Chapter 5: A Mosquito’s Bite Is Still Meat
Professor Chen Song arrived at the department at 1 PM, originally impressed by Lu Cheng’s basic skills, but he had only briefly observed him a few times.
To conduct a horizontal assessment, many details need attention. Chen Song felt he hadn’t paid enough attention to everything at the time.
“It’s good that there’s no problem. I thought Teacher Chen, you were going to give me some pointers.” Lu Cheng quickly chimed in.
Chen Song turned around, hands behind his back: “For suturing technique, first practice overall layout, which means the entire suturing process: needle entry, passing, exit, and knot tying. As surgeons, we must at least complete the entire suturing procedure.”
“Next is controlling the distance. The textbook mentions a few centimeters, and that’s what this refers to.”
“Once these are done well, then comes the meticulous control of force. For example, with common suturing materials like orange peel suturing or tofu suturing, it’s all about this.”
“But if you want to suture tendons and suture them well, while controlling the force delivery for needle entry and exit, you also need to start paying attention to the distance.”
“For example, with common suturing materials like rubber bands or tourniquets, if the suturing depth is too shallow, the suture will cut through the tendon stump. If it’s too deep, it will be difficult to work on the opposite side and other locations.”
“Also, the distance needs to be precise. If the opposite suturing, like up and down or left and right, is not balanced, the resulting tendon will be crooked. Even if the patient’s wound heals, the remaining scar will be messy. This is the first pitfall of tendon suturing…”
Professor Chen’s guidance was detailed and precise.
Previously, Lu Cheng only knew how to practice on suturing materials, but he didn’t know what specific details to focus on for each material, or why those details were important; no one had told him.
These things either require spending a lot of time experiencing and figuring them out yourself, or having a mentor to guide and instruct you.
Lu Cheng looked at his ‘Reward Regulations’ screen!
【 Successfully completed one case of debridement and suturing, diligently instructed the patient on postoperative care, and persuaded the patient to receive tetanus antitoxin, earning 0.6 Skill Points.】
【 Received meticulous guidance on basic suturing skills from a famous teacher, resulting in a slight improvement in suturing technique.】
【 Current remaining Skill Points: 1.7 points.】
When receiving guidance, skills can improve, but they just aren’t displayed on the panel?
That seems quite reasonable.
Lu Cheng smiled even more happily: “Thank you, Teacher Chen…”
…
In the afternoon, at 3:20 PM. Lu Cheng, holding the discharge summary and diagnosis certificate, approached bed 11 in the observation ward and said, “Zhang Linhong, you’re being discharged today, right?”
The patient and his family had already packed their bowls, basins, towels, and other items. Hearing his voice, they quickly got out of bed and walked towards Lu Cheng. The patient’s wife said enthusiastically yet hesitantly, “Doctor Lu, Professor Chen mentioned this morning that you could be discharged after your injection this afternoon!~”
“But Director Lin said yesterday that it’s best to observe for a few more days… Doctor Lu… should we be discharged or not?”
The patient had a deep longitudinal wound on the front of his thigh with muscle damage. Professor Chen Song was the chief surgeon for the debridement and hematoma clearance after his admission on the 1st.
Under the typical inpatient routine at the county hospital, he would have stayed for another three to four days of observation. However, Professor Chen Song, accustomed to the pace at Xiangya Second Hospital, had directly told the patient he could be discharged today.
At that time, Deputy Chief Physician Lin Qianlong assisted Professor Chen Song in the surgery.
Lin Qianlong is the director of the Emergency Surgery Group and the only Deputy Chief Physician in the surgery group.
“Professor Chen came to see you again this morning. Your wounds are healing well. Professor Chen also performed the surgery, so you should follow his arrangements.”
Lu Cheng added, “Of course, if you strongly prefer to stay in the hospital for a few more days, that’s also possible.”
At Hanshi University Zhongnan Hospital or Xiangya Second Hospital, where beds are scarce, patients aren’t allowed to stay longer just because they want to. But here at Long County People’s Hospital, the patient’s “informed consent” is respected to the greatest extent possible.
The patient and his wife exchanged a look, then hesitated: “Then… there won’t be any problems, right?”
Lu Cheng looked at the patient and said, “This is a very common disease type, with no special circumstances. As long as you strictly follow the precautions after discharge, there shouldn’t be any major issues.”
“However, if you are still worried, I suggest you buy some oral antibiotics from an outside pharmacy. Any of the cheapest Cefuroxime will do.”
“We are a hospital, and the medical insurance and regulatory systems do not allow us to prescribe such medication for you,” Lu Cheng advised professionally.
Sometimes, ‘guidelines’ and ‘regulations’ can be too rigid, dictating antibiotic usage timelines like rigid prose.
In actual clinical practice, some patients require antibiotics up to 72 hours post-operation, but the rules do not permit it.
If signs of infection appear, then treatment will proceed accordingly…
Lu Cheng was not an arbitrary junior doctor; he was already an attending physician. He didn’t perform many surgeries when he was in orthopedics, so reading books and searching for small literature was his daily routine.
This was a small experience Lu Cheng had summarized himself—”non-compliant” but not “illegal.”
“It’s okay to buy some more medicine to take… staying in the hospital here is too expensive…” the patient’s wife said, relieved.
The patient nodded: “Doctor Lu, what was the name of the medicine you just mentioned?”
“Cefuroxime axetil, it’s an oral antibiotic. Just buy a cheaper one. You don’t need a large dose; a four or five-day course is sufficient.”
“If the pharmacy recommends a large quantity, don’t buy it! Appropriate dosage and targeted treatment are the best,” Lu Cheng instructed, then handed over the discharge medical record and diagnosis certificate.
“Please go to the nurse station to complete the billing procedures, and after it’s stamped, you can be discharged. I have already issued your discharge orders.”
“Okay, thank you, Doctor Lu…” The woman nodded, picked up a bucket containing a basin, which held bowls and a towel, and helped the limping man walk out.
【 Through detailed postoperative instructions, the likelihood of patient infection was reduced, earning 0.1 Skill Points.】
Lu Cheng watched the retreating figures of the couple, who were reluctant to even buy crutches, and smiled knowingly. This was the meaning of being a doctor.
“Even small mosquitoes are meat. Thank you,” Lu Cheng murmured, then turned to check on the patient who had undergone a splenectomy under Director Lin’s supervision that morning.
The patient had undergone open surgery, and the monitoring equipment had not yet been removed. The patient’s blood pressure and blood oxygen levels were generally stable, and a drainage tube was in place to drain hematoma from the abdomen.
“Big Brother, how are you feeling? Does your wound hurt? If it hurts, please tell us. We now emphasize the principle of pain-free perioperative care; enduring pain is not recommended,” Lu Cheng said politely.
“Doctor, it’s just a little bit of pain, it’s okay. My wife always says I’m being dramatic.” The patient was about Lu Cheng’s age, his complexion was slightly pale at the moment, but his overall complexion was not bad.
Spleen rupture is a hyperacute emergency that can be life-threatening and is not suitable for referral.
Professor Chen Song was on his “rest day” this early morning. The directors of General Surgery and the Emergency Department at Long County People’s Hospital dared not easily perform spleen preservation surgery. To resolve the problem, they directly performed a splenectomy.
“This understanding is incorrect. Pain is a very unpleasant experience!” Lu Cheng’s expression turned stern: “We can endure pain, but there’s no need to be proud of it.”
“Surgery is indeed painful, and one must endure it post-operatively. This is an outdated way of thinking and is not promoted…”
“Big Brother, you still feel pain? If pain is rated on a scale of ten, where ten is unbearable agony, what would you rate your current pain?” Lu Cheng quickly asked using the very professional yet simple Visual Analog Scale.
“It’s not that exaggerated, at most a four or five. I don’t notice it when I’m playing games,” the youth said, shaking his head and chuckling lightly.
A score of four or five indicated the threshold for intervention with weak opioid medication.
Lu Cheng then carefully examined the patient’s left abdomen, ruling out any hidden injuries in other areas, and said, “Then you should have come to us earlier. I’ll go and prescribe you a dose of tramadol.”
“The anesthetic effect is just wearing off now, so pain management is the most important thing.”
Lu Cheng finished speaking and walked away.
Behind him, the youth’s faint voice could be heard: “See, the doctor said not to endure pain when it strikes. And you said I was being dramatic.”
Ten minutes later.
【 Reasonably advised the patient to use analgesics, reducing the patient’s perioperative pain experience, earning 0.1 Skill Points.】
More “mosquito meat,” but the kind that wouldn’t be noticed without careful observation…
