godfather of surgery

Chapter 1273 Family Dispute
The smile on the patient's wife, Ms. Wang, froze on her lips. She clutched the crumpled medicine bag, the clear blue stamp of the local five-star hotel's medical clinic on it glaringly obvious.

He clearly said he was going to Shanghai on a business trip these past two days, so how come he has the stamp and date of a local hotel's medical clinic? Didn't he say he was in Shanghai for that time?
“Li Gang,” her voice was soft, yet trembled with an impending storm, “Didn’t you just get back from Shanghai last night? How come this medicine came from the clinic at the ‘Nandu Hotel’? And it was from the day before yesterday? Huh?”

"Nandu Grand Hotel"!
All the doctors and nurses instinctively turned their gazes from Yang Ping to the couple. Li Gang looked at the bag of medicine in his wife's hand, seemingly bewildered, not knowing what was going on: "Nandu Hotel? Let me see, no way."

"Why is it the Nandu Hotel's medical clinic? I... I don't know either. Xiao Zhang gave me this medicine yesterday, and I don't know where he got it from."

Li Gang looked utterly wronged and aggrieved. The little color that had just returned to his face vanished instantly, leaving him even paler than when his tongue was stiff and his mouth was dry. His eyes were panicked, his lips trembled, and his tongue, which had only recently regained its agility, seemed to be tied in knots again.

He dared not look his wife in the eye, his gaze shifting as he swept over the crowd of people in white coats around him. His face burned with embarrassment, a hundred times more so than when he had stuck out his tongue in public earlier. "The medicine that Xiao Zhang always carries with him will come in handy for me."

Xiao Zhang is a young male employee under him who accompanied him on this business trip.

"Then why was it in a bag in the Nandu Hotel's medical clinic?" Ms. Wang's voice suddenly rose, filled with suppressed anger. She held up the medicine bag, almost poking Li Gang's nose.

“He…he probably bought it at the hotel’s medical room and carried it with him.” A fine layer of cold sweat instantly appeared on Li Gang’s forehead.

Ms. Wang sneered: "Do you think I'm stupid? You said you and Xiao Zhang were in Shanghai the day before yesterday and yesterday, so how did Xiao Zhang manage to go back to the Nandu Hotel to buy medicine yesterday?"

The sudden change left the surrounding doctors and nurses looking at each other in bewilderment. Li Min immediately stepped forward and said, "This is the examination room. If you're not feeling unwell, please go outside now to discuss other matters."

"Li Gang! Speak up! Where have you been these past two days?!" Ms. Wang completely ignored Dr. Li Min's advice and pressed him relentlessly. Tears were already welling up in her eyes, but she held them back. Only her chest heaved violently. After all, with so many strangers watching, she still had some self-control left.

"I...I'm...in Shanghai...really...what's going on with this bag? What's this Xiao Zhang up to? I'll call him and ask." Li Gang's voice grew softer and softer, his confidence completely gone. He felt his throat tighten and his breathing become difficult.

Li Gang was about to make a call when suddenly his eyes widened, his face contorted in extreme pain. His tongue, which had just been retracted from his mouth, began to slowly and stiffly extend outward again, uncontrollably. At the same time, that familiar "hoarse" sound came from his throat once more.

"Heh...heh...tongue..." He managed to utter a few indistinct sounds, his hands helplessly clutching his throat, his eyes filled with pain and pleading.

"Oh no! Here we go again!" the nurse exclaimed.

Ms. Wang was also startled and immediately stopped arguing with her husband, becoming just as anxious as before.

She immediately and instinctively patted her husband's back: "Doctor, doctor, what's wrong? Please help me take a look."

Yang Ping stood up and approached the examination bed. Li Gang's tongue was sticking out stiffly, seemingly slightly different from before. Previously, the tongue was uniformly stiff, dark red with a slight cyanosis, but now, although it was also sticking out, the stiffness of the tongue seemed less uniform, and the color was closer to normal red, only appearing somewhat whitish because he was deliberately exerting force.

"Professor! Professor Yang! Please take a look, what's wrong with him?" Ms. Wang panicked when she saw her husband's condition. She turned to Yang Ping, her voice trembling with tears.

All eyes were once again focused on Yang Ping.

Li Min and the other young doctors also frowned. Theoretically, the effects of scopolamine injection should last for a period of time, and the possibility of acute dystonia recurring so quickly is extremely low.

Yang Ping didn't speak, and continued to bend down to observe the tongue.

He didn't touch Li Gang's neck or examine his throat as he had done before; he just looked at him quietly for a few seconds.

"This time the symptoms have relapsed, and you still need medication, but this time the medication is different and has certain side effects, so you must agree." After reading the prescription, Yang Ping straightened up and said slowly.

The patient nodded painfully.

Yang Ping said, "The side effect of this drug is that it can easily cause male dysfunction, but given your current situation, you can't do without it."

Upon hearing about male erectile dysfunction, the patient immediately shook his head. Yang Ping ignored his head-shaking and said to Li Min beside him, "Give the doctor's orders and have the nurse prepare the medication. If we don't take the medication, it may cause necrosis of the tongue."

Li Min was taken aback. What kind of medicine?
After a moment of stunned silence, he immediately understood what Professor Yang meant.

"Professor Yang, you and your wife need to sign before you take the medication, because the side effects are too severe."

Yang Ping waved his hand rudely: "Forget about signing anything in an emergency. Just give us the medication and get it done as soon as possible!"

The patient shook his head violently.

"Hold him down, he's starting to have hysteria, give him the medication quickly." Yang Ping ordered the graduate students next to him to immediately surround him.

The patient's tongue snapped back halfway: "Okay...okay...how about we observe...observe..." Yang Ping sat down and spoke in his characteristically calm voice, but his words weren't directed at Li Gang; rather, they sounded like he was continuing his lecture:

"In clinical diagnosis, in addition to distinguishing the authenticity of the disease, we sometimes also need to distinguish the authenticity of the symptoms." His voice was not loud, but very clear. "Organic dystonia is caused by an imbalance of neurotransmitters and is the result of autonomic nervous system dysfunction. Patients cannot control it themselves. Its manifestations have their physiological basis, such as the tongue color, the uniformity of muscle tone, and the accompanying micro-tremors that I just mentioned."

He paused, but his gaze remained fixed on Li Gang.

“And psychogenic symptoms,” he continued, his tone as calm as if stating an objective fact, “often have a performative quality, deliberately mimicking severe symptoms from memory or imagination. For example, they may exhibit extreme, dramatic pain, but struggle to perfectly replicate subtle, objective physiological signs. For instance, in true acute tongue muscle spasm, the sublingual blood vessels will show a specific color change due to obstructed blood flow, and the muscles at the base of the tongue will have a unique hard, rubbery texture…”

Yang Ping continued gently, "More importantly, the effects of medication don't lie. As an anticholinergic drug, scopolamine has a sustained half-life in the body. Shortly after injection, when the drug concentration in the blood is at its peak, the probability of the same cause triggering the exact same intensity of symptoms again is extremely low. This does not conform to the basic laws of pharmacokinetics."

These words, like peeling back layers of an onion, revealed the possibility that Li Gang was faking it. It wasn't a harsh accusation, but a calm analysis based on medical logic, yet it was more powerful than any accusation.

The pained expression on Li Gang's face began to crumble.

Yang Ping finally turned his gaze to Li Gang, his tone still calm: "Mr. Li, your body has just recovered from the adverse effects of the medication. What you need is rest and recuperation, not huge emotional fluctuations and unnecessary physical exertion."

“Deliberately maintaining a certain muscle tension is very energy-consuming, and it’s not conducive to your recovery from gastroenteritis,” he added, sounding like he was concerned.

Then, he turned to Ms. Wang, whose face was ashen, and said, “I can understand the family’s feelings. But this is an outpatient clinic, and there are many other patients waiting. I think family disputes are better resolved through calm and peaceful communication in a private space.”

He didn't say directly, "Your husband is faking it," but all his words and all his medical analysis pointed to that conclusion.

After Yang Ping said that, the patient slowly and quietly retracted the remaining half of his tongue, his face flushed: "Professor Yang, it's alright, it's nothing."

“Dr. Li,” Yang Ping gestured to Li Min, “Mr. Li’s acute symptoms have subsided. His gastroenteritis can be treated routinely at the gastroenterology clinic. Please help them contact the gastroenterology clinic.”

"Yes, Professor." Li Min immediately understood, stepped forward, and said to Li Gang, who was still frozen on the examination bed, and Ms. Wang, who was trembling with anger, "Mr. Li, please get off first, we need to clean the examination bed. If you have any gastrointestinal discomfort later, you can make an appointment with our hospital's gastroenterology department."

Ms. Wang glared at her husband, her eyes filled with heartbreak. She grabbed her bag, forgetting even to thank Yang Ping, and stormed out of the clinic.

Seeing this, Li Gang's face turned pale and then red. He scrambled off the examination bed in a disheveled state, not daring to look anyone in the eye. With his head down, he mumbled "Thank you, Professor" in Yang Ping's direction, and then almost fled after his wife's retreating figure.

A brief silence fell over the consultation room.

"Alright." Yang Ping's voice broke the silence. He clapped his hands, drawing everyone's attention back to their work. "Medicine is a science, but ultimately it's the science of studying people. We will encounter all kinds of patients and all kinds of situations. Maintaining professional judgment and providing appropriate treatment is our responsibility."

The nurse quickly changed the disposable sheets on the examination bed. Li Min looked towards the door, shook his head, and whispered to Yang Ping, "Professor, you are really amazing. You not only cured his illness, but also saw through his faking it."

Yang Ping smiled faintly and said calmly, "Sometimes, physical illnesses are easier to treat than mental illnesses. As doctors, we have already done our best if we can cure the former."

"Professor Yang, I really don't understand why you used scopolamine instead of anisodamine to solve the patient's problem?"

"Although both scopolamine and anisodamine belong to the hyoscyamine alkaloid class, these two drugs are significantly different. Scopolamine has a strong central nervous system depressant effect and is often used for sedation and treatment of motion sickness; anisodamine has a prominent peripheral anticholinergic effect and is mainly used to relieve smooth muscle spasms and improve microcirculation. The problem of this patient was in the central nervous system, so scopolamine was used."

"Actually, it is not uncommon for this kind of drug side effect to cause the tongue to be unable to retract. For example, chlorpromazine, haloperidol, olanzapine, risperidone, levodopa, phenytoin sodium, domperidone, etc. can all cause extrapyramidal reactions. Neurologists and psychiatrists are generally more familiar with the side effects of this kind of drug."

"The emergency department called the dentist for consultation, which was the wrong department. If they had called the neurology or psychiatry department, the patient wouldn't have needed to come here."

As Yang Ping spoke, Li Min and the other graduate students quickly took notes in their notebooks.

"So Li Min, you must study hard here. You will be doing the work of a general practitioner at the grassroots level. General practitioners are very important. They are the gatekeepers of health. Our general practice is not well developed at present, and there are not many general practitioners. So many patients often go to the wrong department. Some go to the wrong department in the beginning, and some go to the wrong department all the time. This leads to many diseases that could have been treated well, but either the best time is missed or the correct treatment is not received."

Yang Ping's clinic is usually only recommended for difficult and complicated cases, so he is not very busy. He has time to give lectures to everyone on-site.

"Common misdiagnosis: Rheumatoid arthritis patients go to orthopedics. You might think it's a mistake, but in practice it is. Orthopedic surgeons are skilled in surgery, but most of them have no systematic and standardized concept of the medical treatment of rheumatoid arthritis. They even have a superficial understanding of treatment and are far less knowledgeable than their rheumatology and immunology counterparts. Unless it requires a joint replacement, rheumatoid arthritis patients should see a rheumatologist."

"The same goes for gout. You shouldn't see an orthopedic doctor. It's a metabolic disease, so you should see an endocrinologist."

Upon hearing Yang Ping's words, Li Min had a sudden inspiration: "Professor Yang, now that you mention it, I have an idea. I'll write a booklet to tell everyone how to see a doctor, so that people won't take detours when they have any problems and can find the right doctor in the shortest amount of time, and won't feel uncertain when they encounter any problems."

Yang Ping greatly appreciated his idea: "Your idea is excellent. Some countries have these kinds of medical guidebooks that systematically popularize medical knowledge among the public. This kind of popular medical education can enhance mutual trust between doctors and patients, reduce unnecessary misunderstandings, and improve medical efficiency."