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

Chapter 163 Report!

12:20.

Emergency operating room.

Associate Chief Physician Ding Guoqin, who is in charge of vascular surgery, also entered the operating room. Although he did not go on the operating table, he stood by it.

Lu Cheng used a syringe with a needle to prick all five of the patient's fingers and then waited patiently.

About half a minute later, drops of blood oozed from my fingertip, the blood was bright red.

Surgeons are not afraid of having blood, they are afraid of not having blood.

Blood represents life and vitality.

Seeing this, Lu Cheng finally breathed a sigh of relief, wiped it clean with gauze, and said, "The arteriovenous anastomosis is done. Now let's start treating the fracture."

"Director Hou, were the antibiotics administered before the surgery?"

The amputated limb is an open fracture. Internal fixation is a foreign body. Open fractures are classified as Class III incisions, and antibiotics must be used in sufficient quantities.

"The medicine was given immediately, don't worry," Hou Jiagui replied confidently.

Lu Cheng politely looked at Xiang Kuihua: "Director Xiang, then let's do the internal fixation with steel plates together!"

Xiang Kuihua smiled and said, "No problem, Teacher Lu."

Limb replantation is a team-based surgery, which is one of the reasons why he decided to 'reconcile' with Lu Cheng.

The standard procedure for limb replantation is to first perform internal fixation of the fracture, except for special patients.

It's clear that Xiang Kuihua has performed so many open reduction and internal fixation surgeries with plates and screws for fractures, so his proficiency in this area is quite impressive.

Internal fixation of a broken limb is usually easy, but because the order of limb replantation was changed and the arteries and veins were sutured first, the surgery became more difficult.

However, it's not a big problem. At this time, the internal fixation of the fracture is more transparent and directly visible than that of ordinary fracture patients.

With the cooperation of Xiang Kuihua and Lu Cheng, it took less than half an hour to fix the sawed radius and ulna in place.

After doing all this, Xiang Kuihua stood up and gave up his seat.

The subsequent treatment of muscle, tendon, and nerve suturing is beyond his capabilities.

Naturally, Xiang Kuihua didn't leave either. Instead, he sat down at the lower end of the operating table and watched Lu Cheng's operation intently.

Under the slanted light of the shadowless lamp, even the microscope eyepiece could not block the light, and the surgical field was brightly lit.

Because blood circulation had been restored, a small amount of blood still slowly seeped from the cut ends when Lu Cheng was suturing the muscle.

However, once Lu Cheng finished suturing, the bleeding from the cut ends was contained as if by the closed mouth. Suturing is indeed an effective way to stop bleeding...

Lu Cheng's operation was very serious and meticulous.

His eyes are like they could stare someone to death, never blinking, and he never blinks more than three times in five minutes.

The anesthesia machine kept beeping, the circulating nurse's pace slowed down, the head nurse of the nursing department left the operating room, and the director of vascular surgery in general surgery also left the operating room...

Xiang Kuihua was secretly alarmed at this moment.

Limb replantation is a very standard surgical procedure in hand surgery and is one of the standard surgical procedures for evaluating whether a unit has the professional capabilities in hand surgery.

Xiang Kuihua had heard of this kind of surgery before, but it had always been a blind spot in the capabilities of most county hospitals. It was a procedure that many people wanted to do, but whose capabilities were not up to par.

But this very surgery is now slowly progressing to its final stage in Lu Cheng's hands.

Just after Lu Cheng finished suturing the muscles and tendons, he looked up at Lin Qianlong and said, "Director Lin, could you go out and explain to the patient's family?"

"The patient's hand should survive, but postoperative functional recovery cannot be guaranteed. We should try to lower the expectations of the patient's family as much as possible."

“We don’t have a detailed discussion and obtain consent before the surgery. But we still want the family to have a clear understanding of the situation.”

Lin Qianlong nodded without hesitation: "Okay. I'll go and talk to them."

Such a signing of a document carries more weight when done by a director like him.

Sometimes, county hospitals, which serve as the first stop for many patients in county towns to access medical services, are also the final destination for many others.

Not every patient with a disease has the opportunity to be referred to a higher-level hospital.

Lin Qianlong emerged from the operating room...

Time flies, and before we knew it, it was almost five o'clock.

After personally completing the outermost layer of skin suturing, Lu Cheng applied a cast to the patient. Lu Cheng specifically instructed: "Don't move the cast for the first few days, and keep an eye on the blood circulation."

"Postoperative anticoagulation and blood circulation need to be closely monitored... Postoperatively, the most critical aspects are antivasospasm and anticoagulation... and the vasodilator alprostadil should also be used."

"I will write out all the medical orders by then, Director Lin, but I can't be in the ward 24 hours a day."

Lin Qianlong returned to the stage after speaking with the patient: "This patient is a patient of our department, and it is not someone you, Xiao Lu, are taking care of 24 hours a day."

"I will instruct them to take photos and send them to the group whenever they are available."

"You personally review the postoperative medication every day."

As the ward director, Lin Qianlong naturally had to handle the first limb replantation surgery in the department with great care.

"Yes, you need to keep warm after the surgery. The orthopedics department should have infrared lamp equipment; we might need to borrow it," Lu Cheng said.

Lin Qianlong looked at Xiang Kuihua: "Director Xiang, is this convenient?"

Xiang Kuihua chuckled awkwardly for a moment; "Director Lin, it would be more appropriate for you to go to the equipment department to request it."

Xiang Kuihua was unsure whether Peng Haibo would deliberately block someone at this time. It's not usually that he would act so recklessly, but he couldn't rule out special circumstances.

Therefore, it would be more reliable to transfer personnel from the equipment department.

Lin Qianlong was only testing Xiang Kuihua's reaction; he did not allow Xiang Kuihua to take the equipment back directly.

Lu Cheng: "Director Hou, how are the patient's vital signs? They should be alright, right?"

Hou Jiagui replied, "It's not a big problem. The difficulty for amputees lies in the difficulty of preserving the limb, not in stabilizing their vital signs."

"If the bleeding is stopped before entering the operating room, it is generally difficult for the patient to go into shock."

"Let's leave it at that for now..." Lu Cheng said, and began to move the patients around.

The circulating nurse and anesthesiologist Hou Jiagui first transferred the patient to the recovery room.

After taking off his sterile surgical gown and gloves, Lu Cheng glanced at the surgical form filled out by the circulating nurse.

After a slight hesitation, Lu Cheng replied, "Hey, this surgery wasn't done well. Let's fix it. We'll also change the surgery billing later."

"Don't write limb replantation, just write open fracture internal fixation surgery plus muscle suturing, nerve and blood vessel suturing."

There was more than one circulating nurse. When she heard Lu Cheng's words, her expression stiffened slightly: "Dr. Lu, I've filled out all the forms."

Lu Cheng laughed and said, "Just rewrite it. Your surgical technique is wrong."

"The proposed procedure was limb replantation, but the final procedure was not limb replantation."

Xiang Kuihua glanced at Lu Cheng and thought to himself that Lu Cheng was so cautious that he was practically 'picking his toes,' leaving no blind spots for anyone.

"Fine," the circulating nurse said helplessly.

Her surgical technique was incorrect, and the surgeon is entitled to disregard the surgical inspection report.

The surgeon has absolute authority over the actual surgical procedure. Although she doesn't know why Lu Cheng wants to do it, if she doesn't want to do it, Lu Cheng can apply for another circulating nurse to do it.

Moreover, it's clearly unreasonable for her to have a falling out with Lu Cheng over such a trivial matter during her tour.

……

As they exited the operating room, Lin Qianlong glanced at Lu Cheng and casually asked, "Lu, limb replantation is a bit more expensive. What happened to you just now?"

“Director Lin, our hospital is not approved or registered as a microsurgery or hand surgery specialty. It’s against regulations to do this,” Lu Cheng replied.

Lin Qianlong was taken aback: "Then Professor Tong Yuan'an?"

"Professor Tong has his own surgical authority. He came to the countryside to provide support, so he can be considered to be practicing at multiple locations."

“To be more precise, Director Lin, it would have been perfectly in accordance with regulations if you had called Director Hou. Anesthesiologists for limb replantation surgeries must be at least associate chief physicians.” “Even a regular attending physician's signature would be a mistake…”

Lin Qianlong nodded: "Oh, I see. No wonder the people in the operating room said that Professor Tong had a lot of requirements when performing surgery."

"Is there a problem with how you describe the surgical procedure?" Lin Qianlong asked again.

Has no one considered that you deliberately disassembled the surgery?

"Director Lin, we can't just stand by and watch someone die!"

Lu Cheng said, "If we can't replant the severed limb, we'll try our best to save it, so we can only follow the rules and regulations..."

Lu Cheng immediately went out to communicate with the family members.

The patient's father had also arrived. Upon seeing Lu Cheng, both of them rushed over immediately, looking expectantly at Lu Cheng and Lin Qianlong.

"Director Lin, how did the surgery go? Was it successful?"

Lin Qianlong, a senior associate chief physician, was one of the surgical team leaders, and Lu Cheng was his assistant: "The hand should be saved, but don't have too high expectations for its postoperative function."

"You brought it in too late; it might even become necrotic after surgery."

"Moreover, the bones, blood vessels, and nerves are all broken. Even if they are reattached, they will definitely not be as good as the original ones."

"Even if there is no necrosis, the function will be much worse than the other hand and that of people of the same age."

The middle-aged man had a shrewd and calculating look on his face, but he shook his head helplessly and said, "It's gotten to this point, there's no other way."

Lin Qianlong said, "Don't think too much about it for now. It's good that your hand can be saved for the time being. It's better to have something than nothing."

"You can rest for a bit; he'll be out of the resuscitation room soon..."

"This is Dr. Lu Cheng from our department. He will be your son's attending physician from now on. If you have any questions, you can communicate with him more often."

"Dr. Lu will also explain the precautions you need to take after the surgery."

"Limb replantation is not like growing vegetables, where you can just plant them and they will grow fruit. It still requires careful care."

Lu Cheng then took the patient and family back to the doctor's office in the emergency department, explaining the postoperative precautions and writing out medical orders.

"There will be two oral medications later. One is mecobalamin, which nourishes the nerves, and the other is sodium aescinate, which reduces swelling. Remember to take them on time."

"The nurse will give it to you and explain how to use it again."

"In addition, we must pay close attention to whether his hands turn blue or black in the next couple of days. After surgery, blood clots can easily form, leading to poor blood circulation. These are inherent risks of this type of surgery..."

"Also, if you have time later, please pay the surgery fee."

The man nodded: "Dr. Lu, no problem. As long as my son's hand is saved, we will pay all the fees."

Although there was a prerequisite for this statement, Lu Cheng couldn't say much more.

"There's nothing else special. You wait for him to come out first. I'll go see him again before I go back," Lu Cheng said.

"Dr. Lu, are you going back?"

"Weren't you watching my son the whole time?" The woman panicked instantly.

Lu Cheng chuckled and replied, "We also have doctors on duty in our department. I'm not on duty today; I'm here to work overtime and perform surgery. After I'm done here, I'll definitely need to rest. I'll be on duty again in a few days, and you'll be able to find me then."

“Let’s go, let’s wait for our son to come out first,” the middle-aged man replied.

He was not a woman and would not make things difficult for Lu Cheng.

……

In the orthopedics ward, in the doctors' lounge, Xiang Kuihua and Executive Director Luo were smoking together.

After blowing out a smear of smoke, Executive Director Luo asked, "Xiang Kuihua, do you mean that Xiao Lu really did perform the limb replantation surgery?"

Xiang Kuihua nodded and chuckled: "I participated in the entire surgery. What do Lin Qianlong and the others in the emergency department know about limb replantation?"

"This Lu is truly a talent... He's always been on the edge of a knife, yet he's managed to become this good..."

Executive Director Luo scratched his ear and said, "Xiang Kuihua, don't forget that he wasn't very happy when he was in our orthopedics department."

Xiang Kuihua said, "Brother Luo, whether he's happy or not, how much does it really concern us? Are we responsible for making him happy?"

"We're all adults. Why should he be happy instead of making others happy?"

Executive Director Luo's expression was slightly conflicted. He glanced at Xiang Kuihua and asked in a strange tone, "Didn't Lu Cheng mention wanting to perform surgery with you before?"

"You said so? So what? He said he'd go for it, so he went for it?" Xiang Kuihua replied frankly.

"Why should we let him have his way of learning things? Why should we?"

"Brother Luo, don't overthink it. Xiao Lu isn't that complicated."

“Of course!” Xiang Kuihua changed the subject: “Precisely because it’s not that complicated, it’s not easy to bring it back.”

"Otherwise... sigh..."

Xiang Kuihua sighed, without uttering the word "performance".

Performance that cannot be achieved is not considered a performance at all.

Lu Cheng isn't that complicated a person, so even if you take the initiative to be friendly, it's difficult for Lu Cheng to open up to you again.

"Director Lin of the emergency department really hit the jackpot..." Executive Director Luo flicked his cigarette ash.

Just then, someone pushed the door open without warning.

There was nowhere to hide the cigarettes in the hands of Executive Director Luo and Xiang Kuihua. There were six or seven people lined up outside the door, four of whom were carrying briefcases.

Tang Zhongqi, deputy director of the Medical Affairs Office, and Xie Liao, deputy director, were both present. Tang Zhongqi asked, "Is Director Xiang Kuihua here?"

Xiang Kuihua stubbed out his cigarette, stood up, greeted them with a smile, and offered them the cigarette: "Director Tang, Director Xie."

Several people refused, and Tang Zhongqi even pushed his hand away, saying, "Director Xiang, these are leaders from the county health bureau. They said they received a complaint that our hospital is performing surgeries beyond its authorized scope."

Tang Zhongqi acted as if he wasn't familiar with Xiang Kuihua.

Xiang Kuihua was taken aback and looked at the newcomer: "Director Tian?"

The visitors were from the County Health Bureau, led by Director Tian Qi of the Legal Supervision Section of the County Health and Wellness Bureau.

Xiang Kuihua did not know the other two people, but he had dined with the director of the rule of law supervision section many times.

"Dr. Xiang, we are here today because we received a report, so we are here to conduct a routine inquiry. The person who made the report called 12345, and the order was assigned to us."

"According to the clues provided by the whistleblower, it is said that our People's Hospital is illegally and without the necessary qualifications to perform limb replantation surgery. Is that true?" Tian Qi knew Xiang Kuihua from the orthopedics department, and also knew Executive Director Luo from there.

Those within the system, and those who are somewhat related, will meet frequently.

Xiang Kuihua asked in a low voice, "Director Tian, ​​why did you come directly to me after submitting a complaint through 12345?"

Tian Qi replied, "It was Director Tang from your hospital's medical affairs department who checked the surgeries performed today and tracked down the limb replantation surgery on today's surgical schedule."

"According to the application form, we saw that you, Dr. Xiang, are one of the participating doctors, so we came over to ask about the specific situation first."

Executive Director Luo stubbed out his cigarette and came out, greeting everyone with a smile: "Distinguished leaders, since you've all come to the department, please go to the office and sit for a while. I'll ask the nurse on duty to make you a cup of tea. Take your time with your work and enjoy your tea."

"By the way, was the report submitted through 12345 or some other channel?"

"I find it hard to believe that the order can arrive so quickly."

Executive Director Luo stared into Tian Qi's eyes.

Tian Qi then flipped his hand and said, "Dr. Luo, we still need to do the necessary tests."

"The call was made to me by Peng Lisan, the director of the office."

The office is another department of the county health and wellness bureau.

Therefore, Tian Qi could only give Luo executives hints, not say it outright.

(End of this chapter)