Chapter 10: Assisting To Defeat The Boss
July 7th, Tuesday, 11 AM.
Long County People’s Hospital, Emergency Department, Debridement Room.
After Lu Cheng bandaged the right forearm of a woman in her forties with gauze, he helped her stand up from the operating table. “Auntie, the suturing is done. It’s just a small wound, no damage to the tendons, blood vessels, or nerves. You’re lucky! Be more careful when you’re cutting vegetables next time.”
“The kitchen knife is rusty; you still need to get a tetanus shot.”
“In your case, you don’t have to buy antibiotics elsewhere, but you absolutely must get the tetanus shot. Otherwise, tetanus would be extremely troublesome.”
The auntie was the owner of “Big Bowl Rice” across from Huang Cang Middle School. She often cut her hands while cooking and was quite talkative. “Of course, I have to get it. Old Niu, who owns the noodle shop opposite the vocational school, died because he tried to save money and didn’t get the tetanus shot!”
“He was also a shop owner, so why try to save this little bit of money?”
The auntie continued, “Doctor Lu, you used to be from Hanshi University, right? Your technique is so good. I just saw the suture line; it looks better than what other doctors do.”
“Look at my hand.”
Lu Cheng hadn’t been in Long County since graduating. The vocational school mentioned by the auntie was Lu Cheng’s alma mater, Long County High School, but that was over a decade ago. Currently, Long County High School had relocated, and the original site had become a vocational school.
Lu Cheng didn’t know who the shop owner Old Niu was. “Auntie, thank you for your recognition and praise. Suturing is just for treating the wound; as long as it’s handled properly, that’s what matters. There’s no such thing as particularly good or bad.”
“After you go back, don’t let the wound get wet, especially when washing vegetables. Be extra careful.”
“Also, don’t wear waterproof gloves. They are not breathable, and sweat can cause infection.”
Lu Cheng knew that restaurant owners like the auntie often ran their businesses as family operations with no extra help. They could work hard to manage things normally, but they needed to be extra careful when injured.
“Sigh… I’ll have to hire someone to help, which means more expenses. We’re just running a small business, and earning money is already difficult… Doctor Lu, I’ll come back later to pick up my medical record book…” the auntie said with a sigh and left.
The costs for the debridement and suturing procedure and the tetanus antitoxin had already been paid in advance.
Lu Cheng returned to the debridement room and continued to tidy up the debridement kit while looking at his ‘revenue statement.’
【Completed one suturing procedure, instructed the patient on postoperative care, gained 0.6 skill points.】
【Emergency Medicine （Proficient 6/10）（ +1）】
‘Gaining skill points through clinical operations is much faster than reading books!’
Based on Professor Chen Song’s popular science explanations, Lu Cheng had roughly estimated the learning efficiency of professional master’s degree students in the Emergency Department of Xiangya Second Hospital.
According to Professor Chen, exceptionally excellent doctoral students in their department should reach this level by graduation: at least three theoretical skills, four basic surgical operation skills, two specialty surgical procedures, and three medical image reading skills must reach the ‘Proficient’ level.
Lu Cheng asked Professor Chen what the ‘Proficient’ level meant. Chen Song said that Lu Cheng’s suturing skills could be considered proficient.
By extension, this should be the Specialized Level.
To go from beginner to proficient to specialized in a skill requires approximately 30 skill points. If twelve skills need to reach proficiency, it would require a total of 360 skill points.
Calculating comprehensively, the average learning efficiency for professional master’s degree students in the Emergency Department of Xiangya Second Hospital is about one skill point per twenty hours.
For Lu Cheng, it takes about thirty-five hours.
The difference is that professional doctoral and master’s students have teachers providing close guidance. Lu Cheng can only rely on self-study without any special instruction.
“Knock knock knock!” While Lu Cheng was deep in thought, Professor Chen Song knocked on the operating room door, his voice urgent.
“Xiao Lu, are you done here? We have a car accident victim with a liver contusion who needs Liver Protection Surgery. You’re coming with me.”
“The patient has already gone through the green channel directly to the CT room and will be moved to the operating room soon.”
Lu Cheng sped up his tidying. “Teacher Chen, I’ll write a surgical record and be right there.”
No matter how busy things were elsewhere, Lu Cheng had to write his surgical operation records; not doing so would leave him with a ‘ticking time bomb’!
It might not explode, but if it did, it would cause Lu Cheng a lot of trouble.
“Hurry up. This patient is in life-threatening condition. It seems like the General Surgery department at your hospital has become less talkative lately,” Chen Song said as he turned to leave quickly.
Lu Cheng lowered his head in silence, accelerating his writing of the surgical operation record…
When it came to appendicitis, cholecystitis, cholangitis, etc., people in the hospital’s General Surgery department would rush to handle it.
But when it came to complex diseases, everyone avoided them like the plague.
If Professor Chen Song wasn’t around, the patient would most likely be given a glance by a general surgeon and immediately issued a referral.
As for whether the patient would die on the way to referral, there was nothing that could be done.
The liver cannot be completely removed to save a life like the spleen or gallbladder. The county hospital couldn’t handle this kind of liver rupture. Pushing the patient into the operating room would only lead to death; who would dare admit them to the department?
For such conditions, Chen Song insisted on admitting and treating them, and no one dared to speak a single word of dissent.
After finishing the surgical operation record, Lu Cheng quickly walked to the nurse station, handed the medical record book to the auntie ‘boss,’ and as he hurried back, he still reminded her, “Auntie, be sure not to let the wound get wet! Otherwise, it’s very easy to get infected.”
“For other precautions, you can read the medical advice I’ve written for you… Remember to change your dressing…”
The auntie was getting her tetanus shot and saw Lu Cheng rushing off, looking confused. “Why is Doctor Lu running off?”
“A very complicated emergency case has come in, and Doctor Lu needs to go to the operating room.”
“Fortunately, Professor Chen Song from Xiangya Second Hospital is currently doing rounds at our hospital. Otherwise, this patient would have to gamble their life and be transferred to Zhou People’s Hospital,” the nurse explained patiently and then asked, “The injection is ready… Did Doctor Lu prescribe any other medication for you?”
“No… Doctor Lu said I don’t need any special medication. Do I need to take anything else?” the auntie replied.
The nurse instructed, “If there’s no medication, you can go home directly later. If Doctor Lu didn’t prescribe anything, it means you don’t need to take it.”
If another doctor were on duty, they would likely prescribe some pain relief and anti-swelling medication, but Lu Cheng didn’t seem to do that like others.
…
By the time Lu Cheng arrived at the operating room, the Deputy Chief Physician of General Surgery had already entered. The patient hadn’t waited for Lu Cheng’s arrival to start the procedure; Chen Song had already opened the abdominal wall.
His tone was polite and cautious, “Professor Chen, the patient’s blood loss is considerable.”
“A direct impact to the upper right abdomen has resulted in an AAST grade of four for liver rupture, with destructive liver parenchymal rupture. We must immediately perform an anatomical liver segment resection,” Chen Song’s voice was crisp and unquestionable.
Following this, Chen Song turned to Lu Cheng and said, “Xiao Lu, this surgery is very difficult. You will follow my instructions throughout the procedure; don’t act rashly.”
Lu Cheng wouldn’t dare, but he also knew this was an opportunity for him to participate. He immediately replied, “Okay, Teacher Chen, I’ll go wash my hands and scrub in…”
Afterwards, throughout the entire surgery, Lu Cheng and the Deputy Chief Physician of General Surgery were both made to “stand aside.”
Although Chen Song explained a lot of professional knowledge, such as the anatomy of the liver’s Glisson sheath, liver parenchyma clamping techniques, Pringle maneuver for hemostasis, and hemihepatic blood flow occlusion （Heaney method）, and segmental liver blood flow occlusion （Takasaki method）, Lu Cheng did not recognize this specialized knowledge, nor did it recognize him.
Associate Professor Chen Song single-handedly managed the critical surgery throughout. After a full four hours of intense effort, Associate Professor Chen Song completed the entire liver segment resection procedure.
Then, wiping the sweat from his forehead, he turned to Lu Cheng and said, “Xiao Lu, place the drainage tube and close the abdominal wall incision.”
“I’ll go down and rest for a bit.”
Liang Qiao, the Deputy Chief Physician of General Surgery, immediately put on a smile. “Professor Chen, you’ve worked hard. You can leave the rest to Xiao Lu and me…”
Lu Cheng could only obediently follow Professor Chen Song’s instructions to complete the subsequent steps, receiving a small assist reward:
【Assisted in completing hemostasis by suturing, reducing intraoperative bleeding and to some extent the patient’s risk of shock, gaining 0.6 skill points.】
【Assisted in completing local debridement, clearing necrotic tissue from the patient, reducing the patient’s postoperative complications, gaining 0.6 skill points.】
【Assisted in completing suturing, drainage, knot tying, puncture procedures… Gained 1.3 skill points!】
【Current remaining skill points: 2.8】
Assisting a boss battle and having no presence, yet gaining 1.9 skill points? Lu Cheng felt he had taken a huge advantage from Professor Chen Song, comparable to three days of debridement and suturing alone.
Lu Cheng felt as if he were back at Zhongnan Hospital that year, only able to watch surgeries, not even daring to think of participating.
