We often sigh with emotion that there is a shortage of good doctors in the world, but ask ourselves, have we participated in the creation and creation of such a system and environment for breeding good doctors?
This is a story that makes countless readers cry in my bibliography, and reminds us of a lot… such as the lack of common medical knowledge among ordinary people, the dignity of doctors, the inheritance of medicine, the impetuousness of society, and ultimately the relationship between people should be a how.
Call me if something happens
During the day rounds, a pregnant woman insisted on cesarean section. There is really no medical indication in what, the baby in the belly is not big, and the pelvis is normal. Professor Xu, my superior doctor, said: “It’s not enough to have an operation yet. Try giving birth first.”
The pregnant woman’s lover blocked the door of the ward and shouted, “why don’t you give us a dissection? If you can’t give birth, don’t you still have to do it?” We don’t want to try. If anyone lets my wife suffer two crimes, I will never end with her.]
On that day, Professor Xu was not on duty, but listening to the shouts of the family members outside, she whispered to me: “This pregnant woman may have some trouble. Please call me if there is any trouble during the birth.”
On the same day, the pregnant woman was really in labor, The progress of labor is not bad, but in our routine fetal heart monitoring process, we found frequent fetal heart deceleration. While actively preparing for the operation, we called Professor Xu and talked with the family members to sign. The family members were angry and signed while swearing, saying that if something happens to the child, you will look at it!
After hurrying to the ward, Professor Xu also agreed with our opinion: cesarean section as soon as possible to help the child out of danger.
What is danger? At this moment, the belly of her mother who gave birth to her is in danger. Childbirth is the last test of the fetus by human beings and nature. It can also be called the last natural selection in October.
The child’s first test
Every contraction of the uterus is squeezing the fetus, squeezing out of the birth canal and into this colorful outside world. At the same time, squeezing the water in the fetal lungs makes every alveolus open as much as possible after birth to ensure the child’s breathing.
In addition, this kind of squeeze can also help the child’s skin to establish the sense of touch and feeling after birth, and there are many benefits that human beings have not yet fully discovered. This seems very powerful, but at the same time, this kind of squeeze is also the final test of the fetus.
The blood of the fetus comes from the placenta, and the blood of the placenta comes from bilateral uterine arteries. After entering the uterus, the uterine arteries are spiral and scattered in the myometrium like Simmons’ springs.
Every time the uterus contracts, The myometrium of the uterus is extremely contractured and tightened. At this time, all spiral uterine arteries are compressed and withered. Without blood, there is no oxygen. Every time the uterus contracts, the fetus is in a relatively anoxic state. Only when the uterus relaxes and fresh blood flows back into the uterine arteries can the fetus regain blood and oxygen.
Babies in childbirth, Like a marathon runner swimming in the water, In order to ensure to reach the other side of victory, need to keep ventilation, this ventilation, rely on is the uterus has relaxation. If the uterus contraction is too frequent, or the fetus’s tolerance to hypoxia decline, there may be problems. Can’t tolerate hypoxia, the baby does not cry, is the common people all know suffocation.
At this time, if the delivery room is imagined as a vast African prairie, a child born without crying is like a small antelope born without immediately standing up and running with its mother. It cannot escape the blood of lions, leopards and wolves and is bound to become prey.
But now is a new society, this is not the African savannah, but the civilized society of mankind. We do not allow any baby to have problems, nor do we allow every baby to be selected or eliminated in our hands.
There are always a small number of mothers who will suffer the second crime.
But most of the time, when a specific pregnant woman with normal prenatal examination, happily stroked her big belly and stood in front of you with a smile on her face and asked, Doctor, can I give birth by myself? How did the doctor answer her?
It should be said that the vast majority of them can be born on their own. Although China’s social reform and opening up have gone through the road that Europe has gone through for hundreds of years in decades, some places have gone too far and some things may have gone backwards.
However, the Chinese are still Chinese, and Chinese women are still Chinese women. In the past, they were able to give birth on the kang in the old society. In the new society, with the help of doctors, it should be said that they will certainly give birth better.
However, the reality is that there will always be a small number of pregnant women who may have problems during the more than ten hours of labor from labor to delivery.
For example, the primary uterine atony has no clear cause. Her uterus is not good at working well. The frequency of contraction is slow, the intensity of contraction is small, and the progress of labor is slow. The child will tolerate hypoxia for a long time, which may lead to intrauterine distress and asphyxia when born.
Or, some babies, at the beginning of the combination of sperm and egg conception, the chromosomes or genes in the body determine that she is a weak baby. The number of her brain cells, liver cells and kidney cells may be less than that of normal children. Her birth weight is small and her placenta is small. As people say, congenital deficiency, the fetus’s ability to tolerate hypoxia will also be very poor.
This part of pregnant women, if they try to give birth, are bound to suffer from the second crop of crimes. It was their own attempt to give birth, but the pain, dissection, get a knife.
How to judge, find and find out this small number of pregnant women, not to let them suffer the second crime, but also to protect the slightly weak baby can safely come to the world?
The answer is, there is no way.
With the current examination techniques and methods, there is no way to know in advance. As a doctor, can all pregnant women have cesarean section? Besides, surgery also has the risk of surgery. We can only let pregnant women try to give birth. When giving birth, most of them can give birth by themselves while walking. Any well-known professor dare not say to a pregnant woman who has not yet given birth, if you can give birth, you will definitely give birth.
Although, most of the time, we encourage pregnant women so much, because only when pregnant women have the confidence and determination to give birth can her brain mobilize her whole body to become a harmonious and vigorous motorcycle, experience analgesia, and let a new life be born. This is a positive feedback.
What we can do is to pay close attention to the progress of labor process, find out that a small number of pregnant women with problems in time and as soon as possible, and let the child be delivered as soon as possible or by shortcut through medical intervention, or use drugs to strengthen uterine contraction, or artificial water breaking to stimulate uterine contraction, or midwifery through forceps and fetal head aspirator, or cesarean section.
No big problem, don’t delay his examination of Peking University Tsinghua
After emergency cesarean section, the baby was born, but there was asphyxia. For asphyxiated children, in addition to keeping warm, the most important thing is to clean up the respiratory tract, and then give oxygen. Professor Xu cut the child out of the uterus on the operating table and found that the skin color and tension were not good, which is what we often say in the industry. The child turned purple and was a little soft.
On the same day, the doctor on duty in the neonatology department was very young. After the umbilicus was cut off, Professor Xu immediately took the child off the operating table together, placed the child in an open warm box, quickly dried her body with a large towel, and then cleaned the child’s respiratory tract with a sputum suction tube in my mouth. While delivering the placenta and cleaning the uterine cavity, I looked at the child’s condition intermittently from the corner of my eye.
There is a lot of amniotic fluid in the child’s respiratory tract, and the buffer kettle of the sputum suction tube will soon be full. Professor Xu will definitely suck amniotic fluid and meconium into his mouth if he sucks again.
However, the situation at that time was not even described by every minute, but by every second. Professor Xu did not replace the new sputum suction tube, but vomited out the amniotic fluid and meconium sucked into his mouth and continued to suck sputum.
Then, she moved her lower jaw with her left hand, tilted the child’s head back, fully opened the respiratory tract, buckled the oxygen mask on the child’s nose and mouth, and began to pressurize oxygen. 1, 2, 3, 4… while I sewed up the uterus, I generally heard the familiar rhythm of the pressurized airbag, 5, 6, 7, 8… a total of 12 times. When I took the mask away, wow, the child cried and his body was ruddy.
There was no cheer in the movie, and the little nurse didn’t jump up in the air. Each of us was wearing sterile gloves and guarding our own work. No one clapped to celebrate. No one could stop, but each was relieved in his heart.
Professor Xu hurriedly dealt with the umbilical cord and asked me at the same time, how is the situation on the stage and whether the uterus is contracting well. I said, very good, there is not much bleeding, and it is being sutured.
The newborn was suffocated temporarily. Professor Xu said that it was best to send it to pediatrics for observation for two days, but there should be no big problem and there should be no delay in taking the examination in Tsinghua, Peking University in the future. At this moment, I saw a pair of smiling eyes above her mask. She smiled gently and confessed, “Xiao Zhang, you sew slowly, I’ll go out and talk to my family.”
Later, at the door of the operating room, the family members of the five big and three thick families did not finish listening to the explanation. He punched Professor Xu directly and broke the left clavicle of the old lady. When I finished the last stitch, the old lady had already been sent to the surgical ward.
Does it hurt you?
Before I could change my gown, Rushing to the ward, I saw the old lady’s skinny body nesting on the wide white sickbed, just like my skinny and dry grandmother, just like a leaf, just like a canoe in the wind and rain. But her eyes are still bright and her expression is still calm. When I saw me, she still had her old smile and reserve, her old calm and refusal.
Does it hurt you?
I just had an analgesic needle, and it didn’t hurt any more. I just felt a little uncomfortable and will get better soon.
The old lady was discharged from the hospital because she had no lover, no children, only a distant nephew, who still lived in Fangshan and could not come to see her every day. The doctors in our ward took turns to arrange shifts and sent one person to take care of her every day. When there was insufficient manpower, interns and refresher doctors also took part.
On a summer afternoon, Without speaking, she just accompanied her. The sun shone into her room, mottled shadows fell on the books and shelves, and on the old furniture. She was still wearing a cotton shirt and was always reading. Many of her big cats surrounded her, either sleeping in, or asking for fish fillets, or chasing and biting her tail around her cane chair.
Do you hate it?
No, I don’t.
If I had gone out that day to explain my illness, I would not have been able to hit you. I am young and have strong bones. It is estimated that I will not fracture. At most, my skin will be red and swollen. I will be fine in two days.
If you hit me, you hit me. If you hit you, even if you don’t break your bone, your heart will bleed. You may quit. We are old and will not be able to do it soon. You all quit again. What about those pregnant women?
After recovering from the injury, the old lady completely stopped taking care of the ward and only looked at the clinic. Later, she went to the senior private clinic upstairs in the Hong Kong and Macao Center.
Later, I heard the old lady say, It’s nice there, Rich patients, In general, The quality is still higher, will not always pull the doctor’s neck collar, noisy. There are many foreigners, they all listen to the doctor’s words, never bargain, and take her to and from work by car, now old, don’t want to walk. Most importantly, she whispered to me, the money is still quite large, can buy imported cans to feed my big greedy cats.
For the first time, I saw her smile like a child, innocent and cunning.
Floating in troubled times, can we be calm?
Since then, the indications for cesarean section in obstetrics have no longer been so strictly controlled. Because, we really cannot guarantee that every pregnant woman can be born smoothly, nor can we guarantee that every pregnant woman who has tried to give birth will not be punished by the second crop.
Later, some commonly used midwifery methods, such as hand-turned fetal head and forceps, were gradually lost.
The professors in the ward seldom ask about the ward when they are not on duty. The society is developing faster and faster. Everyone begins to pay attention to their quality of life. Who would like every 24 hours of life to be filled with work? Besides, this job is not only thrilling, but also full of scare.
This has also trained our successors’ extraordinary tenacious fighting ability. When I was 35 years old, I began to work on the third-line night shift. Every night, I was the chief executive officer of all obstetrics and gynecology related matters in the whole hospital.
After experiencing thrilling nights one by one, when I am free, I always imagine whether Dongtangzi Hutong, the thin old man, the old man who has been ready to listen to the call of the ward all his life, and a group of big cats are still safe. Is it still calm in the troubled times?