Chapter 207: Another one left, fighting in times of crisis
This incident at least made Du Leng feel that the situation was very good.
There was no expression on Zhou Can's face. The departure of Song Ze did not have much impact on the surgical capabilities of Deputy Director Liu's team.
Because Song Ze usually plays the role of a second assistant in major operations, pulling the hook, doing miscellaneous tasks and so on.
As for the ability to perform surgery alone, Song Ze is an attending physician with relatively little experience and can perform some simple first and second level general surgery operations alone.
Now that he is gone, Zhou Can has taken over all of Song Ze's surgeries.
Zhou Can and Song Ze watched the doctors from Yang Qing's team leave without saying a word.
When Song Ze passed by him, he even turned his head away deliberately, pretending not to see Zhou Can.
"Is Yang Qing's team really that good?"
I really don’t know what Song Ze is thinking?
I always feel that Song Ze has no dignity at all in Yang Qing's team.
Zhou Can ignored these people and took the patient with bile duct stones into the operating room with the intern.
Not long after, He Hansheng, Deputy Director Liu and others entered the operating room one after another.
Zhou Can's eyes flashed, and he found that there was one less person in the team.
"Director Liu, I have something to tell you. Resident Cheng Gang has moved to another group."
He Hansheng gritted his teeth and told Deputy Director Liu about this matter.
"Another one gone?"
Old Liu was stunned for a moment, his tone was full of loneliness and there was sadness deep in his eyes.
One after another, his doctors left his team and joined other groups at this critical moment. For this man in his sixties, it was tantamount to a repeated mental blow.
Up to now, the entire surgical team is left with only the first assistant He Hansheng and the third assistant Wan Sanlao.
After all, Zhou Can was just a resident intern, and he left after completing his rotation in this department.
So he is not a permanent member of the team.
The other trainees and interns were useless. They could only help with some low-tech and low-risk jobs. And they were leaving too.
An intern still has a long way to go if he wants to become a resident physician under Deputy Director Liu.
There are also many variables involved.
At least 90% of Tuya's interns will eventually be eliminated.
Less than one in ten people can stay.
Anyone who has done an internship knows that when I first started doing an internship at a provincial tertiary hospital, I felt extremely proud and had great expectations for the future. But when the internship was over, I realized that it was extremely difficult to get the qualification to stay in the hospital for regular training, let alone stay in the hospital.
The competition among large hospitals is really fierce.
Thousands of people are trying to cross a single-plank bridge, but only a few can make it. Everyone who successfully makes it is a hero.
Three of Mr. Liu's doctors left in just one day, each of whom he had carefully trained for at least two years.
These people left without even saying goodbye, they just left.
The coldness of human nature is most truly reflected in the face of interests.
"You can't keep those who want to leave. Let's start the operation!"
Old Liu sighed and said with some disinterest.
"Doctor Zhou, you are better at endoscopic surgery. Let's work together to complete this operation and let Director Liu take a break."
He Hansheng asked Zhou Can for his opinion.
At this moment, Elder Liu was so shocked that his hands were shaking. He didn't know whether he was so angry or if he was seriously unwell.
After all, I'm old.
My current condition is definitely not suitable for me to perform the surgery myself.
"I have no problem at all. Just have Elder Liu by my side to instruct me on the key operations of the surgery. I am confident that I can perform this operation well."
Zhou Can had already studied the patient's examination report.
If there are many stones in the bile duct, endoscopic examination, cholecystectomy and common bile duct stone removal are required.
He already had experience with endoscopic gallbladder removal.
Even without the guidance of a senior doctor, I am confident that I can complete this operation well.
"Xiao Zhou, the previous steps are the same as laparoscopic cholecystectomy, you can just do it directly."
Mr. Liu is quite confident in Zhou Can's endoscopic surgery capabilities.
"Okay!"
Zhou Can followed the steps of laparoscopic cholecystectomy.
"Depending on whether the cystic duct is widened, this type of laparoscopic surgery can be performed through the cystic duct or through the common bile duct incision. The former is suitable for cases where the cystic duct is relatively short and thick, and this method can be considered for patients with a diameter greater than 5 mm. For patients like this, the stones in the bile duct are small and few in number, so common bile duct incision exploration and stone removal and T-tube drainage can be performed."
Elder Liu was there to guide Zhou Can as he performed the operation.
"clear!"
While answering, Zhou Can carefully dissected out the upper section of the common bile duct along the cystic duct.
After processing the cystic artery, the cystic duct was freed and the anterior lobe of the hepatoduodenal ligament was dissected toward the junction of the common bile duct and the common hepatic duct.
Until the blue-green bile duct is clearly visible.
These operations require extremely advanced endoscopic surgical skills.
Among Dr. Liu's surgical team, even if Dr. Liu did the surgery himself, he might not be able to do it as well as Zhou Can.
The others just stood by and watched quietly.
Some people stared at the endoscope screen, while others stared at Zhou Can's hands.
Zhou Can carefully cut open the anterior wall of the common bile duct.
Blood vessels appear on the anterior wall of the exposed upper common bile duct.
He calmly used curved separation forceps to lift the anterior wall of the bile duct and then performed electrocoagulation.
Next, place a small piece of gauze with barium sulfate thread in the Wenshi foramen and use curved microscissors to cut the anterior wall of the common bile duct longitudinally or obliquely for about 1 cm.
In these operations, the insertion and clamping techniques that he had practiced hard came in handy.
After successfully completing the operation, you will be directly rewarded with 100 experience points.
Because it is the first time operation and it is quite difficult.
It is of great benefit to his growth of surgical experience and improvement of endoscopic surgical capabilities.
The system rewards 100 experience points, which usually means Zhou Can has made great progress in surgery or diagnosis, or has made significant gains.
"Good, you must keep it up!"
Deputy Director Liu felt very gratified as he watched Zhou Can steadily advance the operation.
Next, fibercholedochoscopy is performed to explore the bile duct and remove stones.
Zhou Can manipulated the endoscope to probe upward to the left and right hepatic ducts, and after finding the stones, he used a stone removal net to remove them. Then he probed downward to the lower end of the bile duct and removed the stones in the same way.
During the exploration, he found that there were many stones in the bile duct.
"Mr. Liu, can we use the laparoscopic rotating joint grasping forceps to directly remove the stone?"
Zhou Can asked for Mr. Liu's opinion.
"Can!"
Old Liu nodded in agreement.
This method of stone removal is very convenient and practical.
After the stones were almost completely removed, Zhou Can used a choledochoscopic examination to remove the remaining stones.
There are still several key surgical steps to be done.
A T-tube was placed, and the bile duct incision was sutured.
This step is a test of suturing skills. If bile leaks around the T-tube, it means that the suturing is not in place.
Fortunately, Zhou Can's suturing and ligation skills have reached the deputy director level.
The whole operation was safe and sound.
At this point, the gallbladder can be removed directly.
After the gallbladder is removed, the surgical field is flushed and a peritoneal drainage tube is placed.
During the operation, the abdominal drainage tube was inserted into the abdominal cavity through a puncture in the right anterior axillary line and placed around the T-tube and in the liver-kidney space. This step was much more difficult than imagined.
Fortunately, after hard work, Zhou Can finally lived up to expectations and successfully completed the entire operation.
"Mr. Liu, I have a question for you. I just found that the patient's gallbladder showed signs of malignant transformation during the gallbladder removal. In this case, do we need to send it for pathological examination?"
Zhou Can asked Mr. Liu for his advice on how to deal with the situation.
"Generally, we don't send the gallbladder for further examination. This can reduce the cost of treatment and save money for the patient. It can also avoid the psychological pressure on the patient if the examination result is bad. The gallbladder has been removed and it is impossible for it to become cancerous, so there is no need to do it again. However, during the postoperative ward rounds, we tell the family members or the patient that it is a good thing that your gallbladder was removed because we found that it may become malignant. After hearing this, the patient and his family will feel more satisfied with the results of the operation."
Elder Liu taught Zhou Can how to communicate skillfully with patients and their families.
Communication between doctors and patients is extremely important.
Filling the entire perioperative period.
Good communication can greatly enhance patients' trust and good impression of doctors. Poor communication will leave hidden dangers for medical disputes.
"Of course, if a clear tumor is found in the gallbladder, and there is even a risk of metastasis, it must be sent for examination. We should also pay attention to whether there are lesions in the surrounding lymph nodes and blood vessels."
If there is a serious problem, lymph nodes are the first defender.
Lymph node enlargement, nodules, etc. can be found.
After the operation is completed, the rest is handed over directly to the medical staff in the recovery room and intensive care unit.
He Xuesheng looked up at the wall clock, hesitated for a few seconds, and said in a somewhat embarrassed tone, "Director Liu, our team has a total of nine operations today. We have already completed the two largest ones. There are seven level one and level two operations left. Originally, Song Ze would have shared some of the work, and we should have been able to finish all of them by eight or nine in the evening. Now I am the only attending physician left... It's really a bit difficult."
Not everyone can perform surgery as fast as Zhou Can.
In reality, most surgeons operate very slowly.
Because they are very worried about accidents happening if they go too fast.
After Song Ze left, all the second-level surgeries would definitely fall to He Hansheng. For the first-level surgeries, resident doctor Wan Sanlao could share some of the responsibilities, but his ability to share was very limited.
No wonder He Hansheng is worried about this.
He may not be able to finish the work until midnight.
In fact, doctors are not made of iron.
Any surgery requires full concentration and physical strength. It is impossible to perform a good surgery on a patient in a tired state.
"You have limited abilities and energy, and you really can't handle so many surgeries. Push a few of them to tomorrow night and try to hold on for the next few days. In the future, we can push some of the surgical patients we receive during our clinic to other teams."
After thinking for a moment, Mr. Liu said bitterly.
Pushing patients to other groups is a sign of incompetence.
Mr. Liu would not have made such a decision if he had not been left with no other options.
He Hansheng is already the attending physician and an important member of the team. His schedule is packed with activities every day.
The next two or three days will be overloaded, which will have a huge impact on him.
Asking doctors from other groups to help absorb the extra surgical patients is one of the few good solutions.
However, doing so would cause great , and the doctors in this group would also be unable to hold their heads up.
It was already embarrassing that three doctors had escaped to other groups.
Now asking other groups to help with handling surgical patients would only make everyone laugh at their group.
In this competition, their group lost on the first day.
This is the cruelest fact.
"Mr. Liu, Doctor He, I have an unwelcome request. If you can agree, perhaps we can continue to accept the surgical patients in our group without reducing the dosage."
Zhou Can took the initiative to step forward at this critical moment.
As long as we help this group win the competition, when we establish a new sub-department, we can recruit more outstanding doctors to join.
The most important thing is to overcome the current difficulties and strive to win the competition.
Their group doesn't need to take first place in every field.
Because of the dismemberment of general surgery, several new sub-departments will be established, at least eight or nine.
No matter which general surgery and disease field you succumb, you will have the opportunity to qualify as a sub-department leader.
"you say!"
Elder Liu, He Hansheng, and even the resident doctor Wan Sanlao, as well as several trainees and interns, all looked at Zhou Can expectantly.
They don't want to fail so easily.
Everyone wants to have a bright future.
"While the two of you are having surgery, I will also be performing surgery alone in the same operating room. For example, if you are performing a level 3 major surgery, I can help you with level 1 and level 2 surgeries. I believe you are aware of my surgical abilities, but what I lack is the qualification to perform independent surgeries."
Zhou Can said this to this extent, and I believe that both Mr. Liu and He Hansheng can understand what he means.
"This... is actually a solution that is not a solution. As long as the surgery performed by Dr. Zhou can guarantee the quality and avoid accidents, it is very feasible."
He Hansheng's eyes lit up. Some operations that seemed to involve certain risks could indeed effectively solve problems.
More likely to create huge benefits.
For Zhou Can, he is not short of money, but what he lacks is surgical experience and experience points.
A large number of first and second level surgeries can allow him to quickly earn a lot of medical experience points and accumulate rich surgical experience.
During the three months of regular training in the emergency department, he performed a large number of surgeries which laid a solid foundation for his surgery.
Until now, he still benefits greatly from it.
"Xiao Zhou has performed miracles in the emergency department before. After more than a year, you have become stronger. I believe you will do better."
Mr. Liu knew about Zhou Can’s heroic deeds in the emergency department.
At that time, the number of surgeries in the emergency department increased by one or two thousand per month, and Director Xie of the general surgery department was extremely anxious.
The matter was even brought to the level of vice president.
"So, you agree with this plan? We can try it out now. I have already learned about today's surgical cases. Only two level 2 surgeries require detailed guidance from senior doctors. I am confident that I can complete the rest independently."
Zhou Can was well prepared.
He had studied all the surgical cases in detail, which gave him great confidence.
Speak with confidence.
"I was supposed to go to Tuya Medical College today to participate in a discussion and research project. I can go there later and see your independent surgical ability from the side."
Deputy Director Liu was still a little worried.
Under normal circumstances, any chief surgeon will never allow interns to perform surgery on patients. Resident trainees will only be given opportunities to perform operations with minimal risk and controllable results.
For example, skin sutures, retractors, and punctures.
Even clamping some important blood vessels with hemostatic forceps will not be done by trainees.
Because I’m afraid of pinching the blood vessels.
When trainees stand on the operating table and see the bloody wound, they are usually extremely nervous. If they are asked to clamp a blood vessel, they must use as much force as possible, which can easily injure the blood vessel wall.
"Thank you Mr. Liu for your trust! I will definitely do my best!"
Zhou Can clearly helped the entire team solve a big problem, but he thanked Mr. Liu very humbly.
It is this gentlemanly quality that makes him loved by his senior doctors.
After discussing it, they changed to a larger operating room and let Zhou Can perform the operation independently, with Elder Liu guiding him.
The difference between participating in surgery and independent surgery is huge.
The first thing to do is to overcome psychological dependence.
The surgeon needs to be familiar with the entire surgical procedure and process. In addition, when encountering various emergencies, solutions need to be provided immediately.
Many large operating rooms have two or more and can perform surgeries simultaneously.
The original intention of this design was to take into account the huge risks of the operation, and there were very few surgeons who could take on the responsibility.
With two operating tables, the chief surgeon can lead his team to perform major surgeries in the outer room, while his attending physicians and deputy chief physicians can perform secondary surgeries independently in the other room.
If you have any questions, you can run over to ask the chief surgeon at any time.
Many surgeons in large hospitals are trained step by step in this way.
Therefore, Zhou Can's independent surgery in the emergency department was not a first.
But there are precedents to follow.
However, the operating room of the emergency department is much simpler than the large operating room of the general surgery department.
The first surgical patient was brought to Zhou Can.
This is just a level one surgical patient.
Subcutaneous tumor resection.
The risk is lower.
