Chapter 2 Chapter two

On the day of the operation, there was a tense atmosphere in the hospital early in the morning.The operation started at nine o'clock, and the interns and students had assembled in the central operating room on the first floor as early as eight o'clock.Except for the four assistants who participated in the operation, the head nurse of the operating room and two young nurses, the rest of the people entered the observation room overlooking the operating room through the glass, waiting for the operation to start. Being able to witness Associate Professor Zaizen's esophageal cancer surgery, and it is also an esophageal cardia surgery with a high mortality rate, made the trainees present very excited.

The shadowless lamp that emits bright and dazzling light coldly shines on the floor covered with light blue tiles. On the empty floor, a white operating table is placed alone. In the glass box next to the operating table, there are scalpels, scissors, Tools such as hemostats and small clips emit eerie cold lights.Even the sterilizer in the corner of the room is white, which makes people feel that the eyes are about to freeze.Although the room temperature in the operating room has been maintained at 22 to 23 degrees, it gives people the illusion of being in an ice cellar. It is white and cold, and there is a dead silence. The only sounds are the metal impact of cleaning utensils and the nurses walking back and forth. footsteps.

Suddenly, the door of the preparatory room connected to the operating room opened, and Zaizen Goro appeared.As soon as he came in, he went directly to the hand sanitizer and took off his white robe.The nurse then helped him change into the sterilized surgical gown. While she helped him tie the straps behind the surgical gown, he washed his hands with sterilized soap, and then washed them thoroughly with sterilized water. Finally, he stretched out his hands forward.The nurse took out rubber gloves from the sterilizer and put them on Caiqian's hairy gloves, making them fit tightly without any wrinkles; then she helped him put on a surgical cap and a mask.Caiqian shook his head slightly, tried to stretch and flex his fingers, and made sure that the rubber gloves, surgical gown, and surgical cap were all put on correctly. After that, he swept his sharp eyes around and entered the operating room.

Send patients in!A firm command came from under the mask.Two nurses quickly opened the door leading to the anesthesia room and quietly pushed the patient in. The patient who had undergone preliminary anesthesia was lying on a stretcher bed, his pale face turned upward, and his eyes were slightly closed.The nurse pushed the stretcher to the side of the operating table, and together they moved the patient onto the operating table. The anesthesia doctor measured the patient's breathing and pulse while giving him general anesthesia, and the assistant covered him with surgical masks. gabe. The light of the shadowless lamp was aimed at the affected area, and it became brighter immediately.Caiqian, with extremely sharp eyes, held a scalpel in his right hand and pressed it close to the patient's chest. In an instant, the knife was raised and lowered, and a large incision was made from the chest to the abdomen.The gushing bright red blood drew a thick line and rushed towards the sides of the body.Caiqian continued to cut down the light pink subcutaneous tissue, avoiding the ribs, cut through the pleura, and entered the chest cavity.Two assistants used tendon hooks to fix the muscles he cut, and hemostatic forceps to stop the bleeding, assisting the smooth operation of the scalpel.Without injuring the surrounding organs, Zaizen carefully removed the heart, lungs, and liver, and finally saw the bumpy yellow-white tumor growing from the esophagus to the cardia.This is cancerous tissue that has metastasized to the lymph nodes.

A medical report transferred from Kyushu Hospital a year ago suddenly flashed through Caiqian's mind. NameSixty-two-year-old seafood trader in Yamada Otoshi Complaints of esophageal dysphagia From the beginning of this year, patients often experience dysphagia similar to choking when taking solid food, which can be improved by taking it with water or taking liquid food.However, the patient's appetite was normal, and he had no symptoms of nausea and vomiting, and he did not lose a lot of weight. The diagnostic urine test at the time of admission was normal; fecal occult blood reaction, TMB method and Guaiac method were all positive; Liver function was normal; serum protein was six per deciliter.Four grams, no obvious abnormality in liver function; although X-ray examination found slight deformation of abdominal esophagus, but esophagoscopy showed no abnormality.

Regarding this report, Zaizen, holding a scalpel, couldn't help but sneer contemptuously.In his opinion, the x-rays had picked up the sclerosis caused by the cancer as early as a year earlier.Obviously, the hospital in Kyushu did not diagnose it as esophageal cardia cancer. If it is delayed for one or two months, the tumor will burst the serosa of the stomach (the inner surface of the body cavity or the surface of the viscera of vertebrates will have a layer of covering, secretion Thin film of serous fluid, such as peritoneum, pleura.), spreads to the entire abdominal cavity, and even surgery is useless.

Caiqian shouted to the assistant: This is esophagus and cardia surgery, be careful! After he sternly said this, he put on a sharp scalpel with a pointed tip.First, he removed all the infected lymph nodes, stripped the esophagus, and then used esophageal forceps to remove the cancer in the esophagus.At the same time, the assistants on the left and right stopped the bleeding with gauze, cotton balls, and hemostatic forceps.Next is the stomach.In the slippery abdominal cavity, the cardia that had been cut away from the esophagus appeared distorted and deformed due to the tumor.Keep the normal parts and cut off the bad parts.Then he bent the remnant stomach into a tube shape, lifted it up to the end of the esophagus in one breath, and prepared to suture the two.This esophagus.The anastomosis of the stomach is the most difficult part of the operation.The esophagus clamped by the forceps will often break away from the forceps and fall into the mediastinum cavity (between the left and right thoracic cavities, where various organs gather, and the middle of the mediastinum is mostly the trachea, bronchi, and heart.), thus missing the first time for suturing .Sweat dripped from Caiqian's forehead, and his throat felt dry and hot.

Just when he wanted to raise his head to wipe his sweat, Caiqian's eyes suddenly narrowed.Professor Dong looked down at everything in the operating room through the glass window of the observation room on the second floor without expression.There was a look of uneasiness in Caiqian's eyes. For a moment, he didn't know how to react, and almost stopped what he was doing.However, this is an operation where every second counts. Caiqian glanced at the clock in front of him, heartbroken, he caught the esophagus with his raised stomach, and quickly sewed it up.In order to avoid incomplete suturing, he first sutured with catgut for preliminary suture, then performed full suture, and finally sutured the serosa with silk thread.With that beautiful technique, the esophagus and stomach were stitched together perfectly.

Get them fully sewn as soon as possible!After speaking, the scissors snapped and cut the suture. This sound announced the difference between life and death. All that was left was to return the dislodged internal organs to their original positions and sew up the severed stomach.The operation has been successful!The difficult operation was successful, Zaizen was immersed in the great joy of saving a life by himself, and at the same time he felt an arrogant self-confidence gushing out of his body.Under the mask, he couldn't help showing a smug smile.He sewed up the open wound, asked his assistants to put on gauze, and watched them wrap the chest and abdomen belt.Putting down the stitches, large beads of sweat dripped from his forehead to the ground.

He took a deep breath and looked up at the observation room. Professor Dong was no longer there, only the excited interns and students crowded in front of the glass window. Doctor, can we push the patient out?asked the chief nurse. Caiqian wiped his sweat while confirming the patient's condition: Yes, but don't push him back to the ward immediately, let him stay in the recovery room first, and then send him back when his condition stabilizes. He gave an order to ask the young nurse to help him take off the surgical gown and rubber gloves, wash his hands with disinfectant, and walk out of the operating room.Suddenly, a hurried voice chased him up from behind.

doctor!Thanks to you, my husband saved his life.The doctor in charge told me in private that the operation would be very difficult without telling my husband, and told me to be mentally prepared, but he was saved because of you.We did the right thing by abandoning the hospital in Kyushu and moving here. I don’t know how to thank you. She is nearly sixty years old and has gray hair. She can’t speak, and just nods frequently. Where, it will be dangerous if it is later.Although the operation is difficult, it also depends on your husband's luck. Hearing what you said, no matter what, my husband would never be saved without you, the doctor.As she spoke, she burst into tears.Suddenly, Caiqian seemed to see his mother in the countryside. Post-operative health care is very important, and you should also pay more attention to the patient's mood. You can go to the ward to see him later. After speaking words of comfort, Caiqian left the old woman's side, walked out of the atrium with a cigarette in his mouth.As usual, he walked towards the construction site of the new building, but he was thinking in his mind why Dong came here early in the morning just to watch the operation performed by the associate professor?The more I think about Caiqian, the more worried I become.Does he still care about the photos published in the weekly magazine a few days ago and the headline of the new authority on esophageal surgery?Shouldn't it?Puzzling uneasiness and slight fear welled up in my heart. Sitting in the dining room on the sixth floor of the department store building facing the Dojima River, he was eating breakfast alone, thinking about the operation performed by Zazen just now. The operation of the scalpel, the accuracy of the incision, the quickness of the suture, and the dexterity and lightness of Zaizen's dancing wrist like a sculptor once again set Dong's retinas on fire. In the past two or three years, in order to pass the case of building a new building, he and Ukai have been running around, so busy that they have no time to worry about what Caiqian is doing, and Caiqian seems to have made rapid progress during this period.Not long ago, my daughter Saeko mentioned inadvertently: Everyone is spreading the word that in the future it will be Zazen surgery. Now this sentence suddenly became somewhat true. Until yesterday, he has been regarded as his successor. When did this kid become his competitor in terms of academic or social status?This realization made Dong extremely disturbed.what happened?How could someone like me care about an associate professor under him?Dong blamed himself in his heart. He adjusted his sitting posture, straightened the napkin, and picked up the fork. After drinking coffee, it was just after twelve o'clock.There is no outpatient clinic this morning, only the director's rounds in the afternoon.The rounds start at 1:00 p.m., and he can just rush back to the hospital by then.To pass the time, he went to the bookstore on the ground floor of the building and read a few books. It was not one o'clock when he returned to the hospital, but the members of the medical bureau were ready to wait for him. Dong put on his white robe and walked to the south ward on the third floor exclusively for the First Surgery Department.Assistants, interns, and those who don't need to see the outpatient clinic at the moment all followed behind the chief physician. About 30 members of the medical bureau formed an emperor's parade formation, and a group of people followed east to the third floor. Infirmary, the chief physician is here to make rounds!The head nurse gave an order, and the voice spread through the long corridor. As if responding to this voice, the doors of each ward opened wide from left to right, and in an instant, a tense atmosphere leaked from every corner.There is only less than a year left to lead a large team of people and carry out the director's rounds in awe-inspiring manner!Thinking of this, Dong felt as if something had dropped from his body, and felt an indescribable loneliness. As soon as Dong's front foot stepped into the ward, the skinny middle-aged woman immediately got up from the bed, lowered her head, and the young girl who was in charge of taking care of her, who looked like her daughter, also greeted the head doctor with courtesy.The ward was cleaned spotlessly, and even the bedside tables and chairs had been rearranged. Next to the bedside tables, the patient's attending physician stood still and waited for the professor. How about it?today's situation This patient has just had gastric ulcer surgery, and today is the third day. yes thanks to you The patient only answered in this way, and then the attending physician reported on the postoperative recovery situation.Dong listened to the report of the attending physician, took the stethoscope handed by the head nurse, put it in his ear, and examined the patient's general condition.He asked the patient to untie the chest and abdominal belt, and looked at the affected area.The wound was kept very clean, and the stitches should be removed smoothly, and the only thing left is the diet and recuperation. Well, things are going well.From today, you can take liquid food six times a day, pay more attention to nutrition. After finishing speaking, he explained to the attending physician: You tell her the details of the diet. As for antibiotics and drips, you can just take the current way. As soon as the words fell, others also walked out of the ward.Unless there are patients with special friendship, each person is only given two or three minutes. If you don't do this, it is impossible to see all the first surgical wards with hundreds of beds. thing. When a group of people came to the door of Ward No. 5, Dong's eyes suddenly sharpened.In the ward, Zaizen Goro was waiting with his hands down. He happened to come to visit the patient who had just finished the operation. The anesthetic effect of the patient had not faded, and the oxygen mask was still on his face. Caiqian stood beside the patient's pillow, handed over the medical records, and reported that it was cancer of the esophagus and cardia.The previous hospital failed to find it after a year of inspection, which delayed the timing of treatment. However, the tumor was finally removed this morning. Without saying a word, Professor Dong took the medical record and browsed it slowly: Yes, it seems that the previous hospital misdiagnosed it.However, it is not a credit to discover this misdiagnosis. Just take a gastroscope or use the urea nitrogen breath method (which is to test whether the exhaled gas contains Helicobacter pylori by drinking a reagent. In addition to the gastroscope, this is the twentieth century. The most widely used stomach disease detection method in Japan in the 1960s.) Anyone can diagnose it through cell detection, but the previous hospital missed this step.I hope you will pay more attention to this point in the future.He deliberately ignored the accuracy of the pre-financial diagnosis and the appropriateness of the operation. So, what was the result of the surgery? Ah, it is a bit difficult, because the esophagus will be removed, the stomach will be lifted, and the reconstruction operation will be performed to replace the esophagus, but the result should be very successful.Zaizen replied in a confident tone. There was displeasure in Dong's eyes: he would not know if the surgery for cardiac cancer was successful or not until a week later.Having said that, I went to see your operation just now, and it was a mess! Why?Mess?Zaizen repeated it in surprise. That's right, you didn't take into account that the patient was old and kept watching the clock during the operation, as if he was desperately in a hurry.The most unbearable thing for elderly patients or frail people is the long operation, so it is necessary to carefully consider whether to divide the operation into two or even three operations.Surgery is not a sports competition to break records, let alone a show.Fast speed and beautiful technique do not mean high skill.Your surgery has always been known for its short duration. Instead of caring about this reputation, it is better to pay more attention to evaluating the treatment itself.Severe criticism cut towards Caiqian like a sharp sword. Caiqian tried his best to maintain a calm expression, and replied: Of course, before the operation, I had checked the patient's liver, kidney and heart, and decided to complete the operation only after making sure that there was no problem.In addition, considering the patient's advanced age, in order to reduce his burden as much as possible, I deliberately shortened the operation time today. To Caiqian, he reported the truth, but to Dong, whose surgery was always delayed for a long time, these words sounded like a satire on his slow movements. Are you contradicting what I said?Doctors can't be self-absorbed!After finishing speaking, Dong looked sharply at Caiqian's face. Although it is only two short sentences, it is simply too mean to completely deny the value of the other party.Caiqian's anger can't help but also come up, but Is there anything else to point out?He turned the conversation to therapy. This patient is operated by you, and you can figure it out yourself.If there is anything you don't understand, just come to my office and ask me. After speaking, Dong turned around and passed through the human wall surrounded by members of the medical bureau, and walked out of the ward.In the tense ward, the patient's family members seemed to be unable to understand the conversation that had just been mixed with German medical terms.The members of the medical bureau were puzzled and curious about Dong Yi's uncharacteristically terrifying appearance, but they also chased after him. Caiqian, who was left alone, pretended to be nonchalant and explained to the patient's family what to pay attention to after the operation, and then walked out of the ward.At the end of the long corridor, a large number of assistants and interns patrolled the ward for a long time. While watching the team leave, Caiqian began to suspect Dong. Secretly, Dong's perception of me may have changed a lot.Maybe, when he said that he would give me the professorship that day, he had already planned how to pull me down.Today, the reason why he came to visit my operation was also to find out my shortcomings. Suddenly, a strange smile appeared on Caiqian's face.He walked quickly back to the associate professor's room, took off his white robe, dressed neatly, and left the hospital as quickly as possible. He came to the Zaizen obstetrics and gynecology clinic. As usual, the place was full of vitality. Obstetrics and gynecology are different from internal medicine and surgery in that most of the patients are pregnant women.Perhaps it was because of this reason that taxis and private cars were always parked in front of the three-story clinic with an area of ​​90 ping. Just looking at this, you can tell that the business of Zaizen Obstetrics and Gynecology is booming.Saizengoro pushed open the door of the clinic and walked to the service desk. Is the dean there?He glanced in the direction of the consulting room. The dean is still seeing the doctor, do you want me to report it for you?Or would you like to sit inside first?The desk clerk stood up from his seat. No, I'm waiting in the waiting room. Where can I go in the examination room? The following picture appeared in front of Caiqian's eyes: the patient stood in front of the clothes basket, took off the clothes on the lower body, climbed onto the internal examination table surrounded by cloth curtains, opened his thighs, and let the doctor insert the hysteroscope, or wash it with a washing machine. liquid to clean the vagina.On the other hand, it is also troublesome to go to the living quarters behind the consultation room.His mother-in-law passed away seven years ago. There is an old servant in the family who was hired by his mother-in-law when she was still alive. She is responsible for taking care of Caiqian and Yiyi's daily life. He is not interested in gossiping with an old woman who is always in charge. He found a place to sit down slowly, and all the women present cast suspicious glances at him, but Caiqian was smoking a cigarette indifferently, looking at everything in the waiting room.There are more than 20 brand-new seats, on which are pregnant women with big bellies, prostitutes who can be seen as regular customers, and young mothers who have just been pregnant, all in different postures. The girl in the dust is extremely impatient, the young mother who is not long pregnant looks happy, and the pregnant woman is lazy.Most of the people seem to have been waiting for a long time. No one is watching the TV and magazines provided by the hospital. Instead, they are all paying attention to the nurse who is in charge of calling the number. As soon as their names are called, they can't wait to stand up from their seats. Get up and go straight to the consulting room. Through the glass door, the sound of young doctors asking questions, and the panic of disinfecting and arranging internal diagnostic equipment, mixed with Zaizen's Osaka dialect like a broken gong from time to time.It is another habit of Caiqian to yell three times and four times when he gets busy. I don't know if he was chatting with patients or giving instructions to the resident doctor, in short, he just opened his throat and spoke loudly, accompanied by hahaha laughter.It was a very happy laugh, and it didn't sound like the sound of a sixty-two-year-old man at all. It was full of spirit and vitality. Not only the voice, but with a slippery and bald head that can be seen, and a hasty mentality that seems to be draining the gutter, Caiqian examines the patient's genitals one after another, and has to take time out of the consultation to busy with the doctor's association; And Huajie’s Xiaobai and Changbai (traditional Japanese music art, Xiaobai means short songs, which originated in the late Edo period and are still popular in modern times. Changbai means long songs, which were originally the dance music of Edo Kabuki, and became popular after the Meiji era. They all belong to the shamisen, that is, the Japanese three-stringed qin ballad, accompanied by shamisen.) He must also attend the party, and sometimes hosts a feast.Where did all this energy come from?It's really puzzling. Caiqian looked around the overcrowded waiting room again and thought to himself: There are 50 to 60 outpatients a day, and the inpatient beds upstairs are close to 30. Why did my father-in-law never think of converting it into a hospital and maintaining the clinic? What about the scale?It's incredible.Judging from the good business situation, it should be very profitable to change it into a maternity hospital. With a bang, the door was opened roughly, and it was Yue Zhang another one.He shook his bald head and asked: Ah, have you been waiting for a long time? No, I didn't keep the agreed time and came early.You are busy with your work, take your time, it's okay. No, I've already found someone to take over later.Come and sit at my house.He led the way and walked to the residence behind the courtyard. The 15-square-meter courtyard is located in the urban area. Although it does not get sunlight and is a bit dark, there are carefully cared for potted plants. Facing the courtyard, it is a house built in the style of a teahouse.Weng and his son-in-law entered the Japanese-style room of the eight folds, and the old servant was already waiting by the side holding the clothes box.She went around to the back of Youyi, and helped him take off the white robe and clothes that he had for consultation, and put on a silk one-piece shirt, a padded kimono with Oshima pattern, and a narrow-flap belt with Hakata Vajra pestle pattern.She has always been used to it, and her hands and feet are very neat. After changing his clothes, he moved his fat body again and sat down on the cushion with difficulty: How is it?How's business going? This sounds like a businessman's statement, but it is another mantra that is often said on the lips.Doctors make a living by their medical skills, so practicing medicine is also a kind of business, he always thought so rudely in his heart. My situation is different from that of my father. As an associate professor, I am just a doctor employed by the university hospital. It doesn't matter whether there are many patients or few patients. Whether the business is good or not has nothing to do with me.Caiqian replied with a wry smile. Having said that, Dad's business is really great. Since it is doing so well, why don't we just set up a few more beds and just turn it into a hospital? Hospital?Aha, you're too young to say that after all.I managed to make Zaizen Obstetrics and Gynecology Clinic make money, and it would be a big loss if it were changed to a hospital. Oh, will it lose money if it is changed to a hospital?Zaizen showed a surprised expression. Of course, if you switch to a hospital, first of all, once the number of beds exceeds 20, you have to hire more than three qualified doctors, not including the director. One nurse is required for every ten outpatients, and one nurse is required for every four inpatients. There is only one nurse to be staffed. In addition, there are a lot of cumbersome regulations for clerks, cleaners, etc. In this regard, the clinic is not so verbose.Despite the signboard of the clinic, the actual number of beds can be set up to 30. In addition to me, as long as two resident doctors, ten nurses, two clerks, and four cleaners are hired, one day can be spent. Fifty to sixty outpatients and 30 beds of inpatients are all dealt with, which is the most cost-effective.In addition, if the scale is expanded to be as large as a hospital, it will not be easy to calculate the medical insurance points well.Privately run clinics are different from university hospitals. No matter how many customers there are, if they don't count the monthly medical insurance points, they will lose all their capital and profits.Since the launch of the National Health Insurance, medical skills are no longer benevolence, but arithmetic. Medicine is arithmetic?Zaizen Goro burst out laughing. Yeah, I'm not kidding, learning arithmetic is essential to running a medical facility if you want to deal with health insurance.Let’s take the scale of this clinic as an example. The total monthly turnover is about 2 million to 2.2 to 300,000 yuan, of which 800,000 yuan is paid by the medical insurance. Can’t you imagine it?In order to get the 800,000 payment exactly, all medical practitioners have to grit their teeth and fight against the medical insurance points every month at the end of the week.how to say?The calculation of this point is very troublesome, one point is converted into ten yuan, the initial consultation fee is sixty yuan at six o'clock, one hundred and eighty yuan for outpatient visits at eighteen o'clock, and one injection is sixty.Seven o'clock, that is, sixty-seven yuan, like this, after calculating like mahjong points, you have to fill out the insurance application form one by one, and send it to the local medical association. Apply for benefits from the social insurance medical fund.After they verify that your declaration is correct, it will take one and a half months or two months before you get the money. After finishing so many words in one breath, another throat made a coughing sound, and he quickly took a sip of tea. For Zaizen Goro, who works in the University Affiliated Hospital, he has no interest in the calculation of insurance points at all, but he still followed his father-in-law's words: Listening to what my father said, medical insurance and medical care are really like arithmetic!By the way, how many points can you earn for an operation like ectopic pregnancy? Is it ectopic pregnancy?This is a common operation, and I can calculate it immediately without looking at the quick calculation table.First of all, the operation fee is 604.Eight o'clock, so it is 6,048 yuan; blood transfusion of 1,000 milliliters to 1,500 milliliters is 1,056 yuan.Six o'clock, it is 10,566 yuan; Ringer's (injection solution containing electrolytes) solution is 500 ml, 400 is 400 yuan; glucose with antibiotics is 500 ml, 200 yuan zero one.Two o'clock is 2012 yuan; vitamin BC compound capsules, forty-four.Five o'clock, four hundred and forty-five yuan; postoperative treatment and disinfection, seventy-four.Two o'clock, seven hundred and forty-two yuan, excluding other hospitalization expenses, room difference, etc., the total insurance points used for the operation is 2021.Two o'clock, twenty thousand two hundred and twelve yuan, how about it?This kind of arithmetic is troublesome enough, right? Youyi used a pencil to list the detailed numbers on the note paper on the Japanese room table. It turns out that this is indeed very cumbersome, but, this kind of thing does not need to be done by Dad himself, it can be left to the resident doctors and administrative staff, because Dad, besides seeing the doctor, you are also a cadre of the Physician Association, there are so many In the middle of the matter, he began to flatter his father-in-law. Where, it would be bad to leave it to the resident doctors and administrative staff. Those people in the medical insurance bureau are all brains with problematic stones. They either think that we are wasting medicines, or that we repeat medical treatment and over-dispose. Your points, so I asked the administrative staff to sort it out first, and I went over it myself.As for ectopic pregnancy and uterine fibroids, the surgery and treatment costs are more complicated. I will calculate it myself. If I encounter a medicine that can’t be paid for even if I use it, I will replace it with other treatment according to its price. The name and drug name, find a way to balance the cost.Think about it, when I got a phone call in the middle of the night, I had to get up, drive the car, and run there in a hurry. As a result, the medical insurance only paid me 60 yuan for the first consultation fee and 360 yuan for the night visit fee. As a matter of course, the rookie doctor who just opened the business received the same salary. Is there any reason for this?It makes people want to cry without tears!Therefore, I had no choice but to calculate the remuneration I deserved, appropriately fill in the medical insurance points, and adjust the unfair treatment.Even if it is only 100 yuan each time, it will be a lot of money if there are too many times.However, having said that, the other party also has the so-called national average points in their hands. Once your points are not smart enough, you will be targeted and fail the review, so this kind of thing has to be handled by me personally.In a word, in order to calculate the insurance points, medical practitioners are exhausted. For example, if you work in a university hospital, you don’t have to think about whether to count points or not. You can do whatever you want. You can’t understand this kind of hardship. of.As he spoke, he coughed again, and quickly took another sip of tea. However, because I practice obstetrics and gynecology, the medical insurance does not pay for childbirth and abortion, and the public must pay the full amount. In addition, many of our major customers are not insured, so the income in this area is one month. 1.2 million to 1.5 million, which is still sustainable.However, the Tao is one foot higher than the devil, and now the patients are becoming more and more cunning. They know that the medical insurance does not pay for normal delivery; the dystocia of abnormal delivery is covered by the medical insurance. Shouting loudly, trying to pretend to be a dystocia, these days, even doctors can't be careless, hahaha! Zaizen Goro laughed too.The old servant who entered the Japanese room looked at the two of them in surprise: Master, do you need to prepare dinner? um, dinner?Goro and I go out for dinner, so there is no need to prepare.Another asked the old lady to bring a short coat, put it on lightly, and stood up from the seat. Ah, Dad, I ask Kyoko to call first. He is in a hurry to explain why he is here. Oh, that thing!Let's talk about that when we go out to eat.After finishing speaking again, he went straight to the direction of the entrance. Before he could speak, he was interrupted, Zaizen Goro felt like a stick in his throat, his heart fluttered.Another one in the lead didn't want to meet the patient face to face, so he came out through the back door.He walked briskly from Dojima Nakacho to Umeda Shindo.On the other foot is a white foot bag (that is, a sock) that matches the Oshima kimono, and a leather rope zori sandal (Zori sandals, Japanese-style slippers worn with a kimono, with a V-shaped strap called a pig nose at the toe.) .When walking, he kept his hands in his arms all the time. He didn't look like a doctor who smelled of medicine at all, but a red-capped businessman who was used to looking for flowers and flowers. After crossing the intersection of Umeda Shindo and heading north, Weng and his son-in-law came to the vicinity of Hatsutenshin and got into the noren curtain of a certain store.This is a small kiosk called Fan House, which is very elegantly arranged. Hello!The guests are coming!He yelled unceremoniously again, regardless of whether he responded or not, he took off his shoes and socks, and walked into the room.The front of this store is only two rooms wide, but there is a long courtyard leading directly from the outside to the inside, which is quite typical of the deep architecture of Osaka. The waitress greeted her in a panic, and he ordered wine and side dishes from her. Ah, how about Goro taking off the smell of potion, taking a bath, and changing into a bathrobe?After he finished speaking, he clapped his hands vigorously, and the sliding door of the Japanese room was gently opened from the outside. A woman with a Western hairstyle appeared. Ah, this is Shi Jiang, the proprietress here, who used to work as a geisha in Xindi to the north.As for his looks, he's fairly ordinary, but according to my examination, his skills in that area are top-notch, and I can assure you of that. Oops, you're so annoying, don't say such nonsense in front of people you're meeting for the first time!She glared again angrily, took the bottle and poured wine for the guests. Ha, what's there to be shy about?By the way, this is my son-in-law Zaizen Goro. He is still an associate professor at Naniwa University Hospital, but he will soon become a famous doctor that you can't even see in line. You should take this opportunity to curry favor with him today. After listening to his introduction, the proprietress immediately sat upright and said: "It's the first time to meet you, hello!"I am Shi Jiang from Ouya, I have always been Another interrupted suddenly: You want to say that you have been taking care of me all this time, right?Say, how many times have you done it? Goro looked at the woman as if frightened. She was about forty years old, right?However, she was born with a plump figure and delicate features. The son-in-law's sluggish face amused Youyi: How is it?Are you startled?With such a wonderful woman so close by, who wants to eat a meal cooked by a wrinkled old woman?When your mother-in-law was still around, I secretly hid one or two secrets like this, and I never let her know.You also have such a person, right? Wulang waved his hands quickly: "Where, I don't even dare to think about it. If I don't say anything else, just Xingzi What?Apricots?Occasionally you have to show the majesty of a husband!That girl probably looks like her dead mother?She loves vanity, hates the philistine vulgarity of Osaka, likes the quietness and elegance of Ashiya and Shukugawa Mountains, and even speaks with a mixture of Osaka accent and Tokyo accent, and speaks standard language that no one can understand, even though she is mine. An only child, but nothing like me.Forget it, for a pretentious and savage girl like her, as long as you have money for her to squander and have a sweeter mouth, she will be happy.If a man is not flirtatious once in a while, he will not show his majesty.I don't know if he was joking or sincere. By the way, Kyoko called this morning and said you have something to ask me, what is it? Ah, to be honest, Caiqian, who finally breathed a sigh of relief, was about to speak, but aimed at the proprietress next to him. Ah, with her here, it's not convenient for you to say yes?Hey, you go down first. As soon as the proprietress left the room, to be honest, I wanted to talk to my father. Zaizen Goro at this time was different from the associate professor Zaizen in the hospital corridor and operating room, and said solemnly almost humiliatingly. How much do you need?One, two, or five? Well, in fact, I want to borrow 500,000 from my father. He originally planned to ask for 300,000 at most, but he followed the other party's tone and said it was 500,000. No problem, I will pay for it.I am only responsible for paying the money, as for how you want to use it, I will not ask.If you want to spend it on a woman, you must make sure that the other party is a first-class woman; if you need it for work, a mere half a million yuan is not enough to fit between your teeth.You think it through, and if you need it, come talk to me again. Ah, Dad, you said that, I don't know how to thank you I give money to my son-in-law, why don't I talk about thanking him or not?By the way, how is the next professor going?From the beginning to the end, the chatting and laughing were endless, and the big sea monster-like face suddenly suppressed a smile. Well, in terms of strength, I have absolute confidence. However, the problem is that in addition to strength, it also depends on relationships, which is troublesome. Zaizen Goro replied uncertainly. This is of course, if everything is resolved by strength, the world will be clear and simple.A guy with no strength can be the prime minister or the boss of a large company, and the same is true for personnel in universities.順水推舟是人類的生存本能，我也是因為看好你的前途才招你做女婿的，可瞧你說的是什麼話？實力上沒有問題，其他的就不知道了，你這麼沒有自信，怎麼成就大事？為了搞定那些實力以外的東西，多少錢我都願意出，實力和金錢結合在一起，還有什麼辦不到的？ 五郎被說得啞口無言。 總之，我的希望全寄託在你身上，無論如何，你都要替我當上國立大學的教授。身為一名開業醫生，不管病患再怎麼多、賺再多的錢，都還是寂寞的。雖然我認定自己是大阪的商業大夫，始終秉持著這個信念，不過我也是寂寞的。人一旦有了錢，就會想要名，人類的最終慾望就是名，有了名後，錢和人自然都會跟著來，不過，錢再怎麼多就只是錢而已。我一輩子得不到的名，作為女婿的你務必要幫我拿到，我拚命賺錢就是為了這個啊。 這著了魔的可怕執念就像一股毒氣，溫熱地吹進財前五郎的脖子，竄入他的體內。 我用才能換取財前家的財力，財前又一拿金錢換取名譽財前五郎覺得自己的周遭正轟隆隆地捲起可怕的慾望漩渦。 Angry?怎麼突然不講話了？自個兒高談闊論、滔滔不絕地把話全說完了，這下又一倒質問起別人來了。 哪裡，沒事財前支吾其詞，其實他是讓又一宛若毒氣般可怕的執著給嚇著了。 It's fine.我們換個氣氛，唱首地唄（三味線聲曲的一種，起源於江戶時代初期，是以關西為發展重鎮的地方歌謠。）怎麼樣？就唱我最拿手的《雪》好了。 又一拍手召喚老闆娘，請她拿了三味線過來 落花、飛雪，輕拂衣袖淨，遍天涯詢問消息，依舊歸期未定。看鴛鴦惹人憂思，孤枕生寒淚痕滋 和著老闆娘彈的太棹（三味線的琴柄，太棹三味線是一種柄粗的三味線。）三味線，又一的聲音透著令人意外的滄桑，流瀉在和室內。地唄的曲調雖不如小唄或長唄輕快，卻宛如特地燻黑的銀器，透著淳樸的光芒。初次欣賞地唄的財前五郎，一邊側耳傾聽，一邊在心裡想著，又一這個開業醫生，不但把忙碌的診療工作處理得井井有條，還吃喝嫖賭、琴棋書畫樣樣精通，自命為玩樂高手，只有大阪這樣的城市，才能孕育出像他這麼有個性的醫生。這種個性是生長在窮鄉僻壤、由寡母一手帶大的財前五郎想學也學不來的。 怎麼樣，這就是大阪的傳統地唄。地唄是太難了，不過，你有空倒是可以學學小唄。以前自稱為商業大夫的大阪醫生，除了拚命工作外，還都是很會玩的高手。每天忙著往返於藏嬌的金屋和急診病患的住處是不用說的，連長唄、淨琉璃（日本三大國劇之一）、能樂等都能露上一手，這其中還有人玩票玩到最後，變成鑽研能樂的大師呢！說起現在的醫生啊，不管是開業醫生，還是大學醫院的教授，器量都太狹小了，既庸俗又缺乏情趣，你呀，千萬不要變成那種乏味的俗氣醫生，也試著培養一、兩樣興趣。 不，這麼藝術的東西我根本他嘴巴這麼回答，心裡卻在想，要是有那種空閒時間，我寧願上慶子那裡和她廝磨。 看來，你真的是那種既無才藝、又無嗜好，每天只知道工作的無趣傢伙。又一嘲笑地說道，將筷子伸向盤子。 我想也是吧，像今天就有一個延誤就醫的食道賁門癌病患被我救活了，換成是別的醫生絕對沒有辦法。 哦，一說起拿手的事，精神就來了。又一滿面笑容，那個食道．胃吻合手術，確實值得你花精神研究。目前為止，只有千葉的小山教授是這方面的權威，住在西邊名古屋的人要給他看，還得舟車勞頓大老遠地跑去，不過，體力差的病人要抬到千葉就困難了，話雖如此，他也不可能跑到大阪、九州來看診。因此，光就這一點來看，你的前途可說是無可限量。但是，你可不能再上媒體露面了，從以前就有人說：還沒在學會裡成名就已紅遍媒體的傢伙，一定會被毀掉。更何況，你們那位東教授又是個小鼻子、小眼睛的人。 財前不禁想起，今早手術的時候，東教授那惡心的臉孔就好像爬蟲類一樣，平貼著觀摩室的玻璃窗。 爸爸為什麼會對東教授產生這樣的看法？ 東和又一只見過幾次面，彼此並不熟。 像我這種自稱為商業大夫，幹了一輩子開業醫生的大老粗，最看不慣那種裝腔作勢、喜歡擺學者派頭的傢伙，像他那種人就是人家在講的書呆子、老冬烘吧？也不知道他是怎麼搞的，把自己弄得活像患了權力病一樣，一點都不灑脫。唉，說穿了就是城市鄉巴佬！ 說完後，他好像忽然想到似的問道：怎麼樣，今晚要不要和我們醫師公會的岩田會長喝上一杯？財前五郎不知他葫蘆裡賣什麼藥，露出驚訝的表情。 你可別小看我們醫師公會。也好，趁這個機會，就讓你和醫師公會的老大見上一面。岩田和我一個是會長，一個是副會長，兩個人是有商有量的好兄弟！本地醫師公會的事都是我倆在處理的，所以沒什麼好擔心的。雖然在大學醫院裡你是高手，但偶爾見見醫師公會的高手，對你也有好處。 說完後，他也不等五郎答應，逕自拿起房間角落的電話撥轉號碼。 喂，岩田診所嗎？請幫我叫岩田院長來聽電話，我是財前。他問話的方式還真是無禮。 一等岩田來接，喂，是我，是我，財前，大海怪啊。生意好不好？What?馬馬虎虎？那你乾脆找人代班好了。我現在在扇屋，有一個人要介紹給你認識。Huh?who is it?這個嘛，你來了再說。又一大著嗓門講完，鏘一聲掛了電話。 只要是我找他出來玩，他一定會想辦法過來。你看著好了，用不了二十分鐘，他就會飛車趕到。 又一露出愉快的笑容，喚來老闆娘，加點新的菜餚。 您的客人來了 和室的拉門被打開了，岩田重吉走了進來。他的體格瘦小乾癟，不若其名字氣派，是一位六十來歲的老醫生。戴著金框眼鏡的他往財前五郎瞄了一眼，連招呼都沒打一聲，就一屁股在又一身旁坐下。 你電話打來的正是時候，今天都是感冒的病人，我看得快要煩死了，隨便編了個理由就跑來了。 感冒病患，初診費加開藥、打針不過就二十一點，你是嫌診療費才二百一十塊太少吧？又一故意調侃地說道。 yes!你說初診費才六十塊像話嗎？現在理個髮都要三百塊了，到哪兒不花個三、四百的，初診費至少也要調到四、五百嘛！甭說保險點數無法隨同物價調漲了，更誇張的是，我們這些幹了四十幾年的資深醫師竟然和剛實習完、還在扮家家酒的菜鳥醫生拿同樣的報酬，其他行業哪有這麼離譜的事？像現在這樣，不問經驗和技術，一律按照人頭累計點數的算法，讓二十七、八歲的菜鳥醫生踩著滑板車去賺最划算了！這可是人命關天的職業，醫生技術的好壞可以決定一個人的生死，又不是夜市在賣香蕉，整箱整箱地賣，真是夠了！就算我不是日本醫師公會的石見太郎（足利幕府時代的赤松家臣，因重新振興衰敗的赤松家而聞名。此處比喻力挽狂瀾的革命志士），碰到這種低能的醫保制度也不免咒罵一番。岩田怒氣沖沖地說著，將老闆娘添上的酒一飲而盡。 就說下次理事例會的議題好了，本地的內科和小兒科診所已經夠多了，竟然還有新的內科要來申請開業？這樣做不是侵害了既有經營權嗎？我不是因為自己開內科診所才這樣講，人家賣饅頭的和賣昆布的都還會制定行規，規定幾町之內最多只能開幾家店，可做醫生的只要寫一封信給都道府縣知事（日本各級地方政府首長），通過醫師公會提出設立申請就可以了。不僅如此，現在還允許先斬後奏，先開了業再通知你我已經開業了，這不是變相鼓勵踩滑板車的菜鳥醫生嗎？下次的理事會，我一定要想辦法遏止這股歪風！ 原來如此，如果放任現狀不管，到時在財前婦產科診所的隔壁也開了家婦產科，我們就沒有話講了。又一附和地說道。 岩田兄，坐在我前面的這位是我的女婿，浪速大學醫院第一外科的副教授財前五郎，今後請您多加提拔。 又一正式恭敬地介紹完，這時岩田才喔了一聲：你就是財前副教授啊，你的大名我早聽說過了，久仰久仰。對了，鵜飼老弟還好吧？ 鵜飼老弟？財前下意識地又問了一遍。 對呀，鵜飼老弟，當醫學部長的那位，他和我是同期，我們可是稱兄道弟的好哥兒們！ 財前五郎露出恍然大悟的神色。 瞧，我說不可小看醫師公會吧？連浪速大學的醫學部長，在我們老大的嘴裡都成了小老弟了。 聽到又一這麼講，岩田忙說：哪裡，哪裡，沒他說的那麼偉大，我們只是同學，一同在第一內科的研究室待過。不過，既然是同學，難免會覺得榮辱與共，這有時值得慶幸，有時也很恐怖。 oh?值得慶幸，也很恐怖？大阪醫專出身的又一不太瞭解浪速大學的內幕，甚感興趣地探出身子。 岩田重吉啜了一小口酒後說道：哈，這關係可微妙了。一所大學，不管它再如何標榜追求真理，沒有錢就搞不出名堂，每次我們在大阪開學會的時候，鵜飼就會講：光靠浪速大學的預算根本維持不了學院的運作，希望醫師公會能在金錢上提供協助。這時如果有校友正好是醫師公會的幹部，辦起事來就容易多了。他可以馬上召開理事會，把會費的一部分撥給你，不過，相對地，你收了人家的錢，人家就有權過問你醫學院的事，像是教授的空缺、幹部的推選等等。比方說，有一位教授想找接班人，不過他不想用浪速大學醫學院出身的人，想找其他大學的副教授來接自己的位子，這個時候，我們就會拚命把自己搞不定的病患塞給那個教授，一下推說病房不夠、開業醫生檢查不出來等理由，把他整得人仰馬翻，無暇處理接班人的事。所以，有時候校友團結起來，搞反對運動，破壞力也是很恐怖的。 嗯，校友會有這麼大的力量啊？又一懷疑地問。 我們海軍同期有一個姓櫻的，就是這樣被搞垮的。總之，對現任教授而言，校友會是個不可輕忽的存在。事實上，鵜飼君競選醫學部長的時候，也是我們這票在醫師公會當幹部的老校友幫的忙。我們事先商量好，跑去向手裡有票的教授遊說，硬是把原先要給現任醫院院長則內的票給搶了回來，讓鵜飼坐上部長寶座。鵜飼做了部長後，能夠毫無後顧之憂地推行新館增建計劃，也是因為有我們這批人做他的後盾，光靠政府的那一點預算能蓋出什麼東西？不夠的部分，就由校友會裡和財界人士交好的人去活動，以一個人捐一百萬的方式募集而來。對財界大老來說，反正年齡到了，自己哪天要拜託大學醫院照顧都不曉得，更何況自己公司的醫務室也希望能請到優秀的醫生駐診，所以，一百萬這種數目，他們想都不用想就可以拿得出來。可是，這種募款的事怎麼能叫醫學部長親自去做？話說回來，國立大學的教授裡也找不出能夠勝任這種交涉的傢伙。大阪的財界人士可是很講規矩的，不管你的醫術再怎麼高明，我給你錢，你不低頭，就會讓我覺得不舒服。要大學的教授向錢低頭，他們會覺得是一種污辱，逼不得已，這種事還是得由我們這批校友來奔走。 每次找他喝酒，岩田一定會發表個人演說，這種事又一已經見怪不怪了，不過，財前五郎好像現在才驚覺，大學的高手和醫師公會的高手在意想不到的地方結下這層奇緣代表著什麼意義，說不定自己的將來將取決於這實力以外的因素。 哈，就是這麼一回事。我們校友會啊，不但是醫師公會的強者，連國立大學醫院裡的強者也不能沒有我們，喔呵呵呵。 岩田晃著瘦小的身體，發出像笛音似的奇怪笑聲，又一也跟著在一旁賠笑。 忽然間，拉門被打開了：今晚歡迎您的大駕光臨活潑年輕的聲音傳來。 四名年約二十歲左右的藝妓，端坐在門檻外，白色的小手向前一伏。 啊，小萬、佔子、春千代、三葉，你們都來了。來，我跟你們介紹，這位是大名鼎鼎的岩田醫生，岩田診所就是他開的，你們要勤快點，不然他可是會生氣的喔！至於這位，他是我的女婿，不用太招呼他，免得我女兒囉唆。又一算準談話結束的時間，請了藝妓過來。 岩田醫生，我幫您倒酒好不好？ 人家也要幫您倒酒。 藝妓爭相替岩田重吉斟酒，全圍在他的身邊。瞬間，岩田笑顏逐開：哎喲，讓你們這樣圍著，不用等到辦正事，我就被你們吸乾了。談笑間語氣相當輕浮。 他輪流喝光藝妓斟上的酒，一邊說道：我總是讓財前兄請客，沒辦法，內科怎樣都比不上婦產科賺錢吶。 哪裡，彼此彼此。岩田君身為會長，掌管對外的所有事務，我身為副會長，負責雜務、稅務還有醫療糾紛的處理，我們只能在醫師公會的例會上碰面，到了這種地方又吵吵鬧鬧、人多嘴雜，很難有機會可以深談，不管怎樣，會長和副會長若不能心意相通、互相支持，事情就不用辦了。說完後，又一露出心照不宣的笑容。 看到這抹笑容的財前五郎忽然在心裡掠過一個想法，今天又一忽然說要到外面吃飯，又忽然把岩田重吉找來，讓他和自己見面，這一切看來好像都是臨時起意的實際上，說不定他心裡早有其他的打算。財前五郎的直覺告訴他，從此刻起，自己已經和一根看不見的複雜繩索綁在一起了。