Chapter 124124 The Great Scholar Debates for Me
Take action as soon as you think of it. Xu Duan accompanied Jin Yue out, but they didn't go to find Director Li or Shi Xuehai. After all, Old Jin's condition was not critical. Jin Yue was not in a hurry and didn't want to mobilize a large number of people in the middle of the night, so she decided to sleep first.
They found a store that could make international calls and called Lin Zhen, who was on the other side of the ocean, to ask her for a favor.
The next morning, she had just arrived at the conference room and had not yet found Director Li to tell him her ideas, when she saw Director Li, Shi Xuehai, and a group of vice presidents and directors of the association gathered together, talking about something anxiously.
Not every director of the hematology department in every province and city can join the national association, and even fewer can become vice presidents. Several of them had gone to the street office to find Jin Yue in the past, and they had spoken well of Jin Yue in the past two days.
Jin Yue was grateful to them and kept paying attention to their expressions. He saw Director Li said something and several people looked surprised, then embarrassed and anxious, and some even looked in Jin Yue's direction.
The more I think about it, the more likely Lao Jin's situation may have changed.
Sure enough, within two minutes, Shi Xuehai and Director Li came to her side in a hurry, "Doctor Shu, I wonder how you thought about it last night?"
Jin Yue didn't say that he already knew the truth, wanting to see what they were going to say, "I have some clues, but it needs further verification. What happened to Lao Jin?"
"Yes, he is not in good condition. After we left yesterday, he fainted three times. So far this morning, he has fainted twice. Each time, his blood pressure rose and he lost consciousness."
Generally, fainting is accompanied by low blood pressure, but Lao Jin’s situation is different from the “norm”.
"Director Li has been giving him blood pressure medication for two days, but his blood pressure is normal when he's not dizzy. The effect is quite good. He said that before he fainted, the roof was spinning, and people and objects were upside down. When I measured his blood pressure, it was indeed high."
Director Li chimed in, "In his own words, he felt a surge of blood rushing to his head, and then he passed out all of a sudden."
This description is quite vivid.
When Shu Jinyue heard that the symptoms and frequency before fainting were basically consistent with her speculation, she was 95% sure that she was right!
She said that these are obviously two unrelated diseases, but she just feels that there must be some internal logic. Whenever this "intuition" that goes against common sense is very strong, it means that she is really right.
"Yesterday, we suspected that he had cerebrovascular abnormalities or a brain tumor. We did a cranial imaging test on him and also did an EEG, and the results showed that everything was normal."
Shu Jinyue thought that any further examination would be useless because this was not a "brain" problem at all!
"Doctor Shu, we have thought of all the methods that Western medicine should use. We have also seen your skills and admire them deeply. Can you see if there is anything else that Chinese medicine can do?"
Shu Jinyue looked thoughtful: "I can give it a try, but..."
"Are you worried about the bet? Don't worry, the bet was our fault for not handling it properly. This matter will be forgotten and no one will mention it in the future. It will not affect your future career at all."
Shu Jinyue laughed. If she just turned the page like that, wouldn’t it be a waste of all her efforts?
"I mean, does the bet still count?"
Shi Xuehai was stunned, "Do you want to continue?"
"Yes, since you have said it, you must fulfill it. Otherwise, it's fine with me, but I'm afraid it will affect Teacher Shi's reputation."
Shi Xuehai's years of self-cultivation could not hide his ugly face. From the first day, those nonsense guys caught his attention, but because he was the leader of the group, he couldn't argue with them and had to endure their nonsense.
To what extent is this nonsense? From saying at the beginning that Jin Yue was the child of his relatives and friends, to later suspecting that he had something to ask of the people behind Jin Yue, and even more outrageously suspecting that he and Shu Jin Yue had an improper relationship between men and women!
If he wasn't the president, he would have wanted to have a fight with these guys who were full of shit and whose minds were full of thieves and whores! Even if he is no longer the president next year, he will have to kick these guys out and ask them to withdraw from the association. They have bad conduct and are full of nonsense. If it weren't for their age, it would be a shame for their hospital to have such people as directors.
Shu Jinyue could naturally guess that some people were like this. When they saw women, especially young women, succeed, they would fabricate rumors about them, otherwise it would seem like they were letting them down for the extra weight they had gained.
As I said, occupation and title cannot screen out scum. Even if they are directors or deputy directors, they cannot hide their heads full of pornographic garbage and dirty thoughts. Otherwise, there would not be so many directors being dismissed every year due to problems in relationships between men and women, and there would not be jokes like "a male surgeon/orthopedic doctor has four wives in his life".
"Teacher Shi, I can tell you the truth. After thinking about it all night last night, I have a rough idea of Lao Jin's situation. I can also solve his problem, but I need to continue the bet."
"Are you sure?"
"Sure."
Shi Xuehai was not one to drag his feet and immediately made the decision, "Okay, then after the class is over, let's go take a look?"
Jin Yue agreed.
Shi Xuehai said something to Director Li, and Director Li's brows immediately relaxed a little. He nodded silently at Jin Yue to express his gratitude.
This class was the longest class in Shi Xuehai and Director Li's 60-year life. When the lecturer finally finished, Shi Xuehai immediately rushed to the stage and tapped the microphone twice, "Wait a moment, colleagues. There is an emergency now."
All the students who were about to leave stopped.
"Mr. Jin, a patient in the Hematology Department of Jing City Hospital, fainted three times last night due to high blood pressure. As of 8:30 this morning, he fainted twice. We need to go to the hospital immediately."
After listening to the class for such a long time, most people were already hungry. When they heard that it was still about Old Jin, they were a little impatient. "Isn't he suffering from tuberculosis? He's already taking medicine. If he has high blood pressure, he should take antihypertensive drugs. If it doesn't work, he should be transferred to the cardiology department. We are not specialists, so it will be useless if we go there."
"We have already consulted with a cardiologist. When he is awake, his blood pressure is well controlled. Before the dizziness occurs, his blood pressure rises suddenly. Antihypertensive drugs are ineffective. We can only wait for his blood pressure to improve on its own."
The person who spoke just now was stunned. He didn't expect that a simple case of high blood pressure would cause so many problems.
"Could it be a vascular malformation or tumor compression in the brain?"
“That’s ruled out, too.”
Old Wang still didn't say anything. He was observing Shu Jinyue, but unfortunately he couldn't see anything. This lesbian is really good at hiding things!
Shi Xuehai looked at the ones who had been shouting the loudest, "Come on, experts, let's go and take a look."
When they arrived at the ward, Lao Jin was sitting on the bed eating lunch. When he saw this group of experts coming again, he quickly stood up.
Director Li quickly held him down and said, "Don't get up. Just sit down. How do you feel today?"
"I was fine when I wasn't dizzy, but when I was dizzy I couldn't stand steadily. I had to close my eyes and lie down, otherwise I would fall down."
Everyone looked at the food in his lunch box. It was a very simple hospital meal, light and nutritious, without any pickles or greasy food.
"What's going on? I'm eating, drinking, defecating and urinating fine, so why am I dizzy?"
"We've checked the heart, brain, liver, and kidneys, but why can't we find the cause of the high blood pressure?"
At this point, everyone turned to look at Shi Xuehai out of habit, but Shi Xuehai looked at Shu Jinyue, "Does Doctor Shu have any clues?"
"Doctor Shu went back and thought about it all night. Could it be that he still thinks that high blood pressure and tuberculosis are related?"
Shu Jinyue looked at the person who said this and smiled faintly, "Yes."
"ah?"
"What?"
Shu Jinyue seemed not to notice the surprise on everyone's faces, as well as the contempt of a few people. "Before that, I would like to ask Teacher Liu a question. Do you think that the Chinese medicines Fangji and Guanmutong contain aristolochic acid, which can cause liver and kidney damage in patients? Then, do Western medicines have similar side effects?"
Teacher Liu was the leader who questioned her that day. At this moment, he looked a little embarrassed and ashamed. "Didn't you say that day that it was all there? Anyway, medicine is three-quarters poison. I didn't say it wasn't there."
He swallowed, "But, I think the side effects of Western medicine are not as serious as those of Chinese medicine. After all, the side effects of Western medicine are very clear. They have been processed and extracted through so many strict processes and are widely used by so many people around the world. If they have side effects, they are written in the instructions. If they don't have side effects, they don't have side effects."
This was such a sophistry that Jin Yue didn't know whether to laugh or not, "Oh, really?"
"Then if I say that Lao Jin's high blood pressure and dizziness are related to tuberculosis, or more precisely, caused by the drugs used to treat tuberculosis, would you believe it?"
"Streptomycin?"
Shu Jinyue nodded. She remembered it very clearly. After taking the anti-tuberculosis drugs yesterday, she specifically looked at the medication records and found that the drug used was streptomycin.
"No, we use streptomycin for tuberculosis. Isn't that the standard treatment? Is it wrong to use it?"
The most widely used antibiotics in this era are penicillin and streptomycin, and streptomycin is not just an ordinary antibiotic, it is also the most important and effective anti-tuberculosis drug. It can be said that if you know isoniazid, you will know streptomycin.
Shi Xuehai, Director Li and others combined the word "side effects" mentioned by Jin Yue just now, and suddenly a light bulb went off: "You mean, Lao Jin, this is a side effect of streptomycin?"
Shu Jinyue nodded.
"We've been using streptomycin for 20 years, and the instructions don't mention any side effects."
"Does streptomycin have side effects?" The leader, Mr. Liu, whispered. The people around him immediately said, "I saw a report saying that it does. It has been discovered abroad, and some hospitals in our country are also aware of it."
"Can you trust things from abroad?" The speaker was an old man who didn't even understand English.
"Clinical pharmacology is advanced abroad, and we are at least 20 years behind them."
Shu Jinyue didn't want everyone to focus on the controversy over which country's pharmacology research was more advanced. She had only one goal from the beginning to the end, which was to present facts and reason.
"Regarding the side effects of streptomycin, I have a statistical research report on the clinical side effects of streptomycin in the past decade issued by Harvard Medical School. Unfortunately, I haven't had time to translate it into Chinese. Teachers can take a look at it. If you are interested, you can find a professional translator."
"What? Harvard Medical School?"
"How did you get this report?"
"Are you studying Chinese medicine or Western medicine?"
…
Shu Jinyue didn't answer. Believe it or not, the report was of course obtained by Lin Zhen from their school last night. It was stamped and signed by an authoritative expert. She faxed it after she found it, and Xu Duan went to the fax machine early in the morning to get it.
"Abroad, streptomycin was discovered and put into clinical use in the 1940s. The person who discovered streptomycin won the Nobel Prize in Medicine/Biology that year. Its efficacy is unquestionable, but as it was put into clinical use, its toxic side effects were gradually discovered and taken seriously by people."
Shu Jinyue paused and pointed to a few bold words on the report: "Mainly ototoxicity, nephrotoxicity, allergic reactions and neuromuscular symptoms. Among them, ototoxicity mainly damages the eighth cranial nerve, which is the auditory nerve."
Hearing this, Shi Xuehai suddenly understood: "The damage to the eighth cranial nerve causes tinnitus, dizziness, and movement disorders. In severe cases, it can lead to hearing loss or even deafness. [1]"
"Yes, that's right!" The others also reacted, and now they understood it all at once. Although Lao Jin's dizziness was accompanied by high blood pressure, it was not necessarily caused by high blood pressure. It was entirely the side effects of streptomycin!
Those who had been clamoring from the beginning that traditional Chinese medicine had side effects that damaged the liver and kidneys were now silent.
First, they had no way of questioning the institution that issued the report; second, the real-life example of Lao Jin was right before their eyes. The miracle medicine that has been used for more than 30 years is such a "poison", and they still have the right to accuse traditional Chinese medicine of being poisonous?
Just like what Shu Jinyue said that day, they allow the officials to set fires but not the common people to light lamps.
But there were still one or two people who refused to accept the news. It was really unpleasant to be slapped in the face by Shu Jinyue, an "outsider". They just didn't believe it. "Okay, let's assume that what you said about the toxic side effects of streptomycin is true. Lao Jin only started using streptomycin yesterday. How do you explain why he started to feel dizzy before yesterday, that is, the night before yesterday? He hadn't used it at that time!"
This time, Shu Jinyue really wanted to sigh, not because of the doubts from his colleagues, but because of Lao Jin.
"Do you remember that when we first came to see Mr. Jin, he had already had vertigo once? That was because he had received professional and continuous anti-tuberculosis treatment in other hospitals before coming to your hospital."
Lao Jin avoided her gaze and didn't dare to meet her eyes.
Shu Jinyue knew that she had guessed right again.
This Lao Jin, a middle-aged man who looks honest, is actually lying!
Director Li was so angry that he huffed, "Old Jin, what do you mean? Didn't you say last time that you had never had tuberculosis treated?"
Lao Jin lowered his head, wishing he could find a crack in the ground to crawl into.
When the others saw this, they all understood and their faces looked unhappy.
They thought Shu Jinyue would lie, and even thought she would find a cover for herself. In order to prevent her from "cheating", they held a nationwide lottery audition and visited the ward in person. However, they did not expect that the patient "chosen one" selected randomly by everyone actually never told them the truth from beginning to end!
Everyone present had been working in clinical practice for decades and had seen all kinds of patients, so they were considered knowledgeable. But no one expected that Lao Jin, a rural old man who looked very honest and simple, actually did not tell the truth!
The air was filled with anger and embarrassment, mixed with various smells. Jin Yue felt a little chest tightness, so she walked to the window to get some fresh air.
At this time, Old Jin's face turned red, and he said timidly: "I..."
Everyone looked a little unhappy.
He gritted his teeth and said, "I had a cough two months ago, and I coughed up blood. It happened that someone in our village was diagnosed with tuberculosis during that time, so the doctor at the health center suspected that I also had tuberculosis. I forgot what medicine he used on me and asked a barefoot doctor to come to my home to give me an injection. But then my cough didn't get better, so the doctor at the health center asked me to take the sputum I coughed up and send it to the county hospital for examination. When they found that I didn't have tuberculosis, they said it was a misdiagnosis and told me not to get the injection... I... I..."
"You thought it was a waste to throw it away, and your cough just didn't get better, so you continued using it for several days until your inguinal lymph nodes became swollen." Shi Xuehai continued.
Old Jin blushed and said, "I... We are country folk, and we are used to saving money."
Everyone didn't know what to say for a moment. It sounded so simple and harmless, but his lies fooled everyone.
In this entire process, there are problems both with the doctors at the health center and with Lao Jin himself. Judging from his expression, he actually knows that taking medicine without permission is wrong, but he has been living here for such a long time and he has not said a single word about taking medicine. He is really tight-lipped!
Shu Jinyue wouldn't believe it if she said it wasn't intentional.
For doctors, misdiagnosis is a mistake in itself. It would be fine if they did not correct the error in time. However, after discovering the misdiagnosis, they did not carefully check how much medicine had been given out, how much the patient had used, and how much was left. They did not even recycle the remaining medicine. This is the biggest problem.
"In fact, as a grassroots health worker, I know that there is a certain misdiagnosis rate and missed diagnosis rate at the grassroots level. This is inevitable due to the limitations of technology, equipment and other conditions." Jin Yue paused, "According to my speculation, Lao Jin should have used a large dose of streptomycin at the time. If conditions permit, we can ask someone to go to his township to check his medical records."
Her meaning was very straightforward. She no longer trusted Lao Jin's words. No matter how much he had eaten or how long he had taken it for, she didn't believe anything he said.
Director Li also understood and quickly asked for the phone number of the township health center where Lao Jin worked.
"This... this is not a big deal, so... just don't bother with it, right?"
"How can it not be a big deal? This is the history of your illness and treatment. It is of great significance to our diagnosis and medication. Just tell me quickly. If you don't, I will call the Public Security Bureau myself and ask the police in Beijing to go to Fangshan to investigate. They will eventually find out."
When he heard that they needed to find the police, Lao Jin shrank his shoulders and whispered the phone number of their village office.
I called the village office and asked about the health center. When they heard that I was from Beijing Hospital, they wanted to find Lao Jin's medical records. They quickly confirmed his name, age, gender and address, and then asked someone to look for it. They also ruled out the possibility of having the same name.
At this point, Lao Jin could no longer conceal the truth, so he had to grumble and tell the doctor about the time he went to see the doctor. The doctor found the prescription in a few minutes, and the dosage read out was indeed very high - "once a day, 4 grams each time."
Almost no one present had not used streptomycin, the "miracle drug" of the era. Everyone knew that when used as an anti-tuberculosis drug, it generally needed to be used in combination with other anti-tuberculosis drugs. The regular dosage was 1 gram per day, and even the elderly and infirm needed to control it at around 0.75. Yet Lao Jin actually used 4 grams! I've been using it for nearly two months!
It's obvious that this dosage is three times more than the normal dosage! The medication time is also long enough!
"Why didn't you tell us about this when you were admitted to the hospital?" Director Li was really angry. If he had been diagnosed with suspected tuberculosis, but the young doctors in the department didn't ask about it, it meant that he didn't teach his subordinates strictly and didn't know how to manage them. But he had been hospitalized in another hospital before being admitted to the hospital, and had used streptomycin for such a long time, he should have said something!
No matter how careless the young doctors in the department are, they can't be so careless as not to ask "what illnesses the patient had before, what medicines he took, and whether he has been hospitalized before"! If Shu Jinyue had not reminded us to worry about tuberculosis, we would have missed this clue. Now, it is harder to squeeze the "truth" out of his mouth than to squeeze out toothpaste. He only squeezes out two sentences every few days.
No wonder when the young man under his command was criticized by him for not writing a medical history, he defended himself with a look of grievance, saying that he had asked and it was Lao Jin himself who denied it, and he denied it in person... Now it seems that the young doctor was really wronged.
It’s not that I didn’t ask, it’s that the patient didn’t tell me.
And now that Shu Jinyue has obtained the evidence and asked directly, Lao Jin is willing to admit it with a grumble. Isn't that infuriating?
"Do you know how much trouble and trouble you will bring to us by deliberately concealing this past history? More importantly, it will affect your treatment and delay your own illness?"
"If Dr. Shu hadn't found something wrong when he examined your pulse, we would still be treating you as if you had leukemia and still not be able to find the real cause. Have you ever thought about how important your life and health are?"
Others were disappointed with Lao Jin and began to blame him.
Shu Jinyue didn't say a word the whole time. She was thinking further ahead. After spending a long time with Xu Duan, she learned to observe and understand what he said about "interest orientation."
She thought of the "nephew" who had been with Lao Jin these days, the medical terms he occasionally uttered, how he was calm and experienced when dealing with Lao Jin's dizziness, and how he said "I can't explain to my mother", which seemed to have other meanings. He even felt that if he could get Lao Jin's original medical records at the township health center, the attending physician's name should be signed on it, probably this nephew, or perhaps his relative.
He might have written the wrong dosage when dispensing the medicine, or he might have increased the dosage privately in order to make his uncle get better quickly, or he might have really not known what the real routine dosage was. After all, the professional quality of grassroots doctors is definitely not as good as that of Beijing Hospital... Shu Jinyue even suspected that it was because of this "relative" relationship that, in order to save some money for his uncle, he roughly diagnosed it as tuberculosis based on his experience and directly used the medicine without a confirmed diagnosis.
He regretted it after the accident, but he didn't realize the side effects of streptomycin. He just thought he had "made his uncle worse," so he hurriedly accompanied him to a big hospital for examination.
I don’t know whether some kind of financial compensation agreement was reached in secret, or whether it was out of love between uncle and nephew that Lao Jin concealed the medical experience for him.
The medical records at that time were not connected to the Internet. Once he concealed the truth, even if Director Li had X-ray vision, he would not be able to tell that he had used such a large dose of streptomycin within two months!
The toxic and side effects of drugs can accumulate. They have been accumulating for such a long time, and I suddenly started using streptomycin again yesterday. Wouldn’t the dizziness come on like a flood breaking through a dam? She even suspected that it was not the first time that Lao Jin had suffered from vertigo that day, as he had had such attacks before at home.
However, everything was just Jin Yue's speculation. In front of so many people, she didn't want to make a big deal out of something that had nothing to do with her. "As for the previous medical experience, it's fine to figure it out now. How to investigate and solve it is up to you guys to follow up. The most important thing for us now is how to treat it."
At this point, everyone, including Old Wang, was completely impressed by the young woman in front of them.
You say she studied traditional Chinese medicine and knows nothing about Western medicine, but it turns out her basic theories are more solid than yours, and her latest pharmacology research is twenty years ahead of you.
You said that she studied Chinese medicine but knew so much about Western medicine that she was no longer a pure Chinese medicine practitioner. But she could tell whether the patient had tuberculosis just by taking the patient's pulse, and she even made the incredible statement that dizziness has a direct causal relationship with tuberculosis. What's more, such ridiculous statement was actually verified and it is true.
Teacher Wang bowed deeply to Jin Yue and said, "I'm sorry, Doctor Shu, please forgive my arrogance and my long-standing prejudice against Chinese medicine."
Regardless of whether he forgave her or not, Jin Yue was curious, "Teacher Wang, have you decided which newspapers to publish in?"
Everyone burst into laughter.
Teacher Wang is also a man who can bend and stretch. Nonsense, if he doesn't bend today, how can he survive in this circle in the future? Jin Yue can still say to him that different fields are like different mountains, and they can just avoid meeting each other, but these people in front of him are all from the same specialty. If he doesn't bow his head today, in the future, his jokes will be passed on through the mouths of these colleagues, from one intern after another to the residents, to the attending physicians, to the deputy directors, the director, the vice dean, the dean... Think about it, even Yugong moving the mountain couldn't be passed down from generation to generation in this way.
Of course, in addition to face, he also really admired Shu Jinyue. "There are not many young doctors like you who are proficient in both Chinese and Western medicine. I, Wang, have no regrets in my life if I can see one in my lifetime. Don't worry, once you say something, it's time to apologize. Otherwise, how about choosing our Shanhe Province and your Shilan Provincial Newspaper, plus the Jingshi Evening News?"
These three places were chosen with great sincerity.
Shu Jinyue smiled and agreed, "Okay."
Director Li is not so keen on betting. He only cares about his patients. "Doctor Shu, how should we treat the disease next? Please teach us a lesson."
"It's not necessary to teach him a lesson. I can prescribe some drugs to promote metabolism and lower his blood pressure. Director Li should stop using streptomycin and switch to one with fewer side effects. That should be enough."
Tuberculosis needs to be treated.
High blood pressure needs to be lowered.
Dizziness also needs attention.
Although there seem to be many problems, as long as the real cause is found and the right medicine is used, it will be fine. Shu Jinyue quickly wrote out a prescription and handed it to Director Li.
Others came over to take a look. Actually, even an outsider couldn't make out what it was. There were only three rows of words with a total of nine medicines, all with dosages of 6 grams or 12 grams. Such dosages were as light as a feather for an unpurified traditional Chinese medicine that had to be taken for two days, or six meals.
But at this moment, no one would doubt Shu Jinyue's medical skills. She must have her reasons for using such gentle methods.
Some people think: This must be how the ancients used it. This is called following ancient rules and inheriting classics.
Some people think: Maybe he doesn’t want Lao Jin to suffer anymore. This is called a great doctor’s sincerity and a doctor’s benevolence.
Some also think: It should be because they don’t want to conflict with Western medicine. This is called being humble and polite, and having both moral integrity and artistic excellence.
If Shu Jinyue knew this, he would have sighed: It is true that after entering the Pass, there will be great scholars debating scriptures for me.
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