The Enhanced Doctor-Chapter 386: Divergence in Diagnosis

(Thanks to friends Elf, Zhu Hong, Silent Guard, Naughty Dragon 1976, Book Friends 20190727205832637, and likeicewolf for their monthly ticket encouragement)

Today’s interview had really drained Liu Banxia of a lot of energy; even when he was reviewing patients’ medical records, he seemed somewhat absent-minded.

His cell phone rang; he received a WeChat message.

"How did it go on the show?" It was from Qiaoqiao.

"It went okay, I think. The host said my suit was really nice," Liu Banxia responded.

"See? I picked it out! Of course, it’s great. No problem at all." Qiaoqiao replied, adding an emoji of a figure with hands on hips, laughing boisterously.

Liu Banxia laughed; this girl could be quite mischievous at times.

However, deep down, he really felt he owed Qiaoqiao. He was now just hoping to step down as chief resident soon, so he could at least have more time to spend with her.

"Teacher Liu, Teacher Wei is requesting you for a consultation." At this moment, Huang Bo walked in.

"Alright, I’m on my way. What’s the situation?" Liu Banxia replied.

"Female patient, 43 years old, fainted while waiting for her consultation. Blood pressure 104/86, heart rate 72. ECG is normal, blood test results are normal," Huang Bo quickly reported.

Liu Banxia furrowed his eyebrows; this patient’s condition seemed rather complicated.

"How is she doing?" Liu Banxia asked as he reached the patient’s bedside.

"Blood tests and urine tests are all normal. We’ve ruled out liver failure, diabetic ketoacidosis, and alcohol poisoning. Now we’re a bit stuck on what to do next," Wang Huan, who was also there, said.

"What’s the story with the scar on her face? Could it be due to trauma?" Liu Banxia asked after taking a look.

"The patient’s family said she was injured in an electric scooter accident two years ago and had metal implanted. However, Doctor Wang and I both believe her current unconscious state isn’t directly linked to that old injury," Wei Yuan explained.

"Can you help determine if it’s a problem with her brain or abdomen? The abdominal ultrasound didn’t reveal any issues. Her friend also mentioned she seemed perfectly normal when she went to work this morning but started feeling unwell in the afternoon."

"I don’t have any great ideas either; we can only try to rule things out one by one," Liu Banxia said with a wry smile.

"Both of you are here, and the physical exam definitely didn’t reveal any abnormalities. Brain, neck, spine, chest, abdomen, pelvis... should we go through them one by one?"

He sounded somewhat helpless. With patients like this, there really weren’t many options. They had to start from the top and check everything systematically.

"We’re thinking the same thing, but the downside is that conducting all these examinations might deepen the conflict with the patient’s family. They’re already very upset. If we still don’t have a diagnosis after two more sets of tests, it’ll be hard to proceed," Wei Yuan said.

Liu Banxia now understood why they had called him over.

Everyone knows the normal order of examinations—check systematically from top to bottom. But if you run too many tests, you risk accusations of over-treatment. The debate around this issue was still so intense that it made them cautious.

"Which area do you think is most likely the source of the problem?" Liu Banxia asked.

"We’re considering a tumor, so we plan to do a combined CT of the chest and abdomen first. But we’re not sure about the second test; should we check the spine, head, or the pelvis?" Wang Huan said.

Liu Banxia smirked. "You never think of me when things are good, only when there’s a hot potato to handle. Let’s go with a CT of the chest, abdomen, and pelvis. Considering she’s a female patient, there’s a significant chance the issue could be in the pelvic region."

"Okay, it’s decided then. If you figure it out, I’ll treat you to an extra dish tonight," Wei Yuan nodded.

"It better be a good one," Liu Banxia said.

They hadn’t called him over to help make the decision because they were afraid of complaints. Rather, they wanted another opinion to help preempt potential medical disputes. Especially with the patient in this state—after expensive and time-consuming tests, the cause of her illness still hadn’t been found. Any family member would be frantic.

"How did the interview go today?" Wei Yuan asked curiously.

"I can only say that it’s put a great deal of pressure on me," Liu Banxia said.

"The setting was comfortable, and the opening was warm, but the host’s questions were still very pointed. After this interview, I’ve decided I’m never doing a TV show again. They can say what they want."

"Did it leave that much of a psychological mark on you?" Wei Yuan asked, laughing.

"You bet. I was just worried I’d misspeak. That stuff gets broadcast, unlike us just chatting casually here," Liu Banxia said.

"If there’s nothing else, I need to go back. I still have a stack of cases and discharge papers to sign. Sigh, if only a day had 48 hours. At least I wouldn’t be this exhausted."

"Just gotta get through it. We all went through the same grind back in the day. Though we didn’t have as many emergency patients as you do now. Anyway, you’re young," Wei Yuan teased him.

Back in his office, Liu Banxia got busy again. With so many patients coming and going in the Emergency Center, he had to at least glance at each one.

However, he still couldn’t fully focus, his mind preoccupied with that last patient. He had to think ahead: if the chest, abdomen, and pelvic scans showed nothing, how would he discuss further tests with the family?

Judging by the patient’s clothes, her family didn’t seem wealthy. It was always easier with affluent people; they didn’t care about the cost of tests and were usually more afraid of too few being done.

His productivity was low today; too many things were weighing on his mind.

While he was busy, Wang Huan came in. "The chest and abdomen CT scans are normal. They’re doing the pelvic scan now."

Liu Banxia grimaced. "Looks like we’re really heading for the toughest scenario. Guess we’ll just have to wait."

BEEP! BEEP! BEEP!

Before Liu Banxia could say more, the Emergency Center’s alarm blared.

Without a second thought, both Wang Huan and Liu Banxia dashed out. That alarm meant a patient was in critical condition.

"What’s the situation?" Liu Banxia asked upon reaching the corridor.

"Bed 7, an eight-year-old child in respiratory failure!" Zhou Li shouted as she ran past.

"Why is everything happening today?" Liu Banxia muttered to himself as he sprinted towards Bed 7.

"Oxygen! Ten units of etomidate, fifty of suxamethonium! Intubate!" Chen Hongyang, standing by the bedside, ordered sharply.

"Intubation complete. Blood oxygen at 86," Liu Man, the pediatric intern, reported after finishing.

"Start nitric oxide inhalation, one part per hundred thousand. Move him to the resuscitation room for a chest X-ray," Chen Hongyang instructed.

Liu Banxia stepped aside, letting the nurses wheel the gurney to the resuscitation room.

Chen Hongyang frowned. "The patient is eight years old, presented with high fever and cough. History of illness is about a week. He was taking over-the-counter cold medicine at home, with little effect. Auscultation suggested mild pneumonia, so we started antibiotics."

"The child is in poor health and has a history of allergies. Previous tests detected multiple allergies; he’s allergic to numerous substances."

"It’s been about twenty-seven minutes since the infusion started, and he’s already in respiratory failure. We’ve ruled out an allergic reaction to the medication. If his blood oxygen doesn’t improve, I’m planning to put him on ECMO."

Even though their past issues were supposedly resolved, he didn’t particularly want to report to Liu Banxia; after all, there was a considerable difference in their ranks.

Still, he wasn’t very confident about this young patient’s case. If the blood oxygen didn’t come up, the child would be in serious trouble.

"Such a severe allergic reaction? His daily life must be incredibly difficult then," Liu Banxia said, frowning.

"His parents are usually very careful with him. He has his own dedicated utensils, and they rarely let him go out to minimize allergic reactions," Chen Hongyang replied.

"Let’s see how the intubation and nitric oxide work first. Putting him on ECMO will not only be very expensive but also create significant hurdles for subsequent treatment," Liu Banxia said.

Chen Hongyang remained silent, but internally he agreed.

Otherwise, he wouldn’t have brought it up with Liu Banxia. But the child’s blood oxygen was critically low, and that needed to be addressed immediately.

"Teacher Chen, the nitric oxide isn’t working! The child’s blood oxygen hasn’t improved, and a rash has appeared on his arm!" Liu Man reported, rushing out of the resuscitation room.

"Prepare the ECMO machine," Chen Hongyang ordered.

Liu Banxia frowned slightly. Although he knew Chen Hongyang meant well, the decision seemed hasty. A rash had appeared on the child’s arm—a new symptom. Could it be an allergy to something in the hospital, like the bedsheets?

As the nurses began prepping the ECMO machine, he walked into the resuscitation room to carefully examine the rash on the young patient’s arm.

"Dr. Chen, do you think this patient might have systemic mastocytosis?" Liu Banxia asked.

"I observed two more patches of rash on the child’s other arm and one on his left leg. If it were an allergic reaction in a hospital environment like this, shouldn’t it be systemic, affecting his whole body?"

"But I don’t see any rash on his head. I suspect it’s because the child has mastocytosis, causing his body to secrete large amounts of histamine, leading to this reaction."

"If we use ECMO, letting his blood circulate through the machine could trigger anaphylactic shock. The inflammation shown in his lungs might not be from an infection but rather a result of mast cell aggregation."

"Are you basing your judgment solely on these rashes? The child’s blood oxygen has already dropped to 84," Chen Hongyang said, frowning.

"But when it comes to the child’s life, I think we should explore other options. For example, what about PLV? Could that improve his current breathing?" Liu Banxia suggested.

Hearing their discussion, even though the nurses had the ECMO machine ready, they hesitated, unsure whether to proceed.

This was the situation: a difference of opinion between two influential doctors. One was an attending physician in pediatrics, and the other was the chief resident.

Even though their official ranks were quite different, within the Emergency Center, Liu Banxia, as chief resident, held slightly more immediate authority than Chen Hongyang in such situations.