Oncology Physician Life

Chapter 66 Chapter 65

When Lu Jiajia rushed to the simulated operating room, Yang Xiaolan happened to be there too.

With a notebook and a pen in her hand, she smiled at Lu Jiajia: "Ms. Jiang is going out, it seems that there is a patient in the emergency department who wants her to go, but Mr. Jiang said that she has arranged for Wei Chen from the oncology surgery department." Brother Wei came over to help guide us."

Lu Jiajia heard that it was Wei Chen who helped guide her, so she breathed a sigh of relief, looked at Yang Xiaolan, and asked, "Did you just come down from regular training for an internship?"

Yang Xiaolan nodded: "Director Qi Dahua asked me to follow Teacher Jiang."

Lu Jiajia didn't expect that he would have a competitor so soon, and he couldn't help but feel a little more anxious.

After a while, Wei Chen walked in with a central venous catheter operation manual and distributed it to the two. ,

He looked at Lu Jiajia and said: "In the oncology department, most of the patients who need to have a central venous catheter implanted, most of them have a poor prognosis and need to supplement nutrition through veins. For the front-line doctors, this is just a trivial matter. On average, our oncology department performs two or three minor surgeries every day."

Holding the practical manual, Lu Jiajia was very nervous after all. Although she had simulated this operation when she was in medical school, but now in the hospital, if she really wants to do it, she will inevitably be nervous.

Wei Chen introduced the details of the operation to the two: "The insertion of a central venous catheter, in simple terms, is to install a 20-centimeter soft catheter in the patient's chest cavity, from the patient's veins to the great blood vessels of the heart. It is a minor operation because almost most patients will do it, and even some patients on the operating table will do it in advance, it is very common and does not even require an operation, but although it is simple, it does not mean that this operation is without any risks.”

Wei Chen's words made the two girls' expressions tremble.

Wei Chen: "This operation has certain risks, because when we insert the catheter, if your catheter deviates from the route, does not enter the patient's vein accurately, but exits from another position in the patient's heart, then an operation is required. Thoracic surgery to adjust the position of the catheter, more dangerous, if you accidentally poke the catheter into the patient's artery, it will cause the patient to bleed heavily and even die."

Yang Xiaolan suddenly asked: "Brother Wei, have you ever made such a mistake before?"

Wei Chen thought for a while: "Don't say it, it really happened. When I was an intern, an intern who came in at the same time as me poked a catheter into the patient's artery on the day of the practice, causing massive bleeding. , although the thoracotomy was performed in time, and the ruptured artery was sutured, but the intern was not so lucky, and ended his internship for a short time, and was sent back to the original place."

Lu Jiajia was very nervous, her palms were sweaty: "Senior Brother Wei, don't scare me, okay?"

Wei Chen looked very serious: "Lu Jiajia, I'm not trying to scare you. There is nothing trivial on the operating table. Even if it's just a 20cm catheter, mistakes are not allowed, because even if a step is wrong, it means threatening the patient. Therefore, the first principle in the operating room of our oncology department is safety first, and every doctor on the operating table must walk on eggshells."

Lu Jiajia took a deep breath, and stood in front of the operating table, with a dummy of medical props on it.

She followed the steps, first checked the tools one by one on the instrument tray, and started to operate after confirming that they were correct.

She picked up the medical towel on the tray, rolled it into a roll, and placed it under the shoulder blade of the silicone dummy, so that the dummy maintained a prominent arch on the operating table, which was conducive to catheter insertion.

Immediately afterwards, Lu Jiajia picked up iodophor cotton balls and disinfected the position where the catheter was to be placed on the dummy's chest.

Wei Chen reminded the two of them aloud at this time: "Although the simulation is a dummy, there is another step you must pay attention to before disinfection, which is local anesthesia. There is no anesthetist for this, and you need to inject anesthesia yourself. .”

Lu Jiajia remembered Wei Chen's reminder, and grabbed the thick and long needle on the tray. This needle was longer and thicker than ordinary needles for injecting drugs.

Yang Xiaolan saw Lu Jiajia's nervousness, and encouraged her from the side: "Come on, senior sister!"

Lu Jiajia nodded, held the needle tightly, spotted the marked vein on the dummy's collarbone, kept the needle at an angle of 90 degrees perpendicular to the patient's collarbone, and poked it directly.

It took a lot of force to poke the needle under the dummy's collarbone, and then push the needle to the bottom in one go.

Wei Chen observed the angle of the needle, and said with satisfaction: "Very good, there is no problem with the angle and strength. At this time, if it is a real person's practice, there will be blood accumulation in the needle tube. If the blood drawn out is dark red, it means that there is no problem. The needle has successfully poked into the patient's vein, but if you find that the blood in the needle tube is bright red, then you are in trouble!"

Yang Xiaolan asked nervously: "What if it is bright red?"

Wei Chen smiled: "If it's bright red, it means that you poked into the patient's aorta just now, which will cause massive bleeding in the patient's arteries and requires surgery."

Lu Jiajia didn't know whether she had pierced a vein or an artery, because there was a silicone doll under her hand, and who knows where the needle pierced.

She proceeded calmly, picked up the vein wall expander from the tray, and wanted to enlarge the hole of the needle hole so that the central venous catheter could be inserted smoothly.

Wei Chen picked up the wire for pushing the tube and handed it to her: "Before inserting the central venous catheter, we need to use a 60 cm wire for positioning."

Lu Jiajia almost forgot this step and hurriedly took over the metal wire.

This metal wire is very similar to the rigid string on the guitar. She wants to pass the metal wire under the needle and enter the human vein until the entire metal wire enters the vein blood vessel, which is used as a positioning before the hose is pushed in. .

This process is called thread pushing.

Wei Chen looked at Lu Jiajia who started to push the thread, and reminded him again: "The whole process of pushing the thread should not be too fast, and don't force it, let alone let go. The best state is to let it go in by itself."

Yang Xiaolan asked curiously from the side: "What will happen if there is a mistake in the process of pushing the thread?"

"If you push the wire wrongly, the instrument will trigger an alarm. Don't panic at this time. Just pull out the metal wire a few centimeters. It means that the process of pushing the wire just now may have touched the patient's heart."

Seeing that the entire metal wire had been sent into the vein, Lu Jiajia picked up a thick vein dilator and inserted it from the pinhole to expand the vein.

Wei Chen nodded in satisfaction, "It's going well so far, and the next step is the insertion of the central venous catheter!"

Lu Jiajia picked up the soft yellow central venous catheter that had been prepared earlier, and put the catheter in along the metal wire.

Because of the positioning of the metal wire before, it was much smoother when the central venous catheter was inserted.

When the central venous catheter was completely inserted into the vein, Lu Jiajia pulled out the metal wire from the needle tube, and the insertion of the central venous catheter was considered complete.

Wei Chen checked the dummy: "It shouldn't be a big problem. It's like taking a driver's license test. Be normal and mentality is very important. It's not asking you to open the patient's chest for surgery, it's just a small operation to insert a central venous catheter. Don't worry too much about it."

Lu Jiajia smiled wryly: "How can you not care about it? This is one of the surgeries that count as an intern assessment. If it can't be completed, it doesn't matter whether you can be transferred to the hospital this year."

Wei Chen chuckled: "Is hospitalization so good? You'll know when you're in the hospital. You stay in the hospital 24 hours a day, and you have to see more than a dozen or twenty patients for each inpatient. You check the room every three hours. Especially in the second half of the night when you are so sleepy, if you encounter one or two patients who are in critical condition, that day, tsk tsk, it is really comparable to hell mode."

"After listening to Brother Wei, is it too late for me to change careers?" Lu Jiajia asked suddenly.

"It's too late!" Wei Chen narrowed his eyes and looked at her with a smile, "If my junior sister changes jobs and goes to another place to make money in the future, don't forget me, senior brother! If you are rich, don't forget each other!"

On the other side, outside the ICU ward, Tan Jiadong's two sons and youngest daughter were there, and Tan Jiadong's daughter-in-law Liu Fengzhi finally got together the surgery and medical expenses.

The eldest son Tan Weiguo sat on the bench in the corridor and complained to his father: "I have already said, I have already raised the money, why are you always in such a hurry, what are you saying, you can't touch Sanya's dowry money, that is The dowry my mother gave her is to marry out of town alone, if the girl has no money, life in her husband's house will not be easy!"

Tan Jiadong was reprimanded by his elder son, and sat in a chair silently.

The second son, Tan Weijia, called his younger sister to him, took out 10 yuan from his bag, put it in the younger sister's hand, and gave her a hard look: "The men of our old Tan family are not dead yet. When is it necessary for you, a little girl, to show up in the film? Don't watch me and the boss quarreling all day long. No matter how much we quarrel, it's our brother's business. It has nothing to do with you. My mother is going to have an operation. Can you really be cruel, watching our mother die? I just want to argue with the boss, our mother has worked hard all her life, buying him a house, doing work, and my mother’s sickness needs surgery, whoever takes the money if he doesn’t.”

The eldest brother Tan Weiguo on the side listened to the words and snorted coldly: "I didn't spend all my mother's money alone. Didn't my mother take the down payment for buying a house for you?"

The second son, Tan Weijia, took out the receipts that had just been paid for the operation and medical expenses, and handed them to him: "I have paid for the operation and medical expenses of the mother. The dowry money, I took it out for Shan."

Ji Han happened to be passing by the ICU, saw the Tan brothers arguing in the corridor again, and looked at Head Nurse Sun.

Head Nurse Sun shook her head and said helplessly: "These two people never came to quarrel. Fortunately, the two brothers finally had a conscience and made up for the surgery and medical expenses owed by Liu Fengzhi. Otherwise, the hospital office and the medical staff I am upset to see the list of reminders every day."

Ji Han looked at the payment form and nodded: "Let's schedule Liu Fengzhi's surgery tomorrow. I looked at the surgery schedule for tomorrow morning, and it happened that I had an aneurysm when I stepped down at ten o'clock, so I put Liu Fengzhi's surgery behind this desk." , Counting noon, it should end at three o'clock, so I just got connected to the lymphoma at 03:30."

Head Nurse Sun was full of worries: "Professor Ji, will you be too tired?"

Ji Han shook his head: "I'm fine, Liu Fengzhi's surgery must be done as soon as possible, and I'm worried that the tumor will metastasize a day later."

After finishing the ICU work, Ji Han turned around and went to the ward to visit his teacher Tan Xudong in the university.

Mr. Tan is a professor of oncology at the School of Medicine. He has made a lot of achievements in China. He educates students all over the country, and some of them are even top experts in China.

But it is such an old professor who stands on a three-foot podium and takes teaching and educating people as his own life, but unfortunately suffers from cancer in his later years.

When Ji Han received Tan Lao's case, he felt despair and sadness for the first time.

Tan Lao had right lung squamous cell carcinoma, mediastinal lymph node metastasis, bilateral lung metastasis, pleural metastasis, and bone metastasis.

Yesterday Ji Han just helped him pump out the fluid in his chest cavity, so that he could not hold his breath so much, but the extensive bone metastases made him feel pain like ten thousand ants biting his bones all the time, even though Ji Han prescribed painkillers for him , also to no avail.

But the reason why Ji Han admired Mr. Tan was not only because he was his teacher in college, but also because Ji Han saw a kind of tension in life from him.

Every time the nurse and the doctor went to make rounds, even though Mr. Tan couldn't eat anything and couldn't sleep because of the pain, he would still tell the nurse and doctor that he was fine with a smile on his face.

When he stayed in the ward, he was always quiet, holding an old laptop computer that was four or five years old, lying on the hospital bed to correct students' papers.

When Ji Han came to Mr. Tan's ward, this very thin old man was still lying on the hospital bed and using that notebook to revise the thesis for the students. Where the citations were wrong and needed to be revised, and which parts were not explained enough by the medical profession Comprehensive, he will mark and revise for the students one by one.

Even though the cancer pain of bone metastases caused him severe pain all the time, he was still so calm and calm, insisting on revising the students' papers bit by bit.

"Old Tan, how do you feel today?" Ji Han walked into the ward, pretending to be fine, and asked habitually.

Seeing his proud student, Tan Xudong forced a smile and said, "It's Xiao Ji, you are so busy, you don't have to watch over me every day, don't forget, your teacher, I am a famous professor of oncology , You surgical experts in major hospitals are all taught by me, haha, I am very clear about what disease I am and what state I am in."

Ji Han didn't know how to answer, and sometimes he knew too much about cancer, an endogenous disease, so it might not be a "lucky" thing.

"You don't understand the truth that doctors don't treat themselves, just listen to the doctor!" Tan Xudong's wife complained from the side.

Ji Han looked at Mr. Tan's wife, Professor Mei, who was also a teacher.Professor Mei, who is in her sixties at the moment, has tears in her eyes and guilt on her face: "Old Tan, you have to trust the doctor..."

Mr. Tan smiled, pretended to be relaxed and held his wife's hand, and asked thoughtfully: "It rained again yesterday, did you suffer from rheumatism in your shoulders again? This time, without me baking moxa for you, you must Does it hurt?"

"It doesn't hurt, I'm fine, thanks to you baking moxa for me every day." Professor Mei forced a smile on his face.

Mr. Tan glanced at his tired wife, and turned to look at Ji Han: "Xiao Ji, do you know why I must go to your hospital and want you to be my attending doctor?"

Ji Han forced a smile: "Is it because I'm your best student?"

Tan Lao laughed: "You kid will put money on your face, because you once argued with me in my class when you were in college, and I decided to come to you."

"Arguing?" Ji Han was startled, and suddenly remembered something.

Tan Lao said with a smile: "At that time, I was talking about the limitations of modern medicine in treating cancer, and it was impossible to cure all cancers. I said that doctors should allow patients to receive effective treatment as much as possible. When developing, we should try our best to improve their life treatment, so that patients can reduce their pain during their limited survival time."

Tan Lao looked at Ji Han: "And you told me at the time that if patients suffer from cancer and medicine can't alleviate their pain, they should be allowed to die with dignity. Your attitude at that time In a word, it shocked me a lot, I didn't expect that a young man in his early twenties would actually consider this level of issue."

Ji Han nodded: "At that time, because our country prohibited euthanasia for patients, the two of us had a big dispute on ethics and medical views. You said that human life is equal, and doctors have no right to decide on patients. No one can deprive a person of the right to life just because of a word, even the patient himself does not have this right."

The smile on Old Tan's face was even bigger: "So, now, I'm here to find you. What you said back then is also my wish now. I hope that when I can let myself pass away, I won't be too embarrassed. I want to leave with dignity."

Ji Han was startled: "You want me to agree with you and give up the treatment?"

Old Tan laughed: "Life is rare in seventy years. I have lived my life with dignity. Now I have entered the stage you mentioned. I have been a tumor research expert all my life and have witnessed countless deaths. , I have also witnessed countless rebirths, and now it is finally my turn, but my thoughts have changed. Instead of lingering in agony, I think, according to what you said, walk with some dignity, I don’t want to have seven or eight pierced Drainage tube, skinny, half-clothed, embarrassing in front of my students, I want to keep my only dignity as a teacher."

Ji Han shook his head: "But teacher, in the ten years I have been a doctor, I have also witnessed the joys and sorrows of countless families. Now I am no longer the student I was back then. I have changed my life a long time ago. Thoughts, I think what you said back then was right. None of us can decide the end of a person’s life with one sentence, even doctors. So, I will not give up using all methods and continue to treat you. Of course, I will also use Do whatever it takes to improve your quality of life for the rest of your life."

Mr. Tan pointed him expertly: "You have changed, you are no longer my favorite student."

Ji Han also smiled: "You have also changed, you are not the stubborn teacher I hated the most."

The teacher and the student looked at each other at the same time, and both of them burst out laughing.

Tan Lao laughed and scolded: "You are a slippery fellow."

Ji Han admitted the scolding, and said humbly: "I can't compare to you, you are so scheming, and you have plotted on my student, but unfortunately, you didn't expect that the two of us ended up becoming the most hated person to each other. "

(End of this chapter)