Chapter 232 Director Shang's high praise, Dr. Yu's disguised request for help
It is like drilling a hole in a wall. No one can guarantee that you can drill accurately to the point marked on the other side.
It's normal to hit the target crookedly or off target.
What's more, the patient's occluded anastomosis segment is not just a little long.
If the occlusion occurs, it would be relatively easy to treat it if it can be treated surgically as soon as possible. But now that several months have passed, the occlusion has been extended a lot, and it is more difficult to open it.
Zhou Can was thinking hard about the surgical plan.
A bold surgical plan gradually took shape in his mind.
"With the help of ultrasound endoscopy and X-ray assistance, it may be possible to successfully open the blocked esophageal and jejunal connection. This requires the cooperation of a skilled nurse, and the surgeon who controls the endoscope must have superb endoscopic surgery skills and puncture techniques."
Needless to say, Zhou Can's endoscopic skills are extremely talented and his techniques are skillful.
In fact, paracentesis and injection are highly similar.
The injection level is high, and the puncture level is also high.
Therefore, Zhou Can personally performed the surgery on this patient and there was no technical obstacle.
It is not difficult to find a skilled nurse to cooperate with.
First, use an ultrasound endoscope to open the blocked section. Just use a thin needle to puncture from the esophageal anastomosis end to the jejunal end. Then place a coated metal stent to open the blocked esophageal to jejunal anastomosis section.
It was successfully connected.
As for the solution to esophageal anastomotic fistula, conservative treatment is generally chosen if the condition is not serious.
This patient's condition is considered very serious, and surgical removal of the fistula is the first choice.
Zhou Can went over the patient's surgical plan several times in his mind, carefully examining and checking for omissions step by step. He even drew a blueprint of the surgical plan by hand.
After doing all this, all that remains is to ask Director Shang for instructions.
If approved, communicate with the family members.
As long as the family trusts the hospital and agrees to the surgical plan, it can be implemented.
After thinking it over, I waited for Director Shang to arrive.
Chief physicians usually come late, and many of them arrive at the department office around nine o'clock.
He didn't have any other work to do anyway, so he might as well just sit there doing nothing.
Start looking at other cases in the group.
Remembering that when he entered the ward in the morning and saw the patient in bed 73 groaning there, he decided to find out about the patient's condition first.
The patient was 51 years old and had a long history of drinking. He was hospitalized for examination because of unbearable abdominal pain. Ultrasound and X-ray examinations showed pancreatic duct stones.
The attending physician was Director Shang, who prescribed endoscopic stone removal for the patient.
Had surgery yesterday.
A pancreaticobiliary sphincterotomy and pancreatic duct dilation and stone removal were performed.
The operation went smoothly.
Both the surgical records and the postoperative care records showed that the patient's operation was successful.
There should be nothing wrong with this patient.
After reading it, Zhou Can continued to check other cases in this group.
What interested him most were those difficult and complicated diseases.
Each time a case of this type is diagnosed, 100 pathology diagnosis experience points will be awarded.
Until now, his pathological diagnosis is still at the lower level of attending physician.
This medical skill is also the most difficult to upgrade among many medical skills.
It is also difficult to advance in pharmacological differentiation, mainly because there was no prescription authority before.
Now that I have obtained my medical license and the right to prescribe, and have entered the internal medicine department where drug treatment is the main focus, my experience in pharmacological differentiation will definitely increase.
"Oh, Doctor Zhou, you're here early! The early bird catches the worm. You're so diligent every day. No wonder your medical skills are so high."
Chief resident Luo Shengsheng came back from the ward after working. As soon as he entered the office, he saw Zhou Can who was carefully checking and studying the cases in this group. He immediately greeted him with a smile.
In fact, there were two other interns and a resident in the huge office.
Luo Shengsheng ignored them and only greeted Zhou Can first.
It can also be seen that this person is a bit of a curry-follower.
Seeing Zhou Can's outstanding potential and being directly led by Director Shang, he had a bright future. Naturally, he had to look up to Zhou Can.
In his mind, Zhou Can's status was even higher than that of an ordinary resident.
"Mr. Luo, please stop praising me! Compared to you seniors, my diligence is nothing. Besides, there's a saying that goes, the early bird catches the worm. I came early, so I might get a difficult patient, and it's very likely that I'll be tortured to the point of being at a loss."
Zhou Can responded with a smile.
"Haha! Doctor Zhou's thinking is really extraordinary. The early worm catches the bird. This kind of reverse thinking is the first time I've heard of it. Speaking of difficult patients, I really met one. The patient in bed 13 had several , and this morning from six o'clock until now, I almost collapsed. By the way, is Doctor Chi here?"
When Luo Shengsheng talked about the patient, he looked worried and as if he had been in great misfortune.
It makes people laugh.
Sometimes, all of them, whether they are residents, interns or trainees, will try their best to avoid difficult patients.
Because everyone is afraid of getting into trouble.
Luo Shengsheng is the chief resident and is on duty all year round, so he cannot avoid this kind of thing.
However, being a resident chief is also the only way to be promoted to attending physician.
It can be considered as a kind of tempering.
It is really a training exercise.
After one year of training, many residents can be transformed.
The ability to work independently, the ability to respond to rescue critically ill patients, and the ability to deal with various emergencies, such as a sharp decline in patients' vital signs, family members making trouble, etc., can all benefit them a lot.
The difficult patient that Luo Shengsheng met was most likely the patient that Dr. Chi was in charge of.
Otherwise I wouldn't ask this.
"When I arrived, I only saw the three of them, but not Dr. Chi." Zhou Can arrived very early.
"Oh! That should arrive a little later. I'd better write the course of illness first!"
Luo Shengsheng sat down in front of the computer and began to write the medical record.
Not long after, Dr. Xia Ping and Dr. Chi walked into the office together.
The two seemed to be in a good mood, chatting and laughing as they entered the office.
"Doctor Chi, the patient in bed 13 almost had a serious accident this morning. The patient's condition has not been good since around 11 o'clock last night. I thought you were tired after a day's work, and as long as the situation was not so dangerous that I couldn't handle it, I would definitely not disturb you. I rescued him six times that night, and I didn't close my eyes once."
Luo Shengsheng was both complaining and seeking credit.
After working all night, he naturally had to let Dr. Chi know.
"Thank you for your hard work! I'll go over and take a look right away."
Doctor Chi put down his bag, went into the inner room to change into his work clothes, and quickly rushed to the ward to check on the patient's condition.
As office hours approached, more and more doctors entered the office.
Zhou Can is just a resident intern who has just worked in the Department of Gastroenterology for one day. His status is not stable.
Seeing so many doctors coming in, he was tactful enough to log out of his account, stand up and give up his seat.
Other trainees and interns are as tactful as him.
Everyone is very self-aware and no one would compete with the senior doctors for seats.
Some people may not know how low the status of interns is.
There wasn't even a hook to hang clothes.
As for arranging a fixed seat for interns or trainees in the office, that is wishful thinking.
Doctors work in shifts. So many doctors came today that the office was crowded, which made Zhou Can extremely confused.
Did a family member want to cause trouble, and the department got the news and called all the doctors over in advance to calm the situation?
No hospital can avoid trouble caused by family members.
He dares to make a fuss as long as there is something they think is unreasonable.
Some things, such as beating nurses and doctors, seemed quite normal to B's family members.
It would be a lie for doctors and nurses to say they weren't scared when faced with such family members.
Basically just avoid them.
Zhou Can saw that some senior residents in some departments had no seats to sit and could only stand like them.
Those who can sit are at least at the attending level or above.
"Ha, you're all here pretty early! Let me know that we're going to have a morning meeting in the conference room."
As soon as Director Shang entered the office, his aura was strong enough to crush everyone.
The originally noisy office suddenly became quiet.
Zhou Can slapped his forehead and remembered that yesterday, Dr. Xia Ping and Dr. Zhang, who was in charge of the patient, almost caused a medical accident. Director Shang mentioned at that time that a morning meeting would be held today to emphasize medical safety.
No wonder all the gastroenterologists are here.
The doctors walked out of their offices and headed for the conference room.
You can see some female nurses walking towards the meeting room in groups of three or five.
It seems that this is a morning meeting held by the entire department.
Tuya Hospital is quite strict in the area of medical safety.
"Doctor Zhou, how is the patient with esophageal jejunostomy fistula?"
Director Shang called Zhou Can over.
Duan Zifu and Yu Xin, two students in the same group, looked at Zhou Can together.
There was a hint of envy in his eyes.
Zhou Can is the only intern who can attract Director Shang's attention.
Neither of them received the same treatment as Zhou Can.
"The patient's vital signs are relatively stable. This is a surgical plan I prepared. It may be immature. Please help take a look when you have time."
Zhou Can had already drawn the surgical plan in the most intuitive way.
Under the current circumstances, Director Shang obviously did not have time to listen to his detailed report.
Handing the drawings to Director Shang is quick and convenient.
"You also drew the surgical diagram?"
Director Shang took it, glanced at it, and an expression of shock appeared on his face.
"Your work is not only solid but also meticulous, which is great. The surgical plan is pretty much what I expected, which shows that you really put your heart into it."
A satisfied smile bloomed on Director Shang's face.
The doctors passing by couldn't help but look at Zhou Can twice.
Everyone knows that a talented resident doctor has come to the department. However, many people do not know Zhou Can yet, nor do they understand his abilities.
Now seeing Director Shang praising Zhou Can with a smile, they naturally looked up to Zhou Can.
Even the aloof female resident doctor Yu Xin looked at Zhou Can seriously for the first time.
Having been trained under Director Shang for such a long time, she knew very well how difficult it was to win his praise .
"Thank you for your affirmation. I checked the patient's previous examination data and medical records in other hospitals. Although the patient had esophageal anastomotic fistula, he had never had abdominal infection. However, after the first operation, he leaked everything he ate, indicating that the anastomotic fistula was very serious. I think removing the fistula is only a better solution."
Zhou Can took the opportunity to raise his own questions.
"Haha, this is a very profound question! I will discuss it with you in detail after the morning meeting. You can ask for the patient's medical records from other hospitals and conduct in-depth and detailed research. This is a very good work attitude. I am also very satisfied with your first day of work. Let's go to the meeting first!"
When Director Shang looked at Zhou Can, his eyes were filled with admiration.
There is no false reputation under a great name.
Zhou Can is appreciated and loved by so many chief physicians, and he must have many outstanding qualities.
"OK!"
Zhou Can took a few quick steps to catch up with Duan Zifu and Yu Xin, and went to the meeting room together.
We are all interns in the same group, so it is natural for us to sit together during meetings.
"Doctor Zhou is amazing! He has only been in training for one day, but he has already received high recognition and praise from Director Shang. You know, I have been in training for nearly a month before I was lucky enough to be appreciated by Director Shang and transferred to work under him."
Residents who are able to work with chief physicians generally have some ability.
Duan Zifu’s strength should not be weak.
"I don't dare to compare myself with you. I just do my job more solidly."
Zhou Can said modestly.
"I heard that Dr. Zhou is very good at both diagnosis and surgery. Can he help Dr. Yu?" Duan Zifu changed the subject and made a small request.
There was no expression on Yu Xin's face and she didn't say anything.
Only her beautiful eyebrows were slightly furrowed.
It seems that this is a rather difficult situation.
"Tell me first, what is it? My ability is also very limited, and may not be as good as yours. I may not be able to help even if I want to."
Zhou Can did not refuse directly.
"It's like this. The patient in bed 73, who is under the care of Dr. Yu, had a pancreatic duct stone removal surgery yesterday. When I went to check on him this morning, I found that the patient kept complaining of stomach pain. His temperature was also elevated. But after investigation, we couldn't find the cause."
Duan Zifu explained the general situation.
"Isn't this the normal pain after waking up from anesthesia after surgery?"
Zhou Can has extensive surgical experience and has performed more surgeries than the average attending physician.
We also have extensive experience in postoperative management.
"It's probably not postoperative pain. The pain is not in the surgical site, but in the lower abdomen. In addition, the patient also has nausea. The body temperature is also elevated."
Yu Xin took the initiative to answer Zhou Can's question.
It seems that she is too shy to ask Zhou Can.
Now that Duan Zifu had spoken for her, she no longer maintained her so-called aloofness.
When faced with such a difficult patient, she couldn't help but worry.
If something goes wrong due to her inadequate management, it will definitely affect her future.
"Didn't you report this to your superior doctor?"
Zhou Can asked again.
She hesitated for a moment, then bit her lip and said somewhat embarrassedly, "There is an unwritten rule in the competition between doctors in our group. Reporting a small matter to a senior doctor will be considered a sign of incompetence. This will reduce points in Director Shang's heart. I want to strive for the opportunity to follow Director Shang to see patients and perform surgeries. If I can solve this problem by myself, I want to solve it by myself."
Fortune and wealth are achieved through risk.
Competition among junior doctors is sometimes very subtle.
Just like the patient managed by Zhou Can, he developed a complete surgical plan by himself, which must have been a big plus in Director Shang's mind.
If you report even the smallest matter to your senior doctor, you will be labeled a "giant baby".
I guess no good doctor would like to be labeled like this.
But she was not capable enough, and she was worried that something might happen if she didn't report the matter.
By then, the loss would outweigh the gain.
The delicate balance between these two can only be grasped by yourself.
