Practicing Medical Skills in a Small Clinic

Chapter 557: Chapter 255: A Mother’s Midnight Tears and ITP Disease

Li Jingsheng quickly opened the retractable door outside, only to see a young mother in her late twenties or early thirties rushing in with a young boy in her arms.

No sign of the child’s father or other relatives.

The woman was walking hurriedly, and perhaps because she was carrying someone, she stumbled and nearly fell.

Fortunately, Li Jingsheng was quick to react and promptly supported her.

"Take it easy, take it easy!"

Li Jingsheng reassured her.

When he supported her just now, he could feel her hands trembling.

The boy she was holding had a slightly frightened look, staring at his mother whose eyes were brimming with tears.

"My sister-in-law came over with her two kids for a visit today. While they were playing, her elder son pushed my son, causing him to fall and hit the TV cabinet. He immediately started having a nosebleed. Since it was his aunt, and kids will be kids, I didn’t make a big deal of it. I thought we could stop the bleeding quickly, but over half an hour passed, and it didn’t stop, which scared me.

So I quickly brought him to your clinic for treatment.

Later, you guys managed to stop the bleeding successfully. My sister-in-law took her kids and left.

Who would have thought that he just sneezed earlier and started bleeding again, and we couldn’t stop it. I had no choice, being home alone with him, so I had to trouble you again."

She truly had it tough.

As she spoke, perhaps feeling wronged and afraid, she began to tear up.

Li Jingsheng quickly reassured her, "It’s okay, it’s okay, first put the child on the bed and have him lie on his side." She seemed quite tired from holding him.

The boy lay in a book-reading side-lying position, motionless.

Seeing how obedient the little guy was now, why wasn’t he thinking of being afraid while playing around?

Li Jingsheng observed, the bleeding wasn’t heavy, but it continued to trickle out.

In such situations, it’s best not to lie flat; otherwise, the blood can flow backward into the deep nasal cavity, making it easy to choke.

Ou Qinglan also came over to help.

"Qinglan, use the small flashlight to illuminate his nasal cavity for me."

"Where is the small flashlight?"

She was unfamiliar with the clinic’s supplies.

Li Jingsheng had to retrieve the flashlight from the drawer himself and shine it into the boy’s nasal cavity.

Inside, there were already blood scabs and quite a bit of blood residue.

Fresh blood continued to flow out.

Upon careful inspection, he was almost certain it was superficial bleeding.

He tried pressing down the side of the boy’s nose bridge, and the bleeding gradually subsided.

But upon releasing, it bled again.

Li Jingsheng instructed Ou Qinglan to fetch an ice pack, attempting a nasal tip ice compress for the boy.

The purpose was to constrict the blood vessels and help stop the bleeding.

It was somewhat effective.

"Kid, you press it with your hand yourself."

Li Jingsheng told the boy.

The boy obediently used his right hand to press the ice pack.

At this point, Li Jingsheng noticed a bruise on the back of the boy’s hand, a pale purple color.

His gaze sharpened, pointing to the bruise and asking, "Did you get this when you fell?"

"No! I’ve had it for a few days now."

The boy replied timidly.

"My son is a bit mischievous, and it’s common for him to get bruises accidentally,"

The boy’s mother said with a mix of distress and resignation.

Kids, being mischievous is inevitable; getting bruised and hurt is unavoidable.

But Li Jingsheng felt it wasn’t that simple.

"Kid, do you have bruises like this elsewhere on your body?"

"I do! There’s one on my foot!"

Children don’t lie, so Li Jingsheng removed the boy’s shoe and sock, indeed finding a bruise on the dorsal foot.

Typically, bruises from bumps or scrapes appear blue with a purple tint.

Yet, the boy’s bruises were all pale purple.

Li Jingsheng looked toward the guardian.

"I, I never physically disciplined him!"

The boy’s mother seemed to misunderstand.

Li Jingsheng wasn’t suspecting abuse.

Seeing the boy’s persistent nosebleed and how distressed his young mother was, how could she ever bear to mistreat him?

With reasonably rich clinical experience, Li Jingsheng was generally able to discern if a parent genuinely cared for their child.

"I didn’t mean that. I want to ask, how long have these bruises been appearing on him?"

"It seems recent! Sometimes they suddenly just pop up, and I keep scolding him for being more and more naughty."

"Has he bled from injuries during this time?"

"He once bit his tongue while eating and bled for quite a long time. Eventually, it healed. No other injury-related bleeding has occurred."

Listening to the mother’s description, Li Jingsheng was even more convinced this boy’s condition wasn’t simple.

Bruises appeared on limbs, and they were purple and located in places not prone to bump injuries.

Twice he had injuries where bleeding didn’t stop easily.

Blood vessels in the tongue were also well supplied.

A minor bite would bleed.

"Kid, open your mouth and let me look at your oral cavity!"

Li Jingsheng had an initial diagnostic direction in mind but was still unsure.

The boy opened his mouth, revealing blood blisters on his tongue.

The oral mucosa also had blood blisters.

Seeing this point, there’s almost no need to investigate further.

"After your child injured his nose and bleeding wouldn’t stop, it’s possible that it’s not just a serious injury causing it. He might have a condition known as ITP. If he hasn’t experienced unstoppable bleeding before, it should be acute ITP. For children, it’s generally related to a viral infection."

Li Jingsheng shared his diagnostic opinion with the family.

"Could it be the virus from the cold he had a month ago that caused the infection?"

The family could only think of this.

"What kind of illness is ITP? I don’t understand it. Could you explain it in more detail?"

"Whether it’s related to the cold, it’s hard to say. Due to the limited conditions at my clinic, I can only make a preliminary diagnosis based on his symptoms and medical history. I just suspect it could be this disease. ITP tends to cause widespread subcutaneous bleeding on mucous membranes and distal limbs.

This disease is fully named primary immune thrombocytopenia, an acquired autoimmune disease.

It mainly causes a reduction in platelets.

Since he hasn’t had this disease before, the chances of an abnormality in T cells or issues with anti-platelet antibodies are relatively low. I suspect it might be related to viral infection."

Li Jingsheng made his explanation clearer this time.

But he still didn’t sound definitive.

"Can you treat it here? The child’s father is training out of town, at an important stage for his promotion. I don’t want to worry him with this. I haven’t even told him about the child’s injury yet."

The child’s mother is a very good wife.

She is a full-time stay-at-home mom, wholeheartedly considering her husband’s career and future.

This requires sacrificing personal prospects.

Most selfish women wouldn’t achieve this.

Because as a woman grows older, she must have her own career. There’s no woman who dares to gamble her future destiny.

Without a career, the possibility of being resented by her husband is immense.

And she will be extremely passive.

Having a career grants dignity without having to ask her husband for money.

"I can try giving him immunoglobulin; it has almost no side effects, and whether it works or not will become apparent quickly. The only thing is it’s very expensive. Having insurance helps a bit, but paying all out of pocket is quite difficult."

Li Jingsheng honestly disclosed the situation to the family.

This disease isn’t hard to treat; it’s fairly common clinically.

However, immunoglobulin is very expensive.

Just the cost price for one is around two hundred, while many hospitals charge four to five hundred.

Administering dozens could cost tens of thousands.

Sometimes using twenty or thirty thousand worth during a single rescue is common.

Now, with strict control over drug costs, when encountering ITP patients who urgently need rescue, this is the only medication usable.

However, using too much might get scolded by the superiors.

Usually, the department head does the scolding.

Sometimes, being a doctor in a big hospital is really challenging. One not only needs to think of which drug treats the patient but must also manage cost ratios.

Expensive drugs can’t be used, requiring thinking of cheaper alternatives.

In actual clinical treatment, encountering patients that urgently need rescue, it’s definitely which drug works best and has the highest success rate is used!

So, being a doctor now is particularly difficult.

"Neither the child nor I have insurance! Only his father has bought it."

"This immunoglobulin costs four hundred a dose, and it won’t be a matter of just one or two days of treatment. The treatment cycle will be long. So, do you want to use it?"

"Yes, definitely, health is the priority; money spent can be earned back! When the child grows older, I’ll find a job."

She showed a great side of maternal love.

With almost no hesitation, she directly agreed to use the expensive medication.

Decades later, when she falls ill and needs rescue, who knows whether the rascal will be willing to spend money on his mom?

Li Jingsheng sees it often at the hospital that sons aren’t happy when they spend more money on parents.

They even proactively request doctors to remove tubes.

He immediately fetched immunoglobulin to inject into the little boy.

He administered two doses.

That’s eight hundred dollars.

According to the dosage, 1g of immunoglobulin corresponds to one kilogram of body weight.

Li Jingsheng was already helping the family conserve medication.

To achieve quick effect, the intravenous drip method was chosen.

Fortunately, after medication, the little boy’s bleeding stopped.

It seems Li Jingsheng’s diagnosis was accurate.

It really is acute ITP.

The child’s mom was still somewhat worried and didn’t leave immediately.

She stayed for over an hour, and only when it was confirmed that there was no more bleeding did she take her son home.

Her home was not far from the clinic.

Her husband was a local born and bred resident, with his parents passing away early. It’s just her now, living with the child at home.

...

The next day, as Li Jingsheng was consulting at the clinic, the woman brought the child again.

She was all smiles upon seeing him.

And seemed quite relaxed.

"Dr. Li, thank you so much for yesterday. After the treatment, the child hasn’t had any further bleeding. Today, I’m bringing him for more of the medication."

"No need to thank me. It’s good that the child’s bleeding has stopped. I’ll prepare the medication for him in a moment, you just need to get a number."

Li Jingsheng was familiar with her.

But he didn’t allow queue jumping.

Rules can’t be broken.

"Immunoglobulin was administered? Is it ITP?"

Dr. Shao’s experience was quite rich; he immediately guessed the cause of the child’s condition.