Gou is practicing medicine in the clinic

Chapter 252: Finally, the hospital opened, but this patient cannot be accepted
"Oh, there's no way! I have dozens of employees, and they work hard with me. If they can't make thousands a year, it's not interesting."

Li Jingsheng almost popped his eyes out.

"You, how much do you say you earn a year?"

"When it was less, it was two or three thousand, and when it was more, it earned more than 4000 a year, which was close to five thousand."

The young man said very frankly.

"I don't want to be a doctor anymore, I want to follow you to sell goods!"

Li Jingsheng really envied this young man.

He looks only 27 or [-] years old, very young, but his annual income in one year is equivalent to the income of an ordinary person in more than ten lifetimes.

"Haha, that's not okay. If the doctor changes his career, who do we go to see a doctor in the future? Besides, whether it's an e-commerce business or a self-media delivery person, luck is needed. If you hit the wind, you can be a bull. Fly up. In our line of work, it looks like a lot of money, but it is also very scary to lose money. It may take ten years of hard work, but only half a year will be enough to lose everything, and you will still owe a whole lot of debt."

"Then I'll be my doctor honestly! At least I have something to eat."

Li Jingsheng was only joking.

Get closer to the patient to facilitate follow-up consultation and even treatment.

"Does it hurt?"

Li Jingsheng felt the swollen area, and there was an obvious mass in the middle and lower part of the humerus.

According to the touch, this kind of mass is definitely not an ordinary hematoma, but more like a tumor.

"It hurts a bit!"

The patient appears calm.

With such a high annual income, I really don't know why I still go to his small clinic to see a doctor.

"It feels a bit like a tumor. My clinic has limited conditions. I suggest you go to a big hospital for further examination and treatment."

Li Jingsheng advised the patient.

The bone feels fine and is not obviously affected.

However, the mass is hard in texture, the boundary is not obvious, and the surface of the swollen part is light red.

It looks similar in color to the bumps after mosquito bites.

It doesn't feel like a malignant tumor.

But without pathology, no one dares to draw a conclusion.

"Can you treat here? I really don't have the time to queue up and be hospitalized in big hospitals. I have heard about your clinic many times, including two of my employees who have treated diseases here, and they all praise you. The medicines are accurate, the medical skills are excellent, and the patients are also very responsible. So I trust you very much, as long as you can treat it here, treat me."

The man said sincerely.

"I think I need to have surgery. If you want to be treated in our clinic, then I'll take you to have a B-ultrasound to check the situation first!"

Li Jingsheng has completed the operating room, but it hasn't opened yet.

This operation feels a bit big, but his current surgical ability is not weak, and his professional title has also been promoted to attending, so he fully has the qualifications to practice medicine.

As long as the patient agrees, he can try it.

"Yes! Can I take a B-ultrasound now? I don't have any other requirements, just give me a quick treatment, and it doesn't matter if you give me a little more money."

With an annual income of several thousand, I really don’t care about this little money.

"It's not necessary to pay more. If our clinic charges excessively, the sign will be ruined. Come with me!"

Li Jingsheng got up and took the man for an examination.

Now we have hired a 'General Manager of Internal Medicine', who can leave at any time when something happens.

This is very nice.

I took the patient for a B-ultrasound.

The mass was hypoechoic, internally heterogeneous, and its borders were not very clear.

This tumor is large in size and fusiform in shape.

The length exceeds 75 mm and the width exceeds 17 mm.

Such a large mass definitely did not form in a day or two.

This is dragged out by the patient!

Li Jingsheng shook his head secretly, the disease is not terrible, but when you meet this kind of people who don't take it seriously, it's fun.

What it likes most is to develop slowly and become stronger.

In the end, it was so powerful that even doctors couldn't do anything to it.

"How? It's just a small problem, right?"

After the patient finished checking, he asked calmly.

If it were an ordinary person, they would have been extremely nervous when they heard that it was a tumor.

This guy really doesn't take his body seriously.

"It should be a tumor. It's hard to say its nature. It's really big. This is a film. You can take a look for yourself."

Li Jingsheng printed out the screenshots of the ultrasound examination.

The report produced is actually no different from that of a large hospital.

The description of the lesion is also very professional.

However, despite his expertise, he is only a part-time medical technician after all, and his ability to read pictures may not be as good as that of the professional ultrasound room doctor in the hospital.

People do one thing every day.

He can't take several B-ultrasounds a day.

Now that the clinic's business is getting better, we only have the opportunity to treat a few patients a day.

"How did this thing grow? I usually pay attention to what I eat, and I never eat those junk foods. The vegetables and fruits are bought by the aunt named Fan who buys them from farmers who grow vegetables. I occasionally go out to drink with friends, but I almost never stay up late, don’t smoke, don’t chew betel nuts. There’s no reason to have a tumor! Could it be related to my usual excessive exercise?”

The patient looked at the test results and wanted to find out the cause of the disease.

"It should have nothing to do with exercise. I suggest cutting out the tumor and sending it to the hospital for a pathological examination to clarify the cause."

"Can you cut here?"

"can!"

"Is the risk big? It won't destroy my hand, right?"

"Surgery is definitely risky, no matter which hospital it is performed in. But if I dare to take this job, I must have the courage to do so with great confidence. The risk-resistant ability of a small clinic like ours cannot be compared with that of a hospital. "

After Li Jingsheng checked his ultrasound, he felt confident about doing the surgery.

So we began to work hard to persuade the patient.

"It makes sense, so do it for me!"

The man agreed on the spot.

"Can you get a family member to sign it?"

"I had no parents since I was very young. I spent two years in an orphanage, and then I was taken in by a kind elderly couple. Unfortunately, they had a car accident in my sophomore year. Well, if they are still alive now , I can give them a rich old age life."

When he said this, the patient's eye circles were slightly red.

Everyone has the most vulnerable point in their heart.

"That's okay! Just sign it yourself later. Do you have your ID card?"

"Why don't you bring it when you come to see a doctor?"

Li Jingsheng negotiated the price with the patient and charged [-] yuan, including all expenses.

Li Jingsheng also did the pathological examination.

Regarding the price of the surgery, the patient readily agreed.

According to the rules, the patient signed the surgical risk consent form and paid the fee before the operation was arranged.

"Meng Luo, Si Ying, enter the operating room and prepare for an operation. The patient needs to remove the tumor on the left upper arm."

They go to work immediately.

Munro is an experienced surgical nurse in the compound.

Packing equipment kits, laying sheets, and disinfecting are all done by her.Han Siying was helping out and learning along.

Li Jingsheng does the preoperative preparation for the patient himself.

Including skin cleansing and detoxification of the surgical site.

This patient has very long hair on his arms, and the skin must be cleansed before surgery, otherwise the effect of the surgery will definitely be affected.

Fortunately, the skin cleansing work is quite easy.

What Li Jingsheng is most afraid of is to cleanse the patient's head and perineum.

……

In the operating room, a skin test of anesthesia is first given to the patient according to the procedure.

There was no allergy, so the patient was injected with brachial plexus anesthesia.

This operation is performed by Munro.

It can be seen that she has rich experience in dosage, injection point and depth.

The goal of brachial plexus anesthesia is to block the conduction of the brachial plexus.

Make the patient's left arm feel painless and the muscles relax.

Li Jingsheng put on gloves and surgical gown and stood at the surgeon's position, while Munro sat opposite him.

The position of the instrument nurse is generally flexibly adjusted. In many cases, she stands on the same side of the surgeon, and in most surgeries, she sits opposite the surgeon.There are no hard and fast rules for this.

A good instrument nurse is not only keen in observation, but also fully prepared before the operation. After the operation, the number of instruments, needles, threads, gauze, etc. must be checked with the roving nurse to ensure that they are correct.

Because if a small surgical needle falls into the patient's body, it will bring catastrophic and serious consequences.

Li Jingsheng and Munro had set up the stage once, that time to suture the wounds of patients who had fallen.

It's a very small operation.

It doesn't even need to be done in the operating room.

This large tumor was removed this time. Although it was a superficial tumor on the arm, it could still be regarded as a second-level surgery.

The technical difficulty is much higher than imagined.

Including important blood vessels, as well as important nerves in the arm, need to be careful.

Li Jingsheng had recalled the anatomical structure of his left upper arm many times in his mind before the operation.

The mass should fit tightly to the biceps.

There are even ones that can cover the triceps.

Its end most likely reached the radial artery and radial recurrent artery at the patient's elbow, because the bending of the patient's left arm had been significantly affected.

There are quite a lot of nerves here.

The posterior cutaneous nerve of the forearm is at the location of the tumor, so care must be taken when separating it.

Also, the underside of the tumor should fit closely with the ulnar nerve.

If this nerve is severed, it would be a major medical malpractice.

Fortunately, his skin incision method has reached the stage of great success, as long as he is careful when cutting a superficial tumor, nothing will happen.

With his current ability, there is no big problem in performing third-level surgeries.

Li Jingsheng cut open the patient's epidermis and dissected them layer by layer.

The speed is quite fast.

The incision is smooth and clean with very little bleeding.

Munro had already seen the boss's suturing level and debridement ability. At this moment, he saw the boss incision on the patient's left upper arm, which was so silky smooth, and the amount of bleeding was surprisingly small.She was extremely shocked in her heart.

At this moment, I realized that the boss I was following was a pervert.

It doesn’t matter if his diagnostic skills are so good, but his surgical ability is still so powerful.It’s hard to find another monster like this in People’s Hospital or Qiaobang Hospital!

Who would have thought that such a powerful doctor would actually stay in the clinic.

After incision, the mass can already be seen.

Its color is fairly normal, and the surface of the tumor is fairly smooth, with no obvious irregular mutations.

The possibility of a benign tumor is high.

Li Jingsheng checked first, and then began to separate.

"Siying, you must pay attention to these soft tissues and ligaments when separating the patient. Be careful not to be rough or rough. You have to remember that surgery is a technical job, and there is only one thing that requires brute force, and that is sawing the bones. "

At his current level, he is fully capable of teaching Han Siying.

I saw that Li Jingsheng flexibly used the combination of sharp separation and blunt separation to separate the tumor little by little.

He found that the borders of the mass were not clearly defined.

This is a very bad thing.

Although it looks like a benign tumor, the boundary is not clear and it is difficult to remove it cleanly.

It's easy to relapse.

About 40 minutes later, the entire tumor was successfully removed by Li Jingsheng.

The surgery process was a surprise and went very smoothly.

Now there is an air conditioner specially used in the operating room, and the temperature and humidity are constant, which is very beneficial to both the surgeon and the patient.

Sweating is basically avoided.

If it is a cold winter, it is even more necessary.

Otherwise, when the temperature is several degrees below zero, the doctor is shivering with cold, and if the knife shakes, he still won’t be able to tell where to cut!

The patient was probably scared away when he saw the doctor shaking like that.

In addition to the comfortable temperature and humidity brought by the air conditioner, the real-time monitoring of physical signs provided by the life monitor also allows Li Jingsheng and Mengluo to monitor changes in the patient's physical signs at any time during the operation.

Not to mention electrocoagulation to stop bleeding.

It is a magical tool for stopping bleeding in small blood vessels.

These surgical tools are also very easy to use, and then there is the very special pair of glasses.After wearing it with a headlamp, you can clearly detect many details.

Not just blood vessels and nerves.

On anatomical drawings, blood vessels are usually marked in red, and veins are sometimes marked in blue.

Nerves are marked in yellow.

However, in actual surgery, these cannot be marked, and the surgeon needs to make judgments and discoveries by himself.

Nerves, in particular, like to be mixed next to blood vessels or in subcutaneous tissue.

It was cut off accidentally.

With a slight sting, it is possible that the patient's hand function will be cut off.

It is precisely because of these equipment that Li Jingsheng's operation can be completed very smoothly.

It must be said that Munro's cooperation is also first-class.

There is no need for Li Jingsheng to remind him, most of the time he can know what tools Li Jingsheng needs next.

After cutting the tumor clean, he gave the patient a second debridement and started suturing.

After more than ten minutes, the suturing was completed.

There is nothing wrong with the wound inspection, so disinfect it.

It can be seen that the patient's right upper arm has lost weight.

But because the operation had just been completed, there was some local hematoma.This is normal and will go away in a day or two.

"Dr. Li, such a big tumor can't be a bad thing, right?"

After the operation, the patient was supported by Li Jingsheng and Han Siying to sit up.

Because of the long-term exercise, the patient's body is still quite good.

Postoperative mental state, physical mobility and other aspects of performance are very good.

"I think it should be a benign tumor. But its boundary is very blurred, and the operation is not easy. To be on the safe side, I cut off some normal tissues. Look at these tissues, they are all normal tissues."

Li Jingsheng pointed to the patient.

"Haha, well done. It seems that I have found the right person for this surgery. Cutting more is a thousand times better than not cutting at all."

After seeing it, the patient laughed with satisfaction.

"These parts are easy to deal with, and some extra normal tissues have been cut. But there are also places that are not easy to deal with, such as the ulnar nerve, which is almost in close contact with the tumor. I want to cut it. Your arm is basically It’s useless. Although I have tried my best to cut it clean for you, you still have to be careful of recurrence. It is safest to check it every three months after the operation.”

Li Jingsheng gained a lot from this operation.

It's not that he earned the two thousand and five treatment fees, but the improvement of his health and surgical skills.

The only hope now is that the patient will not relapse.

"Row!"

The patient readily agreed.

"The wound can't touch water these days, and it's best not to do some powerful movements with the left arm. Then come here for three days of infusion, and you can leave today after the infusion. After all, it's such a big operation, and it's still very difficult to prevent infection and inflammation. Necessary."

Li Jingsheng's operating room cannot maintain a sterile environment.

It's not necessary either.

The cost is too high.

The operations performed are all these minor operations.

He would not dare to accept a surgery that was too demanding on the environment.

"It's all been cut for me, so I must listen to you! Now I will do whatever you say."

The patient was very cooperative.

"I feel relieved with your attitude. To be honest, I am very worried that you will do your own science popularization on the Internet, and then you will not listen to me, but listen to the Internet. I will send this tumor to the hospital for pathology for you, and I need you to give me your identity Give me a copy of the certificate."

"no problem!"

"Siying, take him to the infusion room to rest for a while, and I'll prescribe him here."

"Ok!"

Han Siying took the patient out.

Li Jingsheng saw that Meng Luo was carefully checking the quantity of equipment, consumables, etc. This was a very good work attitude.

"Teacher Meng, I'll leave this to you. Do you know where the instrument sterilization is?"

"It's the compound disinfection cabinet you just bought two days ago! I've used it before!"

With ultrasonic cleaning and high temperature disinfection functions.

Very convenient.

According to Li Jingsheng's idea, he originally wanted to remove all the doors of the operating room.

But just having a door is useless.

It’s better to develop slowly first, and then think about building a high-end operating room when the surgical business picks up!

The purpose of opening a clinic is to make money.

Definitely.

Now I have spent nearly 9 yuan to upgrade the hardware in the operating room, which is enough for the time being.

If he could perform ten operations of today's level in a month, he should laugh.

The patient was prescribed medicine and asked Tang Ping to give him an infusion.

After Li Jingsheng finished his work, he checked the cases that Dr. Shao had received, and found that all of them were handled in a satisfactory manner.

"Dr. Li, these two cases are not what I am good at. You need to diagnose them yourself."

"No problem, come here!"

Li Jingsheng took over Dr. Shao's work.

"What's wrong with you?"

The one who sat down was an old man, led by his children, who was at least 80 years old and walked up.

The hunchback is terrible.

"Cough cough cough..."

The patient coughed violently before he could speak.

Li Jingsheng faintly saw blood in the phlegm coughed up by the patient.

He subconsciously distanced himself a little.

Clinically, infectious diseases must be taken with care.

(End of this chapter)