My Medical Skills Give Me Experience Points Chapter 1428 - 569: Assistant Lecturer, the Severe Consequences of Myocardial Necrosis (Part 2)

Director Tan had clearly undertaken a comprehensive review and analysis of Zhang Qilian’s interventional procedure and its subsequent outcomes. He recognized that Zhou Can's interventional skills surpassed his expectations by a significant margin, which ignited his desire to invite Zhou Can to instruct in interventional surgeries. This arrangement was poised to be mutually beneficial.

"It would be my great pleasure to accept this role. Teaching is inherently rewarding, though I do harbor a slight concern that my abilities may not be sufficient, and I might not be an effective instructor," Zhou Can responded with practiced humility, implicitly agreeing. It was akin to the customary exchange when visiting elders; a polite refusal of a red envelope, met with a gentle insistence until it's accepted with gratitude. The progression for university faculty typically follows a path from assistant, to lecturer, then associate professor, and finally, professor. Beyond the rank of professor, there are further distinctions: Level 1, Level 2, and Level 3 professors. The Level 1 professors represent the pinnacle, often revered as foundational figures within their academic disciplines, commanding absolute authority. Level 3 professors, while holding the lowest rank among professors, are nonetheless individuals of considerable accomplishment, a title not easily attained.

University teaching positions encompass thirteen distinct levels, mirroring the tiered structure of hospital doctor roles, necessitating a gradual ascent through the ranks. Deficiencies in skill will invariably slow this advancement. It is quite common for many university educators to remain lecturers throughout their careers, never reaching the Level 3 professorship. A perhaps unfortunate few, hindered by specific limitations, might even retire as assistants. In essence, the competition across all professional domains is exceptionally intense. The capable ascend, while the mediocre stagnate or are supplanted.

For Zhou Can to embark on a teaching career at this juncture is undeniably a splendid opportunity. A multitude of talented individuals find their true stride after the age of thirty. Commencing his academic journey before this milestone is destined to prove immensely advantageous for his future career advancements. Seizing an early start is paramount for positional advancement.

"Do not concern yourself with the quality of your teaching; everyone must learn to walk before they can run. The academy is committed to providing you with ample time and opportunities for development, without imposing overly stringent demands initially," Director Tan assured him.

"Very well, if you place such trust in me, then there is little more to discuss. I shall dedicate myself to the task, and all will proceed according to your arrangements at the appointed time," Zhou Can accepted with enthusiasm. There was no need for excessive posturing, as such valuable opportunities are fleeting.

...

On the third day, while Zhou Can was engaged in a surgical procedure within the emergency department, an urgent summons arrived from Cardiothoracic Surgery requesting his immediate presence for a critical consultation. The principle of saving lives supersedes all else, and Zhou Can accordingly delegated his ongoing surgery to his two assistants. They now possess the full capability to manage Level 1 and Level 2 surgeries, along with the standard components of Level 3 procedures. However, for high-complexity Level 2 surgeries and crucial aspects of Level 3 operations, Yang Zhi and Pu Dingdong still lack the complete proficiency to execute them independently. This represents remarkably swift progress.

Yang Zhi, benefiting from a robust surgical foundation, demonstrates visibly superior surgical aptitude compared to Pu Dingdong. Nevertheless, Pu Dingdong exhibits very consistent progress, advancing at a steady, uniform pace. It remains challenging to definitively predict their eventual standing relative to each other. Zhou Can regards his two medical assistants with considerable satisfaction. It would be unrealistic to anticipate them reaching Zhou Can's caliber within merely one or two short years. Relative to other doctors at a similar stage of their careers, their advancement is already exceptionally noteworthy.

He promptly proceeded to the Cardiothoracic Surgery department. A palpable tension permeated the consultation room. "Three days prior, this patient underwent emergency intervention surgery for thrombus extraction within our hospital's cardiovascular department. Beginning last night, they started exhibiting pronounced symptoms of distress: difficulty breathing, severe chest pain, and a precipitous drop in blood pressure. We currently suspect acute myocardial infarction accompanied by extensive myocardial ischemia, leading to necrosis due to prolonged ischemia. The patient's condition is exceedingly precarious. Following deliberations with several other directors, we have concluded that the surgical risks involved are substantial. You possess the most intimate understanding of this patient's condition, which is why we specifically requested your participation in this consultation," Director Xue Yan stated, presiding over the consultation table. The first seat to the left remained unoccupied, reserved specifically for Zhou Can. A significant portion of the department's medical staff regards Zhou Can as the de facto second-in-command of Cardiothoracic Surgery.

Traditionally, the left side of a room signifies a position of honor.

The chief seat, typically on the left, is reserved for the second-in-command.

Zhou Can examined the examination materials, focusing on ultrasound and CT scans of the chest, which are crucial for detecting abnormalities.

"When this patient was rushed in for emergency treatment three days ago, the critical window for intervention had already passed. During the interventional surgery, a troubling feeling arose within me that the extent of myocardial necrosis might be substantial. Sadly, our suspicions have now been confirmed."

Discussing Zhang Qilian’s condition presented a significant challenge for Zhou Can.

This case was exceptionally complex.

"Based on my extensive clinical experience, in his current precarious state, refusing surgery guarantees a fatal outcome. Even with surgical intervention, the survival rate is unlikely to surpass fifty percent. We have considered two primary strategies. The first involves proceeding with surgery and re-evaluating the patient’s condition post-operation. The second option is to pursue a direct heart transplant, though securing a suitable donor presents a substantial hurdle. An artificial heart would be the first preference."

Director Xue Yan offered these insights following the discussion.

Despite hearing these points, Zhou Can remained deeply concerned.

"While both proposed surgical methods hold a degree of feasibility, the critical factor lies in the patient’s severe arterial abnormalities and the widespread atherosclerosis evident throughout his body. During my ward rounds, I learned from his family that he has suffered from vascular abnormalities since childhood, necessitating continuous medication for management. He even pursued specialized studies in Japan specifically to address his systemic arterial vascular issues."

The patient's medical presentation was highly uncommon.

Even for a standard patient, heart transplant surgery is fraught with significant mortality risks.

This risk is amplified considerably for someone with such severe arterial abnormalities.

Upon hearing this, the medical team found themselves at a loss for a definitive solution.

For individuals suffering from acute myocardial infarction with extensive necrosis, myocardial remodeling can occur, leading to cardiac enlargement, diminished contractility of the heart muscle, reduced cardiac output, and subsequent heart failure. This can also precipitate a drop in blood pressure, potentially progressing to cardiogenic shock.

If left unaddressed in a timely manner, the necrotic myocardium might protrude outwards, possibly resulting in a ventricular aneurysm or rupture of the papillary muscles, and in the most severe cases, even cardiac rupture.

Due to the myocardial necrosis, the affected heart tissue becomes thin, while the healthy portions thicken, leading to uncoordinated contractions. This situation can foster the development of a mural thrombus within the left ventricle, which, if dislodged, could trigger embolisms affecting the brain, kidneys, spleen, lungs, or extremities.

Consequently, when Zhou Can examined Zhang Qilian's post-operative status in the ward that morning, he cautioned the family that the most perilous phase was far from over.

Although he had successfully removed the thrombus for Zhang Qilian, he could not guarantee against future myocardial necrosis.

This uncertainty stemmed from the fact that during the thrombus extraction, some of the heart muscle had already suffered necrosis due to ischemia, a condition not immediately apparent as the pericardium had not been opened.

Western medicine's therapeutic approach often adopts a reactive stance.

It can be characterized as a secondary, defensive form of medical practice.

For instance, if a tumor is detected but is not yet significant in size, medical professionals might advise a period of observation, with follow-up examinations every three to six months. If the tumor remains stable and does not grow, it is left untreated.

This medical concept is referred to as 'coexisting with the disease'.

The underlying philosophy of Western medical diagnosis is largely built upon this principle, aiming to prolong patients' lives as much as possible and alleviate their suffering.

For example, cancer patients often undergo chemotherapy or radiation therapy initially to manage the proliferation of cancer cells. The objective here is not necessarily a cure, but rather to extend the patient's lifespan.

Subsequently, in the advanced stages of the disease, painkillers are administered to manage the agonizing pain.

While many consider trigeminal neuralgia the most excruciating pain, and others childbirth, these pale in comparison to the suffering caused by cancer pain.

The pain associated with advanced-stage cancer can become so unbearable that it drives individuals to wish for death.