This miracle doctor just wants to be fired!

After the three PCI machines finished in the morning, Zhou Cheng reassigned the tasks.

Li Mingyuan was responsible for re-verifying the indications.

In addition to examining whether the lesion is calcified, we also need to consider the vessel diameter, tortuosity, lesion length, bifurcation location, distal bed condition, and the surgeon's experience to determine whether each case is suitable to be performed independently in a primary care hospital.

Zhao Sisi was in charge of rebuilding the database.

The original form only contained basic information such as age, gender, and underlying diseases, which was too coarse. She needed to supplement the information with the location of the lesion and the changes in the lesion morphology after each step of the treatment from the imaging and surgical records.

Chen Yu's task sounds the simplest.

All she needed to do was record the time points when she "decided to continue" and "decided to stop" each time the surgery began and ended.

"How do you determine if it's a decision?" Chen Yu asked.

"If you can hear the surgeon's voice, record their exact words. If you can't, record what happened," Zhou Cheng said. "For example, after the first dilation was completed, a larger balloon was used two minutes later, or no further treatment was done after angiography, and the stent was implanted directly. Don't judge whether it was right or wrong, just record the process."

"Should normal cases be recorded as well?"

"all."

What about your earlier medical records?

"Record everything."

Li Mingyuan glanced at the portable hard drive on the table.

"Teacher, some of the earliest cases don't have complete audio recordings."

"Record as much as you can."

When do we need these?

There is no time limit.

All three of them were somewhat surprised.

Zhou Cheng continued, "But until the reason is clear, Linjiang People's Hospital has suspended handling these types of cases independently and has arranged for complex patients to be transferred to higher-level hospitals. You don't need to rush to give an answer, and don't stay up all night to meet deadlines."

The three of them each carried their computers to the small conference room.

Chen Yu looked at it for two hours and felt that the table was getting longer and longer, but there was no pattern to it.

She took off her headphones, stretched her stiff shoulders, and just then saw Li Mingyuan zoom in on a screenshot of a medical record.

"What did you find?"

"This case shouldn't have been done at the county hospital."

Which case?

"The seventeenth case."

Li Mingyuan turned the screen around.

Angiography showed diffuse lesions in the proximal and mid-segment of the left anterior descending artery, with severe proximal calcification. The lesion also involved a large diagonal branch, and the vessel was generally tortuous with a smaller distal diameter.

Individually, none of these factors are absolute contraindications, but when combined, they mean that if dissection or branch involvement occurs during surgery, the difficulty of treatment will increase rapidly.

"Is this a complication?"

"no."

Chen Yu was stunned.

"Did it complete normally?"

"Yes, and the result was very good."

Li Mingyuan flipped to another example.

"On the contrary, the perforation case was simpler from an anatomical perspective than this one."

Chen Yu didn't understand the specific risk stratification involved, but she understood what he meant.

If the most complex cases go unharmed, but perforation occurs in better-condition cases, then broadening the indications may increase the overall risk, but it is difficult to explain all the results on their own.

Zhao Sisi overheard their discussion but didn't look up.

"That's why you can't look at variables one by one," he said. "It might not be a single factor, but rather a combination of several conditions that increases the risk."

Before noon, Liu Tao from Linjiang People's Hospital called again.

In addition to reporting on the patients' conditions, this time they also inquired whether it was necessary to issue a public statement regarding the suspension of services.

Within Linjiang People's Hospital, some people already knew about the four cases of complications occurring in quick succession, and the catheterization lab nurses had begun discussing it.

Liu Tao worried that if she didn't explain it soon, the news would spread through informal channels and could easily cause misunderstandings.

The call was on speakerphone, and after listening, Lin Feng asked, "What are you currently telling the patient's family?"

"We explained the treatment process for each case and acknowledged that the complications were related to the surgery without avoiding the topic. We have contacted the two patients with stent problems for follow-up examinations. The family of the patient with the perforation is relatively stable, but the family of the patient with the dissection requested to see the entire surgical video."

"Yes, I can give it to you."

"Preparations are already underway."

Liu Tao hesitated for a moment, "Director Zhou, what I'm most worried about isn't the family members. I'm worried that the hospital will first conclude that the operation was not in accordance with regulations, then punish a few surgeons, and that's it."

The office was silent for a few seconds before the statement was made very bluntly.

In many medical incidents, the easiest answer to pinpoint is often "individual operational error," because it is specific, allows for accountability, and facilitates the provision of corrective measures in a short period of time.

However, if the four cases of complications share common training deficiencies or issues with the boundaries of technology applicability, treating only the surgeons would leave the real risks to other hospitals.

"We have received the original data," Zhou Cheng said. "Before the joint review is completed, we do not recommend determining individual responsibility."

"The hospital is asking when we can expect a conclusion."

"We can't give you time now."

"So what should we say to outsiders?"

"Tell the truth that we are reviewing the incident, the relevant techniques have been suspended, and the patient continues to be followed up. Do not say it was an isolated incident, nor do you say it has been clearly determined to be a procedural error."

Liu Tao was silent for a moment, then said, "I understand."

After hanging up the phone, Lin Feng let out a long sigh of relief. "If their leaders hear what you said, it probably won't sound good."

Which sentence?

"We can't give them time."

"It was never going to be possible."

"What many people dislike most is not knowing when it will end."

Zhou Cheng did not answer; the urgency of clinical practice and the caution of scientific research often conflicted with each other.

The patient needs a timely explanation, the hospital needs to handle the situation as quickly as possible, and the surgeon needs to know exactly where they went wrong.

However, truly reliable conclusions cannot emerge prematurely simply because everyone is anxious.

In the afternoon, Li Mingyuan reorganized the indications into three groups.

Of all the cases, only one was not recommended for testing.

This result has once again rendered the most promising explanation powerless.

"At least it shows that the indications have indeed been expanded," Li Mingyuan said. "Anhe County has been expanding the scope of indications more and more in the later stages, and this problem must be corrected."

"But that's not the main reason." Lin Feng looked at the group assignment results.

Zhou Cheng wrote down the case numbers that were not recommended to be carried out, and then asked Li Mingyuan to list the reasons why each case exceeded the original standard separately.

"Teacher, if this part can't explain the complications, is it still important?"

"important."

Why?

"Because we are currently investigating four cases of complications, it does not mean that the cause of these four cases is the only one."

Li Mingyuan didn't ask any more questions and reopened the form.

Meanwhile, Zhao Sisi's database has also been initially completed.

She first compared the balloon vessel ratio, maximum dilation pressure, and number of re-dilations between the complication group and the non-complication group, and the results showed no significant differences.

Of the four cases with complications, three had maximum stress levels lower than the average in the group without complications, and the number of repetitions was not greater.

At 5 p.m., the latest updates on the four patients with complications came in one after another.

The patient's blood pressure has stabilized and the pericardial drainage has decreased.

Patients with severe aortic dissection experienced elevated myocardial enzymes postoperatively, but did not experience further chest pain.

Patients with poor stent apposition are scheduled for follow-up imaging.

Patients with acute stent thrombosis generally recover well after re-intervention.

There was no new bad news, but there was also no truly relaxing good news.

This is the latest chapter.