Chapter 1315: Surgery and Teaching, Both Done Well

Chapter 1315: Chapter 1315: Surgery and Teaching, Both Done Well

"His luck, indeed, isn’t that good."

After careful observation, Liu Banxia said.

"This small gallstone is not very large and hasn’t caused obstruction or narrowing of the pancreatic duct, so the patient doesn’t have any typical symptoms of pancreatitis."

"However, one corner of this stone is quite sharp and keeps irritating the wall of the pancreatic duct. Plus, the combined action of pancreatic fluid has burned through the blood vessels in this area."

"We can also see several hyperplastic spots in the pancreatic duct, and we need to take samples from these areas. Whenever we see something suspicious, we should sample it to avoid missing any malignant changes."

"In a way, he’s a bit lucky since it didn’t cause much damage; otherwise, it would have required a pancreaticoduodenectomy, or even a total pancreatectomy if it were more severe."

"The condition of this patient indeed has many uncertainties. So for any patients with unexplained rectal bleeding, we should consider examining the pancreatic duct thoroughly."

"If we find stones in the pancreatic duct, there’s likely a very high probability. Not exactly 100%, but 90% is quite possible."

"Actually, this surgery is more suitable for an open procedure, which makes it easier to handle. Although it can be done laparoscopically, it is somewhat laborious due to the surgical field and space constraints."

"When we are performing the jejuno-jejunostomy, we need to cut along the opposite edge of the mesentery segment based on the length of the pancreatic duct incision, and perform the side-to-side anastomosis."

"Honestly, if you ask me, I really don’t know what to say. It’s all very conventional knowledge, and the patient’s condition isn’t that complex; the complexity lies only in the diagnosis process."

"Therefore, we need to be more attentive during diagnosis. Su Wenhao, did you remember what I just said?"

"Uh... I remember."

Su Wenhao hurriedly replied.

"Why be so cautious? I didn’t say you have to do the next part," Liu Banxia teased.

"It’s because the condition of the pancreatic duct here is quite complex; I need to be especially careful while suturing. Otherwise, if a pancreatic fistula develops during recovery, it will be even more troublesome to handle."

"Now a new question arises, everyone listen closely, you can answer quickly. Regarding this patient, after we’ve done all this checking, even making an incision in the small intestine, what if the patient complains?"

Everyone was very focused, thinking he would ask some surgical-related questions. Who would’ve thought he would ask this, which had nothing to do with surgical operations?

"For this patient, our examination was very thorough, from top to bottom—first a colonoscopy, then a gastroscopy. From the outside in—first a CT scan, then an exploratory laparoscopy," Liu Banxia continued.

"During our examination, we made a tentative judgment that the bleeding might be caused by a pancreatic duct stone. But we still poked a hole in the small intestine; how great is that, earning another fee. Was there a procedural error?"

Xu Yino sneaked a glance at him, knowing he was setting a trap, but it wasn’t a real trap, just a matter of perspective.

"Don’t be so silent, you can invite some outside help. Wang Chao has come back after finishing his meal; everyone can be more enthusiastic."

Seeing everyone’s lack of enthusiasm, Liu Banxia spoke again.

"Because this is the case with this patient, it might be another case next time. It’s something we might often encounter. What do we do then? Consider it in advance, I think it’s okay."

"Teacher Liu, I think as long as the procedure is correct, there’s nothing to worry about," Cui Jia said.

"Moreover, bleeding caused by pancreatic duct stones is also uncommon, so I think even if the patient felt we took a detour and complained, we shouldn’t worry."

"Are you just saying that to support me?" Liu Banxia asked with a smile.

"No, I’m just discussing the matter itself," Cui Jia replied.

"If it weren’t for the hole in the small intestine that allowed the endoscope to see blood at the pancreatic duct’s exit, we wouldn’t have been able to determine it was a pancreatic duct bleed. If I had directly cut into the pancreatic duct without any bleeding inside, that would have been a big problem."

"That’s worth extra points, really well said," Liu Banxia said with satisfaction.

"Of course, for such issues, everyone has their own answer in their minds. When diagnosing a patient, we all have inclinations about what the condition may be."

"But there’s one thing we must make clear—all our disposal methods carry responsibility with them. The outcome is not something we can fully control."

"Take today’s patient for example. If I hadn’t performed the small intestine exploration and directly cut into the pancreatic duct, then clarified the bleeding was inside the pancreatic duct, what would the outcome be?"

"People would say, ’Wow, Director Liu is really amazing, finding it right away.’ And I would be pleased with my risky behavior."

"But if the next patient truly has internal small intestine bleeding and I again recklessly cut into the pancreatic duct... It wouldn’t just be a matter of disciplinary action, the harm caused to the patient would be irreparable."

"However, are we supposed to be extremely conservative during diagnosis? I think it can only be analyzed based on specific circumstances."

"With this patient, if the bleeding were very severe, reaching two thousand milliliters each time, and coagulation were difficult, then we would have to be more aggressive."

"You can’t consider whether the patient’s family can handle it; keep issuing critical notices, and give the family pressure to get necessary checks done."

"I know the onlooker, Wang Chao, is surely not happy now because no matter what, I’m the one speaking. Positive, negative, neutral—what should be done? Be aggressive, conservative, what if you’re aggressive and make a mistake?"

Wang Chao, who was observing, was speechless; he had become part of his teaching material.

However, he admired that guy, managing both surgery and teaching. His words never stopped, and his hands didn’t skip a beat, moving gracefully.

"Responsibility, responsibility, responsibility, saying it three times for emphasis. Circle it, maybe it won’t be tested, but it’s very important," Liu Banxia continued.

"No matter who is diagnosing, they’ll encounter very vague symptoms. When diagnosing such patients, we need to be extremely cautious."

"Especially when personal diagnostic experience isn’t very rich, every test and judgment must be made cautiously."

"We often talk about indications, and we need to follow them. What do we do when indications are unclear? That’s how smart people invented consultations."

"When we can’t handle it alone, we call on partners. If the ones around us aren’t enough, we can broaden the scope with a multi-disciplinary consultation."

"Saying so much, it’s all just to remind everyone that we must be responsible during diagnosis. Be serious with the patient, and responsible for yourself. I’m tired of talking, the rest is suturing slowly."

Liu Banxia said a lot, leaving a significant impression on everyone.

Patients with unclear symptoms are often encountered in the diagnostic process. In such cases, deciding which tests to conduct isn’t easy.

Of course, doctors only looking to make money would be happy, ordering all conceivable tests because the symptoms are vague. As for how much more the patient has to spend, that’s their matter, not ours.

That’s what Liu Banxia means by being responsible for oneself. It’s easy to order tests, just a click on the computer. But for patients, it could have a significant impact.

One is wasting time, which might affect the progression of the illness. Another is the financial impact, as every test costs money.

"Oddly enough, occasionally listening to him ramble does leave some impressions. It seems his patients don’t undergo many tests," Wang Chao said.

"Yeah, it appears he has repeatedly emphasized this to the interns and resident trainees," Wei Yuan said.

"Arranging instrumental examinations is indeed an art. Too many can lead to redundancy, too few won’t suffice."

"If arranged appropriately, it can enhance diagnosis efficiency, reduce patient queueing, and fully utilize our examination equipment."

Wang Chao nodded, acknowledging the truth in those words.

Not all symptoms can be resolved through CT or MRI; X-rays and ultrasounds all have their unique purposes.

Properly matched examinations are the best.

The brief discussion between the two also significantly impacted the surrounding interns and resident doctors.

Even though this time Liu Banxia’s teaching was entirely unrelated to the surgery, it was connected to diagnostic operations. This procedure, no matter if they work in the Second Hospital or elsewhere, will relate to their careers as doctors.

In retrospect, it seems that Liu Banxia indeed kept emphasizing this. But previous mentions don’t seem to have made as deep an impression as this one did.

"I really admire our Director Liu. Now he treats such advanced surgeries as routine work. Guys, don’t bear too much pressure like I do," Wang Chao told the surrounding interns.

Everyone grinned broadly.

This issue was just brought up: how can there not be pressure?

Keep at it, there’s no other way but to persist. At least there’s one good thing: even if the pressure is high, the variety of experiences gained in this internship is worthwhile.

In other hospitals, this surgery might have had to wait for doctors to come in, but once Director Liu discovered it, he could handle it directly—that’s skill.