"Rest early, little money. You're a high school student right now, and you're going to morning tomorrow. I should wake up at 6:10, right? At eleven o'clock in the evening, when Fang Xian was chatting with his uncle Fang Yun and his parents, he urged Fang to pray for peace.

Fang Qi'an replied with a smile: "Brother Xian, when you used to be in high school, you probably got up at 6:10, and the first class we read in the morning was already advanced to 6 o'clock, and then there were two early self-study and breakfast. ”

"When I get up at 6:10, our homeroom teacher is going crazy."

After speaking, he rubbed his hands and blew the shell of the peanut rice and threw it into his mouth.

Fang Xian was slightly stunned: "Uncle Yun, now that Fang Qi'an is in high school, are they all going to start rolling like this?" ”

Fang Yun touched his earlobe at the moment, and looked at Fang Qi'an with a little pampering: "Actually, the pressure on them to go to college is not great, and now the enrollment rate of high school students and universities across the country is almost equal." ”

"It's just that parents nowadays are paying more and more attention to education, and if they want to be admitted to better colleges and universities, they are getting more and more papers."

"In last year's college entrance examination, we had a 5-point score segment in Hunan Province, and there were dozens of people above 670, and then there were hundreds of people in the next 5-point score segment, with a score higher than 600, a total of more than 20,000 people......"

"It's long different from our era when educational resources were extremely scarce."

Fang Qi'an was the youngest, and it was a critical period in high school, so the focus of the discussion was on him.

"Then why don't you hurry up and rest? Brother I can't run, you will have a holiday tomorrow afternoon, I will take you out to play if I have time. ”

"Go to bed quickly, ensure sleep, is the premise of learning."

Fang Qi'an's back head seemed to protrude, rubbed another peanut, and looked at Fang Xian: "My mother said that Brother Xian, you slept later than me, and slept less......"

"You're all master's students." Fang Qi'an blinked.

"Me!" Fang Xian raised his hand and wanted to hit someone.

Fang Qi'an stood up with a smile and sat down on the sofa opposite.

When Fang Qian and Chen Hui heard this, they turned their heads to look at Fang Xian, yes, although their son has made some achievements now, the efforts he has made are rarely reported to the family.

According to Fang Qi'an's calculations, Fang Xian was probably studying with an overdraft body before.

The gaze of the two changed slightly. Chen Hui even touched Fang Xian's arm, as if she was looking to see if Fang Xian had become thinner.

"Go to sleep, children still have to grow their bodies, boys don't close until they are twenty years old, if you want to grow as tall as your idle brother in the future, you have to ensure sleep time."

"Otherwise, you are now short, and you can't compare to your idle brother." Fang Yun is worthy of being Fang Qi'an's father, and he found a killer feature at once.

Fang Qi'an immediately got up and went to brush his teeth and wash up.

Without him, there is an empty room in these four bedrooms and one living room, which is Fang Qi'an's permanent residence, and it is estimated that he will rest here today.

"This kid has been with Fang Xian since he was a child." Fang Yun couldn't cry or laugh.

Fang Qian and Chen Hui laughed.

Fang Xian replied with a smile: "Uncle Yun, are you still jealous?" ”

Fang Yun shook his head, and said in a gloomy tone: "The main thing is that I spend too little time with him, after your aunt goes to work in Shashi, the only person who can play with him in his childhood is you......"

The topic suddenly seemed to be not quite right.

Fang Xian hurriedly changed the topic: "When I was a child, I often only played with Uncle Yun, and you were a professor at that time......

……

Nothing was said all night.

The next morning, when Fang Xian woke up, it was already 6:50.

Fang Qi'an had already left, and the family had put milk and bread in the refrigerator in advance, as well as cooked porridge, and after he heated it in the microwave himself, he ate it as breakfast with milk.

Today is Sunday, and Fang Qian and Chen Hui are still asleep.

Fang Xian sent a message to his parents and went out to eat powder.

Shashi is flat powder, Changshi's rice noodles are round powder, the taste has its own merits, but Fang Xian grew up in Changchang since he was a child, the beef jerky mixed powder here, and then add shredded potatoes, such a taste, as if engraved in the bones.

Still want to.

However, the parents' sleepiness didn't seem to be great, and after Fang Xian sent a message, his mother walked out in her pajamas: "Why are you getting up so early?" I thought you were going to work at eight o'clock. ”

She rubbed her eyes.

"Mom, it's the working hours of the specialty, in the operating room of the trauma center, it will be earlier, it doesn't matter, you and Dad continue to catch up on sleep, it's finally the weekend."

"I'm here to learn from Uncle Yun, so naturally I have to learn more things earlier, it will be beneficial."

"Didn't you say last night, the stronger your ability, the more money you can earn every year, and the more comfortable you will definitely be in the future." Fang Xian replied.

Chen Hui said with a slightly hesitant face: "Idle boy, pay attention to your body, although your parents don't have much ability, they have also prepared some money for you." ”

Fang Xian is no longer the age of a junior and senior high school student, and his braincase turned around a little and replied: "Giggles, you just say that, when I went back to my hometown for the New Year this year, I also said it at my grandmother's house." ”

"I have provided for a graduate student's child, and I don't have the ability, and I bought a house in Changshi, and I don't have much ability."

"Look at what my uncle said about you......"

"How capable my mother is, the old Chen family relies on her to glorify Zongyao!"

Fang Xian said and immediately shut up, because Chen Hui had already copied the sole plate. Fang Xian went out immediately.

"Mom, I'm out for breakfast."

"You and my dad are very capable, at least you can train me so well."

"Gone."

"This kid ......" When Fang Xian closed the door, he could only hear Chen Hui muttering.

Fang Xian touched his chin and began to wait for the elevator.

At the same time, he took out his mobile phone and asked, "Uncle Yun, do you prefer soup noodles or dry noodles like me?" I can ask the boss to pack the spices and soup base......"

Fang Xian knew that his workaholic Uncle Fang Yun must have risen at this point.

"Let's mix the noodles, add a yard of beef, I'm about to call the boss to send it to the department. But if you happen to be on the way, you can bring it. ”

"You came at the right time, I went to the general surgery department to ask you for an appendectomy, such an emergency operation is quite rare in our hospital nowadays, if you are interested in gastrointestinal surgery, starting from this minor operation, it is also quite good."

"Let's first understand the normal shape of the patient's intestinal tract in the non-destructive state......

"Ho Yun will transfer thirty yuan to you."

Hoe Yun is Fang Yun's WeChat name, Fang Xian asked Fang Yun why he took this name, Fang Yun said that when he was in junior high school, when he went to the ground to hoe, what he wanted to see most was that there were clouds to cover the sun, and the day would be better.

"Uncle Yun, you are too out-of-this, your eldest nephew's annual salary is also quite a lot now, I put it in Yu Bao, and almost all the breakfast money has come out." Fang Xian played around and returned the money.

Fang Xian really doesn't have many investment channels, although the current income of Yu Yu Bao is less than 1/10,000, but he can't bear Fang Xian's much.

Before signing the contract, it was 50+, but now after signing the contract, the tension is almost 50+, more than 100 yuan a day.

Fang Xian clicked on the transfer to return.

"Forgotten. Okay. Fang Yun was also more casual.

"Come early after eating, don't let the patient wait, the operation is on time at half past seven, you can't get to the operating room at seven thirty, I won't arrange for the patient to wait for you." With the next sentence, Fang Yun incarnated as Director Fang and Professor Amplification.

"Seven fifteen, I'll be there!" Fang Xian also solemnly replied.

Make the patient wait, that's impossible.

Although appendectomy is relatively simple, it can be painful. Although pain can be avoided after anesthesia, the extension of anesthesia time is also a kind of harm to the patient.

Fang Xian quickened his pace and sped up his pace of eating breakfast.

It was really at 7:14, and the powder was finished, and the boss also worked hard to pack the powder.

Fang Xian immediately rushed to the hospital and went to the ward of the trauma center.

After sending it off, Fang Xian said, "Uncle Yun, I won't delay time." ”

"Where is the patient in the operating room? Is there an operating room in Building 1? ”

"No, the patient is in the operating room of our trauma center, and I arranged for the patient to come directly. After you've done the surgery, remember to have the patient take to the general surgery ward. ”

"You are an assistant today, Huang Qian."

"If you have an accident, Huang Qian can still give you a cover." Fang Yun took the powder brought by Fang Yun, and explained while opening it.

Fang Xian was stunned when he heard this, and said, "Uncle Yun, it should be no problem." ”

Fang Yun buried his head and went to eat powder first.

Fang Xian asked the patient again in the operating room, and immediately rushed to the direction of the operating room.

Appendicitis resection, this operation is too simple, so that you don't need Brother Huang Qian to cover himself-

Fang Xian looked at his skill panel.

Appendectomy grade 3.

This is a pure specialist basic skill, which is a fusion of incision and appendicitis theory. And then there is the figure-of-eight suture, and the packing and the like are also closely related to suturing.

Appendectomy, even if Fang Xian has never operated it, he was done to level 3 under the strong basic theory and high-level medical basic skills.

Grade 3 appendectomy, Huang Qian is almost at this level.

This appendectomy, if you add a little more, it will not be very meaningful.

While walking, Fang Xian was grinding appendicitis on the side.

Appendicitis is not fatal, and even if the operation is poor, at most it is a re-infection of the incision, resulting in secondary peritonitis and re-inflammation or perforation of the appendix stump.

The sutured surgical wound became ugly and horrible.

Such a complication, in fact, is acceptable.

Even if appendectomy is cut out, it is not very beneficial to the patient.

After an attack of appendicitis, the main purpose of treatment is to relieve pain, eliminate inflammation and avoid recurrence.

This is the fate of the treatment of this disease, and it is also related to the symptoms of this disease, the outcome of the disease, and the original development of the disease.

Fang Xian walked away, while still thinking, does this appendectomy need to be done laparoscopically?

Or what about making a small incision?

At this point, let's wait until you enter the operating room and see the relevant age of the patient.

If it is a sixty or seventy-year-old appendicitis, laparoscopy does not make much sense, and there is no need to make a big opening for appendicitis, that is, about two centimeters is enough.

At 7:24, Fang Xian came to the 9 operating rooms of the trauma center.

The patient has been anesthetized and is treated with an epidural.

However, in fact, Fang Xian himself can do it through local anesthesia, and his current puncture surgery, with a particularly precise local anesthesia, can also be properly completed, and the standard of puncture that can be pierced by level 5 puncture is not covered.

However, the choice of anesthesia method is the job of the anesthesiologist, and you should not point fingers yourself.

The patient had a CT scan before the operation, as well as an emergency medical record.

After Fang Xian looked at it, he determined that this was a sixty-three-year-old elderly man who suddenly had metastatic pain in his right lower abdomen this morning, and was rushed to the hospital by his family to be admitted to the emergency department of the hospital.

Although the physical examination takes into account the tenderness and rebound tenderness of McT's point, at such an age, who can guarantee that he will not have intestinal obstruction on top of appendicitis?

In fact, it is a good choice to do a color ultrasound.

However, the patient also had a history of gallstones before, and in order to facilitate the examination, the patient's family chose CT, which can also be reimbursed......

In the operating room, Huang Qian has been in place, and has read other medical records, and is now reading films.

"Dr. Fang, it's simple appendicitis, it's relatively simple. The location of the appendix is posterior. The medial cecum is located with the tip pointing to the anterior ileum at 1 o'clock clockwise, and although it is uncommon, it is not difficult to manage. ”

"Do you have a laparoscopy?" Huang Qian asked.

The main knife arranged by Fang Yun is Fang Xian, so the choice is also in Fang Xian.

"What is the procedure for talking to the patient's family before the surgery?" Fang Xian asked, and then took out the informed consent form for surgery.

Huang Qian is very professional and knows that the diagnosis of appendicitis should be classified first, such as simple appendicitis and periappendiceal abscess.

The location of the appendix is also beneficial to the choice of surgery and whether the operation process is smooth.

His son said it was all right. Doctor Fang, just look at it. Huang Qian replied, but still confirmed that the operation of this patient was relatively simple.

"Let's just make a traditional incision, I'm too lazy to make two cuts." Fang Xian said, glancing at the informed consent form for surgery, which said that it was appendectomy (preparation for laparoscopic appendectomy).

It's still more rigorous, that is, more choices are put in the hospital.

The laparoscope requires an operating hole and a visual field hole, and each hole also requires about a centimeter. Fang Xian was too lazy to prolong the operation time.

The laparoscopic operation will be slower to a certain extent.

Before officially taking the stage, Fang Xian took another look at the CT. In order to personally guarantee the correctness of the operation-

Well?

Where is it?

And this look, Fang Xian was about to go out to wash his hands, and he didn't move anymore.

"Brother Qian, have you talked to the patient's family? Who is it? Fang Xian asked.

"O son and daughter-in-law! ~" Huang Qian replied without suspicion.

Fang Xian narrowed his eyes and looked at the CT seriously, but after reading it carefully, Fang Xian sighed again in his heart and didn't say anything.

Klinefelter syndrome is also known as congenital seminiferous hypoplasia syndrome! 47, XXY syndrome!

Can he have children?

However, such a big melon will not be eaten, or the patients themselves will know about it. Maybe you don't know, who knows!

However, the real clinical practice is much more interesting than the operating room.

The patient came for appendicitis treatment, not for 47,XXY syndrome, nor for paternity testing.

Fang Xian felt that sometimes the level was too high, especially the level of film reading, which was not a good thing.

Soon, Fang Xian and Huang Qian were fully armed-

"Instrument teacher, give a round knife and prepare an electric knife!" Fang Xian was still quite polite.

The operation is not difficult, and he will not be humble with Huang Qian.

Completing a complete operation is the only way for every surgeon. He has now obtained the title of a first-level physician, and after being recognized by the medical association, all first-level operations can be carried out routinely.

This is an authorization granted by the Medical Society.

"Give! Dr. Fang. "The instrument nurse is not very old, and the standard posture handed the back of the knife to Fang Xian.

It's just the sound of talking, a little bit abnormal.

After Fang Xian captured this, he looked up and found that the eyebrows of the instrument nurse were very marked, and a little light makeup was applied near the eyes, and she painted the lying silkworm very well, and it was difficult to distinguish the real from the fake.

Fang Xian didn't pay much attention.

The traditional right lower quadrant incision or transverse incision and low median incision were taken, and the skin and subcutaneous tissues were cut layer by layer to separate the external oblique muscle......

This part of the operation, until now, is still the category of incision, which is the basic operation of medicine.

However, the slight difference is that incision and appendectomy need to be organically integrated with the associated anatomy.

However, although Fang Xian shouted that the instrument nurse had prepared an electric knife, he did not use an electric knife, but cut it with a round knife, and did not break the superficial fascia layer under the skin.

However, Fang Xian used the blunt penetration of the incision to reach the muscle layer, which is a belief in his own incision.

Fang Xian quickly separated the internal oblique muscle and the transverse abdominis aponeurosis through the muscle space, and exposed the peritoneum!

After the two hemostats were clamped at the same time, when Huang Qian was still using the retractor to expose his vision, Fang Xian had already broken the peritoneum again with a sharp knife, and he had just used the hemostat to clamp the peritoneum, which was actually a small skill that was flexibly applied to hemostasis.

Didn't say much.

There was no teaching to Huang Qian, just to make the operation go smoothly.

However, even with this simple appendectomy, Fang Xian's operation of directly breaking the peritoneum in less than a minute still made Huang Qian dumbfounded.

This speed is simply too fast, and this level 5 incision technique is too easy to use, right?

Fang Xian used two drawbars to grab the middle part of the incision, and handed it to Huang Qian.

Use your finger to insert a 2 cm incision into the abdominal cavity.

At this time, the level 5 medical basic physical examination kung fu is reflected.

Physical examination, in fact, is about probing, touching, touching and pressing.

Level 1 medical routine physical examination is to be able to complete the basic physical examination content required by the undergraduate degree.

Level 2 medical routine physical examination requires some more professional content, for example, when auscultating the lungs and heart, you need to hear some unconventional sounds, such as galloping rhythm, heart friction rub and other subtle content.

In various specialty fields, the content of the specialist physical examination can be completed relatively completely, such as the visual touch volume of orthopedics......

Level 3 medical routine physical examination is more considerate of a person's hard work.

Through the pressing of the body surface, the exploration of the fingertips, and the basic theories of medicine, and even through the touch of the fingertips, you can know whether there is an infection inside, or what kind of tissue you touch, different tissues, and what kind of feel it feels.

Fang Xian also confirmed these when he was dissecting the corpse of Professor Gui Yuanping.

Level 4 medical routine physical examination, even subtle changes in arteriovenous blood flow can be felt, such as blood turbulence in the arteries at some body surface locations, and the different frequencies that hit the artery wall, subtle changes can be perceived.

This is the foundation of many professors of internal medicine.

And the level 5 medical routine physical examination, the mystery is even more difficult to explain.

This is the most basic operation to find the colon belt and colon pouch with the fingertips.

There was no need to look at it, Fang Xian just slid his hand down, found the location of the appendix, and took it out......

"Huh! ~"Huang Qian only had time to pronounce a syllable of one word.

Fang Xian didn't give himself a chance to pretend to be forced at all, so he continued to operate.

(End of chapter)