top student at medical school

Chapter 80: Realizing It After the Facts (Seeking First Subscription)

However, Luo Tingzhu did not reply again. It was getting late, and Luo Tingzhu probably needed to rest as well.

Fang Ziye finished charging his phone, tossed it aside, rested his hands behind his head, and looked at his knowledge points, which had earned him over forty points in a day, feeling quite pleased with himself.

Yesterday, I used over 60 points to upgrade the Hand Reset Technique to level 3, but now I've recovered over 40 points, which is practically free.

Unfortunately, that won't be possible tomorrow. If I need to be on duty, emergency surgeries will be performed as emergency procedures, which won't be of much concern to me. Besides, my senior colleague Gu Yi has an experiment tomorrow night, so I'll have to miss that too...

There's still not enough time, far from enough.

Once I'm out of residency training, I'll have more freedom, and that's when I'll definitely have the biggest source of knowledge.

Take it slow, there's no need to rush. If Junior Brother Jiehan can really apply for another small research project, then I'll have more experiments to do. With experiments, I'll have papers to publish, new knowledge points to gain, and that will further strengthen my chances of staying at the institute.

Clinical practice cannot be relaxed either. Try to break the first practice room before graduating with a doctorate, no, try to break it before applying to go abroad, so that Professor Deng Yong will have a deeper memory of me and never forget me after I go abroad. Otherwise, what if Professor Deng Yong forgets me when I come back from abroad?
I still need to go abroad to see the labs and clinical environment overseas...

Moreover, to apply for studying abroad, you need research ability to get a full scholarship. Otherwise, if you pay for it yourself, you won't put that pressure on your parents!
Keep it up!
Fang Ziye drifted off to sleep.

November 17th, Thursday, was the second day of the National Orthopedics Annual Meeting.

Fang Ziye washed his face and brushed his teeth early, and after eating a bowl of hot dry noodles in the cafeteria, he rushed to the department.

By now, most of the team members who remained in the department had arrived, except for Shu Lang, who was still missing. Senior Physician Qin Geluo, Gu Yi, Luo Tingzhu, and Lan Tianluo were all busy in the doctor's office.

Gu Yi was chatting with Qin Geluo and others, while Luo Tingzhu was checking and reviewing the relevant medical orders for the patients in her group to ensure everything was in order.

Fang Ziye walked into the office wearing a white lab coat, straightened his name tag, pulled out a chair in front of a computer, and prepared to sit down.

When Jin Hongzhou saw Fang Ziye enter, he suddenly had a flash of inspiration. He looked at Fang Ziye with a slightly surprised expression for a few moments before changing the subject: "By the way, Brother Nuo, Brother Luo, could you take a look at this dislocated joint for me?"

"To me, this anterior dislocation doesn't seem so simple; it looks like it's close to moderate."

There were two anterior shoulder dislocations yesterday. Jin Hongzhou didn't take it seriously at first, but after Fang Ziye sent him the X-rays before and after the follow-up examination, Jin Hongzhou suddenly realized that the aunt's dislocation yesterday was not a simple mild dislocation.

Later, Jin Hongzhou planned to ask, but he was delayed by other things. After the emergency consultation and surgery, he ran to Ping for another consultation until 10 o'clock. Moreover, Fang Ziye and Luo Tingzhu went to Shashi to get cells, so Jin Hongzhou didn't want to bother them.

Just as Fang Ziye flashed past the door, Jin Hongzhou suddenly remembered that there were two senior colleagues in the department who had recently been discharged from the general ward. They shouldn't have forgotten about anterior shoulder dislocation, which is one of the most common emergency dislocations.

Upon hearing this, Fang Ziye appeared slightly nervous. After skillfully logging in with his account and password, he turned to look at the person in question.

It seems I performed the repositioning myself in the emergency room yesterday. Could it be that I made a mistake in my assessment?

Although Fang Ziye was confident in his theory and practice, the person speaking was Jin Hongzhou. General resident physicians like Jin Hongzhou had all passed the training in room 801, and their skill in manual reduction was no worse than his own, but only better.

It is not impossible for a judgment to be wrong due to limited knowledge.

After handing the phone to the two men, Jin Hongzhou looked at Fang Ziye and said, "Ziye, don't be nervous. It's not that you did a bad job of resetting it."

"You know what I mean, right?" Jin Hongzhou's eyes were deep, as if he was hinting at something to Fang Ziye.

Qin Geluo had been hospitalized for a year and a half longer than Li Nuo and had more seniority. After only glancing at him briefly, he professionally said, "Based on the distance of the dislocation, it is classified as a mild to moderate dislocation."

"Relatively speaking, it's not so easy to reset, is it?" Qin Geluo's tone was slightly playful, and his face was full of smiles as he looked at Fang Ziye.

It's as if it's saying, "You little rascal, you've been keeping quiet all this time."

Li Nuo's voice was even deeper: "Ziye, are you eyeing the 'exciting conditions' Professor Deng offered you? Are you planning to leave seclusion early and graduate ahead of schedule?"

There are rewards in the department for those who leave the training room after completing their training; this is a condition that all professors and department heads openly acknowledge.

For master's degree and residency training, students can directly enroll in the training room that aligns with the master's level after completing their studies.

If you graduate from your doctoral program and complete your first training session, we will try our best to arrange employment for you, but it depends on luck, that is, whether anyone else in your year also completes their first training session.

If not, then unless his research experience is so incredibly rich that you have to give way to him, you will have the advantage. This has been the recruitment rule that Zhongnan Hospital has followed for many years.

Upon hearing Li Nuo's rough voice, Luo Tingzhu, who was checking the doctor's orders, twitched her ears and glanced at Fang Ziye, but Fang Ziye was not looking in her direction at the moment.

Even so, Luo Tingzhu still thought that if her senior brother Fang Ziye could graduate early, they could avoid graduating the same year as her.

The people who will compete with Fang Ziye for employment are Yan Zhiming and Xue Cao, both first-year doctoral students. If that's the case...

"Brother Nuo, I really don't have that idea. I only dare to think about it, but I don't dare to actually do it."

"If you can run for three years, why rush through the entire school year in just two? Take it slow." Fang Ziye said, patting his belly with a smile, and remaining humble and cautious.

Just kidding, after graduation comes employment, and employment is much more brutal than the doctoral entrance exam.

If I could accumulate an extra year of experience during my studies, I could publish at least one or two more articles, and my clinical skills would be much more profound. It's still uncertain whether the basic experiments I'm currently conducting will ultimately result in a high-impact paper in a top-tier journal.

The impact factor of the Q1 article that my teacher gave me was as high as 6.

An impact factor of 6 is already quite high in the field of articles.

Reality is not a comment section, nor is it a novel or TV series. A 6-point article, especially one based on basic experimental results, has a value that only those in the know can assess.

Based on actual contribution and research workload, a six-point article is far more formal than a meta-analysis or bioinformatics paper with an impact factor of ten or more.

"It hasn't been that long since we last met, and Ziye is already out of seclusion just by fiddling with that human model in the training room."

"It seems Brother Wei was right. If you don't put pressure on Ziye and just give him empty promises, his explosive power will be like a mule, incredibly fierce." Qin Geluo generously made an analogy at this moment.

Dr. Gu Yi looked at Fang Ziye with envy: "Ziye's talent is truly remarkable, whether in clinical practice or scientific research."

"I really feel sorry for you." Gu Yi stopped there and didn't continue.

By this time, Lu Zhefu had already walked in. Lu Zhefu was a first-year doctoral student who had just joined the department this year.

Although Fang Ziye and Gu Yi will never be in competition, and Gu Yi can openly watch Fang Ziye's growth, Lu Zhefu is different.

If Fang Ziye were to graduate early, he would be in the same year as Lu Zhefu, who would definitely feel immense pressure. There's no need to sell him anxiety.

"Brother Nuo, Brother Luo, Brother Zhou, what are you looking at? Did I not wash my face properly?" Lu Zhefu was tall and 1.8 meters, somewhat handsome, and very talkative. He joked while rubbing his face and then slid it around.

Li Nuo changed the subject first, jokingly saying, "We were discussing, Zhefu, how can you avoid working thirty years less?"

Lu Zhefu, who was rather outgoing, said in a low voice, "Brother Nuo, I'll send you the contact list of rich women in Han City later!"

He also winked at Li Nuo, indicating that he didn't mind joking about himself.

Li Nuo couldn't take it anymore: "No, brother, you're my older brother. Now, don't even think about sending me your contacts. Just send me a phone number, and you'd better add a nickname to it."

"Damn it, your sister-in-law is such a jealous person, I'm too lazy to coax her."

Qin Geluo leaned back and said with a smile, "Who told you, Master Nuo, to become a dashing figure back then and then retire in the end?"

"Even if you don't retire, you'll still be our hospital's Master Nuo."

"Gets up faster than a rooster!"

Li Nuo coughed lightly, stroking his chin at the same time: "Brother Luo, give your brother some face, you're a junior physician after all, and so many junior brothers are watching..."

After Li Nuo admitted defeat, everyone burst into laughter, waiting for the handover to begin.

The junior attending physician had just been discharged from the general ward not long ago.

The general resident, who recently graduated with his doctorate.

Everyone still remembers the hard times, so the distance between them and their subordinates is the smallest, and they get along more harmoniously.

It was supposed to be a handover, but since the superiors weren't around, it was really just a simple report on the medical records.

With Professors Deng Yong and others absent, Qin Geluo, as the attending physician, dared not directly confront a leader like the head nurse; whatever the head nurse said was law.

After finishing their rounds, Qin Geluo led Lan Tianluo, Gu Yi, and Luo Tingzhu out of the operating room. Fang Ziye and Shu Lang, on the other hand, needed to stay in the ward to check on the pre-operative examination results and complete the consultation and signing process with the patient, as there was a patient scheduled for surgery the next day.

Furthermore, today's emergency room visit is probably not related to Fang Ziye, because Fang Ziye still has to work a regular shift in the ward and cannot leave the ward.

Naturally, although there were no emergency surgeries or procedures available, Fang Ziye discovered that more than a dozen patients with minor illnesses had been admitted yesterday, filling almost all the empty beds; all of them had minor trauma.

Perfect timing! With the department short-staffed right now, Fang Ziye can now meticulously refine the pre- and post-operative medical orders for these cases without any reservations. If he can make one or two corrections, that would be a significant learning experience.

Clinical wards, operating rooms, outpatient clinics, emergency rooms, and even laboratories are all treasure troves; as long as you have time to explore them, you'll find more or less problems.

Even if all else fails, you can still gain a little knowledge points by going into the training room every day.

Mosquitoes are meat no matter how small they are.

After Shu Lang finished signing the agreement, he looked at Fang Ziye with a slightly nervous expression, clasped his hands in a slight fist salute, and asked, "Senior brother, today Brother Luo arranged for me to go to the emergency operating room to assist Senior Sister Luo in performing surgery. Could you help me check the test results for the assigned ward?"

Shu Lang is Professor Deng Yong's student and is one of the more talented students in his second year of master's studies.

Long ago, before Fang Ziye's suturing skills reached level 2, Shu Lang's suturing skills had already surpassed Fang Ziye's and reached level 2. Having passed the test of suturing orange peel, he was also highly regarded.

Although Shu Lang has not yet mastered the art of suturing tofu, he has been immersed in it for several months. Now that his superiors are not around, it is normal for him to want to get more clinical practice opportunities.

Shu Lang used to call Fang Ziye "Brother Ye". Although Fang Ziye was also a senior in the third year of master's program, it was actually more natural to call him "Brother Ye". However, after Professor Deng Yong recognized Fang Ziye as a student, he had to change how he addressed him.

"Go ahead, Shulang. I think it's more affectionate for you to call me the same way you used to."

“Senior brother and elder brother, they mean the same thing.” Fang Ziye nodded in agreement.

Shu Lang quickly thanked him, carefully tearing off a page with the important test results to be investigated written on it: "Well then, senior brother, I'll be going now?"

Fang Ziye tucked the paper that Shu Lang had torn off into his notebook and gave an OK sign.

After Shu Lang left, Fang Ziye took another close look at Shu Lang's notes, and thought to himself: Sure enough, the fellow students in the hospital are actually very meticulous and reliable. This is their duty, not something to be praised for.

Ten minutes after he put the things away, Fang Ziye made a discovery.

A patient who underwent minor debridement and suturing showed elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein levels during postoperative follow-up.

Given the current shortage of staff, the attending physician cannot perform such meticulous procedures, so these minor wound cleanings and suturings are often not detected by others. In general, antibiotics are not administered directly for such minor wound cleanings and suturings.

Only routine pain relief.

Moreover, the postoperative blood test results were not due to the attending physician being lazy; the results were indeed not available until this morning, but there was a shortage of staff, and the attending physicians had all been pulled into the operating room by their superiors.

But now that there are indications, it's only natural to take action.

Fang Ziye quickly prescribed cefuroxime and made a note of it, so that Lan Tianlu could fill in the medical record later.

Seeing this, Fang Ziye first put away his notebook and walked out. He saw the head nurse on duty and said, "Sister Xia, I will add some medical orders. It will be finished around 10:30. You can all carry them out at the same time. You don't need to carry them out one by one."

"Thank you for your hard work."

Liu Mengxia was only in her thirties, with a good figure, probably in the prime of her life, and she was very kind: "It's okay, Ziye, you didn't need to come out and tell us. There are fewer people in the department right now, so we understand."

"If antibiotics are to be added, remember to order a skin test."

Liu Mengxia has worked in the department for many years, and she has encountered countless similar situations in the past few days. There is a national orthopedic conference, and then there will be another one at the Hubei Provincial Orthopedic Conference.

This is perfectly normal.

"Okay, thank you for your hard work!" Fang Ziye clasped his hands slightly in a fist and bow. After explaining this, he knew that if he added more medical orders later, the nurses wouldn't ask him why the sheep were dropping one pellet at a time.

For the next hour, Fang Ziye completely transformed into a diligent little bee in the department, reviewing one medical record after another, seeing one patient at a time, and occasionally making changes, mainly to assess whether it was necessary to strengthen analgesia or add antibiotics, anticoagulants, and anti-swelling drugs.

After this series of changes, once Fang Ziye modified the last parecoxib sodium to celecoxib oral administration, Fang Ziye's knowledge points increased by a whopping 12 points.

Fang Ziye looked at his harvest and immediately felt very pleased!

Such huge profits are unmatched, even in the operating room.

In the operating room, the reward is based on the contribution of the procedure; in the ward, new patients are plentiful and well-fed.

After the doctor's orders are revised, Fang Ziye can start changing the dressings for his own bed. Changing dressings is a routine procedure, and each attending physician is responsible for it themselves. Fang Ziye will only help if there is really no time.

After the dressing change, Fang Ziye had a conversation and signed the consent forms for the two beds under his care.

These are two simple closed fractures that require elective surgery. It's best to wait until the swelling subsides before performing the surgery to avoid further skin swelling, which could increase the risk of infection and skin necrosis.

If it's an open fracture, then there's nothing you can do; it's already open, and the chance of infection is even greater if you don't do anything. But if it's not an open fracture, then you should wait and start taking mannitol to reduce swelling and preventative anticoagulation first.

Fang Ziye explained all of this to the patient clearly, explaining why he didn't perform surgery immediately: "There is no way to completely avoid surgical infections. No doctor, no matter how big an expert or professor, can guarantee that there will be no infection during the surgery they performed."

"This statement is pure nonsense, because if a doctor worldwide has never encountered a postoperative infection, it's because he hasn't seen enough patients."

"Therefore, to be on the safe side and to further reduce the risk of infection, it is still best to wait until the swelling subsides before scheduling the surgery. This is the most scientific surgical arrangement and plan. It is also a clinical guideline recommended based on big data statistics. This is not something we doctors are deliberately delaying."

"You can also look up relevant information."

"Secondly, appropriate pain management after surgery will not damage the gastrointestinal tract. Don't let popular science dismiss this as superstition. Pain is the fifth vital sign, and pain-free ward management is very scientific. This will make your postoperative rehabilitation training more proactive."

"Isn't it good to be able to get out of bed and walk the day after intramedullary nailing surgery?"

The patient's family member was stunned: "Get out of bed the next day? Orthopedic doctors on Douyin all say it's best to get out of bed four or five days after surgery?"

"That's a different situation. They had a complex fracture or a comminuted fracture after internal fixation surgery, so it's perfectly normal for them to get out of bed and move around after five days or even a week."

"But your fracture type is different. It's a relatively simple fracture, and we used intramedullary nailing for fixation. If the fixation is reliable, getting out of bed and moving around early can reduce the risk of thrombosis." "That's what we expected. We will definitely let you know when you can get out of bed, right? Based on the actual situation and analysis, it's not necessary to follow the advice of experts from other hospitals entirely."

“The advice from experts at other hospitals is definitely correct, but you might not have noticed the prefix they described. Okay?” Fang Ziye explained patiently.

After everything was explained, the patient and their family asked about the approximate cost.

"You should pay around 10,000 yuan first. Steel plates are now procured centrally, with refunds for overpayments and additional payments for underpayments. The final cost should be around 5,000 to 6,000 yuan. Whether it can be reimbursed depends on your injury mechanism."

"If there is a third party involved, insurance cannot be used. If it is a work injury, it is covered by work injury medical insurance. You can go down to the medical insurance department for consultation. Our clinical doctors have relatively limited understanding of the medical insurance system."

After obtaining the signed consent, Fang Ziye gave the following instructions.

"Okay, thank you, Dr. Fang!"

"It's alright. If you have any other questions, you can contact me anytime today. It's my shift today. Also, if you feel that the surgery is too risky, you can contact me anytime before tomorrow morning to cancel the surgery and reschedule it."

"But if it's after you're in the operating room, then it might be too late!" Fang Ziye continued to explain in detail.

……

However, as soon as the signing of the agreement was completed, Fang Ziye discovered that he no longer had the time he had planned to lie down and rest.

Outside the doctor's office, an intern nurse stood timidly and said, "Dr. Fang, the emergency room has received two emergency patients. Sister Xia said she wants you to take a look at them. She's waiting for you across from the nurses' station."

Fang Ziye put the signed consent forms of the two people back in their places, compared the bed numbers and names, and then held the medical record folder in his hand: "Okay, I'll put the medical record down and go see it right away."

“The patient has been waiting for about ten minutes. Shall I put your medical record book away for you? Sister Xia said that these two emergency patients and their families are quite well-mannered, so we shouldn’t keep them waiting too long,” the nurse replied, reaching out to take the medical record folder.

"Thank you!" Fang Ziye understood what Sister Xia meant.

Reciprocity is key; if you treat me with respect, I will repay you tenfold.

Sometimes, the more you urge or yell at someone, the more priority they will give you.

On the contrary, such patients may delay their own treatment. If you wait quietly, the doctor will come to treat you as soon as they have free time.

People are interconnected; mutual respect is the foundation for mutual understanding.

As Fang Ziye approached the nurses' station, he noticed that one of the patients had an elbow dislocation, and the other had a shoulder dislocation.

Both patients were quite young, the younger one being exactly fourteen years old, thus avoiding the need for pediatric treatment.

Fang Ziye politely invited both of them to the doctor's office. After checking and verifying the dislocation of each of them, he diagnosed the shoulder dislocation as a mild anterior dislocation, which could be treated with manual reduction.

The child's elbow dislocation was also a minor injury, but whether there was ligament damage in the dislocation may require further investigation.

The procedure must be followed carefully, one step at a time.

The patient with the shoulder dislocation was a man in his thirties, probably a worker at a nearby construction site. He was covered in cement dust, had no family members, and was supporting his affected limb all by himself.

He arrived first, so Fang Ziye could only receive him first: "Brother, in your case, it is still possible to reposition the bone manually. However, manual repositioning carries certain risks. It may not be able to reposition the bone, and you will have suffered pain for nothing and still need surgery."

"Did Dr. Kim mention this to you?"

The older brother grinned and said, "I've said it before, none of you doctors can guarantee anything. The last few times I brought patients here for treatment, you gave me the same answer. But I believe you can definitely handle it."

“I asked my nephew before I came here. Generally speaking, if you say it’s possible, then it’s doable. Otherwise, if the failure rate were even slightly higher, I would be in the operating room by now, right?”

Fang Ziye neither refuted nor agreed: "The inherent risks are there. Your dislocation is indeed mild. If it were moderate or more severe, you would need to have an MRI."

"This is the informed consent form..."

"Mom, when are you going to get my doctor? I have to go back to class later," the little boy asked.

Upon hearing his call, the young man felt a pang of pity and licked his lips, his eyes full of affection, saying, "Doctor, why don't you examine the child first? I can bear it. This one looks about the same age as my daughter."

“Brother, it’s possible. But you gave it to us willingly! You can’t report me for favoritism and letting others see it first.” Fang Ziye’s voice was stern.

Fang Ziye needs to explain this clearly, because these are lessons learned from the blood and tears of his predecessors.

During his hospital stay, Li Nuo was subjected to this incident. Although it turned out to be harmless, Li Nuo still wrote a report as a formality, detailing what happened to the medical affairs department...

Fang Ziye then carefully assessed the extent of the child's elbow dislocation and then let out a soft hiss.

Posterior dislocation of the elbow joint can cause significant pain and swelling due to changes in the joint structure. The elbow joint becomes elastically fixed in a semi-flexed position at approximately 45°, resulting in a boot-shaped deformity.

At the same time, the relationship of the posterior elbow triangle changes: the elbow fossa becomes full and plump, and the relationship of the inverted isosceles triangle formed by the medial and lateral condyles of the humerus and the olecranon changes.

This is a posterior dislocation of the elbow joint, a fairly obvious sign.

The diagnosis of posterior dislocation is not a problem. However, judging from the X-ray, the degree of posterior dislocation of the child's elbow joint is quite severe.

Although there was no humeral fracture, given the degree of dislocation, ulnar nerve injury and ulnar collateral ligament injury were likely, with anterior bundle injury being the most common.

For ligament injuries, either a physical examination or an MRI is needed to confirm the diagnosis.

"How is my child, doctor? Is her condition serious?" The person who brought the child to see the doctor was her mother. She was dressed in a suit and should be a white-collar worker, but I didn't know what her profession was. Although she was anxious, she was also quite polite.

Fang Ziye explained, "The dislocation is quite serious. Reduction is definitely the first priority, but there's a problem: he may have ligament damage now."

"There are two options now. The first is to do an MRI first, and then do a repositioning. The ligament damage should be detected before the repositioning."

"The second option is to first perform a repositioning to relieve the pain, and then do an MRI to determine if there is any ligament damage and to assess the extent of the damage."

"However, there is a problem: during the repositioning process, there is a possibility of ligament damage."

"My suggestion is to do one MRI first, and then another. This will provide a more direct comparison and avoid any misunderstandings between us!"

Fang Ziye's explanation was quite clear.

In other words, in your child's case, ligament damage is almost certain, but an MRI is needed first to solidify the evidence and prove that it wasn't caused by our doctor's repositioning. This is a crucial point.

"Isn't that a lot of trouble?" The woman frowned.

“It is quite troublesome, but as you know, you are probably hoping for the best, that there might not be any ligament damage, right? What if it was caused by our doctors?” Fang Ziye bluntly tore off the veil of pretense.

"But in fact, according to statistical probability, the chance of this degree of posterior dislocation being accompanied by damage to the anterior bundle of the ulnar collateral ligament is at least 80%, only the degree of damage varies."

"The ligament injury may require treatment, or it may not. You will need to decide for yourself."

"If you believe what we say, then we can reposition the child first and then conduct the examination to minimize the child's suffering, but you will need to sign a statement confirming that I have fully informed you of this situation."

“Otherwise, you might still have to follow Dr. Jin’s advice. I think Dr. Jin’s advice to you is the same, right?” Fang Ziye said with a smile.

Jin Hongzhou clearly wrote in the emergency room medical record that he recommended an MRI scan first, followed by manual reduction surgery.

But I guess it was the child's mother who made an appointment. Even if it's for the emergency room, the appointment would still be scheduled for noon or afternoon. She couldn't wait, so she came to the ward to try her luck again.

"Ouch, how did you hurt your tendons?" The young man's face twitched with a hint of distress.

"During the school's sports meet, he tripped during the 100-meter sprint and put his hand on the ground to brace himself." The woman was also full of heartache and couldn't make up her mind.

The boy felt a little guilty and didn't dare to speak.

Fang Ziye then said, "Sister, how about this? You can think about it a little more. I'll do a repositioning for this man first, and then he can go for a follow-up examination. Or you can discuss it with the child's father."

"You also need to understand that in the current medical environment, we doctors do need to explain the whole story to you. Although we can speculate that there is ligament damage, there is no evidence to confirm it absolutely."

"If you claim it was caused by our doctor after the procedure, then we have no way to defend ourselves!"

The man signed the papers without hesitation, offering no further advice to the woman, and then followed Fang Ziye into the control room.

After Fang Ziye quickly completed the procedure and the pain subsided, his eyes lit up, and he asked, "Doctor, your repositioning technique is so good, can you directly treat that child?"

"If that's the case, then please don't make things difficult for them, mother and son?"

As Fang Ziye demonstrated the movements for him, he replied, "Brother, that's really not a difficult thing!"

"It's like this: in a place without surveillance cameras, someone hits and scratches someone else's electric bike, but you don't have surveillance evidence. How can you prove that your bike was scratched by someone else, and not by yourself?"

“Even if you call the police, there’s nothing they can do, right?” Fang Ziye said.

Then he said, "Yes, your pain symptoms have been relieved, your square shoulder deformity has disappeared, and your range of motion has been restored. Just wear a forearm sling and rest for a while."

"But you have to be careful not to do any work, especially heavy work. You must rest strictly for at least half a month and then come back for a check-up before you can feel at ease. Otherwise, it is very easy for the dislocation to recur."

"You need to understand this. I can write you a leave request without any problem." Fang Ziye carefully instructed, and at the same time, he received 5 knowledge points, which made him even happier.

"Well, there's nothing we can do about it. We can only follow your doctor's advice." The young man stopped trying to persuade him and let Fang Ziye put on a sling for his forearm.

Then he asked in a low voice, "Doctor, should I take some medicine with me when I go out to take it?"

"Actually, it's not necessary, but if you insist, you can take some swelling-reducing medicine. However, I don't think it's necessary." Fang Ziye knew that the other person's injury was a work-related injury and could be reimbursed.

But taking medicine isn't a good thing, so it's best to avoid it if possible to prevent damage to the gastrointestinal tract.

After explaining the post-reduction precautions to the young man and putting on his forearm sling, Fang Ziye walked out of the operating room. Jin Hongzhou, who had just rushed back from the emergency room, was also there.

There was no other reason than that Fang Ziye had sent photos of the child's condition to Jin Hongzhou, and Jin Hongzhou was worried that Fang Ziye was being too reckless and would perform the repositioning procedure directly.

However, upon entering the office and seeing the woman looking troubled, he breathed a sigh of relief.

Fang Ziye then instructed: "Go for your follow-up examination first. Come up here later to see the results. If there are no other problems, you can go back and rest. I still have patients to deal with, so I won't waste any more time."

"The doctor's orders on this document show the rest and follow-up appointment times. Show them to your workplace, and they should approve your leave. You can call your workplace to ask. If the doctor's orders are still not enough, go to the general management office of the emergency department, take your medical record book, and ask for a professional leave slip."

"Okay, thank you for your hard work, Dr. Fang." The young man nodded, indicating that he understood.

After that, Fang Ziye returned to the office door. Seeing that Jin Hongzhou did not interrupt the woman's call, Fang Ziye said, "Brother Zhou, the child's dislocation is quite serious. It will definitely be accompanied by collateral ligament damage."

"Yes, I already told her to get an MRI first. I didn't expect her to come straight to the ward. It's my fault for not telling you. Luckily you were cautious enough not to reposition her, otherwise it would have been a big problem."

Jin Hongzhou felt a chill run down his spine.

If the dentist really does perform the repositioning procedure with the fearlessness of a newborn calf, then the responsibility lies with Jin Hongzhou, and Jin Hongzhou will be responsible for the emergency consultation.

Of course, Fang Ziye also bears some responsibility.

It seems that Fang Ziye has not only mastered the manual reduction technique, but is also familiar with diagnosis and treatment procedures. He is a very reliable person who does not act rashly.

The manual reduction of this posterior dislocation is simple, and it must be done regardless of whether there is ligament damage; however, the procedure must be followed precisely.

After a while, the woman ended the call.

She stood up and said, "Doctor, I'll sign the consent form. Please reposition my child first; it's so painful for me."

"Just sign it if you say so."

"Go get an MRI after the pain subsides." She sounded quite helpless; although her voice didn't choke up, her eyes were red.

Women are inherently weak, but become strong when they become mothers. At this time, her husband really couldn't leave; he had a sizable project to discuss and could only contact her by phone.

Jin Hongzhou said, "Sister, it's not that we're making things difficult for you, but that's the reality. If you say we'll just diagnose a ligament injury directly, that would be us messing around. Even if we were to speculate based on experience with a 99.9% certainty, that would be a wild guess."

"We can't just make a diagnosis haphazardly."

Fang Ziye had prepared the necessary informed consent forms well in advance, and specifically added a clause stating that the patient's dislocation was severe, with a very high probability of collateral ligament injury. The patient's family, having been informed, strongly requested manual reduction, even though the corresponding risks had been explained...

Actually, this sentence doesn't mean much. The main thing is for the patient to clearly state that they are aware that the doctor has informed them of the extremely high risk of ligament damage, and that manual reduction may also cause ligament damage, and that they are willing to accept the corresponding risks.

After signing, without further ado, Fang Ziye and Jin Hongzhou took turns, with one doing the main operation and Jin Hongzhou assisting, to reposition the child's hand.

The seated traction and flexion elbow technique is a classic choice for repositioning.

For the elbow flexion-extension method, the patient sits with an assistant standing behind the patient, holding the upper arm with both hands. The operator stands in front of the patient, holding the wrist with both hands and placing the forearm in a supinated position. After traction for 3-5 minutes, the operator holds the wrist with one hand to maintain traction, and uses the thumb of the other hand to push backward against the lower end of the humerus, while placing the other four fingers on the olecranon and lifting forward. The operator slowly flexes the elbow joint. If a popping sound is heard, it indicates that the dislocation has been reduced!

When the patient went for a follow-up examination, Jin Hongzhou took off his examination gloves and looked at Fang Ziye: "Not bad, I can tell you have skills."

"Your clinical talent is comparable to Wei Ge's. It's very likely that you'll be out of seclusion for your first training session before you even graduate with your doctorate."

"Thank you for the compliment, Brother Zhou, and thank you for giving me this opportunity," Fang Ziye said sincerely.

Wow, this elbow joint reduction technique, because it was a moderate to severe injury, still earned me 15 knowledge points after the successful reduction, even with an assistant, which is three times more than the previous guy.

Without Jin Hongzhou as an assistant, the score could probably have soared to 20 points.

"You earned this opportunity!" Jin Hongzhou patted Fang Ziye on the shoulder after washing and drying his hands.

“Very good. I’ll bring in all the dislocations we encountered today so you can have a go.”

“Let me know when you’re on duty next time,” Jin Hongzhou said meaningfully.

Fang Ziye was slightly taken aback, then smiled even more broadly: "Thank you, Brother Zhou!"

From that moment on, Fang Ziye decided that he would fall in love with being on duty.

(End of this chapter)