My daily work as a doctor: My treatment value is increasing.

Chapter 127 Dereliction of Duty

Wang Mengrui pursed her lips tightly, her eyes brimming with tears, a mixture of grievance and resentment.

But she didn't argue anymore. She lowered her head again and silently packed her things into her suitcase. The only sound in the small dormitory was the dull rustling of fabric.

Before it was time to leave work, Zhang Ping draped his white coat over his arm and slung his backpack over his shoulder.

He waited for the moment when the director's office was closed and no one was around before he slipped out of the ward with light steps. He posted the surgical patients' conditions in the group chat, simply noting the situation, and didn't linger any longer.

Because of the previous incident of shifting blame, Lu Renxin and Zhang Ping didn't get along. They usually kept a calm facade and would only exchange a few words when it came to work-related matters; otherwise, they didn't speak a word to each other.

But Lu Renxin is clear-headed and never takes his work lightly.

As the medical staff gradually dispersed from the corridor, he tidied up the medical records in his hand, preparing to check the patients scheduled for surgery tomorrow one by one before leaving.

He had to personally confirm the lesions to be sure, so that he could clearly understand everyone's situation when he went on stage. This was a habit he had developed since he was a student.

Lu Renxin walked through the patients' rooms one by one, stopping when he reached bed 23.

-

Lying on the bed was a young man in his early twenties, his face pale and his forehead covered in a fine layer of cold sweat. When he saw the doctor coming, he immediately turned over with difficulty, his voice trembling with barely suppressed sobs: "Doctor, it hurts, it hurts so much, when can you solve my problem?"

Lu Renxin first opened the department's work group and found the message Zhang Ping had sent earlier, which clearly stated that it was a perianal abscess and that surgery was planned for tomorrow.

He patted the young man's cold hand and soothed him in a gentle tone: "Just one more night, and we'll have surgery first thing tomorrow morning. Once the pus is drained, the swelling and pain will subside immediately."

The young man bit his lip and nodded, his eyes filled with helplessness: "Okay—I'll try a little harder."

But Lu Renxin's uneasy premonition grew stronger and stronger.

While common perianal abscesses are painful, they are usually just localized, throbbing pain, not so painful that one would tremble all over or turn pale.

He hesitated for a moment, then said, "Don't try to tough it out. Take your pants down and let me take another look."

The moment the young man forced himself to spread his legs, revealing the affected area, Lu Renxin's heart sank.

this----

This doesn't look like a perianal abscess at all.

The redness and swelling spread beyond the anus to both sides of the perineum, with large patches of purplish-blue skin. The soft tissue of the skin was swollen and hardened. Lu Renxin pressed it with his hand and could vaguely feel a twitch under the skin.

He sniffed and could smell a faint stench, which came from the fluid seeping from the affected area.

It's not a simple perianal abscess; it's clearly necrotizing fasciitis.

Lu Renxin broke out in a cold sweat.

A common perianal abscess can be left to heal overnight, and surgery can be scheduled for the next day without any problems.

Necrotizing fasciitis is an acute condition that spreads rapidly along the fascia; if left untreated even overnight, the infection can easily invade the pelvic cavity.

The abdominal cavity can trigger septic shock, which can be life-threatening at any moment, and there is no time to lose.

What to do? It must be dealt with immediately.

The attending physician is Zhang Ping. Yes, I need to contact Zhang Ping first.

Although somewhat flustered, Lu Renxin's thinking remained organized. In this urgent situation, he disregarded the conflicts he had accumulated with Zhang Ping and quickly dialed his number.

The phone rang several times before being answered. A noisy conversation came from the other end of the line, mixed with the clattering of bowls and chopsticks.

Zhang Ping's tone was full of impatience, sounding like he was having dinner with someone when he was interrupted by Lu Renxin's phone call.

"What's wrong? I'm home."

"Bed 23 doesn't have a simple perianal abscess, it has necrotizing fasciitis. He must come back immediately for surgery; we can't delay." Lu Renxin spoke rapidly, suppressing his anxiety.

Unexpectedly, as soon as he said this, Zhang Ping scoffed and retorted with a tone full of disdain: "This patient is one of my outpatients. I examined him and he had a perianal abscess. How many cases of necrotizing fasciitis have you seen?"

What gives you the right to make such a hasty conclusion?

"The outpatient clinic is in the early stage of the disease. The two diseases are very similar in appearance in the early stages. This patient's infection progressed very rapidly, and now purpura and subcutaneous crepitus have appeared."

"I've worked in the operating room handling these kinds of emergencies, I know exactly what the lesions look like, I would never make a mistake!"

Lu Renxin patiently explained, trying to make him take his condition seriously and return to the hospital for surgery as soon as possible.

But Zhang Ping wouldn't listen. He was already dissatisfied with Lu Renxin, and seized the opportunity to mock him using his seniority: "In terms of clinical experience, I have far more than you. I've performed more surgeries than you've eaten meals. Do I need you to teach me how to treat patients?"

Before Lu Renxin could argue further, the phone beeped twice and the call was disconnected.

He stood at the door of the ward, holding his phone, his brows furrowed tightly, feeling both anxious and angry.

We can't give up; the patient must come first. Since Zhang Ping is unwilling to come, we should find the doctor on duty.

There are doctors on duty at the hospital every night, so he turned around and went back to his office, found the junior colleague who was on duty that night, and asked in a low voice, "Who is the senior physician assigned to be on duty tonight?"

The junior looked around and, seeing that no one was around, whispered back, "Zhang Ping is on the schedule, but he thinks that our proctology department rarely has critical or emergency cases at night, so he often sneaks away early as soon as it's time to leave, only giving us his personal number, and asking me to handle minor matters."

Lu Renxin then realized that he was only there for further study and was not a regular employee of the department, so he did not need to participate in the department's duty schedule and had not discovered that he had left his post without permission.

With lives at stake, it's outrageous that Zhang Ping, the doctor on duty that night, left his post without permission and refused to return after a critically ill patient appeared.

He took a deep breath, suppressing his speechless feelings, and quickly made up his mind that he couldn't rely on Zhang Ping.

No, we need to call in reinforcements immediately.

After thinking about it, he realized he had no choice but to contact the department head, Director Zhao.

Lu Renxin had only been in the department for a short time and had little interaction with the other doctors. With Zhang Ping intervening, he was isolated. The only solution to this thorny problem was to turn to Director Zhao, who was in charge of handling the blame-shifting incident.

He didn't dare delay and immediately found Director Zhao's phone number and dialed it.

As soon as the call connected, he suppressed the surging anxiety in his heart and clearly and systematically recounted the symptoms and physical examination results of the patient in bed 23.

Finally, his voice became slightly anxious: "Director, you know how dangerous the progression of necrotizing fasciitis is. The slightest delay could lead to septic shock. We must perform emergency debridement immediately. If there were any other way, I would never bother you at this hour."

"The patient is currently in our ward. As doctors, we are responsible for his life."

There was a moment of silence on the other end of the line, then Director Zhao's steady voice slowly broke through, tinged with a hint of melancholy: "Who is the attending physician on duty tonight?"

"It's Zhang Ping."

Three consecutive "okay, okay, okay"s came from the phone, the tone revealing undisguised annoyance. Director Zhao replied in a deep voice, "I understand the situation, I'll be there right away."

After hanging up the phone, Lu Renxin's tense shoulders relaxed slightly.

He had a conflict with Zhang Pingqi in the department, and Director Zhao eventually mediated it.

These incidents clearly demonstrate that Director Zhao always handles matters impartially, separating public and private matters, and never favors anyone based on seniority.

It was precisely his impartiality that made Lu Renxin believe that as long as Director Zhao was present, the patient would receive proper treatment.

Not long after, hurried footsteps echoed down the corridor. Director Zhao was dressed in casual clothes, his coat not even properly on, and he had buttoned both buttons wrong.

He hurried into the ward and went straight to bed 23, his expression serious as he prepared to review the situation.

Upon opening it, just as Lu Renxin had said, there was redness and swelling around the anus without boundaries, spreading to the perineum and groin. The subcutaneous tissue was crackling and pulsating, and some of the epidermis was black and necrotic. The infection was spreading insidiously, and it was indeed necrotizing fasciitis.

Director Zhao patted Lu Renxin on the shoulder: "Good young man, if it weren't for you, the patient would have been delayed."

"If anything goes wrong, it will be entirely our department's responsibility!"

He made a phone call to contact the nurses and the operating room, and only after hanging up did he take a moment to ask Lu Renxin for his opinion: "The most important thing right now is to do the surgery. You said you've worked on necrotizing fasciitis surgeries before, so could you work with me this time?"

The operating table was illuminated by lights, exposing the patient's necrotic area. The newly connected monitor kept sounding alarms, and the patient's heart rate remained high.

Lu Renxin stood in the position of assistant, assisting and observing. Last time, when Director Yuan treated this type of necrotizing fasciitis, he first made several long incisions along the red and swollen edge, then simply scraped away the blackened fascia, and stopped after cleaning the surface rotten flesh.

The difference in how Director Zhao operates is immediately apparent.

He didn't rush to make the incision. First, he gently pressed the edge of the swelling with his sterile gloved hand, and judged the extent of the fascia infiltration by following the direction of the crepitus spread under the skin.

Starting from the perianal area and perineum, palpate all the way down to the groins on both sides to find all the hidden abscess cavities.

When making the incision, just like with Director Yuan, I didn't pursue neatness or aesthetics; I just wanted to fully open up the lesion.

Then, taking the scissors, they carefully separated the fascia along the gaps, cutting away any grayish-white, rotten fascia that had lost its luster, was cloudy, and crumbled easily, even if it was hidden a few centimeters below healthy skin, leaving nothing behind.

When encountering septated sinus tracts, he used curved forceps to probe in and open the septa one by one, resolutely preventing any remaining closed abscesses.

Then, every crevice was flushed under pressure with a large amount of diluted iodine and saline solution, and the necrotic tissue flowed away continuously with the flushing solution.

After cleaning, instead of immediately packing the wound with gauze, the edges of the wound were trimmed to prevent premature adhesion and closure of the skin.

Director Zhao's handling of the situation was indeed far superior.

Perhaps because the hospital is larger and has encountered this situation more often, it has accumulated more experience.

Surgical procedures rely heavily on practice and operational experience.

The feelings and experiences of one person who has performed 100 surgeries are different from those of another person who has performed 10000 surgeries.

Not only are they more skilled, but they have also seen a wider variety of patients, leading to different choices and understandings of surgical methods.

Lu Renxin, who followed Director Zhao to complete the entire surgery, also gained a lot and was satisfied with recording the whole process and steps in his mind.

At the same time, the system will provide a healing value.

Director Zhao was also very satisfied with Lu Renxin's performance: he was perceptive, skilled, and competent.

He couldn't help but sigh, "I wish you could be in our hospital too. We're really missing a doctor like you who can handle things and is so responsible."

Lu Renxin smiled but didn't say anything. He was now a formal employee of Anyuan County Traditional Chinese Medicine Hospital, a talent introduction target, with a formal position and a signed contract.

The talent recruitment funds from Anyuan County are not wasted; they require him not to leave for five years.

Lu Renxin felt that it was a good place. The department had a good atmosphere, and the director valued him. If nothing unexpected happened, he would spend five years there to gain experience.

Besides, Director Zhao's words were probably just polite words.

Lu Renxin took it as a compliment and didn't take it to heart.

The next morning, Zhang Ping hummed a song: "We ordinary people are so happy today!"

He walked briskly into the doctor's office.

Lu Renxin arrived even earlier than him. Seeing Zhang Ping's happy expression, he gave a barely perceptible smile: "Haha, still happy here? You're probably going to get a scolding later today."

Seemingly sensing Lu Renxin's mockery, Zhang Ping snorted coldly and walked past him, pretending not to see him, and went straight to the other doctors, standing with them.

Five minutes before the shift handover, Director Zhao, with his slightly protruding belly, stood with his hands behind his back, his face unusually devoid of a kind smile.

His face was terribly gloomy, like the calm before a storm.

Sensing the ominous atmosphere, the doctors who had just been chatting animatedly immediately fell silent and stood obediently in their usual spots.

Director Zhao slammed the medical record book behind his back, the sound echoing throughout the office.

Everyone lowered their heads, trembling like quails, wondering why the director was so angry so early in the morning.

Only Lu Renxin and the junior student who was on duty last night remained calm and collected, both aware of the situation and keeping things under control.

Everyone else was frantically trying to figure out if they had done anything wrong recently, or if they had affected the department's performance, fearing that the director's anger was directed at them.

Director Zhao didn't give them much time to think. He cleared his throat and asked directly, "Who was on duty last night?"

Zhang Ping raised his hand to indicate, "I am the director."

"Did anything happen in the department last night?" Director Zhao asked.

Zhang Ping quickly winked at his junior, signaling him to read out what happened last night.

This is also normal hospital procedure; students are usually on the front lines when patients have problems, such as fever, pain, or difficulty urinating.

If a student can handle a problem, then ask the student to handle it first.

Students only go to their superiors when they can't handle the problem themselves.

When it comes to handing over the class, if there are students present, they should read the text. Zhang Ping, following the usual practice, had his junior read the text, feeling that this matter had nothing to do with him.

He hadn't seen the handover log, so naturally he didn't know what had happened last night.