Arriving at the gastroscoscopy room early in the morning and looking at the patient register, Dr. Li of the anesthesiology department was secretly happy – it was a good day.
On the registration book, there is only one name. At normal speed, it's basically a morning's work. At noon, you can eat properly. I can't guarantee that I can take a nap for ten or twenty minutes.
However, the first gastroscope made him feel bad.
This is because the patient's family asks for anesthesia, and the laparoscopic doctor also requires anesthesia, but the patient's condition is not suitable for anesthesia at all. For a while, the two sides were in contention. The director of the endoscopic room also had to find the director of the anesthesiology department to pressure Dr. Li.
The patient is a middle-aged man in his 50s with initial consideration for esophageal cancer. Recently, eating choked cough. No way, I came to the hospital for treatment. Previous CT shots also support this diagnosis. Therefore, the chest department asked the patient to do a gastroscope to look at the esophagus, and take some diseased tissue for pathological examination.
Things seem to matters that only one gastroscope is needed to solve.
However, when the gastroscope is inserted into the patient's mouth, the patient vomits.
No way, everyone thought of doing a painless gastroscope.
Painless gastroscopy is to give the patient a gastroscope under anesthesia.
However, a paradoxical problem is that the patient may also have esophageal-tracheal fistula. This means that food in the stomach can enter the trachea entirely from the esophagus through the fistula. Entering the trachea may cause choking.
Once suffocated, operations such as normal pressurized oxygen are almost impossible to work. Endotracheal intubation may be able to save one lung if it can save it. Otherwise, just because of a single inspection, people may be gone.
Such a risk, although not necessarily, will never be tolerated by an anesthesiologist.
Therefore, Dr. Lee resolutely refused.
Sure enough, as expected, the director of the endoscopic room called the director of the anesthesiology department.
Things have progressed here, the top floor has been called, and it is reasonable to say that it is basically necessary to be accommodating. In other departments, maybe it really happened.
However, when the director of the anesthesia department learned more about the situation, especially after personally seeing the patient's chest CT, he also refused.
Obviously, this is no longer a negotiable issue.
In order to avoid injury and gas, the director of the anesthesiology department personally came to the endoscopic room and told them the reason: from the perspective of esophageal-tracheal fistula, there is a risk of suffocation; even if the intubation is solved in time, the lung inflammation caused by long-term food reflux will make the subsequent ventilator support not optimistic, and it is difficult to maintain normal blood oxygen.
The director of the endoscopic room saw that the patients had to be taken to the intensive care unit, and knew that this matter could not be forced. Turn around and go out, and begin to explain to the patient's family that "knows what is right and what is moving".
After a good half a day, the director of the endoscopic room came out of the conversation room. Seeing his smiling and helpless expression, Dr. Li could only sympathize silently.
But what can be done about it? Medicine itself is imperfect, and there must always be a "singing red face".
The last thing we want to say is that everyone wants patients to fully enjoy comfortable medical care, but the premise is not to take too much risk. Many times the doctor's polite refusal is for safety.
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