In fact, each of us has a hidden internal organ in our body that can produce "concentrated sulfuric acid", that is, "pancreas".

It is hidden between the spleen and duodenum, and if it is accidentally injured by the outside world, it will leak out deadly "concentrated sulfuric acid", corroding the surrounding internal organs, and the mortality rate after the onset of the disease is as high as 52%.

On the premise that medicine was highly developed in later generations, if in the eighties, this figure would have become 90%, or even more.

If it was in Africa in the eighties, there would have been little hope of survival.

"Pancreatic fistula", simply put, is a leakage of the pancreas.

The highly digestible pancreatic juice flows into the abdominal cavity through a hole and continues to erode the tissues and blood vessels in the abdominal cavity like sulfuric acid.

The fragile blood vessels and intestines simply could not withstand its "attack", and were corroded into one large hole after another, and finally caused massive bleeding in the stomach.

What's even more terrifying is that this attack is at any time, and as long as the patient is alive and the pancreas continues to produce pancreatic juice, the damage will not stop.

This old black man is in the late stages of this stage, and as the saying goes, even his stomach is rotten, and it is a miracle that he survived.

Chen Qi was a hepatobiliary and pancreatic major in his previous life, and he still has some experience in the treatment of "pancreatic fistula".

But this kind of surgery up to level 4+ is not at all something that can be solved by the temporary hospital in this refugee camp, not even at the Freetown State Hospital.

The camp can only do some simple treatments, such as debridement, sutures, disinfection, and then some antipyretics and antidiarrheal drugs.

The treatment of pancreatic fistula should first plug the loopholes in the pancreas, then anti-infection and nutritional support, and the follow-up treatment should be almost always in the ICU.

Then the holes in the duodenum, jejunum, and colon near the pancreas that have been corroded by pancreatic juice must be filled, and part of the intestine will be removed if it cannot be filled.

Finally, it is necessary to fill the holes in the belly, and it is impossible to expose the internal organs and intestines to the air for a long time, which is another big project.

After the whole operation, it didn't take more than half a year, and several stages of surgery could not be won at all.

Not only is it time-consuming, laborious and costly, but also the process is quite thrilling, and the patient will die if there is a slight disturbance, and all the efforts are in vain.

Luo Wei saw Chen Qi in a daze, and quietly touched him:

"Dean Chen, what should I do with this patient? Shall we treat it? How to treat it? ”

Gao Haishi has a different opinion:

"It can't be saved, even if it can be operated, the price paid is too great, and it is not something that these black people can afford at all."

Wang Jiliangshu was a little angry and said disapprovingly:

"As a doctor, in the face of a patient, but choose not to save him, let him die, this can't be justified, it is our duty to treat the sick and save people, otherwise why do we doctors?"

Gao Haishi was anxious when he heard it:

"Whether you can save people or not depends on the situation, if you don't save when you have the ability to save it, it is a lack of medical ethics, but now this patient is obviously in a critical state, can you save it, and how can we operate under such conditions?"

For a while, there was a lot of discussion in the tent, and the little doctors behind them were obviously divided into two factions.

One faction thinks that it is okay to try to save it, and it is a big deal to bring it back to the Friendship Hospital in Freetown, anyway, President Chen can do anything.

The other faction believes that the rescue should also be done in moderation, not to mention that the patient can't come up with the money at all, so who will pay for the medical expenses at that time?

There is also a more cruel view that limited medical resources should be given to those who need it more, and that such an old African man has lost his salvage value.

Chen Qi sat there, unconsciously thinking of a big discussion across the country a few years earlier.

It happened in the summer of 1982 in Xi'an.

At the Fourth Military Medical University, Zhang Hua, a 24-year-old college student, was shopping when he encountered Wei Zhide, a 69-year-old manure digger, who was stunned by the toxic gas in the manure pit and fell into a manure tank more than three meters deep.

In order to rescue Wei Zhide, Zhang Hua jumped out of the manure tank without hesitation to save people.

But in the end, because he inhaled too much poisonous gas in the manure pit, he finally died and was not rescued.

Zhang Hua's deeds soon spread all over the country and aroused widespread concern in the society.

Some people think that Zhang Hua saved an old farmer who digs dung, and his death is not worth it, after all, it is not easy for the country to train a college student, and it is in that era when college students are very scarce.

Wen Wei Po received a letter from a college student, saying:

We must use our limited lives to create value greater than our own value for the country, rather than exchanging the life of a 69-year-old farmer. It is not always cost-effective to take gold in exchange for the same amount of stones.

Then a big discussion began that caused a sensation across the country, and newspapers, magazines, and even TV stations were discussing whether Zhang Hua's sacrifice for robbing the old peasants was worth it?

Two different points of view began to collide violently.

What if from? Hell? degree to see.

?Year? And? Year? 's lives are all lives, no? The distinction between the noble and the low. So? Year? It's worth saving??? Killed.

If you think about the contribution to society.

?Year? The time to contribute to society is more ?,? and potentially more important? Some, and young? Less demand for society.

But? Is it a social animal, it must be integrated? Can society play a role? Only by the value of the body can we contribute to society.

?? Year? At? To a certain extent, they are out of touch with society, and they will not contribute to society, but will only ask for it.

Of course, this kind of debate is often public to say that the public is reasonable, and the mother-in-law says that the mother-in-law is reasonable, and it doesn't matter whether it is right or wrong, but only depends on one's own three views.

In the same way, there is also a dilemma of "whether to save or not to save" in front of doctors.

For example, a middle-aged man with a severe cough and severe emaciation went to the hospital for an examination, and his lung cancer was in an advanced stage and metastasized in many places throughout his body.

The patient was in great pain, not only coughing badly, but also suffering from chest pain, and he was scared to death.

However, the patient has a strong desire to survive, hoping that the doctor will save him, asking for surgery, and asking for everything possible to save him.

The problem is that the patient's family conditions are not good, the family does not have much money, and there is no medical insurance.

Do you save such a patient or not?

If you don't save it, let him go back and eat whatever he wants, and figure it out.

This seems extremely inhumane and lacks medical ethics, and it can even be a "death or no salvation".

At the same time, the dean will not be happy, you don't accept such a "high-quality" patient? Got money or not? Do you want this month's bonus, or don't take it at the end of the year?

But you save it, not to mention whether the surgery can be done, as soon as chemotherapy and radiotherapy are used, expensive drugs are used, and the treatment costs start at hundreds of thousands.

In the end, he ended up with no money, four walls, and debts, which made the family's life completely difficult.

Then you are a doctor, do you save such a patient or not?

Here's another example:

When a pregnant woman gives birth and the baby is delayed, an emergency cesarean section is required.

However, the family has concerns, either that the cesarean section is too expensive, or out of distrust of the doctor, they just don't sign it.

On the one hand, the pregnant woman was shouting in the delivery room that the fetus could not be delivered for a long time has caused intrauterine distress, and it may be dead at any time.

On the one hand, the family refused to sign, the doctor could not proceed with the next step of treatment, and the doctor was not allowed to directly perform a cesarean section in the legal procedure.

At this time, you are an obstetrician, so can you save it?

You don't save? You are a doctor who knows that if you don't save the mother and the fetus, you will die, and if you don't save it, what about your medical ethics? What about your humanity? What about your conscience?

But if you save people, and your family members don't sign it, and in the end you still die because it drags on for too long, then you are violating the diagnosis and treatment norms and going against the wishes of your family, which is a proper medical accident.

The family can sue you, and your doctor will have to pay money. (Real example)

If you meet a dean who doesn't eat, you may not be able to keep your medical license, and your life is over.

In this case, are you a doctor, save or not?

Here's another example:

You are a 120 emergency doctor, you received a call for help, got into the ambulance, and rushed to the patient's home.

And then you're busy treating the sick, when it's very urgent,

Suddenly, a neighbor broke in from the side, saying that there was also a filial asthma patient in his family who needed first aid, and asked to borrow the oxygen tank and electrode defibrillator on the 120 car.

You're a doctor, do you borrow or not?

You said to lend out the first aid tools and machines, you are rescuing the patient yourself, don't you care about the patient in your hand? Who is responsible for the death of the patient?

But you said that you don't borrow, that's okay, the filial piety neighbor died in the end, and your 120 emergency doctor is a person who can't save him when he sees death, and the operation is improper, and he will be suspended from work and fined. (Real example)

Faced with such a dilemma, you are a 120 doctor, do you choose to borrow or not to borrow? To save or not to save?

The same is true of the old black man in front of him.

You said you don't save it, you're a doctor, you see that the patient's condition is critically ill to this extent, and everyone is dying, and there is still the possibility of surgical treatment, but you can't treat it? What about your medical ethics?

If Chen Qi opens his mouth now and says give up, he can't be cured, and believe it or not, he will be despised by many little doctors, and his confidence and consciousness in practicing medicine will be undermined.

But you have to say that the treatment is not enough, the surgical conditions are not enough, the drugs are not enough, and the cooperation team is not enough.

Do you want to give up all the limited medicine and medical resources to this old black man? For example, there are only a few antibiotics, this old man uses them all, and others don't use them?

And the key point, who will pay for the money?

To save or not to save, this is also a dilemma.

Seeing that the little doctors were arguing louder and louder, and many people began to blush, Chen Qi had to come out to stop it.

"Okay, okay, let's stop arguing, save or not, cure or not, now none of you can convince each other, so let me ask you a few questions."

"Now that the diagnosis is clear, pancreatic fistula, do you know what pancreatic fistula is? How much is the mortality rate? Wang Jiliang, you answer. ”

Wang Jiliang is not a surgical professional, and his answer was a bit slurred:

"This is a pancreatic fistula that causes a hole or gap to form after the rupture of the pancreatic duct, and pancreatic juice flows out by non-physiological means, causing the surrounding tissues to melt. This mortality rate, well, should be high, right? ”

Gao Haishi, who was next to him, was a surgeon, and at this time he interjected: "The mortality rate is more than 90%. ”

"So tall?" Wang Jiliang was obviously a little surprised.

"Yes, it is so high, and if you want to treat a pancreatic fistula, you need to do at least 4 surgeries, which is still under the premise of going well, you need a lot of drugs to maintain during the operation, and you need to do a lot of examinations, how much does it cost?"

Chen Qi thought for a while, this kind of pancreatic fistula surgery, plus ICU and surgery fees, etc., does not add up to 100,000 yuan, and you want to leave.

If it's a big dog hospital like Mayo, millions of dollars can easily be lost.

It's 1987, and the labor cost is cheap, but your medicine is expensive.

The drugs are all imported, as well as the gaskets that plug the intestinal gaps, artificial omentum and other medical devices, what do you want without 100,000 US dollars?

Even if you use all domestic drugs and transplant the omentum from yourself, it will add up to at least tens of thousands of yuan.

In China in 1987, how many families could get tens of thousands? How many years has it been since the reform and opening up? Is it good to have just eaten full.

When Wang Jiliang heard that he wanted at least so much money, he was stunned all of a sudden, he was a small director, and his monthly income was less than 100 yuan.

"This, so much money, everyone can, you can think of a way."

Chen Qi sneered and laughed, of course, there was no irony, Xiao Young is always more naïve, and there are more ideals than reality.

"How do you think about it? I don't take a penny for the operation of this old black man, but medicine and surgical instruments always cost money, right? Let's not say much, 50,000 yuan, who will pay for this money? Okay, let's have a fundraiser, come, Wang Jiliang, tell me, how much money are you willing to pay? ”

Wang Jiliang's face turned red, and he said firmly:

"I, I'm willing to work a month, and I donate 82 yuan."

Chen Qi nodded:

"82 yuan, a huge amount of money, okay, even if everyone's consciousness is as high, 100 comrades from our Friendship Hospital, each donated 82 yuan, that is only 8200 yuan, the gap is still very huge, what do you say? Don't count on hospitals, our hospitals have no public accounts, no small coffers, and no money.

Okay, even if I, Chen Qi, personally paid out of my own pocket, filled all the gaps, and used all the medicines, it is still a question of whether this old black man's surgery can be successful, and whether the infection and nutrition barriers can be passed is also a question.

We used the method of moral kidnapping to force everyone to donate so much money. We gave all the precious medicine to the old man alone, leaving other patients with no cure, and finally losing the last hope. It's just to rob an old man of a primitive tribe.

Is it worth it? ”

After Chen Qi finished speaking, he paused, looking at the little doctors with a pensive expression, wanting to see how they chose?

Doctors are science students, doctors need to be rational and calm enough, and hospitals don't need doctors who are hot-headed and impulsive.

This is a cruel reality, to save or not to save, how to choose, this tests the wisdom of a doctor.

There is also the degree of ruthlessness.

A doctor who is indifferent and ruthless when he sees death is not a good doctor.

But a doctor who instigates patients to spend more money, spends money all the time, and treats people until they go bankrupt will not be a good doctor either.

Wang Jiliang thought for a long time, and finally sighed.

I saw him take out 2 white-flour steamed buns and a bottle of mineral water from his backpack, and walked over and put them next to the old black man.

"Old man, eat, this is something delicious, maybe this is the last meal of your life, you should walk decently."

"Go decent!"

As soon as these words came out, Chen Qi knew that the young Wang Jiliang had figured it out.

Chen Qi walked over and patted Wang Jiliang on the shoulder:

"When you're in love, let go when it's time to let go, and break up decently. The same is true for treatment and saving lives, you need to consider the patient's prognosis, economic conditions, family wishes, etc., all of which need to be considered comprehensively by our doctors.

If you are terminally ill, then let go when it is time to let go, and let the patient walk decently, which is the best choice. Overtreatment, impractical treatment, and treatment that ruins the patient's family and separates the wife is not the right choice for our doctors. ”

Wang Jiliang was in a very low mood, and returned with a wry smile:

"I understand, thank you, Dean Chen."

The old black man trembled and picked up the white-flour steamed bun, took a bite lightly, then smiled with difficulty, and then waved his hand to let the family carry it away.

In fact, he knew his own situation, his internal organs and intestines were exposed, and it was impossible to survive.

He was satisfied with a bite to eat before he died, and it was something he had never eaten in his life.

Death, in this devil-like turmoil, is not the worst option......