"Because omental infarction is a self-limiting disease, it does not require surgery, and the treatment plan for acute appendicitis is essentially different, so you refused to do abdominal CT, which made it impossible for us to investigate, and you are required to sign according to the regulations."

After Ji Xiang finished speaking, he looked directly at Dr. Merz, his eyes were firm, with a faint hint of the majesty of a senior doctor.

It's not the skills of the system, but the majesty that Ji Xiang has naturally accumulated after doing a lot of surgery.

After more than ten seconds, seeing that Dr. Merz didn't say a word, Ji Xiang continued, "Dr. Merz, if you are not confident in your diagnosis, I suggest you listen to us. ”

“！！！” Dr. Merz barely spurted out a mouthful of old blood.

He came to the Second Courtyard from thousands of miles away to find trouble with Lin Jiuze.

It's a pity that I met a big demon king who restrained himself everywhere.

No matter what I do, it doesn't go well, and I can't even understand the operation.

Even got acute appendicitis inexplicably, and the big demon king was so black that he didn't allow himself to have surgery.

He's not a doctor at all! He's a big devil! A true Demon King.

Dr. Merz was crying out in his heart.

But Dr. Merz was too exhausted by his illness to resist.

"Xiao Ji, did the CT do it?"

While chatting, Director Bai pushed the door in.

"Good Chief." Mr. Zhao saw that Director Bai was on call like a summoned beast, and immediately lowered his head.

He thinks that today's things are no longer good, and he regrets it a little.

blamed himself, if he hadn't wanted to communicate more with Ji Xiang Ji Dashan, he wouldn't have asked him to be a "translator".

If he hadn't come as a translator, Dr. Merz would have been on the operating table by now, and Director Bai wouldn't have come at all.

If I had dragged Dr. Merz to surgery, I would have seen the appendix by now, and it would have been cut off with just a few clicks, where would there be so much trouble.

The next thing is completely out of control, and Mr. Zhao only hopes that Ji Xiangji and the good people will not make a mess out of control.

"Director Bai, we think the diagnosis is still up for debate, and we recommend abdominal CT. Dr. Merz didn't sign and only asked for surgery, which was very difficult for us. Ji Xiang said.

"This is Lawyer Chu, the legal adviser I hired from the foreign affairs department." Director Bai pointed to a man in his fifties behind him and said, "Lawyer Chu, this is Ji Xiang I mentioned to you." ”

"Hello, Dr. Koji." Lawyer Chu stretched out his hand and shook Ji Xiang.

His eyes swept to the doctor-patient communication document, greeted Director Bai, and asked Ji Xiang to go out with the document.

"It's hard to do, it's better to be cautious about some things." Lawyer Chu chatted with Ji Xiang while reading the documents, "I work in a law firm, and one of the clerks under me has just been complained. ”

"Why complain?" Ji Xiang asked.

She answered a call from a person whose clerk asked what the case number was, and the person immediately hung up to complain. What he meant was that there must be a shady scene, or why a code. ”

"......" Ji Xiang felt that this lawyer Chu was a little interesting.

When they first met, they were all a little embarrassed and unfamiliar, and he casually said a homophonic stalk to shorten the distance between himself and him.

This is emotional intelligence, and Ji Xiang feels very comfortable talking to people with high emotional intelligence.

"Not to mention, the patients you meet are similar to the plaintiffs and defendants we meet." Lawyer Chu looked at the communication written by Ji Xiang word by word, and continued to chat as if he would be single-minded.

"Hehe, I didn't expect you to have so many troubles, I always thought that only doctors would encounter so many strange patients and patients' families."

"Yes, there are too many unreliable things. For example, when I went to the law firm at this time last year, I saw an old man in his 80s on crutches, swearing and swearing, and asked my assistant what was going on, and the assistant said that the old man's children had taken all his money. ”

"Harm." Ji Xiang sighed.

Lawyer Chu raised his eyes to look at Ji Xiang, and the corners of his mouth rose, "Doctor Xiaoji, do you think that the children are not supporting the elderly?" ”

"Uh, isn't it?" Ji Xiang was stunned.

"I thought so at the time, but after I learned about it, I learned that it was the old man who gave a reward to a female Internet celebrity on a live broadcast app after learning to go online, spending tens of thousands of yuan a month, and his children saved all his money on a regular basis, and he was not allowed to reward female Internet celebrities."

“……”

"So, that's what happens in this world, we've been lawyers for a long time, and we're used to seeing all kinds of things in the world. It is said that the walls of the hospital hear more prayers than the church, and our law firm is a little worse, but it can be regarded as having seen the world. ”

"Teacher Chu."

"Huh?" Lawyer Chu lowered his head to look at the communication written by Ji Xiang, and responded casually.

"Imperial capital, is there a very famous lawyer who seems to have been slapped because of an argument with the other party during the trial, and later when he went to examine his injuries, he ......?"

Lawyer Chu was stunned for a moment, he raised his head, his eyes narrowed.

"I knocked out 7 of my teeth."

"How do you know?" Lawyer Chu was stunned for a moment, and then asked cautiously.

"I heard from a teacher in the imperial capital."

Lawyer Chu frowned, and nodded after a few seconds, "Everyone is suspicious, but there is no conclusive evidence. But then again, Dr. Ji, your communication document is really well written. ”

Ji Xiang knew that Lawyer Chu didn't want to mention something similarly sensitive.

Originally, I thought that the empathetic experience in the system and the things mentioned by the NPCs of the system did not exist, but when I asked casually, and then looked at Lawyer Chu's expression, Ji Xiang raised a trace of suspicion.

"Okay."

"I've seen a lot of your doctors' communication, and they all have problems, and you can use this as a template." Lawyer Chu said with a smile, what Ji Xiang said just now seems to have been forgotten for a long time, "Young but thoughtful, no wonder Director Bai thinks so highly of you." ”

"It's fine."

"Well, I don't see anything wrong, let's get the patient to sign it."

Lawyer Chu then found Director Bai, who was communicating with Dr. Merz, and whispered his opinion in his ear.

"Dr. Merz, I suggest you do a CT." Director Bai said very gently, "After all, we have to investigate the problem of small probability. ”

"Small probability! I'm a patient now and I'm diagnosed ......"

"You're a patient now, and never an expert in gastrointestinal surgery, and if you insist, I'd suggest you'd better get in touch with your specialist friends at Massachusetts." Ji Xiang interrupted Dr. Melz.

This is the second time Dr. Merz has heard from Ji Xiang that he should contact an expert friend in Massachusetts on his own.

As for the last time, it was encountered with a patient diagnosed with patent foramen ovale.

Doctor Merz, who was originally determined that he had been trapped, targeted, and repeatedly rubbed under the feet of the Great Demon King, suddenly wavered.

"Dr. Merz, you used to be a doctor, and now you are a patient, please put yourself in the shoes of a doctor."

Dr. Merz listened to Ji Xiang's words and fell into deep thought.

"It's undoubtedly a disaster for people who are not professionals or think they are professionals to get involved in the professional field, and you are a doctor, and I want you to understand all this."

yes, it was a disaster.

Wrong! In an instant, Dr. Merz realized that Ji Xiang was "yin and yang" himself.

The young demon king is saying that he is unprofessional!

In making a simple diagnosis and treatment complicated, and finally the dramatic ending is that the unprofessional doctor himself tasted the bitter fruit!

Dr. Merz was angry, very angry, very angry.

But when he and Ji Xiang looked at each other, they were directly coaxed, and they didn't express their anger at all.

The diagnosis of patent foramen ovale is still vivid, when he was holding an electrocardiogram list and waving it in front of the young demon king, but in the end he was slapped in the face.

It turns out that the patient did have a patent foramen ovale.

Not only that, but after the operation, Wembanyama seems to be getting better day by day.

Dr. Merz was silent.

"Do you need a medical advisor?" Ji Xiang asked.

"I'll make a call." Dr. Merz was slightly embarrassed.

Some of the test data cannot be relayed because he does not understand Chinese.

"I can translate the data." Ji Xiang immediately saw Dr. Melz's dilemma and proposed.

It's disgusting!

Instead of feeling that he was showing kindness to Ji Xiang's "generosity", Dr. Melz thought that the young Great Demon King was suppressing him.

At the same time, the pain in the abdomen intensified.

It's all the fault of the young Great Demon King!

Dr. Merz dialed a familiar gastrointestinal surgeon.

"John, there's one thing I'd like to ask you."

"Oh, where are you? I haven't seen it lately. The doctor on the other side of the phone asked.

"I ...... I seem to have acute appendicitis. ”

As soon as Dr. Merz said this, his mobile phone was picked up by Ji Xiang.

Dr. Merz didn't pay attention to the incident, and when he tried to snatch the phone back, he found that the young demon had already started to communicate with his friends.

The young Archdemon began to state his condition, which Dr. Merz could understand.

"On the ultrasound image, I saw a bean-shaped oval mass appearing in the abdominal wall, and there were not many of them, and I couldn't see it very clearly."

Dr. Merz couldn't believe what a doctor was saying when he reported his medical history.

But Ji Xiang elaborated very seriously.

"Because I didn't do the ultrasound, I can only make a judgment based on the images of the ultrasound."

The doctor on the other side said something, and Ji Xiang listened attentively.

"I don't think we should rush to diagnose acute appendicitis, but do abdominal CT and abdominal enhancement CT first to rule out the possibility of omental infarction. If the CT is confirmed, I recommend doing a contrast-enhanced CT to determine whether surgery is necessary. ”

Dr. Merz was stunned when he heard Ji Xiang say this.

Not only did I have to do CT, but I also had to do enhanced CT, but I only got acute appendicitis!

If it were at Massachusetts General Hospital, the insurance company would never reimburse the money!

It's just too much, and the young big devil not only has to challenge himself, but also tries to challenge the experts and insurance companies at Massachusetts General Hospital.

"Alright, I'll give Dr. Merz the phone and you tell him. My judgment Dr. Merz didn't listen, and he insisted on surgery. As you know, neither the right lower quadrant nor laparoscopy can meet the needs of surgery.

What's more, if contrast-enhanced CT is fine, surgery for self-limiting diseases is certainly unacceptable. ”

With that, Ji Xiang handed the phone to Dr. Melz.

"John ......" Dr. Merz spoke when the person on the other side of the line interrupted him.

"Merz, who is the person who just explained my condition?" The doctor on the other side of the phone asked.

"......," Dr. Merz glanced at Ji Xiang.

Curled up on the examination bed, the perspective was different from the normal one, and Dr. Merz saw that the young Great Demon King was so tall and invincible.

Is it really appendicitis? A hint of doubt appeared in Dr. Merz's mind.

"It's the surgeon who operated on Wembanyama."

Dr. Melz whispered to Ji Xiang's identity.

"Damn it!" Dr. John scolded, "Why would a sports medicine doctor look at a B-ultrasound?" ”

"Me too."

"Nope! Merz, the B-ultrasound of omental infarction is difficult to judge, and the best way is to do CT. Remember the trouble I had a few years ago? ”

Dr. Merz froze.

He vaguely remembered, but John didn't say anything about the specifics of the matter. It's privacy, and Dr. Merz doesn't inquire about it.

"A patient examination considered cholecystitis, and the doctor of the hepatobiliary performed surgery, and the result was that the patient's gallbladder was very good, no problem at all, and the problem was the patient's omentum."

“！！！”

"This damn disease looks so similar to appendicitis and cholecystitis, and there is no way to check it out without abdominal CT. However, the insurance company strongly disagreed with the reimbursement of the expenses of the patients involved. ”

Dr. Merz didn't expect his friend to be completely on the side of the Great Devil.

"You don't understand the details, I suggest you listen to the opinions of local experts."

Dr. John gave his opinion categorically after talking for a long time.

"Why do you think he's an expert?" Dr. Melz asked.

His voice was extremely low, for fear that Ji Xiang would be able to hear it.

Ke Jixiang's ears are good and he can hear clearly. However, Ji Xiang did not have any bad thoughts about Dr. Merz for this, and the patient questioned a lot, as long as he was willing to do a CT scan.

Ji Xiang thought more about not needing to do enhanced CT, otherwise the operation would be difficult, and I was afraid that no one in the Second Affiliated Hospital would have experience.

It's good that everybody is safe.

"Merz, you stupid thing, you want to shove the leftover sandwich from my morning into your mouth!"

“……”

"There's no why, you just listen to the experts, I still have to have a damn operation, and I haven't finished the outpatient volume this month, if I have to go fishing on the weekend, I have to go to the outpatient clinic to see those boring patients after the surgery to make up the number of outpatients this month.

Merz, do you know how busy I am! ”

Dr. Merz reluctantly heard a blind sound from the other side, and hung up the phone.

"Dr. Merz, do you want to do a CT or do you sign it down?" Ji Xiang waved the communication in his hand.

"......" Dr. Merz looked helplessly at the Great Demon King who was showing off his might in front of him, speechless.

Let him pretend again!

Damn it!

Omental infarction, Dr. Merz vaguely knows, is a disease that involves blood vessels.

But it's okay, once something happens, let's say there is no blood supply to a large area of omentum, the next step is an acute abdomen!

If diagnosis and treatment are delayed, the next is bacteremia and other diseases that are difficult to treat, and there is a high probability of infection, toxic shock, and even life-threatening.

It's definitely not as simple as acute appendicitis.

Thinking of this, Dr. Merz was a little anxious.

"I'm going to do a CT! Enhanced CT!! ”

After saying that, Dr. Merz added, "It doesn't matter if the insurance company doesn't reimburse you, I pay for it myself!" ”

The fear of massive necrosis of the omentum was beyond Dr. Merz's idea of defeating the young Great Demon King in front of him, and he almost wailed as he endured the sharp pain in his abdomen.

"What did he say?" Director Bai asked.

"Dr. Merz agreed to do a CT, but he still has a contrast-enhanced CT." Ji Xiang was a little helpless.

"Need I to get in touch?"

There is no doctor on call for the evening with contrast-enhanced CT because it is not an emergency procedure.

If you have to do it, Director Bai needs to call the relevant doctors from home and turn on the machine to get ready.

Ji Xiang thought for a while, "Let's call it, although I don't think it's very likely, but what if?" Specialists from Massachusetts General Hospital died of illness in our hospital. ”

“！！！”

The last sentence startled Director Bai.

It is not an exaggeration to say that the consequences are unimaginable.

Director Bai even thought of the chain reaction brought about by the "death" of the Massachusetts expert in the Second Affiliated Hospital, and his scalp was numb.

Contact the CT room, and Director Bai took someone to send Dr. Merz for an examination.

CT images show large areas of fat density opacities with blurred edges and unclear borders.

Is this wool?

The doctor on duty in the CT room looked at the image suspiciously, he didn't know how to diagnose it at all.

"It's omentum infarction." Ji Xiang said with certainty, "But for the time being, there is no need for surgery, just observe for a few days." ”

Director Bai asked worriedly, "Really? Anyway, Director Niu of the CT room is coming, and by the way, do an enhanced CT? ”

Ji Xiang did not insist, but agreed with Director Bai's opinion.

Anyway, it only needs to be recuperated, and now Dr. Merz's omental infarction is a self-limiting disease.

It doesn't matter to me or Dr. Meltz's illness whether I do an enhanced CT scan or not, but for Director Bai, I can buy peace of mind.

After countless empathy experiences, Ji Xiang subconsciously thinks about problems from the perspective of others.

When Director Niu rushed over, he came to the same conclusion as Ji Xiang after seeing the video, and Director Bai was relieved.

Still, he insisted on doing a contrast-enhanced CT.

Dr. Merz was doing an examination, listening to the buzzing sound, Director Bai asked, "Director Niu, it's okay without surgery, what's going on?" ”

"Director Bai, what do you understand as omental infarction is omentum thrombosis or something."

"Hmm." Director Bai nodded.

"In fact, primary omental infarction usually occurs in children and adults. The pain is usually located in the right upper or lower abdomen and is easily misdiagnosed as appendicitis or cholecystitis. The only predisposing factor is childhood obesity. ”

"I've read a report that says that about 0.3% of patients with acute appendicitis are diagnosed with the wrong diagnosis, and omental infarction should actually be diagnosed."

Director Bai really doesn't understand this.

Also, a neurosurgeon-turned-medical director cannot be omniscient.

He listened very carefully to Director Niu's explanation of omental infarction.

"Primary infarcts tend to occur in the right upper quadrant and may be related to the longer and more mobile omentum there."

"The lower abdomen is not uncommon, most of them are self-limiting diseases, and it is good to raise them for a few days."

"So looking at the clinical treatment of appendicitis and cholecystitis, I feel that it is better to do a CT examination."

"However, it has now been said that we are abusing CT, and after drawing blood for B ultrasound, we will have to scan another CT, and it is estimated that 99.7% of appendicitis patients are unacceptable."

Director Niu said, laughing.

"Do I need surgery?"

"The omentum has a lot of blood vessels that supply blood, and it is generally not needed."

Director Niu began to show off his skills, and he carefully explained to Director Bai what omental infarction really needs to be operated on.

Ji Xiang stood in the corner and looked at the screen, waiting for the results to come out.

This disease is like Director Niu said, it usually does not need surgery, and Dr. Merz does not need surgery.

Most cases of omental infarction are found during emergency surgical exploration, and if they can be easily removed, surgical removal of the infended omental tissue is generally recommended.

Surgical resection of the infarct lesion can rapidly improve the patient's symptoms and signs, and the patient recovers quickly and has a shorter course of disease.

Laparoscopic resection of the infarcted local omentum can more effectively reduce complications such as postoperative pelvic and abdominal abscess, pelvic and abdominal adhesions, and intestinal obstruction.

After conservative treatment of patients with mild disease, the local inflammatory response can gradually subside, the omentum gradually retracts and fibrosis, and most patients basically recover within two weeks, and some symptoms and signs can continue for several weeks. Repeat CT and B-ultrasound examination may show that the mass is gradually shrinking and the boundaries are clearer.

As for how Dr. Melz's omental infarction came about, Ji Xiang had no idea at all.

Maybe it's caused by his overeating, or maybe it's caused by a bad mood and high blood pressure, who knows.

Ji Xiang didn't care how Dr. Merz's illness came about, as long as he didn't need surgery.

If it is operated, according to the system NPC, it is not just a removal, and there are very troublesome follow-up problems.

However, Dr. Merz seemed to be lucky, and Yoshisho breathed a sigh of relief when the enhanced CT images came out.

It is the same as the display in the system operating room, no surgery is required, and conservative treatment is sufficient.

When Dr. Merz was told about the result, he was still very worried and asked for the imaging to be sent back to Massachusetts General Hospital.

The difference in Dr. Merz's attitude before and after is huge, and Ji Xiang feels it very clearly.

But it's normal, Ji Xiang has been a patient many times.

"Dr. Merz, have you been having a lot of mood swings lately?" Ji Xiang asked on the way back to see Dr. Merz off.

"......," Dr. Merz paused.

He thought that he had suffered from abdominal pain after learning that Wembanyama had received a call from Jeanie Buss and was likely going to the Lakers.

How did Ji Xiang know?!

"Although there is no identified cause of primary peritoneal infarction, many patients are caused by blood pressure fluctuations, and I am very strange that your blood pressure should be very well regulated, why does it suddenly fluctuate?"

Dr. Merz felt the Great Demon King slap his face as he knocked him to the ground, asking himself if he knew he was wrong.

F***！！！

(End of chapter)