Chapter 143

"The overall cost of your surgery, if there's no infection, should be around fifteen thousand, but as for exactly how much can be reimbursed postoperatively and how the reimbursement works, you'll have to ask about that."

"This is a car accident injury; we don't really know how the medical insurance side regulates it — it seems if there's a responsible party, the insurance won't reimburse..."

"As for scheduling the surgery, you'll likely have to delay a bit. Admission is arranged in order, but surgery scheduling generally prioritizes the old and the young first, with younger people placed a bit later — basically, hospitals nationwide all follow this sequence for surgery scheduling."

"You were all admitted at the same time, so please understand..."

"If children have surgery early they'll cry and fuss, disturbing everyone's sleep in the ward; if the elderly lie in bed too long they'll develop complications — those two points are why we doctors understand the scheduling. If you really can't wait, you can check surrounding hospitals; I can give you a temporary plaster cast in a bit, that works too."

In the office, Fang Ziye watched Guo Yunlei and Zhang Jinchuan separately admit inpatients, explaining costs and surgery scheduling to them in detail.

It was as if he saw himself on duty — basically, when admitting new inpatients, even if they'd already asked the outpatient professors the same questions, they'd still ask again.

However, fees in prefecture-level city hospitals seem to be slightly lower than at Zhongnan Hospital.

It should be that surgery costs differ somewhat; surgery costs at Zhongnan Hospital are about two to three thousand higher than at Enshi Central Hospital.

Fang Ziye didn't go over to help; although he knew participating in patient admission or applying casts would definitely yield more Knowledge Points than what he was getting now, that would be doing things for the sake of Knowledge Points.

When encountering larger emergency events, running around chaotically would absolutely get you dissed; strict discipline, each doing their own job, following superiors' deployment orders — only that achieves maximum efficiency to properly place every patient.

Fang Ziye couldn't possibly bring up these matters either.

Just then, having only drunk two sips of water, Fang Ziye saw, outside the office, Wang Zhongxing reveal his heavy stubble, putting on a mask as he headed toward the nurse station.

Fang Ziye hurried to catch up.

Right now he and Wang Zhongxing belonged to the minor trauma fracture group, the plaster team — he couldn't let Wang Zhongxing wait for him; this would improve deployment efficiency.

However, Fang Ziye had just stepped out the office door and didn't see any patients or family members waiting at the doorway of the room temporarily arranged as the plaster operating room on the left; looking at Wang Zhongxing, he was already heading in the other direction toward the nurse station.

Slightly puzzled, but Fang Ziye didn't have Wang Zhongxing's contact info, so he didn't chase after him.

Wang Zhongxing quickly reached the doorway of the other operating room for closed reduction and debridement/suturing — actually the dressing room; after Wang Zhongxing went in, another person came out.

If nothing unexpected, Fang Ziye guessed he was the other Deputy Chief Physician, Xue Tao.

As Xue Tao and Wang Zhongxing passed each other, they exchanged a few words; then Xue Tao, rotating his arm, walked toward Fang Ziye's direction.

His right hand tucked into his pocket, his left hand sneakily produced a cigarette box; smiling, he said: "Doctor Fang, hard work — want to go light one?"

As Xue Tao approached, Fang Ziye also saw his name badge: "Teacher Xue, no need, I don't smoke — you go rest?"

Xue Tao wasn't surprised at those words; he nodded: "Not smoking is a good habit; the fractures on this side should be mostly handled by now."

"Want to go to the rest room and rest a bit together? There might be more patients later."

Fang Ziye thought a moment, then nodded: "Okay, Teacher Xue."

"Call me Xue Tao or Brother Tao; what kind of teacher am I in front of you? We're all brothers." Xue Tao had Fang Ziye change his address.

Before reaching the rest room, Xue Tao couldn't resist lighting one; after entering, he immediately took a deep drag, as if pressure and fatigue eased considerably in an instant.

"Brother Tao, are there still a lot of patients on your side?" Fang Ziye smiled and asked.

Xue Tao twisted his neck, slowly rotated his arms, doing simple stretches, expression pained yet enjoying it: "Not bad — you know, reduction is troublesome, some might not reduce successfully."

"Up to now we've only reduced six or seven; there are still people queuing outside."

"Just now this shoulder dislocation — Yuan Hong and I tried reducing it three times, couldn't get it back in, so had Wang Zhongxing come help; my hands are completely worn out." After recovering, Xue Tao slowly rotated his waist, faint cracking sounds coming from his lumbar spine.

Xue Tao had thick eyebrows, a large nose, an ordinary face piled with traces of years and night shifts; the whole person looked remarkably mature.

"Brother Tao, then you and Brother Hong really worked hard." Fang Ziye unceremoniously took off his white coat and sat down first.

Xue Tao gave a half-smile: "This is work; work is part of life. Doctor Fang, you're the one who came to help — that's extra hardship for you."

"If not for today's special situation, we'd already be at the dinner table. Doctor Fang, don't think we're being inhospitable or lacking etiquette, making you come help do work."

As a Deputy Chief Physician, Xue Tao's words carried a certain finesse.

"No no, Brother Tao — this is my first time seeing so many fracture patients; it's truly broadened my horizons. Everything from textbooks and things not in textbooks — I've seen it all. Very happy."

"No wonder many teachers said before: prefecture-level city hospitals temper you the most." Fang Ziye also flattered a sentence, leaned back slightly, both hands braced behind on the lower bunk of the yellow-painted wooden double bed.

Shoulder muscles unloaded, his whole body relaxed.

Xue Tao said: "Maybe this is just different besieged cities — we envy Doctor Fang for easily accessing high-end surgeries and techniques, but Zhongnan Hospital truly lacks opportunities to see orthopedic basic disease types; generally the surgeries you do there start at Grade III."

"Grade IV surgeries are also common, innovative techniques very common, critical patients and difficult cases are daily routine — instead, ordinary debridement/suturing, minor fractures, Kirschner wires, are rarely seen."

"We've seen them until we're sick of them."

"This is the platform difference; no wonder they say your top graduates have good skills after graduation — tempered and grown in such an environment, how could their skills not be good?"

Finished speaking, Xue Tao took another drag; the conversational atmosphere was remarkably considerate, looking after Fang Ziye's emotions, yet neither servile nor overbearing, objectively analyzing.

Fang Ziye shook his head, exchanged a few more pleasantries.

Unexpectedly, Xue Tao had just finished his cigarette, gone to the toilet, drunk half a cup of water, when his phone rang.

It was Li Yuanhong: "Brother Tao, this patient's joint dislocation — seems it can't be reduced; go straight to OR for open reduction, or admit first and schedule elective reduction?"

"Called Director Zhang and Director Hong?" Xue Tao's tone steady; though on speakerphone, hearing the other side's anxiety, Xue Tao wasn't rushed at all.

"Not yet — but earlier Director Zhang called, said he had to go on stage, knew I was here, asked if I was free. I said I'm doing closed reductions here." Xue Tao explained.

"Then call Director Hong for consultation. Director Wu has business down in the town today, don't know when he'll be back."

The department had three groups; Administrative Director was Zhang Mingcan; Wu Guonan and Director Hong were both Team Leader Attending Physicians.

"Good!" Li Yuanhong hung up after hearing.

Xue Tao frowned tightly, downed the water in his cup, then put his mask back on, sighed, and stood up again.

Fang Ziye also stood: "Brother Tao, I'll go see if there's anywhere I can help — anyway I'm idle now."

"That works."

"But you might be disappointed going over — whether joint dislocation or fracture closed reduction, failure rates are a bit high; probability of converting to surgery might be very large." Xue Tao gave a preemptive warning.

Even though Fang Ziye was just a Doctor, Xue Tao had done advanced training at Zhongnan Hospital and knew those former chief residents treated closed reduction like eating and drinking — only a very few cases needed the OR for the old director to handle; only extremely extreme cases needed surgical reduction.

Such technique and foundation, and layer upon layer of backup — prefecture-level city hospitals can't envy it into existence.

Fang Ziye didn't respond, didn't take it to heart.

Following Xue Tao into the other operating room in succession, since both wore white coats, no one thought they were cutting in line; on the contrary, people actively made way.

At this moment, the left lower limb of a young man inside was still in external rotation and eversion deformity, and he was groaning in pain: "I can't take it anymore, Doctor, I can't take it anymore, I can't take it anymore, I can't take it anymore, holy crap..."

His voice was weak and powerless, obviously in extreme pain.

Originally, the best suggestion for manual reduction of joint dislocation is to do it under anesthesia, so the patient has no pain sensation.

But in today's environment, how could there possibly be an anesthesiologist coming specifically to do anesthesia? With so many dislocation patients, if they all had anesthesia one by one, it would be tomorrow morning before reduction could be completed.

On the side, Li Yuanhong and Wang Zhongxing both had faces full of depression, constantly looking at the patient's pelvic X-ray, helpless.

It looked as if this was merely a typical hip joint dislocation.

But adding Xue Tao's reduction attempts together, they had all gone through four reductions, and still fell just a little short. The patient was in pain, and their hands felt as if filled with lead.

Manual reduction of hip joint without anesthesia and muscle relaxation is using arms to twist the thigh; there isn't that much strength, ah.

Fang Ziye also went over first to read the film carefully.

There were only X-rays, no MRI, but Fang Ziye estimated that after so many failed manual reductions, an MRI film would definitely need to be done postoperatively to see if there was soft tissue and ligament damage.

After reading, Fang Ziye also found it very hard to understand; this was clearly a simple hip joint anterior dislocation, so why couldn't it be reduced?

If there were an MRI, one could see if there was muscle interlock or other soft tissue interlocked into the hip joint socket, but there isn't.

Wanting to see if soft tissue interlock exists purely through pelvic X-ray, the difficulty is very high.

At least, Fang Ziye looked very carefully and didn't discover any kind of clue.

In a situation where diagnosis is unclear, if one rashly goes to do reduction again, this is definitely not feasible; Xue Tao and the others all tried four times, and it's impossible for it to be a joint dislocation under routine conditions.

So, should he use the knowledge points first, add points to X-ray Reading Technique to Level 4, to seek increased diagnosis probability?

But his knowledge points aren't abundant; if he rashly adds X-ray Reading Technique, later when something else is needed, there won't be knowledge points to temporarily add points to skills for a safety net.

Fang Ziye pondered in his heart.

But hearing the patient beside him still groaning in a low voice: "Damn it, I'll have surgery, I'll have surgery, Doctor I was wrong, I want surgery, I can't take this anymore..."

Joint dislocation is not comparable to fracture.

Fracture may be quiet, with no pain, but joint dislocation, as long as it's not reduced, correcting the joint's position, then interlocking pain or dull pain poking the muscle will persist.

And possibly because of multiple failed reductions, muscle tissue damage was caused.

Pain intensifies; at this time, what the patient wants most is to do analgesia well, whether it's anesthesia or a shot of strong analgesics.

No other thoughts in mind, just don't let me hurt, please...

Pain as the fifth Sheng Ming Zhi Zhen is considerably painful.

After slight hesitation, Fang Ziye still used four hundred-plus knowledge points to add points to X-ray Reading Technique to Level 4.

He and this old brother are not related by blood or acquaintance, but since he came, there exists a doctor-patient relationship to a certain degree; do what he can, a small loss is a small loss, if it's irrational then be irrational.

Anyway, knowledge points are ultimately for use, his skills ultimately for solving patients' suffering.

After X-ray Reading Technique reached Level 4, Fang Ziye instantly felt his brain had many more things.

For example, the relationships between X-ray Reading Technique Level 1 to Level 4 seem slightly different. At Level 1, as long as you can see the diagnosis it's fine; at Level 2, it seems you can see some subtle changes, like microfractures, the shape of fracture lines.

But at Level 3, you can see anatomical structures, roughly guess what kind of muscle layer this shadow is.

And Level 4 X-ray Reading Technique can very clearly clarify layers, as if the X-ray photo was cut open by you, and in your brain, through your knowledge, corresponding reorganization occurs.

Precisely because of this, Fang Ziye noticed that this patient's femoral head ligamentum teres and acetabulum just happened to form an elastic tension band; the ligamentum teres was like a rubber band, after being stretched, there would exist enormous recoil force. And the femoral head was just stuck interlocked outside the acetabulum.

In this situation, if it's simple, traditional traction toward the distal force line direction, that just happens to be offset by the pressure between femoral head and acetabulum, the ligamentum teres's recoil force; unless you cut the ligamentum teres, let the elasticity disappear, so you fundamentally cannot reduce successfully.

At this time, what needs solving is to move the femoral head first from the acetabulum interlock position, traction toward lateral displacement, disengage from interlock, then proceed with normal force line direction sustained traction.

Operation is not difficult, doesn't need to add points to Manual Reduction Technique to Level 4 either; this is just a tiny problem at the diagnosis level.

A thought reached here, that side, Li Yuanhong just happened to finish calling Director Hong.

"Brother, this, really isn't us doctors trying to make things difficult for you, it's really that there's no manpower now, all our department people are in Emergency Department, Operating Room, and department."

"Your surgery, if it's to be done, can only wait."

"We few will give you one more try; if it really doesn't work, can only give you analgesic injection to handle it." Li Yuanhong conveyed Director Hong Du's meaning.

"Okay okay, fine fine, right now as long as you can make me not hurt, you give me a cut and it's fine."

"I can't endure it..." The patient was already weak and powerless.

Pain index during dislocation period of joint dislocation is at least two times more intense than surgical incision pain after surgery just ends, and it's the kind of colic pain from muscle being pulled, side-pulled.

Hearing this, Fang Ziye said: "Hong Brother, why don't you also rest a bit and do command, I'll do a traction, exert a burst of strength."

What Fang Ziye diagnosed himself, in the current situation, may not be explainable clearly. Plus Li Yuanhong and them had already decided on a final reduction attempt, and seeing Xue Tao and Zhang Jinchuan both already in position.

Fang Ziye didn't waste time with verbose delay, but found himself a position most suitable for exerting force.

This is treating illness, solving patient suffering; that patient hurts so much he almost wants you to directly give him a cut, still delay what fart time, can review later if there's time.

Li Yuanhong had slight hesitation, but seeing Fang Ziye's heart to help was quite sincere, he nodded, looked at Xue Tao: "Tao Brother, then I'll steal some laziness."

Where would Xue Tao have leisure to care about this; he and Li Yuanhong had been reducing here, he himself was tired, Li Yuanhong isn't made of iron either.

Xue Tao was responsible for pelvic position fixation, providing counter-traction force, and then Wang Zhongxing who had exerted force before pinched the patient's lower leg, planning to use his own gravity as a portion of traction force.

Fang Ziye was too thin, gravity's component force too small.

Just right, Fang Ziye could hold the thigh surface.

"Come, one two three, start!" Xue Tao without hesitation.

Hearing this, the patient tightly closed eyes and teeth, took a deep breath, then pondered saying: "Mmm~~~~~~~"

But just at this moment, Fang Ziye slightly toward Xue Tao's pelvic direction exerted a push toward head direction, letting the patient's whole body first slightly shrug toward head, immediately after, Fang Ziye quickly used right hand to push patient's thigh outward, just then, Zhang Jinchuan just happened to start exerting force.

A miraculous scene appeared; that originally seemingly immovable dislocation actually slowly was pulled open—

"Ah? Oh, done?" Reduction hadn't even gone in yet, but the patient's pain actually suddenly relieved a lot; the patient who originally prepared to die of pain once started shouting.

Fang Ziye exerted force again, parallel with Zhang Jinchuan's force.

In an instant, Fang Ziye and Zhang Jinchuan's forces were both completely bounced off.

Because the force of joint normally entering socket is also not something you one or two people can twist.

It was just that the traction force of Fang Ziye and Zhang Jinchuan, the two of them, happened to be the protective force, not letting the rebounding force increase.

After a crisp click sound, the patient's upper body and legs both shrank.

"Ai yo! ~" a sound.

After the brief fear and pain of the joint nearing dislocation disappeared, his whole person went limp and slumped down.

"Comfortable now." The patient closed his eyes, not wanting to move a bit, breathing becoming even, as if a drama queen.

But no one mocked him, and no one had time to mock him.

The reduction action just now, described, is very long, but it was merely a matter of four or five seconds occurring, so Xue Tao and the several people, they only just had time to look toward Fang Ziye's direction.

This pretender, something's not right!

(Chapter End)