Healing Doctor

Chapter 793 Damn it, he got away with it again!

"Because omental infarction is a self-limiting disease that does not require surgery, its treatment plan is fundamentally different from that of acute appendicitis. Therefore, your refusal to have an abdominal CT scan prevents us from making a diagnosis, and according to regulations, you need to sign a consent form."

After Ji Xiang finished speaking, he looked directly at Dr. Meltz with a firm gaze, carrying a hint of the authority of a senior doctor.

It wasn't a systematic skill, but rather an unyielding authority that Ji Xiang naturally accumulated from performing many surgeries.

After a dozen seconds, seeing that Dr. Meltz remained silent, Ji Xiang continued, "Dr. Meltz, if you are not confident in your diagnosis, I suggest you listen to us."

"!!!" Dr. Merz almost spat out a mouthful of blood.

He had traveled a long way to the Second Affiliated Hospital to cause trouble for Lin Jiuze.

Unfortunately, I encountered a great demon king who restrained me everywhere.

Nothing I do goes smoothly; I can't even understand surgery.

Even when he inexplicably developed acute appendicitis, the cunning Great Demon King refused to allow him to have surgery.

He's not a doctor at all! He's a demon king! A real demon king.

Dr. Meltz was screaming in his heart.

But Dr. Meltz was already exhausted by the disease and had no way to fight it.

"Xiao Ji, have you had the CT scan yet?"

As they were talking, Director Bai pushed the door open and came in.

"Hello, Director Bai." Seeing that Director Bai was like a summoned beast, always at his beck and call, General Manager Zhao immediately lowered his head.

He felt that things could not be resolved amicably and felt a little regretful.

It's all my fault. If I hadn't wanted to communicate more with Ji Xiang, I wouldn't have asked him to be my "translator."

If he hadn't come to translate, Dr. Meltz would already be on the operating table, and Director Bai wouldn't have come at all.

If I had dragged Dr. Meltz into the surgery myself, we probably would have already seen the appendix and could have removed it with just a few quick snips. There wouldn't have been so much trouble.

What happened next was completely out of control. Mr. Zhao only hoped that the philanthropist Ji Xiangji would not cause things to spiral out of control.

"Director Bai, we believe the diagnosis is questionable and recommend an abdominal CT scan. Dr. Meltz won't sign the consent form, he only requests surgery, which puts us in a difficult position," Ji Xiang said.

"This is Attorney Chu, the legal advisor I hired from the foreign affairs department," Director Bai said, pointing to a man in his fifties behind him. "Attorney Chu, this is Ji Xiang, whom I mentioned to you."

"Hello, Dr. Ji." Attorney Chu extended her hand and shook hands with Ji Xiang.

His gaze swept over the doctor-patient communication document, he greeted Director Bai, and then, holding the document, called Ji Xiang to go out together.

"It's tough for everyone, so it's always good to be cautious," Attorney Chu said casually to Ji Xiang while looking at the documents. "I work at a law firm, and one of my clerks just got a complaint."

"Why did you file a complaint?" Ji Xiang asked.

"She received a phone call from someone. The clerk asked for the case number, and the person immediately hung up to file a complaint. He meant there must be something fishy going on, otherwise why would they need a code?"

"..." Ji Xiang found this lawyer Chu to be quite interesting.

There was some awkwardness and unfamiliarity when they first met, but he casually made a pun to shorten the distance between them.

This is emotional intelligence. Ji Xiang feels very comfortable talking to people with high emotional intelligence.

"Not to mention, the patients you encounter are quite similar to the plaintiffs and defendants we encounter." Attorney Chu read through the communication written by Ji Xiang word by word, while continuing to chat as if he could multitask.

"Hehe, I didn't expect you guys to have so many troubles. I always thought that only doctors would encounter so many strange patients and their families."

"Yeah, there are plenty of unreliable things. For example, around this time last year, I went to the law firm and saw an old man in his eighties leaning on a cane, muttering and cursing. He asked my assistant what was going on, and the assistant said that the old man's children had taken all his money."

"Sigh." Ji Xiang sighed.

Attorney Chu looked up at Ji Xiang, a smirk playing on his lips. "Dr. Ji, do you think it's a case of children neglecting their elderly parents?"

"Uh, isn't that right?" Ji Xiang was taken aback.

"That's what I thought at the time too. But after I found out, I learned that the old man had been tipping female internet celebrities on a live streaming app after he learned how to use the internet. He spent tens of thousands of yuan a month. His children put all his money in a fixed deposit and didn't allow him to tip the female internet celebrities."

"..."

"So, that's just how things are in this world. We lawyers have been around for a long time and have seen all sorts of human nature. They say you hear more prayers on hospital walls than in churches. Our law firm is a little less so, but we've still seen our share of the world."

"Teacher Chu."

"Hmm?" Attorney Chu replied casually, looking down at the communication written by Ji Xiang.

"In the capital, isn't there a pretty famous lawyer who got slapped during a court hearing because of an argument, and when he went for a medical examination later..."

Attorney Chu paused for a moment, then looked up, his eyes narrowing into slits.

"I knocked out seven of my teeth."

"How did you know?" Attorney Chu was taken aback, then asked cautiously.

"I heard it from a teacher in Beijing."

Attorney Chu frowned, then nodded after a few seconds. "Everyone has suspicions, but no one has concrete evidence. But speaking of which, Dr. Ji, your communication documents are really well written."

Ji Xiang knew that Attorney Chu didn't want to mention such sensitive matters.

Originally, Ji Xiang thought that the empathetic experiences and the things mentioned by the system NPCs did not exist, but after asking casually and seeing Lawyer Chu's expression, Ji Xiang began to have some doubts.

"good."

"I've seen many doctors communicate, and they all have problems. Yours can serve as a template," Attorney Chu said with a smile, seemingly having long forgotten what Ji Xiang had just mentioned. "You're so young yet so meticulous; no wonder Director Bai values ​​you so much."

"That's good."

"Hmm, I don't see anything wrong. Let the patient sign the consent form."

Attorney Chu then approached Director Bai, who was speaking with Dr. Meltz, and whispered his opinion in her ear.

"Dr. Meltz, I suggest you get a CT scan," Director Bai advised gently. "After all, we need to rule out the low-probability issues."

"Low probability! I am now a patient, my diagnosis is..."

"You are a patient now, not a gastrointestinal surgeon. If you insist, I suggest you contact your expert friend in Massachusetts," Ji Xiang interrupted Dr. Meltz.

This was the second time Dr. Meltz had heard Ji Xiang say that he wanted to contact his expert friends in Massachusetts.

As for the last time, it was when I encountered a patient diagnosed with patent foramen ovale.

Dr. Merz, who was initially convinced that he had been framed, targeted, and repeatedly trampled underfoot by the Great Demon King, suddenly began to waver.

"Dr. Meltz, you used to be a doctor, now you're a patient. Please try to put yourself in the doctor's shoes."

Dr. Meltz listened to Ji Xiang's words and fell into deep thought.

"It is undoubtedly a disaster when unprofessional or self-proclaimed professionals get involved in a professional field. You are a doctor, and I think you understand all of this."

Yes, that was indeed a disaster.

No! Dr. Meltz instantly realized that Ji Xiang was "yin-yanging" him.

That young demon king is saying he's not professional!

The unprofessional doctor made a simple diagnosis and treatment complicated, and in the end, the dramatic outcome was that he himself suffered the consequences!

Dr. Meltz was very angry, extremely angry, and very angry.

But when his eyes met Ji Xiang's, he immediately chickened out and didn't express his anger at all.

I still vividly remember the diagnosis of patent foramen ovale. I was waving the ECG report in front of the young "big devil" back then, only to be humiliated in the end.

It turned out that the patient did indeed have a patent foramen ovale.

Not only that, but after the surgery, Wenban Yama seems to be getting better day by day.

Dr. Meltz remained silent.

"Do you need a medical consultant?" Ji Xiang asked.

"I'll make a phone call," Dr. Meltz said, somewhat hesitantly.

He couldn't relay some of the test data because he didn't understand Chinese.

"I can translate the data," Ji Xiang suggested, immediately noticing Dr. Meltz's predicament.

How awful!

Dr. Meltz did not perceive Ji Xiang's "generosity" as a sign of goodwill; instead, he believed that this young devil was suppressing him.

At the same time, the abdominal pain intensified.

This is all the fault of the young demon king!

Dr. Meltz dialed the number of a familiar gastrointestinal surgeon.

"John, there's something I'd like to ask you."

"Oh, where are you? I haven't seen you lately," the doctor on the other end of the phone asked.

"I...I think I have acute appendicitis."

Just as Dr. Meltz finished speaking, Ji Xiang took the phone from him.

The incident happened so suddenly that Dr. Meltz didn't notice anything amiss. When he tried to grab the phone back, he discovered that the young villain had already started communicating with his friend.

The young demon king began to describe his symptoms in a way that Dr. Meltz could understand.

"On the ultrasound image, I saw a few bean-shaped oval lesions on the abdominal wall. There weren't many, and they weren't very clear."

Dr. Meltz could not believe that this was what a doctor was saying when reporting a patient's history.

But Ji Xiang explained it very seriously.

"Because I didn't perform the ultrasound, I can only make a judgment based on the ultrasound images."

Ji Xiang listened intently as the doctor across from him said something.

"I don't think we should rush to diagnose it as acute appendicitis. Instead, we should first do an abdominal CT scan and an enhanced abdominal CT scan to rule out the possibility of omental infarction. If the CT scan confirms it, I suggest doing an enhanced CT scan to determine whether surgery is necessary."

Dr. Meltz was taken aback when he heard Ji Xiang say this.

Not only do I need a CT scan, but I also need an enhanced CT scan, but all I have is acute appendicitis!

If this had happened at Massachusetts General Hospital, the insurance company would definitely not have reimbursed it!

This is outrageous! The young superstar is not only challenging himself, but also trying to challenge experts at Massachusetts General Hospital and insurance companies.

"Okay, I'll hand the phone to Dr. Meltz, and you can talk to him. I think Dr. Meltz won't listen to my judgment; he insists on surgery. You know, neither a McBurney's point incision in the right lower quadrant nor a laparoscopic procedure can meet the surgical requirements."

Moreover, if the enhanced CT scan shows no problems, surgery for a self-limiting disease would definitely be unacceptable.

As he spoke, Ji Xiang handed the phone to Dr. Meltz.

"John..." Dr. Meltz began to speak, but the person on the other end of the phone interrupted him.

"Mertz, who was the person who just explained my condition to me?" the doctor on the other end of the phone asked.

"..." Dr. Meltz glanced at Ji Xiang.

The perspective from the examination bed is different from the normal perspective; Dr. Meltz saw that the young demon king as so tall and invincible.

Is it really appendicitis? A hint of doubt crept into Dr. Merz's mind.

"He was the surgeon who performed the operation on Wenbanyama."

Dr. Meltz quietly identified Ji Xiang.

"Damn it!" Dr. John cursed. "Why would a sports medicine doctor be looking at an ultrasound?"

"Me too."

"No! Melz, retinal infarction is difficult to diagnose with ultrasound; the best way is a CT scan. Remember that trouble I had a few years ago?"

Dr. Meltz was stunned.

He vaguely remembered, but John hadn't mentioned the specifics. It was a private matter, and Dr. Meltz hadn't inquired further.

"A patient was suspected of having cholecystitis, so a hepatobiliary surgeon performed surgery. The results showed that the patient's gallbladder was perfectly fine; the problem was with the greater omentum."

"!!!"

"This damn disease looks so much like appendicitis and cholecystitis, and it's impossible to diagnose without an abdominal CT scan. But the insurance company is adamant about not reimbursing the costs for patients with this condition."

Dr. Meltz never expected that his friend would completely side with the Great Demon King.

"You don't understand the details here, I suggest you listen to the advice of local experts."

After speaking for a while, Dr. John gave his opinion decisively.

"Why do you think he's an expert?" Dr. Meltz asked.

He lowered his voice to a whisper, as if afraid that Ji Xiang would hear him.

But Ji Xiang had excellent hearing and heard everything clearly. However, Ji Xiang didn't have any ill intentions towards Dr. Meltz because of this. As long as the patient was willing to do the CT scan, he was fine with it.

Ji Xiang was more concerned that he hoped the enhanced CT scan would not be necessary, otherwise the surgery would be very difficult, and he was afraid that no one at the Second Affiliated Hospital would have the experience.

Everyone is safe and sound, that's good.

"Mertz, you idiot, I really want to shove the sandwich I left over this morning into your mouth!"

"..."

"There's no reason why. Just listen to the expert's opinion. I still have to have this damn surgery, and I haven't even met my monthly outpatient quota yet. If I'm going fishing at sea this weekend, I'll have to go to the outpatient clinic to see those boring patients after the surgery to make up for the monthly outpatient quota."

Meltz, do you know how busy I am?!

Dr. Meltz listened to a dial tone on the other end of the line with a sense of helplessness before hanging up the phone.

"Dr. Meltz, should we do a CT scan or sign a refusal form?" Ji Xiang waved the communication device in his hand.

"..." Dr. Meltz looked helplessly at the great demon king who was showing off his power in front of him, and had no words to say.

He got away with it again!

Damn!

Dr. Merz had a vague idea that retinal infarction was a condition that likely involved blood vessels.

If nothing happens, then nothing will happen. But if something does happen, for example, if a large area of ​​the omentum is without blood supply, the next step will be acute abdomen!

If diagnosis and treatment are delayed, the next step will be bacteremia, a difficult-to-treat disease, and there is a high probability of infection, toxic shock, or even death.

It's definitely not as simple as acute appendicitis.

Thinking of this, Dr. Meltz became somewhat anxious.

"I need a CT scan! A contrast-enhanced CT scan!!"

After saying that, Dr. Meltz added, "It's okay if the insurance company doesn't reimburse me, I'll pay for it myself!"

The fear of extensive necrosis of the retina had exceeded Dr. Meltz's expectations of defeating the young demon king before him. He endured the excruciating abdominal pain and almost howled as he spoke.

"What did he say?" Director Bai asked.

"Dr. Meltz has agreed to do a CT scan, but he also needs to do an enhanced CT scan." Ji Xiang said with some helplessness.

"Should I contact them?"

There are no doctors on duty for enhanced CT scans at night because this examination is not an emergency.

If it absolutely has to be done, Director Bai needs to call the relevant doctors from his home and turn on the equipment to prepare.

Ji Xiang thought for a moment, "Let's still call them. Although I think the chances are slim, what if it happens? It wouldn't sound good if a specialist from Massachusetts General Hospital died in our hospital."

"!!!"

The last sentence startled Director Bai.

It is no exaggeration to say that the consequences would be unimaginable.

Director Bai felt a chill run down his spine just thinking about the chain reaction that would result from the Massachusetts expert's "death" at the Second Affiliated Hospital.

Contact the CT room, and Director Bai led a group to take Dr. Meltz, this "big trouble," for examination.

The CT images showed a large area of ​​fat density shadows with blurred edges and indistinct boundaries.

Is this yarn?

The on-call doctor in the CT room looked at the images with a puzzled expression, completely unsure how to make a diagnosis.

"It's a retinal infarction," Ji Xiang said confidently. "However, surgery isn't necessary for now; we just need to observe it for a few days."

Director Bai asked nervously, "Really? Since Director Niu from the CT room is coming anyway, why not get an enhanced CT scan done while we're at it?"

Ji Xiang did not insist, but agreed with Director Bai's opinion.

Anyway, all that's needed is rest. It seems that Dr. Meltz's retinal infarction is a self-limiting disease.

Whether or not to have an enhanced CT scan is irrelevant to him or to Dr. Meltz's condition, but it gives Director Bai peace of mind.

Having experienced countless instances of empathy, Ji Xiang subconsciously tries to see things from other people's perspectives.

When Director Niu arrived, he saw the footage and came to the same conclusion as Ji Xiang, which put Director Bai at ease.

However, he still insisted on having an enhanced CT scan.

Dr. Meltz was performing an examination, and hearing a buzzing sound, Director Bai asked, "Director Niu, is surgery not necessary? What's going on?"

"Director Bai, is your understanding of retinal infarction something like omental thrombosis?"

"Hmm." Director Bai nodded.

"Primary omental infarction actually occurs in both children and adults. The pain is often located in the right upper or lower abdomen, and is easily misdiagnosed as appendicitis or cholecystitis. Its only predisposing factor is childhood obesity."

"I read a report that said about 0.3% of patients with acute appendicitis are misdiagnosed and should actually be diagnosed with omental infarction."

Director Bai really doesn't understand this matter.

Indeed, a medical director who is a neurosurgeon cannot be omniscient and omnipotent.

He listened attentively to Director Niu's explanation of retinal infarction.

"Primary infarction is more likely to occur in the right upper abdomen, possibly because the greater omentum in that area is longer and has greater mobility."

"It's not uncommon in the lower abdomen, and most cases are self-limiting, healing on their own in a few days."

"So when I see clinicians talking about conservative treatment for appendicitis and cholecystitis, I feel it's better to have a CT scan to rule it out."

"However, now people are saying we're overusing CT scans. After blood tests and ultrasounds, they have to do a CT scan too. I estimate that 99.7% of appendicitis patients wouldn't accept that."

Director Niu said, laughing heartily.

"Is surgery necessary?"

"The greater omentum has many blood vessels supplying it, so it generally doesn't need blood."

Director Niu began to show off his skills, explaining to Director Bai in detail what a real retinal infarction that requires surgery looks like.

Ji Xiang stood in the corner, watching the screen and waiting for the results.

Just as Director Niu said, this disease generally doesn't require surgery, so Dr. Meltz wouldn't need to perform surgery.

Most cases of retinal infarction are discovered during emergency surgical exploration. Since the infarcted retinal tissue is already open, surgical removal is generally recommended if it can be easily cut off.

Surgical removal of the infarct can rapidly improve the patient's symptoms and signs, resulting in faster recovery and a shorter disease course.

Laparoscopic resection of the infarcted greater omentum can more effectively reduce postoperative complications such as pelvic and abdominal abscesses, pelvic and abdominal adhesions, and intestinal obstruction.

In patients with milder cases, conservative treatment can gradually reduce local inflammation, causing the greater omentum to shrink and fibrose. Most patients recover within two weeks, although some symptoms and signs may persist for several weeks. Follow-up CT and ultrasound examinations can show that the mass is gradually shrinking and has clearer boundaries.

As for how Dr. Meltz developed his retinal infarction, Ji Xiang had no idea.

Perhaps it was caused by his overeating, or perhaps it was due to a bad mood and high blood pressure; who knows?

Ji Xiang didn't care how Dr. Meltz got his illness, as long as surgery wasn't needed.

According to the system NPC, surgery isn't just a matter of removing the part; there are many complicated follow-up problems.

However, Dr. Meltz seemed to be lucky; Ji Xiang breathed a sigh of relief after the enhanced CT scan results came back.

The results are the same as those in the operating room; surgery is not required, conservative treatment will suffice.

When we told Dr. Meltz the results, he was still very worried and asked for the imaging data to be sent back to Massachusetts General Hospital.

Ji Xiang clearly felt the difference in Dr. Meltz's attitude before and after.

That's normal, though, as Ji Xiang has been a patient many times.

"Dr. Meltz, have you been experiencing significant mood swings lately?" Ji Xiang asked on the way back to Dr. Meltz.

"..." Dr. Meltz paused for a moment.

He recalled experiencing abdominal pain after learning that Wimbledon had received a call from Jeanie Buss and was likely going to the Lakers.

How did Ji Xiang find out?!

"Although the cause of primary peritoneal infarction is not definitively known, many patients experience it due to fluctuations in blood pressure. What I find strange is that your blood pressure should be very well regulated, so why did it suddenly fluctuate?"

Dr. Meltz felt as if the Great Demon King was slapping him repeatedly after knocking him to the ground, asking him if he knew he was wrong.

F***!!

(End of this chapter)