diymy Chapter 1519 - 614: Starting from the Course of Illness, Come Sit with Me Whenever You Have Time
Chapter 1519 - 614: Starting from the Course of Illness, Come Sit with Me Whenever You Have Time
Sometimes he really liked to sprinkle in a bit of black humor, cracking dry jokes and the like.And he was especially genuine with people.
Of course, it wasn’t that kind of boundless, bottomless sincerity. With friends and people he trusted, he could be extremely frank, but with patients and their families, it depended on the situation.
Any doctor even slightly older has, at some point in their career, acted out of great kindness and then tasted what it’s like to be bitten back by a "viper."
"So if you weren’t sneaking off, what were you doing? Ran up to the wards to flirt with the pretty nurses?"
Director Yin asked when he heard this.
"Hey, hey, you can’t just say stuff like that. If my girlfriend heard you, she’d make me sleep on the couch for sure. I went to the ward just now to check on that female patient and did some examinations and questioning."
Hearing that Zhou Can had gone to the ward to see the patient, a smile immediately appeared on Director Yin’s face.
"Hoho! Looks like I underestimated you. Any diagnostic breakthroughs?"
What he cared most about was the patient’s diagnosis and treatment.
He immediately asked whether there had been any diagnostic progress.
His eyes were full of expectation, because every time Zhou Can made a move, he managed to make some breakthrough; he had almost never let him down.
"There are indeed a few small findings. Let me carefully work through them again in combination with her lab results, and then I’ll offer some reference opinions."
After he finished speaking, Zhou Can really did pick up the patient’s file and start studying it carefully.
This was already his second read-through.
Sometimes diagnosing a disease is just like that: you have to repeatedly weigh the patient’s test reports against the etiology and medical history, and only after confirming there are no errors can you draw a conclusion.
Walking on thin ice, being extremely cautious—that’s the norm for doctors making a diagnosis.
Director Yin did not disturb him, merely smiled, quietly refilled his tea, and then turned back to studying that high-level paraplegia case on his own.
The two of them were actually quite something.
Whenever they ran into a difficult case, they would diagnose each other’s patients.
In clinical practice, this could be called a consultation.
Pooling ideas and discussing together is a common method doctors use to tackle difficult cases. A single person’s wisdom and strength are ultimately limited; every doctor’s diagnostic thinking is different, and so are the things they notice.
It’s like the blind men feeling an elephant: different diagnostic approaches mean different ways of discovering the cause.
For example, when diagnosing the same cold, some will start from the patient’s fever, some from the loss of appetite, and others from the headache or generalized fatigue. The diagnostic paths differ, but the final correct answer is basically the same.
After nearly twenty minutes, Zhou Can seemed to have reached a conclusion.
He looked up at Director Yin.
"Go on, I’m listening."
Director Yin had long since finished diagnosing that little boy with high-level paraplegia and was leisurely sipping his tea. Seeing Zhou Can look up at him, he immediately understood that Zhou Can’s diagnostic work had also reached a stopping point.
"Although this female patient’s course of illness has been very long, after questioning her I believe her onset was quite acute. It all started after she accidentally got chilled once, then developed a headache, which has persisted ever since. The characteristics of this disease are acute onset, long course, and relatively slow progression. When I entered the ward just now to examine her, I found swelling of the optic disc, traction pain in the head when the right eye moves, and a clear pharyngeal reflex when swallowing..."
"Her white blood cell count is elevated, ESR is accelerated, cerebrospinal fluid cell count is increased with mononuclear cells predominating. CSF protein is also markedly elevated, glucose is decreased, but chlorides are normal. No acid-fast bacilli or cryptococcus, including Cryptococcus neoformans, were detected in the CSF. Her chest X-ray is normal, indicating no obvious lesions in the chest or lungs. Her blood count is also slightly elevated. Combined with the fact that she had a fever upon admission, my diagnostic conclusion is that an acute infection is more likely."
After describing the patient’s overall condition, Zhou Can summed up.
"On this point I agree; the patient indeed has a possible acute infection."
Director Yin nodded, agreeing with Zhou Can’s view.
"Let me first talk about a few diseases I suspect, and then we can discuss them one by one. First, cryptococcal meningitis caused by Cryptococcus neoformans. This disease occurs mostly in young and middle-aged adults; the patient is in her thirties, right in that range. It can have a subacute or chronic onset, which fits well with her acute onset. It is accompanied by moderate or low-grade fever, again consistent with her condition. It also presents with headache, vomiting, blurred vision, diplopia, neck stiffness, and meningeal signs, all of which closely match her symptoms."
"Moreover, as the disease progresses, it can lead to impaired consciousness, and a small number of patients develop generalized convulsions, which also fits her case. The suspicion for this disease is very high."
Zhou Can started from the patient’s clinical manifestations and identified a disease that highly matched her presentation.
"However, although the glucose content in her CSF is significantly decreased, the chlorides haven’t changed, and India ink staining hasn’t revealed any cryptococcus, including Cryptococcus neoformans, so we can’t confirm this diagnosis. We can repeatedly tap CSF and send it to the lab multiple times to look for cryptococcus."
Every disease has its diagnostic gold standard.
For example, with cryptococcal meningitis caused by Cryptococcus neoformans, even if the patient’s symptoms all match, if no cryptococcus is found when the CSF is tested, the disease cannot be definitively diagnosed.
In clinical practice there are many strange and rare diseases whose symptoms are almost identical to another disease, yet they are not actually that disease.
Therefore, doctors are extremely cautious when diagnosing etiologies; unless the gold standard is met, they won’t easily make a definitive call.
"I also suspected this disease. We’ve already been tapping CSF and sending it for testing for several consecutive days, and no cryptococcus has been found in any of the results."