"Doctor Ruan, I heard that you are working as a doctor in a county hospital?" Yan Zhenrong asked with a little curiosity.

"Yes, Wucheng County Hospital. Ruan Bin nodded.

"It's a pity to stay in the county hospital like you, have you ever wanted to come to the magic capital to be a doctor? Yan Zhenrong asked with a smile.

"Of course, I aspire to develop in a big city, but I am only a resident doctor, with an average level, and I am also a third-rate medical school graduate, which is more difficult. Ruan Bin said modestly.

"Your level is still average, I think your clinical experience is good, and you have made the first REBOA in China. If you want, I can help you ask our hospital to see if it still accepts people!" Yan Zhenrong said with a smile.

"This ...... Let's talk about it. "Ruan Bin can hear it, this guy wants to dig him up openly and secretly?

However, if he wants to stay, he still wants to stay in the First Affiliated Hospital of the Demon Capital, and first of all, he knows the senior doctors of this hospital. And Lin Yatong's plastic surgery hospital is diagonally opposite.

When the time comes, it's convenient to make extra money!

If you go to work in the other party's hospital, don't talk about anything else, it will be too troublesome to make extra money at that time, and it will be half an hour's drive from Lin Yatong.

Seeing Ruan Bin's somewhat euphemistic refusal, Yan Zhenrong was slightly disappointed.

If the doctors in other county hospitals heard that they could work in one of the top hospitals in the magic capital, they would probably be in ruins.

Even the doctors in the city hospitals are probably eager to squeeze in.

But Ruan Bin doesn't care much.

But think about it, the talent is so high, and the first REBOA in China was made, it is estimated that the First Affiliated Hospital of Modu will not let Ruan Bin go.

Even if Ruan Bin's surgery is not good and his clinical experience is not good, it will be very useful for him to do pre-hospital first aid alone.

............

The next day, go to work as usual.

Today is Wednesday, and there are not many patients early in the morning.

At about ten o'clock, an operation finally came.

It was sent by a lower-level hospital.

Jiang Yurong took Ruan Bin to take over.

The patient, a 100-year-old female, went to a hospital in the following city for treatment due to epigastric pain for 3 days and vomiting blood for half a day. The local hospital recommended conservative treatment, and the surgery was too risky to do. In fact, it is to prescribe some medicine to go home and wait for death, many children can't bear to watch the old mother wait for death, and then directly ask for a transfer!

Ruan Bin looked at the patient's medical records: there was a history of gastrointestinal perforation and gastrointestinal bleeding.

In the examination report of the lower level hospital, the physical examination showed T 36.8 °C, P 90 beats/min, R 18 beats/min, blood pressure 132/78 mmHg, and pain score 2 points.

Specialist examination: clear, no pallor, yellow staining. Breath sounds in both lungs are clear, and there are no rales. HR 90 beats/min, rhythmic, no murmur. Flat abdomen, tight abdominal muscles, subxiphoid tenderness, no rebound tenderness, no palpable subcostal liver and spleen, negative Murphy.

CT scan shows a perforated gastrointestinal tract, which is a duodenal ulcer and perforated.

Diagnosis: Acute diffuse peritonitis 2.Duodenal ulcer with perforation bleeding 3.Acute coronary syndrome to be ruled out.

After Ruan Bin read it, it is no wonder that the lower level hospital recommended that the patient go home for 'conservative treatment'.

Duodenal ulcer disease is perforated and bleeding, although only a secondary surgery is required - gastric or duodenal ulcer perforation repair can be cured.

But the problem is that the patient is already 100 years old!

What is the concept of 100 years old?

I don't know to what extent the body's organs have failed, and how far the body's functions have declined.

This kind of patient is on the operating table, and there is a very high chance that he will not be able to get down!

The bottom line set by general hospitals for this kind of surgery is within 75 years old, and basically appendicitis and gallstones cholecystitis older than 75 years old are mainly treated conservatively.

Of course, there are many big hospitals that put the bottom line at 80 years old, and even top hospitals even put 85 years old!

But the one in front of me is 100 years old!

This is definitely a no-go area for surgery.

Because the older you are, the higher the risk of surgery and the more complications there are. Even if you have a successful surgery, you often won't survive in the end.

This is why age is definitely at the forefront of the forbidden area for surgery.

Jiang Yurong also understood the patient's situation, and said with a slight frown: "Your mother's age is relatively old, if you take the risk of surgery, it is very likely that she will not be able to get off the operating table, and even if she does, she may not be able to resist it in the follow-up rehabilitation." ”

Since the other party asked to be transferred to the hospital for treatment, I believe that the other party is also mentally prepared.

"This doctor, after discussing with our family, unanimously asked to operate on my grandmother, because we didn't operate on her, and we would go home and wait for death. It's better to give it a go!" said a man in his fifties with slightly red eyes.

"Doctor, don't have a psychological burden, let's sign, you can do it with confidence. Another young man spoke. It is estimated that they are all the sons of the patient's grandson.

Ruan Bin looked at it, and this family was reasonable.

In fact, at the age of 100, it is worth the risk of surgery, or waiting for death at home, this choice is basically the choice of the family.

If you wait to die at home, you will definitely die.

If you take the risk of surgery, you may end up paying a lot of money for treatment, but in the end, there will be no one left.

But overall, it's up to your conscience.

"Okay, then let's go through the hospitalization procedures first, and we have to have a consultation. Jiang Yurong said.

Soon, Jiang Yurong summoned Deputy Director Liu, Dr. Chen, and Ruan Bin for a consultation.

As for Director Qian, he is not available for surgery.

"This is the case with the patient, the family is asking for the operation, whether it is successful or not. Jiang Yurong said.

"At the age of 100, the risk of gastric or duodenal ulcer perforation repair is too high!" Liu Junchi shook his head slightly. According to statistics and surveys, surgery at the age of 80 is a watershed moment in difficulty!

90 years old is another watershed of death!

Currently, the maximum age for stomach cancer surgery is 92 years old!

Of course, gastric or duodenal ulcer perforation repair is much simpler than stomach cancer surgery.

"However, I think that although the patient's cardiac enzyme profile is significantly elevated, the patient's heart rate is normal and there is no chest pain, so I think surgery can be tried!" Jiang Yurong judged.

"Well, the family members have agreed, we can only go to this operation, the patients are 100 years old, and the traditional laparotomy is definitely not recommended. The trauma is too great! Let's consider laparoscopy! If the laparoscopy really can't be done by then, turn the abdomen away immediately. Liu Junchi also agreed with Jiang Yurong's opinion.

"So, who should be on this operation?" Saying that, Liu Junchi and Jiang Yurong both looked at Ruan Bin one after another.