The Godfather of Surgery

On this day, it was Zhang Lin's turn to work the night shift.

"At night, we work night shifts, come early to rest, I'm afraid there will be more emergency rooms at night." Zhang Lin has a concerned tone.

Pick up at 5:30 pm.

Yang Ping came over at four o'clock, ate a bowl of Lanzhou ramen, added beef and fried eggs, was full enough, and brought a bucket of instant noodles to spare.

It was about nine o'clock and nothing happened, Zhang Lin took Yang Ping around the house.

"Doctor Zhang, you are bringing a new intern again." The nurse on duty greeted him. This fellow was lying on the marble table at the nurse's station, flirting with the nurse.

Yang Ping looks a little young. After working for a few years, he is always regarded as an intern who just graduated.

"Where, where, the new Dr. Yang, who is not familiar with the environment, we will be on duty together for the time being." Zhang Lin emphasized that he was on duty together, and he dared to admit that he brought Yang Ping.

"A treat! I'm on duty today!" The nurse smiled.

"Hey tea? How many cups?" Zhang Lin was rather happy today.

"There are four of us, two on duty, and two practice nurses." The nurse counted the number.

Sometimes when on duty, the doctor on duty invites the nurses to drink some drinks and asks them to ring the bell to wake you up before the patient sneezes. This is also considered a duty culture.

"Doctor Yang, what flavor do you like to eat?" Zhang Lin said flatteringly.

Yang Ping is a newcomer and feels that he should treat himself: "Dr. Zhang, let me invite everyone to eat, you can order whatever you want."

"No, no! How can I make you spend money? I'll choose it for you." Zhang Lin took out his mobile phone and started ordering takeout from Meituan.

"Dr. Zhang, you're very generous today." The nurse laughed at him. I've never seen him so generous and straightforward. Every time he laughs at him for a treat, it's because the WeChat change is not enough, or next time, the girlfriend is actually strict with discipline and has no room to pay in order to save money. Down payment is inevitable.

Hey tea was delivered, everyone sat down and rested, drinking tea and chatting.

"It must be Christmas Eve tonight!" An intern nurse drank Hey tea and laughed.

"Pi Pi Pi, Crow Mouth!" Zhang Lin stamped his feet anxiously, pretending to spit on the ground.

There is a rule among doctors that you can’t talk too much, such as: I have not had any operations that have been infected; I will definitely not accept a patient on duty today; the patients I manage will not cause disputes—

Legend, so to speak. No? Then I'll show you one right away.

Such words are taboo, and anyone who dares to speak like this is either a newcomer or a mindless one.

"How did the teacher teach you, you didn't teach the basic rules?" Zhang Lin squinted at the senior nurse.

The senior nurse immediately said, "Okay, I'll give you some replantation of severed fingers today. Is this the head office?"

Replantation of severed fingers takes a long time and is very laborious. Most doctors on duty are afraid to accept such patients.

After drinking Hey Tea, he was safe for the time being. Zhang Lin and Yang Ping chatted at the nurse station. Zhang Lin knew everything about the gossip in the hospital.

The chat was in full swing, and the phone at the nurse's station rang, everyone look at me, I look at you, wouldn't it be so miraculous, the senior nurse grabbed the phone: "Hello, I'm an orthopedic department, emergency consultation, what patient, a broken finger ?"

I rely on! Zhang Lin's eyes spit fire.

The nurse put down the phone gently: "No way, did you hear? Emergency department, consultation, finger cut!"

Zhang Lin suppressed the anger that was about to roar, got up, and gently patted the little nurse on the shoulder: "Brother has served you."

Then he said to Yang Ping: "I'll go down and have a look. When I hear from me, maybe the open phalanx is fractured, and it's said to be a broken finger."

This kind of severed finger is divided into complete severance and incomplete severance. Complete severance means that it is broken into two or more segments, and each segment is completely separated without any connection.

Incomplete amputation, generally more than three-quarters of the amputation, if the blood vessels are not anastomosed, the fingers cannot survive.

Sometimes it is possible to misjudge incomplete finger dissections in the rush of the emergency department.

The fingers are broken a lot, but the main blood vessels are still there, and the fingers can survive without anastomosis, which is generally classified as "open phalanx fractures".

Zhang Lin straightened his hair and got into the emergency elevator.

Ten minutes later, Zhang Lin's phone call came.

"Real broken fingers, right thumb, broken by cutting machine, broken into three sections, ready for emergency surgery."

The chief resident doctor, Dr. Guo, was still busy with a major operation on stage and could not get off the stage within a few hours. Besides, the replantation of Dr. Guo's severed finger was basically a pass, and the technique was not very good.

The chief resident physician is not a professional title, but a doctor position. Generally, a resident physician must serve as a chief resident physician for one year before being promoted to an attending physician. The purpose is to undertake more workload before being promoted to an attending physician, so as to get exercise under high-intensity work pressure. .

Therefore, this position is the most difficult position in the inpatient ward. It is open all year round and is available 24 hours a day near the ward or hospital.

Corey's severed finger replantation, there are three people who do the best, Director Han, Director Tian, ​​and Song Zimo. The others can do it. They are not as good as them. Director Han and Song Zimo have gone to the meeting, and only Director Tian is left.

Director Tian is on the second line, but there is a little emergency at home. I have to go to the city, report to Director Han, go to the main duty office for the record, and let Lao Jin help to take care of the second line. Lao Jin is on the operating table and let Zhang Lin debride first. Director Tian is very Will be back soon.

Zhang Lin called Director Tian again. Director Tian said that it is best to wait for him to come back to do this kind of three-section. He was on the way and put his severed fingers in the refrigerator. It would not be a problem to wait for a while.

The little nurse burst into tears, her innocent eyes seeming to say, "It's not my fault!"

Yang Ping hung up the phone, and another photo was posted on WeChat. The thumb was cut into three sections, which was horrible to see. The two free sections were spread on white gauze one by one, which was particularly dazzling.

"I just called Director Tian, ​​and he said that the operation will be arranged first, and he is rushing over." Zhang Lin said, "Dr. Yang, please go directly to the operating room, draw blood, electrocardiogram, and the emergency department has already done the preoperative examination. I'm talking and signing, and I'll go to the operating room right away."

This kind of emergency surgery can generally go through the green channel, and does not need to be hospitalized before surgery. In order to save time, they do pre-operative preparations in the emergency department, complete the interview and sign, and then send them directly to the operating room for surgery, and then they are admitted to the ward after the surgery.

Yang Ping instructed a Gu Peisheng to see the ward, and then went to the ward to check on a few critically ill people to make sure there was no danger. Take the emergency elevator and go directly to the operating room, change slippers and wash clothes, and wear a mask and hat.

The operating room was brightly lit, Lao Jin and Mr. Guo were busy, the obstetrics and gynecology department had a caesarean section, the general surgery department had appendicitis, the thoracic surgery department had hemopneumothorax, and the neurosurgery department was doing a craniotomy.

The automatic door opened, the patient had not come yet, Yang Ping was waiting in the operating room, and the itinerant nurse was already preparing surgical instruments.

About ten minutes later, the nurse pushed the patient in, and Zhang Lin changed his clothes and came in.

The small refrigerator that kept the broken fingers was placed on a machine cart. Yang Ping opened it and saw that the fractures were still uneven.

"Where's Director Tian, ​​haven't you come yet?" The roving nurse asked Zhang Lin anxiously, her voice a little unfriendly.

Zhang Lin felt that the nurse was embarrassed to talk to him like this, and said angrily, "Flush first!"

The higher-level doctors are not on the first-line shift, but only on the second-line shift. There are emergency surgeries. The lower-level doctors first disinfect and lay the sheets, and then do the laying work slowly. This is the normal flow.

Brachial plexus block anesthesia went smoothly, Yang Ping helped raise his hand, Zhang Lin put on gloves, and began to wash the wound on his hand and the severed fingers. Physiological saline, hydrogen peroxide, normal saline, and Type III Aner's iodine were rinsed twice in this order.

"Doctor Yang? I raise my hand, you wash your hands?" Zhang Lin asked Yang Ping to wash his hands, which was a courtesy.

Yang Ping just arrived, and he is not very familiar with the operating room: "I raise my hand, you can go, it doesn't matter."

The instrument nurse has washed and dressed, the sterile instrument table has been laid, the instruments are placed on the table one by one, and a pair of dexterous hands are constantly fiddling. Soon, the instruments are divided into several areas, and the commonly used ones are placed in the most convenient ones. place.

After Zhang Lin washed his hands, sterilized them, laid out the sheets with the equipment nurse, sterilized his hands again, put on a surgical gown, asked Yang Ping to wash his hands too, and came to the stage to help.

The two of them had everything ready, put on their surgical gowns, and sat face to face. Director Tian had not come yet.

Debridement, let's debride first.

Zhang Lin's expression was a little unnatural, and the self-confidence that he pretended to be at the beginning was reduced.

Rinse - debride - rinse again!

1.0 K-wires and electric drills!

With the sound of a rustling micro-drill, the bones at both ends were fixed with crossed Kirschner wires.

The microscope was pushed in and adjusted. The eyes were facing the eyepiece, and the adjustment, focal length, and interpupillary distance were started. After adjusting, I finally saw the field of vision clearly.

The patient's hand should be fixed so as not to move around and affect the operation. The preparations have been completed, and the rest is the key step, finding the blood vessels and anastomosing the blood vessels.

Zhang Lin can only operate under the microscope simply, kissing the blood vessels, no way. So next, I didn't dare to continue. Even if the three-legged cat tried hard under the microscope, even if the blood vessels were barely connected, the blood would not pass.

After waiting for a while, Zhang Lin picked up microscopic tweezers and scissors and tried to find the blood vessel, his hands shaking a little.

"Brother, can you do it?" Yang Ping asked gently.

I originally wanted to show it, but I didn't know that my hand would not obey me. I immediately put down the microscopic tweezers and scissors, and said, "Let's wait for Director Tian."

"It's been almost half an hour, how come it's not yet!" the nurse said softly in Zhang Lin's ear.

"Reminder!" Zhang Lin also lowered his voice.

Anesthesia is a brachial plexus block, not general anesthesia, only one arm is anesthetized, and the patient cannot hear talking or calling, so as not to worry about anxiety.

The itinerant nurse ran out to call again. A few minutes later, she came in dejected, shook her head, and said in a low voice, "There is a traffic jam in the urban area. Even if it opens to traffic immediately, it will take an hour."

"Then what?" the itinerant nurse asked.

"Wait, just wait on the stage, it should be soon! It's really impossible to call Lao Jin over." Zhang Lin also thought of a countermeasure.

But he was afraid that the patient would be anxious, so he asked the anesthesiologist to put the patient to sleep.

Yang Ping tried to say: "Wait a little longer, I'm afraid of delaying the disease, I'll do it?"

"Have you ever replanted a severed finger?"

Yang Ping said lightly: I did it!

"A lot?"

"Not much, hundreds of units!"

Hundreds of units, I haven't watched hundreds of units either, but you have made hundreds of units, so not many?

"You try!" It's okay to try, Zhang Lin agreed.

Under the microscope, the adventitia of a blood vessel has been trimmed and is being anastomosed, and the operation is very skilled.