The Enhanced Doctor-Chapter 704: Is indifference also a symptom?

(Thanks to Xiaomoshen’s Tentacle and Hyperion for their monthly tickets.)

"Doctor, what’s wrong with Jiaming?" the patient’s girlfriend asked worriedly, seeing the solemn expression on Liu Banxia’s face.

"His condition has taken a new turn; he’s now presenting with neck stiffness. I need to make some arrangements first, and then I’ll explain," Liu Banxia said.

"Miao Rui, schedule an urgent cranial and cervical spine MRI with radiology. After that, add a lumbar puncture to test the cerebrospinal fluid."

"Okay, I’ll get on it right away," Miao Rui quickly responded.

"Doctor, doctor, what exactly is going on?" The patient’s girlfriend was growing increasingly anxious.

"Here’s the situation," Liu Banxia explained. "Based on my manual examination, his neck stiffness isn’t severe yet; it appears to have just begun. There are many possible causes for neck stiffness, and we’re doing a cervical MRI to see if there are any lesions in his cervical spine. The cranial MRI and lumbar puncture are to check for encephalitis or meningitis."

He continued, "Please don’t be alarmed by what I’m about to say, but I believe all his symptoms, including the current neck stiffness, stem from an underlying cause we haven’t identified yet. From our perspective, we now have a clearer diagnostic direction. This pathogen hasn’t just affected his blood; it’s likely impacting his cerebrospinal fluid and lymphatic system as well. We previously speculated whether a lymphatic system disorder might be causing this series of symptoms. Now, I’m quite confident that a single pathogen is responsible for all these symptoms."

"The current high fever is very likely due to encephalitis or meningitis, as these conditions often present with high fever. It’s just that initially, we focused on the thrombus and overlooked his head discomfort, assuming it was just a reaction to the high fever."

"Doctor, just tell me, can he be cured? We’ll cooperate with any tests you need to do," the patient’s girlfriend pleaded.

"While I can’t give you a definitive answer right now, based on his current presentation, I believe a diagnosis is only a matter of time," Liu Banxia answered. "He’ll need to lie flat in bed to rest after the lumbar puncture, so let’s do the MRI first. You can also go ahead and complete the admission procedures, and then we can take him directly to the ward."

Liu Banxia explained patiently and in detail. However, the patient’s girlfriend wasn’t able to fully grasp everything he was saying. The only things she could focus on were the need for admission and payment.

After Miao Rui had made the necessary arrangements, he wheeled the patient over for his MRI.

Liu Banxia glanced into the internal medicine consultation room; Wang Huan still had a patient. He sent a message to update Wang Huan on the latest developments.

He also sent a message to Xu Guosheng and then headed to the neurology department. He still needed to discuss this case with Peng Bo.

The patient’s symptoms indicated a systemic disease. Everyone needed to be alert, and a joint consultation would be necessary. The interns he was leading, Xu Yino and the others, also needed to follow along and observe this case closely.

"It might sound a bit callous, but the patient presenting with neck stiffness actually makes me somewhat optimistic," Liu Banxia said once the three of them had gathered.

Peng Bo nodded. "Based on the current situation of your case, it’s highly probable that some pathogen has entered his bloodstream, leading to this series of effects. However, one thing is very unusual: the patient’s white blood cell count. Neck stiffness is usually a significant sign of meningeal irritation, common in encephalitis or meningitis, but his white blood cell count doesn’t quite support that."

"That is indeed the case," Xu Guosheng said. "I’m now leaning towards President Liu’s earlier judgment: the pulmonary emboli weren’t formed from a dislodged deep vein thrombus in the leg but originated in the bloodstream itself. That raises a crucial question: if thrombi can form in the legs and lungs, can they also form in other organs and parts of the body? Could the patient’s current condition affect multiple organs?"

"The enlarged spleen is one manifestation. It should have already affected the lymphatic system to some degree. Once the blood biochemistry results are out, I believe we should promptly adjust his electrolyte balance. And considering the patient’s current condition, I also personally suggest assigning an experienced doctor to monitor him constantly until we have a clear diagnosis. The patient is in an acute phase. Even though we’ve administered anticoagulants and thrombolytics, we can’t yet control their effectiveness. If this pathogen continues to cause extensive thrombus formation in the blood during this acute phase, it will be very dangerous."

Liu Banxia nodded. "I share that concern, which is why I’ve had Miao Rui constantly monitoring him. The blood biochemistry and stool examination results should be out in a bit. Deep down, I still feel this might be some kind of parasite. But based on my current knowledge of parasites, I can’t find a similar case. We’ve handled several parasite infection cases in the Emergency Center, but they all seem somewhat different, not quite fitting. I even considered some kind of toxin. But the patient and his girlfriend live together—they eat, use, and share everything. If it were a toxin, his girlfriend should also exhibit some symptoms."

"We can’t rule out the possibility of parasites. Parasites these days are diverse—common, uncommon, specific types... let’s see the stool examination results first," Peng Bo said. "Didn’t you also arrange a lumbar puncture? Although the results aren’t back yet, in my personal judgment, it has definitely caused some degree of intracranial infection. We must hurry; we need to find out what it is. This situation where thrombi can form in the blood is truly too dangerous. If we can’t stop it and it spreads throughout the body, what dosage of anticoagulants would we even need?"

Peng Bo’s words plunged everyone into silence.

This was indeed a problem that needed to be faced. The rate of this thrombus formation was still unknown. The only thing that was certain was that the patient’s condition was in the acute phase. Often, once a disease enters the acute phase, it develops at a very fast pace.

"Do you two have any good solutions?" Liu Banxia asked.

Xu Guosheng shook his head. "Let’s see about the cerebrospinal fluid culture. We can also check the CSF for ova or larvae. Then there’s the matter of reducing his temperature. Ice packs alone might not be enough. If necessary, let’s give him an alcohol rub. It might alleviate his symptoms somewhat. Being constantly in a high fever is a significant strain on his body."

Liu Banxia nodded. "We can also check if he has any insect bites. The chances are slim, but it’s a possibility. Given the weather here, it’s very difficult to contract something like that externally. I keep thinking they might have eaten something, but his girlfriend said everything they ate was cooked. Unless the young man ate something outside without telling his girlfriend. His mental state is very poor; if it weren’t for his neck pain, he probably wouldn’t speak at all. It’s really hard to get anything out of him. In this state, other patients, even if their spirits were low, would be more forthcoming. His girlfriend also mentioned he’s usually very cheerful. Hmm... Peng Bo, do you think the patient’s current apathy could also be a symptom? Could this illness have affected his nervous system to some extent?"

Peng Bo frowned. "If so, that would point more towards toxins again. Should we run a heavy metal and toxin screen?"

"You’re making me hesitate. We’ve already run so many tests on him," Liu Banxia said, frowning. "Even if his girlfriend said any test is fine, we still need to be cautious."

"Let’s wait for the blood biochemistry and stool exam results. Then we’ll observe the effects of the anticoagulation and thrombolysis. If the effect is good, we still have some time. If it’s not very effective, we’ll have to act quickly," Xu Guosheng added.

"Okay, let’s go with that for now. I’ll inform everyone of any new developments. I’ll head back first and wait for the test results," Liu Banxia said.

Although they hadn’t reached a clear conclusion, this consultation did provide some direction for diagnosing the patient’s condition.

This is a very tricky case, potentially quite dangerous, Liu Banxia thought. I can’t afford to be careless.

"How was your consultation experience just now?" Liu Banxia asked on the way back.

"Teacher Liu, I honestly feel I’m having trouble following your train of thought," Xu Yino said. "I suppose it’s due to a lack of knowledge and familiarity with medical procedures. When you discuss something, you can quickly move to the next deduction and possibility without much explanation, but I can’t keep up."

"I’m pretty much the same," Su Wenhao said.

"Teacher Liu, are systemic diseases like this generally difficult to treat?" Xu Yino asked.

"That depends on the specific type," Liu Banxia said. "My personal judgment is that it’s blood-borne. Currently, it has affected his legs and lungs, and the findings in the cerebrospinal fluid might indicate some kind of infection. Let’s see how things develop. Sometimes, a condition can appear very severe, but we absolutely must not panic. It’s often in such moments that we might make an unexpected discovery and diagnose the illness. As doctors, we must remain calm. To put it bluntly, our resolve must be strong. If we panic, it becomes even harder to treat the patient effectively."

The interns nodded.

They had attended consultations with Liu Banxia more than once or twice, but each time felt somewhat different. However, through this consultation, they also recognized their shortcomings. They realized their knowledge base was still somewhat lacking.