Yang Chan is a very competitive woman.

She is the class president of class 512, and her academic performance has always been one of the best in the class, and she is extremely proud in her heart. Unexpectedly, after joining the work, he was overtaken by Zhou Can, who had mediocre results, and the gap between the two seemed to be quite large.

didn't say it, but deep down in her heart she was in a panic.

Only by pulling back a game can she be more comfortable.

People, especially those who are proud in their hearts, are more eager to prove that they are not inferior to others.

The relationship between Yang Chan and Zhou Can has always been delicate. She will always be the arrogant and domineering squad leader in front of Zhou Can. When Zhou Can is in trouble, she can help him without asking for anything in return.

Because she feels that she is the class president and has an obligation to take care of her classmates.

This time, she wanted Zhou Can to know that she was still the powerful squad leader, and her sassy and heroic appearance was still there.

Just diagnosing SAS is not her area of expertise.

She had already begun to deduce the cause of the patient. Whether there will be any gains is difficult to say for the time being.

Takami is also working on diagnosis.

The etiology of the patient is related to the central nervous system, and neurology is his strength, so he has a certain advantage and is full of energy.

He also wants to win a game against Zhou Can and regain his confidence.

In the past two years, he has almost been overwhelmed by Zhou Can, because Zhou Can is so good.

The better the competitor, the greater the pressure on the parties.

Compared with the two, Zhou Can is the most calm and leisurely. He is still conducting a deeper analysis based on the slightest clue he has found.

Just when several chief physicians diagnosed the woman, an accident happened.

The woman was just holding her huge head in her hands, half-lying on the table. At this moment, he fell asleep on the table, making a burst of snoring.

This little accident caused several doctors to look at each other, and then they couldn't help laughing.

"Is it easy for her to fall asleep during the day when she is usually at home?"

Zhou Can asked the family the first question.

"Yes! The child would often sit on the couch watching TV, or talking to us, and suddenly fall asleep. Today, she followed us to the hospital for a day of examination, and she was afraid that she was already exhausted. ”

When the woman's mother looked at her daughter, her eyes were doting.

Raising their daughters so fat, parents must have a certain responsibility.

It is said that habitual children are like killing children.

When parents spoil their children too much, they don't really love them, but harm them.

"Does she sleep long during the day?"

Zhou Can wanted to know if the patient had daytime sleepiness.

"It wasn't long. My daughter sleeps very lightly during the day and wakes up easily. "There doesn't seem to be drowsiness.

"Is her snoring always so loud?"

Zhou Can nodded and asked.

"Today was good. When it is very strong, you can feel the vibration of the door and glass of the room. Doctor, my daughter's snoring is loud, does it mean that her lungs are strong? ”

The woman's mother was proud of her daughter's loud purring.

I really don't know what kind of strange parents this is.

"There doesn't seem to be any scientific basis for this!" Zhou Can tried his best to make his tone better, otherwise he would make his family unhappy and quarrel badly.

As far as he knew, the louder the snoring, the more blocked the airways.

It's just that the patient's mother is proud of this, and if Zhou Can tells the truth, I'm afraid that he will immediately attract the disgust of his family.

In the case of central sleep apnea, it is usually mild intermittent snoring.

Her snoring seemed to be severe, and it wasn't intermittent. There seems to be a preference for obstructive sleep apnea.

The previous three chief physicians judged that this patient was likely to have mixed sleep apnea, which should have been correct.

Diagnosis of mixed etiology is more complex and difficult.

No wonder other hospitals have done surgery to no avail.

Suddenly, the patient's snoring stopped.

Her body began to move uneasily, and her face looked a little red. In the end, it was as if the blocked airway was suddenly washed away.

A long popping sound came from the mouth, and the exhaust gases in the body were expelled.

The patient's breathing pauses and then returns to normal.

Zhou Can, Director Zhang and others witnessed the patient's apnea, and in addition to being shocked, they were more happy.

Being able to see the symptoms with your own eyes is definitely beneficial for diagnosis.

When she resumed breathing, she needed to expel air from her mouth just now, blocking her nasal airway?

This gives a direction to their diagnosis.

"When she was apnea, she didn't seem to have any circulatory symptoms. Such as high blood pressure, arrhythmia, myocardial infarction, and so on. This is a good sign, at least she doesn't have to worry about other circulatory diseases when she is apnea. ”

Zhang Bihua said.

Sleep apnea syndrome is very prone to circulatory, respiratory, neurological, endocrine, and metabolic symptoms.

The risk of these complications is even higher than that of SAS itself.

"Inspiratory impairance, hypoxemia, and hypercapnia also do not appear to lead to pulmonary hypertension and right ventricular failure. The patient's condition should be mild, far from extremely dangerous. ”

Zhou Can said as he walked around to the side of the patient and carefully observed her neck.

The family was quite snobbish and did not seem to trust him as a young doctor.

Stood there, just moved to the side slightly.

Zhou Can doesn't mind, he has been a doctor for so long, and all kinds of family members have seen it.

It is even more common to suffer a little grievance.

That is, his current medical status has been promoted, and he can already be treated well in front of senior doctors. When I was an intern in the past, my status didn't come up, so I was really angry at both ends.

After the family members and patients scolded him, they always had to scold him again when they were hospitalized, and the teacher's face was sometimes as black as brushing pot ashes.

After reading it, Zhou Can's heart had a little bottom.

Director Zhang, Deputy Director Shi and Director Jiang have discussed the patient's condition. However, there was no substantial diagnostic breakthrough for the trio.

"Excuse me, did she ever have a headache when she woke up in the morning?"

Zhou Can decided to dig a little deeper.

"I think I really have this symptom. She would often say that she didn't sleep well last night and that her head hurt a little. The mother of the female patient replied.

"Did she have enuresis?"

Zhou Can already had a further judgment in his heart.

"Uh...... Well, I don't think so! The patient's mother replied hesitantly.

Her eyes flickered, and her face changed rapidly, indicating that she was not telling the truth.

In fact, there are other ways for doctors to determine whether the family is honest in answering questions.

For example, when lying, the eyes will look upwards to the left, indicating that the family member or patient is trying to fool the doctor. If the eyes look upwards to the right, they are reminiscing about the past, and they are more likely to be telling the truth.

Just now, when the female patient's mother answered, her eyes looked to the upper left, and her eyes were wandering, and she didn't dare to look at Zhou Can at all, she was probably lying.

"You don't have to feel sorry for your daughter. Telling us her true symptoms is more conducive to finding out the cause of her disease. As long as the cause is identified, it is possible to cure her sleep apnea, and by then, all her symptoms will disappear and her body will return to its normal state. ”

Zhou Can followed the temptation and drew cakes for his family.

"Hmm...... My daughter did have enuresis, but only occasionally. The female patient's mother lowered her head and whispered.

The two family members found that Zhou Can could accurately tell some of their daughter's hidden symptoms, and they couldn't help but think highly of the young doctor.

"Director Zhang, I suggest checking the patient's thyroid function."

Zhou Can made a diagnosis suggestion to Director Zhang, who was headed by him.

Yang Chan and Gao Jian couldn't help but be shocked, they didn't expect Zhou Can to have a breakthrough in diagnosis so soon.

That is, the two have not been in the same department as Zhou Can.

Otherwise, it will definitely be strange for this kind of thing.

There are many chief physicians who have been beaten by Zhou Can, not to mention the two of them who are regular trainees of the same level.

They want to compete with demons like Zhou Can, and they have a greater tendency to find abuse.

"Why do you suspect it's thyroid dysfunction?" Director Zhang did not immediately express his position, but was very curious about the direction of Zhou Can's diagnosis.

For central sleep apnea, the direction of diagnosis should be central neuropathy. Obstructive sleep apnea should be a respiratory pathology.

Zhou Can jumped out of these two lesion directions and locked the patient's thyroid gland, which is extremely rare to jump out to see the problem.

"There are several reasons! First of all, you look at the patient's neck, and based on my clinical experience in general surgery, she should have a problem with her thyroid gland. ”

This ability to detect lesions from the patient's body and appearance through visual examination requires doctors to be well-informed and have rich clinical experience.

Zhou Can rotated in multiple surgical departments, and the number of surgeries he performed was extremely amazing, which had incalculable benefits for his future clinical diagnosis.

For example, he can detect that a patient may have a malignant tumor by the patient's complexion.

Or, as in the case of the present, a look at the patient's neck can reveal that the patient's thyroid gland is damaged.

This ability to spot potential lesions through visual inspection is shared by every doctor present. It's just that their ability to visit and see is limited, and their knowledge is relatively narrow, so they can't implement visits in all fields like Zhou Can.

Even Director Zhang Bihua is only good at the field of obstetrics and gynecology.

For diseases in the field of general surgery, Director Zhang is not a layman, but his understanding of this area is relatively shallow, at most at the primary level.

In fact, the vast majority of chief physicians are like this, proficient in the field they are good at, and know a little about other medical fields.

"Also, when the patient undergoes bronchoscopy, he finds upper respiratory secretory edema, which is actually a typical endocrine and metabolic condition. In addition, patients have easy awakening, centripetal distribution of fat, and muscle laxity, which is also related to endocrine and metabolic diseases. If you can, it would be better to test her bone quality, which will definitely lead to osteoporosis. ”

Zhou Can gave a number of his own diagnostic evidence.

Other doctors either didn't notice these clues, or they didn't pay much attention to them.

"Dr. Zhou's diagnosis is well-founded and logical, and I think it should be adopted. What do Director Shi and Director Jiang mean? ”

Zhang Bihua looked at the other two.

"I'm okay with that."

Deputy Director Shi raised his hands in approval. Zhou Can represents the Department of Gastroenterology and wears the same pants as him. Now that Zhou Can has shown his face, he, a doctor in the Department of Gastroenterology, also has a light on his face.

"Agreed! The afterlife is terrifying! Dr. Zhou is young and promising, and his diagnosis level is first-class, which is really admirable. ”

Director Jiang had a good impression of Zhou Can, and Director Tan of the Department of Internal Medicine has always liked Zhou Can.

Now, Zhou Can has made substantial progress in this difficult case, and Director Jiang simply came to the icing on the cake and praised Zhou Can Yitong.

"Director Jiang praised me so much that I couldn't even find the north! I just happened to have the accumulation in the field of general medicine, so I was able to make some discoveries. Zhou Can was embarrassed.

was praised by the chief physician in public, which made him embarrassed.

He is used to keeping a low profile on weekdays, and he finds himself quite shy on such occasions.

"Since both directors agree with Dr. Zhou Can's opinion, then I will apply for the examination for the patient." Zhang Bihua had no intention of discussing with the family this time.

I believe that as long as the family's brain is not damaged by the door, they will definitely agree.

In fact, the faces of the two family members already showed expressions of expectant joy at this moment.

After visiting so many hospitals, I finally have a little new progress today.

I usually go to other hospitals, in addition to CT, that is, bronchoscopy, and various biochemical examinations. The end result was that there was no result, the real cause could not be found, and their daughter's illness was never cured.

"Dr. Zhou, is it enough to only check the patient's thyroid function and osteoporosis?"

Director Zhang Bihua asked this, which shows that she is a humble and very pragmatic person.

If you change to a better-looking chief physician, you may pretend to make a few comments as a teacher, and directly open the examination application.

I don't ask a junior doctor for his opinion in public.

"Enough is enough!"

Zhou Can nodded again and again.

Director Zhang opened an application for examination to the patient on the spot, and after the family happily took it, he woke up their baby daughter and took it for the examination.

When she woke up the female patient, she asked her parents in a daze.

The mother of the female patient said directly to her daughter, "This young Dr. Zhou and several experts have found out the cause of your disease!" Let's get checked. Oops, it's finally the right place today, the doctors in Tuya Hospital are still very high-level, much better than the doctors in other hospitals! ”

What the family members said to the patients made several experts feel particularly cool and comfortable to listen to.

It was also the first time that they had heard family members praise the high level of Tuya Hospital since they came here for consultation.

A major breakthrough has been made in a difficult case here, and all parties are happy, but Du Leng is still in the process of grieving.

The first two difficult cases could not be diagnosed by him, and he scolded his mother and left.

Now in the third difficult case, he is also confused, and he has not found any clue.

This time, Du Lengxue was smart.

Without waiting for the family to scold his mother, he quickly put down the so-called worthless face, and said to Zhang Bihua, "Director Zhang, Director Zhang, this patient has a low-grade fever, blurred vision, hearing loss, and leg pain." Tests showed abnormally elevated liver enzymes, 52% lymphocytes and 8% abnormal lymphocytes. Bone marrow aspirate shows active growth. There was also a problem with the patient's ESR test. ”

After Du Leng quickly reported the basic situation of the patient, he continued.

"I only specialize in the diagnosis of diseases in neurosurgery and nail breast surgery, and this patient's condition is complex and beyond my ability to diagnose and treat. Please take a look at it with a few directors. ”

Humans are the most adaptable animals.

Du Leng was beaten twice in a row by society, and he learned to bow his head.

If he doesn't bow his head, his face will be swollen today.

That is, the patient's family is a middle-aged woman who is quite well-dressed and has a good temperament. At first glance, you can tell that it is the kind of high-quality people who live a superior life.

If it were replaced by a short-tempered family member, I am afraid that I would have scolded my mother like the first two family members.

Even if the patient's family is of high quality, it does not mean that she is easy to speak.

Looking at her face with delicate makeup, she was already as cold as ice, and I was afraid that she was already extremely dissatisfied with Du Leng's diagnostic ability.

"That lady, please bring the patient here! We'll give her a joint diagnosis. ”

Zhang Bihua said to the family.

"Okay! Then you're in trouble! ”

The family came over with the patient, and her originally cold face warmed up a little.

When he left, he didn't look at Du Leng again, nor did he say hello.

It shows that she is already very dissatisfied with Du Leng.

The female patient looked very young, probably no more than twenty years old. looks like her mother, a beautiful embryo.

It's just that his face is sickly pale and red, his eyes are blank, and his expression is faintly painful, and it seems that he has been tortured by the pain.

No matter how beautiful a person is, as long as he gets sick, he will soon be tortured to the point that he will not be human.

Whether it is body shape, appearance, or temperament, they will be judged by the same as the previous scenery and health.

"Have you been treated in another hospital?"

After Zhang Bihua took the patient's information, she motioned for them to sit down.

"Healed. My daughter has been sick for a long time, almost two years old. Originally, it was just an ordinary cold, and the next day I had a fever, nasal congestion, and runny nose. At that time, I thought it was just a small cold, drink more boiled water, rest well, and soon get better. Unexpectedly, after a few days of delay, the illness still did not improve, and I felt a little anxious at that time. My child's father has been on a business trip abroad for a long time, and I am busy with my own work, so I lack care for my children......"

The family's words were full of remorse.

(End of chapter)