Chapter 437: Some are happy, some are sad, challenging Tetralogy of Fallot
"I'm a doctor in the anorectal and colorectal surgery department. My name is Yang Zhi, and I've been working in the operating room for almost six years."
The man reported his origins.
"You're a doctor in the general surgery department. I heard that after the reform, many departments in the general surgery department have developed quite well! Many people are trying their best to get in. You've worked in the operating room for six years and you're an old comrade. Why do you want to leave?"
Zhou Can felt very puzzled.
In terms of seniority, this person is Zhou Can's senior.
It's just that in any company, those with strong abilities always get promoted. Those who are mediocre and not good at making money will only be low-level employees until they get old. I have never heard of any company that assigns employees positions based on length of service.
Zhou Can's surgical skills far surpassed those of ordinary doctors, so his career rose very quickly.
At such a young age, he was already the second-in-command in the emergency department's operating room. If he hadn't been so inexperienced, he could have even become the number one.
"Alas, you don't know. Some are happy while others are sad. Several major sub-departments are indeed developing better and better. Our anorectal and colorectal surgery department has many overlapping businesses with the gastrointestinal surgery department. Director Mi of our department is too honest and has not been able to seize opportunities in many rounds of competition. Now he has been squeezed by the gastrointestinal surgery department and is almost miserable. I really can't see any hope, so I want to find another way out."
Yang Zhi sighed, his words full of bitterness.
The director of a department is like the leader of a flock of sheep. Whether the sheep can eat fresh and lush green grass or chew mud depends on where the leader leads them.
Development strategies, methods, personal abilities, departmental professionalism, departmental cohesion...there are too many factors that can influence the development of a department.
If there are multiple wrong decisions or insufficient means during the development of a department, the decline of this department is almost certain.
Unfortunately, Yang Zhi met a department director who had good surgical skills but poor leadership ability.
Looking at his sad face now, I'm afraid he won't even have soup to drink.
The origin of gastrointestinal surgery is digestive surgery, which is an extremely powerful professional department.
If anorectal and colorectal surgery wants to compete with gastrointestinal surgery, I'm afraid we can only sigh to the sky and say, "Since we have Yu, why do we have Liang?"
"If I don't agree to accept you, what will you do?"
After Zhou Can found out the reason, he unexpectedly asked Yang Zhi a tricky question.
"I personally have deep feelings for Tuya and am optimistic about its future prospects. If I can stay, I will try my best to stay. For a middle-aged man like me, making money is definitely very important. The emergency department is currently in its initial development stage and should be in great need of talents in all aspects. To be honest, although Tuya recruits a group of very excellent general practitioners every year, there is still a shortage of surgical talents. This is because the training cycle of surgical talents is generally long."
Yang Zhi calmly analyzed the current situation.
As he said, there is a shortage of surgeons in any surgical department. Now, including internal medicine departments, they are also starting to compete for talents with good interventional talents and strong endoscopic surgery capabilities.
It is generally recognized that pilots are difficult to train, but training surgical talents is even more difficult than training pilots.
In recent years, the emergency department has indeed been able to assign one or two general practitioner trainees every year.
It's like Zhou Can, who fought his way out of a huge army and only selected ten or twenty people out of thousands of people.
Each one of them is an elite among the elite.
This is also an important part of Tuya’s talent development.
Unfortunately, the emergency department is poor and has nothing to offer, so it is hard to retain staff. When the training is over, very few people are willing to return to work in the emergency department.
This has further caused a shortage of talent in the emergency department.
How good can it be if you always pick up doctors eliminated from other departments?
An elite general practitioner leaves, and an outdated doctor from a specialist department comes in. This is the true reality of the emergency department.
"If Dr. Zhou doesn't like me, that's OK. I'll try other departments to find a way out. If other departments reject me, I'll consider switching to another hospital."
Yang Zhi has a clear life plan for his future.
Strong sense of purpose.
"How about this, you come and help me tomorrow or the day after tomorrow. Tomorrow is Wednesday, and I will not be working in the operating room until after 5:30. The day after tomorrow, it will be from 8 am to 6 pm ."
Zhou Can has always wanted to find a better medical assistant. Now this one who came to his door seemed quite reliable, so he decided to find out more about him before deciding whether to accept him or not.
The strength of a person’s surgical ability can be determined simply by trying it out in the operating room.
If the patient has poor surgical skills or a bad work attitude, we will definitely not accept him.
His team has become relatively stable today.
Luo Shishen's internship will soon end, and he will definitely have to participate in the regular training, because the regular training certificate is one of the necessary certificates for every doctor to be promoted.
Its importance is equal to that of a medical license and a physician qualification certificate.
However, Luo Shishen also expressed his opinion early on, begging Zhou Can to keep a seat for him. When his training is over, he will find a way to return to Zhou Can's team to work.
During this year, he followed Zhou Can in performing surgery and learned a lot.
At the beginning, I was so stupid that I couldn't even make a hook.
When a patient suddenly convulses, suffers ventricular tachycardia, or even cardiac arrest and needs emergency treatment, he panics and his mind goes blank. Until now, after a year of Zhou Can's teaching by words and deeds, his abilities in all aspects are no longer the same.
Compared with other interns of the same period, it's definitely like he's got a cheat code.
Especially surgical skills.
Many interns may not even get a chance to perform a surgical operation to close the abdominal cavity and suture the skin until the end of their internship.
Luo Shishen is now able to close the abdominal cavity skillfully.
Under Zhou Can's guidance, the suturing level has improved almost by leaps and bounds.
After sending Yang Zhi away, Zhou Can returned to the lounge of the operating room and quickly ate a meal to fill his stomach. There was still an operation waiting for him in the cardiothoracic surgery department.
…
Around eight o'clock, Zhou Can appeared in the cardiothoracic surgery operating room on time.
After a year of growth, Director Xueyan's surgical skills have become quite impressive. However, when she performs some major surgeries, she still invites Zhou Can to come over to provide support.
Most of the people in the operating room are old acquaintances.
Even the anesthesiologist is very familiar with Zhou Can.
"Doctor Zhou, after the surgery, can you go to the ICU and help look after a patient who just had a lobectomy?"
The person who made the request to him was Deputy Director He.
Under normal circumstances, Deputy Director He rarely performs surgery with Director Xueyan.
Tonight's operation is a cardiac surgery. Deputy Director He usually only focuses on thoracic surgery. He is too old to take out the time and energy to learn cardiac surgery.
Then there is only one possibility, that he is waiting here for Zhou Can.
"What happened to the patient?"
Zhou Can asked.
Patients who require postoperative monitoring are generally those with serious illnesses or undergoing major surgery.
The situation is definitely worse.
Deputy Director He's surgical and diagnostic abilities are quite good, and he also has a lot of experience.
The fact that he was forced to stay up so late and wait for Zhou Can in the operating room showed that the patient's condition was far more complicated than imagined.
During thoracic surgery, resection of lung lesions is extremely common.
The number of smokers in my country remains high, and the number of victims who are forced to inhale secondhand smoke is even more alarming. If you encounter a male host who does not pay attention to the safety of his family, he may smoke alone, causing the whole family to be forced to inhale secondhand smoke.
You should know that the harm of secondhand smoke is much greater than direct smoking.
In addition, haze has also caused a serious decline in air quality, and the PM25 index remains high, which is another major factor in the high incidence of lung diseases.
PM25 refers to particles in the atmosphere with a diameter less than or equal to 2.5 microns, also known as respirable particles.
It is an important culprit for the high incidence of asthma and lung cancer.
Especially in developed cities in the north, many people have to wear masks when going out. If conditions permit, install an air purifier at home to deal with PM25 in the air.
"The patient has persistent alveolar leakage. The situation is not ideal. I will tell you in detail after the operation is over."
Deputy Director He was very sensible. He dared not delay Director Xueyan's operation.
Now, a year has passed. Not only has Director Xueyan's surgical skills become quite strong, but the entire department has been completely transformed under her management, demonstrating strong survival ability and cohesion, and unprecedented unity.
Talent training is also very good.
She put all the three good ideas Zhou Can had proposed to her into practice.
"Zhou Can, Director He has not left after get off work because of this matter! You see, why don't you let Deputy Director He go to the duty room to rest for a while, and then go find him after the operation is over. Don't let him stay up late with us and suffer."
Director Xueyan and Zhou Can are like siblings and have a close relationship, so they have no concerns when talking to each other.
Very direct.
"I'm so sorry! I'm really flattered that Director He waited for me like this." He still had to say the necessary polite words. "Go to the duty room and rest first. I'll come to see you after the operation. This operation will probably take at least three hours at the fastest."
Zhou Can felt that although Deputy Director He had many shortcomings, he was very responsible to his patients.
This is particularly admirable.
Then again, he is only responsible for the patients under his care.
This really cannot be elevated to the level of medical ethics. This is what everyone does for a living. Under the high pressure of various regulatory systems, Deputy Director He is afraid of accidents and is highly responsible to the patients. This is also the real working state of many doctors today.
Some patients, as soon as they enter the hospital, question the doctor this and that, and their compliance with the doctor is extremely poor.
There's really no need for that.
Unless you really meet a very unreliable doctor.
Otherwise, I believe no doctor would risk losing his job just to harm patients.
In some small and medium-sized hospitals, doctors have certain task targets. They prescribe more medicines that have no harmful effects and have average therapeutic effects, and order more tests. This is also for the sake of survival.
When encountering patients who pay out of their own pocket, doctors generally try their best to calculate the cost when prescribing medicines and ordering tests.
Patients with medical insurance will understand this.
The current environment is like this. If most hospitals don’t make money from medical insurance, they will go bankrupt.
If that really happens, it will be even more difficult for ordinary people to see a doctor.
Deputy Director He is old and can't stay up late like these young people. After hearing Zhou Can's words, he left the operating room happily.
Zhou Can picked up the patient's information and began to check it quickly.
" This patient's disease is a bit tricky! I thought it was just an ordinary congenital heart disease, but it turned out to be Tetralogy of Fallot."
"We wouldn't have asked you to come if it wasn't difficult. I know that you have a lot of surgeries to perform in the emergency department every day. As long as we are confident in the operation, we will try not to ask you to come and help."
Director Xueyan replied with a smile.
"Sister Yan, call me anytime if you need anything. Don't worry about me being tired from work."
Zhou Can could feel her thoughtfulness.
Tetralogy of Fallot is the most common type of cyanotic congenital heart disease.
Without surgical intervention, patients generally do not live past the age of seven. The average life expectancy of children with this disease is only about twelve years old.
It mainly manifests as cyanosis in children between three and six months old.
Cyanosis may appear on the face, lips, nails, fingertips, and even the entire body.
Cyanosis is particularly serious when the child is crying .
Medically, this disease was previously considered incurable. Later, doctors pioneered cardiac surgery and, through constant exploration, finally found a surgical method to treat this congenital heart disease.
The so-called tetralogy of Fallot refers to pulmonary artery stenosis, ventricular septal defect, coarctation of the aorta, and right ventricular hypertrophy.
Any one of these lesions is sufficient to be called a congenital heart disease.
The combination of four symptoms also increases the difficulty of treatment exponentially.
Surgery is the only option for treating this disease.
Without surgery, the child is very likely to die.
Since this disease is a congenital heart disease, when the child is young, he or she may not be able to tolerate surgery due to poor development or physical condition.
In this case, it is generally not possible to complete radical surgery in one go.
Experienced surgeons often choose to perform palliative surgery first to save the child's life, and then perform a second surgery to completely cure the disease when the child grows up and has a stronger tolerance and the surgical conditions are ripe.
In Zhou Can's impression, Director Xueyan had never dared to perform such a difficult operation before.
The fact that she dared to challenge a Tetralogy of Fallot surgery this time also shows that she has full confidence in her surgical skills.
"Sister Yan, have you checked the patient's coronary artery?"
Zhou Can asked after reading the child's basic information.
"We checked it. The child's coronary artery is visible below."
Xueyan knew that Zhou Can would never ask random questions.
Since you asked, there must be something wrong.
“Can this operation be performed?”
So far, the child has only been anesthetized and the operation has not started yet.
"Don't be nervous. I just want to see where the anterior descending branch of the coronary artery originates. If the patient's anterior descending branch of the coronary artery originates from the right coronary artery, then this operation probably can't be performed. In addition, the patient's left and right pulmonary arteries and peripheral pulmonary arteries are poorly developed, so this operation can't be performed either."
Zhou Can gave his own opinion.
After hearing this, Xueyan smiled and said, "I knew it was reliable to ask you to come and help. You can also help us check if there are any problems. Don't worry, I have checked these two taboos, it's okay."
Even though she had already checked, Zhou Can was still a little worried and checked it again.
Fortunately, this child did not have either of the above two conditions.
"How is his left ventricle developing?"
Zhou Can asked again.
"Not bad, up to par . But not great."
"That's fine. Did the patient drink enough water before the operation?"
Zhou Can pressed the child's skin and found that it had normal elasticity.
“It’s in place.”
This time it was the circulating nurse who answered.
"Okay, I'm basically fine now."
Zhou Can looked at Director Xueyan.
It means waiting for her to give orders.
"Anesthesia, can we start?"
During surgery, it is not impolite to address the anesthesiologist by his/her professional title; it is for the convenience of communication.
Especially when there is a doctor in the operating room who has the same surname as the anesthesiologist, people prefer to call the anesthesiologist directly by the word "anesthesia".
"The patient's vital signs are stable, he has been put into general anesthesia and can undergo surgery."
"Then let's get started! As usual, Dr. Zhou Can will take over as my lead surgeon at the critical moment, and everyone else will take their positions."
Director Xueyan invited him over not only to help with the review, but also for another reason: Zhou Can would help at the critical moment.
Today, Zhou Can's surgical skills have reached the intermediate level of deputy director, or even the advanced level. Coupled with his quick and steady knife skills, his ability is not inferior to that of a first-class chief surgeon.
