Chapter 260: Being recognized, the gastroenterology department has gained face
"Okay, I'll be there right away! And please tell your boss Shang that if I mess up, don't blame me."
Zhou Can and Luo Jingyi are now very familiar with each other, so he dares to joke with her.
Graduate students follow their supervisors, and some like to call their supervisors "boss".
In formal occasions, they usually call their mentors Director X or Professor X. In private occasions, or behind their backs, they prefer to call them Boss.
Graduate students are more like free long-term workers for their supervisors.
This is determined by the demand relationship.
To a certain extent, the tutor determines the fate of his or her graduate students. Once upon a time, a graduate student offended his or her tutor, and the tutor happened to be a narrow-minded person and refused to write a recommendation letter.
This completely ruined the graduate student's future.
"Haha, if you don't want to be scolded by Director Shang, you have to show your ability! I believe you will shock the doctors in the Department of Vascular Medicine."
She said with her hands covering her mouth and laughing.
"You are forcing me to do something I shouldn't do. I am just a resident intern. How can you use me as a chief physician?" Zhou Can was speechless.
When you meet a teacher like Director Shang, he will always be at the forefront of everything and you never have to worry about anything going wrong.
I don’t know whether it is lucky or unfortunate.
When it comes to educating children, Director Shang's way of giving up power and letting students experience and grow on their own is definitely a good one. However, doctors have zero chance of trial and error in clinical practice.
If something goes wrong, it won't just be Zhou Can who will be in trouble, Director Shang will also be in trouble.
How can he be so confident?
Zhou Can gritted his teeth and went to the Department of Vascular Medicine alone.
To be more precise, this should be called Cardiovascular Medicine, which is a combination of Cardiothoracic Medicine and Vascular Medicine.
If the experiment of establishing multiple sub-departments in the general surgery department is successful, the cardiovascular department will be dismembered. The vascular department alone can be divided into multiple sub-departments.
Cardiothoracic medicine can also be divided into cardiology and thoracic medicine.
The two most powerful departments in the Department of Internal Medicine are Cardiovascular Medicine and Neurology.
It was the first time that the Department of Cardiology invited a doctor from the Department of Gastroenterology to consult. Judging from the overall strength of the department, the Department of Cardiology is definitely full of experts and talents.
Zhou Can is relatively familiar with neurology, but not with cardiovascular medicine.
In his impression, the doctors in the Department of Cardiology are comparable to those in the Department of Neurosurgery. They are all arrogant and look down on the doctors in other departments.
Whether it was the one-month experience in the Department of Cardiology during his internship, or the later consultation with a cardiovascular doctor during his regular training in the emergency department, Zhou Can did not have a good impression of him.
Many doctors in the cardiovascular department look up when they see doctors from other departments.
Director Shang sent him to participate in the consultation of the Department of Cardiology this time. He was probably intending to use Zhou Can to let the doctors in this department gain some experience, so that they would not have to look up to others in the future.
"Beautiful lady, may I ask where your cardiovascular department consultation is?"
Zhou Can asked the female nurse at the nurses' station.
Three female nurses sat in a row, all of them were young and beautiful with pretty faces.
"Are you also the doctor here for the consultation?"
The oval-faced female nurse sitting at the edge looked Zhou Can up and down, her face full of surprise.
The other two female nurses also looked up and looked curiously at the young doctor from other departments.
"Yes, I'm a resident doctor in the Department of Gastroenterology." Zhou Can nodded in confirmation.
"Where is your teacher? Director Luo and the others have been waiting in the consultation room for your Director Shang to come." The nurses seemed to be doing only some unremarkable nursing work, but they were well-informed.
There are very few things within the department that they don't know.
This may have something to do with women's love of gossip.
As long as there is the slightest disturbance in the department, the nurses will definitely whisper to each other and spread the news to everyone.
"Director Shang really couldn't spare the time, so he sent me here to take his place at the consultation."
Zhou Can answered honestly.
"Did I hear correctly? That patient is suffering from cerebral infarction. Almost all the chief physicians in our cardiovascular department have participated in the discussion and believe that the patient is very difficult to treat. That's why we asked Director Shang from your gastroenterology department to come for a consultation. Even if he is very busy, he has to send a chief physician over!"
The nurse looked around and lowered her voice.
"I advise you to go back and ask a chief physician to come over, otherwise Director Luo will definitely get angry. Be careful not to scold you then!"
For such a difficult patient, the Department of Gastroenterology only sent a resident trainee, which is simply playing with the patient's life.
It can be seen that this nurse has a good heart.
Zhou Can said calmly, "It's okay, I'll go in and take a look first. If it's beyond my ability, it won't be too late to go back and ask Director Shang." After that, he asked directly.
"Where is the consultation room?"
"Look, walk in from here, it's the fourth room on the left. Many directors of our cardiovascular department are in there, so you're on your own!"
Seeing that she couldn't persuade him, the nurse just let him be.
"Thank you!"
Zhou Can had no idea that he was about to be scolded and walked straight into the consultation room.
Boom boom boom!
He knocked on the door.
"Hello, directors. I am a doctor sent by the Department of Gastroenterology to attend the consultation. My teacher, Director Shang, is busy and can't spare time, so he sent me to attend the consultation."
As soon as Zhou Can entered, all the doctors in the consultation room looked at him.
I took this opportunity to give a brief self-introduction.
"Are you kidding me? Why did Director Shang send a resident trainee to participate in the consultation?"
A male doctor in his forties with a ruddy face and sharp eyebrows got angry on the spot.
"Director Jiang, don't get angry yet. I know this intern. He's Zhou Can, who has become very popular in the hospital recently." Someone recognized Zhou Can at a glance.
He spoke up to help Zhou Can out of the predicament.
"Is he the one that both the internal medicine and surgery departments want to recruit?" Director Jiang not only spoke harshly, but also did not consider Zhou Can's feelings at all.
They are obviously the same person, how can you say in front of Zhou Can that he is a popular person?
Even though it's a compliment.
Still seems a bit disrespectful to Zhou Can.
"Ahem... I'm just an ordinary, plain little trainee. Not as exaggerated as the two directors say." Zhou Can cleared his cough and walked into the consultation room.
His eyes were already on the abdominal X-ray on the screen.
The patient's basic information is also projected on the screen.
A 66-year-old female patient with diabetes and gallstones was admitted to hospital for lacunar cerebral infarction.
The specific treatment plan is not yet clear, but for elderly patients with cerebral infarction, thrombolytic therapy is usually the first choice.
Surgical treatment is extremely risky, and no doctor would dare to use it unless it is absolutely necessary.
What is now projected on the screen is a plain film of the abdomen, which should have little to do with cerebral infarction.
Zhou Can secretly guessed that the patient's cerebral infarction should have been treated and complications were likely to occur now, so he hurriedly asked a gastroenterologist to come for a consultation.
"Zhou Can, no matter how outstanding you are, you are still just a resident intern with very limited skills and experience. You should call Director Shang and ask him to come here in person. We have invited not only doctors from the Department of Gastroenterology, but also doctors from the Department of Endocrinology. Director Hong is from the Department of Endocrinology, and he takes this matter much more seriously than your Department of Gastroenterology."
Director Jiang looked unhappy.
He felt that sending a resident trainee from the Department of Gastroenterology was disrespectful to the Department of Cardiovascular Medicine.
"Let me try first. If I can't do it, I'll ask Director Shang to help. He really is too busy now." Zhou Can said seriously.
"Okay, next time the gastroenterology department invites us to come for a consultation, and also sends a resident trainee."
Director Jiang was so angry that his face turned blue.
"You want to try it, right? Here, on the screen is the patient's recent abdominal X-ray. Can you tell me what disease the patient has now?"
There were several chief physicians sitting in the consultation room, but only Chief Jiang was the most angry.
He questioned Zhou Can in a series of angry voices.
"If the specific cause of the disease can be diagnosed just by looking at an abdominal X-ray, I believe that with the ability of the directors of the Department of Cardiology, there is no need to invite doctors from other departments to come for consultation. I am here to help, not to be scolded. Director Jiang is very anxious about the patient's condition, I can understand. But please give me the minimum respect."
Zhou Can's voice was calm, without a trace of anger.
But it was enough to make Director Jiang feel ashamed and blush.
"Director Jiang, please sit down and rest for a while. I will introduce the patient's basic condition to Doctor Zhou." The chief physician who helped Zhou Can speak twice looked to be at least in his fifties.
He had a kind face, completely white hair, and a thin body. Only his eyes still shone with a terrifying brilliance.
As bright as the stars in the dark night.
"Doctor Zhou, please take a seat! Here are the patient's examination data and medical records. You can first understand the patient's basic situation. If there is anything you don't understand, you can ask me. By the way, my last name is Luo, and I am the director of this department."
It turns out that this person is Director Luo, who is much more approachable than I imagined.
"OK, thanks!"
Zhou Can took the information and read it carefully.
The patient underwent physical examination and had mild tenderness in the right upper abdomen, but no tumor or mass was palpated. The patient had obvious pain when gently tapping the liver area.
The patient currently has chills, high fever, and jaundice.
Bilirubin was significantly elevated.
The patient underwent multiple examinations, including blood routine, B-ultrasound, and CT.
Considering that the patient had gallstones, the cardiovascular doctors initially suspected that the jaundice was caused by gallbladder contraction, which caused gallstones to be discharged into the common bile duct and then obstruction of the common bile duct.
The results of the patient's B-ultrasound showed that the internal and external bile ducts were not dilated, the pancreatic duct was normal, and there was no significant increase in blood enzymes.
After reading this, Zhou Can can basically identify the possibility of jaundice caused by common bile duct obstruction based on what he has learned.
For jaundice, focus on checking the gallbladder and liver.
These two organs are like good brothers.
CT scans showed that the patient's lungs were normal when he was first admitted to the hospital, with no obvious inflammatory response.
The CT scan I did today showed abnormal chest images.
There are cotton-wool-like shadows in both lungs.
What does this mean?
Zhou Can immediately suspected that the patient had a lung abscess.
None of the directors of the Department of Cardiology paid any attention to Zhou Can anymore, but continued to discuss the patient's condition and possible causes.
The chief physician of the endocrinology department basically just came here to make a cameo appearance.
Because it does not involve the field of endocrinology in which he is proficient, he cannot provide any useful reference opinions .
It was probably because the patient had diabetes that the doctors from the cardiovascular department invited him over.
Endocrinology is often the department of endocrinology that specializes in the treatment of diabetes.
However, the patient's current symptoms have basically nothing to do with diabetes.
This left the head physician of the endocrinology department sitting there doing nothing but doing nothing. The key point was that the cause of the disease had not been found, and no conclusion had been reached through discussion, so he could not leave.
Zhou Can continued to check the patient's other test results.
Ultrasound reexamination showed that the patient's right liver lobe was enlarged and presented as a solid space-occupying lesion.
The B-ultrasound before the patient was admitted to the hospital for treatment of cerebral infarction showed that the liver was basically normal.
In other words, the patient's lungs and liver all developed lesions after treatment for cerebral infarction.
It is not difficult to understand why Director Jiang was so anxious.
Any doctor would definitely be anxious if the patient he was treating had such a serious condition!
If things go wrong, the patient is particularly likely to die.
Especially for patients who are old and have multiple underlying diseases.
"Dear Directors, can I give you my diagnosis?"
Zhou Can raised his hand and asked.
Director Jiang looked at Zhou Can in surprise. He didn't expect Zhou Can to come up with a diagnosis so quickly. But he didn't hold out much hope.
How good a diagnostic opinion can a trainee provide?
Director Luo also turned to look at Zhou Can and said, "Please speak!"
"I just read all the patient's information and have a few immature opinions. First, the patient has cotton wool-like shadows in both lungs. Is it considered a lung abscess? I suggest taking a sputum sample from the patient for sputum culture test. Second, the patient's right liver lobe is huge, with solid space-occupying lesions. I suspect it is also an abscess. It is recommended to puncture and draw out the pus under B-ultrasound. If necessary, I can do this puncture."
Zhou Can was sure that if he did the piercing, he would most likely earn 100 experience points as a reward.
"The patient's sputum culture test is already underway, and the results will probably be out soon. I didn't expect Dr. Zhou to be so capable." After listening to Zhou Can's diagnosis, Director Luo couldn't help but admire him greatly.
None of the other chief physicians dared to look down on this intern anymore.
"You can propose a targeted examination plan, which means that you have already made a certain diagnosis of the cause of the disease. Tell me about your diagnosis! Liver abscesses and lung abscesses may occur, which we have already diagnosed. What we need now is the cause of the disease, and try to give the patient accurate treatment in the shortest time possible."
Although Director Jiang's tone was still somewhat condescending, his attitude had clearly changed.
At least he has taken the initiative to find out Zhou Can's diagnosis results.
"The patient's blood was most likely infected with bacteria, resulting in sepsis. Then, because the medication was not used in a timely and accurate manner, the condition worsened and turned into sepsis."
Zhou Can stated his diagnosis conclusion.
This disease is actually not as difficult to diagnose as imagined.
I don’t understand why so many chief physicians in the Department of Cardiology were unable to diagnose the cause of the disease. Is it because their skills are not good enough, or is there another hidden story?
"At first, I suspected that the patient had diabetes and was infected when receiving antithrombotic drugs, and then developed sepsis. However, blood culture and infusion fluid culture showed no sterile growth. Therefore, we ruled out the possibility of sepsis."
Director Hong from the Endocrinology Department was the first to raise objections.
After hearing this, Zhou Can suddenly realized.
No wonder so many chief physicians failed to diagnose the cause of the patient's illness.
It is very harmful to rule out a whole series of diseases by looking at the results of only one test.
Sometimes, there may be no problems when checking again after one or two days, but there may be problems.
At least Zhou Can has encountered many similar situations when diagnosing some difficult and complicated diseases.
The most frightening thing about being a doctor is sticking to the rules.
It's easy to be blinded by one thing.
Only by having the courage to doubt the test results and overturn them with facts can we avoid forming a "diagnostic blind spot".
"I have seen the blood culture and infusion fluid culture test reports. It happened four days ago. Not long after the patient received antithrombotic infusion, he developed high fever, chills and other symptoms. In fact, it is possible that the infection had just occurred at this time, so it is normal that it cannot be detected."
Zhou Can stated his point of view.
"Since we have already done a sputum culture test on the patient, we can still find out the cause even if we don't ask our gastroenterology department to come for a consultation this time."
As long as the sputum culture test results confirm that the lung infection is sepsis, the patient can be immediately diagnosed with sepsis.
"I'm worried that the patient will die! The patient's illness has lasted for four days and is getting worse every day. I'm so anxious that I feel like I'm being scratched by a cat." Director Jiang's attitude towards Zhou Can completely changed.
He even took the initiative to explain why he was so anxious and angry.
Director Hong from the Endocrinology Department was still a little stubborn and said, "It's hard to say whether it's sepsis or not. There are many diseases that can cause sepsis-like symptoms in the lungs and liver. The liver cancer patients I've seen have had similar symptoms."
This kind of stubborn rebuttal is actually very weak.
It's just an attempt to save a little bit of face.
There are many old doctors like Director Hong in the hospital, who are used to a life of luxury. They are flattered every day and their ears are callused by all kinds of flattery.
After a long time, it is easy to make people feel dizzy.
Once you have gained face, it will be hard to lower it.
Director Hong is a typical example. He knew that Zhou Can's diagnosis was likely to become true, but he still defended it for the sake of face.
"Other diseases may also present similar symptoms. Director Luo, can you perform a liver puncture on the patient and extract pus for further diagnosis?"
Zhou Can tried his best to save face for Director Hong.
