Surgery Godfather

Chapter 353: Chapter 0336: Gold Standard

After Professor Su and his team watched the video and visited Orthopedics, they left.

The child, who came for free medical consultation in the teaching room and was suspected of having an osteoma, had already had his surgery. His father was pacing at the doorway to the doctor’s office, upon seeing Little Five he asked: “Doctor Lu, have the pathology test results come out yet?”

“Didn’t we tell you it would take three to five days? You’ve asked me that seven or eight times already.” Little Five was a bit annoyed with him.

The child’s father thought for a moment and then said: “Doctor Lu, can you expedite my son’s examination? Everyone else is not as anxious, if just his examination can be expedited without affecting anything else, no one else will know.”

Little Five was most annoyed with this kind of person who always thought their matters were always urgent, and didn’t respect others’ matters as important. This sort of person was also always cutting the line, thinking that since they were the only one, it wouldn’t impact anyone else.

“It’s not possible to expedite. These things can’t be rushed. If we rush the pathologists, and they hastily review the results, would you be okay with inaccurate results?” Little Five handled it tactfully and refused him gently.

The child’s father was anxious, he pinched his trousers with one hand: “This is so nerve-wracking. Do you think it’s benign or malignant? What should we do if we have to wait so long?”

“If you knew this was going to happen, why didn’t you bring your child earlier? Reading a few articles online doesn’t make you a real doctor. Everyone can wait three to five days, why can’t you?” The mother of the child also came over, as if ready to grasp his ear and drag him away.

This couple was quite interesting. The husband was short and appeared timid, the wife tall and hearty, in terms of both physique and character, this couple was rather mismatched.

If they were to quarrel at home, I suspect the wife could carry the husband around like a chicken, taking a few laps around the house without breaking a sweat.

After being scolded by his wife, the husband returned to the ward in a downtrodden manner. The wife apologized to Little Five and then returned to the ward as well.

Reminded by the question about pathology results, Song Zimo remembered that he had scheduled to visit the pathology department in the afternoon to look at Zhang Zhe’s biopsy slides, he wanted to ask Yang Ping if they should go together.

Yang Ping agreed to show everyone pathology slides, establishing it as a basic skill that all physicians in the department have to master. They wanted Song Zimo and Xu Zhiliang to learn it first, so in the future, they would be able to interpret pathology slides as easily as x-rays.

Some countries, such as the United States, require surgeons to carry out their own pathology examinations. Sometimes, when the chief surgeon excises a tumor, it is sent to the Pathology Department next to the operating room for frozen sectioning. The surgeon then removes his surgical gown, goes in person to the Pathology Department to examine the slide under a microscope, determines what type of tumor it is, then scrubs in again and selects the appropriate surgical procedure based on the pathology diagnosis.

In China, pathology slides are always examined by pathologists; surgeons don’t know how to interpret them and haven’t received any specialized training in this regard. During their time in school, those few experimental pathology classes only served as a kind of experience.

Therefore, in China, if there is a surgeon who can interpret pathology slides, he is truly a rare treasure.

When everyone arrived at the pathology department, they were all busy: Gross Section, Micro Section, Immunohistochemistry. Only two people were in the doctor’s office: Director Guan of the Pathology Department, and Director Shi, who had retired but had been re-hired.

Director Shi was resting on the window side with sunglasses on while Director Guan was looking at something on his computer. As they entered, Director Guan looked up and recognized Song Zimo: “Young Master Song, welcome! Won’t you introduce us? This is Doctor Yang from your department, right?”

Song Zimo was quite familiar with both Director Guan and Director Shi, as he often sought their guidance in examining pathology slides. He also often brought them gifts, like Maotai and the like during holidays, to keep them in good spirits.

“Director Guan, thanks for your efforts.” Yang Ping extended his hand toward Director Guan.

Director Guan laughed and said: “Don’t mention it, we are normally detached from the other departments, dealing mostly with pathology slides all day, yet know very few people. Of course I know you, Doctor Yang. You are young and promising. You all came to see the pathology slides from the orthopedics cases, right? Today’s specimens are still undergoing decalcification treatment, but the slides from a few days ago are ready for examination. I’ll have someone find them so you can have a look.”

“Director Shi, are you admiring the beauty of the outside world with your shades on?” Song Zimo joked with Director Shi.

Director Shi waved his hand: “I’ve been under the microscope for so long that now just a slightly stronger light hurts my eyes. For a few years now, if it’s a sunny day outside, I have to wear sunglasses. Starting this year, I’ve resorted to wearing them indoors too. I can’t stand even the direct light of a lamp, my eyes keep tearing up.”

“After Director Shi finishes this month, he won’t be working here anymore, he’s retiring.” Director Guan explained.

Director Shi said: “I can’t carry on anymore. My eyes are the issue. If not for them, I’d want to work for a few more years.”

Being in the pathology department was indeed lonely and without much financial perks. A bunch of doctors spent their day looking at slides under the microscope. One doctor had to look at approximately three to four hundred slides every day and didn’t get a spare moment even to take a loo break.

However, at places like Nandu Cancer Hospital, a national cancer hospital, the situation for the pathology department was much better. Some patients wishing for a more skillful doctor to privately review their pathological slides would have to give a little something extra.

It wasn’t too expensive. The doctors would charge a service fee of a few hundred bucks, just to aid in looking at the slides.

There was no help for it, the pathology department was really poor. With a salary of just a few thousand per month, it was impossible to make ends meet without doing some private gigs.

If a patient follows the standard process and has pathological tissue sections done elsewhere, top hospitals would likely not help in examining them. They can’t even handle reviewing their own, let alone others’?

The so-called pathological diagnosis is theoretically the gold standard for tumors. However, whether this “gold” is pure gold or gold-plated, there can be different interpretations, after all, it depends on human inspection to read pathological tissue sections.

After looking at them, determining what kind of tumor it is, whether it’s benign or malignant, and if malignant, what stage it’s at, all rely on human knowledge and experience. Therefore, there is also a possibility of error. This probability is extremely low, but it exists.

Typical and simple cases are usually fine. If one encounters complicated or atypical cases, misjudgments might occur. It is not unheard of for non-cancerous conditions to be misdiagnosed as cancer.

Many patients, when diagnosed with malignant tumors at grassroots hospitals, refuse to accept it. Their family members approach the doctors in charge to try to get their pathological sections examined at top-ranked national hospitals. For a few hundred dollars, they seek a private consultation with a pathological specialist in hopes of finding peace of mind.

The chances of misdiagnosis are not high, but they are present. There have been patients diagnosed with malignant tumors who, upon re-examination at a top tier hospital, found out what they had were inflammations. After being treated for inflammations for a while, they recovered.

Director Shi used to be a renowned pathology specialist at Nandu Medical University Cancer Hospital. After retirement, he was hired by Sanbo Hospital.

At this moment, a hospital staff member is trying to reach out to Director Shi through Director Guan to ask for a private consultation regarding a relative’s tissue section.

Director Shi waved his hand dismissively: “No, I won’t look at it. I won’t look, no matter whose relative it is.”

Not long ago, a patient’s relative asked Director Shi to look at a tissue section, giving him five hundred yuan. This was recorded and photographed. After Director Shi had taken a look, the patient’s relative submitted the video to the hospital’s discipline inspection office, demanding the return of the five hundred yuan, accusing the doctor of accepting payments privately.

This incident infuriated the old man. He decided to refuse to look at anymore, regardless of who the relatives were.

During the short time they were sitting there, dozens of specimens from the operating room have been sent to the check room.

The sample bags contained removed tumors, parts of livers, stomachs, and intestines. All sorts of things are present.

On the sampling table, there were a few clean chopping boards, along with neatly arranged tools such as rulers, scissors, and tweezers. The doctors, wearing gloves, were cutting the tumor into sections on the chopping boards.

Surgeons take things out of the human body, and these things are called specimens. They are sent to the pathology department, where the objects go through more than a dozen procedures such as cleaning, fixing, sampling, dehydration, wax soaking, embedding, sectioning, and staining. Only then can a pathological section be made.

This pathological section can be placed under a microscope for examination and pathological diagnosis, forming a verdict on the disease.

For typical cases, the diagnosis made by a doctor will have to be audited by the lead doctor. If it’s a difficult case, the department’s experts will have to discuss it. Everyone comes to look, and only then is the final diagnosis given, to prevent any miscarriage of justice.

“General Surgery sent a specimen and they want to do a frozen section. I need to go take a look. The pathological section for Zhang Zhe, I’ve got someone to find it. You guys can go to the check room to look at it, I need to go.”

“You go ahead,” Yang Ping said to Director Guan.

“Teacher Shi, can you come and take a look with me?”

A frozen section is a rapid pathological diagnosis. The results need to come out within fifteen minutes, requiring doctors with extremely high diagnostic skills. Director Guan asked Director Shi to take a look too, since it would be safer.

Theoretically, pathological diagnoses must be 100 percent accurate, without a single error.

Even though his eyes weren’t good, Director Shi showed no intention of refusing. He took off his sunglasses, rubbed his eyes, and followed Director Guan out.

The surgeon is still waiting in the operation room, waiting for the pathology results to decide on the next steps for the surgery. If it’s benign, surgery can be concluded. If it’s malignant, based on the pathology results, the surgery might need to be expanded, for example, to clear the lymph nodes.

Once they’re in the check room, Zhang Zhe’s pathological section was already under the microscope. Yang Ping let everyone else look first, and Song Zimo sat down to take a peek.

Under the 400x microscope, the bone tissues on the paraffin section were clearly visible. Osteocytes, osteogenic cells, osteoblasts, osteoclasts, bone matrix; Song Zimo examined each cell.

When examining pathological sections, patience is needed. No doubts can be overlooked, and conclusions should not be drawn rashly.

Any negligence, a single misdiagnosis, can ruin a patient’s life.