As an emergency physician, Yuan Pingan does have very serious shortcomings. At the resident level, these shortcomings will be resolved by the supervision and attention of superior doctors. But when he is gradually promoted to the chief resident physician, he needs to start to work alone.
When he took on the diagnosis and treatment work, his flaws began to be gradually exposed.
This flaw, in Zhu Minhua's words, is "over-focus." In Zhou Jun's view, Yuan Pingan's problem lies in his "lack of multi-tasking parallel processing capabilities."
He really looks like a specialist.
How many patients come to the emergency department every day? How many of these patients may have incurable diseases? In the eyes of the director of the emergency department, an excellent emergency doctor must not, like a specialist, throw away all his work for one patient.
Leave it alone and focus on one symptom.
This is irresponsible to other colleagues and patients.
Although Yuan Pingan is still working with the department, it is unrealistic for him to become a combatant immediately. But Zhou Jun has understood that the main reason why Zhu Minhua sent Yuan Pingan to Ningyuan is also to diagnose rare patients. Look at Sun Lien!
Therefore, you have to compare yourself to others, and you have to throw away when comparing goods. He is obviously an excellent emergency doctor, but as long as he can clearly distinguish the focus and tendency of his daily work, he can make earth-shaking changes. The result is compared with Sun Lien, a guy with a plug-in.
, suddenly became a role that needed to be transferred to grassroots hospitals for re-training.
On the other hand, Yuan Pingan is actually quite satisfied with his performance. After all, it is not easy to figure out the type of Yang Jianqiang's disease, the sequence of onset, and the reasons for the rapid progression of the disease. If it were not for reading nearly a hundred articles at home and abroad
Case reports, and if he makes bold speculations by linking the adjustment of the immunization regimen with the disease, it is absolutely impossible for him to guess the correct answer out of thin air. But in such a short period of time, he can string together the above series of key points and propose his own
In terms of diagnostic plans and treatment suggestions, Yuan Pingan's ability is definitely not weak, at least he is worthy of Tong Xie's brand name.
Keren... to put it bluntly, is a kind of paralyzed animal. Just like a table tennis chipper, in other countries, a player with the ability of Chinese provincial teams can definitely attract the attention of many people. But you
If you put this player in China, few people would notice his skills. Do you know the national team? We are all tired of seeing it. As a foreign chipper, no matter how good you are, can you beat the national team? It doesn’t exist.
Yuan Pingan is such a chipper. He was extremely cruelly thrown by his coach into a place where "even fat guys who don't understand football are world champions". Then he accepted the contempt from all walks of life in the national team.
I really don't blame him, it's just that compared to Sun Lien, Yuan Pingan is a bit... too ordinary.
"What is the treatment plan?" Zhou Jun frowned, but didn't say anything else. Judging from Yuan Pingan's face, he knew that Yuan Pingan had probably been checking information since Yang Jianqiang was sent to the hospital. Based on this
He really couldn't say anything critical about his work attitude.
"You can't use sulfadiazine, it's too slow." Yuan Pingan didn't notice the strange atmosphere in the conference room. He was still immersed in his achievements in discovering the problem. "I suggest radiotherapy."
Yuan Pingan has considered this treatment plan for a long time. He also knows how controversial this treatment plan itself will be. However, after comprehensively reviewing many materials and literature, Yuan Pingan believes that currently, it has the fastest effect and is specific enough.
The only treatment option is radiotherapy. According to the data, gamma radiation of 0.46kgy/min and a total dose of 0.55kgy can at least effectively curb the reproduction of Toxoplasma gondii, and can also prevent Toxoplasma gondii from forming cysts in the human brain.
However, there are still big problems with this treatment plan. No one has ever used radiotherapy to treat Toxoplasma gondii infection before. The data on the inhibitory effect of gamma rays on Toxoplasma gondii are limited to animal experiments. Is the radiation dose of 0.55kgy effective in humans?
Whether it is enough to inhibit the reproduction of Toxoplasma gondii, whether the irradiated parasites will die quickly and trigger a more severe immune response, and whether such a large dose will cause severe discomfort to patients, are still unknown.
The most troublesome problem is that, as a treatment method that has never been used before, gamma ray radiotherapy to kill Toxoplasma gondii is a "domestic first" treatment method. According to the corresponding regulations, before carrying out this treatment method, you need to first
With the consent of the family members and the signature of the department director, an ethics committee review will be convened, and it will also be reported to the Provincial Health Commission for review and approval.
If he had so much time, Zhou Jun would not have to worry about this problem and just take sulfadiazine. The current situation is extraordinary and extraordinary measures must be used.
"Go talk to the family first." Zhou Jun listened carefully to Yuan Pingan's explanation about the radiation dose. The radiation dose of 0.55kgy is not too small. The radiation dose of 550gy is almost ten times the prescribed radiation dose for general small tumors. Even
It exceeds the generally recommended upper limit of cumulative radiation of 300gy. Although considering that the radiation sources in these Toxoplasma animal experiments are mostly not highly directional gamma knives, the dose will be much higher. But this is still a
Very dangerous treatment.
Those present were all expert directors who came for consultation. Of course, talking to family members could only be left to the lowest-ranking young doctor in the room. Therefore, Yuan Pingan, who had just broken into the conference room, was arrested as a matter of course.
"You go find Sun Li'en and take him with you to have a family talk." Zhou Jun specifically asked before leaving the house. Using gamma knife treatment on Yang Jianqiang is extremely risky, but it is currently the only one that can make it in time.
Treatment plan. The stakes must be explained thoroughly so that the patient's family can make a decision that is in the best interest of the patient. As for Yuan Pingan... Zhou Jun is not at ease. Although Sun Lien is much younger than Yuan Pingan, several times
During conversations with family members, Sun Lien can come up with some unexpected gains. Allowing Sun Lien to talk with him may help doctors and patients communicate better.
Zhou Jun sent Yuan Pingan away and began to discuss the issue of radiation dose with experts from the Imaging Department and Nuclear Medicine Therapy Department. A radiation dose of 550gy is almost absolutely unacceptable, but how much can the dose be reduced to still ensure the effectiveness of Toxoplasma gondii?
To kill, this requires experts to consult a lot of data and make calculations.
"Do you really want radiotherapy?" Sun Lien was blocked by Yuan Pingan on his way back to the ninth clinic. After he heard the content and direction of the conversation, Sun Lien seemed particularly shocked. Although he initially proposed radiotherapy,
But that was just an "immature idea" of his. When he proposed this idea, Sun Lien's main purpose was to remind Zhou Jun that the patient's condition was serious. Precise irradiation using gamma rays is one of the common treatment methods in the field of nuclear medicine.
First, the content of nuclear medicine is extremely professional, and Sun Lien knew very little about this method. But even if he knew little about it, Sun Lien also knew that using gamma rays to treat toxoplasmic encephalopathy is definitely a deviant approach, and it is not something that ordinary people can do.
Come up with a solution.
"There are basically zero clinical studies in this area. Even the dose data of irradiation are only in vitro experiments on animals... and they are still on the research path of attenuated vaccines." Yuan Pingan, who calmed down, also felt that his suggestion
It may be a bit excessive, "I checked a lot of information, and most of them are research results from 20 years ago. Whether it can be applied clinically or how many side effects there are, no one can say."
"Then we have to convince the patient's family to develop an unprecedented treatment method in her husband's brain. Moreover, the radiation dose is determined by the research direction of creating a vaccine." Sun Lien suddenly felt that the future was bleak, and the more he talked, the more frustrated he became. "
I think...as long as the patient's family members are in good health, they will reject this treatment plan, right?"
"If she refuses the treatment plan, she will have to prepare for her husband's funeral." There was no one around, and Yuan Pingan spoke more straightforwardly. "Actually, this plan is a bet that her husband can survive. Anyway, it won't be possible.
You will definitely die if you gamble, but you may still survive if you gamble."
Sun Lien blinked. He really couldn't put himself into the perspective of these patients' families and think about this problem. As a doctor, of course he knew that this might be Yang Jianqiang's only chance to survive, but would the family members agree? This is really
The unknown. Radiotherapy is originally a treatment option that many patients and their families are unwilling to accept. The idea that radiation causes cancer has been ingrained in the minds of ordinary people for many years. Many people find it difficult to accept the risk of cancer to treat diseases.
.
The role of the doctor's talk is to help these patients and their families turn this corner. Although cancer is terrible, only living people will get cancer.
There are no cancer cells in dead people. Although cancer is terrible, in the face of death, it is just a trivial side effect. What's more, the current gamma knife technology is advanced and its positioning is extremely accurate, so it is generally not too serious.
Side effects. Although some acute radiation damage is inevitable, it is generally not serious enough to induce cancer.
"Gamma Knife? Yes." What Sun Lien didn't expect was that Mrs. Yang agreed to their request without even hesitating. "How many times does it need to be done? What parts of it are done? What dosage is used?" Not only did she agree
It was very enjoyable, and Mrs. Yang also asked questions very expertly.
However, these expert questions, which are supposed to promote communication between doctors and patients, were directly asked to Sun Lien and Yuan Pingan. How to answer this? "Eight areas of the brain will be irradiated, and we are calculating the number and dose?"
"The problem is not about how many times..." Sun Lien pondered for a long time and felt that it would be better to tell the truth. "To be honest, we should only have one chance. If the radiation does not achieve the expected effect, it may be... too late.
"
Mrs. Yang suddenly raised her head, her eyes full of shock, "What?!"