Chapter 268: Doctors’ sense of responsibility: the disciple is better than the master
The patient had lung cancer and the preoperative examination was insufficient.
Although the situation was urgent at the time and the patient's right lung was compressed by 80%, accompanied by complex conditions such as hemothorax and severe pleural effusion, it was still a mistake in the work.
If we knew before the operation that the patient had a tumor in the lungs, we might be more cautious during the rescue and would consider using a double-lumen catheter.
There are various objective factors that lead to the occurrence of every accident.
Medical staff must be extremely careful to avoid accidents.
Now the patient's life is saved, and Zhou Can successfully resolved a medical accident. However, the patient survived the thoracotomy, not to undergo multiple surgeries in vain, but to cure the disease.
If the lung tumor is not cured, the patient will die.
But how to solve it is a difficult problem.
With so many chief physicians and senior physicians here, how could Zhou Can dare to express his opinions carelessly!
We just saved someone, so we can take emergency measures.
Now that the patient's vital signs have stabilized, he will never be the first to take action again.
"What I mean is to listen to you chief doctors and do whatever you say!"
Zhou Can's words made everyone laugh.
The tense atmosphere in the operating room was diluted once again, and everyone could clearly feel that the discussion atmosphere became as relaxed as usual.
Zhou Can made great contributions but he was not arrogant or conceited, which made everyone like him more.
"Director Le, Director Liu, what are your opinions?"
Director Xueyan asked for other people's opinions.
"This operation was full of hardships, and it was not easy to save the patient's life. Everyone can express their opinions and work together to help this patient recover."
She made full use of the gentleness and tolerance of women to mobilize everyone.
Join the discussion.
"Then I will throw out some ideas and express some immature opinions." Director Le's ability is not bad, especially in the cardiovascular field, his level is quite high.
"I personally think that the surgical plan for the patient was originally a thoracotomy. It was just that something unexpected happened during the anesthesia process, which disrupted the original surgical plan. Now that the chest has been opened and the cause of the disease has been found, it is too late. We might as well communicate with the family immediately. Take this opportunity to remove the tumor and create favorable conditions for the patient's subsequent recovery."
This plan is the best one, but many people still have concerns.
The main reason is that everyone still has lingering fears when they recall that the patient almost died during general anesthesia.
Now that the patient has been finally rescued, many doctors hold the principle of preferring to fail in vain rather than make a mistake.
According to them, the goal is to maintain the existing results and ensure that patients can leave the operating room safely.
Don't create any more trouble.
"Removing the tumor is certainly a very good solution, but as we all know, the patient's condition almost killed him. In this case, can the patient tolerate surgery to remove the tumor?"
An associate chief physician raised objections.
"I also think it's better to be safe and wait until the patient's physical condition is better before doing the surgery."
"He looks like a candle in the wind, swaying unsteadily. I'm really worried that he won't be able to get off the operating table."
"Don't seek to achieve anything, but avoid making mistakes. It's better to be cautious."
There are quite a few conservatives.
No one wants to be involved in a medical accident, let alone watch a patient die.
"Director Liu, you are an expert in critical care medicine and an anesthesiologist by training. You have a certain authority in assessing the surgical risks of patients. Please tell me what you think!"
Xueyan looked at Director Liu.
The fact that she asked this showed that she was definitely in favor of Director Yu Le's suggestion, and that she wanted to perform the surgery in one go.
"Well... I can't make the decision on this. Judging from the condition of the patient's tumor, I'm afraid the risk is quite high if the entire right lung is removed."
Director Liu's opinion is relatively neutral.
Being able to become the director of the Department of Critical Care Medicine, he is more tactful in handling various matters.
He just came to help rescue this patient, and now that his mission was completed, he obviously didn't want to cause any more trouble. He just wanted to get away as soon as possible and return to his intensive care unit.
"Doctor Guan, what's your opinion?"
Director Xue did not ask the real anesthesiologist for his opinion first, but asked others first and then asked him last. It can also be seen that the accident in this operation has greatly reduced the status of Dr. Guan.
The decline of the right to speak has become a normal thing.
Doctor Guan was still somewhat shaken and clearly not in good shape.
After hesitating for a moment, he said, "If we decide to remove the tumor for the patient, I will apply for a new anesthesiologist. Please invite Director Feng from our anesthesiology department to come over."
At this time, it can be felt that not only does Dr. Guan's tone of voice sound weak, but he is also beginning to become extremely unconfident in his professional abilities.
Medical accidents have a huge impact on the doctors and nurses involved.
It's enough to make them seriously doubt their own professionalism.
Before this, Dr. Guan gave Zhou Can the impression of being calm, confident, and cool-headed.
I don’t know how long it will take him to get out of the shadow after this incident?
"Please ask Director Feng to come over and help immediately." She said to the nurse on duty, then turned to Director Le. "Director Le, can you come forward to communicate with the family members and seek their opinions?"
"no problem!"
Director Le agreed readily.
"Director Xue, Director Le, would you please reconsider this? The risk is too high!"
An experienced deputy chief physician advised with concern.
"It's not that we don't want to be safe, but the patient's situation only leaves us with two options. Either we take this opportunity to remove the tumor, or we close the chest immediately and treat it conservatively. If we choose conservative treatment, it will take at least half a year before we can have a second thoracotomy. By then, the tumor will have already spread. And it's hard to say whether the patient can survive more than half a year."
Director Le patiently analyzed the patient's condition to the old comrade.
In fact, I believe that even if he didn't say it, this old comrade knew the consequences of conservative treatment.
This is a time when a doctor's sense of responsibility is put to the test.
Taking the risk of removing a tumor from a patient is very beneficial to the patient, but it carries huge risks for the doctor.
Although a consent form will be signed before the operation, if the patient dies on the operating table, it will still be a big problem and will have a negative impact on the doctor's reputation.
Other interests will also be harmed.
After Director Le finished analyzing the situation in public, he didn't say anything else.
Soon, Dr. Feng rushed to the operating room.
Zhou Can was considered his half-disciple, so when he saw him, he greeted him politely.
Doctor Feng is as cold and taciturn as ever.
He just nodded slightly and said "hmm".
He looked at Dr. Guan and said, "It's normal for something to go wrong. There's no anesthesiologist who hasn't had someone die at his hands." Unexpectedly, when they met, Dr. Feng did not blame Dr. Guan at all. Instead, he gave him warm care and comfort.
"That being said, when I really saw a patient almost die from anesthesia, it was still difficult to dispel the psychological trauma in a short period of time. I... really have no confidence in this operation and dare not take the risk again."
Dr. Guan lowered his head in shame, like a child who had done something wrong, confessing in front of his parents.
"You have been working as an anesthesiologist for so many years, and you have seen patients die before. As doctors, we should understand from the moment we start learning medicine that this road is full of thorns, with countless difficulties and obstacles ahead, and cliffs waiting for us to overcome. Accidents are not scary, but not learning from the lessons and falling into the same pit twice."
Doctor Feng's words deeply touched every medical staff present.
Yes, where did that original intention and enthusiasm go when I first studied medicine?
Which medical student really studies medicine just to get a good job and make money? Being able to have a decent job and a good social status is only part of studying medicine.
What everyone wants more is to save the dying and the wounded and to be the angels of this world.
Saving patients' lives and relieving their pain is what every medical student truly wants to pursue. It is also the most sincere sentiment of doctors, nurses, and pharmacists.
It is the passion for the medical industry.
"I...will reflect deeply, adjust my mindset, and strive to resume normal work as soon as possible. I ask you to let me go home and rest for two days, so that I can have some time to adjust myself."
After hearing this, Dr. Guan did not back down.
At least I haven't thought about quitting the anesthesiologist profession.
"I will not approve this leave. You must get up from where you fell. I can help you with the anesthesia for this operation, but I still hope that you will be in charge of the anesthesia work, even including the entire perioperative management." Although Doctor Feng is a little cold and serious, his method of teaching his apprentices is very clever.
Whether teaching Zhou Can or Doctor Guan, he always teaches according to their aptitude . Especially when Doctor Guan encountered a major setback, he did not scold them without thinking, like other senior doctors. Instead, he tried every means to help them get out of the shadow.
"All right!"
Dr. Guan agreed reluctantly, but finally agreed.
Doctor Feng has supported him so much. If he keeps retreating, he will become a hopeless person.
"Director Xue, please communicate with the family members and proceed with the surgery. You don't have to worry about the anesthesia for this surgery. Our anesthesia department will take full responsibility for it."
After Dr. Feng persuaded Dr. Guan, he expressed his opinion to Director Xue.
Do things in an orderly manner.
"Okay, thank you, and thank you to the anesthesiologist for escorting us through this high-risk surgery. Director Le is communicating with the family outside. If the family agrees to take the risk of doing this surgery, we will do it immediately."
Director Xueyan expressed her gratitude to him.
She is always gentle to others, making people feel like a spring breeze and feel very comfortable.
Doctor Feng looked at Doctor Guan again.
"Tell me, what mistakes were made in this operation? What did you learn?"
"There were many mistakes. Before the general anesthesia surgery, as usual, I injected scopolamine into the patient, ignoring the possible risks. This is the first mistake. After the accident, I participated in the rescue of the patient with Director Hu. At that time, I was only concerned with helping the patient recover his spontaneous breathing and heartbeat as quickly as possible, but ignored the risk of blood clots in the patient's pleural effusion, which eventually caused the blood clots to block the drainage tube, resulting in the failure of the first rescue. This is the second mistake."
Dr. Guan examined and corrected himself, and reflected on the two mistakes he made.
"If I encounter a patient with spontaneous hemothorax in the future and perform closed chest drainage and anesthesia after surgery, I will choose double-lumen endobronchial intubation instead of blindly pursuing speed. I will not try to save trouble."
Dr. Guan made a deep review and reflection.
After listening to this, Dr. Feng was somewhat dissatisfied.
"Anything else?"
"Anything else?" Doctor Guan thought for a moment and shook his head slightly.
He couldn't think of any other mistakes.
"Zhou Can, tell me!"
Doctor Feng suddenly looked at Zhou Can.
At this moment, Zhou Can was studying the patient's lung tumor and formulating a resection plan in his mind.
Suddenly hearing Dr. Feng's question, he turned around and looked over.
"Well... I can only provide some precautions. For example, after tracheal intubation, the ventilation volume should not be too large when the mask is inhaling oxygen and removing nitrogen. When I rushed here to participate in the rescue just now, the ventilation volume was quite large. Also, after intubation, the key lung ventilation should be performed with low tidal volume and low pressure as much as possible. Lastly, when maintaining the patient's spontaneous breathing, if the respiratory resistance is found to increase and the water column in the drainage tube does not fluctuate, the ventilation should be stopped immediately."
Zhou Can spoke modestly, and what he pointed out were actually the problems he saw after arriving.
These are the mistakes made by Dr. Guan in his operation.
Perhaps Dr. Guan was completely confused at the time, which led to many mistakes.
If this patient had had problems during the first rescue and ventilation had been stopped immediately, the situation might have been better.
Dr. Guan did not stop ventilation at that time, which shows that his professional knowledge was limited.
"Dr. Zhou's words awakened me from my dream. After listening to him, I realized that there were so many mistakes. Thank you for your advice." Dr. Guan thanked him sincerely. "It is found that the patient's respiratory resistance has increased and the water column in the drainage tube is not fluctuating. In addition to stopping ventilation immediately, are there any other measures?"
He really didn't understand, so he took the opportunity to humbly ask Zhou Can for advice.
"You can try squeezing the drainage tube. If that doesn't work, you can quickly change the patient 's position or perform chest surgery."
Zhou Can was not stingy and shared everything he had learned.
Doctor Feng nodded repeatedly after hearing this, his eyes showing approval.
"It turns out there are so many methods. My knowledge of this area is really insufficient. I need to learn more from Dr. Zhou in the future." It was the first time that Dr. Guan realized that the gap between him and Zhou Can had widened so much.
You know, he was the one who taught Zhou Can about anesthesia many times in the past.
Today, Zhou Can has surpassed his teacher and has clearly surpassed him in some areas of knowledge.
Dr. Guan was deeply shocked when he felt Zhou Can's progress firsthand.
It also aroused his desire to learn and catch up.
Otherwise, it would be really embarrassing to be overtaken by a junior.
Although Director Xueyan and others in the operating room did not speak, their understanding of Zhou Can's ability had quietly risen to a higher level on the original basis.
They are all studying medicine, so it is easy to tell who has a better level and who has a lower level.
Zhou Can didn't know that just because of a small "discussion" with Dr. Guan, the medical staff present had already raised their opinion of him to a higher level.
At this moment, Director Le came in after communicating with the family members.
"The family was extremely shocked when they learned that the patient had lung cancer. They even suspected that our doctor was lying. It took a lot of persuasion to finally convince them. The family agreed to have the tumor removed surgically."
Director Le reported the hard-earned progress to everyone.
Sometimes, being a doctor is really difficult.
Not only do we have to find ways to find the cause of the disease and treat the patient's illness, but we also have to go out of our way to communicate with the family.
Take this patient as an example. The doctors could have just closed the chest cavity and told the family that surgery to remove the tumor was too risky. The patient could have come back to the hospital six months after recovery to see if surgery was possible.
The family members have no solution at all.
Just follow the doctor's instructions.
Nowadays, doctors take huge risks to consider the vital interests of patients, but they still have to endure doubts from their families. This hurts the doctors' hearts and makes them feel tired.
"Let's prepare for the operation! Can Director Le perform the surgery?" Director Xueyan's surgical skills are relatively weak, but her academic ability is very strong.
She has the ability to remove the tumor for this patient, but she feels that the chances of success will be better if Director Le performs the surgery.
"I can perform the operation, but this operation is special. The patient's current condition is not very good, and the shorter the operation time, the better. Dr. Zhou's surgical skills are very good, and his speed is much faster than ours. Moreover, the amount of bleeding during his operation is the least among all the doctors I have seen. It will be more beneficial for the patient if he performs the operation."
Director Le recommended Zhou Can to perform the surgery.
When Zhou Can was doing his resident training in cardiothoracic surgery, his strong surgical skills left a deep impression on Director Le.
Now half a year has passed, and the surgical skills Zhou Can showed when he opened his chest just now are even more terrifying than before. That's why he wanted Zhou Can to do this operation.
"Doctor Zhou, is this okay? You can rest assured that the risk will be borne by me."
Director Xueyan looked at Zhou Can.
In fact, deep down in her heart, she also prefers to let Zhou Can perform the operation.
Being slow can really cost lives.
The patient is in this condition already, so the sooner the surgery is completed, the better.
"I'm fine."
Zhou Can did not refuse.
He has deep roots in cardiothoracic surgery, and now that he can help, he feels obliged to do so.
As for personal gains and losses, he didn't think so much about it.
He had just studied it carefully and was fully capable of removing the patient's lung tumor.
