"Of course, there are no absolutes, and we can't choke on food. Sometimes the cause is clear, the pathological mechanism is not clear, or there are only symptoms, and the cause cannot be found for the time being. At this time, symptomatic treatment can also be a stopgap measure. It can not only alleviate the pain of the patient, but also save the patient's life as much as possible. In the process of practicing medicine, it is important to avoid dogmatism. ”

Director Shang may be worried about teaching Zhou Can as an elm pimple, so he added.

Diagnosis and treatment is an extremely complex process that must be learned.

People who can only be formulaic and rigid are not suitable to be doctors.

Etiology, pathogenesis, syndromes, and symptoms are the understanding and reflection of a disease from different perspectives. This requires doctors to flexibly use several treatment modes such as diagnosis and treatment, disease differentiation and treatment, syndrome differentiation and treatment, and symptomatic treatment.

"Understood!"

Zhou Can nodded in understanding.

He has never been the rigid kind of person.

"Being a regular trainee under me, there are no special requirements. All you need is to maintain a serious and responsible attitude. It would be better if you could take more initiative and diligence on the basis of being serious and responsible. ”

Director Shang's requirements may not seem high, but they are actually quite high.

It is very difficult to be serious and responsible, and it is very difficult to do a good job. Coupled with a sense of initiative and diligence, it is even more difficult. It is equivalent to not only doing the work of the trainees, but also having to deal with the heart of the director.

"You will be given a department login account later, and you can view the patient information of this group at any time. If you have time, you can even check the patient profiles of other groups in the department. If you have any questions, feel free to ask me. ”

This treatment has basically become the standard that Zhou Can can enjoy when he enters the new department.

For ordinary trainees, being able to talk to the chief physician in two sentences is enough to be happy for a long time.

Zhou Can was able to consult the chief physician at any time.

"Then let's talk about your daily work arrangement. For the time being, it is basically normal operations such as checking nursing records, checking examination results, writing cases, prescribing medical orders, and ward rounds. You're now a regular trainee, and you can't compare with those who have just been here for a long time, and you need to take on more work tasks. For example, if a new patient is admitted to the group, it will be randomly assigned to you trainees or excellent interns to manage them individually. ”

Interns generally don't take on much work.

The superiors will not let them take care of the patients alone, mainly for fear of accidents.

After all, most of the interns are fourth-year undergraduate students who have just studied medical theory for four years in school. Medical undergraduates, usually in the fifth year of hospital internship.

Tuya Medical College is one of the top medical universities, and it is interdependent with Tuya Hospital.

Some of its outstanding seniors will be eligible for internships at Tuya Academy.

If you are a little worse, you may get an internship in Tuya Annex II or other hospitals. Basically, the school arranges internship units for students.

The interns have just entered the hospital, and they are basically novices.

Teachers usually don't care much about their interns, and some of them have been interning for a year, and they don't even know what the chief physician looks like. This is not nonsense, but the truth.

Most of the interns are resident doctors, and the total number of inpatients.

Individual excellent can hug the big thick legs of the indicator, and they may also be covered by the indicator.

In short, interns will never be alone in the hospital as soon as they enter the hospital.

Since when?

When your superiors start asking you to write your medical records alone, it's basically a sign that you're ready to manage patients alone.

Zhou Can is a regular trainee, and he has already obtained a medical certificate, so it is necessary to manage patients alone.

However, he has just entered the gastroenterology department, so he has to adapt to it for two days!

There are also disadvantages to being famous.

Director Shang didn't ask him if he could manage the patient at all, and directly arranged it.

And listening to this tone, managing the patient alone is only the most basic operation.

"I have a number of trainees, interns, residents, and attending physicians, and if you want to get more advanced training opportunities, you need to work hard for yourself. Whoever performs well, I will give them more opportunities to grow, fair and just. If you want to have interventional surgery, sit with you, or even participate in projects, you need to perform well. ”

Fair competition is Zhou Can's favorite.

Ordinary interns, regular trainees, and competing with him are basically the result of complete failure.

Resident doctors, it is also difficult to compete with him.

The attending physician is excellent and may be able to confront him.

At least that's the case in almost all departments of surgery. Now that he is in the Department of Internal Medicine, he doesn't dare to say anything big.

After opening the login account of the department, Zhou Can began to honestly check the case information in the group.

By looking at the course of the disease written by others, you can basically deduce the level of that doctor.

"Doctor Zhou, there is a patient who has undergone radical total gastrectomy at bed 71, and Director Shang said that you should be in charge of management."

The nurse girl who greeted him was quite beautiful, with very fair skin and a sweet smile on her face.

"Okay, I'll be right over."

On the first day of work, he assigned patients to him for separate management, and Director Shang estimated that there was also a test of his intentions.

These chief physicians are all old Jianghu.

It is not easy to gain their appreciation.

No matter how famous Zhou Can is in other departments, when he arrives in a new department, or changes the chief physician, if he wants to be trusted and recognized, he must work hard.

In the minds of Director Jia, Liu Lao and others, he already has a very high status.

But when it comes to Director Shang, the treatment is a little better than that of ordinary trainees.

Quickly came to bed No. 71, and Zhou Can saw three family members gathered in front of the bed. A gray-haired old lady, a middle-aged woman who looks somewhat similar to the old lady, and a middle-aged man with a mediocre appearance and extraordinary momentum.

The three family members are dressed with class and taste.

Indicate that the patient's family background should be fine.

But when I got to the hospital, no matter how good my family was, it didn't matter. Everyone is equal in the face of disease.

If it is a malignant tumor, as long as it spreads, even if it is rich and rivals, it will not be able to buy life.

"Hello, I am the 71-bed doctor in charge, my surname is Zhou, if there is any situation during the patient's hospitalization, you can come to the doctor's office at any time. If you have any needs or new progressions in the course of the disease, you can report to me at any time. ”

When Zhou Can had just interned before, he was a little stunned when he saw his family.

Now it's okay, generous and confident, completely no different from those doctors who have worked for many years.

The more you show unconfidence, cringe, and speak without confidence, the more your family will look down on you. This is not conducive to the management and communication of patients during hospitalization.

The family thinks you're an intern and won't tell you anything.

Because he didn't think it would work to talk to an intern.

Therefore, it is usually bypassed by you and directly asked the senior doctor to respond to the situation during their rounds.

The senior doctor will think in his heart, how did the doctor in charge of the bed do it? I can't handle such a trivial matter well, and I have to make trouble when I go through the ward rounds, and my family members come to report to me.

In this way, the senior doctor will have a bad impression of the intern or trainee who is in charge of the bed.

Zhou Can has also suffered many losses, and slowly pondered it thoroughly, and then learned how to handle his family and patients.

"Doctor Zhou, when will your hospital arrange treatment for my father?"

The woman asked politely.

"From the moment our hospital admits the patient, the patient is already being treated. The examinations, as well as the measurement of basic signs during hospitalization, and the selection of various medication regimens, are all necessary preparations before treatment. ”

Zhou Can answered the woman's questions in a row, and picked up the patient's information at any time to check it.

So that you know what to expect.

"He had a total gastrectomy half a year ago, right?"

"That's right! At that time, it was found out that my father unfortunately had stomach cancer, and after evaluation, the entire stomach had to be cut off to save his life. ”

The woman replied.

"After the operation, after my dad eats, the food will turn into liquid and flow directly out of the drainage tube in the abdominal cavity. My dad couldn't eat at all, so he had to make nutritional infusions to stay alive. ”

This patient is really unfortunate.

The total gastrectomy procedure itself can have some adverse effects, as food flows out of the abdominal drain after the procedure, most likely due to anastomosis between the esophagus and jejunum.

"Is it true that the patient developed an esophageal-jejunal anastomotic leak after surgery?"

Zhou Can made inferences based on his own experience.

"Yes, yes, after the doctor's examination, it was said that there was a fistula, and we don't understand these medical jargon. Roughly speaking, there is a problem with the connection between the esophagus and the jejunum. At first, let's observe and look at it for a while, and after two months there is still no change. At that time, we were actually quite angry, which means that the surgery was not done well. We no longer trusted the hospital's technology, so we took my dad to another famous hospital for a second operation. ”

When the woman mentioned this, she was quite sad and indignant.

However, Zhou Can was able to tell her father's illness at that time, which made her feel a little more confident in the medical skills of Tuya Hospital.

Any young doctor in charge of a hospital bed can have such a high level, can the medical level of Tuya Hospital be poor?

She didn't know that the bedside doctor in front of her was one of the best among all the bedside doctors.

Under normal circumstances, there are many surgical skills that have reached the level of deputy director, and pathological diagnosis has reached level 4, but it is impossible for a doctor with this strength to sit in the ward and do behind-the-scenes management.

They will be arranged by the hospital to engage in surgical work and sitting work in the front line.

Any hospital is willing to put excellent doctors at the forefront, so that they can directly face the diseases of various patients, and use their hands to diagnose the causes and pathological mechanisms. For patients who need surgery, doctors with excellent surgical skills will be arranged to perform surgery on the patients.

Those doctors who are relatively ordinary in all aspects, as well as rookies who have worked for a short period of time, will be arranged to do management work in the ward.

Checking beds, changing dressings, following surgeries, writing medical records, and so on.

"After the second surgery, is the problem solved? This kind of esophageal-jejunal anastomotic leakage is actually very tricky, and even if it is a second operation, it is not easy to solve. ”

Zhou Can's surgical experience was learned in digestive surgery.

At that time, Director Jia told him that the total gastric resection operation was not difficult, but the difficult thing was the anastomosis from the esophagus to the jejunum. As soon as something goes wrong, it's going to be tricky.

In addition, the more open abdominal or thoracic surgeries are performed, the more severe the internal adhesions will be.

These valuable surgical experiences are hard to learn from books.

After Zhou Can got the guidance, he kept it in his heart.

Since then, he has had a new concept of surgery. If you can avoid surgery, you will try not to do surgery, and if you can open the chest cavity and abdominal cavity, you will resolutely not open it.

After surgery, the adhesions of organs and tissues in the chest or abdominal cavity are severe, which will definitely have a great impact on the patient.

It's not just about making surgery more difficult later.

"Alas! You've got it all right! After my dad's surgery, not only did the anastomotic leakage persist, but he still couldn't eat, and he also had new problems and it became very difficult to swallow food. Even his own saliva had to be spit out. I can't even drink water. We were all on the verge of collapse. What kind of hospitals are these, and how difficult is it to do an operation? The results get worse every time. ”

When the woman talked about what happened after the second operation, her tone and eyes were full of despair.

Although the other two family members did not speak, their expressions were similar.

With the development of medicine today, many technical problems have been solved, and even kidney transplantation, liver, lung, heart and other important organs can be transplanted.

Even head transplants have been successfully experimented abroad.

But there are still many things that medicine can't solve.

The doctors were helpless about it.

In the nearly two years that Zhou Can has been in Tuya Guipei, there are too many cases that cannot be solved by medicine.

Some patients can really only watch them die, and there is no way to do it.

What impressed him the most was a very young female patient, her child was only six months old, but she was already in the advanced stage of breast cancer. In the intensive care unit, she tearfully begged the doctors to let her live a few more months because she wanted to hear her children call her mommy.

But despite the best efforts of the doctors, they were unable to stop the frantic spread of cancer cells and the damage to her body.

In the later stage, cancer cells will not only destroy the body's immune system, but also cause damage and failure of organs.

In the end, the young mother did not wait for the day when her child learned to call Mommy, and on a gloomy morning, she left this wonderful but suffering world with endless regrets.

At that time, Zhou Can, a big man, was also very uncomfortable when he saw that scene.

If medicine could advance a little further, I believe that the mother of that child would definitely want to live longer. She wanted to hear the child call her mother, and she wanted to see what the child would look like when he grew up.

If you can, you can even hope to be able to watch your children get married and watch your children have children.

But she couldn't see it anymore, and closed her eyes forever.

The patient in front of him is in his sixties, and his life is not short.

At least his children have grown up and are married.

However, ants are still greedy for life, let alone human beings, who are the spirits of all things!

If they live, no one wants to die easily.

"After the patient's second operation, did he have esophageal-jejunal anastomotic stenosis?" Zhou Can saw her sad expression at this time, but he was actually a little unbearable to ask.

"Hmmm! You're absolutely right. ”

She bit her lip and nodded vigorously.

"Doctor, do you think my dad's illness can be cured?"

After two failed surgeries, each one getting worse and worse, she had lost faith in the surgery.

Just looking at her father's painful appearance, she was like a moth to a fire, and wanted to try again.

"You have to look at the results of the examination to know. I guess the surgery will be very difficult. Because after such a long time, the patient's anastomosis is likely to have been formed. He can't even drink water now, I'm just speculating, don't mind if he's wrong. I speculate that the patient's anastomosis may be completely blocked. Just like two hollow steel pipes, when welding against each other, the welded parts of the two steel pipes may eventually change from hollow to solid due to improper operation of the welder, or other reasons. ”

In order to make the family better understand, Zhou Can also made an analogy.

"You're right again. That's what the doctor said after an examination at the local hospital. Originally, I was going to have esophageal dilation surgery to solve the problem of not being able to eat, but after examination, it was found that the anastomosis was completely occluded, and the doctor at the local hospital shook his head and sighed and told us that there was no way to do the operation again. ”

The woman's face was full of bitterness, more helplessness and deep despair.

Family members sometimes don't take the initiative to tell the doctor everything that happened, including which hospital they saw and what the results were.

They have all sorts of ideas.

For example, I am worried that telling the doctor that I have seen it in another hospital and then come here for treatment will make the doctor unhappy. Or maybe you want to hear what the doctor at this new hospital has to say.

It is also possible to understand the strength of this hospital.

Zhou Can was right every time, which made the woman and the other two family members have unprecedented confidence in Tuya Hospital.

"Director Shang's willingness to admit patients shows that it has not yet reached the worst level. Will definitely find a way to give it a try. You don't have to despair too much, as long as there is a glimmer of hope, there will be endless possibilities. ”

Zhou Can comforted the family and patients so that they would not lose confidence in treatment.

This is very important.

"His examination data is very small, and his medical history is not as comprehensive as you described, are the data of examinations and surgeries done in other hospitals still there?"

Zhou Can roughly looked at the patient's examination data and felt that this was far from enough.

Because this patient's condition is very complicated right now.

There is both esophageal to jejunal anastomotic fistula and anastomotic occlusion.

The local hospital that the woman said will definitely not be a small hospital, at least it is a medium-sized tertiary hospital.

If the doctors in that hospital didn't even dare to do the operation, it means that the problem is very serious.

The surgery can also be surprisingly difficult.

The risks of surgery are also very high.

"The inspection materials are all there. I'm worried that I'll need all the information for your medical treatment, so I just brought it all with me and put it in my car. If needed, I'll go to the underground garage and get it right away. ”

She consulted Zhou Can's opinion.

"Bring them all! I guess Director Shang will be able to use it when discussing your father's condition. ”

Zhou Can knew in his heart that Director Shang probably wanted him to be the main force in diagnosing and treating this patient.

(End of chapter)