Chapter 1033: Chapter 1033: A Not-So-Simple Case Review (Part 1)

"Alright, Cui Jia’s suturing was pretty good. Looks like you’ve been putting in some work on tension‑reducing sutures recently, you deserve some praise for that."

When Cui Jia finished closing the abdomen, Liu Banxia gave her a compliment.

"Teacher Liu, you can’t treat people so differently," Li Hao shouted in frustration.

Liu Banxia rolled his eyes at him. "How am I treating people differently? I clear the table after I eat, do I have to wait for Qiaoqiao to praise me? The toys that Beifeng and the others play with get thrown all over the place, and I can’t yell at them either."

Li Hao instantly deflated. It was true: they were long past the stage where you needed praise for suturing.

Once he got the chance, he had to independently finish some impressive surgery, like a partial thyroidectomy or something. Then he could walk with his head held high—that’d be absolutely no problem.

"Alright, we’ve kept her under long enough, wake her up," Liu Banxia said.

"When we’re done and back on the ward we still have to do a case review. My father‑in‑law is coming over today. I’ve got to go home and do a little welcome dinner tonight. I’ll stream it live and make you all drool."

Xu Jie was a bit helpless; he’d just learned that big Director Liu could actually be this mischievous.

The patient slowly came to, and Li Hao hurried forward to talk to him. His memory should still be stuck at the moment of the car accident; it was also possible those memories would only come back slowly.

In fact, if he didn’t have idiopathic thrombocytopenic purpura, he could have been directly sent to a regular ward. With family at his side, his prognosis would probably be better too.

"Alright, you guys take the patient over. You can walk a bit slower, let his wife have a good look at him," Liu Banxia said.

"After you’re back, go straight to the conference room, we’ll review things there. This case is actually quite interesting, and there are a lot of points we need to learn from."

"Okay."

Li Hao answered.

It had been a long time since they’d done a proper review, and he was really looking forward to it.

Liu Banxia hummed a little tune as he strolled back. Several people were already seated in the conference room.

Finding time basically meant whenever he had time. If you were waiting for a moment when the emergency center wasn’t busy, you could only wait for nighttime. During the day, every day was that busy.

"Yo, where are our two heroines? They’re usually the most enthusiastic about this kind of thing," Liu Banxia asked after sweeping his gaze around.

"Because the two of them were a bit absent‑minded this afternoon, their punishment is to do triage outside right now," Huang Bo said with a smile.

"Beautiful. Otherwise I’d really have a hard time laying down the law, and they’d just run to Qiaoqiao’s side to blacken my name." Liu Banxia gave him a thumbs‑up.

"Alright, let’s get back on topic and review the patient I admitted yesterday. You all should more or less know what the situation was, right? It was a pretty tricky case that came in on the night shift."

Huang Bo and the others nodded in unison. Just then the conference‑room door opened and Li Hao and Cui Jia walked in.

"Good, since everyone’s familiar with it, which one of you kids wants to guess what issue I’m going to talk about in this case? Be enthusiastic," Liu Banxia said.

"Teacher Liu, is it that when admitting emergency patients, we need to scrutinize abnormal test results carefully?" Huang Bo asked.

"I’m not telling you the answer yet. You all guess first. Go ahead and guess boldly, don’t hold back," Liu Banxia said with a smile.

"The intraoperative assessment of the patient’s condition?"

"I still think it should focus on interpretation of abnormal values. This patient was extremely high‑risk."

"Is it that we also have to factor in speed of operative technique? If Teacher Liu hadn’t operated so fast this time, even if we’d discovered the problem, we wouldn’t have had a chance, right?"

...

The people below all started talking over one another, and Liu Banxia picked out the key words and wrote them on the whiteboard.

"Alright, listening to everyone just now, if we sum it up, it’s basically these few: lab values, speed, observation—and one of you kids mentioned mindset," Liu Banxia said.

"Now let’s analyze, see whether what you said really hits the key points. It might be on point, or it might not line up exactly with what I have in mind."

"The patient was sent in after a car accident. On exam, his condition was critical. There was no time for more tests so we took him straight to the OR. So under the circumstances at the time, things were very rough—we knew basically nothing."

"The pressure at the time came from two sides. On one hand, the blood loss was somewhat heavy. There were only two injuries, but each of them wasn’t your average grunt—at least second‑class soldiers."

"At that moment Li Hao and I were both a bit stunned—what do we do? We could only ’serve it cold.’ Faced with a situation like this, the only thing you can do is pack and tamponade to stop the bleeding. Do not play the hero."

"Alright, now we’ve used ’speed’ and ’observation.’ We did a rapid laparotomy, we looked at the patient’s condition, we did an assessment and we intervened."

"Then the lab values came in: platelet count low, but not outrageously low; coagulation time prolonged, but not above the limit. At that point, the warning light in our brains was flashing non‑stop."

"But even if the warning light explodes in your head, it’s useless. The lacerations were too big. We could only get temporary hemostasis. If we didn’t repair those tears, sending him to the ICU would have been pointless."

"So we started repairing, repairing while thinking. Here we used ’speed’ again. Many of you kids said that if I hadn’t been fast enough, even if we later discovered the patient’s condition, we wouldn’t have been able to save his life."

"I have to admit that’s exactly right. I pulled off a wave of god‑tier operations—snip‑snip‑snip, mobilized, sutured, cleaned up all the lacerations."

The people below laughed. Teacher Liu was in a really good mood today.

If they asked Xu Yino and Liu Yiqing though, those two would definitely tell them to be careful: when the big demon king is this happy during a review, you’re going to be very sad afterward.

Of course, Huang Bo and the other three already had a bit of a bad feeling.

"Alright, that’s version one—the one in everyone’s hearts, or the one you hope to see: admission, treatment, success. A neat little flow," Liu Banxia’s smile faded.

"But that’s not what I want to talk about today. As surgeons, standing by the operating table, you have to observe and assess the patient’s overall condition, and you also have to interpret any abnormal labs."

Hearing this, everyone’s expressions grew serious. They realized their understanding might not match Director Liu’s.

"This ’mindset’ is very important too." Liu Banxia circled the word ’mindset.’

"Yesterday my own mindset was a bit anxious, so the quality of my mobilization was far worse than usual. If Li Hao and the others had had the time, their work would probably have been better than mine."

"That’s a reminder for us: mindset really matters. Without a good mindset, you can’t give a more accurate judgment for the patient. Whoever mentioned this, add a dish for yourself at dinner—you can reward yourself."

"But mindset, speed and so on are all basic qualities for a surgeon. So we still have to set them aside for the moment."

"Just now I said people like to see version one, because it’s easy on the mind, very positive, and uplifting."

"But I think everyone should be paying more attention to the details. Not every trauma patient we admit is going to have TTP or ITP that we need to rack our brains over, trying to figure out what exactly is going on."

"Take yesterday’s case: the renal laceration wasn’t very long, but it was deep. The hepatic laceration wasn’t very deep, but it was long, with a large volume of bleeding."

"I’ve always said that when we admit a patient, the first thing we have to think of is the patient. Put the patient first. At the same time, we also have to protect ourselves."

"What tests should be done, and on what basis to make judgments—I talked about those last time. This time, what am I talking about? It’s what we should be paying attention to on the operating table."

"I think the first thing we should pay attention to is the patient’s prognosis. We operate in order to relieve the patient’s suffering, not just to make money or take the easy route."

"Yesterday’s patient was a bit special, with relatively heavy blood loss. So, based on my trust in my own technique, I didn’t choose the quick solution of nephrectomy, but opted for repair of the laceration instead."

"Classmates, the part of me that deserves praise is that I actually pulled it off. The patient’s future life will have good quality; he won’t have to carry his whole life on just one kidney."

"But I don’t particularly want that kind of praise, because I’m afraid some of you kids will be led astray by me—trying to force it when you don’t have the technique. When that happens, what you jeopardize is the patient’s life."

"Prognosis is extremely important and something we need to consider when we’re the primary surgeon. But we also must have a clear understanding of our own skill level. Only then can we ensure we give the patient a good prognosis."

"These two ideas don’t conflict. Which is why your lives in the future are still going to be hard: you’ll have to keep grinding your technique. Only then will you know what you’re actually capable of, and avoid doing something you’re not up to while thinking you are—something you’ll regret later."

"To me, that’s a huge taboo for surgeons. Because we’re very good at finding perfect excuses to cover our actual mistakes. Even if we’re held accountable, it barely stings."

"Those with a conscience will reflect for a while. Those without one will even feel wronged—’I was clearly trying to save them, everything I did was for the patient, and they just don’t appreciate it.’"

"Everything has two sides, but many things that happen on the operating table are actually only known to you yourself. Even the people scrubbed in with you have no way to really judge."

"People often say, ’Doctors have benevolent hearts.’ In ancient times, that meant wandering the land with a medicine chest, providing free care. Nowadays we’re doctors, and we also have to make a living. With how expensive surgery is, we can’t just give them away."

"So the only thing we can do is provide the patient with the best‑value diagnostic and therapeutic service. Even if the operation fails, when we step down from the table we can still look the patient’s family in the eye, and our conscience doesn’t accuse us—that’s enough."

The whole conference room fell silent, because what Liu Banxia was talking about could be as big or as small as you made it. This was far from a simple case review.