51 The Pressure Of Silence (1/2)
Li Xiuying had changed and was now dressed in a set of green scrubs. Her hair was tied back and she had a disposable green surgical cap and surgical mask on.
She completed her surgical hand scrub, put on her surgical gown and sterile gloves and entered the theater with her arms crossed.
Li Xiuying made her way to the surgical table where Dr. Liu was currently operating: ”Dr. Liu”
Dr. Liu looked to his right: ”Dr. Li thank you for coming. This patient is a 55 year old female with chronic alcoholic pancreatitis. She has not responded to medical management and is suffering from intractable pain. Imaging has indicated presence of bile obstruction and duodenal obstruction. The patient reported loss of appetite, postprandial pain, nausea, vomiting and right upper quadrant pain. I wanted your opinion on whether I should carry out a Frey's or a Whipple.”
Li Xiuying nodded. She then walked over to the screen that displayed the CT abdomen.
Li Xiuying turned to a theater nurse. ”Cholangiogram? Ultrasound? Bloods?”
The nurse brought up the images one by one then the blood test results.
Li Xiuying: ”Her last CT abdomen?”
The nurse clicked open the image: ”The Last scan was in 2008”
Li Xiuying: ”Thank you.”
Li Xiuying walked back to the surgical table. ”Lower the table please.”
The table was lowered and Li Xiuying looked into the abdominal cavity. She used her right hand to feel the anatomical structures and to move structures out of the way to better visualize all the patient's anatomy.
Li Xiuying mumbled to herself: ”Dilated bile duct, severely enlarged stomach, dilatation of veins and arteries. Also presence of anatomical variation of the arterial and venous supply. ”
Li Xiuying: ”I would carry out a pylorus preserving Whipple's procedure, the disease is predominantly located in the pancreatic head and there is significant biliary and small bowel involvement. Also, the patient has clear symptoms of bowel obstruction. I would also recommend putting in an NG tube alongside the NJ tube to aspirate the stomach content.”
Dr. Liu: ”I was leaning towards a Whipple's myself. Thank you.”
Li Xiuying nodded and proceeded to leave the theater.
....
Emergency Room
Hu Yín Tao was nervously waiting at a computer in the emergency department. She hadn't expected Dr. Li to page her today. She still hadn't covered all the topics she had planned to. Hu Yín Tao thought that she still had two more days to prepare for her session with Dr. Li.
Hu Yín Tao took out her phone and quickly started reading a pocket guide on Emergency medicine.
She had just finished reading about angina when she felt impending doom approaching.
She looked up from her phone screen and spotted Dr. Li in the distance. Li Xiuying was now wearing black scrubs with white doctors' coat on top. Hu Yín Tao swallowed her saliva.
Hu Yín Tao started slowing walking towards Dr. Li.
Hu Yín Tao nervously spoke: ”Good morning Dr. Li.”
Li Xiuying nodded. She walked to the doctor's station and checked the patient list on a computer.
The next patient on the list was a 35 year old man with loin to groin pain. Li Xiuying marked the patient as being seen.
Li Xiuying: ”Loin to groin pain, differentials?”
Hu Yín Tao mind went completely blank, she had read up on this over the weekend but when faced with Dr. Li expressionless face and indifferent tone her ability to think and speak had fled.
Hu Yín Tao: ”erm I erm its err erm I, I. ”
Li Xiuying: ”Words.”
Hu Yín Tao's voice became quieter as she spoke each word: ”Erm I think erm kidney stones?”
Li Xiuying frowned slightly at Hu Yín Tao's hesitation: ”And?”
Hu Yín Tao: ”Cancer?”
Li Xiuying: ”Type?”