Practicing Medical Skills in a Small Clinic-Chapter 293 - 164: Of All People to Provoke, Director Mu’s Call for Help_3
This kind of thing is fine to do once or twice occasionally.
Pushing difficult patients to other hospitals all the time, do you really think the hospital leadership does nothing?
They definitely wouldn’t agree.
Moreover, this kind of action harms one’s reputation.
Li Jingsheng took a cab to the Second Hospital and indeed found Director Mu in the director’s office.
He seemed to be looking up information on the computer.
When doctors encounter difficult cases they can’t solve, it’s a good approach to check similar cases online for reference or to consult reference books. Doctors with connections can also seek advice from colleagues.
"Dr. Li is here! The patient is currently hospitalized. Yesterday, she showed symptoms such as convulsions, severe headache, and aphasia. I have organized a discussion among our hospital’s doctors, but there hasn’t been a definitive result. Currently, we suspect the issue might lie in the central nervous system."
Upon seeing Li Jingsheng, Director Mu immediately stood up to greet him.
Then he went straight to the point, introducing the patient’s condition.
Li Jingsheng remembered that yesterday the female patient had some symptoms but was still fairly conscious.
Communication was normal, and her actions were normal.
Unexpectedly, the condition had progressed so rapidly within such a short time.
"Can I see the patient’s test reports? The patient came to buy cold medicine from me the day before yesterday, and yesterday morning she returned complaining of a persistent fever. At that time, I noticed her skin was jaundiced and she had petechial hemorrhages under the skin, which made me realize it could be a serious illness. After excluding liver and biliary diseases, the only possibility left was hemolysis. So, I advised her to go to a major hospital for further diagnosis."
Li Jingsheng recounted the events.
The ability to arrive at such a precise judgment based solely on a few manifestations made Director Mu hold him in higher regard.
"These are all the tests performed after the patient was admitted. You take a look first."
There was a trace of worry on Director Mu’s brow.
Sometimes doctors hope even more than the patient’s family for the patient to recover soon.
Holding such a patient represents immense pressure for the primary care doctor.
Li Jingsheng first checked the patient’s complete blood count data.
Because hemolysis easily shows abnormal data in blood counts.
Hemoglobin at 65g/L.
The first item appeared extremely abnormal.
The normal range for hemoglobin in adult females is 110-150g/L. This female patient’s hemoglobin is only half of the normal amount.
Red blood cells at 2.3*10^12/L, white blood cells at 8*10^9, lymphocytes at 0.35, platelets at 38*10^9...
Normally platelets range between (100~300)×10^9/L.
This patient’s platelets are only 38.
No wonder she’s experiencing widespread subcutaneous hemorrhaging. Her coagulation must be seriously abnormal.
Urine red blood cells are positive.
Stool tests are normal.
Li Jingsheng quickly reviewed other key indicators — potassium, creatinine, carbon dioxide retention, sodium — all these data are normal.
"The thermal hemolysis test is unexpectedly negative."
He felt surprised when he saw another test result.
"The sucrose lysis test is also negative! This case is indeed quite challenging."
Director Mu patiently accompanied him nearby.
Relying completely on Li Jingsheng is unrealistic.
However, if Li Jingsheng can provide suggestions or direction on some critical thinking paths, with Director Mu’s vast clinical experience, they might just find a breakthrough.
Li Jingsheng found the patient’s cold agglutinin test was also negative.
Liver function is normal.
They even tested her for hepatitis B surface antigen.
Big hospitals are certainly meticulous.
If Li Jingsheng were treating, liver and bile function tests wouldn’t be necessary.
But the Second Hospital carried out extensive tests on the patient, nearly a comprehensive set, for a reason.
These test applications were seemingly submitted late.
Indicating the earlier tests found no issues, then they considered checking hepatitis B.
The liver is the production site of various enzymes in the body.
It is also the body’s most important detoxifying organ.
Many people think the kidneys are the detoxifying organs because they believe toxins are expelled via urine. This perception is actually unprofessional.
The liver quietly acts as a factory in breaking down all kinds of toxins and harmful substances ingested.
Why protect the liver when drinking alcohol?
That’s the reason.
The alcohol consumed doesn’t harm the esophagus, stomach, or intestines chiefly but rather the liver.
Chronic hepatitis or diseases like hepatitis B can both lead to coagulation dysfunction. 𝗳𝚛𝗲𝕖𝚠𝚎𝚋𝗻𝗼𝕧𝗲𝐥.𝚌𝚘𝐦
Director Mu testing for hepatitis B suggests he was almost searching blindly.
Li Jingsheng continued reading, discovering the patient was tested for bilirubin at 27.4UMOL/L, total bilirubin at 72.4UMOL/L.
Not only that but they also checked the patient’s ECG.
Of course, it was normal.
Hemolysis is rarely caused by heart disease, so there’s likely multifaceted reasoning for checking the ECG.
They also performed a chest X-ray.
Result: No abnormalities in the heart, lungs, mediastinum.
After checking the organs in the chest and abdominal cavity and finding no cause, they still had to keep searching.
The patient underwent a cranial CT, a test that is actually quite expensive.
If the patient lacks insurance, even if she’s hospitalized, not much will be reimbursed.
Doctors usually suggest such expensive tests after hospital admission to maximize the patient’s reimbursement.
Outpatient and inpatient reimbursement rates differ.
Unaware of this fact, many patients can’t comprehend the doctor’s considerate intentions.
The CT scans revealed no tumors, substantial hemorrhage, or cerebral infarction in the patient’s brain.
This step increases the difficulty level of determining the illness.
However, truly pinpointing the cause is becoming closer.
Exclusion is a common method in clinical diagnosis.
Simple and practical.
Next, they performed a lumbar puncture on the patient.
With major thoracic and abdominal cavity organs checked and no abnormalities found, but clearly abnormal blood counts, they examined the cerebrospinal fluid.
Cerebrospinal fluid pressure was normal, routine tests and advanced lab biochemical tests were all normal.
At this point, there’s basically only one thing left: bone marrow.
Essentially, Director Mu was also heading in that direction.
