CHAPTER 313: 313 QI WENTAI IS ALSO VERY GOOD

As for Zhou Shuwen’s expectations, Liu Banxia had absolutely no clue. He simply thought that Zhou Shuwen was very busy recently and temporarily lacked the energy to deal with these miscellaneous matters.

Although the current emergency center had not yet met the official operational scale, having its current configuration during the trial operation stage was already quite impressive.

After the morning patient consultations were completed, lunchtime became much livelier. Since there were no patients to track at the moment, the only one being Han, meal times were more concentrated. When everyone gathered, it naturally became lively.

However, right in the middle of this lively meal, Liu Banxia received a phone call that caused his mood to plummet.

"Brother Wang, Li Xue, who had surgery yesterday, is in critical condition. I’m afraid she’s not going to make it," Liu Banxia said after hanging up the phone.

Wang Huan was taken aback and shook his head helplessly. "Other critically ill patients might still have a chance if we intervene, but how many resuscitation attempts can she withstand?"

"I thought she’d pulled through last night and would have a good chance," Liu Banxia said.

"Don’t dwell on it. We’ve done everything we could," Wang Huan comforted.

Liu Banxia nodded. "Although I was mentally prepared, it’s still hard to accept when it actually happens. This is also a wake-up call for us. If we encounter similar patients in the future, we need to be more decisive and not let them waste time debating whether to preserve the anus."

These were all hard-earned lessons. No one had expected such severe adhesions to occur. It could only be said that the patient’s constitution was weaker, causing the inflammation to flare up so aggressively.

With cancer, the prognosis for rectal cancer can actually be very good. As long as it hasn’t metastasized too far, there’s a good chance of success with surgical removal followed by radiotherapy and chemotherapy.

Many people were very clear about this patient’s situation. After hearing Liu Banxia’s words, they were quite saddened. They, too, had thought it wasn’t too serious, that she could at least live for a few more days, especially since the surgery had been so successful.

「Back at the Emergency Center.」

In the afternoon, there were a few more patients. However, most were still trauma cases, along with some who needed to come in for dressing changes.

"Oh, how I wish we had a patient who required a bedside X-ray," Liu Banxia sighed wistfully.

"Don’t even joke about that," Shi Lei said. "Patients requiring that are almost always seriously injured. Besides, bedside X-rays are much more expensive than regular ones. If someone accuses you of overcharging, you’ll be in deep trouble."

"Sigh... I was just grumbling," Liu Banxia said. "Seeing all this equipment sitting unused while our MRI and CT scanners are constantly booked by outpatients—doesn’t it bother you?"

Shi Lei shrugged. "No use worrying about it. It’s good that it’s quiet today; it means nothing major has happened in Binhai City."

"It’s our first day after the move, so a bit of quiet is fine. Once our center’s reputation is established, we’ll likely be too busy to relax. You should actually use this downtime to train them properly."

Hearing Shi Lei’s words, the interns observing from the sidelines were a bit dumbfounded. Has Teacher Shi also become as mischievous as Teacher Liu?

"Speaking of which, I have an announcement," Liu Banxia said, clapping his hands.

"Some of you interns might not know this yet. Now that you’re in the Emergency Center, your evaluations are continuous. The assessors could be your supervising doctors or even other staff members."

"So, I hope everyone takes this seriously. Your performance, no matter which department you’re rotating through, will be crucial for your chances of successfully securing a position here after your internship."

"If anyone is still unclear, just ask Xu Yino and the others. Currently, Su Wenhao has the highest score among them. If he keeps this up, he might just be the top-ranked intern by the end of it."

Hearing Liu Banxia say this, the interns, who were previously scattered, came RUSHING over.

They now knew that their internship evaluations were largely in Liu Banxia’s hands. Even if they obtained their internship completion certificates, it didn’t guarantee them an opportunity to secure a position at the hospital.

Liu Banxia’s assessment, as the chief resident, carried significant weight. Thus, they sometimes envied Xu Yino and her group of five, as well as Zhou Shangkai and Cao Peng, the two internal medicine doctors who had been assigned to the Emergency Department.

"Do you really have that much energy to monitor them all the time?" Shi Lei asked, pulling Liu Banxia aside.

"I’m just bluffing, of course," Liu Banxia said with a smile. "I mostly watch them when they’re performing procedures and then give some general feedback. But based on my judgment, Su Wenhao is very much like you; you might want to keep an eye on him."

Shi Lei felt rather helpless. He hadn’t expected Liu Banxia to be mischievous enough to tease these interns, who were now all on edge.

Just then, ambulance sirens wailed. Three ambulances arrived simultaneously.

At first, Liu Banxia was so excited he almost rushed out. Then he remembered the dispatcher hadn’t called in advance, so despite the number of vehicles, the injuries were likely not severe.

That turned out to be the case: two groups of people had been fighting. The most serious injuries would only require sutures, plus, at most, a few head CTs to check for any complications, and that would be it.

For this kind of work, neither he nor Shi Lei, nor even Wang Chao, needed to intervene; the interns could handle it themselves.

At that moment, the Emergency Center’s phone rang. Everyone’s gaze immediately fixed on Little He, who was responsible for answering calls.

"Teacher Liu, a patient who experienced syncope is being transported here. On-site intubation attempts failed," Little He hurriedly reported after hanging up.

"Qi Wentai, you’ll manage this patient," Liu Banxia immediately directed.

"Li Hao, attempt non-invasive intubation with a 5mm tube. Prepare for invasive intubation as a backup," Qi Wentai said.

Shi Lei nodded. Qi Wentai, despite being somewhat burdened by his association with Qin Hai, still possessed real skill; this assessment was spot on.

The principle was to use non-invasive methods whenever possible and avoid invasive ones. A failed on-site intubation could be due to many reasons: perhaps laryngeal edema, or the intubation tube the paramedics brought was too large, or even technical issues with the paramedic’s on-site procedure.

Invasive intubation is a cricothyroidotomy, a procedure used only in dire emergencies when immediate airway access is critical. This is the kind of procedure often seen on TV where they make an incision in the neck and insert something like a pen barrel.

Although it’s an emergency procedure, because it’s invasive, it’s essentially a type of surgery and naturally carries risks of complications. Bleeding, infection, subcutaneous emphysema, pneumothorax, and mediastinal emphysema could all potentially occur.

Less than three minutes later, the patient was wheeled in, a paramedic manually ventilating them with an Ambu bag.

Qi Wentai was also anxious. This was a procedure in front of many onlookers, an opportunity Liu Banxia had given him. Fortunately, the 5mm tube narrowly passed through the patient’s somewhat edematous larynx. The intubation was successful.

"Connect to the ECG monitor. I see a head injury too. Have the family members arrived?" Qi Wentai asked, wiping sweat from his brow.

"He was just having lunch at home," the patient’s mother, who had accompanied him, explained. "He hadn’t said more than a few words after finishing when he started convulsing. He hit a chair when he fell."

"Blood oxygen 87%, blood pressure 70/110 mmHg, heart rate 100," Zhou Qian reported after connecting the ECG monitor.

"Given the laryngeal edema observed during intubation and the moist rales heard in the lungs on auscultation, let’s start with a complete blood count, followed by an endoscopy to get a better look at the larynx," Qi Wentai said.

Currently, this was the most critical patient in the Emergency Center. After obtaining a basic history from the patient’s mother, they immediately proceeded with the necessary examinations.

"The results aren’t promising," Qi Wentai said after reviewing the endoscopy report, addressing Liu Banxia rather than the patient. "There’s a mass in the pharyngeal area. I recommend a laryngeal MRI, and if that reveals anything, then a thoracic MRI."

The principle was still to proceed with diagnostics from lower-level to higher-level. However, the mass in the patient’s pharynx gave Qi Wentai a bad feeling; it wasn’t ordinary edema. That’s why he suggested skipping the X-ray and CT scan and going directly for an MRI.

Combined with the patient’s low blood oxygen levels, he intended to check the thoracic cavity as well.

Liu Banxia nodded. "Fine. The indications are clear. You can make such calls yourselves. As long as the decisions we make are for the patient’s benefit, it’s perfectly fine."

Qi Wentai felt slightly awkward. It seemed he had been a bit overly cautious in seeking approval.

"Actually, Doctor Qi’s skills are quite solid," Wei Yuan commented with a smile. "I’d never seen him intubate before, but his technique today was decisive and neat."

"Yes," Liu Banxia said. "He used to have a bit of a chip on his shoulder with me, a bit temperamental. Hopefully, he’ll continue to perform well. Then I might also be able to snag a few opportunities to assist the director in surgery."

"Today’s the first day after the move, so it’s fine for everyone to be here together. As for you few," Liu Banxia continued, addressing the attending physicians, "how do you plan to arrange your on-call shifts? Report to me before the end of the day so I can make the schedule."

"I’m fine either way," Wei Yuan said with a laugh. "Early shift, late shift, it all has to be covered eventually."

Shi Lei also nodded his agreement.

"Alright then, we’ll stick to our old system," Liu Banxia said easily.

Previously, it was usually just him and one other attending on duty, which could be overwhelming if patient numbers surged. Now, things were different; with cardiac surgery staff also on call, there would be no shortage of doctors.

Many hands make light work, and they certainly weren’t short on doctors now.

After a short wait, the results of the recent patient’s MRI scan refreshed on the monitor.

Upon seeing the results, everyone present sighed in unison. The patient was only about sixteen or seventeen years old, still just a kid. How could he have developed cancer? And not only that, but it had already metastasized to his thoracic cavity, with lesions on his lungs—no wonder his blood oxygen was so low.

This was the first critically ill patient the Emergency Center had received since opening, yet they were powerless to help. Surgery was no longer an option. In the days to come, the focus would be on palliative care, making him as comfortable as possible.

"He’s so young," Liang Xiaolin remarked after a moment of silence.

"Illness doesn’t pick and choose its victims; it strikes whomever it will," Liu Banxia said, shaking his head.

"Everyone, pull yourselves together. We’re not here to serve just one patient; we’re here to serve every single patient who comes to our Emergency Center."

This first critical case had cast a pall over the Emergency Center’s morale. That wouldn’t do. Patient care had to be approached with full vigor.