"Chen Ni's Cardamom Years" Medical Chapter XIII

The time soon came for the graduation internship, and Chen Ni and several classmates were assigned to intern in the affiliated hospital of the university. In the first two weeks, Chen Ni was in the department of internal medicine, Wang Jie was in the department of surgery, BaoZhen was in the department of obstetrics and gynecology, and several were rotated in various departments. Chen Ni was assigned to the night shift on the first day of her internship, and there were many patients and the internists were very busy. When dinner time came, Wang Jie helped Chen Ni call the lunch box, and they were preparing to eat dinner. This is a special trolley for the ward at the door, and the nurse pushing the cart shouts loudly: "Hurry up, cerebral hemorrhage, who will pick it up"? The doctor on duty, the nurse and Chen Ni all put down the spoon in their hands and ran out. Chen Ni took the medical records in the hands of the cart nurse. The outpatient medical record diagnosis record reads: "Hypertension, cerebrovascular accident, cerebral hemorrhage? ”。 Chen Ni looked at the patient on the cart: It was a man, about forty years old, particularly tall and fat, and definitely weighed more than two hundred pounds. The face is red to a little purple, the skin of the whole body is also red, the eyes are wide open, round, the black iris is in the middle of the cleft, a large circle around the sclera, the white scleral membrane is full of blood, grinning teeth, quite scary. Chen Ni had never seen such a big man and such a look before. The patient was in pain, unable to speak, just desperately gasping for breath, "poof", and his chest rose and fell rapidly. At this time, the doctor on duty in the internal medicine department immediately used the stethoscope to auscultate the patient, and the nurse quickly measured the blood pressure, and Chen Ni was responsible for recording. The doctor on duty orally instructed the nurse to give him an intravenous injection, and later a cardiac injection in the chest area. After that, the doctor took the outpatient medical records in Chen Ni's hand to make up for the medical advice, and the nurse also walked away to the nurse's room to sort out the records and medical orders. The patient's side was only Chen Ni and the patient's wife, a thin middle-aged woman. She huddled next to the hospital bed, trembling, unable to speak, and could tell she was extremely frightened. After a few minutes, the doctor came over to take a look, listened to the heart rate, and then went back to the office to continue writing medical records. After about twenty minutes, the patient's "poof" sound slowly stopped, and his eyes were closed, and Chen Ni quickly called the doctor on duty to come and see. The doctor came over and listened to the heart rate for a while and asked Chen Ni to give him another shot to strengthen his heart. Heart injection Chen Ni has never learned, even if intramuscular injection and intravenous injection are only learned in animals, now the first heart injection will be directly on the patient, Chen Ni is really quite flustered. She was bold, and under the guidance of the doctor, the heart injection was successfully completed. After listening to the heart rate again, the doctor asked Chen Ni to give him chest compressions. Chen Ni tiptoed his feet, pressed him according to the knowledge of "Diagnostic Basics", pressed a few times, and the patient suddenly "jumped" and sat up, his hands were like two huge iron tongs tightly hugging Chen Ni, and his mouth was a rush of "poof". Chen Ni was so frightened that she couldn't break free. At that time, Chen Ni's weight was only eighty-two kilograms, and the patient was definitely more than two hundred kilograms. The doctors, nurses, and Wang Jie all ran over to help Chen Ni break free, and they tried to break open the patient's hand, but they couldn't open it at all. After about a minute or so, the patient's hands were released, and he fell down with a "bang", his breathing and heartbeat stopped, and the doctor announced his death. At this time, Chen Ni was still in a state of extreme panic, the thin middle-aged woman, the patient's family members watched all this happening. After the nurse sorted out the body, she let Chen Ni push it to the morgue, chen Ni did not dare not listen to the nurse's arrangement, but she was still full of excitement and extreme panic. She pulled the patient's family in one hand and pushed the cart with the other, and the patient's family also held Chen Ni's hand in the other hand and helped push the cart with the other. Chen Ni wanted to ask Wang Jie to help, but at this moment, a new patient came, and Wang Jie, who was practicing surgery, was called by the internist to pick up the new patient. Chen Ni and her family, two thin, extremely frightened little women, pushed a trolley carrying two hundred pounds of dead weight to the morgue and handed it over to the master who managed the morgue. After the handover, when Chen Ni was about to leave the morgue, the patient's family members held Chen Ni's hand deadly, and after a while, they returned to the ward with Chen Ni and grabbed Chen Ni's hand all the way. When she got to the ward, she kept crouching in the corner, neither crying nor talking. All night, Chen Ni was in the doctor's office, even if there were no patients, she did not dare to go to the duty room to sleep, Wang Jie accompanied her on duty until dawn, which was the first day of her internship.

On the day of the internal medicine internship, a man in his fifties was sent from the ward, and the outpatient diagnosis was: mania. When the patient arrived at the ward, he had already taken a sedative, and it was also pushed by a trolley, and the patient's wife also came with him. Chen Ni asked about the medical history, the patient "never got sick, nor did he take medicine", "has always been in good health", "do not smoke, do not drink", "temper is also very good, family harmony", "these days inexplicably always lose their temper, sometimes noisy, the same as crazy people". Physical examination: normal vital signs such as heart rate, blood pressure, breathing, and body temperature. Auscultation breath sounds and heart sounds are normal. There is no enlargement of the liver and spleen on palpation, and no other signs are abnormal. Chen Ni recorded truthfully. Ward resident doctors, attending physicians have seen the patient, but also repeatedly asked the medical history, the doctor's instructions to calm, supplemented by nutritional nerves, a few days later the patient inexplicably died. Chen Ni also worked with the patient's family to send the deceased to the morgue. Along the way, the patient's wife cried loudly, and from the process of her crying, Chen Ni heard a sentence: "I knew that you were so short-lived, don't let you quit drinking." Chen Ni was astonished: "Haven't you always stressed that he never smokes and doesn't drink alcohol"? She said: "People say: Smoking and drinking is not good, I am afraid that you will criticize it, I dare not say it." "Oh my God, is this all right? Isn't that a concealment of medical history"? Later, it was learned that the patient had been drinking wine for more than thirty years, about one pound a day, and a few peanuts and rice were sent. Smoking has also been more than one pack a day for more than thirty years. Recently in the park morning transport, many people said that they could not smoke and drink, saying that smoking and drinking is not good for the body.... So when she got home, she confiscated all of her wife's wine and forced him to quit drinking." The cause of death of the patient was finally clear, because of the metabolic disorders induced by the "withdrawal reaction". Since then, repeatedly asking about medical history and emphasizing the authenticity and detail of medical history have become the most important part of Chen Ni's medical career. There were not as many instrumental examinations and laboratory analyses as there are now, and it was particularly important to ask for medical history and physical examination. This is a painful lesson, if the family does not hide the medical history, if Chen Ni emphasizes the authenticity of the medical history, if you tell the family early that there can be no concealment... No ifs!

One day of internship in the infectious disease department, Chen Ni wanted to go from the infectious disease department to the surgical ward diagonally across the road, and when she came out of the hospital gate, she saw a pregnant woman squatting next to the wall outside the hospital gate, looking like she had stomach pain. She came forward to inquire, and the mother said that she was about to give birth. Chen Ni immediately found a trolley for the ward, called the doorman who came to see the door and a passerby, helped carry the pregnant woman to the trolley, and then sent it to the obstetrics and gynecology ward. Because the cart is too narrow, afraid of the patient falling, Chen Ni almost the whole person fell down to protect the patient, about four hundred meters away, the fetus was born, when arriving at the obstetrics and gynecology ward, the placenta also came out, which was Chen Ni's first "delivery". Of course, there will be another birth in the future that is a lifelong nightmare, which will not be said here.

A painful lesson came from the father of a middle school classmate, who just had a cold and fever, went to a hospital, and the doctor gave him the most popular "Xiao Chai Hu injection" at that time, and as a result, the drug allergy led to exfoliative dermatitis, and he died a few days later, less than fifty years old. This incident coupled with Chen Ni's own "acute laryngeal edema" caused by dripping "goose does not eat grass" juice in the forest farm, almost lost her life, and in her future career as a doctor, she definitely did not open Chinese medicine preparations without clear active ingredients and clinical phase III or more experiments, and without clear pharmacological mechanisms.

Surgical practice is very strict, the first time I was ready to enter the operating room, I was inexplicably beaten on the head, and I looked back at the surgical director with the teaching. He found that one of Chen Ni's hair had fallen out of the outside of the hat, knocked her head fiercely, and scolded her, Chen Ni was very grateful to the teacher's strict requirements. Surgical internships cultivate a rigorous scientific attitude and strict self-discipline, which is something that benefits a lifetime. Surgery teacher strict requirements at the same time also very let go, in a "esophageal cancer surgery", Chen Ni was originally only the second assistant, the teacher let Chen Ni the main knife, he said: "You operate seriously, bold and careful, I will tell you when to stop, I did not say that you will continue to do it", the result has been to peel off the diaphragm pleura before the teacher took over. It should be rare for an intern to do this, and Chen Ni was fortunate to be recognized by her teacher, which also laid the foundation for her surgery.

After graduation, she was assigned to the Department of Otolaryngology of the Affiliated Hospital, in fact, the Department of Otolaryngology was really not suitable for girls with short stature, and Chen Ni could not do enough no matter how hard she tried. She could do the surgery beautifully, but she definitely couldn't keep up with her physical strength and height. Especially the most difficult is the "support laryngoscope", the short she does the "support laryngoscope" every time, standing is not, squatting is not, kneeling is not, in short, in any case is not. The high-intensity work is not something she can do. At that time, there were more than two major surgeries per week, and there were small and medium-sized surgeries every day, with an average of at least six surgeries per week. The most done is the "laryngeal cancer and laryngeal reimplantation" surgery. Every day of surgery, Chen Ni would eat breakfast at six o'clock in the morning and leave for the hospital. Weighing more than eighty pounds, breakfast must eat four eggs and two bowls of fried rice, can not drink a sip of water, before entering the operating room, the director of the department also forced everyone to eat a piece of chocolate he brought from home, but still not allowed to drink water. When you arrive at the hospital, check the room first, prescribe medical advice, change the medicine, and wait for the shift after everything is completed. Eight o'clock after the shift immediately into the operating room, and then is ten hours of surgery, the middle can not drink a sip of water, not to pull urine, until six or seven o'clock in the evening off the operating table, and then desperately drink water, eat some noodles to continue on duty, whether you are on duty or not must put a recliner next to the patient, until after ten o'clock the next day can leave work, if there is a new patient to come can not leave work, continue to receive new patients. There will definitely be a minor surgery for you in the afternoon of the next day. This is how the section chief demands of himself and his subordinates. During that time, Chen Ni fainted in the operating room more than ten times, and each time she fainted after getting off the operating table and taking off her surgical gown. At that time, there was no word for "overwork death", and if there was, Chen Ni would definitely be one of them. About three or four years later, the kind male classmate Xie Jin really couldn't stand it, and took the initiative to ask the dean to change positions, he was an ophthalmologist, the work was easy, and he didn't need physical strength. He said to Chen Ni, "I am a man, and I should come to this kind of work." How simple, how gracious! This is brotherhood, forever brotherhood.

There are many stories of internships, more stories after graduation, and every medical student and clinician has a similar experience, so I will not repeat them here. Five years of college life came to an end, and began a career of practicing medicine for several decades.