The Surgeon's Studio c1-799
Page 161
After greeting the deputy senior consultant of the CT room, Sister Zhao, Zheng Ren began operating the machine as the other staff departed for lunch.
The professor personally disagreed with Zheng Ren's habit of skipping lunch, but had likely been brainwashed by Chang Yue into thinking that it was the Chinese spirit and the reason Zheng Ren refused to follow him to Heidelberg University.
Therefore, despite being famished and irritable, he remained silent and sat behind Zheng Ren, observing the man closely.
Ever since Zheng Ren's first 3D-reconstructed 64-slice CT scan on Zheng Yunxia, he had gained a good grasp of the technique.
His skill had especially improved after the reconstruction of a prostate capillary network.
This scan of a liver was much easier in comparison to all that he had done before.
Watching Zheng Ren operate the scanner and perform the reconstruction, Professor Rudolf's initial dissatisfaction and confusion turned into a growing realization.
It was the same thing done during the prostate interventional surgery!
Zheng Ren's proficiency and intricacy during the surgery in Imperial Capital aside, the professor could not comprehend how the man had managed to map out so many capillary networks.
Watching Zheng Ren perform 3D reconstruction of a 64-slice CT scan in person finally answered the burning question.
This was how he had done it!
Since Professor Rudolf Wagner had a background in medical imaging science and interventional surgery, he understood how the reconstruction worked.
He was a world-class physician inside and out.
After a little over ten minutes, he already had several questions in mind.
Zheng Ren had no intention of withholding any information and answered all the professor's queries unreservedly.
Half an hour later, the professor could discuss operational details with Zheng Ren and had his own opinions on the retrograde reconstruction of the tumor blood supply vessels.
Both of them differed in opinion and method as they had had very different upbringings.
Zheng Ren had been groomed by the System while the professor had the experience of thousands of cases.
The latter had a richer well of direct involvement to draw from while the former was stronger in terms of thought process and integration capability.
They listened to each other and occasionally had a heated debate during their discussion. Zheng Ren gained a lot from their conversation.
One and a half hours later, 3D reconstruction of 64-slice CT scans for both patients was complete.
Zheng Ren already had the initial framework for the surgeries tomorrow in his mind.
The insertion point, the choice of artery for embolization, routes to enter to prevent embolization of normal arteries; he had it all planned out.
It was an amazing feeling.
Suddenly, Zheng Ren thought of the nodular hepatocellular carcinoma surgery he had performed in Imperial Capital. This time around, he ought to be able to finish it more quickly.
He could complete ten of these surgeries in a day.
The professor had completely forgotten about missing lunch and working overtime. On his way back, he continued to discuss details of the scan and reconstruction with Zheng Ren.
This was the first time Zheng Ren had shared his thoughts with a world-renowned professor from an academic standpoint. The professor had many ideas worth considering and his input could only help Zheng Ren further refine his skill.
They headed back to the ward, but before they could enter, Zheng Ren heard a commotion down the corridor.
Was it a medical dispute?
Zheng Ren's heart fell.
Doctors would rather face major emergency rescues than medical disputes.
Some people dared to take off all their clothes and sit n.a.k.e.d in the corridor as they wailed to imply that doctors had done something abominable.
However, it was strange how doctors with questionable ethics seldom got into trouble. More often, it was the well-mannered and skilled who got embroiled in controversy.
Going after a soft target was easier, after all.
Zheng Ren's hands were tied.
Perhaps it was true that "bad money drives out good", according to Gresham's law. After enough time, perpetrators would be left with mediocre doctors that could end up misdiagnosing them. What would happen then?
Despite his anxiety, he still had to handle the situation.
He entered the emergency ward and saw a middle-aged man swearing in the corridor.
Beside him was a woman trying to calm him down.
Zheng Ren could not recognize him from appearance, but remembered them as family members of the patient in ward 3-8, who had just gotten a 64-slice CT scan with 3D image reconstruction.
What was happening?
The man was not berating doctors and nurses, but rather going on about how the hospital was not providing the necessary medical care, including something about no IV drip being provided even two to three days post-admission.
Zheng Ren was puzzled, but ignored the man and went into his office.
Chang Yue was typing furiously on her computer.
Chapter 339 - A Long Sigh
"What's happening?" Zheng Ren asked.
"They're doing a double act." Chang Yue's tone suggested she was unpleased.
The professor was stunned. "A double act?"
Even though he was a savant at languages, he had yet to master all the terms during his short stay.
However, neither Zheng Ren nor Chang Yue was in the mood to explain it to the professor.
Zheng Ren had just finished a 64-slice CT scan with 3D image reconstruction for the patient in the ward 3-8, whose condition was assuredly under control based on the data shown.
However, both his children were playing good cop, bad cop, and Zheng Ren could not understand why.
Seeing Zheng Ren's confusion, Chang Yue explained nonchalantly, "The admission was a setup."
It was ridiculous.
"They did it as a display of filial piety toward their family friends. When their father became sick, they didn't bring him to a rural health center and instead, chose to go straight to Sea City's best hospital." Chang Yue's tone was becoming so harsh that Zheng Ren could feel the biting cold behind it.
"After all their family friends came to visit, they started to request a self-discharge."
"I tried to talk to them and asked them to wait for you to return after the 64-slice CT scan to decide the treatment's success rate. However, it was then that the patient's son started to make a scene."
With just a few simple sentences, she had painted the complete picture.
Few were willing to spend money on old folks. They would only splurge on funerals after their seniors passed away.
Everything was designed to show off to the living and uphold their reputation.
Zheng Ren understood that.
And because he understood it, he knew he was boxed into a corner.
The patient's condition could still be stabilized. Although liver cancer was commonly called the emperor of all maladies, Zheng Ren predicted that the patient could live for at least another three to five years without the need for any costly, targeted drugs if he visited the hospital every two months for surgeries and follow-ups.
However…
This was frustrating.
"What are you doing?" Zheng Ren asked.
"I'm drafting the self-discharge consent form." Chang Yue turned to say as she continued typing.
Zheng Ren had no choice. He could not pin the old man to the operating table and perform the surgery, could he?
The office was very quiet. Professor Rudolf Wagner had many things he wanted to discuss with Zheng Ren but was forced to hold it in as he felt the tension within the room.
It felt as if he were being choked.
Soon, Chang Yue was at the office desk and calling for the family of the patient in ward 3-8.
Instead of the man who had been swearing uncontrollably, the woman who had held him back came in.
Immediately, she said in embarrassment, "Doctor, I'm so sorry. My brother has a bad temper."
If Chang Yue had not explained the situation to Zheng Ren earlier, he would have believed her.
It took incredibly acting to successfully lie to an experienced clinical doctor. Her expression was delicate and sincere, filled with sorrow and helplessness.
Nevertheless, after Chang Yue's briefing, Zheng Ren saw right through her.
"Sign here." Chang Yue did not put on her usual smile for communicating with patients' families. She was as cold as a statue.
"Oh, okay." The woman nodded repeatedly as she reached for the pen.
"Write here that you're aware that the patient is diagnosed with liver cancer and that it's treatable with surgery. However, due to financial and personal reasons, his immediate family have decided against having surgery after discussion and are forcefully requesting a self-discharge. You will be solely responsible for any consequences resulting from the discharge." Chang Yue's explanation was cruder than usual.
Zheng Ren could feel the anger radiating from her.
The patient's daughter was shocked.
"Don't worry, no one will see this agreement," Chang Yue said. "It's just to prove that I've briefed you on this. If Old Chief Physician Pan asks, I will have something to show him."
At the mention of Old Chief Physician Pan's name, the patient's daughter squirmed.
She signed the form and wrote the words Chang Yue had said without hesitation.
Zheng Ren felt an indescribable feeling as he watched the woman finish the paperwork.
It was mostly pity.
Even if the patient received only one surgery, he would be able to live for at least another six months to a year.
If he left now, his disease would kill him within three to six months.
Zheng Ren let out a long sigh.
The patient's daughter completed the doc.u.mentation quickly and asked a few questions on the discharge time.
Chang Yue impatiently answered them and left to proceed with other work.
The patient's daughter were going through a mixture of complicated feelings, but Zheng Ren had no interest in digging deeper. Recognizing that she was exactly as Chang Yue had described, he lost interest in her and continued to read the Fundamentals of General Surgery.
The professor found all of this very new and strange. He blinked, seemingly lost in thought.
The patient's daughter hurriedly left the office. Within half an hour, she had packed up and left with the patient.
Such were the difficulties of being a clinical doctor.
The human heart was unpredictable. One could hurt themselves if they were not careful.
This time around, the patient's family members had stopped requesting a self-discharge and avoided berating Chang Yue and Zheng Ren due to Old Chief Physician Pan being around.
Were they anyone else, there would have been a big fuss.
After Chang Yue finished the patient's discharge process, she tossed the case file onto the nurse's station. She then went to change and irritatedly notified Zheng Ren that she was leaving.
Zheng Ren did not dare to step on her toes. It was something not even Su Yun had the guts to do.
The weather was not ideal, the afternoon sun was weak and chilly.
Zheng Ren continued reading, aware that the usual warmth from the sun was absent.
While he read, he texted Xie Yiren via WeChat. Time flew when he chatted with Xie Yiren. In the blink of an eye, it was already time for his evening shift.
…
At that moment in one of the Class Two Grade A Hospital in Horqin Right Middle Banner of Inner Mongolia [1].
An interventional doctor was participating in a multidisciplinary case conference review.
In the ICU, there was a patient being presented with lower gastrointestinal tract bleeding. The entire hospital did not know what to do.
At the beginning, the patient was going to be abandoned. However, after watching the hybrid surgery from Xinglin Garden, the interventional doctor got inspired and joined the conference.
He understood clearly why the hospital had decided to hold a multidisciplinary case conference review.
It was because they were unable to treat his disease.
The purpose of the conference was just to show that the hospital had paid attention to his case. They could not treat him simply because they were unable to, not because of malpractice.
This would have been impossible in the past.
Now, the interventional doctor thought that the patient had a fighting chance.
The deputy chief of the medical administration division had chaired the multidisciplinary case conference review. Each department chief spoke in turn.
All of them thought that the patient was too old, and the complication risks after surgery… No, not risks. The patient would definitely die in surgery.
If they chose the conventional treatment, he had a 1% survival chance.
It would be totally up to fate.
The interventional doctor did not judge them as they were just restricted by current medical limitations.
More than a century ago, pulmonary tuberculosis was untreatable, but times had changed.
Since the interventional department was the last department on the list to speak, the interventional doctor sat at the far corner and waited a long time for his turn to speak.
After they had all finished speaking, the medical administration division's deputy chief had started to pack up before dismissing the conference. He asked one last routine question, "Does anyone else want to share their opinion?"
"I have something to say."
…
Author's note:
One of my patients was the head of the food bureau of Horqin Right Middle Banner of Inner Mongolia. He had retired for a few decades. I've always remembered the name of this place because it sounded interesting.
Chapter 340 - Boundless Merits
All the doctors were stunned.
It was obvious that the deputy chief of the medical administration division had simply planned to dismiss the meeting with that question.
How could someone be so dense?
Also…
Who was he!
There were more than a thousand people in the hospital. The interventional doctor was not a sociable person. More than half of the doctors present did not know what his specialization was, while the other half knew that he was into interventional surgery but did not know what his skills were like.
It startled the medical administration division's deputy chief, and he put down the things in his hand in discontentment.
"We can find the source of bleeding in the lower gastrointestinal tract and resect that portion of the intestine," the interventional doctor said confidently.
If he had only read the surgical procedure from a magazine or a book, he would not be this confident.
However, the surgery kept replaying in his mind, and he could clearly remember every single detail.
Medicine was an empirical science.
After watching the surgery, the only thing he could think was that if he had the skills to perform it, it would be the beginning of a new treatment method.
The patient would not need to lie on the ICU bed awaiting death.
At least his chance of survival would amplify by a few times.
"Hmm?" The medical administrative division's deputy chief and the department chief of general surgery were stunned.
They have never heard before that this disease was treatable!
The interventional doctor stood up. Even though he was at the far corner, his confidence-filled voice sounded throughout the office.
"A few days ago, there was a live surgery broadcast on the Xinglin Garden's professional forum that was similar to this case." The interventional doctor's voice was so firm and confident. "We can
use interventional methods to locate the source of bleeding..."
The general surgery chief interrupted him. "It's pointless, we did try that. After the laparotomy, the source of bleeding was unrecognizable."
"No!" the interventional doctor said. "After locating the source of bleeding, we can perform embolization to block a portion of the blood supply from the mesenteric artery."
"That would lead to necrosis of the intestines!" The chief of general surgery's voice sounded a little sharp and angry.
This was ridiculous!
The necrotic intestines would be seen as an iatrogenic disease. This would be typical medical malpractice. Was this guy trying to ruin himself?
That had to be!
If he wanted to ruin his career, he should be doing it alone without dragging him into this mess.
"Yes! That's my intention." The interventional doctor once again recalled the live surgery broadcast in Xinglin Garden and continued, "About half an hour to an hour after the embolization, the necrotic intestines will show significant changes that are comparable to normal intestines. If we remove the necrotic portion of the intestine and connect the healthy intestines together, the source of bleeding would be removed."
It was fairly simple. Just like a trick, it was worthless after being revealed.
Before the secrets were exposed, it was like an unsolvable math problem.
His assertive voice inspired the crowd to think. Indeed, this method could work according to his description.
Even though it was risky, it was still a feasible method.
The general surgery chief was a little lost. He had never done a destructive operation before…
What if something happened? What then?
He glanced at the medical administrative division's deputy chief.
No chief could decide on the surgery. It would have been best if the hospital could bear all responsibility.
The deputy chief was also a clinical physician, but he was sick and tired of night shifts and decided to join the administrative division.
He considered what the interventional doctor had said and thought that it was worth a shot.
As a clinician himself, treating patients was a natural instinct.
If there was somebody to bear the responsibility, there was no harm in trying.