"It's nothing. She's just having a stomachache; it's nothing serious." The man was firm.
The man's demeanor seemed particularly cold with the girl in the background, curling up on the bed in pain.
"Are you short of money?" Zheng Ren asked out of 'concern'.
"..." He was met with silence.
"An appendectomy isn't too expensive. If you're facing financial difficulties, we can do an open appendectomy instead of the laparoscopic appendectomy. It'll cost around 1,000 yuan," Zheng Ren tried to persuade the patient's father by lowering the price.
"..." There was still no response.
"The cost of antibiotics, anti-inflammatory treatment, and IV drip will cost quite a bit too, not to mention the underlying risk," Zheng Ren added on.
"Doctor, we don't want surgery. Just treat her," the patient's father said in disdain, staring at Zheng Ren with an annoyed expression.
Zheng Ren was at a loss for words.
He sighed internally and nodded. He then brought the patient's father to the office and asked Chang Yue to issue him an admission notice for the hospitalization procedures.
When the patient's father left, Zheng Ren said, "Go and find out why the patient's family refused surgery."
"They refused surgery?" Chang Yue was shocked.
Why would anyone reject a simple appendectomy?
"Yes, I asked him and even offered to exclude part of the medical bill and reduce the admission fee to around a thousand, but he still refused," Zheng Ren said helplessly.
"Hmm, let me ask them," Chang Yue said. "Chief Zheng, when are you going to do Sister Zheng's surgery?"
"I'm going to the Secondary Hospital for surgery tomorrow. We'll schedule hers on the day after." Zheng Ren continued, "Tell Sister Zheng that she may need to get radiofrequency ablation."
"Do you have a template for the preoperative procedures?"
"No."
"You don't even have that. Are you sure you know how to do radiofrequency ablation?" Chang Yue asked suspiciously.
"It should be fine. Lil Fugui can do it if I can't," Zheng Ren laughed and said, "Right, Lil Fugui?"
"Boss, you're pulling my leg," Professor Rudolf Wagner said with a pout. "You have the best interventional skills of all the interventional doctors. You shouldn't make up a bunch of baloney just because Chang's not in surgery."
"..." Zheng Ren was speechless.
The professor was getting more fluent in the Northeastern dialect; even Zheng Ren rarely used words like 'baloney'.
If it was not for the professor, he would have forgotten that the word existed.
"Chief Zheng, you must always be honest to your resident doctor," Chang Yue said in a serious tone.
"Yes, yes, yes," Zheng Ren answered with three consecutive yesses.
"Right, you're not even taking me with you to Secondary Hospital for surgery. Out with the old, in with the new. So disloyal of you, Boss," Su Yun added insult to injury at the right moment.
After joking around for a while, the patient returned after completing the admission procedures. Chang Yue then examined her once more, wrote down medical notes, and started briefing the patient's family.
Half an hour later, Chang Yue walked in with a sullen expression.
"Chang Yue, can't you look happier?" Su Yun could guess what happened from Chang Yue's expression
Chang Yue's emotions were written all over her face.
"Guess why the patient's family refused to operate." Chang Yue said after closing the office door.
"Do we even need to guess?" Su Yun put on an irritating smirk and said, "A sixteen-year-old girl from the village will be married off soon. If there's a scar on her stomach, people will think that she did an abortion or she had gynecological diseases. Anyway, her bride price will depreciate by a hundred thousand at least, from 300,000 to 200,000 yuan."
"..." Zheng Ren heard about something similar before, but it did not cross his mind.
Chang Yue let out a sigh, indicating that Su Yun's prediction was true.
"Let's start with the anti-inflammation treatment then. Hopefully, it doesn't perforate," Zheng Ren sighed deeply.
These things were beyond their control. If the patient's own parents refused to have surgery, what right did they have to force her?
Ugh… They really should not do this if they wanted their daughter to live.
Chapter 407 - Princess Syndrome (1)
While they were lamenting about it, the phone rang once more.
The landline of the emergency ward was different from the one in Old Chief Physician Pan's office. The Chief would mostly receive calls about office politics between departments.
When the phone in the emergency ward rang, it was likely that the emergency department was either sending patients to them or that the patient had an ambiguous diagnosis that required Zheng Ren's opinion.
After picking up the phone, Zheng Ren spoke for a while before getting up and heading downstairs.
"Boss, what's the matter?" Su Yun asked.
"Intestinal obstruction in a fifteen-year-old girl," Zheng Ren said.
"Let's go check it out," Su Yun followed Zheng Ren to the emergency department.
Intestinal obstruction could be caused by intussusception in the infant stage or from loss of function due to old age.
The patient was still a teenager; she should be in the pink of health. It was rare to see intestinal obstruction in a young girl like her.
When they arrived at the emergency department, the internal medicine doctors were busy tending to the never-ending crowd in the consultation room. Most of them were elderly patients above 60.
This was a common scene in the Northeastern region. The younger generation equipped with skills that had a future ahead all moved to the South in search of jobs, leaving the older folks behind.
When the doctor saw Zheng Ren, he quickly comforted the old man he was tending to and rushed over to Zheng Ren. He brought Zheng Ren to the emergency treatment room. On their way there, he said, "The patient is a fifteen-year-old girl. She has abdominal pain and was vomiting for two days before she visited the hospital. When I examined her, her abdomen was bloated, tender upon touching--general pain without any rebound tenderness. The CT scan on the abdomen showed an enlarged intestinal loop and extensive fecalith in the right abdominal cavity."
The doctor's voice was raspy from the non-stop talking from the morning till now. She was so busy that she had not had the time to have even a sip of water.
"What has been done?" Zheng Ren asked.
"We performed a hypertonic saline enema, but it was not effective," the emergency internal medicine doctor answered. "After the enema, we imaged the plain films of the abdomen and saw that there was an increase in the extent and amount of small bowel distension, along with the presence of air-fluid levels."
"Hmm," Zheng Ren pondered.
When they reached the treatment room, he saw a girl curled up on the bed, continuously retching.
There was an anxious middle-aged woman wiping away tears while she gently patted the girl's back.
"Chief Zheng, these are the scans. Please take a look at them. I'll return to my post now," the doctor briefed Zheng Ren quickly and hurried back to the consultation room.
Zheng Ren came to the side of the patient and positioned her in a supine position with her legs bent upwards. Then, he rubbed his hands together to warm them before starting the physical examination.
The patient was very thin, with long black hair. She also had big round eyes with long lashes, but they were watery because of all the vomiting.
"What's your name?" Zheng Ren habitually asked for the patient's information as he performed the examination. He placed his hand on the patient's left upper abdomen.
"I'm Wang Yutong," the girl fluttered her eyes and answered.
"Are you in middle or high school?" Zheng Ren casually asked as he explored the patient's abdomen.
There was no prominent tenderness on her upper abdomen,
which was a typical sign of bloating. However, the patient felt the pain when he reached the left lower abdomen.
Zheng Ren checked carefully to locate the exact location.
The System's monitor diagnosed the intestinal obstruction as Rapunzel Syndrome.
Zheng Ren was a little lost. However, he had to act calm and collected even if he had questions, especially in front of the patient. This was the basic etiquette for a medical doctor.
After the examination, Zheng Ren tapped the girl's shoulders and asked her to cover her abdomen.
He then walked toward the radiographic film viewer and put up the abdominal CT scans and plain films.
It was a typical case of intestinal obstruction, just like the emergency internal medicine doctor said previously. The air-fluid levels and fecalith were all typical symptoms of this disease.
Zheng Ren made a low hum.
Su Yun noticed something was not right when he saw Zheng Ren's expression. He came over and asked softly, "Anything unusual, Boss?"
"What do you know about Rapunzel Syndrome?" Zheng Ren asked.
It never crossed Su Yun's mind that Zheng Ren was actually consulting him. He thought his boss was quizzing him. He quickly searched his mind for information on Rapunzel Syndrome.
A genius like him also had impeccable memory.
Similar to those who made a name in history, Su Yun was equipped with all the skills they had, including photographic memory.
He only took him several seconds to recall information about Rapunzel Syndrome.
"Rapunzel Syndrome, a clinical disease first described by Vaughan Jr. in 1986, manifested by the patient's trichotillomania and trichophagia. The swallowed hair would form a gastrolith and enter the small intestines, causing abdominal pain, vomiting, nausea, malnutrition, hematemesis, diarrhea, and intestinal obstruction if the condition is serious," Su Yun answered softly as if he was back in school, standing beside an old respected professor.
'A test? Did he think he could get me with such a simple question?' Su Yun felt proud.
"Hmm," Zheng Ren nodded after hearing what Su Yun said.
The patient's symptoms matched the description. The intestinal obstruction could be caused by a long-term compulsive eating of hair, which developed into a gastrolith and blocked the colon.
The best treatment method for a conclusively diagnosed intestinal obstruction was surgical resection.
Since the diagnosis was confirmed, the patient could be prepped for surgery.
"Can the patient's family follow me please?" Zheng Ren called out.
The patient's mother was in the middle of taking care of her, so the father followed Zheng Ren out of the treatment room.
"Have you noticed your daughter displaying any unusual behavior?" Zheng Ren asked.
The patient's father looked confused. He tried very hard to recall, but he could not understand what Zheng Ren was asking for.
"It's okay if you don't know," Zheng Ren said kindly. "Your daughter is showing symptoms of intestinal obstruction. After looking at the scans, it was caused by fecalith in the intestines. An enema didn't work, so I plan to treat her with surgery."
Zheng Ren did not directly reveal to the father that the patient had Rapunzel Syndrome, for fear that it would upset him.
Sometimes, the chronology of the briefing was very important.
The patient's parents would feel relieved after they treated her intestinal obstruction. The best option was to explain the cause of this disease and future treatment plans after showing them the gastrolith.
The patient's father had no opinions and agreed with whatever Zheng Ren said.
Zheng Ren then called Su Yun to admit the patient and prepare the preoperative assessment for surgery.
Chapter 408 - Princess Syndrome (2)
Su Yun, Chang Yue, and the others were busy preparing for surgery. On the other hand, Zheng Ren had nothing much to do during this period. He started examining the patient's scans that were put up on the film viewer.
Since the occurrence of Rapunzel Syndrome was rather rare, he should take this opportunity to study it since there was nothing he could do except to wait for the surgery.
This was the privilege of a superior medical officer. Most chiefs would request their subordinates to call them to the operating table after they had finished lining up the sterile sheets.
Zheng Ren did not have that kind of luxury, nor would he be that pompous.
The emergency department was already short-handed at the moment.
After a while, they received the case file and Chang Yue started to write medical notes. The gastric tube and urinary catheter were set aside, prepared. They were only waiting for the patient to complete the preoperative assessment so that they could start the surgery.
"Chief Zheng, are you busy?"
While the staff from the emergency ward were preparing the surgery orderly, a cheerful Chief Sun walked in.
"Oh, Chief Sun," Zheng Ren smiled and greeted, "We have a case of intestinal obstruction. We're in the middle of preparing to operate."
Chief Sun's eyelids started twitching. Recently, the traffic of general surgeries decreased significantly because most of them were dealt with by the emergency department.
However, he did not mention anything about that. Instead, the smile on his face grew, and he said, "Chief Zheng, I'm here to show you the peritoneal loose body you diagnosed the other day."
Chief Sun reached for his phone and showed Zheng Ren the pictures he took.
The specimen looked like a giant goose egg. After closing up, Chief Sun dissected the 'goose egg' and the boundaries of the egg white and yolk were very clear. If the person who saw it did not know anything about medicine, to them, it would look like it belonged in somebody's kitchen.
Zheng Ren had seen it during the operation, but Chief Sun showed him the final diagnosis from pathology and gave a clearer description of the specimen sections.
"Chief Zheng, you're really good at diagnosis," Chief Sun praised him while affectionately patting his shoulder.
"Haha," Zheng Ren laughed dryly and gave him a quick glance before returning to the scans on the film viewer.
Chief Sun felt a little insulted.
He was trying to get on his good side, but Zheng Ren gave him the cold shoulder.
'You really think your diagnostic skills are great?' he thought.
The more he thought about it, the angrier he got.
However, he was far too cunning to express his anger. He just followed Zheng Ren's gaze.
"This is a typical intestinal obstruction. Why are you looking at it, Chief Zheng?" Chief Sun said after glancing at the scans.
The images and the reports of the patient all showed that it was a typical condition; nothing from the scan stood out.
"Oh, this intestinal obstruction is caused by Rapunzel Syndrome," Zheng Ren answered briefly. "I wanted to study it since it's quite rare--to reduce the possibility of misdiagnosing it in the future."
"Ra…what syndrome?" Chief Sun was stunned.
F*ck, what did Zheng Ren say?
Rare disease? Chief Sun regretted right after he asked. He quickly redirected his focus to the scans and tried to look for indicative signs for that syndrome.
"It's called Rapunzel Syndrome." Zheng Ren also had a good memory, but he was busy working part-time to earn a living when he was in school. Therefore, he did not have the luxury to visit the library to read journals.
"The patient has a mental and physical disorder where they can't resist the urge to eat their hair. Since hair is indigestible, it forms a gastrolith in the intestines and causes blockages," Zheng Ren gave a simple explanation while he continued to observe the scans, his hand under his chin, trying to search for other indicative features.
Chief Sun was totally lost.
He had never heard of Rapunzel Syndrome. Eating hair? Why did he never encounter something like that after so many years of practice?
Nevertheless, he buried these question
s and observed the scans with Zheng Ren.
"Lil Fugui, can you come here for a moment?" Zheng Ren called out.
"What's the matter, Boss?" Professor Rudolf Wagner rushed toward him enthusiastically.
"Are there any typical characteristics of Rapunzel Syndrome in imaging?" Zheng Ren asked.
"Boss, you're so funny." Professor Rudolf Wagner pointed at the scans. "The images can only differentiate the density of the fecalith that was causing the obstruction, but the difference is too small to be detected. Surgery will be more ideal as a diagnostic method."
Zheng Ren nodded.
The professor's opinion was similar to his.
He would proceed with the surgery then.
Chief Sun was perplexed. Did Zheng Ren get a conclusive diagnosis? Why was he so confident when he mentioned it to him, yet still asked the professor for advice?
"Chief Sun, please excuse me," Zheng Ren said to Chief Sun with a smile when he heard Su Yun call him to go into surgery. "I'm going in for surgery now."
"I'll come with you," Chief Sun said. "I've never heard of Rapunzel Syndrome."
Chief Sun was used to being on the losing side. He had given up on competing with Zheng Ren long ago.
Even though Zheng Ren was younger than him, his surgical skills were much better.
He had a lot of time on his hands since there were not many general surgeries these days, so he decided to observe the operation.
If it was a confirmed case of Rapunzel Syndrome, he would go back and research it so that he could boast during the annual conference of general surgery.
Zheng Ren did not refuse his request. There was nothing wrong with a chief of the general surgery department observing a surgery.
Chang Yue had already completed the preoperative procedures. Zheng Ren took the case file and headed to the operating room.
Suddenly, Chief Sun called out, "Chief Zheng…"
"Chief Sun, please call me Little Zheng. I'm not comfortable with you addressing me as Chief Zheng," Zheng Ren said with a laugh.
"Sure, Little Zheng. I heard that you went to the Secondary Hospital to perform a few TIPS surgeries?" Chief Sun casually inserted this question on the way to the operating room.
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