"Hiss…" The man beside Cui Heming gasped in astonishment. He had not anticipated that Chief Zheng's diagnostic ability and medical skills had reached the level of senior professors in Imperial Capital.
After finishing the cigarette, Cui Heming approached a trash can and threw the b.u.t.t into its ashtray. Then, he mentally prepared himself to present his silk banner and apologize for his behaviour from that night.
A man needed to be responsible for his own mistakes and stand firm even if he had to receive physical punishment.
Just as he worked out a long list of compliments and was about to walk forward, a car stopped in front of Sea City General Hospital emergency building.
"Chief Zheng, my father has a stomachache. Can you take a look at him?" yelled a middle-aged man anxiously as he got down from the driver's seat.
"..." Shoot! His psychological preparation had gone to waste.
Cui Heming froze on the spot and saw over twenty medical staff, who had been posing for the camera in front of the medical department, scatter immediately. A stretcher trolley was pushed out approximately ten seconds later and an elderly man was transferred onto it.
When he looked again, Chief Zheng Ren had already gone. Chunghwa is a premium brand of Chinese cigarettes produced by the Shanghai Tobacco Group, a subsidiary of China Tobacco. Due to its popularity in the Chinese market, it is considered the most representative brand of Chinese cigarettes and is known as the "national smoke".
Chapter 54 - Intensive Training Again In The System
The patient's diagnosis was displayed in the upper right corner of Zheng Ren's vision—chronic cholecystitis.
Zheng Ren's heart sank immediately as this was clearly a complication of acute food poisoning.
The risk of complications would be minimized if the patient underwent an intravenous infusion of antibiotics for one week, but antibiotic misuse by idiotic doctors had become a trend in the country these days.
There were indeed idiots among doctors. For example, there was the usage of triple-drug therapy—including quinolone, which was metabolized by the kidney—as postoperative prophylactic antibiotics in an underaged patient with an uncomplicated appendicitis case.
The vast majority of doctors had good intentions, and they placed disease treatment and saving patients' lives as their top priorities.
However, their intentions were usually and ruthlessly destroyed in reality.
Veterinarians in charge of the medical industry had issued regulations to restrict the clinical usage of antibiotics. Their prescription was justified only when the patient exhibited signs of pyrexia, positive bacterial culture, derangement in routine blood investigations and so on.
However, only a few people knew that meat and milk actually contained a large amount of antibiotics from animal husbandry. Even producers had no choice. How could they meet the increasing demands of the market if they stopped using antibiotics and production fell?
Would they force everyone to be a vegetarian? Zheng Ren would be the first to disagree as he was very fond of eating meat skewers.
This was a troublesome issue and there was nothing Zheng Ren could do about it.
It was good enough if he could manage the emergency department in Sea City General Hospital.
"Do an emergency bedside B-scan ultrasonography. I'm guessing that he has cholecystitis." Zheng Ren quickly made a diagnosis.
"Chief Zheng, how did he get cholecystitis when he was previously well?" asked the patient's son in distress.
"I told you, an acute toxic liver injury will result in exudation and the exudate has a chance of acc.u.mulating around the gallbladder. Physical function declines with age, and constant stimulation for one week can lead to cholecystitis," Zheng Ren explained.
However, this type of cholecystitis was uncommon. In fact, its risk was less than 10 percent.
Luck was the predominant factor in this issue. Obviously, it had not been on this patient's side.
It was inappropriate to discuss bad luck with the patient and his family members. Zheng Ren was indeed insensible, but that was limited only to women. He was still emotionally m.a.t.u.r.e and was a smooth talker around patients.
This elderly man had the honor of becoming the first patient of the emergency ward.
His B-scan ultrasound showed that his gallbladder was 95x47mm in size, with marked asymmetry in its wall and striated thickening at 3mm. The gallbladder wall had normal echogenicity with echogenic debris noted within the gallbladder itself.
The ultrasound report concluded that he was indeed suffering from late-onset chronic cholecystitis. Other tests—routine blood investigations, coagulation profile, Hepatitis B serology test, HIV and syphilis tests, renal and liver function tests and so on—were then performed in the emergency department.
Electrocardiogram findings were normal with his sinus rhythm noted.
Zheng Ren instructed a nurse to insert a nasogastric tube for gastric decompression before inviting the patient's son to his office for preoperative counseling.
The son was dejected as he was the one who insisted on a hospital discharge due to the noisy environment disturbing his father's rest.
He did not expect his father to have cholecystitis just as Zheng Ren predicted.
Zheng Ren had had a good relationship with the family members of the patients who had been receiving treatment in the emergency department observation unit, so he chose to comfort the patient's son first after they had sat down in his office.
After that, he began explaining the patient's condition based on his ultrasonography.
This was not a simple case of acute cholecystitis, and its cause had been explained previously. Acute food poisoning would cause transient derangement in liver function, which would result in exudation. The exudate would acc.u.mulate in the gallbladder fossa and infiltrate the gallbladder, finally causing acute cholecystitis.
The possibility of young men getting cholecystitis was very minimal. After all, they were in better physical shape and had stronger immune systems, so their bodies would be able to deal with inflammatory responses easily.
Older men were different and could not handle inflammation well, hence the cholecystitis. If conservative treatment with antibiotics was used, it would not have much effect.
After listening to the explanation, the family member stated that he would follow Zheng Ren's arrangements.
It was a sign of trust in the doctor after a period of acquaintance.
If the major rescue operation for nitrite poisoning had been unsuccessful, he would not have so unhesitatingly agreed to Zheng Ren's suggestions.
"Let's do cholecystectomy then." Zheng Ren decided for a surgery in the end.
The old man was prepared for surgery straight away as he was in intense pain and had fasted long enough due to having a decreased appetite after experiencing discomfort in the morning.
The test results came back half an hour later and the patient had no contraindications for surgery. After counseling the patient and acquiring signatures on the preoperative informed consent doc.u.ments, Zheng Ren brought the patient to the operating theater on the third floor of the emergency building.
According to the initial design plan for the emergency building, the first floor had the emergency department, observation units, B-scan ultrasonography room, CT scanner and various auxiliary departments. The emergency wards were located on the second floor with fifty-two sickbeds, and the third floor with a few thousand square meters was designated for operating theaters. This full-flow design was among the top in China.
Various surgery departments had set their sights on the high-class operating theater, which was the main reason Old Chief Physician Pan had been so eager to develop emergency surgery. If the emergency department had no use for it, someone else would take over instead of letting it go to waste.
Deep inside the operating theater on the third floor lay an interventional radiology suite, which was dedicated specifically for interventional radiology.
The suite had been constructed based on a new design—a hybrid operating room.
A hybrid operating room was an advanced procedural space that combined the traditional operating theater with interventional radiology.
This was advanced technology as ordinary Class Three Grade A Hospitals did not have hybrid operating rooms.
However, the hybrid operating room in Sea City General Hospital had been idle for a long time. The hospital management would be held responsible for wasting resources recklessly if no one tried to seize the opportunity to assume control of it.
The operating theater was fully equipped with disinfection facilities and the still air was maintained at a constant temperature to control airborne infection. Anyone who took a deep breath in this room would get the feeling that the air could purify one's soul.
Zheng Ren went to the male locker room to change into surgical attire while the other doctors assisted with the patient transfer.
He was convinced that, instead of conspiring against him, the System had actually predicted that he would perform cholecystectomy in the future. Well, what was he waiting for? It was time to spend all his skill and experience points in the System for intensive training in laparoscopic cholecystectomy!
In the male locker room's smoking area, Zheng Ren lit up a cheap Ziyun 1and took a deep drag comfortably before diving into the System.
As he entered, he decided not to spend his skill points, which were but a drop in the ocean. There was no way he could achieve the Master rank and receive a skill upgrade anyway.
He opened the Shop interface, clicked on cholecystectomy and exchanged his entire stock of 75000 experience points from the last mission reward for 20.83 hours of intensive training. Then, as the operating theater formed around him, training had officially begun.
It saved time performing surgery in the System as the mannequins were anesthetized in advance.
In reality, a cholecystectomy required at least two hours from start to finish, but in the System's operating theater, Zheng Ren could simply focus on mastering his skills without having to wait for the anesthesia to take effect or consider the patient's condition and postoperative recovery.
The first laparoscopic cholecystectomy took Zheng Ren nearly an hour to complete. After all, he had not been qualified to perform a cholecystectomy even when he was still in the first general surgery department even though it was just a tier-one surgery.
Subsequent surgeries became much smoother after he had familiarized himself with it.
The time required for each surgery gradually decreased just like during the intensive training for appendectomies. In a sense, one just needed to practice general surgery repeatedly to master it.
In the end, Zheng Ren required only ten minutes to finish a laparoscopic cholecystectomy.
No matter how Zheng Ren made the best use of his intensive training time, in less than twenty-one hours, he merely did eighty surgeries in total.
Even so, he felt particularly good as those practice runs were more than enough to handle this situation.
After his intensive training ended, Zheng Ren turned around and checked his general surgery skill tree, which had increased from 1692 to 1930 skill points. He was unsure if this sharp increment had anything to do with the difficulty of the operation.
Long, gray wisps of smoke still hung in the air when Zheng Ren returned to reality. He then stubbed out the cigarette that he had just taken a puff of, put it back into its pack, changed into surgical attire and went into the operating theater.
Xie Yiren, who had already prepared herself and was standing in front of the instrument table, gave Zheng Ren a warm smile as he entered.
The first cholecystectomy was about to begin. Yunyan () is a cheap cigarette brand and the Zi () version has better quality among Yunyan.
Chapter 55 - A Live Broadcast of Cholecystectomy
Single room 303 in the special demands ward.
Chief Surgeon Liu Tianxing lay quietly on the bed as Cen Meng sat by him. Neither of them said anything as they were immersed in their own trains of thought.
Random dot-pixel patterns of static flickered on the television on the wall opposite them with its monotonous, dull noise lingering in the room.
Chief Surgeon Liu broke the silence after a while.
"The patient's diagnosis is correct?" asked Chief Surgeon Liu in a croaky voice.
"Yes. Preoperative preparations have been completed and the patient is undergoing general anesthesia now," answered Cen Meng.
"This is a difficult cholecystectomy. First time… Are you sure Zheng Ren is performing laparoscopic cholecystectomy for the first time?" asked Chief Surgeon Liu suddenly.
"I'm sure. He has done a few appendectomies, and he is probably talented in this field as all of them were done well, but I'm sure he has never performed any cholecystectomy—laparoscopic or open surgery—before this!" replied Cen Meng.
"He did assist in cholecystectomy, if I'm not mistaken."
The surgical assistant's main responsibility in laparoscopic cholecystectomy was to hold the laparoscope, a task far more boring than holding a retractor in an open surgery.
It was fine as long as he had not performed it personally.
Chief Surgeon Liu nodded and closed his eyes. "Youngsters have a tendency to act high and mighty after learning one or two surgical techniques. This sort of attitude will do him no good."
"Yes." Cen Meng was aware that Chief Surgeon Liu was going to deliver a speech. As a firm supporter, his job was very simple—answering yes or no would be enough.
"When you're performing surgery, especially an unfamiliar one, accidents are bound to happen without the supervision of a senior surgeon," Chief Surgeon Liu mumbled with his eyes closed as if recalling something from his past and added, "Cholecystectomy is just a tier-one surgery, but do you know why surgeons below chief resident rank are not allowed to perform it?"
"Sometimes there will be morphological changes in the cystic and common hepatic ducts due to inflammatory reactions. The damage will be irreversible once the common hepatic duct is cut." Cen Meng had personally performed more than ten laparoscopic cholecystectomies, so he clearly remembered these precautions.
"Correct, what more with beginners, who can't even differentiate left and right, using a laparoscope for the first time. Chief Physician Pan really has gotten old. How could he let Zheng Ren perform a surgery that he doesn't even know how to do?"
"Accidents will definitely happen with such bold courage."
"We just need to quietly watch the show."
Chief Surgeon Liu opened his eyes as the sound of static from the television suddenly disappeared.
The anesthesiologist seconded to the emergency operating theater today was Cen Meng's classmate, so he would know exactly what Zheng Ren was doing through his "double agent".
A camera system with video recording and streaming functions had been installed in the laparoscope, but no surgeon wanted to broadcast their surgery live and let others observe their operation.
After persistent requests and some unknown promises, Cen Meng's classmate finally agreed to furtively upload the surgery process to him via Bluetooth.
Cen Meng knew that Zheng Ren had no experience in laparoscopic cholecystectomy. In order to make Chief Surgeon Liu happy, he had connected the footage to the television in the special demands ward so that they could watch Zheng Ren's surgery in real-time.
There was no sound, but the laparoscope had been turned on. Perhaps he was insufflating carbon dioxide into the peritoneal cavity to create a pneumoperitoneum.
The laparoscopic camera soon began to shake. The duo spying on Zheng Ren's surgery from the special demands ward were experts, so they knew that he had made a hole and was prepared to insert the laparoscope into the peritoneal cavity.
Silence reigned in the ward, causing the atmosphere to become tense as they felt more anxious watching the surgery than if they had been performing the surgery themselves.
&n
bsp; Zheng Ren's sensational forty-nine appendectomies in one night and endoscopic transrectal appendectomy as his coup de grace, a surgery even Chief Surgeon Liu had never heard of, had anxiety gnawing at Cen Meng.
He must have no clue how to perform this surgery. Moreover, this patient had had exudative inflammation for five days and the adhesions would be very severe, which would make the surgery even more difficult.
…
…
There was a sudden change in the traffic monitoring of Xinglin Garden.
Hundreds of viewers swarmed into a single live broadcast room, but after learning from his mistakes last time, CEO Peng Jia had adjusted the maximum viewer capacity of this particular account to ten thousand viewers and even made a contingency plan in case of system failure.
[God hasn't performed surgery for days. I really miss his awesome and smooth appendectomies.]
[What surgery is he performing this time? Let me have a look…]
[Laparoscopy! Laparoscopy! I'm so excited because I've just started learning laparoscopic surgery. I'm not sure how good this god is in performing laparoscopy.]
[Would you dare broadcast your surgery live if you're in his position? He must be very skillful!]
Hundreds of viewers came into the chat shouting '666'.
Everyone was still buoyed by the crazy night of appendectomies a few days ago, but how good the surgeon was in performing laparoscopic surgery was an entirely different issue.
The atmosphere in the special demands ward was not as lively as that of the live broadcast room. Even though Chief Surgeon Liu and Cen Meng were convinced that Zheng Ren had never performed or underwent any training for laparoscopic surgery before this, they could not help but feel nervous about this operation.
Soon, the laparoscope entered the peritoneal cavity and the triangle of Calot appeared on the television with severe adhesions .
This sight finally put a satisfied smile on Chief Surgeon Liu's face.
The Surgeon's Studio c1-799 Page 32