Chapter 299: County-level hospitals are not necessarily weak, experts have no other options
Eating raw meat and drinking raw blood was the way of life of primitive humans.
After millions of years of evolution, humans have already adapted to eating cooked food and drinking boiled water. Although foreigners often only eat steak and barbecued meat medium-rare, and even eat some fish raw, their food is actually fundamentally different from wild animal meat.
For example, the beef they eat will undergo a series of tests before being sold on the market.
It is necessary to ensure that multiple tests such as hormones, bacteria, viruses, parasites, etc. meet the standards before it is allowed to be put on the market for sale.
Just like the mice used in medical experiments, they are expensive because the quality requirements in all aspects are very strict.
It was a bit naughty for the eight-year-old boy to eat a small fish raw.
"Little boy, what kind of fish did you eat?"
"It was a goldfish I bought from the market! I made a bet with my best friend at the time, and I lost. A real man must keep his word! So I ate a live little goldfish as agreed."
The boy spoke weakly.
But it also amused Zhou Can and others.
It's amazing that such a young child knows how to keep his promises.
"Little man, where did you get that goldfish?"
Zhou Can asked, trying not to laugh.
"We caught them with a net when we were visiting the park! We caught six in total. I ate one, and my friend and I took the rest home to raise. But they all died within two days."
The boy said that all the goldfish were dead and had a look of pity on his face.
"Oh! So when you eat goldfish, do you chew it up and then swallow it, or do you swallow it alive?" Zhou Can continued to ask.
In fact, no matter which method is used, the goldfish cannot survive.
The purpose of the inquiry is to further determine the problem of parasitic infection.
The oral environment and the stomach environment are completely different things.
The mouth is a hotbed of bacteria, but the stomach is a crematorium that kills all kinds of bacteria. It is almost impossible for viruses and bacteria to escape the killing of gastric juice. Most parasites cannot survive in the stomach either.
But there are exceptions.
For example, sparganosis, tapeworms, roundworms, etc.
If he chews the goldfish into pieces before swallowing it, the parasites may take the opportunity to hide in the gaps between his teeth, and then quietly invade his head through the nasal cavity, or invade his lungs through the bronchi.
Parasites are extremely resilient and cunning, and they can quickly seize any opportunity to survive.
"I... was afraid it would jump around in my stomach, so I bit it into pieces and swallowed it with my eyes closed. It tasted very fishy and bitter." He still felt uncomfortable when he recalled the scene of eating the fish.
The bitter taste he tasted was probably caused by the fish gall bladder being ruptured.
Bile is bitter.
Fish feces may also taste bitter.
Zhou Can asked all the questions he needed to ask and continued to look down at the information.
The patient reported that he had experienced repeated nausea and vomiting since he ate the live goldfish. This usually occurred within seven or eight hours after eating, and he also had diarrhea. He had diarrhea four or five times a day.
The first hospital he visited was the local county maternity and child hospital.
The hospital tested the patient's vomit and confirmed it was stomach contents. The diarrhea was yellow, watery stool.
The results of the first blood test showed that WBC (white blood cells) was 2.2*109/L, and EOS% (eosinophils) was 12.3%.
These two indicators of blood tests are important references for doctors.
If the white blood cell count is abnormally high, it indicates that the possibility of viral or bacterial infection increases. Eosinophils are an important indicator for determining parasitic infection.
The county maternal and child hospital performed a gastroscopy on the patient, which showed mild reflux esophagitis.
It seems that this county maternity and child hospital is not bad.
Hospitals that can perform gastroscopy and colonoscopy are all quite capable.
At least for a county-level hospital, it is considered quite good.
Abdominal Doppler ultrasonography revealed a small amount of peritoneal fluid.
Zhou Can took a look at the B-ultrasound report and found that there was indeed a small amount of abdominal fluid.
At the same time, the patient's spleen can be seen to be enlarged.
Generally, an enlarged spleen is either swollen or has a tumor.
However, if a tumor has grown, it can be judged by low or high density shadows.
The density of most tumors is different from that of normal organs.
Continuing to look down, the results of the urine routine showed urine protein (+++).
This means that the patient's urine protein is strongly positive, that is, there is a large amount of protein in the urine, indicating that the patient has serious kidney damage.
These were the only examinations performed by the County Maternal and Child Health Hospital. The patient was given treatments to protect the gastric mucosa and stop vomiting. The patient's condition improved and he was discharged from the hospital.
However, less than a month later, the patient suffered a relapse of his illness, with vomiting, low-grade fever, and diarrhea.
The family may have been worried about the limited medical skills of the county maternal and child hospital, so they did not dare to take the child to see a doctor. Instead, they took the child to the provincial children's hospital for treatment.
In fact, judging from the information on examination and treatment methods of this county-level maternal and child hospital, its strength is not bad.
Many ordinary people think that county-level hospitals are necessarily worse than provincial and municipal hospitals. This is actually a wrong perception.
Every hospital has its own characteristics.
If a county-level hospital has a good doctor who leads a team specializing in a certain medical field, then the strength of this hospital in this medical field may not be worse than that of a provincial hospital.
Inversion phenomenon also often exists.
Zhou Can has seen a township-level orthopedic specialty hospital that is even better than a provincial hospital. Patients from all over the country go there for treatment. Its treatment costs are low, and its level of treatment in the field of bone injuries is very impressive.
Many bone injuries that cannot be cured in large hospitals or that require conservative treatment can be cured here.
Although there are not many such amazing township and county hospitals, there are still some across the country. They have become famous for their real abilities.
Zhou Can then looked at the examination report and treatment plan from the second hospital.
After being admitted to the Provincial Children's Hospital, the patient was first tested with a routine urine test, which showed that the urine protein was still 3 plus.
Such severe urine protein is usually caused by diseases such as lupus nephritis, glomerulonephritis, and nephrotic syndrome. This actually requires high vigilance. However, the doctor at the First Women and Children's Hospital did not seem to attach much importance to this test result, whether it was a misdiagnosis or something else.
The second provincial children's hospital has significantly more experience in diagnosis and treatment.
After finding 3 plus urine proteins, the patient was directly checked for ANA, and the result was negative.
ANA is antinuclear antibody, a general term for a complex mixture of autoantibodies.
In medicine, it is mainly used to screen for rheumatic diseases.
For example, systemic lupus erythematosus, scleroderma, Sjögren's syndrome, and rheumatoid arthritis.
The test result is negative, which basically rules out the possibility of rheumatoid arthritis.
The experts at the Provincial Children's Hospital were quite capable. After ruling out this possibility, they immediately performed a kidney ultrasound on the patient again. They probably began to suspect that there was a kidney lesion.
It’s a pity that after the B-ultrasound, no obvious abnormalities were found in the kidneys.
The experts at the Provincial Children's Hospital checked one item after another and performed a gastroscopy on the patient.
I guess she looked down on the county-level maternity and child hospital to some extent and didn't trust its gastroscopy technology.
During this gastroscopy, a gastric mucosal biopsy was taken directly, and the result showed mild gastritis with occasional eosinophil infiltration.
It is worthy of being a provincial hospital. Although it also performs gastroscopy, its examination direction is more in-depth and more targeted.
Zhou Can found it interesting to review the patient's treatment process in other hospitals and the diagnostic thinking of experts in other hospitals. He could gain a deeper understanding of other experts' diagnostic thinking and use their diagnostic experience to help Zhou Can improve his diagnostic level.
The attending doctor at the Provincial Children's Hospital is definitely a highly skilled expert.
You can tell from his diagnostic thinking.
Each inspection has a strong purpose.
It is not like you imagine that you should check all the tests first. Instead, each test has a profound meaning.
It would be impossible to achieve this without a thorough understanding of pathology and rich diagnostic experience.
Zhou Can only judge the level of other doctors through their tests after his diagnosis level has improved. In the past, whenever he saw other doctors repeatedly doing various tests, he would first curse in his heart, thinking that this black doctor was making money again.
The patient had just completed the examination a few days ago and it still has medical reference significance. Why do we have to do it again?
In fact, not every doctor is a black doctor.
It is possible that doctors like Du Leng, who only know theory but have no practical experience, would give patients all kinds of examinations without any purpose, just for the sake of examination.
Whether it is the former or the latter, Zhou Can can basically tell at a glance with his current diagnostic skills.
For example, this doctor at the Provincial Children's Hospital is 100% a very high-level expert.
After the gastroscopy, the expert performed a colonoscopy on the patient.
The results showed no abnormalities.
Experts tried to give the patient nutritional support, but the results were very poor.
After about a week, the expert found that the treatment of this patient was ineffective and may have asked other experts in the hospital to help with the consultation.
The end was particularly interesting.
After consultation with experts from the Provincial Children's Hospital, the patient was given another kidney ultrasound.
Zhou Can was puzzled. Didn't they check it once more than a week ago and found no abnormalities? Why did they check it again after the experts' consultation?
Hey, you're right, this time the B-ultrasound examination of both kidneys actually found problems.
If this hospital was not the Provincial Children's Hospital, Zhou Can would have thought it was a black hospital that cheated people out of their money.
Because there was no problem last time, but now there is a problem again just a few days later. Aren't you talking nonsense?
The second ultrasound results showed that the patient's renal pelvis were slightly dilated, the bladder was not full, the pelvic fluid was 2.6 cm deep, the rectal wall was thickened, and a suspicious mass was found .
There is such a big difference in the results of the two renal ultrasound examinations.
There is only one possibility, that the doctor who performed the first kidney ultrasound examination was a relative and had a fake certificate.
The medical and technical departments of large hospitals are the hardest hit areas for people with connections.
There really are such 'amateur' personnel.
Any patient who encounters such an unprofessional doctor can only consider himself unlucky.
Who would have thought that in a provincial hospital, there would be unprofessional doctors doing an ultrasound?
In itself, medical imaging examinations do not require very high professional knowledge. As long as a half-baked dude puts a little effort in college, he or she can basically do it.
Of course, a doctor with practical experience will not only be more professional when performing imaging examinations on patients, but will also have a higher chance of detecting hidden lesions.
This examination revealed a mass in the right area of the patient's kidney.
I believe the experts are very excited.
The patient was directly given a laparoscopic surgery and the mass that was suspected to be a tumor was removed.
Pathological examination showed teratoma.
The experts at the Provincial Children's Hospital were full of expectations, thinking, this time we have finally found the cause of the disease and removed the tumor surgically. Will the child be cured?
According to Murphy's Law, things tend to develop in the worst direction.
The child's mass was removed, and the results of the pathological biopsy showed that it was indeed a tumor. However, the child's symptoms did not improve, and he still vomited and had diarrhea.
This expert from the Provincial Children's Hospital probably encountered such a weird thing for the first time.
What should I do?
Zhou Can admired the Provincial Children's Hospital expert's stubbornness. He did not give up and continued to treat the patient.
Shortly after the operation, the patient developed symptoms such as urinary urgency, frequency, and pain when urinating, as well as lower back pain.
This means that surgically removing the tumor not only failed to cure the child's disease, but instead created a bunch of new symptoms.
The condition has obviously worsened and the symptoms have increased.
The family members must be hesitant. Is this expert really capable?
The family members may even doubt whether what was removed was really a tumor or whether the hospital experts were unable to deliver on their promise and deliberately created a tumor to deceive people.
Although this is a large provincial hospital and a public hospital, the family still became suspicious.
However, for family members, there seems to be no better choice than to trust the doctor.
What's more, the expert still gritted his teeth and continued to treat their children.
The expert took another abdominal X-ray of the child.
This time, it was discovered that the patient had a gas-fluid level in his abdomen. The expert gave the patient sesame oil, and his condition actually improved.
After such a long period of treatment, there is finally a little effect.
In other words, a bunch of new symptoms after the operation were alleviated after the patient took the sesame oil. The experts became more motivated and regained a lot of confidence.
The expert began to change his diagnostic thinking.
Considering that the sick child ate a live fish and ate it raw, the possibility of infection with parasites is relatively high.
The patient's eosinophil count was also elevated.
Therefore, experts from the Provincial Children's Hospital checked the patient's stool again, specifically looking for parasites.
Patients with intractable diarrhea like this will definitely have routine stool tests once they are admitted to the hospital.
This time, the experts specifically asked the laboratory to check whether there were parasites .
For example, insect eggs, parasite corpses, and even living larvae.
Unfortunately, despite all efforts, no parasites were found.
The diagnosis was in limbo.
This expert has basically exhausted all the methods he can use, and further investigation will probably yield no results.
And during this period, the patient's condition worsened again.
Not only did the urine protein still exist, but I also started to experience pain in my knees and elbows, and my frequent urination became more severe. I had to urinate hundreds of times a day, but sometimes I only urinated a few drops, and sometimes I urinated no more than 30ml.
Symptoms such as vomiting and diarrhea still exist.
At the same time, the patient continued to have a low-grade fever.
What’s even more frightening is that because the disease has not been cured for a long time, its condition has worsened and the patient has developed symptoms such as shortness of breath and palpitations.
This means that the disease has affected the heart and lung function.
If the treatment continues, most patients will have to walk into the hospital, be wrapped in body bags, and be carried out.
The experts at the Provincial Children's Hospital have run out of ideas and can't think of a better solution.
It is a large provincial hospital and the experts are famous. It is really shameless to directly advise the patient to transfer to another hospital.
However, large hospitals like this have a wide range of methods for dealing with various difficult problems.
For example, they would ask a medical agent to pretend to be a family member or a relative of a patient in the same ward, pretend to be concerned about the patient's condition, and then enthusiastically tell the family member that your disease should not be treated here! You have to go to a certain hospital, which specializes in treating this disease.
After hearing this, the family members must have been moved.
The family members will directly request transfer to another hospital without the hospital asking.
