The Enhanced Doctor

The attending physician from Thoracic Surgery arrived quickly, yet Liu Banxia was taken aback when he saw him. The man who arrived was none other than Chen Xuehai, the grandson of the Chief Director, Chen Zhenxing.

Upon seeing the patient lying in the hospital bed, Chen Xuehai also paused; the situation didn't look as severe as the phone call had suggested.

"The patient presented this morning with an unexplained fever and posterior pharyngeal wall congestion. He has a medical history of hypertension and diabetes," Liu Banxia hurried to explain.

"He was diagnosed with acute laryngopharyngitis and was given antipyretics and antibiotics. He just returned to the outpatient clinic with a high fever of 38.7℃, accompanied by fatigue and chest pain."

"The blood test results aren't out yet, but an ECG has been performed. At the time of consultation, his blood pressure was 140/100 mmHg, and his heart rate was 88 bpm. He has taken nitroglycerin and Betaloc. Heart and lung auscultation were normal, and the echocardiogram was normal."

Chen Xuehai picked up the ECG and took a look. "Call the lab and tell them to expedite it. Does he have a history of heart disease?"

"Doctor, I don't have heart disease. My chest hurt the year before last, and I received a stent. I haven't had any pain for the past two years. It started hurting again today, so I got scared," the patient said.

"You've had a stent? Was it a coronary stent?" Liu Banxia asked urgently.

The patient shook his head. "It was a stent for an aortic dissection."

Chen Xuehai glanced at Liu Banxia. "Let's get a contrast-enhanced chest CT for the patient first. Pay more attention next time. If the patient doesn't understand, shouldn't you ask more detailed questions?"

This was said very bluntly, tantamount to saying they had been too lax and not thorough enough during the initial consultation. But Liu Banxia had no basis for rebuttal. He had been there, and the patient truly hadn't mentioned it.

"I'll wait here for a while. Call me when the results come out. Where's Liang Xiaolin?" Chen Xuehai asked.

"I'm here. What are you doing here?" Liang Xiaolin's voice came from behind them, a trace of tension on her face.

"You guys in the ER make a big fuss and call for a consult over every little thing, and we still have to wait for the test results. How's work? Settling in?" Chen Xuehai said with a smile, walking up to her.

Liang Xiaolin glanced in their direction, then dragged Chen Xuehai off to one side.

"Don't overthink it. It's right for us to be cautious. Who would have thought the patient wouldn't even mention having a stent?" Wei Yuan said.

"Sigh... It was my mistake and Doctor Xu's. Please don't let it be a myocardial infarction or an aortic dissection rupture, or anything like that. If it is, I'll regret it for the rest of my life," Liu Banxia said.

"Brother Wei, help me figure out what's going on with this fever. It doesn't look like acute laryngopharyngitis now; otherwise, the antibiotics we prescribed should have worked."

"You should stop dwelling on it too. Let's wait for the test results and see," Wei Yuan comforted.

It was indeed hard to assign blame in this situation.

From Chen Xuehai's perspective, Liu Banxia had indeed missed the diagnosis by not getting a clear medical history.

However, Liu Banxia and the others had followed normal questioning procedures; they wouldn't typically ask a patient if they'd had a stent. Usually, when asked about their medical history, patients will mention any surgeries they've had.

Earlier today, Liu Banxia had been feeling quite a sense of accomplishment; both his emergency resuscitation efforts had been successful, after all. Now, this one case had completely deflated him. How could he have the heart to wait there any longer? He went directly to the lab.

Once the report was out, he immediately began to look it over.

The results for the complete blood count, cardiac enzymes, and troponin were all normal. Seeing this, he finally breathed a sigh of relief.

Cardiac enzymes and troponin are important auxiliary markers for diagnosing myocardial infarction. The myocardium contains various enzymes and troponin; when myocardial necrosis occurs, these substances are released into the bloodstream.

If the results had shown a significant increase, there would have been no need for further suspicion; it would have been straight to the operating room after the CT scan. This most dangerous hurdle had been cleared. Next was to see if a new aortic dissection had appeared.

Upon returning to the ER, Liu Banxia handed the test report to Chen Xuehai.

"How long until the CT results are out?" Chen Xuehai asked after looking over the report.

"The official report will take a while, but I've contacted the radiology department. They'll call me once the images are ready," Liu Banxia said.

Chen Xuehai glanced at him. "Then continue waiting. If there's nothing wrong with his chest, then you can consult other departments."

Hearing this, Liu Banxia felt his blood rush to his head. Liang Xiaolin, who was beside him, nudged Chen Xuehai. What he said was indeed a bit much.

Right then, Liu Banxia's phone rang.

"Brother Wang, are the results out?" Liu Banxia asked hurriedly after answering the phone.

"Based on the current results, there are only postoperative changes from an aortic dissection. The stent within the blood vessel is visible, and no new aortic dissection or rupture has been found," said Wang Jianwei, the radiologist.

"Shoutian, the patient's temperature is still a bit high; you need to pay attention to this. I'll also get the films out quickly, and then you can take another look."

"Thank you, Brother Wang. This is already the best-case scenario. I'll try to find the cause of the fever again," Liu Banxia said quickly.

"Then I have nothing more to do here. Consult whoever you need to consult," Chen Xuehai said casually, then turned to Liang Xiaolin. "If you're too tired, take a nap. After your shift tomorrow, go home early."

"Aiyah, I know, I know. You're so annoying!" Displeasure was written all over Liang Xiaolin's face.

"Annoying? Even if I'm annoying, I still have to look after you." Saying this, Chen Xuehai even gave Liang Xiaolin's nose a little pinch.

"When you get back, don't forget to wash your hands; otherwise, it's irresponsible towards the patient," Liu Banxia added.

Chen Xuehai frowned. "Liu Banxia, I've heard your name many times. Quite capable, aren't you?"

"Aiyah, just hurry up and leave," Liang Xiaolin said, pushing Chen Xuehai away.

Liu Banxia was truly out of ideas. It wasn't a myocardial infarction, nor an aortic dissection, and certainly not a rupture. The blood tests were all normal too. What on earth was going on?

The only option left was to call ENT for a consult. After all, the posterior pharyngeal wall congestion was still a symptom; consulting the ENT department was the most appropriate step.

To be on the safe side, Liu Banxia personally accompanied the patient for the laryngoscopy.

"Dr. Liu, I also think it's acute laryngitis. Not only are there symptoms of inflammation, but the patient's left vocal cord also shows signs of paralysis, which might be caused by the inflammation," said Du Fancheng, the attending physician from the ENT department.

"So, we should use antibiotics then? Is this causing the fever?" Liu Banxia asked.

Du Fancheng shook his head. "It might be related to the patient's constitution. That's probably why there was no significant change in the white blood cell count."

"How about this," Liu Banxia said to the patient, "I wouldn't feel at ease if you went home like this. Stay in our ER for observation overnight. If anything else happens, we can handle it promptly."

"Alright, I'll listen to you, Doctor." The patient said with a smile, "After all that commotion just now, my chest doesn't even hurt anymore. If you can just get this fever down, I'll feel more comfortable."

Liu Banxia nodded, but this fever symptom still troubled him.