Chapter 304: Let's Make a Bet (Bonus chapter for the Alliance Leader seeing my master ×)

"Xiao Ji, Doctor." The Internal Medicine doctor's words were heavily punctuated, "Doctor Meng is in such a rush, what illness do you think it is?"

"There is subcutaneous emphysema under the axilla; I suspect it is mediastinal emphysema."

"Mediastinal emphysema?!" Internal Medicine Li Yisheng let out a snort of laughter, his tone slightly mocking, "Young man, did you see any trauma on the patient?"

"No."

"No trauma, and you diagnose spontaneous mediastinal emphysema? Tell me, where would it come from?" Internal Medicine Li Yisheng sneered.

In his view, Ji Xiang was just one of those young people who knew a little bit of clinical knowledge but didn't really understand it, and would just blurt out any strange and bizarre diagnosis.

The ignorant are fearless; after learning a little bit of the surface, they have no filter on their mouths.

"The esophagus," Ji Xiang said with certainty.

He had been lectured by the System NPC in the System Operating Room and wanted to speak his mind. But Meng Qingfei understood immediately, went to touch the patient, and directly called for the General Thoracic Surgery department to prepare a bed.

Being too sharp isn't always good; Ji Xiang was full of things he wanted to say but didn't know where to start.

It wasn't that Ji Xiang wanted to show off, but rather he wanted to "review."

"Spontaneous esophageal rupture? Hahaha, have you ever seen one? Or did your teacher talk about it when you were in school?" Internal Medicine Li Yisheng laughed out loud, sounding like a goose.

"Spontaneous esophageal rupture refers to a full-thickness tear of the esophageal wall caused by non-traumatic factors. Because the clinical manifestations are non-specific, it is often misdiagnosed as angina pectoris, acute myocardial infarction, aortic dissection, acute pancreatitis, etc."

"..." Internal Medicine Li Yisheng himself didn't know how long it had been since he heard such professional terminology; hearing these words come out of a student's mouth now felt incredibly strange.

He wanted to refute it, but everything Ji Xiang said was correct, and for a moment, he didn't know where to start.

"What about the cause? It can't just rupture for no reason. You know the esophagus is elastic; it's very rare to see a spontaneous rupture. At least in all my years of practicing medicine, I've basically never seen one," Li Yisheng asked after hesitating for a moment.

"The cause is mainly seen after drinking alcohol and violent vomiting after a full meal. It is caused by the pressure difference inside and outside the esophageal wall due to negative pressure in the thoracic cavity. Because the esophagus lacks a serosal layer for protection, especially the lower esophageal wall where the smooth muscle layer is relatively weak, the lower section is more easily torn."

As Ji Xiang spoke, he looked at Li Yisheng with confusion.

"Teacher Li, the cause is very clear; there shouldn't be any doubt."

"..." Li Yisheng wanted to curse.

Ji Xiang also couldn't understand; he had explained it so clearly, why didn't Internal Medicine Li Yisheng understand?

"The main manifestations are: chest pain after violent vomiting, chest tightness, dyspnea, mediastinal emphysema, subcutaneous emphysema, etc. Vomiting → chest pain → subcutaneous emphysema is the classic triad."

"The patient has a slight crepitus under the axilla. I think Meng Laoshi already had a diagnosis and was just waiting to get a CT scan to see the mediastinal emphysema before pushing them straight to General Thoracic Surgery."

"Pfft." Internal Medicine Li Yisheng wasn't intimidated by Ji Xiang; he scoffed, "How could it be such a coincidence? In our Internal Medicine department, we have people coming to the Emergency Department for gastric lavage after drinking too much or taking pills almost every day. Do you know how often I see an esophageal rupture?"

Ji Xiang heard the displeasure in Internal Medicine Li Yisheng's words and didn't argue with him, just smiled.

By repeating what the System NPC had said, Ji Xiang gained a deeper understanding of this condition.

"You don't see one in a whole year!" Internal Medicine Li Yisheng raised his voice, "Pouring water down, vomiting and retching, even with that much pressure, I've never seen anything happen. You young people learn a few things from books and think they are common in clinical practice; you're inexperienced."

"The symptoms all match, Teacher Li."

"Let's make a bet," Internal Medicine Li Yisheng smiled, "If your diagnosis is right, I'll handle all the minor surgical procedures for the rest of the night."

"If your diagnosis is wrong, you'll follow me for three shifts."

Internal Medicine Li Yisheng envied that Meng Qingfei had Ji Xiang to help him; he revealed his true intentions.

In Internal Medicine Li Yisheng's view, he was bound to win.

"Fine," Ji Xiang smiled, "Teacher Li, those minor surgical procedures you..."

"Actually, many procedures in internal medicine and surgery are about the same," Internal Medicine Li Yisheng said dismissively, "I certainly won't touch major emergency rescues, but I handle patients with Appendicitis, Cholecystitis, and the like myself without asking for a surgical consultation."

"In the middle of the night, who's going to come and remove stitches? Besides, what's so hard about removing stitches in surgery?"

As he spoke, he laughed, "Young man, today I'll teach you a lesson: the things written in books are rarely encountered in clinical practice. The things we see commonly only account for about 2% of the diseases in books."

Ji Xiang didn't speak. Seeing Ji Xiang silent, Internal Medicine Li Yisheng became even more convinced he was right and had already won against this young man, and began to talk incessantly about common clinical content to Ji Xiang.

Half an hour later, Meng Qingfei returned pulling a flat cart.

"Xiao Meng, where's the patient?" Internal Medicine Li Yisheng asked.

"Sent to General Thoracic Surgery," Meng Qingfei replied.

Internal Medicine Li Yisheng was stunned, "Diagnosed with what illness?"

"Spontaneous esophageal rupture, mediastinal emphysema," Meng Qingfei said, "The patient drank some sullen wine at noon and ruptured their esophagus after vomiting twice. The doctor at the lower-level hospital was clueless and insisted it was acute myocarditis."

"..." Internal Medicine Li Yisheng froze, not expecting to have actually encountered a patient with spontaneous esophageal rupture.

"Done, job finished!" Meng Qingfei went to wash his hands, and after coming out, he wiped them vigorously on the seat of his White Uniform.

His White Uniform was newly changed; everywhere else was very clean, but there were two black marks left on the seat, which were quite eye-catching.

Ji Xiang also didn't know why, even though Meng Qingfei washed his hands often and appeared to be very clean, he always wiped his hands on his White Uniform, and always in the same spot.

He didn't tease Internal Medicine Li Yisheng, but instead said respectfully, "Meng Laoshi, then I'll go back to rest."

"Go ahead, you still have work tomorrow. I'm going home to rest after I get off work tomorrow, it's different," Meng Qingfei replied casually.

"Xiao Meng, you go sleep. I'll keep an eye on any emergencies in the second half of the night," Internal Medicine Li Yisheng said helplessly.

"Oh ho, Lao Li, how come you're being so merciful today?" Meng Qingfei asked curiously.

Although Internal Medicine Li Yisheng didn't say anything, being able to lie down and sleep soundly for an hour or two instead of doing sit-ups while on duty was a good thing for an Emergency Department doctor.

Ji Xiang waved goodbye and walked out of the Emergency Department.

The night was deep and quiet, and there were far fewer cars parked in the Second Affiliated Hospital parking lot; the night breeze was slightly cold.

Ji Xiang greeted the burly man in the darkness and wasn't in a hurry to go home, but instead felt his pockets.

His pockets were flat; Ji Xiang scratched his head.

Always going to the System Operating Room and always chatting with Wang Daxiao and the others, Ji Xiang had gotten used to having a cigarette while thinking.

Find time to buy a pack.

Although Ji Xiang knew this habit wasn't good, he had already been led astray without realizing it.

(End of this chapter)