What does a woman lose weight for two years? The cause was a 30 cm tumor.

This is a surgical note from Dr. Tan Xianjie, director of obstetrics and gynecology at Beijing Concord Hospital, which completely restores the front of a high-risk operation. The author is a well-known gynaecological oncologist in China, a complex and high-risk surgery, so that he faces from hesitation, anxiety to challenge, to the perfect process. Behind the operation, we saw a doctor's love for the patient's heart and heart, see the courage and commitment of the doctor to treat, but also see the pressure and dedication faced by the doctor.
the development of medicine, people's expectations of medicine are higher and higher, in the face of some untreated regret, and sometimes will be less rational and accepted. It is the simple wish of the doctor to treat the patient purely and with out of mind. May this simple pursuit get more people's understanding and support, but also willing to doctor-patient love without borders, can be in a harmonious doctor-patient context in the escort. Because, understanding the doctor, is to treat ourselves well.
(Beijing Concord Hospital Obstetrics and Gynaecology Director Dr. Tan Xianjie) can not lose the fat, the original is a tumor. Xiao Zhao (pseudonym) has been losing weight for two years, but the effect is not good, recently walking more and more heavy, can not lie flat at night, even breathing is difficult. Until a tumor 30 cm in diameter is diagnosed.
XiaoZhao (pseudonym) is very young, doll face, smiling and mother to enter the clinic together. As soon as they entered the clinic, my assistant said, "This is not obstetrics, are you going wrong?" There's nothing wrong with that!" Xiao Zhao's mother said very simply.I was surprised
Xiaozhao pulled up his clothes. Belly bulging, like a pregnant woman about to give birth, and a pregnant woman with twins! Even more crashing, the inspection found that the swelling around a little gap, the slightest push not to move!the diameter of 30 cm diameter tumor taken from the patient's abdomen Tan Xianjie / picture
XiaoZhao told me that she is 29 years old, has been losing weight for two years, but the effect is not good, in the last month, walking more and more heavy, can not lie flat at night, even difficult to breathe.
Xiao Zhao first looked at the surgery, but CT reported that the tumor was 30 cm in diameter, possibly from gynecology, so she grabbed my number from the internet.
intuitively, I think it should be benign. But no matter what nature, the risk of surgery will not be small, suddenly moved out of the abdominal cavity such a big thing, blood pressure will not be maintained, not good breathing heart stopped!
sure, Xiao Zhao said she had been to several hospitals and suggested that she go to Concord.
I told Xiao Zhao that I was going abroad for a meeting recently and could nare surgery in the near future. I suggest she go to another doctor and I can refer her to her if I need to.
this time, Xiao Zhao mother said that she and my high school classmate's mother is a relative, checked a lot of information, trust me, she also said that the classmate once sent me AweWei. I looked at WeChat and found that my classmates living in the United States had indeed sent me WeChat some time ago, but I had read the reply by default.
I feel a little guilty, but vaguely hesitant. Practicing medicine, it seems that there is an unbreakable spell: the more acquaintances, the more easy it is to go wrong! Even so, it's hard for me to let her see another doctor, and I can't refuse Xiao Zhao's mother's trusted eyes.
people's expectations of medicine are getting higher and higher, and when things go wrong, it's sometimes hard to accept. There are more and more disputes between doctors and patients, and doctors are becoming less and less emboldened. Some hospitals high-risk surgery can not do without, this is probably the reason why those hospitals do not accept Xiao Zhao.
I asked Xiao Zhao to check the routine and the blood of the stool. If the stool is blood-positive, it is likely to be a tumor in the gastrointestinal tract. I also asked Xiao Zhao to go to the anaesthetic department for a preoperative evaluation - and it turned out that this was the right step.
stool sophistic blood showed negative, largely ruling out the possibility of gastrointestinal tumors. In accordance with the usual and rules, I will be Xiao Zhao's illness to the gynaecological oncology professional group for discussion, please the old professor and colleagues consultation.
I specially asked Xiao Zhao to come to the discussion because I had a little mind. In recent years, people's expectations of medicine have become higher and higher, and when things go wrong, it is sometimes difficult to accept. There are more and more disputes between doctors and patients, and doctors are becoming less and less emboldened. In some hospitals, high-risk surgery can not do without, which is probably the reason why those hospitals do not accept Xiao Zhao.
lucky Concord still adhere to a ray of hope, pay 100 percent of the effort of the faith! But I feel that everyone's courage seems to have been compromised. Therefore, I am worried that if Xiao Zhao is not allowed to go to the scene, only according to the imaging film judgment, the outcome of the discussion may not be surgery. But if you see a living young man, you may change your mind.
it turns out That I'm totally overthinking! Before Xiao Zhao came in, the discussion reached a consensus: surgery must be done, otherwise the patient has no way to live!
I told Xiao Zhao that the bed was very tight and needed to wait. Xiao Zhao said her family's economic conditions are OK, hope to live in the International Medical Department. But I don't really want her to live in the International Medical Department. First, the swelling is not clear, if it is malignant, the cost is very large; Third, if the outcome is bad, or if the medical process is flawed, the consequences are more serious - the claims are usually proportional to the pay. However, Xiao Zhao's husband is committed to the International Department.
two days later, Professor Huang Yuguang, Director of the Department of Anesthesiology, met me in the corridor and said, "The patient's anaesthetic risk is very high, but it's a pity not to do surgery, and then our anesthesiology department will cooperate with me!"
. It gave me a heart-stopping pill.On March 29,
, the Wednesday before Qingming's long holiday, Xiao Zhao was admitted to the hospital.
because CT reported tumor compression ureter, so plans to place the ureter stent on the morning of the 30th to prevent during surgery damage. Angieme is then performed to block the blood supply arteries of the tumor and reduce the risk of hemorrhage during surgery, which was performed on Friday, March 31. But the day's surgery has been arranged a lot, Xiao Zhao's surgery may not start until late afternoon. If the previous surgery is not smooth, Xiao Zhao's surgery is in danger of being cancelled.
was coordinating around when Professor Huang Yuguang called me. He said it was dangerous to have such a big operation before the long vacation, and if there was an accident, it was difficult to move the rescuers, and it was recommended to do it after the holiday. He said he personally guaranteed it if needed. I was moved to tears, for myself, but also for the patient.
, Xiao Zhao was discharged from the hospital for the first time.
the surgeon who consulted warned me that I could tear up large veins during the movement of the tumor, leading to uncontrollable fatal bleeding! After receiving a report of the illness, the Medical Service asked us to conduct a preoperative interview in order to let the family know the seriousness of the problem and the seriousness of ours.On Tuesday, April 4,
, the last day of Qingming's long vacation, Xiao Zhao was admitted to the hospital again.On Wednesday, April 5,
, the ureter stent was placed as scheduled in the morning.
my heart can be put down, but things have changed a little bit.
the surgeon who came to the consultation warned me that the tumor had completely crushed the lower cavity veins, this long-term compression of the veins and the long-term compression of the intestinal tube, may lead to adhesion and isozoic blood vessels, the process of moving the tumor may tear the large veins, leading to uncontrollable fatal bleeding!
my stress has increased sharply.
not only, because xiao Zhao in the International Department surgery, the Medical Service received a report of the illness, asked us to conduct a preoperative conversation notarization, in order to let the family know the seriousness of the problem and our seriousness.
procedure is a must, but time is running out. The lawyer said he would not be able to come to the hospital until 11:30 the next day, and Xiao Zhao's operation began around 10 a.m. So I spoke to the lawyer and begged them to do the preoperative conversation at 8:30.
Wednesday afternoon, April 5, on wednesday afternoon, angiography went ahead as planned, and I got both good news and bad news. The good news is that the blood supply of the tumor comes from the intrauterine artery, which basically confirms the old professor and me's judgment - the giant uterine fibroid; the bad news is that the tumor is not able to determine whether the tumor has traffic with the blood vessels in the lower cavity veins and intestinal membranes, and the tumor appears to be glued to the surrounding organs.
I talked to Xiao Zhao's husband and mother again. Xiao Zhao's mother seems to understand the severity of the illness, but seems very anxious. Xiao Zhao's husband seemed calm, and kept comforting his mother-in-law, saying that doctors would always have a way.
it makes me a little upset. I sent a weChat letter to my American classmates asking if the family expected the operation, and more directly, if the operation failed or even the patient died on the stage, they could actually accept it. Classmates replied that Xiao Zhao husband is very good, the reason is "calm", is not to let the family into a state of chaos.
I'm not a flat-in-the-flat Huahua, I'm just a general practitioner. The patient needs to live, I need to work, I need to support my family. But now, doctors are almost an industry that doesn't allow them to miss, is it worth it to be so adventurous? For surgeons, an accident is a disaster. The patient can't afford to lose, I can't afford to lose!
had been busy and had come home at 7 p.m. After opening the door, I saw a note on the alarm clock: rice in the pot, food in the microwave oven, i eat hot. There's a shrimp in the oven, don't forget! We both went out and bent, and we'll go back in a moment.
I suddenly feel sour! Yes, I'm not a flat-in-the-art general practitioner. The patient needs to live, I need to work, I need to support my family. But now, doctors are almost an industry that doesn't allow them to miss, is it worth it to be so adventurous?
four years ago, the same students introduced, the same blood-soaked struggle, the same is out of good intentions, the same is in the International Medical Department, because of the rules, I got a lesson. The patient can't afford to lose, I can't afford to lose! Mrs.
is not a doctor and has no idea of what we are doing. At this time, I thought of the teacher - Lang Jing and academician. I called Dr. Lang. I texted him and asked if he was in the hospital on Thursday morning. He replied, "Okay." It's morning. "Then I sent him a long message outsic about my illness and my concerns. Dr. Lang quickly replied: "Call me then." "
busy after this, I said to the small students who are packing their bags: "Dad has a very difficult operation tomorrow, can we make some of it in the morning?" The little classmate readily agreed.
I always think that their psychological quality is good, although the exam will be nervous, but once on the examination room there is no problem. I fell asleep for a long time as soon as I went to bed, but that night I had a preview of the operation over and over again, imagining the dangers and countermeasures that might have occurred, and I couldn't sleep in the middle of the night. I got up and took a beer from the fridge and fell asleep quickly after drinking it. Sleep time is not long but the quality is quite high, get up refreshing.
students did not forget the promise of the previous night, we arrived at school ahead of schedule. At the school gate, the little student skewed his head and said to me, "Dad, you have a good operation!" I touched his head and rode the electric bike I had just bought the day before to the hospital.
less than two years, I lost two electric bikes. Pain, I comfort myself: break the money to avoid disaster! For surgeons, an accident is a disaster. If so, the bike is worth it!
i and my assistant layer by layer peeling off the surface of the tumor envelope, a root knotted blood vessels, actually a drop of blood did not come out, the tumor was completely peeled off, the uterus left. Professor Huang Yuguang and I together carry this larger than the head of the tumor to the family waiting area, Xiao Zhao mother hands together ten, on the spot crying ...
. April 6th, sounds like a lucky day. Haze for a few days in Beijing, actually a lot of clear.
at 7:30, I went to Dr. Lang's office and reported him in detail, and Dr. Lang asked me to inform him after the operation began. Before leaving he admonished: "First, the incision should not be greedy, otherwise once the bleeding, it is very difficult to stop the bleeding." Second, if the tumor can be completely separated
, it is basically successful; After coming out of Dr. Lang's office, I walked much faster.
8:30, the lawyer arrived at the ward on time. Xiao Zhao's mother was not happy with the cumbersome procedures of notarization, saying that they "insulted" her trust in us.
everything is ready, just wait for the opening!
at 9:30, the first operation was over. The patient is a 4-month-old baby girl with malignant tumors of the reproductive tract. This is the life in the doctor's eyes: there is misfortune, there is more unfortunate!
10 o'clock, Xiao Zhao was taken into the operating room, Director Huang Yuguang and the patient said hello, turned back and patted me on the shoulder.
Huang director personally to Xiao Zhao infusion, the beginning is very smooth. However, Xiao Zhao soon said that dizziness, should be lying on the reclining low blood pressure syndrome. The patient's abdomen is as bulging as a hill, more spectacular than a full-term pregnancy. Such a large block of compression to the lower cavity veins, blood can not flow back, blood pressure naturally low. Fortunately, Xiao Zhao was soon numbed.
fear of life-threatening haemorrhage, the need for deep venous punctureafter after anesthesia, easy to quickly rehydration, but also arterial puncture monitoring artery pressure. The venous puncture was smooth, but the arterial puncture was difficult. Xiao Zhao's blood vessels are broken, Huang director personally, also encountered trouble. "Don't wait, disinfect the platform!" Director Huang said decisively.
at 10:35 a.m., check the patient and the condition again, announce the start of the operation, the roving nurse informed Dr. Lang.
a knife, all my previous nervousness and uneasiness disappeared! Fears of possible medical disputes have also dissipated. All my spirit, in a flash, was concentrated. The tumor is really too big, the blood vessels are very rich, and there is a stick around. After we carefully decomposed the adhesion, the tumor was delivered. We briefed Dr. Lang on the situation and told him he could rest assured. My assistant and I layer by layer stripped the surface of the tumor membrane, a root knotted blood vessels, actually a drop of blood did not come out, the tumor was completely peeled off, the uterus left behind. Professor Huang Yuguang and I together carry this larger than the head of the tumor to the family waiting area, Xiao Zhao mother hands together ten, on the spot crying ...
. After the patient was pushed out of the operating room, I took a celebratory photo with the supervisor and smiled. However, entering the doctor's lounge, I sat down on the sofa.
yes, I'm not a good doctor. Because, I am not simple enough, think too much! But I seem to be a qualified doctor again, because, I am in awe of life, do my best! Since promised to give Xiao Zhao surgery, can only find a way, create conditions, carefully prepared, seek help ...
. I picked up an abandoned anaesthetic record sheet and wrote down a few words as a personal memory of this Concorde: the bow was opened without a turn ingenuity, and I did everything possible to move forward. More good teachers around to help, an arrow in the end of the year! <