Director Shi rinsed the foam off his arm against the water dragon, and then dipped the soap liquid with a wooden brush that was particularly delicate and small set off by his big hands, ready to do a second brush.What he said about "half and half, anesthesia off, postoperative anti-infection" is "big truth", but the last sentence "better than craniotomy" is purely a joke.Chen Wenqiang understands the difficulty of this operation and knows that it is very likely that he will not be able to get off the stage.He comforted Director Shi dryly and said, "Lao Shi, Lao Zhao said that he can bear it, Lao Hong has already reserved a bed in the ICU and is ready."
That old Zhou personally came to the stage to do anesthesia, and you can rest assured that you can do the operation. ”"Good.Then I'll be relieved and let go of it. ”Director Shi smiled and accepted Chen Wenqiang's relief, otherwise what would Chen Wenqiang, the medical dean, do?
What to do on your own?
Watching this patient die?
I can't do it.Chen Wenqiang wanted to squeeze out a smile, but failed.He cleared his throat and said, "Lao Shi, Lao Liu, the stage is handed over to the two of you."
I'll take care of the things off stage. ”He said this as if assuring and swearing it, and then turned and walked out of the operating room.The back looked a bit like death.Director Liu sighed and said, "Alas!
Lao Chen is also in a dilemma. ”"yes.Fortunately, Lao Zhao transferred the patient to the ICU, otherwise he would be the most difficult one. ”"When you meet such a relation, you will really drive people to death.Fortunately, Lao Chen, the medical director, can hold on. ”"Lucky in the midst of misfortune.Why do you think that man is like that?
On the one hand, he wants others to save his life, and on the other hand, he does not want to pay the hospitalization fee.He also told me that the restaurant only pays after eating.M's, it's okay for Lao Tzu to work for nothing, but not to mention this work, he has to add more money to it, which is too much.Who doesn't have a big family to feed. ”Director Shi's appearance is too rare.Li Min stopped brushing his hands and glanced at him, and then the lips under the mask squirmed obviously, but in the end he didn't say anything."
yes, who doesn't have a big family to feed.It made his family sick, and it was like we owed him. ”Director Liu nodded in agreement.He knew that Director Shi was worried about the patient's family today.He wanted to say some comforting words, but he felt empty comforting words, sorry for Director Shi's friendship with him for helping each other complete those heart surgeries for more than a year.So he pondered and said, "Old Shi, I think that family will have trouble after surgery." ”"You can't get rid of the troubles after surgery.Who do you say can guarantee that the person will be cured after this surgery is done?
, bring Qiu Fazu here, he doesn't dare to promise to do it. ”Director Shi was still angry.Li Min only had a brief face-to-face with the patient's family, and did not do anything more and more in-depth conversations.So she didn't know that Dean Chen and Director Shi went out first, and they encountered such difficulties.But when it comes to hospitalization costs, she can't help but express her position.Because she participated in this operation and had to leave Corey's job, this operation not only has her personal commission as one of the surgeons, but Corey will also receive a corresponding proportion of the commission because of her assistant position.This is prescribed for combined surgery.Although the second assistant doesn't have much money, no matter how small the mosquito's legs are, there is also meat.Li Min thought about it and asked, "What did the family say later?"
Do I have to pay back the surgery fee?
”*Sometimes the work of a clinician is like this, not only about how to treat the patient, but also about various factors other than the disease.There is pressure from the official like today, which makes people feel fortunate from the bottom of their hearts - they are glad that they are lucky that they were not born in the era of feudal emperors, and there is no sentence "dragged out and cut" hanging above everyone's minds.Of course, there are also all kinds of incomprehension and even nonsense from the patient's family.As long as it does not endanger the patient's life, they are willing to slowly grind with the patient and their family when they have time, and explain the reason thoroughly before taking corresponding treatment measures.But in fact, what they are most afraid of is that in the face of the fact that there is hope for the patient's life, but the family members who have just struggled out of the state of poverty will not be able to face a serious illness and return to the debt-ridden pre-liberation period.Such people basically cry and kneel and beg, but they can't ask for free treatment from the hospital, and then they take the patients who are still saved home and wait for death.Seeing a person go home and wait for death, they have to face their own psychological level with difficulty, and the original purpose of studying medicine is to save lives and help the injured.But in the end, they can only force themselves not to think about these things.But occasionally I still think about it, remembering the pleading gazes of those who don't want to die.Now I don't want to face the situation, and there is another one, that is, I can't avoid the innocent question of those interns - doesn't the country care?
*The state really can't manage it.Just looking at the hospital as a public institution, the salaries of the staffed medical staff cannot be fully funded, how can it be possible to afford free medical care for the whole people?
Therefore, hospitals that do not have sufficient funding cannot provide free medical services to patients.Moreover, the provincial court is still in a state where no one believes what it says, but it is actually in debt-externally, it owes a lot of debt to the bank.There is a large amount of loan interest and principal to be repaid in a timely manner every month.Otherwise, the one who is rolling will definitely roll Shu Wenchen back to the mortal world.Internally, the funds owed to the employees were raised.Although you don't have to pay interest on a monthly basis, sooner or later you will have to pay off both principal and interest.The pressure of repayment of principal and interest on the loan was transferred from Dean Shu and Dean Fei to Chen Wenqiang as Chen Wenqiang took over as the medical dean.After Chen Wenqiang took over the work of the medical director, he realized how easy and comfortable his previous days as deputy director of the Department of Trauma Surgery were.There is no need to be responsible for any administrative chores, and the annual changes in the department's assessment indicators are all undertaken by Zhang Zhengjie and Wang Jing, the head nurse.He is only in charge of his clinical team and only needs to give the clinical patients the treatment they deserve.And because of Shu Wenchen's cover for him and his "grievances" of being removed from the director of surgery, he has always picked his nose and eyes at Fei Baode, the vice president of medical treatment.But it wasn't until he completely took over the job of medical director that he realized how much financial pressure the provincial hospital was facing.He knew what would happen to the medical director who had taken on the responsibility of making money if he didn't make enough money in the clinic!
He can no longer say that he doesn't need to pay so much for the hospitalization deposit, and he can't say that he can pay the money in several installments, refund more and make up less.He couldn't say anymore, does such a patient need to do CT or MRI?
He has become "money-loving"!
It's not the kind of "small money" that you deserve to get a red envelope for surgery, and the market will spontaneously adjust the gap between price and value.- but deviated from the general direction of "a gentleman loves money and takes it in the right way" taught by his father.He couldn't have done otherwise.He also thoroughly understood why Dean Fei did everything possible to escape from the position of medical director.Because the burden of making money for the whole hospital is on the medical director.This position has to provide sufficient working capital for the finance - if the bank loan is not repaid on a monthly basis, his Xiao Shu will lose his smile and sacrifice his life to drink with others, so that the bank will not "collect debts" and "make profits".One more day is one less and you can pay a little less.If you borrow less, Xiaoqiang will have less pressure.Therefore, even if the bank was informed and approved for a loan from the West Women's and Children's Center, Shu Wenchen did not dare to reach out and accept it.He would rather slow down the development of the hospital, pay off the arrears of the internal medicine center, and then borrow the next loan to build the women's and children's center.Chen Wenqiang participated in the financial situation analysis meeting of the hospital, and he understood Xiao Shu's accommodation and "preference" for Director Fan of the Pharmacy Department - Lao Fan could cooperate with him to repay the money owed to the pharmaceutical company.An extra month of delay would reduce the pressure on the financial side by three points.He began to understand Director Fan's various "deadlock" and "immutable" practices, and understood the reason why she strictly controlled certain drugs that could only be purchased with cash and was not allowed to have inventory.He understood the new regulations of the blood bank on the monthly accounting of clinical applications for preoperative blood preparation.He understood the unspeakable reason why the outpatient clinic could prescribe three or four medicines for a cold.After he understood so much, after Director Zhao assured that he could afford it, he went to play the vicious and debt-collecting "Huang Shiren".Just now, when he was explaining to the patient's family before the operation, he urged the patient's family to pay the money: "The heart valve costs money.All the patient's medication is paid for by the hospital.After this surgery, the patient will be sent to the ICU for monitoring, and some special anti-rejection drugs will be used.You don't pay back the hospitalization fee, and the pharmaceutical company doesn't pay for this kind of cash purchase.If you inquire a little, you will know that only 60% of our doctor's salary has been allocated this year, and the hospital has to raise the water and electricity bills by itself.Hospitals have no working capital. ”He ignored the repeated hints of Director Qin and Director Zhao, and went into battle shirtless to make an ultimatum: "Before the end of the operation, you have to pay all the hospitalization arrears."
We also have to pay another deposit, otherwise we can only hang normal saline for the patient when we return to the ICU after the operation.Rescue drugs in the ICU are expensive, so they are billed twice a day.Anyone who doesn't have enough money for the deposit won't be able to get the medicine.We also go to the pharmaceutical company every day to buy many medicines with cash. ”The patient's family looks at Director Zhao.Director Zhao was embarrassed and said: "If you don't pay off the medication you used before you are discharged from the hospital, it will be deducted from my salary."
Because I signed your prescription to get the medicine.But I just worked until I retired, and I didn't take a penny of my salary every month, and it wasn't enough to replace my heart valves and post-operative treatment. ”Family members will see the surgeon.Director Shi went out and faced the question of whether he could guarantee cure after spending money.The family didn't want to end up with both people and money, and wanted Director Shi to assure: If the person died, Director Shi and the doctor who did the operation would share it.Director Shi immediately turned his face."
Is it that I am begging you to heal your sick and to save your own relatives?
If you have such a request, you should go to the medical university, go to the capital, go to hospitals all over the world, and see if there is such a guarantee for you. ”It was Director Liu and Li Min who asked the patient's family to sign in the past that interrupted their "persecution" of Director Shi.The "backstage" of that family also took advantage of the situation to get off the donkey and signed the consent form for surgery.Chen Wenqiang was afraid that Director Shi's emotions would be affected, so he deliberately used the excuse of looking for Xiao Zhan to help with the disinfection, and came into the operating room to comfort him.
*Director Shi, Director Liu, Li Min and Xiao Zhan, the four of them have been working together to do cardiac surgery, adults and children, and it has been almost a year.After Xiao Zhan was disinfected, Director Liu rushed up to help lay the sterile sheet.As he worked, he said, "Xiao Li, let's use good steel on the blade."
All you have to do is suture the valves. ”Director Shi said with a smile: "Our Xiao Li is now 'a mother is expensive with a son', and he enjoys the treatment that only a big director can have in advance."
Xiao Li, wait a moment before you come to the stage after removing the valve leaflets. ”Li Min understood the love of Director Liu and Director Shi for her, she sat on her special step stool and thanked them both with a smile for their kindness.…… Director Zhou, who was in charge of this anesthesia, frowned.For him, the underlying condition of this patient is too bad.Blood pressure has been maintained by vasopressors.After high-flow oxygen, the oxygen saturation is only 92%.The worst thing is that the valve vegetation shows signs of detachment because the patient's left arm muscle tone decreases.This is when a blood vessel in the brain is blocked by a detached embolus.He discovered this problem when he was anesthetized just now and called Chen Wenqiang to take a look."
Lao Chen, I'm afraid that this patient has a cerebral infarction."
Chen Wenqiang could only say: "Change the valve first, and then go back and do a head MRI." ”Director Hong supports Chen Wenqiang."
If the primary lesion is not removed, any symptomatic treatment and increasing the dose of antibiotics are nonsense.Lao Zhou, you see that the volume of vegetations provided by color ultrasound is enough to drag the patient into the abyss of left heart failure, pulmonary congestion and pulmonary edema before the antibiotics take effect. ”Before Director Shi entered the operating room, they unscrupulously discussed the new progress of the patient's condition, no matter the "outsider" who accompanied Director Zhao to see the operation, no matter how frightened and ugly his face was.But when Director Shi kicked open the door of the operating room, it was as if he had stepped on a switch to close their mouths, and the three of them all shut up.It can't affect the mood of the main knife!
Therefore, when Director Shi picked up the big round knife and cut the patient's skin, he did not know that the patient's cerebrovascular involvement was affected.The surgery was carried out step by step.Heart valve replacement surgery, this year, Director Shi has done some.Director Liu is more concerned with valve repair and plasty.Because the child still has the possibility of growth and development, how can it keep up with the child's development if the mechanical valve is replaced.Li Min estimated that the progress of the operation was almost over, so he walked to the instrument table and asked for water to wash his hands.The patrol nurse called Director Liu with Li Min's stepping stool."
Director Liu, when will Director Li be on board?"
Director Liu immediately moved out of the way of Yisuke and said, "Xiao Li, you came up." ”"Okay."
Director Shi basically finished cutting the valve and chordae tendinae.Director Liu asked for the curved disc and was ready to pick up the severed mitral valve.The grayish-red adulterated vegetation is about the size of a quail egg, and there are obvious signs of thrombosis on it."
Holy!
If I don't have surgery, will I still be able to live when the blood clot falls off?
”Director Hong said: "Without surgery, such a lesion, relying on antibiotics alone, she will not be able to pass the heart failure and infection."
Didn't I say it just now, I just died not long ago of infective endocarditis that refused surgery.What a sickness, alas!
It is really not something that can be controlled by antibiotics alone in internal medicine. ”The people who saw the growth in the operating room agreed with Director Hong's words.* Director Liu went to the position of the second assistant, and asked Fu Yunxiang, who came to see the operation, when he was idle: "Xiaofu, this growth has fallen off, if you go up, where will it be blocked?"
”"Brachiocephalic trunk (innominate artery), left common carotid artery, and left subclavian artery, all possible."
These are the three branches that emanate from the ascending aorta."
Down?""
It should be able to pass the abdominal trunk."
The celiac trunk is the thickest branch of the abdominal aorta."
I guess I can't get through anything else."
Director Liu was bored and continued to take the test: "What branches does the abdominal aorta have?"
”Fu Yunxiang replied honestly: "The subphrenic artery, the celiac trunk, the upper and lower mesenteric arteries, the left and right renal arteries, ......"
Director Zhou said to Director Liu: "Lao Liu, if you ask again, Lao Liang will make people out." ”Director Liu laughed: "Dean Chen, Xiaofu is the person I want."
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Right?
”Chen Wenqiang pretended not to hear, he asked the instrument nurse for the cut vegetation, handed it to Director Zhao, and asked him to show it to the patient's family.According to the usual practice, Director Shi placed the prosthetic valve on the remaining valve ring, and after choosing two stitches to fix at 180°, he handed it to Li Min to suture the remaining part.Director Liu continued to ask Fu Yunxiang: "Xiaofu, tell me how this situation came about. ”"Caused by bacteria entering the bloodstream.""
Let's go into more detail, how did it get to this point?
Look at the outsiders who are visiting our surgery. ”Director Liu emphasized outsiders, and also asked Fuyun Xiangti: "Do a popular science." ”Fu Yunxiang looked at the outsider and understood the meaning of what Director Liu meant by popular science, that person was not a medical worker.She thought about it seriously and replied, "Bacteria can enter the body's blood circulation through the cracks in the skin and mucous membranes.If the body's own immune system fails to eliminate the invading bacteria in time, bacteremia will develop.After the bacteria flow to the patient's heart with the bloodstream, they invade the patient's heart valve, causing inflammation and inflammatory reaction in the valve, resulting in more and more local accumulation of white blood cells, and the dead white blood cells and bacteria after phagocytosis accumulate on the valve to form vegetations. ”"Harm?""
First of all, the further development of bacteremia will become sepsis and sepsis.Bethune died of sepsis. ”Fu Yunxiang took the Bethune distance that everyone knows as an example.The outsider who visited the operation, after glancing at Director Liu and Fu Yunxiang, kept his eyes on Li Min's operation."
Second, the attachment of vegetations to the mitral valve causes valve insufficiency, and each time blood is pumped into the ventricles, some of it flows back into the atrium, which in turn leads to congestion, edema, difficulty breathing, and decreased oxygen saturation in the lungs.People may have difficulty breathing and have a drowning-like feeling.Moreover, this attached vegetation has become the base camp for bacterial reproduction, and there will be bacteria that are shed by the impact of the bloodstream, and spread to all parts of the body with the circulation of blood. ”"When the bacteria are shed in this way, when they flow into the small and slow-flowing blood vessels, they will stay, multiply, and form embolism."…… Li Min turned a deaf ear to Fu Yunxiang's answer.She flew the needle in the Q&A between Director Liu and Fu Yunxiang.And Chen Wenqiang kept reminding her behind her: "Slow down, slow down." ”"Yes."
Director Zhou couldn't wait to open his mouth and urge Li Min: Hurry up, hurry up, hurry up.But he knew that now was not the time to quarrel with Chen Wenqiang, and Li Min was silent, which did not mean that she could not hear Chen Wenqiang's voice.He reluctantly turned around and talked to Director Hong."
You have something to do when you go back.""
yes.Not only did I have to fight infection, but I also had to prevent those bacteria from embolizing other organs.That old willow, I'm stressed enough, don't let your students beat the side drum for me again. ”"It's not long before you close your ears."
Director Liu joked with Director Hong."
I don't have the ability of you, and I still have a switch in my ears.Is your switch hereditary or a genetic mutation?
”Director Liu avoided answering whether it was heredity or mutation, and only smiled and said to Director Hong: "You can't prevent it."
The bacteria have already spread throughout the body.Xiaofu, come, let's tell Director Hong what treatment method to use in this situation. ”"Only by doing blood cultures, choosing sensitive antibiotics, and increasing the dose of antibiotics can it be possible to prevent bacteria from multiplying in small blood vessels and forming new lesions."
Fu Yunxiang replied without a smile.Director Zhou smiled and said to Director Hong: "This is a solid eye." ”"Remember no Lao Hong?"
Director Liu asked teasingly.Director Hong said to Chen Wenqiang: "Dean Chen, I think this Xiaofu's basic knowledge is quite good."
Give me this little rich.Five years from now, I'm sure you'll have an attending doctor who can afford the NICU and PICU. ”The NICU is the Neonatal Intensive Care Unit and the PICU is the Pediatric Intensive Care Unit.The neonatal unit of the provincial hospital did not meet the requirements of the NICU.And the PICU doesn't even have a shadow in the provincial hospital.In the case of a serious pediatric illness, Director Wu personally went into battle.Because of this, he has been ridiculed by his peers for more than ten years.Laughing at the pediatrics of the provincial hospital with the district hospital is on a level.Director Liu has been in the provincial hospital for more than a year, and naturally knows the status of the pediatrics department of the provincial hospital in the provincial capital.If Director Hong poached people in person, he would immediately lose face.He was very dissatisfied and said, "Hey, Lao Hong, don't dig the foot of the wall like this." ”Director Hong smiled: "Who made you show off?"
I don't know the truth of the brocade night walk.I'm telling you, I'm going to decide on this person. ”He had been tormented all morning by this mind-cultivating patient lying on the operating table, and now he was depressed."
Then you choose from this year's interns.Hundred, eighty interns, I don't believe you can't choose one.Don't be so shallow, you will be greedy when you see that others have good ones. ”Director Liu continued to ridicule Director Hong without knowing whether he was alive or dead."
I'm not going to get people to the ICU, I'm going to stay in your pediatrics.Believe it or not, I'm looking for Director Wu of your Department of Pediatrics to discuss how to set up the NICU and PICU?
Lao Chen, NICU and PICU are blank.Do you want to build a pediatric intensive care unit?
When the women's and children's center is built next year, it will come in handy. ”Chen Wenqiang pretended to be stupid.He really couldn't hide, so he smiled and said, "Let's see the operation first, and we'll discuss it later." ”…… Fu Yunxiang was asked by Director Liu to go to the pediatric surgery first.This doesn't matter to Director Wu of Pediatrics, anyway, the newcomers who are assigned to pediatrics this year will have to rotate inside and outside.He is also willing to assign the undergraduates to pediatrics this year to the Department of Pediatrics after the rotation.It is something he can't let go of to set up the pediatric surgery department, so that the pediatrics of the provincial hospital will not be lame, and the pediatrics of the provincial hospital can be famous in the province.It is as important as his eldest grandson when he gets off work.And after Fu Yunxiang arrived outside her childhood, she received extra care from Director Liu (Director Liu and Fu Yunxiang's father were classmates in the same grade).is different from Li Min's compensatory psychology of taking interest as the first thing for Fu Yunxiang, conniving at Fu Yunxiang to go to pediatrics if she likes pediatrics, and letting her not work hard in surgery.Director Liu took great pains to guide Fu Yunxiang and take her to start with minor pediatric surgery.After two weeks, Fu Yunxiang no longer dislikes surgery.Today's operation, she took the initiative to follow Xiao Zhan to visit the operating room.Director Liu Zhengmei, but he was hit by Director Hong's digging, so how could Director Liu not be in a hurry?
* "It's OK. ”Director Shi spoke, and immediately focused everyone's attention on the field.Li Min has completed the last stitch of fixing the artificial mechanical valve to the annulus."
Rinse."
Director Shi asked for the prepared heparin sodium solution, and after checking that there was no leakage in the anastomosis, he knotted the last two needles with Li Min at the same time.Now it's time to suture the heart."
Xiao Li, go down."
Director Shi didn't leave Li Min behind."
Good.Thank you, Director. ”Li Min accepted Director Shi's care for him and turned around and stepped down.She waited for a while, and when she saw that Director Shi and Director Liu were starting to close their chests, she took off her gloves and asked the patrol nurse to help her untie the straps behind the surgical gown, and left the operating room calmly.() The distance is a bit far