Oncology Physician Life

Chapter 33 Chapter 32 White Moonlight and Cinnabar Mole

In the next few days, Jiang Li's work was carried out in an orderly manner, and the doctors in the oncology department didn't have any special hobbies on weekdays, and everything was operated according to the hospital's procedures.

The only thing is that Xiao Jianghao's surgery fee has been completely settled. On Wednesday morning, Jiang Li turned off all work and devoted himself to preparing for the surgery.

Surgery center of the hospital oncology department.

Early in the morning, little Jiang Hao was pushed into the operating room, and the doctors in the anesthesiology department performed general anesthesia with endotracheal intubation.

In the operation preparation room, Jiang Li was the chief surgeon and Ji Han was the first assistant. The two wore green surgical gowns and stood in front of the stainless steel sink for disinfection.

The cool disinfectant was poured over Jiang Li's slender fingers. Because of holding the scalpel for a long time, some calluses had grown on her index finger.

"This time little Jiang Hao's surgery and medical expenses are thanks to your help, otherwise I really don't know how long the surgery will take." Jiang Li said to Ji Han beside him while cleaning his nails.

There was no expression on Ji Han's face, and he said lightly: "This time it went smoothly, thanks to Gu Jun on the outside of the chest, he helped to say a lot on the outside of the chest, but you still plan to speak at the courtyard meeting Oppose Liu Chong to introduce DC-CIK?"

"These are two different things," Jiang Li said after washing his hands, raised his elbows straight up, and walked outside the operating preparation room, "We will talk about this issue after the operation is successfully completed."

The door of the operating room opened automatically, Jiang Li walked in first, and the roving nurse had already put up the surgical gown and waited.Jiang Li put his hands into the sleeves of the surgical gown, turned around neatly, and the roving nurse fastened the braces for her.

Xiao Jianghao had already completed the preoperative anesthesia, and he was lying motionless on the operating table.

In the entire operating room, the temperature was kept at 21°C and in a sterile state. Ji Han stood opposite her as a first assistant.

He looked at Jiang Li with a serious face, and said: "Because the central part of the patient's thoracic cavity was completely occupied by the tumor, and it protruded into the pleura, we designed three sets of surgical plans in advance according to the condition, and finally chose the first set. After resection of the tumor, pleurectomy was performed to deal with the problem of the dense cavity and ensure the recovery of the lungs after surgery.”

Jiang Li had simulated the entire operation process many times last night, and he knew exactly what each step should do.Although she specializes in childhood cancer and lung carcinoid abroad, she still feels a little nervous when performing surgery on this rare childhood cancer.

"Time: At nine o'clock in the morning on April 4, the operation will officially begin."

Jiang Li glanced at the patient's physical condition displayed on the monitor screen of the surgical monitoring instrument, put on the binocular loupe (Kepler's binocular magnifying glass), passed the electric knife from the equipment nurse, and opened the chest skin, and the subcutaneous tissue, fascia.

"Sternum Saw."

"A chest opener."

Jiang Li broke open the sternum, and Xiao Jianghao's chest was immediately exposed to the surgical field. The huge tumor was solid and cystic and occupied the center of the chest, the heart was squeezed to the right, and the left lung was also compressed by the tumor in the chest.

"Children's pleuropulmonary blastoma is a highly malignant and relatively rare malignant tumor in children. The clinical manifestations are lack of specificity, the misdiagnosis rate is high, and the prognosis of surgery is relatively poor. It requires combined surgery and chemotherapy. Most children's hospitals Pediatricians do not fully realize the severity of PBB, and they should be vigilant enough for children with pneumothorax, multiple cystic lesions, family history of lung cysts, and chest cavity-occupying lesions with DICER1 familial syndrome.”

In the observation room next to the operating room, Lu Jiajia and other interns and residents stood in front of the LED screen in the observation room, taking notes, and Jiang Li's simultaneous teaching came from the screen.

"Scalpel."

"Stop the bleeding. Suction."

"Vascular clamp."

In the operating room, Jiang Li has been holding the scalpel for more than 2 hours.

Lying on the operating table, Xiao Jiang Hao, who was only 8 years old, fell into a deep sleep due to bleeding and severe general anesthesia, and his face looked abnormally pale.

Following Jiang Li cutting off the tumor, he took out a large cystic tumor the size of a cantaloupe from Jiang Hao's chest with both hands, and placed it on the stainless steel tray prepared by the itinerant nurse.

Just when she and everyone breathed a sigh of relief and put Xiao Jiang Hao's heart back in place, the monitoring equipment in the operating room suddenly sounded an alarm.

The nurse guarding the equipment immediately turned around and said, "There is a ventricular fibrillation in the ward!"

Ji Han glanced at Jiang Li who was holding a sharp-tipped scalpel opposite him, big beads of sweat had already formed on his forehead, the operation had been going on for two and a half hours, but an accident happened after the tumor was removed.

His eyes were full of concern: "There is still a part of the tumor on one side of the lung. Otherwise, I will cut it and you will perform defibrillation and resuscitation. It won't be too long!"

Jiang Li nodded, immediately switched places with Ji Han, and at the same time took the defibrillator handed over by the nurse.

"250 joules, charge!"

Jiang Li used a defibrillator to stick directly on Xiao Jiang Hao's heart. After a burst of electric shock, the heart monitor still did not respond.

Jiang Li immediately said: "250 joules, charge!"

She tried again, but there was still no response from the EKG.

Jiang Li immediately handed the defibrillator to the nurse, supported the patient's heart with both hands, and performed intracardiac resuscitation with his thumb.

"Get ready to perform heart compressions simultaneously!"

On the other side, Ji Han, who was undergoing tumor resection, his resonant and unquestionable voice also sounded in the operating room.

"Electric knife."

"Aspirator."

"A pointed scalpel."

However, when Jiang Li was performing heart compressions, she looked at Xiao Jiang Hao's heart, and then at the electrocardiogram that was pulled out, her brows frowning into a Sichuan character.

"The patient may be suffering from mitral stenosis!" She raised her head and glanced at Ji Han who was opposite her.

"When the patient came to the emergency department before, he had a cardiac arrest, but no abnormality was found in the electrocardiogram at that time. I thought it was the tumor compressing the heart that caused the cardiac arrest, but now it seems that it is not."

Ji Han also didn't expect that the operation passed the most dangerous stage, and the tumor was successfully removed, and just when it was finished, an accident happened.

"There is no time to think about it now. If it is determined to be mitral valve stenosis, artificial heart valve replacement must be performed simultaneously!"

Jiang Li took another look at the electrocardiogram held in the nurse's hand, and nodded for sure: "It's basically mitral valve stenosis."

Ji Han glanced at Wei Chen, the second assistant: "Contact the Cardiac Surgery Department immediately to get a bioprosthesis, hurry up!"

Wei Chen didn't dare to delay, turned around and ran out of the operating room hastily.

Jiang Li looked down at the heart monitor, which still showed ventricular fibrillation.

She raised the Kepler binocular magnifying glass outside her eyes, looked at the display screen, and tightly clasped her hands together.

The accident she feared most had happened.

Jiang Li looked at the heavily anesthetized little Jiang Hao, suddenly the child's limbs became rigid and convulsed, his face flushed abnormally, and his throat convulsed.

After resecting part of the remaining tumor, Ji Han hurriedly lay down in front of Xiao Jiang Hao's nose, listened, frowned and said, "The patient can hear intermittent throat noises."

Immediately afterwards, he touched Xiao Jiang Hao's carotid artery with blood-stained rubber gloves: "The carotid pulse can no longer be touched, and the electrocardiogram shows that the heart rhythm waveform is irregular, and it is still ventricular fibrillation."

Jiang Li immediately continued to press the heart, and suddenly a piercing alarm sounded on the ECG monitor, the ventricular fibrillation wave disappeared, and the irregular waveform suddenly turned into a straight line.

Xiao Jianghao's face skin turned abnormally cherry red, and the color of his lips changed from dark red to blue-purple.

Jiang Li's forehead was dripping with sweat, he continued to press his heart, and said without turning his head: "Wipe the sweat!"

The itinerant nurse immediately picked up the gauze piece and wiped the sweat off her forehead.

Ji Han tilted Xiao Jiang Hao's head back, supported his chin with both hands, kept the airway unobstructed, and said to the itinerant nurse: "Immediately issue a critical illness notice and ask the family members to sign it!"

The itinerant nurse walked out of the operating room with the critical illness notice she had prepared long ago.

At this moment, Grandma Yang, the director of Tongxin Welfare Institute, who was waiting outside the operating room, immediately came over with the support of Auntie Jiang from the orphanage.

"Nurse, what happened to our little Jiang Hao?"

The roving nurse handed over the notice of critical illness: "During the operation, the child was found to have mitral valve stenosis and cardiac arrest. Professor Jiang and Professor Ji are in the operating room for rescue. At the same time, they need to contact the outside of the heart to perform mitral valve stenosis replacement at the same time. Dean Yang quickly signed it."

The 68-year-old old director of the orphanage almost fell to the ground after hearing what the nurse said. The big guy spent so much effort to save this child's life, but God couldn't let this child go, why did the bad luck happen? Catch the poor man and never let him go!
Grandma Yang was holding a pen and looking at the critical illness notice, her hands were trembling. She pressed her hand hard against the wall, pressing down on the pen, a distorted name slumped on the critical illness notice.

In the operating room, Jiang Li and Ji Han switched positions, and Ji Han continued to do heart compressions.

Jiang Li looked at Xiao Jiang Hao's eyelids, and found that his pupils had already dilated, and immediately ordered: "Prepare one milligram of intravenous epinephrine, nicothamide, lobeline, dexamethasone, sodium bicarbonate, atropine, amine Iodine heparin, nitroglycerin."

The nurse immediately got busy and started the injection in an orderly manner according to Jiang Li's order.

At the same time, another nurse in the operating room recorded the whole operation and rescue process.

In the observation room next door, all the interns and residents looked at the picture on the LED screen above their heads, and their hearts were raised in their throats.

Just when Ji Han performed the fourth manual cardioversion, Jiang Li showed surprise in the other eye: "Little Jiang Hao's muscles are slack, and he has respiratory symptoms!"

Ji Han continued to press.

Unexpectedly, Jiang Li opened Xiao Jiang Hao's eyelids, and the surprise in his eyes was fleeting: "The pupils continue to shrink, but there is no light reflex, and the aorta in the neck still has no pulse."

She glanced at the heart monitor, it was still a straight line.

Ji Han looked at Jiang Li: "Substitute."

Jiang Li immediately changed to Ji Han's position and continued to perform heart compressions.

Five minutes later, Wei Chen retrieved the bioprosthesis, but the situation in the operating room made him feel heavy.

Jiang Li continued to perform heart compressions.

"Ten times."

"Twenty."

"One hundred times."

On the ECG monitor, there was still a gentle straight line.

Fifteen minutes later, the patient completely lost consciousness, the heart could not restore sinus function, and manual resuscitation failed.

Panting, Ji Han looked at Jiang Li who was still doing heart pressing: "Jiang Li, little Jiang Hao might..."

Jiang Li's lingering eyes glanced at Ji Han, causing Ji Han to swallow the second half of his sentence.

Jiang Li continued to look at Xiao Jianghao's eyelids, his face was more serious than ever, "The patient's pupils have stopped dilating, and he still doesn't respond to light reflexes. A pacemaker is ready."

Ji Han suddenly raised his head: "Do you want to use a pacemaker to stimulate your heart?"

Cardiac pacemaker, dual-chamber pacemaker, uses a wire to go directly to the patient's atrium through the venous blood vessel.

"This is the only way I can think of that can be tried. As long as his heart beats and the implantation of the biological valve is maintained, we can restore his heart defect and allow the blood to complete the return flow in the heart."

Ji Han continued to maintain the heart compressions. On the other side, Jiang Li started to insert a dual-chamber pacemaker simultaneously. With the insertion of the electrodes, the pacemaker was activated and emitted electronic pulses in the ventricle to stimulate the ventricle.

Fifteen seconds later, with the rapid beating of the pacemaker, there was a slight "bang" from the heart in Ji Han's hand, and then the sound gradually began to amplify.

"Boom, bang, bang."

In the quiet operating room, this powerful heartbeat sounded like a hammer, hitting everyone's hearts hard, causing people's whole body to shake.

The nurse looking at the equipment in front of the heart monitor suddenly shouted: "The ECG has responded!"

Ji Han continued to perform heart compressions.

Jiang Li opened Xiao Jianghao's eyelids, took the flashlight to shine on him, and breathed a sigh of relief: "The patient's pupils are all retracted, and he appears weak to the light, and has swallowing movements."

The nurse before the ECG said: "The heart monitor shows a wide QRS wave, ten bands are maintained, and the patient's heartbeat has returned to normal!"

Jiang Li didn't care about being happy, and immediately stood at the chief surgeon's position, with a calm voice: "Continue with the operation."

"Scalpel."

"Biological Valve!"

Regardless of the sterile gown that had been soaked through with sweat, Jiang Li took the bioprosthesis that had been prepared on the tray, and implanted the bioprosthesis in his heart.

Due to the stenosis of the mitral valve of Xiao Jianghao's heart, the position of his mitral valve has completely become a one-way valve. The blood in the left atrium cannot flow to the left ventricle, but with the complete implantation of the biological valve, the pressure has been suppressed for a long time. His blood broke through this valve in an instant, completing the blood return.

The people in the operating room and the observation room all heaved a sigh of relief.

An hour later, Jiang Li completed the pleural stripping operation, watched the second assistant Wei Chen carry out visceral evacuation and chest closure, and ordered: "I will take the patient to take an X-ray in a while to see how the lungs are re-expanding? After that After the operation, the chest wall should be tightly bandaged to prevent abnormal breathing and hypoxia. I have decided to use the IVA-Do chemotherapy regimen with Director Dao Dawei of the Radiation Therapy Department, (ifosfamide + doxorubicin + Changchunxin alkali + actinomycin D and IVA ifosfamide + vincristine + actinomycin), more attention should be paid to the prognosis of patients after surgery.”

Ji Han took off the surgical gown, and patted the young second assistant's shoulder with the bloody rubber gloves: "Everyone worked hard today."

Wei Chen didn't dislike the bloody handprint on his shoulder at all, and even seemed to have received some kind of great affirmation and approval, his face was full of excitement.

Jiang Li and Ji Han walked out of the operating room one after the other, and Grandma Yang from the Tongxin Welfare Institute hurried over and grabbed Jiang Li's hand, with tears in her eyes and her voice choked up several times: "Thank you, Professor Jiang, if there is no You are here, our little Jiang Hao will definitely not be alive now, you are his reborn parents, the old lady has nothing to repay, so I kneel down here for you, thank you for your life-saving grace!"

"Don't be grandma Yang, what are you doing!"

Jiang Li helped Dean Yang of the welfare home: "This is our duty as a doctor. Besides, Xiao Jiang Hao can live to this day. He should be most grateful to you. If you hadn't raised money for him to treat his illness, he might have waited until now." Not for this surgery."

Grandma Yang held Jiang Li's hand and refused to let go: "From now on, I will definitely pray to Bodhisattva every day to bless you all in peace and longevity. If it weren't for you, this child might really..."

Jiang Li bid farewell to everyone in the orphanage, and walked to the French window in the corridor with Ji Han. Ji Han took two bottles of water from the vending machine and handed them to her: "You performed very well today."

Jiang Li gulped down half a bottle of water before feeling satisfied. Hearing Ji Han's words, he laughed: "It's just not bad?"

Ji Han raised his eyebrows, and smiled lightly: "Not only is it good, you are very good, Mr. Jiang."

Jiang Li smiled with satisfaction: "That's about the same, Teacher Ji, you are also pretty good."

Ji Han looked at Jiang Li's smiling face, and the sunlight outside the window was shining on her face, which made Ji Han look a little crazy for a while.

It is said that when you are young, you should not meet someone who amazes you too much, otherwise in the rest of your life, you will never forget her and become the unforgettable moonlight in your life.

Ji Han thought to himself, Jiang Li might be the moonlight that he never forgets in his whole life.

(End of this chapter)