NABC Chapter 17 Chen Yisen's Counterattack
Chapter 17 Chen Yisen's Counterattack
However, Natalia started causing trouble again.
"Dr. Chen, isn't your palpation taking a little too long?"
Her tone rose slightly, similar to when she coached Chen Yisen in Bellevue.
Based on the previous questions, it seems that the mentor-mentee relationship has become accustomed to the past and they are unable to change it in a short time.
But in reality, it was a very malicious implication.
Patients and their families, lacking medical knowledge, are easily influenced by this statement and may genuinely believe that the doctor deliberately prolonged the palpation time, thus suspecting that the doctor is taking advantage of Stacy's position.
If a report is filed, even without concrete evidence, the combination of Omar and Stacey—a Black and Arab couple—would be enough to cause a significant uproar, even if the latter is of secular Arab descent.
It's worth noting that during her residency at Bellevue, Chen Yisen received drastically different evaluations from female patients and their families due to her exceptionally high level of modeling skills.
Fortunately, Omar had already been frightened once last night, and now that he knows Joey is standing outside, he certainly won't be so bold as to cause trouble again.
So Chen Yisen completely ignored Natalia's subtle attempts to sow discord and continued with his diagnosis: "Does lying on your side feel better than lying on your back?"
Stacy had recovered somewhat, but she still couldn't speak much, only nodding with a pained expression.
Chen Yisen nodded, stood up to make way for the female medical student next to him, and gestured for her to come to the bed to help:
"You... Murphy, right? Position her in a knee-chest position."
"Huh? Me?"
Like every unlucky student who gets called on in class, the girl never expected that besides being asked a question, she would also have the opportunity to do it herself.
"Yes, you." Chen Yisen nodded. "Do you know the knee-chest position? It's a kneeling position with your chest on the bed and your hips raised..."
After all that fuss, Stacey ended up kneeling and sprawling on the bed in a disheveled state.
"This..." The girl behind Stacy, who was helping her maintain her posture, blushed slightly, whether from exhaustion or shyness, it was hard to tell.
Clearly, this position, which resembles "or2", is not very suitable for being performed by someone of the opposite sex.
"What's going on here..." Although Omar was wary of Joey, who was leaning against the wall not far away, his tone was also tinged with annoyance.
But Stacy, lying on the bed, suddenly gasped for breath: "It doesn't seem to hurt as much anymore..."
He was immediately stunned.
Natalia, standing beside her, widened her eyes and was the first to understand the essence of the matter.
Then several doctors and nurses also showed expressions of understanding.
But before anyone else could speak, Omar feigned sudden realization and then showed off his knowledge: "It means that as long as you sincerely pray to God, you can obtain..."
Chen Yisen helplessly rubbed his forehead, repeating to himself several times that he absolutely must not beat the patient's family members before he could barely suppress his anger.
"Neither gastroenteritis nor ectopic pregnancy will forgive you just because you kneel down, but this posture can shift the mesenteric blood vessels forward, reducing pressure on the duodenum..." Chen Yisen emphasized to several medical students and resident physicians, and more importantly to Natalia, "She has mechanical external pressure obstruction in the horizontal segment of the duodenum. Considering the patient's age and the time of onset, it can be basically determined to be superior mesenteric artery syndrome (SMAS), not an ectopic pregnancy."
Sometimes, criticism without naming names is more hurtful than criticism with names.
Just like when a leader says "a very small number of comrades" in a meeting, everyone usually knows who it is.
Natalia was in this awkward situation, so she simply turned her head away and stopped talking.
But the others were genuinely curious.
SMAS is generally not a particularly acute illness, so everyone can relax now.
A first-year resident couldn't help but ask, "Dr. Chen, how did you come up with this?"
Everyone understands what Chen Yisen just said, but the key is how to immediately think of getting the patient into the knee-chest position.
In particular, Stacey vomited once outside, but instead of the bile-like fluid characteristic of superior mesenteric artery syndrome, she vomited undigested food.
This is so misleading; even medical school students wouldn't set such difficult final exam questions for their students.
"Because the patient's upper abdomen is distended, peristaltic waves can be seen slowly pushing from below the left costal margin to the right side." Chen Yisen pointed to Stacey's abdomen. "In addition, the positive succussion splash indicates severe dilation and retention of the stomach and proximal duodenum..."
All of these are textbook examples of standard SMAS physical examination evidence.
"But..." The resident doctor felt that something was not quite right, but he couldn't quite put his finger on it.
Frank also chimed in: "I can attest that Dr. Chen has an amazing hearing... This morning he diagnosed a patient with a pulmonary embolism using only his stethoscope."
Chen Yisen knew he couldn't get too entangled, so he quickly tried to divert attention.
He patted the edge of the bed, making a crisp "clang" sound: "Murphy, if you don't have any preference for this position, you can get off now."
The atmosphere immediately relaxed considerably, and some people even let out a soft laugh.
The girl's face flushed instantly, and she quickly jumped off the bed.
"Suprametrial artery syndrome, not too troublesome, just..." Chen Yisen had only spoken halfway when Stacey, whose expression had already eased slightly, suddenly twitched.
"vomit--"
Another bout of vomiting.
But almost nothing came out.
Only a pungent, acrid odor emanated from Stacy's mouth and nose, causing the medical students beside her bed to instinctively back away.
Chen Yisen suddenly realized that something was wrong.
A normal SMAS patient should vomit a large amount of bile fluid.
However, the patient had vomited twice in such a short period of time, but there was no intestinal contents at all (the first vomit was obviously stomach contents).
"Quick, get the gastrointestinal relief kit from the car!" He didn't care about propriety anymore, quickly repositioning Stacey back into the knee-chest position to prevent any small pieces of vomit from being aspirated into her airway. Then he loudly asked Omar, "Did she eat a lot before she fell ill?"
"I didn't eat much for lunch, just..."
Chen Yisen interrupted sharply, "No, I meant before my stomach started hurting!"
Omar was already a little flustered, and only nodded when Chen Yisen asked a second time: "Yes, the night before I first had a stomachache, a friend of mine had a barbecue party at home, and Stacey must have eaten quite a lot."
"How are you usually? Do you often go hungry?"
"I often only eat one meal a day..."
"Fxxk..."
Chen Yisen never imagined that the common sense of life among the American people could be so poor.
Stacey's case was actually caused by long-term starvation leading to duodenal congestion, followed by a sudden and large intake of indigestible proteins and fats. The food entered the already compressed duodenum, completely triggering closed-loop SMAS.
In layman's terms, it means that both ends of the intestines are completely blocked, so food and digestive juices can neither go down nor be vomited out, making the problem even more serious.
The common saying "to burst your belly" often refers to this type of closed-loop SMAS.
If it were at the University of Tokyo, the patient's family would definitely be given priority in explaining the situation.
But Omar was completely unaware that this binge eating following prolonged hunger was problematic...
"No, changing position isn't providing much relief anymore." Chen Yisen noticed that Stacey's expression hadn't improved with the change in position. "If it's a complete occlusion, the gastrointestinal decompression tube might not be able to go in either; surgery is needed as soon as possible!"
Upon hearing the word "surgery," Omar's dark face instantly paled.
Two people who have never been to a regular hospital in their lives naturally wouldn't have medical insurance.
But if I have to pay for it myself...
Even going to a public hospital would be enough to ruin your entire life.
"Can't taking medicine solve the problem?" Omar asked the same question Eva had that morning.
Natalia may be mischievous, but she wouldn't risk a patient's life. She stepped forward and explained, "If she's had these symptoms for several days, the accumulated food is fermenting and could have caused ischemia and necrosis of the duodenal wall. There's a high risk of perforation and diffuse peritonitis... then there's no hope."
Omar understood the last sentence.
Without surgery, you're just waiting to die.
In fact, Natalia had already contacted 911 before she explained.
From both a medical ethics and risk avoidance perspective, it is impossible to leave a patient to die just because the family disagrees.
Fortunately, Omar was indeed a rare, pure-hearted Black man. He gritted his teeth and said, "I'll get the surgery done! I'll find a way to raise the money!"
Chen Yisen asked the female medical student surnamed Murphy to help Stacy maintain her position, while he went to Natalia and Omar's side:
"Dr. Lynch, could we try that medical debt relief program for them?"
Natalia glanced at Chen Yisen with a complicated expression, then nodded: "My iPad is outside, Mr. Campos, could you come out for a moment?"
Soon, Omar filled out the application form under guidance, and the two returned to the temporary observation area together.
When you call 911 to go to the emergency room, the allocation is based on the principle of proximity. It doesn't mean that an ambulance will be dispatched from Manhattan just because Natalia is a doctor in Bellevue.
In the South Bronx, Lincoln Hospital is basically just a few blocks away.
Not long afterward, police sirens sounded outside.
Paramedics quickly arrived and lifted the unconscious Stacey onto a stretcher.
As a family member, Omar naturally had to go to the hospital with her.
Before getting into the car, he paused in front of Chen Yisen and said, "Dr. Chen, you saved Stacey's life, which is to say, you saved mine."
The latter thought to himself that the young man was alright. Although he was not very educated and a bit obsessed, at least he hadn't forgotten the contributions of people just because he believed in God.
Omar took out his phone again and dialed a number: "This is my phone number. Feel free to contact me if you need anything... I don't have any special abilities, but I promise I'll be there whenever you call."
Chen Yisen glanced at the number, quickly memorized it, and then pushed the other person toward the ambulance: "Hurry up, she can't afford to be delayed..."