CHAPTER 474: 474 LIU’S NEW TEACHING PLAN

Liu Banxia liked challenges; they were like solving puzzles. Solving them brought not only a sense of accomplishment but also the ability to greatly help patients.

But it also depended on the timing. When things were leisurely, a challenge was welcomed. But what about now? The recent cases in the emergency center were quite complicated, so he really didn’t want to take on another challenge like this.

Today’s patient, who constantly belched, was also a problem—not an easy one to solve. After auscultating the heart and lung sounds, he hadn’t detected any issues.

During the auscultation, the patient was still belching incessantly. This is definitely not a common symptom; otherwise, it wouldn’t be so frequent, Liu Banxia thought.

Just as he put away the stethoscope, he froze. It seems I’ve overlooked something.

"Could you please take off your glasses?" Liu Banxia asked.

The patient, though slightly startled, removed his glasses.

Liu Banxia sighed inwardly. The patient’s eyes show signs of jaundice.

Actually, while auscultating the patient’s abdomen just now, he’d had a feeling that something wasn’t quite right. The patient’s skin was somewhat dark, making the symptoms of jaundice less noticeable. Moreover, the patient had been wearing glasses, so the jaundice in his eyes hadn’t been accurately visible.

"HIC... Doctor, what’s wrong?" Seeing Liu Banxia silent, the patient asked anxiously.

"Next, we’ll do a complete blood count, blood biochemistry, tumor marker screening, and an enhanced CT scan," Liu Banxia said.

"You’re quite thin now, and you have signs of jaundice. I suspect your belching is due to pancreatic inflammation affecting your digestive system. An enhanced CT scan will give us a more accurate picture."

"Doctor, HIC... is it a serious disease?" the patient asked.

Liu Banxia was already ordering a tumor marker test; how could it be a trivial illness? Any tumor was bad news.

"It’s too early to say. Let’s wait for the test results," Liu Banxia said. "Try not to be anxious. You can contact your family to accompany you for the tests. Ultimately, the test data will guide us. Anything I say now is just speculation."

"Doctor, let me... HIC... think about it," the patient said.

Liu Banxia nodded, giving the patient some time.

This case today is complicated in one way, yet not in another, he thought. What caused my hesitation was my reluctance to order "routine" imaging for the patient. In fact, if it’s pancreatic cancer, an ultrasound could also reveal it. However, because I was overly focused on finding a clear indication for imaging, things got delayed a bit. Plus, the patient wore glasses, making the jaundice less obvious, and all my attention was focused on the belching.

Although the patient was worried, he had to go for the examination. Soon after the patient left, Wei Yuan and Qi Wentai, who had gone for a meal, hurried back.

"Why are you here alone? Where’s Wang Chao?" Wei Yuan asked.

"There’s a case of intestinal volvulus. He’s explaining the surgery to the child’s mother," Liu Banxia said. "I just saw a patient who might have pancreatic cancer. I’m going to grab a bite. The patients in the ER these past few days have all had serious conditions. I wonder when this wave will pass."

No one could answer him. Sometimes, it really did seem like serious cases came in clusters. With the New Year approaching, this situation was particularly trying.

After eating for a short while, Liu Banxia saw Wang Chao approaching. "How did it go? Did you explain everything thoroughly?"

"Thoroughly. Pre-op preparations are underway. President Liu, is there anything we need to be particularly careful about with this surgery?" Wang Chao said.

Liu Banxia shook his head. "It’s just correcting the intestinal position. Did you opt for laparoscopy or open surgery?"

"Open surgery. The family was also worried that if adhesions are severe, we’d have to convert to open surgery anyway," Wang Chao said.

"Then it’s even less demanding on technique," Liu Banxia replied. "Just be gentle and meticulous during the procedure. The main thing is to inspect the twisted bowel segment. If anything feels off, call me. I’ll come take a look."

"Actually, it’s not as difficult as surgery for typical intestinal perforation or necrotic bowel obstruction. It just requires meticulousness. Otherwise, it’s very likely to recur in the near future. Just be meticulous."

Wang Chao nodded; he was also worried about this. This condition can easily recur, he thought. The simplest solution would be to resect the affected bowel segment. But that’s only if resection is absolutely necessary. That’s why I’m afraid I might overlook something. If it recurs in a year or two, I’ll lose face.

"Did Brother Wei mention another suspected pancreatic cancer case?" Wang Chao asked.

Liu Banxia nodded. "That’s why I’m also a bit troubled. Wang Mingxing’s case feels like it just happened yesterday. But I suspect this patient’s condition isn’t good; the jaundice in his eyes is very severe."

Pancreatic cancer is the king of cancers, Liu Banxia mused. It’s really difficult to detect it early, like with Wang Mingxing. This patient’s belching is so severe; it must have already significantly impacted his digestive system. Although the results aren’t out yet, I estimate that even in the most optimistic scenario, it’s probably already stage two. Even if a pancreaticoduodenectomy is performed and chemoradiotherapy is effective, the five-year prognosis still won’t be good. That’s the terror of pancreatic cancer; it develops very rapidly. Especially in the later stages, the intervals are very short. Perhaps just one or two months can mark a new stage.

「After dinner」

They returned to the emergency center.

Things were relatively quiet today. There were no patients requiring emergency surgery, and the interns were all present.

"You six, come over here," Liu Banxia called out.

"Teacher Liu, what’s going on?" Xu Yino asked.

"For you, it should be good news, but it depends on how you interpret it," Liu Banxia said. "After the New Year, you won’t have much of your hospital internship time left. So, I have an excellent idea: a one-week internship each in pediatrics and the ICU."

Hearing his words, only Liu Yiqing was mentally prepared; the rest of them were dumbfounded. The pressure of working with the big boss here is already immense. If we go to pediatrics and the ICU, how will we survive? they thought.

"Teacher Liu, could you shorten the time a bit?" Xu Yino asked tentatively.

"Of course not. This is already the reduced version," Liu Banxia said. "My original idea was 20 days each. How much of a discount is that? Don’t just think about how tiring it will be; it will actually be a great training opportunity for you."

"In pediatrics, you’ll have to deal with many demanding parents. This will hone your skills in communicating with patients’ families. In the future, whether you’re in the emergency center or other departments in other hospitals, I believe you’ll be able to handle this aspect with ease."

"As for the ICU, there are many critically ill patients there. It’s also a test of your composure and your understanding of diseases. ICU doctors are very skilled. They need to devise ways to improve patients’ symptoms and vital signs in a very short time. Although there are only a certain number of patients and some treatment protocols can be pre-set, there will always be exceptions."

"Once you’ve been tempered in these two departments, I truly can’t imagine what could hinder you. You’ll have the composure, adaptability, and medical skills. Strive to quickly become attending physicians who can truly bear responsibility. This is also my hope for you. You are all good seedlings. I don’t want you to waste your internship time. An internship isn’t just about fulfilling your graduation requirements or obtaining your residency certificate; it’s about genuinely learning something."

"President Liu is right. Without his pressure, I wouldn’t even feel this stressed," Wang Chao said.

"Let me put it this way: back in the day in the Emergency Department, only Doctor Qi received this kind of attention. He was the most outstanding among our cohort of residents, and President Liu is a rising star. You guys are growing so fast, I’m worried you’ll take my position. Keep advancing steadily. Others might wish for this kind of hardship but not get the chance. Because when you go to those two departments, their heads will treat you as actual doctors, not just interns. Just like here in our department—who really treats you as mere interns?"

"Teacher Wang, even though we know you’re encouraging us, we still feel a bit apprehensive," Xu Yino said, her face etched with worry.

"No pain, no gain, right?" Liu Banxia said with a smile. "It’s only because our Emergency Center’s general surgery department has a solid team right now that I even dared to suggest this. My initial plan is for this to happen after the Lantern Festival. Once we get through the New Year period, you can face some real tempering. As for the order, you can decide that yourselves. After completing each rotation, you’ll get a two-day break to rest and recharge."

The six pitiable interns nodded. Even Su Wenhao, usually the most docile, looked crestfallen. Those two departments... really, only those who go will truly know. Every day there will feel like a year dragging by, they thought collectively, a sense of dread washing over them.

After the six interns had left, Wei Yuan remarked with a smile, "You’re really investing a lot in them."

"I just want them to take fewer detours and become competent for their future roles more quickly," Liu Banxia said. "They all have considerable strengths. Don’t be fooled by how pitiful they looked just now; they won’t perform poorly once they’re there. We just have to make sure those two departments don’t poach them. Many people have their eyes on them now."

Wei Yuan nodded. "This batch of interns in our emergency center, it has to be said, they’re truly excellent."

"Liu Yiqing is confirmed to stay. Next, I’ll slowly work on the others. We must retain enough doctors for our general surgery department; it’ll make things easier in the future," Liu Banxia said with a smile.

Wei Yuan chuckled. That was indeed true. Even though these interns would become residents, their skill level would be high, meaning they wouldn’t need constant supervision during their work.