Chapter 207: Another 1 place away, playing in danger

This incident at least made Du Leng feel that the situation was going well. Zhou Can's face was expressionless, and Song Ze's loss would not have much impact on the surgical capabilities of Deputy Director Liu's team. Because Song Ze usually plays the role of a second assistant in major operations, pulling hooks, doing miscellaneous things and so on. As for the ability to operate alone, Song Ze is an attending physician with relatively low qualifications, and can preside over some simple primary and secondary general surgery alone. Now that he is gone, Zhou Can happens to take over all of Song Ze's surgeries. Watching the doctors of Yang Qing's team leave, Zhou Can and Song Ze didn't say a word. When Song Ze passed in front of him, he even turned his head deliberately, pretending not to see Zhou Can. "Is Yang Qing's team really so fragrant?" I really don't know what Song Ze thinks? I always feel that Song Ze has no dignity in Yang Qing's team. Zhou Can didn't care about these people anymore, and brought the biliary stone patient into the operating room with the intern. Not long after, He Hansheng, Deputy Director Liu and others entered the operating room one after another. Zhou Can's eyes flickered, and he found that there was one less person in the team. "Director Liu, I have something to tell you. The resident doctor Cheng Gang has gone to another group to develop." He Hansheng bit the bullet and told Deputy Director Liu about it. "Is another one gone?" Liu Lao was stunned, his tone was full of loneliness, and there was sadness deep in his eyes. One doctor after another left his group at this critical moment and joined other groups. For this nearly 60-year-old man, it was tantamount to traumatizing his heart again and again. So far, the entire surgical team has only one assistant, He Hansheng, and three assistants, Wan Sanlao. After all, Zhou Can was just a regular trainee, and after finishing his rotation in this department, he left. So it's not a regular member of the team. The other trainees and interns are useless. It can only help to do some work with low technical content and low risk. And they are leaving too. An intern still has a long way to go to become a resident doctor under Deputy Director Liu. There are also many variables. At least 90% of Tuya's interns had to be eliminated in the end. Less than one out of ten can stay. Those who have practiced know it. Internship in a provincial tertiary hospital, I felt very proud at the beginning, and I was full of bright vision for the future. After the internship was over, I realized that it was even more difficult to obtain the qualifications for regular training in the hospital, not to mention becoming a regular in the hospital. The competition among big hospitals is too cruel. Thousands of troops and horses cross the single-plank bridge, but very few people cross it. Everyone who successfully crosses it is a hero. Three of Mr. Liu's doctors left in just one day, and each of them had been carefully trained by him for at least two years. These people left without saying hello when they left. The coldness of human nature has been most truly reflected in the face of interests. "If you want to leave, you can't keep it, let's start the operation!" Old Liu sighed, and said somewhat dispiritedly. "Doctor Zhou, you are better at endoscopic surgery. Let's work together to complete this surgery and let Director Liu rest." He Hansheng asked Zhou Can for his opinion. At this moment, Mr. Liu was under such a blow that his hands were shaking. I don't know if it's because I'm so angry, or if my body is seriously unwell. After all, he is old. The current state is definitely not suitable for in-person surgery. "I'm fine at all. It's enough for Mr. Liu to guide the key operations of the operation. I'm sure to do this operation well." Zhou Can had studied the patient's examination report long ago. There are many stones in the biliary tract, and endoscopy, cholecystectomy, and common bile duct stone removal are required. He already had surgical experience with endoscopic removal of the gallbladder. For this operation, even without the guidance of a superior doctor, it can be done with confidence. "Xiao Zhou, the previous steps are the same as laparoscopic cholecystectomy, you can just do it directly." Mr. Liu was quite assured of Zhou Can's endoscopic surgery ability. "Okay!" Zhou Can followed the steps of laparoscopic cholecystectomy. "For this kind of laparoscopic surgery, according to whether the cystic duct is widened, two surgical methods can be adopted: transcystic duct exploration or common bile duct incision and exploration. The former is suitable for short and thick cystic ducts, generally with a diameter greater than 5mm. Consider this method. Like this patient, the stones in the bile duct are small and the number is small, and the common bile duct can be explored by incision to remove the stones and T-tube drainage." Liu Lao guides Zhou Can to perform the operation. "Understood!" Zhou Can replied, carefully dissecting the upper part of the common bile duct along the cystic duct. After processing the cystic artery, the cystic duct was freed and the anterior lobe of the hepatoduodenal ligament was dissected toward the junction of the common bile duct and the common hepatic duct. Until the blue-green bile ducts are clearly revealed. These operations require extremely high endoscopic surgical skills. In Liu Lao's surgical team, even if Liu Lao did it himself, he might not be as good as Zhou Can. Everyone else stood by and watched quietly. Some people stared at the endoscope screen, while others stared at Zhou Can's hands. Zhou Can carefully cut the front wall of the common bile duct. Blood vessels appeared in the anterior wall of the exposed common bile duct. He calmly lifted the anterior wall of the bile duct with curved forceps, and then electrocoagulated it. Immediately afterwards, after placing a small piece of gauze with barium sulfate thread in the Veneer's hole, use curved micro-scissors to cut the anterior wall of the common bile duct about 1 longitudinally or obliquely. During these operations, the implantation and clamping techniques that he usually practiced so hard came in handy. After the successful operation, the experience point is directly rewarded with one hundred and one hundred. Because it is the first operation, and the difficulty is quite high. It is of great benefit to the growth of his own surgical experience and the improvement of his ability in endoscopic surgery. The system rewards 100 experience points, usually because Zhou Can has made great progress in surgery or diagnosis, or has made great gains. "That's right, we must keep it!" Deputy Director Liu watched Zhou Can steadily advance the operation process, and he felt very relieved. Next, fiberoptic choledochoscopy was performed to remove stones from the bile duct. Zhou Can manipulated the endoscope to probe upwards to the left and right hepatic ducts. After finding the stones, he took them out with a stone removal set. Then it should be probed down to the lower end of the bile duct, and the stones should be removed in the same way. During the investigation, he found that there were many stones in the bile duct. "Old Liu, can we use the laparoscopic rotary joint grasping forceps to take out the stone first?" Zhou Can asked Liu Lao for his opinion. "Yes!" Liu Lao nodded in agreement. This method of removing stones is very convenient and practical. After capturing almost everything, Zhou Can used a choledochoscope to explore and remove the remaining stones. There are still several key surgical steps to be done. A T-tube was placed, and the bile duct incision was sutured. This step is a test of the suture technique. If bile leaks around the T-tube, it means that the suture is not in place. Fortunately, Zhou Can's suture and ligation skills have all reached the level of deputy director. The whole operation process can be regarded as shocking but not dangerous. At this point, the gallbladder can be removed directly. After the gallbladder is cut, the surgical field of view is washed, and then the abdominal drainage tube is placed. During the operation, the abdominal drainage tube was sent into the abdominal cavity through the right anterior axillary line and placed around the T tube and the space between the liver and kidney. This step was far more difficult than imagined. Fortunately, after Zhou Can's hard work, he finally lived up to his high expectations and successfully completed the entire operation. "Mr. Liu, I would like to ask you. During the gallbladder removal process, I found that the patient's gallbladder showed signs of malignant transformation. In this case, do I need to send it for pathological examination?" Zhou Can asked Mr. Liu for his opinion on how to deal with it. "Generally no more testing. It can reduce the cost of treatment and save money for patients. It can also avoid the psychological pressure on patients caused by bad test results. The gallbladder has been removed, and it is impossible for it to become cancerous again, so there is no need to do it again. However, during postoperative ward rounds, tell the family members or the patient himself that your gallbladder is lucky to have been removed, because we found the possibility of malignant transformation. After hearing this, the patient and family members will be more satisfied with the surgical results." Mr. Liu pointed out How can Zhou Can skillfully communicate with patients and their families. Communication between doctors and patients is extremely important. Flooded throughout the perioperative period. Good communication can greatly enhance the trust and favor of patients in doctors. Poor communication will leave hidden dangers for doctor-patient disputes. "Of course, if an obvious tumor is found in the gallbladder, and there may even be a risk of metastasis, it must be sent for inspection. It is also necessary to pay attention to whether there are lesions in the surrounding lymph nodes and blood vessels." There is a big problem, and the lymph is the first guard. Lymphadenopathy, nodules, etc. can be found. After the operation is completed, the rest is directly handed over to the doctors and nurses in the recovery room and intensive care unit. He Xuesheng looked up at the wall clock on the wall, hesitated for a few seconds, and said in a somewhat embarrassed tone, "Director Liu, our team has a total of nine surgeries today, and the two largest ones have been completed now. There are still seven first-level and second-level surgeries." Surgery. Originally, Song Ze was responsible for part of the operation, but I should be able to finish it all until eight or nine in the evening. Now I am the only attending physician, which is a bit embarrassing." Not everyone can operate as fast as Zhou Can. In fact, most surgeons operate very slowly. Because they are very worried about getting an accident soon. After Song Ze left, the secondary surgery would definitely have to fall on He Hansheng. For first-level surgery, resident doctor Wan Sanluo can share part of it, but the sharing ability is very limited. No wonder He Hansheng was worried about this. He probably worked overtime until twelve o'clock in the evening and couldn't finish it. In fact, doctors are not made of iron. Performing any operation requires full concentration, maintaining physical strength and energy. In the fatigue state, there is no way to perform the operation well for the patient. "You have limited ability and energy alone, so you really can't perform so many operations. Properly push a few until tomorrow night, and try to survive these few days. In the future, we can push some of the surgical patients we receive during the consultation to other groups. " After thinking for a moment, Liu Lao said bitterly. Pushing patients to other groups is a sign of incompetence. If Mr. Liu hadn't really run out of options, he wouldn't have made such a decision. He Hansheng is already an attending physician and an important member of staff. He has a full schedule every day. The next two or three days will be overloaded and it will have a huge impact on him. It is one of the few good ways to ask doctors from other groups to help digest the extra surgical patients. Just doing so will cause great harm to Liu Lao's face. The doctors in this group will also be unable to hold their heads up. It would be a shame to lose three doctors to other groups. Now begging other groups to help digestive surgery patients will only make everyone laugh at their group. In this competition, their team lost on the first day. This is the cruelest truth. "Old Liu, Dr. He, I have an unfeeling request. If you can agree, maybe the patients in our group can be accepted without reducing the dose." Zhou Can took the initiative to stand up at this critical moment. As long as you help this group win the competition, when a new sub-department is formed, more outstanding doctors can naturally be recruited to join. The most important thing is to survive the current difficulties and strive to win the competition. Their team does not need to take first place in every field. Because of the dismemberment of general surgery, many new sub-departments will be established, at least eight or nine. Anyone who wins in any general surgery or disease field will have the opportunity to be qualified as the leader of the sub-department. "Say it!" Mr. Liu, He Hansheng, and even the resident doctor Wan Sanluo, as well as a few regular trainees and interns, all looked at Zhou Can expectantly. They didn't want to be defeated so easily. Everyone wants to have a bright future. "During the operation of the two of you, I also performed the operation alone in the same operating room. For example, if you digest the third-level major surgery, I can help digest the first-level and second-level surgery. I believe you are also aware of my surgical ability. It is the qualification for independent surgery." Zhou Can said to this extent, I believe Liu Lao and He Hansheng can understand what he means. "This is not a solution. As long as the quality of the operation performed by Dr. Zhou can be guaranteed, there will be no accidents, and the operability is very strong." He Hansheng's eyes lit up, and some seemingly risky operations can indeed be effective. Solve puzzles. More likely to create huge benefits. For Zhou Can, he is not short of money, what he lacks is surgical experience and experience points. A large number of primary and secondary operations can allow him to quickly earn a lot of medical experience points and accumulate rich surgical experience. In the three months of regular training in the emergency department, a large number of operations have laid a solid foundation for him. Until now, he still benefited a lot. "Xiao Zhou has created miracles in the emergency department before. After more than a year, you have become stronger. I believe you will do better." Liu Lao knows Zhou Can's heroic deeds in the emergency department. At that time, because the number of surgeries in the emergency department increased by one or two thousand a month, Director Xie of the Department of Surgery was so anxious. It even reached the level of the vice president because of this matter. "So, do you agree with this plan? It can be tried out now. I have already learned about today's surgical cases. Only two second-level surgeries require careful guidance from superior doctors, and the others are confident that they can be completed independently." Zhou Can's Pretty well prepared. He has learned about all surgical cases in detail, which also gave him great confidence. Speak out with confidence. "I was supposed to go to Tuya Medical College to participate in a discussion and research on a topic today. I can go there later and see your independent surgery ability." Deputy Director Liu was a little worried after all. UU reading www.uukanshu. Com any chief surgeon, under normal circumstances, would never allow an intern to operate on a patient. Gui Peisheng will only give some practical opportunities with minimal risk and can be controlled. Such as seaming, pulling hooks, and puncturing. Even if the hemostat clamps some important blood vessels, Gui Peisheng will not be allowed to do it. For fear of pinching blood vessels. When Gui Peisheng stood on the operating table, he was usually extremely nervous when he saw the **** wound. Let them pinch the blood vessels, and make sure that there is as much force as possible, as it is easy to pinch the blood vessel wall. "Thank you Mr. Liu for your trust! I will definitely do my best!" Zhou Can thanked Mr. Liu very humbly for helping the whole team solve a big problem. His humble and gentlemanly qualities made him very popular among the superior doctors. After discussing it, they changed to a large operating room and began to let Zhou Can operate independently. Mr. Liu was guiding beside him. Participating in surgery is very different from independent surgery. First of all, we must overcome psychological dependence. Then it is necessary for the surgeon to have a familiar understanding of the entire surgical procedure and process. In addition, when encountering various emergencies, it is necessary to come up with solutions immediately. Many large operating rooms have more than two, which can operate at the same time. The original intention of this design is also to take into account the huge risks of surgery, and there are very few surgeons who can take the lead. With two operating tables, the chief surgeon can lead people to perform major operations outside. The attending physicians under him, and the deputy chief physicians are independently performing sub-level operations in another room. If you have any questions, you can conveniently run over to ask the chief surgeon at any time. Surgeons in many large hospitals are trained step by step in this way. Therefore, Zhou Can's independent operation in the emergency department was not the first. But there are examples to follow. However, the operating room in the emergency department is much simpler than the large operating room in the general surgery department. The first surgical patient was brought to Zhou Can. This is just a level one surgery patient. Subcutaneous tumor resection. The risk is low.