Author: Sorry
Source: medical field
I'm an ICU doctor.
At ordinary times, there are not many critically ill patients in our maternal and child health hospital, because most of the parturients are healthy young people, but every emergency call is like a storm.
Just came home from work, "Director Tong, 28-week-old female, brain hernia." This call made my heart beat faster and I ran back to the hospital as soon as possible.
The young woman has been intubated and sent to the intensive care unit. There are many doctors around, such as obstetrics, internal medicine, surgery and administration. When Dr. Zhu in ICU saw me panting and putting on my work clothes, he ran in and immediately sent my newly completed head CT to me. The dean and the secretary rushed in from the staff passage at the same speed as me.
"Old chap, old chap." The medical section chief arrived at the hospital one step ahead of me, and when he saw me coming, he eagerly waited for me to make a troublesome clinical decision at once, regardless of the discussion of several obstetricians.
Take a quick look at the brain CT film. There is a huge hematoma in the right occipital lobe, which has broken into the ventricle. Visually, the amount of bleeding is at least 70 ml. The brain stem is severely compressed and has formed a brain hernia.
"Could it be hemorrhagic cerebral infarction caused by venous sinus thrombosis?" Director of surgical gold and I watched the film together, pointing to the hematoma.
I ignored him, put down the film and said directly to the medical section chief, "Contact the First Hospital and ask them to send the director of brain surgery for craniotomy in half an hour."
Then clap Director Jin: "Don't worry about anything. Hurry up and prepare to send the patient to the operating room, prepare the blood, sign and prepare the equipment, and we will take care of the rest."
These two doctors didn't read my medical history carefully, but they jumped through the air and knew the urgency of the situation. Out of the trust and tacit understanding of years of cooperation, the two said nothing, and immediately split up and began to prepare.
Without further ado, the dean stood by and immediately began to call the director of the brain department and the instruments of brain surgery. "Cut the crap, create conditions and have surgery." His firm voice came in a low voice.
"Director, the patient is 25 years old and pregnant for more than 28 weeks. He was admitted to the hospital this morning because of dizziness and vomiting. His family found the patient unconscious 1 hour ago. Just did this CT. The child just had an ultrasound, no problem. " Dr. Zhu from ICU quickly reported my medical history. Speaking like a barrage, he added, "I have asked again and again, and there is no history of head injury."
The nurse is shaving the patient's hair and preparing for the operation. I put on gloves and touched the patient's head. The young pregnant woman looks rosy and seems to have just fallen asleep. There is nothing unusual about the vital signs on the monitor, but now she is about to go through two gates of hell.
Craniotomy+cesarean section!
There is no hematoma in the head, and there is no sign of trauma. I opened the patient's eyelids and looked at the reflection of light. Pupils on both sides are dilated and do not respond to light.
The patient has a cerebral hernia. If she can't perform craniotomy and decompression within 1-2 hours, she will either die or never wake up. This 1 hour included the whole process of the doctor coming, preparing the operating table, disinfection and craniotomy-that's why I dare not delay for a moment, urging the medical section chief and the surgical director to start work at once.
"Xiaofeng." I pointed to the young attending doctor in ICU. "You don't have to worry about anything else. You are responsible for checking all blood tests that the patient needs in the advanced operating room. " Complex preoperative verification items such as blood routine and coagulation function must be completed in the shortest time. No matter how urgent the operation is, this rigor cannot be relaxed. Fortunately, the ICU is in danger now, and all the doctors who have been on the way from work have come back to help. Ok. Xiao Feng gave me a simple and clear answer.
"Is there a problem with cesarean section immediately?" I asked director Shen, who was waiting by.
"Which do you do first, extracranial surgery or caesarean section?" Director Shen asked me. He is an old hand with 30 years of operation experience, and a cesarean section is not much faster.
"Old child, the brain surgery department of the First Hospital lives in a nearby community and will arrive within half an hour." The medical section chief finally hung up the phone and cut in and said to me.
"Then enter the operating room now, and do it at the same time in principle, but brain surgery may take a little time to arrive, so you can start first." I told Director Shen that I had full confidence in the speed of his operation. This is the most important clinical decision, and there is not even time for discussion. This is the general principle of maternal critical care, and the influence of the production process must be considered. I glanced at the dean and secretary who had been standing by dispatching personnel. There were many administrative leaders present, but clinical decision-making still needed the responsibility of clinicians.
Ok. With a simple promise, he turned and went to the operating room.
"Pediatrics, pediatrics" I shouted. Director Huang of the neonatal intensive care unit heard me shout and simply said, "We are waiting in the operating room. It should be no problem after 28 weeks." The 28-week-old premature baby, very fragile, has just reached the passing line of survival and needs to be admitted to the neonatal intensive care unit after delivery.
At ordinary times, the doctors in our maternal and child health hospital are all very mother-in-law and wordy, but in an emergency, they are as simple as the army.
Too many chefs' preoperative preparations have ended in a hurry. The hospital bed is connected with a monitor and a ventilator, surrounded by a group of people, and sent to the operating room. At this time, it is only ten minutes before the emergency call system starts and everyone arrives at the hospital.
I delayed the medical section chief: "Let's go, the two of us are responsible for talking and signing the operation."
Really, I haven't had time to explain my illness to my family in detail. My illness is as endangered as a storm. Now we have to do two operations at the same time, and we can't delay for half a minute. Tell us how critical, complicated and difficult the operation is, and it is up to us to face many families who are at a loss.
There was crying in the intensive care unit and the operating room, and the family that was about to have a newborn baby suddenly had to face the result that both mother and son could die. That kind of blow, in the eyes of ordinary citizens' families, is really unbearable.
Outside the door is a painful dialogue, crying for a while. Under the shadowless lamp in the operating room, the brain and abdomen are operated at the same time.
By the time the parturient was sent out of the operating room, it was already dark, and a large number of doctors were waiting for the patient to come out in the rest room of ICU.
The 28-week-old baby is safe and has been sent to the incubator in the neonatal intensive care unit. A 25-year-old woman was sent back to ICU for continuous monitoring after two operations.
Can she wake up after severe compression of brain tissue? !
I looked at the patient's pupil with a flashlight. After general anesthesia, the drug is still affecting the patient's reaction, but the two pupils have shrunk by 3 mm and have no obvious reaction to light. Ah! Surgical decompression is effective, but I don't know how much the fragile nerve cells are damaged. This is a sleepless night, especially for doctors and their families.
"Director, director, the patient has instructions." The next morning, Xiaolan, the nursing team leader of the night shift, cried when she saw me, looking very surprised.
I ran to see the patient's reaction. Sure enough, my hands and feet began to move involuntarily, and my eyes began to open independently. Even if I am not fully awake, I am only one step away from waking up.
"This effect." I breathed a sigh of relief and immediately called the medical section chief. "Wake up, hey! Thank you, brother. "
Really, really. I can hear him jumping for joy. After a while, he came himself. I still have to see the effect of the operation with my own eyes to rest assured.
Dean, Secretary, Director of Surgery, Director of Obstetrics, Director of Pediatrics, Outpatient Doctor, Director of Anesthesiology Department ... Yesterday, all the doctors who received and discussed came to see the patient's postoperative situation one after another, and their surprise and sense of accomplishment after the disaster were exactly the same as that of the whole family waiting outside the door.
"Review the head CT and chest CT together to see if there is aspiration pneumonia after severe vomiting." I told Dr. Zhu that this is a routine check-up after brain surgery to check the postoperative edema.
Escort them into the CT room together. The results of head scanning are exciting, the hematoma in the operating area is cleared, the brain stem compression is relieved, and the brain tissue structure is clear.
"What is this?" The radiologist looked at me and pointed strangely at the screen. CT is scanning the lung, and there is a cotton ball-like mass in the upper lobe of the right lung. Then there was another big lump in the left lower lung.
Several doctors gathered in front of the screen to see that the mass in the right lung was very large, and there were many cotton ball-like masses in the two lower lungs.
Terrible silence and slowness.
I asked the radiologist inquiringly, "lung cancer?" My heart is cold.
The radiologist looked at it carefully again, took a breath and said affirmatively, "Right upper lung cancer, bilateral lung metastasis."
"Brain metastasis of lung cancer." I immediately thought of that strange brain hemorrhage without trauma, just like falling into an ice cave.
After the CT examination, the ICU medical staff is carrying the patient to the hospital bed, a young woman. Her rosy cheeks, like every woman who has just become a new mother, are full and white, although after the operation, her hair was shaved and one side of her head was swollen and wrapped in accessories. But that youthful vitality! We failed to get her out of her misery. Will she face death again soon? !
The husband and family gathered around the bedside, looking cautious and hopeful. "Xiao Yun, Xiao Yun."
I will tell them the terrible bad news again. Sigh deeply. Grab your hair. I am used to life and death, and I will feel burning pain in the face of such ups and downs. What will happen to them!
Carefully, gently but clearly inform the family members of the extended family who are full of expectations for the disease. The director of obstetrics and the director of pediatrics who know the results in advance are full of pain and sadness.
This kind of dialogue is unbearable for doctors and patients' families. Xiaoyun, a pregnant woman, woke up in the twilight, unaware of the cruelty and ruthlessness of fate.
A cry floated in from the monitoring room like fragments. -25-year-old woman, brain metastasis from lung cancer!
Director Jin, who went to the intensive care unit three times a day, said: "There was indeed an abnormal brain tissue during the operation. We sent it for pathological examination, so we'll see. We don't know what kind of pathology it is. " He sighed heavily, and there was a grain like a meat cleaver in the middle of his frowning brows.
For three days in a row, Xiaoyun gradually improved after the operation, opened her clear eyes and understood the call of her loved ones. Tracheal intubation was successfully pulled out. The 28-week-old weak baby's vital signs are stable and need to continue to grow in the incubator for some time. Xiaoyun's family called her one by one during the visit, and when they turned back, they wiped their tears. True sadness and happiness are inseparable.
The same is true for doctors who come to consult and make rounds every day. The obviously improved mental state is gratifying, and I can't help but sigh when I think of her cruel future.
This emergency call system was started by all the people involved in the rescue and operation. So, in the hospital, wherever I go for consultation, the doctor will catch me and ask: old boys, are you okay after the operation? !
"old boys, old boys, choriocarcinoma!" Secretary Zhao and Director Jin rushed in and told me with the pathological report. The pathological results of intraoperative examination came out.
"ah? Ha! Choriocarcinoma! " I shouted like them.
It is rare to see three doctors so happy about the malignant pathological results, and they are hardly as lucky as their foreheads. Choriocarcinoma, as doctors in obstetrics and gynecology know, is a kind of malignant tumor, which has a good response to chemotherapy and may be cured. The prognosis is completely different from that of ordinary lung cancer.
I went to the neonatal intensive care unit to see her newborn baby. The weak premature baby has little subcutaneous fat, as big as a kitten, and makes a gesture of surrender. With a stomach tube and a ventilator. However, it seems a little older than when I came out of the operating room.
Director Huang accompanied me to see the baby in the incubator. Smiled and said, "Don't worry, TA will grow up and be taller than you."
Xiaoyun's future, after the disaster, is moving towards stability step by step.
For three days, I seldom appear at home. I reported to my wife the story of ups and downs, great sadness and great joy these days. Who knows, after listening to it, she asked me indifferently, "Well, what happened later?" She doesn't understand the "stalk" in this case at all. Without my feeling of ups and downs.
After a while, I realized that this is how doctors feel. Only doctors can understand the anxiety, tension, sadness, surprise, sadness and joy that run through unfamiliar technical terms.
At that moment, our hospital and maternal family shared the same fate, ups and downs, and shared joys and sorrows.
That feeling, only doctors know.
(Thanks to Director Tong Wuhua of Jiaxing Maternal and Child Health Hospital for providing this case)
The author published the book "Medical Narrative: The Story of Intensive Care Unit"!
You must not miss it.
From the perspective of a female doctor, with her unique keen perspective, the author describes the little-known trivial daily life in the intensive care unit, tells the dangerous life story, and the tests and choices that doctors face after the closed door in the ICU.
And indicate the source of the author at the beginning, otherwise it will be reported.
Submission email | yxjtougao@ 126.com
Business cooperation | 021-58545118
Feel good, please click here.
↓↓↓↓