Chapter 174 Real family members, excessive electrocoagulation

Among the five patients in his care, three are awaiting surgery and two are in the postoperative recovery period. Overall, their condition is relatively easy.

It was a rare relief, so he started to check the medical records of each patient in each bed with a learning and responsible attitude, and understand the patient's current symptoms. Now he has more experience in how to communicate with family members or patients.

After all, I have been in regular training for so long.

When chatting, you can easily open up the topic and gain their favor and trust by starting with issues that concern the patient or their family members.

The patient in bed 16 had a thoracic duct ligation two days ago. Currently, all signs of the patient are stable and he is recovering well. There were no complications after the operation.

The patient in bed 17 has a heart aneurysm.

According to the examination report, the diameter of the aneurysm is quite large. There are many surgical options for treating aneurysms, such as aneurysm embolization, stent placement, vascular replacement, and clipping.

If it is an ascending aorta aneurysm, a stent cannot be placed.

The treatment plan Director Xue prescribed for this patient was surgical clipping of the aneurysm, probably because the site of the lesion was not suitable for interventional surgery.

"I'm afraid clipping of the aortic aneurysm is not that easy to perform!"

After reading the examination report, Zhou Can thought that the operation was quite difficult.

He has not performed clipping surgery on heart aneurysms, but he has performed clipping surgery on intracranial aneurysms.

And I have made multiple ones.

We have relatively rich surgical experience in addressing the technical difficulties of clipping hemangiomas.

Director Xue is a chief physician. She dared to decide on the operation and must have made a comprehensive assessment of the risks and difficulty of the operation. This shows that she is confident.

Zhou Can doesn't have to worry about this matter.

The most powerful surgeon in cardiothoracic surgery should be the one with the 'steadiest scalpel' - Director Hu Kan.

Zhou Can is particularly looking forward to seeing Director Hu Kan perform a surgical operation someday.

"Xiao Zhou, the department has arranged an emergency operation for bed 19. The patient will be sent to the operating room around 9:50! Please follow up!"

This person with connections had surgery right after moving in?

Even though it's just a simple chest muscle suture, it's not the right way to do it, right?

Even in the emergency department, it is extremely cautious to perform general anesthesia on patients.

"Didn't he just move in? How can he fast for 12 hours before surgery?"

Zhou Can asked.

Adults who undergo general anesthesia surgery often need to fast for 12 hours and refrain from drinking for 4 hours before surgery. Otherwise, after general anesthesia, if the patient's gastric contents reflux and are inhaled into the respiratory tract, it will be no joke.

"The attending doctor has already asked, and the patient has not eaten since 5pm yesterday evening."

Doctor Zhao explained with some impatience.

"That's fine!"

Zhou Can began to follow up on the surgery of the patient in bed 19.

It is very necessary to do preoperative understanding and necessary examinations to help patients prepare for the operation and welcome the operation in the best condition.

The patient had to be sent to the operating room at 9:50, so time was very tight.

Zhou Can could only do this first.

I walked directly to bed No. 19. Three family members were surrounding the bed, serving the man on it.

It can be seen that this man must have been spoiled by his parents since he was a child.

A normal adult man, even if he is injured and in severe pain, will not scream and cry like a woman.

At this moment, the man had received a painkiller injection and was lying on the bed with his eyes closed.

His beautiful wife took a small plastic stool and sat at the head of the bed, playing with her phone non-stop.

Zhou Can took a look and was stunned.

She was actually searching on Baidu, looking up what to do if her chest muscles were injured?

What I fear most is the patients who do their own popular science on the Internet. They like to use the popular science knowledge on the Internet to determine whether the doctor's operation is correct or whether there is any trickery.

"Hello, please show me the patient's examination report!"

The examination report was in her hand, and Zhou Can could only ask her for it.

The woman looked up at him and asked reluctantly.

“Is it necessary?”

Zhou Can had been making rounds at the patient's bedside, so they must have noticed him a long time ago.

The families of ordinary patients will respect doctors very much.

But this family of four is not ordinary people.

They felt that since they knew the chief physician of cardiothoracic surgery and had some power themselves, they did not take a "miscellaneous" doctor like Zhou Can seriously.

"The patient will be having surgery at 9:50, and preoperative preparations must be made immediately! We need your active cooperation."

Zhou Can said to her seriously.

"How do we do the surgery on my husband? Who is the surgeon? Even if it's a pre-operative talk, shouldn't the surgeon come and talk to us in person? We are very familiar with your Director Xue!"

After asking a series of questions, she even brought up her relationship with Director Xue.

Medical staff are very troubled when they encounter such patients.

Because it's difficult to deal with.

He thinks he is familiar with the hospital's procedures and routines, and always shows off his intelligence and superiority.

Of course, their original intention was to obtain better medical resources.

"The surgeon will discuss the surgical plan with you. I am the attending physician and am responsible for following up the operation and helping the patient make necessary preparations before the operation." Zhou Can felt a headache after being asked this woman's question.

The patient's parents stood by and said nothing, allowing their daughter-in-law to show off.

I guess this woman also wants to show off her knowledge and ability in front of her parents-in-law.

That's why it's so difficult.

"Okay, okay. I knew that you, the attending physician, know nothing! When your chief surgeon comes later, I will talk to him about the situation." The woman reluctantly handed the examination report to Zhou Can.

The contempt for Zhou Can in his eyes and tone was truly undisguised.

Zhou Can concluded that being beautiful does not necessarily mean having good qualities.

Maybe it's just a good-looking skin.

I carefully reviewed the examination report. Before the operation, I at least needed to see whether the patient had undergone necessary tests such as blood routine examinations.

Another thing is whether the patient has infectious diseases, inflammation, etc.

It may seem simple for a resident to follow up on an operation, but there is actually a lot to do.

If there are major omissions, you will be scolded by the senior doctors and the surgeon in charge.

When he first started his internship, he was scolded many times.

Almost every doctor grows up this way.

The patient's condition is OK and there are no contraindications to surgery.

"You don't have any symptoms like cold or fever now, right?" Zhou Can began to ask the patient some basic information.

Some patients may find this annoying, but these questions must be asked clearly.

Before surgery, patients should avoid respiratory diseases, such as colds and inflammation.

"No, no!"

She answered very simply.

"Are you coughing?"

"Of course there are normal coughs, but there are definitely no coughs caused by a cold like you mentioned."

“Do you have any underlying diseases such as high blood pressure or diabetes?”

"My husband is so young, do you think he might have these diseases that only old people get? Otherwise, you should wait until the surgeon comes before coming over! My husband needs to rest well now."

She was annoyed by Zhou Can's questions.

"Don't eat or drink before the surgery! If you need to go to the bathroom, go in advance!"

Zhou Can was too lazy to ask any more questions.

If the family members do not cooperate, they will most likely be scolded if you continue to ask questions.

If something really happens, the patient will definitely be the one who suffers.

Doctors sometimes don't really care that much.

“I know all this common sense.”

The woman was clearly impatient.

"Can you please stop making noise here? Let me get some sleep." The patient was not in a good mood either.

The patient's parents looked unhappy when they saw that their son's rest was disturbed.

Zhou Can didn't say anything else and went straight to other beds to do his own thing.

Not long after, the surgeon came over.

He was a short, ugly man in his mid-thirties, about the same age as Jin Mingxi.

Chest muscle suturing is a level one or two surgery. It is hard to say whether this male doctor is a resident or an attending physician.

"I'm Duan Shangqing, the attending physician in the Department of Cardiothoracic Surgery, and also his chief surgeon. How is it? It doesn't hurt so much after the painkiller injection, right?" Doctor Duan walked straight to bed No. 19 and gently inquired about the patient's condition.

His tone was full of concern.

When the patient's beautiful wife heard that the surgeon was coming, she immediately stood up and greeted him with a big smile on her face, "Thank you, Dr. Duan, for the painkillers. My husband is much better now. Is the surgery necessary?"

The patient's parents also had smiles on their faces and were very polite to Dr. Duan.

"Look at his film. There is an obvious tear here. Theoretically, it is possible for it to heal itself without surgery, but it may cause him to have difficulty moving his left arm and suffer from chest tightness and pain. If we don't pay attention, the tear will expand again, and it may even affect the esophagus, heart and lung functions. In addition, we cannot see internal bleeding. Repairing the wound, stopping bleeding, and suturing it in time are in the best interests of the patient."

"This is just a simple suturing operation between level one and level two, and the risk is very low. It's not like a thoracotomy, which has a high risk."

Dr. Duan tried hard to comfort the family members and let them feel at ease.

"After the operation, my husband's hands and esophagus won't be affected anymore, right?"

She was still somewhat worried.

"As long as the surgery is successful and the recovery is ideal, he can completely return to his pre-surgery condition."

After hearing Dr. Duan's reply, the woman looked at her parents-in-law and exchanged glances.

"Okay, then we'll do the surgery. Please take care of us."

The patient's father took out a red envelope from his pocket and quietly handed it to Dr. Duan.

"Doctor Duan, I only have this one son, so I'm sure you'll take more care of me. This is just a small token of my appreciation, just like inviting you to a cup of tea."

When he stuffed the red envelope into Dr. Duan's pocket, he scared him.

The hospital has repeatedly stressed that no kickbacks or gifts or red envelopes are allowed.

If he accepted the red envelope in front of so many people, he might not even have to wait until tomorrow before the Medical Department would ask him to come over for a talk.

"Don't do this, don't do this. I will definitely do my best to perform the surgery on him. If you give him another red envelope, you'll be harming me."

Doctor Duan is small, so he can hardly be stopped.

After hearing this, the patient's father took back the red envelope embarrassedly.

"You are such a good doctor with a noble character. I will treat you to a meal when my son is discharged from the hospital. I hope you will come!"

"We'll talk about it later! If you have no other questions, please sign the consent form for surgery and prepay the treatment fee."

After the family members signed, Dr. Duan looked at the patient.

"Didn't you notify the attending physician to follow up on the surgery? Why haven't you prepared anything yet?"

Doctor Duan was obviously unhappy.

"I just followed up on the operation and helped the patient prepare for the operation. The family members said they wanted to wait until the surgeon arrived."

Zhou Can won't suffer this loss in silence.

Medical staff help patients prepare for surgery, but if the patients do not cooperate, there is really nothing they can do.

Treating an illness is the patient's own business.

It's useless for the eunuchs to be anxious as long as the emperor is not in a hurry.

"Well... I just asked this young doctor, but he didn't know anything. I'll definitely ask you to come before I tell you!" The woman said, raising her beautiful face and looking at Zhou Can proudly. "Look, after Doctor Duan came, he finished the conversation very quickly. Unlike you, you ask all kinds of useless questions. I think you need to study harder, you are not professional at all."

Instead, she gave Zhou Can a lesson.

Zhou Can's face was turned black by her.

It was foolish to argue with family members, so Zhou Can did not argue with her.

But do what you should do.

It is really tiring to do preoperative preparation for such patients.

The nurse came with a tray to disinfect and clean the patient's skin before the operation. The surgeon had drawn the incision position.

After much trouble, the patient was finally sent to the operating room.

The chief surgeon, Dr. Duan, the resident doctor, Dr. Zhao, a surgical nurse, and an anesthesiologist were all ready.

Taking cost issues into consideration, the medical staff for are often not very numerous.

"Xiao Zhou, the family members told me that you are very unprofessional. You must be more careful and learn more in the future." Doctor Zhao scolded him.

"OK!"

Zhou Can is so depressed, don’t mention it.

You can only blame yourself for this kind of grievance and not take it too seriously with the family members.

The operation started quickly, the patient was put into general anesthesia, and his vital signs were stable.

Doctor Duan held a scalpel and carefully made a longitudinal incision in the middle of the sternum. He then cut open the skin, subcutaneous tissue, and muscles.

Regarding the choice of incision, in addition to the longitudinal incision from the middle of the sternum, you can also make a horizontal incision between the two breasts at the level of the fourth rib and in the inframammary fold. It mainly depends on the part that needs to be sutured, the gender, etc.

If the patient is a female, attention should be paid to the perfection of the incision and try not to destroy her body shape.

When doctors perform surgery on female patients, they take their post-operative life into consideration.

For example, if there is a tear below after a normal birth, the doctor will deliberately sew a little more when suturing it, in order to ensure the harmony of the mother's future sexual life.

The same principle applies to protecting women's bodies.

“Stop the bleeding!”

Dr. Duan was reminding Dr. Zhao by saying this.

I saw Dr. Zhao using electrocoagulation to stop bleeding on the patient, and his operation was OK. His hemostasis skills should have reached the excellent level of resident doctors.

Whether it is the attending physician, Dr. Duan, or the resident physician, Dr. Zhao, both of them have surgical abilities that are consistent with their professional titles.

It seems that although cardiothoracic surgeons are arrogant, their overall strength is quite strong.

There is indeed reason to be proud.

After Dr. Zhao had stopped the bleeding, Dr. Duan continued the operation.

Begin mobilization of the skin flap and pectoralis muscle flap.

Zhou Can watched it very seriously, this was a good learning opportunity.

He saw Dr. Duan's scalpel freeing the pectoral muscle flap little by little from the side of the sternum to the outside.

Whether it was the movement or Dr. Zhao's hemostasis, it was all very steady.

Doctor Duan's incision skills are OK, and his level of attending to lower-level diseases is there. But his level of freeing is much worse, because this requires a strong separation technique to support it.

Optimistically speaking, Dr. Duan's separation skills can at best barely reach the excellent level of a resident doctor.

Separation is very difficult to practice.

Even Zhou Can has only reached the lower level of attending physician.

During the separation, Dr. Duan may have been a little too heavy-handed, and small drops of blood spurted out.

Zhou Can looked carefully and found that a thicker artery was broken during the separation process.

Doctor Zhao immediately cooperated tacitly and performed electrocoagulation to stop the bleeding.

Sizzle!

The electrocoagulation knife burns the blood vessels and surrounding tissues.

The hemostasis level is not up to the level of a doctor, basically it is like this. The hemostasis operation is as fierce as a tiger and seems rough.

Only when one reaches the level of a master doctor can one achieve both precision and dexterity.

Dr. Zhao's bleeding control at this moment was more like a drastic move. If Zhou Can were to stop the bleeding, it would be like a dragonfly skimming the water or a butterfly flying through the flowers, combining dexterity and precision.

Any medical skill that reaches the level of treating patients is already at a very high level.

Going further up, if you want to reach the director level, it will be a qualitative leap.

For example, Zhou Can is now in charge of suture and ligation, and he is now at the deputy director level, which is a world of difference compared to the attending physician level.

Zhou Can looked at Dr. Zhao's fierce bleeding-stopping operation and was hesitant to speak.

If electrocoagulation hemostasis is used for too long or too vigorously, it will seriously damage the surrounding tissues.

Doctor Duan didn't say anything, so he really didn't want to say anything more.

He has a low status and is new to the department. It is almost crazy for him to accuse the senior doctor of being wrong in his capacity as a junior doctor.

Electrocoagulation continued, and finally, the bleeding stopped.

Zhou Can subconsciously looked closely at the bleeding spot and saw that the tissue at that spot had slightly changed color.

Perhaps it was because Zhou Can's hemostasis skills had reached an intermediate level for attending physicians, he had a very bad feeling in his heart.

Dr. Duan continued the operation.

"Here, here! I finally found the tear! The tear is quite big."

Dr. Duan was very happy after successfully finding the torn muscle layer.

Although Zhou Can often helps Director Wen perform level 3 and 4 major surgeries in the neurosurgery department, for many attending physicians, it is actually a matter of pride to independently perform a level 2 surgery.

"The absorbable suture needs to be thicker. The tension here is greater."

The invention of absorbable sutures is good news for surgical patients.

Today, the technology has become very mature.

And the cost is not high.

Before the invention of endoscopy, when subcutaneous tissue needed to be sutured, only ordinary sutures could be used.

When the wound inside has healed, cut the outer epidermis again, remove the stitches inside, and then sew the skin.

One can imagine how much the patients suffered.

This operation is also particularly prone to causing scarring.

After suturing the torn pectoral muscles, Dr. Duan handed over the remaining finishing work such as suturing the skin to Dr. Zhao.

Zhou Can's gaze once again focused on the electrocoagulation area that had changed color slightly.

He moved closer to see more clearly.

"Yes, it is indeed a serious injury. If it is not treated, it will definitely become necrotic."