"Uncle, it's a bit cold," Liu Banxia said as he unbuttoned Liu Liyou's shirt and applied some couplant.
"Uncle, have you noticed that mole the size of a soybean on your neck? It has some spread around it. That's called a spider angioma, a symptom often seen in patients with cirrhosis."
"You have a substantial amount of abdominal ascites, and it's now putting pressure on your lungs, which is why you're having difficulty breathing. But don't worry, we'll drain it shortly."
Even if this patient hadn't offered me the chance to be the primary surgeon, I still have to give him my full attention. As a doctor, my first priority is to be responsible for the patient.
"Doctor, does he need surgery? Is minimally invasive surgery an option?" Liu Liyou's wife asked anxiously.
"Dandan, what was the blood pressure reading just now?" Liu Banxia asked Xu Dan.
"Ah, the blood pressure was 130/80," Xu Dan quickly responded.
Liu Banxia looked at Liu Liyou's wife. "Rest assured, we'll drain the ascites shortly. This is also considered a procedure, but it's a minor one, almost like regular suturing."
"We won't even have to go to the operating room. We can do the procedure in the ward once the admission formalities are complete. Since this is your first time having ascites drained, we won't remove too much, and we'll do it slowly. Otherwise, it could be harmful to your body."
"After the ascites is drained, you'll stay in the hospital for observation for a day. You must not move around too much, to avoid leakage from the puncture site and prevent other potential complications."
DING!
Experience points gained: 30.
Diagnostic skills proficiency points: 50.
"Sister Li, could you please help the patient's family with the admission procedures?" Liu Banxia then turned to Zhou Li.
Shi Lei, watching from the side, frowned slightly. Liu Banxia noticed and gave him a bright smile.
Liu Banxia stood up, walked over to Liu Liyou's wife, and lowered his voice, "Once he's in the ward, have Uncle urinate as much as possible. This way, when we drain the ascites, we won't injure his bladder. Uncle seems a bit nervous, so I didn't mention this to him, to avoid causing unnecessary worry."
"Doctor, thank you so much," Liu Liyou's wife said, her voice full of appreciation.
This doctor is quite young, but he's really thoughtful. My old man talks a big game, but he's actually a real coward.
"Alright, Sister Li, let's get going. I'll come up later. Dandan, you'll assist me then," Liu Banxia said.
Abdominal paracentesis isn't a particularly difficult procedure. However, if it were pericardial effusion, I wouldn't dare to do it myself.
"Showing off, are we? I thought you'd forgotten," Shi Lei said resentfully after Liu Liyou and his wife left.
"How could I? Who trained me? None other than the brilliant Brother Shi!" Liu Banxia said with a grin, then looked at Xu Dan. "Dandan, in the future, when a doctor asks you to measure blood pressure, report the reading to the doctor immediately after you're done. It helps the doctor make a timely judgment."
"Ah... I'm sorry, Dr. Liu. I won't forget next time," Xu Dan said, startled.
"No need to be so formal. You've helped me so much already. Just remember it for next time. As long as..."
"Liu Banxia, come here for a moment."
I still need to encourage Xu Dan a bit. After all, her uncle-in-law is in Neurosurgery. However, before he could finish his thought, the voice of Qin Hai, Director of the Emergency Department, interrupted him.
Liu Banxia turned around and was startled. It wasn't just Qin Hai who had come over, but also his boss's boss, Zhou Shuwen, the Deputy Director of the General Surgery Department, and Qi Wentai, who was standing next to Qin Hai.
"Why have our two esteemed leaders come in person? If you'd sent me a message, I would have appeared before you with a WHOOSH!" Liu Banxia said, hurriedly running over with an amiable smile.
If it were just Qin Hai, I wouldn't care at all. He's always looked down on me anyway, so what? But with Zhou Shuwen, a renowned surgeon from General Surgery, present, I have to show some respect.
Zhou Shuwen could be considered a true protégé of the Second Hospital. After completing his postgraduate studies at Binhai Medical College, he went to Johns Hopkins to earn his doctorate. He was a brilliant surgeon and quickly became the Deputy Director of General Surgery. If not for the prestige of the former director, he probably would have become the Director by now.
"Wipe that grin off your face. I'm asking you, on what medical grounds did you order an abdominal enhanced CT scan for the patient Wang Mingxing, whom you just saw?" Qin Hai asked, his face stern.
Qin Hai's voice wasn't soft, and doctors and patients from other consultation rooms looked over.
"Director Qin, I made the judgment based on the patient's slight scleral icterus, recent weight loss, and the fact that his mother died of breast cancer two years ago. I suspected there might be some issues with his liver or gallbladder," Liu Banxia replied seriously, his smile gone.
"Just based on those? How can you be so audacious?" Qin Hai glanced at him.
"You may be a resident doctor, but you represent the image of our Second Hospital! Do you know what the patient's family said? They said that because the child spoke tactlessly and offended you, you retaliated with over-treatment!"
"This is a very serious issue, and it's something our hospital has always taken very seriously. If I hadn't rushed over to pacify the patient's family, who knows what kind of chaos would have erupted."
"Old Zhou, Liu Banxia is a resident doctor from your General Surgery Department. I usually welcome him helping out in our Emergency Department; the workload here is heavy, and few are willing to come. However, you need to manage your people better! To be a doctor, one must first have moral integrity. I don't welcome people like him here."
These words were harsh, and even Zhou Shuwen's expression darkened.
At the same time, he was a bit curious. Why would Qin Hai, the Director of the Emergency Department, pick on a resident doctor?
No one was a fool. Qin Hai was clearly rushing to assign blame; his intention was to shift responsibility. If this issue wasn't handled well, General Surgery would have to take the fall.
Actually, this wasn't a big deal. Although Liu Banxia's reasons sounded a bit far-fetched, they were valid. The key issue was the impact on Liu Banxia; he might not be able to complete his residency at the Second Hospital smoothly.
This meant his three years at the Second Hospital would be wasted. What's the point of doing a residency if you can't get certified?
"Director Qin, Liu Banxia is my trainee. The abdominal enhanced CT was ordered only after obtaining consent from the patient's family. I believe he bears no responsibility," Shi Lei spoke up.
"Young Shi, whether there's responsibility or not will depend on the results," Qin Hai said, glancing dismissively at Shi Lei.
"We could have perfectly well waited for the blood test results and then made a further diagnosis based on those. Otherwise, what kind of reputation would our hospital get if word got out? Performing abdominal enhanced CT scans for a sprained foot? By that logic, should we order a head MRI for a hand injury?"
"Dr. Liu, my husband is ready. When are you going to drain his fluid?"
At that moment, Liu Liyou's wife walked over with Zhou Li.
"Ma'am, just a moment, please. I have something I need to attend to right now," Liu Banxia quickly replied.
"Drain what fluid?" Qin Hai frowned and pressed.
"The patient has severe ascites and mild liver cirrhosis. The ascites is now compressing his lungs, causing dyspnea," Shi Lei stated firmly.
Qin Hai glanced at Shi Lei, then turned to Zhou Shuwen. "Old Zhou, given the current situation, I don't think it's appropriate for Liu Banxia to treat patients in our Emergency Department."
"After all, Wang Mingxing's father still needs to be appeased. It would be unseemly if a fuss were made. I recommend people based on merit, not personal connections. It's true that Wentai is my nephew, but among the current resident doctors, his medical skills are quite sound. He is fully capable of performing this patient's abdominal paracentesis. Wentai, go upstairs and prepare."
Liu Banxia's eyes widened. Staring at the solitary, stubborn strand of hair combed over from left to right on Qin Hai's head, he felt an overwhelming urge to yank it off.
This is too much! Is he seriously going to snatch away even an abdominal paracentesis? And so blatantly too?