Chapter 477 Medical Ethics, It's Pneumothorax
"You mean a major reoperation? How extensive is it?"
Director Xueyan relies heavily on Zhou Can's opinions.
In terms of surgical ideas, Zhou Can's ability in this area seems to be even better than that in pathological diagnosis. Especially after his surgical experience became more and more abundant, because of his wide knowledge and the essence of many chief physicians of internal and external medicine, when he was formulating the surgical plan, even Dr. Xu praised him many times.
Most of the geniuses in this world have 30% talent, 60% sweat and hard work, and 10% opportunity, which ultimately makes them stand out.
"It may require a complete sternotomy! The specifics may need to be tailored to the patient's current condition."
Although Zhou Can went to the ward to see the patient once, he was driven out by the patient's daughter.
"Come on, while you are here, I will accompany you to the ward and try to finalize the surgical plan today." She knew that Zhou Can was a busy man and had endless work to do every day.
Many of the difficult cases in cardiothoracic surgery need Zhou Can's help to solve.
The two returned to the ward.
When the patient's daughter saw Director Xueyan enter the ward, she immediately put on a flattering smile.
"Hello, Director Xue! I am so touched that you came to visit my father so late at night."
"Your father's condition is progressing rapidly. If the infection worsens, it will easily lead to unpredictable dangers. The sooner the problem is resolved, the better. So, while Dr. Zhou is here, I will quickly bring him over for a consultation, and try to come up with a solution today."
Director Xueyan also responded with a smile.
At the same time, Zhou Can’s role was also emphasized .
"Ah...he, he..."
The patient's daughter covered her mouth and looked at Zhou Can in shock. She regretted it so much that her intestines were broken.
It can be heard from Director Xueyan's words that if she wants to treat her father, she still has to rely on Zhou Can.
If I had known that this young doctor was so capable, I would never have treated him like that.
"Don't underestimate Dr. Zhou because he is young. He is well-known in the hospital for his medical skills! Your father's condition is very complicated and it is very difficult to treat him. Dr. Zhou has rich experience in treating this kind of difficult disease. We need his help this time!"
Director Xueyan tried her best to praise Zhou Can in front of the patients and their families.
But what she said was not exaggerating, Zhou Can is indeed that outstanding.
"Um... Doctor Zhou, please take care of me!"
The patient's daughter didn't say a word of apology after all. But her expression, eyes, and tone of voice all showed that she was apologizing to Zhou Can and trying to please him.
Some family members are very concerned about their reputation and will not admit it even when they know they are wrong, and they are stubborn.
This female family member is already considered good.
Zhou Can would not bother with her and began to conduct in-depth preoperative examinations for the patient and determine the surgical plan.
This time, we could clearly feel that the patient actively cooperated, and his family members were attentive in assisting him and answering all his questions.
The attitude is completely different from last time.
"Sister Yan, I've finished reading it."
Zhou Can went over in detail all the questions that needed to be asked and all the things that needed to be actually understood.
It included the scope of the patient's last surgery, the postoperative films, and even some necessary palpation of the patient's wound area.
When he first entered the ward, he had only asked the first question when the family members' attitude became extremely unfriendly.
He didn't dare to perform this kind of painful palpation on the patient.
He was not afraid when his family members got angry.
There's no need to cause trouble like this.
To be more realistic, if the family members and patients really don't cooperate, there is no need for him to treat them.
You can ask them to seek other help.
"Please come to our office to discuss the surgical plan!" Director Xueyan turned to the family members and said.
"OK!"
The patient's daughter couldn't help but look up to Zhou Can even more.
Now even a fool would understand that Zhou Can was the key doctor treating her father. It seemed that Director Xue was just a foil.
In Director Xue's office, Zhou Can and Director Xue Yan were discussing the patient's surgical plan, with the family members listening nearby.
Perhaps considering that time was very tight, she simply called the family members to come and listen together to avoid having a preoperative conversation.
After some discussion, Zhou Can and Xueyan basically decided on the surgical plan.
"Zhou Can, you should convey the surgical plan to the family members!"
Director Xueyan just felt that the surgical plan was basically determined by Zhou Can, and it would be better for him to talk directly to the family members now.
When answering family members' questions, we can also be more accurate and quicker.
This is also the reason why during major operations, junior doctors are not allowed to talk to the family members, but the chief surgeon performs the operation himself.
"Because your father's sternum has developed osteomyelitis, and the wound infection is quite serious, the artificial material must be removed, and the sternum needs to be completely removed. Our sternum originally plays a very good role in fixing and supporting. If it is completely removed, it will cause chest instability. In order not to affect your father's future life, and to minimize the impact on him after the operation and ensure his safety, we are going to take his ribs to reconstruct the chest wall."
He briefly explained the surgical plan.
"My dad's wounds are difficult to heal. Is it because of the use of artificial materials?"
The family member asked.
“There are reasons for this.”
Zhou Can's answer is more flexible.
"Then my dad has a post-operative infection that hasn't healed. Is it because the surgery at the previous hospital wasn't done well?"
Her question was direct.
Judging from the tone, it seems that they are going to cause trouble for the first hospital.
This is also the instinctive reaction of most family members when their patients encounter problems after surgery.
Since the hospital did not perform the operation well, they naturally thought the hospital should be held responsible.
"Postoperative complications are something that all medical staff do not want to see, but no one can avoid it. I believe that the doctors and nurses in the previous hospital did their best to treat your father. It is completely feasible to use artificial materials to reconstruct the chest wall, which is in line with medical standards. However, the recovery conditions and immune levels of each patient are different. Before using artificial materials, no one knows whether it will cause postoperative infection."
Zhou Can's answer was of high moral character.
There is no statement to discredit Xinxiang Hospital, and they are even trying to absolve the medical staff who performed the first surgery on the patient of responsibility.
This is indeed the case.
Before the operation, who knows if there will be an infection?
Now that a problem has occurred, it is definitely not advisable for the family to cause trouble for the medical staff.
"Thank you for your answer. When can my dad have the surgery?"
The family did not pursue the matter any further.
"Sister Yan, can we schedule him for tomorrow?"
"I'll coordinate with the operating room and try to schedule him for surgery. It may have to wait until after 7pm, Ms. Zhao, is that ok?"
Director Xueyan scheduled the operation for the evening, and she must have wanted Zhou Can to help perform the surgery.
There are many things that are not convenient to say in front of family members.
Only Zhou Can could understand.
"Sure, sure. Thank you Director Xue, thank you Doctor Zhou!"
The family members nodded in agreement.
It was a complete surprise to the family that the surgery could be arranged so quickly.
She understood that a great deal of the credit should go to the young doctor Zhou.
"Okay, that's it for now! If there are no changes, a nurse will notify you tomorrow morning, and then a doctor will ask you to sign. The anesthesiologist will come to evaluate the patient and talk to you. You must do your best to cooperate."
Director Xueyan signaled that the family members could leave.
"Okay, I will definitely cooperate with you fully. I'll leave first. If you have any problem, you can always come to the ward to find me." The family member was obviously in a very good mood when he left.
Many family members are looking forward to scheduling surgery as soon as possible.
Especially for these difficult-to-treat patients, their families are under great pressure because they have been treated in other hospitals for a long time without any effect.
After the family members left, Xueyan looked at Zhou Can.
"You have to come and help tomorrow!"
"no problem!"
Zhou Can agreed readily.
"Sister Yan, there is something I need your help with. Today, Director Lou told me that there is an opportunity for a postgraduate study while working, and he has signed me up. I tried to take the postgraduate entrance examination when I was a senior, but unfortunately failed. To be honest, I still have no idea what I am going to do when I take the exam again this time."
Even though his current strength has increased a thousand times compared to his senior year.
However, the setbacks in the postgraduate entrance examination still left him with a long-lasting psychological shadow.
"Haha, you're so strong, why are you so unconfident about the postgraduate entrance examination? Normally, the pass rate for the postgraduate entrance examination is one to three, which means that one out of three students who take the exam succeeds. The competition has become more intense now, and last year it was closer to one to four. But I believe you will have no problem at all."
Director Xueyan said to him with a smile.
"Besides, since the hospital has arranged this for you, as long as you can pass the written test and the retest, your chances of getting accepted are close to 100%."
She is well aware of some of the unspoken rules in the hospital.
"The problem is, I'm afraid I won't be able to pass the written test or the retest!"
Zhou Can lacked successful experience in this area and was still unsure.
"Which instructor did you apply for? Considering your special situation, the hospital will definitely arrange for you to study with an instructor who has more flexible study time and is relatively easier to get a certificate."
"I heard from Director Lou that he is a mentor in the field of orthopedic traumatology."
"That's probably Professor Wu Xuesheng. He mainly does research and teaching, and rarely does clinical work. Studying with him can help you improve your academic ability and research level. There are two important operations to be performed today. After the operation, if there is time, I will first conduct a knowledge survey on you, and then set a study direction for you. In fact, I think you can find a chief physician in orthopedics. The postgraduate entrance examination questions of medical schools are generally set by the admissions units themselves, and they must know the direction of the test questions better than I do."
Although Director Xueyan is a top student, she is by no means omnipotent.
In the field of orthopedic traumatology, which she is not good at, she is definitely not as good as the chief physician of orthopedic surgery.
"I am quite familiar with orthopedic surgery. After you help me decide on a study direction, I will find the chief to get a feel for it. It will be safer. I'm afraid it's not a good idea to ask them for the exam questions directly."
Zhou Can was worried that this kind of thing was illegal.
"Haha... Last time you took the lead in protesting the hospital's security department's inaction and the medical staff's personal safety was not guaranteed. You were very brave. Why are you timid now? Don't worry, the postgraduate entrance examination papers are highly confidential, and there is no possibility that the chief physicians of orthopedic surgery will leak the questions. It's just that they have more experience in this area, and many chief physicians even directly participate in the preparation of the examination papers every year. They will help you define the scope of the examination questions, which will be more accurate."
Seeing her laughing wildly, Zhou Can felt embarrassed and scratched his head.
"Haha, so that's how it is! I was a little worried that they would be breaking the law by helping me and get arrested. Sister Yan hasn't laughed for a long time. It's actually quite good to be able to laugh like she did just now."
Time will smooth everything and dilute everything.
She gradually came out of the shadow of divorce.
…
"Doctor Zhou, the patient's test results are out. Please help me take a look."
The intern found Zhou Can with the test results of the patient with chest pain and difficulty breathing.
"Let me see!"
Zhou Can took the patient's examination report.
Director Xueyan asked curiously, "Xiao Chen, which patient is this?"
"It was a patient who was admitted to the emergency room. We were notified to come over and take the patient over. My instructor was in surgery at the time, and Dr. Zhou happened to come, so I asked him to help."
After Zhou Can took a preliminary look at the patient's blood test and chest X-ray, he handed the examination report to Director Xueyan.
"This patient really has a left-sided pneumothorax. The chest X-ray shows that the left lung is severely compressed, with a small amount of hemothorax, a blunted left costophrenic angle, and the trachea and mediastinum are displaced to the right. Fortunately, there are no rib fractures. I think we can try to do a thoracotomy to vent the air first."
For him, dealing with this disease is a piece of cake.
The higher the level, the easier it is to solve various diseases that other doctors think are difficult to diagnose and treat.
"This patient is only 28 years old, quite young! How could he develop pneumothorax?" After examining the case, Director Xueyan had no objection to Zhou Can's treatment suggestions.
Women love gossip and are naturally very curious.
As the head of the department, she is no exception.
After all, she is still young.
People in their forties are definitely not as calm as those old ladies in their sixties.
"When the patient was having dinner at home, his mother urged him to get married and complained that he was not working hard enough. In fact, the patient's job was very hard, working night shifts every day, and it was probably hard labor. The work was hard, the pressure to get married was great, and his mother kept complaining about it, so he got very angry and yelled twice. As a result, he developed a pneumothorax."
Zhou Can felt very sorry for the patient.
It is especially difficult for men in their twenties.
If I get married, at least I can talk to my wife about my troubles in work and life.
"So that's how it is. Your puncture technique is recognized as the best in our department. Go and help him do a thoracentesis!"
Director Xueyan nodded after hearing this and directly handed over the treatment matter to Zhou Can.
…
After the patient had a needle inserted to relieve the pressure, the effect was not ideal.
It turns out that no matter how good the puncture technique is, it may not always solve the problem.
In this situation, we can only find ways to get further treatment.
Zhou Can realized that the patient's pneumothorax might be more serious than he thought.
Considering the patient's family situation, he felt that surgery should be avoided as much as possible.
