Doctor of Healing

Originally, Lin Jiu wanted to learn advanced hybrid surgery, but he didn't expect Ji Xiang to shock himself with successive diagnoses.

Since then, Lin Jiuze has been observing Ji Xiang.

Usually Jixiang is like an ordinary doctor, and he can't see anything special.However, the matter of compound licorice tablets and bird allergy has always been imprinted in Lin Jiuze's mind and cannot be erased.

With fewer and fewer holidays, Lin Jiu was also a little anxious.

Not only diagnosis, but also hybrid surgery of joints and ligaments is almost zero.

In fact, Lin Jiuze also knows that Jixiang only "proves" himself through one variety show, and it will take time to ferment, and he cannot reach a consensus in a short period of time.

But I don't have time, I really don't have time!

A sense of urgency emerged spontaneously, and Lin Jiuze even wanted to contact Massachusetts General Hospital to find a patient for the operation, and it didn't matter if he paid for it himself.

a few days later.

Ji Xiang underwent surgery.

"That silly dog ​​of my family has to sneak around every day, otherwise he would be so energetic that he could tear down the house." Ji Xiang turned around and changed his clothes, chatting with Tang Yan.

"What breed?" Tang Yan asked.

"Bian Mu? German Shepherd? I'm not sure, but it's quite sensible." Ji Xiang said.

"Will you do backflips?" Tang Yan asked with narrowed eyes.

Ji Xiang understands this trick, he laughed, "You get up early another day, and I'll take the two of you for a run, and show you what it means to slip through."

Ji Xiang is not willing to lose even if he is cheap in words, Tang Yan thought angrily.

"Xiaoji, you are the most ruthless person I have ever seen." Zhao Zhe said while carrying the patient.

"Ruthless? Not so much."

"How self-disciplined you are. I think all those who can get out of the bed as soon as they open their eyes are ruthless characters! If luck is not particularly bad, they will definitely be promising in the future." Zhao Zhe said, "Being self-disciplined is really strong. I always The next time I want to be more self-disciplined, I won’t be lazy again in three or five days.”

"Speaking of ruthless people, my roommate was ruthless when I was in school." Tang Yan rescued Jixiang. She packed up her equipment and said, "My roommate is 1.7 meters tall and likes to wear high heels. High heels, it's easier to wear too many Paronychia, both of her feet have severe paronychia, and it is said that it is excruciatingly painful to walk."

"One day when I went back to the dormitory, the room was full of blood and the sheets were wet."

"Oh? Sheets? Wet?" Zhao Zhe asked.

"Bah!" Tang Yan snorted, "I thought there was a murder, and I was shocked, but I saw that sister was pulling out her nails with pliers."

"!!!"

"!!!"

"Do you do the nail-pulling surgery yourself?" Ji Xiang asked, "When I was in the urology department, I heard from Senior Colonel Wang that there was a patient who cut the bag by himself at home, and the blood was in the same bed, and finally came to the hospital to stop the bleeding."

"Yes, pull it out yourself, the nails of the two thumbs and toes."

Nail pulling surgery is performed under anesthesia first, and then scissors are used to cut the inner and outer sides of Kandun's nails to the root, and then pull them out.The operation is very simple, and some hospital interns have done it.

But if you do it yourself, you have to say it is a ruthless person.

"The point is!" Tang Yan raised her voice and emphasized, "The sister didn't take anesthesia, so she was pulled out."

"I go!"

"Ten tortures?"

"The teacher only talked about the basic operation process in class, and it was only because the female students were interested. She didn't mention anesthesia. So she thought that there was no need for anesthesia, so she performed the paronychia operation herself."

"This IQ has basically bid farewell to the clinic." The anesthesiologist joked.

"Stupid is stupid, but really brave!" Ji Xiang praised, "I cut my nails to the root and pull them out without anesthesia. Isn't this the punishment for piercing your finger with a bamboo stick?"

"Awesome!" Zhao Zhe gave a thumbs up. He wanted to speak, but suddenly thought of something, and fell silent.

Ji Xiang sensed Zhao Zhe's hesitation and momentary depression, but he did not ask immediately, but carried the patient onto the flat car, and sent the patient with Zhao Zhe instead of changing clothes immediately.

Lin Jiu then followed to help and continued to observe Ji Xiang closely.

"Brother Zhao, what did you want to say just now?" Ji Xiang asked.

"I once met a patient with terminal cancer." Zhao Zhe said lightly, "the family has a little money, but not much. The child is not married yet, and it is already late. The patient does not want to be hospitalized, saying it is too wasteful and unnecessary. But the family unanimously decided that treatment was necessary, so they were sent to the hospital.”

"There is a conflict between the decision of the family and the patient himself. As the bed doctor, I can't say it. I can only let them discuss it themselves."

"For this kind of thing, the doctor is really useless. Knowing that there is a big hole in front of you, you can't fill it up with any money in it. At most, it can be regarded as spending money to buy some longevity."

"I understand, Brother Zhao." Ji Xiang patted Zhao Zhe on the shoulder to show comfort.

"Later, the patient had a few quarrels with the patient's family, and the patient's son brought his future daughter-in-law to persuade her. The girl was really nice, she just put the words aside, saying that she had to see a doctor first if she said that she was bankrupt."

"What happened next?" Ji Xiang asked.

"One day I was on night shift, and the door of the duty room was kicked open by a family member of a patient."

"..." Ji Xiang knew that something serious must have happened, probably because the patient just mentioned committed suicide in the ward, so his family members or the family members of the patient in the next bed kicked open the door of the doctor's duty room in a panic.

"When I passed by, I saw the patient wrapping his head with plastic tape layer by layer, suffocating to death."

"!!!"

"That's the most brutal scene I've seen in my decades of medical practice." Zhao Zhe sighed, "If you want to say a cruel person, that old man is the cruel one. He killed himself... Well, don't talk about this, don't talk about this. "

Ji Xiang raised his eyebrows and didn't continue to chat on this topic.

Lin Jiu thought they were strange.

The flat car rolled out of the operating room, and a doctor wearing an isolation suit and a sterile gown from the operating room was walking out while making a phone call.

"We have had a consultation with the patient. I don't think there is a need for laparotomy. Why don't you use medicine for a while?"

"Acute abdomen does not necessarily require laparotomy, the key is that there is no indication for surgery."

"Wait a minute, I'll go and have a look. But I still suggest to consult with the whole hospital first, call Director Lu, maybe it's some rheumatic immune disease."

Hearing what he said on the phone, Ji Xiang thought in his heart that being indecisive is really a wise saying.

Chapter 665 Must win!

Ji Xiang changed his clothes, returned to the ward, and saw Lu Gang sitting angrily in front of the computer and looking at the medical records.

"Director Lu, what's the matter?" Ji Xiang asked.

"Acute abdomen, the f*ck gastrointestinal, liver and gallbladder gangsters are not willing to have surgery." Lu Gang said angrily, "Although I also think that surgery is not possible, it doesn't look like intestinal perforation, but the patient's condition is not right."

It was obvious that Lu Gang was a little anxious and confused, so he spoke in a mess, as if he hadn't thought about it, and he expressed his anxiety by instinct.

Especially after scolding the liver and gallbladder, stomach and intestines, on the other hand, if he said that he didn't think he could perform surgery, Zhao Zhe almost didn't laugh out loud.

Ji Xiang leaned over and glanced at the laboratory report.

The emergency abdominal color Doppler ultrasound showed that the liver echo was thick, the gallbladder wall was thickened and rough, and a small amount of peritoneal effusion.

Blood gas analysis: oxygen partial pressure 53.8mmHg, oxygen saturation 84.6%.

Serum potassium 2.4mmol/L; renal function: urea nitrogen 22.08mmol/L, creatinine 352μmol/L, uric acid 428μmol/L.

急诊淀粉酶137U/L；血常规：白细胞9.3×109/L，中性粒细胞0.787，血红蛋白105g/L。

Acute renal failure, accompanied by hypokalemia, these are nothing in the face of acute abdomen, which can be treated by drugs.

"Director Lu, how is the physical examination?"

"Blood pressure 210/148mmHg, respiration 23 times/min, oxygen saturation 99%, T36.8°C, heart rate 105 beats/min. Breath sounds in both lungs are coarse, right lung smells moist rales, no wheeze, heart rate 105 Beats/min, regular, no pathological murmurs.

Abdominal muscle tension, full abdomen tenderness, rebound tenderness, flat abdomen, bowel sounds disappear, face and limbs are not swollen. "

"It's a typical acute abdomen. Does the upright peritoneal dialysis support gastrointestinal perforation?" Ji Xiang asked again.

This question was close to the point, and Lu Gang nodded uneasy.

Lin Jiuze suddenly became interested. Based on his knowledge of Ji Xiang, he knew that Ji Xiang would follow Director Lu Gang to attend the consultation.

This time, I must not lose!

He opened the drawer, took out his small notebook, and held it tightly with his hands.

His palms were a little wet, but Lin Jiu didn't notice. He subconsciously wiped the sweat from his palms on the white clothes.

I have a basic understanding of the patient's condition, and it seems that there is no doubt about the acute abdomen. If it is an ordinary hospital, the surgeon will definitely push it to the stage to open it to see where there is a problem.

But Director Lu has been hesitating.

There is a problem, and Lu Gang doesn't know where the problem is.

Some things are hard to explain, and they are all a kind of "sixth sense" formed by seeing patients too much.

As for the "clinical manifestations", it is like Lu Gang's current appearance.

Lin Jiu knew that when encountering difficult and miscellaneous diseases, doctors rely on years of clinical experience to make judgments. If they really want to say one, two, three, four, five, they can't do it.

"When will the hospital consultation start? Have you seen the patient, Director Lu?" Ji Xiang asked.

"I took a look at it yesterday, and I will go to see it together later." Lu Gang replied naturally.

Jixiang re-examined the medical records of the Department of Gastroenterology, "Does the patient have family depression?"

"Well, when I saw the patient, I didn't think everyone in the family had depression. The diagnosis of this disease, hey." Lu Gang didn't continue, just heyed.

Lin Jiu captured this detail, and various diagnoses about depression causing abdominal pain popped up in his mind.

Depression itself does not cause abdominal pain, but long-term diseases such as abdominal epilepsy, and there is no definitive diagnosis, will cause patients to enter a state of anxiety and depression over time.

The cause and effect are just the opposite, but the two appear together clinically, so they are also within the scope of consideration.

Abdominal epilepsy is also possible.

Lin Jiuze went all out this time, he was no longer as lazy as before, his eyes were shining, his hands were tightly gripping the notebook, and the ballpoint pen was rattling.

It's just that he didn't realize it.

Even the harmless expressions of humans and animals disappeared, and Lin Jiu was full of fighting spirit at this moment.

fighting!

fighting! !

Must win! ! !

When they came to the Department of Gastroenterology, Lu Gang and Ji Xiang had their physical examinations, while Lin Jiu stood in the corner and observed their every move as well as the patient's face and body language.

After Lu Gang and Ji Xiang left, Lin Jiu began to write and draw in his notebook.

When you write something, look up and observe; then lower your head to write, and then look up again.

Soon, Lin Jiu fell into deep confusion.

He took this patient very seriously, much more seriously than he did at Massachusetts General Hospital.

The belly case had already been laid out. In a short period of time, Lin Jiu wrote at least ten diagnoses, but none of the diagnoses was correct. He even had deep doubts about the knowledge he had learned.

Abdominal pain and acute abdomen are not organ problems, nor abdominal epilepsy, nor are they common diseases such as volvulus and intestinal spasm.

What else could it be?

Lin Jiu racked his brains thinking.

At the same time, Ji Xiang was chatting with the patient's family about his condition, and Lu Gang began to preside over the consultation of the whole hospital.

"The situation this time is different from before. The patient's plate-shaped abdomen is particularly obvious, accompanied by tenderness and rebound pain. The acute abdomen can be clearly diagnosed. Although there is no crescent syndrome in the upright peritoneal dialysis, it may be intestinal perforation and gas leakage. Not many."

The gastroenterologist said after briefly introducing the patient's situation.

"I remember that this patient has already been consulted for the third time. The first two times..." said the deputy director of the gastrointestinal surgery department. "The most outrageous thing is the second time. The patient said that the pain was relieved when he submitted the order for surgery."

"I have also considered this point. Is it acute cholecystitis? Although cholecystitis is not serious on the B-ultrasound, it will also cause severe pain and acute abdomen. Every time you are hospitalized, you must have intravenous antibiotics. Under the action of antibiotics, the gallbladder It's normal for Yan to be suppressed."

"I don't think it's that simple. Generally speaking, cholecystitis will cause upper abdominal pain. Except for gallbladder perforation and bile flow all over the stomach, there will be no signs of a flat abdomen."

Many doctors have their own opinions, and there is no unified answer.

Lu Gang's hair drooped, and he didn't care about it at all. It seemed that his mind was running rapidly, trying to figure out what was going on with the patient.

There was a knock on the door.

Ji Xiang then pushed open the door and tiptoed in.

"I don't think surgery is possible," said the surgeon. "The patient's pain was relieved before the operation the first two times. If the problem is not found after the operation, or the gallbladder can only be removed after searching for a long time, the pain still persists after surgery. What shall we do?"

"The acute abdomen is already obvious, and this is a typical sign of laparotomy!" The gastroenterologist insisted, "There is no surgery, so what else can be done?"