Oncology Physician Life

Chapter 2 Chapter 01 God's Hand

Shanghai Fudan University First Affiliated Cancer Hospital, C18 Surgery Center, Department of Oncology.

Late at night, one o'clock in the morning.

The diamond-white corridor looked very deserted, but there was a tense atmosphere in the operating room.The first assistant, second assistant, anesthetist, and itinerant nurse involved in the operation have all been prepared in advance.

The bright and dazzling shadowless lamp shone on the operating table, and the patient was sent from the sterile room to the operating table.

Various precision surgical instruments began to advance sequentially.The first assistant cooperates with equipment nurses on cardiac monitors, respirators, and negative pressure drainage devices.

The equipment nurse placed the electric knife, pointed scalpel, esophageal forceps, hemostatic forceps, Bell forceps, tweezers and other surgical tools on the stainless steel surgical tray in turn.

The itinerant nurse pulled over the shadowless lamp, gradually increased the brightness, and aimed at the patient's entire abdomen.

The equipment nurse spreads a sterile surgical drape, exposing the surgical site from the patient's chest to the abdomen, and disinfects it with iodine.

The anesthetist performs preoperative anesthesia simultaneously.

In the operating preparation room separated by a corridor.

Ji Han, the youngest associate professor of oncology surgery, stood in front of the stainless steel sink in a green sterile suit. The air was filled with the strong smell of disinfectant and potassium permanganate.He put his well-proportioned hand under the infrared sensor-controlled disinfectant, soaking his forearm, and the cool disinfectant dripped from the back of his hand.

He tore open the disposable cleaning bag in front of the sink, took out the brush inside, and started cleaning his nails.

The patient is a 35-year-old fitness trainer with a family history of lung cancer. Three relatives in the family died of lung cancer, but the average age is over 60 years old. The patient himself is a fitness trainer and never overeats or smokes. Drinking alcohol, the risk of lung squamous cell carcinoma at the age of 35 is very small.

The patient has ten years of work experience in BJ, and often suffers from dry cough due to air smog. He returned to Shanghai a month ago and began to experience symptoms such as chest tightness, wheezing, and blood in the stool. The gene sequencing report found that the patient's gene mutation induced tuberculosis in the left upper lobe The old lesion became cancerous, and the doctor diagnosed it as "air pollution causes cancer", and the lung cancer cells metastasized to rectal cancer.

According to a report published by the World Health Organization, about 320 million people die from air pollution every year in the world, of which 22 die from lung cancer, and more than half of the cancer deaths are in China and other Asian countries.

There is no doubt that smog can cause disease and cancer.

Smog contains carcinogenic chemicals, among which the composition of PM2.5 is very complex, including hundreds of various chemical substances, such as polycyclic aromatic hydrocarbons, carcinogenic heavy metals, sulfur dioxide, nitrogen oxides, etc.

At ten o'clock in the evening, the patient suddenly suffered from respiratory failure. The electrocardiogram showed that the T-segments of all the leads were elevated, and the cancer cells spread and metastasized, causing pleural effusion, which compressed the heart and caused respiratory weakness. Emergency surgery was performed.

Time: One thirty in the morning.

The door of the operating preparation room suddenly opened to both sides.

Ji Han strode in wearing a green short-sleeved surgical gown.

The two itinerant nurses who had been waiting for a long time stretched out the sterile surgical gowns with rubber gloves. They grabbed the collars of the surgical gowns with both hands one by one, turned the inside towards themselves, and aimed at the entrance of the sleeve.

On the other side, Ji Han had already straightened his hands, and the patrolling nurse immediately put the sleeves on. Then, Ji Han turned around neatly, wrapped the sterile surgical gown around himself, and the patrolling nurse tied it up for him while he was turning around. Tie back.

Several people cooperated tacitly, and a set of procedures was done smoothly.

Everyone had already stood in their positions, the shadowless lights were turned on brightly, the operating room was silent, and no one dared to make a sound.

Ji Han wore a blue medical mask on his indifferent face, and besides the gold-rimmed glasses on the bridge of his nose, he wore a binocularloupe (Kepler's binocular magnifying glass), which is an original optical stereoscopic converging observation technology for surgical The doctor in provides a brighter [-]D vision.

With the help of the itinerant nurse, Ji Han put on white rubber gloves.He bent his fingers to make sure they could move flexibly, and his rather sharp eyes swept across the faces of everyone in the operating room.

As in the past, his voice was quite majestic, and he said: "Time, one thirty in the morning, the operation officially begins."

At the same time, the whispers in the observation room disappeared completely in an instant.

The entire operating room is made of single-sided perspective glass. Behind the glass wall is the observation room separated from the operating room.

At this moment, more than a dozen assistant physicians, regular trainees, and interns from the oncology department gathered in front of the huge monitor in the observation room late at night, and what was broadcast on the screen was the simultaneous live broadcast of the operation.

Ji Han glanced at the patient lying on the operating table, and instructed the second assistant to adjust the shadowless lamp to the patient's abdomen.The second assistant followed his instructions, controlled the shadowless lamp on the operating table at the side, and began to move to the lower left of the patient's abdomen.

Ji Han observed the part illuminated by the light, and suddenly said: "Stop, the upper abdomen is fully illuminated by the light, and the operation is performed."

The second assistant hastily fixed the light and adjusted it to the full-scale illumination mode. Immediately, the patient's upper abdomen was exceptionally clear under the light.

The entire operating room fell silent.

"a!"

Listening to Ji Han's instructions, the nurse at the side hurriedly found the electric knife in the instrument table and handed it over.The electric knife flashed under the shadowless lamp, and Ji Han lifted the knife with his hand and slashed from the upper abdomen to the lower abdomen of the patient in one breath.

The tangent line in the incision was broken open by the high-frequency current of the electric knife, and penetrated below the fat layer. Blood gushed out from both sides of the incision. Everyone in the observation room looked at such a neat tangent line, and found that the amount of bleeding was lower than the normal operation specification .

Looking at the cut edge, Kazuki hastily fixed the cut patient's chest flesh with a tendon hook, and stopped the bleeding with a hemostat.

The patient's abdomen began to ooze blood.

Ji Han carefully opened the patient's intestines, liver, spleen, kidneys and other organs, and after confirming that the cancer cells had not metastasized to other organs, he found one of the protagonists of this operation - the left lung lobe.

He reached into the patient's abdominal cavity with both hands, and began to palpate along the lung lobe with the index fingers of both hands. When he touched the left wall of the lung lobe, Ji Han frowned obviously.
He turned the patient's lung over and only looked at the old tuberculosis lesion that had completely grayed out on the side within 3 cm above the upper part of the left lobe.

Ji Han immediately ordered the excision operation.Everyone just watched the red and black tuberculosis old lesions being quickly cut open, and soon, the section was quickly presented on the electronic screen in front of everyone by the electronic probe.

Everyone looked at the old tuberculosis lesion that had been dissected, and secretly clicked their tongues. They only saw that there were many irregular concave-convex shaped granular cancer cells growing in the three-dimensional section of the lesion, and the gray-white cancer cells could be as big as the size of a little finger.

In the observation room, when a young female intern saw the erosive, bright red mixed with gray and white color of the old tuberculosis lesions, she felt nauseated in her stomach from the supper siu mai she had just eaten, and she couldn't hold it back. He hurriedly covered his mouth and ran towards the bathroom.

After clarifying the old cancerous tuberculosis lesions in the upper lobe of the left lung, Ji Han glanced at the first assistant who was standing there—Tan Tan, a three-year resident in tumor surgery, and ordered in a cold tone: "Change position, prepare for rectal resection. "

Tan Tan immediately switched to the second assistant position. .

"Electric knife."

"Attractor."

Ji Han took the electric knife and cut open the patient's rectal membrane, and blood gushed out immediately.

Seeing the blood filling the incision, Ji Han frowned, and his voice couldn't help but be a bit harsh: "Attractor!"

Tan Tan saw the second assistant staring fixedly at the patient's wound, the young intern Xu Youshu who had just been rotated for less than a month, hurriedly reminded him: "Why are you still standing there, suck blood!"

Xu Youshu was startled, and immediately came back to his senses, and started to suck, but he was already startled by the complicated operation before him.

Ji Han broke open the patient's superficial fascia neatly, and Tan Tan immediately hooked the eversioned flesh with a tendon hook.

"Gut forceps."

In the exposed abdominal cavity, Ji Han stretched out his index finger and pulled out the necrotic rectum and intestines where the cancer cells had metastasized.He clamped the necrotic intestine with esophageal forceps, and gave an order: "Remove."

Tan Tan immediately pressed the esophageal forceps to cut off the necrotic intestine.

He stood opposite Ji Han, facing the light of the Shadowless Lamp, just in time to see Ji Han who was frowning tightly, and saw a few drops of blood splashed on the inner brow tip of his face.

Only the binocularloupe magnifying glass and his special eyes behind the frame remain on the blue mask.

Suddenly, Ji Han looked up, gave him a cold look, and said: "The cancer cells have metastasized to the entire rectum, and the entire rectum needs to be completely removed."

Tan Tan frowned: "If the traditional Miles radical operation is performed, I'm afraid the patient's anus will not be preserved."

Ji Han's hands continued to move: "In this case, no matter whether anus-preserving surgery or radical surgery is used, the cancer cells will remain in the surgical field, and the probability of local recurrence after the operation is very high, so we can only use TATME directly. total anorectal resection).

"We only need to remove the 5cm range above and below the tumor, beyond the distance that the tumor invades up and down along the intestinal canal, and completely remove the entire mesorectum, so as to avoid tearing the visceral layer of pelvic fascia surrounding the rectum and reduce the risk of cancer cells. Intraoperative dissemination ensures the quality of radical surgery and reduces the local recurrence rate to an unprecedented level."

Tan Tan repeated the principle of the operation, and patiently explained it to Xu Youshu, an intern doctor who seemed to be in a hurry.

"Stapler."

"Stop the bleeding."

In the operating room, there was only the voice of Ji Han continuously giving operating instructions, and no one dared to talk loudly.His speed is very fast, and every step is well-organized and organized.

After rechecking that no tumor had metastasized to other organs, Ji Han took a deep breath, his forehead was already covered with sweat.He looked at Tan Tan and nodded, "We are going to shut down the abdomen layer by layer. After the patient wakes up, he will be sent for chemotherapy, and the radiology department will give a follow-up chemotherapy plan."

After finishing speaking, Ji Han turned around and left the operating room without any extra greetings, not even a word of hard work, and directly left everyone who had worked hard all night in place.

Xu Youshu looked at Ji Han who was walking out, and asked curiously: "Professor Ji, what did you do? Didn't you say that tonight is their doctor's gathering? Why is he alone in the hospital late at night performing operations? He Aren't you going to the party?"

Tan Tan gave him a strange look: "You don't know that Professor Ji never attends gatherings among colleagues in the department? Maybe, no doctor who doesn't open his eyes will invite him to the gathering?"

Xu Youshu, who witnessed Ji Han's surgical ability with his own eyes, finally understood at this moment why the No. [-] Tumor Hospital respected him so much.

Known as the "God's hand" in tumor surgery, he also understands why everyone doesn't want to be his partner, and even the doctors of the same period don't take him to play!Even isolate him!

As expected, he is just like the legends, with withdrawn personality, never sees a smile on his face, and treats everyone coldly, it seems that no one in this hospital can get close to him.

But Xu Youshu had to admit that Ji Han did have the capital to be crazy.

In private, he heard many bizarre rumors about him. The most outrageous thing was why Ji Han didn't get married or fall in love after he was over 30?
Single, excellent education, good family conditions, good looks.

But he chose not to get married, and everyone privately suspected that he had problems with the secretion of male hormones and dopamine, which led to problems in that area.

This man really aroused the gossip-seeking psychology of many interns.

(End of this chapter)