Chapter 182 Discovering hidden dangers, a friendly reminder
When Zhou Can makes rounds, he prefers to go to the ward alone as an attending physician or intern to check on the patients' conditions and test results.
When following the attending physician on ward rounds, due to my low status, I basically just had to listen.
Just stand at the end of the bed and watch from a distance.
It would be even worse if you were following the chief physician on ward rounds.
There were at least seven or eight doctors making rounds, plus nurses and the head nurse, a total of more than a dozen people. He, a junior intern, didn't even have a place to stand.
When the director makes ward rounds, the head nurse, responsible nurse, attending physician, and attending physician are all required to be present.
Basically, we listen to the attending physician introduce the patient's condition, and the director gives a few words of summary. This kind of ward round is more like a fashion show.
At least in Zhou Can's opinion, if he wanted to make rapid progress, it would be best to do rounds on his own.
The patient in bed 47 has been diagnosed with right upper lung cancer and pericardial effusion, and is one of the patients who needs surgery today.
It can be seen that the patient has a strong desire for surgery.
After the nurse notified the patient last night not to eat or drink, the patient took a bath, washed up, went to the toilet early this morning and prepared for the operation.
"Doctor, will you perform surgery on me this morning?"
"Yes! The surgery will be officially started around 9 a.m. I estimate that I will take you to the operating room around 8 a.m. for preoperative preparation and anesthesia."
This is a major operation, and there is no accurate answer as to how long it will take to complete.
It will definitely not be short.
There are many surgical procedures to be performed.
Because the right upper lobe of the lung had to be removed, a pericardial window had to be opened, and lymph nodes might have to be cleared, the task was extremely heavy and the risk was very high. So he was scheduled to be the first surgery in the morning.
Chitai surgery involves two areas: cardiology and thoracic surgery, and requires extremely high surgical skills from the doctor.
Director Xue has just been promoted to chief physician for over a year.
For someone as young as her to have successfully been awarded a senior professional title, her academic and academic qualifications must have played a big role.
There are very few chief physicians aged 43 in Tuya Hospital, which can be described as rare as phoenix feathers and unicorn horns.
Her surgical skills are certainly not comparable to those of the veteran chief cardiothoracic surgeons.
Even experienced chief physicians would find it very difficult to perform both cardiology and thoracic surgery at the same time. Many experienced chief physicians would choose to cooperate with others and perform surgery together.
Because most chief physicians of cardiothoracic surgery either specialize in thoracic surgery or cardiovascular surgery, there are really not many people who are good at both fields.
Director Xue is probably young, promising, enterprising and proud, so he dared to challenge this difficult operation.
Zhou Can checked the patient's information, which he had actually read several times on the office computer.
Nothing unusual was found .
The patient's current physical condition also meets the surgical criteria.
Zhou Can asked a few more questions, then went on to check on the patient in the next bed with confidence.
Although he has not been in the group for long, Zhou Can is very responsible.
The team leader, Director Xue, and other colleagues in the group treated him very well.
People are like this. The better you perform and the greater your potential, the more friendly your colleagues will be to you. Except for a very small number of extremely jealous colleagues, they may speak coldly to you.
Zhou Can did not check all the beds, but focused on checking the patients in this group.
When checking bed 53, the patient in bed 54 next to him was holding his cheek with a painful expression on his face.
The patient in this bed is not one of Zhou Can's group's patients, so according to the rules, he doesn't have to worry about it.
After Zhou Can checked the patient in bed 53, he looked at the patient in bed 54 and asked, "What's wrong with you? Is your tooth hurting?"
"Yes! I have had toothaches a lot recently. I had it just last week and it was all better after taking medicine. This time, I needed to be hospitalized for surgery because of cardiovascular problems, and I didn't expect the toothache to come back again."
The patient is a man in his fifties.
"Doctor, do you have any medicine for toothache in your hospital?"
"Of course we have toothache medicine for sale in the hospital. I see you've changed into surgical gowns. Are you preparing for surgery today?"
Zhou Can asked the patient.
"you do not say!"
The patient nodded.
"It's best not to take any medication before surgery to avoid any danger. Just bear with it for now."
Zhou Can then asked another question.
"What surgery are you having?"
"It seems like they are building a bridge! We are from the countryside, we don't have much education, and we don't understand those things. I only know that a chief physician named Le performed the operation on me. I heard that he is the successor of Hu Kan, the most famous cardiothoracic surgery expert, so his medical skills must be good."
Patients and their families care about these gimmicks.
Like to believe in a certain famous doctor.
They believe that the more famous a doctor is, the more capable he is.
Theoretically, that's correct.
However, sometimes we cannot completely trust famous doctors. If it is in their field of expertise, the probability of misjudging is relatively small. If that field happens to be something they are not good at, their level may not be as good as that of a senior attending physician.
This is not to disparage experts, but everyone has their own areas of expertise.
Experts are also human beings.
They basically spend their energy on the field they are good at. As for other medical fields, at most they have a little knowledge of them.
"Director Le should be performing a coronary bypass surgery on you. This is a major surgery, so you should not take any random medications."
Zhou Can picked up the patient's examination information and medical records and took a look at them.
The blood vessels are narrowed, hardened, and contain severe plaques.
To prevent myocardial infarction, vascular bypass surgery is a good treatment option.
The patient's hospitalized symptoms were chest tightness and chest pain.
The medical record shows that the patient reported having no history of underlying diseases, no history of drug allergies, no cold or fever before hospitalization, and was not taking any other medications.
After examining him, Zhou Can gave the patient a few words of advice and left.
After he finished his ward rounds, he returned to his office to review the medical orders for the patients in his group.
Because he did not have a medical license, he had to use the name of a senior doctor when writing medical prescriptions, and he had to take the initiative to ask the senior doctor to check to prevent mistakes.
At around eight o'clock, the doctors completed their shift handover, and Zhou Can assisted the attending physician in sending the patient in bed 47 to the operating room.
If you go too late, the anesthesiologist might scold you.
While he was sending the patient into the operating room, he also saw the patient in bed 54 who was undergoing a heart bypass surgery being pushed into another operating room.
Tuya has no shortage of patients and the outpatient volume is particularly large.
It is common for a cardiothoracic surgeon to see a hundred patients a day.
With such a large number of outpatient visits, even if only about 10% of patients need hospitalization for surgery, it is still a very scary number. In fact, according to relevant statistics, the ratio of outpatient visits to hospitalization in some departments is as high as 19 %.
Every day, a large number of patients seek treatment in the cardiothoracic surgery department who require hospitalization for surgical treatment, so the beds are in high demand.
The number of surgeries performed every day is also quite sufficient.
The chief and deputy chief physicians perform one or two major operations almost every day.
There are seven or eight chief and deputy chief physicians in the entire cardiothoracic surgery department, and the operating room is very busy.
A few days ago, I heard colleagues in the group talking about the fact that the cardiothoracic surgery department was going to add a Class 100 laminar flow operating room to relieve the pressure on the operating room.
Zhou Can watched the patient in bed 54 being pushed into the operating room, and a trace of doubt flashed through his mind.
During the ward round, the patient said that he had also suffered from toothache a week ago.
And the pain went away after taking the medicine.
What pain medication is the patient taking?
Some drugs take a longer time to metabolize in the body.
At that time, he checked the patient's medical record and found no history of medication. This was actually a hidden danger.
The patient may not have concealed the truth intentionally, but the doctor who received the patient did not ask about the situation clearly, which was an oversight. It would be good if nothing went wrong, but if something went wrong, it would lead to an accident during the operation.
For example, the patient who was allergic to rubber when Zhou Can was about to end his internship.
Sometimes the patient himself may not even know what he is allergic to.
Doctors never imagined that disposable sterile gloves used in surgery would become a "killer" for patients during surgery.
"Doctor Zhou, what are you looking at?"
"Oh! Nothing. It's about the patient in their group who had a toothache when I was doing my ward rounds this morning, so I asked him a few more questions. He was a patient who had a heart bypass surgery."
Zhou Can answered absentmindedly.
"The patient is over 50 years old, so it's normal for him to have toothache. Some people don't pay attention to oral health and are prone to tooth decay. Once the decay reaches the nerve root, it will be extremely painful."
The attending doctor, Dr. Wu, is a young resident in his twenties.
I get along pretty well with Zhou Can.
The doctors who take care of the patients are basically young doctors who have been working for two or three years. They all work their way up step by step.
There are many things that can be learned from being a bed manager.
It includes the entire hospitalization process, including patient admission, surgery, rehabilitation treatment, and discharge.
During the whole process, you will encounter many unexpected situations.
The attending physicians can learn a lot from this.
However, the best time to study as a ward manager in the inpatient department is no more than four years. Most people start to manage patients individually after obtaining a medical license, stay in this position for about two or three years, hone their skills, go for further studies, come back to be a ward manager for a year, then take the exam for attending physician, do research projects, and strive to get the title of attending physician in the fifth or sixth year.
This is a more ideal way to get promoted.
Of course, doctoral students are not included in this list. They have an inherent advantage in academic qualifications and are directly promoted to attending physicians.
A master's degree is also okay, and you can be promoted to attending physician in about two years.
However, the competition in Tuya Hospital is extremely fierce. Even if you pass the exam for attending physician, you may not be able to get the hospital's appointment letter immediately. You can only wait in line.
It’s different for PhDs. After all, they are special talents in the hospital and are given priority in all aspects.
So, academic qualifications are actually very important.
For a medical student like Zhou Can, who only has a bachelor's degree, to be able to successfully obtain Tuya's regular training qualification is already very good. Of course, he obtained the qualification of a general practitioner regular training student, which is very valuable.
After the regular training is completed, it is almost certain that you will stay in the hospital to work.
However, future promotions in professional titles and positions will be affected by academic qualifications and will be very passive.
"Doctor Zhou, Doctor Zhou..."
Doctor Wu noticed that Zhou Can was distracted and called him repeatedly.
"Ah... sorry, I was distracted. What kind of medicine do you usually take for toothache?"
Zhou Can asked.
"There should be more sustained-release ibuprofen tablets! But some patients go to small clinics or pharmacies to buy their own medicines, so it's hard to say. I have seen patients using antibiotics through intravenous drips."
Small clinics are not necessarily all black clinics that cheat people, but in pursuit of profit, they try to get patients to pay as much money as possible, and then try to attract customers by offering obvious effects as soon as the medicine is used.
Various drugs, including antibiotics, are often misused.
"If the patient really just took ibuprofen extended-release tablets, it would be okay. I'm worried that he took drugs like aspirin or acetaminophen."
Zhou Can was full of worries about this matter.
If the patient is taking aspirin, surgery cannot be performed.
It is not safe to stop taking this medicine for a week. It is safer to stop taking it for at least two weeks.
Because aspirin not only has anti-inflammatory and analgesic effects, but also has anticoagulant effects.
Patients who have undergone heart stent surgery or cerebrovascular stent surgery need to take anticoagulant drugs for life to prevent blood clots.
Some patients may stop taking anticoagulants after one or two years out of concern about the negative effects of long-term medication, or to save money. This is a very dangerous behavior.
It's very easy to get into trouble.
When Zhou Can was doing his training in neurosurgery, he saw a patient with cerebral infarction who stopped taking anticoagulants on his own in the third year after stent surgery. Less than a year after stopping, he suddenly fell ill at night.
When the ambulance took him to the hospital, his pupils had already dilated.
However, patients who are about to undergo surgery must tell their doctors if they are taking anticoagulants.
Otherwise, it would be a tragedy.
Sometimes, a routine blood test may not be able to detect the disease.
Especially some patients do not take it regularly, but only occasionally.
That really makes doctors defenseless.
"Let's not worry about the patients in that group. Let's send this lung cancer patient in quickly! Otherwise, the anesthesiologist will be more upset if he waits too long."
Dr. Wu didn't want to meddle in other people's business.
Basically everyone is just cleaning up the snow in front of their own door.
Being too controlling is sometimes a thankless task.
Doctors who have worked for a little longer have basically suffered losses in this regard.
Just at this moment, Director Le hurried over with his attending physician.
"Send the patient in first. I have to remind Dr. Le. If something goes wrong, it will be bad for both the patient and the department."
Zhou Can has just started working in the hospital. He has a simple and honest heart and still maintains the initial kindness of a rookie.
Without waiting for Dr. Wu to say anything else, Zhou Can walked towards Director Le who was approaching.
"Hello, Director Le!"
Zhou Can took the initiative to say hello.
"Doctor Zhou, what can I do for you?"
Director Le was quite polite to him, because the patient who had the chest wall muscle suture surgery last time was from his group.
No matter what, Zhou Can cured the patient, which was considered a favor to Director Le.
"For the patient in bed 54 who was just sent in for heart bypass surgery, it would be better to ask clearly before performing the operation," said Zhou Can.
"What's wrong?"
The surgery has been scheduled, how can it be cancelled just like that?
Director Le must clarify the situation before making a decision.
"When I went to the ward for rounds this morning, I found the patient in bed 54 holding his cheek. I asked him if he had a toothache. He told me that he had a toothache again. He had had a toothache just last week and cured it by taking medicine on his own."
Zhou Can recounted what had happened.
"Is there anything wrong with that?"
Director Le looked puzzled.
"There are no other problems. I am just worried that the patient is taking aspirin, which is an anticoagulant. God knows when he stopped taking it. Of course, I am just reminding you. The specific arrangements are up to you."
After Zhou Can finished speaking, he didn't care anymore.
He has fulfilled his obligation to remind others, but if Director Le is stubborn and refuses to listen to his reminders, there is nothing he can do.
Zhou Can went straight into the operating room. He was full of anticipation for today's lung cancer surgery, and he should be able to learn a lot.
The possibility of getting started with exercise is relatively small.
Director Xue had not yet completely established her trust in him, but she would occasionally ask him to do tasks such as sewing skin and sealing cavity.
