Back in 2002 as a doctor

Sitting silently, Director Hao observed all members of the medical team.After more than an hour, someone knocked on the door.

"Director Hao, why are you here? I went to the first hospital to look for you, but I couldn't find you." A middle-aged man in his 40s said with a smile on his face.

"I'm here for something." Director Hao said vaguely, "What's wrong?"

"This is my father. He choked on food recently."

Director Hao began to ask about the medical history.

In front of Zhou Congwen, Director Hao was very serious and did not dare to be careless or negligent.He carefully asked about the medical history, as rigorous and serious as an intern.

The patient's condition is simple and typical.

Progressive dysphagia, has been eleven months.At the beginning, I felt uncomfortable when eating solid food, such as steamed buns; later, it gradually changed to liquid food, and now I feel uncomfortable when drinking water.

After the questioning, Director Hao already had his own judgment. He secretly glanced at Zhou Congwen, and saw that Zhou Congwen had been reading magazines, as if he didn't pay attention to himself at all, so he felt relieved.

"Professor Zhou." Director Hao leaned over, "There is a patient with esophageal space occupying, who has progressive dysphagia for eleven months. Look..."

"Have you had a gastroscopy?" Zhou Congwen looked up at Director Hao and asked.

"not yet."

"Then prepare to have one, check the situation with a gastroscope, and bring it in for surgery." Zhou Congwen said.

"it is good!"

Director Hao went to arrange the blood collection, but now that he is in the Second Hospital of Medical University, some things are not as convenient as at home.

When he was thinking about where to get blood from the patient, Zhou Congwen asked Peng Yiming to take him for an examination.

It can be more convenient, although Peng Yiming is just a doctor in training.

Early the next morning, Director Hao came to wait for Zhou Congwen with various materials.

If the patient is admitted to the hospital, he should be able to follow up with the operation and learn from the practice of thoracoscopic esophageal cancer.

It is said that Zhou Congwen is not stingy at all, as long as he is willing to learn from him, he will teach.

And the most important thing is that he treats the people around him well, not to mention the rabies patient Shen Lang, even the old doctor Lu Tiancheng who also came from Jianghai City, has now gone to Shanghai and is under the tutelage of Academician Chu.

It doesn't seem like a big deal for me to want to learn thoracoscopic surgery.

When thinking of new technologies, Director Hao is also eager to move.

Yesterday Zhou Congwen demonstrated the advantages of the new technology. As long as the technical level is passed, thoracoscopic surgery is just like what he said at the annual meeting-it can perform all thoracotomy operations, and it is better than thoracotomy!

Director Hao was looking forward to it, but he also felt a little slanderous in his heart.

It is still different for patients to undergo examinations in outpatient clinics and inpatients, as far as the reimbursement ratio is concerned.Judging from the medical history, it must be esophageal cancer. It would be better for the patient if he was admitted to the hospital, after all, it is included in the hospitalization expenses.

Yesterday Zhou Congwen asked the patient to check the gastroscopy in the outpatient clinic. Director Hao did not refute, but the first thought in his mind was that Zhou Congwen cared about the bed turnover rate.

When Zhou Congwen came to work and changed his clothes, Director Hao asked respectfully, "Professor Zhou, do you have a gastroscopy after surgery at noon?"

"The old man is getting old, it's inappropriate to be hungry all the time." Zhou Congwen said, "Go now and take a look at the admission hospital. There will be no shift in the morning, and we will go to the endoscopy room."

"Professor Zhou, I'm really sorry." Director Hao rubbed his hands and said, "If it wasn't for the turnaround time of the bed, it could have been taken in and checked slowly. I think our side..."

Before Director Hao finished speaking, Zhou Congwen smiled slightly, "Director Hao, have you ever seen other progressive dysphagia?"

"Others?" Director Hao was stunned for a moment, then smiled, "Some rheumatic diseases can also occur, but they are rare."

"It's not necessarily rheumatic immune disease." Zhou Congwen said with a smile, "I estimate that there is at least a 20% probability that this patient is not esophageal cancer."

"!!!"

Director Hao was stunned, what Zhou Congwen was telling him!

"The patient has been coughing, did you hear that?" Zhou Congwen asked.

As a thoracic surgeon, listening to patients coughing has become an occupational disease, and I will never forget it.

What is the relationship between just coughing and esophageal cancer?Director Hao was taken aback.

"The patient has wheezing sounds. He has shortness of breath and edema at the extremities. It is estimated that he has congestive heart failure."

"..."

Director Hao has nothing to say this time. This is part of the medical history. He is familiar with the patient's son and knows that his elder has this problem, so he didn't ask yesterday.

Unexpectedly, he didn't ask, Zhou Congwen saw it at a glance.

Not to mention anything else, director Hao admired the diagnostic level and clinical experience that can tell a lot at a glance.

"Patients with congestive cardiomyopathy and progressive dysphagia may not be esophageal cancer." Zhou Congwen continued, "Take a look at the gastroscope, and I greeted the director there. Let's go up and do it first, just take a look and go down."

"Ah?!" Director Hao was stunned.

He didn't know what Zhou Congwen said.

But Zhou Congwen didn't say much, went to the endoscopy room, greeted the director and began to examine the patient.

Going in under the gastroscope, the esophagus is empty, just like what Zhou Congwen said, it is not esophageal cancer at all.

Director Hao was dumbfounded.

Patients who can only drink water are most likely to have advanced esophageal cancer. Director Hao has a judgment in his heart.In his imagination, the gastroscope might not be able to go on, and the esophagus should be full of tumors.

When he saw this scene, he felt bad all over.

Chapter 1356 Thought Stamp

"What about the tumor?" Director Hao murmured.

"It didn't exist in the first place." Zhou Congwen said logically.

He took out the gastroscope and asked, "Old man, have you taken any medicine when you feel uncomfortable after eating?"

"Yuck~"

The patient was stimulated by the gastroscope and caused nausea. After a delay of 30 seconds, he took the gauze from Zhou Congwen and wiped his tears.

Gastroscopy is a good thing. It can intuitively see the picture that doctors dreamed of seeing a hundred years ago, but it is also more stimulating.

"Doctor, what do you ask me?" The patient asked in a hoarse voice after he recovered a little.

"Have you taken any medicine recently?" Zhou Congwen asked again, "I mean you feel uncomfortable after eating, and you can't eat it. Is there any medicine that can relieve it?"

"I can't say it, I can't say it." The patient nagged himself, "What a pain."

Director Hao and Zhou Congwen helped the patient up, and faced the patient's nagging, no one urged him.

Because there are other patients behind, I can only help the old man to rest in the corridor.

Zhou Congwen was not in a hurry, he didn't see any tumor in the esophagus, so he immediately declared that he was fine, and ran back for surgery.

Since the old man didn't understand Zhou Congwen's reason, he chatted patiently with the old man.

Director Hao stood aside and listened silently.

What Zhou Congwen asked seemed to have something to do with chest surgery, but it didn't seem to have anything to do with it.

Whether there are other symptoms when eating is difficult, are not characteristics of esophageal cancer.

Asked about the medical history yesterday, when Director Hao heard the most typical complaint of progressive dysphagia, he subjectively judged that the patient had esophageal cancer, and ignored other symptoms.

However, what Zhou Congwen cares about is "others".

A few minutes later, Director Hao was a little dazed.

When the patient complains that it is difficult to eat, he will be accompanied by dyspnea and wheezing, which can be relieved by oral diuretics.

It is said that these have nothing to do with esophageal cancer, but Zhou Congwen was very happy after asking about the symptoms and medical history.

"Let's go, there's nothing wrong with it, it's just a geriatric disease." Zhou Congwen and the patient said gently, "I will be hospitalized for a period of time, but not in surgery but in internal medicine."

The patient did not suffer from persecution delusions, and did not think that what Zhou Congwen said meant to let him go home to eat and drink whatever he wanted.

After leaving the endoscopy room happily, Director Hao took Zhou Congwen to a quiet place and asked the patient, "Professor Zhou, what's wrong?"

"Heart failure."

"..." Director Hao was left speechless by Zhou Congwen's diagnosis.

"The patient's dysphagia was not caused by the tumor, but atrial dysphagia."

"..."

Director Hao remained speechless.

He looked at Zhou Congwen with a dazed look.

From the past history and the medical history inquired by Zhou Congwen, Director Hao has already guessed why the patient has difficulty swallowing.

But guesses are just guesses. Zhou Congwen's diagnosing ideas are so old-fashioned that Director Hao seems to have eaten a pot of fiery red oil, and even the anus reacted in an instant.

"To do an echocardiogram, it should be the progressive dysphagia caused by the obvious protrusion of the left atrium and the compression of the middle part of the esophagus." Zhou Congwen gave the final conclusion, "Go to the circulatory department of the first hospital for hospitalization. By the way, echocardiography I'll take a look at the report, and if it's suitable, I can do minimally invasive surgery."

"!!!"

Director Hao was very confused about Zhou Congwen's saying that he can perform minimally invasive surgery for everything, but he still had a semblance of sanity, and immediately asked, "Professor Zhou, please say a few more words, I..."

"In decompensated heart failure, the fluid load increases, and the volume and pressure of the left atrium increase, expand outward, and compress the adjacent esophagus, producing symptoms of dysphagia."

"So patients have symptoms such as wheezing when they have difficulty swallowing, and diuretics can relieve it."

"..." Director Hao has worked in surgery all his life, and he has never encountered a similar patient.

Or did not notice.

As soon as Zhou Congwen mentioned it, countless knowledge in Director Hao's mind lit up, connecting them into constellations, shining brightly.

"The disease between the left atrium and the esophagus is not as simple as mechanical compression. Clinically, patients often encounter cases where swallowing stimulates the nerves that innervate the heart, leading to tachycardia or syncope." Zhou Congwen said with a smile.

"Uh..." Director Hao looked at Zhou Congwen in a daze.

"Go for an examination." Zhou Congwen glanced at the time, "I'm off to work, and there is surgery."

"Then you are busy." Director Hao's waist could not help but bend down, "Professor Zhou, you have learned a lot."

"No, it's just a little trick, which is easy to ignore at ordinary times. When you hear about progressive dysphagia, you think of esophageal cancer." Zhou Congwen said with a smile, "The distance between the esophagus and the left lower pulmonary vein is smaller than the distance between the esophagus and the right lower pulmonary vein, that is, the esophagus travels in a wrong direction." Left, such patients are more common.

Anatomy or CT images have been studied, and there is only some connective tissue between the esophagus and the posterior wall of the left atrium. The average distance between the two is 2.3±1.2mm, and the smallest is even only 1mm. "

"..."

Director Hao remained speechless.

Until Zhou Congwen was sent away, Director Hao still felt that his eyes were full of gold stars, and he felt a little bad.

He crushed himself without any suspense in the field he was best at, but Zhou Congwen was not complacent. He didn't even seem to pay attention to himself. It's worth showing off.

Director Hao once again felt the gap between himself and the number one in the world.

However, Zhou Congwen made it very clear that Director Hao is also an old surgeon who has been fighting in the clinic for countless years, so it is not a problem to explain his condition.

Explain to the patient's family members, contact the echocardiography of the first hospital, ask the patient's family members to take it for examination and tell the patient's family members to make a copy of the report.

Then Director Hao called the circulation department in advance to arrange hospitalization.

After everything was busy, Director Hao didn't rush to the operation, but recalled Zhou Congwen's performance yesterday and today when this patient was involved.

In the end, Director Hao came to a conclusion - when he asked about the medical history yesterday, Professor Zhou Congwen Zhou already knew that his diagnosis was wrong, but he didn't say what was wrong in front of the patient's family.

Ugh.

Director Hao expressed regret for his mistake in diagnosis, and became more interested in this young Professor Zhou.

what's next?Director Hao had already completely knelt in his heart, prostrating himself.

Professor Zhou Congwen Zhou seemed to be going to undergo an interventional valve replacement operation. Director Hao thought about it and called home to ask if there was any suitable patient.

A technique that I think is not good can only mean that I can't do it, Zhou Congwen can definitely do it!I don't understand that my level is not enough, and Director Hao stamped his ideological stamp on himself.

Chapter 1357 Please Do Something

In Baishui City, Shi Ping sat sadly in the fire escape, smoking a cigarette.

After a brief "fight", he has already applied for transfer from Baishui Central Hospital.

Originally, Dean Guan Xiaozhe Guan came to him to mix sand and shake Xiao Kai's foundation. He usually understands these things.

Before coming here, Shi Ping thought that he had the support of the chief dean, even if Xiao Kai was unhappy, so what.