Chapter 311: Insightful Pathological Analysis, Latecomers Take the Lead
"Teacher, I..."
She enjoyed the feeling of being the center of attention. Since she started working at Tuya Hospital, she had never felt so honored.
I only enjoyed the feeling of being admired and respected by everyone when I was in school.
It was her inner integrity and strong self-esteem that spurred her on, making her involuntarily muster up the courage to clarify everything.
Because the person who actually diagnosed that the pregnant woman might have diabetic ketoacidosis was Zhou Can.
"You are just shy! You did a great job today. You deserve a praise. You don't have to feel embarrassed." Director Zhang looked at his beloved disciple with a kind look.
Parents always think that their own children are the best and the most outstanding, and teachers also think that their own apprentices are the best.
Zhang Bihua never thought that this patient was not diagnosed by her apprentice.
"Teacher, actually the person who diagnosed this patient's abnormal blood sugar was Zhou Can, not me!" Yang Chan gritted her teeth and finally mustered up the courage to tell the truth.
Not only does she look clean, but her heart is also extremely pure.
She refuses to take anything that does not belong to her.
Even though she knew that even if she didn't tell the truth, Zhou Can wouldn't say anything.
However, her integrity and pride did not allow her to do so.
To test a person's character, you only need to look at his attitude towards money. But to test whether a person's soul is pure, you must see whether he can withstand the test and remain unshaken when faced with temptation.
"Zhou Can again?"
Zhang Bihua was only slightly surprised by the result.
"It's also very good that you don't take credit for your achievements."
After praising Yang Chan, Director Zhang looked at Zhou Can who was standing at the door.
This kid always likes to sit in a corner and be quiet and high-profile.
"Xiao Zhou, come here and share your diagnostic ideas with everyone! The diagnosis of this patient is of great learning value, and let these young doctors learn your diagnostic methods."
Zhang Bihua was not unhappy at all because a junior had overshadowed her.
Every inch has its own shortness, and every foot has its own strength.
Everyone has their own strengths and weaknesses. Medicine is a vast and wide field, and one cannot learn everything in one’s lifetime. In addition, each doctor’s diagnostic thinking, knowledge, experience, and understanding of diseases are different, so the ability to diagnose different diseases will naturally vary greatly.
No matter how great an expert is, he will have shortcomings and blind spots even in his field of expertise.
For example, when diagnosing this pregnant woman, even Director Zhang Bihua did not expect that the patient had diabetic ketoacidosis.
She was particularly shocked when she heard the results from the laboratory.
Facing the excellence of her juniors, she remained very calm.
"Doctor Zhou is so strong!"
Gao Jian watched Zhou Can once again shine and achieve great success. It would be a lie to say that he didn't feel jealous.
But ability is something you can't have just because you want it.
At present, Gao Jian had to admit that his diagnostic ability and diagnostic thinking were not as good as Zhou Can's. It seemed that his diagnostic experience was also far behind Zhou Can's.
"What a good letter!"
Du snorted coldly, his expression looking quite ugly.
Unexpectedly, Zhou Can accomplished a great deed right under his nose.
When Zhou Can asked Yang Chan to help check whether the patient's armpits and groin skin had changed color, he had been trying to figure out Zhou Can's diagnostic ideas. Unfortunately, he couldn't figure it out no matter how hard he tried.
It was not until Yang Chan suggested that Director Zhang do a blood sugar test on the patient that Du Leng belatedly understood Zhou Can's diagnostic thinking.
Unfortunately, it was too late to say anything then.
Zhou Can had no choice but to walk to Zhang Bihua under the watchful eyes of the crowd. He glanced at Yang Chan with a scornful look and said, "Why did you drag me out of here?"
"Just share your diagnostic ideas with everyone as soon as possible! How can I take all the credit for your work?" She had a clear conscience, so she felt justified when she retorted to Zhou Can.
She is still the proud class monitor.
"Tuya Hospital is indeed worthy of its reputation. Not only are there many famous doctors of the older generation, but I didn't expect that the younger doctors are also so amazing. Is this Dr. Zhou really just a resident doctor?"
Hu Wanjun was somewhat unable to believe it.
Not to mention resident doctors, even interns find it difficult to have such a high level of diagnostic ability.
Ordinary people just watch the fun, but Hu Wanjun, a senior expert in her sixties, is watching the inside story.
She knew how difficult it was to diagnose the pregnant woman with diabetic ketoacidosis. A seemingly simple diagnosis result, in the absence of obvious symptoms, lack of testing basis, and the blood sugar level of the patient was normal before admission. In this case, to diagnose the patient's blood sugar problem, it requires not only extraordinary courage, but also profound medical knowledge, rich clinical experience, and extraordinary thinking ability.
All four are indispensable.
Professor Hu Wanjun seldom praises others, but at this moment she highly praised Zhou Can.
"It's the truth! I'm actually not as good as you think. I'm just an ordinary resident doctor. There are countless young doctors who are better than me in Tuya Hospital."
When facing this top expert from Xinxiang Maternity and Child Health Hospital, Zhou Can was neither humble nor overbearing, and was modest without undermining the prestige of Tuya Hospital.
"The patient had just had a checkup two days ago. Why did you conclude that there was something wrong with her blood sugar?"
Hu Wanjun is not ashamed to ask questions.
She really wanted to know Zhou Can's diagnostic ideas.
The other doctors were also waiting for Zhou Can to share.
"It's not complicated. I have treated many diabetic patients, so I have a deep impression of some of the superficial symptoms of this disease. For example, the skin becomes dark and brown, or even obvious skin diseases appear. In clinical diagnosis, if the skin in the neck, armpits, etc. is dark, even if it is scary, it cannot be diagnosed as diabetes."
"Only when this condition occurs in pregnant women does it increase the chance of diabetes diagnosis. And the longer the pregnancy lasts, the higher the chance of the patient developing diabetes."
Diagnosing the cause is more complicated than you might think.
It is difficult to determine what disease a single symptom is.
For example, abdominal pain may be caused by enteritis, uterine fibroids, or femoral hernia.
The combination of multiple dark brownish skin patches and the 37th week of pregnancy could be related to diabetic ketoacidosis.
" Later, the patient picked up the cup to drink water, but came up empty. I immediately realized that she might have vision problems. After observing her words and actions, I was more certain of this. At this point, it was basically confirmed that she had diabetic ketoacidosis."
Zhou Can's diagnostic method is obviously much more effective than the method of exclusion.
The combination of these two symptoms and the special condition of late pregnancy allowed him to directly identify the cause of the disease.
"I checked my blood sugar two days ago and it was fine. How come it suddenly became a problem?" Du Leng couldn't help but ask out of curiosity.
As soon as he asked the question, Du Leng immediately realized that he had exposed his weakness.
However, many people wanted to know the answer to the question he asked, so everyone's eyes were not on him, but on Zhou Can.
"The patient had a severe upper respiratory tract infection on the fifth day before admission. This acute infection is a stressful state for the patient. When the patient is stressed, the body's insulin will become insufficient. Insulin in turn regulates hormone increase and glycogen release, ultimately leading to severe hyperglycemia in the patient. If the patient's eating and drinking are restricted during the two days of hospitalization in order to cooperate with the examination, it will further aggravate the condition."
"The above is the complete pathological mechanism that I have identified. There may be omissions, please correct me."
After Zhou Can finished speaking, the whole audience fell silent.
Many doctors were immersed in his analysis.
"Dr. Zhou's analysis is insightful and brilliant, and completely consistent with the pathological mechanism of human endocrinology."
A doctor from Xinxiang Women's and Children's Hospital couldn't help but praise it.
"This case is very instructive. It reminds us to take the stress state of pregnant patients into consideration when diagnosing them in the future." Hu Wanjun is a 60-year-old expert and professor who is very knowledgeable.
But this is the first time such a rare case has been encountered.
Of course, it also has something to do with the fact that her specialty is gynecology, not obstetrics.
"The young are to be feared! From now on, the world will belong to you young people!" Director Zhang Bihua expressed with emotion.
Her specialty involves obstetrics, but she didn't expect that in this case, she was even worse than a resident doctor.
Just as she said, talented people emerge in every generation, and the world belongs to the young.
The old generation will eventually come to an end.
"I was just lucky enough to have some knowledge about this type of case." Zhou Can didn't dare to rely on the heads of these chief physicians.
Everyone present is a big shot, and none of them is simple.
…
After the infusion, the pregnant woman's blood sugar dropped to around 14mmol/L and the fetal heart rate became significantly stronger.
Everyone breathed a sigh of relief.
Director Zhang Bihua asked the nurse to replace the normal saline with 5% glucose and sodium chloride.
The purpose of doing this is to increase the patient's calories, which will help correct ketone bodies more quickly.
At this stage of treatment, the patient has basically turned from critical to safe. A huge stone weighing on the hearts of Professor Hu Wanjun and others has been lifted.
Their expressions relaxed a little.
The group returned to the conference room and discussed several difficult and critical cases that had been piled up.
This time, Zhou Can's status was significantly improved, and no doctor at Xinxiang Maternity and Child Health Hospital dared to look down on him.
As for Tuya Hospital, everyone has already witnessed Zhou Can's abilities, and now they just admire him even more.
At this time, the patient with lower limb pain and venous thrombosis had also completed the examination.
It was basically confirmed that the cause of her illness was deep vein thrombosis in the lower extremities. Moreover, multiple thrombosis occurred, accompanied by varicose veins in the lower extremities. Considering that the patient's family was relatively poor and the patient's own surgical conditions were poor, the experts prescribed a drug thrombolytic treatment plan for her on the spot.
If the effect is not good, you will have to be hospitalized for elective surgery.
The diagnosis of this patient was just a minor episode and was not particularly difficult.
At least for the experts present, this deep vein thrombosis in the lower limbs was nothing.
There were a total of seven difficult or critical cases, and everyone discussed them one by one. The atmosphere in the conference room gradually became lively, and everyone spoke enthusiastically.
The doctors from the two hospitals went from being clearly divided at the beginning to becoming more harmonious.
"We have admitted a 63-year-old female patient to our hospital. The CT scan results showed a mass in the left upper lobe of the lung. The possibility of lung cancer is high. Can the experts present please see if surgery is possible?"
Professor Hu Wanjun signaled her assistant to play the PPT slides on the screen, so that the patient's CT scan images could be clearly seen.
"This should still be early stage lung cancer, which fully meets the indications for surgery."
"I think the patient is relatively old, and traditional open-chest surgery should be avoided as much as possible."
“Thoracoscopic surgery is a good choice!”
Everyone was talking at once.
Many of the doctors present were actually internists and were not good at surgery.
In recent years, endoscopic surgery has developed rapidly, and under the pressure of the market, internal medicine has had to develop interventional surgery and endoscopic surgery in order to survive.
This gave physicians some say in surgery.
Speaking of professionalism, cardiothoracic surgeons are definitely more professional.
"This operation should be quite difficult. There are many lymph nodes to be removed, and the left upper lobectomy is also required. Director He Miao of the cardiothoracic surgery department of our Xinxiang Women's and Children's Hospital is currently studying abroad. Director Zhang, can you ask Tuya Hospital to send a skilled surgeon to provide support?"
This lung cancer patient was left to be discussed last, and Xinxiang Maternity and Child Health Hospital must have already made up its mind to ask for reinforcements.
It was just that this was the first time that the two hospitals had started cooperation, and it was for mutual benefit. It was not an easy task to ask the other party's surgical team to come and help.
Although surgeons are often looked down upon by internal medicine doctors in hospitals, many diseases cannot be treated without surgery.
And there is a big difference between surgery and internal medicine.
In internal medicine, one can often fight alone, and individual heroes abound.
Surgery requires a team with high levels of coordination and strong professional qualities.
Please consult with an internist, or you can go alone.
Asking a surgeon to perform the operation, especially a major operation like this, requires a team.
Let alone Xinxiang Women and Children's Hospital, even if Tuya Second and Third Affiliated Hospitals wanted to borrow surgical teams from the main hospital, they would face many difficulties. The hospital has never been a one-man show, but a group of interests formed by multiple departments.
It's more like a country.
Each department is like a province in the country. Any larger decision requires discussion among everyone.
Cardiothoracic surgery is a very busy department, and there are only a few surgeons who can perform major surgeries above level three.
Xinxiang Maternal and Child Health Hospital wants to invite a team to help it cure this lung cancer patient, but Tuya will definitely not agree.
"Director Hu, this matter is really not something I can decide. If your hospital really has this need, you can directly contact the senior management or cardiothoracic surgery department of Tuya Hospital. Or it is also a good idea to refer the patient to Tuya Hospital for this operation."
Zhang Bihua gave the other party a tactful reminder.
You don't have the ability, but you always want to eat meat. There is no such good thing in the world.
The best way to do things is to do what you can.
"Okay then! I'll report this to Director Tian and make a decision. Thank you all for your hard work today. Thank you very much to all the experts, doctors, and nurses for taking the time out of their busy schedules to help us solve these difficult cases. On behalf of Xinxiang Women's and Children's Hospital, I want to say thank you to you."
Professor Hu Wanjun stood up and bowed to express her gratitude to the medical staff from Tuya Hospital.
As each difficult case was solved, their faces became visibly more relaxed.
Back at the hotel, Xinxiang Women's and Children's Hospital was very considerate and customized fruits and midnight snacks for each medical staff and delivered them to the room. The service was very thoughtful.
The next day, Zhou Can went to the hospital's outpatient hall with the experts to see patients.
Seeing a long queue of more than 20 patients in front of his desk, he thought he was seeing things.
He rubbed his eyes and realized that, yes, it was Dr. Zhou Can's desk.
With such a big sign, it is impossible for these patients to recognize the wrong table.
The situation in front of Du Leng's examination table was similar to the previous two days, with a long queue of eleven or twelve people.
"Doctor Zhou, what were you doing last night? It looks like your examination table is about to be crowded!" Deputy Director Shi asked in surprise.
"I'm a little worried that they might have arranged the wrong table?"
Zhou Can's words made his colleagues laugh.
"It may have something to do with the two news reports yesterday. After all, it is a news program on the satellite TV station. Although it is an advertisement, it is enough to attract many patients to come. Doctor Zhou is the biggest winner of our seven-day expert clinic event! Doctor Zhou, you have to treat us after the event."
Director Jiang also teased him with a smile.
"It's no problem for me to treat you. You decide what we eat then." Zhou Can has always been very generous when it comes to money.
But he never takes advantage of others.
He spent the money where he thought it was worth spending.
"Oh my god, these two news items have directly made an ordinary doctor famous and made him one of the famous doctors. This is too exaggerated. Did you bribe the TV station reporter privately to give you special treatment?"
A middle-aged doctor in his forties asked sourly.
"Haha, I really have this idea. Everyone, please don't wake me up and let me continue to have this dream. The day before yesterday, I only saw two patients in the whole day. It was really sad."
Zhou Can was very happy to see so many patients queuing up for treatment.
He strode over with Ji You.
Sit down at the examination table.
"Doctor Zhou is here!"
The family members and patients in the queue were excited and showed happy expressions.
It seems that they didn't come to the wrong table and came here for me.
Zhou Can immediately felt reassured, and the smile on his face became more relaxed and confident.
This is the first time that so many patients are lining up to see him for treatment.
At this moment, he looked like a lucky man who suddenly became rich overnight.
The effect of being on TV news is really scary.
Now that he has a little fame, he cherishes this hard-earned situation even more. He subconsciously raised his head and looked at the corner of the wall opposite, but did not see the TV reporter and photographer.
I'll have to provide Mu Ming with a big piece of news when I get a chance, and repay this favor.
She really helped Zhou Can a lot.
