Chapter 163: Reporting!
Twelve twenty minutes.
Emergency Department operating room.
Ding Guoqin, the Deputy Chief Physician of the General Surgery department responsible for vascular matters, also entered the operating room. Although he was not on the surgical team, he stood by the operating table.
After Lu Cheng injected the patient’s five fingers with a syringe containing a needle, he waited slowly.
Approximately half a minute later, blood droplets oozed from the fingertips, the blood was bright red.
Surgery doesn’t fear blood, it fears the lack of it.
Blood represents life and vitality.
Seeing this, Lu Cheng finally breathed a sigh of relief. He wiped it clean with gauze and said, “The arteriovenous anastomosis is done, now let’s deal with the fracture.”
“Director Hou, have the preoperative antibiotics been administered?”
Limb amputation is an open fracture, and internal fixation is a foreign body. Open fractures are considered type three incisions, so antibiotics must be used sufficiently and adequately.
“The medication was given immediately. Don’t worry,” Hou Jiagui replied with certainty.
Lu Cheng politely looked at Xiang Kuihua and said, “Director Xiang, let’s do the steel plate internal fixation together!~”
Xiang Kuihua smiled and said, “No problem, Teacher Lu.”
Limb replantation surgery is a team effort, and this factor was one of the reasons he decided to ‘reconcile’ with Lu Cheng.
The standard procedure for limb replantation is to perform internal fixation of the fracture first, except for special cases—
It can be seen that Xiang Kuihua has performed so many open reduction and internal fixation surgeries with steel plates and screws for fractures that his proficiency in this area is quite good.
Normally, internal fixation of a fractured limb is straightforward, but because the order of limb replantation was changed and the arteriovenous anastomosis was performed first, the difficulty of the surgery increased.
However, it’s not a big problem; the internal fixation of the fracture at this point is more transparent and visible than in ordinary fracture patients, it’s visible to the naked eye.
With the cooperation of Xiang Kuihua and Lu Cheng, it took less than half an hour to fix the severed radius and ulna in place.
After completing this, Xiang Kuihua stood up and made space.
The subsequent processing of muscle, tendon, and nerve suturing was beyond his capabilities.
Naturally, Xiang Kuihua did not leave but sat at the lower position of the operating table, watching Lu Cheng’s operation intently.
Under the oblique light of the shadowless lamp, even the microscope eyepiece could not block the light; the surgical field was extremely bright.
Because blood circulation was restored, a small amount of blood slowly seeped out from the severed ends as Lu Cheng performed the muscle suturing.
However, after Lu Cheng completed the suturing, the bleeding from the severed ends was like being sealed with a lid, and it was held back; suturing for hemostasis is also an effective method of stopping bleeding…
Lu Cheng’s operation was very meticulous and careful.
His eyes were as if they could glare someone to death, not blinking, and the number of blinks within five minutes would not exceed three.
The beeping of the anesthesia machine was constant, the pace of the circulating nurse’s movement also slowed down, the Head Nurse from the Nursing Department exited the operating room, and the Director of General Surgery in charge of vascular surgery also left the operating room…
Xiang Kuihua was inwardly astonished at this moment.
Limb replantation is a very standard surgical procedure in hand surgery and is one of the standard surgeries used to evaluate a unit’s capacity for hand surgery specialization.
Xiang Kuihua had heard of this type of surgery for a long time, but it has always been a blind spot for the capabilities of most county hospitals, a procedure that many wish to perform but lack the ability to do so.
Yet, such a surgery was now slowly progressing towards its conclusion in Lu Cheng’s hands.
After Lu Cheng completed the muscle and tendon suturing, he looked up at Lin Qianlong and said, “Director Lin, could you please go out and explain things to the patient’s family?”
“The patient’s hand should be salvageable, but postoperative functional recovery cannot be guaranteed. Try to manage the patient’s family’s expectations.”
“We did not have a detailed discussion and signing of consent forms before the surgery. However, we still need to give the family a rough idea.”
Lin Qianlong nodded without hesitation: “Okay. I’ll go talk to them.”
For such discussions and consent forms, it would be more convincing for a Director like himself to speak.
Sometimes, county hospitals, as the first point of medical service for many patients in county towns, also become the final destination for many patients.
Not every patient with a particular disease type has the opportunity to be referred to a higher-level hospital.
Lin Qianlong left the operating room…
Time flowed like water, and it was suddenly approaching five o’clock.
Lu Cheng personally completed the outermost skin suture, then applied a plaster cast to the patient, and specifically instructed: “Do not touch the cast for the first few days. Constantly monitor the blood circulation.”
“Postoperative anticoagulation and blood circulation must be closely monitored… The crucial aspects after surgery are preventing vascular spasms and anticoagulation… Vasodilators like prostaglandin E1 should also be used.”
“I will write out all the medical orders. Director Lin, but I cannot be in the ward 24 hours a day.”
Lin Qianlong had returned from his talk and re-entered the operating room: “This patient is from our department, so it’s not as if you, Xiao Lu, are expected to stay with them 24 hours a day.”
“I will pass down instructions for them to take photos and send them to the group chat regularly.”
“For postoperative medication, you will review it personally every day.”
Lin Qianlong, as the ward director, naturally had to handle the department’s first limb replantation surgery with extreme caution.
“Yes, pay attention to keeping warm postoperatively. Orthopedics should have infrared lamp equipment; we might need to borrow it,” Lu Cheng said.
Lin Qianlong looked at Xiang Kuihua: “Director Xiang, is that convenient?”
Xiang Kuihua gave a wry smile: “Director Lin, it might be more appropriate for you to go through the equipment department to request it.”
Xiang Kuihua was also unsure if Peng Haibo would deliberately obstruct them at this time; normally, he wouldn’t be so foolish, but special circumstances could not be ruled out.
Therefore, going through the equipment department for requisition would be more reliable.
Lin Qianlong was only testing Xiang Kuihua’s reaction and did not ask Xiang Kuihua to retrieve the equipment directly.
Lu Cheng: “Director Hou, what are the patient’s vital signs? They should be okay, right?”
Hou Jiagui replied: “There are no major problems. The difficulty with limb amputation patients lies in preserving the limb, not in stabilizing vital signs.”
“If bleeding is stopped before entering the operating room, it’s generally difficult to go into shock.”
“Then let’s leave it at that…” Lu Cheng said, and began to move the patient for transfer.
The circulating nurse and Hou Jiagui from the Anesthesiology Department first transported the patient to the recovery room.
After Lu Cheng removed his sterile surgical gown and sterile surgical gloves, he glanced at the surgical slip filled out by the circulating nurse.
After a slight hesitation, Lu Cheng replied: “Hey, this surgery was filled out incorrectly. Please change it, and also change the surgical billing later.”
“Don’t write ‘Limb Replantation,’ just write ‘Open Fracture Internal Fixation Surgery plus Muscle Suturing Surgery, Nerve and Vascular Suturing Surgery’.”
There was more than one circulating nurse; upon hearing Lu Cheng’s words, her expression became slightly stiff: “Doctor Lu, I’ve already filled out the form.”
Lu Cheng smiled: “Please rewrite it. The surgical procedure you listed is incorrect.”
“The intended procedure was limb replantation, but it was not performed as limb replantation in the end.”
Xiang Kuihua glanced at Lu Cheng at this moment, thinking that Lu Cheng was truly cautious to the point of being meticulous, leaving no room for any oversight.
“Alright.” The circulating nurse also felt helpless.
If her surgical method was incorrect, the chief surgeon could refuse to approve the surgical inspection form.
The chief surgeon has absolute authority over the actual surgical procedure. Although she didn’t know why Lu Cheng was doing this, if she was unwilling to do it, Lu Cheng could request another circulating nurse.
Moreover, it would be unreasonable for her, a circulating nurse, to have an unpleasant dispute with Lu Cheng over such a trivial matter.
…
As he exited the operating room door, Lin Qianlong glanced at Lu Cheng and casually asked, “Xiao Lu, the charges for limb replantation are slightly higher. Why did you just…?”
“Director Lin, our hospital does not have accredited registrations for Microsurgery and Hand Surgery specialties. Performing this is against the rules,” Lu Cheng replied.
Lin Qianlong was taken aback: “Then what about Professor Tong Yuan’an?”
“Professor Tong has his own surgical permissions. He is here for rural support, which counts as multi-site practice.”
“To be more precise, Director Lin, your call to bring Director Hou here perfectly aligns with the regulations. The anesthesiologist for limb replantation surgery must be a Deputy Chief Physician or above.”
“Even a regular Attending Physician’s signature is a loophole…”
Lin Qianlong nodded: “Oh, I see. No wonder people in the operating room said Professor Tong had a lot of requirements when he performed surgery.”
“Then, writing the surgical procedure like this, is it okay?” Lin Qianlong asked again.
Did no one consider that you intentionally dissected the surgery?
“Director Lin, we can’t just stand by and watch someone die, can we?!”
Lu Cheng said, “Even if we can’t perform limb replantation, we will still try our best to save the limb. Therefore, we can only act according to the regulations and procedures…”
Lu Cheng went out to communicate with the family immediately.
The patient’s father had also arrived. Upon seeing Lu Cheng, both rushed forward immediately, looking expectantly at Lu Cheng and Lin Qianlong:
“Director Lin, how was the surgery? Was it successful?”
Lin Qianlong was a senior Deputy Chief Physician and one of the leaders of the surgical team; Lu Cheng was an assistant: “The hand should be saved, but do not set your expectations too high for postoperative function.”
“You sent him too late. He might still necrosis after surgery.”
“And the bone, blood vessels, and nerves were all severed. Even if they are reconnected, they will definitely not be as good as the originals.”
“If there is no necrosis, the function will also be much worse than the other hand and compared to people of the same age.”
The middle-aged man had a shrewd and calculating look on his face. At this moment, he also shook his head helplessly: “It’s already like this, there’s no other way.”
Lin Qianlong said, “Don’t overthink it for now. It’s good news that the hand can be temporarily saved. Having it is better than not having it at all.”
“You can also rest for a while. He will be out of the recovery room soon…”
“This is Doctor Lu Cheng from our department. He will be your son’s ward doctor from now on. If you have any questions, feel free to communicate with him.”
“Doctor Lu will also explain some postoperative precautions to you clearly.”
“Limb replantation is not like planting vegetables, where you plant it and it grows fruit. It requires careful nurturing.”
Lu Cheng then took the patient and family members back to the doctor’s office in the Emergency Department, explaining postoperative precautions while writing medical orders.
“Later, there will be two oral medications. One is Mecobalamin, which nourishes nerves, and the other is Sodium Aescinate for reducing swelling. Remember to take them promptly.”
“The nurse will bring them to you and explain the usage again.”
“In addition, for the next two days, you must pay close attention to whether his hand turns bluish or black. Postoperatively, blood clots can easily form, leading to poor blood circulation. These are inherent risks of this type of surgery…”
“Also, if you have time later, please settle the surgical fees.”
The man nodded: “Doctor Lu, no problem. As long as my son’s hand is saved, we will pay all the fees.”
Although this response had a prerequisite, Lu Cheng could not say much more.
“There’s nothing else special. Please wait for him to come out. I will check on him again before I leave,” Lu Cheng said.
“Doctor Lu, you’re leaving already?”
“Aren’t you going to keep watching my son?” the woman said, suddenly flustered.
Lu Cheng chuckled and replied, “We have an on-duty doctor in our department. I’m not on duty today; I came to work overtime for the surgery. After finishing here, I will need to rest. I will be on duty in a few days, and you will be able to find me then.”
“Let’s go, we’ll wait for our son to come out first,” the middle-aged man replied.
He was not a weak-willed person and did not make things difficult for Lu Cheng.
…
In the Orthopedics doctor’s lounge, Xiang Kuihua was smoking with Luo Changwu.
After exhaling a smoke ring, Luo Changwu asked, “Xiang Kuihua, are you saying that Xiao Lu really completed the limb replantation as the chief surgeon?”
Xiang Kuihua nodded and chuckled: “I participated in the entire surgery. What does Lin Qianlong from the Emergency Department know about limb replantation?”
“This Xiao Lu is truly a talent… He was earning a living in a precarious profession, and now he’s reached this level…”
Luo Changwu scratched his ear and said, “Xiang Kuihua, don’t forget that he didn’t leave our Orthopedics department happily.”
Xiang Kuihua replied, “Brother Luo, does his happiness have anything to do with us in reality? Are we responsible for making him happy?”
“We are all adults. Why should he be happy? Why shouldn’t he make others happy?”
Luo Changwu’s expression was slightly conflicted. He glanced at Xiang Kuihua and said strangely, “Did Lu Cheng never mention wanting to scrub in with you for surgery before?”
“He did? So what? If he said he wanted to, he’d get to do it?” Xiang Kuihua replied frankly.
“If he wants to learn something, should we indulge his wishes? On what grounds?”
“Brother Luo, don’t overthink it. Xiao Lu’s intentions aren’t that complicated.”
“Of course!” Xiang Kuihua changed the subject: “Precisely because they aren’t that complicated, it’s hard to pull him back now.”
“Otherwise… sigh…”
Xiang Kuihua sighed, without uttering the word ‘performance.’
Unfinished performance is not a performance at all.
Lu Cheng is not a complicated person, so even if you try to be friendly, it will be difficult for Lu Cheng to open up to you again.
“Director Lin of the Emergency Department has struck gold…” Luo Changwu flicked his ash.
At this moment, someone pushed the door open without warning.
Luo Changwu and Xiang Kuihua’s cigarettes had nowhere to be hidden. Outside the door, six or seven people were lined up, four of whom were carrying briefcases.
Tang Zhongqi, the Deputy Director of the hospital’s Medical Affairs Department, and Deputy Director Xie Liao were present. Tang Zhongqi asked, “Is Director Xiang Kuihua here?”
Xiang Kuihua crushed his cigarette and stood up, a smile on his face, offering his cigarette: “Director Tang, Director Xie.”
They all refused. Tang Zhongqi pushed his hand and said, “Director Xiang, these are leaders from the County Health Bureau. They said they received a complaint that our hospital is performing surgeries at a higher level and in violation of regulations.”
Tang Zhongqi appeared as if he wasn’t familiar with Xiang Kuihua.
Xiang Kuihua was taken aback and looked at the newcomers: “Director Tian?”
The newcomers were a team led by Tian Qi, Director of the Legal Supervision Section of the County Health Bureau (formerly the County Health Bureau).
He didn’t recognize the other two, but he had dined with the Director of the Legal Supervision Section many times.
“Doctor Xiang, we are here today because we received a report, so we are here for a routine inquiry. The informant called 12345, and the case was assigned to us.”
“According to the clues provided by the informant, it is said that our People’s Hospital is illegally performing limb replantation surgery without proper qualifications. Is this true?” Tian Qi recognized Xiang Kuihua from Orthopedics and also Luo Changwu.
Within the system, those with connections often meet.
Xiang Kuihua quietly asked, “Director Tian, you came to me directly after a report to 12345?”
Tian Qi replied, “Director Tang from your hospital’s Medical Affairs Department reviewed today’s surgeries and traced the limb replantation surgery on today’s operating schedule.”
“According to the application form, we saw that you, Doctor Xiang, were one of the participating doctors, so we came to inquire about the specific situation.”
Luo Changwu also extinguished his cigarette and walked out, smiling: “Esteemed leaders, since you’ve come to the department, please come to the office for a while. I’ll ask the on-duty nurse to get you some tea. Work slowly, drink tea slowly.”
“By the way, was the report from 12345, or through other channels?”
“Why do I find it hard to believe that the dispatch was so fast?”
Luo Changwu’s gaze was fixed on Tian Qi’s eyes.
Tian Qi waved his hand and said, “Doctor Luo, we still have to investigate.”
“The call was made to me by Director Peng Lisan of the Office.”
The Office is another agency of the County Health Bureau.
Therefore, Tian Qi could only hint to Luo Changwu, not state it directly.
