Chapter 4: Poor Judgment
At ten in the morning, the sun blazed, causing heat waves to shimmer in the air, and the cicadas chirped incessantly.
Long County People’s Hospital, Emergency Department, in the doctors’ office.
Lu Cheng was reporting the indications for spleen preservation surgery he had just summarized to Associate Professor Chen Song when the telephone ring disrupted their flow.
“Teacher Chen, it’s Zeng Huanqi from the surgical clinic…” Lu Cheng explained briefly before answering the phone, his voice smiling, “Brother Zeng.”
“Sickle injury, the incision is irregular. Okay, I’ll be right there.” Lu Cheng said after quickly noting the key details of the medical record:
“Teacher Chen, it’s just a simple sickle injury, I can handle it. Please rest. I’ll ask for your guidance later.”
Chen Song, upon hearing it was a simple sickle injury, lost interest.
Placing his hands behind his head, he stretched languidly, legs apart in a stretching pose, and hummed softly, “Hmm… I’ll take a look after you’re done with your procedure.”
Lu Cheng stood up, putting on his mask, slightly warding off the faint smell of disinfectant, and quickly left the doctors’ office, heading towards the surgical emergency clinic.
As soon as Lu Cheng reached the clinic door, Zeng Huanqi, who was on duty, told the patient, “Doctor Lu is here. He will take you to the debridement room to treat your wound. You can scan the code to pay or go to the counter.”
“Brother Zeng, have you seen the wound? How deep is the cut?” Lu Cheng asked cautiously.
Zeng Huanqi understood Lu Cheng’s concern, “I only took a rough look. The depth is about 6 millimeters, and it’s 5 cm long. There’s no tendon injury. Please check it carefully when you’re rinsing it in the debridement room.”
“I’ve already told the patient that if a tendon injury is found during the examination, he might need to be referred.”
For patients with tendon injuries, even the specialist doctors in the hospital’s orthopedics department had gotten into disputes. The emergency department was unwilling to easily touch such troublesome cases.
The patient, in his fifties, with graying temples and dark skin, smiled, revealing yellow teeth, “I accidentally cut my hand while cutting grass for the cattle. It won’t be so serious that I need to be transferred to another hospital, right? You doctors just love to scare people.”
Zeng Huanqi tugged at his mask to breathe, “Uncle, this isn’t about scaring you. If our hospital can’t handle it, then it can’t. In any technical field, who would readily admit their skills are insufficient?”
“Of course, this is just a possibility. The specifics can only be determined after Doctor Lu has examined you.”
Lu Cheng entered the clinic to get some debridement and suturing consent forms and politely said, “Uncle, please follow me over here… Do you want to scan the code to pay or go to the counter?”
Paying for medical services was a matter of course. This was not a ‘life-threatening’ emergency. Lu Cheng dared not operate carelessly before confirming payment.
Once an operation was performed, the cost definitely had to be paid!
Either the patient paid, or Lu Cheng would have to cover it. With his salary of only a few thousand yuan a month, Lu Cheng couldn’t afford to compensate.
“Scan the code,” he said.
“Doctor, please scan it for me. I’ll enter the password.” The middle-aged man had injured his right hand, making it slightly inconvenient to operate.
After the payment was completed, Lu Cheng briefly explained some precautions for debridement and suturing to the patient and had him shakily sign his name with his left hand.
Lu Cheng took the debridement and suturing kit and led the patient into the debridement room. He instructed the patient to lie down flat and placed the hand support bracket on his right side before Lu Cheng slowly untied the cloth strips that had been temporarily bandaged to stop the bleeding.
Zeng Huanqi had already opened the wound before, and it hadn’t clotted, but Lu Cheng still operated with great delicacy…
The patient looked up at the ceiling and said with emotion, “Seeing a doctor is really troublesome these days. I have to sign here, and sign there. Doctors, do you want to push all the responsibility onto the patient?”
Lu Cheng shook his head and said, “Uncle, this isn’t pushing responsibility, it’s to respect the patient’s right to informed consent.”
“This kind of thing has happened many times. After sewing up the patient, and they recover well, but they didn’t sign. Then they get sued, and they always win. The operating doctor has to pay, and a lawsuit takes four to five months of work for nothing.”
“Uncle… your cut isn’t deep, there’s no tendon injury, so you don’t need to be referred. But there’s still dirt and rust in the wound. After the procedure, remember to get a tetanus shot.”
“Tetanus bacilli are particularly prone to hiding in rust.”
The uncle furrowed his brows and said, “Those who sue don’t act like people, and officials don’t understand human sentiment? If nothing went wrong, why should doctors pay money?”
“Making the procedures so complicated, it’s the common people like us who suffer.”
Lu Cheng chuckled lightly, picked up the saline solution to start rinsing, and said gently, “The patient’s right to informed consent still needs to be respected. Some patients have high demands and want to seek treatment at better hospitals. That’s their freedom, of course.”
“Also, coming to the hospital for medical treatment isn’t as simple as repairing a TV or a fan. If something goes wrong, even if it can be fixed, the suffering the patient endures is very real.”
“Even a TV repairman can’t guarantee that the TV will be fixed and won’t have problems again. Treating people is hundreds of times more complicated than repairing a TV…”
“If we doctors are held responsible for even the slightest trouble, then all the doctors would have run away.”
Lu Cheng said somewhat talkatively, “Alright, next we can do the debridement and suturing. I’ll go prepare some local anesthetic drugs. The first injection might hurt a bit, so please bear with it.”
Talking more with patients and communicating well is beneficial for doctor-patient relationships. A large part of the essence of doctor-patient disputes is insufficient communication. Lu Cheng didn’t have the opportunity to perform surgery before and had spent some time researching these aspects.
The uncle smiled and said, “That’s true. Which doctor can guarantee 100% that the treatment will be good?”
“Although we common people hope for that, doctors are still human after all.”
“But when we get sick, we can only find you doctors… Why are there so many illnesses now…”
Lu Cheng no longer replied. He efficiently prepared the diluted lidocaine local anesthetic, placed it on a sterile sheet, removed his examination gloves, and put on sterile surgical gloves.
“Uncle, the first injection of local anesthesia will be a bit painful, but it won’t hurt once the anesthetic takes effect… Please bear with it…” Lu Cheng’s voice was gentle, but his actions were quick and decisive, showing no hesitation.
The faster the local anesthesia is administered, the shorter the patient’s pain will be. The more hesitant and conflicted the patient is, the more severe and prolonged their suffering will be.
The middle-aged man’s eyelids didn’t even flutter, “Doctor Lu, where are you from?”
“My hometown is Zhaoshi Town. Uncle, the procedure is starting, please don’t talk for now.” Lu Cheng’s surgical technique and order were very academic, methodical, and straightforward.
Lu Cheng meticulously used tweezers and gauze to search the entire wound layer, cleaning out the dirt and rust before beginning to trim the serrated edges.
Debridement is not just about removing foreign objects and necrotic tissue; trimming the incision to facilitate wound healing is also an important component of the debridement procedure.
Debridement is the most basic fundamental skill in surgery, a technique that Lu Cheng excels at and has encountered frequently.
Lu Cheng’s knife work was decisive, his movements smooth and proficient. When he began suturing, he was even more at ease, and the process of passing the needle through the thread and tying knots was effortless…
What Lu Cheng didn’t notice was that Chen Song, bored and having rested enough, had come to the entrance of the debridement room and was peeking in!
“Hmm?” Chen Song let out a soft hum – his flat eyes narrowed, leaving only a slit –
Lu Cheng’s right hand holding the needle holder was very steady. Each suturing movement applied sufficient force without being overly aggressive.
The needle insertion and withdrawal were decisive and skillful. The choice of entry and exit points was astute, and the angle of the needle was quite sharp. The spacing between stitches was distinct and regular. This level of skill was clearly beyond ordinary basic proficiency…
Lu Cheng’s movements were agile. After four or five minutes, he completed the suturing and the outermost dressing. “Uncle, it’s done. Please go get a tetanus shot later. Make sure the wound doesn’t get wet – neither from sweat nor water. You can come back for dressing changes every two to three days until the stitches are removed…”
“Dressing changes and stitch removal can be done at nearby pharmacies or clinics.”
“If there’s a health clinic in your village, you can also go there.”
“Oh, okay.” The middle-aged man nodded, not paying much attention to how well Lu Cheng had sutured.
If he hadn’t been bleeding profusely and couldn’t stop it, he wouldn’t have come to the hospital. Now that the bleeding had stopped, he felt he had managed.
The most down-to-earth common people in China are very easily satisfied.
“You must remember to get the tetanus shot. Sickles have rust, which is where tetanus bacilli are most likely to hide. You absolutely cannot be careless!” Lu Cheng repeatedly urged…
“Okay, Doctor Lu.” The middle-aged man nodded.
“After you get the tetanus shot, come back here to get your medical record book. I’ll write the surgical operation record after I tidy up. Be sure to come and get it.” Lu Cheng turned and smiled, his instructions meticulously detailed.
The patient nodded and left.
After Lu Cheng tidied up the debridement kit on the operating table, he stepped out and found Chen Song staring at him. Their eyes met for over ten seconds, but Chen Song remained silent.
Lu Cheng then politely asked, “Teacher Chen, there were… no mistakes, right?”
Lu Cheng’s tone was calm, with no other intention.
Lu Cheng’s previous internship and standardized training hospital was Hanshi University Zhongnan Hospital. While Zhongnan Hospital might not be as top-tier as Xiangya Second Hospital in terms of technique, it was still a renowned teaching hospital.
There, the slightly talented Lu Cheng was as humble as ‘dust’. Even with his current skills, he would only be considered one of the most ordinary among his peers at Zhongnan Hospital!
If you randomly picked a professional doctorate of the same age, they might not be weaker than him.
If he were to compete with an attending physician, Lu Cheng would only be able to stand still. If he were to compete with an associate professor or deputy chief physician, Lu Cheng would only dare to admire their skills and aspire to reach their level one day.
If it were a professor’s surgery, Lu Cheng would wish he could chop off the professor’s hands and have a hand surgery professor transplant them to him.
The medical field is like a pyramid, with distinct hierarchical levels!
Chen Song is an associate professor and deputy chief physician at Xiangya Second Hospital, a true “king of competition.” There are at least a dozen, if not twenty, doctorates who have been outcompeted by Chen Song.
“A couple of days ago, I was mistaken. I didn’t examine closely, which is why I didn’t realize your suturing basic skills had reached such a level…” Chen Song’s eyesight was sharp, and he immediately noticed something unusual about Lu Cheng’s hand technique.
If any fellow readers find this satisfactory, please remember to bookmark it.
