"It's possible," Dr. Fang Ziye said.
"Ma'am, do you feel any pain when I press here?" Dr. Fang hadn't felt a distinct pulsating mass, suggesting that if there was an aneurysm, it wasn't very large.
But he needed to clarify a few things.
The woman shook her head. "No, my stomach doesn't hurt at all. I don't feel anything."
"Alright then, please go downstairs for an emergency abdominal vascular ultrasound. When I listened with my stethoscope, I heard some pulsating murmurs in your abdominal blood vessels."
"But I'm not sure what it is! Even though we're planning for surgery, we need to get a clear diagnosis and understand the situation to minimize risks as much as possible," Dr. Fang advised.
The man accompanying the woman said, "We're at the hospital, so of course we'll listen to you, doctor. But this ultrasound, is it expensive?"
"It's not too bad, about 150 yuan. You were going to have a bilateral lower limb vascular ultrasound anyway, so you can do them together," Dr. Fang replied.
Patients with lower limb deformities definitely needed thrombosis checks, as they were prone to blood clots due to prolonged immobility.
"Alright then," the couple agreed, relieved that it wasn't too expensive.
After they left, Lan Tianluo asked, "Senior, is there really a problem?"
"There's a bruit[1]. After they get the ultrasound, you can listen for yourself. It's quite typical," Dr. Fang responded.
Although the patient was currently asymptomatic, the morphology of an abdominal aortic aneurysm was still crucial. It wasn't a matter of ignoring it just because there were no symptoms. If the morphology was unfavorable, surgery would be necessary even without symptoms.
This would require evaluation by a vascular surgeon.
"Tianluo, go to the nurses' station and tell the nurse on duty to assign this patient to our team. I need to report this to my teacher," Dr. Fang delegated.
As a junior doctor, Fang Ziye was essentially a ward physician, at the bottom of the hierarchy. He didn't have decision-making authority, so he could only involve his teacher or report to the chief resident.
But since the chief resident wasn't from his team, even if he reported it, they'd likely say to wait for a consultation. So Fang considered whether he could first bring the patient under his team's care.
After sending a brief message to his teacher explaining the situation and his recommendations, Dr. Fang received a call from Yuan Weihong.
"You're sure about what you heard?"
"Yes, Master. It was a bruit, very typical. I shouldn't be mistaken. I've already sent the patient and family for an abdominal aortic ultrasound," Fang replied.
"In this situation, should we request an emergency consultation or schedule one later?" Fang asked as he took the call.
Patients coming from outpatient to the ward for elective surgery were usually those with severe symptoms who absolutely needed surgical treatment. Even if they went to the vascular surgery department first, they'd still need to come to orthopedics later.
Otherwise, the limp caused by unequal leg lengths would persist.
"Request an emergency consultation. I'll call someone in vascular surgery. Send me the patient's medical record number, and I'll have them take a look," Yuan Weihong said.
"If you call the chief resident yourself, they might not pay much attention. I'll handle it," Yuan added before hanging up.
An asymptomatic abdominal aortic aneurysm, if unruptured, wasn't considered an emergency. But the orthopedic department needed to wait for an assessment to decide whether to transfer the patient.
In such situations, one had to leverage personal connections. Yuan Weihong was often called for emergency consultations to review scans, so this was a matter of mutual assistance.
...
Before the patient and her husband had even returned from the ultrasound, Dr. Fang received another call from his master, Yuan Weihong.
"Call the vascular surgery chief resident and tell them to come quickly to advise on transferring the patient to their department."
"The aneurysm might not be large, but its shape isn't good. It needs emergency treatment. Otherwise, if it ruptures, it's not just about an extra illness—it's a matter of life and death."
"Tell them the call is on behalf of Dr. Deng Haibo from vascular surgery," Yuan Weihong instructed quickly.
"Understood, Master," Fang replied, his heart leaping with joy.
After Yuan Weihong's call ended, Fang's Knowledge Point panel jumped significantly—
[Knowledge Points +21.2!]
Good grief!
This indicated just how dangerous the patient's condition was. If it hadn't been diagnosed in time, it could have cost a life or at least half a life.
With the backing of Dr. Deng Haibo, a senior vascular surgeon, when Fang called the vascular surgery chief resident, there was no hesitation. After asking Fang to send over the medical record number, the chief resident rushed from the vascular surgery department to the trauma department.
Together with Fang, they persuaded the patient and her family. Though both looked grim, they agreed to the transfer for treatment.
The vascular surgery chief resident said, "Sir, ma'am, please don't think Dr. Fang is being difficult. This condition didn't appear because he discovered it; it has been there all along. If Dr. Fang hadn't found it..."
"It could have ruptured during surgery, endangering your life."
"Nowadays, treating vascular aneurysms is relatively simple and can be covered by insurance. The out-of-pocket cost isn't high, you know?"
"Burying your head in the sand and avoiding treatment is not the way to go."
"If undiscovered, losing a life over minor cost savings is not worth it."
Hearing this, the couple sighed and nodded, "Thank you, Dr. Fang."
Fang cancelled all the admission orders he had written, informed the nurse on duty, who then discontinued all long-term orders for their department, and then wrote a new order to transfer the patient to vascular surgery. The couple then headed to the vascular surgery department...
Lan Tianluo, who had witnessed this turn of events, suddenly looked stone-faced and said gravely, "Senior Fang, what if you hadn't done the routine physical examination and something had gone wrong with this patient?"
"Then Chief Resident Jin Hongzhou would have been in big trouble!"
"I just need to do my job of timely discovery and reporting. Because this patient's vital signs showed no indication of an abdominal aortic aneurysm."
"If we hadn't listened to the abdomen, we might not have discovered it even on the operating table," Fang said with a smile.
While feeling relieved, he also felt sorry for the patient and her husband.
It was clear that their financial situation wasn't great. They had come for orthopedic osteotomy and deformity correction surgery, already stretching their budget, and now they had this vascular aneurysm to deal with as well. This would surely put even more strain on their wallet.
But what could Fang do about it?
As the vascular surgery chief resident had said, this condition wasn't created by Fang's discovery; it had existed all along.
If Fang hadn't discovered it in time, and they had gone into surgery expecting to be able to walk normally afterwards, the result could have been never leaving the operating room alive—
[Knowledge Points Balance: 26.9]
Just then, Jin Hongzhou, who had learned what had happened in the department, hurried to the ward. After reconfirming the ultrasound results, he felt both relieved and grateful.
"Little Fang, you're truly my lucky star," the chief resident said. As the overseer of all patients in the ward, he bore some responsibility, whether due to carelessness or failure to discover issues in time.
"Brother Zhou..."
"No need to say more. I'll treat you both to a coffee," Jin Hongzhou said. Then he added, "Brother Zhou just got married and has a little one now, so I can't splurge. Don't say I'm being stingy, Ziye."
Both Fang and Lan shook their heads.
Before Jin Hongzhou could start ordering the coffee, his phone rang for an emergency consultation. He quickly put his phone away, "You guys order. I'll reimburse you later. I've got to run for another consultation..."
Jin Hongzhou hurried off, seemingly caught in an endless cycle. At that moment, from the direction of the nurses' station, a new patient arrived...
Translation Notes:
[1] Bruit: an abnormal sound heard over an artery or vascular channel, indicating turbulent blood flow.