Chapter 229 I love competition, the battle for fame begins
"Of course, nothing is absolute in this world, and we can't throw the baby out with the bathwater. Sometimes the cause of the disease is clear, but the pathological mechanism is not, or there are only superficial symptoms and the cause cannot be found for the time being. At this time, symptomatic treatment is also a stopgap measure. It can not only alleviate the patient's pain, but also save the patient's life as much as possible. In the process of practicing medicine, avoid dogmatism."
Director Shang might be worried that he would turn Zhou Can into a blockhead, so he added another sentence.
Diagnosis and treatment is an extremely complex process that must be learned and applied flexibly.
People who only know how to use formulas and apply things mechanically are not suitable to be doctors.
Etiology, pathogenesis, syndromes and symptoms are the understanding and reflection of a disease from different angles. This requires doctors to flexibly use several treatment modes, including diagnosis and treatment based on cause, diagnosis and treatment based on syndrome, and symptomatic treatment.
"clear!"
Zhou Can nodded to show that he understood.
He has never been the kind of person who acts in a rigid manner.
"There are no special requirements for being a trainee under me. You just need to be serious and responsible. It would be even better if you can be proactive and hardworking on top of being serious and responsible."
Director Shang’s requirements may seem low, but they are actually quite high.
It is very difficult to be serious and responsible. It is even more difficult if you add initiative and diligence. It is like doing the work of a trainee and worrying about the director.
"I will give you a department login account later, and you can check the patient information of your group at any time. If you have time, you can even check the patient information of other groups in the department. If you have any questions, you can ask me at any time."
This treatment has basically become the standard that Zhou Can can enjoy when he enters the new department.
For ordinary trainees, being able to talk to the chief physician is enough to make them happy for a long time.
However, Zhou Can was able to consult the chief physician at any time.
"Then tell me about your daily work schedule. For now, it's basically normal operations like checking nursing records, checking examination results, writing medical records, issuing medical orders, and making ward rounds. You are now a resident trainee, and you are different from those interns who have just been here for a short time. You need to take on more work tasks. For example, if a new patient is admitted to the group, it will be randomly assigned to you resident trainees or outstanding interns for individual management."
Interns generally don't have to take on too much work.
Their superiors would not simply let them take care of patients alone, mainly because they were afraid something might go wrong.
After all, most interns are senior undergraduates who have just studied medical theory for four years in school. Medical undergraduates usually go to hospitals for internships in their fifth year.
Tuya College of Medical Sciences is one of the top medical universities and is interdependent with Tuya Hospital.
Some of its outstanding senior students will be qualified to intern at Tuya Headquarters.
Those who are not so good may get internship in Tuya Second Affiliated Hospital or other hospitals. Basically, the school arranges internship units for students.
When interns first enter the hospital, they are basically newbies.
Teachers usually don't supervise their interns. Some interns have been in the hospital for a year but don't even know what the chief physician they teach looks like. This is not nonsense, but a true story.
The people who supervise interns are mostly residents and chief residents.
Some outstanding ones may be able to hold on to the attending physician's big legs and may also be protected by the attending physician.
In short, interns will never take care of patients alone as soon as they enter the hospital.
When does it start?
When your superiors start asking you to write medical records on your own, it basically means that they are preparing to let you manage patients on your own.
Zhou Can is a resident intern and has already obtained a medical license, so it is necessary for him to take care of patients individually.
But he just entered the gastroenterology department, so he needs at least two days to adapt!
Being famous also has its downsides.
Director Shang didn't even ask him whether he could take good care of the patient and just arranged it for him directly.
And from the tone of voice, taking care of the patient alone is just the most basic operation.
"I have many trainees, interns, residents, and attending physicians under my command. If you want to get more advanced training opportunities, you need to work hard for it. I will give more growth opportunities to those who perform well, in a fair and just way. If you want to get the opportunity to perform interventional surgery, sit in on the clinic, or even participate in research projects, you need to perform well."
Fair competition is what Zhou Can likes most.
Ordinary interns and trainees will basically be completely defeated if they compete with him.
Even the residents found it difficult to compete with him.
An excellent attending physician might be able to fight him.
At least this was the case in almost all surgical departments. Now that he was in the internal medicine department, he didn't dare to brag.
After opening the department's login account, Zhou Can began to diligently review the case information within the group.
By looking at the medical records written by others, you can basically infer the level of that doctor.
"Doctor Zhou, a patient who had undergone radical total gastrectomy surgery has come to bed 71. Director Shang said that you are responsible for his care."
The nurse who greeted him was very pretty, with very fair skin and a sweet smile on her face.
"Okay, I'll be right there."
On his first day at work, he was assigned to take care of a patient individually. Director Shang probably intended this to be a test for him.
These chief physicians are all veterans.
It is not easy to gain their appreciation.
No matter how famous Zhou Can is in other departments, if he wants to gain trust and recognition when he arrives at a new department or becomes a new chief physician, he must work hard.
He already has a very high status in the eyes of Director Jia, Mr. Liu and others.
But when I come to Director Shang, the treatment is only slightly better than that of ordinary trainees.
Quickly coming to bed No. 71, Zhou Can saw three family members gathered around the bed: a white-haired old lady, a middle-aged woman who looked somewhat similar to the old lady, and a middle-aged man with an ordinary appearance but an extraordinary aura.
The three family members were all dressed very elegantly and tastefully.
This indicates that the patient’s family background should be good.
But once you get to the hospital, no matter how wealthy your family is, it's useless. Everyone is equal in the face of disease.
If it is a malignant tumor, as long as it spreads, even if you are as rich as a country, you cannot buy your life.
"Hello, I am the attending physician of bed 71. My last name is Zhou. If you have any problems during your hospitalization, you can come to the doctor's office to see me at any time. If you have any needs or new progress in the course of the disease, you can report to me at any time."
When Zhou Can first started his internship, he was somewhat scared when he saw family members.
Now I am better, I am generous and confident, no different from those doctors who have been working for many years.
The less confident you are, the more timid you are, and the less confident you are in what you say, the more your family members will look down on you. This is not good for the management and communication of patients during hospitalization.
The family members think you are an intern and won’t tell you anything.
Because he thought it would be useless even if he told an intern.
So they will usually bypass you and go directly to the senior doctors to report the situation when they are making rounds.
The senior doctor would think, what's wrong with the attending physician? He can't even handle such a small matter, and he has to make a fuss during the ward rounds, and the family members come to report to me.
As a result, the senior doctor will have a very bad impression of the intern or resident in charge of the patient.
Zhou Can also suffered many losses and gradually figured it out, and only then did he learn how to handle family members and patients.
"Doctor Zhou, when will your hospital arrange treatment for my father?"
The woman asked politely.
"From the moment our hospital admits patients, we have already started to treat them. The examinations, basic physical sign measurements during hospitalization, and various medication regimens are all necessary preparations before treatment."
Zhou Can answered the woman's questions one after another and checked the patient's information at any time.
So that you can have a clear idea.
"He had a total gastrectomy six months ago, right?"
"Yes! At that time, it was discovered that my father had stomach cancer. After evaluation, it was determined that his entire stomach had to be removed to save his life."
The woman replied.
"After the operation, the food my dad ate turned into liquid and flowed out directly from the drainage tube in his abdominal cavity. My dad couldn't eat at all and could only receive nutritional infusions to maintain his life."
This patient is really unfortunate.
Total gastrectomy surgery itself will bring some adverse effects. If food flows out of the abdominal drainage tube after the operation, it is mostly due to problems with the anastomosis between the esophagus and the jejunum.
"The patient developed an esophageal-jejunal anastomotic leakage after surgery, right?"
Zhou Can made inferences based on his own experience.
"Yes, yes, yes. After the doctor examined him, he said that there was a fistula. We didn't understand these medical terms. Basically, there was a problem with the connection between the esophagus and the jejunum. At first, we were asked to observe for a while, but after two months, there was still no improvement. We were actually very angry at the time, because it showed that the operation was not done well. We no longer trusted the technology of that hospital, so we took my dad to another famous large hospital for a second operation."
The woman was quite sad and angry when she mentioned this matter.
However, Zhou Can's ability to tell her the disease her father was suffering from at the time gave her more confidence in the medical skills of Tuya Hospital.
If any young doctor in charge of a ward can have such a high level of medical skills, how can the medical level of Tuya Hospital be bad?
Little did she know that the attending physician in front of her was one of the best among all the attending physicians.
Generally speaking, a doctor who has mastered multiple surgical skills and has reached the deputy director level, and whose pathological diagnosis has reached level four, would never stay in the ward and do management work behind the scenes.
Instead, they will be arranged by the hospital to perform surgical and consultation work on the front line.
Any hospital is willing to push excellent doctors to the front line, let them face the diseases of various patients directly, and use them to diagnose the causes and pathological mechanisms. For patients who need surgery, doctors with excellent surgical skills will be arranged to perform the surgery on them.
Only those doctors who are mediocre in all aspects and rookies with short working years will be assigned to do management work in the ward.
Checking beds, changing dressings, following surgeries, writing medical records, etc.
"After the second surgery, was the problem solved? This type of esophageal-to-jejunal anastomotic fistula is actually very difficult to solve, and even with a second surgery, it is not easy to solve."
Zhou Can learned these surgical experiences in the Department of Digestive Surgery.
At that time, Director Jia told him that total gastrectomy was not difficult, but the difficult part was the anastomosis of the esophagus to the jejunum. If there was any problem, it would be very difficult.
Moreover, the more times the abdominal or thoracic cavity is subjected to open surgery, the more severe the internal adhesions will be.
These valuable surgical experiences are difficult to learn from books.
After receiving the guidance, Zhou Can kept it firmly in mind.
Since then, he has had a new concept of surgery: if surgery can be avoided, then surgery should be avoided; if opening the chest and abdomen can be avoided, then surgery should be avoided.
Severe adhesions of organs and tissues in the chest or abdominal cavity after the operation will definitely have a significant impact on the patient.
It is not as simple as just increasing the difficulty of future surgery.
"Oh! You've got it all right! Not only did my dad still have anastomotic leakage after the operation, he still couldn't eat, but new problems also arose. Swallowing food became very difficult. He even had to spit out his own saliva. He couldn't even drink water. We were about to collapse. What kind of hospital is this? How can an operation be so difficult? The results are getting worse and worse."
When the woman talked about her experience after the second operation, her tone and eyes were full of despair.
Although the other two family members did not say anything, their expressions were similar.
With the development of medicine today, many technical difficulties have been overcome, and even kidney transplantation, liver, lung, heart and other important organ transplantation can be achieved.
Even head transplants have been successfully experimented with abroad.
But there are still many things that medicine cannot solve.
The doctors were helpless about this.
During the nearly two years that Zhou Can has been undergoing regular training at Tuya, he has seen too many cases that cannot be solved by medical methods.
For some patients, we can only watch them die without any way to do anything.
The patient who impressed him the most was a very young female patient whose child was only six months old, but she was already in the advanced stage of breast cancer. In the ward of the intensive care unit, she tearfully begged the doctors to let her live a few more months because she wanted to hear her child call her "Mom".
However, the doctors tried their best but were still unable to stop the crazy spread of cancer cells and the damage to her body.
When cancer cells develop to the later stages, they will not only destroy the human immune system, but also cause organ damage and failure.
In the end, the young mother did not live to see the day when her child learned to call her mother. On a gloomy morning, she left this beautiful yet miserable world with endless regrets.
At that time, Zhou Can, a grown man, felt very uncomfortable when he saw that scene.
If medicine can make a little more progress, I believe the mother of that child would definitely want to live longer. She wants to hear the child call her mother, and she wants to see what the child will look like when he grows up.
If possible, I even hope to see my children get married and have children.
But she could no longer see and closed her eyes forever.
The patient in front of me is over sixty years old, so he is not short-lived.
At least his children have grown up and are married.
However, even ants are greedy for life, let alone humans, who are the most intelligent creatures on earth!
No one wants to die easily if they can live.
"After the second operation, did the patient develop stenosis of the esophagus-jejunum anastomosis?" Zhou Can was a little reluctant to ask when he saw her sad expression at this moment .
"Well! You are absolutely right."
She bit her lip and nodded vigorously.
"Doctor, do you think my dad's illness can be cured?"
After two failed surgeries, each more serious than the last, she has lost confidence in surgery.
Just by looking at her father's painful expression, she wanted to try again like a moth to a flame.
"We'll have to wait for the results of the examination to know. I estimate that the operation will be very difficult. After such a long time, the patient's anastomosis may have been formed. He can't even drink water now. I'm just speculating. Please don't mind if I'm wrong. I speculate that the patient's anastomosis may be completely blocked. It's like welding two hollow steel pipes together. Maybe due to improper operation of the welder or other reasons, the welding part of the two steel pipes eventually changes from hollow to solid."
In order to help the family members better understand, Zhou Can also made an analogy.
"You're right again. That's what the doctor said after the examination at the local hospital. We were originally planning to do an esophageal dilation surgery to solve the problem of not being able to eat, but after the examination, we found that the anastomosis was completely blocked. The doctor at the local hospital shook his head and sighed and told us that there was no way to do the surgery anymore."
The woman's face was full of bitterness, but more of helplessness and deep despair.
Sometimes family members will not take the initiative to tell the doctor the whole story, including which hospital the patient was seen in, what the results were, etc.
They have all kinds of ideas.
For example, you may worry that telling the doctor that you have been to another hospital and come here for treatment will make the doctor unhappy. Or you may want to hear what the doctor at the new hospital has to say.
It can also help you understand the strength of this hospital.
Zhou Can was right every time, which made the woman and the other two families have unprecedented confidence in Tuya Hospital.
"Director Shang is willing to admit the patient, which means it's not the worst yet. We will definitely try to find a way. You don't have to be too desperate. As long as there is a glimmer of hope, there will be endless possibilities."
Zhou Can comforted the family members and patients so that they would not lose confidence in the treatment.
This is very important.
"There is very little information about his examinations, and his medical history is not as comprehensive as you described. Are the records of his examinations and surgeries in other hospitals still available?"
Zhou Can took a quick look at the patient's examination records and felt that this was far from enough.
Because the patient's current condition is very complicated.
There is both esophageal to jejunal anastomotic fistula and anastomotic occlusion problem.
The local hospital that the woman mentioned was definitely not a small hospital, it must be at least a medium-sized tertiary hospital.
The fact that the doctors in that hospital are afraid to even perform surgery shows that the problem is very serious.
The surgery would also be incredibly difficult.
The risks of surgery are also very high.
"The examination materials are all stored there. I was worried that I would need those materials when I see you, so I brought them all with me and put them in the car. If you need them, I will go to the underground garage and get them right away."
She asked Zhou Can for his opinion.
"Give them all here! I think Director Shang will need them when we discuss your father's condition."
Zhou Can knew in his heart that Director Shang might want him to be the main force in treating this patient.
