When Zhou Chengcai hurried back from the medical malpractice appraisal hearing in Chen City, he received another call from Ningling.
It was said that Shashi No. 3 Hospital had invited a foreign aid consultation operation. He and Li Neng from the trauma surgery department had already rushed there and were currently conducting a pre-operative consultation discussion.
And now, neither Professor Ding Changle nor his teacher Professor Chen Tingye are available, and Yang Yifeng is also undergoing surgery. Lei Zhongze is inconvenient to attend, so he hopes Zhou Cheng can go over and take a look.
Zhou Cheng hadn't even taken a break yet and had just gotten off the high-speed train.
"Okay, Professor Ning, I'll be right over." Although Zhou Cheng felt a little tired, he still replied.
After hanging up the phone, An Ruo, who had finally asked for leave to pick up Zhou Cheng, frowned: "We just got off the ground, where are we going?"
"Third Hospital, thank you for sending me there."
"Professor Ding and Professor Chen Tingye are both unavailable. I guess this patient's condition is quite troublesome."
"Professor Ding helped me a lot when I was in the Eighth Hospital." Zhou Cheng explained to An Ruo, hoping that An Ruo would not blame Ding Changle for this.
That's what work is like, especially in the medical industry.
Now that they have given themselves so many opportunities, they must want to promote their professional title to deputy senior position in advance.
The associate professor is an associate professor. After associate professor, there must be countless such things.
And only when he reaches the deputy high position and the trauma center is handed over to his own hands, will it become more legitimate. All the previous preparations must be in place.
However, because Zhou Cheng had already had a counterpart support plan for prefectural-level city hospitals, he didn't need to go to the countryside anymore. Counting on his support resume, he could now take the exam directly and be directly promoted.
"Stop pouting. Pouting can easily lead to mouth wrinkles."
"That's how medicine is. If you can save one more person if you make an extra trip, it's not a loss. At most, you're just a little tired." Zhou Cheng explained to An Ruo.
His current work situation is indeed a bit busy. After reaching a certain level, in addition to treating diseases and saving people, he will have many other tasks. This cannot be avoided.
"Luanluoluo, you workaholic." An Ruo made a face at Zhou Cheng, and then laughed cutely again.
"Aren't you also a workaholic?" Zhou Cheng replied with a grimace.
Now that An Ruo is working, her work and duty tasks are much more arduous than before, but she has survived.
He never complained to Zhou Cheng.
…
"Xiao Zhou, the situation is like this. The patient I met this time is an old man. He is eighty-two years old. He was admitted to the hospital with a fracture due to a car accident. He originally planned to schedule an operation today."
"But the results of today's last pre-operative examination showed that the other party's coagulation function and respiratory function were poor, so the operation was temporarily suspended. We are currently discussing whether the operation is suitable and which treatment method is needed..."
"Of course, this patient's fracture indications are in line with the indications for surgical treatment, and conservative treatment is ineffective. However, the patient's physical condition cannot tolerate surgery, and it is a contraindication for surgery."
"Also, the patient had paralysis of the right lower limb before the operation. If the specific condition is introduced, we will go in and slowly understand it."
Ningling's tone of voice was more honest and respectful.
"Okay, Professor Ning, I hope I can help." Zhou Cheng politely followed Ning Ling and entered the doctor's office with him.
There is no guarantee that it will be able to help.
In the doctor's office, a chair was reserved for Zhou Cheng in advance. In the middle was a square table made of two square red lacquered wooden tables. There were more than a dozen people around it! There were both men and women, and Zhou Cheng didn't recognize any of them.
After entering, one of them was expressing his opinion, while Zhou Cheng followed Ningling and sat in a corner.
Around the office, there are several nurses and a group of people in white coats, all of whom are quite young.
Zhou Cheng didn't intend to sit down when he saw this, but Ningling took the initiative to pull Zhou Cheng's wrist and motioned for him to sit down.
In front of Zhou Cheng, there was a case introduction about the patient.
This case introduction is quite high-level——
Zhou Cheng read it carefully and this is what he wrote.
"The patient's current diagnosis is considered to be Evans type III right intertrochanteric fracture, right lower limb muscle paralysis, coagulation disorder (exogenous), COPD combined with type II respiratory failure, mild respiratory acidosis...
"
"According to the current diagnostic grade fracture classification, conservative treatment is ineffective. According to the patient's current physical condition, it is a relative contraindication to surgery. Considering the patient's preoperative right lower limb muscle dysfunction, the surgical benefits are quite small."
"However, the patient is currently in an advanced age. Considering that conservative treatment will greatly affect the patient's quality of life and life expectancy, experts from various departments are invited to give comprehensive consideration and help adjust the treatment plan..."
The case introduction clearly explains the patient's current difficulties and diagnostic points. However, the most critical point is that if the patient does not undergo surgery, he can predict that his life expectancy will be short if he lies down.
It is estimated that it will only take a few years, and if blood clots occur or blood clots fall off, the time of death will be earlier.
And if the fracture cannot be treated, then for the elderly, it is equivalent to announcing the death line of life experience——
The identity of the speaker was unknown, but Zhou Cheng heard that his speech was very interesting.
"This patient's identity is quite special, so I hope all directors can treat it carefully and come up with the most suitable and best treatment plan."
"The patient's family members have high expectations for surgery and the patient's quality of life after surgery. And because of their special status, if our decision-making this time cannot be consistent with the actual situation, it will definitely be more troublesome in the future."
"Special things should be done..."
Zhou Cheng had heard the words "special status" five times since he came in. It can be expected that he said it at least five times.
Moreover, Zhou Cheng also noticed that Associate Professor Ningling, who was sitting next to him, frowned slightly every time he heard the words "special status".
Finally, after two minutes, he finished his explanation, and then asked Ning Ling: "Professor Ning, how do you consider the current patient's situation?"
"Director Huang, I think we should not specifically emphasize the patient's identity. We should just treat it as a very common case." Ningling's first sentence was to directly express diss to him!
And Ningling's words indeed made the other party's face flicker several times.
Then he smiled awkwardly and said, "As doctors, we still have to consider the actual situation."
The opponent did not confront Ningling directly, but he also said something that Ningling could not refute.
Ningling roughly summarized the patient's situation: "I just listened to the opinions of the department directors and Director Huang of the Medical Department. I think this is what we already know about this patient."
"The main categories of surgeries currently performed on patients with block are coagulation function and respiratory function. Among them, the problem of respiratory function suppression, Director Jiang of the Respiratory Department also said, you can abandon general anesthesia and choose spinal anesthesia."
"In terms of coagulation function, Director Zhou of the Department of Hematology also said that the current patient's coagulation factors are not a lack of key coagulation factors. This means that the patient's coagulation function is not in a state of absolute contraindications."
"After surgery, if appropriate, infusion of coagulation factors can help prevent postoperative massive bleeding."
"According to the opinions of the directors of other specialties, there are no other additional diseases that would affect the surgery."
"Then from the perspective of our specialty, this patient's current fracture must require surgical treatment. Director Xue of the Trauma Surgery Department also supports this. This is also the Trauma Surgery Society of our Orthopedics Department, which treats intertrochanteric fracture Evans III
Cognitive knowledge of type fracture treatment.”
"But another doubt about continuing the operation is that the patient had muscle dysfunction in the right lower limb before the operation. So if the patient's fracture recovers after the operation, he still cannot restore his activity function."
"Then the significance of this operation needs to be discussed."
"But among our many preoperative examination results, both Director Ling from the Spine Surgery Department and Director Su from the Neurosurgery Department also said that the current MRI results do not support intracranial or intraspinal canal
of nerve damage.”
"In other words, it is not a central nervous function injury, but more of a peripheral nerve injury. According to our preoperative examination results, we found that the patient's neuroelectromyogram results did not have obvious abnormalities."
"As a result, how to characterize our diagnosis of right lower limb muscle dysfunction is also a very troublesome matter."
"Professor Li, you think about it this way, right?" Ningling handed over the initiative of the problem to another professor.
Li Neng is quite tall and strong, with thick eyebrows, big eyes, and a high nose bridge, which is very consistent with the outside world's perception of orthopedic surgeons: "This patient's fracture surgery is not difficult to treat."
"But if you still can't move normally after surgery, then the surgery is of little use."
"But if no surgery is performed at present, the patient's current examination results do not support the diagnosis of paralysis of the right lower limb, and then the muscle function recovers after the surgery, but the surgery is lost due to the occurrence of blood clots, muscle atrophy, and bone atrophy due to the fracture.
If the opportunity and recovery time are determined, I would like to perform additional surgery to make up for it.”
"Maybe based on the patient's current physical condition, there is no such opportunity."
"Therefore, the problem we have now is not a lack of technical skills, but a lack of knowledge. That is, what is the reason for this patient's muscles before the operation, that is, before the car accident?
Functionally impaired.”
"If we cannot understand this point, no matter how much we think about the meaning of surgery or the patient's prognosis, it will actually be incomplete."
"Everyone should also know that this patient's family is very pretentious. Basically, if we medical workers had not taken the initiative to inquire, they would not have taken the initiative to inform the patient of the condition."
"This seems to be specifically testing the working ability of our doctors in school, so based on this comprehensive consideration, my suggestion is not to perform surgery." Li Neng said.
While Li Neng was speaking, Zhou Chengcheng discovered that Ningling, sitting next to him, was extracting the key points of Li Neng's words.
Among them, the two key words of cognition and skill preparation are circled.
Moreover, Ningling also classified cognition into three categories: "professional cognition, diagnostic cognition, and prognostic cognition."
This classification is very interesting.
Then, after Li Neng finished speaking, Director Zhang of the Medical Department spoke again. He had a Chinese character face and a more official tone: "Director Xue, Director Chen, I still say the same thing, the diagnosis of this patient is still unclear.
If there is any treatment, it must be treated with caution.”
He did not say the four words "special status" again, but he never left these four words.
Moreover, it seemed that he did not dare to diss Professor Li Neng and Professor Ningling, so he could only operate on the two directors of his own hospital.
Chen Xuehua and Xue Guoqing are the ward directors of microhand surgery and ward directors of trauma surgery.
Xue Guoqing is quite short, only about 1 meter tall. He is not fat, but he looks very shrewd: "Director Zhang, you just heard that our current opinion is that the problem of contraindications for surgery is not a big problem.
.”
"It's about diagnosis. We need to be more cautious. Well, it's getting late now. Directors of other departments and Director Zhang have all worked hard. I would like to invite Director Su from the Neurosurgery Department and Ling from the Spinal Surgery Department.
The director will stay here for now and we will work together to diagnose the problem carefully."
"Director Zhang and other directors, please go back and rest first. How about we contact you later?"
"This time I really trouble all the directors." Although Xue Guoqing is small, his words are very grand, and it is indeed getting late.
Director Zhang and others did not speak, but the director of the Department of Respiratory Medicine said: "Director Xue, if you still have to decide on surgery in the end, please remember to tell me so that I can think it over with Director Zheng from the anesthesiology department.
There are also plans for postoperative respiratory management during the operation.”
Director Zheng also nodded: "During the operation, Director Xue will indeed need to come to the operating room to take care of her."
…
After this, Director Xue acted as the host and sent the other directors out of the ward.
However, when Director Zhang of the Medical Department left, he still said: "Director Xue, the patient has a special status and must be treated with caution."
This was said in a loud voice. After hearing this, Ningling clenched his fist slightly. It was obvious that he wanted to hit someone, and he had been tortured by this sentence countless times!
After everyone else left, everyone left breathed a sigh of relief.
Spine surgery itself is an orthopedic department, and neurosurgery is half an orthopedic department, so there are quite a lot of exchanges between everyone.
Xue Guoqing went to see him off. Chen Xuehua from the Department of Traumatology, who was actually the chief director of the Department of Orthopedics, also shook his head slightly and said: "Professor Li, Professor Ning, this fracture patient we met this time really caused you a lot of trouble.
?”
Li Neng and Ningling were both here for consultation surgeries, which meant they could do some surgical problems that couldn't be solved. There was no need to spend any effort on such complicated patients.
Whether surgery can be performed or not is decided by the people in our hospital, who must make all the preparations before the surgery.
But now they are required to participate in preoperative discussions.
Li Neng did not speak, but Ningling said with bright eyes: "Director Chen, cases like this are interesting. If you always perform operations mechanically, it will definitely not be as interesting as this case."
"Professor Li, as well as Director Su and Director Ling. Now we have just invited our Dr. Zhou here, so we can almost sit down and think about how to crack such a hard nut!"
"The purpose of this conference is actually to allow Director Zheng of the Anesthesiology Department to let go of our department and accommodate the relative contraindications of anesthesia." Ningling said as he started to take a stack of A4 paper, full of fighting spirit.
Ning Ling is tall and thin, but has a rich voice. With his fighting voice, he looks like a surgical maniac.
Li Neng smiled. He looked tall and powerful, but his voice was relatively calm: "Professor Ning's interest in surgery is really inherited from Professor Chen?"
Professor Chen Tingye is the ward director of the Hand Surgery Department of Xiangya Hospital and the current leader of the Hand Microsurgery Group of Hunan Province.
Ningling smiled when he heard this: "Professor Li, please stop laughing at me. Compared with my teacher, I'm still far behind."