There had been few incoming patients the day before and those already in the emergency ward had remained stable throughout the night. Hence, the shift handover was brief.
Once the handover and ward rounds were done, Old Chief Physician Pan returned to his office.
Zheng Ren called the two middle-aged visitors over to ask about the patient’s history, checking their scans and medical test results.
The patient was a 69-year-old male with no prior medical conditions. A week ago, he had sustained some blunt force trauma and had gone to the local hospital for a check up. An ultrasound scan had revealed space-occupying lesions in the liver; the largest was 6 x 7 cm and suspected to be malignant.
The patient’s medical history was simple and clear. The space-occupying lesions had spread throughout the liver and conventional surgery was no longer an option.
Right now, interventional surgery was the best route.
However, Zheng Ren could not tell if the surgery would be effective without a contrast-enhanced 64-slice CT scan.
He informed Chang Yue to admit the patient before heading off with Su Yun to check on the post-surgery patients.
They arrived at the gastroenterology department and were greeted by Department Chief Xia. Her treatment of Zheng Ren had improved significantly; even the other department chiefs did not receive such warmth.
She personally escorted them to the TIPS surgery patient.
His hematemesis had abated and hepatic encephalopathy was no longer an issue. Zheng Ren estimated that the second stent could be removed after one or two days of observation.
The patient’s family thanked him profusely, but he was just glad he had managed to save the man from death.
Gratitude from the patient’s family was secondary.
The sump syndrome patient was also recovering from her surgery. There were still hints of a fever but it was being managed.
She had a body temperature of 39.5 °C pre-surgery, but it now hovered around 38.5 °C.
Zheng Ren was confident in his operation. The next most important thing to treat was the patient’s sepsis. Once that was under control, she would have won the battle.
After the checks were done, Department Chief Xia escorted them all the way to the entrance of the gastroenterology ward.
The gesture was Department Chief Xia’s way of acknowledging Zheng Ren’s expertise. She now saw him as a peer, rather than a subordinate.
The two young doctors quickly made their way back to the ICU.
Su Yun showed no symptoms of a hangover, unlike the last time he tried competitive drinking with Chang Yue.
Zheng Ren was perplexed. The amount of Scottish whiskey Su Yun had imbibed yesterday night far outweighed the alcohol content of 11 packs of Snow beer, but the man was totally fine today.
As they walked, Su Yun suddenly asked, “Yesterday, did you get it?”
Get it… Zheng Ren was not sure how to answer the question.
If a hug was being implied, then yes, but Zheng Ren knew Su Yun meant something else.
“Your mood this morning tells me you at least got something. Don’t rush; girls don’t like a clingy man. One step at a time,” Su Yun advised.
Zheng Ren found himself agreeing. He was glad he had managed to hold back yesterday.
Who knew what would have happened if he had given in to his emotions.
The two doctors changed before entering the ICU. Department Chief Qian was discussing a case, a stern expression on his face.
“Little Zheng, you’re here,” he said upon seeing them.
Sensing that the man had questions, Zheng Ren approached.
“The patient in the fifth ICU bed is struggling. We had thought her breathing tube could be removed today, but when the sedative wore off, her vitals became unstable.”
Department Chief Qian’s explanation was precise and to-the-point.
This would be the trauma patient who had fallen from a great height. Zheng Ren had performed her surgery.
Was there something he had missed?
Zheng Ren thought about it. She ought to be recovering gradually and was due to visit the orthopedic department in the next few days.
The System’s mission, Save People from Misery, was ignored. Zheng Ren was not interested at the moment.
An elective surgery could never be treated like an emergency surgery. There were just too many unpredictable consequences for the patient.
What was going on?
Zheng Ren studied her. The display in the top right corner of his vision was still a mild red.
As expected, her multiple bone fractures had yet to be addressed.
Based on the System’s diagnosis, there was nothing amiss…
Mystified by the turn of events, Zheng Ren silently stood aside and listened to the ICU doctors’ case discussion.
Su Yun sidled up to him and whispered, “Boss, I have a feeling the patient’s adenomyosis is acting up, causing agitation to be observed whenever sedatives wore off.”
Zheng Ren thought it over. Without exact measurements, he could not come to a firm conclusion.
He nodded slightly, putting his right hand on his forehead as he ruminated.
“Little Su, what’s your opinion?” Department Chief Qian asked.
“Chief Qian, I think the patient should undergo an interventional surgery to treat her adenomyosis. If it does not solve the issue, her uterus will need to be removed.” Before anyone could interject, Su Yun continued, “The patient could no longer live with the pain from the adenomyosis and decided to take her life.
“We do not know how much pain she is in, but I believe it must be at fourth grade.”
The pain scale commonly seen online ranged between 1 to 12. In medicine, though, pain was sorted into four grades[1], the fourth being the most severe to the point of affecting blood pressure and heart rate.
The ICU doctors were used to Su Yun being right and did not repudiate him.
Although his diagnosis was out of the ordinary, the more they thought about it, the more it made sense.
Department Chief Qian sighed.
“The pain from the fractures can be lessened by remaining still, so I believe the root cause of the patient’s agitation is her adenomyosis.
“I suggest we inform the patient’s family. If worst comes to worst, we will have to remove the uterus. We shouldn’t delay any longer; the patient has been using a breathing tube for nearly 48 hours and we may end up having to perform a tracheostomy soon.
“There will be a risk of lung infections and other sorts of complications, threatening recovery,” Su Yun elaborated.
Zheng Ren was unsure if the agitation was truly caused by adenomyosis, but agreed with Su Yun’s assessment nonetheless. “We should try.”
The patient was no longer in danger of bleeding out. It was worth a shot.
After all, it was a minimally invasive procedure.
Were it not for her fractures, the patient would be able to walk 24 hours after an interventional surgery.
If they had the compression device and other high-end equipment from Imperial Capital at their disposal, her recovery time could be cut short to 4-6 hours.
Department Chief Qian was impressed. Adenomyosis was not a rare disorder, but most women chose to perform a hysterectomy, giving up their reproductive ability.
The disorder was usually found in older women. Department Chief Qian had no experience handling a younger patient, who had yet to give birth, with it.
After some thought, the chief said resolutely, “I’ll talk to the family. We can give it a shot.”
[1] Non-medical pain scales seem to stretch from 1 to 10 at most. The author could be taking artistic liberties.
