Chapter 224 received a reward of 200 experience points for the first time. Is this a way to pass on the mantle?
After the patient was successfully anesthetized, Zhou Can stood at the operating position and prepared to perform the operation.
"Xiao Zhou, this is your first time to have this kind of surgery, so there are a few things you must pay attention to." Elder Liu told Zhou Can the precautions before he underwent surgery, explaining that the surgery involved extremely high risks.
“During the operation, it is necessary to avoid damaging important anatomical structures such as the carotid artery, internal jugular vein, vagus nerve, hypoglossal nerve and accessory nerve.”
This is a normal reminder.
Even if Mr. Liu didn't say it, Zhou Can would still operate carefully.
"This disease can cause repeated inflammation, so it should be surgically removed as soon as possible after the acute inflammation is controlled. If the fistula is small, there is no secretion or very little secretion, or if the patient is a child under 2 years old, surgery should be postponed."
If the surgical indicators are not met, then the surgery must not be performed.
Otherwise, over-medicalization may easily occur, which will do more harm than good.
Zhou Can listened carefully and kept all these valuable diagnosis and treatment experiences in mind.
"It goes without saying that fistula angiography is required before the operation. This operation can easily cause heavy bleeding, so we must also be prepared for blood transfusion."
Elder Liu continued to instruct Zhou Can and the junior doctors on some key points of the operation.
When doing this type of fistula angiography, iodized oil is often used.
The purpose is to find out the direction, depth and course of the fistula.
Some fistulas may have more than one direction , so you need to be more careful.
If you rush into surgery without undergoing angiography before surgery, you may still fail even if you have extensive surgical experience.
"This patient should have two horizontal incisions, as should all fistulas in the lower third of the neck. Make a transverse fusiform incision along the skin around the fistula in the lower neck, and make another larger transverse incision at the bifurcation of the common carotid artery."
Mr. Liu had already drawn the position of the blade in advance.
But he still explained it to Zhou Can and others.
"If the fistula is located high, a transverse incision is sufficient. The location of the incision is determined based on the results of the examination, and it is necessary to avoid large arteries, blood vessels and important nerves."
Neck surgery has always been considered a high-risk area by doctors.
Zhou Can has been interning for nearly a year and wanted to get a chance to do neck suture, but Mr. Liu agreed very reluctantly.
If it weren't for Zhou Can's great contribution in that thyroid surgery, I would never have agreed to it.
This small incident shows how highly senior doctors assess the risk of neck problems.
Different times, different circumstances.
Now, let alone stitching the skin on the neck, even operating the knife is done by Zhou Can.
In the past year and a half, Zhou Can has made tremendous progress.
Normally, it takes at least six years for a general surgeon to complete his internship and be able to operate a knife on a patient's neck on his own, even if it is just the simplest incision to open a wound.
After three years of regular training and three years of residency surgery training, senior doctors will consider giving you the opportunity to make an epidermal incision in the neck.
He must also be a senior resident with outstanding performance.
Don't even think about those who are careless and rash.
In fact, surgeries on the neck are basically major surgeries of level three or above.
The risk is extremely high.
The attending physician is only qualified to act as an assistant in this type of operation.
Zhou Can carefully cut a wound according to the knife position. When cutting, Elder Liu's nerves must have been tense, and his hands clenched into fists instinctively. He was worried that Zhou Can's knife speed was too fast and cut the patient's carotid artery.
The plasma was already prepared.
If something happens, blood transfusion can be given immediately to save the life.
This also shows how much effort Liu Lao put into Zhou Can's cultivation. Basically, he was risking his future and his job.
[Cut experience +1. ]
[You successfully cut open the patient's neck for the first time, and are rewarded with +100 incision experience points. ]
Zhou Can didn't expect that he could earn 100 experience points as a reward in this way.
I was really happy.
Cutting the neck was not actually a big challenge for him.
It feels no different from cutting the epidermis when opening the abdomen or chest.
After he was promoted to the intermediate level of chief surgeon in incision surgery, he seemed to have a clearer sense of touch of the scalpel. When cutting, he could know more clearly and accurately whether he was cutting the epidermis, subcutaneous tissue, blood vessels, muscles, etc.
The tactile feedback they give Zhou Can is different.
It is this sense of touch that allows surgeons to miraculously move nerves, blood vessels and other important tissues on the sharp tip of the knife.
After incision, it is actually very difficult to clearly distinguish the fistula with the naked eye.
This does not pose a problem for doctors.
They came up with a solution: after cutting open the neck, they would first inject methylene blue into the fistula. This way, the fistula could be easily identified during the separation process.
Next, Zhou Can cut the skin, subcutaneous tissue and platysma muscle along the incision design, then clamped the fusiform skin containing the fistula with hemostatic forceps, and then made a sharp separation along the fistula tract.
This separation process sounds simple, but it is extremely difficult to operate.
It needs to be separated gradually from bottom to top to the bifurcation of the common carotid artery.
"Xiao Zhou, when separating along the fistula to the carotid bifurcation, the carotid sinus should be blocked with 1% procaine to prevent carotid sinus syndrome."
Mr. Liu reminded Zhou Can in time during the operation.
"clear!"
Zhou Can quickly completed the corresponding operations, then made a second transverse incision on this plane and pulled the separated fistula cord tissue out of the skin through this transverse incision.
Even though Zhou Can proved his strength by making the first incision on his neck, when he made the second incision, Old Liu was still worried, fearing that something might happen to Zhou Can.
After all, the risk is too great.
Fortunately, Zhou Can has always been as fast as the wind and as steady as an old dog, so he didn't cause him any trouble.
In the following operations, Zhou Can fully utilized his superb separation skills.
Since this fistula passes between the internal and external carotid arteries and then bends toward the lateral wall of the pharynx, it undoubtedly increases the difficulty of the operation.
Not to mention Zhou Can was the one operating it, even if it was Elder Liu who was operating it, he wouldn't dare to be careless at all.
Zhou Can carefully separated the fistula from the internal and external carotid arteries, and then pulled the external carotid artery forward.
When doing the above steps, you also need to pull the posterior belly of the digastric muscle and the hypoglossal nerve upward.
Then continue to separate inward along the fistula until reaching the lateral wall of the pharynx.
Every step of separation is extremely difficult.
It is of great benefit to the improvement of his separation medical skills.
At this stage of separation, Elder Liu personally assisted him and used his fingers to push the side walls of the pharynx outwards to make the fistula shallower, making it easier for Zhou Can to separate the remaining part of the fistula.
Finally, the fistula was successfully separated by Zhou Can.
[Separation skill experience +1.]
[You successfully separated a very difficult fistula for the first time, and you will be awarded separation experience points +200. ]
This was the first time Zhou Can had ever earned a 200-point experience point reward.
Only he himself knows how difficult the entire separation process is.
It can be said to be full of difficulties and dangers.
Therefore, he felt justified in taking the 200-point reward.
It's much harder than earning two 100 experience point rewards.
"Very well done! Clean the wound and sew it up!"
In fact, Mr. Liu also broke out in cold sweat.
Now seeing that Zhou Can had successfully separated the entire fistula, he breathed a sigh of relief and a happy smile appeared on his face.
It was precisely by virtue of his repeated success in operating the system without incident that Zhou Can gained Mr. Liu's deep trust.
So much so that they dared to give him full authority to perform this extremely high-risk operation.
After flushing the wound cavity, stop bleeding completely.
These operations are simply child's play for Zhou Can.
Level five hemostasis and level four debridement are not given for nothing.
He had performed more than 700 operations in the general surgery department in the past month, and his debridement experience points were also very high. However, he still had a long way to go to be promoted to level five.
The main reason is that you rarely encounter difficult debridements, so the chances of earning a 100-point experience bonus are extremely rare.
It is too difficult to advance to level five by just earning 1 debridement experience point each time.
A full 10,000 debridement surgeries need to be completed.
Many surgeons may not be able to perform so many operations in their lifetime.
After cleaning the wound and stopping the bleeding, Wu Ziyu looked on with envy.
"Director Liu, Doctor Zhou, can I sew it up?"
She watched Zhou Can take on increasingly advanced surgical tasks, while she couldn't even get a more difficult suturing task, and she was very anxious.
Being with strong people will naturally force you to make progress.
She wanted to narrow the gap with Zhou Can.
"The suturing requirements for this operation are very high, and you are not yet capable of doing it! Next time there is a simpler suturing task, I will give it to you to practice!"
Mr. Liu didn't have the heart to dampen her enthusiasm.
However, no senior doctor would easily delegate authority regarding surgery.
Even though Elder Liu dared to delegate such difficult surgical tasks as separating and cutting the fistula in the neck to Zhou Can, it was because Zhou Can, through continuous experience, made Elder Liu believe that he had the ability to do it well.
Wu Ziyu had only performed surgeries for less than two days in total, and in Old Liu's mind, her trustworthiness was still very low.
Moreover, her surgical skills are far from comparable to Zhou Can's.
So it's not surprising to be rejected.
"Doctor Wu, don't be too anxious. When the time is right, everything will naturally fall into place." Zhou Can comforted her.
I can understand her eagerness to improve her strength.
Zhou Can had this experience too.
Especially at the beginning, I didn’t know this or that, and watching other doctors perform the operations made me feel like I was being scratched by a cat.
He had been ruthlessly rejected many times by Dr. Xu.
Now that he has become stronger, he doesn't even need to ask for help, as the senior doctors will directly delegate power to him.
Next, he sutured the wound in layers and placed a rubber tube drainage strip.
Sandbag pressure treatment on the neck.
The operation is considered completed at this stage.
The patient's postoperative care is handled by the attending physicians and nurses in the inpatient department.
"Okay, push the patient to the recovery room! Postoperative care requires the use of antibiotics to prevent infection. Dexamethasone , and nebulized inhalation can be given. After the operation, depending on the situation, the drainage strip will be removed within 24 to 48 hours, and the stitches will be removed 7 days after the operation."
These are the medical instructions given by Mr. Liu.
Doctors and nurses in the inpatient department are required to implement this.
Zhou Can checked the remaining dozen or so operations and felt a great deal of pressure.
I'm afraid I'll have to work overtime until very late today!
He worked so hard to build a foundation for the newly established thyroid and breast surgery department.
In the future, when the Department of Thyroid and Breast Surgery develops, these initial members of the department will have some feelings for it. For Zhou Can, this will definitely be a great benefit.
…
Four days later, Zhou Can was so tired that he lost a lot of weight. He had completed all the backlog of surgeries that the doctors in the thyroid and breast surgery department had done.
His surgical experience has improved by leaps and bounds.
When I performed surgeries with Dr. Liu in the past, the types of diseases I came into contact with were mainly thyroid diseases.
Although there were less than 100 surgeries performed in these four days, they were varied and involved various medical fields, which greatly helped Zhou Can expand his surgical knowledge.
It is difficult for one surgeon to perform operations in so many areas in a short period of time.
Especially the small and big hands plus minor surgeries, Zhou Can almost re-understood the structure and pathological mechanism of the human body. The benefits of learning, understanding, and surgical anatomy of all kinds of diseases in a short period of time are immeasurable.
It's much better than hitting here and there.
The biggest benefit of continuous learning is that it facilitates more comprehensive cognition and comprehension.
After so many surgeries, the prognosis is still good.
The only thing that made Zhou Can feel a little regretful was the patient who underwent the removal surgery for the giant lipoma on his head and face. Because he suffered from unavoidable postoperative syndrome, he was transferred to the internal medicine department for further treatment after the initial healing of the wound.
No one can guarantee what will happen to that patient in the future.
The operation was obviously successful, but the result was somewhat disappointing.
This matter made Zhou Can feel uneasy.
It was this case that made him realize that doctors’ abilities are more limited than they imagined, and they feel helpless when faced with many situations that they cannot handle.
In the office, Mr. Liu looked relaxed with a hint of smile on his face.
Zhou Can helped to deal with all the backlog of surgical patients, so the thyroid and breast surgery department no longer had to worry.
During these four days, Dr. Liu and Zhou Can were busy . The other chief physicians were also busy and devoted themselves to their new work.
The thyroid and breast surgery department has initially gotten on the right track. For patients with thyroid and breast diseases who come to Tuya Hospital for treatment, as long as the condition can be treated by surgery, the thyroid and breast surgery department has ensured that all those who need treatment should be admitted and treated.
Ensure that no one is missed in diagnosis and no patient has to wait in line for days without being able to see a doctor.
The entire medical work of the thyroid and breast surgery department is in order.
I believe the experience for patients is very good.
The doctors and nurses also quickly adapted to their new jobs from their initial discomfort. They all worked very well and worked very hard.
The entire thyroid and breast surgery department showed a prosperous and gratifying situation.
"Xiao Zhou, thank you for your hard work these past few days! If possible, I really want to keep you in the Department of Thyroid and Breast Surgery to continue to help this department develop and grow."
Old Liu knew that Zhou Can was determined to leave and there was no way to keep him.
The young eagle will eventually grow up, go out into the world and continue to hone its skills. Eventually, it will soar into the sky and roar proudly into the clouds.
Zhou Can still has a lot to learn.
It's not enough to just know how to perform surgery.
Internal medicine is difficult, but it is a required course for every famous doctor.
"Thank you for your kindness to me. When I finish my studies, I will definitely have the opportunity to help out in the general surgery department again. The definition, etiology, pathogenic mechanism, epidemiology, natural history, symptoms, signs, laboratory diagnosis, imaging examination, differential diagnosis, diagnosis, treatment, and prognosis of diseases in internal medicine. All this knowledge is what I need to learn in depth. While I am still a resident trainee, I want to seize the opportunity to study hard in the internal medicine department to pave the way for my future medical practice."
During the three months of regular training in the Department of Critical Care Medicine, Zhou Can had already deeply realized the importance of internal medicine.
True medicine originated from internal medicine, not surgery.
Internal medicine studies pathology and pharmacology, while surgery focuses more on technology than on theory.
Chinese traditional medicine was first developed based on medical classics such as Huangdi Neijing and Suwen.
Zhou Can had a clear idea in his mind as to which of the two was more important.
If you neglect the study of internal medicine because you have shown extraordinary talent in the field of surgery and have made some initial achievements, it would be a waste of time. Now it is just a small effort and I don’t think it is a big problem.
If he is really allowed to take charge on his own in the future, the disadvantages will become seriously apparent.
There will be constraints everywhere.
"Your idea is very good, and you haven't lost yourself because of your temporary success. It's very rare for you to have such a clear understanding at your age. Don't worry, I'm not that selfish. This general surgery record is some of my experience and experience in practicing medicine for decades, as well as the surgical ideas, including some mistakes and omissions, all recorded in detail. Take it back and read it when you have time. Maybe you can gain something from it."
Dr. Liu has been practicing medicine for more than 30 years. Although he is only an associate chief physician in general surgery, he has strong surgical skills.
The surgical experience accumulated over the years is like a treasure to a newcomer like Zhou Can.
It was a thick pile of books, with about twenty or thirty bound volumes.
It’s hard to imagine that all of this was recorded stroke by stroke by Mr. Liu.
Zhou Can stood up, took it respectfully with both hands, picked up the top bound volume and flipped through it.
I naturally felt admiration for Mr. Liu.
Every recorded operation, omissions in diagnosis and treatment, and some pre- and post-operative incidents were recorded clearly, with neat handwriting and some even with pictures.
It is definitely a set of medical works.
Decades of hard work in recording were selflessly given to Zhou Can for Zhou Can to study and refer to. Mr. Liu really regarded him as his closest successor.
"Your gift is too valuable. I will take it back, make a copy of everything, and then return the original to you."
Zhou Can felt that the information in front of him was more valuable than a mountain of gold and silver.
"I am old, and I will retire in a few more years. These notes are no longer useful to me. After you read them, if you think they are valuable, you can keep them for other young doctors with potential and high medical ethics. Remember, no matter how high your medical achievements are in the future, you must not pass on some core medical skills to those with bad morals."
Old Liu only made one request to him.
