Chapter 146: Praising people is a skill, and you can make achievements as soon as you join the team
Epilepsy is often caused by excessive and abnormal synchronous discharges of brain neurons. Electroencephalogram (EEG) can be used to diagnose the disease based on the presence of spikes, sharp waves, spike-slow waves, or spike-slow complex waves.
It can also provide doctors with a certain diagnostic basis for determining the type of epileptic seizure and the location of abnormal discharge.
Zhou Can stared at the patient's EEG carefully.
Even compared with the EEG done before the patient was admitted to the hospital.
Soon, he discovered that there were significant differences in the peak values of the two EEGs.
The sharp wave part was abnormally faster.
In addition, the number of scattered abnormal waves on the second EEG is significantly increased.
"Xiao Zhou, tell me your diagnosis!"
Director Wen may also want to find out Zhou Can's bottom line.
He wanted to see what other performances this resident doctor could perform besides implantation.
The eyes of others also focused on Zhou Can's face.
"I'm just a newbie, so I'd better not express my opinion! I'll make a fool of myself."
Zhou Can had just joined Director Wen’s medical team and thought it would be better to keep a low profile.
Too much talk will lead to mistakes. This is the way of dealing with people and things that his parents taught him since he was a child.
"Speak, just speak boldly, don't worry about anything!"
Director Wen insisted that he speak.
How could I let go of such a good opportunity to find out the truth?
This kind of difficult case analysis can better test a person's comprehensive diagnostic ability.
"Then I will make a fool of myself."
Zhou Can no longer hide it.
"I compared the EEGs before and after the operation, and the difference was quite large. Both the speed of the sharp waves and the number of scattered abnormal waves increased significantly compared to before the operation."
After listening to this, Director Wen nodded slightly.
It is quite good that a trainee can find so many abnormalities in such a short time.
"Go on!"
He gestured to Zhou Can.
"From the before and after comparison of the EEG, the surgery not only failed to solve the problem, but made the condition worse."
As soon as Zhou Can said this, the whole office suddenly became extremely quiet.
Many people looked at him in surprise.
This trainee is really young. Doesn’t he have any idea about what he can say and what he can’t say?
Is it okay to say something like this that indirectly criticizes Director Wen for not performing the operation well?
Director Wen originally had a smile on his face, but now his smile froze.
Although he hadn't lost his temper yet, everyone could already feel that Director Wen was burning with anger.
He didn't immediately slam the table and scold Zhou Can, but only because of his status.
"Go on!"
Director Wen's tone had obviously become much colder, and his tone was heavily emphasized.
The look he gave Zhou Can was icy cold.
A person who does not know how to respect his superiors is not worth training.
No matter how powerful you are, it’s useless.
"Look at the comparison of the brain CT scan results before and after the operation. Obviously, the operation has completely removed the original lesion. With all due respect, this kind of malformed vein removal near the internal capsule can be done so thoroughly without causing any damage to the patient's internal capsule. This is beyond the level of an ordinary chief physician."
"At least it's something that only an expert neurosurgeon can do."
Zhou Can first suppresses and then promotes.
Just a few words triggered warm applause.
Director Wen's gloomy face suddenly brightened up, and when he looked at Zhou Can, his eyes were smiling again, and it was even more intense than before.
He felt like a hot June day, and would feel even more comfortable after drinking a glass of rock sugar water.
I have to say that the tactic of first criticizing and then praising is much more effective than directly praising the other person.
Zhou Can actually had no intention of flattering Director Wen.
Just telling the truth.
Maybe even he himself did not expect to achieve such unexpected results.
It is very important to cultivate emotional intelligence from an early age.
It will gradually be ingrained in your bones, and it will be difficult to go wrong in your words and deeds.
At least since Zhou Can entered Tuya Hospital for regular training, he has encountered many crises, all of which were successfully resolved with his high emotional intelligence.
Both Vice President Bai and Shangguan Yan from Tuya Second Affiliated Hospital turned their enemies into friends and were grateful to him.
If someone else handled it, the result would probably be different.
“Haha, this operation is indeed quite difficult, but you said that it requires at least an expert neurosurgeon to complete it. That’s a bit of an exaggeration!” Director Wen is not without cunning.
However, under Zhou Can's attack of first suppressing and then praising, no matter how cunning one is, it is not as satisfying as Can's innocent laughter.
Because he was indeed extremely happy.
My heart feels like it's drinking honey.
After the complications of the operation, Director Wen was under tremendous pressure. He was even more worried about being laughed at for not doing the operation well.
Now, Zhou Can spoke a fair word for him and even made public the highlights and key difficulties of this operation.
Do you think he wouldn't be happy after hearing that?
This is not only a recognition of his surgical ability, but also a high praise for the field of surgery that Director Wen is best at.
It's much more true than what some people are praising.
"I am not exaggerating. The risk and difficulty of removing abnormal veins near the internal capsule is second only to surgery near the brainstem. Many chief neurosurgeons dare not perform this kind of surgery. There are even fewer who can do it well."
Zhou Can continued to praise Director Wen.
Director Wen’s name was not mentioned once during the entire process.
But Director Wen found it extremely useful.
So, flattery is really a skill. It is not just a simple compliment to the other person , such as "you are so handsome, you are so capable, you are so rich..."
The most clever way to flatter is to say something that touches the other person's heart.
Gain deep recognition from the other party.
"Based on the abnormal points of the postoperative EEG and the CT scan results, I think there are only two possibilities for the patient's epilepsy to worsen. The first is cerebral hematoma. The second is that there are other lesions that have not been discovered."
Cerebrovascular malformations are often not single but multiple.
Doctors with rich experience in diagnosis and treatment will often ask to check the patient from the neck artery and vein upwards.
“That’s very well said!”
Director Wen admired Zhou Can's diagnosis from the bottom of his heart.
If it was Dr. Zou or Dr. Tang Li who made this diagnosis, he would not think there was anything wrong with it.
Because they are all experienced attending physicians.
Although both of them are poor in interventional surgery skills, their academic and diagnostic abilities are not bad.
He is even ranked at the top among the attending physicians of neurosurgery.
It is truly remarkable that a resident doctor can have such advanced diagnostic abilities.
"Doctor Zhou, I never realized that not only are you good at implantation surgeries, but your pathology diagnosis skills are also far superior to ours. The three of us will have to learn a lot from you in the future."
The three graduate students all smiled at Zhou Can.
This is a gesture of goodwill.
"It's good to be able to identify two causes. But if we want to cure the patient's epilepsy, we have to identify the final lesion. Can Dr. Zhou make a more accurate diagnosis?"
Doctor Zou has a dagger hidden behind his smile.
It is already very difficult for a trainee to diagnose the general cause of a disease.
Asking Zhou Can to give a more precise answer, isn't this forcing him to make a fool of himself?
As the attending physician, he was suppressed by Zhou Can in the operating room. Now, during the internal consultation and discussion, Zhou Can stole the limelight again.
Dr. Zou inevitably has some unfriendly thoughts.
Suppressing newcomers has always been what all the old people are most keen to do.
"I am not very knowledgeable, and my experience in diagnosis and treatment is not even comparable to that of you seniors. I dare not make arbitrary assumptions."
Zhou Can countered the opponent's move and completely eliminated the opponent's pressure with just two light sentences.
Then the subject changed.
"Since Dr. Zou asked this question, I think he already has the answer. Why not share it so that we rookies can learn from it."
He turned the tables on Dr. Zou.
Doctor Zou's status is much higher than his, so he really can't shirk the responsibility as easily as he can.
"Uh... well! I personally think it's more likely that there are vascular lesions in other parts of the body."
Dr. Zou's stuttering showed that he was not well prepared.
There is definitely no precise diagnosis in mind.
Now I can only give a vague answer.
"Doctor Zou, I heard that the EEG can determine the approximate area of the lesion. Can you tell me which part of the blood vessel is affected? And how serious is the lesion?"
a graduate student asked.
This buddy definitely had no intention of helping Zhou Can deal with Dr. Zou.
I asked this question purely out of my strong desire to learn.
"Hmm... um... I personally think it should be near the thalamus! As for whether the vascular lesions are serious, everything depends on the test results."
Dr. Zou's answer revealed a serious lack of confidence.
And it remains ambiguous and unclear.
This diagnosis is of no use if you want to give the patient surgery.
The location of the lesion is unclear, the condition of the lesion is unclear, and almost everything is based on guesswork. Does it meet the surgical indications?
"The possibility that the lesion is in the thalamus can be basically ruled out. According to my experience in treatment, vascular lesions that cause epilepsy have never appeared in the thalamus. The thalamus is more of an endocrine organ. If it has lesions, it will often only cause systemic endocrine disorders or major changes."
Director Wen directly rejected Dr. Zou’s diagnosis.
There is no room for maneuver at all.
Medicine is inherently rigorous and prudent, and there is no ambiguity.
"Let's focus on checking the patient's preoperative cerebral angiography to see if we can find the lesion. Of course, the postoperative hematoma that Dr. Zhou mentioned is also very likely. We can also check the postoperative CT scans repeatedly to make further inquiries."
Director Wen gave everyone a general direction.
However, the exact location and cause of the lesion have not yet been determined.
Everyone was discussing it one by one.
Express your own opinions.
While studying the films taken by the patient, Zhou Can carefully recalled the patient's specific symptoms and various manifestations.
Eventually, he came to a surprising conclusion.
"Director Wen, do you think it's possible that the patient has a cavernous hemangioma?"
Zhou Can looked up and asked.
“Not ruled out!”
Director Wen is not a god. At best, he has more diagnostic experience than them and more profound medical knowledge about cerebrovascular and cranial nerves.
"Cavernous hemangioma is a hidden vascular disease. It is difficult to detect it even with CT or even the most advanced digital subtraction angiography. In order to rule it out, I think it is necessary to request a head MRI for the patient."
Zhou Can believes that the possibility of cavernous hemangioma is very high.
On the contrary, cerebral arteriovenous aneurysms can basically be ruled out.
If there really was an arteriovenous aneurysm, no matter how small it was, it should have been detected long ago.
"The hospital's MRI resources are quite limited, and the cost of the examination is quite high. Can the family accept it?" Tang Li asked with some concern. "During the ward rounds, the family of the patient in bed 22 was very difficult to talk to. Now the patient's condition has not improved after the operation, but the epilepsy has worsened. It is a bit far-fetched to explain it as a postoperative complication. The family also has no trust in us."
Her concerns are not without reason.
The doctor-patient relationship is already highly tense.
The situation is even worse after this crisis of distrust occurred.
Moreover, the patient has already undergone two additional post-operative examinations, and now needs to undergo an expensive head MRI. The family may really tear down the ward.
"We doctors are not gods. We have indeed cleared the patient's diseased veins. There are only two reasons why the epilepsy is getting worse now. Either it's a hematoma or there are other vascular diseases. We have done so many tests and had repeated discussions before the operation. Ordinary vascular diseases can't be hidden now. The most likely cause is cavernous hemangioma, which is called invisible vascular disease."
"If we want to give the patient further treatment, we can't get around this hurdle. To be honest, if there was a hematoma after the operation, the CT scan would have found it long ago. But the CT scan after the operation did not clearly show the hematoma. So, I think it is very necessary to do an MRI."
Compared with CT scans, MRI examination results are clearer and more accurate.
Back then, it was the advent of magnetic resonance imaging that made it easy for doctors to diagnose many tumor diseases.
It has unique advantages that ultrasound, X-ray and CT do not have.
Director Wen lowered his head in thought.
As a chief physician, he must have his own thoughts.
Zhou Can's opinions are more of a reference.
The doctors in the group continued the discussion.
Gradually, more and more people agree with the idea of doing MRI.
We adopted the method of elimination.
Eliminate some possible situations one by one.
Finally, it was determined that the possibility of cavernous hemangioma was very high.
Because cavernous hemangioma has a characteristic that its blood vessel wall is extremely thin, it is indeed possible that it may rupture and bleed during surgery.
Color Doppler ultrasound of the head can also have certain diagnostic significance.
It’s just that the family members have made such a big fuss.
Every examination request made by the doctor is made with great caution.
Otherwise, the family members will think that the doctor is deliberately making money. Not only is the operation ineffective, but the doctor also asks the patient to do all the examinations again after the operation.
"After careful consideration, I have decided to request a head MRI for the patient. Tang Li, you have always been good at communication and have a strong affinity. Can you communicate with the family?"
A medical team should have all kinds of talents.
Maintaining good communication with family members is also important.
"Okay, I'll go talk to the family right away."
She agreed readily and seemed quite confident.
Female medical staff have certain natural advantages when communicating with family members.
Easier to be accepted by family members.
Also softer.
"Just communicate frankly. Tell the family the specific results of the discussion and let them know that the patient's epilepsy is getting worse and there is indeed a possibility of dual lesions."
Director Wen gave guidance.
Many more complex diseases are prone to dual lesions.
It’s like finding a rat in your home, which means there may be more rats in the entire community.
…
Half an hour later, Tang Li came back after communicating with the family.
Her face looked relaxed, and she even had a faint smile on her face.
The explanation was quite good.
"The family has agreed to do an MRI. After communication, their trust in us has increased a lot. Now we just hope that we can really find the lesion!"
What she was most worried about was that the MRI examination still had no results.
By then, the trust that has been rebuilt will be completely lost.
The family members will no longer have any trust in the hospital.
After a long wait, good news came again.
After an MRI of the patient's head, a large area of vascular abnormality was found in the patient's skull.
Doctors in the medical technology department are actually quite good at reading films.
They can pinpoint the problem more precisely.
Mark the size of the lesion area, the nature of the lesion, etc.
Director Wen couldn't wait to take the MRI film and examine it carefully under the light.
An excited smile gradually appeared on his face.
"Good, great! It is indeed a cavernous hemangioma. This harmful thing is really deep-rooted! It almost ruined my reputation." He was so happy that he even used the word "old man".
This made the doctors under him smile.
"Xiao Zhou, you did a great job. To be honest, if you hadn't conducted a rigorous analysis and insisted on doing a head MRI on the patient, I really wouldn't have made up my mind. Our team formally invites you to join. I will apply for an account for you so that you can check the cases in the team at any time. If you have a good diagnosis, you can also give me feedback at any time."
It is not easy for Director Wen, who is so concerned about his reputation, to give high praise to Zhou Can in public.
