Oncology Physician Life

Chapter 46 Chapter 45
Early in the morning, more than half of the [-] operating rooms in the oncology surgery center were opened, and many nurses in the operating preparation room were making preliminary preparations.

In operating room 1, a 78-year-old man was undergoing common bile duct exploration and T-tube drainage.

Operating room No. 6 is a total abdominal hysterectomy for uterine cancer. The girl is only 23 years old and is not yet married. Once this operation is performed, it means that she will lose her right to be a mother in this life.

Cancer never chooses the age and gender of the patient. Jiang Li has been a doctor for so many years, and he also understands a truth. There has never been the same empathy in this world. If you have not experienced the suffering of others, you are not qualified to persuade others to open up point.

Wearing a green sterile gown, Lu Jiajia followed Jiang Li and walked into the operating room at close range.

It was this total abdominal hysterectomy inside. Jiang Li greeted the surgeons in the oncology and gynecology department, and brought his interns to observe and study the whole process.

The shadowless lamp in the operating room turned on the full exposure mode of the abdomen, and the cold scalpel opened the knife on the girl's stomach.

Jiang Li watched coldly from the sidelines. The bracket on the side of the operating table was connected to the screen. The probe magnified the surgical field of view by nearly a hundred times and displayed it on the screen.

Let you clearly see every blood vessel in the girl's stomach.

There were all kinds of panic on Lu Jiajia's face. It was the first time for her to observe such a complete operation up close.

There was no sympathy on Jiang Li's face, is it cruel for a girl to study medicine?

In the first anatomy class she attended in medical school at the age of 20, the professor used real human anatomy, and put a dead male body naked on the dissecting table. The professor doesn't care if you are a male student or a female student, because For doctors, patients are gender-neutral.

Jiang Li witnessed the professor's complete dissection of a male corpse. Even if the large and small intestines flowed all over the floor, you have to resist the nausea churning in your stomach, and the smell of blood constantly drilling into your nostrils in the dissecting room, because The school does not have a lot of corpses that can be provided to professors to demonstrate human anatomy to students.

This opportunity is very cherished, and it allows medical students to understand the real structure of the human body more intuitively. A real human anatomy is far better than countless boring human tissue structure diagrams in books.

However, most of the young interns of Lu Jiajia's generation are flowers grown in greenhouses.

In the medical school, I learned by rote for several years, and I had to master the brick-thick medical English and medical Latin. After studying for a master's degree for two years, I was faced with transferring to a doctoral degree.

As a result, today Jiang Li heard Xu Youshu, an intern in the department, say that in front of him, almost all the brothers and sisters in the previous year failed to transfer to a Ph.

However, those who pass the medical English test, the professional courses are completely wiped out.

These children born after 98 and 00 don't look like the era when Jiang Li grew up.

"Surgery is called an operation in Medical Miles, which translates to open. Simply put, an operation is to open the internal structure of the human body, accept the invasion of machines, and rebuild the physical order inside the human body!"

Jiang Li pointed to the monitor on the operating table bracket, Lu Jiajia glanced at it and then lowered his head, feeling sick to his stomach.

Jiang Li ruthlessly lifted her head with his hands, making it at a 90° right angle, and asked her to maintain this position after watching the operation.

"Can't you accept this?" Jiang Li asked her curiously.

Lu Jiajia nodded eagerly.

Jiang Li smiled: "Don't treat it as a human being, just take the operation picture on the screen as killing a chicken. You should have seen the picture of killing a chicken at home, right? In fact, the structure of the human body is not much different from that of a chicken. It’s just a magnification of human surgery through a mirror, a chicken can also get uterine cancer and cholecystitis, but no doctor can operate on a chicken!”

Originally, Lu Jiajia could bear it, but after listening to Jiang Li's words and comparing the surgery in front of her to killing a chicken, the braised chicken nuggets that she ate last night kept flooding her mind, and the nausea in her stomach could no longer be restrained. Turning his mouth around, he ran towards the operating room, and ran into the toilet, retching, and didn't stop until he almost spit out bile.

When she came out, Jiang Li was waiting outside, and kindly handed over a tissue.

Lu Jiajia took it over: "Thank you."

"You're welcome." Jiang Li smiled softly at her, "Before lunch, write me the whole process of the operation just now, and add five hundred words of operation experience, and submit it to my mailbox .”

Lu Jiajia's pupils dilated rapidly, she began to howl, and walked back to the intern's lounge dejectedly, and spread it on the desk.

Kang Jun was busy writing his medical history, glanced at the listless Lu Jiajia, and asked curiously, "What's wrong with you? Are you sick?"

"I hope I'm sick!" Lu Jiajia stood up angrily, "Do you know how perverted Professor Jiang is? She forced me to watch a complete hysterectomy at close range just now! You know that What does it look like when the picture is magnified a hundred times by the monitor? All kinds of bloody pictures are clustered together, and Professor Jiang is still in the mood to joke with me? Want me to imagine this picture as killing a chicken?!"

Xu Youshu was eating a chicken leg burger, and just as he took a big bite, his mouth burst out. Hearing Lu Jiajia's complaint, he suddenly felt that the bursting chicken leg meat he was chewing in his mouth no longer tasted good, like chewing wax.

On the other side, after Jiang Li washed his hands with disinfectant at the nurse's desk, he turned and walked into the ward area. Nurse Li Xiaomei just delivered Liu Kaishi's biopsy report.

"Professor Jiang, this is the biopsy report of Liu Kaishi in bed 17 just sent by the biopsy side."

Jiang Li took it, opened it impatiently, and read the biopsy report almost at a glance, it was worse than she imagined.

Bard needle puncture, pathology report "right breast invasive carcinoma", slow paraffin pathological examination report (right breast) invasive ductal carcinoma grade II, immunohistochemical result was Ki67 (60%+) (positive rate 60%, Tumor cell proliferation), ER (-) (estrogen receptor negative), PR (-) (gene regulatory protein negative), P53 (+) (P53 protein positive).

Jiang Li frowned, breast cancer P53 is a very important tumor suppressor gene!

It can promote the gene repair of cell mutations and prevent the occurrence of tumors. Liu Kaishi's P53 result is positive, which also means that the P53 gene has a mutation, and the patient's prognosis will be poor.

Head nurse Sun came over, put down the doctor's order in her hand, looked at Jiang Li and said, "Deputy Director Tao Dawei from the Radiation Therapy Department had a consultation with Liu Kaishi, and asked Professor Jiang to meet him sometime and talk about it. Let’s talk about Liu Kaishi’s GN regimen chemotherapy.”

Jiang Li nodded, at exactly 09:30, the Department of Thoracic Surgery and Oncology was going to organize the last MDT (Multidisciplinary Diagnosis and Treatment) meeting for Zhang Qianyi, and she happened to meet Tao Dawei at the meeting.

A pot of sunflowers was placed in Liu Kaishi's ward, which was left by Xiao Jianghao when he was discharged from the hospital. The child finally planned to go back to the orphanage to save some hospital expenses, and only came here regularly for chemotherapy. Given the prognosis, Jiang Li could only reluctantly agree to this plan.

At this time, only Liu Kaishi was lying on the hospital bed alone in the ward. She turned her head to look at the lush camphor tree outside the window, wondering what she was thinking.

Liu Kaishi's mother Zhang Kaili, because she is a nurse at the hospital, has to earn her daughter's medical expenses during the day and is busy taking care of other cancer patients, so she has no time to spend with her daughter.

When Jiang Li walked in, Liu Kaishi on the hospital bed turned her head to look at Jiang Li, showing a pair of small canine teeth, and laughed happily: "Aunt Jiang!"

Jiang Li gently touched her head, took out the thermometer from her arms, checked her temperature, it was normal.

Li Xiaomei, the nurse who followed in, said with a smile: "We, Kaishi, are the most obedient. We will cooperate with the nurses to do the check-ups. When you recover from illness, my sister will buy you fried chicken!"

Jiang Li picked up Liu Kaishi's hospital gown, observed her chest, and comforted her: "Our Kaishi is the strongest, isn't it? This disease, as long as Kaishi obediently listens to Auntie's words after the operation, it will heal soon. It's going to get better!"

Liu Kaishi nodded solemnly: "My father said that he will take me to Disneyland when he comes back. I have never been to Disneyland when I grow up. I will definitely get better. Then I will go to Disneyland with my father!"

Jiang Li touched her head distressedly, looked at the time, then turned and walked towards the MDT meeting room.

At this time, in the MDT meeting room, the air conditioner was turned on very loudly, and the doctors from the Department of Thoracic Surgery, Medical Oncology, Oncology Surgery, and Radiation Therapy were almost all present for the meeting, and the singer Zhang Qianyi had not arrived for a long time.

Jiang Li walked in and sat beside Tao Dawei, deputy director of the Department of Radiology.

In the meeting room, the major surgical directors drank black tea, smoked and chatted, and the atmosphere was harmonious.

Several experts from the Department of Thoracic Surgery and Director Qi Song from the Department of Medical Oncology discussed Novartis’ latest lung cancer drug, Ceritinib. After taking the drug for a period of time, drug resistance develops.

At this time, India launched the generic drug of Ceritinib two years ago. Several patients in the oncology department started to take the generic drug produced in India through purchasing agents. No matter in terms of price or drug resistance, it gave patients a new opportunity. s Choice.

Qi Song took off his glasses and said slowly: "This drug targets the mutated ALK gene, and only 3%-5% of lung cancer patients have ALK gene mutation. For lung cancer patients without ALK gene mutation, this drug is It’s completely ineffective. We can’t put all our hope on those foreign pharmaceutical companies, can we? Do we want our domestic patients to wait for foreigners to develop new drugs to cure their diseases? This is not a joke! China adds new drugs every year. A country with 70 lung cancer patients and a population of 14 billion cannot develop an anticancer drug!"

Zhao Zhiqiang from the Department of Thoracic Surgery smiled and took a sip of tea: "Director Qi's words are biased. Even for a drug like ceritinib, it would take 10 years, more than 20 years, for a top research and development institution like Novartis in the United States. It was developed with a cost of US$[-] million. With such a large investment of time and money, which domestic pharmaceutical company can take the lead? Other pharmaceutical companies also want to make money, and they are not philanthropists. Therefore, if they want to conquer all cancers, even if it is not in the foreseeable future, It’s also a long way to go.”

Jiang Li didn't speak, but he disagreed with Zhao Zhiqiang's point of view. If everyone had Zhao Zhiqiang's point of view, then there would be no progress in domestic medicine. There are still a lot of cancer research scholars and scientific researchers working in front-line laboratories Struggling desperately, which one of those people does not hold the greatest awe of human life?

Tao Dawei next to him looked at Liu Kaishi's latest inspection report and asked, "Is Professor Jiang planning to undergo radical mastectomy?"

Jiang Li shook his head: "There are two 8X9CM lumps on the right breast of the child, which are hard and have unclear borders. On the right shin and clavicle, there are three enlarged lymph nodes, which are also hard and have unclear borders. For greater consideration, chemotherapy and targeted therapy should be performed first."

Tao Dawei also thought so, took out a pen and gave his own plan in the report: "We are going to give six cycles of GN chemotherapy, the drug is gemcitabine 1.6g, d1, d8, Changchun Binrui 40mg, d1, d8. Herceptin 3mg was given 330 days after chemotherapy, and the third cycle of targeted therapy. After the radiotherapy plan was improved, radiotherapy was planned to start in mid-July: 6MV-X line, IMRT, PTV 40Gy/20f, right neck and right supraclavicular field, 6MV-X-ray, DT 40Gy/20f, and sensitized with glycididazole."

Supporting his forehead with his hands, Jiang Li considered the plan given by Tao Dawei. Glycindiazole is mainly used to increase radiation sensitization. When taking the medicine, he must pay special attention to the patient's allergic reaction. Variety.

On the premise that there was no second plan, Jiang Li nodded and agreed to this treatment plan: "That's it. Before taking the medicine, we will give the patient a PICC (Peripherally Inserted Central Catheter)."

After discussing the plan with Tao Dawei, singer Zhang Qianyi finally arrived late.

This was the first time Jiang Li saw this singing legend up close. His thin body was sitting in a wheelchair and was pushed into the conference room by his manager.

Sitting in the back row of the conference room, Wei Ran looked up at Zhang Qianyi and was stunned for a moment. He didn't expect that Zhang Qianyi's manager was Song Qin, the daughter of Director Song Zhiguo.

Zhang Qianyi was used to being stared at by strangers, he was a little haggard, he whispered a few words to Song Qin, and then fell silent.

Song Qin looked at the white coats in the conference room, and said loudly: "Your hospital has delayed the operation plan for a week, and today we must get an answer. Our goal is very simple, that is, to keep the vocal cords no matter what. .”

Sitting in the first row of the conference room, Zhao Zhiqiang clenched the pen in his hand. The thoracic surgery department can meet Zhang Qianyi's request, but it will undoubtedly increase the difficulty of the operation.

"The cancer cells infiltrated the right laryngeal nerve, cervical lymph, and thoracic lymph. There are obvious shadows. The esophagus is severely deformed and spread to multiple lymph nodes. The safest way, our thoracic surgery department still believes that the vocal cords and surrounding lymph should be connected with the esophagus. Take it off, and then build a rectoesophageal transplant to reshape the esophagus."

Song Qin shook her head: "We cannot accept this plan."

Suddenly, there were whispers of discussion in the meeting room. Qi Dahua, the deputy director of the oncology department who presided over the meeting, glanced at Zhao Zhiqiang, and there was obviously a little more hesitation in his eyes.

Zhao Zhiqiang wants to save face and suffer. Obviously, as the chief surgeon, he has more than enough energy for this operation, and he can't get in the way of face, so he asks Ji Han, who is swollen, to help.

Qi Dahua coughed, looked at Ji Han who was silent in the meeting room, and said, "Didn't the tumor side also propose a surgical plan? The patient's right larynx and half laryngectomy were performed, and the vocalization was preserved. Afterwards, Resction of Carcinoma at the Upper Part of Esophagus (resection of upper esophagus cancer), remove the patient's neck and chest lymph nodes, remove the upper esophagus, and then cut the rectum to transplant the patient's rectum to the upper part of the esophagus, perform esophagus- - Rectal anastomosis."

Ji Han glanced at Qi Dahua, and the corners of his lips curled up: "My operation is already full, and I may not have time for this operation, why don't the Department of Thoracic Surgery see if other professors have time, and would like to help?"

Zhao Zhiqiang's face was livid and he didn't speak.

Qi Dahua took a deep breath. If he hadn't thought about Zhao Zhiqiang's loss of face, he would have directly transferred Zhang Qianyi to Zhongwai, but before the meeting, Liu Chong had specifically told him that Zhao Zhiqiang was the best candidate for the next deputy dean, and he was also a chestnut. The authority of surgery, so in terms of face, you must save it, or you may make a joke.

But the biggest problem at present is that Zhao Zhiqiang is the chief surgeon, and the thoracic surgeon cannot complete this operation by himself, so he must ask Ji Han who has a swollen stomach, but Ji Han will definitely not help Zhao Zhiqiang when something happened four years ago , the relationship was deadlocked, which gave him a severe headache.

(End of this chapter)