godfather of surgery

Chapter 1287: More than eighty medical visits

Since its opening, Yang Ping's outpatient clinic at the research institute has been constantly busy, with an increasing number of patients, the vast majority of whom are referred by other hospitals.

On Monday morning, a pair of special visitors came to Yang Ping's clinic—Professor Zhao Yongchun, director of the Department of Pediatrics at the First Affiliated Hospital of Nanjing University, and behind him a middle-aged woman with a worried look and a boy of about five or six years old with her. The boy looked a little pale.

"Professor Yang, excuse me for bothering you!" Professor Zhao pushed up his glasses, a helpless smile on his face. "This is Ms. Qiao and her son Lele. Lele's condition... has been going on for two years with us, all sorts of tests have been done, but we still can't find the cause. A few old guys got together and said, 'Why don't we send him to Professor Yang? Maybe he can find something we can't.' So I shamelessly brought him here."

Professor Zhao is really responsible; he even brought the patient over personally. It would have been a simple matter of making a phone call.

Yang Ping stood up and gestured for them to sit down, his gaze lingering briefly on Lele. The child was very quiet, hiding behind her mother, her eyes somewhat evasive. Unlike typical sick children who are irritable or clingy, she was unusually well-behaved.

"Director Zhao, you're too kind. The pediatrics department at the First Affiliated Hospital of Nanjing Medical University is top-notch in South China and among the best in the country. If you all find it difficult, it must be a rare and complex case." Yang Ping smiled and instructed Li Min, who had followed him in, to pour water. "What exactly is the situation?"

Before speaking, Ms. Qiao sighed and took out a bulging folder from her large plastic bag. Inside were neatly categorized lab reports, examination reports, medical records, and even her handwritten symptom observation diary, which was astonishingly detailed.

This child has over eighty medical records, with nearly fifty of them from the First Affiliated Hospital of Nanjing Medical University.

“Professor Yang, look at my child, he’s suffering so much.” Ms. Qiao spoke quickly, with an anxious urgency. “Since he was a little over three years old, he’s always been feeling unwell. At first, he said his stomach hurt, in waves, and when it hurt, his little face would turn pale. But when we went to the hospital, they did X-rays and ultrasounds, but they couldn’t find anything. Later, he said he was dizzy, and sometimes he would say his vision would go black. We were worried that there might be something wrong with his brain, so we had him do two MRIs, and they were normal! We’ve had so many blood tests done, immune, metabolic, allergy… we’ve done everything we could, and all the indicators are within the normal range.”

As she spoke, she skillfully flipped to the relevant reports and pointed them out to Yang Ping. Director Zhao added from the side, his tone tinged with confusion: "That's right. We even consulted with neurology, gastroenterology, and rheumatology. Vital signs and physical examinations—aside from the child being a little nervous and timid due to repeated medical visits—we really couldn't find any positive signs. Various tests, including some expensive genetic tests and special metabolic screenings, all came back negative."

“In the last six months, the symptoms seem to have worsened,” Ms. Qiao continued, her brow furrowed. “Sometimes he says his arms and legs are weak, and he falls while walking; sometimes he says his skin is itchy, and scratching it causes red patches; sometimes he has a low-grade fever, but it never exceeds 38 degrees Celsius and it goes down on its own. Last month, he said he had ringing in his ears, but his hearing test was normal. Our whole family is almost driven crazy. Our work has been affected, and we've spent a lot of money, but we still can't find the root cause. Some people say it might be a psychological problem, but he's such a young child…”

Yang listened quietly, his gaze shifting between Ms. Qiao and the child. He gestured for Ms. Qiao to wait a moment, then gently asked Lele, "Lele, can you tell Uncle where you feel unwell?"

Lele looked up at her mother and then whispered, "My tummy hurts a little." Her voice was weak and feeble.

"How does it hurt? Can you show it to your uncle?" Yang Ping asked.

Lele placed her hand around her navel: "It's right here, it hurts a little."

Ms. Qiao immediately chimed in: "It's this kind of pain that's hard to describe, and the location isn't fixed; sometimes it's above, sometimes below."

Yang Ping nodded and smiled at Lele, "Lele is so brave. Uncle will gently press your tummy and tell me where it hurts the most, okay?" He had Lele lie on the examination bed and began to palpate her abdomen with gentle, slow movements. Lele cooperated very well throughout the process, but Yang Ping noticed that Lele's expression didn't change significantly when his hand pressed, and her muscles didn't show the expected defensive tension. He had Lele lie down and carefully examined the child's skin, lymph nodes, and joints, listened to her heart and lungs, and performed a simple neurological screening.

As Director Zhao said, apart from the child being slightly thin and having a pale complexion, no signs of organic abnormalities were found.

"How is Lele's appetite usually? Are her bowel movements and urination normal?" Yang Ping asked.

"My appetite is inconsistent, and I'm a picky eater," Ms. Qiao replied. "My bowel movements are sometimes dry and sometimes loose, and they're irregular."

"What about sleep?"

"I don't sleep well and I wake up easily."

"When do these symptoms usually occur most often? At home? At school? Or on the way to the hospital?" Yang Ping began to ask more specific questions.

Ms. Qiao thought for a moment and said, "It seems like... he spends more time at home. Especially on weekends or when I'm off work and at home with him. When we go to kindergarten, the teachers say he's fine during the day."

Yang Ping seemed to be thinking about something, and then asked, "Since Lele fell ill, who has been mainly taking care of him?"

“It’s mainly me,” Ms. Qiao said without hesitation. “His father is busy with work and often travels for business. His grandparents are old, and they always think the child doesn’t have any serious illnesses. I’m just being too anxious.” At this point, Ms. Qiao’s tone became somewhat aggrieved and emotional. “The child is my own flesh and blood. How can I not be anxious when he’s uncomfortable? Every time he says he feels unwell, I’m on tenterhooks, I quickly look up information, and take him to the hospital. I even quit my job for him.”

Director Zhao whispered to Yang Ping, "We also spoke with the child's father privately once. We felt that the father was far less worried about the child's condition than the mother. He even seemed tired and helpless. The family relationship seemed to be somewhat strained because of this illness."

Yang Ping's vague conjecture gradually became clearer, but more information and observation were needed; this was an area requiring extreme caution. "Director Zhao, Ms. Qiao, I have a preliminary understanding of Lele's situation. It is indeed very unusual; the symptoms are clearly subjective, but objective evidence is lacking." Yang Ping carefully chose his words. "This dissociation phenomenon requires us to consider possibilities from a broader perspective in medicine. Besides the well-known organic diseases, some complex functional problems, and even certain rare behavioral and psychological factors, may also lead to similar manifestations. I may need some time to more comprehensively review all the data, and I may need to arrange for Lele to undergo short-term observation here. Of course, this requires your consent."

Ms. Qiao immediately replied, "We're willing to cooperate as long as the problem can be found out!"

Director Zhao also said, "Professor Yang, just go ahead and do your research. Let us know if you need any materials from the First Affiliated Hospital. A few of us are waiting to hear your insights." He winked, his tone clearly teasing, "Old Sun even bet me that you'll be scratching your head this time too."

Yang Ping laughed: "Director Sun is putting me in a difficult position. Then please ask Director Zhao to tell Director Sun that if I really find something special, I can borrow his treasured bound volume of the inaugural issue of the Chinese Journal of Neurology for a month to study."

"You also knew that Director Sun had this collecting hobby?" Director Zhao was quite surprised.

Yang Ping laughed and said, "Isn't this an open secret?"

"Haha, great! I'll send the bet back right away!" Director Zhao chuckled. "Then I'll leave the child in your care for now. Ms. Qiao, Professor Yang is a top expert; it's good that he's willing to spend time on in-depth observation and analysis. You can rest assured and cooperate." He then waved to Yang Ping, "I have other matters to attend to at the hospital, so I'll have to leave now. I'll await good news!"

After seeing Director Zhao off, Yang Ping arranged for Li Min to admit Lele for surgery, with the purpose of observation only. He specifically instructed that Ms. Qiao and Lele be placed in a room diagonally opposite the nurses' station for easy, discreet observation.

Afterwards, Yang Ping convened a brief internal discussion meeting with Song Ziming, Xu Zhiliang, Li Min, Zhang Lin, Xiao Wu, and other doctors, where Li Min introduced Lele's basic situation.

No clear diagnosis was reached during the discussion, but Yang Ping assigned observation tasks to everyone afterward.

Zhang Lin and Xiao Wu were responsible for "chatting" with Ms. Qiao to learn about her family background, details of the child's illness before and after, her upbringing and interpersonal relationships, paying attention to their approach; Song Ziming and Xu Zhiliang were responsible for reviewing all the test results and designing some tests or inquiries; Li Min was responsible for building trust with Lele and conducting relaxed interactions and observations when her mother was not present; Yang Ping herself was responsible for overall control and intervention at key points.

The observation has begun.

On the first day, Lele was quiet in the ward, playing with the puzzle Li Min had brought. Ms. Qiao, however, was somewhat restless, frequently asking the nurses when the doctor would come for rounds. She proactively told Zhang Lin and Xiao Wu about the "new situation" of her child seeming to be a little dizzy again the previous night, and took out her symptom diary again. When Zhang Lin subtly suggested that some tests might need to be repeated or added, Ms. Qiao showed unusual cooperation and eagerness, even proactively suggesting, "Should we do a lumbar puncture to check the cerebrospinal fluid? Or a more advanced PET-CT scan?"

At noon, Yang Ping asked the nurse to take Lele for a blood test under the guise of a "routine check-up." Only a very small amount was actually drawn for routine monitoring, and the mother was asked to wait in the room. In the blood-drawing room, the nurse noticed that although Lele flinched slightly when the needle went in, he didn't cry; he just kept his eyes tightly closed. After the blood draw, the nurse gave him a piece of candy as a reward. He whispered "thank you," and then asked, "Auntie, does my mom know I was brave?"

The nurse replied, "Of course, I'll tell Mom." Lele seemed relieved, but also a little disappointed.

In the afternoon, Li Min played with Lele in the playroom. Without his mother present, Lele was a little more talkative, but still cautious. Li Min asked him what he liked to eat, and he said, "The nutritious meals Mom makes." When asked what he liked to play, he said, "The educational toys Mom buys." When Li Min asked, "When you're sick and feeling unwell, who do you most want to be with you?" Lele was silent for a moment, then whispered, "Mom... but Mom is with me..." He didn't finish his sentence.

The next morning, when the nurses made their rounds, they found traces of vomit in the trash can next to Lele's bed. Ms. Qiao immediately became anxious, explaining that her child had vomited once in the early morning, but she hadn't pressed the call button for fear of disturbing the doctor. The nurses examined the child and found her vital signs stable and her abdomen soft. Yang Ping, after receiving the report, went to the ward personally.

He gently asked Lele how she was feeling, and Lele said her stomach was a little bloated. Yang Ping listened to her abdomen and her bowel sounds were normal. He discreetly checked the trash can; the amount of vomit was small, and the color and texture were normal. He noticed that Ms. Qiao's handbag was open, revealing an opened packet of cookies inside.

"Ms. Qiao, did Lele eat or drink anything unusual before she vomited in the early morning?" Yang Ping asked.

"No...no, I just drank some water." Ms. Qiao's eyes flickered.

“There could be many reasons why a child vomits. We might need to collect some vomit for testing, although it doesn’t seem like a big problem,” Yang Ping told the nurse. “Let’s take a sample and send it for testing, and add a routine toxicology screening.” He said “toxicology screening” in a casual tone, as if he were talking about a routine test.

Ms. Qiao's expression changed slightly, but she quickly recovered: "Investigate, we should investigate more thoroughly."

The sample was sent away. Yang Ping didn't leave but sat down and continued chatting with Ms. Qiao, asking about her previous work, how she met her husband, and the circumstances surrounding Lele's birth. Ms. Qiao gradually relaxed, mentioning that she had been a biology teacher at a top-tier middle school, highly skilled in her profession, but resigned for her child. She talked about her expectations for her child, how meticulously she researched parenting knowledge, nutrition, and disease care, her tone filled with pride, but also revealing a hint of grievance that her efforts were not understood, especially her complaints about her husband and in-laws.

“I feel like I’ve poured all my heart and soul into my child, but they always think I’m making a mountain out of a molehill, that he’s not sick. Lele sometimes can’t explain himself clearly, but I’m his mother, and I can tell he’s uncomfortable!” Ms. Qiao said, her voice trembling with emotion.

Yang listened quietly, then asked a seemingly unrelated question: "Ms. Qiao, how are your parents? How did they take care of you when you were a child?"

Ms. Qiao paused, her eyes suddenly reddening. “I… my mother passed away when I was ten. It was a chronic illness that lingered for several years. Back then, my father was busy with work, so I spent most of my time taking care of her, going to the hospital, recording her symptoms, and communicating with doctors… I had excellent grades back then, but later, because of taking care of my mother, they were affected…” She choked up, “Maybe… maybe I’m just too afraid of losing loved ones. I’m afraid Lele will end up like my mother…”

That afternoon, the poison screening results came back: trace amounts of emetic were detected in the vomit, a drug not listed on Lele's oral medication list. Yang Ping pondered this, and the diagnosis in his mind slowly became clearer.