Oncology Physician Life

Chapter 72 Chapter 71 No need for obituaries here

Jiang Li held the donor heart in the girl's chest with both hands, leaned over, took the stethoscope in the nurse's hand, pressed it lightly on the chest wall at the apex of the heart, put his ears on it, and listened carefully to the faint heart sounds coming from the heart .

The operating room fell completely silent.

In the sound returned by the stethoscope, Jiang Li could hardly hear the noise produced by the flow velocity of the blood passing through the valve orifice.

If it is a normal heart, when sinus rhythm is accompanied by middle and late diastole, obvious murmurs can be heard.

The loudness of the murmur depends on the blood volume of the heart and the flow rate of blood through the narrow valve orifice.

Only when the heart valve is severely stenotic, the blood flow through the mitral valve is significantly reduced, or when the mitral stenosis is combined with atrial fibrillation, and atrial failure, the murmur will be reduced.

Professor Dong Tianshu always pays attention to the vital signs of the girl under severe anesthesia on the operating table.

The girl's extremities have already developed tonic spasms.

He touched the girl's neck with his rubber gloved hand, his complexion changed, and he said urgently: "The patient has a laryngospasm, and his complexion is abnormally flushed!"

As soon as the voice fell, on the ECG monitor, the irregular waveform suddenly appeared as a straight line.

The skin of the girl's whole body was cherry red, her lips were cyanotic, and quickly turned from dark red to purple.

Jiang Li looked at the cardiac surgeon who took the donor heart.

"Does the provider of the donor heart have a history of heart disease?"

The doctor in the Cardiac Surgery Department hastily shook his head: "The medical record does not mention that the provider has any history of heart disease!"

"It's too late." Jiang Li reached into the patient's chest with his rubber-gloved hands, holding the heart that was no longer beating.

"Chest compressions now!"

The second assistant immediately gave way sideways, and at the same time was ready to take over from Xia Jiangli at any time to perform chest compressions.

Jiang Li looked at the girl's cyanotic lips, and at the cardiac surgeon who was going to take the donor heart: "Immediately contact the parents of the donor heart patient, and ask carefully whether the child has had any heart problems before!"

After finishing speaking, she immediately looked at the itinerant nurse: "Ready to issue a critical illness notice for surgery!"

Hearing this, the itinerant nurse walked out of the operating room as usual with the critical illness notice she had prepared in advance.

At this moment, no sound could be heard in the operating room, Jiang Li looked solemn, and glanced at Professor Dong Tianshu.

"I suspect that the provider of the donor heart may have severe mitral stenosis that violated the detection, and it is a dumb mitral stenosis!"

Professor Dong Tianshu's face became serious: "If the donor heart suffers from mitral valve stenosis and ventricular fibrillation during the transplantation process, then we have to perform a bioprosthetic valve replacement operation on the newly sutured heart! superior……"

Just when the two determined the cause of ventricular fibrillation in the donor heart, the girl suddenly lost her breathing, and the blood oxygen saturation on the ECG monitor quickly began to drop.

The anesthetist turned pale with shock: "Quick, quick! Quick!"

Jiang Li frowned, and the speed in his hand was increased by three points. He took the scalpel handed over by the nurse, and said quickly: "Inject epinephrine 1 mg, atropine 0.5 mg, restart the extracorporeal circulation machine, and prepare for the Heart cut."

The equipment nurse turned on the extracorporeal circulation machine again, and the blood in the girl's heart was immediately drawn out of the body by the catheter again and flowed into the machine. With the rotation of the pump unit of the extracorporeal circulation machine, the artificial venous channel was opened again.

Dong Tianshu glanced at Jiang Li, who was holding the scalpel tightly, and turned to look at the time on the wall of the operating room, his face gradually became serious: "The cardioplegia has been injected for four hours, and the mitral valve replacement operation is now underway. Will it be too long? I worry that this will increase the chance of heart failure, is it too risky?"

"But we are already riding a tiger!"

Jiang Li stared at the donor heart that was no longer beating, "If there is really a problem with the mitral valve, if we don't solve it now, it means that this heart transplant operation has completely failed. The heart of the whole body is beating again, and Chunchun has a chance of survival!"

Professor Dong Tianshu was silent, none of them expected that there would be problems with the donor heart!
This is tantamount to making matters worse for the already risky transplant surgery of heart replacement and tumor removal.

Outside the operating room, as soon as the itinerant nurse came out with the critical illness notice, she was stopped by the girl's mother.

"Nurse, nurse, what happened to our Chunchun family?"

The itinerant nurse looked at the girl's parents who were like ants on a hot pot in front of her, and handed over the critical illness notice.

"During the operation, there was a problem with the donor's heart. Ventricular fibrillation of unknown cause occurred, and the heart stopped beating in the end. The two professors are in the process of rescue. The family members should sign it!"

Before the nurse could finish speaking, the girl's mother collapsed on the ground, her eyes were dazed, she couldn't believe what she heard, her eyes were full of tears, and she was extremely choked up: "How could this happen? How could there be a problem with the donor's heart? "

"Patient's family..."

"I...I sign...I am Chunchun's father, I will sign!"

The haggard man took the critical illness notice with both hands, and the hands holding the pen couldn't help shaking.

Every word on the critical illness notice was like a knife stabbing into his heart, causing him to tremble all over.

In the operating room, Jiang Li held the scalpel and said to the equipment nurse on the side of the operating table: "Prepare for intravenous injection of GIK solution (a drug to protect the myocardium during heart surgery)."

The nurse hastily followed Jiang Li's instructions and started the injection methodically.

On the other side, the itinerant nurse began to quickly record various medications, and recorded the entire rescue process in detail.

Jiang Li didn't dare to delay, the hand with the rubber glove reached into the girl's chest cavity through the incision, and held the heart that was no longer beating. With a sudden movement, his eyes fell on the right atrium.

Just when she was about to cut open the right atrium of the donor heart, Professor Dong Tianshu hurriedly stopped her!

"Professor Jiang, are you sure it's the donor heart's mitral valve stenosis?"

Jiang Li didn't look up, and without any hesitation in the movements of his hands, the scalpel directly cut open the left atrium of the donor heart that had just been stitched up.

"I can't be sure, but that's the only reason I can find!"

Professor Dong Tianshu clenched his hands tightly. This is really too risky. It is basically saving people in the deep well of death. Any mistake in judgment will lead to the immediate death of this 14-year-old girl on the operating table.

The scalpel in Jiang Li's hand didn't stop at all. Almost instantly, the shiny scalpel entered the left atrium from the longitudinal incision in the interatrial groove, extended downward along the atrioventricular groove, and cut open the fossa ovale of the heart. The scalpel expands all the way up and down.

The eyes behind her binocular loupe (Kepler's binocular magnifying glass) stared at the scalpel in her hand, for fear of accidentally injuring the aortic sinus that had just been sutured.

As Jiang Li cut open the right atrium, the mitral valve was completely exposed in the surgical field.

"Pull the hook!"

The equipment nurse hurriedly passed the retractor from the stainless steel sterile tray.

The second assistant propped up the chest wall of the atrium with retractors, and the mitral valve revealed the true face of Lushan.

In the observation room, everyone looked up at the display screen hanging in front of them.

At the moment when the pull hook supported the happy room, there was a sound of gasping in the observation room.

Shu Yusheng looked at the screen, his face couldn't help being shocked: "The valve opening is severely narrowed, and the valve is thickened and adhered. It's unbelievable. How did Professor Jiang determine that the donor heart's mitral valve has a problem?"

Qi Song, director of the Department of Oncology Surgery, couldn't help being amazed: "As expected of a professor of surgery at MD Anderson Cancer Center, he can accurately determine the presence of mitral valve stenosis in the donor heart only through the heart sounds during ventricular fibrillation. This technology and experience , are admirable!"

The moment Professor Dong Tianshu saw the mitral valve again, he also heaved a sigh of relief.

He glanced at the calm female professor on the operating table, and laughed: "Sure enough, the mitral valve is severely stenotic!"

Jiang Li still looked serious, as if he was carrying out the operation in an orderly manner.

"Determine the indications for valve replacement!"

"Scissors!"

She took the scissors from the equipment nurse, cut off the defective mitral valve, and threw it on the sterile tray.

The nurse immediately cut off the mitral valve, and used a tester to measure the size of the valve ring to select a suitable biological valve.

The nurse handed the measured biological valve to Jiang Li.

Jiang Li glanced at the time, without any hesitation, immediately performed mitral valve replacement and suturing.

"Thick silk thread!"

"Right-angle pliers!"

She clamped the traction line with right-angle pliers, and cut the papillary muscle at the tip of the papillary muscle at the same time, took the 2-0 double-ended needle nylon thread handed over by the nurse, and started interrupted mattress suture.

Jiang Li kept moving his hands, which dazzled the people in the observation room.

As the last stitch fell, Jiang Li looked at the valve and annulus that had been sutured, and heaved a sigh of relief.

"Ready to test valve function!"

The nurse immediately carried out the test and replied, "The valve function is normal!"

Under the shadowless lamp, Jiang Li held the nylon thread in his hand, with large beads of sweat on his forehead.

The operation has been going on for more than five hours, and she has completed all the steps of artificial heart valve replacement.

"Tie it up, tie it up!"

She tied five knots in a row on the sutured atrium wall, and pulled the excess nylon thread out of the chest cavity, still with a steady voice.

"shear!"

Second Assistant hastily cut off the excess nylon thread with scissors.

After the atrium was sutured, everyone in the operating room looked at Jiang Li.

Without any hesitation, Jiang Li said again: "Resuscitate the heart, remove the extracorporeal circulation after the resuscitation is successful, and place a drainage tube!"

The nurse started the heart recovery procedure, but the ECG monitor still showed a flat line, and everyone's nerves that had just relaxed immediately tensed up again.

Jiang Li looked stern, "Try again!"

The nurse tried again, and tried to stimulate the donor heart to re-beat, but in the end, there was still no response.

Jiang Li's voice without any emotion came from the operating room again.

"try again!"

The nurse could only continue to try, but there was still no response from the ECG monitoring.

The donor heart in the girl's chest was like a stone, showing no signs of beating.

Jiang Li's voice still did not waver.

"Try again!"

"Keep trying!"

During this process, the nurse did not know how many times the heart resuscitated.

But the result was the same, and Jiang Li's unquestionable voice rang out one after another in the operating room!
"continue!"

"try again!"

In the observation room, everyone shook their heads, almost giving up any hope.

Qi Song lowered his head: "It seems that it is still too late. There was a problem with the donor heart during the transplantation process. Even if the mitral valve replacement was performed urgently, it still failed to save the outcome. This heart transplant surgery with heart replacement and tumor removal , and finally failed.”

In the operating room, Professor Dong Tianshu looked depressed, and touched the girl's neck artery, but there was still no beating.

ECG monitoring showed a straight line.

He looked at Jiang Li who was doing chest compressions, and sighed: "Professor Jiang, it's not your fault, you've tried your best, none of us thought that there would be problems with the donor heart, this...maybe it's God's will Bar!

Without saying a word, Jiang Li continued to perform chest compressions.

"Ten times."

"Fifteen blows."

"Twenty."

A flat straight line was still displayed on the ECG monitor.

The ECG monitor on the side instantly became tense.

Jiang Li continued to press.

"Thirty."

"Forty."

"Fifty times."

The heartbeat on the ECG monitor was completely calm, and the patient lost consciousness.

The donor heart was unable to function normally, and the artificial rejuvenation failed.

The second assistant's face was pale, and he looked at Jiang Li: "Professor Jiang... the patient... has died..."

Jiang Li's sharp eyes swept towards his face, making him swallow the rest of his words.

"I never believe in God's will! I only believe in myself!"

Jiang Li's unquestionable voice came again from the operating room

The time was 7:42 p.m., nearly one and a half hours of manual rejuvenation had been performed, and the ECG still had no response.

In the observation room, Qi Song took off his glasses and said to all the doctors who were observing behind him: "She tried her best, and this is really God's will. None of us thought that the donor heart actually had the defect of mitral valve stenosis , this may be the fate of this little girl."

Everyone in the observation room fell silent.

In the operating room, everyone had given up, only Jiang Li's hands still kept moving.

Professor Dong Tianshu couldn't help persuading: "Professor Jiang, give up, Chunchun has...gone."

Jiang Li continued to perform heart compressions, repeating such a movement.

a bit.

Twice.

Three times.

…………

The nurses shook their heads and stood silently in the operating room.

In the observation room on the other side, Liu Chong, director of the Department of Oncology, entered the observation room at some unknown time.

At this moment, he was getting up from the seat in the corner, opened his eyes, and said, as if sentenced to death, "Professor Dong can declare the patient dead, and the hospital office can issue a death certificate."

After saying this, Liu Chong turned around and walked out.

His face was calm and majestic, and no one could violate it.

From the moment the donor heart had problems, he had already expected this ending.

The idea of ​​heart replacement and tumor removal is good, but unfortunately, not everyone can complete this operation.

This female professor who came back from MD Anderson is not a god!
He said earlier that how could a female professor in her 30s support half of the oncology department.

The other party was still too young and too tender.

But it's good now, he can just use this excuse to drive this woman who is always against him out of the oncology department.

But just as Liu Chong was about to step out of the observation room, someone in the crowd behind him suddenly yelled.

"Jumped, jumped, there is a crest on the heart monitor!"

impossible!
Liu Chong turned his head abruptly, pushed away the crowd in front of him with all his strength, and stared at the screen, only to see that there was a slight fluctuation in the straight line on the ECG monitor on the screen.

In the operating room, everyone seemed to be hallucinating.

They seemed to have heard the donor heart suddenly utter a "bang".

This voice, even if it is very subtle.

But in the operating room at this moment, it was like a thunder on the ground!
Afterwards, the thunder became louder and more violent, like a sledgehammer hitting everyone's hearts one after another!
"Oh!"

"Oh!"

"Oh!"

Jiang Li stopped what she was doing, she was dripping with sweat, but she couldn't help showing surprise in her eyes.

She held the hand of the donor heart and felt a powerful response.

The nurse before the ECG monitoring turned around in surprise and shouted at everyone: "The ECG showed QRS wide waves! It lasted for 11 waveforms! The heart rhythm returned to sinus rhythm! The heart re-beated successfully!"

The girl's donor heart seemed to have given a strong response to these words. Fresh blood flowed in from the left atrium, rejuvenating the whole heart.

Although Jiang Li was physically and mentally exhausted, he couldn't hide the smile on his face: "Turn off the extracorporeal circulation, prepare the drainage tube, and gradually close the chest!"

The second assistant's eyes were flushed, and he immediately nodded heavily, and replied loudly: "Got it, prepare the drainage tube, and gradually close the chest!"

The nurses answered in unison: "Got it, prepare the drainage tube, close the chest gradually!"

Under the bright shadowless lamp, the eyes behind Jiang Li's binocularloupe (Kepler's binocular magnifying glass) regained their former charm.

She was so tired that she had to exit the operating room.

She ordered while tearing off the surgical gown and blood-stained rubber gloves.

"Pay more attention to the chest wall compression pack after surgery to prevent abnormal breathing after surgery. In addition, more attention should be paid to the rejection of the heart. Immunosuppressants should be given to patients within an hour after surgery."

After finishing speaking, she glanced at Professor Dong Tianshu and nodded slightly at him: "Professor Dong will leave the rest of the work to you!"

Professor Dong Tianshu smiled kindly at Jiang Li: "Professor Jiang, I thank you for Chunchun, thank you for not giving up on her!"

Hearing Professor Dong Tianshu's sincere words, Jiang Li smiled softly, turned around and walked out of the operating room.

Outside the operating room, Chunchun's parents had already learned everything that happened in the operating room. Seeing the female doctor in the green sterile gown drenched in sweat, the girl's father directly knelt down to Jiang Li.

"Professor Jiang, thank you, really thank you, you are our pure lifesaver!"

Jiang Li hugged the girl's father, and smiled softly.

"This is what I should do as a doctor. It's just my job. You don't have to do this. You should thank your daughter Chunchun. In the last hour and a half of cardiac arrest, she was 14 years old. They are also engaged in a desperate struggle with the god of death!"

"In the end, it was obvious that Chunchun won. She knew that there were still parents who were reluctant to part with her outside the operating room. Your daughter is really brave. If it weren't for her tenacious will, I wouldn't have survived to the end and took her away." Take it back from the hand of death."

Jiang Li bid farewell to his innocent parents and walked out of the corridor. He saw many visiting doctors standing on both sides of the corridor. In an instant, there was warm applause in the corridor.

She was a little shy, shaking her hands in embarrassment, and walked away as if to escape from the cheers of the crowd.

Just as she passed the hall of the oncology department, she saw a huge slogan on the opposite wall.

"There is no need for obituaries here, only resistance!"

Jiang Li took a deep breath and looked seriously at the sacred statement of the oncology department representing all medical staff on the front line of anti-cancer, as if he had found his place to live and work, a sense of sacredness spontaneously emerged in his heart.

At this moment, she received a message from Pei Xiaonan on her mobile phone asking her to come to Ji Han's lounge.

She bought her favorite boiled pork slices.

When Jiang Li walked into Ji Han's lounge, Ji Han and Wei Ran were entangled with each other, pulling each other's hair and arguing loudly, neither willing to give in to the other.

Pei Xiaonan seemed to be accustomed to this situation, and sat calmly at the table eating the delicious and soft glutinous rice cake.

Jiang Li shook his head, sat down next to Pei Xiaonan, separated the disposable chopsticks, glanced at Ji Han and Wei Ran who were holding each other's hair behind him, and asked curiously, "Why are they fighting again?"

Pei Xiaonan swallowed the hot glutinous rice cake, sticking out her tongue, "Old Ji ruined Old Wei's wife!"

"What?" Jiang Li was startled.

Pei Xiaonan explained: "PS5 game console, the new PS5 game console that Lao Wei bought, was broken by Lao Ji."

Jiang Li shrugged speechlessly: "What a pair of childish ghosts, childish ghosts!"

(End of this chapter)