"It seems about the sa as we speculated, right? It should be the husband who transmitted the infection to his wife. The husband’s chest films show much more severe changes," Liu Banxia said after they reviewed the young couple’s CT scans.
Chen Xuehai nodded. "It appears this infection is chronic. It’s only now reached a certain threshold and entered a rapid phase."
"This ans the infection was likely present before their honeymoon, so it has little to do with their travel abroad. Let’s perform a bronchoscopy for a more thorough look."
"Both husband and wife are coughing. We should ask about that too, right? Perhaps this cough isn’t a current symptom but part of their dical history," Wang Huan suggested.
The three of them reached a consensus and then, accompanied by the interns, headed to the young couple’s ward.
Given the situation, they would have to be admitted directly. The disease was progressing so rapidly that it could beco very dangerous if not diagnosed in ti.
When they arrived at the young couple’s ward, both patients looked anxious. Nurses were busy arranging equipnt, and their family mbers hadn’t arrived yet.
"From the current CT scans, we’ve found severe lesions in both of your lungs," Chen Xuehai began. "Yours are particularly affected, husband; there are signs of suppuration from infection. We can basically determine that you were infected first and then transmitted it to your wife."
"Next, we need to perform a bronchoscopy on you to see the actual condition of your lungs. If our judgnt is accurate, your examination will also help us diagnose your wife’s condition."
The husband nodded, glancing at his wife with an apologetic look.
"Doctor, please do a thorough examination. We’re not worried about the cost," the wife said.
"We will. How long have you both had this cough? Has it been constant?" Chen Xuehai asked.
The wife shook her head. "Just an occasional cough. It started about two years ago, maybe? Could it be related to moving into our newly renovated house?"
"We purchased a villa, and the renovations were rushed. A company did formaldehyde removal, and we moved in right after. We could still sll sothing when we first moved in, but we were too busy with our live streaming to pay it much mind."
"That’s a possibility. We still need to conduct more detailed examinations," Chen Xuehai said, frowning.
"Let do a physical examination to check the lymph nodes," Liu Banxia offered.
If formaldehyde was involved, it was quite possible it had affected the patient’s lymphatic system.
"The lymph nodes are slightly swollen, but not markedly so," Liu Banxia stated after the examination.
Just then, he noticed the husband occasionally scratch his abdon. Liu Banxia walked over and lifted the man’s hospital gown. There were rashes on his abdon.
"Record this: new developnt in the patient’s condition—abdominal rash," Liu Banxia said, then continued checking other parts of the patient’s body. "Also on the inner thighs, bilaterally."
"Did you... did you go ssing around before we got married?" the wife suddenly shrieked. "Did you bring back so nasty disease and infect too?"
"No, I didn’t!" the husband exclaid, flustered.
"You definitely did! You’ve always had this problem! I was truly blind! I—"
BEEP! BEEP! BEEP! BEEP! BEEP! BEEP!
Before the wife could finish, the husband’s monitor started alarming frantically.
"Respiratory distress, oxygen saturation dropping! Twenty units of etomidate, one hundred units of succinylcholine! Huang Bo, intubate!" Liu Banxia ordered sharply.
The nearby nurses sprang into action, quickly administering the drugs.
"Doctor, Doctor, what’s wrong with him?" the wife cried, now genuinely scared.
"He likely beca overly agitated. And try not to bla him just yet; many conditions can cause rashes," Wang Huan said, watching Huang Bo intubate.
"Let’s insert a urinary catheter and a nasogastric tube as well. After the bronchoscopy, we can consider surgery," Chen Xuehai added.
"Patient’s oxygen saturation is rising," Xu Yino reported after Huang Bo removed the stylet.
"Send him for the bronchoscopy," Chen Xuehai instructed.
"Doctor, is it very serious?" the wife asked, her voice trembling.
"It’s hard to say right now. We’ll know more after the test results co back. With signs of empyema, we definitely need to address that," Chen Xuehai replied.
The situation with these two patients had now beco complicated. The progression of the husband’s illness might be a grim preview of what awaited his wife.
Culturing and isolating pathogens takes ti. Moreover, diagnosing infections caused by such chronic lesions was difficult due to the multitude of potential sources.
"Do you think we should do a lymph node biopsy?" Wang Huan asked.
Liu Banxia frowned. "The lymph nodes are slightly enlarged, but I think it might be related to their current pulmonary inflammation. Rember that lymphoma patient I diagnosed, Tiggie’s forr owner? His lymph nodes were much denser and larger than these two. Perhaps we should wait for the bronchoscopy and lab results?"
"However, what concerns more right now is this: the CT scans show severe pulmonary fibrosis due to a chronic condition. But why did it suddenly beco so severe after they returned to the country?"
"Is it simply the climate? They’ve been traveling in places with good weather recently. Could returning to the country and being exposed to cold air have accelerated the disease’s progression?"
"We still need to find out exactly what caused these lesions," Chen Xuehai said, his brow furrowed.
"If it were a bacterial infection, could it have persisted for so long? I feel like the bacteria might just be a catalyst for this current flare-up."
"They’re strears; they usually travel around a lot. Normally, it shouldn’t be related to their work environnt," Wang Huan added.
"Furthermore, their parents started living with them after they bought the villa. If the living environnt caused the illness, their parents, given their age and physical condition, should have fallen ill before them."
Wang Huan’s words made Liu Banxia and Chen Xuehai fall silent again, both desperately racking their brains for any possibility, however slight.
None of the interns dared to utter a sound. This was the closest they had ever been to a real-ti consultation. The discussion among the three senior doctors had already covered a vast range of dical knowledge.
If it were up to them, they could only make simple speculations and then wait for test results. They wouldn’t be able to broaden their diagnostic thinking like these three.
This ability to expand the scope of inquiry, though it seed minor, was crucial when diagnosing patients.
Even though they hadn’t yet settled on a clear direction and still needed to wait for test results, the interns felt a profound sense of vicarious excitent.
Observing like this truly allowed them to learn knowledge far beyond what textbooks could offer.
At that mont, the young couple’s parents rushed in. Xu Yino explained the situation to them and then led them to the ward.
"You saw their parents just now, right? They’re quite healthy. That pretty much rules out the living environnt," Liu Banxia said with a wry smile.
"Sigh... This is such a headache. We’re out of ideas. Let’s just wait for the test results," Wang Huan said, equally frustrated.
"How should we plan the subsequent treatnt?" Liu Banxia asked Chen Xuehai.
"We’ll start with broad-spectrum antibiotics," Chen Xuehai replied. "Then, we’ll identify the infecting bacteria and run a sensitivity test. That’s the standard approach. As for his empyema, I haven’t decided between conservative treatnt or surgery yet. We’ll see how things go."
"Dr. Liu, a myocardial infarction patient is being brought in now!" a dispatch nurse called out.
Liu Banxia looked at Chen Xuehai. "Good, you’re here. You take the interns."
"Tell the cath lab to get ready; we might need to do a bypass. If there’s any news about our two lung patients, inform imdiately. Don’t forget!" Chen Xuehai instructed, then turned with the interns to prepare for the new admission.
Liu Banxia rubbed his face and followed them.
He too needed a ntal reset; he felt like the case of the two lung patients had led him down the wrong path.
"Fifty-three-year-old male, ventricular fibrillation in the ambulance, resuscitated with defibrillation. BP 50/100, heart rate 45!" the paradic shouted, wheeling the stretcher in.
"Take him straight to— Oh no, he’s in V-fib again! Get the defibrillator over here! Charge to 200 joules!" Chen Xuehai, mid-sentence, suddenly tensed.
"Clear!" he shouted.
ZAP!
"Continue compressions! Two hundred joules!"
"Clear!"
ZAP!
"We have a pulse! Connect the monitor! Straight to the cath lab! Rapid blood panel, coagulation tests!"
After stabilizing the patient, Chen Xuehai pushed the stretcher, rushing towards the cath lab.
This patient was suffering from an acute myocardial infarction and had already gone into ventricular fibrillation twice. Another episode, and he might not be salvageable.
Fortunately, the current ergency center was well-equipped. If this had been the old ergency departnt, the patient’s outco would have been highly uncertain.
"That was really dangerous. Old Chen really knows his stuff; his experience is incredible," Liu Banxia remarked with admiration.
"That’s why you have to work hard and beco the true ace of our ergency center," Wang Huan said, patting his shoulder.
"I’ll do my best. And you all need to work hard too," Liu Banxia said, turning to the interns. "You know the situation with those two patients. Your task now is to find the cause of their illness. Anyone who contributes will be rewarded."
The interns grimaced. They couldn’t co up with half as many possibilities as the attending physicians had discussed; this task was far too difficult.
Only then did they truly realize how vast the gap was between themselves and these attending physicians, or even Liu Banxia, the chief resident.
This wasn’t just a small gap, nor was it one that could be bridged simply by being top-tier interns.
At that mont, Liu Banxia’s phone rang. Seeing it was Liang Xiaolin, who had accompanied the patient for the bronchoscopy, he quickly answered.
He hung up, his expression even graver. "Damn it. After the bronchoscopy, they found blood in the patient’s urine bag. It could be renal failure!"
This patient’s illness was progressing too rapidly, almost as if it were advancing in leaps and bounds.
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