Chapter 106: Chapter 0104: From War to Peace

“Let’s discuss this patient in detail.” Yang Ping felt the timing was right.

Director Zeng sincerely said, “Sure, I’ll go get the patient’s records.”

The patient had a lot of medical images, bulging out of several bags. They came from Nanqiao People’s Hospital, Shipo People’s Hospital, and the provincial city hospital. Each hospital had done a complete set of tests.

Yang Ping quickly sorted out these images, X-rays, CT scans, and magnetic resonance imaging, dividing them into three sections. Each section was arranged in chronological order, with those dated earlier at the top, and those at the bottom dated later.

Otherwise, it would be unclear when and where each image was taken from the pile of pictures.

The two men put up each film on the viewing light, one by one, changing out each image after viewing it.

Pointing at the most recent MRI Yang Ping said, “Look at the left femoral shaft. The local signal here is different from other areas. Now let’s look at the CT scan.”

He took out the CT scan from the same period, verified the date, and put it up: “Likewise, the density at this spot is different from other areas. You can see a slight formation of dead bone and local proliferation here. Other areas do not have this phenomenon, they just have uneven bone density reduction and the surface is pitted.”

He then put up the X-ray: “The trabecular bone is unevenly reduced, and the cortical area does not show any voids yet.”

After all this explanation, Director Zeng didn’t understand what Yang Ping was trying to convey.

Seeing his confusion, Yang Ping said, “I suspect that this patient does not have an infection throughout the femur, only a localized infection here!”

This novel viewpoint intrigued Director Zeng. The crux of why this case was tricky and why the provincial hospital did not want to perform surgery on this patient was precisely because they thought the entire femur was infected and was inoperable.

“This patient was once hospitalized at the Provincial People’s Hospital, planning to undergo an infected bone segment resection and bone elongation surgery. But since both ends were also infected, it wouldn’t be possible to cut off the entire femur. What would they elongate then? Hence, the doctors gave up on surgery and suggested going back to the local hospital for anti-infection treatment.”

The so-called return to the local hospital for anti-infection treatment was just an excuse; they didn’t want to take over the case.

Yang Ping said, “If our diagnosis is correct, that it’s only a focal osteomyelitis, that would make things a lot easier. We can completely remove the infected bone tissue, use antibiotic-loaded calcium sulfate to fill the area, then perform a myocutaneous flap to cover the lost part. Problem solved.

Bone elongation technology, also known as bone transportation technology, uses the bone extension technology developed by Dr Ilizarov from the Soviet Union to elongate the bone tissue.”

For a while, this technology was quite popular; many hospitals used it to perform height-enhancing surgeries. That’s right; the infamous method of increasing height through bone-breaking.”

These height-increasing surgeries led to the misuse of the technology and resulted in many accidents. The Ministry of Health later explicitly forbade using this technology for height increase, allowing it only for disease treatment and deformity correction.

“Director Yang, if it’s localized osteomyelitis, how do you explain the imaging changes in other parts, the pitted ones?”

Director Zeng was interested in following Yang Ping’s line of thought, not only to solve the problem but also for the pleasure and sense of accomplishment brought about by such logical reasoning.

A doctor can be like this! He felt that discussing with Yang Ping like this had elevated his level of clinical thinking.

Yang Ping went straight to the point, “The changes in other areas are caused by hyperthyroid bone disease. The disease just coincided with osteomyelitis, making people think without hesitation that the entire femur was infected and beyond salvation.”

Thyroid tests are not part of the routine hospital admittance protocol, and orthopedic patients do not usually get tested for thyroid hormones unless there are symptoms like thyroid enlargement.

“So what should we do next?” Director Zeng wanted to know straightforwardly.

This knowledge was a bit too much; it was thought-provoking!

Yang Ping said, “These are merely my assumptions at the moment. We need further tests, like drawing blood to check the thyroid hormone level and taking bone tissue from multiple puncture points for bacterial culture.”

Medicine is a rigorous science. Decisions can never be made based on mere assumptions, which not only cannot cure diseases but also can easily harm the patients.

“We will use multiple puncture points and conduct bacterial cultures. If bacteria are found at every puncture point, it would mean that the femur is extensively infected. If bacteria are only detected at this point, and not at the others, it would support my diagnosis. We can then perform surgery to remove this area of infected bone tissue and use a myocutaneous flap to cover the defect,” Yang Ping explained in detail.

Director Zeng said, “I’ll arrange for it right away. Shall we draw blood tomorrow morning on an empty stomach?”

“Yes, draw blood tomorrow morning on an empty stomach, and do the bedside bone puncture now to collect bone tissue for bacterial culture,” Yang Ping agreed.

No time to waste, once decided, better start early. Two weeks of dragging their feet will get nothing done.

Director Zeng immediately went to the doctor’s office, grabbed a random doctor, and placed an order for a blood draw on an empty stomach the next morning. He ordered a thyroid hormone test and a surface ultrasound to check if there were any nodules on the thyroid.

In Director Zeng’s eyes, Yang Ping was a miracle worker. He had to take advantage of the next two weeks while Yang Ping was still around to solve the two big issues in his department.

Being a department director wasn’t easy. Every day while he was in the office, before he had a sip of tea, he had to first check if Teacher Yan had arrived.

He even had to take a detour to and from work for fear of being cornered. Although he was no threat to his physical safety, he was bothersome – if someone’s always pestering you, how can you have any peace?

The patient with osteomyelitis of the femoral shaft, though his surgery wasn’t performed here and his family was polite, keeps asking you every few days: “How is it, can the infection be controlled, do you have other ideas?”

You get overwhelmed by being asked so much and every time you can only gloss over it: “Maybe we change the medicine a few more days and see.”

But changing the medicine every day, it leaves you at a loss and feels frustrating!

There was no time to lose, Director Zeng asked a doctor to prepare for a bone puncture kit, preparing for a bedside bone puncture.

“Shall we go see Teacher Yan again?” Yang Ping thought it’s time to check on him again.

Despite full confidence, he still wanted to keep a close eye on him. The human body is complex, and medicine isn’t perfect and cannot account for all changes. This is the uncertainty of treatment.

After undergoing general anesthesia, a six-hour fast is required. Teacher Yan’s son sat at his bedside, dipping a cotton swab in water to keep Teacher Yan’s lips moist.

“Dad, Director Yang and Director Zeng are visiting you,” the old man’s son said.

Teacher Yan was lying on his side, facing inwards to avoid putting pressure on his post-operative site. Upon hearing Yang Ping was here, he said: “Director Yang, I feel no pain now, my body feels so relieved. Thank you so much.”

He reached behind the pillow and grabbed a notebook: “Hand me a pen. Wait a minute, let me jot this down. What’s the time? Director Yang came to check on me. I want to write a letter to thank you. If I had met you earlier, I wouldn’t have suffered this long. You’ve rooted out a disease that has plagued me for more than a decade, and the relief I feel is indescribable.”

“Director Yang, which hospital are you from? Can you tell me?” asked Teacher Yan.

“Provincial Sanbo Hospital,” Yang Ping told him.

“I’ll take note of this. I want to write a letter of praise to your hospital. You are young and promising, a pillar of the country.” Teacher Yan closed his notebook and handed it to his son to place under the pillow,

After they visited Teacher Yan and the bone puncture kit was prepared, the bone puncture ideally should be performed under CT guidance for precise targeting of the lesion.

But as the femoral bone disease was diffusive with widespread presence, a successful procedure merely required the puncture to reach the femoral bone. The suspected infected bone tissue was exposed, a direct vision puncture.

Thus, there was no need for CT-guided, it could be done directly at the bedside under local anesthesia.

The in-charge doctor communicated with the patient and obtained an informed consent form.

Yang Ping performed the operation himself, the whole process was strictly aseptic to prevent pollution that could affect the accuracy of the result.

The bacterial culture would need several days, once the bone puncture was done, they could only wait for the results.

Zhang Lin was checking the doctors’ medical records, guiding them on how to write an excellent medical record. One of his fingers was wrapped with a bandage, he broke his skin while washing clothes.

The hospital had bought a washing machine for everyone to use, but as doctors, many of them were a bit hygiene-obsessed. With over a dozen groups rotating in the rural area, the idea of sharing a washing machine daunted most of them. They preferred to wash their clothes by hand especially when it was just for two weeks.

“Writing a medical record is the biggest test of a doctor’s skill!” said Zhang Lin, emphasising every word, very much in the style of a teacher.

Doctors surrounding him all raptly listened.

“You see, brother, your medical record, it’s written very well. It pointed out the anomalies that others might have missed. A truly worthy talent!” Zhang Lin pointed at the medical record.

Everyone crowded in to look at the medical record; the praised brother swelled with pride.

“Male patient, menstrual history written down in such detail, well, that’s quite the effort,” Zhang Lin pointed his finger at the table.

Everyone wanted to laugh but didn’t dare to.

Song Zimo took Little Five into surgery, a case of finger replantation. It was originally planned to just sew the finger up without attempting to replant it. However, after calling the operating room and learning that they had microsurgical instruments and sutures, plus a second-hand microscope, they decided to proceed with the replantation.

They ran into Director Tian at the cafeteria at noon. Director Tian said that the weather had been nice these past few days and suggested everyone go up to the mountain to provide free medical care to the villagers.

Before going off duty, Yang Ping went to see Teacher Yan again who was still pain-free.

He was most concerned about a rebound, which sometimes lasts for several days. While it could be simply explained to regular patients, if this patient had a rebound, it risked causing misunderstandings.

The system didn’t immediately announce the result as it usually did after surgery. It seemed to be waiting for the result too. The system was so cunning- extracting points from it was not an easy job.

“Director Yang!” Teacher Yan’s voice rang out.

“What’s up?” Yang Ping responded.

Teacher Yan said, “I’ve been considering writing a thank you poem!”