The Enhanced Doctor

(Thanks to Sterling and kenny75 for the monthly ticket encouragement)

Liu Yiqing’s mind was a mess, wondering if her words had upset the big devil.

She was just being truthful, not trying to pick a fight.

When she arrived at the ward, the patient’s family was also looking eagerly at Liu Banxia.

They were genuinely worried, not knowing what was happening.

Liu Banxia moved to the front of the patient, lifted the gauze over the drainage tube, and stared thoughtfully.

Liu Yiqing looked as well and came over to join the inspection.

"Have you noticed anything?" Liu Banxia asked.

"Uh... let me take another look." Liu Yiqing responded.

She didn’t know what to focus on; how could she notice anything now?

She looked more intently this time, perhaps the issue was at this wound?

As she examined further, she indeed noticed something, "Teacher Liu, this wound looks a bit peculiar. Although it’s been some time, hasn’t it necrotized too much?"

"So what should be done next?" Liu Banxia asked again.

"Uh..., well, is this a special case or are other suture sites the same? Could it be due to coagulation issues?" Liu Yiqing asked hesitantly.

"Didn’t I ask you already? Tell me what should be done." Liu Banxia said.

"Well, if we want to be safe, we could open another suture site and check it. But this would be harmful to the patient, as it would need to be sutured again afterwards." Liu Yiqing said.

"Or should we go directly for a muscle tissue biopsy? Does it have such indications? The key issue now is that I’m still unsure if this is due to a bodily reason or coagulation disorder. Coagulation disorder is possible, right?"

"Doctor, how should we proceed with the examination? You tell us how to do it, we don’t mind spending money." The patient’s family approached.

"Don’t be anxious; we have some clues now, let’s study it further." Liu Banxia said with a smile.

"Doctor, no need to study, check first, and then study after the examination." The patient’s family said.

"That won’t work; it would waste a lot of money and trouble her." Liu Yiqing said seriously.

"Director Liu, any leads?" At this moment, Chen Xuehai’s voice came in from outside.

"Your news travels fast, come and take a look at this wound near the catheter." Liu Banxia said.

Chen Xuehai walked to the front and began to observe carefully.

"Muscle tissue necrosis, seizures, lactic acidosis, could it be diagnosed?" After observing, Chen Xuehai asked.

"Liu Yiqing’s idea was to open another suture wound for inspection, or directly perform a muscle tissue biopsy." Liu Banxia said with a smile.

Liu Yiqing was somewhat surprised.

What do you mean my idea? Wasn’t I just following along, unsure of the patient’s condition?

"Take bold steps, proceed directly with a muscle tissue biopsy." Chen Xuehai said with a smile.

"It’ll save the patient from being troubled back and forth, the indications are quite clear. Liu Yiqing, have you considered what the illness might be?"

Liu Yiqing shook her head in confusion.

"This illness might be a mitochondrial genetic disease. It’s manifested in a brain-muscle type, and due to her current state, it hasn’t shown many of the stroke symptoms." Chen Xuehai said with a smile.

"Doctor, is it a genetic disease? And it’s caused this?" The family member was a bit unsettled.

He always thought it was caused by the car accident, resulting in this situation.

"Looking at the current symptoms, it seems somewhat that way. You can understand it as the patient’s body has a problem and can’t provide the necessary energy for the various systems to function." Liu Banxia said.

"Recently, hasn’t she been working out? And she must be controlling her carbohydrate intake. Combined with the energy consumption from workouts, it led to a deficiency of energy in her body."

"Plus, the car accident also requires her body to use more energy to repair itself. The human body can’t function without energy."

"So now there are a series of symptoms, unable to metabolize sugars causing lactic acidosis, and severe wound manifestations on her body."

"Doctor, if it turns out to be a genetic disease, can it be treated?" The patient’s family asked.

"It can’t be cured, only maintained. We can provide as much energy and supplements to the body as possible, our upcoming adjustment methods will focus on this." Liu Banxia said.

"Although we haven’t taken biopsy samples yet, we can proceed in this way first. It’s possible her symptoms might improve even before the biopsy results come out."

The patient’s family, although they heard some bad news, also heard good news. Now, they have no intention to deal with the bad news and must first see if there’s any improvement.

"Liu Yiqing, please perform a muscle biopsy." Chen Xuehai said.

"Okay, Director Chen." Liu Yiqing quickly responded.

Walking out of the ward, both Liu Banxia and Chen Xuehai felt very relieved.

"We were just in the office pondering what exactly was going on, considering many possibilities. We just forgot to consider mitochondrial genetic diseases." Chen Xuehai said.

"The incidence rate of this disease isn’t very high; it’s been listed as a rare disease by the country. Plus, the patient’s symptoms are somewhat peculiar." Liu Banxia said.

"If she hadn’t been admitted due to a car accident, didn’t have lung contusion, and was experiencing normal symptom progression, we might have considered that possibility. The car accident this time acted like a catalyst, suddenly igniting all the symptoms."

"Treating illnesses now is really worrisome. It’s hard to prevent anything. If we delay any longer, I estimate the spleen’s hematoma might rupture. If that happens, whether suturing or splenectomy, it will greatly harm the patient."

"I hope we’re on the right path so we can at least save the spleen. If we told people outside, ’She was only hit by an electric bike,’ and she fell not too seriously, yet got injured seriously, probably no one would believe it."

"But generally, our thought process was correct; we just didn’t think the cause was this. It’s nothing really, I should also report this to Wang Huan and Peng Bo."

Chen Xuehai nodded with a smile and walked into his office.

Meds also need to be prescribed for the patient, some supplements that can’t be taken orally at the moment, so they can only be administered intravenously. Also, high-energy replenishment fluids need to be arranged for the patient.

Since the body can’t produce enough energy at present, it needs external supplementation. Once the patient’s condition improves, we can gradually reduce it.

This is the patient’s fundamental problem; if this isn’t resolved, other symptoms might also struggle to heal.

Going back downstairs and explaining the situation to Wang Huan and Peng Bo, the two of them also felt quite emotional.

"If that’s the case, the patient is relatively lucky. Do you think the reason the patient was hit by an electric bike might be because of some stroke symptoms?" Peng Bo said.

"That’s possible too, but normally, if such symptoms aren’t noticed, they’re hard to detect." Liu Banxia said.

"Having an episode while riding a bike is much better than while driving a car. Who knows how big of an accident it could cause if it happened while driving."

"Nowadays, things are really unpredictable sometimes." Wang Huan shook his head.

From their current consideration, the patient being hospitalized was indeed a fortunate event.

Because the patient’s symptom manifestation is brain-muscle type, with symptoms like epilepsy and stroke syndrome, and high lactic acid.

Whether it’s epilepsy or stroke, once episodes happen, the risk to the patient would be extremely high. For this disease, if not controlled and adjusted, episodes will become more frequent.

If the patient had been hospitalized for checking due to these two symptoms? It might take a long time to diagnose.

𝒻𝘳𝘦𝘦𝘸ℯ𝒷𝘯𝘰𝑣ℯ𝑙.𝘤𝑜𝘮

By then, more attention would have been paid to the brain’s condition, and perhaps a lumbar puncture would have been performed too. After a few days or even ten days of observation, they would consider the possibility of a genetic mitochondrial disease.

Unlike now, where there are wounds that can be visually observed to aid in judgment.

"By the way, this disease is maternally inherited, right?" Wang Huan asked.

Peng Bo nodded, "Yes, it’s maternally inherited. The nuclei from the egg and sperm are combined equally, but the cytoplasm isn’t at all equal."

"The mutated mitochondrial gene is passed down to the next generation through the mitochondria of the egg’s cytoplasm. If it’s a girl, it continues to pass on. If it’s a boy, it’s an isolated random event with very low heritability. Have you told the patient’s family?"

Liu Banxia shook his head, "Not yet, we’ll wait until the patient’s condition improves a bit before telling them. This matter might affect their relationship and have a considerable impact."

"That’s true, we need to be extra careful." Wang Huan said.

"How’s your pediatric general surgery coming along? Are you launching another satellite this year? I think it’s great to launch one each year."

"What’s this about launching a satellite?" Liu Banxia said, half laughing, half crying.

"Why not? The year before was small incisions, last year was NOSES, and this year it’s focused on pediatric general surgery." Wang Huan said.

"What are you planning to stir up next year? Orthopedics, cardiac surgery? Pediatric general is at least generally under general surgery. Orthopedics and cardiac surgery have a higher technical content."

"Sigh..., I don’t even dare to think about it now, thinking too much gives me a headache." Liu Banxia said with a bitter smile.

"Feels like I owe a lot of debts, but I can’t just think like ’the more lice, the less itch; the more debt, the less worry.’ It’s truly worrying."

Hearing this, Wang Huan and Peng Bo burst out laughing.

Even though during his previous explanation, Liu Banxia mentioned it was due to Liu Yiqing’s mention of ’systemic functional disorder’ that led him to think of this disease.

But after all, he thought of it, and that’s ahead of the rest by quite a bit.

Many times it’s like that, the symptoms are plainly there, it’s just that lightbulb moment that makes the difference.