Rebirth 1977 Great Era

Chapter 1102 Are you a gangster doctor? You're covered in bruises (Bonus chapter for 3K monthly votes)

Fang Yan recalled that in Western medicine, erythematous pemphigus is a subtype of pemphigus, belonging to autoimmune bullous skin diseases.

This condition commonly occurs on the face, chest, back, and other seborrheic areas. The rash presents as vesicles or bullae on an erythematous base, and may be accompanied by scaling and crusting. Sometimes, a butterfly-shaped rash similar to lupus erythematosus may appear.

It mainly affects the head and face, such as the bridge of the nose, cheeks, forehead, chest, back, and shoulders, which are areas with high sebum secretion. The limbs and trunk can also be affected. In addition, the oral mucosa of some patients may also be affected, but this is relatively rare.

In his previous life, Fang Yan had seen people with the same illness, but this was the first time he had seen one so severe in both his lives. It was quite serious.

Based on the information provided by the patient, the Western medicine she was taking had almost controlled her symptoms, but recently the medicine suddenly became less effective, which is why she is in her current state.

So Fang Yan asked her curiously:
"Do you remember what medicine you usually take?"

"I brought the medicine!" the patient said to Fang Yan, then turned to his assistant.
"Quickly, take it to Doctor Fang for a look."

The young assistant opened a bag, took out a fairly well-made aluminum medicine box, and placed it in front of Fang Yan.

Not only the dialect, but other people couldn't help but come over, curious about what kind of medicine it was.

Fang Yan took out the medicine from inside; there was more than one type. After Fang Yan looked at it, Chen Mike, who was standing next to him, said:

"It's cyclophosphamide, prednisone, and prednisolone."

Jin Wubing, standing to the side, asked curiously:

"What's the use of all this?"

Chen Mike glanced at Fang Yan and then said:
“I studied Western medicine at the church in my early years, and I know a bit about these drugs. If I remember correctly, prednisone and prednisolone are the core anti-inflammatory and immunosuppressive drugs for treating pemphigus, which are used to directly control the inflammation and autoimmune response that cause skin blistering.”

"Moreover, cyclophosphamide is an important adjuvant drug here. It is used to enhance the overall immunosuppressive effect, especially when the effect of hormone monotherapy is poor or the condition is severely aggravated. As a 'hormone reduction agent,' it helps to reduce the long-term dosage and dose dependence of hormones!"

"The combination of these three drugs is one of the classic clinical treatment regimens for moderate to severe or refractory pemphigus. It mainly involves the safe management and reduction of hormone dosage while ensuring disease control, with the assistance of the immunosuppressant cyclophosphamide."

Fang Yan glanced at Chen Mike, who smiled at him, as if to express his goodwill towards Fang Yan.

"Thank you for your explanation, Mr. Chen." Fang Yan nodded to Mike Chen. Although he himself knew what this thing was, Mike Chen's explanation gave Fang Yan a chance to consider other options.

Hearing the dialect-accented thanks, Chen Mike smiled with great satisfaction.

He also glanced at Huang Qiming beside him. The old man's eyes flashed with a thoughtful look, as if he was pondering something.

He You, who had just recovered, sat to the side and did not come over, but just watched from a distance. Huang Qiming, on the other hand, seemed to have forgotten his old friend and did not even glance in that direction.

Mike Chen's eyes quickly swept over them before landing back on Fang Yan. What he cared about most was how Fang Yan would proceed with her treatment.

"Untie these bandages around your body, I need to check your symptoms," Fang Yan said to the patient, putting down the medicine in his hand.

The patient had anticipated that the patient would want to see the dialect, so he nodded and said:
"Okay, but it'll be a bit of a hassle to remove it, as the scabs on my body are sticking to the gauze."

Mike Chen stepped forward again and said:

"It's alright, I'll handle it!"

After saying that, he picked up the first-aid kit that was next to Fang Yan, placed it on the table, and opened the lid.

He deftly removed the sterilized scissors and toothless tweezers from them.

"Dr. Fang, how about I do it?" He turned to Fang Yan and asked.

Fang Yan noticed that this guy was being quite proactive with this patient.

He hadn't said much before, could it be that he knows the patient?
Fang Yan quickly dismissed the idea, thinking that Fang Yan probably wanted to show off. He thought He You, who was usually the most talkative, had become timid, and Huang Qiming was now pretending to be invisible, so Fang Yan stepped forward.

"Alright, then I'll have to trouble Dr. Chen," Fang Yan said to him.

Then, Fang Yan saw Chen Mike first gently press and probe the edge of the gauze with his finger. This was a typical Western surgical technique, where the fingertip felt an abnormal stiffness and adhesion between the gauze and the skin.

“The scab is stuck very tightly,” he explained to the crowd in a low voice, while with a flick of his wrist, the scissors precisely avoided the weak points where the skin might stick together, and with a “snip” cut open the outer layer of bandage along the edge of the gauze wrapping, the movement was both quick and steady.

The outer layer of gauze fell apart with a sound.

Next, he faced a dressing that was seeping blood and thick secretions from the inner layer, and was severely stuck to the scab on the skin. He did not forcibly tear it off, but instead took out a sterile cotton ball soaked in saline from his medical kit.

He bent down, carefully picked up a cotton ball with tweezers, and gently pressed and applied it to the adhered area, saying, "Moisten it first to soften it; tearing it off forcefully will tear off the skin and flesh."

Even from this glimpse, it's clear that this surgeon possesses exceptional skill.

His accent makes you wonder if he's also working as a gangster doctor in the US.

As the saline solution gradually penetrates and softens the scabs, it emits a slight odor.

Chen Mike's technique was skillful and gentle. The tip of the tweezers precisely probed into the loosest gap at the edge of the adhesion, and with a very small flipping motion of the wrist, he slowly peeled away the dressing that was tightly attached to the skin, bit by bit, inch by inch.

The removed gauze had dark yellow scab fragments and a small amount of translucent exudate on its surface.

The sticky, yellowish-red mess made those around him grimace. Whenever he encountered a particularly stubborn sticky area, Chen Mike would immediately stop, soak a cotton ball in saline solution again, and wait patiently for a moment before continuing.

His movements were fluid and seamless, his eyes sharp, and his gaze never left the operating area as he closely observed the condition of the exposed skin.

As the bandages were removed one by one, the mottled, deep red, and thin, brittle scabs covering the old and new skin lesions were exposed to the public. These were the remnants left after the blisters and bullae that had ruptured on the basis of erythema healed, surrounded by fresh erythema with indistinct edges, and the air was filled with the faint smell unique to skin diseases.

"vomit!"

Suddenly, the patient's assistant behind him gagged.

"..." The patient glanced at her, a hint of displeasure flashing in his eyes.

"I'm sorry! I'm so sorry!" the assistant quickly apologized.

Fang Yan felt sorry for her; it was highly likely that this job was her last.

Meanwhile, Chen Mike, who was closest to the patient, remained calm and composed until the last adhesion point was successfully separated. Except for some bandages still on the patient's chest, all other wrapped parts of the body were fully exposed to the light in the examination room.

He straightened up, placed the blood-stained gauze and instruments into the waste tray, took a half step back, and nodded to Fang Yan: "Except for the chest area, everything else has been removed."

Fang Yan nodded and said to Chen Mike:
"Dr. Chen's surgical skills are superb!"

The whole process was swift and efficient. His technique effectively avoided secondary damage and also revealed a calm, precise, and professional demeanor. Fang Yan knew that most people were not as skilled as him.

This guy's hands didn't shake at all the whole time, and his breathing was very steady.

This means he probably does this kind of thing often. Sure enough, none of the ones who came back this time were easy to deal with, except for Jin Wubing.

"Thank you for the compliment. I often treat people's external injuries, so I'm quite skilled at it," Chen Mike said to Fang Yan.

Fang Yan nodded.

"Do you work as a doctor for gangsters? Do you often treat external injuries?" Jin Wubing asked Chen Mike.

"..." Chen Mike was stunned and looked at Jin Wubing, who had a curious expression on his face.

Jin Wubing said to Chen Mike:
"Hey bro, don't forget I'm from the Zhigongtang!"

Mike Chen was speechless. He opened his mouth, then changed the subject:

"Shall we see Dr. Fang for treatment?"

"Oh, right!" Jin Wubing suddenly realized. He was more interested in seeing how Fang Yan planned to deal with this woman whose body was rotting than in the other person's story.

Fang Yan's gaze then shifted to the patient.

On her face, chest, back, underarms, arms, calves, and inner thighs, there were large areas of erosion, surrounded by redness and covered with greasy scabs. What was most chilling was that some areas had very thin blisters that could burst if poked or touched.

Fang Yan then picked up a cotton swab and gently pressed and rubbed the seemingly normal skin and the edges of the blisters with the tip of the swab to test them.

He then discovered that when the edge of the blister was gently pressed, the blister could expand into the surrounding normal skin.

When normal skin is rubbed, the epidermis separates from the dermis, forming superficial blisters or peeling. This is a phenomenon that occurs when the adhesion between the epidermal layers is weakened in patients with pemphigus.

At this point, it's practically confirmed to be pemphigus.

Seeing this, everyone else felt inexplicably itchy.

This scene is really a bit bizarre.

Only Fang Yan remained relatively calm. He picked up the flashlight and spoke to the patient:
"Open your mouth and stick out your tongue."

The patient nodded and did as instructed in the local dialect.

The first thing you notice in dialects is the tongue; it's pale and has a white, greasy coating.

Not content with just looking at that, he scanned the patient's mouth and shone his flashlight all over the place.

"Fortunately, there are no blisters or sores in my mouth," Fang Yan said.

Erosions can easily breed bacteria or fungi, worsening local inflammation and creating a vicious cycle. Nutritional intake may be problematic, and caution will be needed when taking medication later. It's okay here now, so Fang Yan can breathe a sigh of relief.

Then, speaking in dialect to the patient:
"Extend your hand, let me take your pulse."

The patient obediently stretched out his hand, then froze in surprise.

Goodness... My wrists are covered in sores and scabs, or blisters. How do I diagnose this?
PS: I currently owe you 42000 words after finishing this chapter.

That's all for today, please come early tomorrow.

(End of this chapter)