I run a clinic in the United States

Chapter 319 Oh my god, do you have to fight academically to win a man here? (Ask for monthly ticket)

Community Hospital Surgery Center.

Murphy was performing a radical operation on a middle-aged white woman for early-stage lung cancer.

Because Zhou Qiao had told them that when they performed the operation, they would also take Chiba Nanako with them so that she could learn more about it.

Therefore, Murphy called Chiba Nanako this time.

Because of this operation, Murphy was quite confident, so he did not let Stephanie participate.

There are only two situations for Stephanie to be on the same stage with her. One is that Zhou Qiao is here and requires both of them to assist, or the other is that the operation is too difficult or takes too long for one person to complete.

The same goes for Stephanie.

Now that Zhou Qiao is in Boston and there are no particularly difficult cases, they naturally work on their own.

Zhou Qiao is newly promoted to the top ten shareholders and board members of Boston Medical Company. He needs to stay there for a while to learn more about the company's operations. Boston Medical also arranged a special office for him and gave him an SVP (senior vice president). title and a secretary with a sweet smile.

Of course, according to Zhou Qiao's habit, that is, after getting to know him, he would probably let go of the shopkeeper.

However, he doesn't have to work there, but the other party has to arrange an office and title for him.

That secretary is very beautiful, but compared with the four beauties of the iris, no, now the five beauties, there is a huge difference.

Therefore, Zhou Qiao didn't have much thought about the secretary. On the contrary, the sweet secretary was rather resentful.

……

The patient who was operated by Murphy was found to have a nodule in the lower lobe of the right lung during a regular physical examination. After follow-up, it was considered to be early stage lung cancer. Rachel consulted Murphy and recommended surgical treatment. At the same time, this patient was also treated Over to Murphy.

Preoperative imaging showed that the patient's nodule was located in the posterior basal segment of the lower lobe of the right lung, about 1 cm away from the pleura. It was a pure ground-glass nodule, and local resection was the best option.

However, how to accurately locate this kind of pulmonary nodule is very important.

In order to avoid the risks and discomforts of traditional CT puncture positioning, Murphy used the magnetic navigation bronchoscope fluorescence positioning method this time, and then performed single-hole minimally invasive resection after positioning.

At the same time, after evaluation by Nancy's anesthesia team, Murphy finally decided to use tubeless surgery, that is, no endotracheal intubation, urinary catheter, or traditional chest drainage tube was placed.

This can further reduce patients’ postoperative adverse reactions.

"Such a major surgery without intubation?" Chiba Nanako pursed her lips, feeling that this little iceberg beauty was so brave.

However, Chiba Nanako also understands one sentence, that is - "A skilled person is bold". It is estimated that this little iceberg beauty made this decision because of his confidence.

In order to ensure the postoperative analgesic effect, Murphy performed an ultrasound-guided intercostal nerve block on the patient before the operation, using only a small incision 2 fingers wide to perform the surgery.

During the operation, the location of the pulmonary nodule was located using magnetic navigation bronchoscopy and fluorescence. With the cooperation of Nancy's anesthesia team, ventilation was only controlled during the resection, and the nodule was accurately and completely removed. Furthermore, only a very small pigtail tube was placed. .

The entire surgical process was completed in one go, like flowing clouds and flowing water, giving people a pleasing feeling.

After the operation, the patient felt no pain from the incision and recovered very quickly. He was discharged from the hospital only one day after the operation.

It was so fast that Chiba Nanako was shocked.

The postoperative pathology showed that it was adenocarcinoma in situ. The middle-aged white lady was so happy that she personally bought a large bouquet of flowers for Murphy to thank him for his superb medical skills.

Of course, with this disease, although Murphy was very confident that the removal was very clean, regular reexamination would still be required in the future.

However, there is nothing to worry about, because Americans are almost accustomed to regular physical examinations. Basically, as long as they are not bankrupt or extremely poor, they will have them.

Chiba Nanako was full of praise for Murphy's superb surgical skills, but Stephanie was not convinced.

Then, Stephanie also received a patient who needed surgery and was referred from another clinic.

Therefore, Stephanie also took Chiba Nanako with her to let her see her surgical skills.

Stephanie wanted to tell Chiba Nanako that she was not just a counselor, but that she was strong in many aspects.

In fact, she was just competing with Murphy.

Chiba Nanako also felt this "undercurrent" and felt helpless, but at the same time she was very lucky. Fortunately, it was okay for them to compete with each other, but they must not get themselves involved.

This time, Stephanie went directly to the University of California Medical Center because there is an advanced Prometheus-3000 surgical robot.

Although Zhou Qiao is not here, it was donated by Zhou Qiao, so the doctors at Iris Clinic have priority to use it, and it is not limited to Zhou Qiao alone.

Stephanie's patient had a persistent cough that was not relieved after taking medicine for a week. Then, the clinic arranged a chest CT and bronchoscopy for him.

It was found that a new organism with a length of about 9mm had grown in the opening of the lower lobe of the patient's left lung near the left main bronchus. The biopsy confirmed that it was a malignant tumor. Because the operation was too difficult, the doctor recommended that he come to Iris Clinic for treatment. and refer them over.

Iris Clinic is now truly one of the best in California. It is the industry's top performer in terms of cardiac and macrovascular surgery, neurosurgery, and radical resection of various tumors. Therefore, many clinics or hospitals will consider referring Iris Clinic if they are unsure. Flower clinic.

Or, directly invite Zhou Qiao and others to participate in the consultation.

Iris Clinic never makes referrals, only accepts referrals!

After receiving the patient, Stephanie took the information and discussed the patient's condition and surgical plan with Chiba Nanako.

This kind of intratracheal tumor has hidden symptoms, special location, and extremely difficult surgery. After thorough discussion and evaluation, Stephanie formulated a surgical plan.

What she is going to do for this patient is a robot-assisted sleeve resection of the left lower lobe of the lung.

It was also the first time for Chiba Nanako to see the most advanced surgical robot in the world performing surgery. Stephanie was able to operate this three-headed and five-armed robot alone, without the need for an assistant, to perform various difficult and fancy operations. , seeing Chiba Nanako amazed.

Stephanie's surgical skills were naturally very good. Zhou Qiao had already raised her to the peak level of a master. The surgery was very successful and completed in one go.

Since it is a robotic surgery, in terms of "appreciation", it is even better than the previous one by Murphy.

Postoperative pathology revealed that the patient had invasive nonmucinous adenocarcinoma and no lymph node metastasis. I was discharged from the hospital three days after the operation, but I needed to come back for check-ups two weeks later and one month later.

Judging from the situation three days after the operation, it was not a big problem.

Chiba Nanako was very impressed. Didn't they say that they were the second and third best in heart surgery? How can I be so good at lung cancer surgery?

Moreover, based on Chiba Nanako's understanding, these techniques are internationally leading, and even Japan does not do many.

As everyone knows, regarding magnetic navigation visualization of diagnosis and positioning of small pulmonary nodules, preoperative three-dimensional reconstruction of small pulmonary nodules, AR-assisted lung puncture landmarks, key technologies for precise anatomical segmental resection, and how to use robot-assisted lung cancer surgery, Murphy and Silk Daphne has conducted a series of prospective clinical studies, and has published many articles in top international academic journals, with a cumulative impact factor of over 500 points.

Moreover, publishing academic papers with high impact factors is no longer enough for these two girls. They also plan to write a book.

For example, recently, Murphy is using his spare time to write a monograph: "Visual Precision Surgical Diagnosis and Treatment System for Lung Cancer and Quality Control of Robot-Assisted Lung Segment Surgery for Early Lung Cancer."

Not to be outdone, Stephanie plans to write a trilogy of clinical psychology books, namely: "Clinical Child Psychology", "Clinical Psychology of Adolescence" and "Clinical Psychology of the Elderly".

Chiba Nanako followed them during the surgery and also chatted with them. After learning this, while deeply admiring them, she once again felt tremendous pressure inexplicably.

how? To compete for a man here, is it not just about looks and gentleness, but also medical skills and academic level? Isn’t this too curly?

Oh my God, King Juan!

She was a little envious of Elena and Ava, but those two twins had special status and aloof status in the clinic, which they could not compare with.

Immediately, Chiba Nanako also felt a desire to win, thinking that she was not bad either. A doctor of medicine from the University of Tokyo might not be weaker than those from the University of California, Los Angeles and Johns Hopkins University.

No, I have to make some achievements! We can't let Murphy and Stephanie get too far away.

Murphy said in his heart, who doesn't know how to use a surgical robot? Come on, Nanako, I'll let you see it too.

So, during the next surgery, I took Nanako Chiba to the University of California Medical Center and performed a robotic surgery, which also demonstrated extremely superb skills.

Chiba Nanako felt that she could not compete with these two girls in surgery, so she decided to use her strengths and avoid weaknesses, and planned to work more on comprehensive drug delivery and pharmacokinetics.

After coming here for several days, she has keenly discovered that in terms of comprehensive drug delivery, although Iris Clinic is not bad and can be considered first-class, there is still room for improvement.

Everyone has also discovered that she has expertise in this area, so many people come to her for advice on medication problems. Even Murphy and Stephanie tend to leave the patients' postoperative medication to Chiba Nanako. Come take charge.

Chiba Nanako has participated in the operation and understands the patient's condition. She has also done a remarkable job in the postoperative medication, with more subtle changes than before.

Sometimes, some subtle adjustments in the medication plan can have completely different effects.

Rachel recently encountered a little trouble. She had a hypertensive patient who was clinically diagnosed as essential hypertension. So, based on her years of experience, she prescribed amlodipine for oral treatment.

However, the patient's blood pressure was poorly controlled and fluctuated widely, and he even experienced adverse reactions such as increased heart rate and flushed complexion. So Rachel gave him other drugs, such as Losartan, but the blood pressure-lowering effect was still not satisfactory.

She was a little confused. It was impossible to try all the medicines, right? You know, there are countless antihypertensive drugs on the market for high blood pressure.

There are so many to choose from.

"Look for Chiba Nanako!"

Rachel came to ask Chiba Nanako for advice.

After Nanako Chiba learned about the situation, she gave her an idea: "This can actually be used for genetic testing. Sometimes the medicine is not effective because the medicine does not match the patient's genes."

"Ah? Is there still such a thing?"

Chiba Nanako nodded, then took out a pen and paper, drawing pictures, making lists, and explaining.

Following Nanako Chiba's suggestion, Rachel arranged for blood sample collection and genetic polymorphism testing for the patient.

Finally, based on the genetic test results, Nanako Chiba suggested changing the patient’s medication to irbesartan.

Then, a magical scene happened. The effect was almost immediate. The patient's blood pressure quickly returned to normal, there were no adverse drug reactions, and the quality of life was greatly improved!

Of course, high blood pressure is a chronic disease that requires long-term medication to control.

Precisely because long-term medication is required, it is very important to find a suitable antihypertensive drug.

Appropriate antihypertensive drugs can not only reduce adverse reactions, avoid drug toxicity risks for patients, and increase drug safety, but can also improve drug efficacy, effectively control blood pressure, and reduce complications.

At the same time, it can also shorten the trial period and reduce the economic burden.

After this incident, Rachel, an aunt, felt deeply that she should also keep pace with the times and learn more about today's advanced technologies.

Relying on experience alone is not enough, because she is old and some of her previous experiences may not keep up with the times. The young girls today are still amazing!

Medicine is about living and learning.

……

Iris Clinic, Conference Room.

Murphy, Stephanie, Nanako Chiba, Elena, Ava, and Irises gathered together to discuss the condition of a patient.

This is the second consultation meeting.

This patient's condition was quite difficult and he was referred from a neighboring community hospital.

A fourteen-year-old child was admitted to the hospital due to high fever, with a body temperature as high as 40°C (no conversion to Fahrenheit, intuitive).

After receiving the diagnosis, doctors from the community hospital found that the patient had severe pneumonia with pleural effusion, as well as symptoms such as liver insufficiency and hypoxemia.

The initial diagnosis was pulmonary infection and suspected pulmonary embolism.

However, after symptomatic treatment, the patient's condition did not improve, and he even developed symptoms of heart failure.

The Department of Respiratory Medicine of the community hospital urgently held a multidisciplinary consultation and arranged further examinations.

Chest CT examination found that the patient had patchy shadows on both lungs with multiple thin-walled cavities, and it was highly suspected that Staphylococcus aureus, a bloodstream infection, caused pneumonia.

At the same time, cardiac ultrasound examination found that there were "cauliflower"-like growths around the patient's heart tricuspid valve, and pulmonary artery CTA also showed "bacterial emboli" in the pulmonary artery!

The tricuspid valve is an important valve connecting the right atrium and right ventricle. It leads directly to the pulmonary artery and distal lung tissue. It is an important gateway to ensure one-way circulation of cardiac blood flow. Now there are bacterial clumps attached, which will affect the valve's switching function and endanger life. .

The situation was quite serious and critical, and the community hospital could not handle it, so we invited the Iris Group.

Zhou Qiao was away again, so Murphy and Stephanie took over.

Only in this critical moment will Murphy and Stephanie work together to overcome the difficulties.

In fact, although this kind of heart surgery is difficult, it is nothing to Iris Tiantuan, because they have done it many times before, and they have won national awards for these surgeries.

Normally, not worth mentioning.

However, the patient's high fever persists, which brings huge risks to the operation.

Not only are there surgical and perioperative risks, but the existence of bloodstream infection will affect the stability of circulatory oxygenation. Therefore, after the first meeting, everyone unanimously decided to carry out anti-infective treatment first, and wait until the fever peak subsides and the blood circulation becomes stable. Surgery can be performed after the infection is controlled.

However, anti-infective treatment was not successful.

While at the community hospital, the respiratory physician had administered anti-infective treatment with piperacillin, but the recurrent fever did not improve.

After the Iris Clinic received the patient, the blood culture results came out, so the medication plan was adjusted and upgraded to meropenem anti-infective treatment.

At the same time, intravenous fluid rehydration was performed to address electrolyte imbalances.

Unfortunately, the patient still had repeated fevers, with a fever peak as high as 38.8°C.

其血常规白细胞WBC入院时为29.16↑x10^9/L（远超于正常值3.5-9.5×10^9/L），而现在，经抗生素治疗后依然居高不下，为20.13↑x10^9/L。

In other words, according to the blood culture results, the carefully selected powerful antibiotic Menamperol is almost ineffective?

Chiba Nanako is responsible for this medication.

In the conference room, everyone looked at Chiba Nanako.

Chiba Nanako's face was as dark as water, and she was a little panicked. She thought to herself, am I going to overturn? It's not okay to look down on Murphy and Stephanie.

Underestimation is actually the second best thing. If the patient delays the operation and dies because of this, then...

She forced herself to calm down, her mind raced, she thought quickly, and reviewed it carefully in her mind, trying to figure out what the problem was.

At the same time, Stephanie expressed her opinion and said: "There should be super-resistant bacteria now, or there are other undetected pathogenic bacteria. After all, the test results can sometimes be wrong. But , do another blood culture, we can’t wait, the patient won’t be able to persist by that time, and another blood culture may not be useful. Otherwise, we risk the operation.”

Murphy shook his head: "It's too risky to risk surgery now."

Elena said: "How about calling Joe back, maybe with Joe's participation, the risk of the operation can be reduced."

"This may not be an alternative plan, but," Stephanie pondered for a moment, then said, "Or, simply be more ruthless and use a combination of meropenem + vancomycin hydrochloride."

Everyone fell into deep thought.

The main thing is that vancomycin should not be used lightly. Meropenem + vancomycin is equivalent to a king-level drug. And there are many irreversible side effects.

However, now that the patient's infection has worsened, the high fever persists, and the responsible bacteria cannot be quickly identified. Meropenem + vancomycin is equivalent to empirical anti-infective treatment. If it is a combination of treatments, there should still be hope.

Moreover, I have used both meropenem and vancomycin.

After hesitating for a long time, Murphy said: "How about taking vancomycin."

When there is no other way, this is the only way.

The fever must be reduced as soon as possible, otherwise if it is delayed, the operation will only be risky, which will only increase the risk of surgery.

The patient's life is more important than the misuse of antibiotics.

Although vancomycin is a nuclear weapon, shouldn't medicine be used where it is needed?

The patient's condition is also serious and critical, worthy of the use of vancomycin.

It's not a minor illness, just give me vancomycin.

For such a serious condition, if it is not used at this time, when will it be used?

Just when Murphy and Stephanie reached a consensus, Chiba Nanako's eyes lit up and she stood up and said, "Can you give me a day? I have an idea, but I don't know if it will work. Just one day, let's try it." Just know it.”

Murphy and Stephanie looked at each other.

"Okay, one day at most. If it's any later, I really can't delay it."

(End of this chapter)