"Oh, there's no way! I have dozens of employees, and they work hard with me. If they can't make thousands a year, it's not interesting."
Li Jingsheng almost popped his eyes out.
"You, how much do you think you earn in a year?"
"Sometimes it's less than two or three thousand, and sometimes it's more than 4,000 a year, close to 5,000."
The young man said calmly.
"I don't want to be a doctor anymore, I want to follow you to sell goods!"
Li Jingsheng really envied this young man.
He looks only twenty-seven or seventy-eight years old, very young, but his annual income in one year is equivalent to the income of an ordinary person in more than ten lifetimes.
"Haha, that's not possible. If the doctor changes his career, who will we look for in the future? Besides, whether you are an e-commerce company or a self-media salesperson, you need luck. If you hit the trend, you can do it. Fly. In our business, it seems very profitable, but the loss is also very scary. Maybe after ten years of hard work, you can lose everything in just half a year and still owe a lot of debt."
"Then I'll just keep being my doctor! At least I'll have something to eat."
Li Jingsheng was originally just joking.
Get closer to the patient to facilitate follow-up consultation and even treatment.
"Does it hurt?"
Li Jingsheng felt the swollen area, and there was an obvious mass in the middle and lower part of the humerus.
Judging from the feel, this mass is definitely not an ordinary hematoma, but more like a tumor.
"It hurts a little!"
The patient seemed very calm.
With such a high annual income, I really don’t know why I still go to his small clinic to see a doctor.
"It feels a bit like a tumor. My clinic has limited facilities. I suggest you go to a large hospital for further examination and treatment."
Li Jingsheng advised the patient.
The bone feels fine and is not obviously affected.
However, the texture of the mass is hard, the border is not obvious, and the surface of the enlarged area is light red.
It looks similar in color to the bumps after mosquito bites.
It doesn't feel like a malignant tumor.
But without pathology, no one dares to draw a conclusion.
"Can you treat me here? There are all kinds of queues and hospitalizations in big hospitals. I really don't have that time. I have heard about your clinic many times, including two of my employees who have treated diseases here and praise you. Their medicines are correct, their medical skills are superb, and they are very responsible for patients. So I trust you very much. As long as it can be treated here, I will treat it."
The man said sincerely.
"I think I need to have surgery. If you want to be treated in our clinic, then I'll take you to have a B-ultrasound to check the situation first!"
Li Jingsheng has completed the operating room, but it hasn't opened yet.
This operation seems a bit big, but his current surgical ability is not weak, his professional title has been upgraded to attending physician, and he is fully qualified to practice medicine.
As long as the patient agrees, he can try it.
"Okay! Can I have a B-ultrasound now? I have no other requirements. I just need to treat me as soon as possible. It doesn't matter if I pay a little more."
With an annual income of several thousand, I really don’t care about this little money.
"It's not necessary to pay more. If our clinic charges excessively, the sign will be ruined. Come with me!"
Li Jingsheng got up and took the man for examination.
Now we have hired a 'General Manager of Internal Medicine', who can leave at any time when something happens.
This is very nice.
I took the patient for a B-ultrasound.
The mass was hypoechoic, internally heterogeneous, and its borders were not very clear.
This mass is larger in size and fusiform in shape.
The length exceeds 75 mm and the width exceeds 17 mm.
Such a large mass definitely did not form in a day or two.
This was dragged out by the patient!
Li Jingsheng shook his head secretly. Disease is not scary in the first place, but when you meet people who don't take it seriously, it becomes fun.
What it likes most is to develop slowly and become stronger.
In the end, it was so powerful that even doctors couldn't do anything about it.
"How's it going? It's just a small problem, right?"
After the patient finished checking, he asked calmly.
If it were an ordinary person, he would have been extremely nervous when he heard it was a tumor.
This young man really doesn't take his body seriously.
"It should be a tumor. It's hard to tell its nature. It's really big. This is a film taken. You can take a look at it yourself."
Li Jingsheng printed out the screenshots of the ultrasound examination.
The report produced is actually no different from that of a large hospital.
The description of the lesions is also very professional.
However, despite his expertise, he is only a part-time medical technician after all, and his ability to read pictures may not be as good as that of the professional ultrasound room doctor in the hospital.
Everyone does the same thing every day.
He couldn't take more than a few B-ultrasounds a day.
Now that the clinic's business is getting better, we only have the opportunity to treat a few patients a day.
"How does this thing grow? I usually pay attention to what I eat. I never eat junk food. I ask the aunt who cooks to buy vegetables and fruits from farmers who grow vegetables. I occasionally go out to drink with friends, but I almost never stay up late, never smoke, or chew betel nuts. There is no reason to have a tumor! Is it related to my excessive exercise?"
The patient looks at the test results and wants to find the cause of the disease.
"It probably has nothing to do with exercise. I suggest cutting out the tumor and sending it to the hospital for a pathological examination to clarify the cause."
"Can you cut it here?"
"Can!"
"Is the risk big? It won't destroy my hand, right?"
"Surgery is definitely risky, no matter which hospital it is performed in. But if I dare to take this job, I must have the courage to do so with great confidence. The risk-resistant ability of a small clinic like ours cannot be compared with that of a hospital. "
After Li Jingsheng checked his ultrasound, he felt confident about doing the surgery.
So we began to work hard to persuade the patient.
"That makes sense, so just do it for me!"
The man agreed on the spot.
"Can you find a family member to come and sign?"
"I had no parents when I was very young. I first stayed in an orphanage for two years, and then was taken in by a kind-hearted elderly couple. Unfortunately, they had a car accident when I was a sophomore in college. Alas, if they are still alive now , I can give them a prosperous later life."
When he said this, the patient's eye circles were slightly red.
Everyone has the most vulnerable point in their heart.
"That's okay! Just sign it yourself later. Do you have your ID card?"
"Why don't you bring it when you come to see a doctor?"
Li Jingsheng negotiated a price with the patient and charged 2,500 yuan, including all expenses.
Li Jingsheng also did the pathological examination.
Regarding the price of the surgery, the patient readily agreed.
According to the rules, the patient signed the surgical risk consent form and paid the fee, and then the surgery was arranged.
"Meng Luo, Siying, go into the operating room to prepare for an operation. The patient needs to remove the tumor on the left upper arm."
They immediately went to make preparations.
Munro is a hospital surgical nurse with rich experience.
She does all the equipment packaging, drape, and disinfection. Han Siying was there to help and learn along the way.
Li Jingsheng does the preoperative preparation for the patient himself.
Including skin cleansing and detoxification of the surgical site.
This patient has very long hair on his arms, and the skin must be cleansed before surgery, otherwise the effect of the surgery will definitely be affected.
Fortunately, the skin cleansing work is quite easy.
What Li Jingsheng is most afraid of is cleaning the patient's head and perineum. Sometimes the scratches hurt, and the scolds are scolded.
…
In the operating room, the patient is first given an anesthetic skin test according to the procedure.
There was no allergic reaction, so the patient was given a brachial plexus anesthesia injection.
This operation is performed by Munro.
It can be seen that she has rich experience in dosage, injection point and depth.
The purpose of brachial plexus anesthesia is to block the conduction of the brachial plexus nerves.
The patient's left arm loses pain sensation and the muscles relax.
Li Jingsheng put on gloves and surgical gown and stood at the surgeon's position, while Munro sat opposite him.
The position of the instrument nurse is generally flexibly adjusted. In many cases, she stands on the same side of the surgeon, and in most surgeries, she sits opposite the surgeon. There are no hard and fast rules for this.
A good instrument nurse is not only keenly observant, but also well prepared before surgery. After surgery, the number of instruments, needles, threads, gauze, etc. must be counted with the circulating nurse to ensure that they are correct.
Because if a small surgical needle falls into the patient's body, it will bring catastrophic and serious consequences.
Li Jingsheng and Munro had set up the stage once, that time to suture the wounds of patients who had fallen.
It's a very small operation.
It doesn’t even need to be done in the operating room.
This large tumor was removed this time. Although it was a superficial tumor on the arm, it could still be regarded as a second-level surgery.
The technical difficulty is much higher than imagined.
Including important blood vessels and important nerves in the arm, care must be taken.
Li Jingsheng had recalled the anatomical structure of his left upper arm many times in his mind before the operation.
The mass and biceps brachii should be close together.
There are even ones that can cover the triceps.
Its end most likely reached the radial artery and radial recurrent artery at the patient's elbow, because the bending of the patient's left arm had been significantly affected.
There are quite a lot of nerves here.
The posterior cutaneous nerve of the forearm is located at the location of the tumor, so care must be taken when separating it.
Also, the underside of the mass should be tightly attached to the ulnar nerve.
If this nerve is cut off, it would be a serious medical accident.
Fortunately, his skin incision method has reached the advanced level. As long as he is careful when cutting a superficial tumor, nothing will happen.
With his current ability, there is no big problem in performing third-level surgeries.
Li Jingsheng cut open the patient's skin and then dissected it layer by layer.
The speed is quite rapid.
The incisions are smooth and neat, and there is very little bleeding.
Munro had already seen his boss's suturing skills and debridement capabilities. Now he saw his boss incision on the patient's left upper arm. It was so silky smooth and the amount of bleeding was surprisingly small. She felt extremely shocked.
Only at this moment did I realize that the boss I was following turned out to be a pervert.
It doesn’t matter if his diagnostic skills are so good, but his surgical ability is still so powerful. It’s hard to find another monster like this in People’s Hospital or Qiaobang Hospital!
Who would have thought that such a powerful doctor would be staying in the clinic.
After incision, the mass can already be seen.
Its color is fairly normal, and the surface of the tumor is fairly smooth, with no obvious irregular mutations.
It indicates that the possibility of benign tumors is very high.
Li Jingsheng first checked it out and then started to separate it.
"Siying, you must pay attention to these soft tissues and ligaments when separating the patient. Be careful not to be rough or rough. You have to remember that surgery is a technical job, and there is only one thing that requires brute force, and that is sawing the bones. "
At his current level, he is fully capable of teaching Han Siying.
I saw Li Jingsheng flexibly using a combination of sharp separation and blunt separation to separate the tumor bit by bit.
He found that the borders of the mass were not clearly defined.
This is a very bad thing.
Although it looks like a benign tumor, it is difficult to remove it cleanly due to unclear borders.
It's easy to relapse.
After about forty minutes, the entire tumor was successfully removed by Li Jingsheng.
The operation was a near miss and went very smoothly.
Nowadays, there are air conditioners specially used in operating rooms, with constant temperature and humidity, which is very beneficial to both the surgeon and the patient.
Sweating is basically avoided.
If it is a cold winter, it is even more necessary.
Otherwise, when the temperature is several degrees below zero, the doctor is shivering with cold, and if the knife shakes, he still won’t be able to tell where to cut!
The patient probably was scared away when he saw the doctor shaking like that.
In addition to the comfortable temperature and humidity brought by the air conditioner, the real-time monitoring of physical signs provided by the life monitor also allows Li Jingsheng and Mengluo to monitor changes in the patient's physical signs at any time during the operation.
Not to mention electrocoagulation to stop bleeding.
It is a magical tool for stopping bleeding in small blood vessels.
These surgical tools are also very easy to use, and then there is the very special pair of glasses. After wearing it with a headlamp, you can clearly detect many details.
Not just blood vessels and nerves.
On anatomical drawings, blood vessels are usually marked in red, and veins are sometimes marked in blue.
Nerves are marked in yellow.
However, in actual surgery, these cannot be marked, and the surgeon needs to make judgments and discoveries by himself.
Nerves, in particular, like to be mixed next to blood vessels or in subcutaneous tissue.
It was cut off accidentally.
With just one touch, the patient's hand function may be lost.
It was precisely with these equipment that Li Jingsheng was able to complete the operation very smoothly.
It must be said that Munro's cooperation is also first-rate.
There is no need for Li Jingsheng to remind him. Most of the time, he can know what tools Li Jingsheng needs next.
After cutting the tumor clean, he debrided the patient a second time and started suturing.
After more than ten minutes, the suturing was completed.
There is nothing wrong with the wound inspection, so disinfect it.
It can be seen that the patient's right upper arm has lost weight.
But because the surgery had just been completed, there was some local hematoma. This is normal and will recover in a day or two.
"Dr. Li, such a big tumor can't be a bad thing, right?"
After the operation, the patient was helped to sit up by Li Jingsheng and Han Siying.
Because of long-term exercise, the patient's health is still quite good.
The postoperative mental state, physical mobility and other aspects of performance were very good.
"I feel it should be a benign tumor. But its borders are very blurred, and surgery is not easy to do. To be on the safe side, I cut off part of the normal tissue. You see, these tissues are all normal tissues."
Li Jingsheng pointed to the patient.
"Haha, well done. It seems that I have found the right person for this surgery. Cutting more is a thousand times better than not cutting at all."
The patient laughed with satisfaction after seeing it.
"These parts are easy to deal with. They all require more normal tissue to be cut. But there are also places that are difficult to deal with, such as the ulnar nerve. It is almost in close contact with the tumor. I have to cut it. This arm of yours is basically It’s useless. Although I have tried my best to cut it clean for you, you still have to be careful of recurrence. It is safest to check it once every three months after the operation. "
Li Jingsheng gained a lot from this operation.
It's not that he earned the 2,500 yuan in treatment fees, but that his health and surgical skills have improved.
The only hope now is that the patient will not relapse.
"OK!"
The patient readily agreed.
"The wound should not be exposed to water these days, and it is best not to do some powerful movements with the left arm. Then come here for three days of infusion. You can finish the infusion today before leaving. After all, we have undergone such a major operation, and it is still very difficult to prevent infection and inflammation. Necessary."
Li Jingsheng's operating room cannot maintain a sterile environment.
It's not necessary.
The cost is too high.
The surgeries performed were all these minor surgeries.
He would not dare to accept a surgery that was too demanding on the environment.
"I've already cut it up, so I'll definitely listen to you! Now I'll do it as you say."
The patient was very cooperative.
"I feel relieved with your attitude. To be honest, I am very worried that you will do your own science popularization on the Internet, and then you will not listen to me, but listen to the Internet. I will send this tumor to the hospital for pathology for you, and I need you to give me your identity Give me a copy of the certificate."
"no problem!"
"Siying, take him to the infusion room to rest for a while, and I'll prescribe him here."
"OK!"
Han Siying took the patient out.
Li Jingsheng saw that Meng Luo was carefully checking the quantity of equipment, consumables, etc. This was a very good work attitude.
"Teacher Meng, I'll leave this to you. Do you know where the instrument sterilization is?"
"It's the compound disinfection cabinet you just bought two days ago! I've used it before!"
With ultrasonic cleaning and high temperature disinfection functions.
Very convenient.
According to Li Jingsheng's idea, he originally wanted to remove all the doors of the operating room.
But just having a door is useless.
It’s better to develop slowly first, and then think about building a high-end operating room when the surgical business picks up!
The purpose of opening a clinic is to make money.
Definitely.
Now I have spent nearly 90,000 yuan to upgrade the hardware in the operating room, which is enough for the time being.
If he could perform ten surgeries of today's level in a month, he would be smiling.
The patient was prescribed medicine and asked Tang Ping to give him an infusion.
After Li Jingsheng finished his work, he checked the cases treated by Dr. Shao and found that they were all handled in a satisfactory manner.
"Dr. Li, these two cases are not what I am good at. You need to diagnose them yourself."
"No problem, come over here!"
Li Jingsheng took over Dr. Shao's work.
"What's wrong with you?"
The person sitting over was an old man, led by his children. He looked to be at least eighty years old and was walking up.
Extremely hunched back.
"Cough cough cough..."
The patient coughed violently before he could speak.
Li Jingsheng faintly saw blood in the sputum the patient coughed up.
He subconsciously distanced himself a little.
Clinical care must be taken with infectious diseases.
(End of chapter)
