Xie Wanying told the Chief Surgeon, "No."
Alright, Student Xieâs answer seemed unexpected to everyone and also within their expectations. Even Doctor Yang thought it was only natural for her to come up with any explosive academic insight. Who made this person capable of astonishing others?
"What is it?" Shim Youhuan asked.
"Senior Brother, you should step back a bit and recheck the data. It might reveal that the discrepancy between the two measurements is somewhat large."
"Is the large discrepancy because Teacher Shimâs initial placement was incorrect?" Doctor Yang asked, not quite understanding.
A doctor nearby spoke up, "Donât always ask her, think for yourself."
Doctor Yang felt like crying inside; he had finally caught a top student to tutor him, only for the teacher to disallow questioning her.
Xie Wanying remembered her first time in the emergency room when Teacher Lin caught her giving "cheats" to Student Zhao.
Clinical teachers do not allow questions; discussions are for meetings. When youâre not supposed to ask, you shouldnât ask. If you ask about everything, when diagnosing patients later, doctors practice independently. Who will give you the chance to ask then?
For Doctor Yangâs own good, Xie Wanying did not answer. Back in the operating room, Senior Brother Shim quickly grasped her meaning and started retracting the catheter probe. Itâs not that Doctor Yangâs mentioned placement was off. An adept like Senior Brother Shim couldnât have misplaced the probe.
If the discrepancy is too large and exceeds normal values, it can only mean one thing: the condition of the vascular wall here is extremely unstable. There might be active tiny thrombi forming or shedding, indicating that the regional heart is in a deteriorating state. Under such circumstances, simply performing coronary angiography would not accurately assess the diseaseâs progression in the patient.
The first coronary angiography showed diffuse narrowing of the vessels only between forty and sixty percent, not close to the threshold for stent placement, much less needing a bypass. However, the first IVUS measurement was 4, near the threshold for stent placement; the second 3.4 measurement was even more alarming, indicating suitability for stenting. Given the patientâs youth, attributing the narrowing to atherosclerotic plaques is implausible. It is likely due to an injury. The vascular injury, as seen now, is much more severe than a doctorâs mere examination report would suggest.
With IVUS data support, revisiting coronary angiography with multiple comparative results indeed indicated severe stenosis. Without IVUS, there might have been a missed diagnosis.
Considering the patientâs condition was caused by trauma, simply placing a stent is meaningless. The vascular region corresponding to the heart is definitely injured, consistent with Student Xieâs previously proposed viewpoint. The abnormal area found needs focused re-examination to confirm the diagnosis. Cardiologists cannot achieve this through intravascular techniques alone; only surgeons can visually inspect it.
Surgeons are the safety net for internists. This statement once again reveals its profound significance.
"Junior Sister, your eyes are terrifying." As the surgery proceeded, Shim Youhuan couldnât help but exclaim in admiration, "I couldnât see it, but you could. I know this is a variable, mere observation isnât enough. Yingying, do your eyes come with a built-in calculator?"
Student Xieâs eyes have a built-in calculator; indeed, all the onlookers found this quite agreeable.
Senior Brother Shim felt relieved. The purpose of the internal medicine surgery was basically met, and the issues could be identified as a precursor for the surgery.