godfather of surgery

Chapter 953 The disappearing femur

Dean Xia now has a clear understanding of Ou Lianfeng's matter. This honest man did not lie in his self-report. To be honest, before the investigation results came out, Dean Xia was still a little doubtful. How could such a ridiculous thing happen? The thing is a bit unbelievable.

But now the investigation team he sent out put a thick stack of investigation reports on his desk. He couldn't help it, so he cursed.

Ou Lianfeng's financial situation does meet the conditions of the Sanbo Hospital Rescue Fund. Dean Xia decided to start the rescue process and subsidize Ou Lianfeng's subsequent lung washing, lung replacement and other surgeries. The cost is not a small amount, and it can be done casually The cost reaches hundreds of thousands.

Dean Xia was thinking about Ou Lianfeng when his cell phone rang. It was the old leader of the provincial department. This old leader was going to retire in a few months.

"Xia Changjiang, why don't you let me worry? Has your hospital recently diagnosed a patient with pneumoconiosis?" the old leader asked.

When Dean Xia heard this, he knew something was wrong: "Yes, the patient's name is Ou Lianfeng."

"This is this patient. You still know about this. I thought you didn't know. This should be a private opinion made by the doctors in your hospital, right?" The old leader's voice was a little hoarse because he had been cold for many days.

Dean Xia had no intention of escaping at all: "This matter is all my opinion and has nothing to do with the doctor. The doctor just followed my instructions."

"What's your opinion? You're quite protective. Don't you know the principles of occupational disease diagnosis?" the old leader said angrily.

Dean Xia reported truthfully: "I know this is against the rules, but this matter is a bit special. The patient was seen at the local occupational disease prevention and treatment center. The doctor required the patient to provide proof of employment in the original unit before diagnosing pneumoconiosis. However, the original unit refused. To provide these supporting documents, the patient is stuck in an endless loop, running around. Other hospitals are not qualified for diagnosis, and the local occupational disease prevention and control center that is qualified for diagnosis is unwilling to diagnose it. It is obviously pneumoconiosis, but they just refuse to diagnose it. What do you think the patient should do? If you can go to the operating table to open your chest and check your lungs, no one would resort to such an extreme method unless you are desperate.”

"Xia Changjiang, you are a good person, is this something within your authority? You have violated the rules and will be punished. Now the other party's provincial department has issued an official document asking us to explain and punish the hospital that violated the rules. !" The old leader's tone was serious.

Dean Xia thought for a while and said: "Xia Changjiang will bear all the consequences alone, and it has nothing to do with anyone else. Just punish him as necessary. Even if he is dismissed, I will accept it without any complaints. I know that this matter has already passed me." Authority, but it cannot pass the test of my conscience. Really, if we don’t take over this matter, this patient will have no chance of getting a diagnosis of pneumoconiosis in his life.”

"Dean Xia, what do you mean? Do you think I dare not punish you?" the leader said angrily.

Dean Xia quickly said: "Old leader, I am telling the truth. I am really willing to accept all punishments."

There was a violent cough on the phone, and Dean Xia said with concern: "Old leader, you still haven't recovered from your cold? It's taken you so long, do you want to come and see us?"

"It's okay, it's just a minor cold. In the past few years, my health has been getting worse every year. Okay, don't show off your heroic spirit. You will definitely be punished for this matter. This is a violation. A notice of punishment will be sent out when the time comes. I went to your hospital, but I didn’t report it. Just let the diagnosis be issued. No matter who the doctor was, don’t ask. Since you are responsible for it alone, I will criticize you. It’s too shameful.” The old leader hung up the phone with a cough.

"I'm willing to accept the punishment!" Dean Xia breathed a sigh of relief.

Soon, the old leader called again: "How is the patient now? Can the matter be solved? Do you want me to help coordinate? I don't want this to bother me again."

"Thank you, old leader, we can solve it ourselves." Xia Changjiang said gratefully.

"Okay, pay attention to the method and method of doing things. It must be compliant and legal. It must not violate policies and regulations, and of course it must not violate the conscience of being a doctor." The old leader said a few words and hung up the phone while coughing.

Dean Xia called Dean Sun over and told him what had just happened.

"How to do?"

Dean Sun said worriedly.

"Penalty is punishment. I am responsible for this matter. It must not affect the doctors. They did nothing wrong and just fulfilled their duties as doctors."

Dean Xia firmly said that in the past years when Dean Xia served as dean, he had never been corrupt or accepted bribes. As the saying goes, one must be strong without desire, behave upright, and stand upright. He is not afraid of wind and waves at all.

"We agreed that we should bear the responsibility together, so how can we let you bear the responsibility alone? This is the responsibility of our Sanbo Hospital leadership team and has nothing to do with the clinicians. Their actions were made with our knowledge and consent."

At this point, Dean Sun can only fight with Dean Xia.

"Lao Xia, this matter is a big one, and it will probably have a big impact on you. I think so. Sanbo Hospital can't live without you. Now is a critical time for development. I will take care of this matter. Just say that it has nothing to do with you. , I took the lead without your knowledge?”

Dean Sun said helplessly.

Dean Xia waved his hand: "No, how can I let you carry it alone? I have already reported it to all the provincial and departmental leaders. From what I heard, it shouldn't be too big. At most, I will be punished."

"That's good!" Dean Sun was relieved.
-

At this time, Yang Ping was participating in a routine case discussion in the doctor's office of the Institute of Surgery. A peculiar case attracted everyone's attention.

This X-ray is very strange. Only the proximal and distal ends of the right femur are left, and the femoral shaft in the middle is completely missing. The lone steel plate spans the empty middle from the proximal end to the distal end, forming a weak bridge.

"What the hell does this surgery mean? The bone defect in the middle is not treated? Relying on a steel plate to bridge it is useless."

Zhang Lin now has the demeanor of a great professor. The occasional foul language does not expose his vulgarity, but demonstrates the bloody nature of an educated man.

"I'm afraid simple bone grafting won't work in this situation. You need to find a whole section of allogeneic femoral shaft to replace the defect. Even if you go to the bone bank in Shanxi to select it yourself, it will be difficult to pick such a good and complete femoral shaft. Besides, even if there is such a good The allograft bone is so long, how can it be crawled over instead of crawling? The best method is Ilizarov's bone lengthening technique. Theoretically, this does not involve nerves and blood vessels being extended along with it, and it can be done no matter how long it is. ”

Xiao Wu pointed at the weird X-ray and expressed his own opinion. This is a general case discussion. With so many interns, trainees and graduate students watching, how can we not come up with something?

Professor Zhang and Professor Lu from the Institute of Surgery were calm and relaxed at this time, talking loudly.

"Have you two read the medical records? Read the medical records carefully before speaking." Song Zimo's tone was reminding.

The two teachers lowered their heads and slid on the tablets in their hands. They were careless. This patient originally had a simple right femoral shaft fracture, and then used percutaneous technology to fix it with a locking plate. The first postoperative X-ray during hospitalization There was no abnormality. After discharge, the patient never had a follow-up examination as ordered by the doctor. He remained in a wheelchair. The X-ray taken a year later was like this. The femur had disappeared.

After reading the medical records, the two of them looked up with confused expressions on their faces. What is going on? Why did the good femur disappear, leaving only the two pitiful ends?

At this time, many students' eyes were focused on Zhang Lin and Xiao Wu, waiting for their stunning performance, preferably a eloquent discussion, covering the causes, pathophysiology, pathology, diagnosis, treatment and prognosis. .

But now the two brothers feel as if they are being choked. You look at me and I look at you, speechless. I have never seen this disease, so I don’t know what it is.

If you talk nonsense about other things, you can still talk nonsense, but this is medicine, a serious case discussion. If you talk nonsense and get scolded by the professor without saying anything, your reputation will be ruined for the rest of your life.

"Have you had any other diseases in the past?" Xu Zhiliang asked.

"He was in good health and had no other diseases. This time, he was in a car accident and fractured the right femoral shaft. The X-rays before and after the operation were normal. After discharge, the patient did not follow the doctor's instructions for review. He wanted to walk with the help of crutches for half a year. , because of the pain, he gave up walking, and he has not walked since then. The pain is obvious when he bears a little weight. After a year, the patient felt that he was still unable to walk, so he went to the local place to take a picture. This is the picture, and the femoral shaft miraculously disappeared. " Song Zimo continued to add medical history.

Looking at this magical X-ray, everyone has never seen anything like this before. The femoral shaft disappears even if it does not heal and the fracture end is absorbed after the operation. At most, the entire femoral shaft disappears. The fracture gap just became a little wider.

"This is a patient from the Municipal People's Hospital. Now the patient is arguing with the Municipal People's Hospital. They say that the doctor stole the bones and sold them for money. What's more coincidental is that this patient accidentally checked that he only had one kidney. The patient's family now concludes that the doctor stole the kidney. It was also stolen, and they were having trouble with the hospital. Director Chen had a headache, so he asked us for help. But the bones were missing, but now even the kidney was missing. The media followed suit and even recorded a documentary saying who stole the patient’s kidney and The bones are being roasted on the fire in the Municipal People's Hospital," Song Zimo turned to Yang Ping and said.

Yang Ping looked at it and said, "Type out the urinary tract examination pictures."

Song Zimo typed out pictures of the patient's kidneys, ureters and bladder. His examination included both color ultrasound and CT. Color ultrasound images were not shown much on the report, so Song Zimo typed out the CT pictures.

Yang Ping looked at it and saw that this was not a missing kidney, but a solitary kidney. That is, the patient was born with only one kidney. He said, "This is a typical solitary kidney. He was born with only one kidney. He had done urological surgery before. No color ultrasound or CT?”

"The Municipal People's Hospital has not found the patient's previous images and pictures, so it is very passive in terms of public opinion. One media is now hyping up this matter at length, saying that a black-hearted hospital steals kidneys and bones, and the patient's kidneys and femurs mysteriously disappear. You said these things? Why didn't the author of the article clarify the basic facts? This kind of thing happened not once or twice, and even if the reports were later found to be false, the falsifiers did not have to bear any responsibility. How could this happen? "

Song Zimo was very confused because many similar reports he encountered were far from the truth. For example, it was obviously a thumb reconstruction surgery for a free second toe. This is a classic surgery to reconstruct a thumb after a patient has lost his thumb due to trauma. However, the media reported that the patient only had a finger. He was injured, but the unscrupulous doctor performed the wrong operation and connected his toe to his finger. The patient told the media that he didn't know anything. When he woke up and found that his toe was connected to his hand, he learned that the doctor had done it. Wrong surgery.

Song Zimo couldn't figure out how such an obvious smear could be openly broadcast in the media.

"It's not that they don't know, it's that they pretend not to know. You can't wake up a person who is pretending to be asleep. In today's terms, you don't care about the truth for the sake of traffic. Just say whatever attracts attention. The bottom layer of most things The logic is economic. For example, the fake news you mentioned are all for traffic and money. You said that this patient did not know what kind of surgery he had. Why did you say that? In order to cooperate with the media, he knew that he might get a surgery in the end. Money, if you think about it from the underlying economic logic, it’s not that complicated. Let’s not talk about it. Let’s talk about illness.”

Yang Ping's tone was very calm and he brought back the deviated topic.

"There is no doubt about this kidney. This case must be a solitary kidney. The difference between the effects of a solitary kidney and a kidney removed is very obvious. If you have time, you can read articles on this aspect. Think about the situation of this missing femur. Our understanding of the diagnosis of common and frequently-occurring diseases is only the basis. We also need to learn the diagnosis of rare diseases. The diagnosis of rare diseases tests the doctor's knowledge. We do not necessarily have to see some diseases before we can diagnose them. We have read them in books and literature. , can also be used as a basis for diagnosis. The process of diagnosing the first case of AIDS in my country was a classic case of the diagnosis of rare and unknown diseases. You can read this story. "

Indeed, when Union Hospital diagnosed the first case of AIDS, doctors lacked clinical experience with the disease. All their knowledge came from papers in international journals. At that time, there were not even diagnostic methods and reagents. Doctors used existing experimental equipment and Under the conditions, he designed his own diagnostic method and finally obtained the first diagnosis of AIDS.

Now this miraculous case of missing femur is a rare or unknown disease to everyone, which requires strong clinical thinking to obtain a diagnosis.

"This patient has been to many hospitals, but the cause of the bone loss has never been found. Some hospitals said that amputation is very likely, so the patient and his family are very scared. Director Chen introduced the patient to us to have a look. Can you find out the reason?"

Song Zimo re-screened the patient's X-ray on the projection.