Chapter 195: Not at all polite, stunning skills
The reason why Zhou Can has made such great progress is that on the one hand, he has learned a lot from Dr. Feng, and on the other hand, he has also made up a lot of basic medical knowledge these days, and initial results are showing.
Of course, it also has a lot to do with his accumulation over time.
If you learn a little bit every day through practices such as ward rounds, patient management, and surgical participation, you will make great progress over time.
"Doctor Guan, do you want to put a nasogastric tube in him?"
"Of course you should! You're better than me at this, so I'll leave it all to you!"
Doctor Guan was quite confident in him.
When performing partial intestinal resection, it is advisable to place a nasogastric tube for gastrointestinal decompression, which is beneficial for exposure during surgery.
It can also prevent accidents such as suffocation due to vomiting during anesthesia.
Zhou Can is able to consider all aspects very thoughtfully, which includes many skills and knowledge that only professional anesthesiologists know.
Doctor Guan couldn't help but marvel at it.
He didn't know yet that Dr. Feng had already started teaching Zhou Can about anesthesiology.
Among the doctors standing by and watching, two of them with better skills had already discovered that Zhou Can was not a simple person.
If there is nothing real in the stomach, it is impossible to make accurate preoperative suggestions.
When all the instruments were connected to the patient and general anesthesia was ready, Director Jia finally arrived at the operating room.
"Hey, why is Zhou Can involved in the anesthesia mission?"
Director Jia asked with some surprise.
"Junior Brother Zhou knows the anesthesiologist, so he came forward to help. He seems to know a lot about anesthesiology, and I really admire him." Qiuhong replied with a smile.
“Although anesthesiology is only a sub-discipline, it involves many aspects of life knowledge and comprehensive application. When you see anesthesiologists operating in the future, you can also participate more.”
Director Jia said to several doctors.
This statement is almost equivalent to praising and affirming Zhou Can's behavior.
"Get ready for surgery! We have two tough battles to fight today, so we must hurry."
After all, Director Jia is old, and he can only participate in the core part of the operation. He can no longer complete a major operation that takes four or five hours alone like a young man.
A partial bowel resection, even if it's just the rectum, usually takes about four hours.
This was only possible because the operation went smoothly and the surgeon had superb skills, as it was completed within four hours.
If any unexpected event occurs during the operation or difficulties are encountered during the operation, the operation will only take longer.
This patient needed to have part of his colon removed.
The surgery will be more difficult.
Coupled with the fact that the diseased intestines have severe adhesions, the separation is enough to give people a headache.
No wonder Director Jia called it a tough battle.
"Doctor Guan, is the patient okay?"
"Not bad! We can start the operation!"
Anesthesiologists use four rating criteria to assess a patient's physical condition.
Very good, fair, poor, very poor.
Generally, when the condition reaches a worse level, surgery will be carefully chosen.
If the anesthesiologist feels that the patient's condition is very poor after anesthesia is implemented, the anesthesiologist has the right to terminate the operation directly.
This happens less frequently, but it does happen.
For example, before the patient is pushed into the operating room, all his vital signs are good. But after general anesthesia, his vital signs drop sharply. At this time, the anesthesiologist will immediately stop the anesthesia, and then decide whether to continue the operation or terminate it after observation.
For the safety of the operation, it will most likely be terminated.
This is also a regular large hospital, and accidents rarely happen during anesthesia.
This is an important reason why medical beauty institutions frequently go bankrupt.
Anesthesiologists in medical beauty institutions are merely technicians and lack highly professional predictive capabilities for patients' vital signs.
There is no way to detect danger in advance.
Moreover, ten out of ten medical beauty institutions are private hospitals that pursue profits.
A "plastic surgeon" who has only been trained for half a month dares to perform breast and nose augmentation, double eyelid surgery, face slimming and liposuction, etc. on patients. It would be strange if nothing went wrong.
"The surgical lines have been drawn, who will perform the laparotomy?"
Director Jia looked at his deputy chief physicians and attending physicians. As for the residents, it was difficult for them to have the opportunity to perform surgery.
"I'll do it! Is that okay?"
Zhou Can was the first to rush to do it.
The other doctors were all stunned. This guy was like a hungry wolf, grabbing jobs without any courtesy.
But he doesn’t even see what kind of work this is?
Did you think it was a skin suture? This was an abdominal incision.
The risk is extremely high.
Even the general attending physicians dare not say that they are completely sure.
It's totally brainless of him for a trainee to snatch this opportunity here.
"Laparotomy is a job that requires high technical skills. You, a trainee, can't do it. Let me do it!"
The deputy chief physician was not very old, probably in his early forties.
He is a very young deputy chief physician.
He spoke slowly and methodically, like a senior brother.
"Director Jia said that as long as you are confident, you can speak at any time and take on the surgical mission at any time."
Zhou Can did not argue with this person directly, but looked at Director Jia.
"Zhou Can, this is no joke. Are you sure you want to do it? Let me be frank. If you do a practical task under me and there is a surgical error, your surgical privileges will be suspended for at least three months. If it is serious, it will be directly handed over to the Medical Department for handling. So, you must do it within your ability and don't use what I said as a shield to grab the surgical opportunity at will."
Director Jia speaks very straightforwardly.
He did not regret what he had said.
Just to prevent his doctors from showing off their abilities, the punishment conditions are extremely severe.
"Reverence for life is my first creed. Don't worry, I will never take knife-wielding matters lightly." Zhou Can's words were sonorous and powerful.
It also shows strong self-confidence.
When it comes to rushing for surgery, you definitely can't be timid.
Otherwise, senior doctors will never assign dangerous surgical tasks to you.
As long as you are sure, just go for it boldly.
However, for the vast majority of interns and residents, getting a chance to suture the skin or close a cavity is enough to make them happy for several days.
During the actual operation, it is possible for a novice to take one or two hours to close the abdominal cavity and sew it.
Generally, the surgeon will leave the surgery early after completing the key parts of the operation, leaving a senior attending surgeon to take care of the surgery.
Then the newcomers can take the opportunity to get the chance to sew the skin.
It’s okay to sew slowly.
To prevent the senior attending physician who was in charge of the procedure from getting impatient.
Plus, with him watching, you'll feel nervous as you sew.
You can let him go first, or ask him to sit next to you and rest.
Wait until you finish sewing, then ask him to check it.
As long as you speak nicely, try to gain the trust of senior doctors, and work hard to build a good relationship with them, the attending physician who stays will most likely let you sew as much as you want.
Cooperate with the patient to leave temporarily, or leave the operating room directly.
Because they are very busy, and they also started out as newcomers and have worked their way up.
Naturally, I understand the sadness and difficulty involved.
"Come on! I say stop, you must stop immediately. Also, during the operation, do not act too hastily." Director Jia saw that even words could not scare Zhou Can.
There was no choice but to agree.
If he knew that Zhou Can was so stubborn and courageous, he would definitely not say those words to Zhou Can.
Now it's too late to undo what has been done and he can't save face.
I had to let Zhou Can try it.
"Director Jia, he's just a resident doctor! The risk of laparotomy is too high..."
He seemed somewhat unwilling that his job as deputy chief physician was taken away from him.
More of a worry.
"Let him try! I'll be watching from the side, the risk is controllable."
Director Jia sounded confident, but his expression was nervous.
His eyes were fixed on Zhou Can.
Zhou Can didn't bother to be polite with these people at all. He stood at the operating table, asked the nurse to put on sterile gloves, took the knife, and started operating directly.
This was not the first time he had performed an laparotomy.
Now I am fully capable of doing it alone and can do it well.
The surgical area has been disinfected and the surgical knife line has been drawn. Just cut directly.
His movements were incredibly smooth.
With one cut of the knife, the cortex was cut open.
Seeing him cutting pig skin as casually and at an extremely fast speed, Director Jia covered his heart with his hands and stared at the wound, not daring to blink.
As soon as Zhou Can finished the first cut, he quickly called for a stop.
I almost had a heart attack just now.
"The length and depth of the surgical incision are just right. It was cut so quickly and casually. Good boy, no wonder you are so confident, it turns out you have a lot of hidden talents!"
After Director Jia looked at the surgical incision, he breathed a sigh of relief.
Seeing Zhou Can cut the knife so casually, he was still thinking, it's over, it's over, the subcutaneous tissue layer and even the muscle layer must have been cut open by the knife.
After watching it, he realized that Zhou Can's ability was more than ten times stronger than he had imagined.
This knife seemed to be done casually, but in fact the measure was just right.
The deputy chief physician was so shocked that his eyes nearly popped out.
Even now, he still has an expression of shock as if he had seen a ghost.
Senior Sister Qiuhong’s beautiful eyes were also wide open.
Several other doctors, both attending doctors and residents, were all shocked by Zhou Can's knife skills.
"Can we continue?"
Zhou Can couldn't wait to open the patient's abdominal cavity to see the condition of the colon.
"continue!"
Director Jia's confidence in him has increased several times, and his trust in him has also increased significantly.
Next, Zhou Can opened the abdominal cavity layer by layer like a butcher cutting up an ox.
When cutting through the muscle layer, his knife passed through a section of it, and he clearly felt a different feeling from the knife, which was extremely subtle.
It was something he had never had before.
At present, his incision skills are close to the intermediate level of attending physicians, but have not yet reached it.
Logically speaking, only a deputy director could have such a clear sense of the knife.
Now, he has gained a clear sense of the knife, which is often called tactile feedback, one major realm ahead of time. This makes Zhou Can extremely happy.
He secretly guessed that it might be related to the integration of quick knife techniques into the cutting.
When his brain received the unusual feeling of the knife, his hand stopped immediately.
The biggest disadvantage of the quick knife technique is that the hands are faster than the brain.
Zhou Can was able to quickly stop the knife in his hand when he found the problem, which was a very good phenomenon. It showed that so far, his calmness could still restrain the evil nature brought by the fast knife technique.
Don't be swayed by the extreme sense of speed.
"It's a blood vessel with a relatively large diameter... well, it's a vein. Can I just cut it off?"
After Zhou Can stopped the knife, he looked up and asked Director Jia.
"Let me see!"
Director Jia has extensive experience in surgeries. Although the incision position was drawn by his assistant, he had already secretly reviewed it after he entered the operating room.
There's nothing wrong with that for sure.
Important blood vessels and nerves have been avoided.
"Really! It's no problem to cut off a vein with a diameter of no more than two millimeters. Of course, you can find it in advance when cutting it open, which means your knife sense is already very powerful. The cutting action is so fast, and you can stop the knife momentum in the first place, which is even more amazing. I have witnessed the surgical talent with my own eyes today."
Director Jia was amazed that Zhou Can was able to discover this blood vessel, which was not very thick, in advance.
For an old surgeon like him who has been immersed in surgery for more than 40 years, it is not surprising that he can find important tissues such as blood vessels and nerves with his keen sense of knife.
After all, the director-level cutting level is there.
It is quite abnormal that Zhou Can, a novice trainee, can do this.
In the end, Director Jia attributed it to his talent.
To be honest, Zhou Can’s talent for traditional surgery is not that good.
At best, it is above average.
On the contrary, his talent in nerve anastomosis and advanced surgery is particularly outstanding.
The fact that he is now able to display superb skills in traditional surgery is entirely the result of the combined efforts of his quick knife skills and the experience value system that have helped him to elevate his basic surgical skills to a higher level.
"Can I tie it first and then cut it open?"
Zhou Can wanted to take this opportunity to show off his medical skills so that he could gain more surgical opportunities after opening the abdominal cavity.
In competing for the training opportunity, Director Jia's subordinates were very polite and courteous.
When Zhou Can was interning in general surgery, those people were scrambling for the opportunity to practice surgery like hungry wolves.
That's scary.
"Yes, of course!"
Director Jia readily agreed.
This matter should have been the responsibility of the assistant. However, the deputy chief physician was proud of his status and stood there indifferent. It was clear that he did not want to be Zhou Can's assistant.
Because it would make him feel cheap.
Zhou Can quickly put down the scalpel, asked the nurse for the needle holder, hook, and thread, and then ligated the blood vessel.
The whole ligation process was fast and handsome, and it was done very well.
"Tsk tsk, this ligation level is conservatively estimated to have reached the level of a deputy director. It's too unscientific."
Director Jia uttered a series of exclamations.
The deputy chief physician who was too proud to be Zhou Can's assistant also had a change in his eyes when he looked at Zhou Can.
There has been a rare glimmer of respect.
Zhou Can is so young, but he has such superb incision and ligation skills, which is enough to make him re-examine and quickly adjust his impression of Zhou Can.
Qiuhong was even more amazing. When she looked at Zhou Can with her beautiful eyes, she was already filled with admiration.
Although she is already an attending physician, her surgical skills are far inferior to those of her junior brother Zhou, who is still a resident intern.
Her specific educational background is not known yet, but at least she has a master's degree.
All doctoral students, including some outstanding postgraduate masters, are excellent in academics.
It is hard to say about the actual operation.
After all, this requires a lot of practice to achieve results.
Although ligation seems simple, it actually involves many surgical techniques.
It must be explained here that ligation is not the same as tying a knot.
Tying the knot is only part of the ligation process.
It’s like men belong to the human race, but they are not equal to all human beings.
In addition to men, human beings also include women, children, and the elderly.
Ligation often requires the use of a hook needle to pass through some tissues in a skillful manner, tying up the blood vessels as perfectly as possible without damaging important tissues and blood vessels, and then tying a knot to secure it.
This process should avoid involving surrounding tissues and ensure that the tightness and firmness of the ligature meet the requirements.
Therefore, ligation is not the same as tying a knot.
In medicine, knot tying is never referred to as one of the four basic surgical skills.
After Zhou Can tied a knot in the blood vessel, he decisively cut it off.
He once again carefully felt the tactile feedback of cutting into the blood vessels.
Very wonderful.
This provides safety protection for his future surgeries. As long as the knife touches a blood vessel, he can get this signal feedback imprinted deep in the brain, and then stop immediately.
With his current ability, he should only be able to get feedback on blood vessels of about 2 mm.
As surgical capabilities continue to improve, we may be able to sensitively capture smaller signal feedback from cut blood vessels.
Because this blood vessel was ligated in advance, there was not much bleeding.
The entire laparotomy process was quick and efficient.
After Zhou Can opened the peritoneum, the internal organs in the abdominal cavity were exposed.
After seeing Zhou Can's surgical skills, the deputy chief physician's attitude changed completely.
Started to actively help stop the bleeding.
For those small bleeding points, electrocoagulation is performed.
"Open the abdominal incision to fully expose the surgical field of view."
Director Jia said to the third assistant and one of the residents.
The third assistant is Qiu Hong.
With her current surgical skills, she can only reach this level.
The operating room is perhaps the only place where academic qualifications are not important.
Whoever has better surgical skills will be the boss.
Academics are theory, and surgery is practical ability.
"Oh, this man's colon disease is quite serious! If he had come to the hospital for treatment earlier, he might not have to have part of his intestine removed . Many diseases are not treated until they become very serious. Fortunately, his is just an intestinal obstruction. If it was intestinal polyps, it might have turned into a malignant disease if it was not treated until so late."
Director Jia sighed as he examined the diseased intestinal segment in the patient's abdominal cavity.
"When you see patients in the future, you must remember that if you find that a patient has intestinal lesions, you must explain to the patient and his family that they need to be treated promptly. You cannot let them think that it is okay and then wait until it becomes a serious matter before you deal with it."
