Great Doctor Ling Ran
chapter-28

Chapter 28: An Open Wound

“Please make way.” Two nurses, one at the front and one the back, were pulling a gurney.

The senior attending physician, Zhao Leyi, followed them in small steps and reported to Huo Congjun, “The patient was injured in a car accident. There’s a 7.9 inch open wound on his abdomen. Some parts of the intestines and the greater omentum are exposed and actively bleeding. A sterile pad has been applied to protect the intestines…”

Huo Congjun followed the gurney, and Ling Ran followed Huo Congjun.

The casualty’s two family members were blocked behind them, they were perplexed and worried.

From a normal person’s point of view, this was a terrible disaster because the exposure of intestines was basically what it meant—a person’s intestines had spilled out of his body.

Of course, being transferred to the hospital meant it was not a mild injury. A hospital that was not tertiary grade A might not be capable of handling this, so that was why he was deliberately sent to Yun Hua Hospital.

However, that was the extent of how serious the injury was to the doctors in Yun Hua Hospital.

Because Yun Hua Hospital’s Emergency Department had similar casualties practically every month. They also had casualties who suffered different and even more severe injuries.

Huo Congjun was listening while personally inspecting the wound. Then, he began speaking, partly to provide Ling Ran a description of the wounds on the patient, and partly to describe the patient’s condition to his colleague, Zhao Leyi, “On the left, there are three to twelve ribs obviously dislocated, heartbeat is 105. There’s severe bleeding, we need to prepare for a blood transfusion…”

He did not speak all that fast. There was no extreme sense of urgency in his tone like in the television programs.

The main reason was also that the patient had not reached the point where he needed to receive urgent treatment.

In the hospital’s Emergency Department, the doctors always talked according to the patient’s vital signs. In the Emergency Department’s classification, this kind of patient was a Level 2 patient. The degree of urgency was not as critical as comatose patients.

Hence, the doctors making the decisions could consider more aspects of treatment, and they could also perform the treatment at a slower pace.

Zhao Leyi had worked in the Emergency Department for nearly ten years. He was experienced and knew Huo Congjun well. He calmly translated what Huo Congjun said and spoke as well, ticking off the emergency checklist, “Extract the vein’s blood, immediately perform a routine blood test for kidney function, blood type, electrolytes, the first four items before blood transfusion, and blood clotting function…”

At the same time he spoke, he also filled up the emergency checklist. Huo Congjun nodded his head after he looked at it, the checklist was then sent out.

At that moment, the nurses were also done adjusting the patient’s body position and an oxygen mask was placed on him. The nurses also connected the electrocardioscope monitor to the patient to measure his vital signs.

“Prepare the second venous access device, 17 ounces of Ringer’s solution.” Huo Congjun did not test Ling Ran this time, and he quickly made his decision as he said, “Omeprazole 0.3 ounces, saline solution 0.3 ounces, administer one single-dose intravenous injection.”

After completing these, Huo Congjun then checked the patient’s blood pressure, heart rate, breathing, and other vital signs. He then said to Zhao Leyi, “You continue with the resuscitation, I’ll talk to the family members. Ling Ran, you come with me.”

“Yes.” Zhao Leyi was so busy that he could not lift his head.

Huo Congjun brought Ling Ran with him and said to him while walking, “Other than good medical skills, handling the patients and the patient’s family is also very important. If I tell you so much now, you might not remember it all. The first thing is that you must have confidence, you must be calm, and you must speak gently.”

Normally, Huo Congjun would not actively talk to the family members; he would not do this kind of delicate work.

He was now already the department director. The equivalent of this in a military hospital would be a senior colonel ranked civilian. Unless all bullets and rations had been depleted, he would not enter the battlefield on his own.

Of course, the frequency of the Emergency Department exhausting their resources was relatively high, Huo Congjun still needed to be on the battlefield sometimes.

Huo Congjun laughed after seeing Ling Ran nod his head, he said, “You don’t have to talk later, just observe and remember more.”

“Alright.” Ling Ran nodded his head again.

The two of the patient’s family members were already held back outside the resuscitation room. They extended their necks to look, feeling very anxious.

Huo Congjun came through the door and put on a very friendly expression. The scary look that he had in the resuscitation room was no longer there.

“Good evening, are you Mr Lai Zhongde’s family members?” Huo Congjun remembered the two who came down from the ambulance, but he still asked.

“Yes, I am his wife.” The older-looking women wiped away her tears and asked, “Doctor, how is my husband?”

“Mr Lai is still undergoing resuscitation, I’m the physician in charge, I need to ask you all a few questions. Does the patient have any liver disease or any chronic diseases?”

The patient’s wife shook her head and explained, “He is a civil servant, he has alcoholic fatty liver, as well as problems in the three highs[1].”

Huo Congjun nodded his head, and he asked, “Does he have any infectious diseases?”

“No, we have our check-ups done every year.”

“Does he have problems like Hepatitis B?”

“No.”

“What about other infectious diseases? At this moment, we must be fully aware of the patient’s conditions.”

“No,” the woman said with certainty.

Huo Congjun then made a tick on the paper, asking, “What about allergies? What is he allergic to?”

“He is a bit allergic to pollen, it’s no big deal.” The patient’s wife was trying hard to recall.

Ling Ran discreetly noted it down in his memory while he listened to the their conversation, and tried to identify them with what he knew.

There was a fixed formula in asking about the patient, but it would still require some skill in delivering the enquiries, as well as constructing the order of the enquiries.

Like this patient, if he was a civil servant, and if he had regular check-ups, then she should know about the chronic diseases and allergies he had. There was no need to ask further questions about that. However, infectious diseases could very easily be kept a secret by the patient or those related to him, and this was also something they did often. Huo Congjun, too, asked the most questions regarding this, he was also the most stern in regards to these questions.

He asked a few more questions regarding his drinking habits and his medications. He then said, “From what we have observed, the patient suffered severe bleeding, we need to perform a blood transfusion on him. Do you know if he has gone through a blood transfusion? Does he have a special blood type?”

“He has type-A blood. He has donated blood before.”

Huo Congjun then let the patient’s wife sign the blood-transfusion consent form, the acknowledgement form, and the resuscitation agreement form. He then allowed the patient’s family to make the payment, and then he brought Ling Ran back to the resuscitation room.

Along the way, he said, “You must remember in the future that you must let the patient or their family members sign the agreement form. This is to protect you and the patient, understand?”

“Yes.”

“What do you think about the conversation I just had with the patient?”

Ling Ran spoke while recollecting the process of Congjun’s questioning, “I need to control the rhythm of the conversation.”

“Not bad. What else?”

“Be firm.”

“That’s right, this is a very important point: You don’t give patients unnecessary illusions. I know that to be friendly yet firm is difficult, but the patient does not need us to give them illusions. Our main mission in the Emergency Department is to save the patient.” Huo Congjun stopped after he spoke up to that point.

These words were not what he would tell other interns or residents. It was because Huo Congjun favoured Ling Ran highly that he would explain all this with much patience.

The missions in the Emergency Department were complicated and cumbersome, and they could be messed up easily. However, none of the mistakes should not be equated to the relationship between the patient and the doctor. Yet if one could not manage this well, he or she would not be a doctor for very long.

“Department Director Huo.” When the doctor who was working at the gurney saw Huo Congjun, his voice became two decibels louder.

“How is it?” Huo Congjun could hear the attending physician’s agitation.

“The bleeding won’t stop.” The attending physician gritted his teeth and forced out the words in his throat.

Editor’s Note:

[1] The three highs: high blood sugar, high cholesterol, and high blood pressure. All three are problems closely related to obesity.