The Enhanced Doctor

Chapter 1111: Chapter 1111: Patients with Vague Symptoms

(Thanks to jung20191215 for the monthly ticket encouragement)

Liu Banxia thought his afternoon would be very relaxed, but to his surprise, three patients came in a row.

This is the effect after word of mouth spreads, they all came for surgery after hearing about his reputation.

Even though there were three patients, receiving them was not difficult at all.

Unfortunately, one patient had colon cancer and could not undergo TaTME surgery, but the NOSES criteria were still met, so no incision on the abdominal wall was necessary.

Upon hearing that laparoscopic operation was still needed, and not entirely incision-free, the patient hesitated a bit and wanted to go home to think about it.

After all, Liu Banxia, as rumored, was already very skilled and could perform surgery without leaving any traces for any intestine-related cancers.

This is the exaggeration of rumors, once they circulate a bit, they multiply significantly.

"Teacher Liu, that patient’s lab results are out. Blood count, liver and kidney function, electrolytes, coagulation indices, etc., all normal," Xu Yino ran over.

"Only two indices are slightly off, one is the white blood cell count, which is a bit high. The other is the hemoglobin index, which is 88, at the edge of moderate anemia."

"It’s hard to determine whether the patient is inherently anemic, or if it’s anemia due to hemoptysis. I also asked the patient, the menstrual flow is not heavy, it’s always been normal."

Liu Banxia squeezed his brow, "This is not something that only finding me can resolve, these two indices also match the current symptoms. With the CT images like that, it’s not surprising for the white blood cell count to be a bit high."

"As for the anemia, it could very well be due to hemoptysis. After all, her index is hovering on the critical edge, it’s not easy to judge."

"Let’s see if Doctor Xu is busy, and discuss it. If it’s just unilateral lung like that, the issue isn’t that big, but bilateral lung should indeed be taken more seriously."

Xu Yino nodded and enthusiastically went to find Xu Hui.

Although she also has the authority to give medical orders now, this patient’s potential examinations are too many, so a decision needs to be made by the attending physician.

The reason why Liu Banxia didn’t give direct guidance, instead finding Xu Hui for consultation, is connected to the patient received this morning.

Currently, the patient’s internal medicine symptoms are more prominent, so it’s still better to find a professional person.

He is also becoming more mature; otherwise he would ponder with his team of six apprentices first, only seeking consultation when completely puzzled.

Moreover, the situation of this patient also meets the criteria for a small-range consultation. Her current displayed condition is still very vague, not easily determined.

"Director Liu, what do you think of this patient?" Xu Hui asked as he walked in.

"Have you seen the examination results? The indications are not clear enough, so we still need to continue with instrumental examinations for further screening. What medical conditions do you think are more likely?" Liu Banxia said.

"I’m also somewhat at a loss. Has the stool test result come out?" Xu Hui asked.

"The stool test result hasn’t come out yet," Xu Yino quickly said.

"Then for now, the anemia indication has to be marked with a question mark," Xu Hui said.

"We’ve already ruled out causes like excessive menstruation and hemorrhoids. I think we should also consider gynecological issues. Firstly, we need to clarify the cause of the anemia, right? If there’s no problem on the gynecological side either, I think just hemoptysis might not cause anemia."

Liu Banxia nodded, "Exactly, this patient’s symptom presentation is too confusing, that’s why I called you. The lung images are also worth studying, what about the other examinations?"

"How is the patient’s personal condition?" Xu Hui asked Xu Yino.

"Although she is somewhat scared, she seems okay for now. Teacher Xu, should we admit her for now?" Xu Yino asked.

"Admit her to our internal medicine department, surgical indications are not clear enough," Xu Hui said with a smile.

"If the patient’s condition is still okay, let’s do all the relevant examinations. Otherwise, with such vague indications, if we check one by one, it might increase the patient’s psychological burden."

"Instrumental examinations are perceived very differently by each patient. Some people resist, some want to do more."

"Currently, I think non-invasive instrumental examinations should be considered more, then we can do a sputum culture. The clearest indication could be pneumonia, but we can’t rule out potential major diseases."

"What is the cause of hemoptysis, what is causing anemia, what is the cause of pneumonia; whether there is potential correlation among these three symptom presentations, this is the focus of my personal attention during this patient’s diagnosis process."

"Also, as I just mentioned with the stool test, next time if there are symptoms of hemoptysis, just do one. This is more secure and can save us a lot of time."

"Because sometimes patients find it hard to distinguish between hemoptysis and vomiting blood, although the blood comes up with a cough, the presentation is sometimes ambiguous."

"So first we need to diagnose whether it’s the respiratory tract or digestive tract, then we can focus our considerations on one direction in the subsequent steps."

"Thank you, Teacher Xu," Xu Yino said hurriedly.

This was Xu Hui sharing his experience in handling diagnoses, which was invaluable.

When she was diagnosing today, she initially considered whether it was gastrointestinal bleeding or respiratory bleeding and later leaned towards respiratory.

But now that anemia symptoms have appeared, she has to reassess the situation.

Because the patient’s amount of hemoptysis doesn’t support the indicators of anemia, in such a vague correlation, one must clarify the true relationship.

Xu Hui waved his hand dismissively, "It’s nothing, really. Just pay more attention to hemoptysis and hematemesis in the future. I only suspected something because of the anemia results. Normally, the first examination might not even include a stool test."

"Then I’ll have the patient complete hospital admission procedures and check their body, communicate with the patient, and conduct instrument tests for related projects," Xu Yino said.

"Sounds good, do a gynecological ultrasound too, just in case. Symptoms are often more problematic when they’re this vague," Xu Hui said thoughtfully.

"Thanks again, Teacher Xu, for sharing your experience. I’ll go find the patient now," Xu Yino said happily, and then immediately ran out.

"This girl, I’ve spoiled her too much," Liu Banxia said helplessly.

"Look who’s talking, you spoiled her yourself. Why didn’t you suggest a stool test? Wasn’t it waiting for me to point it out?" Xu Hui said.

"I just wanted them to learn more," Liu Banxia laughed.

"If I said it, she might immediately forget. But it’s different when you say it, coming from a master of internal medicine, it’s invaluable knowledge."

"I’m tired of your nonsense. How are the two little babies? I wanted to check on them but was worried it might be inconvenient," Xu Hui asked.

"They’re doing well, sleeping nicely, and their meconium is normal. But Qiaoqiao is having a hard time; she’s eating a lot to make sure they’re both full," Liu Banxia said.

"She insisted on breastfeeding for at least another week before using formula. I don’t dare argue. We just follow her lead. Certain foods can cause heat, and I don’t want her to be upset."

"Those babies sure went through a lot, but you really are something—having both a son and a daughter with twins," Xu Hui said.

"Heh, honestly, I still feel happy whenever I think about it," Liu Banxia said with a smile.

"Why else would I hide in my office? I’m afraid people will think I’m crazy. Everyone’s thrilled, even Qiaoqiao’s pondering whether to have a third child."

"But that decision will have to be hers. Carrying and birthing a child is a significant burden for her. Since she got pregnant, she hasn’t thought about anything else."

"For at least the next six months, she won’t be concerned about anything else and will focus entirely on the two kids. Her birthing process really had me worried then."

"She’s too strong-willed, insisting on a vaginal birth. Otherwise, it would’ve been easier; she surely didn’t suffer any less," Xu Hui nodded.

Her choice to change the birthing method was known throughout the emergency center, and everyone was concerned about Qiaoqiao’s delivery.

Everyone was truly impressed; having one child would be challenging enough, let alone having two.

"But you shouldn’t let this stop you from managing our emergency center’s affairs. I noticed the intern and resident physician evaluations were quite good," Xu Hui said.

"Especially in the proctology department, Director Jiang seemed very pleased with the results of the trainees. He even mentioned it at lunch in the cafeteria, saying he owed thanks to you."

"Inviting me over to motivate them twice worked well," Liu Banxia laughed.

"But Director Jiang has big plans, aiming to expand and strengthen the proctology department to compete with specialized hospitals. The skill in changing dressings needs to improve to provide the best diagnostics and treatment."

"Okay, keep busy. Let’s meet again once the results come in," Xu Hui said.

Liu Banxia nodded, workdays were indeed busy.

However, as it neared the end of the day, and the available results came in, Liu Banxia’s brows furrowed tightly.

The stool test was occult blood-negative, and the gynecological ultrasound was also negative, confirming respiratory bleeding.

All other tests came back negative too. It’s almost like there’s a fog enveloping this patient’s symptoms, making them indistinct.

Ding! Task released: patient with vague symptoms

Open task: patient admitted for hemoptysis, relevant test results lack clear indications, requiring further judgment from the host. Task reward: issued based on diagnostic results.

Liu Banxia rubbed his brow, the vague symptoms had even triggered a system task.