Chapter 206: 【206】Careful investigation is very important
“Relax a little, okay? There’s no need to be nervous, Auntie,” Lau Jingyun tried to soothe the patient’s emotions.
“I can’t bend over, my back hurts so much,” the woman kept crying out in pain.
Lau Jingyun looked back at the clock, wondering if the operating surgeon might arrive soon. If they saw that the patient hadn’t been properly anesthetized, they were likely to get angry. This was a midday surgery, already a sacrifice of the surgeon’s rest time on behalf of the patient’s emergency.
The result of the surgeon getting angry would be the same as last time with the emergency department—eventually complaining to the anesthesiology department: “It’s only a simple spinal anesthesia, can’t your people even do that right?”
“Don’t be nervous, take a deep breath, Auntie. May I hold your hand first?” Lau Jingyun grasped the patient’s hand, sincerely wishing she could take the patient’s pain upon herself.
Xie Wanying examined the patient from head to toe, looking for any problems.
Lumbar disc herniation—so that’s why the back pain? Was the patient exaggerating her complaint, saying the pain was so bad she couldn’t bend her waist at all? Some patients get nervous upon entering the operating room, amplifying their perception of pain.
The patient’s heart rate was a bit fast on the monitor, and strangely the blood pressure was a bit low?
“Big Sister,” Xie Wanying called out to her senior colleague again.
Lau Jingyun turned around, asking with concern, “What’s wrong?”
“The lumbar puncture shouldn’t be done.”
Perhaps the junior didn’t understand that a lumbar puncture could be done for a lumbar disc herniation. Lau Jingyun was ready to explain this to her junior.
Moving around the patient’s bed to her senior colleague’s side, Xie Wanying whispered, “Perhaps we need to rule out spinal problems, like ankylosing spondylitis?”
A spinal problem? Lau Jingyun was startled.
“Is this an emergency patient? How many tests were done?” Xie Wanying asked.
Lau Jingyun looked back at the medical records on the treatment cart—yes, it was an emergency patient. Perhaps the emergency doctor, fearing complications, rushed to schedule the surgery.
Wondering what exactly the situation was, Lau Jingyun went back to check the medical records more thoroughly. It turned out the patient had an anal fistula and had undergone anal surgery before using local anesthesia. There was no risk with local anesthesia as it was for a low-position fistula. Later, a recurring issue was discovered, potentially involving a high-position fistula. Coming from the emergency room, this time to the operating room, it appeared they intended to perform a definitive anal surgery.
To perform surgery, basic preoperative tests would have been done, such as an electrocardiogram, which showed no major issues, a blood test, and coagulation was not a problem. Due to the fistula, there was definitely an infection, indicated by the high white blood cell count, thus necessitating surgery.
Lau Jingyun thought over and over, why did her junior suspect a problem with the spine?
“If it hurts , could there be spinal deformity? The last time the local anesthesia was done, she probably didn’t need to bend over,” Xie Wanying said. “Plus, the patient is thin, her white blood cell count is high. While it’s said to be caused by an anal fistula, could there be other causes?”
Bending over and back pain usually isn’t described to this extent; the patient can’t bend over at all, and she says her head hurts too.
If there is a problem with the spine, spinal anesthesia definitely couldn’t be administered. It’s a contraindication.
It’s correct to be cautious, but to confirm this reason, the patient would need to get an X-ray, and a clinical doctor would need to be consulted. If it were another teacher, it might be okay, but today it’s Director Zhang, Lau Jingyun dreaded even thinking about it.
Putting down the medical record, Lau Jingyun went back to the patient’s bedside, reaching to feel the patient’s back to assess the spinal condition, a positioning movement she would normally do before anesthesia. Feeling carefully, she discovered that the muscles in the patient’s back were extremely stiff, clearly abnormal, and it seemed quite concerning.
“Wasn’t a chest X-ray taken?”
“She’s a non-admitted patient who came from the emergency department; there wasn’t time to take one,” Xie Wanying helped her senior check the medical records and said.