Chapter 258: Laparotomy, why didn't you tell me earlier?
He began applying pressure to various areas of the patient's abdomen.
When pressing was performed on the middle area of the upper abdomen near the right side, the patient groaned.
“It hurts! It hurts!”
She shouted hurriedly with a trembling voice.
Zhou Can did not stop the tenderness test, but continued to press the surrounding areas, and the patients did not show any pain response.
After finishing the massage, he turned back to the painful area and closed his eyes to feel it carefully while pressing.
If it weren't for his serious face, the family members would really think that this doctor was not serious and was taking advantage of their daughter.
"Okay, her lesion area can basically be identified as the jejunum segment of the small intestine. This is consistent with the results of the gastrointestinal radiography. Duodenal lesions are generally characterized by inflammation and ulcers . In addition to being prone to inflammation and ulcers, the ileum is also prone to bleeding. Only the jejunum segment has the highest probability of developing malignant diseases in clinical practice."
Dr. Chi, who is also a doctor, immediately understood a little bit when he heard what Zhou Can said.
Sometimes , even if the cause of the patient's illness has been found, it is best to be as tactful as possible when telling the patient the diagnosis. Telling the patient directly that he has a terminal illness can easily cause the patient to have a psychological breakdown.
When patients go to the hospital for treatment, many of them are very nervous.
In this case, their psychological endurance should be taken into consideration.
"Doctor, what disease does my daughter have?"
When the family members heard that Zhou Can's words were not right, their faces turned pale.
Poor parents in the world.
The love for your children is like the apple of your eye.
When the family heard that their daughter might be seriously ill, they were extremely panicked.
"This is just a preliminary diagnosis, so it's not worth it. Don't be too nervous. I think she's in good condition now. There's only one spot that's very tender, which is a good thing. It means she's been treated in a timely manner and is still in the early stages."
Zhou Can explained to the family members.
Now he finally understood why the monks in the temple always loved to chant Zen words.
Some things are not acceptable to the person concerned if you tell them directly. Letting them figure it out on their own is more benevolent.
"Doctor Chi, I suggest that the patient undergo an exploratory laparotomy. Of course, if possible, you can discuss this with the family before the exploratory surgery. If surgery is necessary, we can do it together at that time. This can minimize the surgical damage to the patient."
Zhou Can's next proposal shocked not only the family members but even Dr. Chi.
Laparotomy is an invasive exploration and is only performed in cases of serious or malignant diseases.
"Can't I do a colonoscopy?"
Doctor Chi asked seriously.
"I'm afraid not. If the colonoscopy can reveal the cause of her illness, it won't be difficult to diagnose. I personally recommend a laparotomy." Zhou Can's firm attitude made Dr. Chi become serious.
He knew Zhou Can's abilities very well.
If he was not absolutely sure, Zhou Can would never have been so determined to request a laparotomy.
"Doctor Zhou, could you please tell me the basis for this examination?" Doctor Chi would certainly not agree rashly.
He decided to listen to Zhou Can's examination basis first.
"Doctor, my daughter is still so young and unmarried. If she does a cesarean section, it will leave an ugly scar. It will affect her future marriage and life. Please make a careful decision and try to avoid it if possible."
The family members pleaded weakly beside them.
For family members, they actually have little right to change the examination and treatment decisions made by the doctor.
It is often the doctor who has the final say.
Family members and patients are in a disadvantaged position because they do not understand medical knowledge.
Once you arrive at the hospital, you basically have no choice but to trust the doctors and nurses and put the power over your life in the hands of medical staff.
Generally speaking, the vast majority of doctors and nurses are just, kind, and very compassionate. I believe that as the law continues to improve, the supervision and crackdown on that small group of "rotten apples" will become more and more severe.
Some hospitals with a long history have a large number of veteran comrades who spontaneously protect the red line of medical ethics from being trampled upon.
This is the case with Tuya Hospital, for example.
Those with poor medical ethics will hardly have room for development in Tuya Hospital.
"Let's talk outside so as not to disturb the patient's rest."
Zhou Can glanced at the girl on the hospital bed and walked out first.
"When I performed the tenderness test and palpation just now, I have confirmed that there may be hard nodules or tumors in her abdomen . In addition, some of her symptoms are similar to malignant tumors. In addition, I have come into contact with some patients with similar diseases in the Department of Critical Care Medicine, and many of them were discovered too late and missed the opportunity for surgery. This patient is at the age of a flower, and I think her life safety is far more important than leaving a scar on her abdomen."
Zhou Can said this not only to Dr. Chi, but also to tell the family that your sister's illness is very likely a malignant tumor.
He called Dr. Chi and the family outside the ward to talk in order not to cause psychological burden to the patient.
"Doctor, what disease does my daughter have? What does malignant tumor mean?"
the girl 's mother asked nervously.
No matter how dumb the family members are, they can feel that something is wrong with the atmosphere.
At this point, they must have realized that the problem could be very serious.
However, Zhou Can was very young, and the family had doubts about his medical skills and experience. The family still had a lot of luck in their hearts, thinking that their daughter was so young that it was impossible for her to have a serious illness.
"Malignant tumors are what ordinary people often call cancer. In medicine, we divide tumors into benign and malignant. Benign tumors are less dangerous, but once malignant tumors spread, it is almost the end of life."
After Dr. Chi's explanation, the girl's mother turned pale, her body swayed, and she almost collapsed to the ground.
Fortunately, she was supported by her husband next to her.
"This is just a preliminary diagnosis. You don't have to be too pessimistic before the final test results come out. And Dr. Zhou just said that your daughter sought medical treatment in time. Even if the test results are not good, it's not the worst."
Dr. Chi quickly comforted the family.
"So according to you, my daughter must undergo a laparotomy? Is it dangerous to cut open her stomach?"
At critical moments, men can still take charge.
Although the girl's father was also frightened by this shocking news, he still tried to remain calm and took on the responsibility of being the head of the family.
"Any invasive surgery has risks, but our hospital's laparotomy technology is very mature, and the probability of an accident should be one in a million. And before the exploratory surgery, a professional anesthesiologist will conduct a risk assessment on the patient's physical condition, and will only agree to the exploratory surgery if it is considered relatively safe."
Dr. Chi tried hard to allay the family's concerns, but at the same time did not make any final statements.
If something really happens, I'm sorry, your daughter is unlucky and happens to be this 'one in a million'.
If a doctor doesn't know how to fool people, he won't be able to handle the situation.
"The colonoscopy you mentioned earlier is also not possible?"
The girl's father is still making his final efforts.
"If the tumor is in the intestine, it can definitely be detected through colonoscopy. If the tumor is outside the intestine, colonoscopy cannot detect it. Especially some malignant tumors are extremely secretive in the early stages. Because your daughter's condition is more complicated, I am worried about misdiagnosis or missed diagnosis, so I asked Dr. Zhou to come for a consultation."
Dr. Chi said.
"I have something to say, please don't mind me, doctors! Doctor Zhou looks very young, can he make an accurate diagnosis? Can you ask an older doctor to come and help take a look? After all, we have to operate on my daughter's stomach, so it's always better to be cautious."
The girl's father finally questioned Zhou Can.
Zhou Can is indeed very young.
A young man in his twenties doesn't look like someone of advanced medical skills.
"Well... that's fine. I'll ask an older chief physician to come over and take a look later."
Dr. Chi agreed.
"Dr. Zhou, thank you for coming to help today. I will ask Director Shang or Director Zheng to take a look at it and then give you a reply. I will definitely convey your diagnosis to them."
The family members' questions made Zhou Can somewhat embarrassed, and Dr. Chi tried hard to eliminate the embarrassment.
"You're welcome. If you have any questions, Dr. Chi, you can come to me at any time. This patient's treatment must not be delayed. I'm going to go back to work first. Goodbye."
Zhou Can waved and turned to leave.
Not long after he left, Dr. Chi realized the seriousness of the situation and hurried to find the chief physician to help with the consultation.
Director Shang was not there, so he found Director Zheng Hongtao.
Although the chief physicians in the department are very busy, they are all very enthusiastic about the patients' matters.
Zheng Hongtao personally went to the ward with Dr. Chi to examine the female patient.
After reading the female patient's information, Zheng Hongtao pondered for a moment.
"It looks a bit like intestinal tuberculosis to me. You can try anti-tuberculosis treatment and then make further diagnosis."
"Uh... Director Zheng, this is what happened. I just asked Dr. Zhou Can to come and help with the consultation." Dr. Chi did not expect that Zheng Hongtao's diagnosis results were consistent with his own.
He estimated that Director Zheng might have made a mistake this time.
So I quickly told him that Zhou Can had also come to see it.
"Oh! Doctor Zhou was here too? What did he say?"
Zheng Hongtao's long eyebrows twitched twice, and it can be heard that he attaches great importance to Zhou Can's diagnostic opinion.
"Doctor Zhou suggested a laparotomy to determine the cause of the disease. He said that when pressing the patient's abdomen, he could feel an obvious nodule or tumor. Before he left, he specifically told me that this disease should not be delayed."
Doctor Chi quickly highlighted the key points.
"Ah... why didn't you tell me earlier? Doctor Zhou's diagnostic ability is not inferior to mine. He will not easily let a patient undergo laparotomy. Let me take another look. I just took a quick look just now, not that detailed."
When Zheng Hongtao heard Zhou Can suggest that the patient undergo laparotomy, his face changed slightly.
He immediately changed his tone.
A chief physician cannot be slapped in the face by a resident in public.
Moreover, based on his observations of Zhou Can during this period, as long as Zhou Can thought that the patient's condition was very serious, it would almost come true 100%.
When the family members beside the bed heard this, their expressions became complicated.
Judging from the tone of the elderly Director Zheng, the young doctor who had treated my daughter seemed quite extraordinary!
Director Zheng just said that Dr. Zhou's diagnostic ability is not inferior to his.
It is hard to imagine that such a young doctor is as skilled as this old chief physician.
From now on, you really can't judge people by their appearance.
After a while, Director Zheng finished his review of the patient.
"Although I didn't find any particularly serious problems, Dr. Zhou must have his reasons for asking for a laparotomy. And the patient's symptoms do tend to be malignant tumors. I suggest you do this examination. Of course, the decision is yours."
Director Zheng still has some grace.
He was not so shameless as to say the same diagnosis as Zhou Can.
However, he very seriously asked the family to agree to a laparotomy.
"Since you said so, we agree to do the examination. Please ask the hospital to arrange it for us as soon as possible, okay?" The girl's father became heavy-hearted.
I had been holding on to a lot of hope.
But after inviting Director Zheng to come for a consultation, he felt that the young doctor Zhou was more likely to be the right one.
Before leaving, Zhou Can reminded the girl not to delay treating the illness, which made her father start to worry.
I am looking forward to getting a clear check-up and receiving treatment as soon as possible.
It is not easy to raise a daughter to this age.
If anything happens to them, how will they live?
"This examination requires fasting. From now on, the patient should not eat anything, and it is best not to drink even water. I will apply for a laparotomy for her immediately. The anesthesiologist will come to talk to you later, conduct a surgical risk assessment on the patient, and sign a consent form."
Dr. Chi was very happy to see the family members' positive attitude.
Without wasting time, he arranged examinations for the patient on the spot.
…
The next day, Dr. Chi found Zhou Can just after he finished his ward rounds.
"Doctor Zhou, the family of the female patient has agreed to perform an exploratory laparotomy. I have also communicated with the family before the operation as you said. If a tumor is found, it can be removed during the exploratory operation."
The recovery time after laparotomy is quite long, taking more than a month .
It would be best if the surgery could be performed in one go.
Patients can also avoid suffering twice.
"That's great! The family members are much more open-minded than I thought!"
Zhou Can said with a smile.
"Um... do you have time? You have the best surgical skills in our department. Can you help me with this exploratory operation?" Dr. Chi was like a child who was afraid of being rejected.
"Sure, that's no problem at all. But after the exploration, we found a tumor that needs to be removed. Although I can do it, I'm not qualified enough. And our gastroenterology department doesn't have the conditions for this operation. It's safest to take the patient to the general surgery department for this operation."
Zhou Can’s surgical skills are now very strong.
He is even capable of performing many surgeries that can only be performed by associate chief physicians alone.
For some extremely difficult separation and resection tasks, he can rely on his quick knife skills and even reach a higher level, reaching the operating level of a chief physician.
The only problem is that the job title is a bit low.
He is still in the resident training stage and has very little experience.
Under normal circumstances, other doctors would still be happy to be given the task of suturing the skin during an operation at this stage, but Zhou Can was already able to perform an abdominal, thoracotomy, and even craniotomy independently.
He is not at the same level as those ordinary trainees.
"We've already contacted the general surgery department. We'll do this operation in the newly built gastrointestinal surgery department. They've also agreed to have an associate chief physician come to the operating room to guide the operation. But we need to send a capable doctor to complete the operation."
Dr. Chi’s outrageous move made Zhou Can shake his head and smile bitterly.
It seems that Dr. Chi has already noticed me.
However, this type of surgery requires joint surgery with other departments, which is not easy to coordinate.
Even within the surgical department, not every surgeon performs surgery well.
Many surgeons are only half-baked.
In order to implement this matter as soon as possible, Dr. Chi found a deputy chief physician with average surgical ability to circumvent the surgical admission system, and then asked Zhou Can to perform the operation. Although these operations are criticized, they are very practical.
"Doctor Chi has been eyeing me for a long time! How can I refuse?"
Zhou Can smiled bitterly.
"Hehe, you're famous in general surgery. When I discussed it with the deputy chief physician in digestive surgery, he originally disagreed. But when he heard that you were the lead surgeon, he immediately agreed. He also praised you for your quick and good surgery, and your steadiness, and your ability is not inferior to that of ordinary chief physicians."
Doctor Chi grinned slyly, looking very proud.
After listening to this, Zhou Can touched his nose and smiled bitterly.
People are afraid of becoming famous just like pigs are afraid of getting fat.
If a pig grows big, it will be easy for a butcher to target it. If a person becomes famous, more people will target him.
"They really flatter me by promoting me to the rank of chief physician. Should I go in for the surgery now? I need to go to the outpatient clinic with Director Shang later for auxiliary consultation."
Zhou Can has now become one of the busiest doctors in the department.
Even busier than the chief physician.
He is extremely busy with seeing patients, performing surgeries, managing patients in the ward, and participating in consultations on difficult and complicated cases.
"Let's go over now. The patient has been prepared for the operation, so we just need to push him over."
Doctor Chi is a very steady person.
Every time I come to ask Zhou Can for help, I do all the preparations.
Zhou Can followed him and pushed the patient to the gastrointestinal surgery department.
The previous dispute over the right to build a sub-department of the general surgery department also made Zhou Can famous. His reputation in the general surgery department is no less than that of any chief physician.
As he pushed the patient along the way, doctors and nurses would occasionally greet him.
