In the morning, Department Director Huo Congjun stepped into the Emergency Department, made a strong cup of tea, poured away the first brew, sat down, and leisurely drank the subsequent brew.
After that, he walked out of the department director's room with his hands clasped behind his back, and began to make his rounds starting from the observation room.
Behind Huo Congjun were three associate chief physicians and six attending physicians.
The doctors took the formation of a sharp arrow like lions on the plains bringing their lionesses out to hunt.
The resident doctors on duty waited in front of their patients' beds like dholes on the prairie, waiting for the leftovers between the lion's teeth.
The interns seemed like vultures flying freely in the sky. They had no fixed positions, and patients took no notice of them. They could only wait quietly to clean up the remains left behind by the lions and the dholes.
The area belonging to a department was not big. There were only a few dozen beds in observation rooms such as the ones belonging to the Emergency Department.
However, the lions and dholes still needed to maintain the order in the department.
In addition to Huo Congjun, there were two other chief physicians who acted as directors in the Emergency Department of Yun Hua Hospital. They were not required to follow him on his rounds.
Although they were all called department directors, Huo Cong Jun was still the owner of the territory with actual administrative powers. The other two chief physicians had these senior titles attached to their persons, but they were just like wandering lions. They would need to put in more effort to retain their freedom.
The hospital went about retaining order in each department at seven o'clock in the morning every day.
Ling Ran wore a white coat, put that Hetian jade pendant worth 30 RMB into his bag, and went into the emergency room to silently observe everything around him.
He had already acquired some hunting skills that would allow him to kill specific illnesses, but in this territory, those skills were far from enough for him to survive.
"Young Ling..." Huo Congjun suddenly called out to him and waved Ling Ran over.
"This is your patient, please give us a brief outline of the patient's condition." Huo Congjun stood in front of the patient in Bed 12, glanced at her medical record before handing the document over to Ling Ran who was striding forward.
According to the system, the patient actually belonged to Attending Physician Doctor Zhou. Even if everyone in the department knew of Ling Ran's magnificent feat of performing more than 50 sutures the day before yesterday, Department Director Huo should still first ask the attending physician for the patient's condition.
However, the director of a department was the king in a territory. He could do whatever he wanted to do. Even if the department director wanted to remove a kidney from a seemingly healthy patient, the other doctors could only verbally disagree with his decision, but were otherwise helpless to stop him.
Of course, the patient and the patient's family could intervene, but in a hospital environment, the authority of the department director was still second to only a few.
While taking note of the patient's condition, Ling Ran said, "Patient, female, 19 years old, has always been physically fit. There are lacerations on her elbow due to a fall from the stairs, and debridement was carried out..."
As he read off the medical report, he finished his first bedside case presentation.
Without waiting for Ling Ran to catch a breath, Huo Congjun suddenly asked, "Why did you choose the #0 thread?"
The #0 thread was much finer than the commonly used #4 thread in the Emergency Department. According to the standards of the United States Pharmacopoeia (USP), #4 threads were indicated as 2-0, with a diameter of 0.3 millimeters. By those same standards, #0 threads was 4-0 and had a diameter of only 0.15 millimeters, which was exactly half of #4 threads'.
The diameter was twice as thick, and the cross-sectional area of one of the threads was four times the size of the other. That would be similar to the contrast between a little finger and a thumb.
Correspondingly, the tensile strength, which was the force allowing the thread to be stretched without breaking between the threads, was also different, with the #0 thread being much weaker.
In other words, wounds sutured using the #0 thread were more likely to be torn open as compared to the larger #2 threads, #4 threads, or even #7 threads.
Ling Ran was slightly taken aback by the question. The girl on the sickbed and her family members were just as puzzled and looked at the young doctor.
"I think the #0 thread can meet the requirements to stitch this wound," Ling Ran quickly responded, but it was more of an attempt to deflect than to answer, and his response was too simple.
For interns, housemen, resident doctors, and other junior doctors, being asked difficult questions during ward rounds was a daily routine in the hospital. Even so, they would attempt to blurt out two sentences to appear somewhat competent.
After all, being asked difficult questions was still a rare opportunity for the doctors to show off their expertise.
Huo Congjun shook his head and continued to ask, "Why didn't you choose the regular thread? What are you going to do if the wound you sutured using the #0 thread opens?"
"If it opens... I can just restitch it?" Ling Ran thought that it was a silly question. However, he was not going to put his superior in a spot... He might have done something like that before, but he did not need to do it every single time.
Ling Ran gave a kind and caring smile. He looked like a beaming, dazzlingly handsome sun.
Huo Congjun was unable to determine Ling Ran's thought process. He had been performing ward rounds every day and had listened to bedside case presentations for decades, but he had never seen such a clever, young doctor.
The chief physicians, associate chief physicians, attending physicians, and resident doctors who joined the ward round also fell into a long silence.
Good old Doctor Zhou sighed to himself and coughed to clear his throat. "I saw that the wound was not very serious and believed that the #0 thread could bring about the desired effect, so I allowed Ying Ran to use it."
"Don't you defend him, you are also in the wrong," Huo Congjun did not hold back, not even before the patient's family. "Ling Ran was rash in his decision to choose the #0 thread. You had to point it out."
The family members of the patient who could not understand what was being said instantly became anxious. Her mother, who was standing beside the bed, asked hastily, "Doctor, is there a problem with my daughter's arm?"
"There is no problem now, but it requires more careful care, and you have to avoid strenuous activity. We are simply determining the tensile strength of the thread. We are just worried that it would not be strong enough, and if it tears, the wound will not heal well." Huo Congjun always had a pleasant expression when he spoke to patients, and was not as stern and serious as he usually did during meetings.His demeanor was no different just because the patient's injury was mild.
The family members of the patients looked at each other, and all of them seemed worried and anxious.
It was only at this moment that Ling Ran understood the key points of Huo Congjun's question. He immediately spoke up, "The tensile strength of the #0 thread is sufficient. Avoiding activities and being careful is something every patient should do, and I don't think she needs to worry too much about it."
Huo Congjun used the tone he used whenever he lectured his subordinates.
"But those worries would be further assuaged if you were using the #4 thread, don't you think?"
"The patient is only nineteen. The surface area of the wound was large, but not deep. If a thick thread was used, the scar left would be too huge, which could affect her life later on."
The patient did not understand very well about what the doctors said when they rambled on about the #0 and #4 threads, but when Ling Ran spoke about the threads in terms of thickness and thinness, she, along with several other people, instantly understood what exactly the doctors were talking about.
The look given by the slightly plump girl on the bed was no longer full off skepticism, but one of genuine gratitude.
But the former military doctor Huo Congjun was not swayed by his explanation. He said, "It is alright to take scarring into consideration. But you have to understand that there are many causes to scarring. It is related to the patient's physical constitution and the condition of the wound. From that perspective, it is not advisable to choose the #0 thread."
It was only at this moment that the girl on the bed started to truly become nervous. She looked at Ling Ran in panic.
"The thread aside, the tissues on both sides of the wound should be tightly aligned, and the skin should be flat." Ling Ran lifted his head and said, "That has been achieved."
After pausing for two seconds, he continued and said, "The distribution of the suture's tension should be concentrated in the subcutaneous tissue and the deep layer of the dermis. There should be no tension in the superficial layer of the dermis and the epidermis This was also achieved. I think the scar tissue will not grow too much. That is why it is necessary to consider the thickness or thinness of the suture."
When Ling Ran first started to speak, Huo Congjun and the doctors behind him had looked down on him slightly.
From their point of view, Ling Ran had bypassed the larger issue for a childishly short-sighted one. Throughout their professional careers, they had seen far too many of this sort who could not grasp the gravity of the situation and acted rashly.
However, the two problems Ling Ran raised later on and his actions to solve them gave a real surprise to all who were present.
They were not complex problems, but the fact that he had considered them and took steps to resolve them had amazed them.
"Is it time to change the dressing? Let's do it now." Huo Congjun found a reason for the nurse to remove the gauze on the patient's arm.
All the doctors who were present bent over and observed the wound on the girl's arm.
Among them, Huo Congjun was the one who observed the wound especially seriously.
After a long time, Huo Congjun looked up, but he waved and signaled the other resident doctors and interns to come over. He said, "Ling Ran, come talk about your thoughts while you were performing the suture."
Ling Ran had never suffered from stage fright, and he also had, in his possession, a simple interrupted suturing technique at Master Level, which was why he could speak with ease, "Usually, sutures used after debridement are simple interrupted sutures. This was no exception. During the suture, my main focus was to pay attention to the angle and depth when I inserted the needle into the skin. I had to make sure that the part where the knot is tied bulges after the suture, which will then act as a buffer before the scar formation."
There were nearly ten resident doctors and more than ten interns surrounding a sickbed and hence, the space was clearly insufficient. Some people even stood on chairs just to be able to see the patient inside.
The patient's family now understood that the doctor had excellently performed the operation, and they very happily offered up their spaces to the other doctors.
Ling Ran's voice was not loud, but it was clear.
"The underlying principle is that the needle is gently inserted into the thick wound edge, and the needle is deeply inserted into the thin wound edge. Besides, because the patient has a skin defect, the knot should not be too tight to avoid poor blood circulation around the wound, thereby causing a delay in the healing of the wound... After that, I will pay attention to remove the stitches, which could minimize the appearance of scar tissue to its maximum degree..."
"Well said." Huo Congjun led the others into giving Ling Ran a round of applause, and all of a sudden, the sounds of people clapping could be heard in the observation room.
"Everyone, have you learned it?" Huo Congjun looked at the young doctors.
"We've learned it."
The resident doctors and the interns quickly nodded.
"It's good that you have learned it." Huo Congjun nodded slowly, and then his voice became harsh. "But none of you are allowed to perform it!"
Everyone was surprised and confused.
Huo Congjun said, "There are many ways to cover up scars. For example, you can wear long-sleeved clothes in the future or use a tattoo to cover it up. As a doctor, the first thing you need to consider is the treatment."
"I don't want to wear long sleeves or have any tattoos." The girl shook her head immediately.
Huo Congjun ignored her and continued on, "What Ling Ran took into consideration when he performed the stitches is reasonable, but it is only because he is skilled, that's why he could be confident enough to be this audacious. If your skills aren't on par, don't even dream about it. First learn how to perform your sutures well on wounds before you even think about asking me for permission to perform sutures like this, understand?"
"Understood." This time, the morale of the young doctors plummeted.
No one wanted to admit that they were weaker than someone else, especially when that someone else was an insignificant intern.
Huo Congjun's temper when he was in the army rose, and heraised his voice. "I can't hear you lot clearly, have you not eaten?!"
"Understood." The young doctors raised their voices, but their answers were not spoken as if they were one.
After all, hospital staff were not soldiers, which was why Huo Congjun did not try to force them to answer as one. He turned to Ling Ran. "This time, I'll let you pass. Help the patient change her dressing."
"Yes." Ling Ran was startled by the sudden assignment, but nodded nevertheless.
"Hey, so will I have a scar?" the girl quickly asked when she saw that the ward team turning to leave.
Huo Congjun was already several meters away from her bed, but he still turned his head around and replied, "The scar will be shallower, it is impossible to get away scot-free."
The girl let out a sensible utterance of acknowledgment before she smiled sweetly at Ling Ran, "Thank you, Doctor Ling."
"You're welcome." Ling Ran nodded gently. He was about to change the dressing when a white treasure chest appeared in front of him.
[New Achievement Unlocked: Patient's sincere gratitude]
[Achievement Description: A patient's sincere gratitude is the biggest reward to a doctor]
[Reward: Basic Treasure Chest]