White armor

Chapter 15 Appendicitis that still hurts after surgery
Luo Hao didn't even ask what happened. He ran out of the house without brushing his teeth or washing his face and put on the sign 307.

Drove to the hospital.

"Luo Hao, there is a complaint from the general surgery department. Please take a look at the medical records."

After entering Lin Yuming's office, Lin Yuming went straight to the topic without any hesitation.

"The patient was diagnosed with acute appendicitis and had constant pain in the right lower abdomen after appendectomy. Director Wen said that the patient was pretentious and the pain threshold was too low. But after half a month, the situation had not improved. When I went to Director Wen, he ignored the patient. Finally, The patient’s family complained to the medical office.”

Lin Yuming stood up and handed the computer to Luo Hao while briefly introducing what happened.

Pain after appendectomy?

Luo Hao's first feeling was that there shouldn't be any problem.

But if it hurts for a few days, it won't be a problem. If it hurts for half a month, it will become a serious problem.

Before Lin Yuming finished speaking, Luo Hao heard the sound of system tasks dinging in his ears.

[Urgent mission: It’s not just appendicitis.

Task content: Find the cause of the patient's pain after appendectomy and cure it.

Mission time: 3 day.

Mission reward: 10000 experience points, acting level +1. 】

"..."

Luo Hao looked at the system task rewards and was speechless.

I don’t want to be in the entertainment industry, and my acting skills are of no use to me.

It would be great if skill level +1 was added to surgery.

The gray surgical techniques in the system technology tree can all light up, and there are a lot more things that I can do.

Even if it is not added to the surgical skills, it would be good to be able to give a diagnosis aid AI fragment.

"Luo Hao, are you having trouble?" Lin Yuming frowned and asked coldly when he saw Luo Hao was slightly stunned.

"what?"

"Afraid of that guy Wen Youren?" Lin Yuming said disdainfully, "He teased the patient's family about hiring experts. I suppressed him at the time. Do you think I was afraid?"

Luo Hao smiled and shook his head.

"Uncle, I'm not afraid."

"Well, let's take a look at the medical records first. It's best to solve the problem without leaving any trouble. If it can be solved smoothly, I will find an opportunity to send you to the general surgery department before the year. Does Wen Youren want to have a good year? Just dream! "

Luo Hao's eyes were filled with flying fish suits and embroidered spring knives.

Judging from uncle Lin Yuming's intentions, Director Wen must be taught a lesson this time to prevent this bad guy from always making little moves behind his back.

Luo Hao's smile was bright and sunny. He sat in front of the computer and looked at the medical records first.

The patient is male, 42 years old.He went to the emergency department mainly because of abdominal pain and diarrhea for 3 days. (half a month ago)
The patient's abdominal pain started in the periumbilical area and moved to the right lower quadrant and gradually worsened.

The nature of the pain is tingling. Exercise and diet can aggravate the pain. Oral analgesics such as paracetamol can partially relieve the pain. The pain is associated with low fever and decreased appetite.

The abdomen was soft to palpation with diffuse tenderness, the tenderness being most pronounced in the right iliac fossa and accompanied by rebound tenderness.The colon aeration test was positive.

Initial laboratory tests revealed elevated white blood cell counts and levels of inflammatory markers, including erythrocyte sedimentation rate and C-reactive protein.Liver and kidney functions were normal.

The initial diagnosis was acute appendicitis, and the patient underwent laparoscopic appendectomy under general anesthesia that night.

The patient's postoperative recovery was unsatisfactory and he continued to suffer from right lower quadrant pain.

Looking at the description in the medical records, it was a typical case of acute appendicitis. The surgical records were also written according to the standard template. Luo Hao could not see any problems.

But the clinical history is hard to describe in a word. If you want to confirm the diagnosis, you have to go for a physical examination and consultation in person.

Moreover, in the system panel in the upper right corner of the field of view, the diagnostic assistant AI did not give a correct diagnosis due to insufficient conditions.

Luo Hao pondered.

After a few minutes, Lin Yuming asked, "Xiao Luohao, what do you think?"

"Uncle, the conditions are not sufficient. I have no opinion for the moment. I will go to the ward for a physical examination and ask about the medical history personally to see if there can be any breakthrough." Luo Hao said.

Lin Yuming nodded.

He also knew that Zichou Yinmao could not be found simply by looking at the medical records.

The medical records are all copied and pasted according to the panel, which can be said to be the same.

First look at the medical records, mainly looking at the patient's special laboratory indicators and some details.It is extremely difficult to determine what happened through this kind of Class C medical records.

"Let's go." Lin Yuming greeted Luo Hao to leave the hospital building and come to the General Surgery Department.

It was already dark, and nurses were busy collecting blood while pushing carts. In the doctor's office, a doctor wearing a thick mask sat blankly.

Seeing the iconic mask, Luo Hao knew he was Chen Yong without looking carefully.

"Doctor Chen, you are on duty." Luo Hao greeted.

"Uh...ah?" Chen Yong suddenly saw Luo Hao and was stunned for a moment, "Why are you here?"

Then Chen Yong saw Lin Yuming appearing behind Luo Hao.

He stood up suddenly and said as if he was guilty of committing a crime, "Lin...Director Lin."

"There is a complaint. I'm going to see the patient after appendectomy." Director Lin said calmly.

At this time, Chen Yong noticed that both Lin Yuming and Luo Hao were wearing white clothes, and he seemed to understand something.

"Are the patient's family members emotionally stable?" Lin Yuming asked.

"It's not bad, they just want to find the problem and make the patient less painful." Chen Yong said something inappropriate.

Lin Yuming nodded and followed Chen Yong to the ward.

It was still early, and the patient's attendant was still snoring on the bed.The patient was lying on his side with a painful expression on his face.

"Are you feeling better?" Chen Yong asked.

The patient shook his head slightly.

"This is..." Chen Yong was about to introduce Director Lin, but when he saw Director Lin shook his head slightly, he immediately shut up.

Under the mask, Chen Yong pursed his lips slightly, trying hard to guess why Director Lin came in person.

"Please lie down while I check your private parts." Luo Hao came to the patient's side and said with a smile.

A ray of morning sun shot in from Luo Hao's ear, and it was red, making his smile become warmer and brighter.

Luo Hao rubbed his hands as he said, "It's a little cold outside, but it's fine inside the house."

The patient was not surprised when he saw two doctors, one old and one young, coming over. He just complained, "Other people were discharged from the hospital after two or three days of appendicitis surgery. I haven't felt better even after half a month."

"Let me take a look." Luo Hao smiled to reassure the patient.

At this time, his hands were already warmed by rubbing. Luo Hao was still not worried and put it on his neck to test the temperature.

On physical examination, the patient had obvious pain in the right lower abdomen, tenderness, and no rebound tenderness or muscle tension.

The diagnostic assistant AI finally collected all the relevant information and popped up a line of words - it was recommended to check the 64-slice CT scan of the abdomen.

Luo Hao was a little confused, but he didn't show it. Instead, he gave Lin Yuming a look.

There are many things that cannot be said in front of patients.

Lin Yuming said nothing and returned to the doctor's office with a sullen expression.

"Director Lin, I recommend a 64-slice CT scan of the abdomen."

"Huh? Why are you doing this test?"

"Perfect auxiliary examination of the intestines to rule out related diseases."

"Hepatobiliary and pancreatic disease? It's impossible. The B-ultrasound before the operation showed that the patient only had mild fatty liver." Chen Yong asked in a deep voice.

Wearing a mask properly, Chen Yong gives people a weird illusion.

Lin Yuming glanced at him, and without questioning Luo Hao's decision, he decided directly, "Yes, I'll say hello to the director of the CT room and go there early in the morning. Before dinner, Dr. Chen, go and explain to the patient's family."

Chen Yong's delicate eyebrows twitched three times.

The face outside the mask was filled with sadness, "Director Lin, what should I say?"

"Why do you still need me to teach you? Do you want me to come on duty for you?" Lin Yuming stared at Chen Yong and said coldly.

Everyone in the Department of General Surgery was displeased in Lin Yuming's eyes. Even the floor tiles in the Department of General Surgery had an evil look to them. Lin Yuming wished he could step on them more often.

What Director Wen did before was unethical, which made Lin Yuming full of prejudice against them.

Lin Yuming also knew it was prejudice, but he didn't care.

Would a medical director care about the opinions of a junior clinician?

Not at all.

Let alone a junior doctor, even Wen Youren, a famous provincial doctor, was just that in Lin Yuming's eyes.

Chen Yong scratched his neck and became more nervous. Just as he was about to refute, Luo Hao suddenly said, "Just say it's a need for expert consultation from the provincial medical university. That's an easy explanation."

"!!!"

Chen Yong looked at Luo Hao, who was lying without blinking, and was inexplicably surprised.

This is too much nonsense.

"Director Lin, let's go back. I'll go to the CT room and take a look at the machine first." Luo Hao glanced at the time and said to Chen Yong, "Do the examination at 07:30. Don't be too late to avoid making other patients unhappy. "

……

An hour later, Chen Yong communicated with the patient and his family.

He first made a report to Director Wen, then bravely communicated with the patient's family, and tried his best to narrowly pass the test.

As time goes by, all the patience of patients and their families has been worn away. Their complaints and complaints are like a hornet's nest, which may explode at some point.

The medical office knew it was nonsense. Except for a few solid organs in the upper abdomen, the 64-series CT was basically useless.

The same goes for Director Lin, who is so doting on Luo Hao.

Especially patients and their families are on the verge of an outbreak. Just a small lead is enough to make the flames accumulated during this period spurt out and burn everything.

When I reported it to Director Wen, he seemed to be indifferent to it.

Chen Yong was a little confused. He looked at the time and saw that there were still 20 minutes left. He was not in a hurry to take the patient to the CT room, so he hid in the duty room and called Jiang Wenming.

"Master." Chen Yong briefly recounted what happened in the morning.

"What do you think is going on?"

"oh, I see."

On the other side of the phone, Jiang Wenming seemed to be brushing his teeth and talking.

"Master, I don't understand. Director Wen doesn't care at all. Director Lin took Luo Hao to see the patient in the morning, but he listened to Luo Hao's unreliable suggestions. Really, doesn't anyone care about the patient now? .”

Chen Yong complained angrily.

“Hula la la~~~”

Jiang Wenming spit out all the water in his mouth and spoke much more clearly.

"How many times have I told you, you can't be so angry young people in everything. Yes, you may never understand the word "angry youth". Almost no one uses it now. In the past, this word was very popular. Don't be dissatisfied with everything, and analyze it calmly." Jiang Wen Ming scolded.

"But……"

"You remember the patient with the liver cyst?"

"remember."

"For such a big thing, Director Lin did not have an attack. As far as I know, he is not the kind of person with a good temper." Jiang Wenming explained, "Is the patient yours?" "No."

"That's good. Please write down clearly all the treatments and disease processes last night and this morning. Be sure to be detailed. And!"

As he spoke, Jiang Wenming increased his tone.

"Shifting the blame is a given, but the important thing is that you don't take the blame. Chen Yong, you must write down who asked for instructions for every decision. Don't write about Luo Hao, he is too young and can't handle things. Just Write the medical advice given by Director Lin and ask Director Wen Youren for instructions."

Chen Yong was startled.

It’s not necessary to write it so clearly.

"After the examination is completed, you go back and fill in the disease history record first. Remember what I said, be detailed! Even if it is long-winded, don't leave anything out. Not only this time, in the past few months, all patients and all treatments must be careful."

"Why?" Chen Yong was puzzled.

"Be careful not to bleed all over you."

"Uh, okay, Master."

"Come to the clinic and see me when you're done, and I'll explain it to you. It's so early in the morning, and I haven't had breakfast yet."

Hearing what Jiang Wenming said, Chen Yong sighed, "Master, please come back. I think you are the only serious doctor in the department."

"My novel is going to be released on the channel, Douyin promotion, and the editor asked me to update it. How can I have time to go back and take care of the patients? Besides, the earth will not go around without me? Come to me after you are done, and I will tell you what is going on. Something happened."

After Jiang Wenming finished speaking, he hung up the phone.

Chen Yong held his cell phone and stayed there for a long time, listening to the beeping sound coming from it.

It seems different from what I imagined.

Could this be a confrontation between Director Lin and Director Wen?Chen Yong pondered doubtfully.

When the time came, Chen Yong took the patient to the CT room.

When I came to the CT room, I saw Director Lin and Luo Hao standing in the operation room from a distance.

Director Lin seemed to take this matter very seriously, and Chen Yong kept everything in mind.

"Xiaoluohao, what do you think the patient's problem is?"

"For intestinal problems, the initial diagnosis is correct or wrong. It's good to say wrong."

"What do you mean?" Lin Yuming asked.

Luo Hao's words seemed like he was playing a riddle.

"Let's do a checkup first." Luo Hao did not answer immediately.

Everything was Luo Hao's guess, and the diagnostic assistant AI suggested it. Luo Hao continued to think along this line of thinking, and got some insights.

But Luo Hao was not sure.

Leave the needle in the patient, do a skin test, and inject the medicine 15 minutes later.

64-slice CT images appear on the screen frame by frame.

Soon, Lin Yuming saw the "problem"!
After all, he was an undergraduate student majoring in imaging. Undergraduate students at that time were still considered the most favored students, unlike the college students who had expanded their enrollment and then expanded their enrollment.

The patient has abnormal images of the colon!

"Director Lin, this is here." Luo Hao pointed at the screen with his hand and said, "I don't think it's a tumor, it should be a colon lipoma."

"Colon? Lipoma?!" Lin Yuming asked in confusion.

"Here, a 6cm intraluminal lesion was found in the cecum. The lesion had a clear border. It was considered to be a uniform fat density without solid components. The mass of the lesion caused partial colon obstruction, and I diagnosed it as a cecal lipoma."

Luo Hao glanced at the system panel in the upper right corner of his field of vision. The diagnostic assistant AI had given a clear diagnosis.

“Thickening of the colon wall with plica edema is suggestive of pseudomembranous colitis.”

Luo Hao added.

"Is the intraluminal lipoma in the ileocecal region causing incomplete intestinal obstruction and inducing inflammation, so the appendix is ​​a problem?" Lin Yuming asked tentatively.

At this moment, he already subconsciously knew that his clinical level was much worse than that of his nephew.

"Yes." Luo Hao smiled, "So it's good to say whether the diagnosis of acute appendicitis is right or wrong."

It turned out that this was the case, and Lin Yuming's mind suddenly opened up.

He also had his own ideas on how to solve the problem next.

Chen Yong stared at the abnormal "lump" on the screen in a daze. He never expected that Luo Hao would have to do a 64-slice CT scan and suddenly see the problem.

Normally, 64-slice CT will not be performed for acute appendicitis. Even if such patients come back for treatment, they will probably be misdiagnosed.

Rare diseases have never been within the diagnostic scope of prefecture-level hospitals, and encountering them can only be described as "unlucky".

If every patient undergoes a detailed examination, doctors will probably be out of work due to complaints before even a single similar patient is screened out.

Luo Hao was very powerful. Chen Yong looked at Luo Hao deeply.

But Luo Hao had no idea. He looked at the screen and didn't know what he was doing.

"Luo Hao, what should we do next?" Lin Yuming asked.

"There are several solutions. First, laparoscopic exploration and staged localized resection of the cecum accompanied by appendectomy."

Lin Yuming frowned and thought.

"Because the patient had an appendectomy half a month ago, I don't recommend a second surgery."

"Keep it simple." Lin Yuming whispered.

"Second, I recommend resection with colonoscopy."

"Anymore?"

"Not for now."

Lin Yuming was thoughtful and did not continue to ask.

Chen Yong sent the patient back alone and was just in time for ward rounds. Director Wen only glanced at him and passed by as if he hadn't seen him.

Chen Yong, who wanted to report his condition to Director Wen, didn't even have time to ask a word.

Something is wrong, something must be wrong!
After Chen Yong handed over to the doctor in charge of the bed, he started to make up the disease course record according to Jiang Wenming's instructions.

He writes in great detail, even a bit verbose.

After I finished writing, I read it carefully twice before going to the outpatient clinic to see Jiang Wenming.

There were many outpatients, and Jiang Wenming was busy all the time. He didn't take a sip of water until he got off work at noon.

Chen Yong closed the door and said, "Master, I'm here."

"I see you." Jiang Wenming had already opened the hospitalization workstation, found the patient's medical record, and explained it to Chen Yong word for word.

"Master, if you don't want to be so meticulous, it will all be in vain."

"Yes." Jiang Wenming said calmly and calmly, "Don't you feel that the rain is coming?"

"Ha, Master, you are thinking too much."

"Not much, just do as I say." Jiang Wenming said, "Stand aside and watch this matter carefully, stay away, and be careful not to bleed all over you. It's not a joke."

"!!!"

"By the way, you just said it was the diagnosis given by Luo Hao?"

"Ah."

"This young man is pretty good. If I don't say that he is better than the doctors who graduated from Xiehe University with bachelor's degree, master's degree and Ph.D. in 8 years, I admire him." Jiang Wenming sighed in a low voice.

"This... isn't difficult. If you can do the inspection at will, I can do it too."

Chen Yong whispered unconvinced.

"Can you?" Jiang Wenming asked jokingly, but it seemed that he was not laughing at Chen Yong, but talking to himself.

"It's the way it is."

Jiang Wenming picked up the pen, took out a piece of A4 paper from the printer, and began to straighten out the timeline, explaining to Chen Yong the past and present of the matter and his speculation about the future.

……

"Director Lin, what should we do about this?" Luo Hao asked following Lin Yuming.

"I'll handle the rest." Lin Yuming finished speaking slowly, then suddenly stopped and looked back at Luo Hao.

Facing Lin Yuming's gaze, Luo Hao knew that there must be something serious.

"Xiaoluohao, you know what Director Wen's attitude is when we ask experts to perform surgery."

"I know that he disapproved of it and even secretly caused trouble by instigating the patient's family members to complain."

"What do you think we should do?"

Lin Yuming's question made Luo Hao fall into deep thought.

The intrigues in the hospital were far away from him, and the system had no knowledge in this area.

Luo Hao knew very well that his uncle Lin Yuming was sharpening his knife and was preparing to teach Wen Youren a "lesson".

But how to do it specifically... No teacher taught him when he was a student at Union Medical College, so Luo Hao's mind went blank.

"That's it."

Back in the office, Lin Yuming picked up a pen, pulled out a piece of A4 paper from the printer, and began to mark several important points along the timeline.

"There is a lot of pressure on medical insurance now. If many surgeries are performed in the same old way, the hospital will be unable to make ends meet. There is only one solution!"

"Uncle." Luo Hao tentatively called him "uncle." Seeing that Lin Yuming didn't respond, he knew that he was talking to him as a family elder, not as the medical director.

"If we want to completely solve this problem, shouldn't the state increase investment?" Luo Hao asked.

"Haha." Lin Yuming smiled.

"No one pays attention to the medical industry. But others don't, but those of us who are doctors should pay attention, because we are dealing with human lives. So we can't blame others. If we have conditions to treat diseases and save lives, why not do it if we don't have conditions? "

"Uh……"

Luo Hao never expected that his uncle would sing a high-profile song to him, and he didn't even know how to answer it.

"Do you think I have a demonic barrier during the meeting?" Lin Yuming looked at Luo Hao and asked jokingly.

"No, no, uncle, you are right!" Luo Hao replied with a smile.

"The general environment is the general environment. We are doctors, and we must be worthy of the white clothes we wear. What should we do if the general environment is like this? Times have changed, and of course we need to evolve."

"To treat the same disease, for example, the patient in front of me, even if Director Wen did not misdiagnose it, how much would it cost to perform a localized staged resection of the cecum with an appendectomy?"

"How much does it cost to perform a gastroenteroscopic polypectomy?"

"Uncle, that's not a polyp." Luo Hao emphasized.

"I just finished asking, and the director of the Gastrointestinal Endoscopy Department of the First Medical University said that he can do it as if it is a large polyp. It is indeed a bit risky, but it is worth the risk."

Luo Hao glanced at the system panel and realized that he could do it himself.

Although it is extremely difficult to perform a colonoscopy on a lipoma with a diameter of 6cm, and the location of the lesion is in the ileocecal region, making the operation extremely difficult, it is still within the scope of my "ability".

"It costs up to 8000 yuan to perform such an operation, and that's assuming the best titanium clips are used."

"I want to beat Wen Youren, not because of personal hatred, but to let him know that times have changed."

With that said, Lin Yuming looked at Luo Hao and asked seriously, "By bringing people to the general surgery department, can you defeat Wen Youren's arrogance?"

Luo Hao looked at Lin Yuming seriously, trying to find out what Lin Yuming was thinking in his expression.

(End of this chapter)