Gou in the operating room to add some upgrades

Chapter 223: Do it early and enjoy it early (please subscribe)
1 month 8 day.

There are 14 operating rooms in the surgical building, which are used for trauma surgery.

But this afternoon, it was temporarily lent to Fang Xian by Professor Lin Jiemo.

Fang Xian led not many people, only Wang Yang and Li Qiu, and naturally a superior, Associate Professor Song Yu, also followed on the stage.

Fang Xian was checking the medical records very carefully at the moment, while Associate Professor Song Yu was laughing: "Xiao Fang, you must know how to delegate power at the right time. Don't always do everything yourself!"

"The hospital has very strict requirements for bed management doctors to participate in bed management. Even the admission system for operating room assistants has relative standards. Generally, there will be no low-level mistakes."

Fang Xian is now about to become a senior doctor, so he should not continue to obsess over writing medical records, talking and signing. As a bedside doctor, Li Qiu would not be able to do this well if he could not do this well.

Wang Chuntao from the department had long been scolded by Wang Chuntao who was always hospitalized and made him doubt his life. He even sent him back to the training office and asked the teachers there to reinvent the wheel.

Each identity has its own focus. Even if there are occasional flaws in the medical records, as a superior, you have to turn a blind eye. Otherwise, everyone's energy is indeed limited.

Fang Xian turned his head and said, "Teacher Song, this is the first selective function reconstruction our team has done, so naturally we need to be more cautious."

"After the first template is created, you won't have to worry about it in the future."

"Li Qiu and I are classmates, so I have absolutely no doubt about his abilities."

"Right, old ball?"

Li Qiu had been with Associate Professor Song Yu for a period of time. As his preparatory student, he complained very aggrievedly: "No, Teacher Song, Brother Xian always bullies me. You see, I have lost weight."

Li Qiu is also incredibly talented, but he shines brightly when given a little sunshine.

Song Yu knew Li Qiu's personality and didn't do this at all: "It's good to lose weight. If you lose more weight, you will have a healthy BMI (obesity index)."

"Although we are men, there is no need to use our bodies as sexual characteristics. The bigger the better."

Song Yu is already talented, with extremely high emotional intelligence, extremely fast reaction speed, and unparalleled driving speed.

When it comes to driving, even the grumpy Professor Lin Jiemo is occasionally at a disadvantage. Therefore, after quickly reacting, Li Qiu instantly made a bitter face.

Seeing this, Song Yu added another punch: "Generally speaking, the surface area of ​​a person's body is relatively fixed. Other places are larger, and some places look smaller..."

"Teacher Song, I was wrong..." Li Qiu couldn't bear it and apologized quickly.

Wang Yang was studying the MRI carefully at the moment. After reading it, he said, "Dr. Fang, I think this patient is actually more suitable for the second plan, how about it?"

Fang Xian, however, made the final decision: "Just choose the first plan. Stability is the most important thing, and don't create extraneous problems!"

Fang Xian knew that with Wang Yang's out-of-the-box temperament, he definitely hoped to solve the patient's urinary and X functions at once.

But Fang Xian would never touch anything that the patient did not request before the operation.

It is best to strictly correspond to the patient's requirements and the surgical procedures, otherwise it will be an extraneous issue. If something goes wrong, his team will immediately be destroyed, and Fang Xian may also be banned from his current 'team leader' qualification. , and then follow other professors to cultivate their moral character honestly.

Wang Yang frowned slightly, but seeing Fang Xian's expression and determined gaze, he didn't say anything more.

Associate Professor Song Yu said at this moment: "Doctor Wang, do you still want to persuade Xiao Fang?"

"I'm telling you, don't bother. There aren't many people in our hospital who can convince Xiao Fang."

"And when the team is first established, stability is the most important thing. If the patient's demands are met, we will do it; if not, we will not do it."

Fang Xian is one of his own, and Wang Yang has always been branded as a thoracic surgeon. Even if he follows Fang Xian now, Associate Professor Song Yu will still treat him as an outsider and speak for his own people.

Wang Yang glanced at Song Yu without much respect.

In his eyes, an ordinary associate professor is not qualified to discuss theoretical issues with him. Even when it comes to operations, the associate professors may not be any better than his operations. They just have a wider skill pool. In terms of skills, the depth of the pool.

Who is afraid of who?

However, Fang Xian's personality has always been quite stable, and his personality is also paranoid and stubborn. He has to do what he is determined to do, and other people's persuasion will be in a circle on Fang Xian's side. Evaluate the pros and cons for yourself before considering whether to adopt it.

Whether it’s a professor or an ordinary person.

The anesthesiologist said at this moment: "The general anesthesia is over, can we start the operation?"

"I see that the patient's urinary catheter and stoma are still in place, so I can rest assured to balance the electrolytes."

Hearing this, Fang Xian nodded and thanked him.

As soon as the anesthetist finished speaking, everyone moved. Fang Xian and others went to wash their hands and start disinfecting, while Li Qiu honestly went to get dressed first and help lay out sterile surgical drapes.

After the disinfection, draping, and application of sterile skin patches were completed, Fang Xian stood at the chief surgeon's position, leaving Associate Professor Song Yu at the first assistant position and Wang Yang at the second assistant position.

"Tourist, record the operation time. The operation will start at 10:35." Fang Xian unified the recording time of the skin incision to avoid time inconsistency between the operation records of the tour, anesthesia, and clinicians after surgery.

After everything was ready, Fang Xian chose to incise the patient's abdominal wall. The incision he chose was still the scar caused by the suture, so as to avoid the occurrence of new scars after this elective surgery.

Fang Xian took the initiative to expose and cut, and his speed was impressive.

The exposure of the surgical approach was only a basic medical skill, so in just 5 minutes, the patient's lower abdomen was already wide open.

As soon as the abdominal expander was inserted, Fang Xian saw that after the damage reconstruction, the scars of the patient's intra-abdominal intestinal tube were visible, and there was also a lot of adhesion scar tissue in the peritoneum.

This is something that is necessary for scar healing after reconstructive surgery. Without these scars, there is no concept of healing.

"We still follow the scheduled surgical procedure, first perform the fecal function reconstruction near the rectum, and then move to the anterior lower abdomen to reconstruct the urinary function."

"As shown on the preoperative MRI, there is a lot of scar hyperplasia in the abdominal cavity. In this operation, we try to loosen the scars as much as possible to avoid functional limitation during intestinal peristalsis."

"Electric knife." Fang Xian asked Li Qiu, who was closest to the electric knife, for instructions.

Li Qiu handed it over immediately, but hesitantly said: "Do you want to open a plasma electric knife?"

Li Qiu is not an amateur, he is just not outstanding enough when facing Fang Xianshi.But in fact, now, in his seventh year, he has reached the forefront.

Therefore, Li Qiu made a recommendation based on his own understanding.

"The plasma electrosurgery is a bit expensive. It's better to save a little bit so as not to increase the burden."

"It is true that the ordinary electric knife is not so refreshing to operate, but it is not bad." Fang Xian explained.

However, Fang Xian soon added: "If you want to start operating in the future, try to choose a plasma electric knife. A better tool can ensure your smooth operation."

Song Yu helped earnestly and watched Fang Xian's operations carefully.

He kept marveling: "The operating room of the trauma center is indeed a training room for basic medical skills. It is really more than one level higher than the players coming out of the skills training room."

"The application of level 5 skills in clinical practice is really like a miracle."

Fang Xian glanced at Associate Professor Song Yu and explained: "Teacher Song, in fact, such a release can also be achieved with level 4 incision and debridement. The adhesion between the intestinal segment and the peritoneum is mostly caused by peritoneal scars. Heavy."

"The outermost anatomical structure of the intestine is..." Fang Xian said, explaining his understanding.

This is to take care of Associate Professor Song Yu and Li Qiu. These two people have been engaged in trauma surgery before. Nowadays, the reconstruction of bladder and bowel function is strictly a specialty of gastrointestinal surgery and urology surgery.

Doctors in trauma surgery only need to have a little knowledge of gastrointestinal surgery and urology, know what's going on, and be able to guide patients to specialists.

It is not necessary to explore and understand the diseases and basic knowledge of these two specialties in depth.

After surgery for mutilation, few patients would enter the uterus for the second time. At least Fang Xian had no similar experience before. Therefore, it was the first time for Fang Xian to see that patients with mutilation had undergone anatomical surgery. After reconstruction, the functional disability caused by scar adhesion is also an important factor affecting postoperative function.

But there is no other way. In clinical practice, save lives first and then treat the disease.

For many problems caused by trauma, there is currently no particularly perfect solution. This is a limitation of the development of medical technology and cannot be controlled by individual abilities.

The adhesion between the intestinal tube and the peritoneum has a lot of scar tissue, so you can remove a part of the peritoneal tissue, and then tear off the scar tissue that is close to the outer layer of the intestinal wall.

This operation requires extra caution, because the scars are already stuck together. This is a release operation and an extension of the incision...

While Fang Xian was performing the operation, Li Qiu took the opportunity to ask, "Brother Xian, do these scars need to be cleaned?"

"Yes, as long as it does not particularly affect the intestinal peristalsis function, such as some adhesions on the posterior abdominal wall, the intestinal tube is originally connected and fixed with the peritoneum in this part. If you try to loosen it, intestinal obstruction will easily occur."

"Don't worry about it. We need to remove adhesions for better function, not to completely cut off the scar and perform cosmetic surgery on the intestines."

"Well, there is a problem with the peristalsis function of this section of intestine, but judging from the blood color, it is not necrotic, so it can be left untreated for the time being. It should be that the local movement function is limited, but the blood supply is still there."

"As for this section..." The timeline for this operation must be very long. One or two hours is definitely not possible.

If you don't say a few words on the operating table for a long time, the operation may become boring.

Since Fang Xian started operating, he has become more and more understanding why many surgical professors are talkative.

"..."

Another two hours passed.

The surgical operation finally came to the functional reconstruction of the stool, which is related to nerve transposition and nerve transplantation.

At this moment, Professor Gong Ziye, a specialist in gastrointestinal surgery at the General Surgery Department, who came after hearing the sound, stepped on the foot-operated sensor door and walked in from the outside.

After coming in, while rubbing the hand sanitizer in his hands, he raised his hands and asked, "Am I late, Dr. Fang?"

Hearing the sound, everyone quickly looked up. Associate Professor Song Yu was not very familiar with Professor Gong Ziye, so they narrowed their eyes.

Wang Yang quickly called out Professor Gong.

Song Yu suddenly realized that Professor Gong Ziye had retired from the general surgery team of the trauma center and was now a boss-level figure in the gastrointestinal surgery department.

Although he is no longer the director of the ward or department, he is still a veteran-level existence.

"Professor Gong, you're just in time." Fang Xian smiled when he heard this. He didn't wait. Instead, after moving his neck a little, he put his forehead against the microscope dedicated for parietal nerve suturing and refocused the field of view. .

As soon as Professor Gong Ziye came on stage, Associate Professor Song Yu gave way.

He smiled and said, "Hello, Professor Gong."

Gong Ziye glanced at Song Yu, feeling unfamiliar, and said politely: "Thank you, teacher, for giving up your seat."

He knew that Song Yu was originally a helper, and it was a matter of affection to give up his position, and it was his duty not to give in. He was here to benefit from the surgery!

Facing Gong Ziye's politeness, Song Yu hurriedly said he didn't dare: "Professor Gong, I am Song Yu from the Department of Traumatology Surgery. You can just call me Xiao Song."

Gong Ziye is a professor who has been famous for many years. He must have been evaluating level 4 specialists for many years before he can go to the operating room of the trauma center to perform surgery. But like Associate Professor Song Yu, he is not yet qualified to go there. In order to be promoted to associate professor, he had to do surgery in the trauma center. The time in the room has run out.

Now I can only work slowly in the clinic and hone my professional skills before I can go to the operating room of the trauma center to receive the next step of experience and prepare for the career.

Knowing that the assessment of Level 4 professors is not easy, I have even more respect for Professor Gong Ziye’s strength and the dedication of the students he has taught.

Naturally, Gong Ziye didn't come here to say hello. If he came to say hello, there was no need to come to the operating room. There were plenty of places outside for him to say hello.

However, after seeing that Fang Xian found some very small nerve branches from the mesentery, and seemed to pierce some of the nerve stumps around the rectum that he could not find at all.

Gong Ziye was slightly startled: "Fang Xian, it's not difficult for you to find these nerves in emergency surgery. How did you find them in such elective surgery?"

Nerve detection is indeed a professional basic skill, but the applicability of basic professional skills also has a moderate range. It does not mean that you can find whatever kind of nerve you want to find once you know it.

Generally speaking, nerve exploration is only suitable for relatively large nerve branches.

Like the internal mesenteric nerve, I don’t know what level of nerve branches it is, or even the branches of the nerves...

Fang Xian only smiled back.

When it comes to how we found it, there are actually two important factors.

One is the basic theory of level 5, and the other is based on the fact that he has done a full nerve anatomy of the human body before, so he roughly knows the shape and location of some nerves.

Gong Ziye didn't get a reply, so he didn't ask any more questions.

Ask Fang Xian, isn't this just asking for trouble?
Fang Xian's basic theory of general surgery and specialist theory of gastrointestinal surgery are both level 5. This is a level that Professor Gong Ziye has not reached so far, and it is not so detailed.

That is to say, Fang Xian's skill pool in general surgery and gastrointestinal surgery has not gone far. Otherwise, the ability of Professor Gong Ziye would probably be just a foil in this surgery.

However, Gong Ziye was very accurate now. During Fang Xian's surgery, he used some particularly clever methods to expose Fang Xian's field of vision.

Three years of studying surgery means a lifetime of learning about exposure. This saying is not false.

Time flies like water, and another two hours pass.

After Fang Xian finished, he murmured: "The sensory nerves of the intestines are actually not very sensitive to cutting, but are sensitive to tension, such as pain hypersensitivity in intestinal obstruction."

"However, after intestinal resection, the patients themselves actually have no response."

"Such a mechanism is the basis for a functional substitute for patients who want to defecate and know how to defecate. However, it is not known whether these residual nerve branches in the colon and rectum have functional residuals."

"Actually, it should be true. Professor Gong." Fang Xian asked.

Gong Ziye frowned slightly: "Generally speaking, after trauma, the residual rate of neurological function, and the loss of innervation atrophy without ischemic necrosis, is a relatively slow process."

"Aren't you an orthopedic surgeon? Aren't some nerve transposition surgeries in hand surgery also done electively? Isn't it the same if you do it after three months?"

Gong Ziye asked back.

Fang Xian said: "Professor Gong, my understanding of hand surgery is not deep enough. At present, I can only talk about my own theory and have no experience."

"Furthermore, some nerve transpositions in hand surgery involve master-level transpositions."

"For example, functional reconstruction after amputated limbs and injuries is still an unsolved problem."

There are not only large-scale damage, but small-scale damage still exists, and after the small-scale damage occurs, ordinary limbs become just decorations.

There's nothing you can do about it, the damage to your limbs, the deformed nerves and blood vessels, everything is clearly rotten to you.

Moreover, the number of cases of damage to limbs every day is definitely not a few.

If the reconstruction of bowel and bladder function is successful, it can also be introduced into trauma surgery and hand surgery to achieve great results.

This is also the significance of functional reconstruction.

"..."

And amid this discussion and uncertainty, Fang Xian, Professor Gong Ziye and others slowly brought the operation to an end.

At twelve o'clock in the evening, when the twelve-hour operation was over, Fang Xian looked at the surgical field and said, "That's it, we can only treat a dead horse as a living doctor."

"The theory has been combined to the limit, and the operation has reached the current limit of capabilities. It is impossible to pursue better functional reconstruction."

"Anesthesia teacher, we are going to close the abdomen. This patient will be transferred to the ICU after surgery. We have already contacted the bed. From the ICU, he can choose to transfer to our department or the rehabilitation department."

"Okay." The anesthesiologist now is no longer the anesthesiologist he was when he first came to power. He came to take over the night shift.

I was so sleepy at the moment that I didn’t really understand the difficulty, beginning and process of this operation.

For him, as long as the patient does not die, that is the mission of the anesthesiology department.

Fang Xian thought for a moment and said, "Teacher anesthesia, be careful when dispensing the analgesic pump after surgery. Don't use it too harshly."

Fang Xian knew that some analgesic pump drugs had a strong lasting effect and required a large amount of medication, but such an operation required precise control of the drug dosage to avoid further accidents.

The current neural connections cannot withstand any kind of trouble.

"Okay, I know. Professor Zhu reminded me before when he took over the class."

"If I am transferred to the ICU, your specialist doctors don't have to accompany me. Thank you for your hard work." The operation ended at nearly midnight.

As an anesthesiologist, he felt tired, not to mention these surgeons who had not had dinner?
Professor Gong Ziye came to study sincerely, so he fought hard until the end of the operation.

Fang Xian quickly asked: "Professor Gong, let's go have dinner together. It's quite late."

"it is good!"

"Actually, I can take a day off on the day of the operation. I don't have to spend time with my daughter at home. I have to go back to eat with my daughter during normal times." Gong Ziye said.

When Fang Xian heard this, he was a little curious: "Professor Gong's daughter is still very young?"

"I got married late, and now my daughter is in junior high school." Gong Ziye replied with a smile.

Fang Xian nodded and said with a smile: "Then we are lucky."

It is normal for medical students to get married late, and the study period is extremely long.

If 20 years ago, after completing a bachelor's degree, a master's degree, and a Ph.D., if you wanted to enter a first-class hospital, enter a postdoctoral mobile station, and go abroad, you would be 33 or [-] years old before you could officially start working and complete the basic structures such as buying a house and a car.

Apart from the same medical monks, there are probably no other professional girls who can wait until this age.

When a group of people walked out, Gong Ziye gave a thumbs up: "Let's not talk about the prognosis of this operation, but the operation of this operation can definitely be regarded as textbook level."

"I really want to record it."

"Xiao Fang, do you think it's okay?"

When Wang Yang heard this, he immediately said: "Professor Gong, we have a body-worn camera, and these operations are all recorded on video, so that we can use them as materials for academic exchanges in the future."

"We can make a copy for you if you need it."

Hearing this, Gong Ziye turned his head and glanced at Wang Yang: "I forgot that you were here. You are better at these things than me..."

Although Wang Yang is a thoracic surgeon, he is quite famous in the surgical field.

If it's surgery, then many people won't be able to get rid of him, but when it comes to scientific research, academic research, and theory, most people really can't handle him.

Some even say that if it had been 20 years ago, with Wang Yang's current academic achievements and theoretical research skills, he would have become a professor long ago, and he might even have reached the academician level halfway.

At that time, surgeons did not need to perform many surgeries. They had associate professors who needed articles on topics to help with surgeries.

On the contrary, now, due to the limitation of professional ability, Wang Yangcai is only a minor attending physician, not even a deputy chief physician.Of course, not an associate professor either.

The hospital simply did not dare to let Wang Yang take care of the students.

Only now did Song Yu have time to laugh and say, "Professor Gong, I know a place with good porridge. Although we haven't arrived in Laba yet, it's actually quite good to have some porridge at this time."

"What do you think?"

"Okay. I'm free to do whatever I want..."

So Gong Ziye led the team and set off on the advice of Associate Professor Song Yu.

No one drives. The employees of Shonan University Affiliated Hospital rarely commute by car because it is too congested, so they usually live nearby.

A little further away, you can take eDonkey, and a little further away, you can commute by subway.

There wasn’t much to talk about during the meal. We were more interested in talking about this surgery, functional reconstruction, the development of this discipline, and the next step of planning. It’s very scalable.

Functional reconstruction of paralyzed patients, functional reconstruction of amputated patients.

Without mentioning the patient’s functional reconstruction…

To expand a little further, amputated limb reconstruction, amputated limb transplantation, etc. can all be functional reconstruction in a broad sense. It can be said that this is a multi-disciplinary intersection and pivot point.

If Fang Xian can really build this discipline, it will definitely become the most popular center in the future.

Why, just go to a nursing home and you will know. I don’t know how many people live there because of their disabled functions. Although there are people to serve them, they are compared with freedom, especially the freedom of personality functions.

There are so many people willing to spend more money to have such freedom.

It's just that medical technology is limited. This subject has been tackled for many years and there is still no progress. Fang Xian is also trying to cross the river by feeling the stones. He needs to slowly mature this subject.

In the end, Fang Xian and Li Qiu took a taxi back.

At this moment, Li Qiu said seriously: "Brother Xian, I find that following you, the connections I can come into contact with are too strong, right?"

"I just searched and found that Professor Gong Ziye was the former director of gastrointestinal surgery. He later went to the trauma center. Now he is a veteran in general surgery."

"Hey, he's just over 40 years old, why did he quit the front line?"

Fang Xianneng roughly guessed the reason: "Professor Gong has been at the professor level for many years. If he wants to go further, he will be the leader of the subject."

"When you become a subject leader, it doesn't matter whether you are a director in the hospital or an expert or professor. That is the cornerstone and foundation of the hospital, and there is no need for a department director to add to the cake."

"If you want to take this step, you must calm down and give up trivial worldly affairs."

"Oh." Li Qiu nodded.

He sighed: "Alas!~"

"too difficult."

"It's not easy to get a graduate degree at Shonan University Hospital. If you want to study for a doctorate, you have to cross a single-plank bridge with thousands of troops."

"If you want to stay in the hospital, there is a so-called ladder to heaven. But after climbing the ladder to heaven and entering this hospital, you find that the other big guys in the department have all climbed the ladder to heaven."

"Attending is another hurdle. If you want to become associate professor, you need to learn a lot of surgeries, as well as teaching tasks and scientific research tasks. All of these must go hand in hand..."

When Li Qiu was feeling so emotional, Fang Xian explained: "Li Qiu, you must never give up on scientific research."

"Scientific research is not about being high-level. If you want to write a paper or do research, you need to know where the frontier of the subject is and where the boundaries are."

"It's in the process of understanding this boundary that your perception will be different."

"Based on this and making breakthroughs is scientific research, as well as the output of scientific research and articles."

"Today's medical associations actually don't pay attention to scientific research, but they divide scientific research, you know?"

Li Qiu looked at Fang Xian and explained, "I know."

"The hospital blindly asks us to improve our theories, firstly for work needs, secondly for diagnosis needs, and thirdly for scientific research needs."

"If you don't understand in advance, Brother Xian, your current stage will be difficult. Every step you take will become more and more difficult. And the process of exploring step by step is originally the stage of research."

“Without any precedent to refer to, it’s like walking a tightrope.”

"Teacher Wang Yang is too radical because his theory is very solid and he believes in his own theoretical derivation. But in fact, many times, if you go too fast, there may be endless disasters. You must go forward slowly step by step. "

Fang Xian was surprised that Li Qiu had such an understanding!

"Let's practice our surgical skills first. Practice slowly and practice well. There's no rush anyway."

……

Time is like water.

Another few days passed.

When Fang Xian came to the trauma surgery department again, he found a completely different scene.

Many people immediately surrounded Fang Xian.

"Doctor Fang, Doctor Fang..."

"Doctor Fang, you're finally here." The person who looked like the patient and his family members gathered Fang Xian in the center, making Fang Xian unable to move at all.

Fang Xian raised his hands, fearing to hit someone: "Everyone, slow down, slow down."

"I'm here to talk to Professor Lin about something, and then I'll talk to you guys, okay?"

"I have to do my current job well first." Fang Xian knew that these people came to Fang Xian one after another after seeing that the previous patient's post-operative function was good and he could feel the sensation of fart and urine.

If we see that the first patient has shown signs of improvement, then they are no longer experimental subjects.

Seeing hope, they naturally gathered around.

Choosing to wait and see, Fang Xian can actually understand that not everyone is like Professor Hu's uncle who can make money.

Li Qiu also helped explain from the outside: "How about everyone give way first, we really have something to do."

But the patients didn't quite understand: "Dr. Fang, we have something to do with you, and we want to call you..."

"My outpatient appointment was yesterday. Yesterday has already passed. I have to wait until next week."

"Don't worry yet! If you don't let me do things, what will I do with my work?"

"What if I lose my job and can't be a doctor?" Fang Xian explained patiently, with a bit of impatience.

Strictly speaking, these people have no medical relationship with him, so it is certainly inappropriate to block him like this.

These patients gradually dispersed.

Fang Xian looked at them and patiently explained: "I'm sorry, I really have something to do with Professor Lin, and it's quite urgent."

"Can you guys come see me again after I finish my work?"

"Okay, Doctor Fang." Then someone nodded, fearing that Fang Xian would just run away and plunge them into despair again.

Pretend to enjoy it early. Although it is actually a normal function of normal people, for them, it is a kind of enjoyment...

(End of this chapter)