Tokyo, 1994, starting with medical training

Chapter 39 High-scoring essay

First Surgical Professor's Office.

The room was covered with thick carpets, and the mahogany bookshelves were filled with various original foreign language books and skeletal models.

Sumika Nishimura sat behind a large mahogany desk.

As the head of the First Surgery Department, although she rarely goes on the operating table herself anymore, she still pays close attention to difficult cases and special surgeries in the department.

In a university hospital, clinical skills are important in some ways, but not in others.

But ultimately, securing a professorship depends on political maneuvering.

She held the medical records of the senator Ogawara's son in her hand, nodding frequently as she looked through the surgical records.

The use of C-clamps was timely, and the preperitoneal packing was a stroke of genius.

This can be considered a boost to the reputation of the First Surgery Department in front of the council.

After reading it, she picked up the next one.

[Patient: Nobuya Suzuki]

[Surgery Name: Open Reduction and Internal Fixation for C3 Type Comminuted Fracture of the Distal Radius of the Left]

[Surgeon: Imagawa Ori]

[First Assistant: Takikawa Takuhei]

[Second Assistant: Kiryu Kazusuke]

It is a medical record from a routine surgery.

Logically speaking, medical records of this level should not need to be presented to the professor.

However, Professor Sato from the radiology department made a special phone call, saying that she would definitely be interested in the patient's postoperative X-rays.

Professor Nishimura placed the preoperative and postoperative X-ray films side by side on the viewing lamp.

Before the surgery, it was shattered, collapsed, and a complete mess.

After the surgery, the surface was smooth, even, and perfectly sealed.

"That's interesting."

Although Professor Nishimura's surgical skills were only mediocre, and she was even privately referred to as the "clumsy professor" by the younger doctors under her, her eye for talent was excellent.

"As expected of Dr. Imagawa."

Professor Nishimura couldn't help but utter a sigh.

The joint surfaces were so smooth it looked as if there had never been a fracture, and the T-plate was positioned perfectly.

Even the most discerning professor couldn't find any fault with it.

Imagawa Orihime's surgery was indeed excellent.

This is why she can tolerate this young man having "side jobs" outside.

If you're not good at clinical work yourself, but your subordinates are, then that's fine.

She opened the surgical records.

This is the official version written by Takikawa Takuhei; the printed text is neat and clear.

However, the content is extremely brief.

Intraoperative exploration revealed joint instability, which was temporarily reinforced with multiple Kirschner wires. After satisfactory reduction, internal fixation with a plate and screws was performed.

Just this one sentence?

If it were a conventional steel plate fixation, it would be impossible to piece together those tiny bone fragments so perfectly.

So they just glossed over the most important part like that?

This is like discovering a gold mine but only writing "there are some yellow stones here" in the report. Isn't that a waste?

"What does 'temporary reinforcement with multiple Kirschner wires' mean?"

"Is it just simple prying?"

Professor Nishimura tapped his fingers lightly on the table.

Impossible. Simply prying and manipulating won't solve severe joint instability; the bone will collapse once you let go.

She keenly sensed something unusual.

Surgical failure due to occult ligament tears has always been a challenge in the treatment of distal radius fractures.

But the surgery was very successful.

This means that it is likely a new surgical approach, a new technology that can solve complex wrist fracture problems.

If that's the case...

If we could compile this case and explain in detail the technique of "temporary reinforcement fixation with multiple Kirschner wires," along with these perfect postoperative images...

That would be a high-quality case report, and it could even be published in the "Daily Journal of Medical Records"!

At her age, money is no longer important.

If she can publish a few more high-impact articles before retirement, her historical status will be secure.

"Yumi."

Professor Nishimura pressed the intercom button on the table.

"Professor, you wanted to see me?"

"Go and fetch Dr. Imagawa Ori, immediately."

"Yes."

A few minutes later, a knock was heard at the door.

"Enter."

Imagawa Ori pushed open the door and entered.

She was wearing a white lab coat, her hands in her pockets, and her face had her usual indifferent expression.

She was on her way to do rounds and then rush to another private hospital for a part-time surgery when the professor called her over.

This made her somewhat unhappy.

Time can indeed be exchanged for money, but a professor's nonsense is usually worthless.

"Professor, you wanted to see me?"

"sit."

Professor Nishimura pointed to the chair opposite him, a rare kind smile appearing on his face.

"Imagawa-kun, you performed surgery on Suzuki Shinya last week, right?"

"Yes."

Imagawa Ori sat down, glanced at the medical records and X-rays on the table, and felt a little puzzled.

Could there be a problem with the surgery?

impossible.

The patient is recovering very well and was discharged yesterday. The family even brought some snacks over.

Could there be a problem with the surgical records?

After all, it was written by Takikawa Takuhei, the same person who could never pass the medical school entrance exam.

When I submitted it to her for review, I was in a rush to finish get off work and do my part-time job, so I only glanced at it briefly before signing it.

Have you seen it?

Professor Nishimura pushed the surgical records in front of her.

Imagawa picked it up and quickly scanned it again, but didn't find anything wrong.

Imagawa Ori asked calmly, "What's wrong, Professor?"

Professor Nishimura shook his head, looking at him with a disappointed expression: "Too easy."

Imagawa Ori paused for a moment.

She thought the professor was there to nitpick, but it turned out he was just criticizing her writing for being too simplistic.

At the time, Takikawa Takuhei didn't understand Kiryu Kazusuke's operating principles at all, so he could only write some repetitive explanations to fool him.

Although she understood that it was ligament tension reconstruction, she felt that including such an unconventional procedure in her medical record might cause unnecessary controversy, so she tacitly approved of this ambiguous approach.

The less trouble, the better.

Surgical records are not simply a matter of complying with medical regulations and being able to pass medical insurance inspections and court proceedings.

But you can't say these things directly.

She stood up.

"Professor, the surgical situation was quite complicated at the time. In order to ensure the timely filing of medical records, I wrote down a rough draft first."

"I plan to add more details in the subsequent medical records or discharge summary."

"terribly sorry."

As he spoke, he bowed slightly to express his apology.

This is a catch-all excuse.

Professor Nishimura glanced at her. Would Imagawa Ori provide more detailed supplementary surgical records later?

How come I've never seen it before?

However, Professor Nishimura did not intend to expose him on the spot.

What she was more concerned about was the technical details of the surgery that could be used to publish papers.

"Imagawa-kun, that's perfect. I have a few questions I'd like to ask."

"Intraoperative exploration revealed a hidden ligament tear combined with joint instability. Why was such an important finding glossed over?"

"Furthermore, the specific method for inserting the Kirschner wire, including the angle, depth, and tension control, is not described in detail at all."

Sumika Nishimura put her glasses back on and took out a notebook.

"Yes."

Imagawa Inwardly cursed the trouble, but outwardly still respectfully agreed.

She composed herself and began to recall the surgical procedure from that day.

(End of this chapter)