I run a clinic in the United States

Chapter 386 Luo Yourong

"San Francisco is better, warm in winter and cool in summer. The key is that Zhou Qiao is here."

Elena and Ava were on "vacation" in San Francisco and played for a long time. The Queen Princess of Northern Europe called them and asked them to go back, but they were unwilling.

After all, they grew up in San Francisco, so the climate, environment and food here are more suitable for them.

Vacationing in Northern Europe is great, but long-term living is really not as comfortable as San Francisco.

Of course, the most important thing is that, being with Zhou Qiao every day, it is reasonable to be happy and reluctant to miss Shu.

In Northern Europe? Staying alone in the empty boudoir every day is very lonely.

Unfortunately, Murphy is pregnant now and can no longer play with them. It's a pity.

Anyway, the Queen Princess urged them many times, and Elena and Ava both made various excuses and tried to shirk them over and over again. They wanted to stay here if they could.

I just occasionally go back to visit if something happens or if I miss my mother.

Based on the current strength of Baiyan Hospital, it is estimated that it is similar to Zhuhai County People's Hospital. The overall strength is not bad, but it does not have top experts, so when it comes to difficult diseases, it has to seek help from Iris Clinic.

"Let them go, as long as they are happy."

The couple could only comfort themselves in this way.

It's crazy at night, with all kinds of nonsense and embarrassing postures, but during the day everyone is serious about going to work.

However, compared with traveling long distances to the United States for surgery and being hospitalized in a local East African hospital, it is very cost-effective.

"But, I really want to!" Ava was still eager to give it a try.

However, for them, it doesn't matter whether they grow up or not. They are destined to live a life of food and clothing without worries.

One of the main reasons for such rapid development is that medical expenses in the United States are so high. For most middle- and lower-class residents, relatively economical telemedicine is more cost-effective.

Of course, the kind of intercontinental surgery Zhou Qiao had done before was still expensive. This is because the surgery itself is extremely difficult.

Zhou Qiao now easily distinguishes Elena from Ava. In fact, a long time ago, he could easily tell the difference between these two girls. The experience was completely different, but now it is even easier.

Sequoia Hospital can't help them much now because White Rock Hospital has grown.

Elena was the same, her green eyes narrowed.

Ava secretly discussed with her sister: "Murphy and Stephanie are pregnant, should we also get pregnant? It would be fun to have a baby."

Zhou Qiao, Murphy, Stephanie, Chiba Nanako, and the twin girls were all together, conducting a remote consultation.

……

Since Stephanie has done so impressively, given her relationship with Stephanie, she simply won't take it back.

They received a request for support from White Rock Hospital in Texas.

She looks sweet and majestic. If she were to put on a queen's outfit, she would definitely be the kind of mother who would grace the world.

I couldn't stay for a few days after I went back, and I couldn't wait to return to San Francisco.

Baiyan Hospital has now begun to take shape and is running well. It can be said that it is on the right track.

Iris Clinic, conference room on the second floor.

Among other things, there are many large telemedicine companies in the United States, including Teladoc Health, American Well, Grand Rounds, MORE Health, etc. Many of them are listed companies and have formed a sizable industrial chain.

Although Ava is very similar to Elena in appearance, she still retains her previous playfulness and innocence. It can be said that she has not really grown up.

Elena really had no choice but to comfort her: "Let's talk about it later."

However, Elena did not take back the financial power from Stephanie, because she is now a royal princess, and she is just playing around in the clinic.

The crown prince and her husband smiled bitterly and joked with each other: "When daughters grow up, they no longer listen to their parents."

"Why is it inappropriate?" Ava pouted.

She has lived in Harvard Yard since she was one year old, and has been raised and taught by two top academicians as if she were her own grandson. To be honest, even their future children may not be able to enjoy this kind of treatment.

As princesses, they will most likely become crown princes or queens in the future, so they have many things to consider.

Ava suddenly wilted. The royal family had to reject the scandal. Although having children out of wedlock is not illegal in the United States, it has a somewhat negative impact on the Nordic royal family.

They finally found their biological daughter and doted on her very much. Since the daughters wanted to live in San Francisco for a long time, they could live there, it was no big deal.

The royal family and the throne are now just symbols and are not that important to the operation of the national system.

The development level of telemedicine in the United States actually far exceeds that in China.

"Wow~" Ava was envious again. Although she already knew the "inside story", she really couldn't help being envious.

"Furthermore, Murphy and Stephanie are pregnant and will give their children away in the future. They are too lazy to take care of them themselves. Murphy said that they will only send the children to Harvard University when they are one year old at most."

As she adjusts to her status as a princess, Elena's situation becomes bigger and bigger.

Elena was startled and quickly warned her in a low voice: "It's not appropriate now."

Elena and Ava returned to work at the Iris Clinic again. Everyone else was at work, so they were the only ones hanging out, and they couldn't stay any longer.

Chiba Nanako is very happy to have twin girls here. For her, one third of the firepower was just right.

Elena shrugged: "How do you explain to daddy and mommy? How do you explain to the royal family?"

Even if he inherits the throne in the future, he can still live abroad.

One of the core competitiveness of telemedicine is cost-effectiveness.

Medical treatment in China is cheap, the medical insurance system is more reasonable, there are many hospitals, doctors and nurses will not go on strike, and the waiting time at the hospital will not be as outrageous as in the United States. Compared with telemedicine, Chinese people still prefer to go to the hospital for in-person diagnosis and treatment, which is more reliable Spectrum.

The largest telemedicine giant in the United States is probably Teladoc Health, which was established in 2002 and listed on the New York Stock Exchange in 2015. It has since continued to expand into the global market through acquisitions, focusing on services such as primary care and telemedicine for complex diseases. , in 2021, the stock market value once reached 230 billion US dollars. Of course, now I have fallen into a state of decline.

The company has five sub-brands, namely Teladoc, Advance Medical, Best Doctors, BetterHelp and HealthiestYou.

There are also many other listed companies.

In the United States, telemedicine companies have sprung up like mushrooms after a rain, rushing to seize the market.

Zhou Qiao's own clinic and several of its hospitals were too busy with business, so he did not participate in expansion. He takes a sophisticated route.

The patient admitted to White Rock Hospital this time is a 40-year-old Texas woman. She developed high fever about days ago, with a body temperature as high as °C, and her right inner thigh was red and swollen.

After being admitted to the hospital, the woman's condition worsened. Not only did the swelling of her right thigh intensify, she also developed a large area of ​​skin damage of 25cmx25cm, accompanied by blisters and pus-like changes, and her white blood cells were as high as 14x109/L.

After a week of anti-infective treatment, the patient's condition not only did not improve, but continued to worsen.

Blood tests found that the levels of infection and inflammation markers were elevated, and neutrophils continued to rise, reaching 44.67X109/L.

What puzzled and surprised the doctors was that no pathogenic microorganisms were detected in wound culture, blood culture, or NGS sequencing. Later, a vascular Doppler ultrasound was performed, which ruled out that the ulcer was caused by venous insufficiency or arterial disease.

When understanding the condition, doctors at Baiyan Hospital learned that the patient had high fever and skin lumps once or twice a year since he was twelve years old.

When the infection and fever were ineffective, Baiyan Hospital decided to use hormone therapy.

After a period of treatment, the patient's symptoms did improve, but the specific cause is still unknown.

So, Baiyan Hospital asked Boss Zhou for support.

Murphy and the others expressed their opinions, and finally everyone reached an agreement that if the patient has no bacteriological evidence, febrile neutrophilic dermatosis should be considered, and hormone therapy can be continued.

Just as Baiyan Hospital was preparing to conduct wound biopsy and other further examinations on the patient in accordance with the instructions, the patient's right upper limb developed redness, swelling and skin ulcers. Not only did he have a high fever, but he also developed critical symptoms such as dyspnea, reduced ejection fraction, and pericardial effusion. .

After consultation with the Iris Group, it was decided to immediately transfer the patient to the burn intensive care unit.

The progression of the patient's disease must be controlled first.

Under the remote guidance of Iris Tiantuan, the Baiyan Hospital team used ultrasound, USCOM and other circulatory function assessments to find that the patient's cardiac electrophysiology showed no abnormality, but myocardial systolic dysfunction was present, indicating that the patient's cardiac dysfunction was not sepsis. cause.

"Let the patient adopt a semi-recumbent position, control the dosage, and apply diuretics." After Zhou Qiao pondered for a moment, he gave the order.

The medical team at Baiyan Hospital was shocked. Isn't this too risky? And it’s very strange!

Because Boss Zhou’s instructions are completely opposite to the traditional treatment plan of sepsis fluid resuscitation and dynamic support.

No one questioned Boss Zhou's order.

They didn't understand and could only say that their level was low and they did not understand the subtleties of Boss Zhou's measures.

Therefore, this does not prevent them from executing it immediately and unconditionally.

Soon, a miracle happened.

After following Boss Zhou's instructions, the patient's urine output gradually exceeded the intake, the pericardial effusion was reducing, and the ejection fraction was also improving.

Nanako Chiba: "Will such treatment cause pathological dehydration in patients?"

"It's possible. But for the patient's current condition, it should be the best solution I can think of."

Several other girls also agreed.

Murphy suggested: "Closely monitor the patient's electrolyte changes. If there are abnormalities, we will adjust the plan."

Fortunately, the patient's condition gradually improved over the next few days. The partial pressure of oxygen returned to normal, dyspnea was relieved, chest CT improved significantly, and the crisis was temporarily relieved!
The medical teams at Iris Garden and White Rock Hospital breathed a sigh of relief.

However, if it is just like this, it cannot show the level of Iris Sky Group.

What is treating the symptoms? Treating the root cause is the real skill!
Iris Flower Tiantuan arranged a serial combination investigation plan. After receiving it, the Baiyan Hospital team immediately began to implement it intensively.

This is a medical case that requires close cooperation from multiple disciplines and is quite complex. However, this case can also improve the overall strength of Baiyan Hospital.

After obtaining detailed data, Iris Tiantuan combined pathology and reality and confirmed the previous diagnosis: acute febrile neutrophilic dermatosis.

After using hormone therapy, the patient's high fever was controlled and the redness and swelling of the damaged area began to subside.

However, such a large wound inherently carries the risk of skin and soft tissue infection. Topical antibacterial drugs may induce allergies or aggravate systemic lesions due to drug side effects. Precise medication use is particularly important.

Fortunately, this is Chiba Nanako's specialty, and Zhou Qiao is relieved to leave it to her.

Chiba Nanako made a suggestion. Non-chemically absorbable dressings can be used for wound treatment to actively prevent infection and promote healing. Then, you can also use "Delska" in appropriate amounts, which will be very helpful to the patient's condition.

It's expensive, but worth it. The consent of patients and families was also obtained before use.

Subsequently, under the leadership of Zhou Qiao, the Iris Group conducted etiological examinations from multiple lines such as hematology, rheumatism and immunity, endocrinology, tumors, inflammatory colitis, and pregnancy failure history.

In the follow-up treatment, Nanako Chiba made step-by-step adjustments to the patient's hormone dosage, combined with immunosuppressant therapy and other treatments to actively control the primary disease.

At the same time, thanks to the use of the miraculous drug "Delska" and the use of advanced dressings in wound treatment, the wounds healed wetly, promoting autolysis and debridement of necrotic tissue, reducing pain and accelerating healing.

……

After a series of combined punches, the patient's wounds began to improve, the growth of granulation tissue gradually shrank, and the heart function returned to normal. Subsequently, he was transferred to the general dermatology ward for further treatment.

During the treatment of this patient, many departments of Baiyan Hospital, such as the burn and plastic surgery department, dermatology department, rheumatology and immunology department, hematology department, etc., under the coordination of Zhou Qiao, conducted close collaboration for the first time since the hospital was established. Not only has the work routine for disease diagnosis and decision-making and cause screening of difficult wounds been established, but a multidisciplinary MDT mechanism has also been established for programmed disease judgment, condition assessment and cause search for patients with critical and difficult wounds.

It can be said that after this case, Baiyan Hospital has greatly improved its experience in treating critical illnesses such as difficult-to-heal wounds and severe burns, and is no longer inferior to Sequoia Hospital.

Both hospitals grew, and Loya was very happy, so she decided to start planning to build a third hospital in Texas.

Her plan is to build ten hospitals within ten years to take care of all remote or relatively remote medically vulnerable areas in Texas. This is also a very big cake.

Not only can it attract votes, it can also be quite profitable.

Zhou Qiao also took time to go to Texas, firstly to guide the work of two hospitals, and secondly because he missed his "wife" and four sons.

The four big fat boys can already crawl around and are very naughty.

Perhaps they inherited Luo Ya's "martial arts". Although they had not yet learned to walk, the four brothers often fought together.

Zhou Qiao took care of these four "noisy" sons for a few days, but couldn't stand it. No wonder Teacher Domitri disliked them.

Luo Ya rolled her eyes at him: "You've only been with him for a few days? If you dislike him, just don't come here in the future."

"How could it be? My own seed is a treasure no matter what it is. Moreover, good physical fitness and good at sports are advantages. Maybe we can produce a few Olympic champions in our family!"

"Haha, Olympic champions or something. If they grow up, they can get one to play with if they want." Luo Ya is still very confident in her sons. To be honest, if she hadn't gone undercover as soon as she graduated, but had gone to the sports world to develop, she might have become an Olympic champion now.

I dare not say anything else, but gymnastics and shooting are all pretty confident.

Zhou Qiao was in Texas, and it was natural that he and Luo Ya were separated for a little while, and they were engaged in constant battles.

The other girls were no match for Zhou Qiao in one-on-one combat, but Luo Ya and Zhou Qiao were evenly matched.

It has to be said that after giving birth to a child, Luo Ya not only maintained a well-maintained figure, but also had a more gentle and charming temperament.

"Let me give you a Chinese name." Zhou Qiao said as they hugged each other on the bed in the middle of the night, rubbing their ears and temples together.

"What's your name?"

"Luo Yourong."

"What a bad name! It's so ugly!"

Zhou Qiao whispered a few words into her ear, detailing their meaning.

"Bad guy, let's see if I don't suffocate you to death!" Luo Ya was rarely shy.

However, despite her appearance, it does not affect her usual agility.

(End of this chapter)