Chapter 27: The Kidney That Disappeared Inexplicably

The duration of this Empathy was not long, but the shock Ji Xiang received far exceeded that of the time Dahai performed the Extension Surgery.

As for the pain, bleeding, infection, and so on that he felt after the circumcision, compared to this Empathy, it was simply not worth mentioning.

So much so that Ji Xiang did not take stock of his gains right away.

Perhaps because the difficulty of the Empathy had increased, this time the Empathy gave Ji Xiang 30 Surgical Points.

But his mood was extremely poor; his eyes were filled with fresh blood.

He didn't know to what extent things would develop after he left, Ji Xiang thought silently.

"Teacher." Ji Xiang pursed his lips, not agreeing with the System NPC's statement.

"Doctor Xiao Ji, tell me your analysis of this matter." The System NPC looked at Ji Xiang and asked calmly.

Although he knew it was just an illusion, or rather a program, Ji Xiang still remained calm for a long time.

The System NPC handed him a 250ml bottle of 10% glucose, and only after drinking half the bottle did Ji Xiang gradually calm down.

Quietly watching Ji Xiang, the System NPC did not interrupt his train of thought.

"The party at fault in this matter is the Surgeon who participated in the emergency rescue 3 years ago, but the Patient was emotionally agitated, and it was also wrong to take action and hurt the innocent." Ji Xiang stated his judgment simply.

"Your basic knowledge is still weak, to the point that your judgment of the whole matter is erroneous." The System NPC shook his head.

"Hmm?" Ji Xiang was stunned to hear the System NPC say this.

The Patient's right Kidney had disappeared; this was a nail-in-the-coffin fact, how could the System NPC say such a thing!

Could it be that his stance was biased? Even in the System Space, his stance was still biased?!

No wonder they say your position determines your perspective; so it really is like that.

Ji Xiang felt a slight disdain in his heart, and the hot blood of a young man began to surge; even if he had to offend this System NPC who had profound attainments and was awesome to the Extreme Point, he had to stand on the side of justice and fairness.

The System NPC did not smile, but instead scrutinized Ji Xiang's expression very seriously.

He seemed to have guessed what Ji Xiang was thinking.

This young man was like a little beast preparing to Challenge him, completely forgetting the true purpose of coming to the System Space this time.

The old and the young were silent, and the atmosphere in the System Operating Room was inexplicably awkward.

3 seconds later, the System NPC broke this suffocating silence.

"There is a type of disease called Renal Auto-amputation, commonly seen in tuberculosis patients." The System NPC waved his hand, a light screen appeared before them, and he began to explain to Ji Xiang.

Ji Xiang frowned; Renal Auto-amputation was described in only a very small space in diagnostics and other courses.

Although Ji Xiang had almost memorized the textbooks that were as tall as he was by virtue of his superhuman memory, that was just dry memorization; it was impossible to turn it into ability.

"A large amount of calcium salt deposits within the renal tuberculosis lesion, causing extensive calcification of the entire Kidney. Its sonographic characteristics are varying degrees of destruction of the Kidney, or even calcification, when renal function is completely lost and the Ureter is completely occluded.

This condition is clinically known as Renal Auto-amputation or putty kidney."

"Teacher, the Patient had no history of tuberculosis." Ji Xiang tried hard to recall the memory from the Empathy and argued.

The System NPC raised his deformed, chicken-claw-like right hand to press down.

"Renal Auto-amputation is a category of disease, and there is another branch of the disease we call Chuang Shang Xing Ren Zi Jie."

"..."

This sentence was like a basin of cold water poured over his head, and the anger in Ji Xiang's heart was instantly extinguished.

Chuang Shang Xing Ren Zi Jie, as the name implies, trauma can lead to problems with the Kidney.

Combining everything from the Empathy, Ji Xiang naturally thought of the words of the Muniu Waike Zhuren, his own purpose for coming to the System Space, and the Patient's emotions after knowing that their Kidney had been removed.

The System NPC did not care about Ji Xiang's feelings and continued his explanation.

"The Patient was diagnosed with liver rupture and Ren Cuo Lie Shang 3 years ago."

"Ren Cuo Lie Shang can be seen on a CT scan as uneven density, blurring, or cracks in the renal tissue, or hematoma within the renal parenchyma and subcapsular hematoma; it can be seen more clearly with an Enhanced CT."

"Ren Cuo Lie Shang leads to a series of complications such as hematuria, and the simplest approach is to remove the Kidney.

Because of the importance of the Kidney to a person, of course, one should avoid surgical removal if possible. Trying to preserve the organ is a Clinical treatment principle.

For those with persistent hematuria or external bleeding, the location of the problem can be found through Angiography, and highly selective Embolization treatment can be performed, that is, blocking the bleeding branch vessel, which both stops the bleeding and preserves the Kidney."

The System NPC began to tell Ji Xiang about Ren Cuo Lie Shang, and then went on to talk about Ren Po Lie.

If it were any other time, Ji Xiang would definitely think the System NPC was a bit long-winded and hadn't gotten straight to the point.

But this time he listened earnestly and cross-referenced it with the knowledge he had previously learned at school.

"The fifth type of injury is Ren Xue Guan Sun Shang, which is divided into two situations.

The first is rupture of the renal vessels, which can be one of the artery or vein or both, and this can also be counted as Ren Po Lie, or called Ren Di Duan Lie; it is likewise a serious disease that will result in death from massive hemorrhage if not operated on quickly."

"The second one, you must pay special attention to."

The System NPC emphasized his tone to remind Ji Xiang.

Ji Xiang nodded, his eyes fixed on the light screen. His brain was divided into several different threads; on one side he was thinking about the emotions of the Patient, himself, and the doctor in the CT Room during the Empathy, and on the other, he was listening to the teachings of the System NPC.

"Ren Dong Mai Cuo Shang, the main problem will appear in the blood vessels. When the Patient was sent to the operating table for Emergency Rescue, a laparotomy was performed, the morphology of the Kidney had not changed, and there were no surgical indications."

"Even if a CT was done in the emergency room at that time, no problems would have been found."

"Teacher, what if a slice CT was done, the kind where they inject contrast?" Ji Xiang asked.

"Not to mention whether the emergency Patient could give you the time to do this kind of examination, even if it were done, there is a high probability that there would be no diagnosis."

"..." Ji Xiang was speechless.

"Ren Dong Mai injury causes the vascular intima to become unsmooth, fluid dynamics change, and it is easy to gradually form Thrombosis.

From incomplete to finally complete blockage of the Renal Artery; the fast ones change in a few hours after the injury, the slow ones in ten-plus days, or even dozens of days."

"I ask you." The System NPC looked into Ji Xiang's eyes.

Ji Xiang felt a bit flustered being looked at by those bright and clear eyes.

He already understood what the System NPC meant; although it was not very clear, he knew that he had made a huge mistake in the process of the Empathy.

"If a trauma Patient's rescue goes smoothly, how long until they are discharged?"

"10 to 14 days, provided there is no infection or other unexpected circumstances," Ji Xiang replied.

"Mm." The System NPC nodded. "If the patient's simple post-operative check-up is fine, would you order an expensive angiography for the patient?"

"I would not."

Ji Xiang answered earnestly.

"Correct," the System NPC said. "This belongs to a secondary disease. An experienced doctor would instruct the patient to go to the Outpatient Department for a check-up one month after discharge to see if there are any changes to the Kidney.

But since they have mostly recovered, the vast majority of patients forget about this after being discharged."

Ji Xiang let out a soft sigh; as for his complicated feelings, even he himself could not clearly explain them.

"After a Ren Dong Mai Cuo Shang, the most serious situation is that the injured Kidney completely loses its blood supply, which of course leads to gradual ischemic atrophy.

Some have even called it 'aseptic necrosis.'

The tissue of the normal Kidney structure gradually disappears under conditions of ischemia and necrosis, replaced by connective tissue similar to the surrounding tissue, which cannot be seen on a CT scan at all."

"In other words, the patient's right Kidney wasn't removed, but rather suffered from Chuang Shang Xing Ren Zi Jie due to an extremely rare Ren Dong Mai Cuo Shang, and it necrotized on its own?" Ji Xiang found this logic very hard to accept.

The System NPC nodded.

Ji Xiang fell silent.

He had more to say in his heart, but he did not speak it aloud.

"You want to say that the Doctor still bears responsibility, right?" The System NPC, as if they were a deity, saw through Ji Xiang's heart and asked indifferently.

"Yes." Ji Xiang did not hide it and nodded in reply.

"Let me give you an example," the System NPC said solemnly. "Once, the Neurosurgery Department of our hospital admitted such a patient—a car accident injury, a very minor scrape, and the patient was wearing a seatbelt."

"As for trauma, you know how it is."

Ji Xiang was startled. The System NPC spoke simply, but he only knew a little bit about it, and he didn't understand anything beyond that.

If a trauma patient has insurance or the other party is fully at fault, they will basically choose to be hospitalized.

One reason is to be safe, and the other is that it's good to get a full-body physical examination while they're at it.

"The patient was a young woman. After 6 days of hospitalization, all examinations showed no problems, and she was prepared to be discharged the next day. The doctor on duty that day even saw the patient get up to go to the restroom after coming off an emergency surgery; everything was normal."

"But less than an hour later, when the Nurse was handing over the shift, they discovered the patient had urinary incontinence and was unresponsive when called."

"!!!" Ji Xiang was stunned.

"By the time you drag the Doctor over at this point, it's already too late," the System NPC sighed. "A one-in-fifty-thousand probability of carotid artery intimal avulsion led to a large number of emboli in the patient's head vessels, eventually blocking the brainstem, and she died 19 days later."

"!!!"

"These two cases are somewhat similar." The System NPC brought the topic back. "Your idea that if a Doctor's level is high, they can prevent it early is correct, but that requires a Doctor of my level."

Having said this, the System NPC paused.

"With a one-in-fifty-thousand probability, how many similar patients do you think there can be in the whole country?"

Ji Xiang was no longer paying attention to the System NPC's "humblebragging" words. He frowned and asked, "Teacher, if it were discovered early, is there a way to treat it?"

"That is something to think about only after your Urology Department skills reach Level 9," the System NPC said. "Now I ask you, do you understand the mystery behind what the Muniu Waike Zhuren focuses on?"

The reason for not focusing on patients with extremely high difficulty and many post-operative complications—like those requiring partial Kidney Resection—but specifically instructing to pay attention to a patient with a Kidney contusion, surfaced before Ji Xiang.

He knew that the Muniu Waike Zhuren certainly wouldn't pay attention to all Kidney contusions, but rather, relying on years of Clinical experience, vaguely guessed that this patient might have a problem and needed more observation and more communication with the Patient and the Family Member to avoid accidents.

This was pure Clinical experience.

Ji Xiang did not nod, but instead began to ask the System NPC about some questions he still did not understand.

This didn't cost any Surgical Points, and the System NPC was the best kind of teacher, so Ji Xiang was determined to hold on tight and study it thoroughly before stopping.

(End of chapter)