CHAPTER 217: 217 NEW MISSIONS ARE VERY POWERFUL

"You need to contact your family members. We suspect the main cause of your abdominal pain is inflammation caused by the omentum," Liu Banxia said to the patient.

"In this situation, we can only perform an exploratory laparotomy. If confirmed, immediate treatment is needed. Considering your current condition, it’s possible that necrosis has already occurred, and we’ll need to remove a portion."

Although the patient was still in much pain, Liu Banxia’s words frightened him.

First, they told him his appendix was the problem, then his gallbladder. Now, it was his omentum—something he had never even heard of.

"Don’t worry; the surgery will be simple," Liu Banxia reassured him.

"Doctor, I’ll call my family and discuss it. I don’t even know what the omentum does," the patient replied, clutching his abdomen.

"That’s my oversight. The omentum is a special ligamentous tissue extending from the peritoneal tissue of the stomach," Liu Banxia explained with a smile.

"It’s quite rare for the omentum to develop problems. It’s possible that dancing vigorously after a meal caused the omentum to twist, like folding the corner of a piece of paper. This would block blood flow and cause some of your tissue to die."

"Another possibility is a blood clot obstructing a blood vessel, preventing blood from flowing through and thus causing tissue death."

"You’ve been suffering from abdominal pain for a long time. The current CT scans, ultrasound results, and your symptoms at the time of consultation all help rule out the possibility of diseases in other organs."

"The omentum is outside the organs, so the surgery won’t involve any of your organs. If your family lives nearby, we can wait for them to arrive before operating."

"If it takes them more than two hours to get here, I’d suggest we proceed with the surgery first. Necrosis can trigger other complications, which could become life-threatening."

"Doctor Liang, please explain the possible risks and complications of this surgery to the patient. Let this serve as a demonstration for the interns. I’ll go book an operating room."

Regardless of whether the patient agreed or not, the operating room had to be booked. During the day, there might not be any free rooms. Even if two emergency operating rooms were kept available, they could be quickly occupied due to unexpected situations with other patients.

The booking went smoothly; an operating room would be available in an hour. The outpatient department already had a C-section, an intestinal perforation, and an appendicitis case, which had taken up all the reserved operating rooms.

"You’re truly impressive now. I never even thought of the omentum; I was still focused on the intestines," Xu Hui said.

"I’m just guessing wildly at this point. I treated a patient with acute diffuse peritonitis before, and the severe abdominal rigidity—that board-like abdomen—left a deep impression on me," Liu Banxia said with a wry smile.

"Whether it’s actually the omentum or not, we can only find out after opening up the abdomen. Sometimes, during an examination, we can’t help but lean towards a diagnosis we’ve already formed in our minds."

"Actually, if the patient’s appendix had looked even slightly worse today, I might have diagnosed it as acute appendicitis and removed it before it suppurated."

"If I had done that, I would have used my usual small incision. Imagine the embarrassment of pulling out a healthy appendix and then having to enlarge the incision to keep looking. That would be so humiliating."

"Just be content. You’re already doing impressively well," Xu Hui said helplessly.

Xu Hui knew Liu Banxia’s character: he was straightforward and didn’t hold back with friends. Otherwise, one might indeed think he was just showing off. Besides, knowing Liu Banxia, if he wanted to show off, he’d do it openly and directly, not like this.

"If there’s surgery later, are you going to bring all of them in?" Xu Hui asked.

Liu Banxia nodded. "Let them get acclimated. They should start by observing. Even if they can’t assist at the operating table, it’s good for their development."

"During my residency, I didn’t get into the OR enough. Otherwise, many of those past issues wouldn’t have happened. It’s actually quite normal for friends—fellow doctors—to observe or even assist in each other’s surgeries."

"Alright, well, you take care of these eight kids then. You’ll have your hands full. It’s just Wang Huan and me in Internal Medicine now, so you can manage all of them," Xu Hui said.

"What does that make me? Their nanny?" Liu Banxia complained.

"Dr. Liu, the patient is still refusing surgery. We’ve contacted his family, but they said it will take them over two hours to reach Binhai. To get to our hospital, it’ll probably be three hours," Liang Xiaolin reported as she walked over.

Liu Banxia exchanged a helpless glance with Xu Hui. He hadn’t anticipated this snag.

"Keep trying to persuade him. And tell them this: whoever convinces the patient to agree to the surgery gets an extra chicken leg from me at lunch. If you and Qing Kewa manage to persuade him, you can be my first assistant," Liu Banxia said earnestly.

"Also, when you’re talking to him, no using false information to scare him. You must be factual and help the patient genuinely understand and agree to the surgery."

Liang Xiaolin’s expression turned grim. This task is going to be tough, she thought. This was one of her minor weaknesses: she had some difficulty communicating with people she didn’t know well.

"Looks like we have a problem. The patient is very resistant to surgery," Xu Hui remarked.

"That’s why I’m having them try to wear him down. Otherwise, I’d be too exhausted myself," Liu Banxia said with a bitter smile.

For a doctor, there are three main fears: first, patients who refuse examinations; second, patients who refuse surgery; and third, encountering difficult and complex cases.

Today, Liu Banxia’s luck was something else; he’d nearly hit the trifecta of these dreaded situations.

Inflammation of the omentum is rare, so it’s not often encountered, even in the emergency department. Most of the time, the issue is only discovered after an exploratory laparotomy reveals something unexpected.

Although such a discovery can still save the patient’s life, the patient will likely give you a bad review. If they don’t file a formal complaint, you should count yourself lucky.

It was like that previous patient with intestinal tuberculosis. Qin Hai and Qi Wentai had advocated for an exploratory laparotomy. Fortunately, Liu Banxia and Zhou Shuwen intervened. If they had actually gone ahead with the surgery, the hospital would have faced serious consequences.

The current situation was also difficult. If family members were present, they could help persuade the patient. But with no family around, the patient’s own wishes had to be prioritized.

Even if the patient’s condition worsened, became life-threatening, and they slipped into a coma, the decision to operate or not wouldn’t be straightforward.

One could argue that in such a critical situation, the hospital has the right to perform emergency life-saving procedures. However, if you operate, the patient’s family might react emotionally. If you don’t operate and the patient dies, the family certainly wouldn’t let the matter rest.

In modern emergency medicine, some situations are genuinely difficult to navigate.

Patients are wary when seeking medical treatment, afraid of being overcharged or misled by the hospital. Doctors, too, must be cautious during consultations to avoid medical disputes, which can result in penalties ranging from fines to the revocation of their medical licenses.

Another half an hour passed. Then, Xu Yino came running over, beaming.

"Looks like you convinced the patient?" Liu Banxia asked.

"Teacher Liu, I’ve earned that chicken leg!" Xu Yino said.

"Alright, one extra chicken leg at lunch it is. Let’s get the preoperative checks done. We’ll head up as soon as an operating room is free," Liu Banxia said, nodding with a smile.

Thankfully, they had managed to convince the patient. Otherwise, today’s case would have been very difficult to resolve.

When an operating room was ready, Liu Banxia led his contingent of interns over. They were quite a sight, all looking eager and excited.

"Well, look at this army," Li Liwei, the anesthesiologist, quipped as they filed into the operating room.

"They’re our new doctors from the Emergency Department. I brought them to observe. The patient is quite anxious about the surgery, so let’s use general anesthesia. Oh, and everyone, this is Dr. Li Liwei, from our Anesthesiology Department," Liu Banxia said.

"Hello, Teacher Li," the six interns greeted in unison.

"I’ve worked at this hospital for many years, and this is the first time I’ve seen someone bring so many people into the OR," Li Liwei remarked with a smile and a nod.

After a few more minutes of waiting, while the interns watched with anticipation, the patient was finally wheeled in. Liu Banxia reconfirmed the patient’s information, performed a quick palpation, and then Li Liwei began administering the anesthesia.

"Qing Kewa, can you handle the initial incision independently?" Liu Banxia asked while making the surgical markings.

"Dr. Liu, you want me to make the incision?" Qing Kewa asked, her voice full of excitement.

"No pressure, but if you feel confident you can do it well, then you’ll make the incision," Liu Banxia said.

Qing Kewa just nodded vigorously, her eyes shining.

"Liang Xiaolin, you’ll assist Qing Kewa with opening the abdomen. The other six of you, watch carefully. Later, pay attention to how I close and suture. This is a very straightforward surgery, even simpler than an appendectomy," Liu Banxia instructed.

And Qing Kewa truly delivered a pleasant surprise. Her work opening the abdomen was clean and precise, and her coordination with Liang Xiaolin was perfect.

"Visible bloody ascites in the abdominal cavity. The omentum shows a necrotic area approximately seven centimeters in diameter. Suction, then we’ll proceed with the excision," Liu Banxia announced after a brief examination.

DING!

Mysterious Abdominal Pain task completed.

Gained: 300 Experience Points, 300 Diagnosis Skill Proficiency Points, 3 Glory Points.

Task Rating: Perfect.

Bonus Reward: 500 Experience Points, 800 Diagnosis Skill Proficiency Points, 5 Glory Points.

Liu Banxia was ecstatic. The rewards are indeed generous, and this new type of mission is really paying off!

The remainder of the procedure was straightforward: simply excise the necrotic tissue. It was, in fact, much simpler than an appendectomy.

After excising the affected part of the omentum, Liu Banxia meticulously checked the patient’s other abdominal organs. The appendix, initially a suspect, looked quite innocent. The gallbladder, another potential troublemaker, was also fine.

After thoroughly lavaging the abdominal cavity once more, Liu Banxia began to close the incision.

His technique for closing the abdomen drew the rapt attention not only of the six newcomers but also of Liang Xiaolin and Qing Kewa.

Today, Liu Banxia took his time. He explained his techniques as he sutured, layer by layer. Yet, even at this deliberate pace, the six interns still found his suturing speed remarkably fast.