55: Chapter 55 The Eye of Truth: Diagnosis - Acute Attack of Chronic Appendicitis
Lu Chen hung up the phone.
Cross-departmental rounds—he had heard of this before.
To strengthen collaboration between departments and improve teaching quality, Central Hospital organized a cross-departmental teaching round once a month.
The department directors would take turns leading a team of young doctors to walk through the wards of other departments.
They would review cases and discuss them.
In essence, it was a teaching activity.
But in reality, everyone knew that these cross-departmental rounds were also occasions for departments to subtly compete with one another.
Whose case management was excellent and whose diagnosis had flaws would all be brought to the table for discussion during these rounds.
When it came to matters of reputation, no one wanted to lose.
...
12:40 PM.
Lu Chen met Director Li Sen at the entrance of the Emergency Department.
Director Li Sen was wearing a new white coat today and looked to be in good spirits.
Following behind him were Zhao Yaqin and Wu Fan.
"Let's go. Today we're rounding in the Department of Gastroenterology and the General Surgery Department."
The group walked toward the inpatient building.
On the way, Director Li Sen gave a few brief instructions.
"For today's rounds, Director Feng from the Department of Gastroenterology will lead the team, and Deputy Director Qin will be there for General Surgery. They're all familiar faces, so you don't need to be nervous."
"Understood."
Zhao Yaqin added in a low voice from the side.
"Director Feng's relationship with our department is okay, but you should be careful with Deputy Director Qin."
"Why?"
"Deputy Director Qin doesn't get along with Vice President Zeng. They even had an argument during the last hospital administrative meeting. You're currently labeled as one of Vice President Zeng's people, so he probably won't look at you too kindly."
Lu Chen frowned slightly.
"What label do I have?"
Zhao Yaqin glanced at him.
"The whole hospital knows that Vice President Zeng approved your exceptional promotion."
"Regardless of what you think, in the eyes of others, you are on Vice President Zeng's side. You must be aware of this."
Director Li Sen spoke up from the front without turning his head.
"Just do what you need to do. What others think is their business; just demonstrate your professional level."
"Understood."
...
The rounds in the Department of Gastroenterology went very smoothly.
Director Feng was an old professor in his fifties with a gentle personality and patient explanations; he had a stellar reputation for teaching.
They reviewed three cases, all of which were typical cases of gastrointestinal bleeding.
Lu Chen didn't say much throughout the process, simply observing, recording, and learning quietly.
During the rounds, Director Feng asked him a question about the differential diagnosis of upper gastrointestinal bleeding. He answered clearly and logically, and Director Feng nodded in satisfaction.
"Li Sen, this young man from your Emergency Department is quite good."
"As he should be. You flatter him, Director Feng."
After finishing in Gastroenterology, the group moved to the General Surgery Department.
The General Surgery ward was on the fourth floor of the inpatient building.
As soon as the elevator doors opened, Lu Chen saw a group of people standing at the end of the corridor.
Quite a few people had come from General Surgery.
Deputy Director Qin stood at the very front. He was in his forties, with a square face, a sturdy build, and gold-rimmed glasses, looking very authoritative.
Behind him stood seven or eight doctors, including Attending Physicians, Resident Physicians, and several Resident Trainees.
It was quite a lineup.
Director Li Sen took a look, his expression unchanged.
"Director Qin, sorry to keep you waiting."
Deputy Director Qin smiled slightly.
"Director Li is too polite; we just arrived as well."
The two shook hands.
They were being polite, but there was an indescribable layer beneath that politeness.
Zhao Yaqin was right.
They didn't really get along.
"How many cases have you prepared for discussion today?" Deputy Director Qin asked.
"We'll just follow the procedure. We'll look at whatever you've prepared," Director Li Sen said.
"Alright, then let's start with the patient in Bed 401-3."
The group walked into the patient room.
Bed 401-3 was a male patient in his early fifties who had been admitted for a week with a chief complaint of recurring abdominal pain.
Deputy Director Qin signaled one of his Attending Physicians to report the case.
The Attending Physician stepped forward, medical record in hand, and began to read.
"The patient is a fifty-two-year-old male, admitted a week ago due to recurring right lower quadrant pain accompanied by nausea and vomiting. Upon admission, physical examination showed slight tenderness in the right lower quadrant, with no significant Rebound tenderness. Complete blood count showed a slight increase in white blood cells. Abdominal CT suggested intestinal flatulence, with no obvious space-occupying lesions observed."
"What is the current diagnosis?" Director Li Sen asked.
"Irritable Bowel Syndrome, combined with functional dyspepsia."
Director Li Sen nodded and said nothing.
Lu Chen stood behind Director Li Sen, listening quietly.
But the moment the Attending Physician began reading the medical record, his eyes were already on the patient in the bed.
[Eye of Truth] activated automatically.
The patient's body turned into a three-dimensional holographic image in his eyes.
The digestive tract, liver, gallbladder, pancreas, spleen, and retroperitoneal structures unfolded layer by layer.
Then, he saw it.
The ileocecal region in the right lower quadrant.
The appendix.
A swollen, congested appendix, its surface covered with purulent moss.
It was flashing with a piercing red light.
[Eye of Truth Scan Complete]
[Patient Information: Male, 52 years old]
[Chief Complaint: Recurring right lower quadrant pain with nausea and vomiting for one week]
[Eye of Truth Diagnosis: acute exacerbation of chronic appendicitis]
[Danger Level: Medium-High]
[Current Symptoms: Appendiceal lumen obstruction, mucosal congestion and edema, purulent moss formation on the serosal surface, slight adhesion of surrounding tissues]
[Recommendation: Surgical removal of the appendix; delay carries a risk of perforation]
[Warning: Current conservative treatment direction is incorrect; immediate correction of diagnosis is required]
Lu Chen's pupils contracted slightly.
acute exacerbation of chronic appendicitis.
Not Irritable Bowel Syndrome.
General Surgery had diagnosed appendicitis as Irritable Bowel Syndrome?
This diagnostic direction was completely wrong.
The patient had already been admitted for a week. If they continued to treat it as Irritable Bowel Syndrome, the appendix could perforate at any time.
Once perforation led to diffuse peritonitis, the consequences would be extremely severe.
Lu Chen took a deep breath.
Director Li Sen had just said to learn more, observe more, and talk less.
But if he didn't speak up, something might happen to this patient.
It was a choice.
Be obedient, keep his mouth shut, and not cause trouble.
Or speak up and correct the misdiagnosis, but potentially offend the entire General Surgery Department.
Lu Chen thought for about three seconds.
Three seconds later, he spoke.
"May I ask, has this patient had a specific examination for the appendix since admission?"
Everyone's gaze turned toward him at the same time.
The Attending Physician who had reported the case frowned.
"And you are?"
Deputy Director Qin swept a glance over Lu Chen.
"From the Emergency Department?"
Director Li Sen turned to look at Lu Chen.
There was a hint of surprise in his eyes, but he didn't stop him.
"I am Lu Chen, a Resident Physician from the Emergency Department," Lu Chen said.
"A Resident Physician?" Deputy Director Qin's tone carried a subtle edge. "What are your thoughts on this case?"
"I would like to confirm if there was a specific description of the appendix in the patient's CT report."
The Attending Physician flipped through the medical record.
"The CT report states intestinal flatulence with no obvious space-occupying lesions; the appendix was not specifically described."
"Then has an abdominal ultrasound been performed?"
"It was done. The ultrasound report showed no obvious abnormalities in the abdominal cavity."
Lu Chen nodded.
"Then I'll take the liberty of asking, has the patient's McBurney's point tenderness been re-examined?"
The Attending Physician's expression changed.
"What do you mean?"
"I mean that the patient's symptoms are highly consistent with the clinical characteristics of an acute exacerbation of chronic appendicitis."
The room fell silent for a moment.
Deputy Director Qin's eyes narrowed slightly.
"You, a Resident Physician from the Emergency Department, come to our General Surgery ward and tell us our diagnosis for our own patient is wrong?"
The tone wasn't heavy, but the weight of the words was significant.
Lu Chen's expression did not change.
"Director Qin, I just feel it's necessary to rule out an issue with the appendix. The patient has had recurring right lower quadrant pain for a week, a slight increase in white blood cells, and nausea and vomiting. With this combination of symptoms, the possibility of appendicitis should not be ignored."
"So you think our department's diagnosis and treatment for the past week have been entirely wrong?"
"That's not what I mean. I am suggesting we add a targeted ultrasound for the appendix or perform an enhanced CT to further clarify."