Chapter 6: Deep Waters In A Small County And A Treasure Boy!
By four in the afternoon, the sunlight filtering through the east-facing glass of the doctor’s office had disappeared.
Upon seeing Chen Song enter the doctor’s office, Lu Cheng enthusiastically greeted him:
“Teacher Chen, would you like anything else to drink? I was thinking of ordering a milk tea.”
“Sister Gao has already ordered.”
Sister Gao, whose name was Gao Hanqiu, was the on-duty doctor for the Internal Medicine Group’s ward today.
The Internal Medicine and Surgery departments at Long County People’s Hospital had three shifts: the on-duty doctor for the Emergency Clinic, the on-duty doctor for the Observation Ward, Debridement Room, and Operating Room, and the support shift.
The support shift was easy to understand; it was for emergencies that the surgery shift doctors couldn’t handle, so the support shift would provide assistance. However, this kind of support shift was rarely used, even in the Emergency Department…
A remark from Chen Song that morning had directly pushed forward the panel regulations for suturing. Although it didn’t budge the progress bar of the panel, it had certainly improved his skills significantly.
Lu Cheng naturally hoped for more guidance from Chen Song.
Chen Song rubbed his large forehead forcefully with his right hand, his flat eyes narrowing into two slits. He looked left and right, confirmed no one else was in the doctor’s office, and then lowered his voice:
“Xiao Lu, why is the atmosphere at your hospital like this?”
“They’re even fighting over an appendectomy.”
“I originally planned to ask you, but Zeng Huanqi directly called Doctor Zhang. Unbelievable!!” Chen Song gave a thumbs-up, his lips turned down.
Zeng Huanqi was the on-duty doctor for the Emergency Surgery Clinic today, and Zhang Tiesheng was today’s “support shift”!
Lu Cheng wasn’t surprised: “Teacher Chen, I’ve never performed an appendectomy before. Brother Zeng knows that, so he called Brother Zhang, which is only natural.”
Chen Song snorted: “An appendectomy is a surgery for residents. If you guide an intern well, they can do it. What do you mean by ‘never performed it before’?”
Had Lu Cheng performed an appendectomy? No!
Could he do it? Absolutely!
“You need to learn it precisely because you haven’t done it before… I’m truly impressed…” Chen Song had clearly been put in his place by Zeng Huanqi and was in a bad mood.
Lu Cheng immediately changed the subject: “Teacher Chen, would you like some milk tea?”
“What’s this Zeng Huanqi’s background?” Chen Song asked Lu Cheng after calming down.
One could guess with their eyes closed that if he wasn’t a local strongman, he wouldn’t dare to provoke Chen Song, the “dragon crossing the river.”
Lu Cheng had also just arrived at the Emergency Department and needed effort to familiarize himself with the environment. He didn’t have the time to do background checks on others. He shook his head and said, “I’m not sure, and it’s not important, Teacher Chen.”
“After all, our county hospital has fewer surgeries, and you have to wait in line to learn them.”
Lu Cheng inferred from Director Lin Qianlong’s different attitudes towards Zeng Huanqi and Zhang Tiesheng that their statuses were unusual.
Surgical technique was the king of surgery in a county hospital, and surgical techniques were accumulated through surgical volume, making them very valuable ‘resources.’ How could Lu Cheng, who had only been in the Emergency Department for three days, easily obtain surgical volume?
On the surface, everyone of course acted politely, full of social graces, but when it came to core ‘competitiveness,’ they wouldn’t be so humble.
Lu Cheng had nowhere to argue; he just hadn’t done it, and he ‘couldn’t.’
The director wouldn’t ask why you ‘couldn’t.’ If you hadn’t learned well, it was your fault. Being weak was the original sin, with no other reason!
Similarly, if you knew something others didn’t, then you were amazing!
Chen Song looked at Lu Cheng, who had been “polished” by the harsh realities of society, and scratched his few, short hairs again, his eyes slanting upward: “Then get me a cup of milk tea.”
“I’m more curious about what the future holds…”
Chen Song was a bit angry.
Fine, so this was how you guys played your game?
Then I’ll wait and see what happens when Lu Cheng learns surgeries you can’t do, or performs surgeries better than you.
Chen Song, who came for ‘rural support,’ couldn’t even freely bring a ‘student’ to perform an appendectomy.
Lu Cheng didn’t know Chen Song’s thoughts and proactively took out his mobile phone: “Teacher Chen, what would you like to drink?”
“Let me see what’s the most expensive…” Chen Song began to scroll up and down.
The tuition fee shouldn’t be too cheap for this kid Lu Cheng.
“It’s fine,” Lu Cheng said, not thinking much of it, as it was just buying a cup of milk tea.
After Chen Song finished ordering his milk tea, Lu Cheng continued the morning’s topic, summarizing: “Teacher Chen, look here. Through the abdominal CT, we can see that the splenic laceration in this patient has a depth of 3.1 cm, and the hematoma within the spleen parenchyma is approximately 7.3 cm in diameter!”
“Based on the grading by hematoma diameter, it should be AAST Grade 2 splenic injury, but based on the depth grading, it’s a standard AAST Grade 3.”
“These are indications for spleen preservation through combined surgery.”
Chen Song heard this, his eyebrows raised in surprise, and his tone faltered: “You can see the specific depth and hematoma diameter on the CT?”
CT image reading technique has its traceable origins.
Lu Cheng could take time to look up the AAST scoring and know the AAST scoring standards.
He knew the Grade 2 splenic rupture scoring standard was: subcapsular hematoma greater than 10% of the surface area, intrasplenic hematoma diameter 10 cm; parenchymal laceration depth 1-3 cm, length 10 cm…
But if Lu Cheng could be specific on the abdominal CT, seeing that the patient’s splenic rupture depth was 3.1 cm and the hematoma diameter was 7.3 cm, this was beyond the level of superficial image reading that could be ‘guessed’ and memorized.
CT image reading technique also has levels of skill.
Lu Cheng, without suspicion, directly began to draw lines on the image reading system and then adjusted the scale.
“Yes, Teacher Chen, these are very obvious, aren’t they?” Lu Cheng standardly measured the depth of the splenic rupture and the hematoma diameter on the image reading system.
Chen Song’s skill was not ordinary, and his image reading skill was also not ordinary. He knew how the image reading ability of each person varied.
The simplest CT image reading is basically being able to identify different anatomical structures and see that there is a splenic rupture and a splenic hematoma; this is probably the level of a resident physician.
Further, if one can locate the anatomical structures of the spleen and distinguish between anterior, posterior, left, right, superficial, and deep ruptures, then that is approximately the level of a specialized doctoral student.
Being able to find the specific location of the injury and accurately measure the diameter and depth of the injury, even for a specialized doctoral student in the Emergency Department, requires high talent and is not something everyone can master.
For emergency department doctors, diagnostic technique is the most important! Image reading is one of the most important components of diagnostic technique.
Chen Song heard this, and with a glint in his eye, he asked again, “Then take a closer look at this patient’s CT. Can you find anything that the radiologist didn’t report?”
Evaluating a person’s ability should be multi-faceted.
Lu Cheng heard this and was not surprised; instead, he skillfully pulled the CT slice upwards and immediately located a small cyst on the posterior lobe of the liver: “Teacher Chen, are you referring to this?”
“The diameter of this cyst should be only about 4mm, the capsule is intact, there are no calcifications, and it’s basically not malignant. A small cyst of this size also doesn’t have surgical indications.”
Chen Song instantly understood and looked at Lu Cheng with a hint of surprise, his local accent slipping out: “You’re really just an undergraduate student? Are you kidding me?”
“Ah?” Lu Cheng replied, looking confused.
“You didn’t pursue graduate studies?” Chen Song asked.
Lu Cheng suddenly realized and shook his head: “Teacher Chen, I didn’t have such an opportunity. The hospital where I did my standardized training was Hanshi University Zhongnan Hospital.”
Chen Song of course knew Zhongnan Hospital in Hanshi, and his pupils brightened: “Xiao Lu, how old are you this year?”
“I’m two months away from thirty,” Lu Cheng said.
Chen Song sighed with resignation: “What a pity… you’re a little too old. If you were a few years younger… that would be so much better…”
Lu Cheng, however, smiled knowingly: “Teacher Chen, if I were a few years younger, you probably wouldn’t have given me a second glance.”
Although he was older, Lu Cheng also understood that he had learned for a few extra years.
This society is organized by reality.
…
