This is Lilac Garden's brand new novel serial column "Those Years, We Were Little Doctors."
Columnist Chen Gang, post-80s, doctor of Peking Union Medical College Hospital, good at English and Japanese, slightly familiar with programming and writing, previously published the novel "Because I am a doctor", etc., this serial series is a prequel.
This article is the 6th in a series, which can be reviewed in the previous issue.
This article is written by Gang Chen
During the Spring Festival, the taste of the new year on the street is strong, and the white clothes in the ward are still the same.
Before the internship, Nian Wei'er was a blooming firework, short and enthusiastic, it was a lively table, a noisy temple fair, a bustling crowd, it was a childhood taste condensed on the tip of the tongue, with fragrant memories refreshing.
After the internship, the taste of the year changed, and the short Spring Festival reunion became a distant blessing. We enjoyed the full moon with our families in a foreign land, and told our parents to slow down and grow old in the company of the phone.
On the eve of the Spring Festival, Wu Jun, Su Qiaoqiao, Shen Yifan, Mi Mengni and I, five of our first-year residents, gathered at the International Medical Department of Xihe Hospital.
Street lights for the Lantern Festival (Figureworm Creative)
01.
In recent years, exchanges at home and abroad have become more frequent, and the number of patients coming to China for medical treatment has gradually increased, and the International Medical Department of Xihe Hospital is committed to serving the medical needs of international friends, which is divided into emergency department and inpatient department, which is essentially a general ward.
After completing the rotation of some departments, many first-year residents will rotate here to cultivate a sense of service and exercise international communication skills.
Just this Spring Festival, Su Qiaoqiao and Shen Yifan gave birth to their own troubles, and their troubles together stemmed from the 12-bed patients wu jun received.
The patient, Alec Owen, is a 57-year-old Chinese-American who travels to and from China and the United States for many years.
On the tenth day of the first month of the first month, he and the domestic customer signed a big business after holding a celebration banquet, a few glasses of liquor after the stomach felt uncomfortable, the same night by his daughter Sophia sent to the emergency department of the International Medical Department of Hee Wo Hospital.
Wu Jun was the doctor on duty in the emergency department of the International Medical Department that night, as soon as the patient came, he pulled an electrocardiogram sharply, saw several strings of towering ST segment waveforms emerging from the ECG lead, he was immediately diagnosed with acute myocardial infarction, a few short words to Alec and Sophia to explain the condition clearly, followed by several phone calls to open a green rescue channel, the patient was sent to the operating table of the interventional catheterization room in just twenty minutes after the hospital.
Angiography. The blood vessel of the anterior descending branch resembles a truncated branch.
Bracket insertion.
Re-imaging. The branches stretched out comfortably, stretched, and opened up as comfortably as they had woken up from a deep sleep.
Vascular re-passage.
After 2 hours, Mr. Alec was lying peacefully in his hospital bed, the pain of his first arrival in the emergency room was gone, and he was watching intently as the syringe pump next to the bed was injected into his body little by little. Her daughter Sophia's previous ghost was gone, she was wearing a white crewneck sweater, lying on the bed looking at her father, smiling softly, quiet like a cat in the afternoon sun.
Wu Jun knocked on the door, and Su Qiaoqiao, who was on duty in the ward that night, went into the room to visit the postoperative patients, they watched the monitoring, auscultation, and Alec said a few words of greeting, found that everything was normal, and prepared to leave.
"Dr. Wu, you were really handsome just now." Daughter Sophia spoke, "I want to ask you, Dad has coronary heart disease, I just looked it up on the Internet and learned the concept of coronal and sagittal positions in medicine, but I looked at the pictures of coronary arteries, and lo and behold, you look at this 3D anatomy app, as if it is not a certain coronary blood vessel, why is it called this name?" 」
"That's an interesting question." Wu Jun reached out and turned the picture on the iPad, "If you turn your heart upside down and look at the shape of the coronary arteries, is it not like a flower crown?" That's where the name coronary artery comes from."
"Wow, that's true." Sophia leaned over to Wu Jun's side, and Wu Jun's face turned red, "You're really good, you say, is this the romance of medicine?"
Su Qiaoqiao, who was standing by, stomped his feet lightly: "Sophia, let's not talk more, Dr. Wu and I are going to the next ward to see the patient."
Wu Jun pulled up the doorknob and walked out, sophia stuck out half of her head: "Dr. Wu, my Chinese name is Ou Xiaoya, we will see you tomorrow."
02.
The next day during the rounds, several of our residents followed the attending physician, Van Ka Su, into Alec's room, and he was full of praise for last night's treatment.
Alec's face was much better than yesterday, and after answering a series of questions from Dr. Fan Jiasu, in between rounds, he half-jokingly took Ou Xiaoya's hand and pointed at Wu Jun again: "Boy, do you have a girlfriend?" My precious daughter said you are mental and capable, and I think that's true."
Ou Xiaoya put on a light makeup today, and when she saw Wu Jun enter the door, she looked at him consciously or unconsciously, and her thick and slender eyelashes fluttered slightly: "Dad, this is China, and the doctors are still checking the room, how can you talk so bluntly?" Wu Jun waved his hands in confusion, and his eyes swept over Alec and Ou Xiaoya in confusion: "I don't have a girlfriend, no." Oh no, I don't mean that—"
Su Qiaoqiao's apricot eyes narrowed slightly, and he glanced at Wu Jun a few times without a trace. Since being transferred to a department, in his daily work and life, Shen Yifan also sensed Su Qiaoqiao's good feelings for Wu Jun, he rubbed his hands, raised the frame, and silently looked at Su Qiaoqiao at the moment.
In the daily work of the ward, Dr. Fan Jiasu has seen some clues, at this time she smiled slightly, played a round field, and continued to discuss clinical issues at the bedside. At the end of the round, Fan Jiasu took the lead in walking out of the ward, and at the moment of closing the door, she burst out laughing at our team: "Young people, when I see you, I immediately remember my youth."
Su Qiaoqiao put one hand in the pocket of the white coat, slightly lowered his head, and gently swiped his right toe on the ground twice, Shen Yifan looked up at Su Qiaoqiao, and then glanced at Wu Jun.
After Wu Jun withdrew from the ward, the panic just now faded, he sighed lightly, and scratched his head inexplicably: "Dr. Fan, you still look very young now——"
"Silly boy, of course I'm not that old." Dr. Van Ka Su, 33 years old, just had a baby last year, and since then, he has always liked to refer to the young residents in the group by "children".
Not long after turning around the patient and returning to the office, Ou Xiaoya gently pushed open the door, she smiled sideways, her long hair was obediently hanging down from behind the ear pinna, and her dark hair was lined with white cheeks: "Dr. Wu, I still have something to ask you." In the afternoon, Ou Xiaoya came to talk to Wu Jun again, and the next day and the third day, Ou Xiaoya was still like this.
"Hey, Dr. Wu, I just passed by and heard you talking quite hi, why did you talk about any menstrual irregularities?" When Wu Jun walked into the office, Su Qiaoqiao snorted.
"Well, she said she often took international flights to and from China and the United States, and from time to time she had to reverse the jet lag, and she had some irregular menstruation in the past two years." Wu Jun's face turned red, and he turned his back to Su Qiaoqiao and wiped her hands by the sink, "She has been taking short-acting contraceptives for several months to adjust her menstrual cycle."
In the office, Shen Yifan, who was working in front of the computer, stopped typing, poked his head out and glanced at Su Qiaoqiao twice, and buried his head behind the computer screen, and Mimoni and I looked at Wan'er.
Image source: Visual China
03.
The joy of the New Moon Festival is still permeated to the quiet and simple office, this day is the fifteenth Lantern Festival of the First Month, and the red couplets and window flowers on the office doors and windows are permeated with a warm feeling in winter.
At 5:30 p.m., when we were discussing a good meal in the ward in the evening, Ou Xiaoya once again pushed open the office door to find Wu Jun.
"Dr. Wu, I feel a little stuffy in my chest, can you check my electrocardiogram for me?" Ou Xiaoya appeared at the office door, and there was indeed a hint of panic in her eyes that had been as clear as a lake.
"Okay, I'll take you to the examination room." Wu Jun stood up and rolled up the cuffs of his white coat.
"No, I'll help you get an ELECTROCARDI." Su Qiaoqiao jumped up and pulled the chair behind him to the side with a creak. "Do an electrocardiogram for a beautiful girl, so positive." Wu Jun blushed, stunned at the front of the door, hesitated, and followed again.
Wu Jun stood outside the curtain of the examination room, and after a while, Su Qiaoqiao helped Ou Xiaoya pull out an electrocardiogram, she pulled open the curtain, held the electrocardiogram in her hand, and skimmed her lips at Wu Jun: "You see, Miss Ou's electrocardiogram does not look like a big problem except for sinus tachycardia."
Wu Jun gathered around Su Qiaoqiao, stared at the ECG, first nodded, and suddenly he pointed to several leads of the ECG: "How can there be incomplete right bundle branch block?"
Su Qiaoqiao stared at the electrocardiogram for a while, and at the same time turned to look at Ou Xiaoya with Wu Jun: "Did you have any problems with the electrocardiogram before?"
Ou Xiaoya sorted out the buttons and pulled down the corner of the clothes: "I once had an electrocardiogram during the physical examination in the United States, but I didn't hear from the doctor that I had any problems." Dr. Wu, is my ECG problem serious?"
"Incomplete right bundle branch block can also occur in some healthy people, and it is more common in young people, but we still have to rule out some of the heart problems first." 」 Su Qiaoqiao was originally a loving person, and found that Ou Xiaoya was not joking just now, and her tone was much softer, "Miss Ou, when did your chest tightness appear?"
"It's been half a day." It just felt a little bit worse." While listening to Ou Xiaoya's story, Su Qiaoqiao held the oximeter to cover Ou Xiaoya's fingers, and Wu Jun also put the sleeve of the blood pressure monitor on Ou Xiaoya's other arm.
"Finger oxygen 92%, blood pressure 96/62 mmHg." Su Qiaoqiao and Wu Jun glanced at each other, Su Qiaoqiao twisted open the wall oxygen, and Wu Jun tacitly connected the oxygen tube and stuffed it into Ou Xiaoya's nostrils - this degree of blood oxygen saturation should not appear in healthy young people.
Su Qiaoqiao removed the stethoscope hanging around her neck and moved it inch by inch on Ou Xiaoya's chest. Wu Jun suddenly remembered something, patted his head, rolled up Ou Xiaoya's pant legs, and carefully observed.
"Miss Ou, your right calf is slightly thicker than the left one, have you noticed it before?" Wu Jun took out a tape measure and circled around 10 centimeters at the lower edge of Ou Xiaoya's knees, "The left calf circumference is 31 centimeters, and the right calf is 34.2 centimeters."
Ou Xiaoya showed a confused look and nodded slightly: "I think my leg seemed to be swollen a few days ago, but I also had a swollen leg during my previous menstrual period, plus I was a little tired these days, so I didn't care too much."
Su Qiaoqiao and Wu Jun looked at each other for two or three seconds and said in unison, "DVT! Pulmonary embolism!"
04.
DVT is an abbreviation for deep vein thrombosis of the lower extremities, which, as the name suggests, is the coagulation of venous blood in the deep veins of the lower extremities. Slow venous blood flow and hypercoagulable blood are the two leading causes of DVT.
After the thrombosis is formed, it is likely that it will not honestly stay in the blood vessels of the lower limbs, and if it falls off, it will eventually enter the pulmonary blood vessels along the direction of blood flow, forming a veritable medical emergency - pulmonary artery embolism.
Pulmonary arteries are the place where the blood flow through the whole body is concentrated, thousands of troops are waiting to pass, if the embolism is a large blood vessel, the patient will have sharp chest pain, chest tightness, breath holding, and even sudden death when severe.
"Your judgment just now is really powerful." Su Qiaoqiao couldn't help but praise Wu Jun, and then looked back at the ECG just now, "Pulmonary embolism can explain the right bundle branch block, if pulmonary embolism leads to acute right ventricular dilation, abnormal endocardial blood supply may lead to changes in the right bundle branch."
"But it also reminds us that the pulmonary embolism we are facing may be more serious, and the embolism may even be the main trunk of the pulmonary artery." Wu Jun and Su Qiaoqiao glanced at each other hurriedly: "Clarify and treat as soon as possible!"
There was no discussion, no need to plan, very tacitly, Wu Jun stayed behind to explain the condition with Ou Xiaoya, and made an appointment for pulmonary CT angiography by phone, Su Qiaoqiao called the nurse to establish an intravenous pathway, set up a good ECG monitoring, and called Shen Yifan and me in the office, took the first aid kit, and went to the CT room together.
Less than half an hour later, Ou Xiaoya returned to the ward, and Mr. Alec sat in the waiting area at the door of the ward, with Dr. Van Ka Su and Mimoni accompanying him. Seeing Ou Xiaoya's cart, Mr. Alec greeted him and grabbed Ou Xiaoya's hand: "Darling, how are you doing?" Doctors, how's it going?"
"The main trunk of the pulmonary artery is embolized and has a large area. We are discussing further treatment options." Wu Jun held up a tablet of pulmonary vascular CT and handed it to Fan Jiasu, "The vital signs along the way are still stable."
"Why do young women develop pulmonary embolism?" Are there any risk factors?" Fan Jiasu quickly took out the film and watched as he followed the transfer bed forward.
"I asked you carefully." Wu Jun pushed the transfer bed to the door of the newly prepared Ward 11 and pushed open the door, "There is no special underlying disease, but it may be related to medication, Miss Ou has been taking short-acting contraceptives for several months to adjust menstruation."
"The drug may cause hypercoagulant tendencies, no wonder you just went to see Miss Ou's legs based on chest tightness symptoms and ELECTROCardiogram performance, and found DVT." Su Qiaoqiao's eyes were full of admiration.
05.
We moved Ou Xiaoya to the hospital bed, her forehead was bubbling with beads of sweat, her breathing became a little short, she gently touched Wu Jun's hand, and then hung down weakly: "Doctor, I am so uncomfortable."
Despite oxygen inhalation, the finger oxygen saturation on ECG monitoring fluctuates only between 92 and 94%, and the blood pressure is retested, and the value is reduced to 87/58 mm Hg.
"Can't wait, consider the new large-scale pulmonary embolism, which affects hemodynamics and requires thrombolysis." Dr. Fan Jia su usually speaks in a harmonious and pleasant voice, but at this time, his tone is sonorous and loud, "Prepare rt-PA thrombolysis."
At 6:28 p.m. on the Lantern Festival, RT-PA began to slowly enter Ou Xiaoya's body. rt-PA is a new generation of thrombolytic preparations for dissolving newly formed pulmonary artery thrombosis, and once the thrombus dissolves, Miss Ou's discomfort symptoms, unstable blood pressure and blood oxygen will disappear.
RT-PA requires slow infusions, and for the next two hours or so, Alec sits by Ou Xiaoya's bedside, with a hint of anxiety in her gentle eyes. Su Qiaoqiao also walked into the room from time to time to observe Ou Xiaoya's symptoms and the values on the monitor.
Seeing her daughter's stable vital signs and hearing Su Qiaoqiao's patient and meticulous explanation, the uneasiness in Alec's eyes gradually dissipated, and under su Qiaoqiao's persuasion, she finally returned to her room to rest.
At exactly 9 p.m., Su Qiaoqiao once again walked into Ou Xiaoya's room, Ou Xiaoya was resting with her eyes closed, her breathing became stable, and the monitor showed that blood pressure rose to 102/72 mm Hg, and blood oxygen saturation rose to 96%.
Su Qiaoqiao recorded the values on the monitor in the book, looking at her calm appearance, Su Qiaoqiao breathed a long sigh of relief.
Ou Xiaoya slowly opened her eyes, "Dr. Su, thank you for caring about me, I feel much better."
"I'm sorry to disturb your rest." Su Qiaoqiao saw Ou Xiaoya wake up and apologized slightly, "Your situation is much smoother, and the drug should be effective."
"Actually, I haven't slept." At first, I was really uncomfortable and didn't want to open my eyes, but then I slowly got a little more comfortable, so I closed my eyes and rested. In fact, every time you come in to see me, I know it. Thank you." Ou Xiaoya reached out and moved the pillow and lay in a comfortable position, her eyes containing a hint of disappointment, "But Dr. Wu has never come to see me."
"In the hospital, there is a system called the first diagnosis responsibility system, you are the first patient I receive, and it is also my duty to be responsible for the whole process of you." Su Qiaoqiao helped Ou Xiaoya adjust the pillow, "Wu Jun has his own patients to take care of, so he didn't come over for a while."
"Dr. Sue, we're all girls. Actually, I can see that you like Dr. Wu, right?" Ou Xiaoya paused, Su Qiaoqiao's hand movement also stopped, she nodded, sat in front of Ou Xiaoya's bed, and looked at Ou Xiaoya.
06.
"I think Dr. Wu is really charming. I loved him the first time I saw him. But when I saw you working with him, I had a tacit understanding and felt that you were a natural couple. Dr. Wu never showed up during my infusion just now, and I knew he didn't feel anything for me."
Su Qiaoqiao helped Ou Xiaoya sort out the hair scattered in front of her forehead, opened her mouth, and did not say anything.
"I don't know how Dr. Wu feels about you, but if you really like Dr. Wu, you have to take the initiative to tell him, otherwise someone like him may never know." 」 Ou Xiaoya gently grabbed Su Qiaoqiao's fingers, and there was a smile hanging from the corner of her mouth.
"Well, my Miss Ou, you've just experienced a critical illness and you should rest now." Su Qiaoqiao's eyebrows rose, and the corners of his mouth grinned slightly.
There was a knock at the door outside the room, Wu Jun walked in, he habitually looked at the monitor, relaxed and said to Ou Xiaoya: "The current situation is very good, we will continue to supervise for one night." Then he whispered to Su Qiaoqiao, "Let's put the dinner we ordered in the office, let's eat it together."
The two said goodbye to Ou Xiaoya, and Su Qiaoqiao took the door and gently leaned against the doorknob with a light posture.
"Let's go, let's eat something delicious." Wu Jun took two steps forward, but the corner of the white coat was grabbed by Su Qiaoqiao.
Su Qiaoqiao gently tiptoed up and approached Wu Jun's ear and said, "I like you, I've liked you for a long time."
"What?" Wu Jun's face did not suddenly turn red, but the whole person suddenly froze and stood in front of the ward door. Su Qiaoqiao lowered his heels, lowered his head slightly, and pulled the hand that was holding the placket but did not let go.
"I'm not kidding, and you didn't hear me wrong."
"But you, Shen Yifan, aren't you?" You, I—"
"You don't have to promise me anything right away, I'll slowly explain it to Shen Yifan later." Now that I'm done, let's go back to the office." Su Qiaoqiao raised her head, her eyes rippled as if it were mellow wine, she let go of Wu Jun's clothes, turned around, and walked lightly in front of Wu Jun.
Wu Jun gasped twice, watched Su Qiaoqiao take several steps forward, suddenly patted his head, and followed closely.
07.
"Happy Lantern Festival!" Eat, eat!" Seeing Su Qiaoqiao and Wu Jun entering the office together, we shouted cheerfully, everyone was already sitting around the desk, a basin of mouth-watering spicy incense pot was placed in the table, and the dishes and chopsticks had already been set around.
"It's so happy, there's something delicious." Su Qiaoqiao happily jumped two steps, sat down next to Mimoni, pulled a chair next to him, and beckoned Wu Jun to sit down.
Shen Yifan handed Su Qiaoqiao a prepared bowl of chopsticks. Su Qiaoqiao happily took over, turned his head sideways and said "thank you" to Shen Yifan.
"Lantern Festival, everyone can't go home, after eating delicious food, we all call the family." Mimoni happily stuffed a beef ball into her mouth.
As I was talking, my WeChat phone remembered, looking down, it was Mi Meng'an, Mi Meng'an, mi meng's sister, I chewed fish and tofu without thinking, and clicked on the speakerphone.
"Hey, why don't you call me?" Why don't you call me?" Mimone in the video puts her phone on the table and crisply taps her knuckles twice, "Hear me hitting you?" Chinese New Year's EveChinese New Year's Eve don't call me, Lantern Festival Lantern Festival don't call me, want to die you?" 」
Frightened, I quickly swallowed the fish and tofu, jumped up from my seat, turned off the video hands-free, and ran outside the office with a cigarette.
There was a burst of laughter at the dinner table, mixed with Su Qiaoqiao's voice: "Hey, Brother-in-law Mimoni, hurry up and comfort people."
I stood at the end of the corridor of the ward, talking with Mi meng'an for a long time, and the night outside the window was thick, and I could faintly see the moon lying on the thin clouds. I remembered the night I first met Mimonan, and there was a full moon hanging in the sky: Oh, two months have passed.
Time is really fast. It has been more than half a year since I entered Hee Ho Hospital as a resident, and I feel that I am different from before: Hee Ho Hospital has a strong "smoked" culture, when the people around me are so excellent, so motivated, so united, unconsciously, I myself slowly grew up.
Now I have one more Mimone by my side. (Curator: Gyouza)
— To be continued —