Chapter 186: 181 Macro vs Micro, calf pain!

Chapter 186 181 Macro vs Micro, Calf Pain!
Regardless of the liver, the disadvantages of poor English are still manifested. In the past two years, the liver has also passed through several rounds. Self-study and teacher teaching are really different. If you do n’t understand something in university, you can ask the teacher. But self-study will not work, you can only go to find out for yourself. However, self-study is also good. It is profoundly understood and has strong personal opinions.
Not to mention English, lack of environment, and Zhang Fan has not paid much attention to this thing. After two years of smooth sailing, the director of endocrine Di suddenly awakened a pot of cold water. A college student, an ordinary college student, should be proud of having a car and a house in less than two years. Is Zhang Fan ordinary? Not ordinary, so at this moment, Zhang Fan quickly threw away a little bit of pride that had just emerged, and the road is still long!
Endocrinology is too complicated. A disease is a research direction. It is a department that is both integrated and scattered. Respiration, digestion, and heart are all continually adjusted from top to bottom. Knowledge points are coherent and interconnected, while endocrine is not, jumping, and each secretory organ has its own set Run programs, and functions. It can be said that an organ is actually a separate subject.
Although the journal that Director Di gave to Zhang Fan is not one of the top ranking journals in the world, there is still a depth of specialty in endocrinology. Zhang Fan has no time for half of his liver. Language is really a stumbling block for a discipline. Zhang Fan spent three-sevenths of his time translating, and he really didn't have much time to study. This study of foreign journals finally made Zhang Fan make up his mind to conquer English!
On the weekend, Zhang Fan and Shao Hua finally took the time to stroll the street for three or four hours. "You are a bit too hard. You do n’t usually drink tea and coffee. As a result, I found that the coffee and tea I bought for you went down yesterday. More than half! It really doesn't work. You are a doctor. You should be very clear. "
"Time is a bit tight, and the journal is in English, there is really no way, hey! Regrets that you shouldn't have been!"
"What's wrong?" Zhang Fan successfully diverted Shao Hua's attention. He also knew that this was not good, but what could he do? This is not something to compete with, but Zhang Fan to compete with himself again!
"At that time, I chose not to study medical English as an elective in college. Now I don't even find a professional book. This medical word is too ridiculous, sometimes there are two words in a paragraph, and these two words are still unsearchable. To the corresponding translation! "
"So what to do?" Shao Hua snuggled up in Zhang Fan's arms. The weather became colder and the relationship between the two became closer. Now Shao Hua barely agrees to Zhang Fan to touch, hehe! Specific brain supplement!
"There is no good way. I can only check the information a little bit. How are you reviewing recently? Do n’t put too much pressure on yourself, you can take the exam if you don't pass the exam. "Zhang Fan smelled Shao Hua's hair, a faint smell of lavender.
Lavender, usually said on TV that the Netherlands or Finland, there are large tracts of lavender is particularly beautiful. In fact, that's a high level of photographers. It is true that a large area of ​​lavender is in Chasu City. Thousands of acres of lavender planting bases. When lavender blooms every year, the bluish-purple flower field is blown by the breeze, just like the waves in the sea of ​​flowers. , Wave after wave, wearing a white dress and a light yellow straw hat, standing in the sea of ​​flowers is super beautiful! Shao Hua has such a photo, which is extremely beautiful. People hold the scene, the scene presents people, the mountains and rivers in the frontiers are more beautiful!
The essential oils and fragrances of the lavender in the mainland do not know how the condition is, but the tea oil is still good. The consumption of perfumes in several neighboring Stan countries is particularly large. After the oil and oil are produced, the tea oil goes directly to the port and goes abroad.
Especially in recent years, China ’s national strength has improved, and businessmen who have gone abroad to do business have a lot of confidence. The lavender essence of Chasu City has directly made Russian essence out of the five Stan countries! I dare not think about such things before!
When you are in the Mainland, you cannot feel the strength of a country, but in the frontier, you know how powerful this country is to protect you. A large number of products were sent abroad from the port, and the five Stan States could only use natural minerals for exchange.
Zhang Fan doesn't know much about other products, but in terms of medical treatment, Zhang Fan knows some. Even the most basic sugar and salt in the five Stan countries were imported from China, not because they could not produce it, but because China was cheap! The country is slowly infiltrating, the economy is in front and the culture is behind!
The girls in Chasu City use more or less things made of lavender, pillows, quilts, sachets. The most peculiar thing is that there is a small population in Chasu City, and they even receive pollen when they entertain guests.
When Zhang Fan ate pollen for the first time, he thought it was sesame. This pollen looks very similar to sesame. Take a hot cellar, dip it in ghee and dip it in pollen, but when you eat it, it tastes different from sesame and the aroma of oil. Mixed with the scent of pollen, it is particularly delicious. The more you chew, the more flavor it tastes.
"Relax, there is no pressure, just flip through the books and maintain a consistent professional thinking. It should be no problem to register for the exam next year! ~" Shao Hua said proudly.
Reading and studying should emphasize hard work, hard work, and learning methods, but sometimes you have to admire some talented people. The efficiency is really too high. Zhang Fan doesn't have any talent in learning, but his liver is good!
After a rest on Saturday, Zhang Fan's weekend was over, because he had to go to the county for surgery on Sunday. This time, he didn't need to go to a farther county seat, just in the surrounding counties. Laparoscopy is usually performed as an option.
In the past, county hospitals could also perform operations such as appendix and gallbladder. Since laparoscopy became popular, these county-level surgeries have almost no surgery. As soon as the patient was told that he had surgery on the abdomen, he would leave without going to the hospital.
Surgery in the county in the morning, three operations in the morning, it was already more than two in the afternoon after finishing, and did not even drool, hurried to Chasu City, because Wang Yongyong is going to be discharged today. He recovered well. After all, he was still a young man with a strong body. Zhang Fan was going to explain some later recovery issues and then do a medical check-up. After all, athletes are different from ordinary people and their injuries are more serious.
Although I can't force it yet, the swelling has subsided. Wang Yongyong sat in a wheelchair and thanked Zhang Fan and Ma Wentao. Now is not the time to shoot advertisements, but all the previous photos have been taken for comparison with the restoration. Ma Wentao's years of studying abroad are not free.
On Monday, the big round of the endocrinology department began. All doctors, trainees, trainees, transferees, in-patients, led by the director and several deputy seniors began rounds. This moment is the moment when Xue Ba is looking forward to, and the time when Xue Zhu is most worried. Inspection of one ward and one ward.
"Six beds, male, twenty-two years old. He was admitted to our department's emergency department with polyuria of unknown cause and was transferred to our department. After a comprehensive examination, the patient was initially diagnosed with diabetes insipidus." Six-bed tube bed doctor Introduce the doctor to the rounds doctor.
"Wang Xiaoyan, go and do a physical examination for this patient." Director Di started the exam. Wang Xiaoyan, graduated from Jinda Medical College, I do n’t know why she did n’t go to graduate school, but she has a solid foundation, and last year the doctor ’s exam score was only about 50 points lower than Zhang Fan.
Examination, pay attention to a sequential nature. From top to bottom, from front to back, there is no clue to check the body, not only easy to miss the system to be checked, but also to toss the patient, so a qualified body check is sophisticated, rather than the same as stated in the book.
Wang Xiaoyan was very skillful and reported while checking. "The patient's pupils were of equal contour on both sides, and no obvious abnormality was found. No significant enlargement of the lymphatic neck, no obvious abnormality of the heart and lungs, no tenderness and tenderness in the abdomen, and no lower limbs. See obvious abnormalities. "After about five minutes, the inspection was over.
Director Di nodded, it was standard that he could not find any problems. When Wang Xiaoyan returned to the team, he took a special look at Zhang Fan. This was not a provocation, but a kind of competition, technical competition, and mental competition.
"The center of thirst is that organ." Director Di asked and turned to another male doctor in the transfer department. The male doctor had not entered the state, and the question was too biased, although these particular questions were not tested in the exam.
But this is a hospital. It's a human being instead of a machine. An oversight of a problem may cause irreparable damage to the patient, and the human body is a whole. No matter how biased the knowledge points, we should go as far as possible. Study and understand, maybe you encountered such a rare knowledge condition that day.
"Eh! I'm sorry, I don't know." Director Di is slightly better than Ouyang, but it is a little hurting. She will ignore the lower doctors.
"Well, go ahead and read a book." In a simple sentence, he didn't say anything about the doctor, and he didn't punish him for punishment, but this male doctor in transfer department is more uncomfortable than being punished ~! The same young people and the same undergraduate graduates also hope to get the attention and attention of their doctors.
Failures after work Failures in different schools, you can come back again after school failures, as well as make-up exams! And after work, a failure may be a loss of opportunity, and he does not have a second chance to endocrine, so failure must be early!
"Doctor Zhang, you say." Director Di turned to Zhang Fan.
"The hypothalamus."
"The patient's urine is of that nature and how to rescue it."
"Hypotonic. Hydrating, anti-diuretic and timely hormone therapy if necessary."
"There are currently several theories of primary diabetes insipidus." Director Di continued to ask, this question is beyond the outline, let alone refer to a doctor, the endocrine attendant who does not study well may not be able to say it. .
The difficulty of internal medicine is here. The causes or causes of many diseases have not been researched clearly, and the internal medicine departments of major hospitals will make a guess or hypothesis about this disease.
Then the clinical doctor, according to these ideas, then go to the corresponding treatment, because these hypotheses are called hypotheses, because it is not ordinary or it is still uncertain.
In scientific research, you can go to slow tests one by one, and study one by one, but it is not clinically possible. The patient is already lying in the bed, and there is no time for you to do research. You have to give people treatment.
so what should I do now? This is the time to consider the doctor. According to these hypothetical targeted medicines, the patient's symptoms are more similar to which theory. Although an experienced doctor cannot determine the cause, he can treat the symptom according to the symptoms. Even with this technique that cannot solve the cause, a doctor has to ponder and study for more than ten years to have this skill.
"Professor Jerome P. Kasserer of the Massachusetts Medical Society (American Massa Medical Association) has proposed three theories, and our experts have divided these three theories. At present, the mainstream theory is three and five, generally the third type of AVP Hormone) deficiency is the main mainstream. "Zhang Fan replied.
This is the knowledge that Zhang Fangan obtained only a week ago. These knowledge and identification said that internal medicine books, even to see graduate textbooks, may not be available, after all, this has transitioned from clinical to laboratory.
"Listening to your spoken English is too bad. If I didn't listen carefully, I thought you were speaking Russian." Although it was criticism, Director Di said with a smile. She could see Zhang Fan going tried. This knowledge point, if you don't study it seriously, will be ignored because it is too small.
When Zhang Fan finished speaking, Wang Xiaoyan bit her lip, because she didn't know this knowledge. It wasn't the director's eccentricity, but the director wanted to weigh Zhang Fan. Zhang Fan was already well-known at the level of hospital director.
Continue the rounds, everyone questions. Interns and trainees are not under pressure because the director is so good at speaking, even if he can't answer, he doesn't say anything! They haven't realized that this is an opportunity. If the performance is outstanding, it will be very helpful for employment in the future. It is estimated that most of the students who have given up internships and internships in the bird market to the Chasu City are planning to work here after graduation.
The most stressed are some referral doctors who want to stay in endocrinology. There are not many opportunities. Once you ca n’t catch them, you will lose them. Life is the key step. If you take the right path, you may be more frank.
One morning passed, and Zhang Fan and a few doctors who wanted to stay in the endocrinology did not feel that time had passed so quickly. Director Di's question is too tricky, not only to have a lot of basic memory, but also to have his own ideas.
A transfer doctor who has just joined two years, what can you think! But this old lady can find out from your little thoughts or opinions whether you have intentions.
It's too difficult. Zhang Fan and a few people racked their brains to answer the questions, so many questions are vague, this endocrine is really too difficult.
At the end of the last patient round, Director Di stood at the end of the corridor, and white coats, tall or short, or men or women surrounded her, summing up.
"In our department, the most patients are diabetes, and the closest to diabetes is insulin. Who will tell us about pancreas today. Give us a lesson, do not come up if you are not sure." Director Di said in the crowd, she said This is the ignition of the obvious fanaticism.
For several hours of rounds, the most prominent performers were Zhang Fan and Wang Xiaoyan. They did not make any big mistakes, and they were quite equal. Wang Xiaoyan has a prominent personality, good study, and strong personality. She must suppress the surgeon Zhang Fan in the field of internal medicine. This is not an attitude to people but an attitude and a spirit. A group of internal medicine referral doctors asked an established surgeon to do their best in Internal Medicine. Others didn't know how it felt, but she couldn't stand it.
"Director, I'm here!" Wang Xiaoyan stood out after glancing at Zhang Fan.
"Well! Well, Dr. Wang will talk about it." It is usually Xiao Wang, now Dr. Wang. At this moment, Director Di has recognized Wang Xiaoyan, and Wang Xiaoyan has a status in endocrinology! This is the characteristic of the technical unit. Technology speaks.
When Director Di gave way to C, he took a look at Zhang Fan. Zhang Fan's personality is very contradictory. In the face of being unable to retreat, he can show endless courage, but in normal times he does not love to show, this is his personality, there is no good or bad.
Director Di's question is very broad. What is the pancreas? If a knowledgeable endocrinologist is going to speak, it is estimated that one day is not enough. Even if Wang Xiaoyan is going to talk for an hour or two, it is probably not enough. In terms of advantages, what is Wang Xiaoyan's focus and advantage, that is, the biochemistry, pathology, and physiology of the islets.
"The pancreas is a complex and simple organ. The main tissue cells of the pancreas are composed of Langerhans cell tissues ~~~" For twenty minutes, Wang Xiaoyan made the pathology and physiology of the pancreas transparent, which is the essence , Can explain the function and structure of pancreatic tissue so clearly.
"Yes, very concise but can show us the world of a pancreas, yes." After speaking, Director Di looked at the opposite Zhang Fan and said, "Dr. Zhang, you can also go up and talk about it. Tell me about your pancreas. understanding."
Wang Xiaoyan looked at Zhang Fan, with provocations and expectations in his eyes. She also wants to hear Zhang Fan's indirect knowledge of the pancreas, and most importantly, she has finished the basics of the pancreas, and does not know what Zhang Fan will say.
"Isn't he going to repeat what I said!" Wang Xiaoyan was a little smug, after all, still young.
"Eh!" Zhang Fan really has nothing to say. Wang Xiaoyan explained it very well. Zhang Fan opened his mouth to say: When Dr. Wang said very comprehensively. He saw Director Di's expectant look and Wang Xiaoyan's somewhat provocative look.
Zhang Fan gritted his teeth and went up. When he and Wang Xiaoyan stumbled, Wang Xiaoyan whispered, "Pick up your teeth."
Zhang Fan ignored her and didn't care about the little woman! And Zhang Fan didn't plan to repeat what she said. It's not necessary. Since it's up, don't hesitate to come out, is it a man?
"Dr. Wang spoke very well and made me understand a lot. Dr. Wang's microscopic understanding of the pancreas is quite thorough, and I have nothing to add, so I will talk about the macro things." Zhang Fan said.
As soon as this said, other people didn't have any ideas, but Wang Xiaoyan was a little uncomfortable. "Speaking of my narrow sense!" This is Xue Ba, which can be inferred from each other. It is unknown if Zhang Fan has this meaning.
Director Di is also looking forward to Zhang Fan with an interesting look. Some of the interns and trainees below are already a little impatient. It is simple. Some of the knowledge Wang Xiaoyan said, they don't understand!
"The pancreas is located deep in the abdomen and cannot be touched from the body surface. It has a C-shaped duodenum and the tail extends to the left to approach the spleen."
"Who doesn't know the anatomy!" Wang Xiaoyan was a little disappointed. The mortal world of Xueba is incomprehensible. She looks forward to Zhang Fan's extraordinary performance, but she does not want Zhang Fan's performance to surpass her.
After a brief introduction, Zhang Fan began to introduce the anatomy of the pancreas in detail. From the normal vasculature to the abnormal mutation, from the opening of the pancreatic duct to the special variation of the bile duct and pancreatic duct, Zhang Fan said in particular.
This is not only Wang Xiaoyan's surprise, but even Director Di's eyes are a little dazzling. Zhang Fan's explanation is too detailed. The shape of a pancreas, from normal structure to abnormal structure, can be used in almost all the current literature. Coming hand in hand, too skilled.
Of course, if you are proficient, can you be unskilled if you have more than a year of liver? Now letting Fan Fan go to college, it is more than enough to give students anatomy lessons. This is not enough. After finishing the normal function, Zhang Fan continued to talk about some special features of the abnormal function, and how to treat it.
The best treatment for morphological abnormalities is surgery. The shape of the organs that have already been finalized is useless. Therefore, Zhang Fan starts to show off his involuntary skills. Usually, Zhang Fan can hardly stop the car.
First of all, Xiaoyan Wang said very well, and then the endocrine for a week made Zhang Fan experience a lot, so he couldn't help it. He wanted to combine the knowledge learned in the system with his own experience.
Talking, there are not many people who can understand. Continued, "When the pancreatic endocrine tumor shows a cachexia state, there are three types of resections during the operation, one is ~~~~" This is completely incomprehensible. Because of the difficulty of this operation, not to mention that it is in Chasu City, even few people in the capital can do it.
Zhang Fanbarabala said, too excited, he was really excited, and integrated his own experience into the systematic knowledge. The vague knowledge points in the past seemed to be stripped of that veil. Meet naked.
This is ascension, a self-enhancement. This is better than the blessing of the system. After all, the most powerful of the human brain is fuzzy thinking. This way of thinking is very suitable for exploring unknown knowledge.
Once the foundation is solid enough, quantitative change reaches qualitative change, which is qualitative improvement. For the understanding of the pancreas, Zhang Fan can already be said to be everyone in pancreatic surgery.
There is more to talking, Zhang Fan ignored the time, the neglected place, half an hour, one hour, two hours passed. Ren Lina, who had been training for many years, could not stand.
Although I ca n’t understand the knowledge points that Zhang Fan said, I can still hear them. This is not nonsense. What is an intellectual? The most basic point is to respect knowledge. At this time, Zhang Fan has no one to bother. If there is a pancreatic surgery After hearing it, it will be absolutely shocking.
Finally, after two and a half hours, Zhang Fan finished talking, and then suddenly felt something, looked at everyone with a look of embarrassment.
The doctors, including Director Di, were also embarrassed because they did not understand! Director Di coughed and cleared his throat, and said, "Yes, Dr. Zhang has solid surgical skills, but it's a bit off topic, pay attention later. Good understanding."
Director Di, who returned to the department, sat on the sofa rubbing his calf, "Oh! My old legs!"
The top three chapters!
(End of this chapter)