Oncology Physician Life

Chapter 16 Chapter 15
It was the first time for Jiang Li to come to the disease research room of the oncology department. The room was not too big, and there was a conference table that could only accommodate six people, equipped with a projector.She found that the wall on the left was covered with medical records of recent patients in the oncology department, and the entire wall was densely packed.

These gifts include pennants, exquisite pottery artworks, and very cute cloth dolls. In the transparent display cabinet next to them, there are cancer cell specimens growing in various organs of the human body.

These specimens were brought from the hospital's cancer and invasion principle laboratory for display, and some were cut from patients with body donations and directly made into research and teaching specimens.

When he came in, there were already three doctors from the oncology department sitting in the small conference room, including Xiong Xiong, the chief physician of the medical oncology department, Tao Dawei, the deputy chief physician of the radiotherapy department, and another female doctor of the medical oncology department, deputy director Li Anran.

Among them, Xiong Xiong and Jiang Li have met. Dr. Xiong Xiong is the backbone of the No. [-] Cancer Hospital. He is in his early thirties and graduated from Shanghai Medical College of Fudan University. He is a fat man with a big belly. Once declined, fatty liver, hair loss, and spondylosis already appeared in his early thirties.

Tao Dawei in the radiotherapy department is a tall, thin man in his early forties. He is holding a tablet computer in his hand, learning to watch a new study developed abroad.

In fact, many people have a misunderstanding that as long as they pass the residency stage, doctors do not need to study. In fact, whether they are residents or chief physicians, they must force themselves to study all the time.Medical technology is constantly improving, and doctors must also constantly try to learn new research technologies. If they cannot adapt to new technologies, it means that the probability of curing patients is reduced, and they cannot enjoy the benefits of more modern medical progress.

Tao Dawei nodded at Ji Han and Jiang Li, and rubbed his brows wearily: "This year, the latest German imaging technology introduced by the Radiology Department, I read it for three days, and only read a third of the 400-page introduction. No, the most troublesome thing is that there is no introduction in Chinese, and all the equipment is in medical German and medical English."

The same is true for surgeons and even those surgical experts. They also have to keep learning. When a new invention or new point of view comes out, they have to attend relevant courses every year. These courses are usually only one or two days long. Lectures, videos will be played and instruction manuals will be distributed in the class, and then they will try to learn by themselves and simulate exercises.

It is as if the affiliated hospital has introduced the latest 5G network. The most advanced Da Vinci surgical robot has three robotic arms, two feet, and a camera. The surgeon can use the console to control the robot to perform surgery. The robot will not shake hands. The incision is small, which is of great help to the operation and postoperative recovery of the patient.

Dr. Li Anran took a sip of coffee calmly and gracefully, "There is no way, the good cutting-edge equipment is basically in the top three hospitals in the province, and it must be the most prestigious one. High-end equipment and cutting-edge talents can be found in the best hospitals." The siphon effect is formed in the hospital, which is the current situation of domestic medical care, and the prefecture-level cities below, or even the county hospitals under the prefecture-level cities, let alone have such internationally cutting-edge equipment, you may have never even heard of it , even if you have it, you may not be able to find a doctor who can manipulate and use them. When I visited the clinic today, almost all the patients I met were from the prefecture-level cities and counties below. The entire department is basically operating at full capacity, and it is already overcrowded. If If there is no hierarchical diagnosis and treatment, I am really afraid that I may die suddenly at any time."

Xiong Xiong interjected: "I am afraid that the generation of graded diagnosis and treatment is very difficult. It is difficult for everyone to say this theorem, because doctors are also human, so there will be no exceptions. Humans have utilitarianism, and doctors have to live. You can't." Doctors are regarded as gods, their children have to go to school, and they also have a large family to support. Therefore, it is right for people to go to high places. Cutting-edge talents will naturally go to the best medical centers and hospitals. Everyone in Beijing, Shanghai and Guangzhou Willing to go, the metropolitan area, the best schools, the best medical care, the best job opportunities, who would go to a hospital in a prefecture-level city with a graduate degree from five colleges and four departments?"

Tao Dawei shook his head and sighed: "So, now the doctors in the hospital are just like the workers in the factory. Those front-line doctors, including the doctors who are in training, will work in three shifts according to the current plan. Wait for you to get through it." As a resident doctor, you can only work on the second line when you become the hospital chief. I just read the latest shift order of our department today. According to the first-line and second-line shifts, there must be two doctors in the office to receive patients at the same time. They are divided into two teams, day shifts. A group with the day shift, and a group with the doctor on duty during the night shift."

When talking, Tao Dawei kept smiling and looked very kind.

Jiang Li sat beside him, and Tao Dawei looked at her with a smile: "Director Jiang didn't experience this kind of life in Anderson, did he?"

"Actually, it's almost the same. As for Anderson, unless he reaches the associate professor level and doesn't need to be on duty, otherwise it's not too different from the domestic ones."

Li Anran laughed: "Director Tao, let's have fun secretly. You are lucky that you are in the oncology and radiology department. Look at Sun Renyi's surgical emergency department. In addition to being on duty, the doctor also manages the ambulance, emergency room, emergency room, etc. The emergency room and EICU are much more tiring than your radiology department, anyone can complain, but your radiology department can't complain, who doesn't know that your radiology department is the most relaxed department in our oncology department!"

Ji Han sat at the main seat, turned on his laptop, connected to the projector in the meeting room, and projected Xiao Jianghao's CT chest film on the big screen.The few people stopped chatting, and Tao Dawei from the Radiology Department put on myopia glasses, looked at the CT chest film, and frowned: "The location of the lesion is in the child's chest?"

Ji Han nodded and glanced at Jiang Li: "Everyone knows Director Jiang, so I won't introduce too much. This child is admitted to Director Jiang's Department of Pediatric Oncology. Let Director Jiang introduce it to you." .”

Jiang Li picked up the laser pointer in his hand and introduced the condition to several people: "Pleuropulmonary blastoma, PBB for short, also known as pulmonary embryonic tumor, is a primary malignant tumor of the lungs, which often occurs in the lungs. Peripheral part, the incidence of cases is extremely low, about 0.25%~0.5% of the primary malignant tumors of the lung, and the long hair occurs in children under 5 years old. At present, the literature and research on PBB in China are very scarce, and the clinical symptoms of patients are mostly Recurrent respiratory infections, chest tightness and chest pain, coughing up blood, accompanied by loss of appetite, weight loss, etc.”

Jiang Li got up, came to the projection screen, pointed to the chest X-ray and continued: "The tumor focus of this child patient occurred under the pleura, and it is a huge tumor occupying the entire chest cavity, with a clear boundary and a large tumor. According to Dehner's classification, PBB is divided into central type and peripheral type, which are polycystic type, polycystic with solid nodular type, and solid type. It is mostly found in the periphery of the lung, pleura and mediastinum, and has a family tendency. This patient It happens to be the central three-type solid type."

Director Li Anran looked at the chest X-ray and asked: "In this case, the child should be cystic and solid, with a large area of ​​liquefied necrosis in the chest cavity, and the adjacent mediastinum and lungs show different degrees of compression and displacement?"

"That's right, when it was first discovered, the tumor had already squeezed the airways of both lungs, and the child had difficulty breathing, so a pleural aspiration was performed temporarily to ensure the airway is unobstructed." Jiang Li nodded.

Xiong Xiong interjected, "What is this substantive element?"

Jiang Li: "Most of them are tumors with concurrent proliferation, which are composed of undifferentiated small primitive cells, embryonal rhabdomyosarcoma or cord cell sarcoma. At present, the solid part of the tumor can be seen with heterogeneous nodular enhancement, and it is more pronounced in children. Surgical resection is recommended for the protruding growth in the lumen."

Li Anran thought for a moment, and said: "This child's pleuropulmonary blastoma is very similar to the Askin's tumor (a malignant tumor that often occurs in the chest of adolescents, also called primitive neuroectodermal tumor) that we have encountered before. Neuroendocrine function, the tumor protrudes into the chest cavity when it is large."

Jiang Li nodded: "Yes, in diagnosis and treatment, PBB is indeed very easy to be confused with Askin's tumor, but ASkin's tumor mostly grows along the chest wall and is accompanied by rib destruction, while PBB does not have these manifestations. It is very easy to be confused with this kind of tumor. Tumors that are confused with PBB include mediastinal neuroblastoma, which occurs mostly in the posterior mediastinum, is closely related to the spinal canal, and is often calcified; there is also CCAM (bronchopulmonary cyst), sometimes on cystic lesion imaging , there are certain difficulties in identification. Another reason why PBB is rare and easily confused is that pulmonary cystic lesions may evolve into PBB. I have come into contact with Anderson in medical practice, and about 10% of type 1 PBB can evolve into Type 2 and Type 3 PBB."

Tao Dayong rubbed his chin and pointed to the case in his hand with a pen: "That is to say, this kind of pleuropulmonary blastoma in children is accompanied by growth. Gradually evolve into Type 1 or Type 2."

Ji Han looked at several people: "Currently, the outpatient department will cooperate with Director Jiang to discuss a set of surgical plans. First, the tumor in the center of the child's chest cavity will be resected, and then the radiology department and the internal department may be required. A set of detailed radiotherapy and adjuvant treatment plans."

Tao Dawei nodded: "I have no problem here. I will hold an expert meeting with other doctors in the radiology department to discuss a radiation treatment plan when I go back. But there is one thing, the child is only six years old and has a spinal cord injury. Sexual muscular atrophy, while high-dose chemotherapy and radiotherapy can cure cancer, it will also bring long-term and serious side effects to children. At present, the most worrying thing is "secondary cancer". Some children with cancer have been cured for many years. Leukemia and other "secondary cancers" that have nothing to do with the first cancer will appear. This is related to the new gene mutation caused by radiotherapy. In addition, it may also cause neurodevelopmental insufficiency and intellectual impairment to the child. Such problems, currently There is no better solution. Although we have been calling on China to develop new drugs with less side effects for children's cancers, everyone knows that no biopharmaceutical company will care about the current situation of domestic medical care and the scarcity of children's cancer patients in China. These childhood cancer patients."

Director Li Anran and Xiong Xiong also nodded: "I'll go back and talk to Dr. Xiong, and I'll also gather the doctors in the tumor to discuss it intensively at the morning meeting, and try to come up with a plan for postoperative adjuvant treatment as soon as possible."

Ji Han simply recorded: "Then after the operation is completed, let's see the degree of tumor resection. The radiology department will check whether the dose of radiotherapy can be reduced according to the child's physical condition to minimize the damage to the child. Then we This meeting will be here first.”

Jiang Li watched a few people leave, looked at Ji Han, and asked, "Didn't you say last time that you can apply for the Children's Cancer Fund subsidy for Xiao Jianghao? How is it?"

Ji Han's expression froze: "I will find a way."

Jiang Li asked: "Did you encounter any trouble? Or did the director insist on introducing DK immunotherapy from Saman Technology Company?"

Ji Han looked at Jiang Li: "The matter of DK immunotherapy is not something you can decide on your own. You just came back and you don't know much about the situation in the hospital. You should not get involved in this matter. I will pay for the child's surgery fee." Figured out a way."

Looking at Ji Han's expression, Jiang Li didn't ask, maybe Ji Han had his own difficulties, Jiang Li decided that it would be more appropriate to go to the Children's Cancer Foundation in the hospital tomorrow and consult in person.

At eight o'clock in the evening, Jiang Li hurriedly changed his clothes in the locker room and was ready to leave work with his bag. When he passed the corridor of the hospital, he accidentally found that in the garden behind the hospital, the resident doctor Tan Tan was sitting alone on a bench in the garden, alone. Drinking a drink.

Although it's already past the beginning of spring, the weather at night is still a bit cool. Jiang Li wrapped his windbreaker and walked towards Tan Tan: "Why are you sitting here alone?"

Tan Tan turned his head and looked, and found that it was Jiang Li, and hurriedly got up: "Dr. Jiang, are you off work? I just came out to get some air, it's nothing."

Tan Tan is a big boy who can't hide his worries. He basically shows all the troubles on his face, and he can't fool Jiang Li at all: "Is it because of Xu Youshu's punishment?"

Tan Tan was silent for a while, then nodded: "I feel that I have caused him trouble. In fact, after thinking about it afterwards, I did violate the surgical rules of the department, and I should not ask Director Jiang for your help. Xu Youshu is a single-parent family. He applied for the exam When he was in medical school, he chose a special doctor in the oncology department. If he can't stay here, he won't have the opportunity to transfer to other departments..."

Jiang Li sat next to him: "Why don't you ask your father for help?"

Tan Tan smiled wryly: "Indeed, I have a successful father, the dean of the senior medical university, an immunologist, and an academician. Every aura of him makes me feel out of reach and I need to look up to him, but it's not impossible for everyone to choose." What about my background? I was born in such a wealthy family. Compared with children from other ordinary families, I did not experience any hardships in life since I was a child. Since I was five years old, I have been in contact with leaders in the medical industry. Their stories, so when I was in junior high school, I knew that this world is very big, there are people outside the world, and there is a sky beyond the sky, and I Tan Tan, compared to them, is just an ordinary person, my ideal is to be an ordinary person. Average oncologist."

Jiang Li was very curious about him: "You are different from others. Isn't it something to be proud of having such a family? With your father's relationship, at least it can make you go further and higher on the road of being a doctor? "

Tan Tan shook his head: "You are wrong Director Jiang, my father is very upright, and he did not allow me to mention his name outside, but you know, there is no impenetrable wall in the world, and my surname is already It’s rare. Since I was in college, because of such a successful father, I have received far less recognition than my peers. No matter how much I pay, relying on my own ability to eat, in the eyes of others , the results I have achieved will also be marked with the word "fighting father" by others, and others will say in private, it is because you have such a father that you have denied all my efforts!"

Jiang Li thought for a while, then suddenly smiled: "Actually, I feel that if you fight for your father, you can fight for your father. There is nothing wrong with fighting for your father. Having such a father is not chosen by you, it is arranged by God for you. Maybe Others still envy you for having such a successful father, at least he does allow you to go further on the road of studying medicine, including you can go to the United States to study, and even enter Scripps, with more than ten promises Bell Laureate's prestigious institute to study."

Tan Tan hesitated: "But I'm not convinced, it's obviously my own efforts, why should I accept other people's various prejudices."

"Tan Tan, you are still too young." Jiang Li laughed, "Maybe you will be relieved when you are in your 30s or 40s! In fact, we don't live in the evaluation of others. Here, what kind of person you are is not important at all, the most important thing is what kind of person you are!"

Tan Tan glanced at Jiang Li's faint, elusive, and calm eyes, and asked curiously, "What kind of person am I?"

"En!" Jiang Li nodded heavily, "You have to understand, what kind of doctor do you want to be? The reason why you chose to become an oncology doctor was definitely not because of the high salary of oncologists, right? Are oncologists the ones with the most disputes between doctors and patients? Not to mention oncologists who witness life and death every day, who obviously can’t bear life and death in their hearts, but still have to put on a cold and heartless face in front of their families, right?”

Tan Tan muttered to himself, "What kind of doctor do I want to be?"

Jiang Li patted him on the shoulder: "Think about it carefully, you don't have to worry about Xu Youshu's matter, I will find a chance to talk to the hospital office, don't worry."

Hearing this sentence, Tan Tan raised his head in surprise: "Really, thank you Director Jiang!"

Jiang Li gestured handsomely towards him: "Leave the little things to me!"

(End of this chapter)