Zheng Ren would not simply believe baseless speculations without any scientific evidence.
"Zheng Ren, that shop has really good egg tarts, especially when they're fresh out of the oven. You can smell the milky deliciousness along the street," Xie Yiren said while pointing at a bakery not far from them.
Zheng Ren did not look at the bakery as he was too focused on Xie Yiren's hand.
Su Yun mentioned that he needed to use 10 percent of his usual focus on Xie Yiren, then they would…
Zheng Ren decided to make an attempt.
Xie Yiren had no idea that something was approaching her.
She put her hand down gleefully and started walking toward the bakery. When she took the first step, her hand was met with a much larger one mid-air.
She subconsciously tried to free her hand but the other hand was so firm and strong. She felt as if her hand was a small boat, parked safely in a port. She struggled for a moment before slipping her hand into his, holding it gently.
"The other side has a milk tea shop." Xie Yiren's face was reddened due to the chilly winds. She pretended as if nothing had happened and raised her other hand to point to the other shop and said, "That shop has a wide variety of flavors and toppings for their milk tea. It's amazing."
"Hmm? Isn't it just milk tea?" Zheng Ren was lost.
He used his surgical precision and observation skills to track the motion of Xie Yiren's arm so that he could meet her hand halfway to hold hers. That alone had exhausted his emotional and intelligence reserve, so his mind had regressed into a pile of gooey mess.
"Let's try it out," Xie Yiren said excitedly.
It might have been the fact that Xie Yiren tried to hide her awkwardness and embarrassment, or that she was truly happy. She dragged Zheng Ren to the milk tea shop happily.
To Zheng Ren, milk tea was just a normal dessert. The only special thing was the addition of pearls, nata de coco, and grass jelly.
When they entered the shop, Zheng Ren was surprised to see an entire menu of assorted flavors and toppings.
There was barley, oats, taro, red bean, pearls, nata de coco, papaya, almonds, brown sugar…
Xie Yiren chose the ordinary papaya almond milk tea with additional taro paste.
She was quite shy, lowering her sleeves to try her best to cover their linked hands as if the world would not know that they were holding hands if she did that.
"Sir, may I know your preferred choice?" The server asked Zheng Ren after noting down Xie Yiren's order.
"I'll try all of them." Zheng Ren's mind was still in a mess and he had lost all ability to comprehend at that moment.
His entire focus was on the tiny hand wrapped in his palm.
The server was stunned for a moment before asking, "Sir, you want all of the…"
"Uhm, I want to try them," Zheng Ren said.
The server confirmed his order once again with a distracted Zheng Ren before entering the order in with a weird expression.
"I heard that there's a dispute in the emergency department today?" Xie Yiren tried to start a conversation after the server left.
Otherwise, it would be weird for them to stare at each other in silence with their hands linked together.
"No worries, it's just a small matter," Zheng Ren said briefly. "Chief Pan already resolved the issue."
"Oh."
Both their heartbeats were racing at a pace that was dangerously close to atrial fibrillation. They gave their best efforts to continue the conversation and the awkwardness gradually dissipated in the warmth between their fingers.
Chapter 400 - Everything Was Going Well
It was dinner time when they visited the bubble tea shop, which explained the minimal crowd.
Zheng Ren was grateful for that.
As he held Xie Yiren's hand, time passed by in a blur.
A few minutes later, a waitress walked toward their table with two cups of bubble tea.
"Here are your drinks." The waitress placed the drinks on the table and stood behind Zheng Ren, curious as to how Zheng Ren would react.
Zheng Ren removed the cup's cover and looked down. A confused look crossed his face.
His bubble tea looked as if it had all the toppings in the world. It reminded him of an eight treasure porridge.
Half the cup was filled with all sorts of topping. The liquid was so viscous that it did not resemble bubble tea. Zheng Ren tried to taste the beverage with the wide-bore bubble tea straw but his attempts were futile.
The waitress asked awkwardly with a smile, "Sir, d-do you need anything else?"
"Uh… How about another straw?" Zheng Ren sighed.
A smile lit up on Xie Yiren's face. Her fingers stroked Zheng Ren's palm as she chuckled.
The waitress quickly came back with another bubble tea straw and handed it to Zheng Ren. She retreated quietly to the side while keeping an eye on Zheng Ren.
She did not understand why the man had ordered such a concoction.
Even with two straws, there was no way he could drink the cup of eight treasure porridge. There were far too much solids in the milk tea.
Zheng Ren held the two straws like a pair of chopsticks and started to eat the toppings.
The waitress was surprised by his actions.
Seeing the shock on the waitress's face, Xie Yiren pinched Zheng Ren's hand and smiled. "I'll get the bill."
"I'll pay for this."
"You focus on your eight treasure porridge but remember, we still have dinner. What do you want to eat?"
As Xie Yiren scanned the code to make the payment, Zheng Ren's phone started ringing.
The call did not worry Zheng Ren. His heart remained calm.
Su Yun was a dependable doctor. It was unlikely that Zheng Ren would have to rush back to the hospital.
He checked his phone and it was Su Yun calling.
Zheng Ren wondered if he had jinxed himself.
Everything was going well until the mafia had shown up.
"Hello?" Zheng Ren answered the call.
"Boss, sorry for calling." An apologetic Su Yun was a rare creature to behold.
"What's wrong?" Zheng Ren was confused. If there was a mass emergency, Su Yun would get straight to the point without apologizing.
Odd.
"There's an emergency patient ready to be sent to the cardiothoracic department. Multiple rib fractures and trauma-induced pulmonary edema but there's something about the case that I can't quite put my finger on," Su Yun said.
"What's that?"
"The cardiothoracic department's diagnosis is not wrong but I suspect there's something wrong with the patient and an emergency exploratory thoracotomy is required." It was rare to hear Su Yun having doubts.
Was this a case beyond his expertise? He would say so if it was.
Even during the diagnosis of Yang Lili's rare vitamin B1 deficiency, Su Yun sounded much more confident than now.
Zheng Ren remembered how Su Yun was back in the ICU. He could argue all day long about the biochemistry and pathology of a disease, to the point of shutting everyone up.
Where did he turn soft?
"Alright, I'll go back and have a look," Zheng Ren said as he shot Xie Yiren an apologetic look. Her fingers rubbed against his palm gently.
What a shame, another beautiful night was interrupted.
Any night with Xie Yiren without interruption was a beautiful night.
Although he was reluctant for their date to end, Zheng Ren would not abandon his responsibilities.
They held hands while walking to the car.
Zheng Ren's mind was in a daze as he followed Xie Yiren to the driver's side.
Xie YIren chuckled at him. She shook her hand free and pushed him to the passenger's side.
They got into the car and headed for Sea City General Hospital.
…
Along the way, Zheng Ren's mind got to thinking.
Something did not add up.
Su Yun would never call him unless it was a la
st resort.
The last call for help he made to Zheng Ren had been the Amigo Veterinary Hospital case. Zheng Ren knew Su Yun had just been pulling his leg about not being able to operate on an old dog.
'What's the catch?' Zheng Ren wondered.
Zheng Ren called Su Yun to ask about the case.
The patient had been walking home when a vase fell from a few floors up. The patient was lucky to avoid the falling vase but unfortunately, it did not save him entirely.
The vase fell onto a rebar behind him.
This caused the rebar to bounce upward and hit him in the back.
It resulted in fractures on ribs 2 to 9 and signs of pulmonary edema.
From the CT scan, the patient did not show signs of hemopneumothorax.
The patient's blood pressure was low but there were no signs of bleeding. This was what confused Su Yun.
The diagnosis from the cardiothoracic department was not wrong but Su Yun had his doubts.
He had gone through the scans multiple times to identify the cause for concern.
However, despite his reputation as the rising star of the cardiothoracic department in Imperial Capital, he could not produce sufficient evidence to refute the diagnosis.
His instincts warned him there was something unusual about the patient but the specifics eluded him.
Su Yun could only wait for Zheng Ren's return.
Somewhere along the line, just like everyone else, Su Yun had developed unwavering confidence in Zheng Ren's ability to solve all medical problems. Although cardiology was his strong suit, Su Yun could put aside his pride and ask Zheng Ren for help.
Zheng Ren appreciated the gesture.
Despite being the occasional narcissist, Su Yun had the sense to not let his ego interfere with his professionalism.
Su Yun's instincts that had been honed from his many years of bedside care were tingling but up to this point, the test results yielded no clues. It was an odd case and Su Yun was sure of that!
Soon, Xie Yiren's Volvo arrived at Sea City General Hospital.
Xie Yiren would go to the operating room to standby when Zheng Ren would give her a heads up if surgery was about to proceed. If there was nothing urgent, they would meet back in the bas.e.m.e.nt car park.
Meanwhile, Zheng Ren, who did not bother to grab his white coat from the emergency wards, heading straight to the emergency response room.
Su Yun kept the cardiothoracic department at bay. He was adamant about having Zheng Ren assess the patient before deciding the next steps.
Relinquishing the patient to the cardiothoracic department would take responsibility off the emergency department. Based on the diagnosis, it was unlikely the doctors would perform a night-time emergency surgery.
In this scenario, Su Yun suggested performing an exploratory thoracotomy to have a clearer picture.
He would not be able to have a good night's sleep otherwise.
Zheng Ren arrived in the emergency response room in a hurry. The patient was a man in his mid-twenties. His face was pale and his body was contorted from the pain radiating from his broken ribs.
In the System display at the right corner of his vision, the diagnosis listed: multiple fractures on the right rib cage, trauma-induced pulmonary edema, pleural effusion, and a laceration on the right lung.
The diagnosis was similar to the one given by the cardiothoracic department. Trauma to the lung depended on the size of the laceration. A small injury could heal without surgical intervention.
'Can't you tell me the degree of severity?' Zheng Ren cursed the System in his mind.
Su Yun quickly pulled Zheng Ren to the viewer and pointed at the scan. "Boss, I think there's something wrong."
Chapter 401 - A Bald-Faced Lie
"Go on." Zheng Ren tucked his left hand under his right arm, his right hand massaging his temple. He squinted at the scan clipped to the viewer.
"Here. This is the classic sign of trauma-induced pulmonary edema." Su Yun tapped on a spot on the scan. "But with multiple fractures, the volume of blood loss is up to a few hundred milliliters so pneumothorax is often observed."
"The lack of a hemopneumothorax worries you?"
"Yes," Su Yun said conclusively. Only an optimistic fool would think the lack of a pneumothorax meant good news for the patient.
Su Yun was no such fool.
He spoke his thoughts without sugarcoating them.
"I agree. The patient's blood pressure is low. At his age, the normal blood pressure should be around 120 to 130. The pain from the fractures should see a spike in his blood pressure at around the 150 to 160 zone. Instead, it's in the 90s. It's quite concerning," Zheng Ren concurred.
Low blood pressure typically indicated bleeding.
Whether it was from the laceration or rib fractures, bleeding in the c.h.e.s.t cavity would most certainly show up in the CT scan.
However, the patient's CT scan did not show any signs of bleeding.
Even the System did not provide any hint of severe complications. A tear in the lung could be severe or minor.
Under normal circ.u.mstances, the patient would be sent to the cardiothoracic department for further observation. They would monitor the patient's progression and decide the course of treatment when they had more information.
Zheng Ren and Su Yun had other thoughts. They were worried that once the problem presented itself, it would have been too late.
A booming voice cut through their discussion. "Su Yun! Why would you consult me on a case like this?"
They turned around and saw the cardiothoracic department's chief resident, Cao Guozhen.
He was a man of great stature. One could say he was built like a bear. He turned heads wherever he went and spoke.
His tone had a hint of exasperation. Su Yun and Zheng Ren figured it was because they stole the limelight during Yang Lili's emergency rescue.
Cao Guozhen glanced at the scan before smirking.
"This is a classic sign of trauma-induced pulmonary edema. Why are you both scratching your heads at this?"
Thousands of possibilities ran through Zheng Ren's mind. Su Yun ignored Cao Guozhen's mockery and continued to mull over the case, a deep-set frown on his face.
"You guys just want to keep the patient in the emergency ward, don't you? Well, you can have him. A piece of advice, dose him with hormones then administer 10mg of dexamethasone daily with nebulizer treatment for the inflammation and phlegm. Muscosolvan can be administered through IV, 100 bottles a day. Ignore what the guidelines1 say."
His words fell on deaf ears.
"If you follow the guidelines, the patient will exhibit hypostatic pneumonia after the third day. Don't say I didn't warn you," Cao Guozhen continued muttering.
It was sound advice.
Su Yun knew the oral medication—Muscosolvan—was cheap and had no side effects. Back in Imperial Capital, the highest dose he had witnessed was 300 bottles in a day. The solution was pumped intravenously for 24 hours.
The patient had to alternate resting on their sides to prevent hypostatic pneumonia. Most patients could be discharged within a week.
However, Zheng Ren and Su Yun believed the case was not as clear-cut.
Whether in the emergency department or the cardiothoracic department, the first few hours of a patient's arrival was vital…
The patient could die if the wrong rescue protocol was initiated.
It was a slim chance but a chance nonetheless.
Medicine was an experimental field that emphasized empirical data.
Without any supporting evidence, how could one insist on an exploratory thoracotomy? What if the patient died on the operating table?
After a few minutes of thought, Zheng Ren realized why Su Yun had called him back.
Su Yun wanted to perform an exploratory thoracotomy but did not have the qualifications.
Like how Zheng Ren would go to Old Chief Physician Pan to seek protection from any landmines, Su Yun was doing the same.
"We can't follow your advised treatment. We would at least have to perform an emergency fracture internal fixation surgery," Zheng Ren turned to Cao Guozhen and said.
Su Yun was shocked.
Zheng Ren's words were as blunt as a sledgehammer.
The patient's fractures were simple and did not require internal fixation.
Yet, this was the best excuse they could come up with, right?
"Yes. Look here, the dislocation is clear. The fractures might have lacerated the pleural membrane and lung when the patient was moving around, causing a hemopneumothorax," Su Yun said confidently as he pointed to a small fracture on the scan.
In normal situations, a c.h.e.s.t CT scan was to visualize the layers of muscle. It was rarely used to determine bone fractures.
To analyze bone fractures, a 64-slice CT scan with 3D reconstruction was needed.
With the c.h.e.s.t CT scan's limited view, Su Yun pinpointed a spot and exaggerated the fracture.
Cao Guozhen was confused.
Was the emergency department in dire need of patients that they had to resort to a bald-faced lie?
No wonder the general surgery department never bothered to argue with the emergency department.
The emergency department team was basically giving the other departments an ultimatum.
Cao Guozhen considered his options before saying, "Alright then, let's get the patient to the operating room. I'll perform the surgery."
"You?" Su Yun said disbelievingly, a playful smile on his face. "Can you even handle anything other than the fracture? Ever done a lobectomy? A bronchial sleeve resection?"
"You…" Cao Guozhen wanted to kill Su Yun.
He had been kind with his words, maybe there was some sarcasm mixed in.
How dare Su Yun degrade him like that? Was he a rabid dog?
"Bring over ten rib clamps," Su Yun ordered. He exhaled upward through his mouth to fluff up his fringe.
"What? Why?"
"Do you want to go to the medical administration? Or Old Chief Physician Pan? We don't have time to follow your advice. If we ask Old Chief Physician Pan, he would insist on the emergency department handling the c.h.e.s.t treatment. It's just setting up a c.h.e.s.t drainage system. Even a nurse can do it and you want to call it a surgery?" Su Yun chuckled.
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