medical road with you

Chapter 68 I Will Definitely Pull You Back

After breaking up with Lu Ping, Tianhai flew abroad with Su Lin that day.

For four whole years, Lu Ping hadn't heard from Tianhai at all, until he suddenly appeared in Huaguang Hospital that day.

What Lu Ping didn't expect was that she saw Su Lin again at the wedding, and then, within a quarter of an hour, Tianhai was critically ill and fell into a coma. Everything was like acting, with endless surprises.

After listening to Lu Ping's words, Su Lin left. She walked so distraught that Lu Ping could feel that she seemed to have given up on her persistence for so many years.
Through the glass window, Lu Ping looked at the unconscious Tianhai: "Jiang Tianhai, listen carefully, you support me, I don't allow you to die, no matter what method I use, I will definitely pull you back, in this life, you and I Did not play."

Eight years ago, her beloved father fell into a coma. At that time, she knew nothing, knew nothing, and could only watch him leave her.
Now, the person she cares about the most is lying on the hospital bed again, this time, she will never let the tragedy happen again.
Back in the dormitory, Lu Ping dug out the textbooks on systematic anatomy, physiology, pathology, and neurology.
Lu Ping took a closer look at everything that involved the nervous system.
Many people engaged in scientific research only pursue the latest and most advanced technical knowledge, while basic knowledge is often ignored by them.
The foundation is not only the foundation of your profession, but all basic medical knowledge is very important.
Only when your foundation is deep enough and hard enough can you build a taller building.
Lu Ping, on the other hand, has always paid great attention to the solidity of his basic knowledge.
Muscle weakness, which is only the final clinical manifestation, has many causes for this symptom.
It may not even be a neurological disease, for example, hypokalemia can cause muscle weakness.
Muscle weakness, more specifically, is that the muscle bundle fibers cannot complete the contraction and relaxation functions according to the will of the brain.
The contraction of a muscle fiber is a nerve impulse sent by the upper motor neuron, which transmits the information to the lower motor neuron through the transmission of the synapse, and the lower motor neuron passes the synapse, and transmits the information to the effector through the neurotransmitter. That is skeletal muscle.
The skeletal muscle receives the signal, and through the adjustment of calcium ions, neurotransmitters and other chemical substances, it finally triggers the relative displacement of the thick and thin myofibrils in the myofibril, and realizes the contraction of the muscle.
With such a long chain of pathways, any error in any link will eventually lead to symptoms of muscle weakness.
Clinically, there are three main types of diseases that cause muscle weakness, motor neuron disease, nerve-muscle junction disease, and muscle disease itself.
Although Song Zixiang has always been more inclined to attribute Tianhai's illness to motor neuron disease, Lu Ping still thinks that he should think more about it.
At present, all she knows is that Tianhai has symptoms of dyspnea, and Lu Ping knows nothing about Tianhai's other conditions.
It seems that Tianhai needs to be examined carefully to gradually clarify the cause of the disease.
Today happens to be the end of the month, and the rotation of new departments will start tomorrow. This is also the last department for this year's interns. The hospital gave everyone a chance to choose freely. Originally, Lu Ping planned to go to the emergency internal medicine department, but now she Changed attention.
ICU will be her last practice department.
The next day when I went to the department to report, Lu Ping met an acquaintance.
"Why are you here?"

Lu Ping and Song Zixiang asked each other at the same time.
"I'm here for an internship." Lu Ping explained first.
"I applied to the director of the department. I will be on duty in the ICU this month, and the director agreed."

The ICU is somewhat similar to the emergency department, and several people are transferred from each department to take turns to be on duty every month.
"That is to say, you will be my tutor this month, Mr. Song, please give me your advice."

Song Zixiang was not amused by Lu Ping's half-teasing, but said solemnly: "I don't know if we can save Tianhai."

"What tests has he done now, blood routine, electrolytes, liver and kidney function have been checked?"

“The nurse has already drawn the blood and the results will have to wait.”

“What about EEG, EMG, CT and MRI?”

Seeing Lu Ping's eagerness, Song Zixiang said: "Lu Ping, I understand your anxiety to save Tianhai, but it's impossible to use all the tests on him. When he was abroad, his doctor in charge checked his EEG. The graph and electromyogram, and the MRI of the brain and spinal cord were also checked, and there was nothing abnormal."

"That was in a foreign country. How many months have passed since now. All the illnesses are constantly evolving and changing. Normal before does not mean that he is normal now."

Song Zixiang thought about it and nodded: "You're right. I'll give him an EEG and EMG test right now. As for the MRI, I'll contact the imaging department right away."

"Okay, you go to the doctor's order, I will give him a physical examination first."

"it is good."

Lu Ping walked to Tianhai's bed and looked at him seriously. He still closed his eyes and fell asleep peacefully, but his face was much thinner than before.
Holding Tianhai's forearm with his left hand and Tianhai's palm with his right hand, Lu Ping shakes back and forth, left and right.
The muscles are stiff, the resistance to movement is high, and the muscle tone is high.
Lu Ping changed another arm, the same performance.
Lu Ping tried the muscle tension and passive movement of the lower limbs, and did a tendon reflex experiment.
Muscle sclerosis and atrophy, increased muscle tone, and decreased tendon reflexes are very similar to the end-stage manifestations of motor neuron disease.
Is it really motor neurone disease?
The most common causes of motor neurone disease are genetic and immune factors, and a small number of causes are poisoning and viral infection.
If it's really a genetic factor, then even the gods can't save him.
Lu Ping, who kept cheering himself up, suddenly felt a huge sense of powerlessness.
No, Lu Ping suddenly thought of Jiang Fei.
Jiang Fei is almost fifty now, and he looks healthy, and Lu Ping has never heard Tianhai say that his family members have suffered from similar diseases.
Besides, Song Zixiang and the others must have thought of this reason, they must have done a chromosome test, if it was a genetic factor, the cause would have been clarified long ago.
"How is it? What kind of disease do you think?" Zixiang came over and asked after finishing the doctor's order.
"It's still like upper motor neuron disease, and now, he has high muscle tone in all four limbs."

Zixiang walked over and tried roughly: "Now the performance is more obvious. Before, his muscle tone was not so high."

"Has he checked the chromosomes?" Lu Ping still asked.
"Check it out, chromosome 21 is fine."

"What about immunology-related tests?"

"I also checked, and there is nothing unusual."

"What about the poisoning factors, have you checked the trace elements such as aluminum, manganese, copper, and silicon?"

Seeing that Lu Ping started to get angry again, Zixiang said: "Lu Ping, don't be so anxious, Tianhai has been ill for a long time, I believe his attending doctor will screen him for all the factors that can be considered, we Take your time, and investigate one cause at a time, if you are too anxious, you will ignore some clues."

Lu Ping focused on Zixiang's first sentence: "How long has he been ill?"

"The first time I knew he was sick was half a year after he went abroad. At that time, he said that he felt weak all over. I thought it was just a moment of fatigue. I didn't expect the condition to get worse."

"You said that his condition was good and bad, did you find any pattern, what is the incentive for the aggravation of the condition?"

Zixiang thought about it carefully for a while: "I saw his condition worsen once with my own eyes. At that time, he seemed to have a dispute with someone. At that time, he suddenly fell to the ground, twitched once or twice, and couldn't move."

Does your condition get worse after arguing with others?
What is the mechanism, Lu Ping couldn't figure it out for a moment.
Seeing that Lu Ping thought about it for a long time without saying a word, Zixiang said, "Lu Ping, I know you care about Tianhai very much, but don't forget, you didn't come to the ICU to take care of Tianhai alone, and there are several patients who need us to take care of them. ."

Hearing what Zixiang said, Lu Ping bowed his head in embarrassment: "I understand. I don't understand the illnesses of the other patients. I'll go to see their medical records first, and then I'll do rounds with you."

"Alright, go ahead."

**
At two o'clock in the afternoon, some basic inspection results of Tianhai came out.
Serum potassium is normal, except for mild anemia, all test results are normal.
Creatine phosphokinase (CK) is also normal, which basically excludes the lesions of the muscle itself.
At three o'clock in the afternoon, people from the central laboratory came.
The first thing I did was the EEG, except for a very small number of abnormal β waves, it was basically normal.
Then, there's the EMG.
Song Zixiang didn't have much hope, because, after checking it several times before, it was basically normal.
Lu Ping stared at the screen carefully.
The nerve conduction velocity is normal, but there are abnormal motor unit action potentials, MUAPs time limit is widened, the amplitude is increased, and the percentage of multiphasic waves is increased, typical neurogenic changes.
As soon as the results were printed out, Lu Ping quickly tore off the paper and handed it to Song Zixiang: "Teacher Song, look!"

Song Zixiang stared at the graph for a long time: "It's really motor neuron disease!"

I have always suspected it before, but this time I got very strong diagnostic evidence.
"Why didn't there be any abnormality in the previous inspection?"

"That's probably because the disease hasn't progressed to that point yet."

"But, the cause of the disease, the cause of his disease, the chromosome and immunology have been checked, and they are all normal."

"Then check again."

"Okay, check again!"

The electromyogram will show different results again, and the other tests may also show different results.
Hopefully it's the immune factor!
Lu Ping prayed over and over in his heart.
If it is due to immune factors, through plasma exchange, at least it can last for many years.
If it's the inheritance factor, then she is really desperate.
Outside, it was already dark, Song Zixiang looked at the time, it was already seven o'clock.
"Lu Ping, it's time for you to get off work."

Lu Ping, who had been in a daze, realized: "Oh, I see."

Lu Ping started to pack his schoolbag, and Song Zixiang also took off his white coat.
"Let's go together."

When he walked to the gate of the ICU and was about to change his shoes, Lu Ping couldn't help but look back at Tianhai, his right calf seemed to be slightly red.
"You go first, I'll go see him again."

"Lu Ping!" Song Zixiang couldn't help but glared at Lu Ping: "You haven't eaten dinner yet, if you don't eat on time, how can you continue to take care of him in good health."

Lu Ping looked at Song Zixiang with a bit of begging in his eyes: "I know, I'll go back to eat right after I take another look, you go first."

"never mind!"

Song Zixiang angrily left alone.
Putting on the shoe covers and wearing the mask, Lu Ping walked to Tianhai and lifted his calf.
It was indeed red, his muscles were hardened already, and he was lying in one position all the time, so he was prone to bed sores.
Bedridden patients often die from two major causes, a lung infection and a skin infection known as bedsores.
Lu Ping thought for a while and asked the nurse on duty: "Are there any clean towels and hot water?"

The nurse replied enthusiastically: "Yes, there are in the duty room."

Lu Ping found an unused towel, took a basin of warm water at about [-] degrees, washed the towel, and wrung it dry.
Holding the towel, Lu Ping walked to Tianhai's bed, first helped him wipe his face, then his neck, and his hands.
The towel cooled down quickly, but basins were not allowed in the ICU ward, so Lu Ping quickly ran back to the duty room, reheated the towel, and then helped Tianhai wipe it.
Arms, chest, lower limbs.
After finishing wiping the front, Lu Ping turned Tianhai aside, and carefully wiped the back, waist, buttocks bit by bit.
Back and forth, Lu Ping did not know how many times he went back and forth.
Finally, when he reached the red and swollen calf, Lu Ping covered it with a hot towel for a while longer.
After a lot of tossing, it has been more than an hour.
Before, he just gave him a simple physical examination, but this time he wiped his body, Lu Ping realized that the muscles on Tianhai's body were extremely stiff.
Putting the towel back in the duty room, Lu Ping knew it was late and she should go back, but seeing Tian Hai's thin face, Lu Ping couldn't help but walked towards him.
Lifting one of Tianhai's ankles, Lu Ping started from the ankle, little by little, to help Tianhai massage his muscles.
Lu Ping was awakened by Chi Na's phone ringing, and at some point, she fell asleep lying on Tianhai's bed.
"Hey, Pingping, why don't you go back to the dormitory?" Chi Na asked loudly on the phone.
Lu Ping looked at the time, and it was already ten o'clock: "Oh, I'm going back from get off work right now."

"Are you still off work?" Chi Na's tone was somewhat reproachful.
"Let's go."

Lu Ping glanced at Tianhai's monitor, and found that all indicators were normal, so he left the ICU with his schoolbag.
"You just got off work, so you won't even have time to eat dinner."

Lu Ping didn't make a sound. Today, she didn't feel hungry.
Chi Na became even angrier: "You, really, go back to the dormitory quickly, I just brought you something to eat."

What Chi Na brought to Lu Ping was vegetarian roast goose, which was still warm.
Seeing Lu Ping chomping there, Chi Na said, "Jiang Tianhai, how is he?"

Lu Ping paused: "Still in a coma, but the diagnosis is basically confirmed, it's motor neuron disease."

"Motor neuron disease?" Chi Na exclaimed, not knowing what to say. In her impression, the prognosis of this disease is quite poor.
"I'm sorry, Pingping." Chi Na looked at Lu Ping and said carefully.
If she hadn't suddenly slapped Lu Ping at that time, causing a series of accidents later, perhaps Jiang Tianhai's condition would not have suddenly deteriorated.
"It's not your fault. His condition has reached that stage. Respiratory failure occurred only a few days earlier or later."

"Then, what are your plans?" Chi Na asked while observing Lu Ping carefully.
If Chi Na had suspected that Lu Ping had no more love for Jiang Tianhai before, then seeing Lu Ping so recklessly rushing into the elevator with Jiang Tianhai in his arms, Chi Na was very sure that Lu Ping had more than no more love for Tianhai, it was unforgettable.
About 'Song Zixiang', Zhou Feng also told Chi Na, and Chi Na completely gave up the idea of ​​making him and Lu Ping a couple.
"Bring him back!" Lu Ping said very firmly.
"But what if"

Faced with all kinds of strange diseases of human beings, modern medicine seems so helpless, there are too many diseases, even the most brilliant doctors can't do anything.
Chi Na didn't finish her sentence.
Seeing that Chi Na was still talking, Lu Ping patted Chi Na's hand: "Okay, let's not talk about me, how about you, how does it feel to be an intern in the pediatrics department?"

"Very good, I like dealing with children." Chi Na pursed her lips, stammering: "Actually, there is one more thing I want to tell you."

"What's up?"

"The Pediatrics Department of Liyang District Hospital has agreed to admit me."

"That's a good thing, congratulations, you've found a job you want, and soon, you'll be able to make money with your wages."

"And one more thing."

"besides?"

"Next month, we will graduate. Brother Feng and I plan to hold a wedding next month."

This time, Lu Ping really smiled: "Nana, you are really good at both love and career, double happiness, congratulations!"

Chi Na didn't smile, pulled Lu Ping over, and leaned her head on her shoulder: "Pingping, thank you so much, thank you for being able to say congratulations to me. I know, you must be very worried about Jiang Tianhai now, and I will tell you at this time The news of my marriage, I myself feel that I am too much."

"But, you are my best friend, and I want to share my joy with you."

Lu Ping put his hand on Chi Na's shoulder: "I understand, I'm not angry with you."

"Hey," Chi Na sighed: "Pingping, you know what, I thought a long time ago that Brother Feng and Jiang Tianhai are so good friends, and we are best girlfriends, if the four of us can hold the wedding at the same time, then How nice it would be."

Lu Ping stroked Chi Na's hair, but said nothing.
In fact, it's not just Chi Na, she thought the same way back then.
(End of this chapter)