Diagnosing a disease is a technical job, and sometimes it is not as simple as imagined.

Some people say, isn't it easy to diagnose a disease? Especially for this kind of tumor, isn't it clear when the film is shot? Even an ordinary doctor in a county-level hospital can diagnose it!

In fact, this is not the case, which requires doctors to have rich experience and deep comprehensive strength.

Just like now, Nanako Chiba got the film, the imaging features are not obvious, it can be said that there is almost none, if you change to an ordinary doctor, you may suspect it, or even overturn the previous judgment, and then think that it is another disease, which leads to missed diagnosis and misdiagnosis.

But Nanako Chiba didn't, she thought twice and felt that her judgment was not wrong.

In line with the attitude of being responsible for the patient, we tried to find the "culprit" as soon as possible and did not delay the treatment of the patient.

Zhou Qiao, Murphy, Stephanie, and Nanako Chiba discussed together in the conference room, and when they played in private, they were very open, but isn't it work now?

So everybody is very serious and serious.

Work is work, play is play, one yard is one yard.

Everyone expressed their opinions, and after half an hour, they reached an agreement.

"The possibility of the patient's tumor is very high, and the next step is to perform PET-CT examination, and at the same time go to the community hospital to collect blood from bilateral inferior petrosal sinus veins to identify the source of ACTH and clarify the location of the lesion, so as to formulate a precise treatment plan."

Zhou Qiao looked at Nanako Chiba and said, "This blood collection under the rock sinus is up to you." ”

"Huh?" Nanako Chiba was stunned for a moment and said, "I've never done it before." "She's good at medicine, and this kind of surgery is a little worse.

"It's okay, let's split up, I'll teach you later." Zhou Qiao said with a slight smile.

Chiba Nanako couldn't help but look forward to it, Zhou Jun taught me by hand uh, how charming it should be. Of course, learning is the most important thing, but it helps to improve learning efficiency.

If possible, she hopes to sit on Zhou Qiao's body and study.

Infrapetrosal sinus blood sampling, in fact, is a minimally invasive surgery, in which blood is taken deep in the brain, and the catheter is superselectively cannulated from the bilateral femoral veins to the bilateral inferior petrosal sinuses, and blood is collected from different parts to measure the ACTH level at different sites.

If it is of pituitary origin, then the level of ACTH in this segment of the petrosal sinus is high, which can make an accurate etiology and localization diagnosis of Cushing's syndrome, which can be said to be the gold standard for the diagnosis of this disease.

Because the child is relatively small, it will be completed by general anesthesia and microcatheter intubation.

However, there are many variables in the veins, and retrograde venous cannulation cannot predict the anterior vascular structure, which requires that the operating physician must be skilled and experienced.

What's more, the child is only 4 years old, and the infrapetrosal sinus and drainage veins are very small, and can only be intubated and collected with a microcatheter with an inner diameter of about 0.5mm.

Zhou Qiao taught seriously, and Nanako Chiba also learned seriously. Men and women match, study is not tiring.

Zhou Qiao did not have the slightest reservation, which can be described as a gift.

After less than forty minutes of teaching, Nanako Chiba practiced it six times, and the system popped up a prompt dialog box: "Nanako Chiba has reached the level of sinus blood collection surgery under the rock of Nanako Chiba, and has reached the primary level of specialization, congratulations to the host and obtained six rewards." ”

"Zhou Jun, do you think I can really do it?" Nanako Chiba asked.

Zhou Qiao smiled slightly, stroked Nanako's hair in Chiba, and cast an encouraging look at her: "Believe in yourself, you will definitely be able to!" ”

The group came to the community hospital, the operating room, Nanako Chiba took a deep breath and went on the field!

If you want to gain a foothold at the Iris Clinic, you really can't do without real skills, and Nanako Chiba also wants to achieve something in the field of surgery.

She is still young and has a lot of time to further her education. Yiduo is not pressing, she also wants to be an all-rounder.

From another point of view, she was swept up by Murphy and Stephanie, and she felt that the specialty of medication alone was a little untenable.

Despite the difficulty of the operation, Nanako Chiba is the first time to practice in real life, but this Japanese girl is really talented, with the cooperation of the anesthesia team of the community hospital, under the personal guidance of Zhou Qiao, Nanako Chiba completed the operation for the child very smoothly.

"Awesome!" Stephanie gave a thumbs up.

Even Murphy blinked slightly, and said in his heart that this Japanese girl was as good as before me.

Murphy recalled that when she first came to the Iris Clinic, Zhou Qiao taught her to perform surgery every day, and the improvement of her medical skills at that time was simply amazing.

"It was a great memory." Murphy misses it.

Now, Murphy has grown up, and he doesn't need Zhou Qiao's hand-in-hand guidance anymore.

This opportunity, but it's Nanako Chiba's turn.

And after the practice of real people, the level of Nanako Chiba's surgery has been improved by a small level. From the previous beginner level of the specialization level, it has been upgraded to the intermediate level of the concentration level.

The progress is also considerable.

The results of the examination came back, and sure enough, the child had Cushing's disease caused by a pituitary tumor.

Confirmed! The case has been solved!

The "cunning culprit" has been found!

However, new challenges have only just begun. That is, how to safely remove the tumor and protect the pituitary gland function so that the 4-year-old child can grow better?

The pituitary gland is the headquarters of the body's endocrine system and is very important for the growth and development of the child.

It is not only delicate excision, but also precise retention, and the various organs of young children are very small, and the difficulty of operation is high, which can be imagined.

Nanako Chiba had never had such a difficult operation before, and Zhou Qiao didn't dare to hold it up this time, so she was in charge of the operation.

Instead, Zhou Qiao went into battle in person, with Murphy, Stephanie, and Nanako Chiba as assistants, and Nanako Chiba mainly followed suit.

Zhou Qiao's shot must be a high-quality product.

He led a team of beautiful women to patiently, carefully and with extraordinary precision, along the nasal cavity of the child, from this tiny channel to the pituitary gland, and peeled off the tumor entrenched in the pituitary gland of the child.

The child is only four years old, the nasal cavity is not fully developed, the sinus cavity is mostly cartilage and other tissues, not fully formed, and the nasal space available for surgery is very small, which not only needs to accurately remove the tumor without damaging other pituitary glands, but also to reduce bleeding, and the requirements for skills are not generally high.

But in the end, Iris Tiantuan successfully completed the operation.

Nanako, in particular, Chiba has benefited a lot.

After the operation, the child was transferred to the intensive care unit of the community hospital.

Two days after the operation, she was transferred to the general ward, and Nanako Chiba led Park so-joo and Kim Hee-jin to actively monitor the levels of various endocrine hormones in the children.

The results were fantastic, the child's electrolyte levels stabilized, hormone levels decreased, and pituitary gland function was intact!

The quality of this surgery can be said to be the best of the best. Many doctors in the neurosurgery department of the community hospital were impressed again after learning about it.

"Thank you so much, doctor. It's just that my son will be able to catch up with him in the future? The child's mother was worried, and his father frowned.

They regretted that they didn't notice the abnormality earlier and brought their son to the iris clinic for a check-up.

Now, after delaying the growth period for half a year, will it fall behind step by step in the future?

Nanako Chiba comforted: "It's okay, I'll adjust the growth hormone for him later, the child's height will catch up, and the blood pressure will gradually drop to normal." ”

Sure enough, after the later medication of Nanako Chiba, a "little expert in medication", the child's condition became more and more stable. The child's parents were relieved.

……

Iris Clinic, Psychological Counseling Clinic.

"Dr. Stephanie, I've been in so much pain lately that I don't want to go to work every day!" An urban beauty, with a sleepy face, today was a working day, but she specially asked for leave and came to Stephanie for psychological counseling.

"Oh? Let's hear it. Stephanie likes to give psychological counseling, in addition to helping others, she can also "listen to some gossip", understand the hearts of different people, and also help to examine her own heart.

"I'm so annoyed, I just don't want to go to work anyway. I didn't think about it in the morning, and I reluctantly went to the company, relying on cup after cup of strong coffee to survive, otherwise I wouldn't be able to work soberly at all. ”

"During the day, I work under pressure, and I feel that it is getting harder and harder to earn money, not to mention the lack of money, and there are all kinds of messy intrigues in the office, which is just, it's ...... Indescribable, a mess! ”

"At night, when I can't sleep, I will have all kinds of negative emotions of depression, frustration, and terrible things, and I have no choice but to rely on alcohol to anesthetize myself and help me sleep. Day after day, night after night, and then it became a vicious cycle, a mess, like a nightmare. ”

"As a result, my menstrual period was disturbed every month." The haggard lady complained.

Stephanie pondered slightly, and then reassured: "I don't really blame you for this, you are in this situation, consider burnout." ”

"Burnout? Is it a disease? The woman's eyes lit up and she asked.

If it's really a disease, that's fine.

Because if it's a disease, Dr. Stephanie may have a very good solution to help with it. Looking at Dr. Stephanie's expression, there should be a way.

Stephanie had bright blonde hair and eyes like jewels, nodded and said, "Yes, it can be understood as a disease, and it can also be jokingly called not wanting to go to work syndrome." ”

Burnout, which is included in the 11th edition of the International Classification of Diseases (ICD-11), is considered a workplace phenomenon but has not yet been classified as a disorder.

However, it is a state of extreme emotional, mental, and physical exhaustion caused by excessive stress over a long period of time, and if it is not dealt with for a long time, it is very easy to induce depression.

Stephanie peeled back the cocoon and explained it to her in detail. What is burnout?

It is often the emotional, mental, and physical feeling of making ends meet caused by work.

You have the ability to do things, but you don't have the slightest motivation to do them.

When burnout occurs, individuals tend to present three states: tired (emotionally exhausted), unwilling to do (depersonalized), and self-motivated (low efficacy).

Stephanie turned on the computer and pulled up a "Core Scale of Occupational Stress Measurement" to evaluate the current patient.

There are 30 questions that the patient needs to answer according to the actual situation.

Different answers, different ratings, and eventually, Stephanie counted the scores and found that the patient's rating was 56, which is moderate burnout.

A score greater than 57 is severe.

When it reaches a severe level, this emotion can greatly affect physical health, not just mental.

This patient's menstrual period has been disturbed as a result, and his score is close to 57, which is actually a bit more severe.

"Fortunately, you came early, otherwise it would have been more troublesome to delay and become depressed." Stephanie said happily.

Depression is not easy to treat. In severe cases, many people commit suicide.

"Oh my God, I can't accept it, I never imagined that I would have this mental illness." The patient was embarrassed.

Because, she is still very young, thinking back to the years when she just worked, it seems like it was just yesterday.

"Dr. Stephanie, do you know how confident I was when I was out of school, and how much I longed for my job."

Stephanie said, "Yes." Many people have this experience. Because patients with burnout are not in the minority. ”

Stephanie talked to each other, helped her with psychological counseling, untied her knots little by little, and taught her how to balance work and life.

"Maybe you should go on a relationship, or go on a trip. If you want to travel, I recommend China, a country where many people are said to be crowded when it comes to holidays. In your case, it will be beneficial to go to crowded places with a lot of people. Stephanie gave her advice.

"Mmmm, I'll definitely try my best. By the way, Dr. Stephanie, I don't know if it's appropriate to ask. The beauty looked at Stephanie and blinked.

Stephanie shrugged and smiled, "Just ask, it's okay." ”

The beautiful woman said, "Dr. Stephanie, you work here every day, do you have any burnout?" ”

Stephanie smiled, "No, I'm happy every day." ”

Patient: "......" is confused and full of suspicion.

She looked at Stephanie like a monster, and wondered if this doctor was fooling me? I don't believe it, are you really happy at work?

Anyone else will feel happy at work?

Isn't it also a stressful profession to be a doctor?

"Really, I don't lie to you!" Stephanie's smile was as bright as a spring breeze, and she didn't explain, and she couldn't explain it.

It's not that I'm afraid that I can't explain it clearly, but I'm afraid that I will hit this beauty and make her condition worse.

Because, Stephanie thinks, she has a good job now.

She secretly said to herself, I am now in the Iris Clinic, not only do I have less to do, I have more money, and I am also close to home, I am also in charge of the financial power of the clinic, not only that, but there are also high-quality men like Zhou Qiao who can play every once in a while, I don't know how happy I am.

Even if I were asked to be the director of Johns Hopkins Hospital now, I wouldn't do it!

Do I have no-commute syndrome? How can it be?!

Well, even if there is, let Dr. Zhou come over and help me "groom", and I will immediately be energetic and energetic!

If this patient knew about Stephanie's condition and took pleasure in going to work, I am afraid that he would die of envy.

After an hour of counselling with Stephanie, the patient felt better and passed away happily.

It's just that this kind of thing can't be cured by one psychological counseling, it needs to be done several times, and Stephanie is quite expensive here.

However, the patient felt that it was worth it.

Because no matter how important money is, it is not as important as physical and mental health, right?

Nowadays, many companies in the United States have relevant benefits, and the company has signed a cooperation agreement with a third-party psychological counseling agency, and employees can call and make an appointment with a psychological counselor at any time if they are unwell.

Not only at work, but also at home and emotionally, you can call as long as you need to, and the other party will protect the privacy of the person who asks you and will never disclose it to a third party.

Even if you don't get along with your boss and say bad things about your boss, you won't leak it out.

Employees don't need to pay extra because the company has already paid for it, and it's usually an annual subscription.

For companies and groups with a large number of people, the annual subscription service is more cost-effective.

Some foreign companies in China also have similar benefits, but the Chinese people are more subtle and use them less.

(End of chapter)