Chapter 1470: Chapter 589: The Cause of Death Was Not the Catheter, Reliance_2
"You mean the patient’s urine hasn’t been discharged for a long time and was reabsorbed by the body?" Director Shi was clearly dissatisfied with this conclusion.
"No, what I mean is that the urine might have been absent before the catheter was inserted. Even if there’s a small amount, it could have been reabsorbed by the body, leading to anuria."
Zhou Can explained calmly.
"Then where did the patient’s urine go? With the belly swollen like that, you aren’t going to tell everyone that there’s no urine in there, right?"
Director Shi’s tone carried a hint of sarcasm.
He’s a seasoned Internal Medicine doctor, now leading the hospital infection department, so it’s normal for him to look down on Zhou Can, a young doctor.
Others were equally unconvinced by Zhou Can’s explanation.
Even Shang Zhuxing, sitting opposite, didn’t believe it. He thought Xiao Zhou was genuinely loyal, clearly trying to shield Digestive Internal Medicine from blame to lessen the accident’s responsibility.
"There’s indeed no urine in the patient’s abdomen. Did you notice a detail? The patient suddenly vomited a large amount of blood before dying."
Zhou Can’s gaze swept across everyone.
"When examining the patient earlier, I pressed their abdomen; it was soft. This indicates there is a lot of fluid in the abdominal cavity, not just feces."
In fact, even if you don’t defecate for a week, your belly wouldn’t swell up like a pregnant woman.
Because feces are mostly solid matter.
Especially for patients with difficulty defecating, the feces stay inside for too long, and the body absorbs the water, making the feces even drier.
For constipated patients, doctors often advise drinking more water; it’s basically for this reason.
If the water content in the feces is insufficient and too dry, it makes it difficult to be excreted through the intestines.
"I suspect the patient might have a ruptured major artery or vein, causing a large amount of blood to enter the abdominal cavity in a short time, which led to severe abdominal swelling." He concluded.
"But that’s impossible! Since five o’clock yesterday morning, the patient has had no urine. Abdominal bleeding lasting this long would definitely show various symptoms of blood loss. Digestive Internal Medicine, no matter how incompetent, wouldn’t miss such obvious signs."
Director Shi questioned.
"That’s precisely what I find curious. Could there be a possibility? Initially, the patient’s abdominal cavity just bled slowly. But the blood volume wouldn’t be particularly small. The patient already had severe fecal retention; their abdomen would certainly have many discomfort symptoms. So the symptoms of pain due to bleeding were neglected."
"Due to severe internal bleeding, the body mobilizes water from other body fluids into the blood to maintain the normal circulation system. Hence, the patient went almost a whole day without urinating. By nighttime, not only did the bleeding not stop but it increased, leading to vomiting blood and death."
Zhou Can made a bold speculation.
"Even if Dr. Zhou’s assumption is correct, how could the patient bleed into the abdominal cavity and vomit blood?"
Director Ju from the Nursing Department expressed doubt.
The Medical Department people remained silent.
They actually hoped that Digestive Internal Medicine wouldn’t bear any responsibility. Because as clinical trainers, if problems arise, they also bear the responsibility of ineffective guidance.
"Vomiting blood usually indicates bleeding in the upper digestive tract or the respiratory tract. If this patient bled in the abdominal cavity, logically, it shouldn’t result in vomiting blood. There are only two possibilities for this situation: either there is bleeding in the upper digestive tract, or the bleeding in the abdominal cavity has entered the intestines. To determine the exact situation, an autopsy is likely needed,"
Zhou Can too was curious about where exactly the bleeding had occurred, leading to the patient’s death.
What was certain was that the death was related to internal bleeding and not due to an improperly inserted urinary catheter causing urine retention leading to death.
"The family’s stance is that the deceased is greater and they don’t agree to an autopsy. The hospital also hopes to settle things peacefully and quickly lay the deceased to rest. Dr. Zhou’s investigation concludes that the patient had significant internal bleeding, causing death. I wonder if Director Shi and Director Ju agree with this conclusion?"
Vice Director Xiong from the Medical Department timely questioned.
Zhou Can knew this Vice Director Xiong was friends with Director Shang.
Now that Digestive Internal Medicine was in trouble, Vice Director Xiong would surely help cover things up, trivializing major issues.
Having more friends is very advantageous.
"I agree!"
Director Ju Shiman from the Nursing Department nodded in agreement with Zhou Can’s conclusion.
Yet Director Shi from the hospital infection department still harbored some suspicion, saying, "Is Dr. Zhou really sure there was no bladder rupture or urinary catheter malposition?"
"I am sure. If there were a bladder rupture, the patient would be in extreme pain before death. But according to the family and the attending medical staff’s response, the patient’s death occurred within just a few minutes, without time for rescue. So I believe the possibility of bladder rupture can be ruled out. As for urinary catheter misplacement, based on my personal professional and experience level, I can assure you this isn’t the problem."
Zhou Can stated confidently.
Indeed, a bladder rupture would bring immense pain to the patient.
There wouldn’t be no reaction.
Not just pampered humans; even a wild antelope would lose most of its mobility if its bladder ruptured.
An experienced old antelope will urinate at midnight instead of waiting until the next morning.
Because lions and wolf packs typically hunt them in the morning.
This is because experienced predators know a fatal weakness of antelopes. Herbivores eat large amounts of fresh plant stems and leaves, containing a lot of moisture. After a night’s digestion, their bladders will be full of urine.
Many young antelopes, without survival experience, aren’t aware of the danger. At night, they’re sleepy and indulge in comfort.
By dawn, a lion’s sudden roar comes from afar and attacks.
They get startled and flee in panic.
Frightened, to survive, they explode with the fastest running speed. At this point, if the bladder is full, it could easily rupture during the sudden burst. If this happens, that antelope is almost certainly doomed.
Its running speed will quickly slow down due to the intense pain!
It then becomes a lion’s feast.
Moreover, the old antelopes had survived many dawn predator hunts and summarized life-saving experiences. Hence, they overcome drowsiness to urinate far away at midnight. This way, if attacked, they won’t have to worry about a full bladder leading to rupture when fleeing.
Additionally, by expelling a large amount of urine, their weight is reduced, facilitating faster escape.
Humans bear much less than beasts.
If an antelope can’t stand a bladder rupture, if this patient who died had a bladder rupture, they would’ve cried out loud enough to be heard in the entire ward.
So, Zhou Can boldly conjectured that the patient’s bladder was not ruptured.
Of course, to truly verify, performing an autopsy is the only gold standard.
"Alright, I acknowledge Dr. Zhou’s conclusion! The patient’s death is unrelated to improper urinary catheter operation."
After hearing Zhou Can’s explanation, Director Shi finally accepted his conclusion.
Director Shang and others opposite showed elated smiles, breathing a sigh of relief.
Assistant Qin looked at Zhou Can with a highly appreciative gaze.
A person’s reputation, like the shadow of a tree, this youngster made a name for himself in Tuya Hospital in just a few years with only a bachelor’s degree. He indeed has some skills.
The Medical Department folks were well aware of Zhou Can’s prowess, so they seemed quite calm.
Director Ju Shiman from the Nursing Department was also secretly amazed by Zhou Can’s medical expertise. She might not have expected such a remarkable young doctor.
Indeed, being part of the first group in the Quality Control Office itself is a significant achievement.
Every spot in the first group is extremely precious.
It requires passing through numerous tests to stand a chance of being selected.
"Dr. Zhou, now that you’ve helped clear Digestive Internal Medicine from blame, that’s very good. However, it’s hard for us to explain to the family like this. See if you can further deduce the cause of the patient’s death without an autopsy. It doesn’t have to be too specific, just roughly pinpointing a region will do."
Assistant Qin became evidently more reliant on Zhou Can.
