Practicing Medical Skills in a Small Clinic

After coming out from Dean Jin’s office, Li Jingsheng went straight to the orthopedics department to find his girlfriend.

Busy until now, he hasn’t eaten!

Life is really difficult.

When the clinic’s business was bad before, money was hard to earn, and even meals weren’t guaranteed. Now, even though he can earn quite a bit of money, he has become extremely busy, still unable to have regular meals.

Arriving at the orthopedics department, from afar he saw Ou Qinglan walking briskly with medication in hand.

This situation suggests she’s heading to the ward to change a patient’s dressing.

Usually, things like IV drips are done by nurses, but some demanding dressing changes need to be performed by doctors.

During the dressing change, doctors check the recovery of the wound or examine the drainage’s amount, color, and other factors.

He followed her into the ward she entered, wanting to see if her work had improved.

He also wanted to check if the department was dumping all the dirty and tiring work on her.

Once inside, she was changing the dressing on a patient’s leg wound. The patient was a man in his fifties whose calf had undergone surgery. The external fixation steel frame was still visible.

It should be a fracture fixation surgery.

Generally, for severe bone fractures, if they can’t be set manually, surgery is the only treatment option.

In fact, most hospital orthopedics departments primarily rely on surgery for treatment.

Manual readjustment is mostly for simple dislocations like shoulder dislocation.

For highly difficult and complex cases, they simply don’t have the ability to set them manually.

The treatment for this patient involved drilling holes on the intact bone ends of the fracture, drilling two holes on each end, placing a steel frame, and tightening screws to fix the broken bone.

This treatment method causes extreme pain for the patient.

The hospital stay is long, and the costs are quite high.

Ou Qinglan carefully removed the outside wrapped gauze, then checked the wound’s condition.

Clearly, she was very meticulous.

The family was watching nervously beside her.

"Hmm, recovery looks good, the swelling of the wound has basically subsided. Do you feel better today?"

She checked the wound at the fixed site while changing the dressing, asking the patient.

"Everything else is fine, just always feel weak all over, can’t muster energy, and feel dizzy." The patient expressed his feelings.

"It might be because you haven’t rested well since your injury and just had surgery, which caused this. It should get better in a few days." She explained to the patient.

"I think that’s the reason you mentioned. We came here because we heard that your hospital’s orthopedic department has excellent skills, specially came for the surgery."

The family interrupted.

"Darling, hand me my water bottle."

The patient said to the family member.

The woman was forty-five or six, seemed younger than the patient by several years.

Her dress was quite ordinary, slightly overweight, with good complexion.

No doubt, she’s another woman pampered by her husband.

"Don’t just drink water! Should I go buy you something to eat? Doctor, can my husband eat?"

The woman handed the water bottle.

The bottle had quite a large capacity, could hold about twelve hundred milliliters at once.

Only a little water was left inside.

"He can eat, just avoid raw spicy or other stimulating foods, nothing else specific."

Ou Qinglan answered without looking up.

"Dr. Ou, can I eat?"

Li Jingsheng asked with a suppressed smile.

She didn’t pay much attention initially, thinking it was a patient from the neighboring bed, yet the voice sounded familiar. Instinctively, she turned her head towards the questioner.

"Oh, it’s you! I’m going to hit you!"

She playfully said.

Upon seeing Li Jingsheng, she couldn’t help but show a delighted expression.

Being teased by him naturally made her a bit bashfully annoyed.

"Doctors hitting patients can get them fired. Dr. Ou, you need to think it over!"

Li Jingsheng winked and said jokingly.

"Say another word, and I’ll beat you into a patient! Just in time, help this uncle with his dressing change. I’ve been busy all day, my back is about to break."

She immediately enlisted Li Jingsheng for help.

The patient watched the two young doctors bickering and couldn’t help but smile.

Perhaps, from these young people, he saw the likeness of him and his wife in their youth.

"Uncle, does the wound feel a bit swollen and painful?"

Li Jingsheng asked the patient.

"Young man, you are indeed a doctor! You’re spot-on, my leg actually feels swollen and painful, intermittently. After the surgery, the nurse told me that slight swelling and soreness are normal. I didn’t mention it then."

Upon hearing Li Jingsheng accurately describe his symptoms, the patient was greatly surprised.

He also looked at Li Jingsheng anew with admiration.

"He’s Dr. Li Jingsheng from our department, quite famous!" Ou Qinglan proudly mentioned.

The stronger her boyfriend’s skills, the prouder she felt.

"Don’t give me too much credit! I’m very susceptible to praise, once flattered, I get carried away."

Li Jingsheng glanced at Ou Qinglan, then deftly changed the patient’s dressing.

His operations were evidently more skilled than Ou Qinglan’s, appearing more professional.

The only difference was that he wasn’t wearing a white coat.

Since it was already after hours, he naturally wasn’t in his work attire.

"Let me adjust the tightness of the frame slightly for you."

After Li Jingsheng adjusted the tightness and pull-distance of the frame for the patient, the patient immediately felt unprecedented comfort.

The persistent swelling and pain in his right leg subsided significantly.

His gaze towards Li Jingsheng instantly transformed as if he was looking at a deity.

"Amazing, truly amazing, I feel so much better now. Thank you, Dr. Li."

The patient repeatedly expressed his gratitude.

Only those who have endured persistent pain can understand the patient’s feelings at this moment.

He probably cursed that nurse in his heart several times.

This caused him unnecessary suffering for so long.

"You’re welcome."

Li Jingsheng’s intervention immediately made the patient realize he had encountered a skilled doctor.

Far superior to the beautiful female doctor who changed his dressings.

Not even on the same level.

"Because your leg bone is fractured after all, and it’s quite a severe injury. To heal properly, and align correctly with the original bone position, we need to reset the broken bones and keep them securely fixed. So, some swelling and pain is normal. But if it’s too uncomfortable, you can tell the nurse about your situation. Then have the attending doctor or the surgeon check it out.

The tightness adjusted for you now should be relatively suitable.

But be sure to avoid vigorous impacts on it or suddenly moving this leg forcefully. That easily causes the reset fracture to crack or displace, affecting healing time, and can potentially impact your leg function after recovery."

Li Jingsheng instructed the patient on precautions.

"I noticed you were drinking a lot of water just now. Do you usually drink this much water?"

"Usually it’s fine! Just these past two days I feel exceptionally thirsty and drink more water."

The patient also found this strange.

"Could it be because I fasted from food and water before the surgery, making me feel particularly thirsty?"

"That possibility can’t be ruled out. Let me first check your medical records."

Li Jingsheng didn’t dare to be too certain.

But the patient displayed symptoms of thirst, fatigue, and dizziness, which is at least worth investigating for underlying problems.

The issue likely lies in electrolyte imbalance.

Sometimes, it might just be a minor issue, healing without intervention.

Other times it can quickly progress, causing the patient’s condition to rapidly deteriorate, or even lead to death.

After reviewing the patient’s pre-surgery examination data, along with post-surgery urine and temperature records, Li Jingsheng frowned slightly.

"Qinglan, request a test for sodium and potassium, especially serum sodium and urine sodium determinations."

Li Jingsheng looked at Ou Qinglan.

He is the attending surgeon in orthopedics, and although this patient isn’t under his care, he discovered a problem, so he can definitely intervene.

The treating doctor, the department chief, and the group leader will all support him.

The attending physician and the surgeon would be grateful to him for lending a hand.

"Do we need to check now?"

Ou Qinglan seemed to lack the heightened clinical crisis awareness.

Only experiencing a patient’s death can make one realize how fragile life truly is.

Many criticize older doctors for becoming timid, overly cautious in practice, without realizing they were once youthful and fearless.

It’s seeing so many cases of death that genuinely scares them into caution.

"If we don’t check now, should we wait until the grav...until the condition worsens?" Request the test immediately, issues like electrolyte imbalance have better outcomes when detected early."

He initially considered saying, should we wait until the patient’s grave grass grows two feet high to check?

He then felt it was inappropriate and immediately corrected himself.

Many patients are sensitive to words associated with death.

"Miss, help me check, will you? My child isn’t married yet, if anything happens to me, I’d leave without peace of mind!"

The patient was indeed quite humorous.

Primarily due to his admiration for Li Jingsheng’s medical skill, he deeply trusted Li Jingsheng’s words.

Thus, he proactively requested the young female doctor to assist with the test.

Ou Qinglan returned to the office immediately to issue the test request for the patient, and instructed the nurse for blood extraction, while the family handled urine specimens.

Li Jingsheng didn’t rush back to the clinic.

Instead, he first had his meal.

His girlfriend was on duty, and if anything happened to the patient, he would surely be blamed.

Moreover, it would lead his girlfriend to get scolded by superior doctors.

So he stayed behind to lend a hand.

The results came out soon.

Though "soon" actually took over an hour.

Li Jingsheng discovered the patient’s serum sodium test results measured only 112mmol/L.

This is already significantly below the normal range.

It’s now certain the patient is suffering from hyponatremia, explaining the thirst, fatigue, and dizziness.

Hyponatremia is usually caused by disturbances in the body’s water and electrolyte balance.

The specific reasons require systematic investigation.

Currently, two actions can be taken: first, to replenish the patient with fluids and sodium, and second, to identify the cause of the electrolyte imbalance.

Sometimes, this is particularly challenging to pinpoint.

Even seasoned internal medicine experts often scratch their heads over it.

Rumor has it, many older internal medicine doctors have Mediterranean hairstyles from excessive head scratching.