The Enhanced Doctor-Chapter 716 Seeing the Small to Know the Large

"Doctor, my throat was a bit inflamed some time ago, but some medicine made it better," the patient said.

"You should take care of your body. Aside from anything else, with how skinny you are now, there must be some problems," Miao Rui said.

"The tests I’ve prescribed for you right now aren’t very expensive. Just to be safe, it’s best to get them done. You’re already in the hospital, after all. You wouldn’t want to go home wondering, would you?"

"Yeah, Old Zhao, you’re already here, just get the check-up. What if you really do have a heart condition or something?" his colleague suggested.

"I just feel like it’s useless, and it’ll cost several hundred yuan. With that money, wouldn’t it be better if we bought some meat and made a stew?" the patient said hesitantly.

"The main thing is, you have symptoms of chest pain, so we’ve got to do an EKG and an ultrasound of your heart. You also have symptoms of weight loss and have had trouble swallowing, so we need to check your esophagus," Miao Rui patiently explained.

"Actually, it’s really no use. I know my own body. If it weren’t for the fear that I’d die on the worksite, I doubt they’d even call an ambulance," the patient retorted.

"It’s okay, no need to check. I haven’t lost that much weight. I’m bound to put on weight during the New Year at home, but when I’m out working, of course I’d lose weight. If I got fatter the more I worked, everyone would be scrambling for a cushy job like that."

Miao Rui was somewhat conflicted. He didn’t know how to persuade this patient. It was clear the patient was simply worried about the money. However, given the patient’s current condition, these were already the minimum necessary tests.

"Friend, do you usually drink liquor or beer?" Liu Banxia asked.

"I drink liquor at home. Out with friends, we still drink liquor. By myself, a bottle of beer to quench my thirst is enough," the patient answered.

"Doctor, I’m really not ill. The taxi back to the worksite costs dozens of dollars. Fengshan, let’s go. Now that we’ve had a break, I’ll buy some vegetables and have a good meal tonight. My treat."

"You seem to be in a better mood now, but you can’t leave yet. Even if you’re not concerned about your condition, we still need to understand it a bit," Liu Banxia said with a smile.

"What about your daily diet? Do you like hot soup? What kind of alcohol do you usually drink? My dad used to buy draught liquor by the bucket to drink at home."

"That’s right. That cheap liquor goes down smooth, doesn’t give you a bad hangover, and still packs a punch," the patient chuckled.

"Alright then, let’s not do the other tests. How about just an esophageal barium meal test? Just this one, it’s not expensive," Liu Banxia proposed.

"Old Zhao, the doctor has already said this much, just get this one done. I won’t be at ease otherwise," the patient’s colleague insisted.

"Doctor, is it really not expensive?" the patient asked tentatively.

"No, it isn’t. It’s just an X-ray examination. We’re not asking you to do a CT scan or MRI; we generally don’t need those unless absolutely necessary. Miao Rui, go ahead and write up the order. He can get it done right after paying."

"Fine, I’ll just get the one done," the patient nodded.

Miao Rui sighed with relief. He didn’t actually have the authority to decide to skip all other tests and perform only an esophageal barium meal.

"Teacher Liu, you suspect there’s a problem with the patient’s esophagus? Why not order a CT scan then?" Miao Rui asked after the patient left.

"We have to consider the patient’s acceptance level. Even if you talked until you were blue in the face, he wouldn’t believe you and would still be worried about the money," Liu Banxia furrowed his brows.

"Right now, we can only let him see some concrete evidence before he’ll accept further examination. Tell me your assessment. What do you think is going on?"

"Teacher Liu, I suspect it may be an esophageal tumor," Miao Rui said.

Liu Banxia nodded. "So, in the future, when encountering similar cases, you need to find a way to be flexible. The patients we see often have very different ways of thinking."

"Some patients might feel like you’re just tricking them into having tests to earn money. For those, you can sometimes exaggerate the possible consequences a little, speak more seriously, and directly order the necessary definitive tests."

"But with patients like this one today, they’re not unwilling; they just worry about the money. When their primary concern is money, even if you scare them, they may not agree. So, you have to cajole them and approach it slowly, bit by bit."

"Of course, everyone’s personality is different. This patient is relatively agreeable, and having a familiar friend here makes it easier to persuade him."

"Teacher Liu, what’s your assessment of this patient’s condition?" Miao Rui asked curiously.

"Advanced-stage esophageal cancer," Liu Banxia replied.

His words startled Miao Rui. He had only suspected a tumor, but he hadn’t expected Liu Banxia to directly pinpoint it as advanced-stage.

"Teacher Liu, did you make this judgment based on his weight loss, fainting, and the chest pain he had when he fainted today?" Miao Rui asked.

"That’s partly the reason, but the main reason is from my recent questioning and something else he mentioned himself," Liu Banxia said.

"He loves to drink, especially bulk white liquor. That kind of drink, often sold under the guise of ’home-brewed grain liquor,’ who knows what’s actually added to it."

"One thing he mentioned was that his swallowing isn’t as difficult as before. So, my judgment is that the inflammation and edema caused by the cancerous obstruction have temporarily subsided, indicating it has already spread to the surrounding organs and tissues."

"Keep an eye on it. If you find any irregularities during the esophageal barium meal examination, order a CT scan or esophagoscopy right away. It seems Su Wenhao has a situation over there. I’ll go take a look."

Miao Rui nodded. He felt he’d learned a couple more things today. The first was the importance of mastering certain techniques when guiding patients through examinations. The second was that after forming a preliminary judgment about a condition, one also needed to engage in reasoned inference. He had completely overlooked the patient’s comment about his swallowing being easier now, whereas Dr. Liu had been able to pick up on that and extrapolate. He was far from being that meticulous.

"Teacher Liu, could you take a look at my patient’s back? I’m struggling to make a diagnosis," Su Wenhao said as Liu Banxia approached.

Liu Banxia frowned. This patient was the one with a history of diabetes whom Su Wenhao had just seen for acute gastroenteritis. Below his right shoulder blade, there was a coin-sized ulcerated area.

"What did the patient say?" Liu Banxia asked.

"It started to itch about four or five days ago, and he didn’t pay much attention. It ruptured when he scrubbed it during a bath, and now it looks somewhat inflamed. I’m not sure if it’s infected," Su Wenhao said.

"At first, I thought it was a small wound that didn’t heal because of his diabetes and the scrubbing. But then I thought something wasn’t right. If it was caused by diabetes, it wouldn’t have developed this quickly, would it?"

Liu Banxia was also puzzled. Given the patient’s current state, such a large area of broken skin couldn’t be dismissed lightly. His first thought was some kind of herpes, as herpes can also cause itching. However, if it were herpes, an area this size would likely be a cluster of lesions. This presentation was highly suggestive of the initial stage of shingles. But the patient only reported itching. Shingles typically follows a nerve pathway and is very painful. Moreover, shingles doesn’t usually form one large blister like herpes simplex; instead, the lesions tend to remain somewhat discrete or leave gaps between them.

"Doctor, can I just apply some ointment? I can’t reach it myself," the patient spoke up at this point.

"Sir, don’t you feel anything else there? Doesn’t it hurt?" Liu Banxia asked.

"No, it doesn’t hurt. I’ve been feeling a bit fatigued lately from exercising in the park with friends. I’ll wait to take a bath after it heals," the patient said.

SNAP.

Liu Banxia slapped his forehead. "This really could be shingles."

"Teacher Liu, the patient doesn’t feel any pain. Isn’t shingles supposed to cause neuralgia?" Su Wenhao asked in surprise.

He had considered this possibility too but had immediately dismissed it. The pain from shingles is the kind that’s almost impossible to endure; it’s true neuralgia.

"Yes, normally it should cause neuralgia. But we overlooked one thing just now: the patient has diabetes. A complication of diabetes is peripheral neuropathy. The herpes virus may not have affected a healthy nerve yet."

"Given the patient’s current condition, let’s do an anti-VZV specific serum immunofluorescence test. We also have to contact his family, because the herpes virus is very contagious during an outbreak."

"If it’s confirmed, admit him to the hospital immediately. Also, check if any of his family members have similar symptoms. Early intervention can save them some suffering."

Su Wenhao nodded and began patiently explaining things to the elderly gentleman.

At the same time, he was very thankful he had called Liu Banxia over. If it really was shingles, as the disease progressed, the old man would have suffered greatly. Shingles causes neuralgia. Right now, it might only be affecting the peripheral nerves. But what if it spread to the nerve roots? The pain then would be far from easy to bear. Moreover, the intensity of pain from this disease is directly proportional to age; the older the patient, the more severe the pain. Seeing the significant from the subtle—that was Teacher Liu’s strength.

"Sister Li, when you have a moment, please remind our nurses to be extra careful about protecting themselves during patient consultations recently," Liu Banxia said, having found Zhou Li.

"What? Another problem?" Zhou Li asked, startled.

"No. We just had a patient suspected of having shingles," Liu Banxia explained.

"These kinds of infectious diseases are prevalent in spring and autumn. Our workload is heavy, the pressure is high, and our immune systems can be unpredictable. Tell everyone to be more careful, not to cut corners or be careless. They have to protect themselves."

Zhou Li nodded. "Right, I’ll arrange for that immediately."

This was a serious matter. Sometimes it wasn’t about laziness, but simply because there were too many patients and everyone was too busy.

Now that Liu Banxia had given clear instructions, she would ensure they were properly implemented.

In fact, it was merely a reminder for everyone to maintain good personal hygiene and protection, which could prevent a large proportion of viral transmissions.