Although not much happened in the emergency department late that night, Liu Banxia didn’t sleep well. After his usual rounds, he paid particular attention to the patient with the throat inflammation.
"You should pack up and go home early," Liu Banxia advised Liang Xiaolin. "There isn’t much happening in the emergency department right now; no need to wait until your shift officially ends."
"It’s only a little past six. I’m not falling for your trick," Liang Xiaolin retorted.
"Look, Dr. Chen already told you yesterday to head home early. If I don’t let you leave early, he’s going to give me a hard time. Even if I’m completely in the right, I’d still be wary of his bias," Liu Banxia joked.
"I don’t have time for your nonsense," Liang Xiaolin said, glaring at him.
"Dr. Liu, the observation patient you asked me to keep an eye on is awake. I just took his temperature. The fever hasn’t subsided, and he’s still coughing," Xu Dan reported, hurrying over.
Liu Banxia immediately tensed. The patient had received treatment for an infection, but his condition hadn’t improved; it seemed to have worsened.
"Doctor, I’m still feverish," the patient said, removing the towel from his forehead when he saw Liu Banxia.
"Try not to worry. Let’s do another ECG first," Liu Banxia suggested.
The current situation indicated that acute throat inflammation wasn’t the primary issue; otherwise, the patient’s condition would surely have shown some improvement by now.
The ECG results were normal, just like before. This left Liu Banxia completely puzzled. What am I missing?
Currently, the patient’s observable symptoms included fever, a sore throat, vocal cord paralysis, and chest pain. Heart disease, myocardial infarction, and aortic dissection had been ruled out. He had been rediagnosed with acute throat inflammation, but the medication was ineffective.
Picking up his stethoscope, Liu Banxia listened carefully to the patient’s heart and lungs again. Just like yesterday, there were no abnormalities.
Could it be a bronchial infection? If so, a bronchoscopy would be necessary. But even though it’s an endoscopic examination, it’s still somewhat invasive, especially since the patient has a history of high blood pressure.
"Fever, fever, fever. That’s what I can’t figure out right now. The enhanced CT scan didn’t reveal a new aortic dissection, so what’s causing the chest pain? Chest pain, chest pain... and the vocal cord paralysis, the coughing," Liu Banxia muttered to himself, pacing.
"Vocal cord paralysis likely means the recurrent laryngeal nerve is affected. Fever indicates infection, vocal cord paralysis indicates recurrent laryngeal nerve involvement, and chest pain suggests changes in the blood vessels around the heart. The enhanced CT didn’t show an aortic dissection... aortic dissection, aortic dissection... Huh... could it be? No, it can’t be."
Muttering to himself, Liu Banxia suddenly froze.
"What’s wrong? Did you figure it out?" Liang Xiaolin couldn’t resist grabbing his arm.
"It wouldn’t be appropriate for me to call Chen Xuehai at this hour. Could you contact him? Tell him I suspect an arterial aneurysm might be causing all the patient’s symptoms," Liu Banxia said.
"Uh... an arterial aneurysm? Didn’t yesterday’s enhanced CT scan rule that out?" Liang Xiaolin asked, frowning.
"What if the stent and the aneurysm overlapped? Could that have affected the scan results?" Liu Banxia explained. "Besides, aortic dissections often coexist with arterial aneurysms. Don’t worry about that part for now. We’d normally consult a cardiologist, but a cardiothoracic surgeon isn’t a bad option either. He was here yesterday and is already familiar with the patient’s case."
Seeing Liu Banxia’s expression, Liang Xiaolin frowned. "Isn’t this too risky? What if you’re wrong?"
She had been working with Liu Banxia for some time and knew his stubborn streak. He was insisting on calling Chen Xuehai to get back at him. But this was a huge gamble. She knew Chen Xuehai’s personality even better; if Liu Banxia made another misdiagnosis, Chen Xuehai would undoubtedly mock him relentlessly.
"Don’t worry," Liu Banxia said, scratching his scalp. "Who was it that said... ’Once you eliminate the impossible, whatever remains, however improbable, must be the truth’? Or something along those lines?"
Liang Xiaolin shot him a look and walked aside to make the call.
Liu Banxia turned to the patient. "You can relax a bit now. I believe my diagnosis is on the right track, and we’ll be able to treat your illness. By the way, I noticed you came in alone. Do you need us to contact your family?"
"I’m here on a business trip, so I didn’t inform my family. Doctor, can you make a definitive diagnosis this time?" the patient asked.
Liu Banxia felt a little awkward but nodded. "Based on my assessment, it’s highly probable. Moreover, your current physical condition is indeed somewhat unusual; for instance, your white blood cell count hasn’t shown the expected elevation."
"On what basis do you conclude it’s an arterial aneurysm? If it were an aneurysm, why would there be vocal cord paralysis and a high fever?" Chen Xuehai asked, walking in from outside.
"Vocal cord paralysis doesn’t necessarily mean there’s a problem with the vocal cords. What if an aneurysm is pressing on the recurrent laryngeal nerve?" Liu Banxia said with a smile.
"As for the high fever, that can also be explained. If the aneurysm is large enough to compress certain tissue layers, causing ischemic necrosis, wouldn’t that lead to an infection and result in a high fever?
"We’ve been too focused on the patient’s throat, assuming the high fever was due to pharyngitis, when the true source of infection was something we overlooked.
"Although my hypothesis might seem a bit outlandish, considering all the current symptoms, I believe it’s quite fitting. It’s the only explanation that connects all these symptoms.
"The patient’s blood pressure rose, and this pressure impacted the aneurysm, causing chest pain. We administered Betaloc to lower his heart rate and blood pressure, so his chest pain subsided.
"Today, the patient also developed a cough, which could be due to the aneurysm pressing on his bronchus. This is the diagnosis from our emergency department. If you don’t agree, I’ll consult a cardiologist."
Chen Xuehai stared at Liu Banxia, but Liu Banxia met his gaze without any intention of backing down.
"Fine. I’ll personally take the patient for the examination," Chen Xuehai stated.
"Take care now. Don’t be a stranger. Let me know the results when they’re in," Liu Banxia said with a grin, then turned to the patient. "See? You can rest assured now. I even rendered this formidable doctor speechless. My guess should be accurate."
"Doctor, is an aneurysm very dangerous? They mentioned it when I had a stent inserted two years ago," the patient asked.
"Don’t worry," Liu Banxia comforted him. "Any illness is scary when it’s undiagnosed. Once we know what it is, it’s much more manageable."
Chen Xuehai didn’t give Liu Banxia any more time, promptly leaving with a nurse pushing the patient’s bed.
Although Liu Banxia had spoken confidently, it was still a hypothesis based on his current knowledge. After Chen Xuehai left, he grew anxious.
Around seven o’clock, Liang Xiaolin’s phone rang. Liu Banxia instantly darted to her side.
"It’s a message... Hmm... Is it really an aneurysm?" Liang Xiaolin glanced at the screen, her voice rising noticeably.
DING! Sore Throat Patient Mission Accomplished.
Received 1,000 Experience Points, 1,000 Diagnostic Skill Proficiency Points.
Mission rating: Perfect. Received an additional 1,000 Experience Points, an additional 1,500 Diagnostic Skill Proficiency Points, and 5 Glory Points.
Congratulations, Host, for reaching Level 25 (35,255/36,785)! Received 1 Attribute Point and 5 Glory Points.
Seeing the system notifications, Liu Banxia couldn’t stop the grin from spreading across his face. Overjoyed, he impulsively swept Liang Xiaolin into his arms and spun her around.