Chapter 252: How Stupid! Director Zheng Survived the Disaster
Director Shang was already wary of the diagnosis and treatment of this case, and thought that Dr. Huang Liang's treatment was merely to reduce fever and temperature, and that it was inappropriate to replace fluids and expand the volume.
After all, the patient is in such pain, which means that the abdominal symptoms have not been relieved, but are gradually getting worse.
Some diseases progress very quickly.
Once it develops to a certain stage, it will be unstoppable, like a rock cracking or a mountain collapsing.
Countless patients die in Tuya Hospital every year, many of whom die after failing to receive effective rescue efforts.
There are very few deaths after extubation.
When Director Shang heard Zhou Can's serious words, his expression became serious.
Others don't know Zhou Can's strength, but he has witnessed it deeply.
On the first day Zhou Can entered the Department of Gastroenterology, he saved a medical accident and subsequently made great contributions in the diagnosis and treatment of multiple cases.
With such strength, the only thing lacking is qualifications.
Otherwise, he is fully capable of standing on his own and becoming the backbone of the department.
"Director Zheng, this patient is in your group. What do you think?" Director Shang looked at Zheng Hongtao.
In terms of age, Zheng Hongtao is two years older than him.
However, in any organization, status is never determined by age. Instead, it depends on ability, talent, connections, education, performance, etc.
Director Shang and Zhou Can both chose to ignore Dr. Huang Liang, which made Huang Liang's face turn red and then slowly turn blue.
He must have felt bad being treated as invisible in front of so many doctors, nurses, family members and patients.
We can only blame him for not being able to figure things out.
The patient's condition was already so serious, but he was still trying to make his presence felt. It was polite of Director Shang not to scold him in public.
"Does Director Shang also support Zhou Can's point of view?"
Zheng Hongtao was a little hesitant.
The patient's condition was somewhat beyond his control, and he had to admit that he lacked experience in diagnosing such patients.
Not to mention him, even Director Shang found it difficult to diagnose this patient.
There is actually a boundary between surgery and internal medicine.
They are proficient in gastroenterology, so when they encounter symptoms that are more surgical, they are really unsure.
"Zhou Can, tell everyone the basis for your diagnosis."
Director Shang turned and looked at Zhou Can.
"My diagnosis is based on two factors. First, the patient has persistent abdominal pain, and the symptoms have worsened instead of being alleviated after symptomatic treatment. This morning, his body temperature rose and he began to have a fever, which indicates that he is already prone to symptoms of sepsis. The patient does not have a cold, but the elevated body temperature is likely to be due to intestinal perforation, abdominal infection, and inflammatory response in the body."
Zhou Can introduced the basis for his diagnosis in a very calm manner.
As the surgery department performs a lot of operations, some symptoms of patients may be easily ignored by other doctors, but Zhou Can can keenly judge the possible dangers.
When everyone heard that the patient had symptoms of intestinal perforation, they became nervous.
In particular, Director Zheng Hongtao, who originally didn't care much, now has an expression that is even more serious than Director Shang's.
This patient is his responsibility, and if anything happens to him, he will definitely be in big trouble.
Intestinal perforation is extremely dangerous and can easily be fatal.
"Secondly, the white blood cell count was 32.08×109/L, which can also help prove that my diagnosis of intestinal perforation is likely correct. In addition, the patient has compensatory metabolic acidosis and low urine volume, which further proves that the patient has not only had intestinal perforation, but also that the perforation has been going on for quite some time. The intestinal contents contaminated the abdominal cavity and began to cause systemic acute sepsis symptoms, which led to these diagnostic results."
Zhou Can's diagnostic logic is rigorous and his thinking is clear.
The physicians present at the scene were previously blinded by carelessness and unfamiliarity with the diagnosis of surgical symptoms, which is why they failed to detect the danger.
After listening to Zhou Can's analysis, they all had solemn or serious expressions.
"Director Zheng, I think it's better to be cautious. Please ask the gastrointestinal surgery doctor to come for a consultation immediately, or send the patient directly for a second abdominal CT scan."
An associate chief physician under Zheng Hongtao advised.
"I also think that we should take it seriously and rush to rescue him. If it is really intestinal perforation, the disease progresses very rapidly. Once shock occurs, it will be too late to rescue him."
Another chief physician agreed with Zhou Can's diagnosis.
"But...the patient had undergone abdominal ultrasound and abdominal CT scans when he was admitted to the hospital, and no problems were found!"
Huang Liang was still unwilling to admit defeat and was still arguing for the sake of so-called face.
"Stupid! The patient was hospitalized a day ago. It's very likely that the patient's intestines were perforated after such a long time. You are so stupid to argue with the examination results from a day ago."
Zheng Hongtao was the first one who couldn't stand it anymore. Without Director Shang starting to scold him, he just stood there with his neck raised and yelled at Huang Liang.
Any virtuous doctor would hate to see someone ignore the patient's life for the sake of so-called face.
In the face of the patient's life, all personal reputation and interests should give way.
The hospital allows competition and even encourages competition, but never allows infighting.
The first lesson a doctor learns from the first day of medical school is to respect life.
Huang Liang was scolded severely in public by Zheng Hongtao, which actually woke him up a little.
After being stunned for a moment, he lowered his head and said with shame on his face, "I was confused."
No one sympathized with him. Instead, everyone thought that Director Zheng’s scolding was a good one.
"Doctor Zhou, what do you think should be the next step in diagnosing and treating the patient?" Zheng Hongtao asked without hesitation, seeking Zhou Can's opinion in public.
This is also a small reward for Zhou Can's successful help in resolving a medical accident.
Or, it would be more appropriate to say that it is a high recognition of Zhou Can's diagnostic ability.
"In my opinion, it would be best to send the patient to the general surgery department for emergency treatment immediately. However, according to the hospital's diagnosis and treatment procedures, an abdominal CT scan may be needed to determine the location of the intestinal perforation and the current situation in the abdominal cavity before surgery can be performed."
Zhou Can gave his own opinion.
The hospital has relevant standardized procedures for diagnosis and treatment.
It is still unclear whether this patient has intestinal perforation. If we open the patient's abdominal cavity and find no intestinal perforation, it would be difficult to explain to the family.
In addition, the human large and small intestines almost fill the entire abdominal cavity.
Only by knowing the exact location of the perforation can we accurately choose the surgical site for laparotomy.
"Okay, send the patient to do an abdominal CT scan right away! Huang Liang, take two interns to take the patient there quickly. Explain the situation directly to the doctor who is doing the examination. This patient cannot wait."
Zheng Hongtao directly arranged for Huang Liang to accompany the patient for the examination.
In addition to the fact that this patient was under Huang Liang's care, there was also the intention of slightly punishing Huang Liang.
Otherwise, senior residents who are about to be promoted to attending physicians rarely do such errands.
Zheng Hongtao quickly applied for an examination for the patient. When the family heard that the patient's life was in danger, they were already very worried.
They did whatever the doctor told them to do.
What we need to do now is to save the lives of our loved ones.
"Director Zheng, I have another immature suggestion!"
Zhou Can did not become arrogant because of his achievements.
Instead, he remained calm regardless of praise or criticism, and remained humble and polite.
"Please speak!"
Zheng Hongtao's attitude towards Zhou Can now is completely different.
It's no longer lukewarm like the previous two days.
Instead, he directly treated Zhou Can as a person of the same level and talked to him.
"I estimate that the patient's condition will progress very quickly. After the CT scan, surgery should be performed immediately. I suggest that you contact the general surgery department now and have them prepare. As soon as the diagnosis is confirmed, the patient should be rushed over for emergency treatment."
Zhou Can suggested.
If you plan ahead, you will succeed; if you don't, you will fail.
Only by preparing in advance can we avoid wasting every minute of precious rescue time.
"Okay, I'll call Director Xiao right away."
The fact that Zheng Hongtao agreed so easily showed that he had a good relationship with Director Xiao of the Department of Digestive Surgery.
Many times, when the chief physicians meet, they try to expand their personal network, greet each other, and make friends in various ways, just so that when something happens, they can use their acquaintances to get things done.
Zheng Hongtao called Director Xiao on the spot and the matter was resolved in just a few words.
The doctors around looked on with envy.
It’s easier to get things done if you have acquaintances.
Director Zheng has a very deep friendship with the director of the newly established gastrointestinal surgery department, which is truly enviable.
"Director Zheng is indeed the boss of our gastroenterology department. His network of contacts is so wide that it is really enviable."
Director Shang stayed at the scene and watched Zheng Hongtao deal with the matter.
If Director Zheng hadn't handled something properly, he would definitely help. He would never watch a patient get into trouble.
"Hey, my connections are nothing! Director Shang knows many more people than I do. This patient was almost saved thanks to the help of Director Shang, Dr. Zhou and others."
Zheng Hongtao was already scared out of his wits and broke out in a cold sweat.
Because of this incident, he changed his hostility towards Director Shang and Zhou Can.
Sometimes, people are just fighting for a sense of pride.
An opportunity can allow both sides to shake hands and make peace.
"We are all doctors in the same department. We should help each other. Director Zheng, please don't be polite. In the future, if a patient in my group has a problem and I fail to discover it in time, won't I have to ask you for help?"
Director Shang said with a smile.
"You're right. We are all doctors in the same department. We are one family."
With Director Zheng's words, both sides basically put aside their past grievances and shook hands in peace.
The two strongest chief physicians in the department shook hands and made peace, which is good news for all medical staff in the department.
Sometimes, it’s really hard to take sides.
"It's getting late, let's continue our rounds."
Director Shang led everyone to continue the ward rounds.
When they found the female lawyer with cirrhosis in bed 79, Zhou Can reminded Director Shang to perform splenic venography on the patient.
Director Shang prescribed an examination for the patient on the spot without saying a word.
This small incident also shows that Zhou Can's status in Director Shang's heart has risen to a very high level.
The ward rounds hadn't ended yet when Huang Liang, who was taking the patient for a checkup, called.
The results of the CT examination showed free gas shadows in the abdominal cavity, dilated intestine, and severe fluid accumulation between intestinal loops.
This shows that the patient did have intestinal perforation and the perforation had lasted for some time.
No wonder the patient is in so much pain.
CT is generally the first choice for detecting intestinal perforation because its sensitivity is higher than that of traditional X-ray examination.
Many old doctors particularly like to use X-ray examinations.
This is both a complex and a habit developed due to previous medical conditions.
At that time, MRI had not yet been invented, and CT examination equipment was not introduced to China until the 1970s and 1980s.
In the past, the most commonly used examination methods in large hospitals were Doppler ultrasound and X-ray.
Many older doctors grew up in that era, which makes them particularly fond of traditional examination methods.
When Director Zheng heard that the patient was indeed diagnosed with intestinal perforation and that his condition was extremely serious, he felt like he had survived a disaster.
The patient survived thanks to Zhou Can who discovered the danger in time.
Many chief physicians and deputy chief physicians failed to detect the patient's intestinal perforation, but Zhou Can, a resident intern, did. This is because Zhou Can happened to have surgical experience in general surgery and relatively rich clinical experience.
This is also why large hospitals now select core cutting-edge doctors from general practice trainees when training them.
Because doctors with clinical experience in all departments, whether they are assigned to surgery or internal medicine, have significantly stronger diagnostic capabilities than those of specially recruited trainees.
The trainees who are specifically recruited into the hospital are only familiar with diseases in that field.
They lack knowledge about diseases in other fields. After they start working officially, they dare not touch patients from other fields in clinical work.
"Director Shang, I have to rush over and send the patient to the gastrointestinal surgery department for emergency surgery. I will leave now."
After answering the call, Zheng Hongtao hurried to the general surgery department.
The diagnosis of the patient in bed 7 also brought Zhou Can into the eyes of many doctors, and everyone began to know this young and promising resident doctor.
During the ward rounds, several doctors took the initiative to talk to Zhou Can and chat for a while.
All of this is enough to show that his status and reputation in gastroenterology have risen to a new level.
…
After checking the wards, Zhou Can’s truly busy day began.
He sent the gastric cancer patient in bed 77 to the interventional operating room to prepare for endoscopic surgery.
Director Shang will perform the operation himself.
This female patient is currently in the early stage of gastric cancer and is entering the progressive stage.
It is medical practice to exaggerate the severity of the disease.
In fact, her gastric cancer was still in its early stages and could not be considered stage II gastric cancer in the true sense.
That's why Director Shang agreed to perform endoscopic surgery on her.
Usually, if gastric cancer develops to the serious stage II, the cancer cells have metastasized seriously. At this time, the opportunity for surgery is lost. Interventional treatment and chemotherapy are more often used.
This treatment can only prolong the patient's life.
It is already difficult to cure.
Early-stage gastric cancer patients who receive surgery promptly can generally achieve satisfactory results as long as the tumor is completely removed and then given radiotherapy to consolidate the treatment effect.
In the interventional operating room, the patient has completed preoperative preparations and is lying quietly on the operating table waiting for surgery.
Director Shang hurried over with Huang Xinggui and three graduate students.
Zhou Can was thinking in his mind that if he could get this operation, it would be easier for him to get the opportunity for endoscopic surgery in Director Shang's group in the future.
The Department of Gastroenterology performs the most endoscopic surgeries.
Several of his surgical skills are only at level 4. If he can take advantage of the opportunity of regular training in the Department of Gastroenterology in the next two or three months to upgrade them to level 5, it will be very beneficial to Zhou Can's future development.
If you take one step ahead, you can be ahead at every step.
Especially incision, separation and anastomosis, their upgrading is particularly difficult.
Endoscopic surgery often rewards 100 experience points, and is definitely the best choice for quickly upgrading these three medical skills.
"Director Shang, you have checked my experience in endoscopic surgery last time. Can I perform this operation?"
Zhou Can gritted his teeth and before Director Shang took the operating position, he directly asked for the opportunity to perform the operation.
Different from the surgeon's position in traditional surgery, in endoscopic surgery, the surgeon generally chooses a position that is easier to operate, while also being able to easily look up and view the endoscopic screen in front.
"Are you sure you're serious?"
Director Shang stared at Zhou Can. The invisible pressure still made Zhou Can feel scared.
However, he also understood that he had to show strong self-confidence at this time so that Director Shang would be relieved to entrust the operation to him.
"I am serious. If I am not sure, I will stop in time and will never force the operation. I have carefully studied the patient's films many times and I am sure that I am confident that I can complete the operation before I dare to ask you for the chance."
Zhou Can's tone was sincere and his eyes were clear.
A hint of confidence emanates from him.
