No one spoke.
Li Guodong looked at his watch.
"Everyone can familiarize themselves with the institute’s work environnt," he said, "There are no work arrangents today. Tomorrow morning at seven, gather here."
With that, he walked away.
Twenty people stood in place, looking at each other.
Then so started walking back, so continued forward, so took out their phones to check the ti, and so spoke softly to the person next to them.
Chen Xi stood in place, looking at the door at the end of the corridor labeled "Surgery Center." She looked for a while, then took out a brand new notebook, opened it, and wrote another line under what she’d written earlier:
"Tomorrow morning at seven, et in the demonstration room."
Lin Yuan stood next to her, also writing sothing in his notebook.
By six-thirty the next morning, the demonstration room was already full of people.
Twenty people, not one less. So were reviewing the case study they prepped the night before, so were flipping through anatomy diagrams, so were writing out surgery steps in their notebooks. No one spoke, there was only the sound of pages turning.
At precisely seven o’clock, Yang Ping pushed open the door and ca in. He held a stack of dical records and walked to the podium, placing them on the table.
"Today we won’t discuss theory," he said, "Today, we’re seeing patients, and everyone is encouraged to speak boldly."
He pulled out a dical record and handed it to Lin Yuan.
"You present the case."
Lin Yuan took it and opened it.
"Patient, male, fifty-seven years old. Admitted for ’repeated chest pain for three months, worsening for two hours.’" His voice was a bit nervous, but he tried to stay calm, "Ten-year history of high blood pressure, highest at 180/110mmHg, not consistently dicated. Five-year history of diabetes, on oral hypoglycemics, glucose control average. Smokes for thirty years, one pack per day. Drinks for thirty years, two taels per day..."
He finished reading.
Yang Ping looked at him, "Without looking at the record, report it again."
Lin Yuan was taken aback.
"As doctors, we must train our mory," Yang Ping said, "Being able to read a dical record once and ask for a dical history once is crucial for grasping key information, you cannot miss anything. Because what you miss might be the most important clue. It could also lead to a fatal oversight."
Lin Yuan closed the dical record, took a deep breath, and began to recount.
He recounted it, mostly correctly.
Yang Ping nodded.
"What do you think is the diagnosis?"
Lin Yuan hesitated again.
"Heart... heart attack?"
"Why?"
Lin Yuan thought for a mont.
"Chest pain, worsening, history of high blood pressure and diabetes, smoking..."
"What about the electrocardiogram?"
Lin Yuan flipped through the dical record, even though it was already closed, he just did it instinctively.
"No... none."
"What about cardiac enzys?"
"Also none." Lin Yuan’s voice grew softer, "We should further check with a bedside ECG."
Yang Ping looked at him without speaking.
Lin Yuan’s face slowly turned red.
Yang Ping retrieved the dical record and handed it to another person.
"What do you think?"
The person took it and flipped through it—it was Chen Xi.
She looked at it for half a minute, then raised her head.
"It looks more like Aortic Dissection."
"Why?"
"Chest pain, worsening, history of high blood pressure," Chen Xi said, "A heart attack requires the support of ECG and cardiac enzys, which are not available at the mont, so we cannot rule out dissection. Moreover, his blood pressure is poorly controlled because he hasn’t taken dication consistently, which is a high-risk factor for dissection."
Yang Ping nodded.
"What would you do now?"
Chen Xi thought for a mont.
"Conduct a bedside ECG and ultrasound to check if the ascending aorta is widened, and if there’s an intimal flap." She said, "anwhile, check aortic CTA to confirm the diagnosis. Before confirmation, control blood pressure and heart rate to prevent the dissection from progressing."
Yang Ping pulled out a film and placed it on the viewing lamp.
"Here’s his CTA."
Everyone looked over.
The ascending aorta was significantly widened, with a diater of 4.5 centiters. Inside, there was a thin line extending from the aortic root to the aortic arch—the intimal flap.
Aortic Dissection! Stanford Type A!
The demonstration room was extrely quiet.
Yang Ping looked at Chen Xi.
"What’s your na?"
"Chen Xi."
Yang Ping nodded.
"You’ve done well," he said, "We must not be biased initially, especially with cases that seem familiar. We must integrate the dical history, physical examination, and auxiliary tests evidence to conduct rigorous reasoning."
"Familiarize yourself with these dical records here, and attend the shift handover promptly at eight o’clock."
"Also, tonight, each of you write a clinical analysis of this case and submit it to tomorrow morning."
With that, he pushed the door open and left, closing it behind him.
The demonstration room remained quiet for a long ti.
Then soone whispered, "Chen Xi, you’re amazing!"
Lin Yuan sat there, looking at the dical record that had been taken back, his face still red. He thought of his earlier ntion of "heart attack," thought of the look Yang Ping gave him, and thought of the details he had missed.
Chen Xi sat in the corner, head down, writing sothing in her notebook.
The person next to her leaned over to look.
She was writing: "Day one, Professor Yang presented a case, Aortic Dissection. Key points: Chest pain high blood pressure, don’t just consider a heart attack. Quick screening with bedside ECG and ultrasound, CTA for confirmation. Male patient, 57 years, chest pain for 3 months worsening for 2 hours, 10 years of high blood pressure not consistently dicated..."
She wrote very carefully.
Lin Yuan looked at her and suddenly understood sothing.
He took out his own blank notebook, opened to the first page, and wrote another line under what he had written the previous day.
"Day one, Professor Yang presented a case, I didn’t get it right, Chen Xi did. She ntioned checking with a bedside ultrasound, and I rembered that. Key points of Aortic Dissection: Chest pain high blood pressure, don’t just consider a heart attack. I missed the critical point about high blood pressure, need to pay attention in the future."
After he wrote that, he looked at those lines, then looked at Chen Xi’s notebook.
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