Chapter 577 Neurological Problems? Current State of Medicine
Normally, if the bones of two toes do not grow together and each has independent and complete bone structure, surgery is all that is needed to separate them in the middle.
Because of the deformity itself, various unexpected situations are likely to occur during the actual operation.
For example, the blood vessels of two toes are intertwined, or there is only one artery supplying blood to both toes. In this case, the surgery will be more complicated. An artificial bypass is required to reconstruct an artery.
In fact, the anterior tibial artery and the dorsalis pedis artery are the main sources of blood supply to the toes.
As for venous return, the great saphenous vein and the small saphenous vein are the sources.
The posterior tibial artery is one of the two terminal branches of the popliteal artery and can also be used as a blood source for bypass and vascular reconstruction when necessary. It generally supplies blood to the sole of the foot and is rarely used during surgery.
Zhou Can was not clear about the specific surgical details of this patient.
One thing is certain, the operation should not be too difficult. Otherwise, he or the doctor will perform the operation himself.
After removing the gauze, the sutured wound can be seen.
The suture is relatively neat, without skin grafting, but instead a pulling suture is used.
Patients who have the conditions will receive a period of water filling and skin expansion before the operation. However, because it is only a minor operation and the patients come from all over the province, it is often impossible to prepare for everything.
Asking patients to travel back and forth to the hospital multiple times is not realistic in itself.
Doctors certainly hope that the operation can be performed as perfectly as possible, but patients often find it difficult to accept this considering their financial affordability and time cost.
Postoperative suture closure is common.
The skin itself has strong toughness and extensibility. It only needs to rest for a period of time, and it will automatically grow and cover all the wounds.
The only thing to pay attention to during this period is to prevent infection.
In addition, the postoperative hospitalization observation time is often only about one to two days. The rest of the time is to prescribe medicine for the patient and take care of him at home.
Especially in a large hospital like Tuya, where beds are in short supply, it is difficult to use limited bed resources on a patient undergoing a minor surgery.
The patient chose to have surgery in Tuya's emergency room mainly because of Zhou Can's fame.
Originally, this kind of syndactyly surgery was usually performed by general surgery.
The emergency department's operating room is now a general operating room. Except for level 4 surgeries and obstetric surgeries, we dare to perform almost all surgeries.
The operation is mainly divided into two technical parts.
The first is the basic skills of surgery, which are incision, suturing, hemostasis, anastomosis, etc. The second is surgical experience.
Under normal circumstances, as long as the operation is not particularly difficult, every surgeon can transform into an all-round warrior.
Of course, in actual practice, such all-round surgeons are very rare.
If you ask a surgeon who usually only performs general surgery to open the chest to perform heart surgery on patients, basically every patient he treats will die.
This is why cardiac surgery and neurosurgery have always been referred to as the two ceilings of surgery.
Because both of these fields are high-tech surgeries.
Only those with high surgical skills and rich surgical experience in this field can be competent for this task.
The training period for cardiac and neurosurgery surgeons is at least eleven years.
That is to say, it takes at least eleven years to train a novice doctor to be able to independently perform a cardiac surgery. In fact, this training period is even longer. Without fifteen to twenty years of surgical experience, senior doctors will not dare to let you perform an operation alone.
Human life is at stake.
Judging from the suturing technique and neatness, the syndactyly and toe-separation surgery on this patient must have been performed by a relatively experienced surgeon.
Because some details are handled quite well.
"Is this toe numb?"
Zhou Can took a sterile cotton swab and touched the patient's right toe. To be precise, this toe was the third toe.
Typically, the second to fifth toes are most susceptible to syndactyly.
The first toe is the thickest one located inside.
It is the eldest toe and the chance of syndactyly with the second toe is very small.
This female patient mainly suffered from syndactyly of the third and fourth toes of her left foot.
"Yes, that's it."
The girl nodded.
Family members stayed by the bedside.
Judging from her appearance and age, the caregiver should be the girl's mother. However, the woman was very shy and simple, and didn't talk much. She just stood by and watched Zhou Can examine her daughter with a smile on her face.
The patient's father only showed up on the day of the operation. Probably after seeing his child finish the operation, he went home to work and earn money.
Basically, men in most families are the backbone of the family.
It is also the economic pillar.
"Close your eyes first."
Zhou Can said to the patient.
"Do you feel anything?"
He again touched the patient's left third toe with the cotton swab.
"A little bit, but not noticeable."
"Which toe am I touching? The left or the right?"
"right!"
"Which one are you touching now?"
"left!"
“Does the left toe feel different than the right toe?”
"Yes! The feeling is very clear. I can tell that you are touching my toes with the handshake end of the cotton swab."
The girl's answer was very accurate.
This also facilitated Zhou Can's accurate diagnosis.
What I fear most is the patient who knows nothing about anything, gives ambiguous answers, and mumbles.
It really drives people crazy.
It can now be basically confirmed that there is a problem with the patient's third toe of his left foot.
Zhou Can's expression turned serious.
"You can open your eyes now, thank you for your cooperation."
The operation is now complete and nothing can be seen from the outside with the naked eye.
The patient's two toes are relatively rosy, indicating that the blood circulation is unobstructed.
It seems that there may be something wrong with the nerves in the toes.
"Have you ever touched these two toes with your hands before?"
"Yes!"
"Do you feel it when your right toe touches you?"
"Yes! I used to feel it clearly when I cut my nails or scratched my toes. Dr. Zhou, is there something wrong with my toe?"
No matter how stupid she was at this point, she knew that the anesthetic was not effective on the third toe.
There's a good chance something went wrong.
"It's hard to say for now, but there is definitely a problem with the touch of the third toe. Since the surgery has just been completed, you can observe it for another day or two. I will arrange for further examinations for you then."
Zhou Can did not jump to conclusion immediately.
It is difficult to draw a conclusion immediately after the operation because of local hematoma, wound pain, etc.
In fact, there are very few final conclusions in medicine, and the answers given to patients are often vague and flexible.
Even if the doctor knows that the patient's tumor is cancer, and even if the pathological biopsy results support malignancy, he will not tell the patient that he must have a certain cancer. Instead, he will try to be more conservative.
Of course, when a patient is found to have a malignant disease such as a malignant tumor or uremia, the test results are often not told to the patient himself, considering the patient's ability to bear it.
Inform the family instead.
"I had the surgery this time because I wanted to be able to dance ballet better in the future. If there is really a problem with this toe, will it affect my dancing?"
The girl seemed a little nervous at this time.
This is also a normal reaction for most patients.
Once they learn that something went wrong with their body after surgery, they often feel anxious and nervous.
"Don't worry too much for now, just take good care of yourself. If anything goes wrong, we will definitely find a way to help you solve it."
Zhou Can didn't know much about ballet, he only knew that this kind of dance required standing on tiptoes and spinning the whole body like a top, which had very high requirements on the endurance and flexibility of the toes.
Patients undergo this surgery for both aesthetic reasons and to dance better.
Each toe has its own unique function.
In theory, the main function of toes is to stabilize the body.
During the process of human evolution, apes needed to run and jump barefoot in the woods and mountains, and even climb trees to avoid enemies when encountering danger.
This requires the foot to have a certain gripping ability.
The toes are used to grip the ground, hold onto tree trunks, and stabilize the body.
Modern humans have evolved to a high level of civilization, and basically wear shoes to walk most of the time, and the function of toes has further degenerated. Even if a toe is lost, it can quickly adapt and basically will not have much impact on walking.
But it will definitely have an impact on jumping and dancing.
…
After checking the room, Zhou Can found quite a few small problems.
There is some truth to the fact that patients are afraid to let young doctors perform surgery or treat their illnesses.
Among these patients who are hospitalized for emergency surgery, the proportion of patients who are hospitalized for level one and level two surgeries is very low, accounting for only about 30% of the total number of patients hospitalized for emergency surgery. Most patients who are hospitalized for level one and level two surgeries leave immediately after treatment.
At most, you will come to the outpatient clinic once a day to change your medication, or go to the hospital within a week to remove the stitches and have a follow-up check-up.
Level 3 surgeries and level 2 complex surgeries are basically performed personally by Dr. Zhou Can and Dr. Xu. The quality is not perfect, but at least it reaches a high standard.
But the surgeries performed by others are a bit hard to describe.
In particular, the emergency department has continuously introduced new surgeons in the past two years, and they are all young doctors with insufficient experience and poor surgical skills.
In this case, the quality of the surgery can be imagined.
The hospital has always been very tolerant in the training of new personnel.
This means that doctors are allowed to make some minor mistakes and problems in the process of learning and evolution. As long as no accidents occur, the hospital will turn a blind eye.
It is unrealistic to expect every novice surgeon to perform surgery to the same high standard as Dr. Zhou Can and Dr. Xu.
"Which doctor performed the surgery on bed 1?"
Zhou Can asked the attending doctor Jiang Shuangshuang.
Because she was a doctor in the endocrinology department, when she was transferred to the emergency department, the emergency department happened to have an inpatient ward, so she was transferred to the inpatient ward as the attending physician.
At present, the emergency department has more than a hundred beds, and her status here has obviously increased a lot.
If nothing goes wrong, I should be able to get an opportunity for further study this year, and then come back to be the chief resident to prepare for the promotion to attending physician.
This is basically how every resident grows.
When there are few doctors in a department, every doctor will be forced to take turns as the chief resident for a period of one year.
If there are too many doctors, it’s hard to say.
Hospitalization always requires staying in the hospital for a whole year, which means you are on duty 24 hours a day without rest.
It is very unfriendly to married people or young doctors who are in love.
It is a luxury to go home and have a normal married life with your lover.
Many doctors have a love-hate relationship with the position of chief resident.
Because after serving as chief resident, all aspects of ability, including ward management ability, will be greatly improved and exercised. The next step is to be promoted to chief attending physician, which is basically a done deal as long as you can pass the exam.
In fact, the attending physician's exam is not particularly difficult.
More than 80% of doctors can pass it.
If it doesn’t work, you can take the exam again next year.
Therefore, the key to promotion to attending physician is not the attending physician examination, but one year of general resident training.
Those doctoral students who did not work as chief residents were directly promoted to attending physicians after working for one year.
There will definitely be certain defects in clinical practice.
Perhaps his management ability and ability to deal with patients' sudden illnesses and worsening conditions are not as good as those of attending physicians who have been promoted step by step. Hospital leaders are not stupid. When appointing important management positions in clinical departments, they usually do not directly give them to untrained doctoral students.
Besides, their development paths are completely different.
Doctoral students pay more attention to scientific research and work hard to write high-quality papers in preparation for becoming associate professor or full professor as soon as possible.
It is precisely this talent promotion system that is somewhat out of touch with reality that has led to many students who have studied for eight years for master's and doctoral degrees being unable to do anything after entering the hospital to work.
Many famous doctors may not even be able to cure diseases.
This is also a major anomaly in the current medical circle. The relevant authorities have discovered this problem and are formulating a more scientific and reasonable talent training mechanism.
The American medical students’ exams are conducted on living people.
It is very difficult to obtain a medical license abroad. It often takes a very wealthy family to train a doctor or nurse. Doctors in the United States belong to the high-income class.
There is no shortage of medical students in the country at present, but there is a shortage of medical students who can treat patients.
When Tuya Hospital recruited for the emergency department last time, there were only two positions available, and they were relatively low-quality technical positions. As a result, more than 300 graduate students and masters submitted resumes, including a few doctoral students.
This shows how difficult it is for medical students to find jobs now.
There is also a very strange phenomenon: everyone is trying their best to get into large hospitals, but it is difficult for small and medium-sized hospitals to recruit senior talents.
The more top-notch hospitals like Tuya are, the more sought-after they are.
When Zhou Can participated in the general practitioner training recruitment, the hospital initially offered only ten to twelve vacancies, but in the end several thousand people participated in the recruitment.
Over the past few years , Tuya's overall strength and ranking have improved significantly, and it will become more competitive when recruiting.
Jiang Shuangshuang has always had special respect for Zhou Can.
When Zhou Can was making rounds, as long as she was on duty, she would basically wait for Zhou Can to arrive early.
I was able to learn a lot from making ward rounds with Zhou Can.
Zhou Can often gave her some guidance, which benefited her a lot.
"The syndactyly surgery on bed number one was performed by Dr. Fu. Would you like to see the surgical records?"
Jiang Shuangshuang asked.
"You can help me check the surgical records. I need to find out more about the situation from Dr. Fu. There is a high possibility that there is something wrong with the patient's toes."
