This doctor has a system

Chapter 477 541.74 years old with a 60-year smoking history?
Zhang Tianliang was sitting on the sofa. When he saw someone coming in, he looked up. Li Youliang felt uncomfortable when he saw his gloomy eyes.

"Now that medical technology is advanced, you can go for another check-up," he suggested.

"Last time, my mom said she was taking him to do a brain MRI, but before he even lay down, he complained of a severe headache, and then he had a seizure," said Mr. Zhang's son, somewhat helplessly, "and then he came back."

Zhang Tianliang has accepted his condition deep down and is unwilling to go to the hospital again.

"Stop struggling. This is how my life will be," he said to his sister.

Li Youliang reported every word he had asked to Gao Feng, who fell into deep thought after listening.

"Is there any problem?" he asked quietly.

Of course, otherwise the system would not be able to issue such a task.

Completing the task only earns 1 skill point, but failing will deduct 100 points. This is the first time Gao Feng has encountered a task with such a big difference between reward and punishment.

This means that the diagnosis should not be difficult, he analyzed.

Epilepsy, also known as "seizures", is a chronic brain disease characterized by repeated epileptic seizures. It occurs suddenly and for no apparent reason. It can occur in people of any age and is one of the most common neurological diseases.

Epileptic seizures are caused by "abnormal discharges" of brain neurons and are characterized by repetitiveness and transience, which are the main symptoms of epilepsy.

癫痫影响着全球7000多万人，中国人群的发病率在5‰～7‰之间，全国有650万～910万患者。

Every year, 40 to 60 people are newly diagnosed with epilepsy in my country. Epilepsy can occur in people of all ages, but it is more common in children and the elderly. Among pregnant women, the proportion of epileptic seizures is 0.3% to 0.7%.

People with epilepsy will definitely experience seizures, but people who experience seizures do not necessarily have epilepsy.

Could it be that Zhang Tianliang’s diagnosis of epilepsy was wrong?

There was no point in thinking too much, so Gao Feng decided to go and see for himself tomorrow.

As for why not today, it was because President Guo had an appointment with him.

"A relative wants you to see him."

"There are so many experts in the Provincial Hospital, why did you think of looking for me?" Gao Feng asked with a smile.

"I heard that you are best at treating difficult and complicated cases." Director Guo took him to the intensive care unit. "He is my second uncle. He was very kind to me when I was a child." His expression was solemn when he spoke.

Gao Feng immediately perked up, "Let me see what's going on."

The patient, Guo Dahe, male, 74 years old, was admitted to the respiratory department due to intermittent cough and chest tightness for more than 20 years, which worsened and was accompanied by fever for 3 days.

After infection control and symptomatic treatment, the symptoms did not improve significantly. Two days ago, his family noticed that he was a little mentally abnormal.

"You always tell me, Cui'e, you have worked hard. You have worked hard." Guo Dahe's wife said to the nurse.

"Is there anything wrong with that? Do you feel like he's being too polite to you?"

"It's a bit polite, but my name is not Cui'e either."

The attending physician looked at the patient's watery eyes and determined that he had pulmonary encephalopathy.

This is because Guo Dahe has a 60-year history of smoking and has long been diagnosed with chronic obstructive pulmonary disease. It is common for respiratory infections to trigger acute attacks of chronic obstructive pulmonary disease, followed by pulmonary encephalopathy.

Under normal circumstances, the human body inhales oxygen through the lungs and then exhales carbon dioxide. This is the process of gas exchange.

However, patients with chronic obstructive pulmonary disease have impaired ventilation function, which leads to carbon dioxide retention, which in turn causes a series of neuropsychiatric symptoms, including headache, dizziness, irritability, slurred speech, and mental confusion.

This is a more serious situation.

"74 years old with a 60-year smoking history?" Gao Feng asked as he looked at the medical record.

"Yes, he said it's hereditary." The doctor from the critical care department laughed bitterly, "He was still having seizures a few days before he was hospitalized."

God damn genetics
For Guo Dahe, he can skip meals and water, but he must smoke. If you don’t smoke and I don’t smoke, what will the country use to build an aircraft carrier?
It can be said that at least two screws on the aircraft carrier were contributed by Comrade Guo Dahe.

"When he came in, I checked his blood gas and the carbon dioxide partial pressure was 104!" said the critical care doctor. "He was intubated and put on a ventilator. Now the carbon dioxide partial pressure has dropped to 67, but his consciousness is still not good."

This is quite strange.

Logically, if pulmonary encephalopathy is caused by carbon dioxide retention, the patient should regain consciousness quickly after being corrected by a ventilator.

Is it some other problem?
Gao Feng looked down at the medical record and found that the medical history stated that Guo Dahe had been hospitalized once in the Provincial Hospital's Neurosurgery Department.

Four months ago, he suffered from headache and ptosis of the left eyelid for three months, which worsened and became accompanied by numbness of the left upper limb for one month. He went to the People's Hospital for treatment and was diagnosed with a mass in the left prepontine cistern. He underwent resection of the mass in the left prepontine cistern.

Pathological diagnosis: Fibroblasts with large nuclei and dark staining accompanied by extrusion and degeneration can be seen in the fibrous tissue, and a few free and broken squamous epithelial cell clusters with mild atypia are seen. Please combine the clinical findings and regular follow-up is recommended. This is consistent with cholesteatoma.

Cholesteatoma is not a true tumor, but a benign disease, but it can also damage bones, so surgical removal is generally the option.

Gao Feng carefully checked the patient. Guo Dahe was still on a ventilator and in a sedated state. His vital signs seemed OK.

"I don't think it's pulmonary encephalopathy." He hesitated for a moment and said to the doctor in charge, "The carbon dioxide has dropped to 67, which is enough for him."

Guo Dahe has been smoking for many years and has been diagnosed with chronic obstructive pulmonary disease for many years. He has long developed chronic type II respiratory failure and his carbon dioxide levels are usually higher than normal.

67mmHg of carbon dioxide is definitely unbearable for most people, but it is tolerable for him.

"Why do you keep talking nonsense?" the attending physician asked, "What do you think is wrong?"

"Didn't you do an imaging test on the head?" Gao Feng asked.

"No."

Gao Feng pulled up the imaging tests of Guo Dahe's last hospitalization. Both the MRI and CT showed a mass in the left anterior pontine cistern, with a diameter of about 1 cm.

He clicked on the pathology results again, and just after taking a glance, his expression became solemn.

"What's wrong?" The attending physician felt something was wrong.

"Isn't this a keratinized pearl?" Gao Feng pointed at the pathology picture on the computer and asked, "There are also intercellular bridges, why didn't they report the possibility of squamous cell carcinoma?"

"I don't understand." The attending physician said blankly. Although he had studied pathology in college, so many years had passed and he had long since returned this knowledge to his teacher.

"Take the patient to do another head CT scan now." Gao Feng said to him, then turned and left the office.

Director Guo was smoking at the corner of the stairs. There was a no smoking sign next to it, but several family members turned a blind eye to it.

His second uncle Guo Dahe was very kind to him when he was a child. Now the old man has tubes inserted all over his body. The last time he took a look at him, he felt uncomfortable for a long time after coming back, so he simply didn't go in again this time.

"How is it?" "I feel the diagnosis may be a little wrong." Gao Feng hesitated and said, "But we still have to see the results of the examination."

"It's good that the problem was found." Dean Guo breathed a sigh of relief.

The examination results came out very quickly. The head CT scan showed soft tissue lesions in the sella turcica area accompanied by bone destruction, and the area was significantly larger than that before four months.

"It should be a malignant tumor." Gao Feng was now certain of his judgment, and he immediately called Director Ding of the Pathology Department.

When Director Ding arrived, he found that Dean Guo was also there, so he immediately greeted him. Gao Feng made room for him, and Director Ding carefully read the report, and his face suddenly turned pale.

"This is too..." He was sweating profusely at this moment, "It has the characteristics of squamous cell carcinoma. The report is too one-sided."

"Do the patients and their families know about this? We need to think of a solution."

He didn't notice that Dean Guo's face turned dark.

"Bastard!"

Director Guo's angry voice startled Director Ding.

"Director, this misdiagnosis has a huge impact on the hospital's reputation." He quickly explained, "It's better to make a big deal out of a small matter."

high wind
Gao Feng tugged at Director Ding's white coat, and the latter's eyes revealed confusion: Am I wrong?

"This is Dean Guo's second uncle." Gao Feng explained.

Go and ask for it!
"This pathology report was made by Lao Ma, and he is fully responsible," said Director Ding.

"You're talking nonsense!" Dean Guo said angrily, "Just wait! None of you can escape!" After he said that, he turned around and left.

"That old Ma!" Director Ding said depressedly after a while, "He just walked away without a care in the world, but we are the ones who have to bear the consequences."

Lao Ma had always been in poor health and died of a myocardial infarction a month ago.

The family is gone, where can we hold them accountable? It seems that the stick will hit Ding's buttocks, and Director Ding left with a sad face.

After the cause of the disease was found out, the oncologist came for consultation soon.

"It's a bit late. He can't tolerate chemotherapy in this condition." Director Xing said cautiously. He just found out that the patient was Director Guo's second uncle and that he was misdiagnosed.

"Would it have been better four months ago?" asked Dean Guo.

"This...this is hard to say." This question made Director Xing very embarrassed.

"What's so embarrassing about that? Just say whatever you want to say!" Dean Guo was unhappy. "I'm the dean. How could I become a troublemaker?"

"That would be much better. The survival period should be able to be extended for a considerable period of time..." Director Xing whispered. In fact, if the scope of surgical resection could be expanded, the result might be better, but he didn't dare to say.

Director Qiu of the Department of Neurosurgery was also feeling very nervous at this moment. They had just discussed this in the department.

Everyone agreed that the patient's first admission to the hospital combined with the patient's imaging examination diagnosis was a mass in the left prepontine cistern, and the imaging showed obvious mass.

The clinical symptoms included headache and ptosis of the left eyelid for 3 months, aggravated by numbness of the left upper limb for 1 month. Physical examination showed ptosis of the left eyelid and disordered left eye movement, which affected the patient's normal life.

Surgical treatment has clear surgical indications.

So it's all the pathology department's fault, and their neurosurgery department is not responsible at all.

But seeing Dean Guo's frown, Director Qiu swallowed a few times and said, "This... our neurosurgery department also has a great responsibility. We should urge the patient to have a reexamination."

The matter was eventually left unresolved. Investigation revealed that Director Ma of the Pathology Department had looked at nearly 600 films that day as he was on duty.

Because he was worried that he would not be able to complete his work, Director Ma arrived at the pathology department before 7 o'clock. Except for the half an hour he spent on lunch, he sat there until after 9 o'clock in the evening.

There are 62 people in the Pathology Department of the Provincial Hospital. Faced with nearly 4000 sections every day, the staff can only work around the clock.

"Mr. Ma has kidney disease and has not been in good health. He may have made a mistake in a hurry." Director Ding reported to Director Guo, "He is a very responsible person and has never made a mistake in his life."

"Why don't you recruit more people?" Dean Guo had a complicated expression on his face.

"I submitted an application, but someone didn't approve it," said Director Ding. I won't tell you who that person is, but I think you should know.

"We checked the pathology reports from that day, and only your second uncle's had problems."

Guo Dahe went to see Marx one month later, and Director Ding had his performance deducted for three months due to his management responsibility.

This is a later story. At this time, Gao Feng was communicating with Teacher Zhang’s husband.

"Are you a doctor from the provincial hospital?"

"Yes, I accidentally saw your brother-in-law having an epileptic seizure yesterday, so I thought of coming over to see what was going on." Gao Feng said.

"This is an old problem." Teacher Zhang's husband made a cup of tea. "Are you a neurologist?"

"I'm a general practitioner." Gao Feng replied, "I heard that he went to our hospital for treatment before, but it seems that no examination was done."

"Yes, the epilepsy occurred again that time, and he kept complaining of a headache." Teacher Zhang's husband described the specific situation at that time. Since then, Zhang Tianliang was unwilling to cooperate in going to the hospital.

"Well, the examination methods nowadays are much more advanced than before. We can look for the cause of the epileptic seizure." Gao Feng considered, "I think his onset was quite sudden. There should be some clues to follow."

"Oh, I see?" Teacher Zhang's husband hesitated and said he would discuss it with his wife.

Teacher Zhang came back soon. She heard that a doctor from the Provincial Hospital came to visit and was concerned about her brother, so she hurried home from school.

"Doctor Gao, you look quite young." Teacher Zhang's expression was a little disappointed, but she concealed it well.

"This is Director Gao of the General Medicine Department of our Provincial Hospital." Li Youliang said, "Director Gao is a Yangtze River Scholar."

"What?!" Teacher Zhang and his wife were shocked, because they knew the meaning of the Yangtze River Scholar title.

"Are you kidding me?"

"We are not that free to come here to play a joke on you." Li Youliang said, "Director Gao just happened to see your brother having an epileptic seizure and wanted to come over to check on him."

"I feel that this is quite strange, so I'm a little curious." Gao Feng said vaguely.

"He has an old illness." Teacher Zhang repeated her brother's condition, which was similar to what her husband had described.

(End of this chapter)