Chapter 151

The Trauma Center has a total of five senior professional titles: three Chief Physicians with Senior Professional Titles — Ward Director Zhang Mingcan, Team Leader Wu Guo Nan, and Old Director Hong Du.

Then there are the Deputy Chief Physicians with Associate Senior Titles: Xue Tao from Wu Guo Nan's group and Deputy Chief Physician Huang Kai from Hong Du's group.

Director Zhang Mingcan's group — he did not assign himself a Deputy Chief Physician, only took on a few more Junior Doctors.

Xue Tao immediately realized the ambiguity in his wording and explained: "It's not the kind of 'collapse' you're thinking of; it's just digestive disease caused by electrolyte imbalance from exhaustion."

Fang Ziye blinked upon hearing this, thinking: what essential difference is there? It's just that he didn't 'collapse' in the dramatic sense, right?

But Fang Ziye didn't retort, simply following Xue Tao into the Deputy Chief Physician Office.

Sure enough, without Huang Kai, the office was empty. After Xue Tao entered, he had Fang Ziye close the door, then said: "Ziye, there are three computers here total. Before Li Yuanhong was promoted to Deputy Chief, one was always left free — all connected to the intranet."

"If you can't find a computer over there, just come straight here. That's also Director Zhang's intention."

"In the Deputy Chief Physician Office, besides me and Huang Kai, Directors generally don't come in casually." Xue Tao seemed to be setting rules for Fang Ziye, yet breaking them at the same time.

Not having to fight for a computer in the ward is naturally very convenient, but such an exception made Fang Ziye wonder whether it could be a long-term arrangement.

Not out of pride, but he had to consider whether he'd become the tall tree that catches the wind in the Junior Doctors' eyes, drawing resentment.

After a few seconds' thought, Fang Ziye still said: "Thanks, Brother Tao. And thanks to Director Zhang."

What's there to deliberate now? He already has seven or eight beds under his care in the ward — the medical records and orders for those beds alone will keep him plenty busy.

Fang Ziye hadn't prepared in advance, so his current orders couldn't be slowly refined by reviewing literature; for now he just entered all the routine orders that Wu Guo Nan and Xue Tao had given during rounds.

Most are the standard triple combination.

Detumescence, analgesics, anticoagulants. Preoperative medication.

Fang Ziye carefully cross-referenced while verifying the drug dosages, frequencies, and routes in the orders.

Then he asked: "Brother Tao, what direction is our Director Wu most skilled in? I see our department has quite a few sub-specialties."

Although Enshi Central Hospital's sign says Trauma Medical Center, the case mix inside is actually very mixed — trauma, hand surgery, joints, sports medicine, and minimally invasive spine all seem to be treated.

To find the focus, naturally one must ask what one's own Team Leader specializes in.

Xue Tao said: "Director Wu Guo Nan was previously in the Hand Surgery Sub-specialty, so his main focus in the ward right now is trauma plus hand surgery — you can also understand it as treating fractures and tendon repairs and such."

"Old Director Hong Du was formerly a spine surgeon, taking the trauma surgery plus sports medicine and minimally invasive spine route; Director Zhang Mingcan mainly does trauma and joints."

"Our department's sub-specialties certainly aren't as refined as Zhongnan Hospital's — doing just one direction, we wouldn't have enough to eat." Xue Tao joked.

It's not that Enshi Central Hospital's platform is bad; rather, Enshi People's Hospital and Minzu University Hospital's trauma surgery were very strong before, so Central Hospital's development in recent years has mostly gone toward joints and spine.

Current level is top-tier — about fifty percent of joint and spine surgeries are at Enshi Central Hospital, the other two hospitals split the remaining fifty percent.

As for the trauma surgery sub-specialty, the other two hospitals hold seventy percent of the patient volume; Enshi Central Hospital is now filling that gap.

Xue Tao then smiled wryly: "Of course, Doctor Fang, your timing is... not great. Our department's trauma patients are very numerous right now, and very specialized. We'll be handling them for a good long while."

Fang Ziye nodded.

Then asked: "Brother Tao, how many surgeries can our group generally take in a day?"

"Three to four is the limit. Not as fast as Zhongnan Hospital." Xue Tao replied.

Fang Ziye's heart tightened at that —

No wonder. Right now the group has over thirty patients awaiting surgery; at four a day, running non-stop for a week still wouldn't clear them.

That doesn't even count routine trauma patients coming in daily. All three groups are in similar straits; if something isn't done, within half a month we might not see any other case types, and patients and families will certainly be agitated.

Waiting that long for surgery — how could they not be anxious?

"Actually it's not that few." Fang Ziye replied, smiling.

At Zhongnan Hospital, a group could handle at most three or four surgeries a day too; it's just that the difficulty of surgical cases at Enshi Central Hospital can't compare to Zhongnan.

If you really compare volume, Zhongnan might not even have as many as Central Hospital.

Just higher difficulty.

If it were really just fractures — simple or complex — Professor Deng Yong's group could do ten or eight a day, no problem.

After all, whether it's Deng Yong, Xie Jinyuan, or Yuan Weihong, they can freely split stations and open tables; even for the simplest fracture patients, sending Qin Geluo to lead a team to run a separate table is fine.

Split stations like that, a whole day can handle over a dozen.

But for a prefecture-level city hospital, there's no such strong resource allocation; even if Wu Guo Nan wanted to split, there aren't that many hands.

In the group, counting Fang Ziye, there are only five people total — splitting into two tables is the absolute max.

"Ah well, just take it slow."

"Ziye, you haven't managed this many beds before, have you?" Xue Tao suddenly stood up and hurried over to Fang Ziye.

He'd forgotten one thing: he forgot to walk Fang Ziye step by step through writing orders and setting up medical records.

This is Enshi Central Hospital — the medical record system and medical order system are different from Zhongnan Hospital's.

Zhongnan Hospital's cases and order system are in one system; Enshi Central Hospital's system — who knows who got paid off — is damn near unusable, and to this day there's still no intention to update or replace it.

But seeing Fang Ziye already operating the medical order system and medical record system proficiently, Xue Tao didn't meddle, only inwardly marveled at how fast Fang Ziye's learning ability really is.

No, his learning attitude is also extremely fast — because at some point Fang Ziye had already recorded all the account passwords for both systems in his notebook, along with key points.

"Doctor Fang, not that I'm being sarcastic, but with that learning attitude of yours, even a pig could climb a tree." Xue Tao, after reading it, praised without stinginess.

"Brother Tao, then let me return one: bad workmen blame their tools." Fang Ziye carried no genius baggage.

Genius or not, good memory or bad — Fang Ziye just likes recording in his notebook, checking meticulously one by one; and when reading literature, he prefers printing it out to read the paper version.

Although this costs more, it feels more tangible, and Fang Ziye likes making notes in books, dense and detailed; necessary or not, he maintains the habit.

"Bullshit." Xue Tao lightly patted Fang Ziye.

"Right, Ziye, after you finish the orders, set up a template in the informed consent system for all patients: Closed Reduction of Fracture with Plaster Cast External Fixation."

"Director Wu isn't very interested in trauma cases; he said this morning he'd go find Doctor Huang to come help do closed reductions for the department's fracture patients."

"Any that can be reduced and discharged directly — just handle them and be done." As Xue Tao spoke, he touched his nose.

Looking at Fang Ziye's notebook, then at his own single A4 sheet that looked like a loser's, he felt a bit ashamed.

Fang Ziye's notebook — a month after a patient's discharge you could probably still find his old order records; but his own — he wouldn't even dare confirm whether tomorrow he'd still have notes to know what orders he wrote today.

Fang Ziye had just finished writing the medical orders for the second patient, verified them, and clicked submit.

Turning his head, he asked, "Tao Ge, what kind of immortal is this Doctor Huang that Director Wu went to find? Some fractures that shouldn't be treated with manual reduction can actually be handled with manual reduction?"

Both manual reduction and surgical reduction have their own indications, and the indications of the two are actually complementary under certain circumstances.

Whether a patient's fracture type can be resolved through manual reduction is a matter of both cognition and operation, but in Fang Ziye's memory, he couldn't seem to find a suitable patient who could be treated with manual reduction plus plaster cast external fixation.

How to assess this relates to the principles of fracture treatment.

Fracture treatment has three major principles — reduction, fixation, rehabilitation.

Rehabilitation varies little; everyone is different. The most important points are reduction and fixation.

Forms of reduction can generally be divided into manual reduction and surgical reduction; their indications differ. Generally speaking, patients with contraindications for manual reduction must undergo surgical reduction.

And some special patients with contraindications for surgical reduction are best treated with manual reduction.

It sounds like a paradox, but in reality, general patients with contraindications for manual reduction are those for whom plaster cast external fixation cannot achieve fixation after manual reduction, so they must rely on surgical reduction, using steel plates and screws or intramedullary nails for internal fixation to achieve fixation.

As for patients with surgical contraindications, these are patients who cannot tolerate the impact of surgical treatment, where surgical risk is extremely high — basically one surgery, one death. In such a situation, if you don't do manual reduction, you can only let the patient lie there and recover however they can.

That basically means lying in bed waiting to die. In such a situation, manual reduction with plaster cast external fixation counts as palliative treatment, best-effort treatment; recovery depends on fate. Since surgery can't be done, surgery would mean they wouldn't make it off the table.

Listening to this, Xue Tao's thick eyebrows relaxed, and he laughed, as if he had finally poked a blind spot in Fang Ziye's knowledge —

"Ziye, you didn't know this, did you?"

"You really shouldn't disbelieve it. This Doctor Huang is a Deputy Chief Physician who has a very good private relationship with Director Wu. He was originally from a traditional Chinese medicine background, and now he's in Min Da Hospital's Trauma Surgery Department, serving as the Deputy Director of Trauma Surgery."

Xue Tao paused, cupping his hands slightly: "Director Huang studied under the greatest TCM master in our Enshi, Old Doctor Chen. Although Old Doctor Chen is no longer in Enshi, Director Huang learned the essence of Chen's traumatology."

"In the field of fracture treatment, within the scope of our modern medical understanding, cases that cannot be manually reduced — he really can resolve them through manual reduction, achieving functional or even anatomical reduction, and after reduction, plaster cast external fixation can achieve fixation."

Two unfamiliar names were committed to memory by Fang Ziye.

Director Huang, Old Doctor Chen, TCM.

Could this be the big shot his Master told him about before going on rural rotation? A big shot even he couldn't afford to offend.

"Oh oh oh..." Fang Ziye nodded with a hint of admiration.

He didn't understand TCM, had never studied it systematically, but he revered it deeply.

No other reason: Fang Ziye's own grandfather had been snatched back from death by an old TCM doctor in Enshi, and one of his uncles had also received good treatment and care from a TCM doctor.

TCM is real, but good TCM doctors are hard to find. Most TCM doctors seen on the market are people selling dog-skin plasters that only give you skin infections. Fang Ziye had seen such patients at Zhongnan Hospital — skin ulcerated to the point that Fang Ziye felt pity...

Xue Tao returned to his computer and continued: "Director Wu and Director Huang have a very good private relationship. I heard that back then, they were good friends, just walked different paths, so naturally their private ties haven't lapsed."

"The reason Min Da Hospital's Trauma Surgery has been able to flourish in recent years is Director Huang's credit, but because there's no special research output, he's always been a bit short on promotion to Chief Physician."

"Of course, Director Huang is also relatively young, so his title can't rise that fast either."

"When I first started working, I didn't believe it either. I thought: so many big experts and professors have established surgical indications and manual reduction indications — could they be swayed by you?"

"But later I learned that within modern medicine, manual reduction has a fixed upper limit on the relative limitations of surgical indications and manual indications."

"I remember during an annual meeting one year, a professor mentioned this. He said manual reduction's contraindications and indications are related to the individual. If you can't do it, then even a Type A fracture is a contraindication for manual reduction and an indication for surgical reduction."

"But if you can do it, then even Type B2.3 fractures, even Type C fractures, can all be resolved through manual reduction."

"However, manual reduction is hard to promote, seemingly because TCM's diagnostic methods and modern medicine's X-rays are hard to correspond, and someone did an experiment: same fracture type, same doctor handling it, results still vastly different — very strange."

"A tiny manual reduction has both TCM and modern medicine stumped — also pretty funny."

Fang Ziye listened quietly, pondering carefully, feeling Xue Tao made sense.

But pondering more carefully, he felt the professor's words relayed by Xue Tao were a bit unreasonable!

If surgical indications and manual reduction indications can't be uniformly reflected in guidelines, then modern medicine's trauma surgeons might as well go home and farm.

No way around it: first, it's hard to learn; second, I learned surgery, I can treat through surgery. The guideline writes manual reduction, but I can't do it, so I can only refer out, otherwise it's incompetence.

Wouldn't that be nonsense?

If a technique can't be learned by everyone, then it doesn't possess broad-spectrum applicability.

Why have guidelines? First, experts and medical workers guide disease recognition and treatment; second, as a blueprint for relatively assessing whether a doctor has medical malpractice disputes.

Follow the guidelines, basically won't go wrong — this is universally acknowledged.

Personal ability is personal ability, but how do you guarantee everyone's personal ability is that strong?

Guideline revision relates to the national average medical level, not local level. If guidelines were set based on the average level of Eastern Han's Peking Union Medical College Hospital and West China Hospital.

Then everyone in all township health centers and county hospitals nationwide might as well be cleared out — doing it would be wrong, that definitely wouldn't match reality.

"That makes me look forward to Director Huang coming over to teach a bit sooner." Fang Ziye said.

Being able to broaden one's horizons is the accumulation of worldly experience.

This world is vast, full of all kinds of impossibilities that outsiders don't understand.

Just like Fang Ziye, a doctor who can't even give injections — ordinary people, would you dare imagine? But Fang Ziye really can't; he's never given a patient an injection.

Puncture and local anesthesia don't count.

Then the two stopped chatting; everyone's workload was heavy. Even though Fang Ziye had taken on a portion, there were still admission records for seven or eight beds that needed writing.

There were also admission informed consent forms, trauma patient self-pay notification forms, and various other necessary procedures and signatures.

Why trauma patients must self-pay — this is stipulated by medical insurance, not by doctors. Fang Ziye couldn't explain in particular depth, only informing patients and family members that if they need detailed understanding, please go to the medical insurance registration desk downstairs.

Around twelve noon, Fang Ziye finally finished writing the major medical records and inpatient records for eight patients, but hadn't started the informed consent talks and signatures yet.

But the food had already arrived. Xue Tao said, "Ziye, medical orders done?"

"The medical records can wait, eat first. Director Wu ordered boxed meals to the Director's Office."

"And Director Wu and Director Huang are already eating." Xue Tao stood up, rubbing his belly.

"Director Wu brought Director Huang to eat boxed meals together?" Fang Ziye stood up, slightly surprised.

Honestly, this isn't the way to host a visiting director. Fang Ziye had never learned such hospitality from any teacher.

Whether it's a teacher from a superior hospital coming from afar, a peer from an equal-level hospital, or a junior from a lower-level hospital coming for training — all are treated well.

"Iron brothers, what's a boxed meal? I even saw them using peanuts to wash down a few yuan worth of liquor in the department." Xue Tao said with some envy.

"Down-to-earth, a true brother."

Fang Ziye could imagine that strange scene: two Premium Professional Titles, Middle-aged men in their Forties, hiding in the Department, just using ordinary Peanuts and a few dollars' worth of wine to drink together.

What they were drinking was no longer wine, but Human Touch.

(Chapter End)