10: Chapter 10 What makes you deduce that this patient has a heart attack?
Zhou Ze took a deep breath.
In fifteen years in the Emergency Department, what kind of situation hadn't he seen?
It wasn't the first time an intern had come to question his diagnosis.
Young people, they read a lot of books and always think they know everything.
What's written in textbooks and what's seen in clinical practice are two different things.
Books say a certain symptom means a certain disease, but clinical practice isn't that simple.
"Fine, since you're so persistent, let me ask you a question."
Zhou Ze's voice wasn't loud, but several nearby Nurses and interns heard him and looked over.
"On what basis do you judge this patient has a heart attack? Just because he's sweating a bit? Just because he's nauseous?"
"In this June weather, who doesn't sweat? There are a hundred reasons for nausea; even eating something bad last night could cause it."
"You're an intern who's been in the Emergency Department for five days and hasn't even performed an Electrocardiogram independently, yet you dare tell me this is a heart attack?"
Zhou Ze's tone already carried obvious dissatisfaction.
"Your courage is commendable, but your judgment is lacking. These two things combined will get a patient killed."
"Listen to me, go back to your work, or I'll have Zhao Yaqin transfer you back to the Green Zone."
As these words hit him, Lu Chen's expression finally changed slightly.
He wasn't scared.
Rather, he realized that if he continued to butt heads with Zhou Ze, not only would he fail to convince him, but he might also get himself sent back to the Green Zone.
If he went back to the Green Zone, he wouldn't even be able to interact with patients in the Yellow Zone.
Let alone the Red Zone later on.
But.
Lu Chen's gaze instinctively drifted toward the Electrocardiogram room.
That man was still inside.
The diagnosis given by the system was clear.
Acute Inferior Myocardial Infarction, early stage.
There is a high probability of it developing into a massive heart attack within 3 to 6 hours.
If he backed down now and the Electrocardiogram came back as a false negative, Zhou Ze would prescribe medication for "Neuropathic Pain" and send him home.
Then that person might be gone.
Thirty-six years old.
That woman outside, the one who called him husband, was still waiting in the corridor.
Lu Chen stood in place, silent for two seconds.
Then he made a decision.
He didn't speak to Zhou Ze again.
Instead, he turned and walked toward the entrance of the Yellow Zone.
He was going to find Zhao Yaqin.
Zhou Ze was an Associate Chief Physician; the words of an intern like him held no weight in the other man's eyes.
But if a doctor of the same rank brought it up, it might at least make him reconsider.
"Where are you going?" Zhou Ze asked from behind.
"To find Teacher Zhao."
"What are you looking for Zhao Yaqin for?"
"To ask about work arrangements."
Lu Chen didn't tell the truth.
He didn't want to say in front of Zhou Ze, "I'm going to find Zhao Yaqin and have her come tell you there's a problem with this patient."
That would be like reporting to a superior behind his back, making things even more complicated.
He just wanted to find someone who would listen and state his judgment one more time.
...
Lu Chen quickly walked out of the Yellow Zone.
He remembered that Zhao Yaqin should be on duty in the Red Zone this morning.
The Red Zone was next to the Yellow Zone, just a short walk down the corridor.
But when he reached the entrance of the Red Zone, a Nurse told him that Zhao Yaqin had just been called away for an emergency meeting.
"What meeting?"
"It seems the Medical Affairs Department sent a temporary notice; I don't know the details."
"Roughly how long until she's back?"
"Hard to say, maybe half an hour, maybe an hour."
Lu Chen's heart sank.
Half an hour to an hour.
The system said it could develop into a massive heart attack within 3 to 6 hours.
But that was a statistical estimate; the actual situation could be faster or slower.
He couldn't gamble.
Lu Chen stood at the entrance of the Red Zone for a few seconds, then quickly walked back to the Yellow Zone.
He decided to handle this matter in another way.
Not by directly opposing Zhou Ze, but by starting with the patient's side.
He walked into the corridor and found the woman waiting for the results.
The patient's wife.
She was sitting alone on a chair in the corridor, clutching a bottle of mineral water, her expression anxious.
Lu Chen walked over and crouched down.
"Hello, I'm a doctor here."
The woman looked up at him.
"Are you also from the Emergency Department? You're so young?"
"Yes, I'd like to learn more about your husband's situation, if that's okay?"
"Yes, yes, please ask."
"Did your husband have any underlying health conditions before? Hypertension, diabetes, high blood lipids, things like that?"
"High blood lipids. It was found during a check-up last year; his LDL was a bit high. The doctor told him to take medicine, but he thought it was too much trouble and didn't."
Lu Chen's heart sank another notch.
Hyperlipidemia.
This is one of the most important risk factors for Coronary Heart Disease.
When Zhou Ze was taking the history earlier, he asked if there were "any heart problems" or "hypertension."
The patient said no.
But he didn't ask about high blood lipids.
This information had been missed.
"Also, has your husband been under a lot of work pressure lately? Has he been staying up late consecutively?"
"A lot of pressure. He's been working overtime for the past month, coming home at eleven or twelve every night, and sometimes he's still revising plans at two or three in the morning."
"After he woke up this morning, besides the chest tightness, did he feel any toothache? Or discomfort in the left side of his neck and shoulder?"
The woman thought for a moment.
"He didn't mention a toothache, but when he left, he seemed to rub his neck. I asked him what was wrong, and he said he had a stiff neck from sleeping."
Lu Chen's heart sank further.
Neck discomfort.
This is also one of the symptoms of an atypical heart attack.
The Referred Pain caused by an inferior heart attack sometimes doesn't appear in the classic left arm and jaw, but instead in the neck, back, or even upper abdomen.
Hyperlipidemia, long-term high-pressure work, consecutive late nights, a thirty-six-year-old male.
Add to that chest tightness, cold sweats, nausea, and neck discomfort.
All the clues pointed in the same direction.
Lu Chen stood up.
"Thank you. I suggest you tell the doctor performing the examination about your husband's high blood lipids and his recent overtime and late nights. This information is very important."
"Huh? Important? Didn't my husband say it wasn't a big deal? That doctor said it was some kind of Neuropathic Pain..."
Tension returned to the woman's face.
"I'm not trying to scare you, but it's better to do a few more tests to rule things out than to miss something."
"You can tell the doctor that you request to add a Myocardial Enzyme Spectrum and Troponin test. These two tests are very quick; they just require a blood draw."
The woman's eyes filled with panic.
"Doctor, what exactly do you mean? Is my husband okay or not?"
"I can't give you a definitive answer, but I think it's better to be cautious."
"Then is the older doctor right, or are you right?"
Lu Chen opened his mouth, then closed it again.
He couldn't openly question a superior doctor's diagnosis in front of a family member.
Doing so would not only violate rules but would also cause the family's trust in the entire department to plummet.
"I'm just suggesting you do a few more tests; it's not contradictory."
The woman hesitated.
She looked at Lu Chen, then back toward the Yellow Zone.
That older Associate Chief Physician said it wasn't a big deal.
This excessively young little doctor said they needed to check more.
The two doctors' judgments were different.
Who should she believe?