novelraw Chapter 360 - 187: All Four Causes Ruled Out, the Final Breakthrough
Chapter 360 - 187: All Four Causes Ruled Out, the Final Breakthrough
The hospital has a strict hierarchical system, and it’s unlikely any young doctor dares to walk side by side with Lian Tao.
The chief physicians are amiable, which is part of their demeanor, but it never means young doctors can act arrogantly or impolitely in front of them.
Any young doctor behaving this disrespectfully would likely become marginalized, struggling more and losing popularity over time.
The medical staff of the Pulmonary Medicine department noticed that Director Lian seemed to treat this unknown young man with considerable courtesy.
This further fueled everyone’s speculations about the young man’s identity.
"Jingsheng, should we first review the patient’s records in my office or visit the ward to check the patient’s condition?"
"Let’s check the records in the office first! Have some water and sober up a bit. Otherwise, the patient and their family might think we’re visiting them drunk!"
"Haha, Jingsheng, you have quite the sense of humor! Do you know what this is called?"
"Called what?"
"It’s called subtle charm! Haha..."
Lian Tao laughed heartily, quite unrestrainedly for someone in his forties.
The two seemed to have bridged the age gap, fostering a close friendship.
They entered Lian Tao’s exclusive office.
Having a private office in the People’s Hospital is a privilege not usually granted to a regular chief physician.
This speaks volumes about Lian Tao’s status in the hospital.
Lian Tao opened his computer, logged into his personal doctor account, and pulled up the patient’s medical history and examination reports.
"Here is all the information on that patient. Last year, she was diagnosed with nasal polyps because of purulent discharge from both nostrils and had surgery at an external hospital to remove the nasal polyps."
A patient’s illness is unfortunate enough.
The worst is encountering an incompetent doctor.
If it’s just prescribing some medicine and the treatment doesn’t work well, that’s still okay.
In cases like this, where surgery is performed to remove nasal polyps, there are only two possibilities: either the doctor was trying to meet the departmental targets, or the doctor is truly incompetent.
Li Jingsheng reviewed the patient’s detailed information; the temperature was 36.9 degrees Celsius, normal.
Blood pressure was 114/65 mmHg.
The blood pressure was quite normal.
Complete blood count results showed white cells at 9.2 x 10^9/L, hemoglobin at 150 g/L, platelets at 320 x 10^9/L...
Urinalysis showed an unremarkable urine sediment.
24-hour urine protein quantification was between 0.1 and 0.25 g.
Liver and kidney functions were, ALT 68U/L, AST 44U/L, ALB 47g/L...
Testing in big hospitals is indeed thorough.
The advantage is it maximizes the prevention of misdiagnoses and missed diagnoses.
The downside is that patients have to queue here and there, causing trouble all around, and high testing fees are also a disadvantage.
"Her sinus imaging is completely normal! This isn’t rhinitis!"
Li Jingsheng was speechless after seeing the images.
How could they just remove her nasal polyps?
And not once, but twice.
"It’s indeed not rhinitis; our hospital’s ENT specialist evaluated it as bilateral nasal polyps. It’s not a big deal if you don’t operate, although it’s better if removed. But nasal polyps aren’t the true cause of the patient’s condition."
Lian Tao said by his side.
The ’master level’ demeanor of doctors in the big hospital is quite noteworthy.
Lian Tao didn’t speak any words denigrating external hospital doctors; he didn’t even imply it.
"Tuberculosis can also be excluded."
Li Jingsheng continued downward; the tuberculosis test was negative.
Multiple other tests equally excluded the possibility of tuberculosis.
"The patient’s blood, urine, and sputum fungal cultures are all negative, making the root cause difficult to pin down!"
Before coming, Li Jingsheng considered that the situation would require thoracic diagnostic techniques and spent 100 life points to upgrade his thoracic diagnostic skills to Master Level.
Currently, there’s not much need for thoracic diagnostics.
But reviewing the patient’s chest X-rays is still beneficial.
With mastery inside and outside, the diagnostic advantage is quite evident.
"Lian Tao, what’s your diagnostic opinion?"
After reviewing all examination materials, Li Jingsheng asked the other party.
"I’m somewhat suspicious of inflammatory granulomatous disease."
Lian Tao gave his diagnostic opinion.
From the test results, granulomas should be supported.
"Pulmonary Wegener’s granulomatosis?"
Li Jingsheng also suspected this disease, but the correlation wasn’t high.
"Yes, I’m suspecting the patient has this condition. However, the patient only exhibits fever, purulent discharge, and cavitary nodules, making it difficult to confirm the diagnosis!"
Faced with such a challenging case, even with a wealth of medical knowledge, Lian Tao was quite distressed.
"Shall we visit the ward and see the patient? We might find some breakthroughs."
Li Jingsheng suggested.
The two went to the ward to inspect the patient’s condition.
Li Jingsheng carefully performed a physical examination and inquired about some issues.
"Are you currently treating her with prednisone?"
He happened to see the nurse administering medication and asked.
"Yes, initially, the dose was 40 mg per day, now reduced to 35 mg daily."
Lian Tao answered on behalf of the nurse.
Evidently, he personally prescribed the medication, and the dosage was decided by him.
This drug is used for systemic lupus erythematosus, rheumatoid arthritis, rheumatic fever, nephrotic syndrome, chronic active hepatitis, ulcerative colitis, autoimmune hemolytic anemia, idiopathic thrombocytopenic purpura, and other diseases.
It is usually administered orally.
After examining the patient, they returned to the office to continue their discussion.
Li Jingsheng then presented a bold idea.
"Do you think we could tackle the issue from the right lung mass perspective? It might lead to easier breakthroughs."