The atmosphere on the twelfth floor was a bit solemn all night.Dr.
Yang, who worked the night shift, began to rescue the dying patient shortly after the shift was handed over.He was hospitalized by Dr.
Zheng, and a few interns who had dinner and gathered in the ward at night, surrounding the patient's bedside for rescue.This is a patient who belongs to the Pan Chi tube bed.He was admitted to the hospital with persistent coughing up blood and difficulty breathing for 1 week.He was 72 years old.He has a 30-year history of asbestos exposure.Since he only had a consultation with Corey last Saturday, Dr.
Yang was aware of the patient's medical history, all the examinations and treatment details.He took the medical record and asked Dr.
Zheng to direct the nurse to give the rescue medicine, and his ears listened to Dr.
Zheng's instructions, but his eyes lingered on the medical record.It is all the consultation opinions of the department recorded by Pan Zhi.For example, report the medical history (omitted).Physical examination: temperature 37.2°C on admission, oxygen saturation 86%, and fine crackles in both lungs on auscultation.INVESTIGATIONS: Chest x-ray on admission: diffuse ground-glass nodules and consolidation in both lungs, and blunt costo-diaphragmatic angles in both lungs.Chest CT on admission: diffuse ground-glass nodules and partial consolidation in both lungs, blunt costodiaphragmatic angles in both lungs, smooth thickening of the intervalbs at the apical of both lungs, mediastinal lymphadenopathy, bilateral pleural effusions, and pleural plaques.Then there is the result of a string of laboratory tests.The only abnormal serum CRP level is elevated.Here's everyone's opinion.Interestingly, Pan Zhi directly skipped the intern's opinion and didn't remember it, and he didn't remember the opinion of Xiao He, the undergraduate.Because Dr.
Yang remembered very clearly, after Xiao He finished expressing his opinion, Chen Wenqiang said to go back and read more books.Didn't shame the boy to death.Because the diagnosis he gave was asbestosis, pleural effusion.In Dr.
Yang's words, that's what the interns have said, where can it be shown that he has worked for more than half a year and is stronger than the intern.Xiao Huang's opinion is to consider whether he has tuberculosis based on coughing up blood, because in the 50s and 60s, there were more tuberculosis patients in China, and he considered lung cancer for those ground-glass nodules on the chest.Lung biopsy and pleural fluid sampling for cytology are proposed to see if cancer cells can be detected and the diagnosis can be confirmed.This is a decent consultation.Then it was Li Min's turn.
(At this time, Chen Wenqiang and Director Shi didn't regard Li Min as the deputy director of the department) - Dr.
Yang secretly thought that the two of them still saw Li Min's position as normal.She was unusually promoted to the attending physician of neurosurgery, not clinical experience.However, Pan Zhi's consultation opinion recorded below was more than four pages long, which reminded him that Li Min had said that he was distracted during the consultation.Looking at this consultation opinion now, he was shocked at the breadth and depth of Li Min's basic theory.Look, a symptom of coughing up blood, Li Min gave such an analysis.The first is the definition of coughing up blood.Bleeding from any part of the respiratory tract below the throat and coughing up through the mouth is called hemoptysis.Secondly, the amount of blood coughed up: small amount< 100ml; Medium weight 100~500ml, large amount > 500ml, 24 hours.Reason: Dr.
Yang counted more than a dozen.Each has a corresponding pathological analysis.If he hadn't known that the patient had been admitted the night before the consultation, he would have suspected that Li Min had done a preview in advance.I deserted because Li Min also listed irrelevant traumatic hemoptysis.It can be summarized into several mechanisms of hemoptysis: (1) trauma, (2) foreign body, (3) various acute and chronic inflammation (including tuberculosis) invading the blood vessel wall, and (4) bacterial toxins increase the permeability of the blood vessel wall...... (5) Tumor: necrosis and ulcers invade blood vessels (6) The cause of pulmonary hypertension, Li Min directly quoted the data of the textbook, and also specifically stated that it is the second edition of the textbook, and the clinical coughing up of blood and tuberculosis in China accounts for more than 92%.Then there was the reason why Pan Zhi wrote about coughing up blood caused by tuberculosis in the middle of the night.Dr.
Yang felt that he was going to go home and look for Luo Ying's second edition of internal medicine textbooks.This is followed by bronchiectasis, dry and wet coughing up blood, and dry is also emphasized as an indication for surgical treatment.Dr.
Yang also wrote down the data of dry hemoptysis, mainly 300~500ml.Differential diagnosis: involves coughing up blood and hematemesis, mentioning the differentiation of tuberculosis, bronchiectasis, pneumonia, lung abscess, lung cancer, heart disease, gastrointestinal hematemesis, and even biliary bleeding.Five, six, seven, eight.Dr.
Yang came up with the intention of copying these down.Finally, it is the opinion about this medical record, in the advanced stage of asbestosis, there will be signs and symptoms of pulmonary dysfunction and cor pulmonale.Imaging shows pleural plaques and even pleural effusions.Dyspnea, coughing up blood, mediastinal lymphadenopathy, she considered pulmonary lymphangiocarcinoma.
(How could you have thought of this?)
How rare!
）Dr.
Yang continued to look down and saw that the primary site of pulmonary lymphangiocarcinoma recorded by Pan Zhi was the gallbladder.He looked forward and found no pain in the gallbladder area, no history of anorexia, nausea, vomiting, or weight loss.But the face and fleshless body of this dying patient on the hospital bed, who was being rescued, made him intuitively feel that this was a manifestation of malignant abnormality in the advanced stage of cancer.What about pleural mesothelioma?
Li Min's diagnosis reference is to arrange for bronchoscopy as soon as possible.Alveolar lavage, if done, can confirm the diagnosis of pulmonary lymphangiocarcinoma or diffuse alveolar hemorrhage.Because of the CT examination of the chest, it is suggested that the latter is to be discharged.As for lung puncture and pleural effusion examination, I agree with Xiao Huang's opinion.Dr.
Yang held the medical records and read them for more than an hour, and Dr.
Zheng took the interns to work for more than an hour."
Doctor Yang, do you see it now?"
Dr.
Zheng asked him, a senior doctor, for a final diagnosis."
Announce the time of death.""19:55."
Watching the family members of their patients rescuing them, the long-suppressed cries immediately wailed out in the ward.* Yang Weihua was led by Lao Sun into the couple's box.It is the American movie "Roman Holiday", the original dialogue with Chinese subtitles.But they went in a little late.In the dark, Lao Sun politely apologized, and the couple entered their ticket box.The so-called box is a sofa with a very high backrest.If you don't stand up, you can't see the person on the side, and you can't see the person in front.The price, of course, is not an ordinary fare.The velvet sofa, in the dark cinema, is illuminated by the bright light on the screen with a dark red texture.Although the two have been married for more than half a year, such an environment still makes Yang Weihua nervous in curiosity.Lao Sun also thought this box was quite strange.But just now the two of them held hands to buy tickets, and the little girl who sold the tickets gave these two tickets after receiving her own 50 yuan.I wanted to ask her why it was so expensive, but she was very strange and asked: "This movie ticket is the most expensive."
Your ticket is a box seat.If it's a weekend, if you come so late, you must have no tickets. ”There are box seats in the cinema?
In recent years, Lao Sun, who has only participated in unit activities and has only watched movies, saw that Yang Weihua was full of curiosity, so he silently took the movie ticket.The pretty princess slips out and gets acquainted with reporter Joe.After having fun, she went to Qiao's house as a guest and spent the night.Yang Weihua clenched Lao Sun's hand and said in a low voice, "This shouldn't be." ”"yes.How can you go to a strange man's house to spend the night?"
Lao Sun had the same opinion as her.But I have to admit that this light comedy captures the true heart of Joe - the true heart of this young man, who is in love with the princess.I gave those photos as a gift to the princess as a souvenir.Out of the cinema, Lao Sun drove home.Yang Weihua still failed to come out of the movie."
Old Sun, what if Joe didn't fall in love with the princess?""
He'd give the film to the newspaper.He's still in debt. ”Then the princess □□ annoyed.She was so naïve. ”"yes."
Yang Weihua thought for a while and relied on his intuition and said: "Old Sun, this movie is good-looking."
But how do I think this movie is too fake, the foundation can't stand, and it can't stand scrutiny.And I think this movie will teach bad girls.You see, such a young and beautiful little girl went home with a man she didn't know so simply, isn't she afraid of being trafficked and raped?
It's just incredible.This is still a movie from 40 years ago.Was the social security in Rome so good at that time?
”Lao Sun smiled and said: "The screenwriter's brain is too romantic.We can only take it as a joke, and we can't seriously scrutinize its rationality. ”"Don't let your kids see this.""
Good.I listen to you. ”Lao Sun turned on the turn signal and the car changed lanes."
Wei Hua, you can find a time to learn to drive.If I want to go down to the grassroots level, I won't be able to pick you up and send you every day.You learn to drive, you can drive this car, you don't have to crowd the bus. ”"I can go back to my parents' house.""
If you know how to drive, it's easier to go to your parents' house and drive there yourself than to wait for the driver to pick you up.In the next few months, I had to go down to the grassroots level for half a month to do the assessment. ”Yang Weihua thought about it and asked, "Is it easy to learn?"
”"Very studious.It's easier than if you operated on someone else.According to the traffic rules, drive slowly first, and then drive skillfully. ”Yang Weihua thought for a while and said: "Then I can only study on Monday and Friday evenings and Wednesday mornings, and other times I am either at work, on duty, or in class." ”"Then I'll arrange for you to learn to drive next Monday night.Tomorrow I will send someone to send you this information, and you can check the traffic rules at noon, etc. ”"Okay."
There is no romance between the two that has gone through young people, but they also do not have the financial pressure of ordinary couples.After open and honest communication last night, the purchase in the middle of the afternoon today, and the movie in the evening, after Yang Weihua opened his heart, the distance between the couple was shortened a lot.With a smile on his face, Lao Sun stepped on the accelerator briskly with the traffic.Suddenly, Yang Weihua said to him: "Old Sun, tell me about your ex-wife." ”Lao Sun was stunned for a moment, he slowed down and changed lanes, and then the smile on his face remained unchanged, but he said with a trace of recollection: "She also works in the provincial government."
After I was transferred from the army to the provincial government, my comrades introduced me.She's a year older than you.He is a very strong and hard-working person.Around New Year's Day the year before last, the unit organized a physical examination, and in your provincial hospital, it was found that it was liver cancer or advanced stage.Director Cheng of the Department of Surgery said that he could not do the operation.Later, I went to the Affiliated Hospital of the Medical University and the Union Hospital in Beijing, and this is the conclusion.Then I spent a few months in the dry ward of your hospital.From discovery to death, it took less than half a year. ”"Do you think of her often?"
Yang Weihua cautiously stared at Lao Sun's side face and asked."
Hmm—it's going to be.But slowly accept the facts.And there's no way I'm going to stay single, am I?
But, Weihua, I'm glad you asked me about her.Because you care about me, you ask.Isn't it?
”Yang Weihua was a little embarrassed, but he still replied in a small voice: "Yes." ”"Wei Hua, you should think so, I have lived with her for 13 years, this is a thing of the past.But in the future, if I live to be 75 years old, we will be together for 31 years.Can you understand?
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”Yang Weihua nodded heavily.The man honked his horn to alert passers-by in front of him, the turn signal came on, and the vehicle pulled into the small road heading for their home.
*Nurses in the Pediatric Intensive Care Unit (ICU) with small night shifts and large night shifts are doing shifts.Dr.
Wang was looking at his little daughter, who was already on a ventilator.His eyes were full of regret, and he hated that as a father and as a doctor, he could only watch his daughter suffer and be helpless.The nurse who had finished the shift said to him, "Doctor Wang, let's see which of you two go back to rest and sleep."
Does someone have to be here during the day tomorrow?
”For the couple and their husband, this day and night were enough to choke.Especially Wang Qiuyun, she has been guarding the child for a day and a night, unlike Dr.
Wang, who went back to sleep for half a night last night.But after her child was put on a ventilator, she suddenly ran out of milk due to anxiety.Now the child has to rely on the nasogastric tube to get formula and intravenous nutrition.Doctor Wang pondered for a moment and said, "Qiuyun, you can go home."
Go back and take a shower, take a look at the kids, you can sleep well, tomorrow during the day you come to see the orb, and I have to go back to Corey to see the work. ”Wang Qiuyun looked at her little daughter and was reluctant to leave, but there were still pearls and Xiaozhi at home.Although the two children were entrusted to Mrs.
Luo's care, it was time to go back and have a look."
Then, then I'll go back and see Xiaozhi and Pearl.You take the time to squint for a while. ”"Okay."
When Wang Qiuyun returned home, she found a note left on the dinner table, which Xiao Zhi had left for her father.Roughly speaking: Grandpa sent a car to pick me up, and Pearl was at Uncle Yang's house downstairs.After she took a shower and changed her clothes, she went to Luo's house to watch the children.Dr.
Yang went to work the night shift, and Pearl was watching TV with Director Luo's parents."
Uncle Luo, Aunt Luo, I'm sorry for you.""
No hassle.How is the child?
”Mrs.
Luo asked."
I got on a ventilator in the afternoon."
Wang Qiuyun's tears are about to fall again.Director Luo was studying in the back room, and when she came out and heard that she was on a ventilator, her face immediately changed.The child is less than 9 months old, and what that means is self-evident.But she could only say some comforting words: "I heard that today's pediatric consultation, Dean Fu and Dean Guan both went to the pediatrics?"
Who works the night shift in pediatrics tonight?
”"Yes.Dean Guan has been guarding the orb for a day.In the evening, Director Qi worked the night shift. ”"Then you better relax.This is the strongest breathing lineup in our provincial hospital.Guan Lan studied at the Medical University, and his level is also good. ”Wang Qiuyun nodded, wiped the tears from the corners of his eyes, squeezed out a little smile and said, "I'll take the pearls home."
Thank you, Uncle Luo, Aunt Luo.Thank you, Director Luo, for the trouble. ”"Xiao Wang, you're welcome.You can't keep busy, and you'll let Pearl come to our house tomorrow.After Wang Qiuyun and her daughter thanked them repeatedly, the mother and daughter went up to the second floor and went back to their home."
Mom, my brother sent me to Grandma Luo's house, and I took the car to his grandfather's house when I was done.It was the guy who usually came to pick him up who drove. ”"Good.Are you done with your homework?
”"I'm done.I finished it in school.I had a meal at Grandma Luo's house.Mom, is my sister okay?
”"Not yet.""
When will it be okay?""
It should be soon.Pearl, mom bathes you, and you take off your clothes and go to the room by yourself. ”"Hmm."
Wang Qiuyun cleaned up her daughter and sent her daughter to sleep in her room.She took a shower, washed clothes, and tidied up the room, and when everything was tidied up, it was almost midnight.She went back to the master bedroom and picked up the family portrait on the bedside table, a family of five, all grinning.Her eyes were fixed on her little daughter's face, and the carefree smile made her burst into tears again.It also made her heart ache like a knife.There are so many sick children in the nursery, but my own child is on a ventilator......
She didn't need Dr.
Wang to say anything, and she didn't need the dean and director to explain to her, she could guess the general idea.In the hospital, she didn't want to cry in front of others, and she still held on to the hope of what happened - hoping that the child would be saved.But when she returned home, in the dead of night, the intuitive pain of losing her child, like a heart-plucking heart, made her understand that the child was probably not well.She held the family photo, covered her mouth and cried in a low voice.※※※※※※※※※※※※※※※※※※※※ Baozhu - Hold on helplessly, unfortunately I didn't keep (catching insects) () It's a little far away