Chapter 590: Hospital version of the forensic doctor, the truth of the cause of death emerges
Now that the person is dead, trying to determine the cause of death without an autopsy will undoubtedly greatly increase the difficulty of diagnosis.
Zhou Can often found it difficult to diagnose living people, so this was the first time he had to diagnose a dead person.
Faced with Qin Yuanzhu's hopeful eyes, Zhou Can finally decided to give it a try.
"I'll try! But as you know, after a patient dies, he or she can no longer provide much meaningful diagnostic data, so please don't hold out too much hope."
Zhou Can took on this difficult task.
After a person dies, all symptoms disappear, and key reference indicators such as blood pressure, respiration, heart rate, and body temperature all disappear.
This is very unfavorable for diagnosis.
We can only make a comprehensive inference based on the nursing records, X-rays, and symptom descriptions left by the patient during his lifetime, combined with the symptoms at the time of death and some manifestations after death.
"I understand this! We just need to do our best. If it really doesn't work and the family members don't accept our opinion, then we can only suggest that they go through the legal process and have an autopsy!"
Assistant Director Qin nodded.
Director Shi from the hospital infection control office looked at Zhou Can meaningfully.
"When our first team encountered this kind of dead patients in the past, we were able to quickly find out the cause of death almost every time. After Lao Song left, this ability of the first team was interrupted. Now that you have taken over Lao Song's position, I hope we can develop more in this direction."
Zhou Can was full of curiosity about Old Song mentioned by Director Shi.
"Who is Lao Song?"
He asked casually.
"A ward doctor with rich clinical experience later joined our quality control department. He started as an ordinary member of the fifth group and finally joined the first group."
Director Shi was full of admiration when he mentioned Lao Song's past experiences.
From his words, it is not difficult to hear that there are actually differences in rank among the five groups in the Quality Control Department. The highest status should be the first group, and the lowest status is the fifth group.
I wonder which group Zhong Hui, the team leader who once dealt with Zhou Can, is from?
Being able to become a team leader, and being treated very respectfully by the then Chief of the Medical Department, Xin Wanshan, his status must have been high.
Zhou Can and Zhong Hui are now colleagues in the same department. I wonder if the other party will feel embarrassed when they meet?
But what happened back then is a long time ago, and Zhou Can is not the kind of person who is petty.
I definitely won't hold on to it.
He has just started working in the Quality Control Department, and there must be many hospital leaders watching him. If he takes revenge on those who have suppressed him right after taking office, it will only ruin his bright future.
"After Lao Song entered the Quality Control Department, he taught himself forensic medicine considering the needs of the job, and later went to the Criminal Police Team for further studies for a period of time. After returning, he showed great talent in forensic medicine. Moreover, his forensic research direction is different from criminal investigation. He specializes in studying the cause of death of patients who died during clinical treatment. Whenever a patient dies in the hospital, he is asked to go over and take a look, and he can often find out the cause of death quickly."
"At the beginning, the family members did not trust the conclusions he gave. As a result, after requesting an autopsy, the conclusions were almost identical to Lao Song's. Later, Lao Song became the hospital's version of a forensic doctor. Not only would we ask him to analyze the cause of death when a patient died in our hospital, but other hospitals would also hire him for help at a high price when they needed it. You have a great clinical talent, and you can learn from Lao Song and study forensic medicine. Now that you have joined the Quality Control Department, you must do your job wholeheartedly."
Director Shi tried his best to let Zhou Can pursue a career in forensic medicine.
It's a hospital version.
It is difficult to judge whether the intention is good or bad.
Zhou Can has his own dreams, and it is impossible for him to give up pursuing his dreams for a job in the quality control department.
What people fear most is being indecisive.
He also believes that being a clinical doctor has much more prospects than being a hospital version of a forensic doctor.
Forensic medicine is responsible for determining the cause of death of a patient.
Clinical doctors save living patients, save lives, and relieve patients' pain. This is definitely much more meaningful than being a forensic doctor.
"Thank you Director Shi for your advice. I will consider it carefully."
Zhou Can responded with a cliché.
He no longer wasted time and began to carefully review the patient's medical records and examination reports one by one .
In fact, I had already seen it once when I was outside.
But this time I looked more carefully.
And the emphasis is different.
When checking the ward, the main purpose is to find out whether the medical staff of the Department of Gastroenterology have any irregularities in the diagnosis and treatment process. Now, the purpose is to find out the cause of death of the patient.
The patient had a routine stool test before hospitalization, and the result for occult blood was negative.
This indicates that gastrointestinal bleeding can be basically ruled out.
However, before the patient died, he suddenly vomited a large amount of blood and his abdomen was swollen like a drum. All signs indicated that the patient was most likely suffering from gastrointestinal bleeding.
And there is a high probability of upper gastrointestinal bleeding.
“Did the patient have a bowel movement before death?”
"No! He has difficulty defecating. He needs to use a suppository and then have the nurse help him to dig it out with his hands."
The attending physician replied.
Nursing is a job that is absolutely worthy of respect. They are more like unsung heroes who work silently. When a patient's disease is cured, the credit goes to the doctor, and few people mention the nurse.
However, all kinds of care and medication for patients during hospitalization are performed by nurses.
Only a few medications are administered by the attending physician.
A nurse is more like a wise minister, while a doctor is a king.
When picking out feces for patients, male nurses are usually used if there are male nurses available. However, male nurses are scarce talents, and many departments do not have any male nurses at all.
All kinds of difficult nursing tasks fall on female nurses.
One by one, they eventually transformed into tomboys.
In the inpatient ward, they help the attending doctors or interns lift the patients onto the flat bed and send them to the operating room or for some important examinations. In the ICU, they help the patients feed liquid food, turn over, and deal with feces and urine... As for ordinary injections and dressing changes, these are just their most basic daily operations.
Now that the patient has died, the nurse involved has been called in for investigation.
Zhou Can looked at the young female nurse opposite him with tears in her eyes and a frightened expression, and couldn't help but feel sorry for her.
It was especially refreshing to hear the attending doctor say that she had to help pick out the patient's feces with her hands.
This is a heroine worthy of respect.
“Was the patient who died someone you had been caring for?”
Zhou Can's eyes turned to the female nurse.
"Um!"
She bit her lip and nodded heavily.
The tears in my eyes seemed like they would burst out at any moment.
When she looked at Zhou Can, there was obviously a deep gratitude in her eyes.
Because at the beginning, Director Ju Shiman of the Nursing Department and Director Shi of the Hospital Infection Control Office both believed that the catheter was not inserted correctly, which caused the patient's death because he was unable to urinate.
Indeed, holding your urine for a long time can really kill you.
But with the current level of medical care, this kind of thing rarely happens.
If the patient is unable to urinate for more than one day, he or she will go to the hospital for treatment. After the doctor finds out the cause, there are many ways to help the patient urinate.
It is not just a method of inserting a catheter. For example, a fistula can be created at the waist and a urine bag can be hung on the body.
If a man's urethra collapses or becomes blocked due to inflammation, a dilator may be considered.
Various specifications are available.
Catheter dilation feels very sour, but it works.
Zhou Can deduced that the patient's death had nothing to do with the catheterization, which helped her clear up the injustice. She was naturally grateful to Zhou Can.
"Don't be afraid. You have done a great job in clinical care, especially in picking out feces for patients. This is very brave and dedicated."
Zhou Can first gave full affirmation and praise for her work.
She felt very relieved after hearing this.
Nod vigorously again.
"Thank you! Thank you for your evaluation of me!"
"What is your name?"
"Luo Xiao!"
"Teacher Luo, when was the patient's last bowel movement?"
Doctors call nurses. If they have a professional title, such as deputy chief nurse, chief nurse, or head nurse, they can be called director. If they do not have a senior professional title or position, it is generally more respectful to call them teacher.
However, in recent years, the title of "Teacher" seems somewhat unfriendly to female workers in non-educational fields.
Because many are called Teacher So-and-so by their male compatriots.
The job of a nurse is rather special and is also prone to misunderstanding.
In hospitals, many directors do not like others to call them teachers, and this is also the reason.
Of course, this is only part of the reason.
It's mainly because of people's vanity. People generally think that the director is more senior and sounds better than the teacher.
"Uh...it should be two days before the patient died. On the evening of the 19th, the patient kept complaining of chest tightness and severe abdominal pain. I helped him to defecate manually."
Nurse Luo Xiao replied.
After hearing this, Zhou Can couldn't help but feel moved.
As a cardiothoracic surgeon, he is very sensitive to many symptoms of cardiothoracic diseases. When he hears a patient's chest tightness, other medical staff may ignore it.
Zhou Can thought about the fact that the patient vomited a lot of blood before his death, and the medical staff had no time to rescue him, so the patient died directly.
Let’s make a bold inference: does the patient have cardiovascular disease?
For example, aortic dissection, especially ascending aortic dissection is the most dangerous. Or aortic aneurysm.
However, even if the aortic dissection ruptures, the bleeding will accumulate in the chest and abdominal cavity and it is impossible to vomit it directly from the mouth.
Most patients with aortic dissection present with acute onset of severe chest pain.
The pain is often stabbing, stabbing or tearing, usually continuous and unbearable, and opioid analgesics are often ineffective.
However, she mentioned that the patient had experienced chest tightness, which was an important clue.
"Was Mr. Luo present before the patient died?"
"I was there. It happened to be my night shift today! When the family member rang the bell, I immediately ran to the ward to check. The patient's blood pressure was very low at the time. I realized that something was wrong, so I immediately called the doctor on duty to treat it, and also called the attending physician, Dr. Wang."
When she mentioned the scene at that time, she still seemed to be frightened.
Watching a life disappear with your own eyes, even for medical staff who are used to seeing death, every time you see it, it still brings you great mental pain.
Female medical staff are generally more fragile mentally than male ones.
Watching patients die with their own eyes often has a greater impact on them.
"The patient's blood pressure was very low at the time?" Zhou Can couldn't help but suspect that the patient might have suffered a ruptured aorta and bleeding. "Did you notice the patient's appearance at the time? Did the patient have symptoms similar to shock, such as pale face, sweating, cold skin on the limbs?"
Zhou Can asked.
If it is really aortic dissection, the patient will generally only have symptoms similar to shock, but rarely actually go into shock.
Most die within a very short time.
It can also be understood as death due to lack of time for shock.
"Hmm...his face was indeed frighteningly pale at the time. I didn't notice whether he was sweating or not. When I took his blood pressure, the skin on his arm seemed a little wet and cold. At the time, I saw that the patient was in a bad condition and was quite nervous. I didn't pay too much attention to these details."
She said a little embarrassedly.
Most young medical staff would often react like this when they see a patient in critical condition.
Nervous, anxious, and only thinking about saving people as soon as possible.
Afraid that the patient will die in his hands.
Zhou Can also received regular training in the Department of Critical Care Medicine for several months, which enabled him to remain calm when faced with various emergency situations.
When he was in the intensive care unit, Vice President Ye personally arranged for him to continue his training for a longer period of time, which brought great benefits to his medical career.
Among the college-level leaders, although Zhou Can has certain connections with President Zhu and Vice President Bai, deep in his heart, he is closest to Vice President Ye.
It’s hard to put it into words, but from many details, one can see that Vice President Ye is truly doing this for his own good and is always thinking about him.
"The patient had an abdominal CT scan at the time, and the films should be archived. Can you retrieve them all now?"
"No problem, I'll contact the medical technology department immediately."
Director Shang highly cooperated with Zhou Can's request.
In the past, Zhou Can had studied with him and was considered his student and subordinate.
But now Zhou Can has grown beyond him.
With the administrative position, Zhou Can has become a leader.
Of course, this leadership is watered down.
Because he is just an ordinary member of the Quality Control Department and does not hold any leadership position.
"Did Doctor Zhou make a major discovery?"
Deputy Chief Xiong of the Medical Department asked.
"I guess so! I suspect the patient died from a ruptured aorta and massive bleeding."
Zhou Can didn't dare to be too sure now.
Because there are still many doubts that have not been resolved.
"Aortic rupture and massive bleeding? This should be ruled out because the patient vomited a lot of blood before dying. This is more like death from upper gastrointestinal bleeding." Director Shi retorted.
"Under normal circumstances, that's true. But everyone's body is different. For example, a normal person's heart is on the left side, but there are also people whose hearts are located on the right side of the chest. In clinical practice, I have even encountered a very special case where the heart was located inside the abdomen. So, everything is possible."
Zhou Can talked freely.
His gradually rich clinical experience makes him more confident when dealing with such matters.
Only by being well-informed can we break the conventional and rigid thinking.
