Chapter 1059: Chapter 1059: Meeting the Patient’s Expectations
(Thanks to Inner Mongolia Brother Dong and Lu Tie Zhu for encouraging with monthly tickets)
Just as Liu Banxia was chatting with Shi Lei, his phone rang.
"Xu Yino, has the patient woken up?" Liu Banxia asked after answering the call.
"Teacher Liu, you should come over, she just woke up," Xu Yino replied.
"Alright, I’m heading up now," Liu Banxia said as he hung up the phone and walked out.
Xu Yino didn’t stay idle; she sent out a group message inviting others to come and join the observation if they were available.
"So, did you sleep well?"
Upon arriving at the ward, Liu Banxia asked the patient.
The patient nodded, "Thank you, Director Liu, for letting Doctor Xu stay here while I slept. Could you prescribe more painkillers? The meds here are effective."
"Let’s hold off on that for now. How are you feeling?" Liu Banxia inquired.
"It’s manageable now, still some pain, but not as intense as before," the patient replied.
"Doctor Xu asked me as well, but I still can’t pinpoint the most painful area. It’s just the entire stomach that hurts, not the dull physiological pain."
Liu Banxia nodded, "Let me examine you again. Try to relax as much as possible; the purpose of this exam is to determine the general area of your pain."
"Director Liu, isn’t it the whole stomach?" the patient asked.
"Right now, we’re trying to distinguish that. Based on current results, there’s no support for symptoms of total abdominal pain," Liu Banxia explained.
"Typically, cases like yours involve a tight abdomen due to tense muscles. But your abdominal muscles are soft, which is a bit contradictory."
"I suspect the prolonged pain has led to some divergence and stress response, which makes it feel like total abdominal pain."
"These are my students. I’ve studied your symptoms with them. Can they observe the exam later?"
The patient nodded without hesitation; even if the exam doesn’t reveal the condition, she’s already quite satisfied.
She appreciates the attention from Liu Banxia and the other doctors. At other places, they’d just wake you up directly for an exam.
Liu Banxia rubbed his hands to warm them before putting on gloves, then rubbed them again to prevent the gloves from being too cold and overly stimulating the patient’s abdominal wall.
His examination method isn’t the conventional hospital procedure; it relies on the tactile sense of his hands.
Given the patient’s complex condition, he had little confidence in discerning it.
During the initial exam, it matched his expectations. Upon touching the patient’s abdominal wall, tense muscles were felt.
Pushing slightly harder, the patient consistently reported pain wherever touched.
Liu Banxia shook his wrist and started ignoring the patient’s responses, relying on his fingers’ tactile sense.
At the most painful area, abdominal muscles would contract faster and tense more.
To outsiders, it might seem like Liu Banxia’s fingers were just pressing all over the patient’s abdomen, almost as if taking advantage rather than examining.
However, no one among Liu Banxia’s trainees and interns thought it was nonsense; they were attentively observing.
Whether this method would work was unknown, but if anyone had a chance of success, it was likely to be Liu Banxia.
An anesthesiologist Xu Jie had mentioned that Liu Banxia’s hands seemed to have eyes; he could investigate even during heavy bleeding.
He relied on his fingers’ sensitivity to feel the force of blood flow, guided by it.
After a full five minutes, Liu Banxia pressed several times more on the patient’s left side abdomen before taking off his gloves.
"Teacher Liu, is it the left side abdomen?" Xu Yino couldn’t wait to ask.
"Based on the feedback from her abdominal muscles, it should be the left side abdomen," Liu Banxia said.
"Can you recall anything?" Xu Yino asked the patient.
"Don’t put pressure on her. Any answer she gives now might be influenced by us. If she remembered, she’d have mentioned it earlier," Liu Banxia said with a smile.
"Following the exam, we’ll proceed with an enhanced CT scan, focusing on the left kidney. I need to tell you that it’s an invasive procedure requiring a contrast agent injection into the blood vessels."
"Director Liu, do you think there’s a problem with my kidney? Just remove it then," the patient straightforwardly responded.
"Miss, it’s not that simple. Director Liu is just starting the examination," said a lady beside the bed.
"Yes, you can’t just remove a kidney on a whim. Besides, I’m currently suspecting that it’s not an issue with your kidney itself, but rather a problem with the blood vessels in your kidney," Liu Banxia said.
"But we haven’t confirmed the diagnosis yet, so I can’t give you false hope. Let’s do the examination first, and if it’s confirmed, I’ll consult a skilled doctor to see if conservative treatment or surgical intervention is necessary."
"I don’t care about surgery, even removing a kidney. Director Liu, can we really confirm it this time?" the patient asked hopefully.
"Don’t worry about that for now; let’s focus on the examination first," Liu Banxia replied.
"Xu Yino, take her to get ready. I’ll prepare the examination orders. We need to primarily observe the left renal vein as we’re suspecting nutcracker syndrome."
Xu Yino nodded, determined to do a good job.
"Teacher Liu, how likely do you think it is?" Liu Yiqing asked curiously after they stepped out.
"How would I know without the examination? My eyes can’t see through, let alone see the blood vessels," Liu Banxia said with a smile.
"The patient is currently experiencing left abdominal pain, but no back pain. However, there’s hematuria with two plus signs of occult blood. If the hematuria isn’t caused by a urinary tract infection but is due to the main condition, it would make sense."
"But we still don’t know for sure. Although we can aid the diagnosis by measuring the left renal vein’s expansion during positional changes, it’s not as direct as an angiography."
"Also, it would cause the patient some inconvenience. Even though the upcoming examination is invasive, it’s justified because of the clear indication."
In his mind, Liu Banxia felt a sense of reflection. Had it not been for considering the hematuria issue more in the office, he might not have thought of this condition.
But now it’s all speculation; we’ll have to see how the angiography results come out.
"Teacher Liu, did you feel anything distinct with your fingers earlier?" Li Hao asked out of curiosity.
Liu Banxia shook his head, "Not very distinct. Otherwise, I wouldn’t have examined for so long. I suppose the patient’s whole abdominal pain aligns with my judgment; it’s likely due to the prolonged duration of the condition causing a psychological and stress reaction."
"It’s like when we give injections; even though it’s just the needle insertion point that hurts, we feel that the whole area hurts. Whether it’s a deltoid injection or a gluteal injection, the effect is the same, affecting a whole region."
"If we really diagnose this time, it’s another reminder for us. Can someone tell me what this reminder is?"
"When unsure about a condition, ask Teacher Liu—definitely won’t go wrong," Miao Rui said.
Liu Banxia gave him an exasperated look, "You get one more chance between an extra chicken leg tonight and the correct answer."
"Heh, it’s the importance of asking the patient about their medical history," Miao Rui said with a laugh.
"Teacher Liu has reminded us many times that the patient’s account is crucial. When we encounter complicated issues, we need to confirm repeatedly with the patient."
"Sometimes things the patient inadvertently mentions can help us diagnose. But we also need to learn to discern, filtering out descriptions that clearly have no relation to the condition."
Liu Banxia nodded in satisfaction, "That’s right. If the patient clearly expressed left abdominal pain during the consultation, we would pay more attention to the left kidney."
"That way, we can shorten the diagnostic time and spare the patient some suffering. This patient also brought up something I’ve mentioned to you before..."
"Teacher Liu, I know, isn’t it about the symptoms of hematuria?" Huang Bo eagerly chimed in.
"Wow, you’re all so eager! But we still need to wait for the results to see if it can be diagnosed. If not, it would have been for nothing," Liu Banxia said with a smile.
"Teacher Liu, let’s not consider Huang Bo for now; can I get extra chicken legs tonight?" Miao Rui asked.
"If you want extra, go ahead; why ask me? I never said I’d add it for you, just that there’s a choice between the chicken legs and the correct answer," Liu Banxia replied nonchalantly.
Miao Rui was dumbfounded, not expecting this outcome; Teacher Liu was still so cheeky. Diagnosing the condition should be a joyous occasion, and joy deserves extra chicken legs.
Everyone else was thoroughly amused; Teacher Liu really knew how to play the game.
Waiting was a bit of a struggle, but an enhanced CT scan isn’t like other tests where it’s over with a click; it requires preparation and a sensitivity test.
Waiting and waiting, Liu Banxia’s phone finally rang. As soon as he took it out, everyone else gathered around quickly.
"Is the examination done?" Liu Banxia pressed speakerphone and asked.
"Teacher Liu, we can confirm it now; it’s nutcracker syndrome, with the left renal vein vessel indeed being compressed," Xu Yino excitedly announced.
One could vaguely hear teasing comments on the other end of the line, but no one was in the mood to focus on that.
Ding! Task from the abdominal pain patient who came seeking fame is complete
Earned 500 experience points, Glory Points +4
This task was rated as perfect, earning 800 experience points, Glory Points 5+5, and 1 stony solidification
Liu Banxia felt a great sense of relief; he hadn’t let down the patient’s expectations. Although there were some detours, the diagnosis was made.
