Chapter 2838: 2744.2634 Persecutory Delusion

2744.2634 Persecutory Delusion

Wu Yuanzhang stared at the complicated medical record for a long time, and when he slept at night he had a strange dream, but after waking up he completely couldn't remember what he had dreamed of. He could only vaguely recall that it seemed related to the condition, but he couldn't recall any more specifics.

This matter was like a fish bone stuck in his throat, making Wu Yuanzhang feel very uncomfortable.

Two days later, he picked up the medical record again and began to flip through it.

The patient's condition was more complicated than he had imagined: thyroid cancer, with surgery done in the capital. But it was only a thyroid nodule, yet in the end they performed a total thyroidectomy.

This was a bit excessive; Wu Yuanzhang looked at the record and increasingly felt that the patient truly had a psychiatric disorder.

Although the final pathology diagnosis was thyroid cancer, it certainly didn't warrant removing both sides of the thyroid.

Seeing that the hospital where the surgery was performed was 912, Wu Yuanzhang pondered for a long time, but he still couldn't get past that hurdle in his mind, so he began contacting the doctor who had performed the surgery on the patient back then.

Doctors in the capital are so busy that the surgeon might well not remember the patient, but Wu Yuanzhang tried to contact a doctor he knew at 912 and also get in touch with Professor Wei, who led the thyroid department; yet he discovered that Professor Wei still remembered this patient even after so much time.

Through Professor Wei's introduction, the patient had been examined in the capital for 'delusional-type schizophrenia,' and the examination revealed severe iron-deficiency anemia and severe vitamin D deficiency.

During the examination, a thyroid nodule was found; Professor Wei had seen the patient in the outpatient clinic and thought observation at home would suffice, but the patient strongly demanded surgical treatment, even threatening to die if it wasn't done.

The patient's parents and Professor Wei talked for a long time, and in the end they decided to follow the patient's wishes and go ahead with the surgery.

The reason it left a deep impression is that Professor Wei was worried something might go wrong, so when Wu Yuanzhang called, he was quite nervous.

When he learned that Wu Yuanzhang was only consulting and that there was no problem with the patient, Professor Wei relaxed considerably. He told Wu Yuanzhang that back then he had felt something was off about the patient's condition, and in his over twenty years of medical practice he had never seen anyone voluntarily request a total thyroidectomy.

Ordinary patients fear surgery; when doctors advise home observation, hardly anyone voluntarily asks for an operation. But this patient was different—not only did he demand surgery, he insisted on a bilateral total thyroidectomy.

The patient had no history of head trauma, epilepsy, or social withdrawal. So Professor Wei wasn't certain the patient truly had a psychiatric disorder, but his behavior was somewhat odd—that was his assessment.

However, Professor Wei's main basis for thinking at the time was that psychiatric disorders usually show signs from adolescence, whereas this patient was said to have been normal before, studying all the way to a doctorate.

There was also no family history; the patient's parents were quite normal.

At that time, because he was worried something might go wrong, he wanted to run some related tests, but the patient refused them all.

After the surgery, the patient was monitored; she took levothyroxine sodium tablets, and oddly, when taking this medication to supplement thyroid hormone, TSH should drop, but there was hardly any change.

Professor Wei explained everything he knew, but afterward the patient's symptoms grew worse, and she even said over the phone that if it hadn't been for his persistence, this thyroid cancer would have been directly delayed.

That remark was full of distrust and hostility; even if Professor Wei had the best temper, he would still get angry.

Although the patient's parents sincerely apologized after learning of this, Professor Wei did not want to have any further contact with the patient.

Wu Yuanzhang hung up the phone and fell into deep thought.

Based on Professor Wei's account, this is a very typical case of persecutory delusional disorder, but Professor Wei's opinion… seems worth considering.

Could there be some issue that Director Jiang hadn't considered? Wu Yuanzhang suddenly became interested.

He then sent all of the patient's lab reports to Professor Wei, asking him to take a look.

The most recent lab report showed a TSH value of 9.4 pmol/L, slightly below normal. Aside from that, there currently appears to be nothing noteworthy.

The professors in the capital couldn't see any problem, so Wu Yuanzhang could only temporarily set the matter aside. He thought to himself that the greatest possibility was still that the patient's mental state was the issue.

But while Wu Yuanzhang wanted to let the matter drop, Director Jiang kept insisting on a hospital-wide consultation, arguing that the patient's physical condition was poor, with continuous progressive weight loss over the past year or more.

The examination revealed no malignant tumor, and the patient had no nausea, vomiting, diarrhea, or other gastrointestinal symptoms.

Wu Yuanzhang knew that many patients with persecutory delusional disorder have poor diets, because they worry that family members or restaurants might poison their food, so they deliberately reduce their intake to avoid being harmed.

This is just making trouble out of nothing, and Wu Yuanzhang felt somewhat helpless. He knew what Director Jiang was thinking—he was essentially slapping himself in the face with his own words.

Am I wrong in what I said?! Guard against the slightest flaw, yet he seized on it to launch a tirade of insults. Relying on his seniority and impending retirement, he shows no mercy even when he's in the right.

During this period Wu Yuanzhang has been rather troubled, even feeling that he might have depression. He thought maybe he could ask Zheng Lao Ban to take a look; surely he couldn't be invited, but having Zheng Lao Ban glance over things, voicing his inner worries, would also be a way to vent his frustration and get to know Zheng Lao Ban better.

Wu Yuanzhang thick-skinnedly opened WeChat and sent a message to Zheng Lao Ban.

【Zheng Lao Ban, are you there?】

After a long time with no reply, Wu Yuanzhang sighed and gave an embarrassed smile. He wasn't close to begin with, and now the person is a Nobel laureate, making contact even harder.

Forget it, don't go looking for trouble for no reason.

Until two days later, Wu Yuanzhang suddenly received a WeChat message.

【Director Wu of Nanshan City? Hello. I've been abroad these past few days and just got back.】

Upon seeing Zheng Lao Ban's reply, Wu Yuanzhang was overjoyed—it turned out the person had just been out of the country, not blowing him off due to arrogance.

【Sorry to bother you, but on my end I have a case that a clinical director suspects is problematic, and we can't make a diagnosis.】

【Oh, just wait a moment; I'm heading back to the capital.】

【Okay, thank you for the trouble.】

……

……

Zheng Ren was sending a message on his phone when Xie Yiren asked from the side, 'Zheng Ren, anything going on in the department?'

'There's something, but it's not about the department.' Zheng Ren laughed, 'It's probably Director Wu of Nanshan City Psychiatric Hospital wanting to consult me.'

'A psychiatric hospital?' Xie Yiren was a bit puzzled.

'Not long ago weren't you selected by lottery to go to Nanshan City for a medical appraisal? I went with Su Yun, and in the end the patient was misdiagnosed.' Zheng Ren said, 'That's why I have Director Wu's contact information.'

'Oh, what patient?'

"It's the information from a few days ago, probably nothing major." Zheng Ren said, "Let's talk when we get home; looking at my phone in the car for too long makes my vestibular nerves act up."