Chapter 234: On One Hand, Healing the Sick and Saving Lives; On the Other, Performance Evaluations

Ji Xiang and Meng Yisheng chatted quite congenially; he would wander over to the Emergency Department every four days, keeping Meng Qingfei company during night shifts, helping to stitch up wounds and check on patients.

Time flew by, and over half a month passed.

"Xiao Ji!" Liu Zhuren walked out of his office, stood in the doorway, and shouted.

"I'm here, Zhuren." Ji Xiang used his elbow to open the door while wearing disposable gloves, poking his head out from the dressing room, "What are your instructions, Zhuren?"

"Hurry up and finish the dressing change, we're going for a consultation."

"Alright." Ji Xiang replied, then turned back to quickly explain the precautions to the patient who had undergone a circumcision over the weekend.

The circumcision he performed was excellent; there were almost no postoperative complications, and because his explanations were detailed, the patient's fear was also lessened.

"Alright, just come back to see me in three days for a dressing change." Ji Xiang said as he took off his gloves.

"Doctor, should I go to the Outpatient Department or come back here?"

"Just come here; going to the Outpatient Department requires registering again, and it's just a dressing change, not worth the trouble." Ji Xiang said.

Turning to head out, Ji Xiang bowed slightly and smiled, "Sorry about that, Zhuren."

"What's there to be sorry about." Liu Zhuren laughed and chided, "Changing dressings is honest work; don't be so hypocritical, learn more of the good stuff."

As he spoke, Liu Zhuren glanced at Ji Xiang.

"Zhuren." Ji Xiang felt a bit guilty.

"Did you not charge the disposal fee when changing the patient's dressing?" Liu Zhuren asked leisurely.

"..." Ji Xiang sighed inwardly; he had been found out by Liu Zhuren after all.

"If it's your own patient, changing the dressing yourself, it doesn't matter if you don't charge. It's fine." Liu Zhuren suddenly smiled craftily, "But don't let the Head Nurse know; that housekeeper is a real nag."

"Ah?"

"The department's performance metrics, heh! It's a joke when you say it out loud; on one hand, you're told to heal the sick and save lives, and on the other, you're held to performance evaluations. Don't you think it's schizophrenic?"

"A little."

"Let's not talk about that. Being a doctor is hard these days, mainly because of this schizophrenia."

"Zhuren, what kind of patient is the consultation for?" Ji Xiang gave a sheepish smile and immediately asked.

"The patient was admitted due to Lower Extremity Deep Vein Thrombosis. Thrombolysis treatment wasn't effective, so we're preparing for catheter-directed thrombolysis. A CT was done pre-operatively, and they found a problem. I just took a look at the scans on the computer, and I keep feeling like something isn't right." Liu Zhuren said as they walked.

"Not right?"

"Yeah, I don't think it's a Tumor, but I can't put my finger on what it is." Liu Zhuren said, "The renal parenchyma is already gone; by rights, it should be a renal cyst, but this thing is just too big. I don't dare to commit to that diagnosis."

"How big?" Ji Xiang asked curiously.

"I estimate there's 5000ml of fluid inside, and the parenchyma is like a sheet of paper." Liu Zhuren said with confusion, "It shouldn't be possible. Renal cysts are very common; I've seen ones ten or twenty centimeters long, but the renal parenchyma being pressed into a sheet of paper..."

Ji Xiang didn't speak, accompanying Liu Zhuren as they continued toward the Digestive Medicine Department.

A kidney pressed into a sheet of paper—this sounded very strange. The reason Ji Xiang didn't chime in was that he wanted to see the patient's records.

Without even seeing the scans, what right did he have to speak up?

Arriving at the Vascular Surgery Department, Liu Zhuren was the first to arrive; he requested the patient's imaging files and inserted them into the film viewer to take a look.

Although the hospital's internal system was now fully electronic and one could view scans on a computer, Liu Zhuren was older and more accustomed to looking at films on a viewer.

Ji Xiang stood behind Liu Zhuren and watched along with him.

The patient had a massive mass in the left abdomen, about 7 vertebral bodies in length, and its width exceeded the abdominal midline.

If the density hadn't told Ji Xiang that it was a "water sac," anyone would have suspected it was a Tumor.

But such a large "water sac" didn't look like a renal cyst either.

Ji Xiang's ability to read scans wasn't high, just barely passing the standard line. After looking carefully, he went to check the Medical Record.

The System NPC was not easy to fool. Although he rarely tested him, if he were to ask a question and Ji Xiang couldn't answer... Ji Xiang felt that would be too embarrassing.

It had to be said that the Medical Record written by the Internal Medicine doctor was detailed enough, and even though the patient's admission time was short, everything that needed to be written had been.

If it were a Surgery Department patient, even if they were admitted to the ICU, the surgical notes might not even be written before discharge.

After memorizing it, Ji Xiang entered the System Space.

"Teacher, the cyst is very large." Ji Xiang said after reporting to the System NPC.

"It's not a cyst, or rather, it's not an ordinary cyst." The System NPC said, "Consider it to be Giant Hydronephrosis."

"Teacher, hydronephrosis where the kidney is already gone?"

"Yes." The System NPC nodded, "Usually, when hydronephrosis is discovered, there is more or less some kidney tissue remaining. It might not have function, but it can be seen on imaging."

"But Giant Hydronephrosis..."

"Teacher, why is the name of this disease so strange?" Ji Xiang asked.

"It's just exceptionally huge; there's nothing else to describe it." The System NPC said, "It was first proposed by Dr. Stirling in 1939 as the concept of Giant Hydronephrosis."

"That is to say, the volume of fluid in the collecting system exceeds 1000ml, the imaging shows the fluid reaching or exceeding the abdominal midline, occupying half the abdominal cavity, or the long axis of the fluid exceeds the length of 5 vertebrae."

"However, in clinical practice now, 1000ml of fluid doesn't count as 'giant' anymore. I've seen patients with over 5000ml."

"This one must have at least 5000ml too."

"It does, but the patient had no discomfort and only came for treatment when complications appeared, which is quite rare. The formation of Lower Extremity Deep Vein Thrombosis is because the Giant Hydronephrosis compressed the Inferior Vena Cava, causing restricted blood flow and leading to the formation of Thrombosis due to decreased blood velocity."

"It's quite rare; it's normal that your Zhuren hasn't seen it."

"The principle is the same as hydronephrosis; causes include ureteropelvic junction obstruction, vesicoureteral reflux, megaureter, and posterior urethral valves, among which 80% of patients are caused by ureteropelvic junction obstruction."

"As for the treatment..." The System NPC paused.

"Surgery to release the obstruction?"

"Ordinary hydronephrosis can be treated that way, but with Giant Hydronephrosis, the kidney on that side has already lost its function. Retaining it would do more harm than good; it must be surgically removed."

Ji Xiang nodded.

"Don't underestimate this surgery." The System NPC said, "Surgery for Giant Hydronephrosis is quite difficult. Although the concept was proposed in 1939 and Laparoscopic Surgery was already being performed in the last century, it wasn't until 1991 that there were reports of using Laparoscopic Surgery for Giant Hydronephrosis."

"Why, Teacher."

"Because the duration is quite long, the renal capsule and the peritoneum have fused, and the local anatomical tissues have mutated, making it very difficult to complete the surgery using a laparoscope."

"If it were an open surgery, it would be a little simpler."

"Doctor Xiao Ji."

"Here." Ji Xiang replied immediately.

He felt somewhat distressed, guessing whether the System NPC wanted him to experience Empathy once.

"Let's train the surgery directly; watch me perform the surgery once, then try it yourself a few times," the System NPC said. "Only after doing it with your own hands will you understand why it is said that the surgery is difficult to perform."

"No need for Empathy?" Ji Xiang asked.

"The Patient felt nothing at all before discovering the venous Thrombosis, so what is there to try?" the System NPC said. "If you fail the surgery, you can go and give it a try."

Ji Xiang clicked his tongue, not daring to raise any further objections.

(End of this chapter)