CHAPTER 366: 366 HYPERSOMNIA

"Let’s pause the operation for now. The tumor has severely infiltrated the base. Sparing the anus will be difficult. I’ll go discuss with the patient’s family," Liu Banxia said.

Everyone came to a halt.

This situation was what everyone hated to see. Even though they had anticipated it preoperatively, they didn’t really want things to develop for the worse.

"Liu Feng’s family," Liu Banxia called out once he was outside.

At his call, Liu Feng’s wife, son, and daughter rushed over.

"It’s chaotic here. Come with me to a room on the side," Liu Banxia said.

"Dr. Liu, are we unable to save the anus?" the patient’s son asked.

"Infiltration has occurred at the tumor’s base, and it is spreading towards the anus. Visually, the distance seems adequate at the moment, but based on my judgment, I’m afraid it won’t be sufficient to support it after the pathological examination," Liu Banxia stated.

"There are two choices here. One, we continue as planned. I’ll try to excise as little as possible to save the anus. However, if the pathology later doesn’t support it, we’ll need a second operation."

"This will mostly affect the cost, and undergoing two such operations in a short period will definitely impact recovery. However, you don’t need to worry about the cancer itself, as there’s no chance of it spreading upwards."

"Dr. Liu, what’s your opinion? We came here specifically for you," the patient’s son asked.

"If you’re asking for my personal opinion, my choice would be an abdominoperineal resection," Liu Banxia said after a moment’s thought.

"This is often the case with rectal cancer; the lesion is typically near the anus. It’s not that we doctors choose resection to save ourselves trouble. In fact, preserving the anus means we might perform at least one additional surgery later on."

"Take ten minutes to think about it. If you agree to the abdominoperineal resection, please sign here. The postoperative risks and complications are similar to those of the entire surgery, so I won’t go into detail to avoid taking up too much of your time."

"Dr. Liu, I can sign right now. Chief Director Xu recommended you to us, and we trust you. We believe your decision will be the best one," the patient’s son promptly replied.

Liu Banxia smiled and nodded. "Alright, I’ll proceed with the operation then. It will take about an hour or so to finish."

"Don’t worry too much; the five-year prognosis after rectal cancer surgery is quite good. The only somewhat troublesome part will be changing the ostomy bag and the nursing care, but our nurses will explain that when the time comes."

"Thank you, Dr. Liu," the patient’s son said appreciatively.

"Alright, I’ll head back in," Liu Banxia nodded.

Liu Banxia was quite pleased with the patient’s son’s decisive attitude, not because it saved him time or having to make lengthy explanations, but because a shorter anesthesia period is always better for the patient.

More often than not, the more relatives a patient has, the harder it is to communicate. Everyone has their own views, and their intentions are all for the patient’s sake. But in the process of considering, too much personal emotion gets mixed in, making it impossible to think calmly.

He had encountered similar patients before, many times in fact, among those with rectal cancer. He had also experienced cases where a second abdominoperineal resection was necessary. The longest discussion time for a patient’s family in such situations had been nearly an hour.

What could you do? You could only wait for the patient’s family to reach a clear decision. Even if there had been comprehensive communication before the surgery, the final choice still rested with the patient’s family.

"Teacher Liu, how did it go?" Su Wenhao asked after Liu Banxia returned to the operating room.

"Abdominoperineal resection. You guys will do the rest. I will supervise," Liu Banxia said.

There are many things to note during an abdominoperineal resection. However, Su Wenhao and the others had completed similar surgeries with Liu Banxia before, so they were capable of performing it.

Many chief surgeons lacked Liu Banxia’s boldness, typically only allowing their students to participate more extensively after careful consideration.

None of them possessed Liu Banxia’s reaction speed and adaptability. Otherwise, these interns wouldn’t be so devoted to following him.

DING! Operation completed.

You have received 400 experience points, 200 points in Diagnostic Skill, 200 points in Dressing Change Skill, 200 points in Suturing Skill, 500 points in Intestinal Surgery Skill, and 5 Glory Points.

"Alright, let’s move him to the ward," Liu Banxia said, stretching his neck.

A day of surgeries was exhausting, and he was also worried about the patient suspected of tularemia. If it wasn’t that, the patient’s condition might deteriorate further, delaying the optimal rescue time.

"Wang Chao, where’s Wang Huan?" Liu Banxia asked upon returning to the emergency center.

"Wang Huan is in the ward upstairs. The patient doesn’t seem to be improving even after the administration of streptomycin," Wang Chao said.

"I’ll go take another look," Liu Banxia nodded.

He was in a bit of a foul mood today. He hadn’t been able to preserve the patient’s anus as he’d hoped, and now his suspected diagnosis of tularemia also seemed unsupported.

"Finished with surgery? It probably isn’t tularemia. I’m considering ordering an MRI with contrast for the patient’s head and re-testing the serum," Wang Huan said.

"While I was in surgery just now, I thought about it carefully," Liu Banxia said, hesitating a moment. "What if drowsiness is the primary manifestation of this patient’s illness, rather than a complication arising from it?"

"But regarding hypersomnia, this also seems a bit off," Wang Huan said with a wry smile.

Liu Banxia shook his head. "Then what if it’s sleeping sickness? We both overlooked that, didn’t we?"

Wang Huan frowned. "I considered that. In fact, it was the first thing I thought of after the test results came back. But I dismissed it after speaking with the patient’s husband."

"They’ve always lived in Binhai City. They haven’t even left the city in the past year, let alone traveled to Africa. Both sets of parents live in the urban area, and their son attends Binhai University of Technology. Unless..."

"Perhaps the ’unless’ you mentioned is indeed the case. Should we question the patient again? After careful thought, I believe it’s sleeping sickness if we exclude tularemia. All symptoms are consistent. If confirmed, it could already be in the second stage," Liu Banxia said.

"Sigh... This is the patient I admitted. I’ll be the one to question them separately," Wang Huan said with a wry smile.

Sleeping sickness is very common in African countries, its primary symptom being lethargy or drowsiness.

It is also a parasitic disease, specifically caused by trypanosomes. It’s difficult to confirm through tests, so diagnosis often relies on current symptoms and patient history due to detection difficulties.

The mortality rate of this disease is extremely high because by the time it’s discovered, it’s usually in the advanced stage—the second stage—where the parasite has already affected the central nervous system. Consequently, the patient will frequently fall into a stupor, and the ultimate outcome is that they will never wake up again.

This parasite often lurks under the skin. If it is Trypanosoma brucei gambiense, the incubation period can be even longer, possibly several months or even years.

The main transmission route for this disease is bodily fluids, which is why Liu Banxia had posed his earlier question in such a manner. Since the couple had never left Binhai City, it implied there must have been a carrier who had returned from Africa.

It was possible that one of them had an affair with that carrier. Judging from the current situation, the probability seemed higher for the patient—the wife.

However, based on the husband’s description of their happy marriage, the chances of the wife having an affair seemed low.

But no one could be 100% certain about such things. And if it were true, it could affect the entire family.

"Teacher Liu, why can’t we inquire immediately?" Su Wenhao asked curiously after Liu Banxia came downstairs.

"You haven’t learned about this disease yet, have you? Look it up in your books. The knowledge you gain from researching it yourselves will be more impactful than if I just tell you," Liu Banxia responded with a smile.

"But this case serves as a reminder for us. We mustn’t rule anything out without clear examination findings and indications. Both Doctor Wang and I made this mistake. We both thought of it, but we also denied it in our minds."

"This was our oversight. Hopefully, it won’t affect the treatment. It’s already in the second stage, affecting the central nervous system. The effectiveness of medication varies from person to person."

"After all, in African regions, the mortality rate for this disease is nearly 100%. It’s discovered in its late stages, they don’t have that many medications, so all that’s left is to wait for death."

"Even the drugs for the second stage are very dangerous, with many side effects and complications. The prognosis is also very poor. So, this family is about to face a severe test."

"Teacher Liu, how do you know so much?" Su Wenhao exclaimed.

"Wow, hearing a compliment from you is truly not easy," Liu Banxia teased.

"Actually, it’s not that I know a lot; I just read a lot. You all should read more too. The Earth has become a village now; a disease prevalent at the east end of the village could also spread to the west end."

"So we must keep abreast of the times. We need to pay attention not only to common cases domestically but also to rare cases internationally."

"Especially in a place like Binhai City, with its large population of external incomers, the chains of mutual infection during their air travel and transfers can become very long. One oversight could allow a terrible infectious disease to spread."

"Just imagine if today’s patient had a different occupation, and the incubation period of the disease exceeded six months. Can you fathom how many people could have been infected?"

What Liu Banxia said startled the interns. Some behaviors might be frowned upon, but that doesn’t mean they don’t occur. If it were really as Liu Banxia described, over six months, infecting eighty or a hundred people would be a conservative estimate.

Because this kind of spread isn’t unidirectional; there can be many branches. Combined with a long incubation period, the outcome was truly unthinkable.

But this only deepened their respect for Liu Banxia. After all, not everyone has that much energy to pay attention to so many diseases. There are truly too many infectious diseases in the world; how could one possibly learn about every single one?