Chapter 88: Jade cannot be made into a useful object without polishing, multiple medical skills
Everyone was watching Zhou Can demonstrating his powerful medical skills that should not belong to a resident doctor.
He successfully peeled off the blood vessels on the tumor bit by bit.
Finally, we were almost separated.
"Teacher, I plan to cut off the capillaries growing in the tumor, and then use electrocoagulation to stop the bleeding. Finally, I will completely separate the tumor from the muscle tissue and remove it. Do you think it's okay?"
Out of respect and caution, Zhou Can did not rush to finish.
Instead, consult Dr. Xu first.
“This is a great plan!”
Dr. Xu never hesitates to praise him in front of his patients.
With the teacher's affirmation, Zhou Can felt more confident.
Follow the procedures and complete the remaining surgical work step by step.
Cut off the tiny blood vessels growing in the tumor, and then use electrocoagulation to stop the bleeding.
In fact, the root of the main blood vessel was clamped by Dr. Xu, and the amount of bleeding was very small when the capillaries were cut off.
During surgery, bleeding must be minimized as much as possible.
Not only does the bloodiness bring psychological pressure to the operator, but the gushing blood also blocks the view of the operation, causing considerable trouble.
The correct method for removing a tumor is generally to cut off the supply first, and then proceed to the subsequent steps.
Dr. Fu had seen Zhou Can's hemostasis technique before, and he was still amazed when he saw it again.
Not to mention Dr. Lu, Dr. Lin and Jin Mingxi.
Seeing Zhou Can's superb hemostasis skills, they felt envious but also under a lot of pressure.
But this is also a good thing.
There is motivation only when there is pressure!
If you travel with tigers and wolves, you are probably a ferocious beast; if you fly with the phoenix, you are probably a beautiful bird.
Only by associating with the strong can you become stronger.
Zhou Can finished treating the blood vessels and successfully separated the tumor from the surrounding tissues. Only the last step was left.
That's excision.
He showed no mercy and cut off the tumor completely without hesitation.
"Xiao Zhou, you did a great job removing this tumor. Remember, no matter whether it is benign or malignant, it is okay to remove as much normal tissue as possible during the removal. The goal is to remove it completely in one go and prevent recurrence."
"clear!"
Zhou Can nodded and took note of it.
If the malignant tumor is not completely removed, the consequences will be very serious.
This will cause cancer cells to spread and eventually make surgery impossible.
This kind of thing is very common.
For example, breast cancer, uterine fibroids, gastric cancer...it is common that if you encounter a doctor with poor medical skills, the cancer cannot be removed cleanly.
Tumors have one biggest characteristic.
If you don't stimulate it, it may just grow normally.
Once stimulated, it is true that the devil is always one step ahead of the good.
In order to survive, it will frantically enter the "explosion" mode.
Not only does the speed of division and replication double, but it also quickly spreads to surrounding tissues.
If it comes to that point, it will definitely be a disaster for the patient.
"Teacher, do you think it's time to clean and suture the wound?"
The tumor was successfully removed and the patient's originally swollen cheek has basically disappeared.
Dr. Xu checked carefully and found no problem.
Signaling him that he could start cleaning and suturing.
After more than 20 minutes, Zhou Can successfully completed the debridement and skin suture.
The right side of the patient's face appears to have become flatter.
"Okay, the operation was completed well. The subcutaneous tumor on your face has been successfully removed. If there is any abnormality in the wound, please report it to our medical staff in time."
Dr. Xu advised the patient.
While Zhou Can was stitching, he had already written the medical advice.
Let Qiao Yu take the patient to the infusion area for an IV.
After the patient left, Dr. Xu looked at Zhou Can, then glanced at Dr. Lu, Jin Mingxi, and Dr. Lin.
"Pay attention to postoperative care for this type of surgery. If the wound becomes infected and festered, it must be treated promptly and decisively. It is best to use antibiotics through intravenous drips and oral anti-inflammatory drugs after surgery. In the first three days, the patient can be asked to come for an infusion once a day to facilitate observation of the patient's wound condition."
Dr. Xu imparted his surgical nursing experience to several people.
"Xiao Zhou, if you practice medicine independently in the future, you must instruct the nurses in the infusion area to pay special attention to the patients who are at greater risk after surgery. So, it's actually good if you occasionally buy them a cup of milk tea. They will also pay more attention to what you tell them to do."
Doctors and nurses are two systems.
Interdependence.
Doctors have a higher status than nurses, but if the relationship is not good, it will also be disadvantageous to the doctors.
They are just doing their normal work and no one can say anything to them.
If something really happens, the doctor involved will definitely be the one who suffers.
Among the doctors here, Zhou Can is the only newcomer. There are many unspoken rules in the department and Dr. Xu was afraid that he might not understand them, so he revealed them and taught him.
"Overall, you did a pretty good job on this operation. But you should also be aware of some shortcomings. For example, when you were removing the tumor, the cutting edge was not neat. Also, the debridement was not very thorough. The suturing was not particularly good either, it was just above average. These are areas that need to be improved."
In front of everyone, Dr. Xu pointed out many of Zhou Can's shortcomings.
Debridement has now become Zhou Can's weakness.
Because it is still only at the lower level of regular training.
There is nothing he can do about it, after all, his working hours are too short.
The foundation is still quite weak.
You can't become fat in just one bite.
Improving any medical skill takes time and requires opportunities to practice, so you have to do it slowly.
This time, he was able to successfully remove the tumor independently without causing any trouble, which was a huge improvement for him.
“I will work harder!”
Zhou Can humbly accepted the teacher's suggestions.
Also face up to your own shortcomings.
At the same time, he also noticed that after Dr. Xu pointed out a bunch of his shortcomings in public, Dr. Lu and others looked at him with much friendlier eyes.
Only then did Zhou Can understand the teacher's good intentions.
A tree that stands out in the forest will be destroyed by the wind.
Being too outstanding can easily attract jealousy.
Finding some appropriate shortcomings will help other jealous people find psychological balance, which is also a kind of protection for them.
It can also reduce a lot of unnecessary troubles.
"Oh, Dr. Xu's expectations for Xiao Zhou are too high! His level is already outstanding among the interns, you can't expect him to be at the same level as our attending physician!"
Look, the effect is here.
Dr. Fu began to speak well of Zhou Can.
"If you don't polish a piece of jade, it won't become a useful thing. It's always better to be strict with him!"
Dr. Xu achieved the desired effect and did not delay any further.
"Okay, the operating room is now in your hands. Let's call it a day and go home."
…
The days passed one by one, and Dr. Fu never mentioned asking Zhou Can to work overtime again.
Many colleagues in the emergency department always keep their distance from Zhou Can.
Zhou Can goes to get off work and comes home on time every day, and has been performing first-level surgery independently under the care of Dr. Xu.
Since he demonstrated the incision and separation skills of an intermediate level for a resident, Dr. Xu gradually began to perform some simple excision surgeries on him.
However, as long as the risk is slightly higher, Dr. Xu will stand by and provide guidance when Zhou Can is operating.
When it comes to safety, Dr. Xu is particularly strict.
In addition to quickly gaining experience in the operating room, Zhou Can would buy eight to ten white mice every day and return to his apartment to practice because he didn't have to work overtime during this period.
His experience points in the three medical skills of incision, separation and ligation continued to soar.
It really is different every day.
However, this practice mode is also very expensive.
The cost of purchasing white mice alone is 1,600 to 2,000 yuan per day.
It costs nearly 60,000 yuan a month.
If it were an ordinary person, he would not be able to bear it at all.
Fortunately, the white mouse training was only necessary in the early stage. When most of his medical skills were upgraded to the attending physician level, the main battlefield for practicing medical skills would be completely transferred to the operating room.
At that time, you can earn medical experience points directly from patients, which is faster and not only does it not cost money, but you can also make money.
However, the salary of trainees is relatively fixed.
According to relevant national documents, doctors in training are paid 10 yuan for writing a case and 50 yuan for each shift, but when it comes time to get paid, these money is not there.
It’s useless to look for teachers from the Regulations Training Office.
I'm afraid I don't have the guts to ask the department director. Occasionally, there are some people who are not afraid of death and really ask the department director about this matter, but in the end, nothing is done.
If the hospital doesn't pay, it's impossible for it to be deducted from the department, right?
Therefore, what the trainees can get is basically only a pitiful monthly meal allowance, basic salary, and government subsidies. Overtime pay may be given appropriately.
What bonuses, performance commissions, and surgery commissions? That's just bullshit.
However, some doctors come to Tuya for regular training as further students. In addition to the above-mentioned salary, their original units will also pay them a lump sum salary.
Of course, there is a huge difference between those who participate in regular training as further students and those like Zhou Can who are recruited by our hospital as regular trainees.
If you want to learn real skills, you must be a full-time trainee like Zhou Can.
Belongs to the hospital's 'core disciple'.
The hospital will train them as future successors.
In addition, there are also regular trainees, whose status is much lower than that of full-time regular trainees.
But we also train them as our own.
Some of the interns are particularly outstanding and eventually become leaders of a certain subject in the department, or team leaders, chief physicians, or department directors.
In short, if we want to rank the three types of regular training students.
General practice is the best, as there are very few recruitment vacancies, the difficulty is high, and the weight is also high. Targeted recruitment is the second best. As long as the department has a need, a group of regular trainees with relevant majors will be recruited for training, and the fittest will survive. After the regular training, some people may be lucky enough to get the opportunity to stay in the hospital and become full-time employees. Some people may be eliminated after getting the regular training certificate.
Continuing education and regular training are the worst.
To put it simply, further training means that some municipal hospitals or small hospitals send doctors here to gain experience.
You can learn something, but the core medical skills are difficult to learn.
Tuya Hospital conservatively estimates that the total number of resident doctors recruited each year is at least more than 200.
The difference can only be experienced by yourself.
…
It is worth mentioning that he discovered an obvious problem while practicing medical skills on white mice.
That is, since his hemostasis technique was upgraded to level four, there was nothing abnormal.
But not long ago, when the experience value reached level 4 1000/10000, it suddenly stopped increasing.
Experience points can still be increased by 1 point each time the patient's bleeding is stopped.
However, when practicing on mice, the hemostasis effect can only increase by 0.001 each time.
He knew very well that this was punitive experience given by the experience system.
He had encountered similar problems before when practicing suturing.
The only solution is to earn money from the patients.
Other methods are basically ineffective.
He secretly guessed that his practice of hemostasis on white mice might have reached its peak.
This is why continued practice is basically ineffective.
Come to think of it, it’s quite reasonable.
Hemostasis below level 4 is mainly based on electrocoagulation. However, after reaching level 4, the methods of hemostasis have become more complex and diverse. It is no longer a simple electrocoagulation hemostasis or ligation of blood vessels.
Its hemostasis has risen to a whole new level in all aspects, from diagnosis to drugs, hemostasis ideas and hemostasis methods.
When you reach this level of hemostasis, every hemostasis will be a test.
Zhou Can had a feeling that since this problem had occurred with hemostasis, other medical techniques would definitely appear as well.
He has only been using the experience system for a short time, so there is still a lot to explore.
This system can help him improve his medical skills quickly, but it is not a one-on-one practice. Instead, it guides Zhou Can to find the most correct way to practice by the amount of experience points he gains at a time.
For example, for diagnosing extremely difficult and complex cases, in addition to gaining 1 ordinary experience point for each diagnosis, you can also receive a reward of 100 large experience points.
Even though it was already difficult to earn experience points for stopping bleeding on the white rats, he did not become discouraged.
Instead, continue to use white mice to quickly earn other medical experience points.
Anyway, he can afford to spend the money.
…
Sixteen days passed in the blink of an eye.
Zhou Can has been living a very fulfilling life these days, and his medical skills have been improving by leaps and bounds. He has also accumulated a lot of first-level surgical experience through surgeries.
Following the hemostasis technique, several other medical skills were successfully promoted to the attending physician level.
Incision, suturing, ligation, injection, separation, these medical skills have now all been successfully promoted to the attending physician level.
When their experience points rose to above 1000/10000, the same problem as that of hemostasis appeared.
Practice on white mice has stopped increasing the amount of blood.
It can only be earned by performing surgery on patients in the operating room.
Currently, the experience points of these five medical skills are basically more than 1,000. The injection skill is a little less, only 252/10000.
Mainly because he had never practiced the injection technique on mice.
It has been brought to its current level simply by giving local anesthesia to patients every day in the operating room.
Now, his injection skills are on par with those of the older head nurses. Many young nurses are not as good as him in giving injections.
Of course, injections have more uses than just injections.
In the future, as he gains access to more advanced surgical opportunities, there will definitely be wider application areas.
In addition, his debridement skills were finally upgraded from level two to level three.
Current experience value: Level 3 41/1000.
Lower level of residency.
With this level, the first and second level surgical debridement is basically sufficient.
This shortcoming has finally been made up.
Of course, it would be better if I could get promoted higher in the future.
"My four basic surgical skills have all been upgraded to the attending physician level, and I can no longer upgrade my white mouse training skills. It's time to upgrade the three advanced medical skills of anastomosis, grasping, and insertion."
Zhou Can thought about it and made a new training plan for himself.
The anastomosis of the rat's tail nerve, blood vessels, and intestines can all be practiced.
Although the earning speed is a bit slow, and you can only get 0.2 experience points for a successful match, it is still pretty good.
He can basically successfully anastomose a small blood vessel in about fifteen minutes.
After practicing for one night, you can earn about 6 to 7 experience points.
I believe that if I persist for about a year, the anastomosis surgery will definitely be upgraded to the attending physician level.
Ever since he learned that the field of minimally invasive surgery in China was very backward, he secretly included the improvement of minimally invasive surgical capabilities in his plans.
In the morning, Zhou Can went to work at the hospital as usual.
"Morning, Doctor Zhou!"
"morning!"
"Wow, Dr. Zhou is getting more and more handsome!"
"Haha, it's your eyes that have become more beautiful!"
Zhou Can responded to them one by one with a smile.
After his colleagues in the emergency department distanced themselves from him for a while, the rumors eventually came to an end.
More than half a month had passed, and Zhou Can was fine every day, and no hospital leader had troubled him.
The rumors spread by Dr. Lu were thus refuted.
Everyone gradually resumed normal interactions with him.
That’s the reality of the workplace.
Although friendship is important, the most important thing is interests.
Taking advantage of the last incident, it was like a magic mirror, allowing Zhou Can to recognize the faces of every colleague.
This is also a good growth for him.
"Xiao Zhou, Jin Mingxi, don't go to the operating room yet. Come with me to the morning meeting!"
Doctor Xu greeted the two of them.
Zhou Can has not attended any meetings since he became a resident doctor.
On the contrary, when I was an intern, I had to attend meetings frequently. If I didn’t attend, I would be deducted 50 yuan each time.
"Teacher, can you give me some more difficult level 1 surgery patients today?"
Zhou Can asked with a shameless face as he followed Dr. Xu forward.
After he mastered many medical skills and reached the level of attending physician, he was no longer satisfied with simple debridement and suturing, but wanted to perform more difficult operations.
