Polite to Annoyed

The radiographer finished taking the X-rays. Li Xiuying looked at the images, 3 broken ribs on the left. The ribs just need to be wrapped, and analgesia to manage the pain.

Li Xiuying checked the monitors and re-examined Xǔ Luli.

Li Xiuying: "Vital obs improving, breathing normally. 3rd year, she has numerous cuts over the left-hand side of her body, clean each laceration and ensure there is no glass or debris and dress the wounds. Some of the lacerations may need suturing. The patient will need antibiotics. D place a catheter and continue to monitor her, assist the 3rd year. I want a full body CT to check if she has any other injuries we've missed."

Li Xiuying moved to stand beside Xǔ Enlai: "E, F and Xǔ Enlai's 3rd year. Report on patient status."

Xǔ Enlai's 3rd-year resident: "The patient is conscious and responsive to speech, he is breathing normally, saturation of 95%, respiratory rate of 16 normal breath sounds, Capillary refill <2 seconds, pulse 86 normal rate, rhythm and strong. Normal heart sounds, no murmurs. Pupils are equal in size and reactive to light, blood glucose is 7 mmol/L, Left arm dislocation and what appears to be a broken right Tibia. The patient's obs are stable."

Li Xiuying: "Plan?"

Xǔ Enlai's 3rd Year resident: "We have started administering IV fluids, and 1 gram of IV paracetamol. We have given the patient a dose of morphine sulfate. We have sent off bloods and will continue to assess the patient's status. We have bleeped the orthopedic team and they are sending someone down. A theater has been booked."

Li Xiuying: "You need to X-ray the patient's leg. How long for the orthopedic team? When did you call?"

Xǔ Enlai's 3rd year: "5 minutes. I called them at 7:10 pm."

Li Xiuying: "Fine."

She approached Xǔ Enlai.

Li Xiuying: "I'm Dr Li Xiuying, can you tell me your name?"

Xǔ Enlai groaned in pain: " Arrrgghhhh it hurts, it hurtsss!"

Li Xiuying immediately went to assess Xǔ Enlai's right leg. 'Suspected compartment syndrome, the fracture also appeared unstable and the right leg is significantly shortened compared to the left.'

Li Xiuying: "Can you describe the pain?"

Xǔ Enlai: "It hurts so bad and it feels like my skin is burning. It was painful from the beginning but it just kept getting worse."

Li Xiuying turned to the 3rd year: "Where are the orthopedics team? It's been 6 minutes and 42 seconds."

Li Xiuying: "E and Xǔ Enlai's 3rd year get an X-ray of Xǔ Enlai leg then take him to theater. I'll need to carry out an emergency fasciotomy and repair the broken tibia. You have 15 minutes."

Li Xiuying stepped over to Xǔ Enlai's left arm. 'It's clearly dislocated.'

Xǔ Enlai groaned again: "Argghhhhhh!"

Li Xiuying moved Xǔ Enlai into a sitting position. She bent his arm at the elbow, arm pointing forward. She held his upper arm to his body and twisted his arm outwards so it formed an L, then she pulled his upper arm anteriorly by 5.5 cm and rotated Xǔ Enlai's lower arm to lie across his body.

The shoulder was put back in place.

Li Xiuying turned to a nurse: "Could you put his arm in a sling please?"

Li Xiuying: "Xǔ Enlai did you hurt your head in any way?"

Xǔ Enlai moaned: "Aarrrghhh noooo."

Li Xiuying: "I need to carry out an emergency surgical procedure called a fasciotomy. You have a build up of pressure in your right leg which if left for more than 6 hours could result in you losing your leg. I'll be putting lateral incisions in your leg with a scalpel. I will also be inserting screws and a plate to mend your tibia, depending on the extent and type of fracture the treatment may change. You will first need to get an X-ray."

Xǔ Enlai: "Just make the pain and burning stop."

The orthopedic consult came running in.

The orthopedic consult was gasping for breath: "I'm sorry, I'm late I was with a patient."

Li Xiuying raised an eyebrow. "What year of specialty training?"

Orthopedic consult: "4th"

Li Xiuying headed towards Xǔ Junjie: "One patient left to assess."

Xǔ Junjie was talking quietly with Ren Longwei beside him about the accident. He knew it had to be a planned hit. But who would be stupid enough?

When Li Xiuying approached Xǔ Junjie, she noticed that he didn't seem to be in any pain at all.

Xǔ Junjie pain threshold was exceptionally high and he had been through worse in his past occupation.

Li Xiuying: "I'm Dr. Li Xiuying. Can you tell me your name and where you are?"

Xǔ Junjie: "Xǔ Junjie, Unity Hospital emergency department."

Xǔ Junjie: "What happened to my cousins?"

Li Xiuying: "I need to do some checks and arrange management. We can then discuss the situation after your treatment."

Li Xiuying did a physical examination of Xǔ Junjie and looked at his obs.

Li Xiuying spoke to the orthopedic consult: "4th year, broken left clavicle requires sling, analgesia and physiotherapy. X-ray his arm it appears to be a broken radius will require surgery. You need to take a full history and do an examination before entering the theater, check for any injuries both internal and external that could have been missed. Prescribe him analgesia before you do anything else. I will meet you in the doctor's coffee room after you finish."

Li Xiuying rushed off to the theater to operate on Xǔ Enlai.

...

Xǔ Junjie's Private Room

Xǔ Junjie was sitting up in bed. Ren Longwei was by his side.

There was a knock on the door,

Xǔ Junjie: "Come in."

Li Xiuying walked through the door in her scrubs. She took a seat next to Xǔ Junjie's bed.

Li Xiuying: "Xǔ Luli had a collapsed lung and fluid around the heart which was resolved. She has 3 broken ribs on the left, which have been wrapped. There is extensive bruising on her body. She has numerous small lacerations on the left side of her body which have been cleaned, sutured and dressed. She did wake up earlier and her cognitive faculties were all intact. She is now sleeping."

Xǔ Junjie nodded.

Li Xiuying continued: "Xǔ Enlai, had a dislocated left shoulder, which has been treated. He had a fracture to a bone in his leg i.e. tibia that resulted in acute compartment syndrome. I carried out an emergency fasciotomy and fixed the tibial fracture via screws and a plate. His leg is safe. Both of them will need to stay in the hospital for the next few days for monitoring. Xǔ Enlai will also need physical therapy in the future."

Ren Longwei released a breath: "So they're both okay?"

Li Xiuying: "They are out of immediate danger. However, there are still risks such as infection, clot formation, etc."

Xǔ Junjie: "Thank you for everything that you've done Dr. Li."

Li Xiuying nodded.

Li Xiuying: "You have a left collar bone fracture which will require you to wear a sling and attend physiotherapy sessions. Your right radius is broken and you have had screws and a plate inserted. All of you will have follow up appointments in 6 to 8 weeks with the orthopedics team."

Li Xiuying: "Do you have any questions?"

Xǔ Junjie his voice held a hint of hope: "Will you be the one we will see for follow up?"

Li Xiuying: "No I don't do clinics. If that's all I'll be leaving."

Ren Longwei stood up: "Thank you for..." Li Xiuying had already left and closed the door behind her.

Ren Longwei sighed: "She never lets me finish talking."

Li Xiuying started making her way to the doctor's coffee room. She put her hands in her pockets as she thought: 'Tonight is going to be a long night.'

Li Xiuying was meandering along through the hallway, passing by the private rooms and wasn't paying attention to her surroundings.

Someone stepped out of one of the private rooms and bumped into her. Li Xiuying stumbled back a step.

The man: "Oh I'm sorry I didn't.."

Li Xiuying looked up, she felt her blood go cold.

The man's voice changed from polite to annoyed: "Li Xiuying, what are you doing here?"

Li Xiuying continued to stare into the face of her fiance, Chen Wei.