CHAPTER 314: 314 HEADACHE PATIENTS

The human mind is simple. Even though a hospital isn’t a place for conventional business, people still hope for a good start, to complete a successful rescue operation and cure the patient.

But not everything goes as planned. Indeed, the number of admitted patients increased a bit, but those were simple debridements.

The only severely ill child could not be treated. The only thing we could do was transfer him to the oncology department, hoping that radiotherapy or chemotherapy might have some inhibitory effect.

Performing surgery was meaningless now.

"Sister Wang, how many patients have we seen so far?" Liu Banxia asked.

"A total of forty-three, not too few," Wang Ying replied.

"The admission process was easy; these kids were quick to learn. Now that there are more people, they work efficiently, saving a lot of time."

"Indeed. If this were before, so many patients would have kept us busy for a while," Liu Banxia said.

"And now we don’t need to go so far to deliver blood samples. The lab is just around the corner. This new place is great. It would be even better if there were more emergency patients. I saw the municipal hospital’s trauma emergency center once, and it was unforgettable."

"Things are good enough for now; everything has to be done step by step," Wang Ying said with a smile.

"And now we have our own ICU ward, which can greatly improve the treatment success rate. Things might seem quiet now, but you’ll see, within a month, we’ll have our hands full."

"Teacher Liu, there’s a patient with a head injury here to see you. A two-centimeter wound on her forehead, registered under your name," Su Wenhao, who was at the triage desk, called out.

"You better go quickly. You’re the best at suturing; she must be afraid of scarring," Wang Ying said with a smile.

Liu Banxia chuckled. In fact, no one wants to leave a scar. It just depends on the suturing technique.

"How did this happen? I see there’s still some dirt in it. It needs to be cleaned carefully first, and then I’ll suture it," Liu Banxia asked after seeing the patient.

"There was a small pit on the road. I didn’t notice it while walking and tripped, hitting the curb," the patient answered.

"You weren’t playing with your phone, were you? Nowadays, too many people use their phones while walking. It’s best not to use them on roads or stairs. We’ve seen many patients who were injured from using their phones, many more serious than you," Liu Banxia said while cleaning the wound.

"I’m not in the mood to play on my phone; maybe I used to play too much. I often have headaches," the patient said.

"Doctor, does keeping the head down for a long time affect the cervical spine and then lead to headaches? It used to be occasional pain, but lately, it’s been getting worse, especially when I wake up in the morning."

"Headaches? Generally, they aren’t related to cervical spondylosis," Liu Banxia said.

"The pain caused by cervical spondylosis is mostly radiating pain in the upper limbs. It can affect the head, resulting in dizziness. Besides, you’re only twenty-six, so you generally shouldn’t have cervical spondylosis at such a young age."

"Have you ever felt nauseous? Or experienced weakness or numbness in your fingers? If you had those symptoms, it might be more indicative."

"No, it just hurts; it comes in waves," the patient answered.

"Don’t worry for now. Let me suture the wound first, and then I’ll give you a thorough examination," Liu Banxia said.

"There are many causes for headaches; the most common are tension headaches. There are also intracranial lesions, cerebrovascular diseases, and so on, which can cause headaches. What’s your daily routine like?"

"It’s very regular. I go to bed before 11 p.m. every day, get up at 6:30 in the morning, tidy up, and go to work after breakfast," the patient answered.

"Is there a lot of work pressure?" Liu Banxia continued to ask.

"My job isn’t stressful. I’m an office worker; it’s not a lot of work, and I don’t earn much," the patient said.

This made Liu Banxia a bit puzzled. Sometimes, excessive work or life pressure can cause anxiety and trigger tension headaches.

But this patient had a very regular life, a comfortable job, a very optimistic attitude, and she was so young; perhaps there really were some intracranial lesions.

However, there was no need to consider this at present. After cleaning the wound and applying the anesthetic, he still had to suture it first.

For him now, suturing such a small wound was really easy. Watching him do it so effortlessly, Liang Xiaolin pouted a little, feeling unconvinced.

He’s just good at suturing, what’s there to be so smug about?

"Okay, the suturing is done. Let’s address your headaches," Liu Banxia said after cutting the suture thread.

"Are there any specific triggers before your headaches usually start? Or, aside from the pain being severe in the morning, does it hurt at other times too? How often?"

"The headaches aren’t usually that frequent, but they are quite severe in the mornings. It’s right after I wake up, not long after, that my head hurts the most," the patient said.

"I’m starting to dread getting up. I don’t even dare to take a nap at noon. I’m afraid if I fall asleep, I’ll wake up with a worse headache. If that happened at work, it would be so embarrassing."

Liu Banxia checked the patient’s pupils and found nothing out of the ordinary. He also listened to her heart and lungs; the sounds were normal.

Actually, the simplest method would be to give the patient a brain CT scan; it’s straightforward. But you can’t just order a CT scan for every patient who complains of a headache.

After asking the patient more questions, Liu Banxia grew more puzzled.

The patient had a history of headaches for less than three years, with no apparent triggers, only that the pain had gradually intensified. Also, it wasn’t localized pain on the left, right, forehead, or back of the head, but a diffuse pain affecting her entire head.

It should be a primary headache. It’s very regular, starting right after she wakes up. Of course, secondary possibilities can’t be ruled out, but it’s more likely a primary headache.

"We can’t reach a diagnosis through the physical exam alone; we have to do a head CT scan," Liu Banxia stated.

"I had one last year, and they found nothing wrong. No brain tumor or brain hemorrhage. I even had acupuncture treatment for more than three months, but it didn’t help," the patient said, shaking her head.

"Actually, as long as I get through that period in the morning, I’m fine. It doesn’t affect my life or work. Will this wound leave a scar?"

"Normally, it won’t. Just avoid getting it wet in the short term. Even when washing your hair, you need to protect the wound area. There will be some marks after the stitches are removed. It depends on the individual; for some people, the marks disappear after a few months, while for others, it might take more than a year," Liu Banxia said.

"However, regarding your headaches, I personally believe you should get them thoroughly checked out. Some conditions don’t show lesions in their early stages. As the condition progresses, lesions might become visible."

"Take cerebral hemorrhage, for example. Some people bleed immediately after an impact. For others, the bleeding might only become visible on scans an hour or two later."

The patient hesitated for a moment, then nodded.

Liu Banxia breathed a sigh of relief and ordered a brain CT and an electroencephalogram (EEG).

"Isn’t a CT scan enough?" the patient asked curiously.

"A brain CT scan checks for structural abnormalities, while an EEG checks for functional neurological issues. Since you’re already here, let’s be thorough with the examination," Liu Banxia replied.

"Later, I’ll ask a neurologist from our department to consult as well. Let’s try to find the cause of your headaches so they won’t continue to torment you."

The patient nodded. Although she didn’t want to undergo so many examinations, worrying about the cost, the headaches were truly unbearable, and she was hoping for even a slim chance of finding a solution.

"What if both the brain CT scan and EEG don’t find anything wrong? I observed just now that the patient doesn’t have any specific signs," Liang Xiaolin asked.

"If these two tests don’t reveal anything, I would advise the patient to be hospitalized for observation. An EEG can also be performed while she’s sleeping. Since her headaches usually start when she wakes up, we can see what the EEG shows at that moment," Liu Banxia replied.

"What if the patient doesn’t agree?" Liang Xiaolin asked again.

"Then we persuade her. I’ll leave that task to you. You can be the one to persuade her," Liu Banxia said.

"Why me?" Liang Xiaolin was a bit stupefied.

"Because you asked, naturally, it falls to you," Liu Banxia shrugged.

"All of you should learn from Doctor Liang and have the courage to take on important tasks. If you don’t understand something, you must ask, and if you ask, you must take responsibility. This patient definitely has an underlying condition; otherwise, she wouldn’t be experiencing these headaches."

"Many people often say that someone gives them a headache, but that’s a metaphor. The pain that real headache patients experience is very severe."

"Teacher Liu, can you determine the cause of this patient’s condition?" Xu Yino asked curiously.

Liu Banxia shook his head decisively. "I can’t figure it out; that’s why we need to do diagnostic tests. If we still can’t figure it out after the first round of tests, we’ll have to find a way to get the patient to stay for observation."

"In fact, sometimes, tension headaches are similar to heart conditions. An EEG done when the patient isn’t having an attack might not show anything. But structural damage and functional neurological issues are often interrelated, so I ordered an EEG as well today."

"When we see patients, we need to avoid unnecessary diagnostic tests but also not miss any necessary ones. How we proceed depends on the actual situation."

"The principle of diagnostic testing is to go from basic to advanced, unless there are clear indications otherwise. Like that young man today; Doctor Qi noticed some abnormal swelling in his throat when intubating him."

"You all need to work hard. In a few more months, you’ll be allowed to see patients independently. You’ll have attending physicians supervising you, so you must not be careless."

Upon hearing his words, they all felt a thrill of anticipation. Seeing patients independently! That’s a huge deal. But they were also worried, afraid of misdiagnosing or missing something.

Just moments ago, they were still pondering the headache patient’s case, but now their thoughts had shifted to the prospect of seeing patients independently; even Liang Xiaolin was now thinking about this new responsibility.