(Thanks to Chen Feifei, sjh56, Qianshan Taoren, Yao Wenrou Ken Woshuo, efgege, Shenfu Tiaoxi Mushi, gxc4587, 435012.qdcn, Maoer Wang Yue, Jiutian Shenlong, Liulian Xiao Long, Jingya Xiaoqi, Wen Xuelu, Judy218, Shengxia Feiwu, alan-xu, Gujide Feng, lxt Mingliu, Team Mingji, Shuyou20180322232223210, Shuyou20200610161849685, Xu Boliong, Guji Feishuang, Tiantian Laiguang, Congming De Shudaizi, Shuyier Ha, mangmangliu, Mengxing Laishi Mingtiam, for encouraging with monthly tickets)

Back at the emergency center, this tour was quite worthwhile. Although internally there was some resistance to such tasks, actually trying it out was not bad.

"Xu Yino, I borrowed a TEM set from the proctology department," Liu Banxia said.

"Remember for tomorrow, send it to the operating room after handling it. Are all the tests for that girl done? Is there no issue with day-after-tomorrow's surgery?"

"Teacher Liu, no problem," Xu Yino replied.

At this moment, Li Hao came down from upstairs looking dejected.

"What's wrong? The patient woke up?" Liu Banxia asked.

Li Hao nodded, "Teacher Liu, the patient indeed has bipolar disorder, overdosed on lithium carbonate pills. Now he insists on being discharged, wanting to continue using lithium carbonate. His reason being, if living like a madman, might as well be dead."

Liu Banxia gave him a glance, "The patient's body can at least adjust for two more days, even if he wants to discharge, it has to be the day after tomorrow. Tell him, we will not disclose his real medical condition to anyone."

"Teacher Liu, isn't that just letting him commit suicide?" Li Hao asked in shock.

He had tried persuading upstairs for over an hour, but the patient was as stubborn as a turtle eating a weight, determined. No matter what you say, no matter how you persuade, he just disagrees.

He dares not to persuade anymore, fearing to worsen the patient's condition.

The only one he could think of was Liu Banxia; in his mind, Liu Banxia was nearly omnipotent. With previous patients encountered, Liu Banxia could manage them all.

Now he was dumbfounded, because from Liu Banxia's perspective, it was also left to the patient to choose.

Isn't this just suicide? He really couldn't accept it, Liu Banxia just leaving it like that.

"A silly kid, still emotional," Liu Banxia replied.

"Actually, many times, principles are universal. Now I ask you, if a terminal cancer patient gives up on treatment, what would you do?"

"Oh...of course provide hospice care, prescribe painkillers, help alleviate suffering," Li Hao responded.

"In this patient's mind, he's no different from a terminal cancer patient," Liu Banxia said.

"He opts to use a non-existent number in the employee register, works hard every day, even lacks a girlfriend. I guess he's searching for the most splendid point in his life."

"We only see bipolar disorder as a disease, but there are many manifestations of bipolar disorder. Some people can adjust slowly through medication and environmental nurturing."

"But for some, bipolar disorder is severe. For example, our patient, if he's only emotionally excited, there's some chance to control it. But he already has violent tendencies, hard to control."

"He can foresee what he would become after stopping medication, not only unrecognizable to himself but also a burden to family."

"Due to the severity of his condition, even reducing dosage, it's not easy to control later, otherwise he wouldn't increase his dosage himself. Eventually, the result still falls on lithium overdose."

"For us doctors, diagnosing isn't the toughest; diagnosing and having no effective treatment is the hardest."

"We all think maybe it's better to die than to live poorly, but some people's hearts see the way of living as the key. Living unrecognizable even to oneself feels no different than dying."

"Back to this patient, he has bipolar symptoms and slightly extreme thoughts. I judge he might also have depression because he knows he can't look forward to life like others."

"Teacher Liu, if it's like this, can't his depression be slowly adjusted? If depression is controlled, might he have a different view?" Chen Hongmei asked.

"That's one approach, but we don't have that much time," Liu Banxia replied.

"Antidepressant medications are also neurogenic, just opposite to his current bipolar disorder, somewhat刺激性, may make him agitated, tense."

"Plus, his kidneys are already in this state, if he admits next time, we can't perform full dialysis."

"I guess, patient might die of renal failure or take matters into his own hands. Anyway, that's my thought, maybe someday he'll feel life is good, who knows."

Li Hao grimaced, how could it be? Even if the patient has a sudden epiphany, there's not enough time to wait. His renal failure only worsens, and it's unclear how much longer he can endure.

"Let's communicate with the patient as I said. Many times, we still have to respect the patient. No matter what kind of advice we give, we have to comprehensively consider it based on the patient's actual situation," Liu Banxia said.

Li Hao nodded and walked back listlessly.

It's frustrating, but he still has to face it. This is just the beginning of his medical career, and he may face more similar patients in the future.

"Tsk tsk, isn't it too cruel? Just letting Li Hao handle it on his own?" Wang Chao, who was listening on the side, asked.

"What else can we do? It's also a kind of medical experience," Liu Banxia said. 𝘧𝑟𝑒𝑒𝘸𝘦𝘣𝑛𝑜𝘷𝑒𝓁.𝘤𝘰𝓂

"Sometimes it's just like this. We have to bravely face the things we least want to face. Do you remember Tiggie's owner?"

Wang Chao nodded.

"Even now, I haven't forgotten his face, while many patients, once I've treated them, that's it. Even if I performed surgery, I forget them as soon as I turn around," Liu Banxia said.

"He knew the chances of cure or control were very small and wanted to give up, to live out the rest of his life happily. I recommended chemotherapy, but the drugs weren't effective, shortening his already limited lifespan even more."

"Although I know it's not my fault, no one would have expected both drugs to be ineffective. Considering his stage at the time, chemotherapy was the best choice."

"But knowing it is one thing, and your true feelings inside can't fool anyone. Especially in our emergency center, it's the easiest place to encounter such situations."

"For example, a car accident patient shows signs of brain death when brought in. In the event of cardiac arrest, what kind of mindset should we have to perform CPR?"

"Actually, I don't have an answer myself; I can only decide in the moment of facing that situation. Who knows, sometimes my own thoughts make my head spin."

Wang Chao nodded in understanding; he never expected Liu Banxia still remembered that patient. This is why Liu Banxia often repeatedly warns the interns not to involve too much personal emotion with patients.

Many things aren't simply black and white or right and wrong.

For instance, reflecting on today's patient, truly putting oneself in his shoes, one might also choose to give up treatment. Of course, this decision is made with a clear mind, but when the time comes, it's uncertain.

"By the way, you mentioned earlier that you're going to perform a TEM surgery. Are you really planning to research in this area?" Wang Chao asked.

"Absolutely, I've been reading up on it recently. Actually, if you evaluate it now, NOTES surgery techniques are more advanced and can achieve truly scarless outcomes."

"However, such surgical techniques are highly difficult, and the training period is too long. When I think about it myself, it gives me a headache, let alone training future interns."

"Another difficulty is the risk during surgery, limited clinical samples, and a restricted population it can serve. It's currently only in a limited open phase. Even famous hospitals have done little experimentation in this area."

"Compared to NOTES, although NOSES still requires a laparoscope, it eliminates one incision for specimen extraction. Anyway, the introductions in those papers suggest a much better prognosis for patients."

"Be it psychologically or the degree of invasiveness during surgery, although it's still more difficult than traditional laparoscopy, it's not excessively so. I guess this will be a big direction for the future."

"Anyway, I see many hospitals are promoting related surgeries in this area and doing related publicity. Hmm... my intuition is that the development of this surgical technique is somewhat chaotic and fast, but it's not without benefits, not just putting on a show."

"Have you been researching these things lately?" Wang Chao asked, frustrated.

"Yes, I've actually been pondering over it since I was in charge of the inpatient department," Liu Banxia nodded.

"We have to progress and write papers. Small incision appendectomy has become a thing of the past, and this is a minor trend, I guess. Let's see how practical it turns out to be."

"No more talking, tonight you're buying pig trotters. Wang Lei also said he has to get a meal off you after work today before leaving," Wang Chao said.

"Always bullying me, even the landlord's family doesn't have much surplus grain," Liu Banxia complained.

"Think about it, is my thinking correct? Anyway, reducing one incision is great, and it saves a lot of surgery time. Isn't that the reason?"

"If I can manage most surgeries with a laparoscope, I'd be secretly happy. Don't stress me out, okay? Go discuss with Dr. Shi and Dr. Wei, or you can consult with the director."

It's truly frustrating; I guess it's useless to hope to catch up with Liu Banxia's pace. This isn't just a case of one step behind, but rather a matter of his long strides, each equivalent to two of mine.

There is much mature experience in laparoscopic surgery for me to absorb gradually, but this? Forget it, there must surely be many requirements. I won't bother to make things difficult for myself.