In the first twenty-four hours, Zhang Fan also worked hard to defeat the mountain and Zhenhu. Sometimes, in terms of surgical techniques, there is really no way to compare, especially with conventional surgeries. You say you did well, and I say I did well. After all, difficult surgeries are still rare and do not happen every day. Therefore, Zhang Fan's 24-hour continuous operation is also a way of showing off his cards, telling everyone directly and rudely: I'm here!
Doctors can be regarded as literati. There is rarely a tit-for-tat confrontation in departments or hospitals. Unless it is a critical moment, such as changing the dean or director, the competition under normal circumstances is relatively mild. But Zhang Fan couldn't wait any longer. He didn't want to waste time on such things, so he announced in a crude way: I'm here!
Zhang Fan performed seven operations in a row, and the anesthesiologist, surgical nurse, and circulating nurse changed three times. The assistants were Wang Yanan and Xue Fei. By the time the last operation was over, Xue Fei was so tired that he lay directly on the floor in the operating room and couldn't get up!
"Dr. Zhang, you are exhausted too. Please lie down for a while! Seven surgeries are really amazing!" The slightly older nurse in the operating room said to Zhang Fan. Zhang Fan was waiting for this sentence. Both Wang Yanan and Xue Fei were put on the ground like dead pigs after surgery, and they were unwilling to open their mouths. There was no need to say anything else.
"It's okay, where are you now? I haven't had an operation for a long time and I haven't had enough yet!" Zhang Fan said cheerfully, and then helped the nurses pack their things. Isn't Zhang Fan tired? Damn, it’s definitely tiring, and now he’s just trying to show off!
"Hey! Doctor Zhang, don't dare to move anymore, we can clean it up ourselves." Another nurse hurriedly took the things from Zhang Fan's hand.
"I'm really not tired." Zhang Fan said with a smile.
"If you're not tired, take a rest quickly, drink some water, go to the bathroom or something!"
Zhang Fan really wanted to say one more thing, there was no one who could fight, but no one praised him. The nurse packed up her things and left. Xue Fei and Wang Yanan were already asleep!
Although Zhang Fan felt that the effect of pretending was not very good, the surgical system already knew about it the next day, especially the three orthopedic doctors. "Do you know, Zhang Fan performed seven operations in a row yesterday, and the last one was completed." From now on, just ask directly if there is anything left, and then start the activity!"
"real or fake?"
"Did you hear that?"
"What?"
"Zhang is preparing to dominate the operating room!"
"What can I do? Hey! You said this thing, not to mention its high technology, is as strong as a big animal. Don't let others live!" These are two doctors from the orthopedics department chatting.
In the morning, have a morning meeting. Zhang Fan and his team take over shifts. In the department, whoever is on duty usually takes over. Zhang Fan started to take over the shift: there were 43 original patients, 11 were discharged, 12 new patients were admitted, and 10 operations were performed yesterday. Among them~~~~, these new patients and surgical patients and discharged patients all need to explain what surgery was performed, what the situation was like after the operation, what the situation was at night, and what the situation was in the morning.
Did the patient have pain or fever at night? How was the pain or fever treated? What medicine was used? Did the patient bleed? Did the gauze penetrate? All these must be explained, because these are the daily work of doctors. Most people think that doctors may perform surgeries all year round and do nothing else every day.
In fact, except for some senior surgeons, ordinary surgeons perform operations during working hours, observe patients and write medical records during off-duty hours. The time consumed by these tasks is not much shorter than the operation time, so doctors are busy and have to Busy, for example, this medical record has time requirements, and now it is all electronic medical records. A new patient must complete the large medical record within a certain number of hours. If it exceeds this time, well, it cannot be written, and it cannot be typed directly. Open this big medical record, and then wait to be criticized and fined. The boss doesn't care how many surgeries you performed yesterday.
Zhang Fan explained the conditions of the patients one by one, and the doctors in the Department of Orthopedics opened their mouths in surprise. Others only performed three surgeries, and Zhang Fan did all the remaining surgeries. The doctors in the department suddenly heard a voice in their hearts: Is this still a human being?
Normally, in this situation, the doctor would divert the patient to doctors from other groups, but Zhang Fan and his group just finished the operation without saying a word. Can you not be shocked?
After Zhang Fan finished his shift, Lao Gao said: "In the future, when there are many patients for surgery, call those who can and don't collapse from exhaustion."
"Okay Director!"
After yesterday's patient handover was clear, the next step was to discuss tomorrow's surgery. In general, especially non-emergency surgeries, there will be a big discussion in the department before the operation. The surgical method to be used and the fixation equipment to be used must all be planned.
"Tomorrow, a patient with 16 beds in our group will be admitted due to an oblique fracture of the femur. After completing the relevant examinations, it is planned to undergo internal fixation of the femoral fracture with a steel plate tomorrow. A titanium alloy locking plate will be chosen~~" A patient in Zhou Chengfu's group. This is the time to bring it up and start discussing it.
Zhang Fan frowned a little as he listened. How should I put it? Especially this kind of surgery for femur fractures, there is a lot of controversy in the medical community, with two schools of thought. They are divided into two groups because of the characteristics of their bones. Because bone nutrition and blood supply are also divided into two sets, one is the tiny capillaries crawling on the surface of the periosteal bone, and the other is the blood supply inside the bone marrow.
Surgery is to treat diseases and save lives, but because it is an open treatment method, there will definitely be damage. Doctors are constantly improving surgical methods in order to reduce damage. For example, for this femur fracture, there are two conventional methods, two methods of internal fixation.
One is the steel plate, which fixes the broken ends of the fracture. The advantage is that it is simple and direct. The disadvantages are also obvious: a large amount of periosteum is damaged, and the fixation method is a bit too strong. Bones are not wood. The more firmly they are fixed, the better. In fact, how can a fracture heal quickly and well? It means that the broken end of the fracture can have a slight degree of mobility, no less than two millimeters, under a fixed and solid precursor. Mobility. It sounds very contradictory, but this is the biological nature of bone healing.
Another type of fixation is intramedullary fixation. An opening is made from the proximal end of the femur, the intramedullary needle is driven into the femoral cavity, passed through the broken end, and then fixed at the distal end. The advantage is that the axis is fixed, which not only hardly damages the periosteum, but also conforms to the biological characteristics of bone growth. The disadvantage is also obvious, it will damage the blood supply system in the medullary cavity.
Zhang Fan is not an admirer of any surgical technique. He prefers to choose the most appropriate surgical method based on the situation and the patient's conditions.
After Zhou Chengfu introduced his condition and surgical plan, he looked at Lao Gao. In the department, the doctor in charge will first make a plan on how to perform surgery on a patient and by what method, while the director determines whether to perform surgery, when to perform it, and who will perform it. He can be regarded as the last approval checker before the operation.
Lao Gao, looking at the X-rays on the film viewer, said to everyone: "Discuss and discuss. Everyone tells us what they think." In the hospital, especially in the surgical department, everyone usually talks and laughs, and works together during the operation. We work together to resist disease and pain, but during pre-operative discussions, we often blush. This is especially true when academic research is still undecided, and there are many such undecided times.
"Let me tell you, I think intramedullary fixation is better for this operation. The first patient is a woman in her sixties. The plate fixation damaged the periosteum too seriously. It will be difficult for the patient to recover later. If the plate is removed later, it will be a second time. Injury." A vice-president from another group spoke. At this time, the resident doctors in Zhou Chengfu's group were taking notes. This discussion must be recorded, and everyone's speech will be reflected in the medical record.
"Yes, it will cause periosteum damage, but secondary damage may not be possible. This patient is over sixty years old. The current titanium alloy steel plate is antibacterial. There is no need to remove the steel plate at such an old age. The second intramedullary fixation is Is there no damage? The patient is already quite old, and the blood supply to the bone is mainly bone marrow, so plate internal fixation definitely has advantages over intramedullary fixation."
The doctors began to express their opinions one by one according to their rank. Not all surgeries will have such discussions, but once they encounter such an academically inconclusive surgery, the debate will be very fierce. This is an academic debate, a debate over interests, and a debate over the right to speak.
When it was the turn of the attending doctor and the resident doctor to speak, they immediately took sides. Doctors at the deputy senior or senior level had already made their advantages and disadvantages very clear. There was no need for the resident doctor to talk nonsense and they took sides! At this moment, once the director is unable to suppress and technically cannot suppress and crush, over time the department will become a battlefield without cohesion.
Among the five groups, two groups supported plate internal fixation and two groups supported intramedullary fixation. Finally, Zhang Fan and his newly formed team members were left to express their opinions.
"Xue Fei." Lao Gao called.
"I think everything is suitable!~" This thing is heartless, but what he said is indeed impeccable. Yes, both are suitable. And there is no evidence-based medicine to prove which one is better!
"Zhang Fan." Lao Gao glared at Xue Fei and continued to roll his name.
Everyone looked at Zhang Fan in unison. The old doctor who had seen Zhang Fan's past and present achievements also wanted to hear Zhang Fan's opinion. He knew that he could not escape this shackles, but he still looked over. Young doctors, especially the new Xu Xian, also wanted to see Zhang Fan's vision. He believed that intramedullary fixation definitely had advantages. It would depend on whether Zhang Fan had this vision.
"I think both surgical methods are inappropriate!" Zhang Fan said without any surprise.
"What? I want to get external fixation. Isn't this nonsense!" Zhou Chengfu and his team's deputy senior officer became anxious when they heard this. External fixation is also a method of fixation. To put it simply, it is like erecting it on the outside of the building when building a building. Like the steel frame, fractures can also be fixed in this way. The benefits are obvious and the damage is small, but the disadvantages are also obvious. The applicability is too narrow, it is also prone to infection, and post-care is too troublesome.
This femur fracture is not suitable for external fixation, and this fracture cannot be used for external fixation, so the impatient deputy high-ranking officer directly interrupted Zhang Fan's speech. Although it was a bit rude, his mood was understandable.
Zhang Fan didn't care, but smiled and said, "Director Chen, do you think external fixation can be used for this surgery?" Now Zhang Fan is about to raise a flag, especially in this kind of academic discussion, which is not about humility. If you can convince others, you must bring out the real thing. Since you can interrupt me, I will ask you so that when we discuss it again in the future, think through it when you speak and think about it before interrupting. I!
"Uh! No." Dr. Chen's aura immediately disappeared. Zhang Fan asked Dr. Chen directly and broke out in a cold sweat. Zhang Fan didn't say it was external fixation. "Hey! Rough." Lao Chen cursed himself in his heart!
"Go on! Let's talk about surgery." Lao Gao interrupted Zhang Fan's questioning. Lao Gao's face was colorless, neither happy nor sad, and he had his arms folded. He also wanted to hear Zhang Fan's thoughts. For this operation, Lao Gao actually preferred intramedullary fixation.
At this time, Zhang Fan stood up and gently swayed the hem of his white coat with his hands, just like an ancient master shaking the hem of his white coat before going on stage, giving off a burst of momentum. "Click!~" Zhang Fan opened the folding plastic ruler usually used to measure bones, held it in his hand, and walked towards the viewing lamp.
"Everyone, please see! The fracture end is interrupted at the femur, and it is an oblique fracture, an unstable fracture. However, the displacement of the port plane is not very severe, and it is still a non-open fracture. Considering the patient's age, my The opinion is intramedullary fixation.”
As soon as Zhang Fan finished speaking, he heard a disdainful "bang" from many doctors below. Lao Gao also frowned, but after thinking about it for a moment, his expression became expressionless again. Xu Xian was a little disappointed when he heard this. Zhang Fan had enough momentum, but his words were lacking. "That's it!" He thought secretly in his heart.
Everyone has overlooked one point. The two surgical methods Zhang Fan mentioned earlier are not suitable. Lao Gao understands, but the surgery is too difficult.
"Closed intramedullary fixation!"
"Closed intramedullary fixation?" It's a word for many people, but the difficulty has increased in magnitude! Someone couldn't help but ask the question. This can't help but come from doctors at the deputy senior level. Doctors below the deputy senior level can't understand the difficulty of this operation. Several vice-presidents looked at each other, their faces were not shocked but confused. However, some attending doctors and a group of resident doctors who have not studied well have faces full of confusion. Yes, confusion. What is closed intramedullary fixation? For example, Xue Fei is like this!
Closed intramedullary fixation is actually simple. It means that the skin and soft tissue are not cut, and the broken end of the fracture is not exposed but fixed directly. Simply put, it is a blind fixation. This is too technically demanding, and this surgical method is generally used for This surgical method is only used for fairly stable fractures. Even if the fracture is stable, ordinary hospitals and doctors will not choose it.
Yes, this surgical method causes the least damage to the patient, but it is too dangerous for the doctor. Because it is blind typing, the possibility of accidents and deviations is too great. The error of this kind of fracture is only two centimeters or even millimeters. of. Once the fixation is not good, or the fixation causes the broken end of the fracture to shift and form an angle, which then causes the fracture to heal abnormally, it becomes a medical accident. Once a medical accident occurs, no one cares whether you consider the patient or not. Therefore, this kind of surgery, let alone in grassroots hospitals, even in large hospitals, doctors who are not director-level will generally not perform it easily.
"This is an oblique unstable fracture, not a stable fracture, my little brother! Can you ensure that the broken end reaches the physiological anatomical position?" Another deputy commander said to Zhang Fan with a regretful or helpless tone. This is the helplessness of doctors. They never dare to try or take a step forward unless they have the skills.
"I can!" Zhang Fan stood in front of the light viewing machine, holding a ruler and said with a serious face.
"Uh! He can." The doctor, a first-level deputy senior doctor, stopped talking even though he was about to speak. Because Zhang Fan's record is too terrible! They were very torn between doubting and not doubting!
The sound of the private discussion was gone, quiet! As if a street-cleaning tiger appeared, everyone stopped even making eye contact and looked at the director quietly, while the director looked at Zhang Fan.
Finally, Lao Gao said: "Have you ever done it?" This is a grassroots hospital. No matter how advanced your surgical skills are, when encountering a special surgery, the first thing asked is whether you have ever done it and whether you have experience! Large hospitals still have the conditions and various guarantees to allow you to innovate, but the first priority for grassroots hospitals is safety. What is a grassroots hospital? Except for the top 30 hospitals in China, they are all grassroots hospitals!
The differences between these grassroots hospitals are just the advanced level of equipment, the level of academic qualifications of doctors, and the speed of learning new treatment methods from higher-level hospitals. Do scientific research! It is just a floating cloud, that is, it is spinning around the edges and corners of the disease.
Want to take risks and innovate? Let’s not talk about the patient’s family, the hospital can break your legs! There are good and bad aspects to this matter. There is no way to discuss it, but one thing is very clear. Although technological development has progressed very slowly and all research tasks have been handed over to higher-level hospitals, medical accidents have indeed been significantly reduced. It is said that we are responsible for patients. It seems irresponsible, anyway, it’s very awkward.
"I've done it!" Zhang Fan didn't even blush. Although he hadn't done it in reality, Zhang Fan didn't have white liver in the system. It's hard to say about surgeries in other departments, but orthopedic surgery, this kind of surgery Zhang Fan had already done. I know how many times. This is his guarantee, this is his confidence!
"Sure?"
"Sure!"
Lao Gao pondered and hesitated! It seemed like centuries had passed, but in fact it was only a dozen seconds. Then he turned around and said, "Director Chen, what do you think?" Lao Gao asked. In fact, this was to give Lao Chen face. Lao Gao had already leaned towards Zhang Fan, and now he was giving Lao Chen a step forward!
They are all smart people. It would be useless if Lao Chen stretched his neck to disagree. Lao Gao simply gave the patient's number to Zhang Fan. If Zhang Fan's operation was successful, it would be difficult for Lao Chen to do it in the future! This is the power of the director, the power that most doctors aspire to.
"The difficulty is too high! I'm not sure at all, Director!" Lao Chen could still speak harshly or teasingly when dealing with Zhang Fan, but when it came to Lao Gao, he was very low-key.
"How about I take Dr. Zhang with me to perform this surgery?" Lao Gao asked again. This means that the steps have been set up for each other. Lao Gao wanted to have the surgery alive. What was the risk? The risk is not small. If Zhang Fan fails to do it or has a medical accident, it will be Gao Gao's turn to do it. If not, he, the director, will not be able to do anything.
But Lao Gao is willing to believe in Zhang Fan and is willing to support Zhang Fan. These are technical dogs who engage in technology, not politicians. In the technology industry, once you can show your excellence, someone will definitely support you, which is just a difference in the intensity of support.
And Lao Gao really supported Zhang Fan wholeheartedly. What is a great doctor? This is what Lao Gao is! There are too many such doctors in this place of life and death who take risks themselves and let the younger generations go forward! They are the cornerstone of China's medical industry!
"Okay, I'll help too!" Lao Chen didn't add insult to injury or be a bystander. Academics can be debated, but once the decision is made, all that remains is to work together. This is an excellent department!
"Okay! All non-emergency surgeries are suspended tomorrow. Let's observe this operation!" Lao Gao finally smiled, with a smile on his face. Since this is the case, he simply raised the stage a little higher, maybe Zhang Fan could take off earlier!
At this time, all the doctors turned to look at Zhang Fan. Zhang Fan, like Lao Gao, smiled and slowly closed the ruler in his hand, "Click!"
