Chapter 23: Crisis in the Emergency Room

After reviewing the medical records, Director Lou found no useful clues.

His gaze inevitably fell on the child.

“The patient is 11, with a temperature of 39.7°C and a high fever. Breathing is short, blood pressure is dropping—86/54 mmHg—and heart rate is 155 per minute.”

Each of these basic indicators was heart-wrenching.

The child’s condition was critical; without quickly identifying the cause of the shock, death in the resuscitation room was highly likely.

The physician had fulfilled his duty in the rescue, so he wouldn’t be held responsible.

However, it would still tarnish the hospital’s reputation.

Based on the family’s earlier behavior, a medical dispute was very likely.

Director Lou and the attending physician grew increasingly grim, a trace of anxiety etched on their brows.

“Have all the necessary tests been conducted?”

After all, doctors are human, not gods.

When experience and medical knowledge couldn’t pinpoint the cause, only modern, advanced equipment could help.

“These are the blood test results and the images from the brain, chest, and abdomen—all showing no abnormalities.”

There are many reasons for shock—such as extensive internal bleeding in the abdomen, a brain tumor pressing on major blood vessels, nerves, and so on.

Director Lou took the test reports and examined them carefully, hoping to find even a faint clue.

Oil-sweat continuously beaded on his forehead.

Droplets, about the size of mung beans, rolled down, and he didn’t even bother to wipe them away.

“According to the blood test, poisoning can essentially be ruled out, as can sepsis. The images also indicate that there’s no internal bleeding or obvious cranial injury. No, I need to ask the family—how was he treated at the clinic?”

With his rich experience, Director Lou suspected there was something off about the clinic’s medication.

Of course, that was only a suspicion.

“We’ve already asked. The family said they bought Ganmaoling Capsules for the child. Other than that, they followed the clinic doctor’s advice to have him drink plenty of boiled water, and nothing else was done.”

The attending physician was highly seasoned; his procedure was meticulous.

He had clarified everything that needed to be asked.

The medication use was confirmed to be proper.

“Clinics love to give patients infusions. Are you sure he wasn’t given any IV fluids?”

“The family said no.”

Sometimes what families say isn’t entirely reliable.

“Was his arm checked for signs of an IV injection?”

“We inspected it carefully and found no needle marks from an infusion.”

This time, the speaker was a middle-aged doctor with darkened skin and a lean build. His stern appearance, accentuated by deep horizontal wrinkles between his brows from years of frowning, left no room for doubt about his severity.

His gaze was as sharp as a knife, piercing right through you.

“Dr. Xu personally examined him, so there shouldn’t be any mistake. I won’t recheck. This child’s condition is critical and time is of the essence. Contact Internal Medicine immediately and have them send a doctor for a consultation.”

Without hesitation, Director Lou decided to call in a consultation from the Internal Medicine department.

Internal Medicine is often called the mother of medicine; its expertise covers disease definitions, causes, pathogenesis, epidemiology, natural history, symptoms, signs, laboratory diagnosis, imaging differential diagnosis, pathology diagnosis, treatment, and prognosis.

In cases of shock where the cause is elusive, only an Internal Medicine physician might offer a more professional diagnosis.

“I’ve called; I’ve requested someone from Cardiology to come for a consultation and mentioned that the case is urgent. We really need a chief doctor on board.”

A nurse nearby whispered.

Director Lou fell silent for two seconds. “How long has it been since you called?”

“Almost fifteen minutes.”

The nurse muttered, puffing her cheeks.

Internal Medicine doctors were always cool and somewhat aloof—it wasn’t easy to get hold of them.

The Emergency Department wasn’t as esteemed as Internal Medicine; occasionally calling on them was acceptable, but overdoing it would test their patience.

“Give them another nudge.”

Director Lou knew that Internal Medicine doctors were hard to reach.

But lives were at stake, and the hospital’s policy allowed the Emergency Department to call upon any required specialist when a case was unsolvable.

No department was allowed to refuse.

“Forget it—I’ll call Director Tan myself!” Worried that the nurse’s reminders wouldn’t work, Director Lou decided to swallow his pride and personally call Director Tan from Internal Medicine.

Director Tan did not refuse and promised to immediately urge a cardiologist to come over.

Zhou Can had interned at Tuyu Hospital for a year, rotating through several crucial departments.

He had noticed the mutual disdain between departments firsthand.

Internal Medicine was one of the hospital’s top two departments; nearly all critical patients and cases like various cancers or leukemia required its support. About sixty percent of the drugs dispensed came from Internal Medicine.

In terms of both medical authority and revenue generation, Internal Medicine was undoubtedly the leader.

Cardiology was considered the crown jewel of Internal Medicine.

When a cardiologist was called in for an emergency, it was only natural for them to put up a bit of a front.

After all, cardiologists were notoriously arrogant.

Perhaps it was their way of subtly reminding the Emergency Department not to summon them for every minor issue since everyone was busy.

Time ticked by by the second.

Zhou Can’s eyes stayed locked on the child, still in shock.

The child’s face was pale, yet his cheeks, flushed by high fever, bore two sickly red patches; he was not sweating, and his fingertips were cyanotic… These symptoms seemed strangely familiar, as if seen before in a medical book.

He had read so many books that he couldn’t immediately recall where he’d seen it.

“Let’s ask the family—maybe they’ll provide a clue.”

Zhou Can stepped out toward the family area.

At this point, no one paid any attention to him, a mere junior trainee. Director Lou only glanced at him before resuming his detailed study of the blood test report.

A cold virus can trigger viral myocarditis, which in turn might lead to shock.

But such a complication in a child was very rare.

Both the imaging and blood tests indicated normal results.

It could essentially be ruled out.

Zhou Can left the resuscitation room and went straight to the family.

“May I ask, who are Zhu Wenwen’s parents?”

“I am his mother. Doctor, how is my son?”

“He’s currently in resuscitation, and his situation isn’t looking too optimistic. Has Zhu Wenwen been staying with you recently?”

“Yes, absolutely! My son has always been so well-behaved. I never imagined that a simple cold could become so severe… sob…”

Zhu Wenwen’s mother began to tear up as she spoke.

“Please listen—I assure you the hospital is doing everything possible to save him. If you could provide any crucial information, it might greatly aid the rescue efforts.”

Zhou Can patiently communicated with the family.

“Feel free to ask whatever you need—I’ll cooperate fully.”

Through tear-filled eyes, she looked at Zhou Can; at that moment, she could only rely on the doctors.

“After the cold began, you’re sure he wasn’t given any injections or IVs at the clinic, right?”

“Absolutely not.”

“He only took the Ganmaoling Capsules?”

“Yes. I personally administered them to him.”

“How many capsules in total?”

“Four. Two last night and two this morning—strictly following the instructions: two capsules per dose, three times a day.”

“Did you bring the leftover medication?”

“Yes, yes—I was worried they might continue the treatment at the hospital, so I brought them all.”

She rummaged through her bag and produced a small plastic bag containing a box of medicine.

Zhou Can took it and examined the contents.

The box read ‘Ganmaoling Capsule Granules – Specially for head pain, nasal congestion, runny nose…’

Something was off. It didn’t match the packaging of the hospital pharmacy’s Ganmaoling Capsules.

Upon closer inspection, he realized it was a knock-off brand.

These days, pharmaceutical companies had also learned to ride on popular trends.

They would repackage their similar drugs to mimic well-known brands.

For instance, the famous 999 Ganmaoling Capsules.

This company had dropped the extra nines, skirting the edge of legality.

All the manufacturing details were genuine, from a company name that most had never heard of.

What concerned Zhou Can most was the drug’s composition.

Every drug sold on the market had passed multiple layers of regulatory scrutiny. This couldn’t be faked.

All ingredients had to be truthfully declared.

“It contains Tripterygium, Wild Chrysanthemum, Caffeine, Acetaminophen, Chlorpheniramine Maleate, and Peppermint leaf, with talcum powder as an excipient.”

The ingredients were identical to those in the genuine 999 Ganmaoling Capsules.

One couldn’t help but admire these small companies for their impressive imitation skills.

He counted the capsules: originally twelve, but now only eight remained.

This confirmed that the child’s mother was telling the truth.

The child had taken four capsules.

However, the dosage was formulated for adults; for a twelve-year-old the dose should have been halved.

But many parents, fearing insufficient effect, choose to give children an adult dose.

Usually, there would also be a paper insert included.

After removing a capsule, Zhou Can found a folded white instruction sheet inside the box.

Its content was almost identical to what was printed on the box.

Most consumers wouldn’t bother reading it.

Only professional medical personnel could glean additional insights from the insert.

“This medication contains strong antipyretic and analgesic components that rapidly alleviate pain and promote recovery.”

That single, advertisement-like line immediately caught Zhou Can’s keen attention.

What did they mean by ‘strong’?

Only by increasing the dosage could a stronger effect be achieved.

What is acetaminophen? Ordinary people might not know, but Zhou Can was well aware that acetaminophen and paracetamol are the same drug.

This meant that the knock-off Ganmaoling Capsules likely contained far more acetaminophen than the genuine 999 capsules.

Small pharmaceutical companies, eager to gain market share, often increased the active ingredient to boost efficacy.

As for patient safety, unscrupulous bosses simply didn’t care.

As long as it wasn’t lethal or permanently disabling, it was business as usual.

“I see—this child is most likely either allergic to acetaminophen or suffered an overdose, leading to shock and a critical condition.”

A lightbulb went off in Zhou Can’s mind.

No wonder the symptoms seemed so familiar—he’d read a similar case in a medical textbook in the library.

He never expected to encounter such a case today.

【Pathology Diagnosis Experience +1】

The experience points were credited right on time.

It appeared that the child’s shock was indeed due to an overdose of acetaminophen.

“Now I don’t have to beg for those so-called ’emperors’ in Cardiology.”

Zhou Can, an Emergency Department doctor, tied his honor to his department.

Being able to ease the burden on the Emergency Department made him very happy.

“Thank you for the valuable information. This box isn’t genuine—I’ll have the drug’s composition tested.” Zhou Can briefed the family before eagerly returning to the resuscitation room.

Upon reentering, he found that the ’emperors’ from Cardiology had finally arrived.

It was a young doctor, around thirty-five or thirty-six.

Judging by the situation, he must have just arrived.

He was examining the child’s condition.

At such a young age, he was definitely not a senior consultant. Cardiology had probably sent a junior doctor to handle the case.

“Still needing a Cardiology consult for a cold? Don’t you Emergency doctors read any books?”

The man’s expression was cold, and instead of finding the cause, he had started to chide the Emergency Department physicians.

The Emergency doctors seethed silently—when you’re in need, you have to swallow your anger.

“Based on the symptoms, heart rate, blood pressure, and blood oxygen levels, the patient’s shock isn’t extremely severe. It doesn’t pose an immediate threat to life. Now, show me the blood test reports.”

His imperious tone was very off-putting.

Having Director Lou personally hand over the test reports didn’t seem appropriate, especially given his commanding tone.

Imagine if an emperor had his subordinate from another country deliver documents—would that be acceptable?

The Emergency Department, although lower in status, wasn’t so low as to be subservient.

Zhou Can was about to step forward as a go-between.

Unexpectedly, the nurse beat him to it.

She naturally took the test reports from Director Lou’s hand and passed them along.

“Dr. He, here are the blood test reports for the child.”

Dr. He took them and examined them carefully, seemingly finding nothing of value.

“Have any imaging studies been done?”

“Yes, we conducted a color ultrasound and CT scan—no issues were found.”

She also handed over the images.

Dr. He reviewed each image meticulously but still couldn’t find any significant abnormalities.

After all, one shouldn’t overly idolize the doctors from Cardiology; in basic medicine, most people’s skills are not far apart.

If a doctor couldn’t interpret a scan or blood test correctly, they wouldn’t have stayed at Tuyu Hospital.

“Dr. He, have you found anything yet?” Director Lou asked.

At this point, his primary concern was how to save the patient.

“Hold on—the case is a bit complex. I need to think it through a bit more.” Dr. He, having initially been too cocky, now found himself struggling to maintain his composure.

“Heh, even Dr. He from Cardiology has to really ponder the diagnosis. Looks like this isn’t just a simple cold!”

An irate Emergency Department doctor fired off a remark.

It wasn’t an outright mockery—merely a sarcastic comment.

After all, when Dr. He first arrived he had arrogantly quipped that even a cold required a Cardiology consult. Do Emergency doctors not study at all?

“It’s not that difficult—just a bit complex, and we need to be extra cautious when diagnosing,” Dr. He insisted stubbornly.