thefictionvixens Chapter 32 The Patient's Life Hangs by a Thread
Chapter 32 The Patient's Life Hangs by a Thread
My first day at work after being reborn.
The first patient we treated.
It's a super bomb.
If Chen Yisen hadn't had the experience from his previous life, he would most likely have prescribed some antacids and sent the person away.
Even if he were on high alert, without the help of some unreasonable genius, he would most likely treat it as a regular heart attack and prescribe nitroglycerin to the patient.
That could even cause the patient to go into shock.
The situation of a patient dying from a misdiagnosis on the spot is completely different from a patient dying after leaving the clinic.
This kind of thing weighs a ton even without being weighed.
At least a thousand aspiring young lawyers would be vying to help with a case.
"I somehow managed to turn a crappy shift at the clinic into a thrilling and nerve-wracking experience."
After seeing off the Dominican old man, Chen Yisen silently complained to himself.
As for Shanis's translation error, he did not immediately make a fuss about it.
The main problem is that there's no concrete evidence.
No matter how much I didn't get along with Natalia before, we wouldn't hold each other back when it came to medical treatment.
This gave him the illusion that "everyone here is a respectable person," and he assumed that it would be the same at the clinic.
Fighting is one thing, but business shouldn't be taken lightly.
Therefore, recording is always initiated after the consultation has begun, mainly to prevent the patient or their family from causing trouble.
Who knew that someone would actually treat patients like dirt, willing to kill a sixty-year-old man on the spot just to drag him down with them.
Furthermore, Chen Yisen did not believe that such a big matter could be handled by a mere nurse like Shanis on her own.
Not even the head nurse outside would have the audacity to do that—
Zulika must have known about all of this today, and may even have been indirectly involved, but she could not have been the instigator.
There has to be a head of internal medicine or a head of medical affairs backing them up.
Therefore, before an effective counterattack can be launched, simply driving Shanis away will not only fail to solve the problem, but will also make the already controllable risks uncontrollable again.
It's better to pretend you don't know anything first, gather enough evidence when the other party makes a move again, and then crush them in one fell swoop.
Starting with the second patient, Chen Yisen secretly began recording the conversation ahead of schedule.
But it's unclear whether Shanis became more vigilant or if the person behind it didn't want to make it too obvious.
Until that afternoon, all the patients assigned to Chen Yisen's group were normal.
Occasionally, there would be one or two people who couldn't speak English very well, but these were usually for minor issues like wound cleaning or for routine prescriptions from patients with chronic illnesses who had already registered. There was simply no room for Shanis to make a difference.
As for the basic procedures of a nurse, as long as the examination forms and prescriptions issued by Chen Yisen are correct, then messing around at the execution level is tantamount to suicide.
So there's no need to worry.
And so, the two people, each with their own ulterior motives, managed to work together smoothly until almost the end of the workday.
Until a roar erupted from the waiting room.
"My bones are screaming, I need that D!"
The source of the sound was a chair.
On top was an oversized jacket, much larger than a normal person's size, and on the ground was a pair of yellow ankle boots that were clearly disproportionate to the person's height.
At first glance, it looks like a lump of clothes.
Only when you get close can you see that he is actually a curled-up person.
A young Black man in his early twenties with a buzz cut.
This guy's English is quite good; Chen Yisen could hear him shouting at the top of his lungs even in the waiting room.
Soon, the person repeated it a second time.
"I need that D!"
But the volume was much lower than at the beginning, as if it couldn't handle it.
Chen Yisen was the only doctor who did not have any patients at the moment.
This patient was naturally manually assigned to his name.
"What's going on?"
Seeing that the other person was no longer able to move on their own and was slumped in the chair screaming in pain, Chen Yisen had no choice but to go outside with Shanis.
Fortunately, because it was close to closing time, the waiting hall was much emptier than during peak hours.
The groans only kept the remaining patients at a distance and did not cause much chaos.
The Black man was still conscious. Seeing a doctor approaching, he immediately moved closer and said, his voice trembling slightly:
"I feel a lot of pain, I need D."
Chen Yisen then realized that the "D" the other party mentioned should refer to Dilaudid.
A highly targeted, long-acting pain reliever.
Shanis soon came over with her tablet and reported the basic situation to Chen Yisen:
"The patient's name is Demia Rodriguez..."
Chen Yisen turned around, somewhat puzzled, seeing that the other person had only mentioned a name:
"and then?"
"That's all." Shanis shook her head first, then tugged at Chen Yisen's arm, signaling him to speak to her privately.
"This Jamia has a record of requesting painkillers more than ten times at several community clinics. He was refused about 55% of the time, and those who weren't refused basically gave him the medication..."
Chen Yisen immediately became alert.
This is Shanis implying that she is trying to influence her own judgment.
Just like the first patient in the morning.
He subtly increased the recording sensitivity and pretended not to understand the other party's implied meaning.
"What do you mean?"
Seeing that Chen Yisen looked completely clueless, Shanis had no choice but to be blunt: "This record, and his attire... he's probably here to scam drugs."
In fact, Chen Yisen had the same concern just now—
The patient's needs were very clear.
Hydromorphone has a lower profit margin and is more troublesome to use, unlike fentanyl tablets which are relatively easy to buy on street corners.
So if someone really has this kind of taste, then they do have a strong motive to come to the clinic to scam medicine.
But Shanis's words changed his mind.
If this guy offers you advice, you have to be extremely wary.
Chen Yisen didn't waste any more words with Shanis and directly took the iPad from her hand.
First, I quickly checked the electronic medical records.
Indeed, as Shanis said, the record only contained a dozen or so detailed entries requesting painkillers due to various pains, with no other useful information.
Then, at the fastest speed, I pulled up an anatomical diagram of the human body with numbers marking the approximate locations and sections.
Even patients who have never studied medical English and cannot name the specific parts of their bodies can be given relatively accurate descriptions.
Where does it hurt? Or where is the pain most intense?
Chen Yisen placed the tablet in front of Jamia and asked loudly.
后者勉强凑到近处看了一眼，然后报出了一串数字：「3、5、11、13、17……」
These correspond to the knees, elbows, and hips, respectively.
Chen Yisen glanced meaningfully at Shanis beside him.
This answer alone can largely eliminate any suspicion of drug fraud.
Because people who fake pain are almost never mentally prepared to answer this kind of question beforehand, they will basically only give a vague answer that they are in pain all over their body. Or they will point to a specific area that is easiest to inject medicine into, such as the vein in their arm.
In the few dozen seconds that followed the question and answer, Jamia's condition seemed to have worsened considerably.
Through the collar, which was almost thicker than a normal person's waist, Chen Yisen could see the patient's chest rising and falling with an astonishing amplitude and frequency.
The respiratory rate was conservatively estimated to be over 40 breaths per minute, and the heart rate, roughly measured by palpation, had soared to at least 120 beats per minute.
"Head Nurse, Andrew!"
This situation was much more critical than the old man's situation that morning, so Chen Yisen didn't dare to be too overconfident and only let Shanis help him. So he directly called on Nurse Zulika and a medical assistant.
Intentionally misleading doctors into making a misdiagnosis is a federal felony if it is verified.
Therefore, the execution level cannot involve too many steps.
Apart from the instigator and Shanis herself, most others simply acquiesced.
It's impossible to actually put yourself in that situation.
Bringing in more people is a very effective way to mitigate risk.
"Shanis isn't strong enough, you two help me move her to the temporary observation room!"
None of the community clinics have inpatient wards, but the Morissania clinic is so large that it often encounters special situations, so it has a few wards for temporary (within 48 hours) observation.
As the attending physician, Chen Yisen still had the authority to command the nursing staff in the command center during such a critical situation.
Moreover, the clinic was already close to closing down, and the two people who were designated didn't have any other work to do.
"good!"
Zulika nimbly emerged from behind the nurses' station, while Andrew pushed over a wheelchair.
Both of these staff members were experienced veterans, and given the patient's extremely thin physique and the fact that he was not completely unconscious, they quickly moved him to the medical bed.
There were two patients in the observation room who were about to finish their intravenous infusions. Dr. Lyndon Rojas, who was nearing the end of his work, also came over, seemingly wanting to see Chen Yisen's treatment process.
While helping to lift the person, the latter used electrical impedance tomography to examine Demia's elbows and knees.
No obvious abnormalities were found.
This indicates that there is no problem with the structure of these parts.
Rather, it is a symptom caused by a certain disease.
When Chen Yisen looked up again, he noticed that Jamia's lips had turned a strange dark reddish-brown.
Based on Omar's previous experience, he knew that due to skin color, some typical skin color variations of Black people were different from what he was familiar with.
Therefore, he directly pulled Demia's arm out of the wide sleeve, and at the same time gave instructions to the other two:
"Shanise, cut the patient's clothes open!"
"Andrew, check the patient's blood pressure and heart rate!"
"Head Nurse, prepare hydromorphone for intravenous injection!"
Although it was still unclear what disease Jemia was suffering from, Chen Yisen had already activated his instincts as a battlefield medic from his previous life, and began to treat her methodically amidst her groans.
Shanis and Andrew immediately began to act according to Chen Yisen's instructions.
But Nurse Zulika was in a bit of a dilemma:
"Dr. Chen, the DEA has been strictly reviewing the distribution of hydromorphone in community healthcare institutions recently, so regulations require a reasonable explanation before its use... How about switching to something else?"
Chen Yisen didn't have time to dwell on why the Narcotics Control Bureau was targeting a specific opioid painkiller while ignoring other similar drugs. He quickly revised his request: "Then tramadol, 50mg, intramuscular injection!"
While Zulika went out to get her medicine, Chen Yisen refocused his gaze on Jamia's fingertips.
Even among Black people, this part of the skin is relatively lighter, making color changes easier to spot with the naked eye.
Sure enough, the nail bed covered by the fingernail was noticeably purple.
Based on the changes in the lips, it can be determined that the patient has developed obvious cyanosis.
A sign of insufficient oxygen supply.
At this point, the results of the two basic tests were also displayed.
"Blood pressure 90/55 mmHg, heart rate 144 bpm!"
Chen Yisen nodded to indicate that he understood, and then gave a new instruction: "Andrew, check the patient's pulse oximetry!"
Soon, Zulika returned to the observation room with the medicine and quickly injected tramadol into Demia's upper arm.
"Pulse oxygen concentration is 96%," Andrew reported.
This number made Andrew, who had already begun preparing for nasal cannula oxygen therapy, hesitate.
The figure of 96% is "lower than normal," which doesn't seem to indicate that oxygen therapy is needed.
But Chen Yisen didn't care about any of that: "Prepare pure oxygen at 3L/min!"
With the combined administration of painkillers and oxygen, Demia's struggles and groans gradually subsided.
"Draw blood, do a basic blood test...and check blood type and antibodies."
After initially controlling the symptoms, Chen Yisen finally had time to investigate the cause of Demia's illness.
However, the good times did not last long.
Before the blood test results could even be available, just over ten minutes later, Demia's vital signs began to fluctuate violently again.
Blood pressure dropped further to 81/50 mmHg, and heart rate continued to exceed 170 bpm, reaching a dangerous threshold.
"The patient is confused and could go into shock at any moment!"
Even Zulika, a veteran of countless battles, sounded somewhat flustered at this moment.
Everyone in the observation room turned their attention to Chen Yisen.
"Dr. Chen, what should we do?"