"It's better in San Francisco, it's warm in winter and cool in summer, the key is that Zhou Qiao is here."

Elena and Ava were on vacation in San Francisco for a long time, and the crown prince of the Nordic side called them to go back, but they didn't want to.

After all, they grew up in San Francisco, which is better suited to the climate, environment, and diet.

It's a good vacation in Northern Europe, but it's really not as comfortable as San Francisco in the long term.

Of course, the most important thing is that it is reasonable to be happy with Zhou Qiao every day.

On the Nordic side? Alone in the empty boudoir every day, very lonely.

Unfortunately, Murphy is now pregnant and can't play with them. It's a pity.

Anyway, the crown prince urged many times, and Elena and Ava found all kinds of excuses, and shirked it again and again, and stayed here if they could.

It's just that when I have something to do, or I miss my mother, I go back to visit.

After returning for a few days, I couldn't wait to return to San Francisco.

The crown prince and her husband smiled wryly and joked with each other: "When my daughter is older, she won't listen to her parents." ”

"Let them be, as long as they're happy."

The couple can only be comforted like this.

They finally found their biological daughter, and they were very spoiled, and since their daughters wanted to live in San Francisco for a long time, it was not a big deal to live there.

Even if you inherit the throne in the future, you can live abroad.

The royal family, the throne, is now just a symbol, not so important for the functioning of the state system.

With twin girls here, Nanako Chiba is very happy. For her, a third of the firepower, this intensity is just right.

Crazy at night, all kinds of Hu Tian Haitian, shameful postures, but during the day everyone goes to work seriously.

Elena and Ava are back at work at the Iris Clinic, and everyone else is at work, so they can't stay even if they just hang out.

It's just that Elena didn't take back the financial power from Stephanie, because she is now a royal princess, and she is in the clinic to play tickets.

Since Stephanie has done a good job, with her relationship with Stephanie, she simply won't take it back.

As she adapts to her status as a princess, Elena's pattern grows bigger and bigger.

She looks sweet and magnificent, if she changes into a queen's dress, she is definitely the kind of mother in the world.

Although Ava is extremely similar to Elena, she still retains her previous playfulness and innocence, and it can be said that she has not really grown up.

However, for them, it doesn't matter whether they grow up or not, they are destined to be carefree and carefree for a lifetime.

Zhou Qiao now distinguishes between Elena and Ava, and it is easy. In fact, a long time ago, he could easily distinguish this pair of girls, and the experience was completely different, but now it is easier.

Ava secretly discussed with her sister, "Murphy and Stephanie are pregnant, should we also get pregnant?" It's fun to have a baby. ”

Elena was startled and hurriedly whispered to her, "It's not right now." ”

"How is it not appropriate?" Ava pouted.

Elena shrugged, "How do you explain to Daddy Mommy?" How do you explain to the royal family? ”

Ava suddenly wilted, the royal family, have to refuse the scandal, although having children out of wedlock is not illegal in the United States, but for the Nordic royal family, it has a bit of a negative impact.

As princesses, they are likely to become crown princes and queens in the future, and there are many places to consider.

"But, I really want to!" Ava was still eager to try.

Elena really had no choice but to comfort her: "Let's talk about it later." ”

"Moreover, Murphy and Stephanie are pregnant, and they are going to give away their children in the future, and they are too lazy to bring them themselves, Murphy said, at most, they will be sent to Harvard University when they are one year old."

"Wow~" Ava was envious again. Although, she already knew the "inside story", but she really couldn't hold back her envy.

Elena was the same, her blue eyes narrowed.

lived in Harvard Park at the age of one, and there were two top academicians who raised and taught them as grandchildren, to be honest, this treatment, even if their future children, may not be able to enjoy it.

……

Iris Clinic, 2nd floor meeting room.

Zhou Qiao, Murphy, Stephanie, Nanako Chiba, and twin sisters are all together and are conducting remote consultations.

They received a request for support from White Rock Hospital in Texas.

Baiyan Hospital has now begun to take shape, and it can be said that it is on the right track.

With the current strength of Baiyan Hospital, it is estimated that it is about the same as Zhuhai County People's Hospital, and its comprehensive strength is okay, but there are no top experts, so when encountering difficult diseases, they have to ask for help from the Iris Clinic.

Sequoia Tree Hospital can't help them much now, because White Rock Hospital has grown.

In fact, the development of telemedicine in the United States is far greater than that of China.

Not to mention, there are many large telemedicine companies in the United States, including Teladoc Health, American Well, Grand Rounds, MORE Health, etc., many of which are listed companies, and have formed a large-scale industrial chain.

One of the main reasons for such rapid development is that the cost of medical care in the United States is too high, and for most middle- and lower-class residents, telemedicine is more cost-effective than economical.

Of course, for the kind of intercontinental surgery that Zhou Qiao did before, it was still expensive. This is because the surgery itself is extremely difficult.

However, it is more "cost-effective" than traveling to the United States for surgery and being hospitalized in a local East African hospital.

One of the core competencies of telemedicine is cost-effectiveness.

China has cheap medical treatment, a more reasonable medical insurance system, many hospitals, doctors and nurses will not go on strike, go to the hospital to queue, and the waiting time will not be as outrageous as in the United States.

Teladoc Health, which was established in 2002 and listed on the New York Stock Exchange in 2015, has been expanding the global market through acquisitions, focusing on services such as primary care and telemedicine for complex diseases, and its stock market value once reached $23 billion in 2021. Now, of course, it's fallen into a dog.

The company has 5 sub-brands, namely Teladoc, Advance Medical, Best Doctors, BetterHelp, and HealthiestYou.

There are also quite a few other listed companies.

In the U.S., telemedicine companies have sprung up to seize the market.

Zhou Qiao's own clinic and several of his hospitals were too busy to do so, so he didn't participate in the expansion. He took the high-end route.

The patient admitted to Baiyan Hospital this time is a 36-year-old Texas woman who began to have a high fever about 20 days ago, with a body temperature as high as 40°C, and the right inner thigh is red and swollen.

After being admitted to the hospital, the woman's condition worsened, not only the swelling of her right thigh increased, but also a large area of skin damage of 25 cm x 25 cm, accompanied by blisters and pus-like changes, and white blood cells as high as 14x109/L.

After a week of anti-infective treatment, the patient's condition not only did not improve, but continued to deteriorate.

Blood tests showed elevated levels of markers of infection and inflammation, and a sustained rise in neutrophils to 44.67 X109/L.

To the confusion and wonder of the doctors, neither wound culture, blood culture, nor NGS sequencing detected pathogenic microorganisms.

Later, vascular Doppler ultrasonography was done to rule out venous insufficiency or arterial disease.

While learning about the condition, the doctors at Baiyan Hospital learned that the patient had one or two high fevers and skin lumps once or twice a year since the age of twelve.

In cases where infection and fever were ineffective, Baiyan Hospital decided to use hormone therapy.

After a period of treatment, the patient's symptoms do improve, but the exact cause is still unknown.

So, Baiyan Hospital asked Boss Zhou for support.

Murphy and the others expressed their opinions, and finally agreed that if the patient has no bacteriological evidence, febrile neutrophilic dermatosis should be considered, and corticosteroids can be continued.

Just as Baiyan Hospital was preparing to conduct further examinations such as wound biopsy on the patient according to the instructions, the patient's right upper limb was red, swollen and skin ulcer, not only did the high fever not go away, but also showed critical manifestations such as dyspnea, reduced ejection fraction, and pericardial effusion.

After the consultation of the Iris Heavenly Group, it was decided to immediately transfer the patient to the burn intensive unit.

The progression of the patient's disease should be controlled first.

Under the remote guidance of the Iris Tiantuan, the team of Baiyan Hospital found that the patient's cardiac electrophysiology was not abnormal, but the myocardial contractile dysfunction was not caused by sepsis through ultrasound, USCOM and other circulatory function assessments.

"Have the patient in a semi-recumbent position, control the intake, and apply diuretics." Zhou Qiao pondered for a moment before giving an order.

The medical team at Baiyan Hospital was shocked, this is too risky, right? And it's weird!

Because, Boss Zhou's instructions are diametrically opposed to the traditional treatment plan of sepsis fluid resuscitation and power support.

No one questioned Boss Zhou's orders.

They didn't understand, they could only say that their level was low, and they didn't understand the subtleties of Boss Zhou's measures.

Therefore, this does not prevent them from implementing it immediately and unconditionally.

Soon, a miracle happened.

After following Boss Zhou's instructions, the patient's urine output gradually exceeded the intake, the pericardial effusion was decreasing, and the ejection fraction was also improving.

Nanako Chiba: "Will this treatment cause pathological dehydration in patients?" ”

"It's possible. But for the patient's current condition, it should be the best solution I can think of. ”

Several other girls also thought so.

"Monitor the patient closely for electrolyte changes," Murphy advises. Once there is an abnormality, we will adjust the plan. ”

Fortunately, the patient's condition gradually improved over the next few days. The partial pressure of oxygen returned to normal, the dyspnea was relieved, the chest CT was significantly improved, and the crisis was temporarily relieved!

The Iris Tiantuan and the medical team at Baiyan Hospital breathed a sigh of relief.

However, if it's just like this, it doesn't show the level of the iris group.

What is the symptomatic treatment? Cure the root cause is the real skill!

The Iris Tiantuan arranged a set of serial combination investigation plans, and after receiving it, the team of Baiyan Hospital immediately began to implement it in full swing.

This is a case that requires close cooperation between multiple disciplines, which is quite complex, but it can also improve the overall strength of Baiyan Hospital through this case.

After obtaining detailed data, Iris Tiantuan combined pathology and reality, and confirmed the previous judgment: acute febrile neutrophilic skin disease.

After the use of hormone therapy, the patient's high fever was controlled, and the redness and swelling of the damaged area began to subside.

However, such a large wound itself carries the risk of skin and soft tissue infection, and topical antimicrobial drugs may induce allergies or exacerbate systemic lesions due to drug toxicity and side effects, so accurate medication is particularly important.

Fortunately, this point is Nanako Chiba's specialty, and she is in charge of it, and Zhou Qiao is very relieved.

Nanako Chiba suggested that wound treatment with non-chemically absorbent dressings can be used to actively prevent infection and promote healing, and then it is also possible to use "Delska" in moderation, which will be very helpful for the patient's condition.

It's expensive, but it's worth it. Consent is also sought from patients and families prior to use.

Subsequently, under the leadership of Zhou Qiao, the iris Tiantuan carried out etiological examinations from multiple lines such as blood diseases, rheumatism and immunity, endocrine, tumors, inflammatory colitis, and pregnancy failure history.

In the follow-up treatment, Nanako Chiba adjusted the patient's hormone dosage in a down-graded manner, combined with immunosuppressant therapy and other treatment methods to actively control the primary disease.

At the same time, due to the use of the miracle drug "Delska", advanced dressings are used in wound treatment to make the wound wet heal, promote autolysis and debridement of necrotic tissue, reduce pain and accelerate healing.

……

After a series of combination punches, the patient's wound began to improve, the granulation tissue growth gradually shrank, and the cardiac function returned to normal, and then he was transferred to the general ward of the dermatology department for further treatment.

In the process of treating this patient, many departments of Baiyan Hospital, such as the Department of Burn and Plastic Surgery, the Department of Dermatology, the Department of Rheumatology and Immunology, the Department of Hematology, etc., under the deployment of Zhou Qiao, carried out close cooperation for the first time since the establishment of the hospital, not only establishing the routine of diagnosis and decision-making of difficult wounds and etiological screening, but also establishing a multidisciplinary MDT mechanism of programmed disease judgment, disease assessment and etiological search for patients with critical and difficult wounds.

It can be said that after this case, Baiyan Hospital has improved its experience in the treatment of critical and severe diseases such as refractory wounds and severe burns, and it is no longer weaker than Sequoia Hospital.

Both hospitals have grown, and Luo Ya is quite happy, so she decided to start preparing for the construction of a third hospital in Texas.

Her plan is to build 10 hospitals within 10 years to take care of all the remote or relatively remote medically disadvantaged areas of Texas. It's also a very big piece of cake.

Not only can it attract votes, but it is also quite profitable.

Zhou Qiao also took the time to go to Texas, one is to guide the work of two hospitals, and the other is to think about his "wife" and four sons.

The four big fat boys can already crawl around, very naughty.

may have inherited Luo Ya's "martial virtues", although they haven't learned to walk yet, the four brothers often fight together.

With such a "noisy" four sons, Zhou Qiao took them for a few days, and he couldn't bear it, and said in his heart that it was no wonder that Teacher Domitri disliked it.

Luo Ya gave him a blank look: "You have only been taking it for a few days?" If you don't like it, don't come in the future. ”

"How so? My own seed is a treasure no matter what it is. Moreover, good physical fitness and good exercise are advantages. Maybe we can have a few more Olympic champions! ”

"Haha, Olympic champions or something, if they grow up, they can also go and get one to play with." Luo Ya still has a lot of confidence in her sons. To be honest, if she hadn't gone undercover as soon as she graduated, but went to the sports world to develop, maybe she would have become an Olympic champion now.

I don't dare to say anything else, gymnastics and shooting are quite sure.

Zhou Qiao is in Texas, and Luo Ya is naturally a newlywed Xiaobiesheng, and there are many battles.

The other girls, one-on-one, are not Zhou Qiao's opponents at all, but Luo Ya and Zhou Qiao are evenly matched.

I have to say that after Luo Ya gave birth, not only is her figure still well-maintained, but her temperament is a little more gentle and moving.

"I'll give you a Chinese name." In the middle of the night, the two hugged each other on the bed, grinding their ears and temples, Zhou Qiao said.

"What's the name?"

"Luo Yourong."

"What a broken name, so ugly!"

Zhou Qiao whispered a few words in her ear, detailing its meaning.

"Bad guy, see if I don't suffocate you!" Loya was unusually shy.

However, although she has tolerance, it does not affect her usual agility.

(End of chapter)