Chapter 268 The Disappearing Fish Bone
Shen Zizai didn't want to understand, but he didn't hesitate. He turned back and took Zhuang Yan to find Meng Liangren.
"Lao Meng, you will take care of Xiaozhuang from now on. If you have any questions, come to me directly. Don't hold it back." Shen Zizai said very straightforwardly.
The subject of his words was Lao Meng, but his eyes kept staring at Zhuang Yan, for fear that Zhuang Yan was young and would not understand.
And the director called a middle-aged old doctor Lao Meng, and there was an unusual kindness in his words.
"Thank you, Director Shen. I won't cause you any trouble in the future."
"That's too polite." It was inconvenient for Shen Zi to stay longer, so as not to leave the impression that his little doctor was a licker.
When Shen Zizai left, Zhuang Yan bowed slightly and said, "Teacher Meng, please give me some advice."
"Don't you dare, just call me Lao Meng." Meng Liangren He quickly declined, "I'm not a teacher. I don't know anything. It would be great if I could become a general teacher when I die."
"???" Zhuang Yan was startled, then laughed.
She knew Meng Liangren and spent a week adapting to Luo Hao's medical team some time ago.
But now my identity and status are different. I am considered a new member of the medical team.
"Teacher Meng, I learned how to write medical records in the Imperial Capital. How about I try it on new patients?" Zhuang Yan was not polite.
Meng Liangren nodded.
Zhuang Yan took a breath and prepared to show off her master's degree.
When asking about the medical history, almost everything was in accordance with the medical record writing standards, and there were no flaws.
Even Zhuang Yan herself feels quite proud.
After all, I am from a major, one of the few in the country. As long as I want to be professional, I can still do it.
This medical record was obtained from several affiliated hospitals of Peking University and can be used as a model medical record. Zhuang Yan has absolute confidence in this.
When she was in graduate school, Zhuang Yan had a medical record that was used as a model medical record. The level of care in writing was much worse than the one in front of her.
Not surprisingly, Meng Liangren was also full of praise for Zhuang Yan's medical records.
"Xiaozhuang, your medical records are really good. You are worthy of being a top student at Imperial Medical University."
"Teacher Meng..."
"Just call me Lao Meng, teacher. But I don't dare to take it. It's not polite, I really can't take it. I'm just an old doctor." Meng Liang was humble to the core.
Zhuang Yan had no choice but to change her tune.
"Old Meng, please give me some advice."
"Perfect!" Meng Liangren said firmly.
Zhuang Yan felt proud, and she also thought her medical records were perfect.
"Lao Meng, it's already past 7 o'clock, what are you having for dinner?"
"Eat whatever you want, it's getting late, Xiaozhuang, please go home quickly."
Zhuang Yan came to the medical team on her first day. Although Luo Hao was not there, she still tried hard to leave a good impression on the members of the medical team.
And Zhuang Yan wants to show her ability.
Writing medical records is one thing, staying up late and working overtime is another.
There are no doctors who don’t work overtime, they are just bullies.
She did not go home, but ordered some food to eat with Meng Liangren.
Then the two of them wrote medical records respectively. Zhuang Yan wrote slowly, but she still persisted until she finished writing all the medical records of today's patients.
“Finish the fight and call it a day.” Meng Liangren said with a smile.
Zhuang Yan was sleepy and looked at the time. It was already 23 o'clock.
"Old Meng, the work is done, I'm going back to sleep."
"Well, let's go." Meng Liangren stood up to see Zhuang Yan off.
Zhuang Yan was startled for a moment, "Lao Meng, don't you go home and sleep?"
"I am born to work hard, so I just need to sleep 3 or 4 hours a day. It's still early, so I'll go around the ward again. Luo The professor is not at home, so I have to ensure that the clinic runs smoothly."
Meng Liangren said with a smile.
Zhuang Yan felt powerless and wanted to stay up late with Meng Liangren, but she couldn't stay up anymore.
It doesn’t matter if it’s just one day, but looking at Meng Liangren’s condition, it’s obviously like this every day. Zhuang Yan is so strong, but she has the brains to know that she can't do it.
I managed to hold on for a few days, but finally gave in. It would be even more embarrassing then, so I might as well set the rules now.
"Xiaozhuang, please go back and sleep quickly. We are just like cows and horses. Don't fool around by yourself. It's meaningless." Meng Liangren said.
“What?”
Meng Liangren was also startled for a moment, then smiled bitterly.
I am a cow and a horse, but Zhuang Yan is not.
"Rest when you need to. You can't finish clinical work." Meng Liangren said, "Pay more attention to your health and don't tire yourself out. Professor Luo doesn't usually stay up late, and he is quite averse to emergency surgery."
"Really?"
"Of course, the body is the capital of revolution." Meng Liangren sent Zhuang Yan away.
......
The next morning, Zhuang Yan got up and saw her father sitting at the table watching the news.
"Get up, why did you come back so late yesterday?" Dean Zhuang asked.
"On the first day I go to the medical team, I always have to finish writing the medical record. I asked for it myself, and it was written perfectly."
Dean Zhuang smiled slightly, he knew Zhuang Yan very well The thing on my mind - when talking about it from now on, I want to say that I am Zhuang Yan's father, not Dean Zhuang's daughter.
The difference here is huge.
Children, many of them will have this idea, but few can do it. Not destroying the home is considered a small achievement.
Luo Hao's side was very busy. This kid will know how powerful he is after a while.
He ate randomly, washed up and went to the hospital.
Zhuang Yan saw Meng Liang chatting with the patient in the ward as if he hadn't gone home.
She followed Meng Liangren without disturbing him, but listened carefully to what Meng Liangren said.
All kinds of trivial things, these things are meaningless to Zhuang Yan, but Meng Liangren enjoys them endlessly.
After finally finishing chatting with more than a dozen patients and leaving the ward, Zhuang Yan asked, "Lao Meng, you didn't go home?"
"You did. I slept for 4 o'clock, which was enough." Meng There was no trace of fatigue on the beloved man's square face.
Zhuang Yan was surprised. Although she was still a little unconvinced, she also knew that some things could not be forced.
This is all talent.
At the end of the shift, Luo Hao's team has no surgeries for the time being. When everyone is going to have surgeries, Zhuang Yan casually opened the medical record she wrote yesterday to read it again.
This is the most perfect medical record I have ever written!
After a few glances, Zhuang Yan saw something was different - the medical record had been altered!
It’s Meng Liang! It must be the medical record that he secretly modified! !
Zhuang Yan felt unhappy. She was stunned for a moment and tried to remember and compare.
A full hour later, Zhuang Yan discovered that the changes that Meng Liangren later made were all those that should be made.
Where is the standard and model medical record? In front of Meng Liangren, his own medical record is full of loopholes and worthless.
"Xiaozhuang, after you left yesterday, I went a step further and changed your medical record." Meng Liangren said with a guilty tone, "I'm really sorry."
"... "Zhuang Yan couldn't stand Meng Liangren's politeness.
For him to speak like this, he might as well point at his nose and scold himself.
For Zhuang Yan, Meng Liangren is more like Yin and Yang herself.
"It's not that there's something wrong with what you wrote, it's that every hospital has its own habits. Our habits come from Professor Luo, and we calculate how he writes." Meng Liangren continued to explain.
But he didn’t say too much, he just hit the mark.
Zhuang Yan nodded and gave a gentle smile, indicating that she knew.
Zhuang Yan then tried hard to compare her memory and habits and find out all the places Meng Liangren had modified.
If you can't even write medical records well, it will be difficult to integrate into the medical team, Zhuang Yan knows this.
In the morning and noon, Zhuang Yan spent 6 or 7 hours studying Meng Liangren's medical records.
Although Meng Liangren’s words are honest and low-key, the medical records are really good and shockingly good.
On the first day Zhuang Yan entered Luo Hao's medical team, she was hit on the head with a silent killing stick.
3:30 pm.
Shen Zizai hurried in.
"Lao Meng, has Ronaldinho got on the plane?" Shen Zizai asked.
"Director, Professor Luo's flight is after 5 o'clock, are you okay?"
"Nothing, intraoperative emergency consultation." Shen Zizai said, "Cardiothoracic surgery is really sick. I can't find the fish bone. "
"? "
Meng Liang and Zhuang Yan were both startled.
Fish bones? What does it have to do with the interventional department?
The shallower ones are the work of otolaryngology, the more advanced ones are the work of digestive endoscopy, and the work of cardiothoracic surgery is to puncture the esophageal wall and knock down the aorta.
No matter how you put it, it has nothing to do with the interventional department.
Fish bones can only puncture blood vessels, so what should the interventional department do? Imaging? The fish bones are not in the blood vessels either.
"Director, shall I come with you to take a look?" Zhuang Yan volunteered, eager to give it a try.
She has just arrived in the clinic and is fresh to everything and everything. Moreover, Zhuang Yan has met all the directors in the hospital, at least they are familiar with each other.
Shen Zizai nodded slightly and took Zhuang Yan to the consultation.
Other young doctors did not dare to make this request, but she was Zhuang Yan. Meng Liangren watched from a distance, turned around and started working.
"Director, what patient?" Zhuang Yan asked as she walked.
"It was said that he was a patient who had eaten fish thorns. At first, he said that he had no serious symptoms, only chest tightness."
"No chest pain?"
"Probably not, I just gave them someone I called and asked." Shen Zizai said as he walked, "The patient was not hospitalized because of fish bones, but because of chronic gastritis. He had already made an appointment for hospitalization and found out by chance.
After being hospitalized, no problems were found during gastrointestinal endoscopy. A CT scan revealed that the fish bone was stuck in the esophagus and was close to the aorta. "
"This is too dangerous!" Zhuang Yan said immediately, "I heard this when I was in school. The teacher told a similar case, saying that a big boss got stuck on a fish bone after eating mandarin fish, and he couldn’t believe Mayo who flew directly from China.” (Note)
"Fei Mayo, he is really rich, he is indeed a big boss." Shen Zi smiled, his words a little sarcastic.
But he was a patient after all, and the prognosis was likely to be bad, so Shen Zizai didn't say more.
“I went there for three months of treatment without any surgery. The teacher said that when I came back, the adventitia of the aorta had been corroded and the area was still very large. Seven or eight hospital-wide consultations were organized, and the teachers were all I thought it was gone."
"What happened next?" Shen Zizi gossiped patiently with Zhuang Yan.
“Suddenly one day he spurted blood all over the wall, and the person disappeared.”
"Oh." Shen Zizai said flatly.
"Director Shen, how is the patient on the operating table?" Zhuang Yan then remembered to ask.
"Oh, it was said that the CT scan showed that the fish bone pierced the esophagus and pierced the aorta below the tracheal bifurcation."
"!!!" Zhuang Yan was dumbfounded.
She saw Shen Zizi as relaxed and at ease, and thought the patient was not overweight. But!
The fish bone has penetrated into the aorta, can this person still live? I'm afraid the operating room is not even prepared for extracorporeal circulation. Once the fish bones are removed, the blood spurts out and there is no time to suture... No, if that's the case, extracorporeal circulation will be useless.
Zhuang Yan fell into deep thought.
Shen Zizai smiled slightly when he saw Zhuang Yan's expression.
This child is indeed a new recruit. He is a clinician who knows a little but has little experience. He was obviously frightened by what he said.
If Zhuang Yan's basic knowledge was not solid, she wouldn't have understood how serious it was to have a fish bone pierce the esophagus and pierce the aorta.
If she had seen several patients who died after spitting blood on the roof, she would not have this expression.
"Director Shen, why are you not in a hurry?" Zhuang Yan quickened her pace, but soon realized that Shen Zizai had not followed, so she asked immediately.
Zhuang Yan seemed a bit strong, Shen Zi evaluated in his mind.
It has nothing to do with him whether she is strong or not. Let Luo Hao fix her. Luo Hao will definitely not be used to others.
"Xiao Zhuang, if I invite you alone for this consultation on stage, do you know what to pay attention to?"
Zhuang Yan immediately pricked up her ears and listened carefully.
"Huh?"
"Director Shen, I don't know, please tell me." Zhuang Yan said honestly.
"The consultation with us this time is not to seek medical treatment from us." Shen Zizai said calmly.
"Gah!" Zhuang Yan let out a duck's cry in her throat.
Shen Zi was stunned, what does this mean.
Zhuang Yan immediately realized something was wrong and smiled sheepishly, "Director Shen, this is a way of speaking for young people. What are you doing? If you say it too fast, it's like, sorry, sorry."
< br>Shen Zizi had a smile on his face, but sighed in his heart.
They are both young people, Zhuang Yan is not much younger than Luo Hao, but there is indeed something wrong with the way she handles things.
Every word made me unhappy.
If it weren’t for a good old man, I would have asked her to pack up and get out tomorrow. Even if he doesn't get out, he still has ten thousand ways to make her unhappy.
But who has the best talent for reincarnation?
However, even though he thought so, Shen Zizai still explained, "We make collective decisions when we go to the consultation to make up the numbers."
"???"
"Let's put it this way, they didn't find any fish bones when they came on stage."
"Gah!" Zhuang Yan habitually squeaked again, and immediately lowered her head after reacting, "No fish bones were found? Wasn't there in the film? ”
“Yeah, that’s the weird thing My son. It was there on the radiograph, but not after the thoracotomy. Where was the fishbone? And I don’t know if there is any problem with the aorta. The radiograph showed an esophageal-aortic fistula.”
“Esophageal-aortic fistula. "Zhuang Yan murmured as she thought about this diagnosis, and her whole body started to feel worse.
She had never heard of this diagnosis.
Shen Zizai rarely sees similar diagnoses.
As for the fish bone, where did the missing fish bone go? Is there a problem with the film or with the surgeon?
There are countless questions here.
After Shen Zizai explained here, he got on the elevator and stopped when he saw someone and said nothing more.
The whole thing is full of inexplicable weirdness.
Forget it if it was a common disease, it was an esophageal-aortic fistula diagnosed before surgery!
The culprit is just gone? Who would believe it? !
When he got to the locker room and got off the elevator, Shen Zizai stopped and said in a low voice, "We make collective decisions. Although we are not the relevant departments, we still have to embolden others. If something goes wrong, we will not blame everyone. You can also ask the hospital to take it seriously."
"..." Zhuang Yan had a question mark.
"We have invited experts from all departments that should be invited, and we have also invited experts who should not be invited. The first hospital of our medical university is at this level, don't you think so. If something goes wrong, it is life."
"..."
"Let's go and make a gesture to show our concern. In clinical work, everyone should look after each other and don't undermine each other. Who hasn't had time to ask for consultation on the stage?"
Said, Shen Zizai smiled slightly, "You go change clothes, we will meet at the door inside."
"Okay."
Shen Zizai changed clothes leisurely, he Not in a hurry, not curious.
No matter how weird things are in clinical practice, Shen Zizai has seen them all, but the fish bone is missing, and the previously diagnosed esophago-aortic fistula probably needs to be re-diagnosed, which is nothing to an old gun like Shen Zizai.
Ga.
Shen Zizai let out a "Gah" sound.
It is indeed the harmony of the two words "what are you doing" said quickly.
Young people? Shen Zizai curled his lips, "I'm still young."
After changing clothes, he walked slowly out of the dressing room. Shen Zizai saw Zhuang Yan already standing at the door waiting for him.
Changing clothes was quite easy, Shen Zizai put his hands behind his back and said, "Let's go."
Zhuang Yan remained silent and followed Shen Zizai into the operating room.
The operating room was crowded with people, and the always strict operating room nurse did not come out to scold people, accusing them of violating sterility regulations.
"Old Shen, take a look at the film to see where the fish bones were before the operation, and then take a look at the surgical area. You are good at reading films, please help me take a look." Director Xu of the Department of Thoracic Surgery said weakly.
Shen Zizai sped up as soon as he entered the door, being rigorous and serious, performing a full set of acting.
If you are sarcastic at this time, you are not here to help but to cause trouble.
The film inserted into the reader was not in the format of the first hospital of the Medical University, nor was it the resolution of the machine in the First Hospital of the Medical University. Shen Zizai knew it at a glance.
Going over and taking a closer look, there was nothing wrong with the preoperative diagnosis.
A 2cm fish bone pierced the esophagus and stuck in the aorta below the tracheal bifurcation.
The diagnosis of esophagoaortic fistula is also quite satisfactory.
The patient is lucky. Generally, when the saliva in the mouth affects the fish bone, a big gap will appear in the aorta, and the person will die without even a chance to be rescued.
And the patient was able to survive the surgery.
The film was nothing interesting. Shen Zizai immediately turned around, pushed a director who was watching the operation off the footstool, and stood up on his own.
“There is nothing wrong with the film, and there is nothing wrong with the diagnosis. Lao Xu, can you do it horizontally? It’s below the bifurcation of the trachea.”
"Well, come and see for yourself." Director Xu of the Department of Cardiothoracic Surgery sighed.
Shen Zizai looked down at the surgery area.
The anatomy of the tracheal bifurcation is clean and clear. But for this surgical anatomy skill, I have to give Director Xu a thumbs up for his surgical skills.
The surgery was really great.
But problems also appeared at the same time.
Precisely because Director Xu of the Department of Cardiothoracic Surgery did a good job, cleanly and with a clear surgical field, it was clear at a glance whether the "damn" fish bone was there.
Shen Zizai was startled.
There were some other speculations at first, but after seeing the surgical area, they all disappeared.
No, just no, not even a glance.
"Old Shen, you are good at watching movies, help me take a look at this place." Director Xu asked exhaustedly.
"Yes, the location is definitely correct. It's strange, there are fish bones." Shen Zizai muttered.
"Old Shen, please develop the fishbone. I remember it should be imaging."
Obviously, Director Xu of the Department of Cardiothoracic Surgery has been driven crazy. He is not even confident to ask such a question. .
"Development." Shen Zizai said firmly, "And one side is stuck in the esophageal wall and the other side is stuck in the aorta, yes."
"But what about the fish bones?" Xu The director muttered to himself.
His voice was low, lost, and frustrated to the point of self-destruction.
Gan, how do I know? Shen Zi cursed in his heart. But Shen Zizai knew very well that no matter who he was on the operating table, his claws would be numb.
"Brother, have you boarded the plane?"
A delicate voice suddenly came from the silent operating room.
Zhuang Yan!
Shen Zizai sighed.
Seeing that Director Xu and the head nurse of the operating room were about to curse, he quickly said in front of them, "Xiaozhuang, go out and make a phone call for the operation."
After saying that, Shen Zizi then introduced to Director Xu and the head nurse of the operating room, "This is Director Zhuang's daughter. She has just graduated with a master's degree and has come to work in our department."
Director Xu's anger was still not revealed. All the anger finally turned into an embarrassed smile, "Xiao Zhuang, who are you calling?"
"Senior brother." Zhuang Yan listened carefully to the words on the other side, answered casually, and then took pictures of the surgery area Take a photo, take a photo of the film on the reader, and click Send.
"Senior brother, the film has been sent to you, please give it a slap."
Zhuang Yan imitated the experts' tone of voice and gave Luo Hao a slap, delicate and delicate, as if she was coquettishly coquettish.
“Which senior brother?” Director Xu’s smile was uglier than his cry. Although he was wearing a mask, it was obvious to the naked eye that he was about to cry.
"Professor Luo Haolo, my senior brother." Zhuang Yan said with some pride.
“……”
"..."
There was silence in the operating room.
Zhuang Yan heard what Luo Hao said and hung up the phone. Just as she was about to speak, she instantly realized something was wrong and looked around timidly.
"Director Shen, what's going on?" Zhuang Yan moved closer to Shen Zizai, like a child who made a mistake. The more he spoke, the softer his voice became, until his voice finally curled up.
"It's okay, why did you want to call Luo Hao?" Shen Zizai asked pretending not to care.
"When something happens, you have to shake people. This is what my senior brother told me. When he encountered mushroom poisoning in Xiehe, he directly shaken his senior brother in Nanyun Province. Senior brother said that if the diagnosis is not clear, just shake people. There is no shame. If you really can't get off the stage, , That’s embarrassing.”
“Pa~”
A slap fell on Shen Zizai’s face.
Shen Zizai couldn't laugh or cry.
This is indeed true, but even if it is true, it is not true when scoring.
Now the clear fish bones on the film have disappeared, and the patient is lying on the operating table with a thoracotomy. At this moment, Luo Hao is still far away, so what's the use of shaking people.
"What did Ronaldinho say?" Shen Zizai asked.
"Senior brother said, don't worry now, he will come back to solve it."
……
……
Note: It was about an incident in 2002. I flew to Mayo, but I didn’t have any surgery. I came back after 3 months and left with a mouthful of blood spurting out in the Imperial Hospital.
Note 2: This medical record is from Huaxi. I only found this one similar medical record. The fish bone went from the esophagus to the aorta and then inexplicably entered the aorta.
I can’t figure out how to get in.
(End of this chapter)