Chapter 1057: Chapter 1057: Consultation
(Thanks to An Lin Xiaoxiao, Helpless Cloud, 8901210, Eternal Wu Creek, Black Overlord Bear, Cool Wolf, Wang Lintai 1, The Road Is Tortuous, and Reader 110813135333134 for the monthly ticket encouragement)
In fact, even Liu Banxia didn’t want to appear so "weak and incompetent" in front of a patient; that would make the patient lose confidence, even become suspicious.
But this patient was different. She was someone who had sought medical help many times without any result before finally coming to the emergency center. What he needed to do now was be honest with her and not give her false confidence.
Because sometimes the greater the hope, the greater the disappointment.
"Try to think carefully again—where exactly was the very first point where the pain started?" Liu Banxia asked.
"I really can’t remember, it’s been several months already," the patient said.
"At the beginning it didn’t seem this painful, and then after a few days it suddenly hurt a lot. I haven’t had a single good night’s sleep or a proper meal in these past few months."
"Director Liu, can you prescribe me more painkillers? I’ve taken ibuprofen, it doesn’t work. The medicine from your hospital works. I won’t take it during the day, I’ll just take it before bed, okay?"
"Hang in there a little longer, we’re also trying to find a way," Liu Banxia said.
"Painkillers can only relieve the pain temporarily; no matter how you take them, if the time is too long they’ll be addictive. Then the dosage will keep going up and it will damage your nervous system."
"Let us work a bit harder and figure out a direction for the illness. I’m thinking of arranging a 24‑hour EEG and ECG for you, to see whether, during the course of your symptoms, there are any other changes. Is that okay?" Liu Banxia asked.
The patient nodded. "Any kind of test is fine, as long as you can stop the pain. Whatever you want to cut out is fine too."
Those were very helpless words, reflecting nothing but how much the illness was tormenting her.
"Teacher Liu, what do we do? I already feel so sorry for her. It’s a good thing Qingqing didn’t see this, otherwise she really wouldn’t be able to take it," Xu Yino said after they walked out.
"We can only check step by step. For now we’ve done all the tests we can do, and what’s left are invasive examinations," Liu Banxia said.
"But from her abdominal plain film we still couldn’t see what’s going on at all, not a single thing that’s even slightly suspicious."
"So you think this patient’s pain is neuropathic?" Xu Yino asked.
Liu Banxia nodded. "And I have another idea: while monitoring her EEG and ECG, we also give her a placebo."
"That way we can determine whether she has phantom pain. If it still hurts after she takes the placebo, we can rule that aspect out."
"Teacher Liu, is that okay?" Xu Yino asked.
"Whether it’s okay or not, we still have to try. Find a vitamin tablet that’s a bit larger and have her take it first and see. If her ECG and EEG stay normal all afternoon, then we’ll discuss other options."
"After lunch I’ll get a few more people and we’ll have everyone do a joint consultation. Fortunately we didn’t trouble Teacher Wu; this has nothing to do with the kidneys."
"Okay, I’ll go arrange it right now." Xu Yino nodded.
This really was one way to go. There are many possible causes of pain. As long as they could dig out the cause, the disease could be diagnosed.
Right now they were basically using the exclusion method, ruling out every possible disease one by one.
Originally he had planned to wait until after lunch, when everyone had time in the afternoon, and then gather them for a case conference. But when he went back to the main hall and saw there weren’t many patients today, he directly issued a martial world summons.
Of course, for the moment he only needed to call Internal Medicine and Neurology. If the patient had any kidney issues, he could invite Wu Wenlin over.
Now the patient only had some minor inflammation, and her kidney function was fine, so he couldn’t trouble him casually.
For a consultation you also need some specificity; you can’t drag a whole bunch of people over for everything. Everyone has their own pile of work; it’s not that easy.
"Just now Xu Yino already filled you in on the situation. Regarding this patient, if either of you has any ideas, just say it directly."
After Xu Yino finished presenting the case, Liu Banxia looked at Wang Huan and Zhang Ping.
"Director Liu, it’s been a long time since we had a consultation, and I didn’t expect it’d be such a big case," Zhang Ping said.
"From the current instrumental and routine examinations, we can indeed rule out the possibility of an organic lesion. With such a long disease course, even the slowest‑developing organic problem would have been picked up."
"You’re also leaning toward psychological factors now, or rather neurological factors? Phantom pain is mostly seen in patients with a history of amputation."
"I can’t be sure yet; it’s only a suspected direction. So I ordered a 24‑hour EEG and ECG, and we’ll also try using a placebo," Liu Banxia said.
"I’m honestly at my wits’ end right now, I’ve got no tricks left. Median arcuate ligament compression syndrome, mesenteric ischemia syndrome, those two can be ruled out as well."
"And at the moment the only symptom the patient is showing is abdominal pain. It’s just that the course is too long, so we can’t pinpoint the most painful spot. Doctor Wang, any ideas?"
"How does the patient respond after taking painkillers?" Wang Huan asked.
"The painkillers still work; she slept very well last night. She was just asking me for more painkillers, wants to take them long term," Liu Banxia said.
"Given what we have so far, I don’t really have any other suggestions. You’ve already considered everything that should be considered, but I think we can try something."
"Have you ever done an abdominal exam on her after she’s taken painkillers? Of course, that’s assuming we’ve set aside the psychological factors first."
"If you examine her at that point, even if her subjective feeling is a bit dulled, her body’s natural reactions should still be there."
"Others might not be able to pick up on it, but once she’s in your hands you should be able to get a sense of it, right? That way maybe you can at least narrow down the general area?"
"That’s just my idea. We still need to rule out psychological or neurological factors first, and only then can we try it. Whether it works or not, that depends on you."
Liu Banxia pinched his chin and thought it over carefully.
"I think Teacher Wang’s method is very workable. Other people might miss it, but Teacher Liu definitely won’t," Xu Yino said excitedly.
"And this exam doesn’t need any machines and it’s noninvasive, so it really suits this patient. I just gave her a placebo tablet; in half an hour I’ll go up and see how it goes."
"Okay, let’s keep that as a backup plan for now. What about neurological or psychological causes?" Liu Banxia turned to Zhang Ping again.
"Honestly, it’s not easy to assess, and I even feel that doing an EEG might not show anything," Zhang Ping said.
"Because her pain is too nonspecific, and she doesn’t have any other obvious symptoms. If it were caused by intracranial nerves, she’d show other signs too."
Liu Banxia nodded. "Her eye movements and thought process are both very clear. If you say her pain pathways are the problem, it wouldn’t just be the abdomen."
"Let’s watch first. If the placebo has no effect at all, at least we can rule out psychological factors," Zhang Ping said.
"Then you can try Doctor Wang’s method. If you can really delimit the area, you can focus on the organs in that region for further workup."
"If that still doesn’t work, we may have to go for exploratory laparoscopy or intraoperative ultrasound and check all the abdominal organs one by one. That’d be a big project."
Liu Banxia nodded with a bitter smile. "That’s my last-resort, last-resort option. If it were the old me, I might have gone straight to laparoscopy already. Now I’m thinking more and being more cautious."
"Yeah, you really do have to be cautious with invasive procedures," Wang Huan said.
"Oh right, there’s one more thing. Later on we’ll need to pull interns and residents from both of your departments to take part in the ’Emergency knowledge enters the campus’ activity," Liu Banxia continued.
"I’ll draw up the plan later. Anyway, that big group of them all has to take a turn. Old Chen and I will take turns leading the teams out. If you’re interested in joining, even better."
"Forget it, we’re not going out there to toss ourselves around," Wang Huan said.
"Have the interns review this stuff again this afternoon too. Don’t let them be all thumbs when the time comes. Our internal medicine is a bit weaker than surgery in this; we get fewer chances to practice hands-on."
"It’s fine, they’ll still manage. Later we’ll have them practice some emergency intubation and invasive intubation properly as well. Those are must-have skills for us emergency center doctors."
"Alright, that’s it for the consult, yeah? Not adding a dish for us at lunch? Pulling off such a difficult surgery in such a short time, and so successfully at that," Zhang Ping said.
"Add, I have to add. I figure if I don’t, you’ll be talking about me for at least half a month," Liu Banxia said helplessly.
"And whose fault is that? Who told you to keep breaking our hospital’s records for no reason? Just say how many you’ve broken already. If you don’t treat us, who will? Don’t think we’ll go easy on you just because you’re the deputy director. When it’s time to rob you, we can’t show mercy. Right, Xu Yino?" Wang Huan said.
"Teacher Wang, for now we can only support you spiritually. Anyway, I’ll go upstairs to check on the patient," Xu Yino said with a straight face, then dashed out.
"You all go get busy too. We’ve already wasted a lot of time this morning; now we have to buckle down and work," Liu Banxia said.
The other five looked a bit resigned. They hadn’t managed to catch Qingqing, so now they were the ones getting caught.
But they were used to working anyway; this was just the daily routine. They were actually quite looking forward to the afternoon exam, though—they were curious whether Teacher Liu’s dexterous hands could pick up those faint tactile clues.
Just like Teacher Wang said: if it were someone else, maybe not, but if it’s Teacher Liu, it’ll definitely work.
You could call it blind faith in Liu Banxia, pretty much the same as Qiu Huaili and the others had.
