"Orthopedic surgery generally rarely studies urological cases. Doesn't this patient have pain in his right waist and lower limb? Has his pelvis been checked?"
Li Jingsheng feels that starting from pain, we should be able to make some different discoveries.
"I haven't checked it out! It's not very related to the pelvis. It's probably the pain caused by the compression caused by the enlargement of the kidneys. I've encountered many cases of this kind of situation in clinical practice."
Dr. Tan Shuilin has his own opinion.
Doctors prescribe examinations based on their own diagnostic ideas.
Only those examinations that are of reference value and diagnostic significance will be applied to patients.
Regardless of the ins and outs, he directly prescribes a lot of examinations based on formulas. Either he is a novice doctor, or he has a problem with his medical ethics, or he has set task targets and failed to complete them.
The two of them had arrived at the ward while they were talking.
Since it was already past midnight, the lights in the ward had already been turned off, and the patients and their accompanying family members were already resting.
"37 beds Chen Guixiang!"
"Dr. Tan, are you going to give me an examination or an injection?"
The patient is less than 40 years old, and may have very light sleep due to physical ailments.
As soon as they entered the ward, the female patient woke up.
Her husband was resting on the edge of the bed.
In fact, the accompanying bed next to the hospital bed can be pulled out as long as you scan the QR code and pay the fee.
The accompanying bed in the second hospital is 15 yuan/night.
The family may not know that this service exists, or they may not be willing to spend the money.
Seeing the doctor coming, her husband quickly stood up and got out of the way.
"Let's check you out! How do you feel now?"
"After you helped me take the medicine, I stopped vomiting, but my stomach is still very bloated, and my right leg and buttocks all hurt. It's like pins and needles."
The female patient showed obvious shortness of breath when speaking.
It seems her lung infection is not under control!
Li Jingsheng's intra-breath diagnosis level is considered to be very high. Just by standing nearby and listening, he can know the condition of her lungs.
"Can you lie on your side? Let me check your pelvis and leg bones!"
Li Jingsheng knew there was no way to convince Dr. Tan Shuilin to prescribe a pelvic examination for the patient.
You can try the bone touching technique now.
"Husband, help me turn over."
There should be no big problem for a woman to turn over, but enlarged kidneys in her waist will cause her pain and discomfort.
The male family member came over to help her turn over and lie on her side.
It can be seen that she looked in pain when she turned over.
"If it hurts during the examination, just remind me."
If Li Jingsheng hadn't seen the patient's husband who was an honest man, he would not have dared to perform this bone examination on her.
The examination began quickly. Li Jingsheng first touched the side of the patient's pelvis.
The bones of the hip are easiest to feel.
"How long have you been feeling pain on your right side?"
"It's been almost a month!"
"Did you have any slight pain a month ago?"
As soon as Li Jingsheng touched it, he immediately noticed that there was something wrong with her pelvis.
He had a deep memory of the feeling like a dead tree. It was undoubtedly a malignant tumor in the bone.
"It seems to be true! It may have been a long time ago. In the past, it only hurt occasionally, and it would get better soon. And it's not as painful as it is now."
The female patient said after recalling carefully.
"Let me look at your leg bones again!"
Li Jingsheng did not touch her hip joint, but skipped directly and touched the patient's kneecap and femoral head.
Still the same dead wood and bones.
"Okay, the examination is ready. Dr. Tan will let your husband know the results later. You should have a good rest!"
Li Jingsheng motioned to Dr. Tan to speak outside.
Tan Shuilin looked at him and didn't do much examination. He just touched the patient's hip, knee and part of the femur.
Is the inspection over so soon?
Dr. Li said he was here to gain knowledge, but it seemed a bit like he was just watching the show!
After the two walked out of the ward, Li Jingsheng had basically sorted out the diagnostic ideas in his mind.
"Dr. Tan, I suggest you immediately apply for a pelvic and femoral examination on this patient. It is likely to be a malignant tumor."
Just when Dr. Tan Shuilin felt that the doctor named Li was superficial and not at all practical, Li Jingsheng spoke.
"Malignant tumor?"
Tan Shuilin was stunned.
"It shouldn't be possible, right?"
It was hard for him to believe the result.
Moreover, Li Jingsheng's entire stay in the ward took no more than three minutes, and the examinations he performed were very limited.
"It's very simple, just check it out. The patient's pain is neither pain caused by kidney compression nor sciatica, but cancer pain. I suspect that there may have been spread of malignant tumors in her lungs. It is even possible that the original The lesions were in the lungs and slowly spread to the kidneys, pelvis and other places."
Li Jingsheng was not too sure about this.
But when he felt that the patient's bones looked like dead wood, he then thought of the unexplained severe pain in the patient's right hip and lower limbs, as well as lung infection, enlarged kidneys, etc. All of these, when combined, suggested the possibility of cancer. Extremely high sex.
"This... Doctor Li, first of all, thank you for coming to consult on this case late at night, but you said the patient had a malignant tumor, which surprised me. I will report the situation to the superior doctor tomorrow and see if I can apply to the patient according to your wishes. A pelvic X-ray examination. If you can write down the general diagnosis idea, it will be easier for me to report to the superior doctor! Is it convenient for you to see? "
Tan Shuilin felt that this young doctor from the orthopedic surgery department was simply fooling around.
A doctor's diagnosis is not a child's play.
If you suspect it's a malignant tumor, you can't confirm it just by touching it with your hands, right?
"No problem, I'll lend you some paper and pen."
Li Jingsheng readily agreed.
I roughly wrote down my diagnostic ideas.
"I strongly recommend that patients get a pelvic X-ray as soon as possible, preferably a lung CT or MRI."
"The lungs have been checked once, and it is currently confirmed to be a lung infection. He is already being treated with anti-infective drugs."
Dr. Tan Shuilin really wanted to roll his eyes when he heard this.
Lung CT or even MRI examination, do you just do it as you say?
A lung CT costs more than 200 yuan, which is a very expensive price for families in need.
It is even more unnecessary to think about MRI, as the patient's family will not agree at all.
Moreover, the patient has been hospitalized for almost four days, and his condition has not improved significantly. His trust in the doctors of the Second Hospital is declining.
He smelled a trace of alcohol coming from Li Jingsheng when he spoke, and seriously suspected that the orthopedic surgeon was drunk and went to the hospital in the middle of the night to show off his presence.
"Let me write down my phone number too! I won't be at work tomorrow. When you report to your superior doctor, if you have any questions, you can call me at any time."
Li Jingsheng is a steady person.
After thinking about it, I wrote my personal mobile phone number at the back.
"Sorry to bother you, Dr. Tan. Goodbye!"
Li Jingsheng was relieved that he had diagnosed both difficult cases.
Since it was already late at night, it was not easy to get a taxi on the road.
He didn't even consider it at the entrance of the hospital.
The fare, which usually costs up to ten yuan, was quoted at fifty yuan. It's less than three kilometers away, and it only takes about thirty minutes to walk.
As luck would have it, a regular Volkswagen Bora slowed down next to him.
"Take a taxi?"
The driver is a man in his late thirties.
“How much does it cost to go to Chengnan Old Street?”
"I'll charge you ten yuan, okay?"
"Brother, a taxi usually costs eight yuan."
Li Jingsheng opened the car door and got in.
"Eight yuan is eight yuan, but as you said, that's normal time. What time is it now? Just treat it as two more yuan to buy me cigarettes!"
"Haha, brother is right."
Li Jingsheng happened to have some change in his pocket and took out a ten-dollar note.
Now the daily income is more than 10,000 yuan stably, the facade issue has been successfully solved, and it is quite stable after moving to the new location. Naturally, he wouldn't care about the two yuan fare.
"Oh, it's hard to make money now! I used to be a white-collar worker in a big company. I was promoted all the way to the position of supervisor. My monthly income was no less than 10,000 yuan. When I was high, I got nearly 30,000 yuan. Last year, when the company was upgraded, They kicked me out, the capitalists are so fucking ruthless. I have worked hard for the company for many years, and even if they cut my salary a little, they fired me directly. You can say it’s heartbreaking or not.”
The eldest brother was afraid that he had finally caught someone who was complaining, so he told Li Jingsheng his unfortunate experience.
"Then I should pay you a sum of money, right?"
"You have to pay for it! My current bosses are better than each other. They make me wear small shoes every day, find faults, and then fine me and deduct money. Last month I had to pay 8 yuan to the company for working. Do you think I can still stay here?" ?”
"Did you resign on your own initiative?"
"Yes, I got the pay stub and slapped it directly on the boss's face. I quit. Because of this, I also paid 3,000 yuan in medical expenses."
The driver brother is really a tough guy.
That slap hit the boss on the face, I'm afraid it was not done lightly.
"Young man, as someone who has been there, I would like to advise you that you must save more money when you are young and not have too much debt. Because you never know whether you can get that high salary next month. I have learned this lesson hard. Now I can only earn some money through online ride-hailing services. The mortgage loan, decoration loan, and car loan are all over 18,000 yuan a month. Fortunately, I sold the BMW X1 last month, and the car loan is gone. .”
With a loan of nearly 20,000 yuan a month, this big brother is really a cruel person.
Thirty thousand a month, it will take more time to get this amount. After deducting personal tax, there is only more than 26,000 left.
Then according to the minimum social security contribution, an individual must pay at least more than 600.
Including medical insurance and other things, you can get more than 25,000.
If you can maintain this level of income every month, there's no problem.
Otherwise, unless his wife can have a higher income to make up for this gap.
"Why should I buy a BMW when I owe money for the mortgage and decoration loans?"
Li Jingsheng asked.
"It saves face! At that time, I thought, I am the director of the company, and I can be regarded as a middle-level manager. What will it be like to drive a scooter? So I gritted my teeth and took out a loan to buy a BMW. I shed tears even if I talk too much. Let me tell you, don’t take out a loan to buy a car. It’s full of pitfalls. I paid off the loan for more than a year, and I couldn’t bear it last month. When I disposed of the BMW car, I still had to find two more to buy it. More than a thousand yuan.
The car dealer saw that I was pitiful and the car was in decent condition, so he said forget it. "
Second-hand car dealers will strip every layer of their skin even if their own father is gone, and they will definitely lower the price to death when they take delivery of the car!
But buying a car with a loan is a bit tricky.
It would be even worse if you encounter a shady credit company.
Li Jingsheng also experienced the days of debt, and it was hard to look back on the past. Let him take out a loan to buy a luxury car just to save face, without even thinking about it.
Even if I beat him to death, he wouldn't do such a stupid thing.
After the driver dropped him off, he paid him ten yuan for the fare.
Watching the driver drive away, Li Jingsheng shook his head. Life is full of ups and downs, so just get over it.
It only took less than three months for him to get out of the trough and reach his current achievements.
These three months of hard work and good luck changed his destiny and allowed him to stand up again.
I silently wish that the driver brother can get out of the trough of life as soon as possible.
After returning to the clinic, he quickly fell asleep.
No more sleeping in that small, stuffy attic.
There are so many rooms now, and any one you find will be a very spacious bedroom.
…
When he woke up the next day, it was already around 8:40 in the morning.
There are steamed buns and soy milk at the door, packed in plastic bags and placed on the window.
The phone received several text messages.
Tang Ping bought him buns and soy milk. She knew that Li Jingsheng was sometimes too busy to go out and buy breakfast, so she brought him one.
She didn't call him to wake him up so late, which showed that she sympathized with his hard work and deliberately let him sleep a little longer.
Ou Qinglan also sent him a WeChat message, saying that she was coming to see Li Jingsheng after get off work tonight.
I guess this little girl misses him.
A man and a woman in love are like three autumns apart if they don't see each other for one day.
I originally wanted to invite her to come over for dinner last night, but she didn't want to come because of social fear.
The two didn't see each other for a day.
It must have been another busy day for the two of them during the day.
I sent her a message back and then went to the bathroom.
I quickly brushed my teeth and washed my face. After eating breakfast, I hurried to the reception hall downstairs to work.
Arriving at the reception hall, patients are treated in an orderly manner.
"Boss, these patients are waiting for you to come and handle them personally. Siying has already taken the temperature, heart rate, etc. of some patients. The medicine sales side is busy, so she ran over to help."
Now that medicines are sold on shelves, it will be much more convenient for regular customers to buy medicines.
New customers need to be explained and get membership cards for them, which is time-consuming.
The charging is quite convenient, and it is now more intelligent.
And Tang Ping can also support.
Li Jingsheng began to consult patients one by one.
"Dr. Li, I came here specifically for you. My old father broke his leg. I asked several hospitals in my hometown for surgery. The surgery you performed on my wife's wrist last time was particularly good. This time I came here specially. Take a look."
Judging from the accent, he should be from around Jiangli City, not too far away.
The old man who broke his leg was sitting in a wheelchair, humming and showing pain on his face.
They had filmed it at a local hospital.
Li Jingsheng took the film and checked it. He found that the tibia of his leg was fractured, which was not difficult to treat.
The patient's age is actually not as old as expected, only 56 years old. At this age, he is considered young and middle-aged.
"Didn't you get any treatment at the local hospital?"
"I heard that I was going to have an operation, and I happened to know that your bone-setting techniques are very good, so I rushed back that night to take my dad over."
"Thank you for your trust in me. I'll check him first. Judging from the film, the tibia fracture is quite serious."
When Li Jingsheng meets such a "die-hard fan", what else can he say? He should try his best to help others.
He can basically treat limb fractures as long as they are not particularly complicated or serious.
After feeling the patient's bones, he was already confident.
The fee is six hundred yuan.
In fact, it is not expensive, because the cost of manual bone setting, splinting, and bone rejuvenation cream are all included.
With Li Jingsheng's current level of bone-setting techniques, it really didn't take much trouble to reset the leg bones. Put on a plaster, fix it, and let the patient go home and take good care of himself.
Come back for a review in a month.
While explaining the precautions to the patient and his family, a young man in his mid-twenties ran in from outside, looking panicked.
In her arms was a crying child, only two or three years old.
"Doctor, doctor, my child accidentally cut his finger. Can it be treated here?"
"Let me see!"
Li Jingsheng hurried over to check. I saw that the child's left index finger had a deep incision on the first section, with only a layer of skin attached.
"I'll give the child a simple bandage. You can send him to a big hospital as soon as possible. He should be able to take care of him."
This kind of replantation of severed fingers is something that Li Jingsheng’s clinic cannot afford even if it wants to.
Large hospitals can handle it, but the charges will definitely not be cheap.
As long as you can take jobs, that's good.
The biggest fear is that he will not be able to survive the reconnection, and will have to amputate it, which means he has to pay twice, and the finger is not saved. Doctors can only do their best, and no one dares to guarantee it.
Li Jingsheng now only has Tang Ping as a capable nurse. Plus he himself, even with Han Siying as a medical assistant, they are still a third-rate surgical team.
He can do ordinary minor surgeries, but for high-precision and complex surgeries involving nerves, blood vessels, and tendon anastomoses, he may have to work hard for another two or three years before he can perform them.
Not even close yet.
After the bandage was applied, the child's bleeding became much smaller and basically stopped.
Li Jingsheng's bandaging and hemostasis technique came in handy.
"How much does this bandage cost? I'll give it to you."
"If I don't charge you, go to a big hospital as soon as possible! The child is so young and it's so painful."
At this moment, Li Jingsheng began to show a hint of the style of a great doctor.
Earn the money you should earn with all your might, never too much.
But when it comes to such small things, I can help anyone.
And it's voluntary work.
"Thank you, thank you so much!"
After the man thanked him, he took a taxi to a large hospital with the child in his arms.
These things are just daily routine in the clinic, considered as minor episodes. He continues to diagnose and treat patients one by one. Each one is handled with great care.
He found that after improving the immune diagnosis last night, it would be helpful in the diagnosis of almost any disease.
It was close to ten o'clock when Li Jingsheng's cell phone rang.
It was a call from an unknown number.
"Hello, who are you looking for?"
"Dr. Li? I am Dr. Zhang Zhongsheng, Department of Urology, Second Hospital!"
"Oh! Hello, Director Zhang!"
Li Jingsheng had heard of Zhang Zhongsheng, who was regarded as a general in the Department of Urology of the Second Hospital, with a very high level.
I heard that his surgical skills are particularly superb.
"I have seen the diagnostic ideas you wrote last night. I have done a pelvic X-ray examination on the patient. It is found that the patient's right iliac bone has a fuzzy structure, uneven density, insect-like bone destruction, and local bonelessness. There was no abnormality in the left pelvis. A metastatic bone tumor was found in the right pelvis, and the bone was destroyed by osteolysis. It seems that your diagnosis is correct, and the patient is likely to have a malignant tumor."
Zhang Zhongsheng's tone was both complimentary and a bit heavy.
"I have long heard that the Orthopedic Surgery Department has recruited an excellent young doctor. I didn't think it was a big deal before, but now I know how high your level is. The patient has been arranged for a lung CT scan, and the pelvic X-ray was just done After the report comes out, I just want to tell you the results in time."
This is not the chief physician talking to a young resident doctor, it is clear that he is treated as an equal.
And no matter how you listen to it, there is a hint of gratitude and goodwill.
"Thank you for taking me so seriously. That patient's lung infection may also be a malignant tumor!"
Li Jingsheng sighed.
He was not surprised at all by this result.
Yesterday, when I felt the bones of the female patient, I could already conclude that it was a bone tumor.
And bone tumors tend to occur in children and adolescents. Bone tumors generally occur in adults, and most are caused by cancer cell metastasis.
In other words, bone tumors are not primary lesions.
"Oh! If that's the case, I can persuade her to eat and drink well! The patient is less than forty years old, what a pity."
Zhang Zhongsheng also sighed.
As a doctor, you will feel heavy when encountering this kind of situation.
But there is nothing to be done.
I just hope that human medical science and technology can progress faster and conquer malignant tumors as soon as possible. The good news is that foreign countries have developed targeted drugs that can eliminate a variety of cancer cells.
It is more advanced than existing chemotherapy drugs and has relatively fewer side effects.
At the same time, it also has the biggest improvement. It no longer only targets a single type of cancer cells, but can target multiple types of cancer cells.
This is really worth looking forward to.
Maybe within a few years, treating cancer will be as simple as treating a cold.
(End of chapter)
