The term "surgery season" is quite contrary to the laws of nature, do people avoid holidays and choose a certain time period together when they are sick?
But that's really the case in real life.Post-segmentation trauma surgery begins with rectal cancer, followed by esophageal cancer, and various cancers that are undergoing preoperative examinations.On the morning of the 6th, listening to the nurse's shift, I had the feeling of entering the surgical oncology.Fortunately, there were patients with cerebral hemorrhage, appendicitis and intestinal obstruction in the last 24 hours, so that the illusion of doctors and nurses did not become a reality.The nervous trauma surgery made Zhang Zhengjie arrange five days of elective surgery for next week's six working days at the morning meeting on the 6th.But counting the three nights of 4, 5, and 6, there are no less than two emergency surgeries on the night shift every night.These emergency surgeries were crowded with excitement, which immediately reduced the number of spare beds in trauma surgery and increased the workload of nurses dramatically.The number of patients undergoing major surgery and emergency surgery began to increase, and the head nurse was happy that her income was increasing, and she also began to worry about the rest of the nurse's night shift and morning shift.She followed Zhang Zhengjie into the director's office, sat in the position that Chen Wenqiang never refused to sit and abused Zhang Zhengjie, asking him to let the director's office out and make a temporary rest place for the nurses on the night shift and the morning shift."
Director, don't be reluctant, now that the department is so tight, two more nurses are resting in the department, in case there are really not enough people to use, they can also catch them for a while, don't you say?"
Zhang Zhengjie wanted to read a book in his office, so he did not hesitate to give up the operation.But the head nurse's refusal to leave until he reached his goal forced him to seriously consider the benefits of this proposal.Alas, he couldn't read books anyway when he hid in the director's office, so he had to surrender to the head nurse and give up the director's office, and instead pondered how to use the duty room to read books.The duty room is also good - the old man doesn't like to come to the duty room unless he sleeps, Li Min basically doesn't enter the duty room during the day, and even doesn't want to sleep in the duty room at night.As for the other attending doctors in his treatment team, they are going to go for an elective surgery for prostate cancer together this morning.Zhang Zhengjie asked to move the bedside table in the duty room, and moved his and Dean Chen's desks into the duty room, which made the duty room unique.The head nurse pursed her lips and beckoned the nurses and hygienists to place them as the director intended.It doesn't matter how you put it, it's good that the nurse has a place to rest.Director Li looked at the people who were busy carrying tables and chairs back and forth in the director's office and the duty room, and said to Chen Wenqiang with a smile: "You have this exam, it's best to come once a year."
In the last three to five years, we will not say whether the medical technology level of our provincial hospital can be raised to a higher level, but the theoretical level will definitely be greatly improved. ”"That's natural."
Chen Wenqiang received such affirmation, and secretly proudly prepared for the harsh examination plan he proposed."
Is Xiao Li done?"
Director Liang greeted Li Min, who was rummaging in the medical record car."
I'm done.I asked the nurse to confirm the premedication, and then I could take the patient there. ”Li Min agreed, and walked away with his medical records."
Okay.Lao Chen, are you really not going?
”"Don't go.Go ahead, I'll watch over the house.There are many postoperative patients in our group. ”"Okay, Director Li and I will go to the operating room.""
Go, go."
Chen Wenqiang waited for him to be the only one left in the office, so he took out the case summary report of ependymoma handed over to him by Li Min from the drawer, walked to the window and read it carefully.He didn't expect Li Min to hand in the first draft this morning, but after he read it carefully, he found that there were only a few places where he could submit the manuscript with a simple revision.So he took out a red pen and changed it seriously.And the reason why Li Min was able to hand in the first draft so quickly was because of the sticky notes and work notes she carried with her, which recorded the things about the child in more detail than the medical records.Before the operation of this child, Director Li, Director Liang, Director Wu of Pediatrics, and Director Hu all discussed and analyzed the CT film and condition of the child.Of course, Chen Wenqiang's consultation and analysis in the first draft, and when he later did the postoperative ward rounds for this child, his guidance to Li Min occupied an important position.The more Chen Wenqiang looked at it, the more satisfied he became, and then he explained to the head nurse that he went to the hospital.He took the patient's X-ray and CT scans before and after the operation, went to the typist of the hospital office, watched her print out the revised first draft, copied a few copies of the film himself, and circled the important places with a red pen to make annotations, and then went to the medical department to register and seal it with satisfaction, put it in an envelope with the name of the hospital, and send it directly to the neurosurgery journal.He believes that these additions, together with the detailed preoperative analysis of the case report and the record of effective postoperative treatment, will make this article public.
*In the operating room, Director Li stood in the position of the chief surgeon and confidently and steadily pushed forward the surgical process of esophageal cancer; Director Liang's cooperation as an assistant made Director Li feel like a tiger; As for Li Min, she finally stood back where she should be standing - the hook.In fact, she was not needed with the retractor, and after the automatic retractor opened the arc incision between the sixth intercostal space and cut the pleura, she could not intervene and visited the operation instead.Thoracic surgery really makes short people really can't afford to hurt.The tallest stepping stool in the operating room was stood by Director Li, and the one she moved from next door was stood by Director Liang, and the two second-highest stepping stools were stacked together, and she could only place them along the way—forget it, watch it from afar.If you really want to knock over the step stool and throw yourself on the operating table, it will be a big disaster.Open your chest.The textbook of "Surgery" only has a simple three-page introduction to esophageal cancer, which is full of pictures and texts, and also has the role of outline.But for specific surgical treatments, it was really a word, and it was so stingy that it only gave four lines.And Director Liang also smiled and encouraged Director Li: "You see that we are busy here, but our Dr.
Li is bored, so let her tell you about the cause of esophageal cancer." ”"Okay.Xiao Li, read it to me.You'll have to take the exam at the end of the year anyway.Let's start with the distribution of etiology and pathological classification. ”Li Min had no choice but to answer the question honestly as required: "The causes of esophageal cancer in China are different depending on the region.In general, the incidence rate is higher in men than in women, and it is more common in the north and south, and the common age of onset is over 40 years old.Epidemiological investigation shows that the incidence rate in the north is about 7/100,000, which is related to hot food, drinking, eating sauerkraut, and eating fast.One county in Henan Province has the highest incidence rate of 67-130/100,000, which is related to mold infection in the diet of sauerkraut.The high incidence of Taihang Mountain is related to the deficiency of molybdenum, a trace element contained in soil and drinking water. ”"That's a good memory.What about pathology?
”"According to cytology, it is divided into squamous cell carcinoma and adenocarcinoma.It is divided into four types according to the morphology.Medullary type, cancer infiltrates all layers of the esophageal wall and the whole circumference, esophageal hypertrophy, high malignancy, and poor prognosis for surgery.However, this type accounts for more than half of the cases.The second is coarctation, where the cancer grows in a ring, so the clinical symptoms of esophageal coarctation and dysphagia will appear in the early stage, so the patient will seek medical treatment early and the postoperative effect is good.The third type of mushroom, which grows into the lumen of the esophagus, also appears early in obstruction.The incidence of this type ranges from 5% to 10%.The last type is ulcerative, with an incidence of about 5%, and the tumor grows to the muscle layer, and the symptoms of obstruction dysphagia appear relatively late and mild.Once you seek medical treatment, most of them are already in the middle or late stages. ”"What about our case?""
Our gastroscopy report shows that it is ulcerative.However, it is not known whether the cancer has eroded through the entire thickness of the esophagus. ”"What do you think the prognosis will be?""
Not good."
Li Min felt a little bad after answering, and hurriedly added: "Although this patient did not find lymphatic metastasis in the physical examination, and no liver changes were found in B-ultrasound, according to the gastroscopy report, the muscle layer was basically penetrated, and the cancer occurred in the middle and lower segments, and it is likely that there is abdominal metastasis."
However, there are also advantages to the fact that the cancer occurs at a relatively low site and can be completely removed. ”"Did you hear that, Lao Li, Xiao Li not only comforted you that this cancer is easy to remove, but also reminded you to be careful of abdominal metastasis.""
That's why I chose the left breast path.It is easy to cut the cancer and clear the lymph nodes, and it is also convenient to free the stomach.Xiao Li, what are the benefits of the left chest path?
”"The surgery takes a short period of time, is less invasive, and has low complications and mortality."
Director Li and Director Liang cooperated tacitly, and the esophagus, which went up to the aortic arch and down to the cardia, quickly became free.Then the diaphragm is cut, the abdominal cavity is explored, the stomach is free, the cardia is removed, the esophagus is severed, and finally the anastomosis."
Our provincial hospital really has to buy a stapler.It's too slow to rely on the two of us for a stitch and a thread. ”Director Zhou also agreed with Director Liang's opinion."
It's time to buy it, you can finish the operation a quarter of an hour earlier, and the pressure on the anesthesia side is a little less.""
You have to say it's better for the patient."
Director Zhou nodded in agreement: "Lao Li, you apply, I don't think Chen Wenqiang will refute anyone." ”"Where's the money?
You two don't know how expensive firewood and rice are if you don't have a family.Just because I know he won't reject my application, then I can't make a request lightly.Do you two know?
”*Dean Shu looked at Chen Wenqiang with a headache, "You know that I won't refute you easily." ”"yes."
Chen Wenqiang nodded as a matter of course."
Lao Li's imprisonment, let's squint our conscience and push it to the catastrophe of the past ten years, and that's it.But the four children in his family have suffered a lot since they were young, and their studies have been delayed.The year before last and last year, I mobilized him to bring the boss in first, but he refused to say anything, but told me that the child's junior high school Chinese class had not yet been completed, and he did not have a junior high school diploma or anything.The strength of this brain-dead melon bone.What does it take to move the infusion bottle in the preparation room, and it is enough to graduate from elementary school.But you know that he is really seriously abiding by the rules of the hospital, and asking someone to transfer his two sons in their twenties to junior high school for tutoring.Alas, I'm worried about his thoughts.The eldest of his family is almost twenty-seven or eighteen years old this year, and the second eldest is more than two years younger, and he has no partner.In those years, the little brothers picked up the rags together and helped raise their younger siblings.He came out in 78 and resumed his job, but his salary alone could not support six people, and his two eldest children were still doing odd jobs outside.He can teach both children well and go back to school to pass the junior high school leaving exam, alas!
The hard work and pressure he and his children have put in over the years. ”Dean Shu's implication was that he should not apply easily, but he didn't expect to provoke Chen Wenqiang's string of words.He frowned and knocked on the report under his hand, and after muttering for a while, he had to find a way to "wipe his ass" for Chen Wenqiang, and at the same time reason with him."
I understand your thoughts about Director Li's day as a teacher and a father for life.But if you want to get Lao Li's three children into the preparation room together, I tell you that you really have to think about it carefully.Do you think this is good, my indicator has been useless, this time I will use my one to give Lao Li a child to the provincial hospital. ”Chen Wenqiang immediately laughed, clapped his hands and said, "That's great." ”"To take care of the work of the children of the employees of the provincial hospital, especially the indicators of entering the preparation room, it must be the title of deputy chief physician or above, and the children are under the age of 25.This is the hard standard.Therefore, Lao Li's son, only the one under the age of 25 can enter the preparation room, and the two who are over the age will go to the logistics to make other arrangements. ”Chen Wenqiang immediately quit: "The logistics is also the bonus of the preparation room.Maintenance or anything is to earn a basic salary, and there are not many bonuses to get. ”"The rules of the hospital are for everyone, and you and I have to follow the rules.I say don't take the rules seriously!
When you sit in my position, you will be able to taste the benefits of doing things according to regulations and policies.Otherwise, the people from the respiratory department will come to you to plead with you, and the director of the pediatric gastroenterology department will still complain to you, and everyone has specific difficulties that you have to solve.You can't do it and can't do it all if you promise it all, but as long as you don't help one of them, the subsequent troubles will be endless.Can you understand what I mean?
”Chen Wenqiang nodded: "Understood, but" "Nothing but."
When we reach the leadership level of the hospital, we have to lead by example.Otherwise, staring at the staff of the hospital leaders - as long as the hospital leaders take the lead in disobeying the rules, the employees will definitely follow the mess, no one will abide by the rules and regulations anymore, and the hospital will definitely end up in chaos. ”"I know that."
Chen Wenqiang was not very happy, the matter was only half done!
He didn't care about Shu Wenqiang's tactful criticism of him, and stepped forward to pick out the application form signed by Li Min from Dean Shu's men.Dean Shu shook his head and sighed, "I said you shouldn't just stare at the preparation room.Although the current bonus of the preparation room is the first in logistics, the initial level of Chinese entry, basically a lifetime of hard work to carry infusion bottles.You discuss with Lao Li, the one who meets the age standard enters the preparation room, and the rest sends one to the cafeteria to wash dishes, and another to the car class to wash the car.In this way, even if the child enters the provincial hospital for a year, the deputy chief physician of our provincial doctor will only have one per person, and you and I are willing to give it to him, and it will not attract the disgust of the masses. ”"Washing dishes, washing cars?"
Chen Wenqiang was immediately stunned.He hurriedly extinguished the small half of the cigarette in his hand and shouted to Dean Shu: "Xiao Shu, Lao Li is my teacher."
When I first entered the clinic, he took me for almost two years. ”Dean Shu immediately put his index finger to his lips after Chen Wenqiang shouted to wash the dishes and cars, and Chen Wenqiang's voice immediately came down, but his face was full of hurt expressions."
Xiao Shu, when those two children were young, you also took them to play, so let them wash dishes and cars for the rest of their lives?
Even if you go to the preparation room to move the infusion bottle for a lifetime. ”"Oh, you, you.What if you don't?
The eyes of the whole staff of the hospital are watching.You talk to him well, go wash the dishes and the car first, and then I will ask Dean Fu to greet the logistics side.Perform well for a year and strive to become an advanced worker, which will facilitate the next step of job transfer.In the cafeteria, I learned to cook well, and those who went to the car class learned to repair or drive, all of which have a skill, which is the long-term plan for my children. ”"Good.Listen to you. ”Chen Wenqiang smiled.I told him this: the boss is more able to endure hardships, first go to the cafeteria to wash dishes and then learn to stir-fry; The second child is more flexible to go to the garage to wash the car first and then learn to repair the car or repair the car; The third child is young, so he first goes to the preparation room to work hard for three years, and he can also make up for his high school homework after work.Let me tell you that the third child in his family is also a good boy with rigidity, he finished junior high school early, and when Lao Li went to study, he went to the train station to make money as an anti-big bag, and he also had to change his eldest brother and second brother to go back to study. ”Chen Wenqiang said that he was moved, and finally sighed with embarrassment: "Alas, the old dean's matter, it's not authentic, and it has made Lao Li's family suffer." ”"Don't talk about the old stuff anymore.People die and the debt disappears.He took good care of you and me back then.Let's just think that he was good when he was alive.I've taken care of this, and you're going to turn over what he did to Lao Li, okay?
”"Okay."
Chen Wenqiang responded happily."
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You remember telling Lao Li what I mean."
Seeing Chen Wenqiang nodding, Dean Shu continued: "You tell Lao Li: When his third child gets his high school diploma, he will go to the health school and medical college for on-the-job training, and he will not be afraid of later, as long as you and I are in the position of the provincial hospital, no matter whether he chooses Chinese medicine massage in the future, or goes up to study a junior college or something, it is better than moving an infusion bottle in the preparation room for a lifetime." ”"Yes, yes, you arranged it so well."
Chen Wenqiang's heart was overjoyed: "I knew that you had to plan such a thing." ”"For your sake, too.Anyone else, do you think I'm in charge of one?!
”Chen Wenqiang was even happier by what Dean Shu said.Dean Shu is willing to plan so much for Director Li's son, one is to see Chen Wenqiang, and the other is to see that Director Li can insist that the child really go to junior high school.The stress of sitting in a junior high school classroom in your twenties......
He believes that the children of the Li family, who have experienced hardships in their childhood and can still go to junior high school in their twenties, will be successful no matter which industry they are in in the future.As for myself, it's a matter of brains.Chen Wenqiang is his brother, and he should pull him, push him, support him, and let him be safe and smooth, which is to fulfill his filial piety to Chen's father and Chen's mother.Just like their siblings in high positions, they always have to find ways to fill in a little bit for themselves, so that they can feel less guilty about their parents."
Director Qin has cleaned up the office for you, I have seen it, and it is all neatly prepared.You go past him to get the keys and talk to them politely.In the future, if you look up and don't look down, you have a lot of things to help with the hospital.It doesn't matter how close he is to Faybot, as long as he can do what you ask and do what you tell him.Do you understand?
And you must put away the careful thoughts of these people who look down on you who have retired from the clinic, and don't let the logistics and agency people find out.Some people are only talented enough to work in the communication room, and some people can only work as nursing assistants in your department.If you stiffen the relationship, they won't be able to work, and the trouble they cause will delay your business. ”"Okay, I won't show my mind to look down on them."
Chen Wenqiang has long been accustomed to Shu Wenchen, who is a few months younger than him."
Then I'll go back to Corey."
*This patient after esophageal cancer surgery, Director Li said that he would personally manage it.So after eating at Sihai Restaurant, Li Min was able to go back to the dormitory to rest.She was afraid that she would forget the details of the operation when she woke up, so she first recorded the operation record in detail in her work notes, and then looked at the time at just over two o'clock when she was done.She slept with her head covered for two hours, sat up in the alarm, packed a few clothes, thought about pulling out the pillow and towel, and then buttoned the walkman to her belt, so that she could listen to the new concept with headphones, and when she was ready, she took this basin of clothes and waited to go to the water room to wash.Mu Jie called the anesthesiology department to find Director Liu, who teased him with a smile, and finally told him: "My junior sister will go back to the dormitory after lunch, and if you call five minutes late, I will call home."
What did you cook at night?
”"You'll see it when you get back."
Mu Jie put down the phone and filled the thermos bucket with food, and rushed to the dormitory just in time to see Li Min coming back with the washed clothes.Mu Jie took the laundry tub and handed the cloth bag in his hand to Li Min, "Have you slept?"
”"Slept for two hours.Li Min took out the key to open the door."
Why did you remember to send it here?""
I'm afraid to be sent to the office, and you're going to have emergency surgery again.It's better to eat and go to work. ”With Mu Jie helping her dry her clothes, Li Min no longer needs to move stools back and forth, take off her shoes and put on shoes, and tumble up and down on the ground.Moreover, Mu Jie's hands are also strong, and the clothes and pillows are twisted by his hands, which is close to the dehydration effect of the washing machine.Mu Jie dried his clothes, and Li Min laid out the meals: two rice, steamed pork ribs with Huaishan tempeh, fried green peppers with potato chips, and scattered chopped green onion leaves floating on tomato and egg soup.It is a very home-cooked two dishes and one soup, but it is full of color and flavor, which makes people's appetite move and appetite."
I had an early dinner today, so you can eat with confidence.Maybe tonight the night shift will have to be operated on, and it will be very late to sleep. ”Mu Jie gave Li Min vegetables and persuaded her to eat more."
Hmm."
Li Min took three bites of everything, then sighed and put down the spoon."
Mujay.""
What's the matter?
Why don't you eat it?
”"If you cook like this every day, I won't be a big fat man of 200 pounds in the future, and I will have to be at least 150 pounds.It's true. ”Li Min emphasized."
No, it won't.The distance you run in the morning is not short, and surgery is also heavy physical labor, and you can't get fat if you want to. ”Li Min shook his head: "I ate a lot at noon, and I really can't eat anymore at night."
If you get used to eating, you will have an appetite.You can eat it for me.I'm going to go to the operating room again in a while, and I'll take my weight. ”"When I went to weigh myself after dinner, it was definitely heavier than in the morning on an empty stomach.In life, the word food and clothing in the world, the first thing is to eat well and eat enough.The world is big, and the food is the biggest. ”Mu Jie tricked Li Min into eating more."
Well, you have a point.Then let's decide, you work eating, and I work hard to wear it. ”Li Min smiled and joked with Mu Jie, but he didn't want to eat in his mouth anymore.Mu Jie saw that Li Min said that he would not eat any more, and began to pour food into his mouth like a storm."
Hey, hey, you eat slowly, slowly."
Li Min hurriedly stopped him, "If you don't chew food, it will increase the burden on your stomach and intestines."
There's still time. ”Seeing that Li Min was in a hurry to stop him, Mu Jie immediately slowed down and chewed slowly and ate slowly.He also explained to Li Min seriously: "The habit brought out from the military academy has been eaten like this for the past twelve years. ”"It's not good for your health."
Li Min frowned lightly and rubbed the piece of petroleum jelly ointment on his hand: "If the conditions allow, you still don't gobble it anymore." ”"Good.Listen to you. ”After eating, Mu Jie put away the thermos bucket and said, "It's almost time, you go to take over, and I'll take it back to wash." ”"Hmm.If there are no accidents, I will be able to check the room in about 40 minutes. ”"Then I'll wait for you at your seat at 10:60."
The two went downstairs hand in hand.The big and thick hands are warm and powerful, and they hold the cool hands that are white and smooth tightly.When I got to the door of the dormitory building, I had to let go of my hand, one was about to walk in the direction of the hospital, and the other was reluctant to look at the back of his sweetheart and refused to turn around.
※※※※※※※※※※※※※※※※※※※※*Note: The esophageal cancer screening data cited in this article are from before 1990.Now the incidence rate in Linxian County, Henan Province has exceeded 478 per 100,000 population.The lowest incidence rate in Hotan Yutian County, the country, is 2 per 100,000 population.
**There is no gold finger in this article.,It's a common disease.,In the future, there will be a little bit of a relatively rare case that will slowly grow up with the heroine in the clinic ^-^()The distance is a little far.