The Enhanced Doctor-Chapter 414 Chen Hongyang’s Consultation Request

(Thanks to my friend Fishwo for the encouragement with monthly votes)

Although this patient was concerned about the cost, given the lack of medical insurance, the related expenses were significant. However, this was a matter of his life, so after some persuasion, he agreed to undergo a biopsy.

"It’s worrying. If there is no medical insurance and the condition turns out to be malignant, this patient might give up on treatment," Liu Banxia said, massaging his temples.

"Actually, there are many such patients; some have changed jobs, others are freelancers," Shi Lei said.

"As doctors, there’s really nothing much we can do about this. All we can do is diagnose the condition and do our best to treat the patient."

"Eh? Dr. Chen from Pediatrics is looking this way. Does he need you? Keep your temper in check; you’re the chief resident now. He probably wants to consult with you."

Liu Banxia looked up, and indeed, Chen Hongyang was looking in his direction. He hesitated slightly, then walked over.

"Dr. Liu, I have a case here that needs a consultation," Chen Hongyang said.

"What’s the situation?" Liu Banxia asked calmly.

"A four-year-old boy with a history of frequent nosebleeds. After a brief respite, he started bleeding again today. In the summer, he had an allergic reaction on his arm resulting in a rash, and it recurred today," Chen Hongyang explained.

"During today’s examination, the child also displayed a cough. Upon oral examination, post-nasal drip was observed. His temperature was slightly elevated at 38.3 degrees Celsius. His mother mentioned he threw a tantrum during breakfast, so he was probably already feeling unwell then."

"My initial diagnosis is an allergic reaction. The blood test revealed elevated levels of urea nitrogen, creatinine, and white blood cells, indicating dehydration."

"Given the increased white blood cell count, post-nasal drip, and persistent cough, I suspect bacterial sinusitis. However, the child’s parents refuse antibiotics, only allowing saline."

"When the child’s breathlessness worsened and his body temperature rose by another 0.2 degrees Celsius, I ordered a chest X-ray. The result was negative. Blood and sputum cultures were also done. Now, the child’s parents are resisting further examinations, as well as drug treatment."

Hearing Chen Hongyang’s extensive explanation, Liu Banxia felt quite troubled.

Clearly, they had not yet diagnosed the child’s illness, and the child’s parents were losing faith in their diagnostic process.

He had dealt with a child with nosebleeds once before, a case that turned out to be a bit of a joke in hindsight. This child’s situation seemed different, apparently more severe and complicated.

DING! Task issued: Consultation request from Chen Hongyang

The young patient remains undiagnosed after a lengthy period. Pediatrician Chen Hongyang requests the host’s assistance in the consultation. Task rewards will be based on the diagnostic results.

Seeing the task prompt, Liu Banxia was slightly dumbfounded. It had been a long time since such indirect tasks had been issued. They were typically given only when he had first received the system, back when the system was trying to ensure he developed a good learning attitude.

It seemed that the system’s training for him was really comprehensive, covering not only medical skills but also interpersonal relationships and management skills.

A qualified, good doctor might indeed need comprehensive improvement in these aspects.

"Dr. Chen, the child’s condition is complex. I’ll examine him first. Then I’ll talk to his parents and hopefully persuade them," Liu Banxia said, pushing aside the random thoughts in his mind.

"What is your preliminary diagnosis for the child? His temperature is over 38 degrees Celsius, which is already somewhat dangerous. We really need to hurry."

"My initial diagnosis is pneumonia. Auscultation findings weren’t good either. But the chest X-ray didn’t show anything, which makes me doubt my own judgment."

"Did you perform an endoscopic examination?" Liu Banxia asked.

Chen Hongyang shook his head. "The parents are very resistant to invasive procedures. Besides vaccinations, they rarely give the child medicine. They’re very protective of his health."

"In the child’s meal plan, there are many immunity-boosting foods, like fish oil chewable tablets and children’s Centrum tablets."

"This is quite troublesome. Children often can’t accurately describe their symptoms, and the parents won’t allow an endoscopic examination. I should talk to the child’s parents first and see if that helps," Liu Banxia said with a wry smile.

Chen Hongyang nodded. He was truly out of options; otherwise, he wouldn’t have sought Liu Banxia’s help.

The biggest hurdle at the moment was the parents’ resistance to examinations. Drawing blood was somewhat manageable, but performing the chest X-ray had taken a lot of persuasion.

When Liu Banxia walked in, the child’s parents didn’t seem to be in good spirits.

"Hello. This is Liu Banxia, chief resident of the Emergency Center. I invited him to participate in the consultation," Chen Hongyang introduced.

"Dr. Chen, it doesn’t matter which doctor you call. Can you just cure our Shan Shan?" the child’s father said.

"Please try not to worry too much. Since you’ve come to us for treatment, we all share the same goal: to restore your child’s health," Liu Banxia said.

"I heard Dr. Chen explain the child’s situation. There are many conflicting signs. The child shows symptoms of allergies, sinusitis, and pneumonia. May I ask why you’re so apprehensive about the recommended examinations?"

"Every examination causes harm to Shan Shan," the child’s mother replied impatiently, glancing at her phone.

"Last year, Shan Shan had an ear infection, and the doctor prescribed amoxicillin. After just one dose, Shan Shan broke out in rashes all over his body and had to be hospitalized for a long time before he recovered."

"It’s not that we don’t trust your medical skills, but some doctors are truly incompetent. The child is suffering so much already; what if something else goes wrong?"

"Just look at today! We arrived early this morning, and it’s been so long. His cough hasn’t stopped, he’s still struggling to breathe, and his fever hasn’t gone down. I..."

"I understand how you feel. It’s a universal parental instinct. Even though I don’t have children of my own, if my child were sick, I’d surely be even more worried," Liu Banxia interrupted gently.

"Dr. Chen is actually more anxious than you are. He’s the best pediatrician in our Emergency Center. Please also try to understand our position. Unlike traditional Chinese medicine practitioners, we can’t diagnose a condition without detailed examinations and supporting data."

"That’s perhaps where we fall short compared to traditional Chinese medicine. Could you please be patient and wait a little longer while I talk to Shan Shan?"

The child’s parents exchanged a look and nodded. Liu Banxia’s humble demeanor made it difficult for them to press further.

"Your name is Shan Shan, right?" Liu Banxia asked, sitting on the edge of the bed.

The little boy nodded and coughed again.

"Shan Shan, can you tell Uncle if your throat itches when you cough?" Liu Banxia asked, examining the rash on the boy’s arm.

Shan Shan shook his head, still not saying a word.

"Then, Shan Shan, can you tell Uncle why you didn’t eat your breakfast properly? I heard your mom say that Shan Shan is a very good boy who always eats with big bites," Liu Banxia asked with a smile.

"Uncomfy," Shan Shan finally mumbled.

"Can you tell Uncle where it feels uncomfy?" Liu Banxia pressed gently.

Shan Shan stretched out his little hand and pointed to his chest.

Liu Banxia also extended his finger and gently tapped Shan Shan’s chest a few times. The little boy squirmed a bit as it tickled. However, the movement made Shan Shan start coughing again; this time, the bout lasted for more than ten seconds.

Liu Banxia then took out his stethoscope and carefully listened to Shan Shan’s lungs.

"I understand you’re both very concerned about Shan Shan and want him to avoid as many instrumental examinations as possible," Liu Banxia said, handing the stethoscope to Shan Shan to play with.

"But just now, when I was listening, I noticed a wheezing sound in his trachea when he inhaled. Moreover, Shan Shan also said that his coughing isn’t due to an itchy throat caused by some illness. The way he coughs seems more like he’s choking."

"Considering all these factors, I suspect there might be a foreign object in his lungs or trachea. Please don’t worry prematurely. The foreign object is unlikely to be large, but it might be attached to the wall of his trachea."

"These things sometimes don’t show up on a chest X-ray. The most direct method is a bronchoscopy. Shan Shan might feel some discomfort during the procedure, but it will allow us to diagnose his condition quickly and alleviate his suffering."

"Doctor, can’t we use other methods? I know what bronchoscopy is; it will make Shan Shan very uncomfortable," the child’s father said with a frown.

"I actually think Shan Shan is quite a brave boy. Sometimes, when we eat, we accidentally inhale food into our trachea, and that’s a very unpleasant feeling," Liu Banxia said.

"Shan Shan has endured this far without making a fuss. I think he’s been incredibly strong. Let’s do the bronchoscopy. Although it might be a little uncomfortable, we all want Shan Shan to get better quickly."

"Alright, Doctor. Please try to make sure Shan Shan doesn’t suffer too much," the child’s mother said, relenting.

Liu Banxia let out a long sigh. Today, he had truly experienced the challenges of being a pediatrician.

When dealing with patients who resist examinations, you can sometimes scare them into compliance. But what about when you’re dealing with the parents of a child? If you resort to intimidation, it could easily lead to a confrontation.

On their way to the bronchoscopy room, Chen Hongyang was deeply impressed. He hadn’t detected the wheezing sound in the child’s trachea. He had to admire Liu Banxia for catching it; it must have been very faint for him to have missed it.

But Liu Banxia had caught it. That was true skill.

Little Shan Shan was indeed very cooperative. However, as they looked at the images on the bronchoscope’s screen, both Chen Hongyang’s and Liu Banxia’s expressions turned solemn.

It wasn’t sinusitis or pneumonia. Numerous tiny blood clots and inflammatory spots were scattered in Shan Shan’s lungs and trachea. These were the culprits causing Shan Shan’s fever and cough.