"Teacher Liu, what on earth is going on here?"
Although Miao Rui knew he shouldn’t ask this way, as it might make the patient and his family feel that his dical knowledge was deficient, he couldn’t help himself.
"Let ask you, what could cause this elderly gentleman’s previous symptoms?" Liu Banxia asked.
"Organic brain lesions, subdural hematoma and edema, hydrocephalus, brain tissue infection, related inflammation, and so on," Miao Rui quickly responded.
Even though he was just a general surgery intern, he knew these basic concepts. After all, working in the ergency center ant he needed to know as much as possible to provide better care for ergency patients.
"You’re correct. These are just manifestations of a condition. In my opinion, there are two underlying reasons: one is the pressure exerted on the brain tissue, and the other is related to inflammation in the brain tissue," Liu Banxia said.
"That’s right. Organic lesions, tumors, or edema all exert pressure on the brain tissue, and inflammation affects the brain tissue," Xu Yino said.
"Let’s get back to our elderly gentleman here," Liu Banxia said with a smile.
"The cerebrospinal fluid hasn’t been tested yet, so we don’t know if there’s inflammation. But there’s one thing we can be sure of: after drawing so cerebrospinal fluid, the old man’s symptoms alleviated. Why is that?"
Indeed, why was that? This was a question the interns, and even the patient’s son who was listening intently, were pondering. What exactly was the reason?
"I’ve got it! It’s because the intracranial pressure decreased, right?" Qing Kewa suddenly exclaid.
Liu Banxia gave a thumbs-up. "Exactly. Conditions like hydrocephalus and subdural hematoma pose a threat to the patient precisely because their presence increases intracranial pressure."
"Of course, so large hematomas can also directly compress brain tissue. But we’ve looked at the elderly gentleman’s CT scan, and everything is normal. So, the fundantal cause of his condition is increased intracranial pressure."
"Even without such organic lesions, high intracranial pressure can compress brain tissue. When we drew out so cerebrospinal fluid for testing, it temporarily lowered the intracranial pressure, which is why he recovered."
"Initially, I overlooked the issue of intracranial pressure, assuming it was due to a brain tumor. Actually, this is also a type of hydrocephalus, just involving cerebrospinal fluid."
"The official na is NPH, Normal Pressure Hydrocephalus. Based on the old man’s condition, it’s likely idiopathic. Please call a neurosurgeon over. We need to place a shunt to drain so cerebrospinal fluid when the intracranial pressure is high."
"Doctor, although I didn’t quite understand everything, can my father’s illness be cured?" the patient’s son asked.
Liu Banxia nodded. "The purpose of implanting a shunt is to relieve intracranial pressure. If the pressure within the cranial cavity is released, it will naturally no longer compress the brain tissue."
"Doctor, how long will the shunt be needed?" the patient’s son asked.
Liu Banxia frowned. "Given your father’s condition, I’m afraid it will likely be permanent. However, it also depends on the cerebrospinal fluid analysis. If the fluid is normal, then yes, it will have to be permanent."
"If it’s caused by another condition, such as related inflammation, we can remove the shunt after treating the underlying issue. But let put it this way: your father has been ill for so long that if there were another inflammatory condition, it would likely have already beco life-threatening."
"That’s why I just said it’s probably idiopathic. Idiopathic conditions are those for which we currently cannot find a clear cause."
"However, this won’t affect his daily life. It will be much better than his life over the past six months, right? He can eat dumplings if he wants to eat dumplings, read books if he wants to read books; nothing will be hindered."
The patient’s son nodded. Thinking about it that way, it really wasn’t too bad.
"Dad, don’t worry, it’s nothing serious. Just a small surgery will do," the patient’s son comforted his father, who was lying on the bed.
"I’m not going ho," the old man said, waving his hand.
The patient’s son was taken aback for a mont and looked towards Liu Banxia.
"His intracranial pressure must be a bit high again. Coincidentally, Dr. Zhang has just arrived. Miao Rui, please explain this patient’s situation to Dr. Zhang," Liu Banxia said.
Miao Rui quickly summarized the important parts of the situation for Zhang Xiao.
Zhang Xiao glanced at Liu Banxia. "CT normal? No signs of ventricular enlargent?"
Liu Banxia nodded. "Wu Bo and I puzzled over it for quite a while. It seems the intracranial pressure isn’t excessively high, and the disease has been progressing slowly."
"Well, we’re lucky then. Let’s wait for the cerebrospinal fluid test results," Zhang Xiao said.
"If everything is normal, placing a shunt will be sufficient. It’s unlikely there’s any permanent damage to the brain tissue. He should be able to live a normal life in the future without any issues."
Hearing Zhang Xiao’s words, the patient’s son grinned widely; he was genuinely happy.
"Alright, this patient is all yours now. Our work in general surgery is finished," Liu Banxia said.
"Doctor, thank you. If it weren’t for you, we’d still be mistakenly thinking it was Alzheir’s disease," the patient’s son said.
"It was just a fortunate coincidence. If you want to thank soone, you should thank this police officer. If he hadn’t brought your father directly to the hospital, it would have been very difficult for us to discover this," Liu Banxia said with a smile.
"No, no, don’t thank . This is just what we do. How could we see an elderly man wandering on the street and not help?" the police officer said quickly.
"We should thank everyone, thank you all. We encountered good people. I won’t even sue that caregiver anymore. If it hadn’t been for her being such a scoundrel, my father’s illness might never have been diagnosed and treated," the patient’s son said.
Liu Banxia chuckled. This matter was really a bit too tangled to explain clearly.
Logically speaking, the caregiver bore considerable responsibility. But it was precisely because of her dereliction of duty that the old man’s illness was diagnosed. So, it really was a muddled situation.
"Dr. Liu, why didn’t you reward with a chicken leg?" Qing Kewa asked as they walked back.
"A reward, a reward, of course, there’s a reward. Answering correctly deserves a reward," Liu Banxia said.
Qing Kewa was delighted. She ate chicken legs often, but a rewarded chicken leg tasted different.
Liu Banxia was also in a good mood. Although the old man’s illness wasn’t exactly a rare or complicated disease, it wasn’t that easy to diagnose either.
Especially since the old man had already been diagnosed with Alzheir’s disease at another hospital; without clear signs of ventricular enlargent, it was indeed very easy to misdiagnose.
If it hadn’t been for his sowhat persistent nature, insisting on figuring out what was truly wrong with the old man, he probably wouldn’t have ordered the lumbar puncture and would have just let the patient’s son take him ho.
「 」
"What’s happening here?"
Just as Liu Banxia returned, he saw two groups of people in the waiting hall, with police officers maintaining order.
"It’s those ergency patients we admitted last night. They’re causing a commotion now. It’s a ss. Luckily, the police are here; otherwise, I would have had to call you," Zhou Li said.
"What are they still fussing about? Their conditions are already serious. Do they want a couple more of them to end up in the hospital or sothing?" Liu Banxia shook his head.
"I overheard a bit. It sounds like they’re now trying to find the organizer of the gathering to share the responsibility. It’s quite complicated. Good thing I’m not a judge, or I’d never be able to sort out these relationships," Zhou Li said.
"Good thing I’m not either. As long as we treat the patients admitted to our care, that’s all that matters. Although it can be a headache sotis, as long as we find the right approach, we can usually follow the clues to get to the bottom of things," Liu Banxia said.
"Forget about following vines to lons for now. The director went to a eting early today, so he’s left the ergency center in your hands," Shi Lei said as he walked over.
"Ah? I thought I could take a day off tomorrow! Does this an I have to work straight through until after the New Year?" Liu Banxia was dumbfounded.
"What can be done? It seems there’s a patient over there who needs a consultation too, so he left early. He left behind two hemihepatectomies. How about we each take one?" Shi Lei asked with a smile.
Liu Banxia nodded. "We can stagger the tis so we can guide them all. I still need to tell Qiaoqiao later; I was hoping we could go to Jinshui District for teppanyaki during our break."
"Then you can forget about that. Normally, I could cover for you, but it’s the end of the year. Major situations are likely to occur," Shi Lei said.
"Yeah, like last night. Who would have thought they’d all co pouring in like dumplings? It’s the end of the year, so everyone will have to work hard. Let know what dishes you all like to eat, and I’ll go discuss it with our Manager Zhou," Liu Banxia said.
Hearing him ntion this again, everyone’s spirits lifted a little.
This was making the best of a tough situation. After all, who was really short of one al? If skipping one al could get them half a day off, they’d all be fighting for the chance.
The interns, however, were quite excited. They would get to participate in another liver surgery. Moreover, knowing Teacher Liu’s and Teacher Shi’s personalities, their level of involvent in the surgery would likely be very high.
"Teacher Liu, Teacher Zhang Xiao from Neurosurgery asked to tell you that the elderly gentleman has been diagnosed, just as you predicted. Surgery will be arranged for this afternoon," a nurse hurried over to say.
DING! Patient diagnosis completed.
You have gained 200 experience points, 200 proficiency points in diagnostic skills, and 1 Glory Point.
Liu Banxia was stunned for a mont. His performance had been so good, so why such a ager reward? There wasn’t even a task rating.
On second thought, he figured it out. The old man’s condition, while sowhat misleading, could still be diagnosed through systematic examination.
That was the system for you; it wouldn’t give you any leeway. No matter what, it stuck to its own principles.
"For the next few days, use your night shift rest ti as much as possible. In a few more days, don’t expect any breaks. Even if you get a break, you’ll have to be on standby in the lounge," Liu Banxia said, looking at the interns again.
The six of them nodded in unison, knowing the imnse pressure Liu Banxia was currently under.
Even a minor mistake could potentially be blown out of proportion because of the New Year period. This applied not only to admitting patients but also to the nursing care of patients within the hospital.
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