Chapter 532: Another family member in trouble, control the infection first and then perform surgery
"Can this be used as a vascular stent? The experts at the Provincial People's Hospital made the same diagnosis as you, saying it was chronic arterial ischemia. I looked up the treatment for this disease on a very professional medical website. If the blood flow is blocked due to stenosis or blockage of the blood vessels, a very small minimally invasive surgery can be performed to place a stent in the blood vessel to open it up."
After the old cadre's daughter-in-law said this, Zhou Can finally understood why the Provincial People's Hospital did not perform surgery on the patient.
Even Zhou Can was disgusted when his family told him how to treat his illness. Which of the experts in the Provincial People's Hospital is not a well-known figure in the medical field? He was blindly told by a family member who thought he knew a lot and looked up some information on the Internet.
The experts were unable to refute the woman in person due to her identity.
The best way is to handle it softly.
The old cadre continued to be treated using the treatment method that had been tried and proven ineffective in the previous hospital.
When the old cadre saw it, he was shocked. He thought the experts at the Provincial People's Hospital were so great, but it turns out they are no different from doctors at prefecture-level hospitals! It's still anti-infection treatment. Will that work?
As long as the old cadres are not stupid, they will definitely change hospitals for treatment.
If the experts from the Provincial People's Hospital mentioned it in a serious tone again, saying that we are not sure about your disease, we can try amputation first.
I guarantee that this will scare the old cadre so much that he will ask to be transferred to another hospital overnight.
Sometimes, patients and their families feel that a certain expert’s level is poor, but maybe he is not really that bad, but is deliberately acting bad to make you think he is bad.
"It is rare to place a stent in this situation. I suggest you do an angiogram first. Because your father-in-law is older and has no history of smoking, the possibility of arteriosclerotic occlusion can be considered."
Zhou Can glanced at the woman calmly and explained patiently .
Unlike myocardial infarction, this type of chronic limb arterial ischemia is rarely caused by a large plaque growing inside the blood vessels and blocking them.
The inner walls of blood vessels become narrower due to arteriosclerosis, which may eventually lead to complete blockage.
"We agree to do an angiography. If a problem is found, we still hope to avoid major surgery as much as possible. We hope to adopt the treatment plan given by experts after consulting online, and use minimally invasive interventional surgery and stent placement to solve the problem."
The woman is quite stubborn.
In fact, in clinical practice, we often encounter such family members or patients who only believe in the conclusions drawn by acquaintances, online "experts", and Baidu searches, and are unwilling to trust the doctors who treat them.
What’s even more frightening is that the attending physician told them not to believe what they heard on the Internet and asked them to follow the treatment I prescribed. Not only did the family members not listen, they thought the doctor was trying to cheat them out of their money.
When encountering such family members and patients, the only way is to let them go to that acquaintance for treatment.
Zhou Can stood up and glanced at Director Xueyan.
The latter blinked at him and gave him a hidden wry smile.
If it wasn't in front of the family members and the patient, she would probably shrug and look helpless.
"Then you can think about it again. If you agree, you can do an angiography first. The patient's condition is getting worse every day, so the earlier the treatment, the earlier the benefit. If it's delayed for too long, amputation should be the last option."
This is all Zhou Can could say.
There was nothing he could do if the family members and patients refused to listen.
Doctors can only give treatment plans that they think are most beneficial to patients. As for the final choice, it is up to the patients to make it.
"Doctor Zhou is right. I can't put off my illness any longer. I'll listen to you. Can you arrange an angiography now? Don't worry. You don't have to worry about the money. As long as the disease can be cured, I don't care how much it costs."
After all, veteran cadres are people who have been in officialdom for a long time and have rich experience.
He had already sensed a clue from the expressions of Zhou Can and Director Xueyan. When he heard that if the treatment was delayed for too long, amputation would be necessary, this statement was exactly the same as what the experts from the Provincial People's Hospital said.
His heart was filled with fear.
A man with a big mouth must have a law, and a woman with a big mouth must have disaster.
This daughter-in-law is filial, but she is a little too strong.
It is normal for the doctor to feel disgusted as she insists that the hospital treat her according to her requirements.
If I say that what happened at the Provincial People's Hospital was a bit strange.
If they cannot change their ideas at this moment when they go to Tuya Hospital, they may encounter quack doctors again.
"Dad, don't worry. A friend of mine who is a doctor told me that doctors like to exaggerate the severity of the condition. If the patient is cured, it's a great achievement. If not, it's because the patient's condition is too serious and the doctor has done his best."
The woman leaned close to the old cadre’s ear and whispered.
"Just listen to me, let's discuss treatment plans with the doctor."
She looked caring, as if she was worried that her father-in-law was old and didn't understand the dangers of society and might be easily deceived.
After hearing this, the old cadre raised his head and said to Director Zhou Can and Xueyan, "It's okay, please arrange it for me as soon as possible, the sooner the better." After saying that, he turned to look at his son and daughter-in-law.
"It's getting late, you guys should go back! There are nurses here anyway. I'll contact you when the surgery needs to be signed."
"Afen, let's go back first!"
The old cadre’s son said to his daughter-in-law.
"Dad, if the test results come out, you must tell us in time! Then we can decide on the surgery plan. Please wait for us."
The daughter-in-law still looked worried.
"I know my limits. Go back and take good care of your mother."
The old cadre waved to his son and daughter-in-law.
It was almost like rushing the two of them home.
Zhou Can saw all of this and thought to himself that big shots are indeed different from ordinary people. After all, they relied on their own efforts to climb up step by step, and their reaction ability is quite strong.
Judging from the performance of this veteran cadre, he has probably realized where the problem lies.
Since this person was a key patient personally assigned by President Zhu, angiography was arranged for him overnight.
Unlike cerebral angiography and cardiovascular angiography, limb angiography is relatively less risky and easier to perform.
However, necessary preparation work must be done.
In the office, Zhou Can shook his head and said, "Sister Yan, should we first give this old cadre an X-ray examination, and then do an arterial angiography?"
This can be more targeted.
X-rays can reveal plaque calcification in the arteries.
But eventually an arteriogram will definitely be needed.
Because angiography can determine the location and extent of arterial blockage.
For example, is the artery tortuous? Is the lumen diffusely and irregularly narrowed? Or is there segmental occlusion?
Only by finding out the specific conditions inside the blood vessels can the most favorable surgical plan be formulated.
This case is not complicated.
The real problem is the patient's daughter-in-law.
There are so many things to do that it is inevitable that doctors will have great concerns.
Originally, X-ray examination should have been done in the Provincial People's Hospital, but they didn't do it.
Even one more examination can generate more income for the hospital.
But doctors would rather not make this money.
Doctors are paid a salary, and when they encounter a lot of patients, they really don't care if they treat one more or one less.
In order to save one more patient, we are complained by the family members and patients, and even subjected to violence, lawsuits, and various personal threats. It is better to have fewer problems.
Director Xueyan had no objection to Zhou Can's examination plan.
Nodded in agreement happily.
"This patient is a pretty good person, but his daughter-in-law is too troublesome. His wife is even more cunning. I was disgusted at the time. Fortunately, his wife has high blood pressure and heart disease, so it is not suitable for her to stay in the hospital for a long time, so she went home."
After hearing this, Zhou Can couldn't help but feel frightened.
The fact that the patient is the daughter-in-law of an old cadre is already hard enough to handle. If the patient's wife is even worse, this disease is really incurable.
"The family members will need to sign before the operation can be performed. What should we do? Or we can just persuade the patient to transfer to another hospital. The cardiothoracic surgery department is extremely busy right now, and we can't let such a busy patient occupy too many medical resources."
Zhou Can suggested.
"Let's see what the situation is first! If it really doesn't work, we can only find a way to transfer the patient to another hospital."
Director Xueyan finally softened her heart.
It's common for women to be soft-hearted.
Meeting a cruel and vicious woman is every man's nightmare.
…
By the time Zhou Can finished two operations in the cardiothoracic surgery department, it was already midnight .
The major surgeries we receive nowadays are extremely difficult to perform, and the operation time can easily be three to four hours, or even longer.
Zhou Can increasingly felt that time was not enough.
There are so many advanced and sophisticated surgeries in cardiothoracic surgery, and many of them are large projects.
Sometimes, in order to anastomose a blood vessel, remove a tumor, or repair the mitral valve, extreme care is often required, and a lot of auxiliary work is done for the smooth implementation of the operation.
In order to remove a tumor, not only the chest must be opened, the pericardium must be removed, and even extracorporeal circulation must be established and the heart stopped.
None of these preparations can be missed.
And every step is like walking on the edge of a knife, so you have to be extremely careful.
After dragging his tired body out of the operating room, Zhou Can now just wanted to go home, take a shower and go to bed.
I had originally thought about getting off work early and going home to write my thesis.
I can't do anything now.
After getting through this period, he will definitely have to think of some ways to squeeze out as much time as possible to study and improve his academic qualifications and academic level.
Because many senior colleagues have taught him through bitter lessons that academic qualifications are very important.
"Zhou Can, the two examination results of that old cadre are already out. I know you are a busy man, so why don't you help him look at the results before you leave?" Director Xueyan called Zhou Can after taking the examination report from the attending physician.
If we don't ask Zhou Can to help with the advisory now, we'll probably have to wait until after seven o'clock tomorrow afternoon.
"OK!"
Zhou Can did not refuse.
He took the inspection report and examined it carefully under the dim light in the corridor.
"Hey, we also did an extra color Doppler ultrasound examination, which is good!"
Zhou Can found that in addition to X-ray examination and arterial angiography, color ultrasound examination was also performed.
"When the test results came out, I took a look and found that the patient's popliteal artery and iliac artery were both stenotic, so I took the initiative to apply for a color Doppler ultrasound examination."
The attending physician is a young doctor in his thirties, currently at the attending physician level.
Most of the newly recruited doctors in cardiothoracic surgery have a doctorate degree, and some are even postdoctoral fellows.
These people have a very big advantage, they can be promoted to chief physician directly after working for one year.
In terms of career advancement, they are like rockets compared to doctors with ordinary academic qualifications.
"That's good. We should be flexible."
Zhou Can nodded, and greatly appreciated the attending physician's initiative.
In clinical diagnosis and treatment, the patient's condition is ever-changing, and doctors need to adapt to changes. If you are a rigid doctor, you are not suitable for frontline clinical work.
Working in an administrative position or in a medical technology department are both good choices.
Of course, there is a greater possibility that one will eventually be forced to change careers.
After Zhou Can carefully reviewed the patient's three examination reports, he already had an idea in his mind.
Color Doppler ultrasound showed that the patient's abdominal aorta, iliac artery, and popliteal artery were all significantly narrowed. Zhou Can had never expected that the abdominal aorta was narrowed.
This also shows that his diagnostic skills are far from being top-notch.
Of course, even the world's top experts cannot diagnose some hidden lesions of patients by relying on palpation and some simple auxiliary examinations.
Zhou Can was able to detect lesions in the patient's popliteal artery and even iliac artery simply by palpation, which was already very impressive.
The color ultrasound results also showed that there was no blood flow signal below the patient's right superficial femoral artery.
No wonder I couldn’t feel the pulsation of the popliteal artery and the dorsalis pedis artery in my right foot.
Next, let’s look at the patient’s angiography results.
There is extensive irregular stenosis of the abdominal aorta and bilateral iliac arteries. The right common femoral artery can be visualized, but the superficial femoral artery is not visualized.
The angiography results were basically consistent with those of color Doppler ultrasonography.
"Based on the examination results, it can be basically confirmed that the patient has sclerosis and occlusion of the right superficial femoral artery."
After reading the examination report, Zhou Can gave a diagnosis.
In fact, the doctors present can basically give a diagnosis based on these examinations.
What Director Xueyan and the attending physician really expect is that Zhou Can will come up with a treatment plan.
"Zhou Can, can you give me a surgical plan now? Or you can take the test results home and give me a surgical plan tomorrow morning."
Director Xueyan did not hide the fact in front of other medical staff in the department that she liked to hear Zhou Can's opinion first on the surgical plans for some key patients.
"I'd better give it to you now! The examination data will be kept in the department so that other doctors can refer to it and learn from it."
Zhou Can felt that the patient's condition was not particularly complicated.
The surgical plan is not particularly difficult.
"The patient's angiography results showed that contrast agents were present in the right deep femoral artery and the right popliteal artery above the knee joint, indicating that blood still flows out of the arteries of the lower limbs. There were moist rales when auscultating the patient's lungs, indicating that there may be a lung infection. If surgery is required, I am afraid that the patient's lung infection needs to be controlled with medication first, and then the surgery can be performed. As for the surgical plan, I think a bypass between the right common femoral artery and the popliteal artery can help the patient restore blood circulation in the right leg."
There are many factors to consider when doing surgery.
Lung infection, especially in such elderly patients, must be controlled before surgery.
