Chapter 69: A Little Famous!
August 26th, Wednesday, the sun blazed like fire, turning Long County into a steamer once again.
At 8:30 in the morning, after finishing rounds, Lu Cheng went straight to the doctor’s lounge. Du Daihua, who was eager to learn from Lu Cheng, actively went to change dressings and modify medical orders.
Lu Cheng wasn’t worried about Du Daihua’s execution of medical orders; he was much better than Peng Kun. Du Daihua would follow whatever Lu Cheng suggested.
As long as the medical order was suggested by Lu Cheng, the skill points gained would go to Lu Cheng, along with a few skill points for dressing changes. Lu Cheng didn’t want to ‘haggle’ with Du Daihua over these.
Lu Cheng opened his thick, large notebook and wrote on the page for August 25th, meticulously preparing to write the next sentence.
He found that his pen had run out of ink. He wondered which heartless person had replaced the ‘pen’ in his white coat…
Lu Cheng had to take out another one from his backpack—
【 Splenic injury, In Situ Spleen Preservation Surgery, Segmental Resection among Subtotal Splenectomies, get! 】
【 Splenic Lobe/Segment Resection: Dissect hilar vessels → Ligate target lobe/segment artery → Resect along ischemic line; Indication: Grade III （ regional injury ）
Subtotal Splenectomy: Preserve ≥30% splenic tissue of the superior or inferior pole （ requiring preservation of 2 or more splenic segment arteries ）; Indication: Grade IV multiple regular lacerations 】
【 Irregular Splenectomy, Total Splenectomy + Autotransplantation, Vascularized Splenic Transplantation, none mastered, ☆☆☆ 】
Lu Cheng drew three five-pointed stars to remind himself, to strictly control his range of abilities, so as to prevent patients from dying from ‘shock’ due to spleen preservation surgery.
Compared to death, admitting one’s incompetence and performing a splenectomy was not shameful.
Recognizing one’s limits and clearly categorizing diseases outside of one’s ability would be more beneficial for his clinical work.
After all, once Professor Chen Song left, no one would have his back…
【 Absolute Contraindications for Gallbladder Preservation Surgery:
1. Gallbladder non-function: Gallbladder atrophy or cavity disappearance, porcelain gallbladder （ gallbladder wall calcification ） with severe lesions;
2. High risk of gallbladder canceration: History of gallstones > 10 years, gallbladder adenomyomatosis or local wall thickening;
3. Acute complications: Gallbladder perforation, suppurative cholangitis, biliary pancreatitis （ cystic duct obstruction ）
4. Gallbladder ejection fraction <30% 】
“Gallbladder stone removal surgery has high technical difficulty, requiring strict selection of patients due to stringent equipment and operator experience requirements. Domestic and international guidelines still prioritize gallbladder removal surgery, as gallbladder preservation surgery does not address the cause of stones （ gallbladder metabolic abnormalities ）,” Lu Cheng murmured to himself.
“So the surgery is difficult to learn.”
This is an optional surgery. Guidelines recommend direct removal, but if the patient has strong demands, gallbladder preservation surgery can be performed. The patient’s strong demands should, to some extent, outweigh the guidelines, unless the indication for a specific surgical procedure is particularly strong.
“Doctor Lu, there’s a patient outside specifically looking for you. They said they were transferred from the Traditional Chinese Medicine Hospital,” said Nurse Li Guofang, her voice as gentle as jade, as she pushed open the door.
Lu Cheng turned his body slightly, feeling a little surprised, his eyelids twitching slightly as he looked at Li Guofang: “Transferred from the Traditional Chinese Medicine Hospital? Looking for me?”
Li Guofang’s apricot-shaped eyes were lively and her gaze clear. She had always been an honest girl with a very good disposition, hardworking and uncomplaining. She was also quite delicate in appearance, but her association with A and her junior college education made her a bit “submissive” in her usual interactions, often working shifts on holidays.
“Yes, Doctor Lu. The patient had their dressing changed at the Traditional Chinese Medicine Hospital and is at the nurse station. They said they only wanted to see you. It seems Doctor Luo from the Emergency Department there recommended them.”
“Doctor Zhang Tiesheng from the Emergency Clinic said he would see them first before calling you, but the patient disagreed,” Li Guofang said, her melon seed face delicate and pure, her voice quite refined.
“Alright, let’s go take a look.” Lu Cheng put down his pen.
He didn’t know Doctor Luo from the Emergency Department of the Traditional Chinese Medicine Hospital. He had mostly worked in Orthopedics before and was familiar with his colleagues in the Traditional Chinese Medicine Hospital’s Orthopedics department.
“Uncle, the Doctor Lu you’re looking for is here,” Li Guofang said softly to the patient.
The person who arrived was two middle-aged men, similar in age, both around fifty years old.
As they turned to look, their eyelids immediately widened, thinking they were being teased. But as Lu Cheng approached and the name and photo on his badge matched the person, one of the middle-aged men said.
“Hello, Doctor Lu. We were introduced by Doctor Luo Shanpei from the Traditional Chinese Medicine Hospital. He said the Traditional Chinese Medicine Hospital couldn’t handle my brother’s tendon injury and that we should either go to the prefecture or come find you.”
“We were supposed to butcher a pig this morning. When the knife fell, my brother inexplicably went to catch it. Look at this mess…” the middle-aged man said with extreme annoyance.
Lu Cheng took one look and knew this was a standard District Two flexor tendon injury.
Under normal circumstances, catching a falling knife wouldn’t damage the inner layers of the tendon, let alone cause a complete rupture. But a pig slaughtering knife was different.
Lu Cheng nodded slightly: “Have you registered? If you haven’t registered, I can’t formally accept your case.”
“Not yet. Doctor Luo specifically instructed us to find you first before registering, to avoid… well, to avoid misunderstandings. I’ll go register. Doctor Lu, please take my brother to be seen first.”
“If it can be treated, we’ll do surgery. If not, we’ll quickly charter a vehicle to Jishi City,” the middle-aged man said evasively.
Peng Kun was handling tendon suturing, and perhaps the Traditional Chinese Medicine Hospital had heard about it. But they were not from the same system; while others might give face to Young Master Kun, the ‘colleagues’ at the Traditional Chinese Medicine Hospital certainly wouldn’t.
“Doctor Lu, thank you for your trouble…” the injured middle-aged man said with a hint of helplessness.
“It’s alright. Come with me to the procedure room. Whether I can operate depends on whether you’ve injured any blood vessels or nerves. If you have, I won’t be able to handle it either,” Lu Cheng replied.
A patient’s condition is usually not textbook-perfect. Pig slaughtering knives are very sharp. If nerves and blood vessels are injured, it’s not just a tendon rupture; it’s a partial finger amputation, requiring replantation, which is beyond Lu Cheng’s scope.
Lu Cheng efficiently led the patient into the procedure room. After opening the gauze and sterile supplies, he examined the area and looked up, saying, “The only stroke of luck in this misfortune is that no blood vessels or nerves were injured.”
“Surgery can be performed, but if you want to pursue better surgery quality, I recommend you go to the Zhou People’s Hospital,” Lu Cheng replied conservatively.
The patient was stout and had a deep voice: “Doctor Lu, are you treating us like ignorant outsiders?”
“Doctor Luo Shanpei from the Traditional Chinese Medicine Hospital is my brother-in-law. He told me about your background. Going to the Zhou People’s Hospital would be no better than coming to you.”
“He definitely wouldn’t lie to me. Doing it here is cheaper and the quality is just as good.”
Long County is a poor county. For most families, having one member in the public service system is a sign of prestige and makes them highly trusted by their relatives.
“Uncle, Doctor Luo has praised me too much. It’s not as exaggerated as Doctor Luo described. I can do it, but I can’t guarantee it’s better than others.”
“We’re all in the same profession. I won’t step on others to elevate myself. Of course, I appreciate your trust. I will do my utmost to preserve your hand function as much as possible.”
“After the surgery, you’ll need to follow instructions for functional rehabilitation, which is also one of the key factors,” Lu Cheng said, not letting the reputation-driven patient cloud his judgment, clearly explaining the important points.
