Practicing Medical Skills in a Small Clinic

"If you don’t tell me, I wouldn’t dare touch it again!" The patient’s girlfriend was terrified after the mishap.

Maybe she didn’t anticipate that twisting her boyfriend’s arm playfully would actually result in a dislocated joint.

The human shoulder joint is relatively simple in structure, probably the easiest joint to dislocate.

Especially for some people with lax joint capsules, making shoulder dislocation even more likely.

"Dr. Li, please have a look at my grandson. While playing with his classmates, he pressed his hand hard against the wall, and now it hurts too much for him to hold a pencil and write. It seems swollen too. Knowing about your good skills here, we rushed over right after picking him up from school."

A little boy, just over 1.2 meters tall, quite obese.

Accompanied by his grandmother and mother coming for a consultation.

His face still showing traces of dried tears.

Clearly, he had been crying.

It’s not unusual for even adults to cry when injured, let alone a child.

He was injured at school, likely bearing the pain alone at first until he realized he couldn’t write, then reported it to his teacher. Afterward, his parents were informed and came to pick him up.

The moment he saw his relatives, he probably burst into tears.

"Hey there, young man, sit here. How old are you?"

Li Jingsheng gently waved for the little boy to sit on the chair.

"Just turned seven."

The child’s grandmother answered for him.

"You’re quite chubby, must be well-nourished!"

Li Jingsheng noticed the boy’s obesity exceeded normal levels but wasn’t extreme.

He glanced several times at the boy’s chest and neck.

But didn’t say much more.

"Haha, my grandson eats well. He eats a lot of things daily! From calcium milk to regular milk and bread, he has a big appetite. Eats more than us adults. A big diet makes him sturdy!"

Speaking of her grandson’s chubbiness, the grandmother quickly jumped in.

Proudly praising her grandson’s hearty appetite.

"Eating well is great, but I noticed his chest development seems a bit early. If you have the time, you might want to take him to pediatrics for a check-up."

Li Jingsheng expressed it tactfully.

A seven-year-old boy developing like a girl is definitely unusual.

Yet the grandmother took pride in it.

Li Jingsheng dared not say, "Auntie, you need to control your grandson’s diet. Don’t feed him like this, or he’ll be ruined."

Guaranteed, the family would turn hostile.

Being a doctor is sometimes challenging; many truths can’t be stated outright, only gently hinted to family or patients.

"Having a bit of meat is good! Like a man. I’ve raised three kids, amply experienced; I raised each very well. Now, my little grandson, I strive to make him taller than his father."

The child’s grandmother indeed wouldn’t listen to advice.

She remained in her self-congratulatory mood.

The child’s mother stood by silently, but her expression showed she likely agreed with the grandmother.

Li Jingsheng ceased persuasion and swiftly got down to business.

"Did you get an X-ray here at our hospital?"

"Yes, here it is."

The child’s mother handed the X-ray over.

Li Jingsheng examined it; the issue wasn’t severe.

After the family paid for the treatment, he performed a manual reduction for the boy on the spot.

With just a few casual maneuvers, he successfully relocated the joint. Seeing how young the boy was, he massaged and kneaded a bit more to help reduce swelling and clear bruises.

"Little buddy, grip my finger with your right hand."

The little boy followed the instruction.

Seeing the child gripping Li Jingsheng’s index finger with his right hand, both the grandmother and mother smiled.

"Good job!"

Li Jingsheng felt the strong grip of the child’s right hand, knowing he was healed.

"All done, be more careful next time!"

He said to the little boy with a smile.

"Thank you, sir!"

Unexpectedly, the boy was quite polite.

"Haha, you’re quite polite! Your grades must be good?"

"I get A’s in language arts, but sometimes only B’s in math."

"That’s great! Keep studying hard, and I believe you’ll always score A’s in the future!"

After thanking Li Jingsheng, the family took the child and headed out.

"Hey, mom of the child, take him for a pediatric check-up! I noticed his neck skin is dark; check his insulin levels."

Unable to hold back, Li Jingsheng gently reminded the child’s mother.

"Alright!"

It seemed the child’s mother heard the advice.

Yet faintly, as the three left, the grandmother was muttering, "My grandson’s perfectly fine, why the check-up? Don’t listen to that doctor’s trickery, just wants to rack up fees."

Hearing this, Li Jingsheng felt helpless.

It’s not the first or second time patients and families metaphorically stabbed him in the heart, so he’s grown numb.

Endocrinologists develop awareness of such diagnoses; seeing someone’s neck skin darkened, they can’t help but take a closer look.

This is, in fact, a doctor’s responsibility.

Darkened necks don’t always indicate disease, but issues with insulin secretion—commonly the onset of diabetes—usually show signs. For example, increased thirst, appetite, and urination.

And skin darkening, especially around the neck, often marks diabetes onset.

This doesn’t apply to sun-induced tanning.

If an obese person hasn’t been in the sun recently but has a darkened neck, it’s a cause for concern.

Actually, when the triad appears, it’s already happening.

Diabetes benefits from earlier intervention.

Delayed action might even destroy both kidneys, leading to what’s commonly known as uremia.

However, in normal circumstances, as long as diabetic patients take active medication control, it typically won’t progress to uremia.

Conversely, kidney failure progressing to uremia is hardly preventable.

For a young child, excessively obese with a darkened neck but no issues on other parts of the skin, Li Jingsheng highly suspects there might be an insulin problem.