Chapter 109 Director Yin's excitement, being loyal to someone who has entrusted you with a task
The relationship between blood and the body is like that between gasoline and a car.
When a car is without gasoline, it loses its power source. When the blood in the body is not circulating, nutrients and oxygen cannot be supplied to the body's cells.
Paralysis is often accompanied by problems with blood supply.
For example, patients with hemiplegia will feel that the paralyzed side is particularly sensitive to cold, has poor blood flow, and is numb and so on.
"The blood supply to her lower limbs was not seriously affected!"
Director Yin said affirmatively.
So many famous doctors have seen it. If they can't even find such a simple problem, wouldn't those famous doctors be just famous for nothing?
"No, no, no, I'm not referring to the blood flow to the lower limbs, but the blood flow to the upper limbs."
Zhou Can's eyes were firm, revealing an excitement of finding the truth.
"Is there a problem with blood supply to the upper limbs?"
Director Yin frowned. If he hadn’t seen Zhou Can’s ability, he would have cursed, “You need to go back to school for a few more years!” and then turned around and left.
At this moment, he maintained great patience and even had a hint of anticipation.
This difficult case was one he had not been able to solve three years ago, and three years later, he still could not make a clear diagnosis.
The more difficult it is, the more interested he is.
Because at his level, cases of ordinary difficulty are no longer challenging for him.
"Paralyzed patients will naturally suffer from insufficient , especially to the extremities. To be honest, I shook hands with the patient and her hands were very cold, which means there must be a problem with the blood supply to her upper limbs. I was just a little curious at the time. After listening to your advice just now, I got some inspiration."
"Since her electrocardiogram does not show any major abnormalities, it means that the blood supply to her body should be relatively balanced. So I suspect that she has insufficient blood supply to her body due to motor neuron damage."
Zhou Can boldly carried out a series of inferences and dialectics.
"Yes, that's a possibility. But it doesn't mean anything. Paralyzed patients generally have weaker blood supply than normal."
Director Yin Hua didn't care much about Zhou Can's discovery.
It can even be said that I am a little disappointed.
Weakened blood supply throughout the body is a common phenomenon that occurs in most paralyzed patients.
To put it in the terms of traditional Chinese medicine, it refers to the excess and deficiency of blood and qi, and qi deficiency and weak blood.
"I checked the cause of the patient's miscarriage that year. The patient said that she first carried a heavy object upstairs, then felt unwell. Finally, she fainted at home. But the diagnosis after admission to the hospital was a viral infection? Brain nerve abnormality?"
Zhou Can clicked on a diagnosis sheet from her first hospitalization.
This is a very original medical record.
That year, after she fainted, she was sent to the Third Municipal Hospital for treatment by the 120 ambulance based on the principle of nearest rescue.
After the miscarriage, she developed lower limb paralysis, and the Third Municipal Hospital was unable to diagnose the cause, so her family sent her to the Provincial People's Hospital, which had a higher level of medical care. Later, the Provincial People's Hospital also could not find the cause, and the patient became severely depressed.
The family transferred him to Tuya Hospital for further diagnosis and treatment.
Many patients have had this experience: they thought it was a minor illness, but it turned out to be ineffective after treatment in an ordinary hospital, and ultimately they could only be transferred up the hospital level one level at a time.
Three years ago, the Provincial People's Hospital was as famous as Tuya, or even slightly better.
Today, Tuya Hospital has left it behind.
It has become the best hospital in the province in terms of both medical level and diagnosis and treatment capabilities.
"Do you think the patient had already shown symptoms of lower limb paralysis before being admitted to the hospital?" Zhou Can made another extremely bold guess.
"It's unlikely. Before she was admitted to the hospital, the doctor would have done a series of tests on her. The medical level and diagnosis and treatment capabilities of the Third Municipal Hospital are not bad, and their medical quality control has always been very strict. If the patient had lower limb paralysis at the time, it would have been written in the admission record. But they clearly wrote in the medical record that she was paralyzed after the miscarriage."
Director Yin is well aware of the strength and medical style of various hospitals in the city.
At his level, he should be often invited to major hospitals to participate in exchanges, guidance or lectures.
After interacting with the doctors in those hospitals, you will naturally have the opportunity to learn about that hospital.
"Could it be that the patient's lower limb paralysis was not obvious when she was admitted to the hospital, so it was overlooked? The 120 consultation record stated that the pregnant woman fainted in the toilet at home."
Zhou Can persevered in sticking to this belief.
"That's possible."
This time, Director Yin agreed with Zhou Can's point of view.
"It's a pity that the Third Municipal Hospital lacks high-level doctors who can support the hospital. It would have been better if they had done an electromyography test on this patient at that time."
If an electromyography test had been performed when the pregnant woman was admitted to the hospital, it would have provided a strong basis for the subsequent diagnosis.
Now that the incident happened more than three years ago, the significance of doing the examination again would be very different.
"Director Yin, please take a look at these examination reports. This is the electromyography test done by the Imperial Capital Renhe Hospital. I specially compared it with several normal people's electromyography monitoring reports yesterday. Qiu Jie's nerve conduction speed is not slow, but from the neck down, the intensity of the electromyography signal continues to decay. It's like climbing a slope. The closer to the lower limbs, the weaker the attenuation."
"Then her evoked potential electromyography test, as well as her motor unit count, were all normal."
Director Yin had already discovered what Zhou Can said.
"What do you want to say?"
Director Yin doesn’t know what he wants to diagnose after he has given so many supporting evidences?
Pathological diagnosis is extremely complicated, especially for difficult cases like this one, where the difficulty of differentiation is incredibly high.
Everyone will read the inspection information.
To find a clue from a myriad of threads and then sort them out, this is the level of diagnosis.
"I think the patient's illness is caused by a problem with the source of the motor nerves in the lower limbs. Her lesion is above the neck, and the postpartum infection should be just a false cause."
What Zhou Can is doing now is to clear the clouds and see the sun, and identify the real cause of the problem.
"It could be a problem with the spinal nerves, or it could be a problem with the nerve center or the brain stem," Zhou Can added.
【Pathological diagnosis experience value +0.9.】
Looking at the sudden increase in experience points, his heart beat faster and he became more convinced that his diagnosis was correct.
His diagnostic method, which is almost a blind guess, would not be recognized by famous doctors, let alone senior residents who have undergone standardized training.
However, pathological diagnosis sometimes requires the courage to break out of the constraints of the framework and not stick to the rules.
One of the biggest drawbacks of Western medicine is that it is not flexible enough.
It all comes down to inspection data.
Even with the examination data, there is still a question mark behind the diagnosis results.
Why?
Because they are afraid of being overthrown and slapped in the face!
Under China's current medical system, doctors are most afraid of misdiagnosis and medical accidents. The question mark after the diagnosis reflects many real problems.
After all, it is also a kind of lack of confidence in Western medicine.
Looking at the old Chinese doctors, there was rarely any ambiguity. Either I can't diagnose your disease, please ask someone else for help. Or they clearly identify the lesion, write down the pathology, and then prescribe a prescription.
"Why did it only increase the diagnostic experience by 0.9?"
This was the first time Zhou Can encountered such a situation.
In the past, I had encountered a situation where the experience value was increased by 0.2. That was because the patient had multiple lesions at the same time, but he only diagnosed one.
The experience value obtained this time is already very close to 1. The difference of 0.1 is probably because the specific location of the lesion has not been clearly identified.
After listening to Zhou Can 's diagnosis, Director Yin fell into deep thought.
One minute passed, two minutes, three minutes...
This time it was his turn to fall into the "madness" like Zhou Can.
In fact, many famous doctors have these characteristics.
In order to cure a certain disease, one can forget about food and sleep, and even think about diagnosis and treatment while eating, going to the toilet, and even sleeping and dreaming.
Nearly six minutes passed before Director Yin followed Zhou Can's diagnosis and sorted out his thoughts.
There was a gleam of excitement in his eyes.
That was the excitement and thrill that came after a major breakthrough in diagnosis.
"Xiao Zhou, what you said is entirely possible. After repeated discussions, I think the female patient's paralysis is most likely caused by changes in the cranial environment or compression of the cranial nerves. Hemangioma, neuroma, and osteoma can basically be ruled out."
After all, a lot of inspections have been done.
There is a tumor in the brain, it must have been found out.
"If the patient is willing, you can make an appointment for her to come to the hospital to see me for another diagnosis. My suggestion is to give her another head MRI. There is a high chance that the exact location of the lesion can be found."
Director Yin said to Zhou Can.
If the patient is unwilling to believe Director Yin, or has given up hope on Tuya Hospital and refuses to come, then there is nothing we can do.
"Okay, I'll inform her now."
"If she's willing to come, she doesn't need to register. I'll explain it to the hospital then."
Director Yin provided certain conveniences.
You know, his special expert number is very hard to get.
800 yuan is a lot of money for ordinary people.
"Okay, thank you! I'm sorry for keeping you busy today, please go back to your work!"
Zhou Can stood up and said goodbye.
"Don't say that. If you have any questions in the future, you can always ask me. Today's diagnosis of this patient has made a major breakthrough, and your contribution is no less than mine. The talent you have shown in pathological diagnosis is truly unique in my life. This unconventional diagnostic approach is truly unique in the world."
Director Yin's attitude towards Zhou Can became more and more polite.
This kid is indeed a rare talent.
"Xiao Zhou, if you are willing to come to our neurology department, I can transfer you over. Although the emergency department is very good for training, three months is enough. It is difficult to learn a lot of advanced medical knowledge in the emergency department. Our human life span is very short, and it is difficult for us to work for more than fifty years."
"The medical field is becoming more and more specialized . It is not easy to master a single field in one's lifetime. Talented people like you will definitely achieve great success in the Department of Internal Medicine. In addition, it will be easier for you to improve your academic qualifications in the Department of Internal Medicine. Director Tan is a first-class professor and an academician. You can choose the subjects he teaches when you apply for the exam."
Although the words were not fully explained, they were basically hinting at Zhou Can.
As long as you enter the internal medicine department, they will take care of improving your academic qualifications.
The evaluation criteria for first-level professors are extremely strict, and basically only academicians can meet them.
I never thought that Director Tan of the Internal Medicine Department would be so awesome.
However, internal medicine is indeed easier to achieve success in academics.
Director Yin now invites Zhou Can to develop in the Department of Neurology and promises him a lot of benefits, which is enough to show how much he values Zhou Can.
"Thank you for putting yourself in my shoes and considering so much. I'd better stay in the emergency department first." Zhou Can had made up his mind at the beginning to make a name for himself in the emergency department.
We need to make it clear to those department heads who did not choose him that academic qualifications are not the only factor.
"Well, if you change your mind, you can come to me anytime. You can even go directly to Director Tan. He also admires you very much." Yin Hua nodded helplessly.
There was nothing he could do if the other person didn't want to develop in internal medicine.
"By the way, have you chosen your training direction?"
Even for general practitioners, after being assigned to a department, they still need to choose a regulatory compensation direction.
"I wanted to choose general surgery before, but now it seems that I can only choose emergency medicine?"
Zhou Can was not quite sure about the hospital's arrangements for these general practitioner trainees.
Both he and Jin Mingxi were assigned to the emergency department, and he thought that the direction they chose for regular training would definitely be emergency medicine.
"Emergency medicine is a good choice for regular training, and you can change departments in the future. As for general surgery, I suggest you don't consider it, because the road is too narrow. The development prospects of general surgery are far less than those of neurosurgery and cardiothoracic surgery. As for internal medicine, neurosurgery and cardiothoracic medicine have the most development prospects."
Director Yin actually guided him in choosing the direction of his regular training. He must have valued him so much to put so much effort into it.
"Thank you for your thoughtful guidance. I am very touched."
Zhou Can and Director Yin Hua also got to know each other through fighting.
When they first met, Yin Hua even scolded him in public. At that time, he also had a very bad impression of Zhou Can.
Later, with Zhou Can's outstanding performance and humble character, Yin Hua's impression of him gradually improved.
…
After coming out of Shennei, Zhou Can called Li Lao directly.
"Brother Lao, it was me, yesterday..."
"I know, Zhou Can! Do you want to come to my house and play today?"
Li Lao chatted with him yesterday and they got along very well.
As soon as he opened his mouth, he directly invited Zhou Can to come over and play.
I guess he must be bored enough being alone at home with his wife.
"I won't go today. I'm still in the regular training stage and need to work hard to improve my surgical skills! Oh, studying medicine is really hard!"
Zhou Can sighed.
"Haha, who told you to choose this line of work? You regret it now!"
Li Lao laughed.
"I don't regret it that much. After all, I like this line of work. Brother Lao, let me tell you something. Didn't you send me your sister-in-law's medical records yesterday? I asked a few teachers to look at them today. Director Yin of the Neurology Department made a major diagnosis after looking at them. His opinion is that if you and your sister-in-law are willing, you can go to him for another diagnosis. Maybe you can get an MRI of the head."
Zhou Can didn't dare to continue arguing with the chatterbox Li Lao.
Instead, let’s get down to business.
Otherwise, he could bring up some topic of common interest and chat for an hour or so.
Zhou Can also likes chatting with him, which helps him gain a lot of knowledge and learn a lot.
But now my main focus is still on practicing medical skills.
Anyway, there will be plenty of time to drink and chat together in the future.
"Wow! That's great!"
Li Lao was so excited when he heard the good news.
Zhou Can even suspected that he jumped for joy like a child.
"I knew you were a sincere person. I just didn't expect you to care so much about my wife's illness. Brother, I won't say much, but I will remember this kindness in my heart. Even if your sister-in-law goes for another checkup tomorrow and still can't find the cause of the disease, I still thank you for your kindness."
Li Lao was almost going to become the president of Tianyu Interactive, and he had a strong ability to judge people.
Although he seems a bit unruly, he has great talent and ability.
When dealing with people, I don't like to play tricks.
This can be felt when both parties chat.
He never played any tricks when chatting with Zhou Can.
"Hey, is Director Yin's name Yin Hua?" Li Lao seemed to remember something and asked again.
"Yes! It seems you still remember him! When I showed him my sister-in-law's information today, he was also very impressed by her. He said that he was very sorry that he was unable to find out the cause of my sister-in-law's illness three years ago."
"It's really him. I'll take my wife to find him tomorrow."
Li Lao was extremely concerned about his wife's illness.
He was particularly happy when he heard that there were new findings in the diagnosis.
Although every time I went to see a doctor, I went with hope, but in the end I returned disappointed.
But as long as there is a glimmer of hope, he never gives up.
indomitable.
"Director Yin said that you don't need to register. But I think out of respect, you should still register."
Zhou Can has his own principles in life.
He believed that Li Lao would not care about the 800 yuan registration fee.
"You definitely have to register. I understand this, don't worry, brother. It's just that Director Yin's appointment is hard to get, so I'm afraid those evil scalpers will give it away again."
In recent years, Li Lao often took his wife to seek medical treatment and medicine.
I'm afraid he has suffered a lot from scalpers.
So I hate scalpers particularly.
"There's no need to buy a number from a scalper. Everything has been agreed upon anyway, so just ask Director Yin to add a number when the time comes." Zhou Can gave them an idea.
He has a strong sense of justice in his bones.
We will never encourage unhealthy tendencies unless it is absolutely necessary.
If patients stop buying numbers from scalpers, the scalper profession will naturally disappear.
After ending the call, Zhou Can was very happy.
Being loyal to a friend's trust is a display of credit. If nothing unexpected happens, this matter will soon have a good result.
He also wanted to see where Qiu Jie's disease was and what the specific cause was.
I believe that after completing the examination tomorrow, Director Yin will be able to diagnose the specific cause of the disease.
