Chapter 264: Chapter 0248: The Indecisive Patient
The results of Sisi’s dad’s examination were out. He had a right ankle joint fracture with rotation and four degrees of external rotation, with damage at all four frontal and internal points. It also involved an internal ankle fracture, external ankle fracture, and posterior ankle fracture, with a torn tibiofibular ligant, widened ankle joint, dislocated talus, and semi-dislocated ankle joint. Surgery was essential for such fractures, as even if manipulative reduction was satisfactory, it still would not provide good stability.
Every treatnt thod has its indications. It is against scientific principles to mythologize any treatnt thod diverging from its indications.
“The Lange-Hanson classification – rotation and four degrees of external rotation, AO classification – C!”
Song Zimo opened the digital image viewer; Sisi’s dad’s X-rays and CT scans appeared on the screen. Several standardized training students and interns gathered around as Song Zimo explained the knowledge regarding ankle joint fractures.
Among the classifications for limb fractures, ankle joint fracture is the most complex, especially the Lange-Hanson classification, which often leaves many experienced orthopedics confused.
In the classification system, what does it an when rotation is ntioned, what states they refer to, what is external and internal rotation, and why are they combined in this way, these are the things that Song Zimo explained to everybody in detail.
...
He even took out a piece of A4 paper to illustrate his explanation with diagrams. He drew a hinge, mimicking the chanism of an ankle joint injury, to provide a better understanding for everyone.
Most of the students were very enthusiastic in their learning, especially after seeing Dr. Yang Ping and Song Zimo demonstrate their superior surgical skills in the academic conference. This resulted in a fervor amongst these young people who were looking up to their seniors in admiration. It further cented the students’ determination to be good doctors.
The power of a role model is not to be underestimated. It serves as a guiding light, showing us hope and giving us direction, and encouraging forward progression.
Being able to learn in the Departnt of Orthopedics for a period of ti is seen as a great honor. To be strictly disciplined by the teachers of this departnt is also a great honor, at least that’s how they saw it.
In terms of teaching, Dr. Yang Ping advocates learning centered around clinical cases, requiring thorough understanding of all relevant knowledge for any given case. Even interns leaving from the Departnt of Orthopedics should have a deep understanding and strong grasp of the knowledge they should acquire.
Usually, Zhang Lin is in charge of interns and standardized training students. The basic knowledge is taught by Zhang Lin and when it cos to complex professional knowledge, Song Zimo takes over.
Dr. Yang Ping normally gives lectures to Song Zimo, Zhang Lin, and Little Five, and during ward rounds he explains cases to the standardized training students and interns, raising so questions and evaluating the practical effects of the clinical teaching in the departnt.
“First we should reduce the swelling, once it reduces we will arrange the surgery,” Dr. Yang told Song Zimo.
This type of fracture cannot be operated on during the swelling period, otherwise it can easily lead to complications in the incision, such as inability to suture, necrosis, infection, etc. Surgery can only be perford when the swelling has subsided.
Song Zimo’s phone vibrated. It was from Duan Xiaoming, the director of gamma knife surgery. “Young Master Song, are you performing a surgery on a hepatic tumor tomorrow?” “Yes”
“The hospital administration just called saying you’ve overstepped. Only the general surgery departnt, oncology departnt, and our departnt have authorization for this surgery. Your departnt of orthopedics doesn’t have the authority.”
“The surgery for Sisi tomorrow is for hepatic tastasis. This isn’t within our orthopedics departnt’s jurisdiction but lies with general surgery and oncological surgery. Brother Ming just called and said that we’re being monitored by the hospital administration and they want to cancel the surgery,” Song Zimo said after hanging up the phone.
Dr. Yang Ping and Song Zimo had been so focused on treating Sisi’s disease that they hadn’t considered they’d overstepped the authority of their departnt in arranging the hepatic surgery.
“Should we first handle the primary tumor in left femur?” Song Zimo suggested.
Dr. Yang shook his head. “The current treatnt is only palliative. We should prioritize resolving the most painful part first. During the ward round, you also noticed Sisi’s painful expression while lying in bed.”
“Could we have the surgery under Brother Ming’s na, while you operate?” Song Zimo pondered.
Issues of surgical authority are critical—it’s like needing a driver’s license in order to drive.
Brother Ming, whose real na is Duan Xiaoming, is the head of the gamma knife departnt. He can perform any surgery involving any type of tumor, as long as it is suitable for gamma knife treatnt.
This is a good solution, but he may not agree to lend his na since it involves risk.
“I’ll talk to him. I’m confident he will agree,” Song Zimo declared confidently.
It was Song Zimo who had helped Duan Xiaoming with his child’s school admission problem. Given this favor, Song Zimo believed Duan would be willing to help him.
Given Dr. Yang’s credibility at Sanbo, if he’s willing to perform the surgery, he must be fully confident, and Duan Xiaoming would not have much to worry about.
“There’s no need to rush. I’ll discuss it with Director Han first!” Dr. Yang called Director Han to explain the situation.
Not long after, Director Han called back. “Dr. Yang, go ahead with the surgery. I just finalized the communications with the dical departnt. We will grant you one-ti temporary authorization for the procedure. Dean Xia and I have signed as guarantors. I’ve already talked to General Surgery and Oncology departnts and explained that this is a special case, and the patient is a charity-funded case of our departnt and it is related to research. They won’t have any objections.”
Within a few sentences and without asking Dr. Yang too many questions, Old Han had resolved the issue.
Old Han’s thinking was simple: if you want to do it, just do it. He was willing to move anything standing in the way and bear any risk.
“Director Han sorted out everything,” Dr. Yang put down the phone, relieving Song Zimo of the need to negotiate further.
In the hospital, doctors are specialized and only do things within their field. It’s not permissible to overstep one’s authority.
Overstepping the boundary this ti was acceptable for a one-off case, but it definitely couldn’t beco the norm. The idea of performing any and all surgeries is nonsense.
Cheng Liquan sent a ssage saying that his dical tourism group had already arrived at the hospital. He asked when the surgeries could be scheduled. There were eighteen patients to undergo surgery.
Eighteen?
Initially, it was ntioned that there were eleven, which later increased to sixteen.
Now the exact number is eighteen; two patients from Southeast Asia have joined the group last minute.
Are surgeries being perford in groups now? Do group surgeries co with group discounts? Yang Ping was curious, but it was inappropriate for him to ask Cheng Liquan.
At this rate, the number would only continue to grow. He must find a ti to get through all of them. Considering currently there were not many patients in his departnt, he should set aside Sunday to clear these eighteen patients off his list.
If Professor Zhang were at full steam in the clinic, he could fill the ward in just two weeks. By that ti, finding a slot to schedule these surgeries would be quite challenging.
Professor Zhang has a well-established reputation and is very responsible. Many patients co from other provinces to seek his consultation.
So of his patients have been under his care for twenty to thirty years post-surgery.
One patient had undergone congenital hip dysplasia surgery at the age of two. Now that patient’s child is in middle school, Professor Zhang still conducts follow-ups with him.
During that ti, there was no WeChat, and telephones were not widely used. Follow-ups relied entirely on written correspondence and ho visits. The perseverance demonstrated a fantastic level of commitnt and responsibility.
The serious and diligent attitude of the older generation of doctors outshines the majority of today’s doctors. That’s perhaps the main reason why many patients place their trust in him and travel long distances for his consultation.
The nurse station called the on-duty doctor. Professor Zhang had admitted a patient – a young girl in her twenties. He suspected a case of thoracic spine tuberculosis.
Tuberculosis has beco less common recently, but it has shown a rebound in recent years due to the mutation of the tubercle bacillus.
Zhang Lin was the doctor on duty. He went to see the patient. As Yang Ping had nothing else to do, he decided to join him.
The patient, Fang Xiaoyun, a twenty-four-year-old woman, had a slender figure. She had been experiencing back pain for three years and numbness and weakness in both lower limbs for three days. Physical examinations revealed a posterior convex deformity on the ninth thoracic spine. She had reduced skin sensation below the inguinal regions in both lower limbs and a muscle strength of grade four.
Considering that the patient had dical insurance, which would cover the cost of an MRI if the patient were admitted to the hospital, Professor Zhang only perford an X-ray of the patient’s chest and lumbar spine in the clinic. The X-ray showed bone destruction on the upper and lower edges of the ninth thoracic vertebra. The intervertebral space between them had narrowed, and there were signs of enlarged soft tissue extending from the vertebrae.
Based on the patient’s dical history, physical examination findings, and X-ray, Professor Zhang, with his wealth of experience, made a diagnosis. He called Zhang Lin, who was on duty, instructing him to further investigate the case with an MRI.
This was a case of thoracic tuberculosis resulting in paralysis. The patient needed ergency surgery to relieve the pressure on the spinal cord caused by the pus, granulation tissue, caseous necrotic tissue, and necrotic bone. This would help restore the nerves’ function.
As long as these compressive materials could be removed in ti, the paralysis could be completely reversed. However, the problem lay in the fact that the images taken from the X-ray indicated that the compressive materials had already entered the anterior part of the spinal canal. If this were to cause embolism in the anterior spinal artery, it could result in permanent spinal cord damage. Then, no matter how perfect the surgery was, paralysis would persist afterwards.
Zhang Lin arranged an ergency MRI scan for Fang Xiaoyun’s thoracic and lumbar spine. When the test results ca out, they confird the initial conjectures based on the X-ray.
The compressive materials had entered the anterior part of the spinal canal at the thoracic 9 level. Yang Ping imdiately took Zhang Lin to discuss the disease with Fang Xiaoyun. They recomnded that she undergo ergency surgery as soon as possible.
Fang Xiaoyun’s eyes were slightly red, as if she had been crying and feeling aggrieved.
“Doctor, do I have to have surgery for this disease?” Fang Xiaoyun asked.
Yang Ping asserted, “You must have the surgery. Otherwise, you may risk paralysis in the lower half of your body.”
“Based on the MRI findings, the compressive material has already entered the anterior half of the spinal canal. If it causes embolism in the anterior spinal artery, it could result in permanent spinal cord damage. Then, no matter how perfect the surgery was, paralysis would persist afterwards. You’re still so young. Don’t delay things. We’ll arrange an ergency surgery for you.” Yang Ping was not scaring her but honestly informing her about the risks.
Fang Xiaoyun seed uncertain and found it tough to reach a decision, “Can I think about it and give you an answer tomorrow morning? Will it matter if I wait for one night?”
“If we wait for one night, there will definitely be so impact. The level of risk cannot be determined right now. If you can’t make a decision at the mont, please don’t procrastinate too long and give us an answer as soon as possible. Let us know if you have any key questions.”
“Okay, thank you, Doctor Yang. I’ll give you a definite answer by tomorrow morning at eight o’clock.”
“Please tell as soon as you make up your mind. Absolutely don’t delay. If there are any difficulties, please tell us.” Zhang Lin noticed that her deanor seed a bit off. Her eyes were red as if she had been arguing with soone and had cried.
She had co specifically for the surgery, but now that she was offered ergency surgery, she seed undecided. Perhaps there was sothing more to her situation.
As doctors, they could not pry further. All they could do was leave her with so words of advice.
After they left the ward, Yang Ping instructed Zhang Lin, “You need to keep an eye on this patient. Do not delay further.”
User Comments
0 comments from readers