The Enhanced Doctor

Chapter 1080: Chapter 1080: A Well-Timed Wake-Up Call

"Teacher Liu, the enhanced CT results have come out. There’s a mass in the upper left lung, and there is lymph node enlargement in the hilum and mediastinum. It’s in the middle-late stage." Li Hao rushed over just as Liu Banxia was having dinner.

"Ah...lymph nodes, quietly handling big matters." Liu Banxia sighed.

"Has the type of lung cancer been diagnosed? However, looking at this silent action, I think it might be small cell lung cancer. No surgical intervention is possible anymore, only chemotherapy. In his forties, still quite young."

He truly felt regret. He was chatting with the patient during the consultation, not expecting it would be lung cancer, which has a poor prognosis.

"Teacher Liu, Director Chen also said it might be small cell lung cancer. A biopsy sample has already been taken. This can only be treated with systemic chemotherapy and thoracic radiotherapy, right?" Li Hao asked.

Liu Banxia nodded, "The situation is indeed very tricky. The chance of detecting small cell lung cancer in the limited stage, that is before metastasis, is very low. If it hasn’t metastasized, whether it’s surgical treatment or chemoradiotherapy, the efficacy would be quite good."

"But once it starts to metastasize, entering the extensive stage, systemic chemotherapy only prolongs the survival period, often with a remission period of less than a year due to drug resistance."

"Actually, this is the routine for many cancers: as long as it hasn’t metastasized, it’s easier to handle. Once it metastasizes, all our methods are just about prolonging the survival period."

"This time it’s a lesson; I was too hasty. In the future, during patient consultations, physical examinations must be thorough. Chest cavity, abdominal cavity, body temperature, underlying symptoms, lymph node checks, none can be missed."

"Sometimes our experience is helpful, and sometimes it misleads us. When a patient is dizzy, we merely think about vertigo."

"Teacher Liu, why does the patient have such severe dizziness symptoms if it is lung cancer? Or is it his multiple lacunar cerebral infarctions causing insufficient cerebral blood supply which leads to dizziness, implying two conditions?" Li Hao asked another question.

"That’s an excellent question, which is why I mentioned that experience is important," Liu Banxia replied.

"I judge that the patient’s multiple lacunar cerebral infarctions are just coincidental and haven’t affected the patient’s body. The most fundamental cause of the patient’s dizziness is hyponatremia."

"Interesting, isn’t it? If the patient had a brain tumor, this explanation is easily understood. But lung cancer, chest pain could be understood, but not chest pain but dizziness."

Upon hearing his words, the group began to think carefully.

Li Hao’s recent question was indeed what they had been pondering.

They understood Liu Banxia’s point about thorough examinations during consultations, but not why the patient has lung cancer yet experiences dizziness.

If there were lesions in the heart, brain, cervical spine, or even within the ear and nasal cavity, dizziness could be understandable. But why dizziness?

"Actually, this is also one reason why I lean towards diagnosing it as small cell lung cancer, kind of backward reasoning." Liu Banxia continued.

"Like I mentioned earlier, the patient has hyponatremia, which presents quite low numerical values. The clinical symptoms of hyponatremia are convulsions, stupor, coma, increased intracranial pressure, consistent with the patient’s dizziness symptoms."

"So what’s causing the hyponatremia? Most common is kidney function decline due to aging body functions. Another manifestation often seen in hypertensive patients."

"Many antihypertensive drugs contain diuretics, which cause excessive sodium loss, and the time taken to restore electrolyte balance is relatively long."

"For this patient, although he has hypertension and is on antihypertensive medication, his blood pressure is well-controlled. He’s not very old, so what causes increased diuretic secretion?"

"Then it becomes more interesting, returning to the patient’s lung cancer. One rare paraneoplastic syndrome of small cell lung cancer is abnormal secretion of antidiuretic hormone and Cushing’s syndrome caused by corticotropin secretion."

"Both of these complications can lead to electrolyte imbalance, causing hyponatremia. When a patient seeks consultation, especially such internal medicine patients who do not have fever or pain, it’s impossible to initiate blood tests immediately."

"If you did that, it would confirm people’s suspicions: as long as they avoid hospitals, but once they go, no matter the illness, blood tests will follow."

"That wouldn’t work, and if at that time we’d detected hyponatremia after blood tests, it’s likely we’d attribute it to recent loss of appetite."

"So the key to diagnosing this patient lies in the enlarged lymph node above the clavicle. Speaking of it, I’m embarrassed. I checked the cervical spine but didn’t notice the lymph node."

"The lesson is profound, with the face being smacked hard. Small cell lung cancer’s cunning nature is no excuse for our errors. Fortunately, conditions were found during the admission examination. Had we been careless then, it would truly have been a case of missed or misdiagnosis."

After speaking, Liu Banxia lowered his head and earnestly began eating.

To him, this was a wake-up call of cold water, but he embraced it.

For so long, he had become somewhat proud. After all, he could perform many complex surgeries, diagnose intricate conditions, and patients came to him by reputation.

As a doctor, currently, he could be considered to have some achievements.

But now, this patient? Even if just a more diligent intern had done a thorough examination, problems could have been found earlier.

Then he, a prominent deputy director, easily missed the correct diagnosis.

Recently, I’ve been feeling a bit too full of myself, not as attentive as before.

During the process of diagnosing a patient, there can’t be any oversights. If you miss something, it could affect the patient’s condition.

He was having an inner self-reflection, and the six little ones dared not make a sound, only obediently eating their meals. They kind of knew what Liu Banxia was thinking, but in this situation, they didn’t dare to console him.

"What’s going on with your table? Weren’t you all chatting just now? Why has it gone so quiet?" Xu Jie curiously leaned over and asked after finishing his meal.

Nobody made a sound, only Xu Yino rolled her eyes and smirked at Liu Banxia.

"What’s up? We still have a surgery later." Xu Jie asked again.

"Nothing, just reflecting on my mistakes. There’s no problem with the upcoming surgery; after a full battle meal, we’ll return to the battlefield." Liu Banxia said seriously.

"My goodness, finally someone is talking. Quickly eat, or you won’t finish your meal later." Xu Yino said.

"Why so secretive?" Xu Jie became even more curious.

"It’s just a patient we admitted yesterday; we missed the diagnosis. Fortunately, Peng Bo and the others were more thorough and found out, or else there would have been a big issue." Liu Banxia said.

"Although the final result didn’t really impact the patient much, we can’t use this as an excuse. Let it be as it is, we have to take responsibility for our mistakes."

Xu Jie nodded, "That attitude is pretty good, that’s the way."

"It really is because of the nature of our work; we can’t afford large margins of error." Liu Banxia said.

A small symptom overlooked could be the key to diagnosing the illness. Going forward, we need to be careful, careful, and more careful; cautious, cautious, and more cautious."

Xu Jie was amused; it was the first time seeing Liu Banxia look so serious.

But he didn’t think Liu Banxia’s self-reflection was just for show and then forgotten. Even though he joined the emergency center later, he’s come to understand Liu Banxia quite well over time.

Liu Banxia isn’t someone who likes to put on a show, and given his current status in the emergency center, he doesn’t need to.

Even if he ranks third, what can Chen Xuehai, who ranks second, do to bully him at work? At most, extort a dish or a chicken leg from him.

Liu Banxia’s somewhat exalted status isn’t just because he’s the director’s favorite student but also because of his medical skills and character.

He’s already helped several people in the emergency center buy houses, and this time his house purchase even sparked rumors. Even if it’s not a lot cheaper, it’s still a great help.

It’s actually quite admirable how unpretentious Liu Banxia is; it’s really hard to maintain, unless this is how you’ve been from the beginning. Otherwise, an unstable persona will make colleagues in the department resentful.

No wonder there have always been rumors that the old Liu Banxia had a stubborn and impatient temper, but only such a straightforward person could be so candid.

"The next one will be easier, at least collecting specimens won’t be as strenuous as this one. I’ll try to be quicker so everyone can have more rest time." Liu Banxia said.

"Sigh, both of us have to go on stage again." Liu Yiqing sighed.

"There’s no choice since we don’t have many female doctors in the emergency center, and with five of us going each time, there will always be repeats." Liu Banxia chuckled.

"Of course, the ones who get picked repeatedly are the outstanding ones; we won’t use just anyone. Keep it up, it’ll depend on you all in the future."

"Sigh..., I’m really envious of Linlin now, soaking in the operating room every day, how nice." Xu Yino sighed.

"Nice? Heh, just ask her how she really feels when you see her." Liu Banxia said.

"Why, is it really tiring?" Liu Yiqing perked up.

"Improving quickly in medical skills is really tough; you have to put in a lot more effort." Liu Banxia said with a smile.

"Look at her, many surgeries every day, at least one a day. But to digest all that knowledge, is it really that easy?"

"Uh..., Teacher Liu, you haven’t been doing many surgeries recently; why are you still so skilled?" Liu Yiqing asked.

"Me? Well, can they even compare to me? I’m just that awesome." Liu Banxia said with a straight face.

Everyone was amused; indeed, there’s no comparison.