Granting You a Second Life 141 Speak of The Devil And He Shall Appear

Li Xiuying: "Thank you Dr Fa. Here are the results and notes I have taken." She handed everything over and left.

Mrs. Qiáo assessed Dr Fa: "I hope you know more medicine than the last doctor. These doctors who just get out of medical school know nothing at all."

30 minutes later Mrs Qiáo left the department whilst shouting about lodging a formal complaint and the sheer incompetence of the doctors of Unity hospital.

Li Xiuying was not phased in the slightest by Mrs Qiáo and continued to see patients. She also managed to somehow acquire a shadow.

Mousy had begun by asking her a few questions regarding the management of a patient, interpreting x-rays and now she was presenting a patient.

Mousy: "Cui Ming is an 18-year-old male who has come in today with a sudden onset of breathlessness. He is accompanied by his friend. He said the breathlessness started 2 days ago and has been getting increasingly worse. He has no past medical history and no past history of surgeries. He is not allergic to any medication. Not currently on any medication. No family history of any disease. He is taking a gap year before going to university next year. Social smoker, social drinking.

On examination, he appears slightly breathless at rest. He has no signs of finger clubbing and his capillary refill time is 2 seconds. Respiratory rate of 18.

There is no conjunctive pallor and no central cyanosis. The JVP is not raised.

On inspection of the chest, there were no obvious abnormalities and the trachea has not deviated. On palpation chest expansion is asymmetrical; less expansion on the right-hand side. On percussion, there is hyper-resonance over the right middle and lower area. Breathe sounds and vocal resonance were decreased over the right middle and lower zone.

Normal heart sounds, his abdomen was soft and non-tender. "

Mousy looked up to see Li Xiuying looking at her. Li Xiuying then looked at her watch and back at Mousy.

Mousy was a little nervous: "The most likely differential is a pneumothorax."

Li Xiuying: "Vital observations?"

Mousy sounded unsure: "Normal?"

Li Xiuying frowned: "If you don't know, just say so."

Mousy: "I don't know."

Li Xiuying: "Did you check his pulse?"

Mousy: "Yes, sorry I forgot to mention it. It is..." She searched the notes she had taken.

Li Xiuying strummed her fingers on the desk.

Mousy: "90 bpm, regular, normal volume."

Li Xiuying: "To summarise peripheral findings; No peripheral stigmata of any disease."

Mousy: "Okay."

Li Xiuying: "How do you asses the capillary refill time?"

Mousy confidently replied: "By pressing on his nail for 5 seconds then measuring the time it takes for the flesh to turn pink once again."

Li Xiuying: "Central capillary refill is important to assess when adequacy of perfusion is in question."

Li Xiuying: "General appearance?"

Mousy: "Erm male, breathless."

Li Xiuyign frowned: "Is he tall and thin?"

Mousy: "Yes, he appears very thin and looks like he's about 5ft 10."

Li Xiuying: "Tall thins males are more likely to develop spontaneous pneumothoraces. Drug intake?"

Mousy: "He's not on any medication."

Li Xiuying frowned: "Recreation drugs."

Mousy: "Oh I didn't ask. He did say that he was a social smoker."

Li Xiuying: "Cannabis and/or cocaine are risk factors for developing a pneumothorax."

Mousy: "I'll go and ask him."

Li Xiuying: "Later. Also, ensure that you tell the patient that the information regarding personal drug use is kept confidential. Ask him without his friend present. Management?"Size? Am I meant to measure something? A size that informs management maybe? Oh, I've got it!'

Mousy: "Decreased lung markings on the right side of the lung, consistent with a pneumothorax."

Li Xiuying: "Anything else?"

Mousy: "Erm trachea is not deviated."

Li Xiuying: "Size?"

Mousy looked at Li Xiuying and then at the screen. She felt Li Xiuying's penetrating gaze on the side of her face. She frantically tried to find an answer '

She used the mouse to click on the measurement tool and measured the pneumothorax.

Mousy: "2 cm."

Li Xiuying: "Treatment?"

Mousy: "Aspirate the pneumothorax using a 16 to 18 gauge cannula and then repeat the x-ray to assess if it has resolved."

Li Xiuying: "Any relevant 'negatives findings' that would inform your next step?"

Mousy: "I don't think so."

Li Xiuying: "The patient does not have any other lung pathologies. Hence it is a primary spontaneous pneumothorax. Read up on types of pneumothorax in your own time."

Mousy: "Yes."

Li Xiuying: "Putting all the findings together, what would you expect the ABG results to show?"

Mousy: "Erm. Respiratory alkalosis?"

Li Xiuying: "Are you asking me?"

Mousy: "I don't know."

Li Xiuying: "Call the respiratory trainee Liao Ru. Tell him there's a case for him to aspirate. Shadow him. Perform the ABG and read about pneumothoraces." Liao Ru had sent an email around the respiratory and A&E team to request them to notify him if possible of any potential respiratory conditions.

Mousy: "Yes Dr Li. I will come and find you after I'm done."

Li Xiuying: "When you are done, shadow your assigned consultant or senior. I am not taking any students this week, I made an allowance for this patient. If you would like to shadow me in the future, you will have to contact my PA and he will assign you a date and time slot."

Mousy: "Oh okay Dr li."

Li Xiuying went to see her next patient.

.....

Emerald hospital 

The security team were having a difficult time removing the journalists from the hospital.

Chen Wei and his lawyers had made their way down to the clinic room and had been discussing what to do next. 

Chen Wei: "What can we do to remedy the situation?"

Lawyer 1: "I think that regardless of what we do the hospital's reputation will be affected. We have to find a solution that will cause the least damage."

Chen Wei snapped: "Am I paying you to tell me what I already know? I want you to tell me the best course of action and the legal ramifications."

Lawyer 2 interjected: "Dr Chen it's important to keep calm and not be at each other's throats. The police will be coming here soon and..." 

He trailed off as he thought out loud: "The police should have arrived here already. Why are they taking so long? If the journalists were able to find out details of embezzlement, conspiracy to commit murder/ cause GBH among the long list then the police will surely know."

Chen Wei clenched his fists: "Someone planned this. They have deliberately set us up."

Lawyer 2 nodded: "Exactly. The journalists are here to rattle us and try to make us lose our rationality. It is important to remain calm, ambiguous and show ignorance with regards to the allegations. The police will be coming here soon enough to arrest Dr Yang Zian."

Lawyer 1: "I will accompany you to the police station, so you have legal representation." 

Yang Zian: "Okay." He sneered internally. Clearly, this lawyer was just a weasel who was coming along to spy on him and feed infomration back to the Chen family. Yang Zian had sneakily texted his personal lawyer earlier when the discussions began, he could tell that the situation would be disastrous for him and he would need to cut a deal to escape. He asked his lawyer to lie in wait at the police station. 

Lawyer 2: "I think that we need to find the real perpetrator." He was hinting that they needed a scapegoat. 

Chen Wei: "That's already taken care of." He had long since set up someone to take the fall when they decided to save Yang Zian. 

Yang Zian felt nervous, he didn't think that Chen Wei had already prepared for this situation. He assumed from the conversation last night that Chen Wei was just stating what he could/would do. 

Chen Wei's phone started ringing. He looked at the caller ID and smirked 'speak of the devil and he shall appear.' One of his scapegoats was calling.

Chen Wei acted normal: "Hello Dr Zhi Weizhe. How are you today?"

Dr Zhi Weizhe: "Drop the pleasantries. What the hell is going on? I've had journalists banging on my door since this morning and now they're camping outside my home."

Chen Wei walked closer to the door and raised his voice slightly:" Dr Zhi Weizhe I think you better than anyone else knows what you've done. I've heard from the journalists today of your deeds. Without them, I wouldn't have even known the truth. How could you be bribed into doing something so heinous? You want to use Emerald hospital as your playpen to conduct dirty dealings? We will be supporting the police and the medical council in their investigation and we will certainly stand on the side of justice and our patients." 

Dr Zhi Weizhe blustered and was struggling to speak: "How dare you! You dirty rat ba****d, you, you..."

Chen Wei: "I do not want to be insulted by someone so amoral. Any future correspondence will be through our lawyers." He hung up the phone and faced the people in his room. Windpipemethod of tapping on a surface to determine the density of structuresResonance increased above the normaldescribing areas of the lung as 'zones'BellyCollapsed/collapsing lung. Air gets into the space between your lung and chest wall.Includes blood pressure, temperature, respiratory rate, pulse, oxygen saturationBeats per minuteexternal signs of disease- pathologies in the hands, face, legs, feetThe trachea is normally central in position. It can be forced left or right by certain pathologies.remove the airarterial blood gas - aids in checking ph, lactate, gas levels, electrolytes levels in bloodincreased respiration elevates the blood pH beyond the normal range (7.35–7.45)C139- the journalists questioned Yang Zian about him

Chapter end