into Tuya as a regular trainee just for the opportunity to learn core technologies.
…
The operation lasted nearly four hours.
The difficulty is beyond imagination.
Finding and reconstructing tendons is extremely difficult, especially the loss of the flexor tendon, which almost brought the operation to a halt.
The subsequent nerve anastomosis is also extremely difficult.
Doctor Shan was very good at delicate surgery, but the process of anastomosing those nerves almost made her collapse.
In the end, it was Zhou Can who managed to successfully connect two nerves.
This is because Zhou Can has a talent for neural matching.
Otherwise, I'm afraid Director Shen will have to .
The subsequent vascular anastomosis is equally difficult.
It is extremely difficult to suture a blood vessel with a diameter of one millimeter under a microscope.
There are also cases where the blood vessels that need to be anastomosed are not the same size.
These all need to be solved.
The final flap coverage was also fraught with difficulties.
Fortunately, the whole team worked together and after some hard work, they finally completed the operation.
The next step is to bandage the finger and observe the blood circulation after the transplant.
After the blood circulation, the nails of the fingers have a hint of blood color.
But the overall look is still a bit dry.
This is a normal phenomenon. After one or two days, if the transplant is initially successful, the color of the finger will become rosy, turn pale when pressed, and rebound and quickly return to rosy after release.
This means that the capillaries are filled with fresh blood.
Otherwise, there is a problem with blood circulation.
Just like the patient who had four severed fingers replanted when I was doing the ward rounds in the morning. His fingers were pale and it was obvious that there was something wrong with them.
It takes about a week to determine whether the transplanted finger survives.
If after one week, the fingertips are red, warm, plump, and the capillaries respond well to pressure, it means the graft is successful. If they are black, shrunken, or even infected, it means the graft has failed.
Must be dealt with immediately.
It must be said here that the sooner the necrotic limb is amputated, the better.
Otherwise, necrotic limbs or body tissues will produce a large amount of toxins, harmful substances, and bacteria, which will invade the human body through the blood.
At that point, it’s unclear whether you can save your life.
A city-level hospital performed a lower limb artificial vascular bypass surgery on a patient. During the surgery, the chief surgeon was away on business and was irresponsible in various ways. They shirked responsibility in every way regarding the patient's demands and responses, and in the end, the patient's life could not be saved even after a high-level amputation.
Doctors who neglect their duties and treat patients' lives as a joke should be banned from practicing for life.
Unfortunately, in this case, the patient's family members sue the hospital and usually get a compensation.
That doctor continues to wreak havoc on the world.
"Okay, we can give the patient anesthesia now!"
Director Shen said to the anesthesiologist.
"I have to go to the outpatient clinic this afternoon and go to school. You two can lead your teams to continue the surgery. This Class 100 operating room will have other arrangements this afternoon, so let's leave! Let's go eat and take a rest first."
Looking at his two favorite generals, Director Shen made arrangements for them.
The professor who leads a group should be one of the busiest doctors.
Attending meetings, presiding over surgeries, making ward rounds, teaching, conducting research, giving classes, seeing patients...their time is often fully scheduled.
At the level of Director Shen, each one of them is a treasure of the Chinese medical community.
"Xiao Zhou, you did a good job today. I specifically looked at the treatment and suturing of the patient's foot wound. This fish-mouth suture is a very good choice. The suturing technique and knotting are impeccable. Who is your instructor in the emergency department?"
Director Shen's eyes fell on Zhou Can's face.
"Doctor Xu!"
In Zhou Can's mind, Dr. Xu is his only master.
Director Shen nodded. "I guessed a little bit. Doctor Xu was once one of the three famous surgeons in our surgery department. With him teaching you, it's no wonder that your surgical skills are so outstanding. It's no exaggeration to say that except for your experience, your surgical skills are no weaker than those of the attending physician. Even some attending physicians with poorer surgical skills are far inferior to you."
This evaluation is a bit high.
But it's still fair and true.
Zhou Can really has that ability now.
"Xiao Zhou, please don't mind if I say something unpleasant."
Director Shen looked at him with a sincere gaze and tone.
"Please go ahead and talk. I'm all ears!"
Zhou Can knew that when someone at Director Shen's level spoke, everything he said was from the bottom of his heart and based on his experience.
It's because I see that he has talent and his performance is outstanding that I'm willing to tell him these things.
"When I saw you separating blood vessels yesterday, you looked like Dr. Xu back then, and your style was very similar. Do you know how Dr. Xu fell from being one of the three most famous surgeons to being the chief surgeon now?"
"I know a little bit. Back then, Dr. Xu performed surgery on a patient and a medical malpractice occurred, and he was eventually punished."
Zhou Can didn't know much either.
"Back then, Dr. Xu's knife was too fast during the operation, and his hands were faster than his brain, which almost killed the patient. Later, the top chief physicians from multiple departments of the hospital tried their best to save the patient's life. However, the patient is paralyzed forever and cannot take care of himself. He is like a vegetable."
"The patient's identity was not simple. The incident caused a big stir at the time. The higher authorities wanted to impose the maximum penalty on Dr. Xu, banning him from practicing medicine for life, revoking his medical license, and putting him on the industry's banned list. Later, several hospital leaders and a big shot who had been saved by Dr. Xu stepped in to mediate, and he was saved."
"Your knife speed is so fast, which is particularly worrying. I'm really afraid that you will follow his old path one day."
Director Shen said earnestly.
"Your talent is stronger than any genius I have ever seen. Talents like you, as long as they are properly trained and continuously improve themselves diligently, will definitely be able to become the pillar of our Tuya in the future. As for your low education, that is nothing at all, there are many ways to solve it. You can take advantage of the fact that you have just started practicing this fast sword style and are not affected much yet. Stop pursuing speed blindly in time."
Director Shen tried so hard to persuade him, and he really had good intentions.
He really admired talent and didn't want to see such a genius go down a path of no return.
"Thank you for your kind advice today. I haven't decided to use the quick knife as my main attack direction yet, I'm just doing preliminary practice. When I need to choose my main attack direction after one year of regular training, I will definitely weigh the pros and cons carefully and make a careful choice."
Zhou Can’s current level of quick knife skills is just the beginning.
It is still a long way from even achieving a small success.
He also made an agreement with Dr. Xu to give it a try by practicing first.
If Zhou Can feels that it is not suitable or the risk is too high and is faced with the choice of main attack direction, he can give up at any time.
"Just listen to me. Through these two days of understanding and observation, I have a preliminary understanding of your abilities. From now on, whenever I have a surgery, you can follow Dr. Shan to participate. If you encounter medical questions you don't understand, as long as it is in the field of orthopedics, you can ask me at any time . But let me make it clear in advance that I am more proficient in the field of bone trauma and some microsurgery. I am not proficient in joint surgery, spinal surgery, bone disease specialists, and foot and ankle surgery."
Every doctor has a specialization.
Director Shen’s area of expertise is orthopedic traumatology.
"Thank you for your cultivation of me!"
Zhou Can bowed deeply.
Director Shen waved his hand and said, "I am a very down-to-earth person, and I will avoid empty formalities if possible. Let's hurry up and have dinner."
Through today's operation, Zhou Can's position in this group has basically been established.
Although they are called resident trainees, their actual status is almost equivalent to that of attending physicians.
Just look at the two special favors Director Shen just gave him and you will know.
As long as Director Shen is performing surgery, Zhou Can is allowed to participate.
If you have any medical problems, you can consult him at any time.
These are the treatments only enjoyed by two excellent attending physicians.
In the following days, Zhou Can began to follow Dr. Shan day by day.
Director Shen's surgery time is uncertain.
He would only take time out to perform surgeries in the operating room involving grade three and grade four bone trauma.
Whenever he performed an operation, Dr. Shan would always bring Zhou Can along.
Zhou Can especially likes to perform surgery with Director Shen.
Because you can indeed learn a lot of advanced surgical knowledge and skills. These are Director Shen’s core techniques, which are difficult for ordinary people to learn.
Also, there are many opportunities for exercise during Director Shen’s operations.
Zhou Can always manage to get some from time to time.
His orthopedic surgery skills are improving every day, and he has gradually gained a more systematic and comprehensive understanding of orthopedic diseases.
On this day, Dr. Shan performed a femoral head bone grafting operation on the patient.
But it’s simpler than last time.
This time, there is no need to take a bone flap with a blood pedicle. You only need to drill a hole directly on the femoral head and fill it with broken bones to reduce the intraosseous pressure and promote the recovery of blood supply to the necrotic femoral head.
"Doctor Shan, can you let me try bone filling?"
Zhou Can is now very familiar with Dr. Shan, Dr. Tang and others.
He has a pretty good position in their small team.
Many important surgical tasks can be obtained.
This also gradually broke the ban of the Quality Control Department that only allowed him to perform level one surgery.
This kind of thing basically happens when the people don't report it and the officials don't investigate it.
Zhou Can does have the ability to perform the surgery, and the senior doctors trust him enough. It is his ability to get the opportunity to practice.
In theory, even if he participated in a level 4 operation, he would not have violated any laws.
The Quality Control Department made a fuss out of nothing and insisted on using the quality and safety of the surgery as an issue, not allowing him to participate in surgeries above level one. This was pure malicious suppression.
But there was nothing he could do. The emergency department was weak, and he himself was too weak to compete with a big shot like Director Xie.
"This bone grafting has lower risks and requires lower technical skills. You can do it! I'll be there to guide you."
She gave up her seat.
Zhou Can was overjoyed. He thought that he had made the right decision by insisting on following Dr. Shan.
She often performs various high-risk surgical tasks during her operations.
For example, separation of blood vessels and nerves, connection of broken bones, internal fixation of fractures, etc.
As he filled it with broken bones.
Just filled out.
[Congratulations on getting the bone graft. Bone flaps and bones can be transplanted to a designated location. This procedure can repair damaged bones, save necrotic bones, and help restore blood supply. ]
[Bone grafting, current experience value is 1/10 of level 1, failing level of internship.]
Zhou Can felt very satisfied looking at the newly added orthopedic surgery skills.
Now, he has learned all four basic medical skills in orthopedic traumatology.
As long as he continues to improve them, he can become a qualified orthopedic surgeon.
As for other more advanced orthopedic surgical skills, we can only wait for the opportunity.
…
Time flies, and before he knew it, he had been interning in orthopedic surgery for more than two months.
I have a deeper understanding of orthopedic surgery.
He discovered that orthopedic surgery and neurosurgery are twins.
Many orthopedic diseases and neurological diseases are like twin brothers and sisters. There are many major operations that Director Shen cannot complete alone, and he must invite neurosurgeons to perform joint operations.
Zhou Can has made great progress in orthopedic surgery.
The basic medical skills of the four orthopedic surgeries have all improved by leaps and bounds.
Including the difficult bone grafting technique, he has now reached level two, the lower level of regular training.
In more than two months, the total number of bone grafting surgeries was close to forty.
The quantity is OK.
However, about one-third of bone graft surgeries require the implantation of a bone flap with a blood pedicle. This is a very difficult operation, and Dr. Dan usually performs it himself.
The only training opportunity Zhou Can could get was a bone grafting surgery without a blood pedicle.
Then Dr. Shan has two residents and two trainees under him, so it is impossible for him to give all the surgical training opportunities to Zhou Can.
On average, he was able to get the opportunity to perform bone grafting surgeries sixteen times in more than two months, which was already very good.
From filling in the broken bones at the beginning to learning how to select points and drill holes, the entire bone grafting surgery process is completed.
It was a very rapid growth for him.
Bone grafting is currently the one with the lowest experience value among the four basic orthopedic surgical skills.
External fixation of fractures is currently at level three, the lower level of resident doctors.
This is due to his hard work.
After get off work, he ran around the inpatient wards to look for work.
When someone needed a plaster cast, he happily rushed to do it.
Over two months, external fixation treatment for fractures was completed for more than 170 patients.
