The Enhanced Doctor-Chapter 417 Uncontrollable Roundworms

(Thanks to reader 20181111012931999 for the monthly ticket encouragement)

"You all should also take a close look at this film. See if I’ve missed anything," Liu Banxia said.

In fact, the interns were already examining the image on the computer, even without him needing to say so. However, they were just as baffled, unable to spot any issues.

"Doctor, am I seriously ill?" the patient asked worriedly after a short wait.

"Let me listen to your chest again. How is your breathing right now?" Liu Banxia inquired.

"It’s much better now than it was. I just had a sudden spell of shortness of breath earlier," the patient replied.

Liu Banxia took out his stethoscope to listen to the patient’s lungs again, confirming the presence of moist rales. However, they were fainter than when he had first listened.

He felt conflicted, unsure whether to opt for an endoscopy or a CT scan for the patient.

Just then, he happened to notice some papules on the patient’s abdomen.

"Sir, when did these papules on your abdomen appear? Do you recall?" Liu Banxia asked.

"Papules? Eh? They weren’t there last night. Now that you mention it, they do feel a bit itchy," the patient responded, casually scratching the area.

Liu Banxia furrowed his brows, wondering if his eyes were playing tricks on him or if he had indeed observed a linear bulge on the patient’s abdominal skin.

"Sir, please don’t scratch. Let me take a closer look," Liu Banxia stated.

COUGH, COUGH, COUGH...

Just then, the patient began to cough again.

Liu Banxia hurriedly pressed the stethoscope to the patient’s chest over his lungs and listened carefully.

He could hear them more clearly now; the moist rales had grown considerably louder.

The abdominal papules and the fluctuating intensity of the moist rales were new symptoms. However, with the current information, Liu Banxia was still unable to make an accurate diagnosis.

"It’s getting difficult to breathe again," the patient said, struggling.

"Sir, please lie down. Let’s continue the oxygen," Liu Banxia quickly advised.

His condition was relapsing, and the cough had returned.

"What’s going on?" Liu Banxia mumbled to himself.

"The condition is relapsing, with distinct moist rales and coughing during each episode. Mild anemia, high fever, high blood pressure, elevated white blood cell count, papules... hmm?"

As he finished mumbling, Liu Banxia froze. The tiny bulge he thought he’d seen while examining the patient’s abdominal papules flashed before his eyes again. What if his eyes hadn’t deceived him? What if there really had been a bump that surfaced for a moment and then disappeared?

The thought made his forehead break out in a sweat as a disturbing possibility occurred to him.

"Li Hao, come here," Liu Banxia called out.

"Teacher Liu," Li Hao quickly came closer.

"Take this patient for urine and stool samples. Ensure all protective measures are taken," Liu Banxia instructed.

"Zhou Qian, did the patient cough or spit phlegm during the X-ray? Were you in close contact with him then?"

Zhou Qian shook her head, looking a bit lost. "No, I was wearing a mask the whole time."

Liu Banxia nodded. "Change into a new mask, wash and disinfect your hands thoroughly. The patient might have a roundworm infection. Li Hao, tell the lab to expedite the tests. If the first test is negative, continue collecting samples for a second and third attempt."

Everyone tensed up at Liu Banxia’s words. This particular roundworm was no ordinary parasite. Larvae could be present in the patient’s saliva, and anyone who unknowingly came into contact with it could become a new host.

Although the parasite’s eggs were mostly found in soil, with larvae primarily in feces and sputum, there was still a risk of contagion.

Once the patient’s breathing had stabilized somewhat, Li Hao quickly took the patient to collect the samples.

Liu Banxia and the others nearby also changed into new masks and gloves and arranged for someone to disinfect the corridor leading to the X-ray room.

Actually, there was another detection method: the ELISA test. However, this procedure took even longer.

First, blood had to be drawn. After half an hour for coagulation, the serum could be collected. This was followed by an hour of incubation, washing the plate, and adding the substrate. Then, after another half an hour for the light-sensitive reaction to complete, the values could be read.

The wait was agonizing, and Liu Banxia grew anxious.

"Teacher Liu, filariform larvae were found in the stool and saliva samples!" Li Hao reported, running back.

DING! Strange Pneumonia task completed.

Received 300 Experience Points and 300 proficiency points in Diagnostics Skill.

Task Rating: Flawless. Reward: 500 Experience Points, 500 proficiency points in Diagnostics Skill, and 5 Glory Points.

This old man is in danger, Liu Banxia sighed inwardly.

Roundworm development occurs in two generations: the free-living generation in the soil and the parasitic generation within the human body.

He hadn’t been mistaken; the filariform larvae had indeed spread to the dermal layer, causing the bulge. Once the infection progressed to this stage, the efficacy of anthelmintic drugs would be greatly diminished, and most patients would not be able to withstand either the disease or the aggressive treatment.

"Sir, we’ve diagnosed your condition. You have a parasitic infection," Liu Banxia said, approaching the patient’s bedside.

"This type of parasitic infection is very challenging to treat. We’ll need to admit you to the hospital and also inform your family. The deworming treatment is a process, and the medication can have a considerable impact on your liver and kidneys."

"Doctor, that can’t be right, can it? How could anyone get parasites these days?" the patient said, finding it hard to believe.

"This particular parasite isn’t very common in our area. Have you traveled south in the past six months or year? Especially to places like Hainan Island or Sanya?" Liu Banxia asked.

The patient shook his head. "I don’t have the money for trips to places like that. I’ve just been working here in our city."

"Sir, we’ve detected parasites, specifically roundworms, in your stool, urine, and saliva," Liu Banxia continued.

"There are many routes of transmission, and these parasites can remain dormant in the human body for a very long time—months, years, even decades."

"If ordinary anthelmintics had been used before the parasites became active, the eggs could have been eliminated. But now that they are active, we must use thiabendazole. This medication might affect your liver and kidney function, so it’s important that your family members are here to support you."

"The reason you’re having difficulty breathing is that these larvae are migrating through your lungs. They are minuscule, which is why X-rays sometimes can’t detect them."

"It’s likely the prednisone you took suppressed your immune system, which allowed these roundworms to become active and seize the opportunity."

Liu Banxia explained as best as he could, but the patient still seemed unable to grasp the situation.

This was a normal reaction. Patients were ordinary people; if they all possessed extensive medical knowledge, they likely wouldn’t need to come to the hospital.

However, treatment couldn’t be delayed. Thiabendazole was the most effective drug, with an experimental cure rate exceeding 95%. Even though it could cause some liver and kidney damage, it was the current first-choice medication.

If the patient experienced a severe reaction, they could be switched to less potent drugs like Albendazole or Pyrantel.

"Li Hao, keep trying to persuade the old gentleman to contact his family. Hmm... this might be their last chance to see him," Liu Banxia said after the patient had been moved to the ward.

"Teacher Liu, is this roundworm infection really that serious?" Li Hao asked in surprise.

Liu Banxia nodded. "It has spread to the dermal layer; I initially thought my eyes were deceiving me. We also need to inform his family members so they can get tested. This type of roundworm has a high potential for cross-infection. Let’s hope his family is all right."

Hearing Liu Banxia’s words, everyone shivered again.

They understood the implications of parasites reaching the dermal layer: it signified a widespread infestation. While such signs might only be occasional at present, after medication, the larvae could become visibly active over large areas beneath the skin.

"Since this parasite can remain dormant for a very long time, tracing the original source of infection now would be extremely difficult. We’ll just have to see how lucky this old gentleman is. Let’s hope for a positive outcome," Liu Banxia said.

"Li Hao, go talk to the patient. This is also an opportunity for you to learn. The rest of you, stop dwelling on this case and continue with other patients. I’ll supervise."

Upon hearing Liu Banxia’s words, the interns dispersed and got back to work.

"It seems this case has affected them quite a bit," Shi Lei remarked.

"Yes, it’s not just them; it’s hit me hard too," Liu Banxia said.

"To be honest, what I dread most is encountering cases like this—where we can make a diagnosis but can’t offer effective treatment. That patient with infectious myocarditis in the ICU has finally shown some improvement, which is a huge weight off my mind."

"The more patients we see, the higher the proportion of untreatable cases will become. I honestly don’t know if I can handle it in the long run. It’s a trial for all of us, let alone these interns."

"I was wondering why you’ve seemed so steady lately," Shi Lei said. "Just hang in there. This is a process every doctor has to go through."

"I’ve actually considered letting the interns get some experience in the ICU," Liu Banxia said. "But then I thought better of it. In Su Hongbo’s words, they’d be ’keeping company with Death every day’ in there."

"This teaching and training work is no walk in the park; it’s giving me a headache. And I can’t just abandon it midway. I wonder when the new Vice Chief Director’s appointment will be announced."

"Just wait for it. Personnel appointments can’t be rushed. This isn’t hiring a regular doctor; it’s appointing a Vice Chief Director," Shi Lei said.

"You should take a break. If more patients come in, the three of us can manage. We’ve certainly had a surge of patients these past two days. We’ll need to plan the surgery schedule carefully later on."

"Don’t worry," Liu Banxia said. "My stitches come out tomorrow morning, and then I’ll be back in the OR, tackling surgeries."

Shi Lei chuckled. This was the Liu Banxia he knew. If Liu Banxia’s mood soured, the entire emergency center’s atmosphere would turn oppressive.

Perhaps it was because they had grown so accustomed to Liu Banxia. While his sometimes erratic behavior could be a headache, more often than not, it actually helped everyone de-stress.