Healing Doctor

Chapter 27 The Mysteriously Disappearing Kidney

This time, the empathy didn't last long, but the shock Ji Xiang felt far exceeded that of the time when Da Hai underwent the lengthening surgery.

As for the pain, bleeding, infection, etc. that I experienced after the circumcision, they are nothing compared to what I felt this time.

As a result, Ji Xiang did not take stock of his gains immediately.

Perhaps because the difficulty of empathy has increased, this time Ji Xiang was given 30 surgery points for empathy.

But he was in a terrible mood, and his eyes were filled with blood.

Ji Xiang thought silently, unsure of how things would unfold after he left.

"Teacher." Ji Xiang pursed his lips, not agreeing with the system NPC's statement.

"Dr. Ji, please give your analysis of this matter." The system NPC looked at Ji Xiang and asked calmly.

Although he knew it was just an illusion, or rather, a program, Ji Xiang remained calm for a long time.

The system NPC handed him a 250ml bottle of 10% glucose solution. Ji Xiang gradually calmed down after drinking half of the bottle.

The system NPC quietly watched Ji Xiang without interrupting his thoughts.

"The fault in this matter lies with the surgeon who participated in the rescue three years ago, but it's also wrong for the patient to be emotionally agitated and injure innocent people," Ji Xiang simply stated his judgment.

"Your basic knowledge is still weak, which is why you made a mistake in your judgment about the whole matter." The system NPC shook its head.

"Huh?" Ji Xiang was taken aback when he heard the system NPC say that.

The patient's right kidney is gone; that's a certainty. How could the system NPC say that?

Did he sit on the wrong spot? Even inside the system space, his butt was still crooked?!

No wonder they say your position determines your perspective; it's really true.

Ji Xiang felt a slight disdain, but the passion of youth began to surge. Even if it meant offending this powerful and incredibly skilled system NPC, he was determined to stand on the side of justice and fairness.

The system NPC didn't laugh; instead, it scrutinized Ji Xiang's expression with a serious expression.

He seemed to have guessed what Ji Xiang was thinking.

This young man was like a little beast, ready to challenge himself, completely forgetting his true purpose in coming to the system space.

The old man and the young man remained silent, creating an awkward atmosphere in the operating room.

Three seconds later, the system NPC broke the suffocating silence.

"There is a type of disease called renal autotomy, which is common in tuberculosis patients." The system NPC waved his hand, and a light screen appeared in front of him. He began to explain to Ji Xiang.

Ji Xiang frowned. The kidney was removed spontaneously, a fact described only briefly in the diagnosis and other courses.

Although Ji Xiang has memorized almost an entire textbook the size of his own thanks to his superhuman memory, it's just dry memorization and it's impossible for him to turn it into a real ability.

"Large amounts of calcium salts are deposited within the renal tuberculosis lesions, leading to extensive calcification of the entire kidney. Its sonographic features include varying degrees of kidney damage, even calcification, and when kidney function is completely lost, the ureter becomes completely blocked."

This condition is clinically known as autoresection or keratostomy.

"Teacher, the patient has no history of tuberculosis," Ji Xiang said, trying to recall the memory of feeling empathy.

The system NPC raised its deformed, chicken-claw-like right hand and pressed it down.

"Autorenectomy is a type of disease, and there is another subtype of disease that we call traumatic autorenectomy."

"..."

These words were like a bucket of cold water poured over his head, instantly extinguishing the anger in Ji Xiang's heart.

Traumatic nephrectomy, as the name suggests, is caused by trauma that can lead to kidney problems.

Combining all those feelings he had experienced, Ji Xiang naturally thought of the words of the head of the urology department, his purpose in coming to the system space, and the emotions of the patients after they learned that they had been given kidney scraping.

The system NPC didn't care about Ji Xiang's feelings and continued explaining.

"The patient was diagnosed with a ruptured liver and a contused kidney three years ago."

"Renal contusions and lacerations can be seen on CT scans as uneven density, blurred vision, cracks, intra-parenchymal hematomas, and subcapsular hematomas; enhanced CT scans can show them more clearly."

"The simplest solution to a kidney injury that leads to complications such as hematuria is to remove the kidney."

Given the vital importance of the kidneys, surgical removal should be avoided whenever possible. Preserving organs as much as possible is a clinical treatment principle.

For patients with persistent hematuria or external bleeding, the problem can be identified through arteriography, allowing for highly selective embolization therapy. This involves blocking the bleeding branch, stopping the bleeding while preserving the kidney.

The system NPC began to tell Ji Xiang about kidney contusion and laceration, and then about kidney rupture.

Normally, Ji Xiang would definitely think that the system NPC was a bit long-winded and didn't get straight to the point.

But this time he listened attentively and compared his understanding with what he had learned at school.

"The fifth type of injury is renal vascular injury, which is further divided into two situations."

The first type is a ruptured renal blood vessel, which can be one of the arteries or veins, or both. This can also be considered a renal rupture, or a renal pedicle rupture. Without prompt surgery, it is a serious condition that can lead to death from massive hemorrhage.

"The second one requires your special attention."

The system NPC emphasized a reminder to Ji Xiang.

Ji Xiang nodded, his eyes fixed on the screen. His mind was divided into several threads, on one hand thinking about the emotions of the patient, himself, and the CT room doctor when they were experiencing the same thing, and on the other hand listening attentively to the teachings of the system NPC.

"In cases of renal artery contusion, the main problem lies in the blood vessel. The patient was taken to the operating table during emergency treatment, and an exploratory laparotomy was performed. The kidney's shape was unchanged, and there was no indication for surgery."

"Even if a CT scan had been done in the emergency room at the time, no problems would have been found."

"Teacher, what if I want to do a 64-slice CT scan, the kind where they inject medication?" Ji Xiang asked.

"Even if an emergency patient could give you time to undergo these kinds of tests, there's a high probability that no diagnosis would be made."

"..." Ji Xiang was speechless.

"Renal artery injury causes the vascular intima to become rough, altering the fluid dynamics and making it easier for thrombi to gradually form."

The blockage progresses from incomplete to complete occlusion of the renal artery; the change can occur as quickly as several hours after injury, or as slowly as ten days, or even several weeks later.

"I'm asking you." The system NPC looked into Ji Xiang's eyes.

Ji Xiang felt a little flustered under the gaze of those bright and clear eyes.

He understood what the system NPC meant, although it wasn't entirely clear, but he knew that he had made a huge mistake in the process of empathizing with the situation.

"How long does it take for a trauma patient to be discharged if the rescue goes smoothly?"

"10-14 days, assuming no infection or other unforeseen circumstances," Ji Xiang replied.

"Hmm." The system NPC nodded. "The patient's simple post-operative checkup was fine. Would you prescribe a more expensive imaging test?"

"Won't."

Ji Xiang answered seriously.

"Yes," the system NPC said. "This is a secondary disease. The doctor is experienced and advised the patient to go for a check-up at the outpatient clinic one month after discharge to see if there are any changes in the kidneys."

However, most patients have already recovered and forget about it after being discharged from the hospital.

Ji Xiang let out a soft sigh of relief. As for the complex emotions in his heart, even he himself couldn't explain them clearly.

"After a renal artery contusion, the most serious situation is that the kidney on the injured side completely loses its blood supply, and will gradually atrophy due to ischemia."

It has also been called "aseptic necrosis".

Under conditions of ischemia and necrosis, the normal kidney structure gradually disappears, replaced by connective tissue that is similar to the surrounding tissue, making it impossible to see on a CT scan.

"So, the patient's right kidney wasn't removed, but rather it died on its own due to traumatic renal autotomy caused by an extremely rare renal artery contusion?" Ji Xiang found this logic hard to accept.

The system NPC nodded.

Ji Xiang remained silent.

He still had something to say, but he didn't say it aloud.

"Are you saying that doctors still bear responsibility?" The system NPC seemed to see through Ji Xiang's thoughts as if it were a god, and asked calmly.

"Yes." Ji Xiang didn't hide anything and nodded in reply.

"Let me give you an example," the system NPC said seriously. "Our neurosurgery department once treated a patient like this—a car accident victim with very minor scratches; the patient was wearing a seatbelt."

"External injuries, you know that too."

Ji Xiang was taken aback. The system NPC's explanation was simple, but he only knew a little bit about it and didn't understand anything more.

If a trauma patient has insurance or the other party is fully at fault, they will generally choose to be hospitalized.

Firstly, just in case, and secondly, it's good to have a full physical examination while we're at it.

"The patient was a young woman who had been hospitalized for six days and all her tests came back normal. She was scheduled to be discharged the next day. The on-duty doctor saw her get up to go to the bathroom after the emergency surgery that day, and everything seemed normal."

"But less than an hour later, during the night shift change, the nurses discovered that the patient was incontinent and unresponsive."

"!!!" Ji Xiang was stunned.

"It's too late to bring the doctor over now." The system NPC sighed. "A one in 50,000 chance of carotid intima-media rupture caused a large number of emboli in the patient's head blood vessels, which eventually blocked the brainstem, leading to death 19 days later."

"!!!"

"These two cases are somewhat similar." The system NPC brought the topic back on track. "Your idea that if a doctor is highly skilled, it can prevent problems early is correct, but that requires a doctor of my level."

At this point, the system NPC paused for a moment.

"With a probability of one in 50,000, how many similar patients do you think there are in the entire country?"

Ji Xiang stopped paying attention to the system NPC "Versailles'" words. He frowned and asked, "Teacher, if it's discovered earlier, is there a way to treat it?"

"That's something you only think about after your urology skills reach level 9," the system NPC said. "Now I'm asking you, do you know the secret of what the head of urology focuses on?"

The reason why Ji Xiang was given special attention instead of focusing on a patient with a kidney contusion, who was a patient with a highly difficult partial nephrectomy and had many postoperative complications, came to mind.

He knew that the head of urology would not pay attention to all kidney contusions, but rather, based on his extensive clinical experience, he vaguely guessed that this patient might have a problem and needed to be observed more closely and communicated more with the patient and his family to avoid any accidents.

This is packed with clinical experience.

Ji Xiang did not nod, but instead began to ask the system NPC some questions that he did not yet understand.

This doesn't require surgery points, and the system NPC is the best kind of teacher, so Ji Xiang will definitely hold on to it and want to thoroughly understand it before making any decisions.

(End of this chapter)