Surgery Godfather-Chapter 342 - 0325: Three People Group
Chapter 342: Chapter 0325: Three People Group
Thanks to Song Zimo’s meticulous treatment, Yu Shuilian did not experience liver and kidney failure. Her hemoglobin rose to more than 90g/l, and her biochemical, liver and kidney function, and coagulation function all remained within normal limits.
The standby artificial liver and bedside dialysis machine were not needed; her wounds remained clean. The dozens of drainage tubes started to be gradually removed.
By the time she was transferred from the ICU to the general ward, only one drainage tube remained, used for renal pelvis drainage via bilateral ureteral stent.
Cleanliness is an important aspect of quality assurance, and this is also true in medical activities. High levels of cleanliness help to reduce the incidence of infection by preventing bacterial colonization and division. This is similar to the removal of stagnant water garbage to reduce the presence of mosquitoes and flies.
As soon as the sheets were slightly soiled with secretions or excreta, the nurses immediately changed them. The frequency of sheet changes exceeded ten times a day.
If there was wound exudate, Song Zimo immediately changed the dressing with the nurses. Sometimes it took up to an hour to change the dressing, and they would do this over a dozen times a day, which exhausted the doctors and nurses.
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Song Zimo would culture each bit of exudate for bacteria. As soon as he detected the presence of bacteria, he would use sensitive antibiotics precisely, according to antibiotic susceptibility tests. This meticulousness helped eliminate small details, thus preventing the escalation of infections.
To allow the remaining liver to gradually adapt its function, Song Zimo meticulously calculated the daily amount of intravenous nutrition to minimize the load on the liver.
Director Pan of the ICU suggested Dr. Meng to turn Yu Shuilian’s treatment into a PowerPoint presentation and use it as an exemplary case study for the doctors in ICU to study repeatedly.
This case study fully exemplified what eradication of risks in their infancy means, as well as what is meant by meticulous observation and proactive prevention.
Finally, Yu Shuilian was transferred from the ICU to the Comprehensive Orthopedics. Cai Qiaojun had prepared a single room for her and assigned three nurses, one of who was a stoma nurse with an international certificate for stoma care and extensive experience in stoma management.
Yu Shuilian was about to gradually start eating. Her fecal elimination relied on a colostomy in her abdomen. However, this stoma lacked the ability to contract and had no control. Without meticulous care, feces would be everywhere. The stoma nurse’s job was to manage the two stomata in her body.
Another stoma was a bladder stoma which was currently the urinary tract. After the ureter and bladder healed, the drainage tube left in the ureter would be removed.
Before her artificial urethra and anus were rebuilt, the stoma nurse would be in charge of managing her excretion.
In the medical team, Song Zimo appointed a few people. Because Zhang Lin and Little Five were taking care of the patient, Song Zimo called Takahashi and selected several graduate students and standardized trainees to form a dedicated medical team.
In the ward of the Comprehensive Orthopedics, Yu Shuilian finally saw her husband and son again.
Her husband and son were both looking haggard and thin, especially her son. His pitiful appearance beside the bed made Yu Shuilian feel distressed.
“Have you been eating enough these days?” Yu Shuilian asked, holding her son’s hand.
The son shook his head: “No, I just have some cold rice in the morning. At noon and evening, either the dishes dad cooked are extremely salty, or they’re burnt.”
Fu Xiayang felt quite embarrassed at his son’s words, but they were indeed true. In these days, his mind was not in the right place. He was absent-minded when cooking. He either absent-mindedly added a spoonful of salt or forgot to turn off the fire.
“Once mom gets better, I will make delicious food for you.” Yu Shuilian stroked her son’s face, her heart aching.
Seeing her husband standing there like a child who had done something wrong, Yu Shuilian said emotionally, “Thank you, Xiayang, for all your hard work!”
“It’s okay, we are all waiting for you to get better and come home.” Fu Xiayang stroked his son’s head.
“Mom, let me see.” The son wanted to lift the quilt, but Fu Xiayang immediately grabbed his son’s hand.
He was afraid of scaring the child, and Yu Shuilian also signaled her husband not to let the son know. But the son insisted on seeing, and sooner or later he would have to know. His mother’s sigh finally signaled her husband to let go.
Fu Xiayang let go of his son’s hand. The son lifted the quilt and saw that his mother had only half of her body, and there were two holes in her belly, both connected to bags.
The son acted bravely, “Mom, I’m not afraid. From now on, I will carry you wherever you want to go. I will carry you to see the national flag raising and climb the Great Wall.”
“That sounds good, you’ll take mom to see the flag raising and climb the Great Wall when the time comes.”
Yu Shuilian was moved to tears. The warmth of her family gave her the determination that she had to survive and should never be abandoned.
“Xiayang, though you might be too busy in the morning, you could take him to the breakfast shop near our store, or simply let him eat breakfast at school. The rainy season is coming, so make sure to close the windows, especially the wardrobe. Don’t touch the things in the vacuum bags, otherwise they may get damp. There’s half a black chicken in the fridge. You can cook a soup with longan and lotus seeds and have it with our son.”
Yu Shuilian gave point-by-point instructions to her husband. Now that she was bedridden, all she could do was to give advice, which would at least help her husband a little.
Looking at the two of them appearing helpless and downcast, Yu Shuilian genuinely felt their pain.
Song Zimo, Xu Zhiliang, and Takahashi gathered together. Whenever they had a moment, they would discuss the next step for the reconstructive surgery.
The bladder function was still intact, and the restoration of urination only required the reconstruction of an artificial urethra.
However, the reconstruction of the anus, where Yang Ping intended to recreate an artificial anus capable of controlling defecation, posed a challenging question—how could this be done?
In order to accomplish the homework assigned by Yang Ping, the three of them found it immensely challenging to design the surgery procedures separately. Hence, they decided to pool their wisdom together to solve this difficult problem.
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Although defecation seems simple, it’s actually an intricate process.
When feces enter the rectum, it stimulates receptors in the rectal wall. This impulse follows the sacral nerves and the pelvic nerves, transmitting to the primary defecation center in the lumbar sacral region of the spinal cord.
Simultaneously, the entering impulse also transmits to the cerebral cortex, thus causing a sensation of needing to dispose of the waste.
If the conditions for defecation permit, the impulse transmits through the pelvic nerves (parasympathetic fibers), causing the descending colon, sigmoid colon, and rectum to contract, resulting in the relaxation of the internal anal sphincter.
At the same time, the outgoing impulses from the pudendal nerves decrease, causing relaxation of the external anal sphincter, leading to the expulsion of feces.
Additionally, nerve excitement causes the abdominal muscles and diaphragm to contract, increasing the intrabdominal pressure, thereby promoting defecation.
If conditions for defecation do not permit it, the cerebral cortex emits an impulse, suppressing the activities of the primary lumbar sacral nerve center in the spinal cord, suppressing impulses to transmit through the descending nerve fibers, causing an increase in the tension of the anal sphincter, relaxation of the sigmoid colon, and the defecation reflex would be inhibited.
In this way, feces are temporarily stored in the body, thus avoiding uncontrollable incidents.
The patient currently doesn’t have an anal sphincter or rectum. The sigmoid colon wall lacks sensors that can be compared to those in the rectum that can reconstruct the reflex arc and imitate the standard defecation process.
Regarding Xiao Chuanguo’s reflex arc, there were redundant body nerves that could be utilized. However, both the bladder and the anus were intact, anatomically, meaning, once connected, they would possess an intact nerve arc.
Unfortunately, the patient’s nerve arc lost its receptor and effector, there was no way to conduct the surgery without these two indispensable endpoints.
Takahashi, an internationally respected master of trauma, wracked his brain but couldn’t come up with a surgical plan.
“Dr. Song, Dr. Xu, the regrettable fact is that I can’t figure it out for now—how to proceed with this surgery. If I were to operate on this patient, he’d be obliged to resort to uncontrollable methods for defecation for the rest of his life.”
Takahashi dropped his pencil and sulked in his chair.
Only the three of them were in the meeting room at this time.
Xu Zhiliang also shook his head, “I’m the same. I’ve boldly thought about taking a part of the bladder sphincter to replace the anal sphincter and then applying rehabilitation training. But, even if this is possible, what nerves should be used to complete the muscular contraction and nerve connection?”
Song Zimo felt relieved. Prior to the arrival of Xu Zhiliang and Takahashi, discussing with Yang Ping? There was evidently no need for discussion; he just listened to Yang Ping’s lectures.
Currently, with Xu Zhiliang and Takahashi, Song Zimo finally didn’t feel alone anymore. He had peers with whom he could genuinely discuss.
“Both of you, what if we use an artificially constructed apparatus with electronic components, such as a silicone device, implanted at the end of the descending colon to fulfill the function of the anus? The device might function according to certain stimuli to close and open?” Song Zimo looked at Xu Zhiliang and Takahashi.
“You mean an artificial anus?” Both Takahashi and Xu Zhiliang asked simultaneously.
Song Zimo nodded, “Have we lost our way? Reached a deadlock? Should we necessarily utilize the body’s own structures for reconstruction?”
“If we continue following this thought process and designing an artificial anus, the difficulty level would not be any less than utilizing the body’s own structures for reconstruction,” said Takahashi.
Xu Zhiliang disagreed: “Although designing an artificial anus is difficult, at least it’s achievable.”
Song Zimo, Xu Zhiliang, and Takahashi, this trio took over the closed meeting room and engaged in fierce discussions, each finding a kindred spirit in the others.
For such eminent individuals, finding a kindred spirit to fully express themselves was a cause indeed for great joy.
