Chapter 279: The young are formidable. After suffering a beating from society, Dr. Du bowed his head.
Yang Chan is a woman with a very strong competitive spirit.
She was the monitor of Class 512, and her academic performance was always among the best in the class, so she was very proud of herself. But after she started working, she was overtaken by Zhou Can, who had mediocre academic performance, and the gap between them seemed to be quite large.
Although she didn't say it, she felt very anxious deep down.
Only by winning the game back can she feel more comfortable.
People, especially those who are proud inside, are more eager to prove that they are no worse than others.
The relationship between Yang Chan and Zhou Can has always been delicate. She is always the arrogant and overbearing monitor in front of Zhou Can. When Zhou Can is in trouble, she can help him without hesitation, without asking for anything in return.
Because she felt that she was the class monitor and had an obligation to take care of her classmates.
This time, she wanted to let Zhou Can know that she was still the powerful squad leader, and her heroic spirit was still there.
However, diagnosing SAS disease was not her area of expertise.
She had already begun racking her brains to deduce the cause of the patient's illness. It was hard to say whether she would gain anything.
Gao Jian is also working hard on the diagnosis.
The cause of the patient's illness is related to the central nervous system, and neurology is his strong point, so he has certain advantages and is full of motivation.
He also wanted to win a game against Zhou Can and regain his confidence.
In the past two years, I have been almost suffocated by Zhou Can because he is so outstanding.
The better the competitor, the greater the pressure on the parties involved.
Compared with the other two, Zhou Can was the calmest and most leisurely one. He was still conducting a deeper analysis based on the clues he had discovered.
Just as several chief physicians were diagnosing the woman, an accident happened.
The woman was originally half lying on the table with her hands supporting her huge head, but now she actually fell asleep on the table, snoring.
This little accident caused several doctors to look at each other in confusion, and then they couldn't help but smile.
"Does she usually fall asleep during the day at home?"
Zhou Can asked the family the first question.
"Yes! This child often sits on the sofa and watches TV, or talks to us, and then suddenly falls asleep. She has been with us in the hospital for a whole day of examinations today, and she must be exhausted."
The woman's mother looked at her daughter with doting eyes.
The parents must be responsible for making their daughter so fat.
It is said that spoiling a child is like killing him.
When parents indulge their children too much, they are not really loving them, but harming them.
"Does she sleep a lot during the day?"
Zhou Can wanted to know whether the patient had daytime sleepiness.
"That's not long. My daughter sleeps very lightly during the day and is easily awakened." It seems that she is not drowsiness.
"Has she always snored this loudly?"
Zhou Can nodded and asked.
"Today is still relatively good. When it's severe, I can feel the vibrations in the door and glass of the room. Doctor, my daughter's snoring is loud. Does it mean that her lungs are functioning well ?"
The girl's mother was actually proud of her daughter's loud snoring.
I really don’t know what kind of weird parents these are.
“This doesn’t seem to have any scientific basis!” Zhou Can tried his best to make his tone nicer, otherwise he would make the family members unhappy and it would not be good if they started quarreling.
As far as he knew, the louder the snoring, the more blocked the respiratory tract was.
It’s just that the patient’s mother is proud of this, and if Zhou Can tells the truth, he will probably immediately arouse the disgust of the family members.
If it is central sleep apnea, it is usually mild intermittent snoring.
Her snoring seems to be more severe and not intermittent. It seems to be more like obstructive sleep apnea.
The three chief physicians' previous judgment that this patient was likely to have mixed sleep apnea was probably correct.
The diagnosis of mixed etiology is more complicated and much more difficult.
No wonder the surgeries done in other hospitals were ineffective.
Suddenly, the patient's snoring stopped.
Her body began to move restlessly, and her face gradually turned red. Finally, it was as if her blocked airway had suddenly been opened.
A long puffing sound came out of the mouth, and the waste gas in the body was expelled.
The patient's paused breathing then returned to normal.
Zhou Can, Director Zhang and others witnessed the patient's respiratory arrest with their own eyes. In addition to being shocked, they were more happy.
Being able to see the symptoms with your own eyes will definitely help with diagnosis .
Just now when she was recovering her breathing, she needed to expel the air from her mouth. Was it her nasal airway that was blocked?
This provides a direction for their diagnosis.
"When she had respiratory arrest, she didn't seem to have any circulatory symptoms, such as high blood pressure, arrhythmia, myocardial infarction, etc. This is a good sign. At least she doesn't have to worry about developing other circulatory diseases when she has respiratory arrest."
Zhang Bihua said.
Sleep apnea syndrome is very likely to cause combined symptoms of the circulatory, respiratory, nervous, endocrine and metabolic systems.
The risk of these complications is even higher than that of SAS itself.
"There seems to be no respiratory impairment, hypoxemia, or hypercapnia, which would prevent pulmonary hypertension and right ventricular failure. The patient's condition should be relatively mild, far from being extremely dangerous."
As Zhou Can spoke, he walked around to the patient's side and carefully observed her neck.
The family members were quite snobbish and didn't seem to trust him as a young doctor.
Standing there, just moved slightly to the side.
Zhou Can didn't mind. He had been practicing medicine for so long and had seen all kinds of family members.
It is common to suffer minor grievances.
That is to say, his medical status has been raised now, and he can be treated very well by senior doctors. When he was an intern before, his status was not raised, and he really suffered from both sides.
After being scolded by his family members and patients, he would always be scolded again when he was hospitalized. Sometimes the teaching teacher's face was as black as if he had been washing soot from a pot.
After reading it, Zhou Can felt a little more relieved.
Director Zhang, Deputy Director Shi, and Director Jiang have already discussed the patient's condition, but the three have not made any substantial diagnostic breakthroughs.
"Please ask again, did she complain of a headache when she got up this morning?"
Zhou Can decided to learn more about it.
"It seems that this symptom really exists. She often says that she didn't sleep well last night and has a headache." The female patient's mother replied.
"Did she ever have enuresis?"
Zhou Can has already made a further judgment in his mind.
"Uh...well, it seems not!" the patient's mother replied hesitantly.
Her eyes flickered and her expression changed quickly, indicating that she was not telling the truth.
In fact, there are other ways for doctors to determine whether family members answer questions honestly.
For example, if the eyes look up to the left when they are lying, it means that the family members or patients are trying to deceive the doctor. If the eyes look up to the right, it means that they are recalling the past and are more likely to tell the truth.
Just now, when the female patient's mother answered, her eyes looked to the upper left, and her eyes were wandering. She didn't dare to look Zhou Can in the eye at all. She was probably lying.
"You don't have to be embarrassed for your daughter. Telling us the real symptoms will help us find the cause of her illness. As long as the cause is found, it may be possible to cure her sleep apnea syndrome. At that time, all her symptoms will disappear and her body will return to normal."
Zhou Can patiently persuaded the family members and painted a rosy picture for them.
"Well... my daughter does have enuresis, but it only happens occasionally." The female patient's mother lowered her head and whispered.
The two family members found that Zhou Can could accurately describe some of their daughter's hidden symptoms, and they couldn't help but look up to this young doctor.
"Director Zhang, I suggest checking the patient's thyroid function."
Zhou Can made diagnostic suggestions to Director Zhang who was in charge.
Yang Chan and Gao Jian were shocked. They didn't expect Zhou Can to have made a diagnostic breakthrough so quickly.
In other words, the two of them had never been in the same department as Zhou Can.
Otherwise, this kind of thing would definitely be nothing new.
There were many chief physicians who had been beaten by Zhou Can, not to mention the two interns at the same level as them.
They want to compete with a monster like Zhou Can, and they are more inclined to seek abuse.
"Why do you suspect there is a problem with thyroid function?" Director Zhang did not express his opinion immediately, but was very curious about Zhou Can's diagnosis direction.
Central sleep apnea should be diagnosed as central nervous system disease, while obstructive sleep apnea should be diagnosed as respiratory disease.
However, Zhou Can went beyond these two pathological directions and focused on the patient's thyroid gland. This way of thinking, which is to look at the problem from a different perspective, is extremely rare.
"There are multiple reasons! First, look at the patient's neck. Based on my clinical experience in general surgery, I think there is something wrong with her thyroid gland."
This ability to detect lesions from the patient's body shape and appearance through visual examination requires the doctor to be knowledgeable and have rich clinical experience.
Zhou Can rotated in multiple surgical departments for regular training and performed an astonishing number of surgeries, which was of immeasurable benefit to his future clinical diagnosis.
For example, he can detect that a patient may have a malignant tumor by looking at the patient's complexion.
Or, as is happening now, by observing the patient's neck, we can find out that the patient's thyroid gland has been diseased.
Every doctor present has the ability to discover potential lesions through inspection. However, their inspection abilities are limited and their knowledge is narrow, so they cannot perform inspection in all fields like Zhou Can.
Even Director Zhang Bihua is only good at obstetrics and gynecology.
Director Zhang is not a layman when it comes to diseases in the field of general surgery, but his understanding in this area is shallow and at best at an elementary level.
In fact, most chief physicians are like this. They are proficient in their own areas of expertise and have some knowledge of other medical fields.
"Also, during bronchoscopy, the patient was found to have upper respiratory secretory edema, which is actually a typical endocrine and metabolic disease. Furthermore, the patient was easily awakened, had centripetal fat distribution, and had muscle relaxation, which is also related to endocrine and metabolic diseases. If possible , it would be better to test her bone mass, as this disease will definitely lead to osteoporosis."
Zhou Can gave his own multiple diagnostic bases.
Other doctors either did not notice these clues, or did not pay too much attention to them even if they did.
"Dr. Zhou's diagnosis is well-reasoned and logical. I think it should be adopted. What do Director Shi and Director Jiang think?"
Zhang Bihua looked at the other two.
"That's fine with me."
Deputy Director Shi naturally agreed with both hands. Zhou Can represented the Department of Gastroenterology and wore the same pants as him. Now that Zhou Can showed up, he, a doctor in the Department of Gastroenterology, was also very proud.
"I agree! The young are really promising! Dr. Zhou is young and promising, and his diagnostic skills are first-rate. I really admire him."
Director Jiang already had a good impression of Zhou Can, and Director Tan from the Department of Internal Medicine has always been particularly fond of Zhou Can.
Now, Zhou Can has made substantial progress in this difficult case, so Director Jiang simply added icing on the cake and praised Zhou Can highly.
“Director Jiang’s praise has made me feel so lost! I just happened to have accumulated experience in the field of general surgery, which is why I was able to make some discoveries.” Zhou Can felt ashamed.
He felt quite embarrassed when the chief physician praised him so much in public.
Being used to keeping a low profile on weekdays, he found himself quite shy in such occasions.
"Since both directors agree with Dr. Zhou Can's opinion, I will apply for a check-up for the patient." Zhang Bihua had no intention of discussing this with the family.
I believe that as long as the family members’ brains are not damaged by the door, they will definitely agree.
In fact, the faces of the two family members were already showing expressions of joy and anticipation.
After visiting so many hospitals, I finally made some new progress today.
When they went to other hospitals, they would do CT scans, bronchoscopy, and various biochemical tests. But the final result was that there was no result. The real cause of the disease could not be found, and their daughter's disease could not be cured.
"Doctor Zhou, is it enough to just check the patient's thyroid function and osteoporosis?"
Director Zhang Bihua's question shows that she is a humble and very pragmatic person.
If it were a chief physician who was more concerned about his reputation, he might put on some pretentiousness, make a few comments as a teacher, and directly issue the examination application.
I would never ask for the opinion of a junior doctor in public.
“Enough is enough!”
Zhou Can nodded repeatedly.
Director Zhang wrote an application for examination for the patient on the spot. The family happily took it, woke up their precious daughter, and took her for the examination.
When the female patient was woken up, she asked her parents in a daze what happened?
The female patient's mother said directly to her daughter, "This young doctor Zhou and several experts have found out the cause of your illness! Come on, let's go get checked. Oh, we finally came to the right place today. The doctors at Tuya Hospital are very good, much better than those in other hospitals!"
What the family members said to the patient made the experts feel particularly cool and comfortable.
It was also the first time since they came here to provide medical services that they heard family members praising the high level of Tuya Hospital.
A major breakthrough was made in a difficult case here, and everyone was happy, but Du Leng was still in misery.
He was unable to diagnose the first two difficult cases and left cursing.
Now he had the third difficult case, and he was equally confused and had no clue.
This time, Du Leng learned his lesson.
Without waiting for the family members to curse, he quickly put aside his worthless so-called face and said to Zhang Bihua, "Director Zhang, Director Zhang, this patient has a low fever, blurred vision, hearing loss, and leg pain. The examination showed abnormally elevated liver enzymes, 52% lymphocytes, and 8% atypical lymphocytes. Bone marrow puncture showed active growth. The patient's erythrocyte sedimentation rate was also problematic."
After Du Leng quickly reported the patient's basic condition, he continued.
"I am only good at diagnosing diseases in neurosurgery and thyroid and breast surgery. This patient's condition is complicated and beyond my ability to diagnose and treat. Please help me and the other directors."
Humans are the most adaptable animals.
Du Leng was beaten by society twice in a row, and he learned to bow his head.
If he doesn't bow his head, his face will be swollen today.
That is, the patient's family member is a middle-aged woman who is well-dressed and has a good temperament. You can tell at a glance that she is a high-quality person with a good life.
If it were a family member with a bad temper, he would probably have cursed like the previous two family members did.
Even though the patient's family member is well-educated, it doesn't mean she is easy to talk to.
Look at her face with delicate makeup, which is already as cold as ice. I'm afraid she has long been extremely dissatisfied with Du Leng's diagnostic ability.
"Ma'am, please bring the patient over here! We'll give her a joint diagnosis."
Zhang Bihua said to the family members.
"Okay! Thank you for your help!"
The family members brought the patient over, and her originally cold face warmed up a little.
When he left, he didn't even look at Du Leng or say hello.
This shows that she is very dissatisfied with Du Leng.
This female patient looked very young, probably no older than 20. She looked like her mother, a natural beauty.
But his face was pale and flushed like a sickly disease, his eyes were lifeless, and his expression showed pain. It seemed that he was suffering from illness.
No matter how successful a person is, once he gets sick, he will soon be tortured beyond recognition.
Whether it is body shape, appearance, or temperament, they will be completely different from when they were beautiful and healthy before.
"Have you been treated in other hospitals?"
After taking the patient's information, Zhang Bihua motioned for them to sit down.
"I have. My daughter has been ill for a long time, almost two years. It was just a common cold. The next day she had a fever, nasal congestion and runny nose. I thought it was just a minor cold. I thought she would get better soon if she drank more water and had a good rest. But after a few days, she still didn't get better. I was a little worried. The child's father was on a business trip abroad for a long time, and I was busy with my work and didn't pay enough attention to the child..."
The family members' words were full of self-blame.
