System Came When the Doctor was Thirty

Professor Chen Song came to the department on the 1st, originally attracted by Lu Cheng’s fundamental skills, but he had only observed them a few times roughly.

To conduct a level assessment, many details need attention, and Professor Chen felt he might not have noticed everything thoroughly at the time.

”As long as there’s no problem, that’s good. I thought, Teacher Chen, you wanted to offer some guidance.” Lu Cheng quickly chimed in.

Chen Song turned around with his hands behind his back: ”First practice the overall layout for suturing skills, which is the whole process of suturing—needle insertion, threading, exiting, and knotting. As surgeons, we must at least complete the suturing process first.”

”Next is distance control; the textbook mentions several instances of ’one centimeter,’ which means this.”

”After mastering these, what follows is the meticulous control of force, like common suturing materials, such as orange peel suturing and tofu suturing, they are all like this.”

”However, if you want to suture tendons and do it well, while controlling the force of needle entry and exit, you must also start paying attention to distance.”

”For example, common suturing materials like rubber bands or tourniquets, if the suturing depth is too shallow, the suture line will cut through the ends of the tendons. If too deep, it becomes difficult to suture the opposite side and other positions.”

”Moreover, the distance must be clear. If the opposite stitches, vertically and horizontally, are not balanced, the sutured tendon will be a cripple. Once the patient’s wound heals, the remaining scar will be a mess, which is the first pitfall of tendon suturing...”

Professor Chen Song’s guidance was both specific and comprehensive.

Previously, Lu Cheng only knew how to practice with suturing materials. However, no one had ever explained what specifically to practice, which details to pay attention to, and why these details were important for each suturing material.

Either he spent a lot of time figuring these things out on his own, or he had a mentor to provide guidance and instruction.

Lu Cheng glanced at his ’results list’!

[Independently completed a debridement suturing case, carefully guided the patient on postoperative care, advised the patient to receive a tetanus antitoxin injection, and gained 0.6 Skill Points.]

[Skill in fundamental suturing technique improved slightly under the meticulous guidance of a master.]

[Current remaining Skill Points: 1.7 points.]

When being guided, skills can also improve, just not displayed on the panel?

Seems quite reasonable.

Lu Cheng smiled happily: ”Thank you, Teacher Chen...”

...

In the afternoon, at 3:20 PM. Lu Cheng, holding the discharge records and disease diagnosis form, arrived at bed 11 in the observation ward, and stated: ”Zhang Linhong, are you being discharged today?”

The patient and his family had already packed bowls, pots, towels, etc., and hearing him, quickly got out of bed and approached Lu Cheng. The patient’s wife expressed with enthusiastic yet hesitant tones: ”Dr. Lu, Professor Chen told us this morning that after the injection this afternoon, we can be discharged!”

”But yesterday Director Lin said it’s best to observe for a few more days... Dr. Lu, should we be discharged?”

The patient has a trauma to the front of the thigh, vertically deep, with muscle damage. He was admitted on the 1st, where Professor Chen Song performed the debridement and hematoma removal.

According to the discharge routine of the County Hospital, he would have stayed for another three or four days of continued observation. However, Professor Chen Song, accustomed to the pace of the Xiangya Second Hospital, simply instructed the patient to be discharged today.

At that time, Lin Qianlong, associate chief physician, assisted Chen Song in the surgery.

Lin Qianlong is the director of the emergency surgery group and the only deputy chief physician in the surgery group.

”Professor Chen checked this morning again, and your wound is healing pretty well. Since the surgery was done by Professor Chen, I suggest following his discharge plan.”

Lu Cheng continued, ”Of course, if you strongly wish to stay for a few more days, that can also be arranged.”

If this were at Han City University Zhongnan Hospital or the Xiangya Second Hospital, where beds are scarce, patients wouldn’t be permitted to stay longer just by choice. But at Long County People’s Hospital, the patient’s ’informed consent’ is respected to the maximum extent.

The patient and his wife exchanged a glance, feeling conflicted, ”So...there won’t be any problems, right?”

Lu Cheng looked at the patient and said, ”This is a very routine condition, nothing special. After discharge, as long as you carefully follow the precautionary measures, there shouldn’t be any major issues.”

”If you’re really worried, I suggest you can buy some oral antibiotics from a pharmacy outside, just the cheapest cefuroxime will be fine.”

”Here at the hospital, the health insurance and regulatory system won’t allow us to prescribe those meds for you.” Lu Cheng provided a rather professional suggestion.

Sometimes, the ’guidelines’ and ’regulations’ are too rigid, and the ’time limit’ standard on antibiotic usage is like an essay rule.

In reality, in genuine clinical practice, certain patients’ conditions warrant antibiotic use until seventy-two hours post-operation, but the rules do not permit this.

If signs of infection arise, then further treatment is administered directly...

Lu Cheng isn’t just any young doctor anymore; he holds an attending position. Previously, during his time in orthopedics where there weren’t many surgeries to perform, reading and researching small literature pieces was Lu Cheng’s daily routine.

This is a small insight Lu Cheng has summarized himself—’non-compliant’ but not illegal.

”Buying some medicine to take is fine... staying in the hospital is quite expensive anyway...” the patient’s wife settled down with comfort.

The patient nodded, ”Dr. Lu, what’s the name of the medicine you just mentioned?”

”Cefuroxime axetil, an oral antibiotic, buy a cheaper one, and you don’t need a lot, a four or five-day course will suffice.”

”If the pharmacy advises you to buy a lot, don’t follow that advice! Medicine should be taken in moderation and match your condition, that’s best.” Lu Cheng explained, then handed over the discharge records and the disease diagnosis form to them.

”You need to go to the nurse’s station to handle the checkout procedures, and after getting the seal, you can be discharged. I’ve already arranged for your discharge order.”

”Alright, thank you, Dr. Lu...” the woman nodded, carrying a bucket, which had bowls and towels inside, and assisted the limping man as they walked out.

[Through detailed postoperative guidance, reduced the risk of patient infection, gaining 0.1 Skill Points]

Watching the couple who couldn’t afford a crutch leaving, Lu Cheng smiled knowingly, sensing the significance of being a doctor.

”Even a mosquito is meat in the end, thank you...” Lu Cheng murmured, then turned around to see the spleen removal patient operated on by Director Lin that morning.

The patient had undergone open surgery and was still under monitoring without the drainage tube removed. The patient’s blood pressure and oxygen levels were stable, with a drain to evacuate the abdominal hematoma.

”Brother, how do you feel? Does the wound hurt? If it does, remember to tell us. Currently, we emphasize perioperative pain management; enduring the pain isn’t recommended.” Lu Cheng said courteously.

”Doctor, a little pain is actually bearable, right? My wife always says I’m fussy.” The patient, who was around the same age as Lu Cheng, appeared somewhat pale but was overall in decent condition.

Splenic rupture is an ultra-emergency associated with mortality and isn’t suitable for referral.

This morning, it was Professor Chen Song’s ’day off.’ Neither of the directors from the General Surgery and Emergency Departments at Long County People’s Hospital dared to perform the spleen preservation surgery, so they decided to remove it directly to resolve the issue.

”This notion is incorrect. Pain is a very unpleasant experience!” Lu Cheng’s expression turned serious: ”It’s possible to endure the pain, but there’s no need to take pride in it or boast about it.”

”Sure, surgery involves pain, but thinking it’s mandatory to endure afterwards is a rather outdated perspective and isn’t promoted nowadays...”

”Brother, you still feel pain, right? If you had to score your pain out of ten, with ten being unbearable, where would you rate your current discomfort?” Lu Cheng promptly made use of the visual analogue scale for pain, which is professional and simply applied for inquiry.

”It’s not that exaggerated, probably just four or five.” The young man shook his head and smiled lightly. ”When gaming, you don’t notice it.”

Four or five suggests reaching that threshold of intervening with mild opioid medication at five points.

Lu Cheng carefully re-examined the left abdomen of the patient and, having ruled out hidden injuries elsewhere, said, ”You should have told us earlier; I’ll go get you a shot of tramadol.”

”Now is when the effect of the anesthetic has just metabolized, and it’s crucial to manage the pain.” Lu Cheng commented and walked away.

Behind him, came the young man’s murmuring voice: ”See, even the doctor says don’t endure the pain. You always said I was fussy.”

A few minutes later.

[Proper guidance on using painkillers reduced the patient’s perioperative pain experience, acquiring 0.1 Skill Points]

Another bit of mosquito meat, albeit mosquito meat not keen-eyed would notice...