On the second day of the first lunar month, the whole hospital still had to go to work for a big round as usual.But the snowfall at night made everyone who went to work on time have to clear the snow first when they arrived at work.Zhang Zhengjie looked at the newly admitted patients on the list of inpatients, and felt very embarrassed.Depending on the admission of these patients, Corey should have been accredited with a doctor.But this snow clearing is manual work, so if the male doctor doesn't go, why should the nurse do it?
The head nurse said, "Director, I'll ask upstairs to see if Li Min stays, and if she stays, we don't have to keep people." ”Zhang Zhengjie nodded, it's really like this."
Director Li, happy New Year, I'm Wang Jing on the eleventh floor.Then I want to ask, did you leave Li Min on the twelfth floor to take care of the family, our department has admitted more than a dozen hospitalizations in the past two days.If we keep her at home, we will be relieved. ”"Okay, then keep her."
Li Min disagreed."
Director Li, you stayed to look after the house, and you bothered about those patients downstairs."
Director Li said, "Downstairs asks you to be the hospitalist."
I'm not familiar with the patients who have just been hospitalized, so it's easy for you to leave something to deal with. ”Chen Wenqiang listened to Director Li's nasal voice, thinking about what Li Mincai reminded him, so he persuaded him: "Xiao Li is kind enough to do it for you, so don't go to clear the snow." ”Director Shi also advised: "If you catch a cold and then get frozen, you really have to take injections and medicine when you turn around."
The on-duty arrangement of our surgical group can't afford to leave you behind. ”Seeing Director Shi say this, Director Li reluctantly agreed.Director Li's cold also came out of the snow on the 30th day, and he refused to be persuaded to take medicine at home, so he only drank some ginger soup to deal with it.In the morning, Director Li had his front foot in addition to the door of the house, and his wife called Li Min on the back foot and asked Li Min to tell Chen Wenqiang not to let Director Li go to clear the snow again.When Wang Jing saw that Li Min also came out to clear the snow, she was very surprised, and she quickly asked: "You came out to clear the snow, who did you leave to watch the house?"
”"Director Li has a cold, leave him to watch the house."
Wang Jingxin palpitated: "There are still several people in our department who were injured in the fight." ”"Don't worry, he'll definitely be careful this time."
Director Shi persuaded her.But Zhang Zhengjie will not be reassured.It didn't take long to find an excuse to send the head nurse back."
You go back and watch, don't do anything else."
Wang Jing understands his thoughts, this person has been as strong as himself for half his life, and he has not passed that hurdle in his heart after being criticized.She also obeyed her own wishes, and according to Zhang Zhengjie's words, she put down the scraper that pushed the snow and went back to Cory.When she returned to Corey, she saw Director Li walking out of the custody room on the eleventh floor."
Why did you come back at this time, are you worried about me?"
Director Li asked very bluntly.Wang Jing concealed and said: "Corey has other things, I have to come back to deal with it, otherwise I won't dare to come back with so many eyes watching." ”“？”
Director Li's face was full of questions.Wang Jing saw that she couldn't hide, so she had to say: "There was a sum of money in the department a few years ago, and our department director said that it was sent to everyone during the New Year, so I came back to pack the money first, and I wanted to be auspicious." ”"How much?"
Director Li asked tentatively: "There was no such precedent in previous years. ”"Not much, one hundred."
Director Li thought about the small vault on the twelfth floor, calculated the accounts, and found that one person was also emptied for a hundred.He nodded and said, "I'll discuss it with them when I go back and see if we can send it too."
Xiao Jing, it's not authentic for you to do this.You said that it didn't take long for the upstairs and downstairs to be subscribed, and you just did this thing, didn't you shake the morale of the army. ”The head nurse smiled and said, "We can't help it."
At the end of the year, the bonus for the two months was a big difference from last year, and the orthopedics department surpassed, and if you don't do something to win people's hearts, it may not be good to ask for people this year. ”"Hehe, Fan's wool is out of the sheep.""
That's a terrible thing to say."
The head nurse took out a stack of laisee packets with bank markings from the drawer of her desk and filled them with money one by one.Brand new 100 yuan, she has to look at the number, otherwise there may be two sticks together."
Is there any Xiao Li?"
Director Li waited for her to finish pretending and asked."
There's definitely hers.Director Zhang said that Dr.
Li was the general hospitalist, and he didn't wait to think about the department when he slept. ”"That's it."
Director Li sniffled and tightened his military coat."
Was it freezing the day before yesterday, did you drink some ginger soup and scald your feet?""
I'll drink it when I go back today.I'm old, and I can't stand it if I'm a little freezing.If Xiao Li hadn't thought about me, I would have gone out to clear the snow just now. ”"Then you don't have a fever when you come back."
While the two were talking, the call bell in the monitoring room rang, and Director Li looked at the room number and immediately walked out.muttered in his mouth: "It's not good to drink and eat dumplings at home during the Chinese New Year, but I have to come to the hospital to spend money." ”* When I came back from snow clearing, the head nurse called Li Min: "Doctor Li, come down, our department will send you New Year's money." ”Is this a good thing?
But Li Min knew that the head nurse on the eleventh floor was not a person who joked nonsense, she saw that Director Li was talking to Chen Wenqiang and Director Shi, as if she would not immediately check the ward for a while, so she said to Lu Qing: "I'll go downstairs and come back immediately." ”Everyone on the eleventh floor rejoiced.Signing and receiving New Year's money, "Happy New Year" is full of everyone's ears.Li Min received the money and thanked Zhang Zhengjie and the head nurse, and Zhang Zhengjie said, "This is what you deserve."
There is still half a year of hospitalization, continue to work hard. ”"Yes, yes."
Li Min carried the money and went upstairs happily."
Let's start the rounds."
When Chen Wenqiang saw her come back, he immediately proceeded to today's main content."
After checking the house, go home early for the holidays."
There are few patients on the twelfth floor, and those who can be discharged from the hospital have already gone home for the New Year, and the rest are all surgeries done before Xiao Nian.Although the patients are in a stable recovery period, no one dares to take it lightly, led by Director Li.After carefully checking the more than 20 patients, Chen Wenqiang greeted Li Min: "Xiao Li, you go downstairs with me to have a look, there have been a lot of people downstairs in the past two days." ”"Yes.""
Lao Li, Lao Shi, then the rest of you can go home."
Today's day shift is Zhang Zhengjie on duty.There are more patients downstairs, and I am about to live on the eleventh floor.Zhang Zhengjie checked carefully, and several doctors walked slowly.Chen Wenqiang had Li Min to introduce him to his condition, and soon caught up with them."
Dean Chen, Happy New Year.""
Happy New Year."
Chen Wenqiang saw that Zhang Zhengjie had investigated carefully, and followed them with great satisfaction.There was no need to report the medical history, and Li Min quietly breathed a sigh of relief.asked Chen Wenqiang for leave and said, "Teacher, I'll go upstairs and drink a few sips of water and come down." ”"Go ahead, no need to come down."
Li Min walked out of the ward and walked a few steps to the stairs, when a nurse shouted behind him: "Doctor Li, Doctor Li, the patient with 6 beds in the 2nd ward is not feeling well." ”2 wards with 6 beds?
Is it the old man who picked up the rags after the internal fixation of the femoral neck fracture?
I've just seen him, and there's nothing wrong with that.But the old lady of the patient's family appeared behind the nurse, and although the distance was far away, her panic was not fake.Li Min hurried to the 2nd ward.Less than half an hour ago, I saw this patient say "Happy New Year" to himself, but this moment, he was lying on the bed, panting, sweat beads on his forehead, cyanosis on his lips, and his expression made Li Min feel terrified - this is a typical manifestation of hypoxia.Suffocate!
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Li Min hurriedly pressed the emergency bell at the head of the bed, unscrewed the oxygen supply facility with his other hand, and quickly put a transparent silicone tube on the patient's head to give him oxygen.Then he took out his stethoscope, and he didn't care about listening to it, and ripped off the old man's chest clothes to auscultate: wheezing in his lungs.This is true for the left lung, and the same is true for the right lung!
Li Min was very clear about the patient's medical history, but she was afraid that the patient would conceal the medical history, so she hurriedly asked the old lady: "Does he usually have asthma?"
If you tell me the truth, I can save people!
”Li Min's sweat dripped down.The nurse came in, and she asked the old lady in a loud voice, "You rang the bell?"
Isn't Dr.
Li here?
”"Push the ambulance.ECG monitoring, fast!
”Li Min's voice changed.My throat was dry and hoarse after talking a lot just now, and now it hurts when I shout.The nurse also found that the patient on the bed was wrong, so she ran out in a panic, shouting as she ran: "Director Zhang, rescue in ward 2." ”When the old lady saw Li Min change color, she was so scared that she choked up and said, "No, he doesn't have asthma."
The two of us were talking, and he was suddenly like this. ”Li Min counted the date after the operation, could it be a pulmonary embolism?
Before she could figure it out, Zhang Zhengjie, Chen Wenqiang and others rushed in when they heard the sound, and the head nurse and others who didn't leave also pushed the ECG monitoring and ambulance in."
Call the ICU and anesthesiology department and ask them to come."
Chen Wenqiang was present to command, and everyone immediately settled down and began the rescue work in an orderly manner according to his instructions.The old lady pulled Li Min who stepped back and asked, "Girl, what's wrong with him?"
”Zhang Zhengjie turned around and replied for Li Min: "I was in bed for too long after surgery, and I considered that there was a pulmonary embolism." ”He knew the old couple too well, and he was reluctant to spend money on snacks except for three meals, so there was no possibility of aspiration.Preoperative lung radiographs do not support emphysema; The lungs reported by Li Min just now were full of wheezing, and the possibility of a pneumothorax was also discharged; If there is no history of asthma, then the rest, it is likely to be a pulmonary embolism.The most terrible complication after surgery for orthopedic patients!
ECG monitoring shows that the heart rate is 142 beats per minute, the breath is 35 beats per minute, the blood pressure is 190/110mmHg, and the oxygen saturation is only 88%.Everyone present also thought that it was a pulmonary embolism!
In patients with fractures, it is very likely that there are fat cells free at the fracture of the bone at that time; In addition to the previous cause, there is also a possibility that the operation caused the fat cells to enter the blood vessels; Then there is the possibility of bed rest, which may cause deep veins to form blood clots.Then, whether it is an embolus formed by fat cells or a blood clot that breaks off from a deep vein, it enters the pulmonary artery with blood circulation.Once the pulmonary artery is occluded, the patient is unable to receive effective oxygen and the clinical manifestation is a sudden and acute hypoxia.But in this patient, he has been in bed for ten days after surgery, and it is very likely that he has formed a deep vein thrombosis in his lower extremities during these days of postoperative bed rest.In the past few days he has started to get out of bed and do light activities......
Causes a blood clot to break off in a deep vein.But no matter which one it is, as long as a pulmonary embolism occurs, it is really a life of death.Because the blood in the human body travels, it has to pass through the pulmonary arteries and enter the alveoli for gas exchange, and then to the left ventricle and then to the rest of the body.If the pulmonary artery is blocked by a blood clot, it takes less than 2 minutes for the patient's heart to stop.Even if you push it to the operating room to remove the thrombe, it will be too late - everyone knows that there is no room for thrombectomy if the pulmonary embolism is completely blocked......
Because anesthesia, it takes time; It still takes time to open the chest......* The patient suddenly rolls his eyeballs, screams, and faints.But his breathing was still so rapid.But the occurrence of these changes did not take more than 2 minutes from the time Li Min entered the 2nd ward.On the ECG monitor, the patient's heart rate is dropping, 130 beats, 120 beats, 100 beats, 90 beats ......
"adrenaline." ”Chen Wenqiang shouted so loudly that his voice was torn.The head nurse moved very quickly, and immediately pushed the prepared epinephrine in his hand into the patient's vein, which opened the fluid path.Dr.
Jiang from the Department of Anesthesiology and Director Hong from the ICU also came.It seems that he answered the phone and ran over.Li Min stood at the end of the bed and quickly reported the rescue history, and before they could take any measures, the patient's heart rate dropped to 0.The tide is over.But who is willing!
The director of the ICU was Chen Wenqiang from the ICU of the Medical University, and Dr.
Jiang came from the anesthesiology department, who is also an experienced attending doctor.Chen Wenqiang and Zhang Zhengjie moved out of the way, and they immediately took over the rescue work.Zhang Zhengjie saw Li Min standing at the end of the bed and recording, so he shouted at her: "You mix the old lady out." ”Li Min hurriedly moved, and dragged the old lady out.The head nurse also instructed the nurse to bring in two screens, which were unfolded to block the view of patients on both sides."
Girl, girl, is my old man okay?
Is he okay?
You say I believe you. ”The old lady tugged at Li Min's sleeve, and her expectant eyes made Li Min speechless.What should she tell the old lady?
The rescue in the ward continued, and more than half an hour later, Zhang Zhengjie walked out dejectedly.His sad expression and the look in his eyes that didn't dare to look at the old lady made the old lady subconsciously grasp Li Min's sleeve."
Auntie, we did our best.Your uncle went to him.Alas!
”Zhang Zhengjie smashed a fist into his palm to vent his frustration and frustration of being unable to save the patient's life.The pain made him grin, and it made him frown, and it was almost coming together.The old lady looked at Li Min in disbelief and then at Zhang Zhengjie, she repeated "gone, gone", as if she was wondering what Zhang Zhengjie's "gone" meant.But she suddenly threw off Li Min's sleeves and ran into the house at a speed that did not match her age.Thanks to Zhang Zhengjie's quick movements, he grabbed Li Min, who was thrown off, and then stepped over with an arrow step, narrowly grabbing the old lady's vest, so as to prevent the old lady with her left foot from stumbling and hitting her face.The old lady fell, but less than half a foot from the ground, she was caught by Zhang Zhengjie with her hands.The person was not bruised, but her howling and crying suddenly erupted when Zhang Zhengjie helped her to the bed of the deceased."
Oh my God, why did I take you away!
How can I live without you?
”The old and hoarse voice, mixed with the lonely wail of losing his partner, and the cry of pain and grief to the bones, made Chen Wenqiang, who had seen a lot of life and death, turn his face.This old lady's life is too difficult.Her future will be even harder.The head nurse beckoned someone to call the morgue, and in any case, the person had to be pretended to be buried first.When the person is completely stiff, it will be difficult to change clothes.Li Min followed Chen Wenqiang and Zhang Zhengjie back to the director's office, and the entire eleventh floor instantly lost the joy of the New Year.No time in the face of death has made Li Min so sad as this time.She even had a faint self-blame, if she hadn't persuaded the old lady that the patient didn't choose to have surgery, would there be less than half of the pulmonary embolism.That's what she thought.Chen Wenqiang sneered: "Half?
Are the likelihood of fat cells entering the venous blood during surgery outweighing the chance of free fat from the severed end of his femoral neck entering the bloodstream?
”Zhang Zhengjie's face was discouraged: "If you encounter such a complication during the Chinese New Year, it is also fate."
Without surgery, he would have been in bed longer and would have a higher chance of deep vein thrombosis.Blame yourself like you, shouldn't I commit suicide by throwing myself into tap water now?
”Such a witticism, no one can laugh at this time."
Director Zhang, you have a good talk with the old lady, we should still clarify the cause of death of this old man.Pulmonary embolism is just our guess, and the specific situation depends on the autopsy results. ”Chen Wenqiang instructed Zhang Zhengjie."
Let the medical office help with the work."
Zhang Zhengjie nodded heavily.Director Qin was called when he got home.Sitting in the office on the eleventh floor, Director Qin was in a very bad mood, but looking at Chen Wenqiang, Zhang Zhengjie, Li Min, and Jiang Ma who accompanied him, his mood was suddenly not so bad.After understanding the situation, he asked Li Min: "What about the old lady?"
”"The head nurse is accompanying you in the doctor's duty room."
He supported Li Min: "Doctor Li, you go and invite the old lady." ”"Yes."
Li Min acted at the order, and Xiao Cao stepped forward to follow, but was stopped by Zhang Zhengjie with a stern look.As soon as Director Qin told him what he meant, the old lady asked, "What is the autopsy?"
”"This, Dr.
Li, you explain to her."
Li Min didn't have a seat at all, so he took a step forward and said to the old lady: "Auntie, the autopsy is a way to find out the cause of death."
It doesn't help him, but it can improve our medical care for us. ”"How do you check it?"
Li Min took a deep breath and said, "I want to ask an expert to cut open his pulmonary artery to see if there is a blood clot in his pulmonary artery and whether the blood clot has blocked the blood vessel."
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Only when it is completely blocked will there be such a situation that cannot be rescued in such a short period of time. ”The old lady didn't say anything."
Auntie, this is Dean Chen, you saw the rescue he presided over.He is a specialist in our provincial neurosurgery specialty.Director Zhang is the attending doctor of the Department of Orthopedics, and he was an advanced individual who learned from Lei Feng the year before last.This is Professor Hong, the director of the ICU who was transferred from the Medical University, and he is the director of the ICU at the Medical University.As you saw just now, he and Dr.
Jiang came quickly.We really did our best. ”The old lady nodded and said, "Girl, I know you did your best.As soon as the nurse calls you, you run over.But, but, but what will I do in the future!
”Li Min looked at Director Qin, and the old lady understood what she said, but the old lady didn't answer according to her question.But Director Qin didn't say anything, and Chen Wenqiang didn't say anything, so Li Min had to bite the bullet and continue to speak."
Auntie, we know you're sad.I, I'm sad too.However, I would like to advise you to undergo an autopsy and find out the cause of death, so that Director Zhang, and we, the clinical doctors, will see if our judgment is correct. ”The old lady still didn't speak.Li Min painstakingly organized the wording and said: "The autopsy clarifies the cause of death, and it is also to accumulate treatment experience for similar patients in the future. ”The last sentence of Jiyin Dexiu in the afterlife touched the old lady, and the old lady nodded silently, and tears flowed down her wrinkled skin.She raised her chapped hand and tried to wipe away the tears with the back of her hand, but the tears grew more and more.But she wiped handfuls in vain, oblivious to the new towel she was holding in her other hand.The head nurse reached out and lifted the towel to help her wipe her tears."
Then, auntie, you sign here, I, I," Zhang Zhengjie couldn't go on."
We'll take care of all the formalities for you.You've been staying in our hospital's guest house for the past two days. ”When Director Qin went out to invite people from Li Min just now, he listened to Zhang Zhengjie introduce the situation of the old lady.After the old lady cooperated and agreed to the autopsy and signed, he wanted to do his duty to provide the poor old man with a little convenience and help within his ability.The old lady hurriedly waved her hand: "No, no, no, I don't have any money, I'll go home and live."
Also How much does an autopsy cost?
”"I don't take your money.The latter fee is also paid by our provincial hospital first.Head nurse, you send her to the guest house, and then go back and ask the union to send someone to accompany her. ”Director Qin watched Zhang Zhengjie put away the opinion letter agreeing to the autopsy, and he took the matter over.Li Min retreated to the corner and watched the head nurse help the old lady out.Somehow, sorrow welled up in my heart.Her eyes were sour, and after a slight gesture to Chen Wenqiang, she quietly retreated.
*Director Hong of the ICU has a similar experience as Director Luo, and he also came to the three-bedroom house in the provincial hospital.For Li Min, who graduated from the Medical University, he has seen her many times in the ICU, but it is the first time he has seen her so emotional.So, in the face of the heavy atmosphere of the office, he opened his mouth to provoke a light-hearted topic."
Dean Chen, you see that the students who graduated from our medical university are good.In a few words, the old lady was convinced.Elderly people of this age generally do not agree to have an autopsy. ”Seeing that Chen Wenqiang smiled reservedly and didn't mean to speak, Director Qin answered: "Your students who graduated from the Medical University are not only good, they are simply amazing.This Li Min also won a prize in the debate competition of your medical university.Otherwise, I wouldn't have asked her to persuade the old lady just now. ”Zhang Zhengjie said: "Director Qin, is Xiao Li's position enough to take you in the future?"
”Director Qin smiled and said, "That's overkill."
In the Department of Surgery of our provincial hospital, the only one who can compete with Director Xie Xun Xie is Dr.
Li.She is going to take over Dean Chen's class in the future, isn't she, Dean Chen?
”Chen Wenqiang smiled and said, "I still have thirteen or fourteen years to retire."
Xiao Li was not yet forty years old at that time, and he was in the best years of a surgeon.Let's talk about it. ”But his smug look was not hidden at all.Director Hong was finally able to confirm with his own eyes that the rumored Chen Wenqiang was very optimistic that Li Min did not have any false elements.He thought of Chen Wenqiang's age, so he asked, "Dean Chen, is Jin Zhenggao almost ready?"
”"I'm going to take the English test this year to see if I can pass it."
Director Hong understood that Chen Wenqiang's paper had been settled, and he arched his hand at Chen Wenqiang and said, "Congratulations." ”Chen Wenqiang smiled reservedly: "Joy and joy." ”He only learned by telephone yesterday that several papers submitted last year would be published in the second and fourth issues of this year and the sixth issue at the end of the year.Within the three-year validity period of the essay, it is enough to spell out the English test by yourself.When it comes to the promotion level, it is not like being promoted to the intermediate level, not only is it difficult to speak English, but it is even more difficult to write professional papers.Many people get stuck in English in the first step; The rest of the people were lucky enough to pass the professional English test, and most of them were stuck in the level of professional papers that did not meet the requirements."
National professional journal with Chinese prefix, first author", in addition, the review committee also evaluates the specific academic level of the applicant.As for the several affiliated hospitals of the medical university, which are full of talents, there is also the problem of the proportion of high and deputy high.That ratio is the primary, intermediate, sub-high, and positive ratio.Pyramid-shaped structure.Everything has been reached, but it is high pressure not to retire, there is no place for promotion, and it is useless to be in a hurry.If you're unlucky, your English and essay are approaching or you're past the expiration date, you'll have to re-prepare.- There must not be a Zhenggao suddenly giving way, only to find that you do not meet the most basic conditions for declaration.Therefore, in the medical university, if you want to be promoted to a high level, you should always be ready when you have enough years.The foreign language score is valid for two years, so the test is taken every two years.Professional papers are valid for three years, and there are many people who submit them every year.Even if it is not for promotion, it is also an endorsement of the level of reputation and status in the academic community, but Director Hong thought that Chen Wenqiang, as a director of the Provincial Neurosurgery Association, should have no problem with his professional and technical level.I heard that at the last annual meeting of the Department of Neurosurgery, he ridiculed several professors of the medical university to the point of choking.Director Qin thought that Chen Wenqiang was going to enter Zhenggao, and the joy of getting the consent of the patient's family for an autopsy without any effort just now immediately disappeared.He couldn't help but calculate and calculate in his heart, and when Chen Wenqiang retired at the age of 65, M's, he was even more embarrassed than Dean Fei's current age at that time.Actually want to retire with Chen Wenqiang?!
This realization forced Director Qin to rethink how to negotiate with Dean Fei.How can I convince Dean Fei to work hard and help myself to the position of assistant to the dean?
Only by stepping on that step can you ...... to take care of his two sons, a daughter and daughter-in-law.※※※※※※※※※※※※※※※※※※※※ wrote this on Christmas Eve, and the doctor said that I was ruthless, and the little sister next door said that it was evil...... () The distance is a bit far