Chapter 102

There were simply too many junior doctors in the department; even though Fang Ziye was quite outstanding, he was ultimately not in the same group as Jin Hongzhou. During last year's annual meeting banquet, Jin Hongzhou was the Chief Resident, so he wasn't in the private room.

Later, when the superiors returned, even though Fang Ziye and Luo Tingzhu treated Jin Hongzhou to a meal of KFC, it still failed to leave a particularly deep impression in this Chief Resident's heart.

Now that he had finally connected with that little brother in the department, Jin Hongzhou finally sent a few minor dislocations Fang Ziye's way from the Emergency Department.

After Fang Ziye reviewed the corresponding diagnoses one by one, he found that the diagnoses weren't very complex.

One was a mild anterior shoulder dislocation injury, and the other was a mild ulnar-sided wrist dislocation.

Neither counted as a very complex disease type.

Because the "fellow trainee" with the ulnar-sided wrist dislocation said he was a student from Han City University Medical College, Fang Ziye simply had him wait a moment, and he went to see the middle-aged man first.

"Your dislocation requires closed reduction. Currently in our department, quite a few people can do it."

"But the doctor who does it relatively the most is that Doctor Jin you just saw in the Emergency Department..." Even after the other party finished signing, Fang Ziye still had to ask if he agreed to Fang Ziye performing the operation himself.

This had to be made clear; if the other party suddenly said he didn't want this young doctor to reduce him, even if Fang Ziye reduced him successfully, and he made a huge scene, Fang Ziye would still feel uncomfortable inside.

The middle-aged man hurriedly said: "Doctor Fang, I understand what you mean, but don't you worry."

"Just now when this young man and I entered the department together, that Doctor Jin already said it — he said Doctor Fang, your technique is very good, not inferior to him at all, telling us we can rest assured."

Fang Ziye's undergraduate fellow trainee also nodded, while sizing Fang Ziye up and down, seemingly curious and scrutinizing something.

Fang Ziye collected the informed consent form, started writing some treatment orders in the middle-aged man's medical record book, looked up and said: "Not at all, Doctor Jin is just being polite. Doctor Jin is my superior and teacher; he would certainly be more proficient and experienced than me."

"The teacher's kindness, you can believe, but I can't take it seriously. Real ability still has to be learned step by step."

"It should be manageable; if it's not, I can still call a senior physician to handle it for you." Fang Ziye finished writing the middle-aged man's orders, then took the "fellow trainee's" medical record book and wrote two lines as well —

One line: closed reduction. Second line: return for consultation anytime if discomfort occurs.

"No problem, Doctor Fang." The middle-aged man nodded first.

Immediately after, Fang Ziye, without any surprise, directly pulled both of them into the operating room one after another, completing the reduction and fixation operations simultaneously in an assembly-line fashion.

Naturally, when operating on the middle-aged uncle, Fang Ziye grabbed a strong young man — the classmate who accompanied that fellow trainee, also a Clinical Medicine Five-Year Program student from Han City University — and had him act as an assistant.

It made him overjoyed.

So during the operation on his classmate, this guy's eyes were full of ill intent.

Even when that classmate wore a miserable expression, seriously staring at Fang Ziye's name badge and calling out "Senior Brother Fang," Fang Ziye ignored him.

Not making him write the emergency medical record himself was already good enough.

Fang Ziye remembered he had a first-year master's student classmate from Urology, doing meniscus plasty in Sports Medicine; during his standardized training rotation in Orthopedics' Sports Medicine, it was even more ruthless.

Write admission records and case summaries himself, do informed consent talks and signatures himself, write operative notes himself, issue medical orders himself — the four words "cheap labor" were elucidated crystal clear.

Even that Orthopedics classmate managing the bed didn't write the postoperative record; he established a template, and from the Urology graduate student's admission all the way through to the final postoperative ward round, discharge summary, and discharge diagnosis certificate, he perfected it himself. Heard he left the Sports Medicine ward with tears in his eyes...

Two closed reductions finished; the disease types were minor, yielding only eight knowledge points.

But it was enough.

"Wait a bit, go for a re-check first. After the re-check, Big Brother, come find me to look at the films. Then you two, look at your own films. You can reference textbooks or look up data; if you really can't figure it out, come find Senior Brother." Fang Ziye instructed the three people outside the operating room like this.

The middle-aged uncle laughed: "Right, should read your own films. You're all doctors, one look and you'll understand."

That medical student surnamed Huang, tears nearly fell instantly.

His whole face's expression and eyes seemed to say: Uncle, it's really not the same, you don't understand...

Different trades are like different mountains.

But at this moment, Fang Ziye gave the two fellow trainees his most fervent smile: "It's fine, Senior Brother isn't ignoring you, right? Actually, you can deduce part of it now."

"What are the surface landmarks and clinical manifestations of successful closed reduction of joint dislocation?"

The fellow trainee surnamed Huang didn't reply; the other fellow trainee wearing a jacket pushed his glasses first: "Deformity disappears, joint reduced, swelling still exists, pain relieved or even gone. Also, also... don't know the rest."

The young uncle had already left.

Fang Ziye then saw the two fellow trainees partway, and when walking toward the ward doorway, he nodded: "Close enough. Especially 'swelling still exists' — this proves you read the book very carefully. But there's one more point: active and passive range of motion restored."

The other fellow trainee hurriedly slapped his head, having forgotten the most typical clinical manifestation — he deserved a beating.

Fang Ziye waved his hand, telling them to hurry and take the elevator down to the first floor for X-ray re-check.

The re-check results were all fine, but Fang Ziye was idle anyway, and they were his fellow trainees after all, so he patiently stayed with their films, teaching them a few more things.

From film reading, to joint dislocation classification, to surgical indications and closed reduction indications, then to how to assess postoperative reduction success, then to postoperative rehabilitation, how to cold compress and hot compress, and the corresponding principles.

Even at the end, Fang Ziye told the two: if interested, you can go one layer deeper, slightly compare indications of different closed reduction techniques, writing a meta-analysis would also work...

The two fellow trainees were instantly scared into fleeing. But after running a distance, they turned back to look at Fang Ziye a few times. Meanwhile, Fang Ziye had entered the doctor's office and started doing his own things.

The dressing changes for his assigned patients hadn't been done yet...

Morning, twelve o'clock.

Fang Ziye looked at his knowledge points, which had surged again to seventy-six points — equivalent to an increase of twenty-three points in a single morning.

Five patients, average knowledge point gain per patient as high as 4.6.

Clinical operation knowledge point gains are truly equivalent in efficiency to doing experiments in the lab; even the Outpatient Clinic has to be ranked slightly behind.

However, while Fang Ziye was in the office working hard to wolf down his food, he discovered that his teacher Yuan Weihong, at some unknown time, had tiptoed in like he was dodging gods and ghosts, sneaking in.

After entering the office, he even conveniently closed the door behind him.

Hearing the creak of the door, Fang Ziye subconsciously jumped back violently: "What are you doing!"

"Master!" Fang Ziye really felt a chill down his spine.

Generally speaking, at noon, in the office, basically only the duty doctor or the bed-managing doctor off surgery would come to the office to write orders.

Neither of these two identities would close the door for no reason.

Fang Ziye thought he was about to suffer a backstab from a family member of unknown identity.

There was precedent for this.

"Shh—"

"You only ordered one takeout?" Yuan Weihong looked left and right.

Fang Ziye nodded. "Yes, Master. You haven't eaten yet?"

Who orders two takeouts when they have nothing better to do?!

Yuan Weihong wiped his forehead; the swelling on his forehead was already four fingers high.

Yuan Weihong found a chair and sat down first, pulling out his phone while saying, "This Jie Han — can't afford to provoke him, can't afford to provoke him. You eat first; I'll eat later."

"Master? Does Fellow Trainee talk a lot?" Fang Ziye asked.

"Not just a lot — he's a total chatterbox. When he usually interacts with you, is he like this too?" Yuan Weihong countered.

Fang Ziye thought carefully for a moment, then shook his head. "Just yesterday during the experiment, Fellow Trainee talked a bit more; other times he's been fine."

"Actually, sometimes having a sharper mind and keener grasp is a good thing." Fang Ziye felt Jie Han wasn't bad — just asked too many questions, and those questions were the kind that get asked.

"A certain degree of sharp thinking is good; too much and it annoys people. Where does he come up with so many weird questions? It's really mind-boggling."

"No way, he can't go this afternoon. If he goes, the outpatient clinic already has few patients this afternoon, and I'll get interrogated to death by him."

Yuan Weihong waved his hand dismissively, then after ordering takeout, had Fang Ziye pick it up for him, and he went to hide in the nest inside the Inpatient Department General Duty Room where Jin Hongzhou was on duty.

Fang Ziye agreed.

Then he sent a message to Jie Han: "Fellow Trainee, what did you ask Master this morning?"

"I didn't ask anything. I asked about the patient." Jie Han replied.

Fang Ziye: "..."

Sure enough, after spending more time together, you understand more deeply. Fang Ziye only now discovered Jie Han actually had this side to him.

"Use your head. Do things honestly. If you don't give the teacher time to speak, how can the teacher teach you?" Fang Ziye gave a word of guidance.

"Oh, I got it. Thanks, Senior Brother." Jie Han was still very obedient, very compliant.

And just as Fang Ziye delivered the KFC Yuan Weihong ordered to the Inpatient Department General Duty Room, from the Nurse Station direction came another emergency dislocation patient. Fang Ziye passed the Doctor's Office doorway, and one glance made his eyes light up.

He immediately adjusted his mask and went over to greet them.

They had only just started talking.

At this moment Yuan Weihong came out of the Inpatient Department General Duty Room. He walked to the Office doorway, looked left and right, locked onto Fang Ziye's direction, and said, "Yeah, right, Ziye is in the Department. But, Zheng Ge, having Xiao Fang come to your Hand Surgery to do a suture — isn't that unsuitable?"

"He hasn't had any specialized training in vascular suture."

"Can't help it. Don't know what's going on today — our Department's emergency surgeries piled up in a stack. All Professors and Deputy Chief Physicians are split across stations. I'm now only bringing one Junior Resident, solo on a split station."

"Professor Ni Yaoping said, for the vascular suture on my end, have Ziye come help. You know, his vascular patency rate for suturing vessels is even better than mine."

"Wei Ge, do me a favor — lend Ziye to us?"

"He's on duty?"

"Mm. It won't take long here. You call your Department's Chief Resident, have him come back and temporarily cover."

"Desperate times call for flexible measures. Who could've predicted nine stations of finger replants and limb replants in one morning?"

"We even borrowed the operating rooms over to the Emergency Department." Yang Wenzheng explained in such detail over the phone.

"Alright then." Yuan Weihong also felt that if Hand Surgery's people hadn't all been dispatched out, they wouldn't have come borrowing from Trauma Surgery.

After hanging up, Yuan Weihong walked over, patted Fang Ziye's shoulder, and conveniently took over the joint dislocation closed reduction Fang Ziye was supposed to do, saying, "Emergency Operating Room, Room 4. You go make a trip."

"Yang Wenzheng called for you. I'll call your Fellow Trainee later to cover your shift for a bit."

Fang Ziye's brain briefly crashed — this situation was something he hadn't encountered in the past few years.

But very quickly, Fang Ziye nodded. "Master, then what about the dislocation here?"

"Leave it to me. I'll call Jin Hongzhou in a bit." Yuan Weihong replied.

"Thanks for the trouble, Master." Fang Ziye very cunningly ran straight for the Doctor's Rest Room.

The reason for calling Jin Hongzhou was because all Duty Doctors must be at their Ward posts. If something truly requires going out, the Chief Resident Jin Hongzhou must be informed.

That way, if an accident happens, it won't all land on Fang Ziye this Duty Doctor.

Of course, there still has to be someone in the Ward on 24-hour duty.

Fang Ziye took off his white coat, left the Orthopedics Building, went to the Emergency Department, then wound his way into the Emergency Department's Operating Room.

He felt some emotion — recently, during duty shifts he could be bored out of his mind. Now, just when Jin Hongzhou found the right person for a massive feeding operation, Hand Surgery pulled a grand summoning technique.

His fast track to gaining Knowledge Points was gone.

He just didn't know if this trip to the Operating Room would let him earn back the Knowledge Points.

But since it was Hand Surgery's Yang Wenzheng who spoke, Fang Ziye definitely wouldn't dare drag his feet.

A few minutes later, he scrubbed in, gowned up, and got on the table.

On the table, only Yang Wenzheng, plus a Hand Surgery Fellow Trainee Fang Ziye didn't recognize — Master's First Year, the same cute-newbie type as Jie Han.

"Zheng Ge." Fang Ziye called out.

Yang Wenzheng looked up at the sound. "Perfect. Ziye, you hurry up and suture these few arteries. Restore distal perfusion — this is an upper limb semi-detached amputation."

"I've already mapped the course of the arteries and veins. I still need to do a debridement here, prepare the vascular bed above."

"The earlier the vascular suture, the better."

Fang Ziye didn't dare be negligent. "Was the injury time long at admission?"

"Yes, transferred from Xian City. Our Hospital really invited trouble — this kind of injury could've been handled directly at Xian City People's Hospital, secondary transfer would've been fine too."

"But this patient has a relative at Our Hospital. They trust us too much. Had the ambulance bring them straight here. You see what a mess this stirred up." Yang Wenzheng told the real story.

Fang Ziye then understood why Yang Wenzheng had him come over.

Immediately after, Yang Wenzheng roughly explained the suture requirements to Fang Ziye.

Mm, major artery suture isn't as demanding as the tiny artery suture in finger replantation, because the vessel is thick enough — even 80-90% patency can temporarily guarantee the distal limb won't necrose.

This patient's injury was coincidentally clever — a chainsaw severed the brachial artery, yet nerves and vessels weren't badly damaged.

The other wound was a longitudinal forearm laceration — only tendon and soft tissue injury, no nerve or vessel damage.

A relative from Ben Yuan, not hesitating over hundreds of li, had the patient rush straight here. The Hospital will certainly do its utmost, but the problem is his condition isn't severe either. Other Professors are all scrubbed in, Associate Professors have no time to come over — so they could only have Fang Ziye come do a temporary arterial suture first.

First ensure the blood supply is unobstructed, guarantee the distal limb does not necrose, then later may still need to do a repeat reparative suture to ensure a higher vascular patency rate.

Suturing technique, suturing blood vessels, in terms of suturing operation, there is no problem.

But vascular anastomosis is a relatively specialized operation in vascular surgery and hand surgery; Fang Ziye's experience and proficiency are both not high, therefore the upper limit is estimated to only reach ninety percent, unless he can upgrade to a higher level of plain suturing technique.

Only then would there be hope to not rely on vascular anastomosis's specialized basic operation to improve suture quality.

Counting as impromptu teaching, Fang Ziye also could not care too much anymore.

Put all remaining knowledge points into vascular anastomosis, and vascular anastomosis then upgraded from the original level 2 all the way to level 3 44/500 proficiency.

Regardless of whether it is sufficient use, Fang Ziye himself also did his best.

After adding points, there were indeed not a few techniques infused into his mind; although lacking the solid feeling of gradual point allocation, emergency over protocol.

The exquisiteness of suturing technique will not be specially reflected in the suturing technique's operation. Suturing is just these things.

Level 3 vascular anastomosis, looking at it compared to level 2 suturing technique, also not too far apart; only in the mastery of fire candidate and postoperative efficacy's objective data is there a differential manifestation.

The brachial artery's diameter is not considered very large.

After suturing the artery, Yang Wenzheng hurriedly opened the artery channel, letting the patient's affected limb distal end, for a short time, have unobstructed blood flow for a while.

And this time, already from when Fang Ziye entered the operating room, had been about half an hour's time.

【133】 "Huu, it's done."

"Hah, that'll do."

"Thank you, Ziye."

"You finish the venous suture, then you can go back." Yang Wenzheng said this.

"Mainly we still act considering the patient, so try best to make every step the best, that's why we called you over; heard your master say you still have to be on duty, you go back first."

"Later professors and associate professors will come over to further handle it." Yang Wenzheng was only temporarily transferred, naturally use up then return.

Fang Ziye did not reply, first silently did the work, another forty-plus minutes later...

Fang Ziye asked Yang Wenzheng's opinion, then nodded: "Teacher Yang hard work, then I'll leave first."

Yang Wenzheng's words, and what they did, all made Fang Ziye no longer jokingly call Zheng Ge, but use teacher as address.

If not emergency situation, acting on attitude of being responsible to patient, Yang Wenzheng several needles just stabbed.

Who is not more willing to not request help?

(Chapter End)