Chapter 1949: 1881 Pre-operative Patient Examination

Zheng Ren spoke softly, his words not harsh. Even so, the gentle tone made Xia Hua feel somewhat embarrassed.

Generally, the initial symptoms of onset are severe nausea and vomiting, followed by chest pain and upper abdominal pain.

Some patients have hematemesis or bloody vomitus.

The pain is tearing, intolerable, and not easily relieved by large doses of analgesics. The pain is usually located in the upper abdomen, behind the sternum, both flanks, and lower chest. Sometimes it radiates to the shoulder and back. When symptoms are severe, there is obvious shortness of breath, difficulty breathing, cyanosis, and even shock.

Zheng Ren looked at the image, found the spot he wanted, and calmly explained it to Xia Hua.

"I haven't looked at the medical record and don't know the patient's condition, but why can I be fairly sure it's an esophageal spontaneous rupture? Because there are typical imaging findings."

"On a lateral chest X-ray, mediastinal emphysema can be seen, with subcutaneous emphysema in the neck, and in the anteroposterior view sometimes a unilateral posterior mediastinal air shadow appears, triangular in shape."

"This is a typical imaging sign, shown on CT here." Zheng Ren then outlined an area with the mouse.

"If you're worried, you can choose to do an upper GI contrast study with barium, which would show barium draining from the pleural cavity."

"Moreover, the drainage fluid in the chest tube is turbid, which does not match the characteristics of a bronchopleural leak."

"But further tests are unnecessary; go straight to surgery, performing an open-chest exploration. If I'm correct, after freeing the esophagus we'll do a simple suture and place an esophageal stent."

"If you're right, we'll repair the lung lobe—does that work for you?"

After that speech, Xia Hua was left completely bewildered.

"Did you send the pleural fluid for amylase testing?" Su Yun asked from behind, her tone full of contempt.

"Although his words were a question, you could feel he was actually saying you hadn't even tested amylase, and you're spouting nonsense about a bronchopleural leak!"

"No……" Xia Hua froze.

Is this the difference between the provincial capital and the imperial capital?

"No need, just open the chest and explore." Zheng Ren smiled: "The diagnosis is very clear; I look at the patient and send him straight to the operating room."

"You still need to look at the patient?" Su Yun said from behind.

"Examining the patient before surgery is the rule; you can't overlook it just because time is short." Zheng Ren said.

Although the diagnosis was clear, Zheng Ren still liked to refer to the system panel—it had become a habit.

Yet the shock this statement gave Gao Shaojie and Xia Hua was far more than just a simple explanation of the patient's condition.

Responsibility is a must for a doctor.

But everyone has been worn down by life for decades, and some original intentions have changed.

Flying in to perform surgery, spending a day going back and forth, the more surgeries done per unit time, the higher the income.

The higher the income, the better the life for wife and children.

This is a simple calculation that everyone does.

So many professors, having viewed the phone-transmitted images beforehand, are unwilling to examine the patient again.

Of course, doing this doesn't matter, after all the local hospital has already passed the first checkpoint. If there were any problematic patients, they would certainly be brought up directly.

Professors can finish the surgery and leave, but the attending physicians cannot.

Moreover, this surgery brings Zheng Lao Ban no profit; it's purely a favor, lending a hand.

Gao Shaojie felt a bit embarrassed, but he didn't say anything.

Xia Hua immediately contacted the escort who had sent the patient for testing, saying the patient was already on the way. The few of them then went straight to the hallway to wait, to avoid moving the patient onto a bed and back again.

"Zheng Lao Ban, how's Old Liu over there?" Gao Shaojie asked when the patient returned.

"Pretty good, just really tired—I feel……" Zheng Ren hesitated.

"His hair is getting thinner, and he even said he wants a hair transplant; I estimate the hair on the back of his head is almost gone. Old Liu's hairline really reaches his waist." Su Yun said with a smile.

"Is the improvement obvious?" Gao Shaojie asked, pretending not to care.

"Not bad, it can go up a tier. Now that Old Liu is back doing TIPS surgery himself, there shouldn't be any mistakes." Zheng Ren glanced at the door and said offhand.

Gao Shaojie's heart felt like it had been tossed into a frying pan, sizzling and rolling about.

Back then, a single thought of mine……

But the child has the college entrance exam; I truly can't leave. Even if I could start over, Gao Shaojie estimates he'd still choose to stay home.

As parents, how could we abandon the child in the final months, introducing instability?

Wait until the little one at home gets into college; then I'll say whatever, but I'll wait for Old Liu to return before going to the imperial capital.

If the child can get into a university in the imperial capital, that would be perfect.

By then, I'll be doing both accompanying studies and further training… Gao Shaojie is planning his future in his heart.

"Zheng Lao Ban, after Old Liu returns and my son finishes the college entrance exam, can I go for further training for half a year or a year?" Gao Shaojie asked.

"Welcome." Zheng Ren smiled: "Old Gao, if you can go, that's best. Fugui'er and Old Liu are leaving, so I have no one to perform surgeries on my side."

Gao Shaojie's heart was set at ease.

As they spoke, the sound of a gurney approached.

It had been a while since he'd been away from the emergency department, but hearing the gurney wheels roll over the marble floor still made Zheng Ren's heart race.

This habit, I guess, will never be cured in a lifetime.

He stopped the gurney and Zheng Ren examined the patient.

Breath sounds on the left were extremely faint, with faint crackles, but not obvious. That didn't matter; the key was that Zheng Ren checked the system panel, and it was indeed an esophageal spontaneous rupture.

"Let's go up, to the hybrid operating room." Zheng Ren said: "Doctor Xia, you or have the resident do the pre-op briefing."

Xia Hua forgot his fatigue and began to rush about busily.

He explained the condition to the patient's family, mentioned the emergency surgery, and needed signatures. Although the patient had a gastric tube, urinary catheter, and IV line, just preparing the skin was enough, but there wasn't half an hour to finish everything.

After more than ten minutes, Xia Hua handed over the pre-op briefing and signatures to the resident, then took the patient whose skin had been prepped and went up first.

"Boss, you're just too easygoing." Su Yun said dissatisfiedly: "I remember you changed after going abroad—what's going on?"

"It's the same after going abroad; there's no difference." Zheng Ren said.

"At King's Hospital, I remember you kicked Gai De into the wall with one foot."

「He wants to do chest compressions; look at that posture, once he presses down, there's no need for rescue. That's killing, not saving—how can one not be anxious? 」 Zheng Ren said, 「As for you, you smashed Director Sun of the Medical University Affiliated Hospital with forceps; the impact is very bad. 」

「I find that guy displeasing. 」 Su Yun said: 「He just came over to nitpick; can you get by in Shou Bing just with talk? Really, starting off with a dog, Shou Bing all relies on talk. 」

Gao Shaojie listened, stunned speechless.