CHAPTER 215: 215 COMPLICATED ABDOMINAL PAIN

For the eight newbies who had just reported today, their first day was quite blissful. At the very least, it was very relaxed, and they even got to munch on chicken legs. This made their other young colleagues incredibly envious, as their own first day after reporting had put them straight to work.

The emergency department was relatively calm. Aside from the incident yesterday involving a technician under Qiaoqiao’s command, no patients needed admission.

First, they headed to the Gastroenterology Department to change dressings for Qiu Huaiyuan and Doudou. Then, they went to the wards on the second floor for their rounds, having efficiently managed their morning tasks.

"Brother Liu, Han Miao is being discharged today. I’ll go and help out for a while," Qiu Mingyuan said as he ran over.

"Go ahead, help to your heart’s content," Liu Banxia said, glancing at Xiao Yue, who was chatting with Xu Dan.

Qiu Mingyuan felt a bit frustrated. Brother Liu was a good guy, but sometimes he was a bit too casual.

"Today, you have all officially started. Dr. Wei and Dr. Wang aren’t here, so Liu Yiqing, Miao Rui, and Su Wenhao, you’ll follow me for now," Liu Banxia said. "It’s just temporary. When we move to the new building and get more doctors, we’ll be able to split shifts. Right now, we only have so many examination rooms, so too many doctors wouldn’t be manageable. You can also start getting used to the work rhythm of the emergency department. Regarding night shifts, I don’t have any specific requirements for now. Anyone who wants to can apply. In the future, an assessment will be needed before assigning night shifts."

"Teacher Liu, what about us? Teacher Shi has surgery today," Xu Yino asked.

"I’ll cover for everyone," Liu Banxia said. "If there’s nothing else later, I’ll take you all to the operating room for a look. Remember to follow the rules in the operating room. If anyone makes a mistake, who knows when they’ll be allowed in again."

This got everyone quite excited; of course, being able to go into the operating room was a good thing. They had been in during their internships but had only managed a glimpse from afar.

"One more thing," Liu Banxia continued, "the nurses are currently managing triage. In the future, it will be handed over to you, and you’ll all take turns daily. When you get back, discuss it amongst yourselves and create a duty roster. This is also one of your training assessment items. If the triage accuracy rate is high, there will be bonus points."

Hearing this, the group was somewhat disappointed. If they truly took over this task, they would spend their entire day at the triage desk. Even if a patient needed urgent treatment, they wouldn’t be able to participate.

"Eh? Why are you all back again?" Just as Liu Banxia was about to lead them on a tour of the operating room, he saw the TV station reporter who had interviewed him yesterday walk in again with her crew.

"Dr. Liu, hello. After a discussion at our station, we’ve decided to produce a special program about emergency department doctors. Starting today, we need to film and gather material here," Qu Feng said cheerfully.

Liu Banxia frowned. "Have you already requested permission from our management?"

Qu Feng nodded with a smile.

"Well then, go ahead and film. But I have one request: don’t block the main pathways, and no filming inside the resuscitation or examination rooms," Liu Banxia said after a moment’s thought. "The emergency department is a bit different from other departments. It might not always seem like there are many patients, but some require emergency treatment the moment they arrive."

"Dr. Liu, rest assured, we will adhere to all of these and definitely won’t interfere with your work," Qu Feng assured.

Liu Banxia nodded. "Alright then, do what you need to do."

However, he was still quite puzzled. If the TV station wanted to gather material, wouldn’t it have been better for them to go to the First Affiliated Hospital or the City Hospital? Those places have more patients and more cases.

He decided not to dwell on what he couldn’t figure out. Then, like a mother hen leading her chicks, he kept his group close by in the emergency department.

"Dr. Liu, there’s a patient with abdominal pain. Dr. Qi is with another patient," Xu Dan called out.

"Stay sharp. Every patient with abdominal pain in the Emergency Department requires special attention," Liu Banxia said. "There are many causes of abdominal pain. If we don’t consider all possibilities thoroughly, the patient’s condition could worsen, even becoming life-threatening."

The patient was a woman in her forties. She seemed to be in great pain, her face ghastly pale, with sweat on her forehead.

"How long has it been hurting? Can you tell me where it hurts?" Liu Banxia asked.

"My stomach started hurting after dinner last night," the patient explained. "At first, I thought it was just an upset stomach from something I ate. Then the pain got worse and worse, and painkillers didn’t help. However, the pain isn’t always severe; it comes and goes."

"Please lie down so we can examine you. Is the spot you’re covering with your hand the most painful?" Liu Banxia asked.

"No, it’s the right side that hurts. I don’t dare to touch it," the patient replied.

Liu Banxia furrowed his brow. If the pain were on the left side, it would be easier to deal with. But if it’s on the right side, it could be an acute abdomen caused by appendicitis. If it really was appendicitis, her pain tolerance was impressive. Most people wouldn’t be able to bear it for more than an hour or two before seeking medical attention.

"Qing Kewa, take her blood pressure and temperature," Liu Banxia ordered, then pressed on the patient’s McBurney’s point.

As Liu Banxia’s finger pressed down, the patient shivered from the pain, her body instinctively curling up.

"Ouch!" the patient cried out.

"Blood pressure is 80/120, temperature 38.6 degrees Celsius," Qing Kewa reported.

Liu Banxia nodded and palpated the patient’s abdomen again. He could feel her abdominal muscles were somewhat tense, but it wasn’t a severe, board-like rigidity, which reassured him slightly. If it were board-like, it could be peritonitis from a perforated appendix, which would be extremely dangerous. That’s one of the most feared aspects of an acute abdomen. It was only slightly tense now, suggesting the inflammation within the abdominal cavity had spread to the abdominal wall or peritoneum.

"We’ll draw some blood and do an ultrasound of your abdomen. If it’s acute appendicitis, surgery will be necessary. Otherwise, a ruptured appendix can be very dangerous," Liu Banxia said.

Hearing Liu Banxia, the patient was visibly startled. "Doctor, can’t we just use medication? Isn’t surgery very expensive?"

"Let’s wait for the test results. Are you from Binhai City, or elsewhere? Do you have health insurance?" Liu Banxia asked.

"I came to Binhai to work as a cleaner. I don’t have health insurance, but I have rural cooperative medical care," the patient said.

"That’s also acceptable; it provides reimbursement at a certain percentage. This is an emergency, so as long as it’s within the province, it’s covered. Let’s assess the situation first," Liu Banxia said. "Although conservative treatment can be considered for appendicitis, it’s very risky. If the inflammation becomes severe, it could lead to perforation, necrosis, and other complications."

The patient felt somewhat relieved hearing Liu Banxia say this; otherwise, two or three months’ wages probably wouldn’t cover the cost of such an operation.

Xu Dan drew the blood, and a portable ultrasound machine was wheeled over. Liu Banxia began the scan.

However, looking at the image on the screen, Liu Banxia was taken aback. The appendix looked normal, with no obvious swelling. How could this be possible? The symptoms of appendicitis were so clear: right lower abdominal pain, rebound tenderness at McBurney’s point... yet it wasn’t appendicitis. Could it be an issue with the gallbladder?

He applied more couplant and scanned the patient’s right upper abdomen. From the image, the gallbladder did appear somewhat inflamed, and there were some gallstones. However, he didn’t make an immediate diagnosis because the patient clearly stated the pain was in her right lower abdomen. If it were truly acute cholecystitis or gallstones, the pain should be in the right upper abdomen. Although one is superior and the other inferior, and the distance isn’t vast, in medical diagnosis, these are distinct indicators.

「DING! Task Issued: Mysterious Abdominal Pain」

"Open Task: The patient’s contradictory abdominal pain symptoms make diagnosis difficult for the Host. The Host must apply learned knowledge to provide appropriate medical treatment. Task reward is related to the Host’s diagnostic process and results."

Liu Banxia frowned as he looked at the task prompt. The system had indeed changed. Now, it wasn’t just the final result being assessed, but the process too. It was like answering an exam question: you not only had to give the correct answer but also show your work and reasoning. The more streamlined the approach, the higher the reward would be.

After a brief hesitation, Liu Banxia performed percussion over the patient’s gallbladder area again. The patient had no strong reaction. If it truly were acute cholecystitis, tapping the gallbladder during percussion would elicit a much stronger reaction from the patient than the tenderness at McBurney’s point earlier.

To be more cautious, Liu Banxia then scanned the patient’s kidneys and ureters to see if kidney stones were causing the abdominal pain.

Although there were stones in her kidneys, there was no sign of obstruction, and the ureter scan was clear.

"Based on the ultrasound, your appendix seems fine. However, you do have some gallstones. To diagnose further, we’ll need a CT scan," Liu Banxia told the patient.

"Doctor, can’t you give me some effective painkillers first so the pain stops? It really hurts so much," the patient said.

"I’m afraid not right now. If we give you painkillers, it might mask important symptoms during further examinations. Let’s do a CT scan; it will give us a more accurate picture," Liu Banxia said. "Also, can you contact your family? If surgery is necessary, we require a family member to be present, and you’ll also need someone to look after you."

"My family isn’t in Binhai City; I came here to work. Doctor, am I very seriously ill?" the patient asked.

Liu Banxia shook his head. "Don’t be nervous. We’re just asking these questions as part of our standard procedure. Let’s get a CT scan; it will give us a clearer picture."

Perhaps truly tormented by the abdominal pain, the patient, though worried about the cost, reluctantly nodded in agreement.

Liu Banxia, however, wasn’t as relaxed. This complex case of abdominal pain had truly stumped him. The concern remained the same: if the cause of her illness couldn’t be found, it might delay her treatment, leading to more severe complications and potentially threatening her life.