White armor

Chapter 590: Overlay? It can be like this!
Chen Yong also felt that Miao Youfang was a little strange.

This kid is too confident in himself. Is this the emotion that someone who can score 400 in the postgraduate entrance examination should have?
No wonder Luo Hao, that bastard, keeps saying things like "my Union Medical College" and "my Union Medical College". As for a poor student like Chen Yong, he can't understand the feelings of a top student at all.

I can’t even get a one-day trial card.

Even Zhuang Yan would occasionally hear Luo Hao say that her foundation was not solid.

Chen Yong couldn't understand who gave them the confidence.

It is often said that doctors in the capital and Shanghai are big-mouthed and they look down on doctors in other city hospitals.

But Chen Yong was not in a hurry. He walked downstairs slowly and found Miao Youfang and the patient near the ultrasound room.

Miao Youfang was talking to the patient, who nodded, and the doctor seemed to be doing well.

"Xiao Miao, why don't you even bring gloves?" Chen Yong asked.

"Ah, Teacher Chen?"

"Call me Brother Yong, not teacher. There is only one person in our group who can be a teacher, and that's you, Teacher Luo." Chen Yong said without losing the opportunity.

"..."Miao Youfang couldn't tell whether Chen Yong was slandering Luo Hao or joking.

"All of them are teachers? Not necessarily." Seeing Miao Youfang looking stupid, Chen Yong smiled and said, "From now on, just call me Teacher Luo Hao. You can call others what you want. Just call me Brother Yong."

"Oh oh oh." Miao Youfang nodded repeatedly.

"Don't worry, I will tell others. Don't be so cautious. So, what do you want the patient's urine sample for?" Chen Yong asked.

Miao Youfang was stunned for a moment and seemed a little hesitant.

"The most unpleasant thing about you is that you act sneaky, as if you have some secret. If they ask, just tell them. It's simple, rough and direct, and it saves communication costs. You're a student, and no one will blame you if you say something wrong. Why do you act like a thief?" Chen Yong said disdainfully.

"Oh, Chen...Brother Yong, did you notice that the patient was wearing the hood of his down jacket when he came in?"

"I noticed that he was wearing a mask. It's not that cold this year. The Ice and Snow Festival almost didn't open." Chen Yong replied, "The weather is getting warmer. It's true. I heard that there were more than 230 days of summer in Dongguan this year."

"Uh……"

Chen Yong changed the subject.

However, Miao Youfang spoke logically. He did not pay attention to Chen Yong's nagging, but brought the topic back.

"Brother Yong, the area around the patient's eyes is a little red."

"Ultraviolet allergy?"

"It could also be porphyria."

"Porphyria? That's the vampire disease? That can't be." Chen Yong smiled and patted Miao Youfang on the shoulder. "You think too much. There are not so many rare diseases. I think this patient has a small amount of bleeding caused by arteriovenous malformation. He needs a duodenoscope to check it out."

Miao Youfang was very determined and did not change because of Chen Yong's words.

"You want urine, do you want to put it in the sun for a few hours to see if it changes color, like in ER?"

"Yes." Miao Youfang nodded.

"Try, try."

Chen Yong was unexpectedly curious to Miao Youfang, and even instigated him.

"There won't be anything wrong with me doing this." Miao Youfang was a little worried.

"Oh, Luo Hao already knew about this. Just do your thing. In this case, if the urine changes color, porphyria seems to be diagnosed."

"what?!"

"Recall what Luo Hao said when you called him."

Miao Youfang then recalled bit by bit and realized that something was indeed wrong.

Moreover, Chen Yong caught up with him and wanted to look at the patient's urine together.

Does that mean that no matter what he thinks or does, everything is transparent? Miao Youfang was a little confused.

The patient came out with a test tube containing urine, and Chen Yong took out a disposable PVC glove from his trouser pocket like a magician.

"Look at you, you are so busy holding the test tube that you don't even wear disposable gloves. Although surgeons don't care about things like shit and piss, you still have to be clean." Chen Yong pointed out Miao Youfang's problem with a smile.

Miao Youfang nodded repeatedly.

He no longer has the confidence he had at the beginning.

Chen Yong took the test tube and went straight back to the ward. Miao Youfang was a little anxious, "Brother Yong, let's..."

"Simple, rough, and direct." Chen Yong didn't even look at Miao Youfang. "In the medical team, there is nothing that cannot be discussed. Don't make simple things so complicated. It doesn't matter if you make a wrong judgment. Aren't mistakes allowed in preliminary diagnosis and differential diagnosis?"

“……”Miao Youfang felt that this medical team was different from the medical teams he had encountered before.

Professor Luo might be a little more reserved, but Chen Yong said it simply, bluntly and directly, clearly.

"Let me tell you, half a year ago, I went out to eat for free to cheer up Old Liu, and I called 120 for an ambulance."

"Isn't this a waste of public resources? Is this possible?" Miao Youfang was surprised.

Chen Yong frowned and glared at Miao Youfang. "I told you to keep it simple, not to make things difficult for me. You little brat, do you know how to talk?"

"..."

"I didn't think much about it at the time." Chen Yong just said it casually, without taking it seriously, and continued to talk about the incident, "My master heard about this practice from his master. The 1990s were so chaotic."

"Later, Luo Hao helped me to settle the subsequent matters, but he didn't say anything to me. But I know in my heart that if it happens again, Luo Hao will definitely be very unhappy." Chen Yong explained with deep emotion.

"Everyone knows what's going on. No one is stupid. You're being mysterious, and it won't do any good except attracting other people's attention."

Miao Youfang remained silent.

Chen Yong returned to the office, found a shelf to put the test tubes on, took off his disposable gloves and washed his hands.

"Brother Yong, what are you doing?" Zhuang Yan asked.

"Xiao Miao suspects the patient has porphyria. Did you see it?"

"There are some symptoms, but there are eight types of porphyria: X-linked sideroblastic anemia, ALA dehydratase deficiency porphyria, acute intermittent porphyria, congenital erythropoietic porphyria, porphyria cutanea tarda, hereditary coproporphyria, mixed porphyria, and erythropoietic protoporphyria."

Zhuang Yan has a good foundation and can speak fluently.

Chen Yong particularly hates people like them who are graduates from prestigious institutions and who always want to show off.

"The patient's main complaint is black stools. Although there are few blood tests, the blood routine should not be like that." Zhuang Yan said naturally, "I just suspected it, but I didn't think about it that way."

Chen Yong didn't even look at Miao Youfang's expression. Instead, he pulled over a chair and sat next to the window sill, staring at the urine in the tube.

"That being said, it's good to be able to make a differential diagnosis."

Miao Youfang was a little confused; he was not used to doing things so blatantly.

But Chen Yong didn't care at all and stared at the urine.

"Brother Yong, what are you looking at that urine tube for?" a nurse walked in and asked.

“We in the Northeast are all like this.”

"Don't make a fuss. I admit the other things, but I'm not as interested as you in staring at urine. Are you too lazy to send a urine sample? Urine at this time... must be from someone you know. No, is Old Liu pregnant?!"

"..." Chen Yong was sweating profusely, "Don't talk nonsense, it's not good if this gets out."

"Then why are you looking at this thing?" the nurse asked doubtfully.

"Are you from Northeast China?"

"???"

"We Northeasterners are very advanced in many areas. Northeasterners are all existentialists. Let me give you an example."

"Male gaze, it's the gaze theory proposed by a French scholar Michel Foucault in the 20s and 60s, you know."

"I know."

"It's obvious that he's not from the Northeast. Let me ask you, when you're walking down the street and someone comes towards you and looks you up and down, you feel very uncomfortable. Why?"

"Who wants to be looked up and down?" said the nurse.

"Well, that's not what I'm talking about. Theoretically, you become the object of his observation, and he becomes the subject of observation."

"???"

"???"

"This is the so-called confusion caused by staring, but this kind of confusion will not appear in the Northeast. If you meet such a person, what will you do?"

"What are you looking at!" the nurse blurted out.

"Yes, this is a struggle for subjectivity. The other person will say, 'What are you doing?' This is also a natural reaction of free people to protect their subjectivity. It's a very normal reaction."

"!!!"

"!!!"

The office fell into silence.

No one expected that Chen Yongdong could talk so much nonsense and say so many specious things.

"They all say that people from the Northeast are simple and straightforward. Is that simple? Let me analyze it for you. Do you think it's simple? This is a confrontation between two existentialists, a contest between the willfulness of philosophy."

Fuck...

The office was quiet and no one spoke.

Chen Yong's nonsense blocked everyone's words, and everyone felt a little lost and empty.

"Let me tell you, if I ever hear anyone say that Lao Liu is pregnant, you will lose your paper this year."

"Brother Yong! I won't tell anyone!!" the nurse wailed.

"I can't help it. You just said this. According to the existentialist deconstruction method, I can only assume that it was you."

The nurse almost cried. Why was she so mean?
"Brother Yong~~~" The nurse immediately changed her voice to a squeezing one, squatted in front of Chen Yong, and pretended to hug Chen Yong's thighs.

"Stop making trouble. My husband Liu will be unhappy if you see us. If that happens, everything will be gone." Chen Yong laughed, not afraid at all.

In the past six months, Luo Hao has not written any papers, and all the papers are written by Chen Yong.

Moreover, Chen Yong also gained more "authority" in the top journal "The New England Journal of Medicine". His status in the department was only slightly lower than that of Luo Hao and Shen Zizai, and even slightly higher.

After all, the county magistrate is not as good as the current manager. If he offends Shen Zizai, as long as there is a staffing, can Director Shen really care about anything? But if he offends Chen Yong, there will really be no thesis.

After the paper fraud was exposed, everyone needs a decent paper for promotion, at least one.

Otherwise, your future promotion will be affected.

The nurse quickly clasped her hands together, begged for mercy, and then ran away.

"Brother Yong, you are exaggerating." Zhuang Yan laughed out loud.

"Why are your group's treatments getting weirder and weirder? I don't understand it at all." The resident manager sighed as he sat aside. "It's just a patient with black stools. The manifestation of porphyria is not here. How did you make this connection?"

"I don't know either." Chen Yong had a good relationship with the hospital manager. He knew that the guy was not a mean person. Although his words sometimes made people unhappy, there was no need to always wonder if he was a troublemaker who wanted to harm him.

"Then watch it."

"Hasn't Luo Hao already sent the patient's information to the group? Even Luo Hao is hesitant. Let's see what's going on." Chen Yong said lazily, "It's just a matter. Let's wait and see. Maybe it will be helpful to Luo Hao's diagnosis. But I don't think it's likely. Let's just take it as a joke."

Miao Youfang started to get upset again.

The diagnosis that he thought was certain to be correct was actually called a joke by Chen Yong.

However, in the medical team, he was just an extra member and had no say at all, so Miao Youfang could only remain silent.

"Brother Yong, why do you have a problem with Lao Liu being pregnant?"

"What are you talking about? If I'm going to get pregnant, I'll get pregnant after I get married. How could I do such a stupid thing as taking the child's life?" Chen Yong said disdainfully, "It doesn't matter whether Lao Liu is pregnant or not. The main thing is that I can't afford to lose face as a person."

The hospital manager was totally unable to understand Chen Yong's thoughts. Perhaps this was a level of thinking that had surpassed a large level.

While he was still working as the chief resident, toiling away the day and fantasizing about having a girlfriend after he stopped being a chief, his brother Yong was already too busy and needed to lighten his load.

The gap between humans is sometimes greater than the gap between humans and dogs.

"Then you keep busy. I'll go look up some books about this patient. Is it porphyria? Is it reliable?"

"I think what Xiao Miao said is half reliable, just as it should be."

"What does Ru Pu mean?"

"Porphyria should be fine, but it is definitely not caused by porphyria. Don't ask me why, that's just what I said.

In-depth diagnosis is basically based on guesswork. Luo Hao has the medical records database of the Union Hospital, so he is not guessing most of the time. But for this, didn’t you see Luo Hao start to call for help? "

Chen Yong was very relaxed and spoke in a somewhat long-winded manner.

"Brother Yong, are you a little tired from writing the paper? Why do I feel like you talk so much today?" Zhuang Yan discovered some clues.

"Yeah, give yourself a break. You can't keep working like a slave, you should relax a little. The main reason is that Luo Hao is too cunning and hard to fool. Even though he doesn't talk much, if you dare to fool him, he will throw a big bag at you."

Chen Yong sighed.

“Brother Yong, the gaze deconstruction you mentioned…” the resident manager asked casually.

But he was interrupted by Chen Yong just before he finished speaking.

"You, an ordinary person, want girls to stare at you? You must be kidding." Chen Yong's mask moved, as if he was pouting, but his contemptuous tone could not be concealed, "I am the only one who understands the distress of being stared at by girls, you guys don't understand shit."

"!!!"

"!!!"

What Chen Yong said was just like what Luo Hao said about my Union Medical College Hospital. It was impossible to refute, but one also lost the desire to continue chatting with him.

After waiting for several hours, Chen Yong observed the urine sample while chatting on his mobile phone.

His patience seemed limitless, and there was no sign that he would explode with anger as soon as he touched the steering wheel.

In winter, the sun sets early.

In the sunset, the tube of urine suddenly changed color.

red!

scarlet!

Like blood!
"Xiao Miao has something." Chen Yong looked at the test tube, not surprised at all, and said calmly, "It is indeed porphyria, this time it is correct."

Miao Youfang was not excited at all. For some reason, he felt that he was wrong again.

Since joining Professor Luo's medical team, except for the first diagnosis of Madelung's disease which was slightly surprising, several consecutive diagnoses have had problems of one kind or another.

Miao Youfang felt that this time would be no exception.

It was really confusing. He sighed, feeling somewhat uneasy but also expectant, hoping that Professor Luo could give him a definite answer.

"Why hasn't Luo Hao come back yet?" Chen Yong glanced at the time. "It's almost time. Xiao Miao, how do you judge?"

His words had several meanings, which made Miao Youfang a little confused.

"Brother Yong, I didn't judge."

“Hereditary hemorrhagic telangiectasia, also known as Osler-Weber-Rendu syndrome, is an autosomal dominant vascular disease.

Common clinical manifestations include epistaxis, gastrointestinal bleeding, and iron deficiency anemia with characteristic telangiectasia. In addition, arteriovenous malformations are also common in the lungs, liver, and brain. ”

Chen Yong held the phone, mumbling and thinking.

"Nosebleed, that's consistent," Zhuang Yan said. "I didn't see any of the multiple cutaneous and mucosal telangiectasias in typical locations, so I have my doubts."

"Internal organs are affected, such as dilation of gastrointestinal capillaries, lungs, brain or liver. There is a problem with the lungs and the brain is being investigated, so it should also be consistent." Chen Yong added.

"It's really strange. If it's hereditary hemorrhagic telangiectasia, the patient's hemoglobin should be low. How come I've had black stools for several months, but my hemoglobin is still normal, and there's no change in my platelets and red blood cells. Did the laboratory make a mistake?"

Zhuang Yan followed suit and kept nagging.

"Erythropoietic porphyria is commonly known as hemochromatosis."

Just when I was at a loss, Luo Hao's voice came.

He was talking about the detailed diagnosis of one of the eight types of porphyria!
Chen Yong stood up and saw Luo Hao striding in.

Luo Hao saw the bloody urine on the windowsill. He was not surprised, but just nodded, "This is the urine from this afternoon."

"Yes, Xiao Miao insisted that it was porphyria."

Miao Youfang wanted to explain, but in the end he said nothing.

“Patients with hemochromatosis present with various clinical symptoms due to iron accumulation in the body. The liver is the first organ to be affected because iron absorbed from the gastrointestinal tract into the blood first passes through the liver before reaching other organs.”

"Yeah."

Luo Hao just kept talking on his cell phone.

“When iron is deposited in the heart, it often leads to dilated cardiomyopathy and electrophysiological abnormalities. Iron is also selectively deposited in the pancreatic beta cells, leading to diabetes.

When iron is deposited in the skin, it can give it a bronze color.

Cirrhosis of the liver, diabetes, and skin pigmentation make up the hemochromatosis triad, so hemochromatosis is also called "bronze diabetes."

"Boss, please stop testing me. I have never seen this disease before. Just give me a definite answer." Luo Hao started to complain after he finished speaking.

No one knew what was said on the other end. Luo Hao just stared at the test tube on the windowsill.

"If our patient has hemochromatosis, long-term nosebleeds and gastrointestinal bleeding, like regular bloodletting, can keep the body's iron in balance, thus masking all the symptoms of hemochromatosis, leaving only the vague clue of hemoglobin."

"That's all I can think of, boss."

As he spoke, Luo Hao placed his phone on the windowsill, turned on the speakerphone, and stretched out his hand.

Meng Liangren appeared out of nowhere and handed a disposable glove to Luo Hao.

“Monism is the basic principle of clinical diagnosis, that is, to use one disease to explain all the symptoms, signs and auxiliary examinations of the patient as much as possible.

If monism does not work and more than one disease is needed to explain it, we should pay attention to the fact that one plus one does not necessarily equal two, that is, the addition of two diseases is not a simple superposition of the symptoms, signs and auxiliary examinations of the two diseases. "

An old voice came from the phone.

"Boss, do you mean there are other genetic diseases superimposed on it? Is it thalassemia?"

Luo Hao's eyes seemed to light up. He raised the hand holding the test tube and observed the changing color of urine under the light.

"Yes, when a thalassemia or sickle anemia carrier has hereditary porphyria, the two genetic diseases will cause an offset, and the symptoms will be alleviated or disappear. In fact, it can be considered a good thing."

"Then I understand, boss." Luo Hao put down the test tube, respectfully picked up the phone and turned off the speakerphone.

Miao Youfang is really right this time, thalassemia or sickle anemia superimposed on porphyria? !
"Oh, you really have seen so many patients. I didn't think of that and only considered the previous step. I've learned it this time, boss."

"thank you boss."

"Okay, okay, come after winter. There's snow here, so don't fall. There's no rush to pet cats. Or you can go directly to the Qinling Mountains. I'll take you to see wild bamboo."

"Boss, please don't scold me. We really can't transport bamboo to your home. The little guy looks good, but he's too naughty. Besides, he's a first-class protected animal. It's really inconvenient."

Luo Hao was chatting happily with the person on the other end. Even after the diagnosis was completed, he still didn't hang up the phone.

It looks like a grandmother and her grandson are chatting about family matters.

After an unknown amount of time, Luo Hao finally hung up the phone.

"Luo Hao, is this the old man you were looking for last year who was the chief ward inspector of Jiangsu and Zhejiang Province when he was young?"

"Yes, superposition, superposition. We still have to look under the microscope and wait for the results." Luo Hao squinted at the test tube, "You said, superposition of two serious illnesses is normal, who would have thought of such a thing."

Chen Yong laughed and looked at Miao Youfang.

Miao Youfang was already distracted, and no one knew what he was thinking about.

"Xiao Miao."

"Xiao Miao?"

"Xiao Miao!"

Luo Hao called out three times before Miao Youfang heard him and hurried over to Luo Hao's side. The expression on his face was a little tangled, and Miao Youfang didn't expect it to be like this.

Both thalassemia and sickle anemia are serious diseases, and porphyria is also a difficult disease. However, when they are combined, the patient's symptoms are actually milder, so that there are so many changes in the diagnosis.

This was something Miao Youfang had not expected.

"Teacher Luo, please speak."

(End of this chapter)