American Medicine: I survived the death knell thanks to the devil.

The construction industry in the United States has one of the highest mortality rates in the country.

More than a thousand construction workers die on construction sites every year, accounting for nearly one-fifth of all work-related deaths.

Nearly ten out of every 100,000 full-time construction workers will lose their lives in that year.

The scale of China's construction industry is nearly ten times that of the United States, yet the mortality rate among its 100,000 employees has remained stable at less than 1 for many years.

Less than one-tenth of that of the United States.

In the United States alone, there are more than 20,000 emergency room visits each year due to nail guns, two-thirds of which are penetrating injuries to the hands and fingers.

Behind the numbers are people.

They are people from all over the world, including Mexico, Guatemala, Honduras, and more.

Many of them lack legal status, and many don't even have workers' compensation insurance.

The employer settles accounts in cash on a daily basis, without signing contracts or purchasing insurance.

New York State law stipulates that even unlicensed workers are entitled to claim workers' compensation, and the application form does not even require a Social Security number.

But the law is one thing, reality is another.

Most people are unaware of this law.

Those who know about it dare not use it.

They were afraid of being reported, afraid of losing their jobs, and afraid of being deported.

They could only treat the wounds in the cheapest way possible: wipe them with alcohol, wrap them with tape, and then go back to the scaffolding the next day.

Until the wound changes color.

Until he lost a hand.

Lynn didn't intend to ruin this hand.

"instrument."

The nurse handed me a basic surgical tray.

Lynn glanced at them: mosquito hemostats, Alice tissue forceps, ophthalmic scissors, probe, and iodine-soaked cotton balls.

"Give me a fine periosteal elevator and a headlamp."

Julian was already in position, his hands pressing down on the patient's left forearm.

Lynn turned on his headlamp and adjusted the focus.

He disinfected the surgical area with chlorhexidine gluconate, picked up mosquito hemostats, and made a five-millimeter incision on the skin next to the nail head.

The patient hissed, and his forearm tried to tremble.

But Julian's arm remained completely still.

"Continue," Julian said.

Once the incision was made, the nail head was fully exposed.

A standard pneumatic frame nail has a head diameter of six millimeters, a body length of eight centimeters, and a surface covered with spiral serrated barbs.

You can only go in, not out.

If you pull it out violently like you would a regular nail, these five barbs will become like the blades of a meat grinder, tearing apart any tendons, nerves, and blood vessels they snag along the way, ripping them out of the body.

The only way to break the deadlock is to carefully remove the barbs from the entangled tissue, one by one, along the extremely narrow wound.

Lynn put down the hemostat.

Extend the index and middle fingers of your right hand.

His index finger slowly probed into the wound along the surface of the nail.

Press your fingertips against the metal.

Then he felt the first barb.

A serrated protrusion less than one millimeter high, as sharp as a shark's tooth.

The tip of the barb pierced a dense mass of fibrous tissue, the flexor retinaculum.

If this structure is cut or torn in order to remove the nail, the pulley's restraining effect will be lost, and the patient's finger strength will collapse instantly, making it impossible to clench their fist again.

Lynn used the tip of the periosteal elevator to cut into the base of the barbs and carefully separated the fibers one by one, close to the metal surface.

The patient's breathing became rapid.

"Don't move," Lynn said calmly.

"Advanced Foreign Body Removal Procedure Without Anesthesia"

It doesn't mean it will be completely painless, but rather that the surgery can be performed without anesthesia.

The first barb is loosened.

The fingers continued to probe deeper.

The second barb.

This one is deeper and in a more treacherous location, right next to the outer membrane of the median nerve.

He can feel the nerve fibers in his index finger.

Like a bundle of compressed electrical wires, wrapped in a thin, slippery sheath.

The tip of the barb is less than two millimeters from the epineurium.

If the patient twitches their hand at that moment.

The median nerve controls the most important sensations in the palm and the opposition function of the thumb.

Once severed by a barb, it means irreversible "ape hand deformity," with atrophy of the thenar muscles and loss of all dexterity in the thumb.

This hand will never be able to hold a drill bit, lift a bucket of mud, or even hold a water glass.

For a manual laborer who earns a living with his own hands, this is more cruel than taking his life.

"Press him down."

Julian Gali.

The patient let out a muffled groan, as if squeezed from deep in his throat.

His right hand gripped the metal railing of the bed, his knuckles turning white.

But his left hand remained completely still.

Lynn gently parted the nerve with the side of the periosteal elevator, creating a space of less than three millimeters.

Then, in this space, use the tip of a mosquito-style hemostat to clamp the fiber at the base of the barb and cut it off in one go.

Loosen the second barb.

The third.

the fourth.

Every barb is a gamble.

The stakes in every gamble are the same thing.

A father's left hand.

The fifth barb is the last and also the deepest.

It is embedded in the gap between the palmar cortex of the trapezium and the superficial palmar branch of the radial artery.

Lynn felt a pulse in his index finger; it was very faint.

The blood vessel was not completely severed, but was flattened by the side of the nail, narrowing the lumen to the point of near blockage.

This is why the temperature of the fingers drops.

The superficial palmar branch of the radial artery is the main blood supply to the hand. In this less than two-millimeter blind spot, if the instrument is slightly off-center, or if the hand trembles by half a millimeter when picking open the fibers, the sharp barbs will cut through the fragile arterial wall.

Once an artery ruptures deep within the carpal tunnel, high-pressure arterial blood will instantly fill the entire carpal tunnel.

The rapidly increasing pressure of the hematoma in a confined space can crush and kill the nerves that have just been saved.

He needed to loosen the barbs while avoiding the artery.

The operating space is less than two millimeters.

Lynn closed her eyes.

Concentrate all your awareness on the pad of your index finger.

The coldness of metal, the hardness of bone.

The elastic pulsation of the arterial wall and the toughness of the fibers.

He constructed a three-dimensional map in his mind, a more accurate real-time map of the living body than a CT scan.

The periosteal elevator is inserted.

It was pressed against the nail tip.

Bypassing the artery.

挑。

A barely audible sound of fibers snapping.

The last barb is loosened.

Lynn opened his eyes.

With the left hand holding the nail head and the right index finger guiding the nail along the shaft, the eight-centimeter-long frame nail was slowly and evenly removed along the original wound.

When the nail slid out of the flesh, it brought with it a small amount of dark red blood and a few strands of torn fiber.

There was no major bleeding.

That means all the key structures—the median nerve, the pulley-like flexor tendons, the radial artery supplying blood—are intact.

Lynn put the nail into the curved plate.

An eight-centimeter frame nail.

Five barbs.

From insertion to withdrawal, it took a total of four minutes and twelve seconds.

"Stop the bleeding, rinse, and check motor function."

Julian slowly released his hand from pressing down on the patient's forearm.

His arm ached slightly; for more than four minutes he had been fighting against the pain-driven, instinctive spasms of an adult construction worker.

He glanced at the nail in the saucer, then at Lynn's right hand.

"Check it out," Lynn said to the patient.

He freed the patient's left hand from the splint.

"Move your thumb. Yes, palms together, touch your little finger. Okay, now extend your index finger. Bend, extend."

The patient followed every instruction.

The movements were complete and without any delay.

The median nerve is functioning normally.

The flexor tendons are intact.

"Your hand is saved."

The patient looked at his movable fingers and remained silent for a long time.

Then he cried.

The middle-aged man bit his lip desperately, but his shoulders trembled uncontrollably.

After the adrenaline subsided, what remained was lingering fear.