Come on, Dr. Wu

Chapter 369 Special Fund
In fact, compared to the outpatient clinic, the eight interns are truly like fish in water in the ward.

After all, they have only followed the teacher to the outpatient clinic a few times, but they have actually stayed in this ward for many years. Recently, they also interned in the ward of the First Affiliated Hospital for two weeks.

During these two weeks, they have already become familiar with the procedures. With so many inpatients in the First Affiliated Hospital every day, they have basically seen all kinds of cases.

They also know basically how to treat various diseases. Even Song Tiantian and her friends can come up with abcd or even more solutions when they see various diseases.

Therefore, the most important thing is actually their outpatient work. As long as the outpatient diagnosis is correct and the direction is right, the subsequent diagnosis and treatment process will not be a problem at all.

Just like Cheng Shi is now.

After returning to the ward, we performed a color Doppler ultrasound on the patient and found out that he had ascariasis. The diagnosis was immediately confirmed after another angiography.

Then just treat it as biliary ascariasis.

Take medicine first. Although biliary ascariasis rarely occurs in China, the treatment standards are now basically unified around the world. Just follow the diagnosis and treatment process.

If it's not ideal, surgery will do.

Of course, for biliary ascariasis, you must pay attention to the care after deworming, and feces and other things must be handled centrally.

After returning to the ward, Wu Xiaofu and his team had a clear idea after reviewing the treatment plan for Cheng Shi and the other eight people.

The assessment only lasted one day, but even though there were only five patients, Cheng Shi and his team were busy until late at night.

However, after returning and lying on the bed, they felt particularly fulfilled. After all, this was the first time they had examined a patient so completely.

Although they treated patients before, it was only in the ward and under the guidance of senior doctors.

Generally, they just follow the medical orders of their superiors and do whatever their superiors tell them to do.

But it is different here. They see patients independently, make diagnoses independently, and develop treatment plans independently. There is no interference from anyone during the whole process.

Especially after seeing the patients’ conditions improve and hearing their thanks, their inner joy and sense of accomplishment are irrepressible.

This feeling is really amazing.

It seems that no matter how hard or tiring their daily life is, it doesn’t matter. This is the profession they love, and they can find their own value in this profession.

Even at this moment, the test results are not that important. What matters is that they use everything they have learned to try their best to treat patients.

Thinking about these two assessments, the eight people were sincerely impressed. Although the assessments became more difficult, they were able to learn a lot from them.

Teaching is replaced by examination, and what they learn is something that can benefit them for the rest of their lives, which makes them no longer have any aversion to examinations.

The next day, the eight people were planning to have a good sleep in, but they found out that they were not destined to sleep in, and they woke up on their own before eight o'clock.

After waking up early, their first reaction was to check on their patients and see if the results of yesterday's examination had been released.

They couldn't wait to see these patients to see if yesterday's medication had taken effect.

Sense of responsibility. At this moment, they truly felt their sense of responsibility. Those were their patients, patients for whom they had to be responsible to the end.

Ward.

Cheng Shi and Jiang Bei met in the ward by chance. They smiled at each other and began to check on their patients.

After hearing the good news that the patient's condition had improved and watching the patient's diagnosis and treatment process progress step by step, they were no longer so unhappy about working overtime on weekends.

"Hey, you two came pretty early, not bad, how is the patient?"

Wu Xiaofu came over at nine o'clock, and after seeing the two of them, he said with a smile.

Jiang Bei saw Wu Xiaofu and hurriedly said, "Boss, I had a patient with colon cancer yesterday. I should be able to finish the examination today. How about making an appointment for tomorrow?"

Wu Xiaofu did not refuse and nodded. It was the abdominal CT scan for Jiang Bei's appendicitis. Wu Xiaofu had seen it and the basic situation was similar. It could be done tomorrow.

"Okay, schedule the surgery. I'll let you be the assistant surgeon tomorrow."

The surprise came so suddenly. Jiang Bei did not expect that not only would she be responsible for the patient's consultation and hospitalization, but she would also be able to perform the surgery.

He nodded hurriedly, "I'll get it done right away."

Looking at Jiang Bei's appearance, Wu Xiaofu shook his head. This girl was so impetuous and seemed like a surgeon.

Wu Xiaofu looked around the ward. Cheng Shi had finished seeing his own patients and followed Wu Xiaofu.

"Cheng Shi, yesterday's patients were treated well, and the preliminary diagnosis was basically fine. However, what do you think of the last patient?"

The last patient!
Cheng Shi pondered for a moment. In fact, after he went back, he also thought that his treatment of this last patient was actually flawed.

“Boss, I know. I should have admitted the last patient to the hospital for abdominal pain first, and then made a diagnosis after a detailed examination.

But I was still affected by the assessment yesterday and had a competitive spirit, so I made a direct diagnosis. Biliary ascariasis was not a 100% diagnosis based on my examination.

It was a gamble based on various factors, and to be honest, it was a bit irresponsible.”

Wu Xiaofu glanced at Cheng Shi. This kid always has a clear mind. Even when he was gambling yesterday, his mind was still clear.

What matters is that the bet was won.

In fact, it’s the same with seeing a doctor. It doesn’t matter whether you gamble or not. What’s important is to win, and to win forever.

Of course, Wu Xiaofu does not encourage gambling.

"It's good that you know it. Pay attention next time."

I am not afraid that Cheng Shi will gamble this time, but I am afraid that Cheng Shi will become addicted to this feeling. As a teacher, I have to remind him when necessary.

"Teacher, rest assured, this kind of thing will not happen again after you officially take up the post."

confidence.

At this moment, Wu Xiaofu felt confidence in Cheng Shi. This kid had the ambition to stay, and after this assessment, Cheng Shi was obviously more confident.

Looking at Cheng Shi, Wu Xiaofu really likes Cheng Shi's steadiness. With Cheng Shi by his side, Wu Xiaofu can rest assured no matter what he tells him.

He needs someone like this, and Wu Xiaofu would certainly be happy if Cheng Shi could finally stay.

"Boss." Chen Zhendong also came over and happened to see it in the ward. Looking at the patient in front of him, Chen Zhendong was obviously a little depressed.

"Is this your patient?"

"Well, the preoperative diagnosis was common bile duct stones, but no stones were found during the ERCP. All I could see was jelly-like bile. It was my negligence."

This is a patient Chen Zhendong admitted from the outpatient clinic.

"Doctor, my mother has been vomiting repeatedly for more than ten days, and she has started to have frequent fevers in the past few days."

Everyone in the ward called the patient Aunt Wang, and Chen Zhendong also called her that. In the outpatient clinic, Aunt Wang's son entered the consulting room and saw Chen Zhendong, and he spoke anxiously as soon as they met.

Chen Zhendong asked as usual, "How many times a day do you vomit? What is the highest temperature you have a fever?"

"I vomited about 3 to 5 times a day, all I vomited was what I ate. My body temperature was as high as 39 degrees Celsius."

"Have you ever been treated in a local hospital? Do you know what tests you've done and what drugs you've used?"

“After being hospitalized at a local hospital and undergoing an MRI, the doctor told me that although the gallbladder had been removed, there were now stones in the common bile duct.

I was given antibiotics and some nutritional fluids. I can’t tell you what they were, but it didn’t seem to work at all. But now I’m still vomiting and having a fever.”

As she spoke, Aunt Wang's son handed the MRI film made at the local hospital to Chen Zhendong.

Chen Zhendong opened the MRI film of Aunt Wang's upper abdomen. The bile duct was obviously dilated, and there were long nodule shadows in the common bile duct. Chen Zhendong had no idea how many films like this he had to look at in a day.

With just one glance, Chen Zhendong basically confirmed the diagnosis of the patient's common bile duct stones.

Bile duct dilatation is basically caused by stones in the bile duct, and the results of the MRI report are the same as Chen Zhendong's judgment.

On the same day, Chen Zhendong admitted Aunt Wang to the hospital. In the ward, the resident doctor arranged an emergency blood draw for Aunt Wang. Laboratory test results also found that her infection indicators were significantly elevated, and her high-sensitivity CRP, neutrophil percentage, procalcitonin, and bilirubin indicators were basically abnormal.

The patient also had typical Charcot triad, severe upper abdominal pain, chills, high fever and jaundice, and the diagnosis of acute cholangitis was even more certain.

Now that the diagnosis is clear, ERCP surgical treatment is of course the best choice.

ERCP gallbladder stone removal surgery is a minimally invasive surgery, the full name of which is endoscopic retrograde cholangiopancreatography, which is mainly used to remove common bile duct stones.

It is particularly suitable for patients whose gallbladder has been removed but who have stones in the bile duct. Now, this type of operation is basically performed in hepatobiliary surgery and gastroenterology departments, and the effect is very good.

The operation is also very simple. It involves entering the bile duct from the patient's mouth through a duodenoscope, then retrogradely entering the bile duct through the duodenal papilla, and removing the stones after local incision or dilation.

It involves less trauma, quick recovery after surgery, and short hospitalization time. Patients can be discharged from the hospital about 3 days after surgery. This is just like laparoscopy replacing major surgery. Everyone knows how to choose.

Of course, it’s expensive.

ERCP is now widely used and can also be used to diagnose bile and pancreatic diseases, such as biliary tumors, gallstones, pancreatitis, etc.

Chen Zhendong arranged surgery for the patient the next day.

Chen Zhendong was already very skilled in this type of surgery. He casually inserted the duodenoscope into the descending duodenum, and after seeing the papilla on the inner wall, he selectively cannulated the bile duct and inserted a guide wire.

However, the angiography situation gave Chen Zhendong a bad feeling. He saw that the diffusion of the contrast agent was worse than usual. Before Chen Zhendong could think about it, he saw jelly-like bile flowing out.

At this moment, Chen Zhendong knew that things were not simple.

A name came to his mind: intraductal papilloma.

This disease is not common, even rarer than gallbladder cancer. It is so rare that many doctors are not familiar with it, and some even choose to forget about it when seeing a doctor.

But if you dare to forget, it will dare to surprise you.

Without too much time to think, Chen Zhendong hurriedly cleaned the bile duct repeatedly, but no matter how hard he looked, he did not find any obvious stones, mostly some tiny residues that were excreted with the bile.

Finally, after the operation was over, angiography was performed again, and it was seen that the diffusion of the contrast agent had improved significantly compared to before.

After the operation, the jelly-like bile collected was subjected to pathological examination and it turned out to be bile duct papilloma.

Later, I, Chen Zhendong, informed Aunt Wang and her son of her condition in detail, hoping that further surgical treatment would resolve the problem.

Unfortunately, Aunt Wang herself chose to give up surgical treatment.

Chen Zhendong could actually understand it, but understanding is one thing, and heartache is justified. Although Chen Zhendong didn't know how worried she was about her illness, he knew that compared to worrying about the worsening of her own illness, she was far less worried about the burden that the cost of the surgery would bring to the family.

In the past few days, Chen Zhendong came to see Aunt Wang almost every time he had time. He felt that it was his misdiagnosis that affected everything.

Intraductal papilloma is really easy to diagnose because its onset is too hidden and its clinical symptoms and imaging manifestations are non-specific, which makes preoperative diagnosis very difficult. It is easy to misdiagnose as other biliary diseases such as hilar cholangiocarcinoma and common bile duct stones.

Of course, there are also reasons why we rarely see it.

In fact, bile duct papilloma is just a precancerous lesion, but this precancerous lesion is very aggressive and has a high rate of subsequent malignant transformation, which is difficult to avoid even after surgery.

Chen Zhendong told the patient and his family everything, including the problems he had misdiagnosed. He had been thinking of making some compensation, but he did not expect Aunt Wang to not only not blame Chen Zhendong, but also comfort him.

This made Chen Zhendong feel even more guilty, "Boss, I wish I had asked you to take a look for me at that time."

Chen Zhendong performed the operation too quickly. He didn't even go through the general ward rounds and went straight to the operation. Wu Xiaofu only found out about it later.

"Okay, don't worry about it. Biliary papilloma is too rare. I may not be able to tell if you show it to me. However, if the patient doesn't insist on treatment due to financial problems, I can help."

This!
Chen Zhendong hurriedly shook his head when he heard this. "Boss, how can I let you pay for my misdiagnosis? I should pay for it, but I told Aunt Wang that I was willing to help, and she refused."

Wu Xiaofu smiled and said, "It's not me who is spending the money. If we spend the money, we can save a few people, but we ourselves will have to starve. It is me, a patient, who is bringing benefit to our hospital."

This is Jones, who was treated by Wu Xiaofu in the United States before. He gave Wu Xiaofu 70% of the share of the subsidiary, which is a huge sum of money.

Wu Xiaofu had no intention of putting these things in his pocket. Although it was not illegal, after all, he was abroad, but it would easily cause trouble if he put these things in his pocket.

Wu Xiaofu actually doesn't lack these things now. He has more than enough money from his patents, so he simply plans to use the income to set up a special fund and place it in the First Affiliated Hospital.

In the future, we will provide help to those patients who cannot afford medical treatment.

The procedures there have just been completed, and the fund has been put on the agenda. Aunt Wang is the first patient to benefit.

Chen Zhendong was also very surprised when he heard this, "Boss, you really saved my life. I knew it was right to follow you. From now on, I will be your most loyal little brother. I have to tell Aunt Wang the good news quickly. I'll go now."

(End of this chapter)