The Godfather of Surgery

Director Fang's motivation is really high now, because he is now a person with pursuits, not an ordinary person. He has set his career goal to be the world's top general surgery expert.

This goal is still far, far away, but Director Fang feels that it will be achieved if possible.

So from now on, Director Fang will demand himself according to this goal. Of course, Director Fang did not tell anyone about his ideal. He wanted to realize it quietly. Director Fang's blood boils every time he thinks of his ideal.

Now, Director Fang met a patient in the outpatient clinic, Nong Tiesheng, male, 57 years old, who suffered from recurrent laryngeal nerve injury after thyroid cancer surgery. Now the patient has obvious hoarseness. He easily chokes when drinking water and has difficulty eating. It is very easy to choke and it affects breathing.

From the medical records brought by the patient, Director Fang found that the tumor should have invaded the recurrent laryngeal nerve and its surroundings. In order to completely remove the tumor, the recurrent laryngeal nerve was segmentally resected.

However, the injury to the recurrent laryngeal nerve on one side does not cause such serious symptoms. Now the patient feels that it is difficult to breathe, which means that the recurrent laryngeal nerve on the other side is also damaged, but not broken. It may be a contusion at the time, or pressure from the postoperative scar.

If treatment is required, surgery is necessary. One side of the recurrent laryngeal nerve needs to be repaired and the other side needs to be explored.

This surgery is actually nothing. It is just a routine surgery. Repairing the recurrent laryngeal nerve usually involves bridging the damaged nerve, or connecting a nerve from another place to replace the original nerve.

This patient has undergone several operations, but the operation is still difficult. Director Fang decided that it would be better to discuss it with Yang Ping. Director Fang now has different requirements for himself, and his realm is completely different from before. Every patient He wants to perform surgeries to the best of his ability, and he even wants to try to innovate and improve surgeries.

Director Fang took the patient to the Institute of Surgery to find Yang Ping to study the condition together.

Yang Ping looked through the medical records brought by the patients and found in a thick pile that the surgeries had been performed twice, and the scope of the surgeries was relatively large.

The recurrent laryngeal nerve is the nerve that controls the human vocal cords. There are two left and right nerves. If it is damaged unilaterally, it will cause hoarseness and coughing when drinking water. If both sides of the recurrent laryngeal nerve have been damaged, it will cause pronunciation, eating disorders and dyspnea. .

The protection of the recurrent laryngeal nerve is an important part of thyroid cancer surgery. The surgeon must be very careful to protect it and prevent it from being damaged.

However, in some patients, if the tumor has seriously invaded the trachea and recurrent laryngeal nerve, in order to completely remove the tumor, it is necessary to remove the part that has been invaded by the tumor. This is called segmental resection of the recurrent laryngeal nerve.

Because the physiological function of the recurrent laryngeal nerve is very important, it cannot be left alone after resection. Otherwise, the patient may have a hoarse voice and cough when drinking water, or in severe cases, breathing, eating, and pronunciation may be seriously affected.

If the recurrent laryngeal nerve has been segmentally resected, the recurrent laryngeal nerve needs to be repaired after surgery. There are three traditional repair methods: the simplest is to directly pull together and suture; however, some resection distances are too long and cannot be directly pulled together at all. Other nerves can be cut to bridge the severed end of the recurrent laryngeal nerve. This is the same as coronary artery bypass grafting. The difference is that coronary artery bypass grafting bridges blood vessels, but here it bridges nerves. If the bridge distance is too far, it will lead to poor postoperative recovery. ; At this time, the phrenic nerve can be cut or the hypoglossal nerve loop can be anastomosed to the stump of the recurrent laryngeal nerve, so that another nerve can be used to replace the original recurrent laryngeal nerve to function.

The patient brought a lot of medical records, and Yang Ping slowly flipped through the pages. Almost all the examinations had been done, and they were also included in the medical records, but there was no pathology report. Did the patient forget it?

''Why is there no pathology report? Yang Ping handed the medical records to Director Fang.

Director Fang also looked through it again, and indeed he did not find the pathology report. He just looked through it roughly and didn't pay much attention to it. He focused on looking at the discharge records.

Who did you do this surgery in Annex 4? Director Fang asked the patient's son Nong Zhiwen.

The Fourth Affiliated Hospital of Nandu Medical University, among the several affiliated hospitals of Nandu Medical University, was established relatively late and is not very well-known. In terms of strength and reputation, it is far inferior to the Affiliated Hospital of Affiliated to Affiliated to Affiliated to Affiliated to Cancer Hospital.

But the Fourth Affiliated Hospital is also an affiliated hospital of Nandu Medical University. It is a tertiary teaching hospital. It will not be far behind in any case. It is also considered a second-tier powerhouse in Nandu Province.

Director Qian! Nong Zhiwen replied.

''Qian Lisheng? Director Fang is very familiar with Director Qian.

Yes, it's Director Qian Lisheng. Nong Zhiwen confirmed.

It was his patient. If he had known he was Qian Lisheng's patient, Director Fang would not have touched him at all.

Because Director Qian has a bad reputation in the industry, and his level is also notoriously poor. Of course, this is only known to people in the industry, and ordinary people don’t know it at all. Everyone outside thinks that his level is very high, because he has to shoulder a lot of responsibility. The title of great expert and great professor.

Director Qian's surgeries are rarely smooth. As long as the surrounding doctors know about it, they dare not take on his patients. The probability of his thyroid cancer surgery damaging the recurrent laryngeal nerve is extremely high. Not only this surgery, but all his surgeries are rough. It was rough, and few had good results, but this did not prevent him from continuing to be a great professor.

Director Fang was a little panicked when he met Director Qian's patient. He wanted to re-examine whether it was thyroid cancer.

This bastard would sometimes operate on some benign tumors in general surgery. Many patients who had no indication for surgery and did not need surgery at all would treat them as malignant tumors. In the end, he said they were cured. The patients did not know and were in tears of gratitude.

Many benign thyroid tumors originally only require regular thyroid color ultrasound examinations, but in the hands of Director Qian, special measures must be taken.

This guy has quite a few patients, and most of them got them through crooked means.

He once performed a da Vinci robot surgery on a patient with a small cyst in his liver, and ended up spending hundreds of thousands, and he was still an acquaintance of his.

Therefore, whether it is medical skills or character, Director Qian really stinks.

But he is a chief physician and professor, and he also takes his master's and doctorate degrees with him to attend academic conferences everywhere.

Why is there no pathology report? You have to find the pathology report. Without the pathology report, we cannot formulate a surgical plan.

Director Fang looked through it again, and there was indeed no pathology report. He just wanted to use this matter to push the patient away, because he really didn't want to touch Director Qian's patient.

Yang Ping said: No matter what, the recurrent laryngeal nerve must be repaired. Otherwise, you should admit him to the hospital and let him find the pathology report as much as possible.

The patients and their families were immediately grateful when they heard this, because they visited many places in the provincial capital. As long as they saw the doctors, they initially planned to admit them to the hospital, but after looking through the medical records, they finally said that this operation was effective. Difficulty, it is recommended to go to the original surgical hospital or a higher-level hospital.

Now there is a place willing to take him in, and they are really grateful.

''In this case, you go and get the pathology report. We must see the pathology report before we can make a surgical plan and then perform inpatient surgery. Director Fang insisted.

Pathology report?

Nong Zhiwen looked through the thick medical records by himself. He didn't even know that there was such a thing as a pathology report. He did what the doctor said. He didn't understand what the disease was and how to treat it, so he listened to the doctor.

''What does this thing look like? Where to get it? asked Nong Zhiwen.

Director Fang gestured and said: A piece of paper with a color photo on it and a detailed diagnosis on the bottom. You can use your ID card to go to the medical records department in Attachment 4 to make a copy. If you really don't know how to do it, you can contact the surgeon at the time or The doctor in charge must be in the medical records.

Why don't you go to Director Qian for a follow-up consultation? It would be great if you could have the recurrent laryngeal nerve repaired there. He is familiar with your situation. Director Fang couldn't help but ask curiously.

The patient had difficulty speaking, so he had not spoken. His son said: Professor Qian is very busy, either going abroad or attending meetings, and their beds have been tight. We have been waiting for half a year, and we really can't afford to waste this time, so we have to think of other things. Method.

Like This!

Director Fang probably guessed something. It's definitely not that simple. It's better not to wade into this muddy water, so as not to get yourself involved.

Okay, that's it, you go get the pathology report and wait until you get it. Director Fang didn't want to dwell on it any longer.

Yang Ping said to the director: When he gets the pathology report and the situation is clear, you can admit him to the hospital. This operation is probably still a bit difficult.

Director Fang hummed.

After the patient left, Director Fang immediately reminded Yang Ping: This is Director Qian's patient. As long as he has performed surgery on the patient, no doctor in the circle dares to take over it, especially the tumor surgery he has done, which is a mess, including secondary surgeries. There’s just no way to do it.”

It's okay. We don't care what his previous condition was. As long as he trusts us and is willing to accept our diagnosis and treatment, we will do our best. As for Director Qian, we don't care about that. Yang Pingke had no intention of paying attention to Director Qian.

However, Director Fang was worried that this patient would cause trouble for Yang Ping, so he wanted to dissuade him. Director Fang also had good intentions. He felt that Yang Ping usually focused on academics and did not understand the world, and was afraid that Yang Ping would get into trouble.

But Yang Ping is not worried about this at all. If this patient does not undergo surgery, he will always have a hoarse voice, cough when drinking water, and now has difficulty breathing. In the future, it will not only be a problem of quality of life, but may also affect his life. He has this Ability, why not help patients? As for who he consulted before, it has nothing to do with him. He doesn't want to care about these things.

It’s just that this patient has a lot of doubts. Judging from the various objective examinations in the medical record, it doesn’t seem like thyroid cancer, but the medical record is indeed thyroid cancer. The key is the lack of a pathology report, so it’s okay to look at it after getting the pathology report. Relatively safe.

——

The patient's son Nong Zhiwen had to come to Appendix 4 again. Because Director Qian did not go out to the outpatient clinic, he could not find Director Qian in the outpatient clinic, so he had to go to the ward to look for him. The doctor in the ward said that Director Qian did not come back very late after undergoing surgery.

Nong Zhiwen then waited at the door of Director Qian's office until night. He did not go back until the security guard told him that he could not stay here, but he never saw Director Qian.

Nong Zhiwen had no choice but to return to the hospital clinic to ask Director Qian about his schedule, but everyone had already got off work, so he went to the emergency department to ask. He was not from the same department, and the emergency doctors said they didn't know. Later, an emergency doctor said I asked the ward for you, so I called the doctor on duty at the general surgery department, and then I found out Director Qian's schedule.

It just so happened that Director Qian was out for the outpatient clinic the next morning, and Nong Zhiwen was going to go to the outpatient clinic to see Director Qian the next day.

After finally waiting until the next day, Nong Zhiwen found Director Qian in the outpatient clinic.

Director Qian, hello-

Nong Zhiwen was very polite. He came to the provincial capital from the countryside and it was not easy to see a doctor.

You are? Why did you come in without lining up?

Director Qian was very impatient.

''My dad used to be your surgeon. My dad's name is Nong Tiesheng, and I am his son. That's how it is-- Nong Zhiwen explained hurriedly and handed over the discharge information.

Director Qian looked through the discharge information: Nong Tiesheng, isn't it fine after the operation?

Yes, thank you, Director Qian, but now I keep choking on drinking water, have difficulty speaking, and have trouble breathing.

Oh! With such a major surgery, the recovery will definitely be a bit slow. Let's recover slowly and see. I'm very busy now. Let's wait until I have time. There are still many patients waiting for me.

Director Qian waved his hand like a great professor.

''I only have two minutes. My father is going to Sanbo Hospital for hospitalization. The doctor looked at the medical records and said that he was missing a pathology report and asked me to get it.

Pathology report? You can just go to the medical records room to make copies. You see, I'm quite busy.

I went to the medical record room, and they said there was no pathology report in the medical record. I just checked the fee list, and it contained the charges for pathological examination, so this examination should have been done at that time. The people in the medical record room said they didn't know the situation, so I asked I looked for the doctor who was in charge of the bed. I contacted the doctor who was in charge of the bed at that time. He is now studying for a doctorate in another province and is no longer in your hospital. He asked me to come to you. Look, I am disturbing you.

''Find me? I don’t directly care about the patient, so how do I know where the pathology report is? Can I help you find the pathology report? I am so busy every day, do I still need surgery? There must have been a copy given to you at that time, but you lost it.

''No, really, I have kept this copy of the information very well.

''Then there's nothing I can do about it. How can I find a report for you? It's been going on for so long and I have so many patients, but you didn't tell me earlier, right?

We didn't know about the pathology report at the time. Now the doctors at Sanbo Hospital are eager to ask for it, saying that the pathology report must be available before we can make an operation plan.

Sanbo Hospital? What kind of doctor does he know? Why do you need this thing? If you don't have it, you won't be able to treat the disease? Who did you see at Sanbo Hospital?

''I first saw Director Fang Nansheng, and then Director Fang took me to see Professor Yang Ping.

Director Qian's heart skipped a beat when he heard Yang Ping's name, and he couldn't help but feel chills running down his spine.

He swallowed, his attitude turned 180 degrees in an instant, and his tone became very gentle: How do you go to Sanbo Hospital? The quality there is not good. You come to me and I will help you solve it.

You keep saying that there are no beds. We have no choice but to go to other hospitals to find a solution. You see, my father can't speak now. He chokes when drinking water and has trouble breathing. It won't be a problem if this continues. Nong Zhiwen Said helplessly.

It was true that beds were too tight before, and I was very busy. In your situation, let me think about it. Let's do it this way. It's not easy for you to come to the provincial capital. I will help you think of a way and arrange beds for you. Your father is my old patient. , I am familiar with his situation, don’t go to Sanbo Hospital, that Yang Ping, you look so young, what do you know, you don’t even know how to do several surgeries, you must not be fooled, come here quickly, I will help you solve it , come to me for surgery.”

I heard from patients in their hospital that Professor Yang is very powerful.

''Everything about being awesome is just bragging. Look at him. He is so young. He has only graduated a few years ago. He can do a few operations and just wrote a few papers. Don't ask him for surgery. Surgery is a big deal and you can't do it casually. , you see I helped you perform the operation, and you are recovering well now. How can other people be so energetic after cancer operations, right? Don't trust others casually. Let me tell you the truth, these people are just deceiving. Is Sanbo Medical ranked among the best in the province? Do you have our top four attached?

I don't understand either. I can't help it if I'm anxious.

Just like this, you haven't gone through the admission procedures over there yet? I'll say hello to you and get you a bed.

Not yet. Okay, thank you Professor Qian.

''It's okay. I was really busy some time ago, so I can't help it. I don't know your situation. If I knew this was the case, I would definitely find a way for you. The beds are very tight now, and I have been attending a lot of academic meetings recently.

I know! Thank you, I'll come over when.

In this case, you call someone over now, and I will help you issue a hospitalization certificate. I will have the patient discharged from the hospital tomorrow. Once discharged, I will ask the nurse to notify you immediately. You are really filial and I am very touched.

Where, then I won't go to Sanbo Hospital?

''Go to Sanbo Hospital, don't listen to their lies.

Do you still want the pathology report?

''No, I don't know what the operation is like, so what's the use of such a piece of paper?