top student at medical school

Chapter 143 Something's Wrong with This Guy (Please Subscribe)

"The total cost of your surgery, assuming no infection, should be around 15,000 yuan. However, you'll need to ask about the specific amount and reimbursement process after the surgery."

"Your injury falls under the category of a car accident injury. We're not really sure about the medical insurance regulations, but it seems that if one party is at fault, the medical insurance won't cover it..."

"As for the surgery arrangements, you'll probably have to postpone them a bit. Although hospital admissions are arranged in order, the surgery schedule is generally arranged with the elderly and children first, and younger people will be scheduled a little later. This is basically the order in which hospitals across the country arrange surgeries."

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

“If a child has surgery too early, he will cry and make a fuss, keeping the other patients in the ward awake. Elderly people will also develop problems if they lie in bed for too long. These are the two reasons why we doctors understand the situation. If you really can’t wait, you can go to a nearby hospital. I can put a temporary cast on you later.”

In his office, Fang Ziye watched as Guo Yunlei and Zhang Jinchuan admitted inpatients separately, explaining the costs and surgical arrangements to them in detail.

It was as if I was seeing myself on duty. Basically, when admitting new patients, I would ask them the same questions that the professors in the outpatient department had already asked.

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

There should be a difference in the cost of the surgery. The cost of surgery at Zhongnan Hospital will be about two to three thousand yuan higher than that at Enshi Central Hospital.

Fang Ziye did not go over to help in any way. Although he knew that participating in patient treatment or applying casts would definitely earn him more knowledge points than he was doing now, he was doing it for the sake of knowledge points.

When faced with a major emergency, running around aimlessly will definitely be criticized. Orders must be obeyed, everyone must do their own job, and follow the instructions and orders of superiors. Only in this way can all patients be settled as quickly and efficiently as possible.

Fang Ziye couldn't possibly bring up these matters.

However, Fang Ziye had only taken a couple of sips of water when he saw Wang Zhongxing outside the office, revealing his stubble and wearing a mask as he walked towards the nurses' station.

Fang Ziye quickly followed.

He and Wang Zhongxing are now in the team that treats minor fractures and applies casts, so they can't let Wang Zhongxing wait for them; this will speed up the process.

However, as soon as Fang Ziye stepped out of the office, he did not see the door to the left, which had been temporarily set up as a plaster casting room, where patients and their families were waiting. Looking at Wang Zhongxing, he was already heading in another direction toward the nurses' station.

Fang Ziye was slightly puzzled, but since he didn't have Wang Zhongxing's contact information, he didn't pursue him.

Wang Zhongxing soon arrived at the door of another operating room for manual reduction, debridement and suturing, which was actually a dressing room. After Wang Zhongxing went in, another person came out.

If nothing unexpected happens, Fang Ziye guesses that he is another associate chief physician, Xue Tao.

When Xue Tao and Wang Zhongxing passed each other, they exchanged a few words. Then, Xue Tao walked towards Fang Ziye while wrapping her arm around herself.

He put his right hand into his pocket, while his left hand quietly took out a cigarette case, and said with a smile, "Dr. Fang, you've been working hard, would you like to light one?"

As Fang Ziye approached Xue Tao, he noticed his name tag and said, "Teacher Xue, no need, I don't smoke. Please go and rest."

Xue Tao was not surprised to hear this and nodded: "Not smoking is a good habit, and the fractures here should be almost treated."

"Shall we go to the rest room to rest for a bit? There might be more patients coming in later."

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

"Just call me Xue Tao or Brother Tao. What kind of teacher am I in front of you? We're all brothers." Xue Tao told Fang Ziye to change his form of address.

Before reaching the lounge, Xue Tao couldn't help but light one, and then after entering the door, he quickly took a deep breath, as if the pressure and fatigue were relieved a lot in an instant.

"Brother Tao, do you still have a lot of patients over there?" Fang Ziye asked with a smile.

Xue Tao twisted her neck and slowly twisted her arms, doing simple stretching exercises, her expression a mixture of pain and enjoyment: "It's alright, as you know, repositioning is quite troublesome, and some may not even be able to be repositioned."

"So far, we've only reset six or seven people, and there's still a queue outside."

"I tried to reposition my dislocated shoulder three times with Yuan Hong, but we couldn't get it back in place. So I asked Wang Zhongxing to help me because my hands were completely exhausted." After recovering, Xue Tao slowly started to wrap his waist around his waist again, with a faint cracking sound coming from his lumbar vertebrae.

Xue Tao has thick eyebrows and a large nose. Her face is ordinary, but it bears the marks of time and night shifts, making her look quite mature.

"Brother Tao, you and Brother Hong have really worked hard." Fang Ziye took off his white coat without ceremony and sat down first.

Xue Tao smiled enigmatically: "This is work for us, and work is part of life. Dr. Fang, you're the one who came here to help, so this is extra work for you."

“If it weren’t for the special circumstances that happened today, we would already be at the dinner table. Dr. Fang, please don’t feel that we have been unhospitable or impolite, and that we have asked you to come and help us with our tasks.”

As an associate chief physician, Xue Tao has a knack for speaking.

"No, no, Brother Tao, this is the first time I've ever seen so many fracture patients. It's really broadened my horizons. I've seen everything that's in textbooks and not. I'm very happy."

“No wonder many teachers said that city-level hospitals are the best for training people,” Fang Ziye flattered, leaning back slightly and supporting himself with his hands on the lower bunk of the yellow lacquered wooden double bed.

The muscles in my shoulders relaxed, and my whole body relaxed.

Xue Tao said, "Perhaps this is the difference between different besieged cities. We envy Dr. Fang for being able to easily access high-end surgeries and procedures, but Zhongnan Hospital really doesn't have the opportunity to see basic orthopedic diseases. Generally, the surgeries performed there are at least level three."

"Level IV surgeries are common, and innovative surgical techniques are also very common. Critically ill patients and patients with difficult and complicated diseases are commonplace. On the contrary, we rarely see ordinary debridement and suturing, minor fractures, or Kirschner wire injections."

"We're all sick of seeing it."

"That's the difference between platforms. No wonder you top students are so technically skilled after graduation. You've been honed and grown up in this kind of environment, how could you not be technically skilled?"

After Xue Tao finished speaking, he took another puff. The atmosphere of his conversation was quite considerate, taking care of Fang Ziye's feelings, yet he remained neither humble nor arrogant, offering an objective analysis.

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

Unexpectedly, Xue Tao had just finished smoking, gone to the restroom, and drunk half a glass of water when his phone rang.

It was Li Yuanhong: "Brother Tao, this patient's joint dislocation seems to be unable to be reduced. Should we transfer him directly to the operating room for open reduction, or should he be hospitalized first and reduced electively?"

"Have you called Director Zhang and Director Hong?" Xue Tao's tone was calm. Although the speaker was on, he could hear the urgency on the other end, but Xue Tao himself was not anxious at all.

“Not yet, but Director Zhang called earlier and said he was going to go on stage. When he found out I was here, he asked if I was free. I said I would perform manual repositioning here,” Xue Tao explained.

"Then let's call Director Hong and ask him for advice. Director Wu went to town today and I don't know when he will be back."

The department has three groups. The administrative director is Zhang Mingcan, and Wu Guonan and Director Hong are both chief physicians leading their respective groups.

"Okay!" Li Yuanhong hung up the phone after hearing that.

Xue Tao frowned slightly, then drank the water in her glass in one gulp. She then put her mask back on, sighed, and stood up again.

Fang Ziye also stood up and said, "Brother Tao, I'll go over and see if there's anything I can help with. Anyway, I'm just sitting here doing nothing."

"OK."

"However, you might be disappointed if you go there. After all, the failure rate is quite high for both joint dislocation and manual reduction of fractures, and the chances of needing surgery are very high." Xue Tao gave a heads-up in advance.

Even though Fang Ziye was only a PhD, Xue Tao had studied at Zhongnan Hospital and knew that the previous chief inpatients treated him like livestock, using manual reduction as if it were just eating and drinking. Only a very small number of cases required going to the operating room to be handled by the senior director, and only extremely rare cases required surgical reduction.

Such technology and expertise, along with layers of safety nets, are something that prefecture-level city hospitals can only envy.

Fang Ziye didn't respond, nor did he take it seriously.

After following Xue Tao into another control room, since both of them were wearing white coats, no one thought they were cutting in line; instead, they made way for each other.

At this moment, a young man inside still had an external rotation and eversion deformity in his left lower limb, and he was groaning in pain: "I can't go on, doctor, I can't go on, I can't go on, damn it..."

His voice was weak and feeble, clearly indicating extreme pain.

Ideally, manual reduction of joint dislocations should be performed under anesthesia so that the patient does not experience pain.

But in today's environment, how could there possibly be an anesthesiologist to administer anesthesia? If so many dislocated patients were anesthetized individually, the repositioning wouldn't be completed until tomorrow morning. Beside them, Li Yuanhong and Wang Zhongxing looked utterly frustrated, constantly glancing at the patients' pelvic X-rays, utterly helpless.

It appears to be just a typical hip dislocation.

However, including the number of times Xue Tao performed the repositioning, they had undergone four repositionings, yet it was still just a little short. The patients were in pain, and their hands felt like they were filled with lead.

Manual reduction of the hip joint without anesthesia or muscle relaxation involves twisting the thigh with your arm, but you don't have that much strength.

Fang Ziye also went over and carefully reviewed the film first.

There was only a plain film, not an MRI, but Fang Ziye estimated that since the manual reduction had failed several times, an MRI would definitely be done after the operation to check for soft tissue and ligament damage.

After reading it, Fang Ziye also found it hard to understand. This was clearly a simple anterior hip dislocation, so why couldn't it be reduced?
If you have an MRI, you can see if there is any muscle or other soft tissue trapped in the hip socket, but there isn't.

It is very difficult to determine whether there is soft tissue compression simply by using a plain pelvic X-ray.

At least, Fang Ziye looked at it very carefully and didn't find anything amiss.

If the diagnosis is unclear, it is definitely not feasible to rush into repositioning. Xue Tao and others tried four times, and it could not be a joint dislocation under normal conditions.

So, should we use up our knowledge points now and upgrade our X-ray reading skills to level 4 to increase our diagnostic chances?

However, I don't have enough knowledge points. If I rashly add X-ray reading skills, I won't have any knowledge points to temporarily add skills to cover myself when I need them later.

Fang Ziye pondered to himself.

But the patient beside me was still moaning softly, "Damn it, I need surgery, I need surgery, doctor, I'm sorry, I want surgery, I can't take it anymore..."

Joint dislocation is different from fracture.

A fracture may not cause pain when at rest, but a joint dislocation will persist as long as it is not reduced and the joint position is not corrected. This can manifest as a locking pain or a dull ache that feels like it is poking into the muscles.

Furthermore, the repeated failures to reposition the muscle tissue may have caused damage.

When the pain intensifies, what the patient wants most is pain relief, whether it's anesthesia or a strong painkiller injection.

I have no other thoughts in my mind, please don't hurt me anymore...

Pain, as the fifth vital sign, is quite painful.

After a slight hesitation, Fang Ziye still used more than 400 knowledge points to upgrade his X-ray reading skills to level 4.

He had no relation to this man, but since he was there, there was a certain degree of medical relationship between them. He would do his best, even if it meant losing a little money. If he was being irrational, then so be it.

Ultimately, knowledge is used to help patients alleviate their pain.

After reaching level 4 in X-ray reading, Fang Ziye instantly felt a surge of new information in his mind.

For example, the relationships between X-ray interpretation levels 1 to 4 seem to differ slightly. At level 1, you only need to be able to make a diagnosis, while at level 2, you can see subtle changes, such as microfractures or the shape of fracture lines.

However, at level 3, you can see the anatomical structure and roughly guess what kind of muscle layer the shadow represents.

Level 4 X-ray reading skills can clearly distinguish the layers, as if the X-ray image has been cut open and reorganized in your mind using your knowledge.

It was for this reason that Fang Ziye noticed that the patient's ligament teres of the femoral head and the acetabulum formed an elastic tension band. The ligament teres, like a rubber band, would have a huge retraction force after being stretched. And the femoral head was stuck outside the acetabulum.

In such a situation, if you simply apply traction in the traditional direction towards the distal end of the force line, it will be counteracted by the pressure between the femoral head and the acetabulum, as well as the retraction force of the ligament of rounds. Unless you remove the ligament of rounds and make the elasticity disappear, you will not be able to successfully reduce the position at all.

At this point, the solution is to first move the femoral head from the position where it is trapped in the acetabulum to the side and pull it out of the trapping position, and then perform continuous traction in the normal force line direction.

The operation is not difficult, and you don't need to upgrade the hand repositioning technique to level 4 yourself. This is just a diagnostic issue, and there was a tiny problem.

Just then, Li Yuanhong finished his phone call with Director Hong.

"Brother, this is really not because we doctors want to make things difficult for you, but we are just short-staffed right now. Everyone in our department is in the emergency room, operating room, and other departments."

"If you want to have this surgery, you'll have to wait."

"We'll try one more time. If that doesn't work, we'll have to give you a painkiller injection," Li Yuanhong relayed Director Hongdu's message.

"Okay, okay, fine. As long as you can stop me from feeling pain, you can cut me, I'll do it."

"I can't hold back anymore..." The patient was already weak and powerless.

The pain during a joint dislocation is at least twice as intense as the pain at the surgical incision site immediately after surgery, and it is a kind of cramping pain caused by the muscles being pulled and stretched to the side.

Upon hearing this, Fang Ziye said, "Brother Hong, why don't you take a break and take charge, while I'll provide guidance and lend a hand?"

Fang Ziye's own diagnosis might not be able to explain things clearly in the current situation. Furthermore, Li Yuanhong and others have already decided on the final repositioning, and Xue Tao and Zhang Jinchuan are already in place.

Fang Ziye didn't waste time with unnecessary chatter, but instead found himself in the most suitable position to contribute.

This is about treating illness and relieving the patient's pain. The patient over there is in so much pain that he almost wants you to just cut him open. What's the point of wasting any time? We'll review this later when we have time.

Li Yuanhong hesitated slightly, but seeing that Fang Ziye's willingness to help was genuine, he nodded and looked at Xue Tao: "Brother Tao, then I'll take a break."

Xue Tao had no time to care about this. He and Li Yuanhong had been working on their resetting for a long time and were exhausted. Li Yuanhong wasn't made of iron either.

Xue Tao was responsible for fixing the position of the pelvis and providing counter-traction, while Wang Zhongxing, who had previously exerted force, pinched the patient's calf and intended to use his own weight as part of the traction force.

Fang Ziye is too thin; the component of gravity is too small.

Perfect timing, Fang Ziye can support his thighs.

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

Upon hearing this, the patient closed his eyes and clenched his teeth, took a deep breath, and then mumbled, "Hmm~~~~~~~"

But at that moment, Fang Ziye exerted a slight upward force towards Xue Tao's pelvis, causing the patient to tilt slightly towards his head. Immediately afterward, Fang Ziye quickly pushed the patient's thigh outward with his right hand. Just then, Zhang Jinchuan began to exert force.

Then a miraculous scene unfolded: the seemingly immobile dislocation slowly began to separate—

"Huh? Oh, all done?" The patient's pain was relieved a lot before the repositioning was even done. The patient, who had been prepared to suffer excruciating pain, started shouting.

Fang Ziye exerted his strength again, making his force parallel to Zhang Jinchuan's.

In an instant, Fang Ziye and Zhang Jinchuan's power was completely deflected.

Because the force required for a joint to properly engage is not something that one or two people can easily twist.

However, the pulling force of Fang Ziye and Zhang Jinchuan was precisely the protective force, preventing the rebound force from increasing.

With a crisp snap, the patient's upper body and legs jerked back.

"Ouch!"

After the brief, intense pain and fear of his joint nearing dislocation subsided, he collapsed completely.

"I feel better." The patient closed his eyes, not wanting to move at all, and his breathing became even, as if he were a drama queen.

But no one laughed at him, and no one had time to laugh at him.

The repositioning process, though described as lengthy, only took four or five seconds, so Xue Tao and the others barely had time to look in Fang Ziye's direction.

Something's not right with this guy!
(End of this chapter)