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This was essentially a pre-operation pep talk, which could play a significant role in easing the patient's emotions.
"Dr. Liu, what exactly is going on?" Xu Chengjun asked curiously.
"Didn't we agree to relax yesterday? I took both of them, and the two outside, to a patient's stall for a barbecue. Incision 1.5 centimeters, electrocautery," Liu Banxia said.
"And then we encountered that kind of unscrupulous streamer who wanted to take advantage of Qing Kewa, which led to some verbal disputes. Actually, it wasn't a big deal, but young people these days can be a bit thoughtless."
"Honestly, setting you aside, I also really hate streamers like that; they're disgusting just to look at," the patient chimed in.
"Isn't that the truth? Initially, I thought his singing was quite good. Who would have thought he was that kind of person?" Liu Banxia said.
"You two, pay attention. The abdominal cavity is completely exposed now. The next key step is to find the appendix. Everyone has their own methods. Dr. Liang, you're a bit lacking in this area. Qing Kewa, you need to be meticulous."
"Lass, when I lift the appendix out later, you might feel a slight pulling sensation. If you feel scared, just tell me, and I'll give you a shot of local anesthetic," he added.
"It's fine, it's fine. Go ahead," the patient said excitedly.
"Feifei, this is the first time I've seen you so brave," Xu Chengjun complimented.
"Uncle Xu, it's because I met my idol," the patient said with a smile.
"I was really worried in the ward last night, you know, since I was going to have surgery. But watching that video cracked me up."
"Alright then, I have a small request. Could you let them try to locate your appendix now?" Liu Banxia asked.
"Sure, no problem," the patient agreed readily.
Liu Banxia nodded at Qing Kewa, who carefully inserted her finger. Her movements were very slow as she palpated, mindful of the many organs nearby.
However, for Qing Kewa at her current skill level, this technique was still a bit too difficult for her to master. Even Liang Xiaolin, despite having much more experience than Qing Kewa, took nearly three minutes before she nodded at Liu Banxia.
"Okay, the examination is complete. Next, I'm going to directly lift out the appendix and remove it. Then we should be able to finish the surgery in about ten more minutes," Liu Banxia explained.
"Actually, it's fine if it takes a bit longer. I'm not scared at all anymore," the patient said.
Liu Banxia chuckled and inserted his finger as well. This time, however, he didn't extract the appendix as quickly as usual; instead, his brow furrowed.
"Chief Director Xu, my finger seems to be cramping. How embarrassing for today. Let's step outside to confer," Liu Banxia said, winking at Xu Chengjun.
Xu Chengjun's heart skipped a beat. Liu Banxia's finger wouldn't actually cramp; he must have felt something amiss. And based on Liu Banxia's demeanor, if he couldn't discuss it in front of the patient, it usually wasn't good news.
"Lass, I'm going to step outside to flex my finger. Is it alright if Qing Kewa chats with you for a bit?" Liu Banxia then asked the patient.
The patient looked a little puzzled but nodded. "Sure, you go ahead."
"Dr. Liu, what's the situation?" Xu Chengjun asked anxiously once they were outside the operating room.
"Just now, although I located the appendix, I also felt something else. There's a mass on the cecal wall. It's not very large, but if we were to address it now, we'd have to perform an exploratory laparotomy," Liu Banxia stated.
Xu Chengjun glanced at him. "Are you sure you didn't misidentify it?"
Liu Banxia nodded firmly. "I'm sure. Our option now is to remove the appendix first, and then investigate what this mass is."
"It's very close to the appendix. If one isn't careful, they might think there are two appendices. Except one is soft, and the other is hard. The pain could be from the mass, or it could be appendicitis caused by the mass."
Xu Chengjun was now in a difficult position. The last time Liu Banxia had visited, he had identified a missed diagnosis. If this was another missed diagnosis, it would be truly unacceptable.
"In that case, let's do as you say. Remove the appendix first and see what the situation is," Xu Chengjun said after some hesitation.
"It's not that I don't trust you. But even though her family are my good friends and we're very close, converting a small incision to an open exploration without solid findings... they might not accept it."
Liu Banxia nodded. "That was my thinking as well, otherwise I wouldn't have called you out."
Returning to the operating room, they put on new gloves.
"Next, we're going to remove the appendix. You'll feel a pulling sensation," Liu Banxia said, standing beside the operating table.
"Mm-hm, go ahead and remove it," the patient replied with a smile.
Liu Banxia inserted his finger, then the appendix forceps. After he lifted the appendix out of the abdominal cavity, Xu Chengjun's brow furrowed as well.
At the very least, by his current assessment, this was a healthy appendix, showing no signs of inflammation. This also confirmed that Liu Banxia's earlier assessment was accurate; his decision not to insist on an immediate open exploration was to give himself some leeway.
The others also sensed that something was wrong. An inflamed appendix would definitely show symptoms. Combined with Liu Banxia and Xu Chengjun stepping out earlier, this situation seemed quite serious.
Xu Chengjun was now utterly conflicted. He didn't know whether to feel relieved or distressed. Although it was somewhat embarrassing, at least it wasn't exposed to outsiders, and Liu Banxia was, in a way, one of their own. However, the patient's father was his old friend, and he was also worried that this mass might be something bad.
"Chief Director Xu, let's step outside and discuss this again," Liu Banxia suggested.
"Lass, don't worry, your appendix has an ectopic growth, I..."
"Dr. Liu, don't lie to me. Is there something wrong with me?" The patient's voice grew agitated.
Liu Banxia looked at Xu Chengjun. Xu Chengjun sighed internally. "Feifei, when Dr. Liu was examining you, he found a mass on your cecal wall. And looking at your appendix now, it's perfectly healthy. The pain you've been feeling, both this time and before, was likely caused by that mass."
"There are two options now. One is to close the incision and then perform detailed examinations. The other is for Dr. Liu to proceed with an exploratory laparotomy immediately. If it's something we can deal with, we'll remove it right now."
The patient was twenty-four years old and fully capable of making her own decisions. So, after a brief hesitation, Xu Chengjun decided to tell her the truth. Otherwise, when it came time for general anesthesia, she might sense something was amiss.
"Uncle Xu, is it very serious?" the patient asked, her voice a bit shaky.
"It's hard to say right now, which is why we need to do an exploratory laparotomy. However, I believe it's likely just a simple mass. My recommendation is to undergo detailed examinations," Liu Banxia said.
"Uncle Xu, what should I do then?" the patient asked, turning to Xu Chengjun again.
"Feifei, try not to panic. We'll go out and discuss this with your father again. You know Dr. Liu is very skilled, so don't worry," Xu Chengjun said comfortingly.
The patient nodded. Qing Kewa, who was beside her, immediately took her hand. She didn't know the detailed situation, but she knew the patient needed comfort right now.
"Sigh... I don't even know what to say anymore," Xu Chengjun said with a wry smile after they stepped out again.
"Don't take it to heart. I looked at the scans too. All I can say is that the location of this mass was incredibly coincidental. Anyone would have diagnosed it as appendicitis unless an enhanced CT scan was performed," Liu Banxia said.
"That's why being a doctor is so challenging. It's not like fixing a car, where the faulty part is obvious. But this is also a good thing; otherwise, this mass would have been very difficult to discover."
Xu Chengjun nodded. That was indeed the case, but he still felt a sense of unease.
When they arrived at the surgical waiting area, the patient's parents were startled to see only Xu Chengjun and Liu Banxia, the two doctors, emerge.
Liu Banxia didn't participate in the ensuing conversation. Xu Chengjun was closer to the family, which would make communication easier. Liu Banxia had accompanied Xu Chengjun out solely to lend his presence and add weight to Xu Chengjun's words.
"Dr. Liu, they'd like to hear your opinion as well," Xu Chengjun said, beckoning him over.
"Hello," Liu Banxia greeted them.
"Hello, Dr. Liu. What do you think is the best course of action?" the patient's mother asked.
Liu Banxia appeared somewhat troubled. "The situation isn't entirely clear at the moment. There are many possible causes for a mass, and detailed examinations are needed for a definitive diagnosis."
"Currently, we have two main approaches. One is to proceed with removing the appendix and then conduct further examinations on the mass. The other is to close the incision now and then conduct comprehensive examinations for the mass."
"Although an exploratory laparotomy could also address it now, I don't recommend that. While the patient fasted for the appendectomy, no bowel preparation was done. If intestinal surgery is actually required, there's a high risk of anastomotic leakage later on."
He really didn't want to say this much, and it wasn't about the five thousand yuan freelance surgery fee. That money was secondary now; the patient's well-being was paramount. As he'd mentioned, anastomotic leakage is the most common complication in intestinal surgery. The risk is even higher without proper bowel preparation. However, this wasn't the Second Affiliated Hospital, nor was the patient directly under his care, so offering such definitive advice felt somewhat presumptuous.
"My opinion is similar to Dr. Liu's. We can conduct the initial examinations here. If intestinal surgery is indeed necessary, we'll be better prepared for it. Thorough preparation can reduce the likelihood of surgical complications," Xu Chengjun said.
"Dr. Shi is off tomorrow," Liu Banxia reminded him.
In this area, Shi Lei was far more skilled than him; it was better to ask Shi Lei than anyone else.
"Alright. Since you're both considering Feifei's best interests so carefully, we'll follow your advice," the patient's father finally decided.
"Please rest assured. My feeling is that it's more likely diverticulitis. That's usually quite manageable. If it weren't for the lack of bowel preparation today, I would have taken care of it directly," Liu Banxia said with a smile.
Even though today's surgery wasn't completed, he felt no regret. One must be responsible for one's patients, even if they are only indirectly so.