This doctor is already middle-aged, and he's only just started practicing medicine.

Chapter 5 No matter how small a mosquito is, it’s still meat

Professor Chen Song came to the department on the 1st. He was originally interested in Lu Cheng's basic skills, but he had only glanced at them a few times.

To conduct a level assessment, many details need to be considered, and Chen Song felt that he probably hadn't paid enough attention to them at the time.

"It's good that there's no problem. I thought you would give me some pointers, Professor Chen." Lu Cheng quickly stepped forward.

Chen Song turned around, hands behind his back: "In suturing, we must first practice the overall layout, that is, the entire suturing process, including the four steps of needle insertion, needle passage, needle withdrawal, and knot tying. As surgeons, we must at least master the complete suturing process first."

"Next is distance control, which is what the textbooks refer to as the 'one centimeter' rule."

"After all that is done, the next step is the meticulous control of force. For example, common sewing materials, such as orange peel sewing or tofu sewing, are all done in this way."

"But if you want to suture the tendon and suture it well, you need to control the force of the needle insertion and withdrawal while also paying attention to the distance."

"For example, common suture materials like rubber bands or bandages, if the suture depth is controlled too shallowly, the suture will cut the tendon stump; if it is too deep, it will be difficult to suture the other side and other locations."

"Furthermore, the spacing must be clear. If the sutures on both sides, such as above and below or left and right, are not balanced, the resulting tendon will be crippled. After the patient's wound heals, the remaining scar will be a messy clump. This is the first pitfall of tendon suturing..."

Chen Song's guidance was specific and detailed.

Previously, Lu Cheng only knew how to practice sewing materials, but no one told him what to practice with each type of sewing material, what details to pay attention to, or why these details were important.

These things can either be figured out by spending a lot of time on your own, or you need a teacher to guide you.

Lu Cheng looked at his 'Profit and Loss Regulations'!
[Single-handedly performed debridement and suturing in one case, carefully instructed the patient on postoperative precautions, and persuaded the patient to receive a tetanus antitoxin injection, earning 0.6 skill points.]

[With meticulous guidance from a renowned instructor on the fundamentals of suturing, my suturing skills have improved slightly.]

[Current remaining skill points: 1.7 points.]

When given guidance and instruction, one's skills can improve, but this improvement may not be displayed on the panel.

That seems quite reasonable.

Lu Cheng smiled even more broadly: "Thank you, Teacher Chen..."

……

At 3:20 PM, Lu Cheng, holding the discharge record and medical diagnosis, arrived at bed 11 in the observation ward and said, "Zhang Linhong, you're being discharged today, right?"

The patient and family had already packed bowls, basins, towels, etc. Hearing the noise, they quickly got out of bed and went to Lu Cheng. The patient's wife said enthusiastically but with some hesitation, "Dr. Lu, Professor Chen said this morning that we could be discharged after the injection this afternoon!"

"But yesterday Director Lin said it would be best to observe for a few more days... Dr. Lu... should we be discharged?"

The patient had a deep, longitudinal wound to the front of the thigh with muscle damage. After arriving at the hospital on the 1st, Professor Chen Song performed the debridement and hematoma removal.

Normally, according to the hospital's inpatient schedule, he would have stayed for another three or four days for observation, but Professor Chen Song was used to the schedule at Xiangya No. 2 Hospital, so he directly told the patient that he could be discharged today.

The surgeon who assisted Chen Song during the operation was Associate Chief Physician Lin Qianlong.

Lin Qianlong is the director of the emergency surgery group and the only associate chief physician in the group.

"Professor Chen came to see you again this morning. Your wounds are healing very well. Professor Chen also performed the surgery, so I suggest you follow his instructions."

Lu Cheng then added, "Of course, if you insist on staying in the hospital for a few more days, that's also possible."

In hospitals like Zhongnan Hospital of Wuhan University or Xiangya No. 2 Hospital, where beds are scarce, patients are not allowed to stay longer simply because they want to. But here at Longxian People's Hospital, patients' informed consent will be respected to the greatest extent possible.

The patient and his wife exchanged a glance and then hesitated, "Then... there won't be any problems, will there?"

Lu Cheng looked at the patient and said, "Your condition is very common, there are no special circumstances. As long as you follow the precautions after discharge, there shouldn't be any major problems."

"However, if you are really worried, I suggest you go to an outside pharmacy and buy some oral antibiotics, the cheapest kind of cefuroxime will do."

“This is a hospital; the medical insurance and regulatory system don’t allow us to prescribe this drug anymore,” Lu Cheng advised professionally. Sometimes, guidelines and regulations are too rigid, and the time limits for antibiotic use are like rigid, formulaic rules.

In reality, there are some patients in clinical practice who require antibiotics to be used up to 72 hours after surgery, but regulations do not allow it.

If signs of infection appear, treatment should proceed immediately...

Lu Cheng is not just any ordinary doctor; he is already an attending physician. When he was in orthopedics, he didn't perform many surgeries. Reading books and searching for small literature articles were Lu Cheng's daily routine.

This is also a little experience that Lu Cheng himself summarized: 'non-compliant', but not illegal.

“It’s okay to buy some more medicine… Staying in the hospital here is too expensive…” The patient’s wife felt relieved.

The patient nodded: "Dr. Lu, what's the name of the medicine you just mentioned?"

"Cefuroxime axetil is an oral antibiotic. Just buy the cheaper kind, and you don't need a lot. A course of treatment for four or five days is enough."

"If the pharmacy recommends you buy a large quantity, then don't buy it! The best medicine is the right amount and the right prescription." After Lu Cheng finished speaking, he handed the other party the discharge medical record and the diagnosis certificate.

"Go to the nurses' station to complete the settlement procedures and get the stamp, then you can be discharged. I have already given you the discharge instructions."

"Okay, thank you, Dr. Lu..." The woman nodded, picked up the bucket (which contained a basin, and the basin contained a bowl and a towel), and helped the limping man walk out.

[By providing detailed post-operative instructions, the chance of infection for the patient is reduced, and 0.1 skill points are gained.]

Lu Cheng watched the couple, who couldn't even afford to buy crutches, walk away and smiled knowingly, reflecting on the meaning of being a doctor.

"Even a mosquito is still meat, thank you all..." Lu Cheng murmured, then turned around to check on the spleen removal patient that Director Lin had operated on that morning.

The patient underwent open abdominal surgery, and the monitoring device is still in place. The patient's blood pressure and blood oxygen levels are basically stable, and a drainage tube is in place to drain the hematoma in the abdomen.

"Brother, how are you feeling? Does the wound hurt? If it does, please tell us. We are now adhering to the principle of pain-free perioperative care, and we do not recommend enduring pain," Lu Cheng said politely.

"Doctor, a little pain is actually not so bad, right? My wife always says I'm being dramatic." The patient was about the same age as Lu Cheng, and although his face was slightly pale, his overall complexion was not bad.

Splenic rupture is an extremely urgent condition with a high mortality rate and is not suitable for referral.

Early this morning, Professor Chen Song was on his "rest day," and the two directors of the general surgery and emergency departments at Longxian People's Hospital dared not easily perform a spleen-preserving surgery, so they simply removed the spleen to solve the problem.

“That’s a misconception. Pain is a very unpleasant experience!” Lu Cheng’s face hardened. “We can endure pain, but there’s no need to be proud of it or take pride in it.”

"The idea that surgery is painful and that you have to endure it afterward is outdated and not recommended..."

"Brother, you still feel pain, right? If pain is rated on a scale of ten, and ten is excruciating pain, how would you rate your current pain?" Lu Cheng quickly asked using the very professional yet simple Visual Pain Rating Scale.

"It's not that exaggerated, maybe four or five points at most." The young man shook his head and chuckled. "You can't notice that when you're playing games."

A score of four or five indicates that a score of five is the threshold for intervention with weak opioid drugs.

Lu Cheng carefully examined the patient's left abdomen again, ruling out any hidden injuries in other locations, and said, "Then you should have come to us sooner. I'll go and prescribe you an injection of tramadol."

"Now is the time when the effects of the anesthetic have just been metabolized, so we need to pay the most attention to pain management."

After Lu Cheng finished speaking, he walked away.

Behind him, the young man's soft voice came: "See? The doctor said not to endure the pain. And you still say I'm being dramatic."

Ten minutes later.

[Reasonably persuade patients to use pain medication to reduce their pain experience during the perioperative period, earning 0.1 skill points]

Another mosquito bite, but one that's hard to spot unless you're very observant...

(End of this chapter)