This case is the grandfather of a middle school classmate of Luo Shuxiang, and their hometown is thousands of miles away from the provincial capital. This incident happened when Luo Shuxiang was an undergraduate. At that time, Xiao Ying should still be in middle school, and it was impossible for him to know about this incident thousands of miles away.

Luo Shuxiang returned to his hometown during winter vacation and heard about it, but the patient had already died of illness. The patient's family suspected that the doctor had misdiagnosed her, which was a medical accident because she was studying medicine, and begged her to investigate.

So she took the patient's family to the hospital to ask the patient's attending physician, checked the relevant medical records as the patient's family, and finally confirmed that it was not a misdiagnosis, because tracheal cancer is difficult to find, and the doctor has done the necessary attention.

It was this case that gave Luo Shuxiang the most intuitive understanding of the danger of tumor disease, and became one of the motivations for Luo Shuxiang to focus on oncology at the master's and doctoral levels, so she remembers it very well. She had never told anyone else about the case, nor had it been reported in any of the media, nor had it been cited in any of the books he had read. How did Xiao Ying know?

She didn't believe that Xiao Ying really knew how to tell fortunes, which contradicted the basic common sense of her materialist education for many years, but she couldn't explain it.

Luo Shuxiang saw Xiao Ying looking at her with a teasing expression, and didn't know how to answer for a while, and was unwilling to nod and admit his failure, unwilling to accept this fact that he couldn't accept at all. So, he casually asked, "Then why do you say tracheal cancer is difficult to detect?" ”

If this question was before this, Xiao Ying would have really struggled to give a satisfactory answer to Luo Shuxiang with the medical knowledge he had learned in his undergraduate years. But now it's different, when Luo Shuxiang's father, Luo Qingsong, commissioned him to explore the reasons why Luo Shuxiang committed suicide, he began to study Luo Shuxiang's relevant information. When he found out that this woman would become a well-known oncologist in the country in the future, he was very interested in seeing many cases in which Luo Shuxiang was the attending doctor.

And Luo Shuxiang has a good habit, that is, when she records the medical records, she will write in detail the thinking process of each ward round, consultation and discussion of the patient's condition, as well as the treatment experience and perception as data preservation, so she gave Xiao Ying the convenience to answer this question.

He immediately used tracheal cancer as a search keyword, searched for relevant cases after Luo Shuxiang later became an oncologist, and soon found important arguments that Luo Shuxiang wrote in his medical records several years later.

But this still took some time, and Luo Shuxiang saw that he had been silent, so he said coldly: "If you can't even answer this question, it is enough to show that your medical level is not very good." ”

Xiao Ying snorted in his heart, you have all studied for a doctorate, I am just an undergraduate, and you specialize in tumor problems, use your strengths to let me answer, is this fair?

But he didn't say these complaints, just shrugged his shoulders very elegantly: "Tracheal cancer is difficult to be diagnosed by doctors, mainly for several reasons: one is that trachea is relatively rare in cancer. Wheezing dyspnea in patients with tracheal cancer is often misdiagnosed by doctors as tracheitis, asthma or emphysema. In particular, patients with chronic bronchial diseases are more likely to be misdiagnosed. This case was just like that. ”

Luo Shuxiang was slightly surprised: "Is it all what you imagined or the empirical conclusions you collected through the cases?" ”

Xiao Ying cheekily said: "What I liked most when I was studying as an undergraduate was to read medical records, and I have seen many cases. ”

"Oh, really?"

"Of course it's true, and you'll know later that I'm very familiar with all kinds of cases."

Xiao Ying didn't tell a lie at this point, because the pathological data of all hospitals in the country since the establishment of the hospital were stored in his brain and memory. Some even have pre-liberation materials. These precious historical medical records have been scanned into electronic documents by the hospital and stored in the general medical record database, thus recording them in Xiao Ying's brain.

Of course, Luo Shuxiang would not believe his words lightly, but he couldn't find a reason to refute it, so he continued: "Is there any other reason?" ”

"The second reason why tracheal cancer is not easy to detect is that the clinical manifestations of the disease are atypical. Initial cough, sputum production, and blood in the sputum are not specific. In the middle and advanced stages of tumor erosion infection, the use of antibiotics can be effective, so misleading doctors do not further investigate. At the same time, the trachea is located in the mediastinal shadow of the chest X-ray, and the tumor in the atmospheric tube is shown on ordinary X-ray, making it difficult for doctors to find the tumor in it. ”

Luo Shuxiang's eyes widened again, and she was very surprised.

Xiao Ying continued: "Also, the doctor did not carefully analyze the patient's medical history, symptoms and signs, and omitted some subtle features that were diagnostic. For example, dyspnea caused by tumor blockage is generally inspiratory dyspnea, which can be aggravated or relieved with changes in body position, and the cough is generally irritating dry cough, and wheezing mainly appears in the expiratory phase. At the same time, there is unexplained coughing up blood and blood in the sputum. ”

Luo Shuxiang's eyes widened, dripping round, like two large longans that had been peeled.

Xiao Ying smiled even more and continued: "Middle-aged and elderly male patients suffer from chronic bronchial diseases such as asthma, irritating dry cough, and inhibitible coughing up blood with blood in sputum for more than a month, and inspiratory difficulties without obvious triggers, and the effect of anti-asthma and anti-infection treatment is not obvious. Tracheal cancer should be considered and tracheoscopy, pathologic biopsy, and sputum exfoliation cytology should be performed. CT and X-ray tomography. ”

Luo Shuxiang was simply stunned, she couldn't believe that she was a medical undergraduate graduate in front of her. Because even she, a doctoral student specializing in tumors, could not have been so fluent and uninterrupted in a short period of time to make such a detailed and comprehensive summary of the causes of tracheal cancer misdiagnosis. Because this topic was asked suddenly by him, it was impossible for Xiao Ying to prepare in advance.

What surprised Luo Shuxiang even more was that Xiao Ying had some views in her assertion just now, which she had not seen in her previous professional papers. Now Xiao Ying's judgment gave her a sudden revelation.

Unbeknownst to her, this revelation actually came from some medical insights that she had written in her medical records many years later. Xiao Ying just told her many years later that she was many years ago.

Luo Shuxiang was stunned by this series of surprises, his eyes widened and his mouth widened, and he looked at Xiao Ying in disbelief.

Xiao Ying shrugged his shoulders: "Do you have any other questions?" ”

Luo Shuxiang continued to remain dumbfounded, as if she had returned to her zombie mode a few days ago.

――――――――――――

Huang Lili took the note written by Xiao Ying, hurriedly returned to the Nephrology Department of the Second Provincial Hospital, and found Director Qiu of the Nephrology Department.

When Director Qiu saw her, a reluctant smile appeared on his face, and he asked, "How is it?" Did Master Abbot agree to lend you money? ”

Huang Lili didn't answer the question, put the note in front of him, and said, "I want to ask you to give my husband a test, bone marrow aspiration." Because someone told me that his disease was aplastic anemia. By doing this test, I will be able to confirm the diagnosis, and I will be able to cure his disease, so that the money I spend will not be in vain. ”

Director Qiu frowned and took the note and looked at it: "The patient is pure red blood cell aplastic anemia combined with anemia heart failure, and bone marrow aspiration can be confirmed." He threw the note on the table and looked at Huang Lili, "Who wrote this thing?" ”

"It's a ......, you don't care who it is, you just have to check it according to this."

Huang Lili originally wanted to say that he was a fortune teller, but he himself had a natural resistance to fortune tellers, and he also believed that other people were like him, thinking that fortune telling was a feudal superstition. Let her convince others with the words of someone she doesn't believe in, she herself is naturally resistant. She did this only because the abbot master asked for it, and she had no choice. So it was not spoken.