Chapter 462: Xueyan wants to be proud of herself
After Zhou Can cut open the abscess cavity wall, he first used a curette to carefully and meticulously scrape away the rotten tissue on the abscess cavity wall until fresh tissue was exposed. He earned another 11 points of debridement experience points.
When performing this type of chest wall tuberculosis lesion removal surgery, the most profitable thing is probably the debridement experience points.
After scraping the abscess cavity clean, he changed to a scalpel and removed the abscess cavity wall and necrotic muscle tissue bit by bit.
This process seems easy, but it actually requires a lot of resection and separation techniques.
Because the abscess cavity is irregular in shape, and when removing the necrotic muscle tissue, it is necessary to carefully search for sinuses and possible deep abscess cavities.
The operation not only tests the surgeon's skills, but also requires the surgeon to have rich surgical experience.
It also requires flexibility during surgery.
Moreover, extreme caution must be exercised when removing the diseased tissue to avoid damaging the surrounding important blood vessels, nerves, tissues and organs.
Even an ordinary associate chief physician would feel weak and helpless when performing an operation of this level.
Director Xueyan, Director Le and others unanimously decided to let Zhou Can perform the surgery because of the complexity of the operation and the technical requirements in all aspects.
"Oh my goodness, Dou Dao is here!"
Modern high-tech examination equipment can certainly bring a lot of convenience to doctors, but the specific surgical process is not something you can easily complete by just looking at the film.
When looking at the film, you can clearly see how big the abscess cavity is and where the sinus tract is approximately.
If angiography is performed, the direction and route of the sinus tract can be clearly seen.
But when you actually cut open the abscess cavity, you'll find that's not the case.
There are too many variables and too many things .
After discovering the sinus, Zhou Can cut it open little by little and cleaned it out.
"This sinus is really annoying. How did it penetrate behind the ribs?"
He dared to say that this was definitely one of the most complicated operations he had ever performed.
"How do we do that?"
Director Le must know some way to deal with it, which is to respect Zhou Can, so he used an inquiring tone.
"There is no other way. We can only cut this rib to expose the bottom of the sinus and completely remove the lesion. Otherwise, our operation will be in vain."
Zhou Can is considered a skilled and courageous veteran on the operating table.
Counter each move with a countermove.
Finding the sinus tunnel running behind the ribs, he decided to bite the bullet.
This is also the principle that Director Hu, Dr. Xu and others taught him when they were performing surgery. Doctors are like parents to their patients, and when treating patients, they cannot just give a few tricks and leave it at that.
The surgical plan must be considered from the perspective of the patient's interests.
Some doctors with poor medical ethics usually consider their own interests first when they encounter such major troubles during surgery.
Cutting the ribs will not only increase the difficulty and time of the operation, but also greatly increase the unknown risks.
When explaining to the family members, there may be disputes or even complaints.
Rather than doing good things, you'll get into trouble.
It is better to sew up the wound against one's conscience and tell the patient that the operation has been completed. As for the patient's recurrence after the operation, it is the patient's bad luck and he can only go back to the hospital for another operation.
In the operating rooms of major hospitals, there are many patients who need to be operated on for the second time.
Not to mention that every patient who has to go back to the hospital for the second time has this result because the doctor is unethical and does not perform the operation thoroughly, but at least more than 40% of them have this result.
Sometimes it may not be that the doctor has no morals, but that the doctor’s level is just that high.
If you ask him to perform this type of operation ten times, he can guarantee that the patient will not need a second operation ten times.
In general, the current tense doctor-patient relationship is also a major reason that forces doctors to choose defensive medical measures.
He rarely sawed bones, especially the patient's ribs and skull.
This is a good opportunity to practice.
If surgical skills are not used for a long time, they will easily become rusty, or even become unskilled and deteriorate.
It is also not conducive to the upgrading of medical skills.
After carefully sawing through the ribs, the sinus tract was exposed. It was dissected until the bottom of the sinus tract was reached. It was then scraped clean with a curette.
"Sister Yan, can you help me check if this rib is broken?"
For patients like this whose sinus tract invades the back of the ribs, rib necrosis is likely to occur if treatment is not timely.
"The situation is still ideal. I didn't find any necrosis."
After reading it, Director Xueyan gave her opinion.
Women are more careful, so it is often a good choice to let a female doctor check some details of the disease.
Fortunately, this patient met Zhou Can, who spared no expense to cure his disease.
He began to resect the sinus tract.
The number of separation and resection operations is increasing.
The operation itself is quite difficult, so it is normal to get some experience points as rewards.
"Hey, there seems to be another abscess cavity here! Give me an empty needle with a tube." Zhou Can felt that there might be a lot of pus in the newly discovered deep abscess cavity.
The difficulty of puncture is almost zero.
I tried to draw out the pus inside, and actually drew out almost 70 to 80 milliliters.
This deep abscess cavity is much larger than imagined.
"No wonder I always felt there was something wrong with this area when I looked at the CT scan! It seems that when I encounter this type of patient in the future, I should not blindly trust the CT results and should be careful about overlapping abscess cavities, which may lead to missed diagnosis in the scan results."
Director Xueyan suddenly realized at this moment.
Not to mention her, even Zhou Can gained a lot.
This is how studying medicine works, accumulating knowledge over time and making continuous progress in practice.
After Zhou Can's efforts, the deep abscess cavity was cleaned again, then separated bit by bit and completely removed.
"It's really dangerous. There is a small sinus here. Fortunately, it was discovered, otherwise the patient would be in great danger."
While removing the deep abscess cavity, Zhou Can discovered another sinus tract.
It's small, but it's quite deep.
When encountering the surgeon will generally try every means to drain the pus, provided conditions permit, and wait for the right opportunity to perform surgery again.
This is because abscesses have a strong ability to damage surgical wounds and tissues in the body.
If the abscess is not completely removed, secondary infection and recurrence are very likely to occur.
There may even be some unexpected postoperative complications.
…
After nearly an hour, the operation was completed.
Zhou Can was very satisfied with the medical experience points he had gained. What was more meaningful was that he had successfully cured the patient's illness. As long as he was sent back to the ward for good care, the patient would recover soon if nothing unexpected happened.
Many of these patients experience a relapse of tuberculosis, and they think this is due to the difficulty in curing tuberculosis.
In fact, it is more likely that the lesions were not completely removed, or residual cavities were left when the incision was closed, or preoperative anti-tuberculosis treatment was insufficient, leading to active tuberculosis lesions in other parts of the body and original drug-resistant Mycobacterium tuberculosis infection, ultimately causing recurrence of tuberculosis.
When treating such diseases, mutual trust between doctors and patients is very important.
The second thing is to have confidence. The surgeon must have confidence, and the patient and family members must have confidence as well. As long as you believe that the disease can be eliminated, most people will eventually be cured.
If tuberculosis recurs, people will question the doctor and develop a confrontational attitude.
In this case, it is recommended to change hospitals and seek treatment from another doctor.
If you go back to the original doctor, because the trust is gone, the doctor will be extremely conservative in treatment, which is commonly known as a defensive medical strategy.
"Thank you for your hard work. As usual, I've ordered some midnight snacks. Eat them before you leave. Or you can take some home!"
Director Xueyan was particularly happy to see the operation completed successfully.
Under her leadership, cardiothoracic surgery gradually developed.
In the eyes of many people, this is a miracle.
When Director Hu Kan suddenly passed away, the cardiothoracic surgery department was in a period of transition. In addition, Director Xueyan lacked experience in leading a large department. Under the joint siege of multiple external hospitals, she lost her composure and forced a difficult cardiothoracic surgery, which resulted in the patient's death on the operating table.
At that time, everyone in the cardiothoracic surgery department was convinced that it would collapse.
Everyone, including the top management of Tuya Hospital, has made preparations for an emergency change of leadership.
At the critical moment, Zhou Can spared no effort to help Director Xueyan and the cardiothoracic surgery department. In addition, she regained her confidence and continued to work hard, which gradually led to the current situation.
Vice President Zhang of the Third Hospital would put aside his status and personally go to the emergency department of Tuya Hospital to interview Zhou Can, trying his best to poach Zhou Can.
This is enough to show that the cardiothoracic surgery department of Tuya Hospital has regained its footing.
Although not as good as during the peak period, the Third Hospital, Provincial People's Hospital and Xinxiang Hospital should have felt tremendous pressure.
Just like countries, when a neighboring country becomes stronger and stronger, its neighbors will definitely feel tremendous pressure.
If you are really capable, you don't need any publicity.
No matter how low-key you are, your opponents can still feel your strength.
There are only so many cardiothoracic surgery patients in the province. Excluding the cases that can be handled by some small and medium-sized hospitals, the rest is the cake of a few large hospitals.
When the situation at Tuya Hospital was bad last year, a large number of patients left the cardiothoracic surgery department, and other hospitals must have benefited from it.
Today, the cardiothoracic surgery department of Tuya Hospital is rising again, attracting more and more patients. Those large hospitals can naturally notice that the number of outpatient and emergency patients is decreasing little by little.
The cure rate and number of outpatient and emergency departments in each hospital are no secret.
If you want to check, you can find it.
"Zhou Can, how about going to my office to chat for a while?"
Director Xueyan took off her gloves and mask and invited Zhou Can.
She knew that Zhou Can was very busy during the day, and she only had the chance to chat with him after the operation.
Don't chat here, but invite him to the office and explain that you don't want others to know what you want to discuss.
"no problem!"
Zhou Can readily agreed.
The two of them came to Director Xueyan's department director's office one after another. She was about to make tea for Zhou Can, but was stopped by Zhou Can.
"We are not strangers, so you don't have to be polite, Sister Yan. If you have anything to say, just tell me directly."
"Then I really didn't treat you as a guest! I think the current strength of the cardiothoracic surgery department is pretty good. The number of outpatients and emergency patients is increasing every month, and the cure rate is also getting higher and higher. So I want to do some publicity to increase the popularity. Do you think it's okay?"
Director Xueyan suffered a great loss last year, so whenever there is any major issue, she will consult Zhou Can.
At the beginning, Zhou Can gave her three good suggestions, one of which was to focus on development, do practical things, and not care about fame and outpatient volume.
It is this low-key strategy of "storing food and building high walls" that has helped the cardiothoracic surgery department of Tuya Hospital get rid of many burdens and gain the energy and determination to develop.
"You've been silent for too long. Is Sister Yan planning to rush onto the tree branch?"
Zhou Can asked with a smile.
“I guess so!”
Director Xueyan nodded slightly.
"Your ambition is really not that big! I thought that even if you can't spread your wings like Kunpeng and soar up to 90,000 miles, at least you can soar into the sky like an eagle. You just want to rush up to the branches, your vision is so small!"
Zhou Can feels that cardiothoracic surgery can reach greater heights.
When he promised Director Hu Kan that he would help the cardiothoracic surgeons and Director Xue Yan, he had this ambition and believed that he could at least make Tuya's cardiothoracic surgery department one of the top ten cardiothoracic specialty departments in the country.
"Oh, you are trying to trick me! How mean of you!"
Director Xueyan scolded.
"Seriously, Sister Yan, there won't be any big problems with this publicity. Maybe we can even take the opportunity to win back some key patients from other hospitals. But I suggest that you must be well prepared. The publicity will definitely attract more patients, and there will definitely be some difficult cases. Whether you can handle it or not is something you must consider. If you can't handle it, you must think of a way out. You must not pretend to be rich and admit patients when you know you can't cure them."
Zhou Can didn't say anything else.
I believe Director Xueyan will understand.
If we admit high-difficulty cases knowing full well that we do not have the ability to treat them but still perform surgery on them, and if that patient dies on the operating table or a lesser medical accident occurs, the consequences will be extremely serious.
It's basically like shooting oneself in the foot.
"I will prepare carefully before promoting it. Any other suggestions?"
Xueyan attaches great importance to his opinion.
In terms of strategy, women are naturally inferior to men.
Because men have stronger logical thinking, are more decisive, and have broader minds than women, they look at problems more comprehensively.
Since ancient times, people who have accomplished great things have basically been men, and this is not due to the feudal society's patriarchal society.
It was difficult for women to get ahead in ancient times, partly because of the influence of the feudal system, but that was not the only reason.
It’s not that there were no female emperors in ancient times, they were just very rare.
"I hope that my publicity is targeted and can highlight the strengths and avoid the weaknesses. Take my own experience as an example. When I was a patient at Xinxiang Hospital, I treated a child with a dislocated joint. This case happened to be the one used in my publicity. Therefore, the patients who came to see me during that period were basically children with various fractures. They even included children with related bone deformities."
Zhou Can's meaning was very clear, which was to ask her to choose the treatment areas that the department excels in when selecting cases for promotion.
For example, tricuspid valve surgery is currently performed averagely, not particularly well.
We must reduce the publicity of such cases as much as possible.
This will attract the greatest number of patients whose treatment capabilities match those of the patients.
"I've noted them all. Do you have any other suggestions?"
Director Xueyan recorded it carefully in her notebook.
"Not yet. If I think of anything, I'll call or tell you on WeChat."
Zhou Can personally thinks that it’s a good idea not to rush into promotion for the time being.
However, he could understand that Director Xueyan had been suppressed for too long, and now that she finally had some strength, she wanted to show off her strength. And the other people in the department also needed such a publicity event to boost their morale.
"Among the cases I'm going to select for publicity, the one with heart failure transferred from the Third Hospital is one of them. Do you think it's feasible? After publicity, the Third Hospital will definitely feel that they are stepping on them to get ahead."
She raised a highly sensitive issue.
