Chapter 56: Chapter 56: First Collaboration with Jiang Ming’s Team

The emergency department wards steadily filled with appendicitis patients. Some were difficult cases transferred from lower-level hospitals.

Jiang Ming’s team kicked into high gear, everyone eagerly rising to the challenge.

Song Qi was an attending physician under Jiang Ming and one ofof the more senior doctors in the surgical group, with seniority comparable to Qin Donglai.

Song Qi made a special trip to the ward to check on the patient in Bed 5.

Yasui, a resident physician, followed behind him and reported on the patient’s condition:

"Dr. Song, the patient in Bed 5 was transferred from a lower-level hospital. He’s been experiencing distending pain in his right lumbar and abdominal region for four days. He was diagnosed with acute appendicitis at both the previous hospital and here. I recommended surgery, but the patient requested conservative treatment. He’s been on anti-inflammatory medication for four days, but his symptoms haven’t improved. In fact, they’ve progressively worsened."

Dr. An then carefully recited the patient’s physical examination findings:

"Patient’s temperature is 36.6°C. Abdomen is flat and soft. There’s tenderness at McBurney’s point in the right lower quadrant, as well as above and below it. No rebound tenderness, no palpable mass, and no percussion tenderness in the right renal area. Slight lateral curvature of the thoracolumbar spine. White blood cell count is 7.6×10⁹/L, with 85.1% neutrophils. Urine is negative for red blood cells and occult blood..."

After reviewing the information, Song Qi mulled it over.

’Looks like conservative treatment isn’t working. We’ll have to go ahead with an appendectomy.’

Dr. Song discussed the situation in detail with the patient, who ultimately agreed to follow his advice. 𝗳𝚛𝗲𝕖𝚠𝚎𝚋𝗻𝗼𝕧𝗲𝐥.𝚌𝚘𝐦

"Yasui, schedule a preoperative 64-slice spiral CT with abdominal contrast for the patient. If nothing comes up, arrange for surgery as soon as possible."

Song Qi gave one last glance before laying out the next steps. After all, with the rapid development of modern technology, the diagnosis of appendicitis had become quite refined and routine.

It wasn’t like the old days, which relied on traditional diagnostic methods—taking a detailed medical history and performing a systematic physical exam. Now, with advanced technology, a diagnosis and treatment plan could be made with minimal, or even no, physical contact with the patient.

It was undoubtedly far more efficient!

Before leaving, Song Qi gave Yasui another instruction:

"Yasui, Director Jiang is currently preparing a project on laparoscopic appendectomies, and the team has been restructured. Dr. Wu Ting, from Qin Donglai’s group, has officially joined us. The patient in Bed 5 is a perfect case. Once the enhanced abdominal CT results are back, we’ll hold a preoperative consultation to finalize the surgical plan. Go get Wu Ting and have him join us."

"I’ll be the lead surgeon for this laparoscopic appendectomy, and Wu Ting will be participating. Tell him to get ready."

Song Qi hadn’t had much contact with Wu Ting, but he was curious about this red-hot rising star of the emergency department. He wanted to see what he was really made of.

Among doctors, after all, skill is what matters. If you had the skills, you earned respect.

"Understood, Dr. Song. I’ll inform you the moment the results are in."

After checking on the patient in Bed 5, Song Qi moved on to his next patient.

Yasui immediately notified Wu Ting to attend the afternoon consultation for the patient in Bed 5.

「That afternoon」 Wu Ting arrived at the conference room as instructed by Yasui.

Inside, Yasui and Song Qi were already present.

Wu Ting greeted them and took a seat to the side.

"Yasui, what do the patient’s enhanced CT results look like? It’s good Dr. Wu is here to listen in as well. Afterward, we’ll formulate a surgical plan and get the patient into surgery as soon as possible."

Yasui was still organizing his files. "Dr. Song, just a moment. I’m almost finished compiling everything."

Song Qi turned to Wu Ting with a slight smile. "Dr. Wu, have you ever assisted with a laparoscopic appendectomy before?"

Song Qi planned to assign Wu Ting’s role in the upcoming surgery based on his current level of experience.

Director Jiang had specifically instructed him to give Wu Ting more hands-on opportunities, an order he didn’t dare to defy.

Wu Ting replied calmly, "Dr. Song, so far I’ve only assisted Dr. Qin with a few traditional appendectomies. As for laparoscopic procedures, I haven’t had any hands-on experience yet, though I have watched and studied some surgical videos in preparation."

"I see."

Song Qi considered this. ’Looks like I’ll have him start as the scope operator,’ he thought. ’Once he’s mastered the fundamentals, he can move on to more advanced tasks.’

Just then, Yasui projected the physical exam results and the latest test data onto the screen.

Dr. Song began to review them, his brow furrowing deeper the more he read.

With his Diagnosis Skill (Purple), Wu Ting was quite confident in his diagnostic abilities. He also began reviewing the data and quickly spotted the problem.

’Something’s not right. The patient’s 64-slice spiral CT with abdominal contrast shows no appendiceal enhancement...’

’Based on these latest indicators... this isn’t right. Could it not be acute appendicitis?’

Song Qi and Wu Ting arrived at this possibility at the same time.

"Yasui, go get Director Jiang. It seems this case isn’t so simple. It’s not a typical case of appendicitis. Performing surgery rashly would be risky."

While Yasui went to fetch Director Jiang, Song Qi examined the data carefully, pondering the possible nature of the patient’s illness.

"Dr. Wu, feel free to take a look as well and see what you make of the patient’s condition."

Seeing Wu Ting unoccupied, Song Qi made the suggestion casually. Of course, it was merely a polite gesture; he didn’t actually think Wu Ting would have any real insight.

A short while later, Jiang Ming arrived at the conference room.

Upon entering, he was pleased to see that Song Qi had already invited Wu Ting to participate in the diagnosis, a sign that he was beginning to integrate into the team.

"Wu Ting, welcome to the team. I was originally thinking this would be a routine appendectomy, a good chance for you to experience the entire process from diagnosis and planning to the surgery itself, post-op management, and discharge. I didn’t expect this patient’s case to be so unusual."

"So let’s discuss the patient’s condition together. Feel free to share any ideas you might have."

Director Jiang had a high opinion of Wu Ting and knew he wasn’t afraid to speak his mind.

As both a newcomer and a rising star, Wu Ting was placed by Director Jiang’s side.

Jiang Ming held out his hand, and Yasui immediately handed him the file. Jiang Ming began to review it carefully.

As he read, Jiang Ming glanced up at Song Qi.

"Dr. Song, what are your thoughts?"

Although Song Qi was significantly older than Jiang Ming, he didn’t dare show the slightest hesitation in answering his director’s question.

"Director Jiang, based on the latest enhanced abdominal CT scan, the patient’s condition probably isn’t acute appendicitis. However, finding the true cause is proving difficult."

"Based on these scans and the various test results, there are many possibilities. Could it be a deep vein thrombosis in the lower extremities?"

"Or omental torsion?"

"Could it be a tumor in the ileocecal region?"

...

Combining the results from the advanced tests with his own experience, Song Qi listed several possibilities.

"But all of the possibilities you’ve mentioned can only be ruled out intraoperatively, which carries its own risks and potential complications," Jiang Ming pointed out.

Jiang Ming largely agreed with Song Qi’s reasoning, but it wasn’t the ideal approach.

After all, you should avoid surgery if you can and confirm the diagnosis preoperatively if possible. Once you’ve opened a patient up, there’s no going back. Besides, some conditions might be resolved with conservative treatment, sparing the patient from going under the knife.

"Then should we run more tests based on the current possibilities?" Song Qi suggested.

His diagnostic process was rigorous, relying on high-tech equipment and various test metrics to rule out or confirm conditions.

Listening to Song Qi and Jiang Ming’s conversation, Wu Ting thought for a moment before offering his own idea.

"Dr. Song, Director Jiang, what if we go back to the ward and conduct another detailed patient history and a systematic physical exam?"

"Traditional diagnostic methods?"

Song Qi was surprised. For someone so young, Wu Ting’s diagnostic thinking was quite "old-school." To him, it even seemed a bit hidebound.

Song Qi considered traditional methods—taking a detailed history and performing a physical exam—to be more or less optional. In his experience, patients’ descriptions weren’t always accurate and could even be misleading.

He put more faith in machines and test data. Besides, he had already performed a basic physical exam.

Jiang Ming, however, agreed with Wu Ting’s idea.

"I think Wu Ting’s approach is a good one. We can’t rely solely on advanced technology and test data. The proper application of traditional diagnostic methods is a testament to a surgeon’s fundamental skill."

"Case discussions require a free exchange of ideas. Let’s head to the ward now."