Come on, Dr. Wu

Chapter 403: Treating a disease is like solving a case

Pan Ying has already entered the operation room.

This is a patient with a knife wound. He had a fight with his wife and was stabbed in the back by her with a pair of scissors. The cut was deep, but fortunately no vital parts were injured.

After debridement, the blood vessels are sutured and the wound is sutured.

Another tetanus shot will do the trick. However, all these operations need to be completed by Pan Ying. Pan Ying's first patient was taken to the operating room, and the time consumption for this is destined to be more than that of the others.

Song Tiantian’s situation isn’t much better.

The patient needed an arterial blood sample, but his left and right wrists were covered with ornaments, and two bracelets restrained his hands tightly, making them impossible to remove. The bracelets were smashed, but the patient refused to agree. One bracelet cost tens of thousands, how could he bear to do that!
Song Tiantian was helpless. She had originally asked the nurse to do an arterial blood test, but now it was pushed into her hands.

There was no other way, Song Tiantian could only try to collect samples from the brachial artery.

In fact, arterial blood gas analysis can be done on any artery in the body, including the radial artery, brachial artery, femoral artery, etc.

It’s just that collecting data from the radial artery is the least risky and most convenient.

Of course, the patient now has acid-base imbalance, breathing problems, and damage to the ulna and radius. We have to take off the patient's bracelet not only because we need to draw arterial blood, but also because we are afraid that the patient's hand will swell up in a while, and the bracelet will become the culprit that restricts the patient's blood flow.

Everyone has his own difficulties.

As the number of patients increased, everyone encountered some difficult problems.

In the gap between the last patient leaving and the next patient coming in, Chao Yuan had some time to think about other issues.

For example: If you don’t finish eating the sugar-roasted chestnuts in the evening, will they go bad if you leave them until tomorrow?
This is Chao Yuan's favorite snack. For a month, others could always see Chao Yuan taking out sugar-roasted chestnuts from his pocket everywhere.

Yesterday, Chao Yuan got off work early, so he also bought some. However, considering the assessment on Saturday, he didn’t eat much and put it aside.

I don’t know what was wrong with Chao Yuan’s brain at this moment, but he actually remembered this matter again.

This century-long problem seems to be encountered by everyone.

Although Wu Xiaofu didn't know what Chao Yuan was thinking about, he could tell from Chao Yuan's expression that this guy was daydreaming again.

After a month, Wu Xiaofu also discovered that there were some differences between this fellow villager, such as his trance state.

This is commonly known as wandering thinking.

However, Chao Yuan's thoughts tend to wander only when he is free, but he is very serious when he is working.

But Wu Xiaofu was also a little curious about where Chao Yuan's mind was wandering at such an important time.

"You've noticed it too, right? I've been noticing this kid's problem for a long time."

Lin Dongping also noticed that Wu Xiaofu was paying attention to Chao Yuan, and said to Wu Xiaofu.

"This kid is really careless, but he won't have time to spare after sending this patient over."

Miao Qingyan also added that there was a computer in front of each of them, and they had everything including the situation in the clinic and the patient's information.

Obviously Miao Qingyan thought that Chao Yuan's patient would not be easy to deal with.

Suddenly, there was a sound of footsteps outside Chao Yuan's outpatient clinic.

Before Chao Yuan could react, he saw a patient's family member running in from outside the door.

Without waiting for Chao Yuan to say anything, he stuffed the registration slip into Chao Yuan's hand.

"Doctor, come on, check on my friend."

It turns out to be a friend, Chao Yuan thought to himself, and then he saw a flatbed cart being pushed in.

Looking at the patient on the stretcher, Chao Yuan took a glance and knew what was going on. He did not rush to see the patient, but quickly browsed the patient's medical record first.

You know, sometimes collecting off-site information is more useful than seeing the patient immediately, especially for patients with unknown conditions who are not in critical condition.

After all, they are doctors, and what they need to do is to find the cause of the patient's illness and symptoms, and then diagnose and treat them.

Asking about the patient's health and well-being certainly makes patients and their families feel at ease, but for patients who are brought in on stretchers, it is not the most important thing.

Therefore, every visit to the doctor actually begins from the moment “off-site information” is collected.

As long as the patient has been treated in our hospital, the patient's information can be found.

Sure enough, after a quick check, the patient's information came out.

The patient cannot be left alone for too long, so the medical records must be browsed quickly.

The patient is a 44-year-old male and his medical insurance type is self-paid.

Self-paid medical insurance means that the patient does not pay for the medical insurance locally. In this case, doctors sometimes have to think about it.

Because it involves a cost issue, and also the issue of communication with family members, but those are things to think about later.

Occupation: Unknown.

The patients had not filled in the information carefully before, and many people did not select this column to save trouble, so the default was unknown.

The patient has come to see the doctor twice in the past week. This can be considered as "three visits to the thatched cottage", Chao Yuan thought to himself.

The patient first visited the clinic three days ago.

The main complaint at that time was: diarrhea for 1 day.

After some tests, routine blood and stool examinations showed only that the neutrophil count was slightly high and the white blood cell count in stool microscopy was 1/HP.

According to the chief complaint and the results of the examination, the patient's condition was not serious.

So the initial diagnosis at that time was just "acute gastroenteritis" and "diabetes".

The doctor at that time gave a series of auxiliary treatments including fluid replacement, antidiarrhea, antiemetic, antipyretic and analgesic, and viral infection.

The patient's second visit was one day ago.

This time the main complaint changed to: headache for 3 days.

Seeing this, Chao Yuan took it more seriously.

He has seen many patients with this type of complaint. When the treatment for gastroenteritis did not work, they came back with headaches. Obviously, the patients' gastrointestinal symptoms were most likely caused by the headaches.

This time, we checked more things, including routine blood tests, CRP, blood sugar, and head CT scan. The results showed that the neutrophil count was further elevated, the blood sugar was elevated, but no obvious abnormalities were found in the head CT scan.

To be honest, doctors both love and hate the headache of not finding any problems during examinations.

I like it because there is a high probability that these patients will be fine, but the small probability is a big deal.

This is the big thing I’m afraid of.

But if it's not a big deal, then we can only treat it as a small matter. After all, sometimes medicine is also a subject of probability theory.

So the second diagnosis was: headache (neurological).

This is the so-called neuralgia, which is the universal explanation for headaches and is also the most difficult to treat because there is no cure.

In fact, it is a headache for which no cause can be found.

You can only take painkillers to relieve the pain, but the effect is not very good.

However, the patient's inflammatory index is high, so anti-inflammatory treatment is indispensable.

Therefore, the treatment used included cephalosporin for anti-inflammatory, hormone for anti-inflammatory, intravenous antipyretic and analgesic, and oral analgesic medication.

"Doctor! I have a headache!"

A shout interrupted Chao Yuan's thoughts. Chao Yuan didn't bother to look at it anymore and hurried to the patient.

"Hello, why are you feeling uncomfortable this time?"

"Every visit to the doctor is actually a live version of a real-life deduction. The way out is to follow the principle of logic first and find the real culprit from every clue."

This sentence was said by Wu Xiaofu. Looking at Chao Yuan and then at the patient, Wu Xiaofu felt that this principle was really applicable.

This is also the diagnostic principle that Wu Xiaofu has always adhered to. In fact, when facing an unfamiliar patient, there is no difference between diagnosing a disease and investigating a case.

Lin Dongping and the others nodded upon hearing this.

“This reminds me of what Keigo Higashino said: Not knowing the truth is sometimes a sin.

It’s the same for us doctors. If we can’t find the root cause of the patient’s illness, then everything we do is wrong. So, finding the root cause is what we need to do first.”

The patient looked at a figure approaching, probably a doctor, and seemed to hear the doctor asking questions.

It seemed like he was asking what 100 minus 9 equals. He was still wondering why the doctor asked him such a simple question.

But soon he no longer had time to think about it.

Because he found that he couldn't seem to solve this problem. What is 100 minus 9?

Ouch, what a headache.

After a headache, the patient seemed to have entered a dream.

The previous scenes seemed to be playing like a movie.

He is a man in his forties who came to Beijing alone.

He once thought that this place was full of gold, just like in the East China Sea movies he had seen before.

But after coming here with his dream, he found that there was no gold there. All he saw were falling cigarette butts.

After coming here, he honestly found a job that was stable and ordinary, and lived a mediocre life.

Just like most people, they are intermittently full of ambition and continue to eat and wait for death...

After the fall, the weather turned cooler and it rained a lot this year. He felt like he had a fever.

After a normal fever, you should take your temperature immediately and then go to the hospital for treatment.

But he didn't dare take his temperature because he didn't have local medical insurance and getting sick might make his year's work go to waste.

So even if he had minor illnesses like cough and cold, his first thought was to tough it out. At most, he would buy some medicine himself. In his hometown, he would take painkillers, and when he came here, he did the same.

He has diabetes, but he doesn't feel any discomfort normally and his overall health is pretty good.

Moreover, he felt that he was still young and that minor illnesses and disasters could be overcome with patience.

But this time, in addition to the fever, there seems to be nausea, vomiting and diarrhea.

The lights in the room were so dazzling that he could no longer concentrate on his work. This made him feel uneasy and he was afraid that he really had to go to the hospital this time.

The hospital was bustling with people, which made people feel irritated. He just wanted to recover quickly and go back to work.

He was treated by a burly male doctor. He described his symptoms and demands to the doctor in a halting manner. The doctor did not say much because there were too many patients and the doctors were too busy. After listening to him, the burly male doctor did not say much and directly arranged for him to have his blood drawn and stool collected.

He didn't think there was anything wrong. Didn't the Internet say that Western medicine only examines?

The results came out so slowly that he almost fell asleep while leaning back in his chair waiting.

After the results came out, he rushed to see a doctor, who, as before, told him it might be "acute gastroenteritis."

This was pretty much what he thought. He thought that taking medicine would not work, so he asked for an IV, and the doctor agreed without saying much.

As for what kind of fluid to be injected, he didn't know, but he took a special look at the information on the bottle containing the liquid.

Lysine aspirin 0.9g, VitB6 100mg, VitC 1g, GNS 500ml.

He didn't understand what this meant, but as the liquid entered his body, he felt much more comfortable.

When he left the hospital, the doctor prescribed him some oral medication.

He had never taken Changweikang, montmorillonite powder, and bifidobacterium before, but seeing the effectiveness of the previous infusion, his trust in doctors has increased a lot.

After leaving the hospital and looking back at the bustling and crowded emergency department, he had only one thought in his mind: It’s great to be healthy!

He thought things would get better later.

But things seemed to be going in a bad direction. He thought he would feel better if he stopped having diarrhea, but it didn't. Not only did his condition not improve as expected, but he vomited even more.

Not only was he vomiting, he was also having intermittent chills, a splitting headache, and an increasingly poor appetite.

He couldn't wait to finish taking these medicines. They took too long to take effect and he might need intravenous drips.

Moreover, he felt so uncomfortable that he couldn't help but have some bad thoughts in his mind. He wondered if he had some serious illness.

Thinking of this, he didn't dare to delay any longer and hurried to the hospital again.

This time he was treated by a female doctor. Unlike the male doctor last time, this female doctor spoke very quickly but was very patient.

After the female doctor asked about his symptoms, she mentioned a word: subarachnoid hemorrhage.

It was a word that was unfamiliar and unsettling to him.

He had never heard of this word, and didn't know what disease it was, but he knew about bleeding. It seemed like a serious illness, especially when the female doctor said it was a brain disease, which made him even more scared.

Following the female doctor's advice, he had a brain CT scan and a blood test. The CT scan was very expensive, but he didn't dare to be reluctant to do it.

Fortunately, after the test results came out, the doctor told him that there was nothing special about the brain CT scan.

This relieved him.

Although the inflammatory indicators in the blood have increased, they are not high. According to the female doctor, there is no big problem at the initial stage.

Thank goodness!

As long as it’s not a serious illness, it’s fine. Although I feel relieved, the physical discomfort is real.

He thought about continuing the infusion, and this time he wanted the doctor to prescribe some "stronger" medicine for him. He wanted to get better quickly, and he couldn't take too long off.

If it was the doctor from last time, he definitely wouldn't have made such a request, but this female doctor seemed quite easy to talk to.

The headache was indeed much better after the infusion, but he still felt groggy. He was afraid that he would have a headache again after returning home, so he went to see another doctor, who prescribed a "strong" painkiller.

He would take one pill when he felt pain, and he would take another pill when he got home because he really wanted to have a good sleep.

Before going to bed, he looked at the English word Tramadol on the medicine box. There was also a Chinese name next to it, which seemed to be "Tramadol".

He has been lying in bed for two days. He feels really bad. He thought that he would feel better after intravenous drips and painkillers, but the situation seems to have not only not improved, but has become worse.

The severe headache made him unable to sleep or eat anything. He was now exhausted...

This state even made him unable to help but have a thought: Is he about to die?

Not daring to delay, he quickly called his friend.

"Take me to see a doctor."

In a daze, he was pushed directly into a room. At this time, he was still conscious. Perhaps because he was in the hospital, he felt a lot more relaxed. He even had the leisure to think that this time he didn't have to queue up.

(End of this chapter)