System Came When the Doctor was Thirty

August 26th, Wednesday, the scorching sun blazed, and Long County once again turned into a steamer.

At 8:30 in the morning, after making his rounds, Lu Cheng went straight to the doctors’ lounge. Du Daihua, who eagerly sought to learn skills from Lu Cheng, proactively went to change dressings and modify medical orders.

Lu Cheng had no worries about Du Daihua’s ability to execute medical orders; he was much better than Peng Kun. Whatever Lu Cheng suggested, Du Daihua would implement accordingly.

As long as the medical orders were Lu Cheng’s recommendations, the skill points would accrue to Lu Cheng, including a bit for changing dressings, so Lu Cheng didn’t bother to ’haggle over every ounce’ with Du Daihua.

Lu Cheng opened his bulky notebook and turned to the page for August 25th, preparing to write a sentence meticulously.

But he found the pen had no ink, and he had no idea which wretched soul had replaced the ’pen’ in his white coat pocket with this one...

Lu Cheng had no option but to take out another from his backpack—

[Spleen Injury Spleen Preserving Surgery, Partial Splenectomy’s Rule-Based Resection, get!]

[Spleen Lobe/Segment Resection: Anatomize splenic hilum vessels → ligate target lobar artery → excise along ischemic line; Indication: Grade III (regional injury)

Partial Splenectomy: Preserve upper or lower pole ≥30% spleen tissue (requires preservation of at least 2 splenic segmental arteries); Indication: Grade IV multiple rule-based lacerations]

[Non-rule-based Splenectomy, Total Splenectomy + Autologous Spleen Transplantation, Vascularized Spleen Transplantation, all not mastered, ☆☆☆]

Lu Cheng drew three stars in succession to remind himself that he must strictly control the reach of his capabilities to avoid patient death from ’shock’ due to attempting Spleen Preservation Surgery.

Compared to death, admitting one’s incompetence in performing Splenectomy is not disgraceful either.

Clarifying the limits of one’s abilities and summarizing types of diseases beyond those limits will aid more in his clinical work.

After all, once Professor Chen Song leaves, there’ll be no one to back him up...

[Absolute Contraindications for Gallbladder Preservation Surgery:

1. Loss of gallbladder function: Atrophied gallbladder or cavity disappearance, porcelain gallbladder (gallbladder wall calcification) with severe pathology;

2. High risk of gallbladder cancer: Stone history >10 years, adenomyomatosis or localized wall thickening;

3. Acute complications: Gallbladder perforation, suppurative cholangitis, biliary pancreatitis (cystic duct obstruction)

4. Gallbladder contractility

”The technical difficulty of gallbladder-preserving stone extraction surgery is high, requiring stringent patient selection and strict demands on equipment and the surgeon’s experience. Domestic and international guidelines still prioritize cholecystectomy because gallbladder preservation surgery does not address the cause of stones (gallbladder metabolism abnormalities),” Lu Cheng muttered.

”That’s why the surgery is quite hard to learn.”

This is a facultative surgery, guidelines recommend direct removal, but if the patient strongly requests, Gallbladder Preservation Surgery can be performed. Patients’ strong requests sometimes outweigh the guidelines unless the surgical technique is particularly critical.

”Dr. Lu, there’s a patient specifically looking for you outside, saying they’re transferred from the Traditional Chinese Medicine Hospital.” Nurse Li Guofang opened the door, her voice gentle as jade.

Lu Cheng tilted his head, slightly surprised, furrowing his brows as he looked at Li Guofang: ”Transferred from the Traditional Chinese Medicine Hospital? Looking for me?”

Li Guofang’s almond-shaped eyes were lively, clear in expression, consistently a straightforward girl with a very good personality, hard-working and uncomplaining. Her appearance was somewhat sweet, though her level A degree and college diploma often made her feel ’humble’ in usual times, often taking shifts during holidays.

”Yes, Dr. Lu, the patient had a dressing done at the Traditional Chinese Medicine Hospital, now at the nurse’s station, saying they only want to see you. It seems to have been recommended by Dr. Luo from the Traditional Chinese Medicine Hospital’s emergency department.”

”Dr. Zhang Tiesheng from the emergency consultation room said he would check first and then call you, but the patient disagreed.” Li Guofang’s delicate face was pretty, spotless, looking pure and gentle with a refined voice.

”Alright, let’s go and take a look.” Lu Cheng put down the pen in his hand.

He wasn’t acquainted with Dr. Luo from the Traditional Chinese Medicine Hospital’s emergency department; most of his time in the past was spent in orthopedics where he knew some fellows from the Traditional Chinese Medicine Hospital’s orthopedics department.

”Uncle, the Dr. Lu you’re asking for is here.” Li Guofang softly told the patient.

Two middle-aged men arrived, approximately of the same age, both around fifty years old.

Turning to look, they stared at him, initially thinking they were being teased. However, upon Lu Cheng’s approach, seeing the identification badge matched with the name and photo, one of the middle-aged men spoke.

”Hello Dr. Lu, we were introduced by Dr. Luo Shanpei from the Traditional Chinese Medicine Hospital. He said the Traditional Chinese Medicine Hospital couldn’t handle my brother’s tendon injury, suggesting either go to the State or come here to find you.”

”Originally, we planned to slaughter a pig this morning, but when the knife fell, my brother instinctively went to catch it, leading to this mess...” The middle-aged man was extremely regretful.

Lu Cheng took a glance and recognized it as a typical Region II flexor tendon injury.

Generally, catching a knife wouldn’t injure the inner layers of tendons, certainly not to the point of complete rupture, but a slaughter knife is different.

Lu Cheng nodded gently: ”Have you registered yet? If not, the reception won’t be quite official.”

”Not yet. Dr. Luo specifically instructed us to find you first before registering, to avoid... uhm, misunderstandings. I’ll go register, Dr. Lu, please take my brother to see first.”

”If it can be treated surgically, we’ll proceed; if not, we’ll quickly rent a car to Ji City.” The middle-aged man’s words were somewhat implicit.

Peng Kun was dealing with tendon suturing issues, possibly something the Traditional Chinese Medicine Hospital had heard about, but everyone wasn’t within the same system, so others might show courtesy to Young Master Kun, but the Traditional Chinese Medicine Hospital’s ’peers’ likely wouldn’t.

”Dr. Lu, thank you very much...” The injured middle-aged man’s expression showed a bit of helplessness.

”It’s no problem, please come with me to the operating room first. Whether it can be operated on depends on whether you’ve sustained vascular and nerve damage because if there is, I won’t be able to handle it either,” Lu Cheng said.

Patients’ conditions generally aren’t textbook, slaughter knives are very sharp, and if nerves and blood vessels are injured, it isn’t just tendon rupture; it’s partial finger severance requiring finger replantation, beyond Lu Cheng’s capabilities.

Lu Cheng swiftly led the patient into the operating room, opened the gauze and sterile materials, inspected thoroughly, then looked up and said: ”The good news amidst the misfortune is that there’s no vascular or nerve damage.”

”Surgery can be done, but if you’re looking for superior surgical quality, I suggest you go to the State People’s Hospital.” Lu Cheng replied cautiously.

The patient’s husky voice was thick: ”Dr. Lu, aren’t you playing us for fools?”

”Luo Shanpei from the Traditional Chinese Medicine Hospital is my brother-in-law; he’s told me your background, going to the State People’s Hospital isn’t as good as coming to you.”

”He wouldn’t deceive me. Getting it done here is cheaper, and the quality is good.”

Long County is a poor county, among most people, having a relative with a job in the public system makes them an ’important figure’ in the family, earning their relatives’ trust.

”Uncle, Dr. Luo is overpraising, it isn’t as exaggerated as Dr. Luo makes it seem. I can do it, but I can’t guarantee it’s better than others.”

”We’re all in the technical field, let’s not diminish others to exalt oneself. Of course, I appreciate your trust, and I’ll do my best to preserve your hand function.”

”Post-operatively, you’ll also need to listen and follow instructions for functional exercises, which is another key point.” Lu Cheng wasn’t overwhelmed by the patient coming with admiration, explaining all the critical points clearly.