"Banxia, have you found out anything yet?" Wang Huan asked, calling again.
"It should be almost there. Their underlying lung condition should be chronic pneumoconiosis. Then, their trip outside, combined with the Nocardia infection, caused it to develop into acute pneumoconiosis," Liu Banxia said with a smile.
"Pneumoconiosis? Impossible. They are online strears, not people who work in dusty environnts," Wang Huan said.
"Ah, this is what we overlooked," Liu Banxia sighed.
"We knew they were online strears and that their content involved wandering about, singing, and the like. However, we didn’t consider another aspect of their streaming content: handmade craft production."
"I’m at their studio now; there’s a cara pointing at the clay. It’s just left on the ground, with crafting tools next to it. They even soundproofed the room so as not to disturb the elderly."
"In such a confined environnt, they don’t even have to do it every day. By doing it intermittently, as long as the dust accumulates, how could their health possibly be okay?"
Over the phone, Wang Huan didn’t know what to say. He really hadn’t thought that this young couple would lack such basic common sense. The concentration of dust in an enclosed space would be even higher. If they didn’t care about it, it would be akin to gradually poisoning themselves.
"Alright, let’s wrap it up," Liu Banxia said after putting away the phone.
"Teacher Liu, could such a small amount of clay have such a serious impact?" Xu Yino asked curiously.
"The amount of clay doesn’t seem like much, but they must have made quite a few items. Didn’t you see all the things on the nearby shelves? And think about all those flower pots on their bay window," Liu Banxia said.
"These are just the finished products; how many semi-finished ones must there be? Auntie, how long have they been making these handicrafts themselves?"
"It’s been about five or six years. They started by making these and then selling them at stalls. Later, when they saw that streaming online was doing well, they started broadcasting their crafting. But not many people watched, so they began to stream while out and about, traveling and playing," the patient’s mother said.
"After gaining so popularity, they only picked this up again a little over a year ago. Before, few people watched, but now that they have more followers, more people watch. Doctor, are you saying it’s related to them making these?"
Liu Banxia nodded. "The dust from these materials becos airborne during the crafting process. The room is enclosed, and there isn’t even a ventilation system, so the dust settles in their lungs."
"Our current examinations haven’t found any symptoms of tuberculosis. As long as they receive treatnt and actively adjust their lifestyle, the prognosis should be very good."
The old woman still didn’t quite understand. She knew about pneumoconiosis; mostly coal miners contracted it. Liu Banxia’s words were sowhat comforting to her; at least it was so good news.
With the task completed, Liu Banxia led the interns back to the ergency aid center.
Their attitude was completely different from when they had just set out. They were all so pumped up, following Liu Banxia, that they practically swaggered as they walked.
Even Su Wenhao was swept up in it, having been thoroughly swayed by Liu Banxia.
"Smug, just so smug."
Seeing this group, Zhou Shuwen, who was in the lobby, remarked helplessly.
"Director, we perford so well, shouldn’t we get so reward? The Chief Director even gives rewards," Liu Banxia said with a grin.
Hearing his words, the interns looked eagerly at Zhou Shuwen.
After all, they had gone out on a field call today and solved the problem, so they deserved credit. Liu Banxia’s usual rewards of chicken legs no longer impressed them; only rewards from their director or the Chief Director truly excited them.
"Linlin, why are you fooling around with him too? Alright, lunch is on today. Just don’t go overboard, alright? I’m not as wealthy as Teacher Liu," Zhou Shuwen said earnestly.
This made the interns overjoyed.
It wasn’t just because they got a reward, but also because of Zhou Shuwen’s attitude.
In their impression, Zhou Shuwen was famous in Second Hospital for his stern deanor. When had they ever heard such "gentle" words from him?
"This case should be thoroughly docunted later; there’s a lot we can learn from it," Zhou Shuwen remarked once the interns had left.
"You can rest assured, Director, I’ll definitely do a solid job. This case is indeed very complex. If they hadn’t gone to Bali, they might not have suffered such serious consequences," Liu Banxia nodded.
"They must have also inhaled so volcanic ash that drifted from the eruption in Bali, which then caused the current acute pneumoconiosis."
"Actually, I think the Nocardia bacteria rely added fuel to the fire. Now, they should even be thankful. If their pneumoconiosis had continued to develop slowly, it would be much more difficult to deal with by the ti tuberculosis broke out."
"Go and talk to Wang Huan and Chen Xuehai. With the current situation, a thoracotomy to debride the pus will definitely be necessary," Zhou Shuwen said.
DING! Mission: Patient with rapidly worsening lung disease - Completed.
Received: Experience Points 200, Diagnostic Skills Proficiency 100, Glory Points 3.
Liu Banxia nodded cheerfully and skipped away happily.
Zhou Shuwen watched, feeling rather helpless. He’d heard Liu Banxia had beco much more mature, but it seed his own return had unleashed Liu Banxia’s playful side again.
Liu Banxia was indeed delighted; it felt as if he were slacking off with official approval. This return to his old ways, so to speak, was because Zhou Shuwen’s return gave him a pillar of support. Anyway, now he could consult Zhou Shuwen about any problems he couldn’t solve himself. He no longer had to shoulder all the stress alone.
"Appropriate treatnt has been administered. Your field trip wasn’t in vain," Wang Huan said with a smile.
"I guess I was just lucky. If this young couple had stopped making flower pots a long ti ago, I really might not have figured it out," Liu Banxia said.
"The director just asked to summarize the case. At first glance, it seems there’s a lot to summarize, but when I think about it carefully, this case involved so many coincidences."
"First, their work environnt. During our questioning, we could only ask about their current work; it’s impossible to ask about every detail of their entire work history."
Wang Huan nodded. He was the first physician to see them and had already asked questions during the initial consultation; otherwise, he wouldn’t have had so much information to give Liu Banxia when he arrived.
"Second is the patients’ own negligence," Liu Banxia continued. "They’ve been doing pottery for so many years. I imagine they couldn’t have been unaware that they should install a dust extraction system in their workshop."
"They probably thought that since nothing had happened before, and they were only doing it occasionally now, it wouldn’t have any impact. This attitude of trusting to luck not only delayed the diagnosis but also worsened their lung damage."
"Third, this aspect was truly unpredictable. The progression from chronic to acute pneumoconiosis typically follows a certain course."
"But what about them? They just happened to be exposed to volcanic ash and then got infected with Nocardia. Encountering just one of these would have been bad enough, but they ran into both."
Wang Huan rubbed his face. "Actually, if I had inquired more thoroughly and tried harder to differentiate the findings on the chest CT, maybe I could have diagnosed it earlier."
Liu Banxia laughed. "Do you really think you’re so kind of miracle doctor? It’s easy for us to deduce symptoms from a known disease because we’re essentially working backward from the answer."
"But can we make the most accurate diagnosis instantly just by looking at the symptoms? If that were the case, we could just put you on a pedestal in the main hall, and you’d solve everything."
"There are so many similar diseases, often with only subtle fundantal differences. Each ti, it’s like trying to pick the right thread from a tangled ball. Who doesn’t pick the wrong thread a few tis?"
"Not only did I look at the films, Dr. Chen did too. And he’s a leading expert on lungs, yet he didn’t recognize the pneumoconiosis at first glance either."
"Talking about behind my back?"
Just as Liu Banxia finished speaking, Chen Xuehai’s voice ca from outside.
"Haha, I’d say the sa thing even if you were here. I can’t summarize any real lessons to be learned from this case. Can you guys think of anything?" Liu Banxia said with a laugh.
"Well, if you insist, I suppose there is sothing," Chen Xuehai said after a mont’s thought.
"It’s that we dismissed possibilities too quickly. If we had held off on ruling things out, we might have avoided so detours. And it’s a good thing you persisted; otherwise, the male patient might have ended up in the ICU for a couple of days."
"Exactly. This case had too many coincidental factors. All these circumstances just happened to converge to cause the current outco. If even one factor had been missing, it wouldn’t have turned out like this," Liu Banxia shrugged.
"And I’ve also reviewed our treatnt process; there were no delays on our part. It’s just that their condition progressed too quickly and caught us off guard."
"If, and I’m saying if, they had co to us a few days earlier, perhaps we could have diagnosed them sooner. Because we would have had more opportunity to ask the patients questions directly, and maybe a crucial piece of information might have surfaced."
Chen Xuehai and Wang Huan both nodded. This wasn’t to shirk responsibility; it was a genuine possibility.
TCM emphasizes observation, auscultation and olfaction, inquiry, and palpation. The sa applies in Western dicine, though so aspects have been replaced by instruntal examinations.
Take inquiry, for example. Every doctor does it, whether through the patient’s answers or reminders from the patient’s family. Sotis, this can introduce distracting information, but more often, it provides helpful clues for diagnosis.
Today, because the male patient’s condition was sowhat critical, Wang Huan directly arranged a chest CT scan to get a more accurate result more quickly.
If the patients’ condition had only been at the chronic pneumoconiosis stage, and they hadn’t had the subsequent two "misadventures," the process would have been an X-ray first, then a CT scan.
While viewing the films, the doctor would also continue to ask the patient questions, which could very well bring out the patient’s older work history.
Again, doctors aren’t gods. They also need to synthesize various pieces of information to make a diagnosis. Pneumoconiosis isn’t like acute appendicitis, which can be confird by checking McBurney’s point.
That was the conclusion of their review—sowhat frustrating, but that’s the reality of dicine.
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