Back in 2002 as a doctor

"I'm already considered a useless person. It's not too much to ask for a place to retire."

"How could it be?" Zhou Congwen squinted and looked carefully at the patient's three electrocardiograms.

"Originally, the city didn't care much about the Third Hospital. I belong to the distribution frontier, so there is not much resistance." Li Qinghua laughed.

"What about Director Wang?"

Speaking of Wang Chengfa, Li Qinghua smiled, "Don't worry, I won't have two ends. One body has two sides, the warmth like spring always has the coldness like winter."

"The patient is not a myocardial infarction." Zhou Congwen suddenly brought the topic to another dimension.

"..." Li Qinghua was stunned for a moment.

The patient's electrocardiogram clearly "pulls a small flag", and the ST segment is intermittently elevated. How could it not be a myocardial infarction?Did Zhou Congwen test himself on purpose?When he mentioned Wang Chengfa just now, he "pointed at a deer as a horse"...

It would be too much to use this to test himself, Li Qinghua thought in bewilderment.Countless thoughts flooded him, and he was suddenly plunged into darkness.

"Three years ago, the patient was diagnosed with cardia cancer and underwent esophagectomy. The chest X-ray showed the left chest and stomach. The transthoracic echocardiogram showed no abnormalities in the size of the heart and valves, and the ejection fraction was 60%. It is said that our People's Hospital cannot do it yet. Coronary angiography?"

"Yes, Director Li just came back, and the interventional heart surgery has not been carried out for the time being, and is still under active preparation." Li Qinghua carefully answered Zhou Congwen's words carefully.

Li Qinghua is good at dancing, but he has never been able to figure out how to get along with a "little doctor" like Zhou Congwen.

With new challenges in the new era, Li Qinghua felt that no matter what he did, it seemed wrong.

No wonder, normally speaking, a young doctor like Zhou Congwen, no matter who sees him, he can't call Li Ge?But he...

Just as he was thinking, Li Qinghua's thoughts were interrupted.

"There are some problems with the patient's electrocardiogram, and some are not. What do you think?"

Chapter 0203 Beyond the People's Hospital

"There is a problem during the attack period, and there is no problem if there is no ECG attack. I think the patient's coronary artery stenosis is relatively mild, so he is suitable for interventional surgery. Director Li just came back, and the machine is not in place yet, so I think..."

"No, no, no, Qinghua, there are some details that you probably didn't pay attention to." Zhou Congwen said, laying a few electrocardiograms flat on the table, facing Li Qinghua.

Li Qinghua didn't know what Zhou Congwen meant.

Because of the idea of ​​becoming the director of cardiac surgery, Li Qinghua has been studying the business even though he has never been in contact with surgery.

The electrocardiogram is indeed relatively advanced, but it can't help him.

These few electrocardiograms can be seen at a glance. Is there any detail that I haven't noticed?Li Qinghua read it again, and still felt that his previous judgment was correct. He couldn't figure out what Zhou Congwen was thinking, so he remained silent.

There is no problem, but this is the biggest problem, what does Zhou Congwen mean!

"This is the electrocardiogram of the routine examination on admission. It shows sinus bradycardia and no ST-T segment abnormalities."

Zhou Congwen pointed his finger on an electrocardiogram.

This is nonsense, and Li Qinghua is still wondering what Zhou Congwen's subtext is.

"This is the ECG at the time of onset, sinus bradycardia, ST-segment elevation in leads II, III, and aVF, and ST-segment depression in leads I and aVL."

"This is also the electrocardiogram at the time of the onset."

Zhou Congwen tapped his fingers on the remaining two ECGs, and looked at Li Qinghua with a smile.

There are two trees in front of the door, one is a jujube tree, and the other is also a jujube tree...

What the hell!Li Qinghua looked at Zhou Congwen helplessly.

The man in front of him was too young, but his charade skills were not inferior to those old fritters at all.Li Qinghua was a little confused that he couldn't comprehend Zhou Congwen's potential meaning for a while.

When he mentioned Wang Chengfa, he also explained his attitude, but Zhou Congwen's tone changed immediately. Could it be that he was implying something to himself?

But I have already expressed my attitude very clearly, isn't it enough?

Li Qinghua himself doesn't like Wang Chengfa, neither the retired old director Gong nor the current director Zhu like him in the People's Hospital, so Li Qinghua doesn't have any psychological pressure.

None of this works?Then what else do I have to do!

Just as he was thinking wildly, trying to figure out Zhou Congwen's subtext, he heard Zhou Congwen's voice.

"Qinghua, check the inspection time."

Li Qinghua was puzzled.

check the time?Could there be any problems due to the different time?There are indeed similar situations clinically. For example, kidney stones tend to occur at three or four in the morning in early autumn and early winter.

Myocardial infarction tends to occur during the period when the temperature drops suddenly, but there is no clear statement.

"The two ECGs in question were both taken between 12:30 noon and one o'clock. I suspect that the patient did not have a myocardial infarction, but was fed up."

eat……

full……

support...

Li Qinghua was not angry, his thoughts returned to Wang Chengfa again.What does Zhou Congwen mean by this? !

"Thorax and stomach, after eating, the stomach expands and oppresses the heart, causing symptoms of myocardial infarction. How many similar cases have you seen?"

Zhou Congwen asked lightly.

Li Qinghua thought over Zhou Congwen's words carefully, and suddenly felt ashamed.

People kept talking about diseases and patients, but I was always thinking about Wang Chengfa...

The height of the realm can be seen at a glance.

Li Qinghua immediately calmed down and carefully checked the electrocardiogram for the Nth time.

"It's normal if you haven't seen it before, and few people connect these signs." Zhou Congwen said very casually, "A large Swedish registry study was conducted on the diagnosis of type 2 coronary artery stenosis. A total of 20138 cases of myocardial infarction were diagnosed. The hospitalized patients were examined, and most of the cases... if I remember correctly, 88.5% had type 1 coronary stenosis and 7.1% had type 2 coronary stenosis."

The rhythm of the conversation was originally based on the two people taking what they needed, and it was difficult for Li Qinghua to adapt to the rhythm of academic discussion when Wang Chengfa, who was unwilling to leave, was swept into the dust dump of history and directly entered the rhythm of academic discussion.

Doesn't Zhou Congwen know what he is looking for?

Li Qinghua looked at Zhou Congwen in a daze.

"Qinghua, what are you looking at?" Zhou Congwen asked with narrowed eyes.

"Uh..." Li Qinghua was speechless.

"It's fine if you come, first ask Professor Chen to do your surgery, and then carry out thoracoscopic surgery after surgery. As for Wang Chengfa, it's just a incidental matter, not important at all." Zhou Congwen said with a smile.

Li Qinghua sighed.

"Having said that, this electrocardiogram is very interesting."

"Type 2 MI is considered to be an imbalance between myocardial blood supply and demand, resulting in myocardial ischemia without coronary plaque rupture, such as coronary endothelial dysfunction, coronary spasm, coronary embolism, tachyarrhythmia, anemia, respiratory failure, Hypotension and hypertension with or without left ventricular hypertrophy."

"Type 2 MI after gastric dilation is not uncommon, and the patient's past history has shown this. And the time of ECG also shows that the stomach dilation after lunch leads to myocardial ischemia, and symptoms of myocardial infarction appear."

"It would be great if I could do a coronary angiography, but it doesn't matter, first give drugs that promote gastric motility and protect the gastric mucosa to see if it can relieve symptoms. By the way, let the patient eat less."

"After cardia cancer surgery, why do you still eat so much? How do you follow up after surgery?"

While talking, Zhou Congwen automatically switched to the mode of leading doctoral students, and reprimanded him softly.

Li Qinghua became dazed.

"Okay, the patient's situation is like this." Zhou Congwen put away the report sheets in chronological order, and handed the file bag to Li Qinghua, "When can I come?"

"Ten days."

"Hurry up." Zhou Congwen said with a smile.

"Ah."

Li Qinghua has accumulated countless energy in the past few days, and it has been empty. Why did he ask Zhou Congwen to teach himself a case, and it was over after the case was finished...

Isn't the main topic about changing jobs and coming to the Thoracic Surgery Department of the Third Hospital?

"If you have nothing to do, go to work, hurry up, I will contact Professor Chen." Zhou Congwen took out the white cigarette case, but hesitated for a moment, his wrist did not shake, and Bai Lingzhi did not jump out.

He smiled, "Is that so?"

"Uh..." Li Qinghua always felt that he still had something to say.

Before coming here, Li Qinghua thought of talking mainly about coming to the Third Hospital to squeeze Wang Chengfa away, but Zhou Congwen took the introduction of the medicine as the key point, and the conversation turned into a consultation.

"Qinghua, you can't even transfer jobs, can you?" Zhou Congwen asked in surprise.

"No, no. It's not that I was transferred from the Third Hospital to the People's Hospital. People go to high places. I'm at the end of the road. The water flows to low places, and no one will stop it." Li Qinghua said.

"Oh, I thought there was something wrong with your expression."

Li Qinghua had an impulse to talk about what happened next, but he held back in the end.Do as Zhou Congwen said, and then look at the situation before talking.

"Now that I've come to this point, I want to ask you something." Zhou Congwen looked at Li Qinghua with a smile.

"Ok?"

"What are you going to do after you come to the Third Hospital?" Zhou Congwen asked directly.

Li Qinghua was a little confused. After going to the third hospital for surgery, of course he was taking care of the elderly, so what else could he do.

It is suppressed by the People's Hospital above, and the basic board of the Third Hospital is in the emergency surgery area.Unless it is a strong person against the sky, it is meaningless for anyone else to come.

"Qinghua, do you want to counterattack?" Zhou Congwen asked.

"Counterattack?"

"You know the situation in the People's Hospital. You are obviously the crown prince of the chest department, but there is a high probability that the bamboo basket will be empty in the end." Zhou Congwen told the truth, and his words without scruples would hurt Li Qinghua's heart.

Li Qinghua stared at Zhou Congwen in a daze, since he was going to the Third Academy, should Zhou Congwen come down first?How could this young doctor be so arrogant.

Thinking of this, Li Qinghua felt bored for a while.

"To be honest, the old directors of that era had the same problem. I don't like it very much. You are never allowed to have a higher grade operation. Are you convinced?"

"I'm not convinced, but I can't help it." Li Qinghua didn't know what Zhou Congwen wanted to say to him, so he could only respond calmly.

He carefully observed Zhou Congwen's gaze and expression, trying to find the answer.

But soon Li Qinghua gave up, Zhou Congwen's eyes were clear and his expression remained unchanged.

"That's right, let me put it simply. If you come to be the director, you have the opportunity to make the thoracic surgery department number one in the city within a year. Are you interested?"

"..." Li Qinghua was dumbfounded.

When Zhou Congwen spoke just now, he thought about many possibilities in his heart, but he never expected that Zhou Congwen would actually say this to himself.

No. [-] in the city?

Doesn't Zhou Congwen know the gap between the Third Hospital and the People's Hospital?

What kind of hospital is the Third Hospital?A few years ago, it was a health center, and then several buildings were built to become the health care hospital of the group company.

It is said to be a health hospital, but it only treats some minor illnesses.Moreover, the personnel of the third hospital were all supported by the People's Hospital back then, and the people who went there were all the "bad people" that the People's Hospital didn't want, such as Wang Chengfa.

With this basic strength, Zhou Congwen actually told himself that he would surpass the People's Hospital within a year?

Isn't this a joke!

Li Qinghua was sure that Zhou Congwen was joking, but he couldn't figure out why.

"Do you think I'm joking?" Zhou Congwen asked lightly.

Li Qinghua nodded.

There's nothing like that to deny.

"Qinghua, times have changed."

"Ok?"

"The explosion of technology and several industrial revolutions have nothing to do with us in detail, so I won't talk about it. Let's just talk about thoracoscopic surgery, down to the details."

"From the beginning of thoracic surgery in China until now, there has been no special change in the operation method. Except for electric cauterization, rib removal and opening length, generations of people have followed the same path."

"However, the aftermath of scientific and technological progress has spread to the medical field. Thoracoscopic surgery is a major event that changes surgical methods, and it is an earth-shaking event."

Li Qinghua looked at Zhou Congwen in a daze. What was he talking about?It's not that a thoracoscopic surgery has never been done, and its advantages and disadvantages are all too clear to me.

Thoracoscopy is particularly difficult to operate, but consumables such as linear cutting staplers and staplers are very useful, and they are an important supplement for thoracotomy.But if thoracoscopic surgery can change the ecological environment of thoracic surgery, Li Qinghua refuses to believe anything.

"I'm looking for you to come to the Third Hospital, and it's just a matter of sending Wang Chengfa away. What I want more is that the Thoracic Surgery Department of the Third Hospital will surpass the People's Hospital within a year."

Hearing Zhou Congwen say this again, Li Qinghua finally couldn't bear it anymore, and he asked, "Congwen, do you think it's possible?"

"Let's not talk about the sleeve resection under the laparoscope, the radical operation for esophageal cancer, and various heart operations in the future..."