When the Doctor Uses A Hack

Meng Xi took the medical record folder from Chen Cang and casually flipped through the lab reports and imaging results.

Then, bending over, he said to the patient, “I’m going to examine you, lie flat and keep your hip and knee joints extended.”

Meng Xi held the patient’s ankle in his left hand and took out a pen from his pocket, using the blunt end to swiftly draw a light stroke from the lateral plantar region forward to the base of the little toe, and then turned towards the side of the big toe.

The patient’s big toe dorsiflexed and the other four toes spread apart in a fan shape.

Chen Cang gave a start – a positive Babinski sign?

A slight smile appeared on Meng Xi’s lips. Although he had not yet made a definite diagnosis, he already had a fairly good idea.

The patient seemed a bit anxious, “Doctor… what’s wrong with me? Why did my hands and feet suddenly start twitching?”

Meng Xi reassured, “It’s okay, don’t worry. I’m waiting for Doctor Ge to bring the lab report.”

Meng Xi could actually make a conclusion now, but to be on the safe side, he still wanted to wait for the lab results to come out.

A group of graduate students in clinical training, dressed in white coats and holding notebooks, nervously entered the ward, also curious as to what kind of heart disease could cause convulsions?

After entering, they obediently lined up against the wall, leaving the aisle on both sides of the bed clear, fully aware that they wouldn’t be able to help if the patient had any complications—these spots near the bed and in the aisle were prime positions, reserved for the experts.

They were there just to quietly observe the experts in action!

Soon after, Ge Huai came running in with a long string of lab results, not even having had the chance to tear them apart.

“Director Meng, take a look, here are the lab results.”

Meng Xi took the lab results, scanning through them quickly, and relaxed – just as he had suspected.

Meng Xi asked Ge Huai, “What medications have been administered these past few days?”

Ge Huai paused, slightly taken aback, “Currently, we are mainly using digitalis, along with diuretics, to prevent heart failure.”

After hearing this, Meng Xi frowned and turned to ask, “What were your treatment considerations after the patient was admitted to the ward?”

With Meng Xi’s question, the atmosphere in the room suddenly grew serious!

Caught off guard by Meng Xi’s question, Ge Huai was momentarily at a loss for words, “The patient’s ECG showed ST-segment prolongation, low T-waves and the echocardiogram clearly revealed an enlarged ventricular cavity, thickened septum, reduced pulsation, as well as mitral valve regurgitation and significant pericardial effusion. So, I considered primarily treating the heart condition since the lab results weren’t out at the time…”

Before Ge Huai could finish explaining, Meng Xi interjected, “Now the results are here, take a look. What do you think is the situation?”

Ge Huai’s face turned red; he had already understood on his way over, “This is likely due to the combined effects of low calcium and low blood magnesium levels, which caused excitability-contraction coupling in the myocardial fibers, and the low calcium affecting the electrophysiological properties of cardiac muscle cells, inducing arrhythmia.”

“The patient has had long-term hypocalcemia, which should be the main cause of abnormal limb sensations or muscular cramps and even convulsions.”

The surrounding graduate students suddenly had an epiphany.

So that’s how it is!

Without commenting, Meng Xi turned to Chen Cang, “What should the normal blood calcium level be, and specifically, what is its use?”

Chen Cang was taken aback. You’re making me show off again…

My physiological and biochemical metrics are under the tutelage of Professor Fang Yonglin; this is one of the only two perfect-level skills I possess!

Without any hesitation, Chen Cang blurted out, “The normal blood calcium level in adults is 2.25~2.75 mmol/L. Calcium in the body has important functions: it is an essential component of bones and teeth. It also helps to maintain the normal function of nerves, muscles, and the myocardium, and lastly, it is involved in blood coagulation.”

Meng Xi looked at Chen Cang askance, his face calm and somewhat surprised.

The surrounding graduate students were flabbergasted – had this big shot rehearsed beforehand?

Definitely!

Ever since you started your shift today, this is the third time you’ve showed off.

There’s a limit to everything… Aren’t you going a bit too far?

You’re making us graduates look like fools…

You must have reviewed the materials or rehearsed in advance – today looks like a staged play.

The students felt a twinge of emotion. Are you not considering our feelings at all in your showboating?

Memorizing the normal blood calcium levels while we’re still memorizing routine blood tests – are you already on to memorizing electrolyte values?

Memorizing indicators is one of the essential qualities required of clinical medical students, especially in emergency medicine, where one should have a good grasp of common lab reports.

Meng Xi handed the lab report to Chen Cang, “Take a look. What information can you gather from the lab report?”

Chen Cang casually reviewed the lab report and immediately furrowed his brow slightly.

This might not be a simple heart condition.

Chen Cang looked up slightly, “Professor Meng, this might be a case of hypoparathyroidism-induced cardiopathy!”

Upon hearing this, Meng Xi could not help but pause.

The surrounding group of students looked at each other bewildered, exchanging glances in confusion.

“What is this thing?”

“Don’t look at me, how the hell should I know what this thing is!”

“I know about the parathyroid glands, and I know about heart disease, but why don’t I recognize them when they’re lumped together?”

“What are you staring at, staring at me is going to make me get it?”

After gazing for a long time, everyone reached a final consensus!

This guy is going to put on a bigger act than all of the first three combined!

Are we, a group of graduate students, really going to be upstaged by an undergraduate???

At this thought, everyone felt an overwhelming sense of loneliness and desolation…

When Ge Huai heard what Chen Cang had said, he suddenly recalled the term!

A very rare disease!

He hesitated for a moment, then hurriedly took over the lab report, scrutinized it carefully, reflected for a while, and connected it with all the patient’s symptoms. The more he looked, the clearer and more alarming it became!

Finally, he had an epiphany!

Right!

Why hadn’t he thought of it himself?

This kid is really impressive!

Meanwhile, Chen Cang was somewhat stunned; he noticed nobody was paying attention to him. Did he perhaps lack an audience?

Shouldn’t there be some voices of doubt?

I’m putting on such an act; there should at least be someone for me to prove wrong.

After waiting a few seconds and seeing no one spoke, Chen Cang couldn’t help feeling disappointed.

This act, five out of ten… not passing!

Nevertheless, Chen Cang still felt they should finish speaking, “The patient may have idiopathic hypoparathyroidism. This disease is rare, but usually sporadic and linked to immunity. According to the laboratory indicators, although the proportion of the patient’s lymphocytes is normal, this ratio is very similar to that of patients with idiopathic hypoparathyroidism.”

“The patient’s blood calcium is only 1.9, phosphorus elevated to 1.59, and blood serum immunoactive parathyroid hormone is virtually undetectable.”

“A reduction in the patient’s PTH can affect myocardial contractility, and just as Professor Ge said, low blood calcium and magnesium affect myocardial fibre contraction. Therefore, I suspect it is hypoparathyroid heart disease.”

“When calcium is low, the excretion of sodium ions decreases, and the retention of water and sodium can increase the cardiac burden. The patient already has reduced renal function, so… looking at it this way, Professor Ge’s treatment is not problematic.”

“However, if we were to combine it with some calcium supplementation, such as oral vitamin D3 or Rocaltrol, the effect might be even better, and it might even alleviate the heart failure!”

After Chen Cang had finished speaking in one breath, he couldn’t help but sigh. Flexing without an audience to prove wrong is utterly meaningless…

No sooner had Chen Cang finished speaking—

Applause broke out from outside the door.

“Good! Good! Good!”

Xia Gaofeng walked in excitedly, his eyes brimming with pleasure and joy. Indeed, a truly outstanding talent—a one-in-a-million thoroughbred!

To be frank, it had been a long time since Xia Gaofeng had encountered such an insightful and capable student.

That wasn’t an exaggeration at all.

Firstly, his practical skills were extremely strong, with a good foundation in suturing, and now his analysis of diseases, especially the analysis of physiological biochemical laboratory indicators, was thorough to the utmost extent.

These abilities, when combined and analyzed, could fully reveal a person’s clinical thinking and surgical talent!

At that thought, Xia Gaofeng watched Chen Cang with satisfaction: “Not bad! Your analysis is quite reasoned!”

At Xia Gaofeng’s level, many diseases are crystal clear to him, having seen too many, even a rare disease like hypoparathyroidism didn’t seem so unusual.

But for Ge Huai, it might indeed be very rare.

What should one fear about diseases?

It’s the combination that’s frightening!

Once a bunch of diseases are stacked together, it becomes very difficult to clearly discern the patient’s real condition.

Yet Chen Cang was able to analyze hypoparathyroid heart disease from a cardiothoracic lab report.

That was truly commendable!

Alas…

The thought that such a student wasn’t his filled him with pain.