White armor

Chapter 610: Recruiting People (Part )

"A friend of mine is not feeling well and is coming to the emergency department to see a doctor. He saw you passing by." Director Tao said with a smile, "Xiao Miao, why are you in the emergency department? I remember the last time I saw you, you were in the interventional department sending a patient back to the ward."

He pretended to be nothing and chatted with Miao Youfang about family matters in a friendly manner.

"Teacher Luo asked me to come to the emergency department in the evening to see emergency patients and gain some clinical experience." Miao Youfang explained the situation honestly.

"..." Director Tao and Professor Chen were silent.

What does Dr. Luo mean by this?
Not letting Miao Youfang go home after working all day, and forcing him to come to the emergency department to continue working at night?

You don't use cows and horses like this.

The landlords' cattle and horses had to be used sparingly and given good food and drink. Even the hardiest mules were not used in this way.

It seems that Dr. Xiao Luo really is using this student who is going to Peking Union Medical College for graduate studies as a mule, and he is planning to throw him away after using him. He looks like a scumbag.

But he didn't use it in his own department, which was weird.

"Are you used to it?" Director Tao was surprised and puzzled, but still asked with a smile.

"It's OK. The teachers in the emergency department all take good care of me." Miao Youfang was respectful and generous, neither humble nor arrogant, giving people a very good impression.

Although he has an ordinary appearance and his shadow can be seen in a crowd, his attitude towards others is impeccable.

Director Tao and Professor Chen were both very satisfied.

Nowadays, the post-00s kids are very lively. It is a pleasant surprise to see a mature young man.

"If I'm particularly busy at night, I can also sew leather." Miao Youfang said happily.

Sew leather!

Professor Chen smacked his lips. Only doctors who have little clinical experience would like to sew skin.

The sound of the 120 ambulance was heard.

Miao Youfang lowered his head slightly and made a bowing gesture, "Director Tao, please go ahead and take care of yourself. I'll go pick up the patient."

"Well, go ahead and get busy."

Seeing Miao Youfang and the nurse hurried to the door, Director Tao said, "It looks good."

Professor Chen nodded.

"Generally, children of this age who have not come to the clinic are a bit socially anxious. After all, they spend their days reading books as tall as their bodies, and they don't socialize much. This child is different. Old Chen, you have a good eye."

"What was Dr. Luo thinking, throwing someone else's child to the emergency department?" Professor Chen was puzzled.

As they were chatting, Miao Youfang pulled a stretcher and quickly ran to the emergency room, then picked up the information provided by the patient's family and quickly read it.

After looking through it, the emergency physician just arrived at the emergency room.

"Teacher." Miao Youfang began to report the medical history in a low voice.

Professor Chen had an idea and walked to the door of the emergency room, listening attentively to Miao Youfang's report on the medical history.

"The patient, a 71-year-old male, complained of diarrhea for 2 days and abdominal distension and pain for 5 hours. He had diarrhea 2 days before coming to our hospital, with more than 20 watery stools per day, each volume of about 50 mL, accompanied by nausea and vomiting, but he did not pay attention to it and did not receive any diagnosis or treatment.

5 hours later, severe pain developed under the xiphoid process, which was unbearable, accompanied by chest tightness, shortness of breath, and severe abdominal distension. He was treated at the county hospital, given "pethidine hydrochloride" analgesic treatment, and was sent to our hospital by 120 ambulance. "

Reporting the medical history was like writing a medical record. Professor Chen nodded and became more and more satisfied with Miao Youfang.

Even though Miao Youfang spoke quickly, every word he said was heard clearly, with important parts emphasized, as if they were marked.

"B-ultrasound results...blood test results..."

I underwent two tests at the county hospital, and the emergency physician immediately ordered a blood test.

This is the busiest time in the emergency department. The nurses are so busy that they almost never touch the ground, and sparks are almost coming out of their work.

After reporting the medical history, Miao Youfang began to follow the doctor's orders and helped the nurse draw arterial blood.

Professor Chen hit the nail on the head and noticed that it was bright red arterial blood, not dark red venous blood.

Sampling arterial blood for blood gas analysis requires certain skills. Some young nurses who have just started working have no idea how to do it. Some of the blood samples sent for testing are venous blood, which leads to huge deviations in values ​​and requires repeated sampling.

But Miao Youfang's movements are concise and have a subtle beauty.

"Old Chen, very good!" Professor Tao also saw the steps of Miao Youfang drawing arterial blood and praised him.

"It's really good. He felt the position of the artery and inserted the needle directly. A nurse without ten years of experience in the intensive care unit can't do it."

Ten years is a bit exaggerated, three years is still necessary.

Director Tao looked at Miao Youfang with admiration and suddenly nudged Professor Chen with his shoulder.

"Old Chen, what do you think is wrong?"

"Respiratory acidosis." Professor Chen, who has extremely rich clinical experience, took a quick glance and saw the patient's bloated stomach, restlessness, even tremors and confusion, and made his own judgment.

"Great! You are worthy of being an expert from Union Medical College. You can tell the difference at a glance." Director Tao said.

"You'll know if you see more. Look at him..." Professor Chen was about to say a few more words, but suddenly he had an idea and stopped talking. Instead, he stared at Miao Youfang.

After everything was done, an infusion line was left, an IV drip was hung to maintain the intravenous access, blood samples were sent for testing, and the doctor went to the emergency room next door for ultrasound and CT examinations before Miao Youfang came out.

"Xiao Miao." Professor Chen called out directly.

"Hello, teacher." Seeing Professor Chen wearing the white uniform of the First Hospital of Medical University and a cotton vest, Miao Youfang thought he was a doctor from the same family, so he walked over respectfully and politely.

"Patient, the one we just saw, what disease do you think it has?" Professor Chen asked.

He had a kind expression, afraid to scare Xiao Miao.

Just by seeing Miao Youfang seeing patients, Professor Chen's love for talent was greatly aroused. Deep down in his heart, he already regarded Miao Youfang as his own student and cared for him.

“???” Miao Youfang was silent, seeming to be thinking.

"The patient's medical history includes chronic obstructive pulmonary disease." Professor Chen was ready to show off his skills and shock this young man.

"Yes, the patient has a 30-year history of COPD," Miao Youfang replied.

"For patients with COPD and abdominal distension, respiratory acidosis should be considered." Professor Chen taught, instantly starting substitute teaching mode.

As for testing Miao Youfang, Professor Chen felt that it was normal for the child not to know the correct diagnosis. After all, there is a huge gap between clinical practice and textbooks.

I don’t know what’s so great about it now, but with more clinical exposure and the solid basic knowledge of Miao Youfang, I will definitely be able to put what I have learned into practice in the future.

Miao Youfang was a little surprised and looked at Professor Chen.

Professor Chen saw a hint of admiration in Miao Youfang's surprised look.

“Acute severe respiratory acidosis is manifested by shortness of breath, dyspnea and obvious neurological symptoms such as headache, blurred vision, irritability, and even tremors, confusion, delirium and coma.

Physical examination may reveal optic disc edema, increased cerebrospinal fluid pressure, and cardiac arrhythmias.

But be careful - the symptoms of chronic respiratory acidosis are often masked by the underlying disease."

"When you and the emergency physician were doing the physical examination just now, you checked the light reflex too quickly. You only checked whether the pupil's light reflex was sensitive, but did not carefully check whether the optic nerve was swollen."

While explaining, Professor Chen pointed out the flaws in Miao Youfang's diagnosis and treatment.

He just said it lightly, without any scolding.

Miao Youfang was silent, seemingly thinking.

Professor Chen smiled and said, "Please keep an eye on the patient's blood gas analysis results. I'll be waiting here. Please let me know when the results come out."

"Okay, teacher." Miao Youfang responded crisply.

Turning around, Miao Youfang was a little hesitant, as if he was struggling with something.

Professor Chen laughed, "Xiao Miao, is there anything you don't understand that you want to tell me?"

Miao Youfang is still young and can't keep things in his heart. He has something to say but swallows it back. His expression is too obvious.

But he still said respectfully, "Teacher, there is nothing to say. I will report to you when the blood gas analysis results are returned."

"If you have anything to say, just say it. Don't hide it." Professor Chen pretended to be angry. "Is there something about the diagnosis that you don't understand? Let me tell you, the probability of COPD in the elderly in the north is very high. When the emergency physician examined the patient just now, the patient's abdomen was swollen and his abdominal breathing was obvious. Did you pay attention to these details?"

"Teacher, I noticed it." Miao Youfang answered seriously.

Professor Chen frowned. This kid was fine before, but his stubbornness was a shortcoming.

But it doesn’t matter. Professor Chen thinks it’s okay for young people to be stubborn. It’s just because they care about their reputation.

Wait until you have convinced him, then take him under your wing and slowly bring him under your wing. There is no need to rush.

"After preliminary examination, we ruled out diseases such as acute pancreatitis, aortic dissection, myocardial infarction, and calculous cholecystitis, and the diagnosis was in a dilemma. What do you think at this time?"

Miao Youfang was about to open his mouth to speak, but he closed it at the last moment.

"Xiao Miao, time is precious, so just say whatever you want to say. You need to know your role. You are just a little clinical doctor who is here to help. Have you passed the medical certificate exam?"

"The test is over, teacher."

"Oh, then tell me what you think." Professor Chen said.

Miao Youfang didn't say anything, but just bowed. "Teacher, I'll call the laboratory to urge them. The results will be out in about 10 minutes."

As he spoke, Miao Youfang took out his phone and checked the time, "It's almost time."

This child must be unconvinced in his heart, but he doesn't say it. Professor Chen thinks he is really stubborn.

And he's stubborn.

The advantages are obvious, and as for the disadvantages, there are a few, which are acceptable.

Professor Chen said with a smile, "You must have your own judgment. Tell me about it."

"Xiao Miao, I'm in the gastroenterology department. I've seen a lot of patients with abdominal pain, but similar patients are relatively rare. If you have any questions, just tell me." Director Tao chimed in.

Suddenly, Director Tao found it a little funny.

Two great experts are making things difficult for a student. How can this be called?

Similar patients would definitely be misdiagnosed in township hospitals and county hospitals. Even in municipal-level tertiary hospitals, the probability of misdiagnosis is very high. However, they have various examination equipment. It is highly likely that they can first conduct a thorough examination and then work backwards to find the result.

But if one really wants to tell everything about the patient just by looking at him/her, even the chief physician in a municipal hospital would find it difficult to do so.

Let alone the student in front of him, he looks green and immature, and it's obvious at first glance that he's a rookie.

It is better to hope that the patient will get better suddenly on his own than to expect Miao Youfang to tell the answer.

"Xiao Miao, tell me your judgment, it's okay. You don't have much clinical experience and you are still in the growth stage. It doesn't matter if you are wrong." Professor Chen encouraged.

Miao Youfang showed a stubborn look in his eyes, and then whispered, "Teacher, you two didn't check the body, so you may have overlooked something."

"???"

"???"

Fuck! This kid is crazy!
What does this mean? If you haven't examined yourself, you are not qualified to make a diagnosis?
Professor Chen and Director Tao were immediately unhappy. They looked at Miao Youfang deeply, waiting for the child to continue. This was the result of being stubborn. In order to argue the pros and cons, they added drama to themselves and found all kinds of excuses.

In clinical practice, such subjective doctors are very annoying.

"Xiao Miao, I asked you to give your diagnosis, why are you adjusting our problems?" Director Tao scolded bluntly.

"Director Tao, I smelled a rotten apple when I was testing the patient's bilateral pupillary light reflex."

"!!!"

"!!!"

"There is acidosis. The teacher's judgment is correct, but it is not respiratory acidosis, but ketoacidosis caused by high blood sugar."

Miao Youfang finally spoke out the answer and felt relieved, with a smile on his face.

He looked at Professor Chen and Director Tao like a little beast. There was no complacency in his eyes, only a hint of eagerness to try.

"!!!"

Professor Chen was stunned.

Acidosis caused by diabetic ketoacidosis?
It was indeed a similar situation, but he... He went for a physical examination and smelled the typical rotten apple smell.

Professor Chen was a little confused.

Am I trying so hard to show off that I'm reaching the wall?

"It shouldn't be the case. Diabetes can be checked at the county hospital," said Director Tao.

"Director Tao, I think the patient had severe abdominal pain when he was sent to the county hospital by his family. The emergency department of the county hospital considered it a surgical disease. After a routine blood test and B-ultrasound of the liver, gallbladder and spleen, there was no typical evidence. The patient was given an injection of pethidine and sent to a higher-level hospital."

Miao Youfang explained.

Director Tao's eyes changed when he looked at Miao Youfang. How could this guy guess something about the county hospital?
It was obvious that Miao Youfang was not speaking casually. Putting himself in his shoes, Director Tao knew that what Miao Youfang said was roughly the same.

The county hospital believed that it was a disease such as cholecystitis or pancreatitis, so they only conducted relevant tests.

However, the examination results did not support the diagnosis, so they sent the patient directly to the First Hospital of Medical University without hesitation.

This happens no less than a hundred times every year.

but!

How can a young doctor who has just passed the postgraduate entrance examination and has not yet entered school know so much?
Miao Youfang's various behaviors are more like those of a veteran who has been working at the grassroots level for more than ten years but has not forgotten his original intention, rather than a young man who has just started clinical work.

"Xiao Miao, who told you that?"

"Teacher Luo said that he should pay special attention to patients referred from lower-level hospitals."

Luo Hao, it’s actually him!

Director Tao was stunned for a moment. Seeing that the patient had just been pushed out of the emergency CT scan, he quickly walked over and leaned over to smell it.

It really smells like rotten apples.

Damn it! How come the county hospital didn’t even know this! Director Tao was furious.

But this anger cannot be directed at Miao Youfang.

He was a little confused. Old Chen wanted to show off and impress Miao Youfang. But he didn't expect that he would fail in his pretense and was taught a lesson by the young man.

"It does smell like rotten apples." Professor Chen came over and smelled it, then nodded, "Xiao Miao is right."

"Teacher, I'll get busy then." Miao Youfang was still respectful, still polite, and still neither humble nor arrogant.

But the attitude seems to have changed under the current.

Director Tao and Professor Chen watched Miao Youfang leave. After nearly a minute, Director Tao said, "This guy is quite interesting."

"Indeed." Professor Chen also nodded.

Although the results were not out yet and they were not sure whether they had lost face, deep down they were both certain that Miao Youfang was right.

The smell of rotten apples is indeed pungent, but if I had checked my body myself, I wouldn't have had such a problem.

But that's just an assumption.

Soon, the emergency physician ran to the emergency room and began to direct the rescue.

Miao Youfang came up to the two of them and greeted them respectfully.

"Routine blood test: WBC 21.5X109L-1, renal function: BUN 16.4 mmol/L, CRE 308 umol/L, electrolyte K+ 6.6 mmol/L, TCO2 3.8 mL/L, urine routine: occult blood + protein + ketone bodies +, blood gas analysis: pH 6.89, lactate >15 mmol/L, blood glucose 15.38 mmol/L."

Miao Youfang gave a bunch of numbers.

Ketoacidosis caused by increased blood sugar!
His judgment was correct.

Professor Chen narrowed his eyes and stared at Miao Youfang. He saw that his expression was calm, without any suppressed joy, as if he had just completed a small task in his clinical work.

"Teacher, I'm going to be busy now." After Miao Youfang finished his report, he turned and left.

Professor Chen sat on a chair in the waiting area, watching quietly. He admired Miao Youfang more and more.

The child's previous hesitation to speak now seemed to be thinking about how to save face for himself and not embarrass himself.

On the contrary, I kept chattering on according to my own diagnosis, feeling a little self-righteous.

"Old Chen, what should we do next?" Director Tao also felt it was a difficult situation and asked.

"Let me take another look at the kid." Professor Chen felt a little regretful. It was a pity that his first kick did not go well. He might as well just tell him that he was a master's supervisor at Union Medical College.

Is it possible that I have no destiny with this child?
Professor Chen saw Miao Youfang working skillfully. He was not only helping with the doctor's work, but also helping with some of the nurses' work. He was diligent and down-to-earth.

The more I watch it, the more I like it, and the more I like it, the more regretful I feel.

Although he had not yet discussed serious matters with Miao Youfang, Professor Chen already knew that the bond between him and Miao Youfang had faded a lot.

Miao Youfang didn't speak to the two of them anymore. Once when passing by, Professor Chen saw that there seemed to be culture medium inside Miao Youfang's phone case!

The red liquid moved as Miao Youfang picked up and put down his phone.

"Xiao Miao!" Professor Chen couldn't help but greet her.

"Teacher, what's wrong?"

"Is your phone case a culture medium?" Professor Chen asked in surprise.

"Yes, Mr. Luo ordered it for me."

Customized, culture medium? What is Dr. Xiao Luo going to do? !

Professor Chen looked confused.

"Teacher Luo said that there is no easy task in scientific research, and I will have to enter the laboratory sooner or later, so he found a product manager to make a mobile phone case with culture medium." Miao Youfang showed a smile on his face.

"The color of the liquid in this culture medium phone case is a 1:1 replica of the DMEM culture medium."

DMEM medium is a medium containing various amino acids and glucose, which is developed on the basis of MEM medium.

Compared with MEM, the dosage of various ingredients is increased, and it is divided into a high-sugar type below 4500 mg/L and a low-sugar type below 1000 mg/L.

The high sugar type is conducive to the cells to stay in one location and grow, and is suitable for tumor cells that grow faster and have difficulty attaching.

DMEM culture medium is also the most commonly used one by clinical graduate students and doctoral students.

"Is that real culture medium?" Professor Chen asked curiously.

"I don't know. Teacher Luo gave it to me, so I looked it up. I'll be in contact with DMEM medium frequently in the future, so using it as a phone case can be considered as a way to get used to it in advance."

When talking about the mobile phone case that Luo Hao gave to Miao Youfang, Miao Youfang's ordinary face was filled with a sincere smile, which was completely different from the mature look of a young man just now.

Professor Chen noticed that there was a colorful print on the back of Miao Youfang’s phone case, which was almost exactly the same as the DMEM culture medium in the laboratory.

Miao Youfang held the culture medium phone case, as if he was growing cells in the phone, and he felt a sense of accomplishment that only clinical researchers could understand.

Dr. Xiao Luo is really... Professor Chen didn’t know how to describe Luo Hao.

"Teacher Luo said that even if you leave the laboratory, as long as you take out your mobile phone, you will feel that the cells you culture are thriving."

"..."

"..."

Miao Youfang shook his phone case as he spoke, looking even more proud than the patient who had just been diagnosed with diabetes-induced ketoacidosis accompanied by abdominal distension and pain.

The feeling of pride was beyond words, and Miao Youfang didn't even think about suppressing it, and looked quite happy.

Professor Chen was stunned. He felt that there was something behind these words. Maybe Luo Hao treated Miao Youfang as a culture medium. During the time away from Luo Hao, Miao Youfang was also growing vigorously.

Director Tao suddenly remembered something, "Xiao Miao, where is your ballpoint pen?"

Miao Youfang handed the ballpoint pen in his chest pocket to Director Tao.

Director Tao took a look and laughed, "Dr. Xiao Luo's medical team's pens are all custom-made. How about yours?"

“???” Professor Chen was stunned.

Miao Youfang's expression suddenly became solemn.

"I'm just saying it casually, don't take it seriously. It might have been custom-made for you but hasn't arrived yet." Director Tao just hit Miao Youfang jokingly, and then comforted him.

"I do!" Miao Youfang said stubbornly.

"Oh?" Director Tao didn't take it seriously.

"Here." Miao Youfang took out his ballpoint pen from his shirt, but he did not hand it to Director Tao. Instead, he held it in his hand and shook it in front of Director Tao.

Luo Hao Medical Team of Peking Union Medical College Hospital: Dr. Miao Youfang.

There was a line of words written on the ballpoint pen.

"I hadn't been confirmed to join the group yet. Mr. Luo only ordered a ballpoint pen for me, but didn't give it to me." Miao Youfang explained, "Old Meng gave me one and said that no matter whether I could join the group or not, it would be a souvenir."

“……” Professor Chen was stunned.

Are all ballpoint pens custom-made?

Although it doesn't cost much, the thought behind it is worth pondering.

Things seem to be heading in a bad direction and are becoming increasingly out of control.

Professor Chen, who originally thought that he and Luo Hao were evenly matched, now feels that he is in a difficult position because Luo Hao had already made his move.

"Sister Fang, wait a moment!" Miao Youfang seemed to have seen something and shouted.

"Teacher, please wait a moment. I have something to do over there." He explained hurriedly.

Miao Youfang quickly put the ballpoint pen with his name on it into his shirt pocket. As for Director Tao's ballpoint pen, he did not take it back and ran into the ward.

(End of this chapter)