1986: Old Stories in Northeast China

"Comrades, today's operation is very special."

Standing at the edge of the operating table, Chen Tiezhu spoke.

"In fact, as surgeons, we often face such a choice, that is, whether to perform this operation or not."

"Let's talk about this later. I will tell you my judgment criteria. Let's talk about this operation. The difficulty coefficient is not very high, but it needs to be done more skillfully."

"Although the humerus fracture has been reset, it needs to be suspended. But his forearm has undergone fasciotomy and decompression, and there are burns on his hands, which undoubtedly increases the difficulty of the suspension."

"So my idea for this operation is to embed it at the pedicle of the abdominal skin flap. This can help the flesh and skin on the fingers grow, because there will be blood supply from the blood vessels of the abdominal wall."

"This is also a common method in many skin grafting operations, but in the past, it was taken off and sutured, but that was for patients with less serious injuries."

"But he can't do it, the burns on his hands are still quite serious . I just took a closer look, and his thumb, index finger and ring finger all need to be embedded. ”

“My first judgment was to embed the whole hand, and my second judgment was to embed the thumb and index finger. This is my final judgment. ”

“And the basis for my final judgment is that this can bring better treatment effects to patients without causing too much harm to patients.”

“The ring finger is between being treatable and not being treatable. If it is treated, the prognosis will be better in the future. Because this finger will wear a wedding ring in the future.”

“Brother, we will do anesthesia in a while. This time it is spinal anesthesia. Although you can't see, you can hear and feel it, so don't be nervous.”

“Doctor, I am like this, why should I be nervous. I believe you, do whatever you want. Even if it fails, I won't blame you.” The patient said calmly.

"Hahaha, this is what I like to hear the most. Come on, turn around slowly, don't use your arm hard, hold it like a cooked shrimp, it's done, anesthesia." Chen Tiezhu said happily.

"I'm quite curious, what did you think at that time? Did you think of countless heroic deeds of revolutionary martyrs in your mind like what is written in the textbook?"

"How could I have time to think about this? I heard the sound of the motorcycle, saw it, and rushed over." The patient said with a wry smile.

"That's right, in fact, many times when we do things, we are following an instinctive reaction of the body." Chen Tiezhu nodded.

"After the medicine is injected, I will perform surgery on you after it takes effect. I will chat with everyone first, and you will be responsible for listening. I just said that we surgeons will face many choices."

"For example, Lao Fang and Zhenwen have encountered first aid in the wild. Save or not? If not, the patient will definitely die. If saved, it may not be successful, and the other party is still a bad person."

"For example, we received a cancer patient in the middle and late stages. Do surgery or not? How should we explain the condition to the patient?"

"For example, this brother, although it is trauma and burns, should I take the risk of my surgery? Everyone has their own standards in their hearts."

"In the first case, Lao Fang and Zhenwen chose first aid on the spot, and they succeeded by chance. I asked Lao Fang, and his thoughts at the time were the same as this brother. He didn't think so much. As a doctor, he is to cure diseases and save lives."

"What about the second case? My judgment still depends on the specific situation. It needs to be judged according to the actual situation of the patient, but I am very likely not to perform surgery on this patient."

Hearing him say this, many people frowned. Because according to his thinking, it should be surgery, which can extend the patient's life to some extent, right?

"What is my judgment standard?" Chen Tiezhu continued.

"Because such operations are major operations, such major operations will cause great harm to patients. His recovery period after surgery will be very long, and he will also need drugs to curb the growth of cancer cells in his body."

"We may extend his life a little bit beyond the original expectation, but is this life extension meaningful? If he does not have surgery, he can live normally for a few months. After surgery, he will spend most of his time lying in bed."

"But whether to do it or not is not for us to consider, but we need to explain all the circumstances to the patient, and let him make the final decision."

"As a doctor, our duty is to cure diseases and save lives, and help patients relieve the pain caused by the disease. But we know that after relieving this pain, it will increaseIf you are suffering from new pain, you can't do surgery just for the sake of surgery."

"I think this is medical ethics. We can find many reasons to support our decisions, but sometimes we should ask ourselves, is this decision really not driven by any interests?"

"This brother's situation is different from the previous one, so we have to discuss it separately. In other words, the situation of each patient is different. When we face similar situations in the future, just ask ourselves."

"How to choose? In fact, there is no right or wrong. Because after each choice is made, you don't know what the result of the plan you didn't choose will be."

"Okay, the anesthesia has taken effect, let's do this operation. There are not so many difficulties, it's just to choose the size of the flap and do the axial joint suture. Strengthen postoperative care to avoid infection. "

After that, Chen Tiezhu started to operate directly.

But his words just now touched the people in the operating room and the observation room.

Because sometimes they really didn't seriously consider the options mentioned by Chen Tiezhu.

Although the county hospital is of a low level, it has not faced such a big operation. What will I do when it really happens?

Will I persuade the patient to undergo surgery in order to increase my surgical experience?

When facing such a big risk, will I choose to escape?

For many people, this question still has no answer.

Because they really haven't reached such a height now, which makes them feel a little bitter.

It turns out that the gap between them and the consultant Chen who often tossed around is so big.

The messy thoughts were collected, and now all their attention is focused on Chen Tiezhu's operation.

It's still so perfect, it doesn't seem to be operated very quickly, but it's so smooth.