My Medical Skills Give Me Experiences

After sending Wei Fang away, Zhou Can was also full of expectations for the effect of the medicine. Whether it is really effective is still hard to say. After Hu Wei took it, it took about 72 hours to know whether it was effective. The recipe was learned from Director Wen of Neurosurgery. At that time, Director Wen was only excited, and mentioned this prescription to Zhou Can. Moreover, this prescription was not researched by Director Wen, but was passed on to Director Wen by Director Wen's mentor before he died, so that he could continue to study it. He does not mean that. Zhou Can felt that it was very miraculous, so he wrote down the formula. After learning it, there has been no clinical trial for the time being. It's not bad to take Hu Wei as a free drug tester. ...The next day, around ten o'clock in the morning, the patient with diarrhea and diabetes insipidus queued up for an abdominal ultrasound examination. Director Zheng has already explained that he will perform two important endoscopic surgeries in the operating room in the morning, and the patient can go directly to the inpatient department to find Zhou Can after receiving the examination results. This difficult case is really too much for ordinary people. The patient's mother found Zhou Can with the test results. Unexpectedly, after Zhou Can took over the B-ultrasound results and read them, he remained silent for a long time. "Doctor Zhou, can my son's illness be found out? Is his illness serious?" The family members may also feel a little panicked. This is the love of a mother for her son. It was not easy for her to raise her son alone. Her son is her lifeblood and her hope of living. Zhou Can could clearly feel her anxiety and tension. "Judging from the results of the b-ultrasound examination, the situation is not very good. The b-ultrasound indicates that there are multiple space-occupying lesions in the liver. This means that the patient is likely to have a pancreatic endocrine tumor." Before the b-ultrasound examination, Zhou Can hoped that the patient no big deal. But now it was developing in the direction he least wanted to see. Pancreatic endocrine tumors can be divided into functional and nonfunctional tumors. Nonfunctioning tumors do not produce neuroendocrine substances and do not cause specific clinical symptoms in patients. Obviously, the patient's diarrhea is so severe, it must be a functional tumor. What kind of tumor it is is unclear. Insulinomas, gastrinomas, glucagonomas, vasoactive intestinal polypeptide-secreting tumors, somatostatinomas, etc., are all likely to occur. Pancreatic cancer is qualified to be called the cancer king, and it has its own scary features. "Tumor..." The patient's mother had a frightened and painful expression on her face after hearing this. Immediately afterwards, he held his forehead and temples with his hands, and his body began to shake, as if he could no longer stand still. "Don't get excited, don't get excited. Right now, I just suspect that it might be a pancreatic endocrine tumor, and this is not the final result." Zhou Can could only say something against his will to appease his family. In fact, he was very clear that the results of the b-ultrasound had basically confirmed that the patient had a pancreatic endocrine tumor, and it was likely to have spread. At least midterm. This means that after the patient is diagnosed, it is likely that there will be no chance of surgery. Cancer King is best at not giving patients a chance to live. Do not give the doctor any chance to rescue. Even if it is just a chance to control its growth, it is not given. Zhou Can quickly stood up and helped the woman sit down on the doctor's office chair. Then he walked to the door and waved to the nurse's station, "Xiao Li, come and help me if you're not busy." The nurses in the Department of Gastroenterology have asked Zhou Can for help many times, and Zhou Can is very familiar with them. In addition, Zhou Can is young and rich, and spends a lot of money. From time to time, he invites all the nurses to drink milk tea and barbecue after get off work. It must be explained that he invited the nurses to barbecue after get off work, and he would not go there himself. Instead, account for the payment of a leader, who will be reimbursed the next day. Although these female nurses in the Department of Gastroenterology are all beautiful and have a high level of education, it doesn't affect their psychology of taking advantage of small things. Every time I hear that Zhou Can treats guests, even if I don't go to work, I have to form a team to rush over to eat barbecue. However, their quality is still quite high, it is true that they love to take advantage of small things, and they are not greedy. After eating Zhou Can's food, they will give something back. In addition to paying special attention to Zhou Can's affairs at work, sometimes they will reciprocate in their own way. For example, give Zhou Can two biscuits, or put a pack of snacks in his pocket. This really made him dumbfounded. In the hearts of girls, sneaking some snacks at work is very enjoyable. It’s just that for Zhou Can, he almost never eats snacks except for some fruit. On the one hand, work and study are very busy, on the other hand, there is still a big difference between men and women on this point. The female nurse named Xiaoli ran over, "Brother Zhou, what do you order?" "Here, the female family member inside almost fainted after learning that her son might have a pancreatic tumor. You can help him by the side. Just in case I fell down, or something happened, I can’t tell later.” Zhou Can is really hard to help others as a man. Although this female family member is already fifty years old. But he has to watch the impact. Words are scary. These days, a distorted photo can easily ruin a doctor's career. For example, in the process of rescuing patients, there was a lot of noise a while ago, and the incident of nurses playing with mobile phones. Anyone with a little brain knows that when rescuing a patient is so urgent, which doctor or nurse would dare not take the patient's life seriously and sit by and play with a mobile phone? Afterwards, it was found out that the nurse was not playing with the mobile phone, but was trying to contact doctors in related fields to come to rescue, and used the mobile phone to coordinate the rescue supplies. But because of the death of the patient, the family members blamed the female nurse and took photos of her and exposed her on the Internet. Eventually it caused an uproar. Fortunately, the truth was found out later, and the female nurse was cleared. In reality, there are too many things that doctors and nurses sweat and cry. The female nurse is very good at comforting people. Under Xiaoli's comfort, the family members' emotions gradually stabilized. It's just that there is a sad look between his eyebrows and eyes, which can't be erased no matter what. This patient is under the responsibility of Director Zheng. Now that the diagnosis has made significant progress, Zhou Can feels that it is necessary to report to Director Zheng in time. Even if Director Zheng might be performing surgery on the patient, that's okay. Zhou Can decisively dialed Director Zheng's cell phone. "Doctor Zhou, has the patient with diarrhea and diabetes insipidus been found out?" "The exact cause is still unclear. However, the patient's abdominal ultrasound has indicated multiple space-occupying lesions in the liver!" Zhou Can said the patient's The situation was reported. "This is really terrible!" After hearing this, Director Zheng was silent for a few seconds, and then he sighed heavily. Medical predictions are sometimes as accurate as scientific predictions. The higher the level of doctors participating in the diagnosis, the more accurate the prediction results will be. Before the B-ultrasound, Zhou Can predicted that the patient's disease was likely to be a malignant tumor. It finally came true. "It's really distressing. Do you think it's still necessary to do a blood plasma hormone level measurement? Although the B-ultrasound result is not very good, the final diagnosis is still two to three steps away." Zhou Can asked Director Zheng's next diagnosis and treatment plan. "Let's do it! You can determine the type of pancreatic tumor after you finish it." Director Zheng readily agreed. "I don't think there is any suspense in the results of the plasma hormone level test. Now there is a last ray of hope. Further imaging examinations are needed to see if the tumor has metastasized. If there is no metastasis, or if it only metastasizes to the surrounding lymph, there may be a chance for surgery. I suggest another CT scan, focusing on the chest and abdominal cavity and the neck.” If the pancreatic tumor metastasizes, the neck and neck of the human body have the most abundant lymph nodes, which is the key screening object. And the viscera of the chest cavity are also very easily affected. This is like a neighbor's house burning up, and the surrounding adjacent houses are easily affected. When a tumor occurs in a certain organ or tissue site, it is often the adjacent organs or tissues that suffer the most. "Okay! I'll arrange for Huang Liang to issue the inspection application form and send it over immediately. I'll take care of the communication with the family members." Zhou Can and Director Zheng have been diagnosing this patient almost all the time, and they are the only ones who care about it The patient's condition is best understood. Huang Liang ran errands and sent an inspection application form, but it was too difficult for him to communicate with his family members. Inspection applications will be opened soon. The communication between Zhou Can and his family was also very smooth. When the results of the plasma hormone level measurement came out, Zhou Can found that the patient's plasma vip and sst increased significantly. The VIP value, that is, the vasoactive intestinal peptide value has reached an astonishing 300-890. You must know that normal people are only about 60. The patient's vip measured value was more than ten times higher than the normal level. The sst value is what is often referred to as somatostatin, reaching a terrifying 600-2500ng\/l, and the normal value is only about 25. It exceeded the standard by a full hundred times. Seeing this result, Zhou Can's heart sank directly to the bottom of the valley. It would be nice if we could find him sooner. But look for him earlier, maybe he was far from the current diagnosis level at that time, and he was not able to diagnose the cause of the patient at all. Now it can basically be concluded from the plasma hormone level that the patient has a mixed tumor secreting vip and sst. Now I finally understand why the patient has more than secretory diarrhea. Vasoactive intestinal peptide widely exists in the nervous tissue of the digestive system and pancreatic endocrine cells. It has many physiological effects, including relaxation of smooth muscle, stimulation of bile sweat secretion, stimulation of intestinal secretion of water and electrolytes. The patient's elevated vasoactive intestinal peptide is the main cause of the patient's secretory diarrhea. As for somatostatin, it is mainly distributed in the thalamus, pancreatic d cells and small intestine. Its role is mainly to inhibit the secretion of the digestive system. The patient's sst value exceeds the standard by a hundred times, which will cause steatorrhea. But this patient also has secretory diarrhea, which can just offset part of the secretory diarrhea. Now all the real causes of the patient's diarrhea and diabetes insipidus have been found. It's the truth. The only prayer is that in the next CT scan, the tumor has not metastasized significantly. Things backfired, and the CT results were quickly delivered to Zhou Can. It shows the patient's pancreatic body space occupying lesion and liver metastatic lesion. Clinical evidence-based practice proved that the middle section of the main pancreatic duct was completely obstructed. Abnormalities were also found in supraclavicular lymph nodes. Without a pathological biopsy, Zhou Can can be sure that the patient's tumor has metastasized to the liver and supraclavicular lymph nodes. After investigation, it was confirmed to be a metastatic neuroendocrine tumor. Seeing such a bad test result, Zhou Can's heart was already half cold. However, he still held on to the last ray of hope and proposed to perform surgical exploration on the patient to see if there was still a chance of removal of the pancreatic tumor? A cure is out of the question. At least it can prolong the patient's life. After surgical exploration, the patient's pancreatic body and neck were several times larger than normal. The tumor had invaded the surrounding tissue and had metastasized to the liver. The patient completely lost the opportunity for surgery. When the patient was pushed out of the operation, the patient's mother was already waiting anxiously outside the operating room. He greeted him immediately. "Doctor Zhou, is my son's surgery going well?" In fact, she already had a very bad premonition in her heart. It can be seen that when she asked the question, her face was pale and her hands were shaking uncontrollably. Just like a ninety-year-old man, his body is out of control. Before the surgical exploration, Zhou Can had already told her. If it is determined that there is still a chance for surgery, she will be asked to sign a new consent form for surgery, and the tumor will be removed directly. If there is no chance of surgery, then we can only find a way to make the patient spend the last time of life as painlessly as possible. The operation ended so soon, and no one asked her to re-sign the consent form for the operation. She could already foresee the result. "You push the patient back to the ward first, and I will talk to the family about the patient's situation." Zhou Can said to the nurse and Dr. Huang Liang. Zheng Hongtao was originally responsible for this patient. Out of responsibility and morality, Zhou Can has been working hard and busy for the patient. It's a pity that in the end, I can only do my best and cannot resist the destiny. Facing this patient with advanced neuroendocrine tumors, Zhou Can was helpless, and Tuya Hospital was also helpless. With the current level of medicine in the world, there is no way to cure this kind of terminal cancer patients. It is difficult to even extend the life of patients. Considering the patient's family situation, as long as a doctor with a little conscience will not let the family members continue to sell the house and empty their savings for the patient's treatment. Because this is no longer something money can do. The end result will only be a loss of people and wealth, and there will never be any hope. When a patient is diagnosed with cancer, doctors generally do not tell the patient directly, or even avoid it intentionally. As for whether the family members tell the patient or not, that is the family's business. Zhou Can led his family members to sit down on the row of chairs in the aisle. "After surgical exploration, your son's tumor has metastasized to multiple places, and the cancer has reached an advanced stage, which means that he has lost the opportunity for surgery. What our hospital can do is to alleviate his pain as much as possible." After listening to the family members Finally, he tightly grasped the edge of the seat with one hand and closed his eyes with an extremely painful expression. A whimper sounded from the depths of her throat, and tears gushed out, like broken beads, sliding down her slightly rough cheeks. It can be seen that at the age of fifty, she has many wrinkles on her face. If it is a well-maintained woman, with a carefree life, a healthy lifestyle, and active exercise, she may look similar to a thirty-year-old woman. This woman's face is aging like this, her face is haggard, and her life is too hard. Now, because her son has cancer, she will fall into a greater pain. It's very worrying to watch. "Doctor Zhou, how long can my son live?" She tried hard to wipe away her tears, but she couldn't. As soon as it was wiped off, it came out again. "If there are no accidents, you should be able to live for about three months. In the late stage of cancer, because cancer cells invade various tissues and organs in the body, it will cause great pain to the patient. You should try your best to let him eat and drink well! Do all kinds of hard work! Expensive treatment, I personally don’t recommend it.” Zhou Can won’t make unconscionable money, and he doesn’t guarantee that other hospitals and doctors won’t. In particular, some private hospitals will never give up until the last drop of blood pressure of the patient's family is squeezed out. For a terminal cancer patient, it is too much to treat several million. A hospital is not a hospital belonging to a certain person, but a collective. As long as the family members are willing to pay, the hospital will never object to the behavior of the doctor involved. On the contrary, they will support and acquiesce. After all, any hospital needs to make money, and only when it makes money can it continue to operate stably. The performance of a department is also closely related to the doctor's income. No doctor or nurse wants to live a good life. "Only...three months to live..." The patient's mother almost fainted on the spot after hearing this. After a long time, she was relieved, and then covered her face and wailed loudly, sobbing endlessly. Zhou Can dared to deal with even the most difficult illness, but faced with the crying and despair of his family members, he seemed a little at a loss. The woman's crying also attracted the attention of many people. Sitting here, Zhou Can felt even more uncomfortable. In the future, I will discuss this kind of matter with my family members, and I must be in the office. Otherwise, it's too embarrassing. Fortunately, he was very popular, so a nurse walked over quickly. "Doctor Zhou, who is she?" "She learned that her son has reached the terminal stage of cancer and has only three months to live, and she has a nervous breakdown. Help her comfort her." Zhou Can seemed to have grasped at straws. The usual milk tea and barbecue are finally not in vain.