Dr. Chi didn't pay much attention to it at first, because Zhou Can was just a regular trainee.

He thought it was a doctor from the intensive care department who summoned Zhou Can to come over to understand the patient's diagnosis and treatment.

"Can you describe the details of the patient's intestinal bleeding when you examine the patient?"

"At that time, an angiogram was done on the patient, and the bleeding was mainly concentrated in the colonic segment of the large intestine. Multiple, diffuse hemorrhage. Dr. Xia Ping described the situation at that time.

He is the treating physician and the attending physician of the patient, and knows the patient's condition best.

Diffuse hemorrhage generally occurs most dangerously within the skull.

It spreads like smoke and bleeds wide. It often refers to bleeding at multiple points at the same time, and is more common in chronicity. This bleeding is mostly associated with superficial capillary lesions or dilation. Then there is sepsis, which is the most common.

"What about the other intestinal segments? Is there bleeding? ”

Zhou Can continued to ask.

The gain from making this call is very great.

At least he had been asked what he wanted to know.

"There was hardly any bleeding from the cecum and there were a few signs of bleeding in the rectum. No bleeding was also found in the anorectum. Later, unable to withstand the repeated pleadings of the family, I took the risk of having a colonoscopy on the patient. Consistent with angiography, bleeding is concentrated in the colonic segment. There is also a small amount of bleeding in the rectal segment. Thrombin therapy and cryotherapy were ineffective. ”

"Through observation and comparison, I also found that the bleeding spots found during endoscopy were not the same as those found during angiography. I'm sure the location of the patient's bleeding point is constantly changing. ”

Dr. Xia recounts all his findings.

After hearing this, Zhou Can was even more convinced that there was something wrong with the small intestine.

The details learned from Xia Ping are too precious.

"Do you think it is possible that a malignant tumor may infiltrate the intestinal wall and cause bleeding?"

Zhou Can made the final elimination.

If malignancy can also be ruled out, then he can further narrow the diagnosis.

"The likelihood of a malignant tumor is extremely small. At least colon cancer and rectal cancer can be ruled out. ”

Xia Ping is quite conservative in his speech.

This is also an experienced doctor's speech skills that have been forced to practice in various beatings.

Unless a doctor who really has great skills is completely sure in the field he is very good at, he dares to say it more certainly.

Otherwise, it is generally a speech skill that can be retreated and advanced.

"Doctor Zhou, who is your senior doctor? Did he ask you to ask about the patient? Xia Ping seemed to hear something wrong, and began to interrogate Zhou Can in turn.

"My senior doctor is Hu Yiba from the Department of Intensive Care Medicine. Dr. Hu didn't know about this, but I wanted to know about the patient's condition, so I took the liberty to disturb you. ”

Zhou Can didn't dare to talk nonsense.

Many of the doctors in the hospital know each other, and they will know if something is true or false as soon as they inquire about it.

He would never dare to bear a charge of dishonesty.

"I see! I'm busy here, so if there's nothing else to do, let's talk about it here! As soon as Xia Ping heard that it was Zhou Can's own idea, his attitude immediately became much colder.

Senior doctors often encounter novices like Zhou Can.

Like a curious baby, always ask a senior doctor all kinds of questions.

Senior doctors may be able to be a little patient with the junior doctors they are responsible for teaching. This is basically the attitude towards those junior doctors who have nothing to do with it.

"Can you tell us about the specific treatment you've done with your patients?"

Zhou Can also wanted to know more about the situation.

In particular, the treatment methods used by the treating doctor, the effect of the treatment, and the reaction of the patient.

This data is invaluable and can help him better diagnose the cause of the patient's disease.

Why is it difficult to diagnose some incurable diseases?

Because all the common causes have been ruled out. It is up to the doctor to try it himself like a pony crossing a river, and find a way that no one has ever walked before.

"You can directly look at the medical records for the specific treatments that have been done. There's something going on here, goodbye. ”

The words fell, and he didn't wait for Zhou Can to say anything more.

The other end of the phone hung up, and a busy tone came to end the call.

This Dr. Xia is really realistic.

Zhou Can was speechless for a while.

Fortunately, I have asked a lot of key information, and the harvest of this trip is okay.

"It's good for a novice doctor to be diligent and inquisitive, but pay attention to moderation. Our attending physicians are often very busy, and few of them are willing to spend their spare time answering miscellaneous questions. ”

Doctor Chi said these words to Zhou Can, which was more of a warning.

Nothing malicious.

Just told Zhou Can not to be like this next time, Meng Lang, it is very disgusting to disturb the senior doctor casually.

Zhou Can didn't argue anything with him.

Instead, he thanked him and left quickly.

It has now been almost identified that the patient's lesion is in the small intestine.

The specific cause of the disease, after being ruled out one by one, a flash of inspiration suddenly flashed in his mind.

Could it be a parasite? And this parasite is not in the large intestine, it hides in the small intestine.

[Pathological diagnosis experience value +1.]

The experience points have arrived, indicating that his diagnosis is correct.

In order to make a final diagnosis, the patient must be further examined.

Zhou Can was excited.

The hard work paid off, and the diagnosis of this patient has finally taken a big step forward.

At this point, the cause is basically clear.

The patient has parasites in the small intestine.

As for how to do it, it can be further debated.

The patient's stool has been routinely tested, and if there are parasites, they can usually be detected. At least eggs can be found.

However, if no parasites or eggs are found during the stool routine, it means that the parasites are likely to hide in the small intestine while frantically absorbing the patient's nutrients, and then produce substances that can cause bleeding in the large intestine.

It can be a larvae, or it may be a hormone or a harmful substance that can stimulate intestinal bleeding.

Consider that the patient has diffuse bleeding and that it is concentrated in the colonic segment.

Zhou Chan prefers parasites to lurk in the small intestine, absorb the nutrients they need from the intestinal fluid, and then expel irritating harmful substances that can make the large intestine bleed.

After the small intestine fluid enters the large intestine, the cecum segment is very short, and the function is similar to that of the small intestine, it mainly absorbs nutrients from the small intestine that does not absorb clean, and impurities.

Those intestinal fluids stay in the cecum for a shorter period of time.

On the contrary, the colon is 1.1 m long. When food passes through the stomach and small intestine and reaches the colon, it secretes some alkaline substances to protect the intestinal mucosa and lubricate the intestines. At the same time, it absorbs electrolytes such as water and sodium.

After food debris reaches the colon, it is slowly formed into stool through water absorption.

As the colon continues to move and the stool is discharged to the rectum.

Eventually, it is excreted through the anorectum and anus.

From here, it can be seen that the fluid excreted from the small intestine stays in the colon for the longest time.

And it also has the process of turning manure from liquid to solid.

During this process, the harmful substances that cause bleeding in the intestinal wall are absorbed by the intestinal wall, causing telangiectasia and diffuse bleeding.

The idea of diagnosis has reached this point, which is very clear and unambiguous.

That harmful substance can cause telangiectasia in the large intestine.

It may be that the irritation is not particularly strong, so it only causes mild chronic bleeding.

[Congratulations to you for successfully diagnosing an ultra-difficult case, and the experience value of pathological diagnosis is +100.] 】

At this moment, the truth is revealed.

After Zhou Can clenched his fists hard, he raised his arm.

I was very excited.

Not only did he receive a reward of 100 experience points for pathological diagnosis, but he could also save a life.

It's so meaningful.

Now that it has been determined to be a parasite and is playing tricks in the small intestine, taking deworming medication should be able to quickly stop the gastrointestinal bleeding of the 7-bed patient.

Although the cause has now been diagnosed, how to convince senior doctors is still a problem.

The senior doctor is extremely cautious in the use of medicines, and the patient is already extremely weak, and in case of an accident, no one can afford to take this responsibility.

He decided to call the senior doctor Hu Yiba first.

When he first entered the intensive care medicine department, Zhou Can was only familiar with Hu Yiba.

I took out my mobile phone, but fortunately, I saved Hu Yiba's phone when I got off work.

Call directly.

Ringing twice, the phone is connected.

"Who?"

It seems that Dr. Wu did not save his number.

From this, it can also be seen that the doctors actually look down on the 'related households' who have someone to greet them.

Zhou Can is much stronger than those who have a background and no ability.

At least he was cultivated by Vice Dean Ye with his strength.

But in Dr. Hu's eyes, the status is still very low.

"Hello Doctor Hu, I'm Zhou Can, a trainee who was just assigned to you today."

Zhou Can introduced his name with a very humble attitude.

"Oh! It's Xiao Zhou, is there something wrong? ”

Dr Wu's attitude remains mild.

"After hard work and dialectic, I consulted the senior doctor, and it seems that I have found the cause of the bleeding of the patient in bed 7."

Zhou Can knows that his qualifications are shallow, and if he doesn't talk about two unwarranted senior doctors as tiger skins, I'm afraid it will be difficult to convince Dr. Hu.

"Hehe, the cause of the bleeding was found so quickly? Let's talk about it. ”

Dr. Hu apparently didn't take it too seriously.

even felt that Zhou Can was a little anxious for quick success, and he thought about making meritorious contributions as soon as he entered the intensive care medicine department.

The 7-bed patient was consulted by a number of doctors in the Department of Gastroenterology, including the chief physician. After being admitted to the ICU, Dr. Hu, Dr. Shi, and the chief physician of the department all learned about the patient's condition.

None of these people have found the cause of the bleeding.

On the first day of his arrival at the intensive care department, Zhou Can told him that the cause of the patient's bleeding had been found.

Dr. Hu only felt that this young man was a little naïve and superficial.

Of course, he doesn't break it to his face.

"I talked to the patient's attending physician, Dr. Xia, about the situation, and the patient mainly had diffuse colonic segment and widespread bleeding of unknown cause. The spot of each bleeding is different. A variety of common gastrointestinal bleeding disorders can be ruled out. After dialectic, we believe that the patient's true lesion is likely to be in the small intestine. It is also possible that the excretion of the parasite causes telangiectasia of the lining of the large intestine, which eventually causes bleeding ......"

Zhou Can could naturally hear that Dr. Hu did not attach much importance to his diagnosis.

He still struggles to tell the idea of diagnosis.

Even Dr. Xia said it.

"Hmmm! I will pay attention to your diagnosis, I am off work now, if there is any problem, we will discuss it at work tomorrow! ”

Dr. Hu's words are purely clichés.

Most of the ingredients are perfunctory.

"The patient is in critical condition, and it would have been of great significance if it had been diagnosed early and treated with medication. Do you think you can handle it today? ”

Zhou Can asked stiffly.

Listening to Dr. Hu's tone, he definitely didn't take it seriously.

The cause was finally diagnosed, but the senior doctors did not trust it, and the follow-up treatment could not be implemented.

This made Zhou Can extremely unwilling.

The rewards of the experience point system are already in place, and his diagnosis must be correct.

I didn't expect to be stuck in the level of senior doctors.

"Xiao Zhou, newcomers are most afraid of quick success, and they must be calm. Every patient admitted to the ICU is dying, and according to you, most likely will need to use insecticides. All insecticides are sprayed pesticides, which will have a certain effect on the body. Normal people can tolerate it, and even no symptoms are noticed. But in critically ill patients, the slightest adverse effects on the body may be multiplied. ”

"You say that parasites are at work in the small intestine, and you can't just infer it! There must be a scientific basis for diagnosis. It is extremely irresponsible to infer the use of insecticides on critically ill patients. No doctor can afford the consequences. ”

Dr. Hu tactfully criticized him.

All of this is true.

That's what it is.

But everything is done according to the rules and the process, which is inevitably a bit dogmatic.

Such an arbitrary approach will certainly delay the treatment of patients.

"Of course, your spirit of daring to explore and be diligent in research is very encouraging. The diagnosis and treatment of patients with 7 beds, let's talk about it tomorrow, now that the regular departments of the hospital are off work, they can't carry out their work. Rest early! ”

With that, Dr. Hu hung up the phone.

Zhou Can froze in place.

Full of joy and excitement, he was poured with a basin of cold water.

Taking two deep breaths and adjusting his mood, he decided not to hit the south wall and not look back.

Go directly to the duty room of the intensive care ward to find the taciturn Dr. Shi.

It takes a great deal of courage to do so.

Because in the end, it is likely that things will not work out, and you will touch the nose.

A man wants a face, and a tree wants bark.

I was constantly rejected and criticized by senior doctors, and I believe that no doctor is willing to do such a thankless task.

Zhou Can has always been a bit 'stupid' in the matter of treating patients.

He walked straight to the door of the Critical Care Medicine Unit.

Ring the doorbell.

The door quickly opened.

A nurse stands inside.

It looks quite familiar.

Nurses work 12-hour hours in the intensive care unit. In practice, it is often necessary to work more than 13 hours.

Zhou Can got off work, and the nurse did not take over the shift.

"Doctor Zhou, aren't you off work? Is this forgetting something? ”

The nurse asked him with a smile.

"I would like to ask Dr. Shi to report some of the conditions of the 7-bed patient."

Zhou Can walked in directly.

"Doctor Shi happens to be in the duty room, you can change your clothes and go to him."

"Thank you."

Zhou Can changed into an isolation gown and walked into the duty room.

Several doctors and nurses are discussing the patient's treatment and condition. Dr. Shi seemed to be prescribing medical orders to patients, constantly operating on the computer, sometimes frowning and thinking.

Zhou Can entered the duty room and did not attract much attention from other medical staff.

"Doctor Shi, can I disturb you?"

Zhou Can walked up to Dr. Shi and said hello.

Dr. Shi looked up at him and recognized him.

"Aren't you the Gui Pei under Dr. Hu? What are you looking for me? ”

There was no smile on his face, and his tone was rather cold.

Zhou Can gritted his teeth and told the story of the 7-bed patient.

Dr. Shi listened silently, and the expression on his face did not change much.

Gui Peisheng, who was sitting next to him, showed an imperceptible expression of disdain at the corner of his mouth. may think that Zhou Can is purely looking for trouble.

After listening to Zhou Can's narration, Dr. Shi did not have much change in his expression.

His eyes were still cold and his face was serious.

Zhou Can stood next to him very worriedly, if Dr. Shi still didn't pay attention to his diagnosis, I'm afraid he would have to wait until tomorrow to find a way to convince Dr. Hu.

The cause has been diagnosed, but treating the patient has become the biggest problem.

No doctor would dare to take that risk.

And there really is no basis for inspection.

Dr. Shi pondered for a moment, not saying a word. He then operated the computer and continued to prescribe medical orders to the patient.

Zhou Can stood there, looking very embarrassed.

It's not going to go, and it seems more embarrassing not to go.

It seems to be treated as air by Dr. Shi.

After seven or eight minutes, Dr. Shi finally finished prescribing.

This waiting time is really a torment for Zhou Can. The other doctors and nurses looked at him strangely from time to time, which made him feel even more uncomfortable.

It feels like a clown standing there waiting to be looked at.

"You came up with these diagnoses?"

Doctor Shi hadn't forgotten him, and turned around slightly to stare into Zhou Can's eyes.

"Yes!"

Zhou Can couldn't lie, because the other party's gaze seemed to be able to penetrate people's hearts.

It's even more difficult if you're not honest.

Hard-nosed admission is the best thing to do.

"As soon as I heard it, I knew that it was you who made it yourself, so why do you have to get involved with a senior doctor who doesn't exist? Experienced senior doctors, the diagnosis idea is step-by-step, and each step is based on examination data or symptoms. Your diagnostic thinking is more like a whimsical, child's scribble. ”

Dr. Shi looked taciturn, but he didn't expect his insight to be so perverted.

A cold sweat broke out on Zhou Can's back.

"But it's your alternative way of thinking of breaking the rules and jumping out of the shackles that gives me a glimmer of hope. I urgently need to go in and deal with the patient right now, and will be out in about half an hour to an hour. If you wish, you can wait for me here, and then I will discuss the 7-bed patient with you. ”

Dr. Shi said.

(End of chapter)