This doctor has a system

Chapter 557 620. Smells so good!

The leaders didn't quite understand this, but they were all very happy. They had all heard that the total investment in this project was as high as 5.6 million US dollars.

That’s 5.6 billion US dollars!
This is a huge political achievement, and everyone who gets a share of the cake will feel excited.

The happiest person among them is probably the district leader. The leader himself attaches great importance to Fengxin Technology. There is nothing he can do about it. This company is small, but the taxes it pays are frighteningly high. The key is that the company has a background.

He had always been very friendly when he had been in contact with Gao Feng before, and now he was smiling so much that all the wrinkles on his face disappeared.

"You must not forget your roots!" Director Guo also called, "Please include the name of the hospital when publishing the news!"

"Forget it. You're so busy. It's useless for me to tell you." He called Li Youliang directly. "Youliang, I'll arrange something for you. Please give it to me."

"Can these Chinese people do it?" A small island whispered to the minister, Masuyama Shuichiro, "They seem to have mediocre abilities."

"Let's wait and see." Hideichiro Masuyama said uncertainly. It has been more than half a month since he came here, and there has been almost no progress on the project.

So far, these Chinese have not yet figured out the experimental records they brought with them.

However, thinking of Gao Feng's sharp remarks in Sweden, he felt inexplicably filled with confidence.

After Gao Feng came back, he directly threw the improvement steps to Hu Jiaran, who still hadn't fully understood them. But he wasn't in a hurry, because it wasn't a good idea to do the project too fast.

They took 5.6 million U.S. dollars in real money, and a few days later, you said: Okay, come and get your things.

This is an extremely hurtful behavior to the other person's physical and mental feelings, and will most likely lead to disputes.

It's like asking someone to open your lock when you forget your keys. He clearly states the price is 100 yuan, and you accept it. But when he comes, the lock is opened in 3 seconds. You will definitely feel that the money is not worth it.

Some people even say, "This is too easy, how about 10 bucks?"

But if the master has been busy at the door for more than two hours and finally opens the door, you will definitely give him the 2 yuan sincerely, and I would feel guilty not not giving it to you.

Hu Jiaran also understood this truth. He decided to complete the project step by step in half a year in an effort to satisfy both parties.

At the East Campus of the Provincial Hospital, several tall sycamore trees stand tall in the mottled sunlight. Their branches and leaves sway gently in the breeze, making rustling sounds, as if they are whispering.

Under the tree, some stone chairs were placed in appropriate locations for patients and their families to rest. Occasionally, a patient would sit on a chair with a little fatigue, looking up at the broad tree canopy, trying to find a little comfort from the dense greenery.

Under the shade of these trees, the walls of the hospital no longer seemed so cold, and the footsteps of the medical staff walking through them seemed to become much softer.

Although the air in the hospital is filled with the pungent smell of disinfectant, the fragrance of the sycamore trees brings a touch of comfort whenever the wind blows.

"Zhengyang, am I not qualified to be the director?" Gao Feng asked, "I disappeared for almost two months."

"No, I'll talk to Dean Guo about it and let you do it."

"Director, I didn't make any mistakes, did I?" Bu Zhengyang said nervously. He felt that he did a good job.

'No."

"Then why are you so sarcastic?" Bu Zhengyang said aggrievedly.

Gao Feng clearly felt that he was very sincere.

He thought about it. Bu Zhengyang is now in charge of the department's work. It seems unreasonable not to give an explanation. If not, he can promote him to deputy director of the department.

The department has been really stable during this period, except for some trivial complaints.

A nurse was changing the medicine and whispered, "The packaging is not damaged, the medicine name is correct, the patient's name is correct, everything is normal." However, the patient complained that there was a curse in his medicine.

There was also a resident trainee who was complained by a patient. When he was looking at the patient's throat, he said to the patient: "Open your mouth wide." Because the female patient's surname was Zhang, she felt insulted and ran to the medical and patient office and made a fuss for two days.

The incident ended because on the way back, a patient's family member asked her for directions and praised her when thanking her: "You look like a celebrity, what's her name? Oh, I remember, Yao Chen, Yao Dazui!"

"Doctor on duty, bed 58 has a fever again, 37.8℃." The nurse said into the intercom.

"I'll go and take a look." The intern, who was a little drowsy, woke up suddenly. He rubbed his sore eyes, put on his white coat and walked out of the duty room.

"She has had a fever for many days. I usually give her a tablet of ibuprofen." The night nurse kindly reminded me. The implication was that I could just give her the doctor's orders and go back to sleep without having to run to the ward.

The resident paused for a moment, and finally decided to go see the patient. This was something the teaching secretary had repeatedly emphasized when he entered the department: if the patient felt unwell, it was best to go and see him in person, as this was the basis for becoming a good doctor.

As long as you do everything yourself, it won’t be long before you are faster than others in all aspects, such as: progress faster, faster heart rate, faster aging, and faster death.

"It's OK, I just have a slight headache." The patient in bed 58 was a 58-year-old middle-aged woman. She yawned and said, "Give me a fever-reducing pill."

At this moment, the roar of the family member sleeping next to him was deafening, and the intern couldn't help but frown.

"Your sleeping environment is terrible!"

"Ah?" The eldest sister was stunned for a moment, then she laughed, "It's okay, I'm used to it."

Seeing that the patient was in good condition, the trainee felt relieved, "It's not good to take antipyretics for a long time, it will irritate the stomach."

"Your fever isn't that high. You can use an ice pack to cool it down physically."

"I'll listen to you." The eldest sister is very compliant.

The nurse who received the notification quickly brought an ice pack for physical cooling to the patient, who took it swiftly.

About an hour later, the intern who had just fallen asleep was awakened again by the sound coming from the intercom.

"It's still the lady in bed 58," the night nurse said in a complicated tone, "She"

"What happened to her?!" The trainee was shocked. "Quick, call the second line!"

"Don't!" the nurse hurriedly stopped her, "Her temperature has dropped."

After five seconds of silence, the trainee on duty said a little unhappy: "And then?"

The body temperature has dropped, what can you say on the intercom?
He is indeed quite handsome, tall, and speaks quite humorously. Could it be that this nurse is attracted to him?
The possibility is very high! The more the intern thought about it, the more likely it seemed.

"She drank the ice pack." The nurse's next words left him speechless, "I didn't expect that either. I told her it was physical cooling."

The patient tore open the ice pack and drank it with water. When the nurse came to measure the temperature, the elder sister told her happily that the temperature went down quickly after drinking the glass of ice water, and the effect was very good.

She is old and energetic now.

"It has nothing to do with me. You should take the responsibility tomorrow." The trainee said unhappily.

the next morning

"Brainless idiot." The head nurse pointed at the night nurse and cursed, "How long will it take you to say a few more words? Huh?"

"She used it before. We told her to wrap a towel around her armpits." The nurse felt a little aggrieved. "I don't know if she was confused by the fever yesterday or what."

"Write a 200-word self-examination!" The head nurse glared at him, "Finish it before you leave work!"

Gao Feng felt a little sorry for the nurse, but this was indeed caused by inadequate notification, and the head nurse did nothing wrong. Fortunately, this was a relatively minor mistake, and the patient did not show any symptoms of discomfort.

Huang Huili, female, 58 years old, was admitted to the Hematology Department of the Provincial Hospital with the main complaint of "fever for half a year", and was later transferred to the General Medicine Department.

The patient started to have fever half a year ago, with the highest temperature reaching 40°C. He initially thought he had a cold, so he took some medicine at a local clinic, but there was no relief.

So I went to the town hospital and received intravenous drips for a few days, but the fever was still not under control and I had a fever several times a day.

Her family felt something was wrong, so they sent her to the local county hospital, where Huang Huili was hospitalized for more than 20 days.

"He had a low fever for a while, but within two days of returning home, his temperature went back up again." The family members were almost worried. "Experts, you have to take a closer look at him."

When the patient was examined at the local county hospital, it was found that the total bilirubin, direct bilirubin, and indirect bilirubin were all high, and the routine blood test showed a decrease in the number of red blood cells.

A bone marrow puncture was performed, and the proportion of nucleated red blood cells in the smear increased significantly, dysplastic hematopoiesis was seen, and ring sideroblasts were seen. The patient was diagnosed with myelodysplastic syndrome.

This was also the reason why she was initially admitted to the Provincial Hospital's Department of Hematology.

However, according to the "Chinese Diagnosis and Treatment Guidelines for Myelodysplastic Syndrome" formulated by the Hematology Branch of the Chinese Medical Association, the diagnosis of myelodysplastic syndrome must meet two conditions: persistent reduction of one or more lineages (≥6 months) and exclusion of all other hematopoietic or non-hematopoietic tissue diseases.

In addition, some auxiliary conditions are needed for diagnosis, such as flow cytometry detection of bone marrow cell phenotype, gene point mutation analysis, progenitor cell colony formation detection, etc.

The county hospital did not conduct these tests for the simple reason that they did not have the conditions.

The Provincial Hospital's Hematology Department performed a bone marrow puncture on the patient again and also performed flow cytometry to detect the bone marrow cell phenotype. The results suggested that the possibility of myelodysplastic syndrome was low.

Most patients in the Department of Hematology have poor resistance, and everyone feels uneasy when a patient with unexplained fever is placed here.

So they called the doctor from the infectious disease department, saying that the patient had a long-term fever and had to be transferred to you.

The infectious disease doctor said there were no beds available, "No, transfer to the general practice department. We can go for a consultation."

Gao Feng looked through the results of the lady's examination, which were very detailed. The doctor from the infectious disease department recommended ruling out malaria, Leishmania, dengue virus, Salmonella typhi, Brucella, Leptospira, and Babesia.

Some common sources of infection that cause fever were not spared, such as Coxsackie virus, Epstein-Barr virus, cytomegalovirus, herpes virus, dengue virus, pneumotropic virus, respiratory syncytial virus, rhinovirus, tuberculosis, etc.

But the results were very disappointing, all were negative.

Blood cultures were drawn four times, but no bacteria were found, and the diagnosis was at a standstill.

Gao Feng also felt it was very strange. Logically speaking, if it was an infectious disease, such a long period of treatment should have been effective.

The patient had used antibiotics such as meropenem, levofloxacin, vancomycin, cefoperazone sodium and sulbactam sodium, and even used artemisinin, a drug for malaria, for a period of time.

But these empirical medications had no effect at all, and Huang Huili still had a fever every day.

Because she had been having a fever for too long, her body's tolerance to fever has increased significantly. Now, as long as her body temperature does not exceed 39°C, she only feels fatigue and a mild headache.

After Gao Feng returned to the office, he reviewed the patient's examination results. The upper abdominal CT scan done three days ago showed: hepatosplenomegaly, and dilatation of the portal vein.

This symptom cannot be explained by myelodysplastic syndrome. Could it be that the patient was really misdiagnosed in the county hospital?

"Could it be early liver cirrhosis with secondary hypersplenism?" Bu Zhengyang asked, "Or hemolytic anemia and connective tissue disease?"

"The possibility of hypersplenism secondary to cirrhosis is very small." Gao Feng replied.

Because in case of liver cirrhosis, in addition to elevated bilirubin, liver enzymes should also be elevated, but the patient's liver enzymes were normal. In addition, hypersplenism is a three-line reduction, which usually first causes a decrease in white blood cells and platelets, and then a decrease in red blood cells, but this patient's white blood cells and platelets were normal.

Hypersplenism secondary to cirrhosis should indeed be considered, but Gao Feng feels that a very important item has been missed: why does the patient have repeated fever?
"There should be concurrent infection. For example, the blood system of patients with hemolytic anemia is affected, which may affect the immune system. The patient's white blood cell count is 3.7×10^9/L. Although it is not lower than the normal value, it is also a critical value, and there is a risk of infection."

"What you said makes sense," Gao Feng said, "but it's not right."

Step into the sun.

"I think we should try to use monism to explain it. Have you ever thought that infectious diseases may cause this series of liver enlargement, anemia, jaundice, and fever?"

"But this series of tests are all normal." Mao Wen on the side said with a frown. The current situation is that everything that can be checked has been checked, but no valuable evidence has been found.

This is the problem. Gao Feng is also very puzzled. What kind of difficult and complicated disease is this?

"Stop taking the antibiotics first," he said, adding that drug fever also needed to be eliminated.

Two days later, Gao Feng went to see the patient again. She was in good spirits, but still had a fever. Sighing, Director Gao prepared to go home for dinner.

Just at this moment, he smelled a fragrance.

"The family of bed 58 sent this meal. It seems their family runs a breeding farm. There is a lot of meat!" Mao Wen said happily, "Director, you should come and have some too."

The disease hasn't been cured yet, how dare you eat other people's meat? Gao Feng despised him.

"It's so fragrant!"

Gao Feng picked up another large piece of mutton and said, "Is this made by the family members themselves? Their craftsmanship is amazing."

"Yes, they specially transported the meat from home and found a nearby kitchen to cook it." Mao Wen quickly picked up the meat while speaking.

(End of this chapter)