Chapter 2348: They’re Really Calculating It
It’s just that this case is too complicated right now; the people in Radiology can’t work it out in their heads.
Cup-shaped cases are the easiest to succeed with this method. When they run into difficult cases, because they can’t calculate it mentally, most clinicians will resort to manual massage and repeated trial injections, basically groping around on experience like a blind cat blundering into a dead mouse.
Now these two young doctors are going back to the very essence of air enema, intending to calculate a set of precise procedural steps instead of trying things out? Is that even possible?
The problem with groping and trying is that it takes too long and you might not make it in time; better for the doctor to calculate everything in advance, adjust to the optimal, shortest pathway of steps, and then act. That would be a very elegant, almost perfect ideal plan. If it works, the others are thinking: that would be a miracle.
Because of this, the radiologists know in theory this method is workable, yet they have no confidence that these two young doctors can actually calculate it.
The ensuing dialogue between Student Xie and Student Duan goes like this:
"Based on the previous data, with air injected at 8 kPa, the splenic flexure was pushed outward along a forty-five-degree angle, moving about 0.5 cm along the distal z-axis, while the hepatic flexure was pulled out along the distal z-axis on a flat line."
"Doctor Xie, you think 8 kPa isn’t enough force, right?"
It was obviously not enough; the segment was firmly trapped. But—
"We haven’t done decompression yet. I estimate that once we vent the air, the leading edge will move forward again, though the distance won’t be large..."
"I get it. From the child’s current status, the decompression steps are more important for him. How about we center the treatment plan around decompression?"
"Personally, I think we can do several cycles of injection and decompression over a short period, and it’s safer if the pressure doesn’t exceed 10 kPa."
"The duration of the first injection can be very short, and the duration of the third injection extended. For decompression, keep the first two the same, shorten the third decompression, and the fourth decompression must be maintained for a full five minutes..."
The group on site: ...These two are really calculating it.
With Student Duan helping to adjust the injection–decompression sequence, she no longer had to improvise step by step, countering each new problem as it came. No doubt that was better for the child; producing the right answer was faster.
The two doing the calculations stayed fully focused, talking only to each other; in under five minutes, they had their result.
"Teacher Yang, please carry out the maneuvers according to what Doctor Xie says." Duan Sanbao asked the radiologist for cooperation.
Doctor Yang’s assistants looked at Doctor Yang: Teacher Yang, did you understand how they just solved that problem?
Doctor Yang did not understand; the one thing he did grasp was that the direction and objective of their solution were correct. Since it was correct, might as well try.
At this critical juncture, trying is better than not trying. Anyway, there were people on site to backstop them. The young med students were fully fired up about the case, unlike him, who had already noticed the movement at the doorway early on.
The leader at the door hadn’t spoken up to stop them, which was equivalent to tacitly allowing them to proceed.
They began.
Everyone stared fixedly at the monitor screen. Following the steps the two students had just calculated, injection then decompression, injection then decompression, back and forth, operating strictly according to the precise mathematical answer. To be honest, many people were skeptical at first, not believing that doing math could accomplish anything.
Halfway through the sequence, the monitor showed that the leading edge of the intussusception hadn’t retracted but had shifted further forward; if this continued, once it reached the splenic flexure it would be even harder to reduce. This made one of Doctor Yang’s assistants anxious enough to shout, "Is this going to work or not?"
Doctor Yang forced himself to stay calm. The leader at the door had said nothing; he continued to operate according to the steps.
"Oh no, it’s moved further forward again." The assistant called out once more.