(Thank you to my friends Yuan Qi Yuan i Yuan Zi Yuan for their generous support. Also, thanks to my friends mangmangliu, Shi An Tian Xia, and Xian Ren Ah Xian Ren for their monthly subscriptions.)
"President Liu, here are the results of the thyroid function test. The T3, T4, FT3, and FT4 levels have significantly increased, and TSH has decreased. This confirms hyperthyroidism."
Wang Huan, holding Tang Feifei’s thyroid function test results, joyously rushed to the orthopedics departnt.
Liu Banxia was also working part-ti in orthopedics. Wu Mingyu quite enjoyed having Liu Banxia assist him; whenever there were more patients, he would call for him.
"Brother Wang, hold on. This is a shoulder dislocation. I’ll count to three... one... CRACK! Done. Now go for an X-ray. Wear an arm sling for half a month, and don’t lift heavy objects during this period," Liu Banxia said.
"Doctor, didn’t you say you’d count to three?" The young man with the dislocated shoulder, holding his left arm, was caught between laughter and tears.
"I was just trying to prevent you from getting too nervous," Liu Banxia said with a smile.
"You could have just kept it a secret, you know. You scared so much! I was ready to grit my teeth when you counted to two," the patient explained.
"Isn’t it better to have a sense of anticipation? Don’t you feel relieved and exhilarated now?" Liu Banxia asked.
The patient was startled. It seed to be true. Even if Liu Banxia hadn’t told him he’d count to three, he knew setting the bone would hurt—they always showed it on TV. He would have been worried regardless.
Now that the tense anticipation had passed, he indeed felt quite relieved and exhilarated.
Cheerfully holding his arm, he went for an X-ray. Liu Banxia took the diagnostic report.
This was a thyroid function test, and the listed data were very clear. Plus, since he had conducted the ultrasound himself, everything matched up.
"But this is just a new finding. We can’t link it to the bed-wetting. How are the new blood and urine test results?" Liu Banxia asked.
"All are still normal. Should we start her on thiamazole?" Wang Huan said with a wry smile.
Liu Banxia was stating a fact. Among all known diseases, it was unheard of for thyroid issues to cause bed-wetting.
It could be said that Tang Feifei was sowhat unlucky. Hyperthyroidism wasn’t easy to cure. Even with her relatively mild condition, it still required a coordinated approach of dication, diet, and proper rest.
Even if she didn’t need radiation therapy or surgical intervention at present, the drugs she was taking had certain side effects. Continuous monitoring was necessary to adjust the dosage according to her reaction. If she exhibited severe side effects, the dication would have to be stopped.
Liu Banxia nodded. "That’s the only way for now. We’ll deal with that later. I want to conduct a full-body scan for her. Otherwise, I really can’t figure out what her underlying problem is."
"This condition is quite troubleso. You should first talk to Qiaoqiao, then to Tang Feifei. Having Qiaoqiao by her side to offer support might help ease her mind."
"President Liu, just do your best. If her bed-wetting can be cured, it would be a greater relief than anything. I’m out of ideas; I’ve never encountered a case like this before," Wang Huan said.
"I would very much like to try, but the thing is I haven’t encountered it either. I have looked up many cases of bed-wetting, but none of them is like hers," Liu Banxia said with a wry smile.
At that mont, Liu Banxia’s phone rang. It was a call from Wang Chao. "This is Liu Banxia."
"President Liu, if you’re not busy, please co over. I just received a foreign patient, and communication is difficult," Wang Chao’s voice sounded sowhat urgent.
"Coming," Liu Banxia said and hung up.
"What’s the exact situation?" Liu Banxia asked upon arriving outside the resuscitation room.
"It was a taxi driver who brought him in. He’s a foreigner in his twenties, apparently from India. We can’t understand what he’s saying," Wang Chao quickly explained.
"He has a high fever of 40 degrees Celsius, blood pressure 80/150 mmHg, heart rate 115, and has vomited twice. I’m not sure, but it looks like he might have an infectious disease. I’ve followed standard procedure."
"The taxi driver has been isolated and is being tested. We’ve also perford a complete blood count, blood biochemistry, sputum culture, rapid infectious disease panel, and a strep test on the patient. The X-ray shows so lung inflammation, and auscultation revealed moist rales, but his heart sounds are normal."
"What about you guys?" Liu Banxia asked.
"We disinfected the area imdiately after he was brought in. Thankfully, our admission protocols are very strict, so there shouldn’t be any issues," Wang Chao said.
Liu Banxia nodded and turned to Wang Huan. "Brother Wang, what’s the plan?"
"Let’s start him on tronidazole. We can’t be sure about the sanitary conditions in India," Wang Huan suggested.
"Start him on tronidazole. Get a set of PPE, and I’ll go in to take a look," Liu Banxia said.
Wang Chao nodded and promptly went back into Resuscitation Room 1.
"Brother Wang, should we report this to the hospital administration now?" Liu Banxia asked.
Wang Huan shook his head. "I don’t think so. After all, there’s no confird diagnosis yet, and we’ve already taken precautions. I see they’re disinfecting the corridor now too. Let’s observe for a while."
"The main issue is that we can’t determine if it’s a febrile infectious disease or sothing caused by parasites, and communication is impossible. Hey, doesn’t Qing Kewa speak English? Maybe she could try communicating with the patient?"
"Right, where is Qing Kewa?" Liu Banxia glanced around but didn’t spot her.
"Teacher Liu, Qing Kewa is assisting Dr. Wei in an ergency surgery," Xu Yino quickly replied.
"Notify her to co out. When it cos to verbal communication, our broken English is not going to cut it," Liu Banxia instructed.
If this patient spoke English, they might be able to guess and muddle through. But since he’s Indian, English is likely a foreign language to him, so we need to be as precise as possible.
When Liu Banxia arrived at Resuscitation Room 1, it had been prepared for isolation, and Wang Chao’s team had just started the patient on an IV drip of tronidazole.
"Let’s do another round of Physical Cooling. His eyelids are a bit swollen, he’s tearing up and has a runny nose. Have you checked his oral cavity?" Liu Banxia asked.
"Yes, his throat is a bit red and swollen, but there don’t seem to be any other issues," Wang Chao replied.
At this mont, the patient on the bed began to babble unintelligibly. Based on Liu Banxia’s limited experience from watching Indian movies, he figured the language was likely Hindi or a similar dialect.
"English?" Liu Banxia ventured to ask.
The patient rambled on again, then suddenly turned onto his side and vomited a couple more tis.
"Seal the vomitus and send it for testing," Liu Banxia ordered.
A nearby nurse quickly complied.
Perhaps the vomiting had relieved so discomfort, as the patient seed slightly better. However, the words he spoke were still unintelligible to all.
Liu Banxia observed the patient closely again. Besides the previously noted symptoms, the patient was also coughing. His current condition seed to be affecting his upper respiratory tract, but Liu Banxia still couldn’t determine if it was an infectious disease, or what kind.
"President Liu, he still has a fever despite the Physical Cooling," Wang Chao stated after checking.
"Let’s give him so Tylenol as well. It’s a pediatric dication, so it’s relatively safe and might help a little. Tell the lab to expedite the blood test results, and also prepare for a lumbar puncture," Liu Banxia said.
The dication was an antipyretic and analgesic for children. Given their limited knowledge of the patient’s condition, using a pediatric drug was a safer option.
If the wrong dication was used during treatnt, it could potentially lead to an international incident.
"Teacher Liu, I’m here, I’ll be coming in soon," Qing Kewa’s voice could be heard from outside.
"The patient doesn’t understand English. If you want to observe, you can co in," Liu Banxia said.
"Okay," Qing Kewa replied.
"COUGH! COUGH! COUGH!..."
"BEEP! BEEP! BEEP!..."
Just then, the patient began to cough violently. Simultaneously, the monitor started beeping erratically, and the patient showed signs of respiratory distress.
"President Liu, I haven’t started the lumbar puncture yet!" Wang Chao said anxiously.
"It looks like bronchospasm. Administer 1mg of racemic epinephrine, 125mg of thylprednisolone IV, 20mg of etomidate, and 100mg of succinylcholine. Get the intubation kit ready," Liu Banxia ordered.
Upon hearing his instructions, the nurses quickly sprang into action.
"His oxygen saturation is improving."
After Liu Banxia finished the intubation, Wang Chao let out a sigh of relief.
"Teacher Liu, the rapid strep test just ca back negative!" Xu Yino called from outside.
"Understood," Liu Banxia responded.
"President Liu, how is he doing?" Wang Huan asked from outside.
"It’s still hard to say. We can’t communicate with him, so we don’t know his dical history. He just had a bronchospasm, and the strep test was negative," Liu Banxia said.
"Too many conditions could present with these symptoms. We might not be able to wait for culture results; his condition seems to be deteriorating."
"I’ll collect another nasal swab for testing. Maybe now that his symptoms have worsened, we’ll get a clearer picture."
"President Liu, if he gets worse, will he need to be put on a ventilator?" Wang Chao asked worriedly.
"Let’s see how he responds to the dication... Wang Chao, hand a flashlight. Help keep his nostril open." Liu Banxia’s voice held a trace of excitent as he was collecting the patient’s nasal secretions.
Wang Chao didn’t dare to delay and quickly brought over a penlight.
Liu Banxia carefully observed the patient’s nasal mucosa and noticed minute signs of bleeding.
"Draw blood for a asles serum antibody test," Liu Banxia ordered.
"What? President Liu, seriously? He doesn’t have a rash or any spots in his mouth. How could it be asles?" Wang Chao asked, baffled.
"So patients who’ve been vaccinated can still get asles, and severe cases can cause mucosal bleeding. Perhaps this patient fits both criteria. Let’s test for it first and see," Liu Banxia said.
"Right now, there are too many possibilities and no clear indicators. If it’s asles without a rash, it’s even harder to diagnose. We’ll have to see if his serum antibody titer is elevated."
Wang Chao nodded. So President Liu doesn’t have any concrete evidence either; he’s just making an educated guess. Still, at least it was a direction to pursue.
Truthfully, Liu Banxia was also feeling the pressure. Making a diagnosis based on a hunch was nerve-wracking. A wrong guess could delay critical life-saving treatnt.
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