Healing Doctor

Chapter 234 Balancing healing and saving lives with performance evaluations (Bonus chapter by Alliance Leader sueyee12 x 5)

Ji Xiang and Dr. Meng got along very well. Ji Xiang would visit the emergency department every four days and accompany Meng Qingfei on duty at night, helping to suture wounds and check on patients.

Time flies, and more than half a month has passed.

"Xiao Ji!" Director Liu walked out of the office and shouted loudly from the doorway.

"Yes, Director." Ji Xiang, wearing disposable gloves, opened the door with his elbow and peeked out from the dressing room. "What instructions do you have, Director?"

"Hurry up and change the dressing, let's go for a consultation."

"Okay." Ji Xiang replied, then turned around and quickly explained the precautions to the circumcision patients who were scheduled for surgery over the weekend.

His circumcision was excellent, with almost no postoperative complications. He also explained everything in detail, which reduced the patient's fear.

"Alright, just come back in three days to change the dressing," Ji Xiang said to the patient, taking off his gloves.

"Doctor, would you like to go to the outpatient clinic or come here?"

"It's fine to come here. Going to the outpatient clinic requires registration, and it's just for changing the dressing, it's not worth it," Ji Xiang said.

Turning to leave, Ji Xiang bowed and smiled, "I'm sorry, Director."

"What's there to be embarrassed about?" Director Liu said with a smile. "Changing dressings is a proper job. Don't be so hypocritical. Learn more good things."

As he spoke, Director Liu glanced at Ji Xiang.

"Director," Ji Xiang said, sounding slightly guilty.

"Is there no treatment fee charged for changing the patient's dressing?" Director Liu asked leisurely.

"..." Ji Xiang sighed inwardly, realizing that Director Liu had still found out.

"It's my own patients, I'll change their dressings myself. If they don't want to admit me, they don't have to, it's no big deal." Director Liu suddenly smiled slyly. "But don't let the head nurse know, she's such a nag."

"what?"

"The department's performance evaluation system? Hey! It's a joke. On one hand, they're supposed to treat and save lives, and on the other hand, they have performance reviews. Don't you think that's contradictory?"

"A little."

"Let's not talk about that. Being a doctor is difficult these days, mainly because of schizophrenia."

"Director, what kind of patient are you consulting on?" Ji Xiang chuckled and then asked.

"The patient was admitted to the hospital because of femoral vein thrombosis in the lower extremity. Thrombolytic therapy was ineffective, so we were preparing for interventional catheter thrombolysis. A CT scan was done before the procedure, and it revealed a problem. I just glanced at the images on the computer, and something just doesn't seem right," said Director Liu as he walked.

"Something's not right?"

"Hmm, I don't think it's a tumor, but I can't quite put my finger on what it is," said Director Liu. "There's no kidney tissue left, so it should be a renal cyst, but this thing is too big for me to recognize."

"How big?" Ji Xiang asked curiously.

"I estimate there's about 5000ml of water inside, and the parenchyma is as thin as a sheet of paper," Director Liu said with a puzzled look. "It shouldn't be like this. Kidney cysts are very common; I've seen some that are ten or twenty centimeters in size, but for the kidney parenchyma to be compressed into a sheet of paper..."

Ji Xiang didn't say anything and accompanied Director Liu to continue walking towards the gastroenterology department.

The idea of ​​a kidney being compressed to the size of a sheet of paper sounded very strange. Ji Xiang didn't say anything because he wanted to see the patient's medical records.

You haven't even watched the movie, what right do you have to talk so much?

When we arrived at the vascular surgery department, Director Liu was the first to arrive. He asked for the patient's imaging data and inserted it into the image reader to look at it.

Although the hospital's system is now fully electronic and films can be viewed on a computer, Director Liu is quite old and still prefers to view films on a screen reader.

Ji Xiang stood behind Director Liu and watched along with him.

The patient has a large mass on the left side of his abdomen, which is about the length of seven vertebrae and its width extends beyond the midline of the abdomen.

If it weren't for the density telling Ji Xiang that this thing was a "water sac," anyone would suspect it was a tumor.

But such a large "water sac" doesn't look like a kidney cyst.

Ji Xiang's ability to read medical images is not high, barely above the standard. After carefully reviewing the images, he went to look at the medical records.

The system NPC is not easy to fool. Although he rarely tests himself, if he can't answer a question, Ji Xiang feels too embarrassed.

It must be said that the medical record was written by an internist, which was detailed enough, and although the patient's hospitalization time was short, all the rewrites were also included.

If it were a surgical patient, even one admitted to the ICU and about to be discharged, the surgical record might not be written.

After writing it down, Ji Xiang went to the system space.

"Teacher, the cyst is very large," Ji Xiang said after reporting to the system NPC.

"It's not a cyst, or rather, it's not an ordinary cyst," the system NPC said. "It's more likely a massive hydronephrosis."

"Teacher, fluid buildup where the kidneys have disappeared?"

"Yes." The system NPC nodded. "When hydronephrosis is usually discovered, some part of the kidney is usually preserved, even if it is not functional, it can still be seen on imaging."

"But there's massive hydronephrosis..."

"Teacher, why does this disease have such a strange name?" Ji Xiang asked.

"It's just extremely large, there's not much to describe," the system NPC said. "The concept of massive hydronephrosis was first proposed by Dr. Stirling in 1939."

In other words, the fluid accumulation in the collecting system exceeds 1,000 ml, and the imaging findings show that the fluid reaches or exceeds the midline of the abdomen, occupying half of the abdominal cavity, or the long axis of the fluid exceeds five vertebral lengths.

"However, 1000ml of fluid accumulation is no longer considered a huge amount in clinical practice. I have seen patients with more than 5000ml of fluid."

"This must be at least 5000ml."

"Yes, but it's very rare for patients to have no symptoms until complications develop before seeking medical attention. Deep vein thrombosis in the lower extremities occurs when massive hydronephrosis compresses the inferior vena cava, obstructing blood return and reducing blood flow."

"It's quite rare, so it's normal that your director hasn't seen it before."

"The principle is the same as that of hydronephrosis. The causes include ureteropelvic junction stenosis, vesicoureteral reflux, megaureter and posterior urethral valves, etc. Among them, 80% of patients are caused by ureteropelvic junction stenosis."

"As for treatment..." the system NPC paused for a moment.

"Surgery to release the narrowed area?"

"This can be done for normal hydronephrosis, but for massive hydronephrosis where one kidney has already lost its function, preserving it would be counterproductive and would require surgical removal."

Ji Xiang nodded.

"Don't underestimate this surgery," the system NPC said. "Surgery for massive hydronephrosis is quite difficult. Although the concept was proposed in 1939, laparoscopic surgery was already being performed in the last century. It wasn't until 1991 that there were any reports of laparoscopic surgery for massive hydronephrosis."

"Why, teacher?"

"Because of the long duration of the procedure, the dorsal membrane and peritoneum of the kidney have fused, and local anatomical changes have occurred, making it difficult to perform the surgery laparoscopically."

"If it's an open abdominal surgery, it can be a little simpler."

"Dr. Ji."

"Yes," Ji Xiang replied immediately.

He was somewhat distressed, wondering if the system NPCs would have to experience the same feelings firsthand.

"Let's train you to perform surgery directly. Watch me perform one surgery, and then you can try it a few times yourself," the system NPC said. "Only after you've done it yourself will you understand why surgery is so difficult."

"Don't you have to empathize?" Ji Xiang asked.

"The patient didn't feel anything before the venous thrombosis was discovered, so what's the point of trying?" the system NPC said. "If your surgery fails, you can give it a try."

Ji Xiang clicked his tongue in disbelief and dared not raise any further objections.

(End of this chapter)