Chapter 30 Folie A Who?

The door handle turned, everyone held their breath as the door slowly opened.

They all watched as Elder Qin, Qin Song, director Qin and a cute little stuffed bun sauntered into the room.

The doctors that were sitting on the largest sofa all stood up to grab chairs at the side. The Qin's sat on the now empty sofa.

You could cut the tension in the room with a knife. Everyone was now even more scared that they would get fired.

After a few minutes they heard a cute little voice.

Little 4th asked his father sweetly: "Daddy, where is sister YingYing?"

Elder Qin patted Little 4th's head: "She should be on her way, she went to go talk to some patients."

Little 4th: "How long do you think she'll be?"

Elder Qin: "I'm not sure, she should be here soon."

Little 4th screwed up his little face: "How long is soon?"

Elder Qin sighed:"Little 4th, have some patience."

There was a minute of silence.

Little 4th whined to his eldest brother: "Elder brother, when will sister YingYing be here?"

Qin Song: "5 minutes."

Little 4th started looking through his father's pockets until he found his smartphone.

He lifted it to his father to be unlocked it.

Little 4th then looked through the apps until he found the clock app, he opened it and set the timer for 5 minutes.He looked at his elder brother and showed him the timer, his little face saying you better not have lied to me big brother.

Qin Song smiled at little 4th's antics.

Little 4th stared hard at the phone screen, as the timer started counting down.

6 minutes and 30 seconds later. Little 4th was staring daggers at his elder brother.

His face clearly said 'how could you deceive me elder brother, I'll never trust anything you say again.'

Qin Song didn't know whether to laugh or cry.

I understand now why father had been ambiguous with his answers.

The door handle turned again. This time Li Xiuying stepped into the room.

Li Xiuying looked around and was surprised to see the Qin's in the room.

Little 4th immediately jumped down from the sofa and ran over to Li Xiuying and gave her a smile that could outshine the sun.

Li Xiuying patted Little 4th's head with her gloved hand.

Little 4th was so happy he could burst.

Big sister YingYing patted me! I'll never let anyone else pat my head except big sister YingYing.

Li Xiuying: "Since everyone is here let's begin."

Li Xiuying went over to the white board. Little 4th followed behind her like a little chick.

Li Xiuying looked down at her little shadow, who looked up at her with puppy dog eyes.

She looked around the room and spotted an empty chair, she went to it along with her little shadow. Then she put the chair next to the whiteboard, picked up little 4th and put him on the chair and patted his head twice.

Little 4th was so happy he giggled.

Li Xiuying turned to the Qin's: "Does anyone have a phone and head phones for little 4th?"

Qin Song took out his smart phone and found little 4th favorite TV show. He then plugged in the headphones and gave them to Li Xiuying. Li Xiuying then put the phone in little 4th's, she placed the headphones in his ears.

Little 4th's attention was successfully diverted.

Li Xiuying faced the room again: "We are here to talk about the events from this evening. Lets start with the phone call, who's Yang Rong?"

Yang Rong lifted her hand up tentatively.

Li Xiuying: "What do you think you should have mentioned during the phone call?"

Yang Rong nervously answered:"I should have mentioned that I was a first year resident?"

Li Xiuying: "Yes. Also, the type of injuries the patient's had and that there where only residents in the emergency department."

Li Xiuying: "Next, Xǔ Luli's 3rd year resident, what should you have done differently?"

Xǔ Luli's 3rd year resident: "I should have assessed the patient more thoroughly, I messed up taking her respiratory rate and failed to listen to her heart sounds."

Li Xiuying nodded: "When assessing a patient its good to have a systematic approach such as ABCDE. Airway, breathing, circulation, disability and exposure. There are lists of certain things to check under all these subheadings. Stopping a bleed when the patient has stopped breathing is not going to keep the patient alive. Accurately measuring a patients respiratory rate is important, it can often be a major indicator to how unwell a patient is. Make sure you always assess the patient accurately, the patient's life is dependent on it. You should practice assessing patient who are not in a critical situation. For the whole of next week I want you to find me and present a patient to me."

Xǔ Luli's 3rd year resident nodded.

Li Xiuying: "C you should have used some initiative and got involved, in a high pressured situation you may get lost in the crowd."

C nodded, she had just stood off to one side during the management this evening.

I will definitely do more next time. She clenched her fists.

Li Xiuying: "D, you should have asked me if I preferred the ultrasound or echocardiogram machine, when carrying out a pericardiocentesis an ultrasound can be used continuously whilst inserting the needle it allows for more precision."

D: "Yes Dr. Li."

Li Xiuying: "Any questions about Xǔ Luli's management?"

C put up his hand: "Dr. Li, why did you insert a nasogastric tube before carrying out the pericardiocentesis?"

Li Xiuying: "Decompresses the stomach and decreases the risk of gastric perforation, advised if there is enough time."

Li Xiuying: "If there are no other questions. Xǔ Enlai's 3rd year resident what did you do wrong?"

Xǔ Enlai's 3rd year resident: "Erm nothing."

Li Xiuying raised an eyebrow. "Nothing? You didn't speak to the patient, if you did he would have told you about the pain and burning sensation in his leg. You also didn't examine his leg thoroughly otherwise you would have noticed the signs of compartment syndrome."

Li Xiuying: "Come forward and right the 6 P's associated with compartment syndrome."

Xǔ Enlai's 3rd year got up from his seat picked up the pen and started writing on the board.

He wrote pain, pallor, paresthesia, pulseless, perishingly cold and paralysis.

Li Xiuying: "Now tick all that apply to the patient"

Xǔ Enlai's 3rd year hesitated and ticked pain.

Li Xiuying: "Tick all of them"

Xǔ Enlai's 3rd year's face was full of shame as he ticked all of the P's.

I should have checked properly, the patient could have lost his leg if the compartment syndrome wasn't noticed within 6 hours. He paled at the thought.

Li Xiuying: "Do you still think you did nothing wrong?"

Xǔ Enlai's 3rd year shook his head from side to side : "I'll always ensure I speak to the patient if they are conscious, I will also fully assess the patient for any other signs or symptoms and not just stop assessing after I find what I think is the most likely diagnosis."

Li Xiuying nodded: "E And F again like C you both need to be more involved. Any questions?"

F put up his hand: "Dr. Li what method did you use for the patients dislocated shoulder?

Li Xiuying: "Kocher's method. Any other questions?"

There was silence.

Li Xiuying: "A, b and Xǔ Junjie's 3rd year you all had it easy as your patient was conscious and not distressed.But you all assumed that just because he wasn't complaining about pain he didn't have any. He had a broken collar bone and radius, do the three of you think that they aren't painful fractures? He should of at least had IV paracetamol and been prescribe PRN morphine sulfate "

All three of them nodded.

Li Xiuying: "4th year did you do anything wrong?

4th year: "Erm, I'm not sure, I thought the surgery went well."

Li Xiuying: "The surgery wasn't the problem. You were bleeped for an emergency patient but you were late. You said you were with a patient which is even more disconcerting, considering your clothes were messy and buttons done up wrongly, there was also lipstick on your collar and your trouser zip was undone. so the reason for your lateness..."

Everyone in the room turned to him,some had looks of shock whilst other held expression of disdain. How could he have an affair with a patient?!

The 4th year immediately paled: "I lied, I lied I was with someone in the on call room but it wasn't a patient!"

Li Xiuying didn't spare him a second glance: "Any questions about this patient?"

Li Xiuying: "In the future everyone should make sure that they know which patients are coming in to the emergency department and anticipate the management and subsequently the equipment that may be needed."

Li Xiuying spoke to the Qin's: "I don't know where all the consultants or higher ranking doctors were tonight. They clearly exist because they were in the lecture hall the other day. Unless we were all suffering from a folie a deux?"

Everyone had confused looks on their faces.

Huh? Folie a who?

Little 4th looked at Li Xiuying in awe: "Big sister YingYing you know how to speak french too?!"

Is there anything my big sister can't do?

Everyone: "..."

That's not the point!