Chapter 2463: 2376 Like a 134‑Year‑Old Patient

After explaining the surgical images, Zheng Renyi felt a stone drop from his heart.

This kind of cardiac X syndrome is not rare, but it is especially easy to overlook. After all, noninvasive tests struggle to pinpoint the exact cause; patients shuttle between countless hospitals, and ending up without a definitive diagnosis is perfectly normal.

"Ahhh!" Su Yun suddenly froze, then said, "I forgot something!"

"Huh? What's wrong?" Zheng Ren asked in surprise.

"Just now, Wang Zong was looking for you." Su Yun said, "He asked if you had time, and as soon as I came out I saw a patient with cardiac X syndrome..."

"Oh, what does Wang Zong want from me?" Zheng Ren asked.

"He said there's a patient with breathing difficulty who gets dizzy when walking, nothing much to diagnose, and he wants you to take a look." Su Yun said, "The Hai Cheng side is preparing a hospital-wide consultation; it's already off work, and I don't know if the consultation is over."

"Oh?" Zheng Ren asked, "Did they judge it as pulmonary emphysema or vertigo?"

"Boss, should we charge for future consultations? We're already experts from the Imperial Capital, yet they just summon us for consultations like ordering a head maid around." Su Yun didn't answer Zheng Ren's words, but went on complaining about other things.

"Don't put it so harshly." Zheng Ren chuckled, "Has the data been sent over?"

"No, he's just asking, seeing if you're interested." Su Yun said.

"Let's have a look; if we can't figure it out, we'll have the patient come over." Zheng Ren said offhand.

"Come over for what?"

"..." Zheng Ren paused, then said, "Inspection, palpation, percussion, auscultation, observation, listening, questioning, pulse-taking—all require seeing the patient. Do you think remote consultation can solve all difficult and complicated cases?"

"Boss, why do you suddenly seem like you've had your tail stepped on?" Su Yun asked with a laugh. He was just making a casual remark, never expecting his own boss to be so serious.

However, Su Yun didn't mind; he merely habitually retorted at his own boss and then left it at that.

"Cut the nonsense, go get the data from Wang Zong." Zheng Ren said.

Su Yun took out his phone, his hands almost leaving afterimages as they flicked back and forth across the screen.

The hospital-wide consultation on that side hasn't ended yet; it looks indeed troublesome, Zheng Ren judged. Whether it's the condition or the patient's family, there will be trouble.

Soon, Wang Zong sent over the patient's information.

The patient's chief complaint is general weakness, fatigue accompanied by breathing difficulty for three months before admission.

He doesn't smoke or drink, keeps no pets at home, eats normally, and has had no recent special changes. No past medical history, no family history, etc. His job is a bank clerk, with no exposure to dust or other metallic substances.

But this condition appeared suddenly and persisted; neither patient nor doctor could do anything about it.

During the first visit a few months ago, a chest X-ray was taken, diagnosed as a lower respiratory tract infection, and targeted treatment was given.

After anti-inflammatory and symptomatic treatment, his symptoms initially improved, but they relapsed after a month, and even more strangely, after the second episode his X-rays showed nothing abnormal.

All tests were performed, yet still nothing was found wrong with the patient.

Judging solely by the test results, this is a very healthy person. But according to Wang Zong's description, the patient's condition is extremely severe; he can't climb stairs, walking on flat ground makes him tremble and sway, and he needs to rest after just a few steps.

Looking at the patient's case summary, Zheng Ren sat in Zhou Litao's duty-room chair, arms crossed, and began to ponder.

"Judging from the case summary, it looks like severe cor pulmonale, but the chest X-ray and lung CT show no problems at all." Su Yun said.

Zheng Ren clicked the mouse to enlarge the chest X-ray image.

"Do you want the raw data?" Su Yun asked.

"No need, I can see clearly." Zheng Ren said: "The medical record doesn't note wheezing; Su Yun, do you think asthma can be ruled out?"

"During an early asthma attack, both lungs can show increased translucency, appearing overinflated, which isn't seen on the film, but there's also the possibility that the film was taken when the patient wasn't having an attack." Su Yun continued: "But I also don't consider it, since wheezing isn't mentioned at all; I feel such an obvious symptom shouldn't be missed."

After saying that, Su Yun smiled, "No matter what, if a top-tier hospital can't even hear wheezing, the dean could resign in shame."

"Yeah, and asthma, when not active, isn't considered to cause limb weakness." Zheng Ren added, ruling out asthma.

"The heart looks fine on examination; a 24‑hour Holter was also done, and the patient is very healthy."

"Epilepsy?" Su Yun asked.

"It's possible, maybe the patient self‑reported the symptoms as convulsions…… no, that's not right, limb weakness…… let's hold this diagnosis for now; although unlikely, it's still possible." Zheng Ren said in a low voice.

Su Yun noted the epilepsy diagnosis on A4 paper; if we wanted a definite diagnosis, we could do an EEG on the patient when an episode occurs.

After all, it's a remote consultation; wanting to check for other reactions during activity to make a clearer diagnosis makes the chances slim.

"What about pneumonia?" Su Yun said, "On the first check's X‑ray you can see a vague shadow of inflammation. Although it's gone later, we can't simply rule it out."

"Anatomically, pneumonia is classified as lobar, bronchial, or interstitial. Given the patient's condition, I think interstitial pneumonia is more likely."

"By cause, it's divided into bacterial pneumonia, viral pneumonia, mycoplasma pneumonia, other pathogen pneumonia, fungal pneumonia, and pneumonia from other non‑infectious factors, such as radiation pneumonia, inhalation pneumonia, allergic pneumonia……"

Zheng Ren and Su Yun went through the differential diagnosis one by one, starting to carry out various differential diagnoses.

Zhou Litao silently watched from behind; the patient is only 34, with limb weakness plus breathing difficulty, many tests done yet no clear diagnosis—it's just too strange.

The first thing he thought of was that the patient's age was written wrong.

34 years old! This patient looks like he's 134.

……

……

Hai Cheng, City First Hospital.

Although work hours are over, the doctors are still working like worker ants.

Wang Zong is participating in the hospital‑wide consultation.

As a support expert from the Imperial Capital, the City First Hospital now calls on him to take a look whenever there's a hospital‑wide consultation.

But this time, Wang Zong had no ideas either, so helplessly he had to resort to his ultimate skill—summoning Zheng Lao Ban.

"The patient's family is very dissatisfied; after all these tests there's still no definite diagnosis." The head of the Medical Department, Zhou Chu‑zhang, tapped his fingers on the table and said in a low voice, "If we still can't get a clear diagnosis, the patient should be referred to a higher‑level hospital."

The head of the Respiratory Department nodded.

She had long wanted to transfer the patient away, but because the first diagnosis in respiratory medicine was pneumonia and she gave symptomatic treatment, she still felt some worry.

No one expected an ordinary pneumonia patient to linger and eventually become a huge problem.

But there's nothing to be done; we simply can't figure it out. If we don't go to a higher‑level hospital, I'm afraid the patient's condition will only get worse.

Judging by the degree of breathing difficulty, even if he needs a ventilator in a few days, that possibility isn't out of the question.

If that's the case, once they enter the ICU……

The director of respiratory medicine, He, has already started thinking about the patient's transfer; it doesn't matter if the illness isn't clear, who can guarantee that every illness will be understood?

As long as the patient doesn't crash under my care, that's fine.

Director He began to consider how he would communicate with the patient's family—whether going to Sheng Cheng or Di Du would be better; it seemed that if they went to Sheng Cheng, the family would be more accepting, after all the journey is shorter.

But she didn't think Sheng Cheng could solve this case; such a strange situation…… she drifted off in thought.

The next few consulting directors also gave their opinions, all quite simple; they didn't have anything particularly special to say.

What to check, what's normal—what's there to say?

It's all just the same old talk, completely meaningless.

Wang Zong repeatedly reviewed the patient's medical history, yet still had no clue. Autonomic nervous dysfunction? Or hysteria? It didn't look like either.

For a 34‑year‑old man to be hysterical to the point of panting while walking—that's quite difficult.

Just then, his phone vibrated.

Wang Zong glanced at it—it was a call from Su Yun. Feeling embarrassed, he smiled at Director Zhou, lowered his head, and stepped out to answer.

Thank goodness this isn't Room 912; if Director Wei were sitting here, or if Director Lin were presiding over the hospital-wide consultation, I'd surely get scolded bloody. As for Director Ye, Wang Zong didn't even dare to think about it.

To an ordinary doctor, Ye Qingqiu, Director Ye of the Medical Department, is like the Jinyiwei's commander; if he actually showed up, you'd either die or be flayed alive.

Director Zhou shook his head, glanced around at the heads of the relevant departments at City First Hospital, and from their expressions he could already guess a thing or two.

Nobody had a solution.

While arranging the transfer paperwork, they sent the patient to Sheng Cheng by 120 emergency ambulance. As for who to contact in Sheng Cheng, Director Zhou thought it better to let the patient's family reach out first.

If they did this too often, the patient's family would surely think the hospital's medical practice was problematic—why would they be so earnest if there were nothing to gain?

The key lies in finding the right balance; Director Zhou gradually grasped how to manage it. Clinical work is truly a hassle—thinking about it, he grew weary. When could he move to logistics work?

"Then it's settled—Director He will talk to the patient's family." Director Zhou said, "This illness…"

"Director Zhou." Wang Zong returned with his phone, interrupting Zhou's words.

"Director Wang, what's your opinion?" Director Zhou asked.

"I just consulted Zheng Lao Ban; he suggested that when the patient has breathing difficulty we should do an EEG, and also a contrast‑enhanced CT of the lungs." Wang Zong said seriously.

He didn't change his expression just because it was Zheng Lao Ban's consultation opinion; he simply stated the fact calmly.

Director Zhou paused for a moment—Zheng Ren? Why would he suggest a contrast‑enhanced lung CT?