blogombal Chapter 22 Killing someone by destroying their spirit
Chapter 22 Killing someone by destroying their spirit
When Chen Yisen helped Amber Zheng lie down on the bed, he had already used electrical impedance tomography to examine her once.
It is definitely pulmonary edema.
Since it's not TACO, it must be non-cardiac pulmonary edema.
Symptoms also include shortness of breath, coughing up frothy sputum, worsening of moist rales in the lungs, and rapid improvement of symptoms after oxygen therapy, all of which are similar to TACO symptoms.
Chen Yisen quickly began brainstorming.
This time, he not only used the original owner's memories, but also his own.
Fortunately, I quickly recalled a case I encountered many years ago when I was doing my internship in a company.
Transfusion-related acute lung injury (TRALI).
Its outward appearance is very similar to TACO, but the reasons are completely opposite.
Anti-leukocyte antibodies or bioactive lipids in donor plasma trigger pulmonary inflammatory storms in recipients, leading to increased pulmonary capillary permeability.
Simply put, it means the lungs are leaking (TACO means the lungs are blocked).
Therefore, it manifests as hypotension and non-cardiac leaky pulmonary edema.
Because the production, storage and use of modern blood products are quite standardized, and there is a systematic white blood cell antibody screening process, doctors of Chen Yisen's generation are less likely to encounter similar cases.
Emergency blood transfusions under extreme conditions increase the associated risks.
Unexpectedly, he ran into me on my first day of work at Xida University.
Chen Yisen quickly began the physical examination according to the new approach and found that Amber Zheng did not have jugular vein distension or lower limb edema.
Another electrical impedance tomography (EIT) was used, but no liver enlargement was found.
Now, it's basically confirmed.
Chen Yisen disliked Gao Hua, who was a disgusting person like Amber Zheng, but since he had started treatment, he wouldn't deliberately kill the person.
Moreover, homeless shelters are not hospitals; if someone dies there, it involves two administrative systems, which is very troublesome.
It would be better to refer her to another doctor and just let it go.
He thought for a moment, then gestured for Nurse Brown to stop what she was doing: "Brown, that's enough."
The latter looked up in surprise, only to see that Chen Yisen had already picked up the iPad.
It's obvious they're preparing to enter medical records.
"No...it's diagnosed already?"
Brown is a licensed nurse (NP), which is one level above a regular registered nurse (RN).
After 2025, New York State will allow licensed nurses to practice independently, but they will be subject to a collaborative agreement framework.
In most cases, they can prescribe medications completely independently, just like licensed physicians.
The real hurdle is that you need to go through a transition period of 3000 valid certification hours.
That's why he was willing to be assigned to such a godforsaken place.
If you can endure for two years, you can defy fate and change your destiny.
Brown has always believed that while he may not be as good as the big shots at private hospitals, he is on par with ordinary doctors at community clinics.
But watching Chen Yisen's entire day of diagnosis and treatment shattered his worldview.
Is this what the world of doctors is like?
Can't afford to provoke...
Chen Yisen, of course, had no idea that he had almost crushed a young man's professional confidence. He simply explained, "A confirmed diagnosis would require testing for B-type natriuretic peptide, which we don't have the facilities for, but a referral is sufficient."
After saying that, he glanced at Amber Zheng, who was still unaware of what was happening on the bed, and lowered his voice to say, "Go and call 911 and get an ambulance."
"what?"
Brown paused for a moment, then quickly pulled out his phone and ran out the door.
"Normally, the use of the emergency access channel requires the consent of the patient or their family."
However, if a doctor determines that the situation is particularly urgent, they can make a decision directly.
After watching Brown leave, Chen Yisen opened his iPad, logged into the system, and began writing a referral form.
"Dr. Chen, you...have you figured it out?"
"Transfusion-associated acute lung injury, simply put, means that the blood you received contained some anti-leukocyte antibodies... You can think of it as a substance that triggers a defensive response in your body. In the process of eliminating antigens, the immune system also messes up the entire lungs, so you feel short of breath and have a severe cough."
What's both infuriating and amusing is that Amber Zheng, upon hearing the conclusion, not only showed no fear but seemed quite pleased.
It seems that this proves that the blood transfused into them has truly had a "blood exchange" effect.
For a fleeting moment, Chen Yisen even considered calling Brown back from outside.
That's fucking insane.
Tired, destroy it.
But the other party had already ended the call. Lincoln Hospital's ambulance usually only takes 10 minutes to get here, so it was too late to say anything.
"Ms. Zheng, there's something... I feel I need to explain it to you."
He may be spared the death penalty, but he cannot escape punishment.
Chen Yisen decided to deliver a blow to the heart.
"You say it." Amber Zheng had calmed down now and returned to her previous rather irritating demeanor.
"This disease... is extremely rare," Chen Yisen began, "The female doctor this morning probably had never encountered it before, which is why she didn't consider this possibility."
Amber Zheng meant he was going to talk about dealing with Natalia, so he immediately nodded: "Don't worry, I'll report her... but don't forget to investigate her background. Only by combining the two things can we really affect her."
"No, no, no." Chen Yisen waved his hand. "What I mean is that the process of collecting and storing blood itself removes some of the anti-leukocyte antibodies, so most blood products, even those from unofficial channels, will not be enough to trigger an immune storm... unless you are drawing someone else's blood directly into yourself through a tube."
"Of course not..." Amber Zheng said impatiently, "So what are you trying to say?"
"Based on... some clinical experience, only one group of people's blood, even after basic processing, remains a high-risk factor for transfusion-related acute lung injury." At this point, Chen Yisen's lips couldn't help but curl upwards, "Those are middle-aged women of Caribbean descent who have had multiple... at least four or more pregnancies..."
This part has nothing to do with the previous life; it was something the original owner saw in an unpublished paper.
Because the entire study was suspected of racial discrimination, the results were never officially published.
However, considering the large sample size, the incidence of some blood diseases in the Caribbean region is indeed abnormal, so the conclusion should be correct.
"..."
A look of confusion flashed across Amber Zheng's face.
Then came profound astonishment, which finally transformed into anger and shame.
She had just boasted about her requirements for custom blood products: white, female, under 35, and childless.
What they actually received was: Caribbean descent, middle-aged, multiple pregnancies...
It's fair to say that everything except the gender doesn't match up.
in other words.
She was fooled and treated like a fool.
"No—impossible!"
The sharp voice mixed with wet, raspy sounds startled even Chen Yisen, who was prepared.
"Also, there's one more thing," he continued, "Transfusion-related acute lung injury is a self-limiting disease... meaning that even if you leave it alone, it will usually recover naturally in three to four days."
"However, due to the misjudgment of Dr. Natalia Lynch, whom you specifically chose this morning, she prescribed a large dose of furosemide, a diuretic, for cardiogenic pulmonary edema. This further reduced your already low circulating volume, leading to mild hypotension and... a very high probability of kidney failure."
For a moment, the room was eerily quiet.
The only sound was the "ho-ho-ho" sound that accompanied Amber Jung's every breath from his lungs.
"But...you don't need to worry too much." Chen Yisen shrugged. "I've already prepared the referral form for you and called an ambulance. Judging by the time, you should be here by now..."
Before the words were even finished, the sound of police sirens was already approaching from afar.
"ambulance?"
Upon hearing this keyword, Amber Zheng immediately shuddered.
The ambulance took her to the emergency room, but this was not included in her normal referral insurance reimbursement and fee reduction list.
Her stocks won't be available for cash until early next year. If she signs a contract for an exorbitant rescue fee at that time, the compounding interest will likely mean that the money she earns will be handed over to someone else.
"No, you can't..."
"It's my duty as a doctor, Ms. Zheng," Chen Yisen sighed. "Kidney failure can turn into an acute condition at any time and is very likely to be fatal, so I can't let you go and transfer you on my own; that would be too dangerous."
Then, feigning innocence, he said, "Besides, you mentioned this morning that you had a huge amount of stock profits... so the medical system and I agree that we should open an emergency lifeline for you..."
That was exactly what he wanted.
For doctors, calling an ambulance to transfer patients to another hospital is the safest and least risky option.
Moreover, it could cause Amber Zheng to lose a large sum of money.
Even if she did make a fortune in the stock market, she would have absolutely no chance of making a comeback...
As they were speaking, paramedics in dark blue uniforms rushed in with a stretcher.
The leader approached Chen Yisen: "Dr. Chen, right? Is this the patient in bed who needs emergency care?"
"Yes, the referral form is here, I'll submit it to you..." Chen Yisen opened his iPad.
Before clicking submit, he added two more sentences in the remarks column:
1. It is recommended to measure pulmonary artery wedge pressure and B-type natriuretic peptide.
2. The patient was mistakenly given a high dose of furosemide by the previous doctor, resulting in severe volume depletion and likely decreased renal function. It is recommended to immediately perform crystalloid resuscitation and administer glucocorticoids to prevent iatrogenic shock.
Attending Physician: Ethan Chen (in cursive English).