Yi Hui, the attending physician who assisted Wuhan, and together with her colleagues, conducted a rescue of a severe covid-19 patient. The reporter reviewed the details of the operation in detail, recorded how the doctor judged the condition and chose the surgical plan under the condition of limited conditions, and finally completed it with difficulty. The operation looked thrilling, but it was a routine routine in a Wuhan hospital.
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At 5 a.m., Yi Hui got up on time to wash her face, brush her teeth, and eat breakfast. She was the attending physician of the intensive isolation ward of Hankou Hospital, prepared a bucket of instant noodles and half a box of soda biscuits for herself, and did not dare to drink more water in order to avoid going to the toilet when she was on duty.
Xiong Zhiqiang, a family member of the 73-bed room, also failed to sleep soundly. The old father is 75 years old, and his blood oxygen saturation hovers between 86% and 88%, "If it is usual, it must be 'intubated'." He woke up several times in the early hours of the morning, wearing a translucent raincoat and acting as a protective suit. There was no light outside the window, and he couldn't help but feel anxious when he thought of his mother, who was also hospitalized elsewhere.
Yi Hui was impressed by the polite family. She is accustomed to life and death in the ICU and often responds to the fierce emotions that erupt from her family, but Xiong Zhiqiang never complains.
At breakfast, she put a "hydrocolloid dressing" on the bridge of her nose to prevent strangulation marks, and hurried out the door. Arriving at the hospital at 6:30, she put on her protective clothing, gloves, shoe covers, and goggles, entered the isolation area through 4 doors, and saw the family of 73 beds, sitting quietly there, with her waist straight.
After completing the shift at 7:00 a.m., Yi Hui began to check the room. She was not tall, thin and weak, and used to draw a heart-shaped pattern when marking clothes with their names.
Suddenly, she heard the responsible nurse calling her name. Bed 73 suddenly felt a cramping pain in his chest and screamed in pain.
It turned out that Xiong Zhiqiang's father had eaten, just rested for a while, sat up on the pillow, stretched out his arm, and the situation took a sharp turn. At 9:20, Yi Hui rushed to the scene, and the blood oxygen saturation displayed on the monitor screen suddenly dropped to more than sixty percent, and if he did not want to rescue him, after a few hours, the patient would die.
Yi Hui remembers that it was January 31, 2020. The 7th day of the "lockdown" of Wuhan.
<h1 class="pgc-h-arrow-right" >❶ puncture? </h1>
The long light pipe in the hallway shook people's eyes. Inside the ward, the humidified bottles of oxygen tanks grunted, and various machines made humming noises, more and more.
Yi Hui flipped out the infrared finger vein of the 73-bed fingertip. The clip did not come off, the mask was well worn, and the tank was full of oxygen. She has been practicing in the ICU for many years, developing the conditioned reflexes of the first to check the equipment.
There are too many possibilities of a sudden drop in oxygen saturation in patients. For example, "pulmonary embolism", the patient lies for a long time, the blood in the lower limbs is stasis, the blood clot is easy to fall off, and it is necessary to take the thrombolytic drug "Ruitongli".
It is also possible to have "cor pulmonale", the pathology of which is more complex. The human heart is divided into two ventricles, the right ventricle returns anaerobic blood, pumped into the lungs through pressure, and supplemented by alveolar expansion and contraction. Oxygenated blood flows to the left ventricle and sprays into the artery to supply the whole body. The venous blood that has been pumped with oxygen by the upper and lower organs is again recovered from the right heart and pumped into the lungs to replenish oxygen.
After lung lesions, immune cells instinctively protect themselves, produce "exudation" at the location of the virus attack, attach to the outer wall of blood vessels, build a barrier, intercept the oxygen in the lungs and disperse into the blood, so that the blood transported to the left ventricle by the processing of the alveoli of the two lungs is insufficient, which is one of the reasons for the decline in blood oxygen saturation.
When recalling the patient's situation, Yi Hui looked straight ahead, spoke at an even speed, and spoke difficult and complex medical terms word by word. After introducing the professional content, she resumed the flat tongue tone of the thick nasal sound, and the tone was also mild.
"Worse, the trachea in the lungs narrows due to lack of oxygen," she went on to explain, adding that it was difficult for the right heart to pump blood, and the internal pressure soared, squeezing the atrial space, and the left heart continued to collapse.
Among the elderly patients with severe COVID-19, it is very common to suffer from these two "comorbidities". "A lot of people's deaths are related to this." Easy Hui analysis.
"There's also a possibility, and that's pneumothorax." At 9:23, Wu Jianfeng, a doctor in the same group, came to help. Wu Jianfeng is a "big bull" in the field of critical care medical disciplines, and his companions are called "Teacher Wu". He stared at the ECG monitor, the blood oxygen saturation was only 68%, turned his head, and said to Yi Hui: "The possibility of pneumothorax is also very large."
Between three words, Si Xiang also heard the news and arrived. The space seemed cramped, the doctors nervously communicated about the patient's situation, and the grunting of the wet bottle was drowned out.
Of course, the possibility of pneumothorax is also very large, Yi Hui said, which means that the situation is more urgent. In the case of extreme lack of oxygen, the patient will try his best to breathe, the force is too strong, the negative pressure in the cavity increases sharply, and the alveoli burst instantly. The gas overflows along the crack and remains between the two membranes in the chest cavity.
The current difficulty lies in how to diagnose pneumothorax. On weekdays, even the simplest stethoscope can be roughly distinguished according to the different sounds of the chest cavity. Now the ears are wrapped in masks and face shields, and the hands are covered with three layers of gloves, and the basic operation cannot be performed. If you are in a well-equipped ICU ward, you can also pull out an ultrasound meter to find out the lesion.
Several people exchanged opinions, and with experience, suspicion of pneumothorax was the most likely. The usual response is to do a "puncture" between the second ribs under the collarbone, and insert a tube to release the accumulated gas.
The situation is urgent, do you want to wear it directly? "Still not." Not sure, Wu Jianfeng recalled, there is a distinctive feature of the pneumothorax, the chest cavity bulges after the "air leakage", it does not look obvious, "at least the part is not accurate."
Listening to the discussion of colleagues, a greater uneasiness emerged from the bottom of Yi Hui's heart - it may also be the patient's own new crown disease, irreversible and suddenly aggravated.
<h1 class="pgc-h-arrow-right" >❷ Mom really loves you</h1>
My name is Yi Hui, chief physician of the ICU of the First Affiliated Hospital of Sun Yat-sen University in Guangzhou, and I arrived in Wuhan that night Chinese New Year's Eve. On January 20th, after Zhong Nanshan finished speaking, colleagues in our department discussed, and everyone was saying that the pneumonia thing may be very big, and there is a premonition that it will go to the "front line". Unexpectedly, so urgent.
We have a mouth to Wuhan's Hankou Hospital. The situation is much worse than the worst outcome imaginable. The hospital is basically in a semi-paralyzed state, full of patients, and many of the original medical staff have fallen. We came over, first to clean up, to move oxygen tanks, and once, I came out of work at one or two o'clock in the middle of the night and saw our Liu Office picking up garbage there.
To be honest, I have been a doctor in the ICU for more than ten years, and I have encountered all kinds of great joys and sorrows, but I have never had such a strong feeling of powerlessness as this time. It's too weak.
In 2019, my most impressive patient was a little girl, she was a common pneumonia, but it was very severe, and lung transplants have been recommended elsewhere. But the family did not give up, we did not give up, she lived in the ICU for more than 20 days, but little by little survived, and finally recovered and was discharged from the hospital.
This was one of the patients I had a deep impression of last year, and had reached that point, and had been dragged back from death. So I believe in miracles.
ICU's working style is often to rescue at any cost, like the extracorporeal membrane lung method, which consumes hundreds of thousands of dollars at every turn, uses the strength of the entire department, and seizes a glimmer of hope to save lives. But it's too hard right now. At the beginning, oxygen inhalation became a problem, the pipe network was aging, coupled with high flow, if the valve of a hospital bed was too large, others could not suck it. You say, who to suck and who not to suck?
In Wuhan, the first patient I didn't pull back was an aunt in her 50s. There had been no beds and could only be isolated in the outpatient clinic and the community. When I could receive her, I quickly sucked in oxygen for her, but after just over an hour of living in, the person was gone.
My profession requires myself to try to keep a normal mind and maintain rationality, but I have seen a lot of such things, and I am still sad.
Many people did not see the last side of the patient, lying on the ground crying, crying while saying, yesterday was fine, how all of a sudden people are gone, there are many things not told to you. They have lovers, couples, and children to Mom and Dad, or Mom and Dad to their children.
This has a great impact on my attitude towards life and my worldview. I have always told my friends around me that we should not hide our feelings for the person we love, and if we have anything we want to say, we should say it. I've always been like this to my parents, to my husband, to my daughter.
These days in Wuhan, it coincides with my daughter's fourth birthday, which is the first time I have not spent my birthday with her. She was very unhappy and got angry and said she didn't want her mother anymore. I want to say to her, Mom loves you, Mom really, really loves you.
<h1 class="pgc-h-arrow-right" >❸ "lung point, found lung point"</h1>
"The ultrasound is coming."
It was a plastic cart the size of a computer desk, with a laptop-shaped mainframe with a 5-centimeter-thick base, and a panel with a handle attached to a thin line nearly 2 meters long, straight through the mallet-shaped probe.
The model is old, but it can be used. Wu Jianfeng just held the mentality of trying it out, called the medical department, asked whether the hospital had an ultrasound, and did not expect that there was. At 9:35 a.m., the nurse pushed in the entire set of ultrasound equipment.
"Let me come."
"Hmm."
Yi Hui spoke softly and her movements were clean and neat. She pushed the device in and erected it close to the oxygen tank. Si Xiang took the ultrasound panel, applied a small amount of coupling agent to the probe, and walked to the bedside.
Si Xiang is 33 years old and is a rising star in the business of Zhongshan Yifu Medical College. He sat on the edge of the bed and touched the patient's heart with the probe. Through the mask, he looked down at the LCD screen on the panel, where the snowflakes were pocket-sized and densely arranged, and the grayscale gradually lightened from bottom to top, and the transition was natural and smooth.
"Not cardiopulmonary disease." Yi Hui judged through the large screen of the host.
The probe goes up to the critical lobe area. Pleural sliding, clear, normal.
Change the sides and take another picture. Ah, the pleura sliding gone.
Si Xiang explained that the "visceral pleura" and "parietal pleura" between the two lungs, exhaling and inhaling back and forth, the phenomenon of the two layers of pleura sliding against each other, called "pleural sliding". This is normal, indicating that no gas is flowing.
"If you don't move, you see, the two white dots and two black dots don't move, which means that there is gas running in the middle and can't move."
On the dark panel, the white belt like a cloud is wide and narrow, and it solidifies in an inverted triangle. At 9:40, the suspicion of pneumothorax was further corroborated.
Next, if you can find the "lung point" - the reason for the decline in blood oxygen saturation value is a foregone conclusion. Si Xiang turned his head and glanced at Yi Hui and Wu Jianfeng, but he could not clearly see their expressions. He said his professional instincts told him that the two teachers encouraged him to continue.
The probe squirmed from left to right along the chest line, touching the ribs and exploring half a root down.
Yi Hui took a deep breath and felt her body being tightened. She and Wu Jianfeng stared dead at the screen.
Time passes minute by minute. 9:43 a.m.
9:45 a.m.
46 points.
"Thank you. Thank you doctor. The 75-year-old Abel was conscious and muttered a few words.
Yi Hui has worked in the ICU for 14 years, she understands that ICU is the art of stepping on a tightrope, every time you make a choice, you will face new risks, and it is very important to gain the trust of patients or families. "Life and death are related, and life is entrusted." This trust is important to doctors. ”
Academics recognize that the lung point is a "golden thread" for the diagnosis of pneumothorax, which is the dividing point between the sliding and disappearing of the lung membrane in real-time ultrasound imaging. However, the lung spots are extremely hidden and are often difficult to see. At present, the pattern of pleural sliding in the right lung is clear, and it cannot be dragged on all the time.
The chest piercing kit necessary for the desk was found temporarily. A chest wear sleeve box, needles, silk thread, gas cylinder is enough, there is no pumping hose, had to take a slightly larger thick tube, transform the front and back openings, ok to use. There was no exhaust water seal bottle, and the doctor mobilized the nurse to dedicate the only bottle in the department.
"Lung point, find lung point." At 9:55, Si Xiang almost roared out. Found, this can be confirmed, Si Xiang extended his finger to point to the computer repeatedly, you can do punctures. Wu Jianfeng nodded and said to everyone, OKAY.
On the main screen, the tapered density of the horizontal stitching is evenly proportioned, and a truncated black belt is wrapped around the waist. Frame by frame, you have to discern the eyebrows, a blurry point, which appears at the dark gray junction.
Yi Hui said, now it's time for me to play.
<h1 class="pgc-h-arrow-right" >❹ Dad's rib soup</h1>
The first person in our family to be infected was my father. On January 16, he felt a fever and went to the hospital to see a doctor, where he was hospitalized on the same day. At that time, I hadn't heard much about the virus, so I went to Hankou Hospital to see him, but I just thought there were more people than usual. About the 20th felt that something was wrong, and when I went to the hospital again, the doctors and nurses began to wear protective clothing, which looked very scary.
After dad was hospitalized for a few days, my mom also started having a fever. She went to Changhang Hospital. Coincidentally, there was just one bed, so I moved in. A day or two late, even if it is half a day late, the bed is gone.
My mother later transferred from Changhang to Jinyintan, so I went to Jinyintan to take care of her, and my brother went to Hankou Hospital to take care of my father. A younger sister in Changsha was also infected.
Mom is recovering well, getting better every day, and the situation on Dad's side is not optimistic. I went to see my dad at Hankou Hospital, and he told me he wanted to drink soup, so he made good food and drink for him. Dad came downstairs to pick up, only a few days did not see, the appearance has changed, if it is not him to call me, I thought it was a patient to help to get things.
His hair was disheveled and his walk trembled. When I recognized that it was Dad, I was startled, and the rib soup fell to the ground and spilled on the ground. It was so sad, how Daddy had become like this. I ran back and gave him a bowl of broth, which I could not forgive myself for the rest of my life if I hadn't let my father drink that bowl of soup.
Dad was getting more and more serious and couldn't get out of bed, so I sent him in. It seems that according to the regulations, the isolation ward did not allow the family to enter, at that time it was a mess of porridge, and it was not so much to take care of, and then later, I heard that I would not let it in again. I was very careful, I could wear everything I could wear, and we had several raincoats in our house, blue, yellow, and green in turn.
Dad didn't want anyone to go in to see him, and he was worried that he would infect me, so I sat in the doorway and waited for the need to go in to help. I am very grateful to the doctors and nurses, they really give a lot.
My name is Xiong Zhiqiang, and my brother's name is Xiong Zhiyong, which means brave and strong. I am a very optimistic person, my father and my mother, our family is very optimistic, after this incident, I will teach my son, to be optimistic, to be positive about life. However, deep down, I am still very sad, and the pain will always be there.
<h1 class= "pgc-h-arrow-right" >❺ "Seeing the sun, I feel alive again"</h1>
The needle is 15 cm long. Yi Hui pulled it out of the box and held it up in front of her eyes. The place where the lung point was confirmed had been disinfected, and the conditions were limited, and local anesthesia was done between the lateral ribs. She separates her index and middle fingers, fixes the patient's skin, pinches the blue "tee bolt" at the end of the needle tube, and slowly stabs the 0.4 mm diameter needle eye at a point in the midline of the armpit.
Yi Hui stood and operated, bending her waist into a bow shape. Si Xiang and Wu Jianfeng retreated to a space one meter away.
"Ah!" The old man tried his best to cooperate, but it still hurt.
After puncturing the skin, the needle protrudes through the subcutaneous tissue and the touch becomes tighter. Yi Hui mastered the rhythm and continued to probe forward until the long needle was buried 5 cm into the meat. When the feeling of resistance disappears, it means that it has penetrated the pleural cavity.
"That's why it's best to find out the precise position of the lung point, and if you don't damage the lungs again, it will undoubtedly make it worse."
Next is the installation of a guide wire, which is a very thin steel wire, which Yi Hui inserts along the needle eye into the chest cavity, and then uses a dilator to expand the hole. She put the hose she had prepared earlier into her chest along the wire.
Well, the accumulated gas can finally flow out.
But it's not enough. There is too much gas in the chest cavity, the automatic leakage is too slow, and it is necessary to artificially induce air. The tail of the drainage tube is left with a hollow incision, inserted into the syringe and sucked outward. The syringe size is 50 ml, while pumping, Yi Hui remembers the number in her mind. Si Xiang leaned over and counted out.
"One tube".
"Two tubes".
"Three...".
"It's up, [the oxygen] saturation is up." After drawing the 5th tube, Wu Jianfeng's voice suddenly increased, he reported the data displayed by the ECG monitor, and the blood oxygen saturation increased by two percentage points.
The description has an effect. Yi Hui still did not speak. However, following Dr. Wu's reminder, he looked at the LCD screen, raised his head, and then put it down. The green character quickly broke through 70%, and then, little by little, climbed up. She remembered very clearly, a 50 ml syringe, a full 10 tubes.
After the finger felt the negative pressure of the injection syringe, Yi Hui stopped pumping. Eventually, the oxygen saturation was frozen at 83 percent.
Compared with the 87% before the accident, it is still a lot lower. At the very least, pull people back from the ghost gate.
Leave at two o'clock in the afternoon. As the weather turned hazy for days, the temperature also rose. Bathed in the warm sun, the crowd came to be interested and left a group photo at the entrance of the hospital. After eating, Yi Hui began to be active, saying in the group WeChat group: "Everyone sent the sunny photo of us today to the group Liha." ”
A few photos came over. Yi Hui was wearing a surgical gown, comparing to the big thumb brother, laughing mouth to prop up the mask. Companion left a message under the picture: Seeing the sunshine, I feel that I have come back to life.
<h1 class = "pgc-h-arrow-right" >❻ a precious bed </h1>
"Mom, when are you coming back?"
"Mom went back after fighting the monster."
Every night at eight o'clock in the evening, Yi Hui had a video call with her daughter and lover. It has been almost ten days since she came to Wuhan, and she quickly adapted to the extraordinary period of life, but the heart disease that could not be overcome was missing her daughter. The child has just turned 4 years old and is growing rapidly.
Chinese New Year's Eve received a notice from Aid E, and Yi Hui was going to leave in a few hours. The husband's obstetrician-gynecologist was able to understand the decision. On the way to the airport, Yi Hui struggled all the way, not knowing how to tell her parents. In the terminal, she asked her colleagues, and it turned out that everyone had confessed to the old man. She picked up her phone and called her hometown. Both parents are retired health system workers, and they have expressed their support.
Only the daughter, not very willing to accept.
After the conversation on the evening of February 2, Yi Hui was a little lost. The well-behaved, sensible daughter, obviously unhappy, wants her mother to come home.
Yi Hui was restless. On February 3, she was on the second half of the night shift from 1 a.m. to 7 a.m. The weather was sunny for two days in a row, but it was cold again. She set off for the hospital at twelve o'clock, passing the edge of the viaduct, where there were almost no cars, the street lights were bright, and huge shadows were cast on the sidewalk. Several people exchanged that they did not know when this wave of epidemics would be a head.
On the afternoon of February 2, doctor Zou Zijun was on duty and informed Xiong Zhiqiang, the family member of bed 73, that the patient was dying. Xiong Zhiqiang told Dr. Zou that his mother was recovering well and was picked up from the hospital in the morning. Unexpectedly, I received bad news from my father at night.
"It's a pity that the old man didn't survive," Dr. Zou announced at 9:50 p.m. that night that Mr. Xiong's death. According to Zou Zijun's recollection, Xiong Zhiqiang did not blame, and kept saying thank you, thank you for the rescue in the past ten days. He said that when the old man was dying, it was a fate to meet such a good doctor.
In the early morning of the 3rd, Zou Zijun was a little tired, he handed over some of the work to Yi Hui, and talked about the situation of several key patients.
"That, the old man of the 73 beds, is gone." Zou Zijun finally said.
"Ah," Yi Hui replied, "still, gone." ”
73 beds are still gone. Looking closely, Uncle Da's condition must be intubated. Unfortunately, there are too many patients in Wuhan to meet the demand. If the ventilator can be turned on early and the blood oxygen saturation can be increased to more than 90%, the probability of cure will increase a lot.
Yi Hui never saw Xiong Zhiqiang again.
According to the funeral industry regulations issued by the Ministry of Civil Affairs on February 3, during the epidemic prevention and control period, funeral handling should be simplified, and no ceremonies such as vigil, farewell, and memorial service should be held.
Previously, the nurse had filled the 0.5% peracetic acid cotton ball into all the open passages of the patient's mouth, nose, ear, etc., and the micro-traumatic opening left behind was sutured, and it was dressed neatly, wrapped in a double-layer cloth and loaded into a double-layer plastic bag.
Then she set up the UV lamp and pointed it at the bed for half an hour. Remove pillowcases, duvet covers, sheets, put them in orange pockets, wipe the bed, cabinet, call bell, wall with 2000mg/L chlorine, and shine it with ultraviolet light for half an hour. When you're done, put on the detoxified white pillowcase, duvet cover, and sheet.
In Wuhan during the new crown era, a bed in the intensive isolation area is precious.
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Interviews: Liu Junpeng, Yan Liyuan, Gong Roushan
Author: Liu Junpeng
Editor: Jin Jin
Photo courtesy of Liu Junpeng and interviewees
Operations Editor: Ershui