The Enhanced Doctor-Chapter 398 Difficult Decision

(Thanks to friends Anxi Huixiang, Nanren Xian, and Lazy Misty Bug for their monthly vote encouragement)

"Teacher Liu, the MRI results for that patient are out, and the situation doesn’t look good," Su Wenhao approached Liu Banxia as soon as he stepped outside.

"The gallbladder inflammation is very severe; the entire gallbladder is almost completely full of gallstones. Although no stones have fallen into the common bile duct yet, I predict it’s only a matter of time."

"I’m currently waiting for the latest blood test results to see if his blood sugar level has changed. If he meets the surgical criteria, I’ll recommend a cholecystectomy."

Liu Banxia nodded. "Okay, let me see the blood test results when they’re out. If he’s suitable for surgery, you’ll perform the operation. Also, contact the patient’s family as soon as possible. After all, removing a gallbladder is different from removing an appendix."

Su Wenhao nodded happily and ran off toward the laboratory to hurry them along with the results.

This was becoming a new problem in the Emergency Center. As the number of patients increased, test results were taking much longer than before. Unless a case could genuinely be expedited, no one could jump the queue. After all, all patients had the same rights. One couldn’t enjoy special privileges just because they were your patient; even Liu Banxia couldn’t pull strings.

"Sister Li, we still need to ensure the waiting hall is thoroughly disinfected. It seems like there are more flu patients recently." After a while, Liu Banxia found Zhou Li.

"I’ll arrange it in a moment. There are quite a lot of patients right now," Zhou Li said.

"Thanks for your hard work, Sister Li," Liu Banxia said with a smile.

"Sigh... When can you suggest to the Director that we need to add another three to five nurses? That would be great. The number of patients has increased so much recently, we’re getting overwhelmed," Zhou Li said.

"I’ll try. We’re actually in a transitional period right now. Only when we have a stable patient volume can we submit a staffing plan to the hospital," Liu Banxia said.

Zhou Li nodded and went back to her work.

"Teacher Liu, the blood test results are out! His blood sugar has dropped a lot, but his calcium ion level is low, while the amylase, lipase, and white blood cell counts are abnormally high. This confirms gallstone pancreatitis. I’m afraid he can’t have surgery now," Su Wenhao rushed over again, saying.

"What medical orders should be given then?" Liu Banxia asked.

Su Wenhao’s assessment was very accurate. These elevated amylase and lipase levels are important indicators of gallstone-induced acute pancreatitis. Combined with the patient’s current condition, the diagnosis could be confirmed.

This is also a very serious acute illness, its clinical incidence rate second only to common acute conditions like appendicitis and intestinal obstruction.

The illness is caused by pancreatic lesions resulting from gallstones or inflammation, leading to pancreatitis. Otherwise, this patient’s blood sugar wouldn’t have been sky-high on admission today.

"Increase the IV flow rate, add some nutritional fluids, and admit him to the hospital. This might buy us a few days, allowing his pancreas to stabilize before we remove the gallbladder," Su Wenhao said.

"Good, proceed with that plan. It’s a solid approach. It looks like the patient’s family has arrived too. Explain the situation to them thoroughly; I’ll listen in," Liu Banxia said.

Hearing this, Su Wenhao became a bit nervous. He was somewhat intimidated by the prospect of communicating with patients’ families.

"Doctor, what’s wrong with our Xiaowen?" the patient’s father asked as they walked over.

"Based on our current diagnosis, he has acute pancreatitis caused by gallstones," Su Wenhao said.

"Please look at this MRI film. The patient’s gallbladder is almost completely filled with gallstones. What we can do now is try to alleviate his condition. Only after his physiological indicators recover can we perform the cholecystectomy."

"So he can’t have the surgery now?" the patient’s father asked.

"Because the pancreatic inflammation is quite severe right now, operating immediately would be too traumatic for the patient and could likely cause more complications," Su Wenhao explained.

The patient’s parents exchanged a glance, then looked at their son lying on the hospital bed, their faces etched with worry.

Liu Banxia didn’t stay long. Su Wenhao had finished his explanation. Though somewhat formulaic, it was adequate.

Although Liu Banxia was also on duty, he wasn’t getting too involved in the actual diagnostic and treatment processes; he was mostly observing. He needed to accurately assess these interns to determine who among them possessed the capability for independent consultation. This was a crucial matter, equivalent to delegating authority to the interns. However, authority meant responsibility. If he delegated this authority, he would have to bear the corresponding responsibility.

"Brother Wang, how’s your patient?" Liu Banxia strolled into the internal medicine consultation room.

"He’s been transferred to the Emergency ICU," Wang Huan replied with a wry smile.

"During his chest X-ray, he experienced rapid breathing, chest tightness, and muscle weakness. A quick check revealed his blood oxygen had dropped to 92. We gave him oxygen and sent him directly to the ICU."

"That serious?" Liu Banxia frowned.

"Yes. He can receive more thorough care in the ICU. His blood oxygen has risen somewhat, but the cause of his illness still hasn’t been identified," Wang Huan said.

"Over there, they’ve put him on high-flow humidified ventilation, diuretics, and Physical Cooling. His temperature has already climbed to 39 degrees Celsius and shows signs of rising further."

"I’ll stay over tonight. I need to monitor this patient’s condition constantly. Otherwise, I wouldn’t be able to rest properly even if I went home. I keep feeling like there’s something I’ve overlooked."

"Oh, by the way, he’s already been asked to contact his family, but they haven’t arrived yet. Do you think his illness might be related to the current season?"

Liu Banxia shook his head. "I wouldn’t dare guess wildly. When it’s less busy here later, let’s go check on him together."

He was starting to feel troubled. He hadn’t expected to encounter such a thorny case right after returning to work. Even if this wasn’t a patient he had personally admitted, it was still an Emergency Center patient.

"Teacher Liu, that patient from before is having difficulty breathing! His lung sounds are normal, and I increased his oxygen supply, but he’s still not improving," Su Wenhao rushed over again at this moment.

"Let’s go together," Liu Banxia said, already heading out.

There was a critically ill patient with an unknown etiology on one side, and on the other, a patient with a clear diagnosis but in equally critical condition. His heart began to pound with anxiety.

"Have you done another blood test?" Liu Banxia asked on the way.

"We did. His blood sugar has returned to normal, and his amylase and white blood cell counts have also decreased significantly. This proves the initial treatment was effective. But the patient is struggling to breathe, and his oxygen saturation is dropping. Oh, and his blood pressure is falling too."

"Next time this happens, use the bedside emergency call button. It saves precious time in a rescue," Liu Banxia said.

Su Wenhao paused, then nodded.

That was indeed his mistake. The Emergency Center had protocols for when a patient’s condition deteriorated. His error today was delaying the call, not making it immediately.

Arriving at the bedside, Liu Banxia immediately auscultated the patient, his brow furrowed.

"Did you listen to his heart just now?" Liu Banxia asked.

"I did. Heart and lung sounds were both normal," Su Wenhao quickly replied.

"I just heard a friction rub. Get a portable chest X-ray and a cardiac ultrasound. Call a cardiac surgeon, and prepare the defibrillator," Liu Banxia ordered.

As soon as he finished speaking, the nurses standing by sprang into action.

This swift and orderly reaction was a testament to their long-standing teamwork, enabling a rapid, methodical, and unflustered response.

Looking at the chest X-ray, Liu Banxia’s frown deepened. In the lower lobe of the right lung, there was a large, well-demarcated mass, highly likely to be non-small cell lung cancer.

The probability of such a tumor being malignant was extremely high. Given the current situation, even with surgery, the five-year prognosis would be very poor.

"Teacher Liu, there’s pericardial effusion," Su Wenhao, who was performing the cardiac ultrasound, reported nervously.

"President Liu, what’s going on?" Chen Xuehai, the cardiac surgeon, rushed over at this point.

"Large, well-demarcated mass in the lower right lung, likely non-small cell carcinoma. Dyspnea, blood oxygen and blood pressure continuously dropping, and now pericardial effusion," Liu Banxia quickly summarized.

"The patient was diagnosed with acute gallstone pancreatitis on admission. If we perform pericardiocentesis to drain the effusion, can it stabilize him?"

"Doubtful," Chen Xuehai’s brow furrowed as well.

"The patient’s current pericardial effusion is likely due to acute pericarditis caused by the lung tumor. Even if we drain it, I’m afraid it won’t be very effective."

"The best approach would be to remove this tumor immediately. But the patient also has acute gallstone pancreatitis. What do his latest blood tests show?"

"His indicators have stabilized. Blood sugar is normal, and white blood cell and amylase levels have also come down," Liu Banxia said.

"Which approach do you favor? An immediate thoracotomy to resect the tumor, or trying chemotherapy to see if we can shrink it first?" Chen Xuehai asked.

Liu Banxia gritted his teeth. "I’m not an oncologist, but for chemotherapy to be effective, wouldn’t it take at least four cycles? Considering the acute gallstone pancreatitis, the number of cycles might need to increase, and the risks would be higher."

"Rather than that, I’m inclined to gamble on immediate surgical resection. However, the risk is equally high, comparable to chemotherapy; in fact, chemotherapy is a slightly milder option."

This was a very difficult decision to make. Even though the choice could be left to the patient’s family, respecting their autonomy, as doctors, they still needed to propose the most medically sound option. Otherwise, what was the purpose of doctors? For this patient, however, either path was fraught with high risk, making the decision incredibly tough.

Chen Xuehai felt similarly, also leaning towards surgery. Yet, the patient’s acute gallstone pancreatitis would introduce many variables into the operation.

"Let’s recommend the surgical option to the family," Liu Banxia decided after less than a minute of consideration.

The patient couldn’t afford a lengthy discussion. His breathing was already very poor, and Liu Banxia needed to make a quick decision.

Because he was the chief resident, and this was a patient Wang Chao had handed over to him, he had to make this decision, no matter how difficult.