Surgery Godfather-Chapter 2012 - 1358: Newcomers (3)

No one spoke.

Li Guodong looked at his watch.

"Everyone can familiarize themselves with the institute’s work environment," he said, "There are no work arrangements today. Tomorrow morning at seven, gather here."

With that, he walked away.

Twenty people stood in place, looking at each other.

Then some started walking back, some continued forward, some took out their phones to check the time, and some spoke softly to the person next to them.

Chen Xi stood in place, looking at the door at the end of the corridor labeled "Surgery Center." She looked for a while, then took out a brand new notebook, opened it, and wrote another line under what she’d written earlier:

"Tomorrow morning at seven, meet in the demonstration room."

Lin Yuan stood next to her, also writing something in his notebook.

By six-thirty the next morning, the demonstration room was already full of people.

Twenty people, not one less. Some were reviewing the case study they prepped the night before, some were flipping through anatomy diagrams, some were writing out surgery steps in their notebooks. No one spoke, there was only the sound of pages turning.

At precisely seven o’clock, Yang Ping pushed open the door and came in. He held a stack of medical records and walked to the podium, placing them on the table.

"Today we won’t discuss theory," he said, "Today, we’re seeing patients, and everyone is encouraged to speak boldly."

He pulled out a medical record and handed it to Lin Yuan.

"You present the case."

Lin Yuan took it and opened it.

"Patient, male, fifty-seven years old. Admitted for ’repeated chest pain for three months, worsening for two hours.’" His voice was a bit nervous, but he tried to stay calm, "Ten-year history of high blood pressure, highest at 180/110mmHg, not consistently medicated. Five-year history of diabetes, on oral hypoglycemics, glucose control average. Smokes for thirty years, one pack per day. Drinks for thirty years, two taels per day..."

He finished reading.

Yang Ping looked at him, "Without looking at the record, report it again."

Lin Yuan was taken aback.

"As doctors, we must train our memory," Yang Ping said, "Being able to read a medical record once and ask for a medical history once is crucial for grasping key information, you cannot miss anything. Because what you miss might be the most important clue. It could also lead to a fatal oversight."

Lin Yuan closed the medical record, took a deep breath, and began to recount.

He recounted it, mostly correctly.

Yang Ping nodded.

"What do you think is the diagnosis?"

Lin Yuan hesitated again.

"Heart... heart attack?"

"Why?"

Lin Yuan thought for a moment.

"Chest pain, worsening, history of high blood pressure and diabetes, smoking..."

"What about the electrocardiogram?"

Lin Yuan flipped through the medical record, even though it was already closed, he just did it instinctively.

"No... none."

"What about cardiac enzymes?"

"Also none." Lin Yuan’s voice grew softer, "We should further check with a bedside ECG."

Yang Ping looked at him without speaking.

Lin Yuan’s face slowly turned red.

Yang Ping retrieved the medical record and handed it to another person.

"What do you think?"

The person took it and flipped through it—it was Chen Xi.

She looked at it for half a minute, then raised her head.

"It looks more like Aortic Dissection."

"Why?"

"Chest pain, worsening, history of high blood pressure," Chen Xi said, "A heart attack requires the support of ECG and cardiac enzymes, which are not available at the moment, so we cannot rule out dissection. Moreover, his blood pressure is poorly controlled because he hasn’t taken medication consistently, which is a high-risk factor for dissection."

Yang Ping nodded.

"What would you do now?"

Chen Xi thought for a moment.

"Conduct a bedside ECG and ultrasound to check if the ascending aorta is widened, and if there’s an intimal flap." She said, "Meanwhile, check aortic CTA to confirm the diagnosis. Before confirmation, control blood pressure and heart rate to prevent the dissection from progressing."

Yang Ping pulled out a film and placed it on the viewing lamp.

"Here’s his CTA."

Everyone looked over.

The ascending aorta was significantly widened, with a diameter of 4.5 centimeters. Inside, there was a thin line extending from the aortic root to the aortic arch—the intimal flap.

Aortic Dissection! Stanford Type A!

The demonstration room was extremely quiet.

Yang Ping looked at Chen Xi.

"What’s your name?"

"Chen Xi."

Yang Ping nodded. 𝚏𝗿𝗲𝐞𝐰𝚎𝕓𝐧𝚘𝘃𝗲𝐥.𝐜𝚘𝕞

"You’ve done well," he said, "We must not be biased initially, especially with cases that seem familiar. We must integrate the medical history, physical examination, and auxiliary tests evidence to conduct rigorous reasoning."

"Familiarize yourself with these medical records here, and attend the shift handover promptly at eight o’clock."

"Also, tonight, each of you write a clinical analysis of this case and submit it to me tomorrow morning."

With that, he pushed the door open and left, closing it behind him.

The demonstration room remained quiet for a long time.

Then someone whispered, "Chen Xi, you’re amazing!"

Lin Yuan sat there, looking at the medical record that had been taken back, his face still red. He thought of his earlier mention of "heart attack," thought of the look Yang Ping gave him, and thought of the details he had missed.

Chen Xi sat in the corner, head down, writing something in her notebook.

The person next to her leaned over to look.

She was writing: "Day one, Professor Yang presented a case, Aortic Dissection. Key points: Chest pain + high blood pressure, don’t just consider a heart attack. Quick screening with bedside ECG and ultrasound, CTA for confirmation. Male patient, 57 years, chest pain for 3 months worsening for 2 hours, 10 years of high blood pressure not consistently medicated..."

She wrote very carefully.

Lin Yuan looked at her and suddenly understood something.

He took out his own blank notebook, opened to the first page, and wrote another line under what he had written the previous day.

"Day one, Professor Yang presented a case, I didn’t get it right, Chen Xi did. She mentioned checking with a bedside ultrasound, and I remembered that. Key points of Aortic Dissection: Chest pain + high blood pressure, don’t just consider a heart attack. I missed the critical point about high blood pressure, need to pay attention in the future."

After he wrote that, he looked at those lines, then looked at Chen Xi’s notebook.