As an emergency doctor, Yuan Ping'an does have very serious flaws. At the residency level, this deficiency is resolved by the supervision and attention of senior physicians. But when he was promoted to chief resident physician and had to start taking care of the work on his own, his shortcomings began to be exposed.

This defect, in Zhu Minhua's words, is "excessive concentration". In Zhou Jun's view, Yuan Ping'an's problem is that "he does not have the ability to multi-task parallel processing".

He's so much like a specialist.

How many patients do we have to come to the emergency department every day? How many of these patients may be incurable? In the eyes of the director of the emergency department, a good emergency physician must not be like a specialist, who abandons all the work at hand for the sake of a patient and then focuses on a symptom.

This is irresponsible to other colleagues and patients.

Although Yuan Ping'an is still running in with the department, it is not realistic to make him a combat force immediately. But Zhou Jun has already understood the main reason why Zhu Minhua threw Yuan Ping'an to Ning Yuanlai - it is also to diagnose rare patients, look at Sun Lien!

Therefore, people have to die more than people, and goods have to be thrown away. Obviously an excellent emergency doctor, as long as he can clearly distinguish the focus and tendency of his usual work, he can have a drastic change. As a result, compared with Sun Lien, a guy with a plug-in, he suddenly became a role that needed to be delegated to a grassroots hospital to re-exercise.

On the other hand, Yuan Ping'an is actually quite satisfied with his performance. After all, it is not easy to figure out the type of Yang Jianqiang's disease, the sequence of onset, and the reasons for the rapid progression of the disease. If he hadn't consulted nearly 100 case reports at home and abroad, and made bold speculations about linking the adjustment of immunization regimens with the disease, he would never have guessed the correct answer out of thin air. And to be able to string together the above series of keys in such a short period of time, and put forward his own diagnosis plan and treatment suggestions, Yuan Ping'an's ability is definitely not weak - at least worthy of the signboard of Tongxie.

Lovely ...... To put it bluntly, it is an animal that can be paralyzed. Just like a chipper in table tennis, in other countries, a player with the ability of China's provincial teams can definitely attract the attention of many people. But if you put this player in China, probably not many people will notice his skills - does the national team know? We're all tired of looking at it. You are a foreign chipper, no matter how good you are, you can beat the national team?

Yuan Ping'an is such a chipper. He was extremely cruelly thrown by his own coach to a place where "even a fat man who doesn't know how to play is a world champion". and then accept the contempt from all walks of life in the national team.

I really don't blame him, but compared with Sun Lien, Yuan Ping'an is really a little ...... It's too ordinary.

"What's the treatment plan?" Zhou Jun frowned, but didn't say anything else. Looking at Yuan Ping'an's face, you can know that since Yang Jianqiang was sent to the hospital, Yuan Ping'an has probably been checking the information. With this work attitude, he really can't say anything critical.

"You can't use sulfadiazine, it's too slow. Yuan Ping'an didn't notice some strange atmosphere in the conference room, he was still immersed in his achievements in finding the problem. "I recommend, do radiotherapy. ”

Yuan Ping'an considered this treatment plan for a long time. He also knows how controversial the treatment itself can be. However, after synthesizing a large number of data and literature, Yuan Ping'an determined that the only treatment with the fastest effect and sufficient specificity is radiotherapy - according to the data, after γ radiation of 0.46kGy/min and a total dose of 0.55kGy, it can at least effectively inhibit the reproduction of Toxoplasma gondii, and can also prevent Toxoplasma gondii from forming cysts in the human brain.

However, there is still a big problem with this treatment plan - no one has ever treated Toxoplasma gondii infection with radiotherapy before, and the data on the inhibitory effect of γ radiation on Toxoplasma gondii is limited to animal experiments. It is still unknown whether the radiation dose of 0.55 kGy is sufficient to inhibit the reproduction of Toxoplasma gondii in humans, whether the irradiated worms will die quickly and thus trigger a more serious immune response, and whether such a large dose will cause intense discomfort in patients.

The most troublesome problem is that as a treatment method that has never been used before, γ radiation therapy to kill Toxoplasma gondii is a "first-of-its-kind" treatment in China. According to the corresponding regulations, before this treatment can be carried out, it needs to be approved by the family first, and submitted to the department director for signature, and the ethics committee is convened for review, and it must also be reported to the provincial health commission for review and approval.

If there was so much time, Zhou Jun wouldn't have to worry about this kind of problem - just go directly to sulfadiazine. Now is an extraordinary state, and extraordinary measures must be used.

"Let's go talk to the family first. Zhou Jun listened attentively to Yuan Ping'an's explanation of the radiation dose. The radiation dose of 0.55kGy is not small. The radiation dose of 550Gy is almost ten times the prescribed radiation dose for the average small tumor. It even exceeded the generally recommended cumulative radiation limit of 300 Gy. Although considering that the irradiation sources in these toxoplasma animal experiments are mostly not highly directed, the γ knife is not very direct, so the dose will be much higher. But it's still a very dangerous treatment.

The people present were all experts who came for consultation, and of course talking to family members could only be left to the lowest-ranking young doctor in the field. So, Yuan Ping'an, who had just broken into the conference room, was naturally arrested.

"You go to Sun Lien and take him with you to talk to the family. When he was about to go out, Zhou Jun specially instructed. The use of Gamma Knife for Yang Jianqiang is extremely risky, but it is the only treatment that can catch up with the time. The stakes must be clearly explained so that the patient's family can make a decision that is in the best interest of the patient. And Yuan Ping'an...... Zhou Jun was not very relieved. Although Sun Lien is far younger than Yuan Ping'an, in several conversations with his family, Sun Lien can make some unexpected gains. Letting Sun Lien talk with him may help doctors and patients communicate better.

Zhou Jun sent Yuan Ping'an away and began to discuss the issue of radiation dose with experts from the imaging department and the nuclear medicine treatment department. The radiation dose of 550 Gy is almost absolutely unacceptable, but how much the dose is reduced can still guarantee the killing of Toxoplasma gondii, which requires a lot of research and calculations by experts.

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"Do you really want to have radiotherapy?" Sun Lien was blocked by Yuan Ping'an on the way back to the ninth clinic. After he heard the content and direction of the conversation, Sun Lien looked extremely shocked. Although he initially proposed radiotherapy, it was only an "immature idea" of his, and Sun Lien's main purpose when he proposed this idea was to remind Zhou Jun that the patient's condition was serious. Precise irradiation using γ rays is one of the commonly used treatment methods in the field of nuclear medicine, but the content of nuclear medicine is highly specialized, and Sun Lien has little understanding of this method. But even if he doesn't know much, Sun Lien also knows that using γ rays to treat toxoplasmosis encephalopathy is definitely a sword off the edge - this is not a solution that ordinary people can come up with.

"There is basically zero clinical research in this area. Even the dose data for irradiation has only been done in vitro experiments on animals...... And it is still on the path of attenuated vaccine research. Yuan Ping'an, who calmed down, also felt that his suggestion might be a bit excessive, "I checked a lot of information, most of which were research results from 20 years ago. Whether it can be applied in clinical practice and how many side effects there are, no one can say. ”

"Then we have to convince the patient's family to have an unprecedented treatment in her husband's head. Moreover, the radiation dose is determined by the direction of research in the manufacture of vaccines. Sun Lien suddenly felt that the future was bleak, and the more he talked, the more frustrated he became. "I think...... As long as the patient's family is in good shape, they will all reject this treatment plan, right?"

"If she refuses the treatment plan, then she has to prepare for her husband's funeral. There was no one around, and Yuan Ping'an spoke a lot more bluntly. In fact, this plan is a gamble, betting that her husband can survive. Anyway, if you don't bet, you will definitely die, and if you gamble, you may be able to live. ”

Sun Lien blinked, he really couldn't put himself in the perspective of these patients' families to think about this problem. As a doctor, of course, he knows that this may be Yang Jianqiang's only chance to live, but it is really unknown whether the family will agree. Radiotherapy is a treatment that many patients and their families are reluctant to accept – the myth that radiation causes cancer has been ingrained in the minds of ordinary people for many years. Treating diseases at the risk of causing cancer will be difficult for many people to accept.

The role of the doctor's conversation is to help these patients and their families turn the corner. Cancer is scary, but only living people can get it.

Dead people don't have cancer cells. Cancer is scary, but in the face of death, it is only a small side effect. What's more, the current gamma knife is advanced in technology and extremely accurate in positioning, and generally does not have too serious side effects. Although some acute radiation injury is unavoidable, it is generally not severe enough to induce cancer.

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"Gamma knives? Yes. What Sun Lien didn't expect was that Mrs. Yang agreed to their request without even hesitation. "How many times do I need to do it?What is it?,How much is it used?," not only did she agree very happily, but Mrs. Yang also asked very expertly.

However, these expert questions, which are supposed to promote doctor-patient communication, directly asked Sun Lien and Yuan Ping'an. How do you answer that? "All eight areas of the brain are irradiated, and we are counting the number and dose?"

"The problem is not a few ......" Sun Lien pondered for a long time, and felt that it was better to tell the truth. "Truth be told, we should only get one chance. If a single radiation does not have the desired effect, it is likely to ...... It's too late. ”

Mrs. Yang raised her head suddenly, her eyes full of shock, "What?!"

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