When he entered the operating room, he found that the patient was lying on the operating table.

Instead of the expected supine position, the patient is in a 90-degree position on the left side.

This recumbent position is considered according to the surgical field, location, and the content of the operation. It's not a constant supine position. Even, Zhou Can once saw a manic patient doing general surgery, and was pressed on the operating table by several doctors and forcibly put on a breathing mask to implement anesthesia.

Later, after the operation, the patient was sent back to the ward and tied his hands and feet directly to the bed with gauze.

Prevent him from going berserk and hurting people.

Depending on the needs of the surgery, the doctor will ask the patient to choose a different lying position.

In the operating room, in addition to Zhou Can and Dr. Wu, there are three nurses and an anesthesiologist.

An anesthesiologist is administering anesthesia to a patient.

This preparation is usually done in advance. Nurses will go into the operating room in advance to sort out the items and check whether all the garbage has been disposed of. Then prepare the instruments and drugs needed for the surgery, etc.

"You're anesthetizing him and intubating both chambers, right?"

Zhou Can did not learn professional anesthesia operations. It's just that I've seen a lot, and I can basically guess the anesthesia method of various surgeries.

Then the surgical trainee needs to go to the anesthesiology department for one month.

At that time, I will definitely learn some advanced anesthesia knowledge and specific operation methods.

"Yes!"

The anesthesiologist is a male doctor in his mid-fifties, with a zombie face and never a smile when he speaks.

"Can I help you?"

Zhou Can is interested in the experience points of the two-point placement of the intubation.

As the number of departments he trained continues to increase, his knowledge is also increasing, and he has a clearer understanding of the future direction of medicine.

Minimally invasive, endoscopic surgery is moving from a new trend to the mainstream.

All things are foreseen, and those who are not prepared are wasted.

In addition to practicing traditional surgery, Zhou Can will spare no effort to improve his advanced medical skills as long as he has the opportunity.

"Let's get it!"

Anesthesiologists are really precious words. Coupled with the fact that there is no trace of a smile on his face, it is difficult to get close to.

The official doctor is much more easy-going than this man.

Zhou Can was also not polite, helping with intubation, upper respiratory masks, etc.

The anesthesiologist was also slightly surprised when he saw that he was playing with bronchial intubation, and couldn't help but look at Zhou Can twice.

Without saying anything, the two silently made all the preparations for the patient before anesthesia.

Zhou Can stepped aside.

It didn't take long for Director Xue and Deputy Director Lu to rush to the operating room with the surgical team.

"Yes, the patients are anesthetized!"

Director Xue's personality is quite cheerful, and he praised it with a smile.

Then she began to ask the handwashing nurse to help her put on sterile gloves, check the knife position drawn on the patient's body, and the patient's physical signs, verify that there are no errors, and the operation begins.

"Who did the routine disinfection?"

"Me!"

The patrol nurse replied.

"Next time, remember to expand the scope a little bit. I think you must be a frugal girl in normal times. ”

It was originally a critical sentence, but it came out of Director Xue's mouth, which made people very happy to accept it.

The atmosphere is also very relaxed.

The nurse girl smiled embarrassedly.

"It's best to spread a towel before making an incision, and then extend the right posterior lateral incision."

Director Xue patiently taught his doctors while operating on patients.

Her movements were as steady as ever.

Zhou Can found that the vast majority of doctors in cardiothoracic surgery, as long as they are of a higher level, have inherited the 'steady' of Director Hu Kan's surgical style.

In addition to being steady, Director Xue also has the dexterity unique to a female doctor.

"When making an incision, you must remember that you should not be fast, but layer by layer. The skin layer is cut first, then the subcutaneous tissue layer, and then the muscle layer. At this point, you can see the ribs. Cut off the 5th posterior rib. ”

After speaking, she motioned to Deputy Director Lu to cut off her ribs.

"Then enter the thoracic cavity through the fourth intercostal space for exploration."

None of the thoracotomy surgeries are simple.

Zhou Can stood under the operating table, watching and learning carefully.

The basic skills are practiced, but I have a good surgical foundation. There is still a lot to learn to complete a major surgery like this on your own.

In particular, the surgical skills and precautions are worth studying.

Even if the lobes are removed, the surgical method may be completely different.

This requires the surgeon to be knowledgeable and apply what he has learned in order to be flexible.

"There are three main goals of exploration, to ensure that there is no adhesion between the chest wall and the lungs, no pleural effusion, and the specific location of the tumor on the lung lobe."

Each of the above three is very important.

In the middle and advanced stages of lung cancer, the lung and chest wall are prone to adhesions. At this time, if you want to operate, you must carefully separate them.

In fact, patients who have progressed to this stage have no need for surgery.

Most have already metastasized to cancer.

Conscientious doctors who diagnose that the patient's cancer cells have spread throughout the body, or that they have spread widely, involving multiple organs and tissues in the chest, will generally tell the patient. There is no need to spend a lot of money on healing, what you want to eat and drink, hurry up. Then, in the case of medication, the main thing is to relieve pain and improve the quality of life of patients with advanced cancer as much as possible.

After investigation, this patient was considered very lucky.

There is no adhesion between the lung and the chest wall, there is no pleural effusion, and the posterior segment of the upper lobe of the right lung of the tumor is about 4cm in diameter.

Not particularly big.

No tumors were found in the surrounding organs and tissues.

This is already a very ideal situation.

At the time of surgery, because of the superficial pleural contraction. The tumor is close to the hilum and very close to the upper lobe trachea, which cannot be removed locally.

In addition, the upper mediastinal lymphadenopathy is enlarged and innominate veins are involved, and there is a significant effusion in the pericardium.

It is basically consistent with the results of the examination.

Director Xue performed a right upper lobectomy on the patient to ensure that the cancer cells were removed and no recurrence was avoided.

Looking at the plucked lobes of the lungs, the tumors on them make people feel numb in the scalp.

Even though doctors deal with blood and sepsis every day, when they see cancer, they are still naturally afraid.

It is also a sign of reverence for life.

Only when ordinary people hold a knife around their neck will they feel fear and realize that their lives are threatened.

Doctors know much more about medicine than ordinary people, and they know that human life is fragile.

Even today, cancer is still synonymous with death.

The main reason is that there are no obvious symptoms in the early stage of cancer, and most of the people in China are very frugal and do not like to do physical examinations. As long as cancer is detected, it is basically in the middle and advanced stages.

Developed countries should do a much better job in this regard.

Their cancer mortality rate is low, not because their medical skills are many times better than those of Huaxia, but because they are detected and treated early.

In the early stage of cancer, as long as it is removed and supplemented with radiotherapy and chemotherapy, it can basically achieve a satisfactory curative effect.

It's like a forest fire, when it first burns, it's easy to extinguish.

When its fire grows bigger, it spreads out a long line of fire, and it will be difficult to extinguish it.

Director Xue's skills in removing lung lobes were remembered by Zhou Can.

"The lymph is the body's loyal guard, and when it is attacked by inflammation and cancer cells, it swells. The upper mediastinal lymphadenopathy is swollen in such a way that it must be swept away. This cleaning needs to be thorough, and the pericardial effusion can be treated before the cleaning. ”

Her movements are not fast, but she is steady and organized.

It's like fighting a war.

There is a certain strategy for which part of the enemy to destroy first, which part of the enemy to deal with, and finally to finish.

I saw that after she opened the pericardium, she removed part of the pericardial wall, and then skillfully released the yellow transparent effusion. The mediastinal pleura is then cut in a circular motion.

Lymph nodes in zones 10 and 11 are revealed.

After dissection, the vein in the upper lobe of the right lung is dissected.

There are many application scenarios for incision, and what she performs now is basically incision.

Next, she double-ligated the proximal end of the upper lobe vein and severed it.

Then the pulmonary fissure was opened, and a total of 3 branches of the right pulmonary artery trunk and the upper lobe branch were dissected. It is re-applied according to law, and after double ligation of the proximal end, it is cut off.

The purpose of doing all this is to dissect the bronchial tube in the upper lobe of the right lung.

After the bronchi of the upper lobe of the right lung is dissected, the stump closure is used directly to close the stump.

The operation was just too complicated.

Zhou Can even felt that his head was not enough.

Director Xue is so young, he can fight out of thousands of troops, and he is rated as a senior professional title, and his surgical ability is even stronger than Zhou Can expected.

Of course, her academics may be even better.

This is a super good female doctor.

"Once it is removed, the lymph nodes and mediastinal pleura in zones 1, 2, 3, 4, 7, and 8 can be dissected. Finally, the bloodless venous blood vessel that is involved is removed. The spread and cunning of cancer cells and their concealment are far beyond imagination. If you can't be meticulous during the surgery and let go of the fish, it is easy to recur after surgery. ”

She admonished everyone.

"Once you relapse, it means the end of a life. Patients choose to trust us, so we must also be highly responsible, as if we were doing our own things. ”

Tuya's doctors can basically be promoted to the title of deputy director, and they are all quite excellent in terms of medical ethics.

At least none of the chief physicians that Zhou Can has come into contact with take the lives of patients as child's play.

Finally, the lower lung ligament was opened and the 9-zone lymph nodes were removed. At this point, the operation is complete. After careful examination, if there are no fish that slip through the net, the operation can be ended. ”

The whole operation was successfully completed, and Deputy Director Lu took over the rest of the work.

She sat next to her with a satisfied face and rested.

"Director Lu, can you leave the stitches to me?"

Zhou Can has been watching it for so long, and his hands have long been itchy.

It is impossible for him to get started with those high-risk sweeps and excisions, but he is fully capable of suturing in the finishing work.

And have the confidence to do it well.

"Your level of stitching is no worse than mine, I'll leave it to you."

Deputy Director Lu has seen Zhou Can's suturing surgery, and the level is high enough to beat a group of attending physicians.

"Thank you for your trust!"

Zhou Canmei began to suture the patient.

Deputy Director Lu was also happy to be relaxed, and gave guidance from time to time on the side.

After several hours, the fourth-level surgery was finally over.

It started at 9 o'clock in the morning, and it is now 4:27 in the afternoon.

During this period, everyone did not eat or drink water.

have always insisted on their posts.

Whether it's a doctor or a nurse, it's a very hard job.

"Okay, let's go eat first and rest for a while. About half an hour later, we came back for the next surgery. ”

Director Xue has two major surgeries today.

Neither this cancer patient, nor another patient who had tracheal fistula closure, could not be delayed.

Surgery must be performed as soon as possible.

No matter how hard and tired she is, she has to grit her teeth and persevere.

Therefore, it is too important to train a few successors.

With a competent assistant, the master knife is much easier. Everyone cooperates with each other to maintain energy and physical strength.

The operation just now was basically operated by Director Xue, and she should be the hardest of all of them.

It may also be that he wants to accumulate more surgical experience while he is young, so as to prepare for the promotion of second-level director and first-level director in the future.

It must be explained here that the third-level, second-level, and first-level directors belong to a post level set by a top hospital like Tuya, not a professional title. There are only four professional titles of physicians: resident physician, attending physician, deputy chief physician, and chief physician.

The directors attach more importance to the post level.

Because it is evaluated internally, theoretically speaking, the gold content is also higher.

Why is the status of the attending physician far inferior to that of the deputy chief physician?

It's not that their level is much worse, but because as long as the attending officer passes the exam and has enough years of work, he will be automatically promoted.

The evaluation of deputy senior professional titles is much more difficult.

As for the evaluation of a higher level of senior professional titles, it is many times more difficult than that of deputy senior professional titles. And the current trend seems to be getting harder and harder.

There are reasons for the serious involution, and there are also reasons for the rapid development of Huaxia's medical technology.

Huaxia has been on par with the developed countries in many fields, and even surpassed it, and it is estimated that it will only become more and more difficult to evaluate high professional titles.

Director Xue is so young and has a high rating, and his own efforts are also inseparable.

The operation just now is enough to fully show her surgical ability.

Everyone changed their clothes and walked out of the operating room one after another.

A few doctors came in front of him, and the leader was calm and stable, and his aura was extremely powerful.

It's none other than Director Hu Kan.

followed by Director Le and others.

"Director Hu, Director Le, are you going to do that super difficult surgery?" Xue Yan seemed to know what kind of surgery they were going to do.

"That's right! This is a rare learning opportunity, and you just happened to have the surgery done, so why don't you come with us? ”

Director Le hurriedly answered, because he knew that Director Hu didn't like to talk much.

"There's no way, I still have a major operation today, and it's probably night when I'm done."

Director Xue was helpless.

The workload of each chief physician is very heavy, and he has two major surgeries a day, and he is basically too busy to have time to eat.

Generally speaking, at her level, there will be teaching and research tasks.

That's even busier.

"Looks like you're busy today. It's okay, I will make a teaching video when the time comes, and I will put Director Hu's surgical explanation into it, and you can also have a certain learning effect if you take the time to watch the teaching video. ”

Director Le comforted her.

Female doctors, especially beautiful and temperamental female doctors, are still very popular in the department even if they are in their forties.

Director Le obviously has the intention of showing courtesy to her.

This kind of overture is an instinct of men, and it doesn't have to be an extramarital affair or something.

"Thanks! See you soon! ”

She smiled and waved.

"This Doctor Zhou in your group is very unusual!" Director Le didn't mean to end the conversation right away.

He ...... What's wrong? Is it young and reckless, and words have hit you or other doctors? ”

Director Xue is still very protective of the doctors under him.

Even though Zhou Can had just been working in her group for a few days, he still had a strong desire to shelter him.

"No, no, no. In the morning, he reminded me that the 54-bed heart bypass surgery patient might have taken anticoagulant pain medication. Later, after I checked with the patient before the surgery, the patient had actually taken aspirin five days earlier. Although coagulation screening was done before surgery, no obvious abnormalities were found. ”

Director Le: This is obviously going to praise Zhou Can in front of Director Hu and Director Xue.

For Zhou Can's kind reminder, there is a sense of gratitude in it.

Otherwise, I wouldn't have chosen to talk about it on this occasion.

"If it weren't for his carefulness, neither I, nor the bedside doctor or the attending doctor would have found out about this matter. It's also a safety hazard. As you know, we do some minor surgeries, invasive tests, and as long as the patient's medical history does not suggest a significant coagulation disorder, we will not do a coagulation test. Because screening for coagulation before minor surgery can do more harm than good. ”

The coagulation function was mainly checked by platelet count and procoagulation enzyme.

"With Dr. Zhou's reminder and questioning the patient to confirm that he had indeed taken aspirin, and the interval was very short, there was a potential risk of major bleeding during surgery. So I made preparations to prevent heavy bleeding, including fresh platelets, which are usually rarely prepared, just in case. ”

When Director Le said this, there was a hint of happiness on his face.

"During the operation, the patient's bleeding was significantly higher than normal. Fresh platelets and anticoagulants came in handy to ensure the success of the procedure. Dr. Chow is really, really good. ”

When he said this, Director Le smiled gratefully at Zhou Can.

Surgery is like fighting a war, and being prepared and not being prepared are two different concepts entirely. It is also possible that the ending will be very different.

Director Xue heard that Zhou Can had done a good deed, and she couldn't help but smile with relief.

"Is that 54-bed patient under Zhou Canguan?"

Director Hu Kan, who had not spoken, asked.

"It's not his business. It is the patients of our group. He was able to find problems and plucked up the courage to tell me that he was careful, responsible, and had excellent character. ”

Director Le knew what Director Hu Kan meant by asking.

"Well, it's really very well done! Such a good young man deserves to be vigorously cultivated, and I can take him with me when I have some important surgeries in the future. Director Hu Kan gave a huge compliment.

Being able to follow Director Hu Kan for surgery is definitely a dream of many doctors.

There will be more to learn.

In particular, some advanced surgical skills and methods.

"Thank you, Director Hu! Director Le! ”

Zhou Can was secretly happy in his heart, he had more and more opportunities in cardiothoracic surgery.

The learning experience of these major surgeries will have unimaginable benefits for him to perform separate surgeries in the future.

The rapid growth of surgical ability requires not only talent and diligence, but also opportunity.

Seeing a top expert perform surgery every day is definitely different from watching an ordinary director or attending doctor perform surgery.

(End of chapter)