Chapter 777: [(777)] Believe in your own medical judgement Chapter 777: [(777)] Believe in your own medical judgement Is that really the case? Clinical patients present with complex symptoms, and it’s hardly possible to easily and neatly identify the cause. If it were, no one would suddenly discharge a patient after a three-week hospital stay.
Xie Wanying chose this moment to listen to the patient’s heart. Upon reflection, there were many puzzling aspects in Yangyang’s Mom’s case that deserved further scrutiny.
For instance, the patient’s jaundice was relatively mild, hepatitis B markers were positive but transaminase levels were largely normal, and cirrhosis typically involves a shrinking liver whereas Yangyang’s Mom had an enlarged liver and spleen.
The patient’s chest X-ray appeared normal, with only a slight coarseness in the left lung striations and a normal mediastinum and heart shadow.
As for the ultrasound, both kidneys showed diffusive substantial damage which matched the manifestation of late-stage ascites due to cirrhosis. The liver displayed an enlarged portal vein. Due to the presence of ascites, the ultrasound was not clear enough to confirm if there was obstruction in the inferior vena cava, but based on their experience, the sonographer suspected it might be.
Given these results, it seemed necessary to rule out Budd-Chiari syndrome. Budd-Chiari syndrome is a kind of posthepatic portal hypertension, primarily caused by blockages of the liver veins and the hepatic segment of the inferior vena cava. Why no further examinations specific to the inferior vena cava were performed for the patient needed to be asked of Dr. Gong.
“Take a deep breath,” Xie Wanying instructed the patient.
Yangyang’s Mom took a deep breath and exhaled slowly.
After listening to both lungs, Xie Wanying noticed that the breath sounds in the patient’s left lung were coarse, which indicated some signs of inflammation.
Upon a careful listen to the patient’s heart, she detected a soft systolic murmur in the mitral area, but it was weak, probably grade two, certainly not reaching the threshold for organic heart disease.
In fact, patients typically have limited benefit from abdominal paracentesis. Thus, the treatment plan was adjusted to salt and water restriction and diuretics, with better effects based on the overflow theory. All that could be done in the hospital had been done, so the patient was allowed to be discharged after her condition improved.
Even so, after listening to the heart, Xie Wanying continued to mull over the stethoscope in hand; she felt that there was more to consider with this case. Now she would place even greater trust in her medical intuition, primarily because the case of the patient Li Yaxi in the bed next to hers had set off alarm bells for her.
Yangyang’s Mom looked up, as if she wanted to speak.
Xie Wanying leaned in to listen.
Yangyang’s Mom whispered to her, “The girl next door can’t sleep at night; she’s very frightened.”
Despite battling a serious illness herself, Yangyang’s Mom didn’t forget to show concern for her fellow patient. Perhaps, in her eyes, to see a young and beautiful college student admitted to the hospital was something that naturally invoked sympathy.
The medical staff were aware of Li Yaxi’s fear. The nurses had drawn a curtain between beds 20 and 21 to help shield the patients from each other’s view. But it was no use; for some patients, fear in such an environment becomes deeply ingrained. If one isn’t strong enough, like Li Yaxi, they might feel like they’re living a nightmare, both day and night.
“What is she suffering from?” Yangyang’s Mom asked the doctor, apparently wanting to offer the fellow patient some support.
“Whatever the disease, once admitted to the hospital, doctors will treat it with all their might,” Xie Wanying assured the patient.
Xie Wanying was confident about Li Yaxi’s condition, as Senior Tao had assigned Doctor Song to take charge, and breakthroughs were expected.
Yangyang’s Mom felt somewhat relieved by her words.
“I’ll discuss with Dr. Gong again when I go back, see if we can arrange another examination for you,” Xie Wanying told Yangyang’s Mom, “A clearer diagnosis means more targeted medication, and better treatment effects.”