Chapter 9: A Critical Diagnosis

Boom boom boom!

A knock at the door sounded, its rhythm oddly pleasing to the ear.

It was nearly time to clock out, and at this hour, a follow-up patient was highly unlikely.

Follow-up appointments usually cluster early in the morning or at the start of the afternoon.

Zhou Can stood at the ready, eager to gain some valuable experience.

“Come in!”

Dr. He’s voice was always gentle yet commanding.

The consultation room door swung open as a man in his forties, supported by a family member, stepped in. One hand pressed against his abdomen, his face twisted in pain.

“Ouch, ouch… Doctor, my stomach is in excruciating pain. Please check me out!”

The man’s face turned pale, and cold sweat dotted his forehead from the pain.

“Have a seat first!”

Dr. He remained calm and composed.

“When did the pain start?”

“Two days ago. It’s been hurting for two days now, ouch…” he groaned repeatedly.

For a middle-aged man to suffer such agony, the pain must be quite severe.

“You haven’t eaten anything poisonous, have you? Like toxic mushrooms, toads, or pesticide-laced produce?”

“No, definitely not. I’ve been eating at home, and my wife and kids are fine.”

“Do you smoke or drink?”

“Yes.”

“Is there any similar history in your family?”

“No!”

“Now, help him lie down on the bed so I can do a physical exam.”

After instructing his relatives to help the patient lie down, Dr. He began his examination.

Zhou Can quickly got up to observe.

Based on the patient’s account and symptoms, Dr. He started forming a tentative diagnosis.

However, lacking complete test data and with limited clinical experience, clearly defining the pathological mechanism was challenging.

There are many causes of abdominal pain.

Peritonitis, gastroenteritis, gallstones, appendicitis – numerous conditions can trigger severe abdominal discomfort.

Dr. He pressed firmly on the patient’s abdomen.

“Ouch… take it easy…”

The patient immediately let out a cry of agony.

“Is it just this area that hurts?”

“My right shoulder and upper back also ache, although not nearly as bad as my stomach.”

Hearing this, Zhou Can quickly recognized the symptoms of referred pain from acute upper abdominal distress.

It was akin to tossing a stone into a pond – ripples radiating outwards from the impact point.

The pain spread similarly.

It transmitted through the nerves to the surrounding regions.

Medically, this phenomenon is called referred pain.

It was now almost certain that the pain’s origin was the upper right abdomen.

“Did the pain start suddenly two days ago, or did it develop gradually?”

“It came on suddenly. No warning whatsoever – it hit in waves, and with every bout, the pain worsened. When it became unbearable, I even vomited a few times.”

This additional clue was significant.

It underscored the importance of thorough questioning.

There’s no harm in asking for details.

“Since the pain is this severe, you couldn’t have waited until now to seek help, could you? Have you visited another hospital?”

With his extensive experience, Dr. He quickly inferred some details the patient hadn’t mentioned.

“Uh… I did visit a small clinic. They started me on IV fluids for inflammation, but it wasn’t effective. The clinic owner, fearing trouble, advised me to come to a larger hospital.”

Those small clinics often rush to set up IV drips.

Their overuse of antibiotics is their biggest flaw.

For minor colds or slight symptoms, IV antibiotics may work quickly.

Yet, it’s akin to trying to quench your thirst with poison.

You might recover quickly, but your immune system gets thrown off, making you more susceptible to severe illnesses later.

Repeatedly, this creates a vicious cycle.

When the need for antibiotics truly arises, you sadly find there’s nothing effective left.

Because the bacteria have grown highly resistant.

Even a common cold could trigger a superbug outbreak.

“Besides the abdominal pain and the pain in your right shoulder and back, do you have any other symptoms? When I touched your abdomen, it felt unusually warm!”

A physical exam is the initial step when a doctor sees a patient.

It’s extremely important.

It helps uncover underlying conditions.

Some patients might feel embarrassed or think certain symptoms are trivial and might even hide them. That’s when a doctor’s keen observation comes into play.

“I’ve been feeling feverish and experiencing chills.”

“Alright, let’s take your temperature, check your heart rate and blood pressure. Relax – we’ll do our utmost to treat you.”

After reassuring the patient, before he could say another word, Zhou Can eagerly rushed to measure his blood pressure, heart rate, and temperature.

Basic tasks like these hardly ever require the senior doctor’s direct involvement.

A bit of initiative never failed to please Dr. He.

Next time, if he accompanies the consultation, his chances of being involved will surely increase.

“Temperature 39.6°C, Pulse 98 BPM, Blood Pressure 120 mmHg. Lung percussion revealed no abnormalities; no extra sounds during respiration, with approximately 25 breaths per minute.”

Zhou Can then conducted a series of measurements.

A temperature between 39.1°C and 41°C is considered a high fever.

This patient’s condition was more severe and complex than initially assumed.

“First, let’s run a complete blood count and an ultrasound. If the results aren’t promising, we may need to do a CT scan,” Dr. He instructed, addressing both the patient and Zhou Can.

Zhou Can quickly entered the medical test orders into the computer.

“Due to the complexity of your case, our outpatient department is closing soon. Until the results clarify your condition, we cannot admit you. Once your tests are done, I recommend you visit the General Surgery ward and see Dr. Fang. I’ll brief him on your situation.”

The patient’s condition could deteriorate at any moment.

Dr. He remained vigilant.

If the case wasn’t serious, the patient would typically be asked to return the next day.

After the patient left, Dr. He stood up, preparing to clock out.

“Xiao Zhou, how was it? Did you learn anything useful from spending the afternoon with me?”

“I learned a great deal. Handling various cases and their treatments has been invaluable, especially witnessing your exemplary ethics and professionalism.”

“Haha, you do speak too sweetly, kid. Alright, the triage nurse is coming to close up – let’s go.”

Following Dr. He out of the consultation room, Zhou Can’s mind lingered on the final case – what exactly did the patient have?

He was just 1.4 experience points away and wasn’t about to give up!

The intense pain in his upper right abdomen radiated to his right shoulder and back. Coupled with his smoking and drinking habits, and his high fever with chills, all signs pointed to a biliary problem.

Could it be choledocholithiasis?

Zhou Can’s eyes lit up as if he’d uncovered something crucial.

Each diagnosis was like solving a math problem.

When the answer was correct, the sense of achievement was immense.

【Pathology Diagnosis Experience Points +0.4】

The eagerly awaited experience points finally appeared.

But the gain was minimal!

Only 0.4 points were added.

Normally, a correct clinical diagnosis would net 1 experience point.

Why did I get less than half?