Chapter 2451: and translation of chapter title

"Old problem." The elderly lady chuckled and said to Zheng Ren, "It's nothing."

But need to be faithful, not padded. Let's translate naturally but concise.

We'll need to keep quotes and punctuation? Probably keep as is but translate Chinese to English. Keep the quotation marks? Usually we keep them as part of translation. We'll output English sentences.

Let's go.

It's an old problem. The elderly lady chuckled and said to Zheng Ren, "It's nothing."

Translation: "Old problem." The elderly lady chuckled and said to Zheng Ren, "It's nothing."

Old problem. The elderly lady chuckled and said to Zheng Ren, "It's nothing."

How could it be nothing? Zheng Ren quickly helped the elderly lady up and seated her on a small stool to the side.

Translation: How could it be nothing? Zheng Ren hurriedly supported the elderly lady and helped her sit on a small stool at the side.

"Auntie, what's wrong with you?" Zheng Ren asked with a chuckle.

Translation: "Auntie, what's wrong with you?" Zheng Ren asked with a chuckle.

Zhao Wenhua and Gao Shaojie also didn't find anything strange; this is a commonly used way to bridge the distance with patients' families. However, most of the time it's the attending physicians who are meticulous, while leaders of the medical team or department heads rarely do this.

Translation: Zhao Wenhua and Gao Shaojie also didn't think it strange; this is a common way to bridge the distance with patients' families. Usually it's the attending physicians who are meticulous, while leaders of the medical team or department heads rarely do this.

"Well, I have a bone spur. Plus, I got a few blisters on my foot before coming here; walking hurts a bit, but that's all." The elderly lady chuckled.

Translation: "Old lady, I have a bone spur. Plus, I got a few blisters on my foot before coming here; walking hurts a bit, but nothing else." The elderly lady chuckled and said.

"Are the blisters from friction?"

Translation: "Are the blisters from rubbing?"

"I was soaking my feet at night, thinking about the old man coming for surgery, didn't notice the water was too hot, and ended up with two blisters."

Translation: "I was soaking my feet at night, only thinking about the old man coming for surgery, didn't notice the water was too hot, and got two blisters."

In diabetic patients, peripheral sensory problems can appear early in the disease. They are characterized by symmetrical sensory disturbances in the limbs, more pronounced in the lower limbs than the upper limbs, with sensory abnormalities appearing before pain.

Translation: Diabetic patients often have peripheral sensory problems, which can appear early in diabetes. The feature is symmetrical limb sensory disturbances, more common in the lower limbs than the upper, with sensory abnormalities preceding pain.

Sensory abnormalities encompass many indicators, which, when cross-referenced with the system panel, led Zheng Ren to vaguely realize that the family's behavior suggested they were not sensitive to pain.

Translation: Sensory abnormalities include many points; cross-referencing with the system panel, Zheng Ren vaguely realized the family member's performance indicated insensitivity to pain.

When soaking feet, if the water temperature is too high, normal people will lift their feet; this is an instinctive reaction.

When soaking feet, if the water temperature is too high, normal people will lift their feet; this is an instinctive reaction.

However, due to peripheral sensory neuropathy, the patients' families have a diminished protective reflex.

Translation: But the patient's family, due to peripheral nerve sensory impairment, has this self-protective reflex diminished.

Moreover, they all show signs of toe necrosis, yet they can still walk with a limp, which also confirms this from another angle.

Translation: Moreover, they show symptoms of toe necrosis, yet can still walk with a limp, which also proves this from another angle.

"Auntie, let me take a look." Zheng Ren said with a smile, "The blisters aren't a big deal; I'll also check if they need disinfection."

Translation: "Auntie, let me take a look." Zheng Ren said with a smile, "Getting blisters from rubbing is nothing; I'll just check if disinfection is needed."

Although the family members were somewhat puzzled, they saw Professor Zhao, who was performing their surgery, treating the young doctor with respect, so they didn't object. Instead, they sat down honestly and took off their socks.

Translation: Although the patient's family were somewhat puzzled, seeing Professor Zhao, who was to perform their surgery, respectful toward this young doctor, they didn't object. Instead, they sat down honestly and took off their socks.

As the socks were removed, Zheng Ren's brows furrowed.

Translation: As the socks came off, Zheng Ren's brows furrowed.

The family member's left foot was wrapped in gauze, with seepage at the toes, and a faint odd smell emanated.

Translation: The patient's family had gauze wrapped around the left foot, with seepage at the toes, and a faint odd smell drifted out.

Gao Shaojie was taken aback; he didn't expect Boss Zheng to casually pick a patient's family member, only to find the situation so severe.

Translation: Gao Shaojie stared for a moment; he hadn't expected that Boss Zheng would "casually" pick a patient's family member, only to find the situation so serious.

Zhao Wenhua felt the same; he had previously complained that Boss Zheng shouldn't be doing the work of an attending physician. Now, seeing the bandage on the family member's foot, he couldn't help but be startled.

Translation: Zhao Wenhua felt the same; earlier he had slightly complained that Boss Zheng shouldn't be doing the attending physician's work. Now seeing the bandage on the patient's family member's foot, he couldn't help but stare.

"Change the dressing." Zheng Ren picked up another stool and said in a low voice.

Translation: "Change the dressing." Zheng Ren picked up another stool and said in a low voice.

The young doctor beside Zhao Wenhua hurried to fetch the dressing kit, running all the way back to the ward.

Translation: The young doctor beside Zhao Wenhua hurried to fetch the dressing pack, running all the way back to the ward.

"Auntie, let me change your medicine." Zheng Ren said gently.

Translation: "Auntie, I'll change your medicine." Zheng Ren said gently.

"Doctor, it's no trouble; I can do it myself."

Translation: "Doctor, it's no trouble; I can do it myself."

"Those blisters look quite serious." Zheng Ren didn't get caught up in whether it was a hassle, but instead, somewhat awkwardly, got straight to the point.

Translation: "Your blisters look serious." Zheng Ren didn't follow the patient's line about whether it was troublesome, but rather, slightly awkward, got straight to the point.

Su Yun wasn't around, and Zheng Ren didn't want to dwell on more details. Gao Shaojie had just arrived; as for Zhao Wenhua… even if he had doubts, what could he say?

Translation: Su Yun wasn't there, and Zheng Ren didn't want to consider more details. Gao Shaojie had just arrived; as for Zhao Wenhua… even if he had doubts, what could he say?

Unbeknownst to him, Zhao Wenhua had already been ignored by Boss Zheng. The person who used to advocate taking more and occupying more had long been dismissed by Zheng Ren.

Translation: Unnoticed, Zhao Wenhua had already been ignored by Boss Zheng. The person who used to talk about eating more and taking more had long been tossed aside by Zheng Ren.

Upon removing the bandage, Zheng Ren saw that the family member's feet had multiple scabbed toes; the left fourth toe was red, swollen, ulcerated, with a small amount of blood seeping out. The toe tip was blackish-purple, indicating partial necrosis.

Translation: Unwrapping the bandage, Zheng Ren saw that the patient's family member's feet had multiple scabs on the toes; the left fourth toe was red, swollen, ulcerated, with a small amount of blood seeping out. The toe tip was black-purple, indicating partial necrosis.

"Prepare for hospitalization." Zheng Ren confirmed the system diagnosis of the big pig's trotter, which was accurate, and sighed.

Translation: "Prepare for hospitalization." Zheng Ren verified the Big Pig Trotter's system diagnosis, which was accurate, and sighed as he spoke.

The patient's son was dumbfounded; he hadn't expected his mother's condition to be so serious.

Translation: The patient's son was dumbfounded; he hadn't expected his mother's condition to be so severe.

Just seeing the toe tips black as charcoal filled him with dread; added to the foul odor, even a layperson could tell it was necrosis.

Translation: Aside from anything else, just seeing the toe tip blackish like charcoal filled him with dread. Moreover, there was an odd smell; even a non-doctor could tell it was necrotic.

"There are already early signs of gangrene." Zheng Ren then said.

Translation: "There are already preliminary signs of gangrene." Zheng Ren then said.

"What?" The patient's son, bewildered, didn't catch Zheng Ren's words.

Translation: "What?" The patient's son, startled, didn't catch Zheng Ren's words clearly.

"This toe already shows signs of necrosis. Wet gangrene occurs because the necrotic tissue contains more fluid, leading to severe infection by putrefactive bacteria, causing noticeable local swelling and a dark green or blackish hue." Zheng Ren lightly pointed at the elderly lady's left fourth toe.

Translation: "This toe already shows necrosis. Wet gangrene occurs because necrotic tissue contains more water, leading to severe infection by putrefactive bacteria, causing obvious local swelling, appearing dark green or dirty black." Zheng Ren lightly pointed at the elderly lady's left fourth toe.

"Putrefactive bacteria break down proteins, producing indole, skatole, etc., causing a foul odor. Because the disease progresses quickly and inflammation is diffuse, there is no clear demarcation between necrotic and healthy tissue."

Translation: "Putrefactive bacteria break down proteins, producing indole, skatole, etc., causing foul odor. Since the lesion progresses quickly, inflammation is diffuse, so there is no clear demarcation between necrotic and healthy tissue."

"……" The patient's son was truly stunned.

Translation: "……" The patient's son was truly stunned this time.

He leaned in and smelled a foul odor; it wasn't strong, but up close he could definitely detect it.

Translation: He leaned in and smelled a foul odor. It wasn't strong, but up close he could indeed smell it.

"Doctor……"

Translation: "Doctor……"

"Go to the trauma department for inpatient treatment; you'll likely need a toe amputation." Zheng Ren said, "Auntie, do you have any other illnesses?"

Translation: "Go to the trauma department for inpatient treatment; likely toe amputation will be needed." Zheng Ren said, "Auntie, do you have any other illnesses?"

The elderly lady knew her foot's condition, though it wasn't very painful, she had held onto hope that it would get better. Hearing Zheng Ren say this, she looked somewhat confused.

Translation: The elderly lady knew her foot condition, though it didn't hurt much, she had held onto hope it would get better. Hearing Zheng Ren say this, she felt a bit lost.

"I also have diabetes."

Translation: "I also have diabetes."

"How is your blood sugar control?" Zheng Ren asked.

Translation: "How's your blood sugar control?" Zheng Ren asked.

"I'm on insulin; my fasting blood sugar is 8.2."

Translation: "I take insulin; fasting blood sugar is 8.2."

"Your condition is otherwise fine; it's just that treatment was delayed." Zheng Ren said, "Don't worry about your loved one's situation; the surgery is already done, and he'll be discharged soon."

Translation: "Your condition is still okay; it's just that treatment wasn't timely." Zheng Ren said, "Don't worry about your loved one's condition; the surgery is already done, and he'll be discharged soon."

With this situation, the patient can be discharged home, but the family member coming to care for them will likely need hospitalization. Moreover, her hospital stay will probably be much longer than her spouse's.

Translation: With this situation, the patient can be discharged home, but the family member coming to care for them will likely need hospitalization. Moreover, her hospital stay will probably be much longer than her spouse's.

In a case like this, after toe amputation, negative-pressure suction is needed to draw out inflammatory exudate and other substances. Zheng Ren has performed these procedures during earthquake relief efforts.

Translation: In cases like this, after toe amputation, negative-pressure suction is needed to draw out inflammatory exudate and such. Zheng Ren had done these during earthquake relief efforts.

Necrotic conditions are similar in nature; only the triggers differ.

Translation: Necrotic conditions are similar; only the causes differ.

"Professor Zhao." Zheng Ren said in a deep voice.

Translation: "Professor Zhao." Zheng Ren said in a low voice.

"Boss Zheng." Zhao Wenhua slightly bowed, standing beside Zheng Ren with respect.

Translation: "Boss Zheng." Zhao Wenhua slightly bowed, standing beside Zheng Ren, respectful.

"Send Auntie to the trauma ward for hospitalization; if the family is overwhelmed, help arrange a caregiver."

Translation: "Send Auntie to the trauma department for hospitalization; if the family is overwhelmed, help arrange a nursing aide."

While speaking, Zheng Ren simply disinfected and cleaned the elderly lady's toes, then bandaged them.

Translation: While speaking, Zheng Ren simply disinfected and cleaned the elderly lady's toe, then bandaged it.

"Don't wear shoes; go by wheelchair."

Translation: "Don't wear shoes; go by wheelchair."

Zheng Ren stood up, patted the elderly lady's shoulder, and said gently, "Auntie, don't worry; the hospitalization and surgery will have you feeling better soon."

Translation: Zheng Ren stood up, patted the elderly lady's shoulder, and said gently, "Auntie, don't worry; the hospitalization and surgery will heal quickly."

"……" The elderly lady hadn't expected such a huge change; upon hearing about the toe amputation, she couldn't accept it right away.

Translation: "……" The elderly lady hadn't expected such a huge change; upon suddenly hearing about toe amputation, she couldn't accept it for a while.

After offering a reassuring word, Zheng Ren turned and left.

Translation: After Zheng Ren offered a word of comfort, he turned and left.

As a senior physician, Zheng Ren no longer deals directly with patients' families; he has subordinates like Chang Yue handling that, which is more convenient.

Translation: As a senior physician, Zheng Ren indeed no longer deals with patients' families; having someone like Chang Yue under him handle it is relatively worry-free.

Even under the heaviest workload and high turnover, Chang Yue handles tasks in an orderly manner, with no oversight.

Translation: At the very least, under heavy workload and high turnover, Chang Yue handles things in an orderly manner, with no oversight.

The situation has been explained, the solution outlined; what remains is for Zhao Wenhua to communicate and for the patient's family to make their own choice.

Translation: The situation has been explained, the solution given; what remains is for Zhao Wenhua to communicate and for the patient's family to make their own choice.

Gao Shaojie followed Zheng Ren to the treatment room, watched Boss Zheng wash his hands, and said, "Boss Zheng, you've really been busy today."

Translation: Gao Shaojie followed Zheng Ren into the treatment room, saw Boss Zheng washing his hands, and said, "Boss Zheng, you've really been busy today."

Now we need to output each line with 【N】 prefix and translation on same line.

After all lines, output

Then

How could this be nothing? Zheng Ren hurriedly supported the elderly woman and helped her sit on a small stool to the side.

Auntie, what's wrong with you? Zheng Ren asked with a smile.

Zhao Wenhua and Gao Shaojie also didn't find anything odd; this is a common way to draw closer to patients' families. Usually it's the attending physicians who are meticulous, but the Leader of the Medical Team or department heads seldom do this.

Old lady, I have a bone spur. Plus, I got a few blisters on my foot before coming here; walking hurts a bit, but nothing else. The elderly woman said with a smile.

Are the blisters from rubbing?

I was soaking my feet in the Evening, thinking about the old man coming for surgery, didn't notice the water was too hot, and got two blisters.

Diabetic patients often have peripheral sensory problems, which can appear early in diabetes. The characteristic is symmetrical sensory impairment in the limbs, more pronounced in the lower limbs than the upper limbs, with sensory abnormalities preceding pain.

Sensory abnormalities include many points; cross-referencing with the System Panel, Zheng Ren vaguely realized that the patient's family's performance likely indicated insensitivity to pain.

When soaking feet, if the water temperature is too high, normal people will lift their feet; this is an instinctive reaction.

However, due to peripheral nerve sensory impairment in the patient's family, this self-protective reflex of the body becomes less keen.

Moreover, symptoms of toe necrosis appear; the patient's family can still walk with a limp, which also proves this from another angle.

Auntie, let me take a look. Zheng Ren said with a smile, "Getting blisters from rubbing is nothing; I'll just check if disinfection is needed."

Although the patient's family was somewhat puzzled, seeing Professor Zhao, who was performing their surgery, respectful toward this young doctor, they did not object. Instead, they sat down honestly and took off their socks.

As the socks were taken off, Zheng Ren's brows furrowed.

The patient's family's left foot was wrapped in gauze, with seepage at the toes, and a faint strange smell drifted out.

Gao Shaojie stared for a moment; he didn't expect that Zheng Lao Ban would casually pick a patient's family member, only to find the situation so serious.

Zhao Wenhua was the same; he had previously muttered that Zheng Lao Ban shouldn't be doing the work of an attending physician. Now, seeing the bandage on the patient's family's foot, he couldn't help but stare.

"Change the dressing." Zheng Ren picked up another stool and said in a low voice.

The young doctor beside Zhao Wenhua hurried to fetch the dressing pack, running all the way back to the ward.

Auntie, let me change your medicine. Zheng Ren said gently.

"Doctor, it's no trouble; I can do it myself."

"Your blisters look serious." Zheng Ren didn't get caught up in whether it was troublesome per the patient's remark, but rather, somewhat awkwardly, got straight to the point.

Su Yun wasn't around, and Zheng Ren didn't bother to consider more details. Gao Shaojie had just arrived; as for Zhao Wenhua… even if he had doubts, what could he say?

Unbeknownst to him, Zhao Wenhua had already been ignored by Zheng Lao Ban. The person who used to say "the more you eat, the more you take" had long been tossed aside by Zheng Ren and vanished from sight.

After removing the bandage, Zheng Ren saw that the patient's family's both feet had multiple scabbed toes; the left fourth toe was red, showed Swelling, ulcerated, with a small amount of blood seeping out. The front of the toe was black-purple, and part of the toe had already necrosed.

"Prepare to be hospitalized." Zheng Ren confirmed the Big Pig Trotter's Xitong Diagnosis, which was accurate, and sighed as he spoke.

The patient's son was dumbfounded; he hadn't expected his mother's condition to be so serious.

Without mentioning anything else, just the blackish color of the toe tips, like charcoal, made him feel terrified. Added to the strange odor, even a non-doctor could tell it was necrotic.

"There are already preliminary signs of gangrene." Zheng Ren then said.

"What?" The patient's son, in his bewilderment, didn't hear Zheng Ren's words clearly.

"This toe already shows signs of necrosis. Wet gangrene occurs because necrotic tissue contains more moisture, leading to severe infection by putrefactive bacteria, causing obvious local Swelling and appearing dark green or dirty black." Zheng Ren lightly tapped the elderly woman's left fourth toe.

"Putrefactive bacteria break down protein, producing indole, skatole, etc., causing a foul odor. Since the lesion develops quickly, inflammation is fairly diffuse, so there is no clear boundary between necrotic and healthy tissue."

"..." The patient's son was truly stunned this time.

He leaned in and smelled a foul odor. It wasn't strong, but up close he could indeed smell it.

"Doctor..."

"Go to the Trauma Surgery department for inpatient treatment; likely toe amputation will be needed." Zheng Ren said, "Auntie, do you have any other illnesses?"

The elderly woman knew her foot's condition, though it didn't hurt much, and she had held onto the hope that it would get better. Hearing Zheng Ren say this, she looked a bit bewildered.

"I also have diabetes."

"Is your blood sugar under control?" Zheng Ren asked.

"I inject insulin; my fasting blood sugar is 8.2."

"Your condition is not bad; it's just that treatment was delayed." Zheng Ren said, "Don't worry about your loved one's condition; the surgery is already done, and he'll be discharged soon."

In this situation, the patient can be discharged home, while the family member coming to care for them likely still needs hospitalization. Moreover, her hospital stay could be much longer than her spouse's.

In cases like this, after toe amputation, negative-pressure suction is still needed to draw out inflammatory exudate and the like. Zheng Ren had done these things during Earthquake Relief.

Necrotic conditions are similar in nature; only the triggers differ.

"Professor Zhao." Zheng Ren said in a low voice.

"Zheng Lao Ban." Zhao Wenhua slightly bowed, standing beside Zheng Ren, respectful.

"Take Auntie to the Trauma Surgery department for hospitalization; if the family is overwhelmed, help arrange a nursing aide."

While speaking, Zheng Ren simply disinfected and cleaned the elderly woman's toes, then bandaged them.

"Don't wear shoes; go by wheelchair."

Zheng Ren stood up, patted the elderly woman's shoulder, and said gently, "Auntie, don't worry; the hospitalization and surgery will get better soon."

"..." The elderly woman hadn't expected the situation to change so drastically; upon suddenly hearing about toe amputation, she couldn't accept it for a while.

After Zheng Ren offered a word of comfort, he turned and left.

As a senior physician, Zheng Ren indeed no longer deals with patients' families; having someone like Chang Yue under him to handle it is relatively worry-free.

At the very least, under the heavy workload and high turnover, Chang Yue handles things in an orderly manner, with no oversight.

The situation has been explained, the solution given; what remains is for Zhao Wenhua to communicate and for the patient's family to make their own choice.

Gao Shaojie followed Zheng Ren into the treatment room, watched Zheng Lao Ban wash his hands, and Gao Shaojie said, "Zheng Lao Ban, you've really been busy today."