The lineup for this multi-department consultation was quite formidable.
As the patient's attending physician, Qin Donglai was responsible for chairing the entire meeting.
The invited consultation team included the head of the Emergency Department, Director Huo Yun; the Director of General Surgery, Lin Hu; the Director of the Pain Department, Zhang Shuxin; and a special guest, the Deputy Chief Physician of the National Medical Department, Huang Hong.
Lin Hu was particularly skilled in the field of acute abdominal conditions, external abdominal hernias, and hepatobiliary diseases. With years of experience on the clinical front lines, he had a wealth of expertise in treating hepatobiliary and pancreatic diseases, as well as inguinal hernias. He was also an expert in minimally invasive treatments for general surgical conditions and was highly renowned in Fan City and even throughout all of Jin Province.
As for Zhang Shuxin, he specialized in the diagnosis and treatment of trigeminal neuralgia, advanced cancer pain, and various intractable neuropathic pains. He was a professor, a master's degree supervisor, recognized as a "Second-Level Talent" in the provincial "151" program, named one of Fan City's Top Ten Young Scientific Talents, and had won multiple provincial awards for scientific and technological progress.
Dr. Huang Hong was the heir to a National Medical Family and a member of the China Democratic League. She specialized in endocrinology, particularly in the diagnosis and treatment of diabetes, thyroid diseases, and other critical and complex illnesses.
With these three top experts from City First Hospital presiding, this could be considered the highest-level departmental consultation the hospital could offer.
At a consultation of this caliber, even Qin Donglai was just a junior, there only to briefly present the patient's case and not daring to say much more.
As for Wu Ting, his role was even more minor. His main jobs were to serve refreshments, organize documents, and manage the slideshow.
Once the three senior directors had arrived, Qin Donglai motioned for Wu Ting to distribute the patient's case files. He then had him get the slideshow ready and began to lead the consultation.
"Thank you, Director Lin, Director Zhang, and Director Huang, for taking time out of your busy schedules for this consultation. Everyone's time is precious, so I'll get straight to the point and give a brief report on the patient's condition."
"The patient is a 36-year-old female presenting with recurrent, severe abdominal pain. She also exhibits hypertension, tachycardia, fatigue, and peripheral neurological symptoms such as numbness in her limbs. Her urine turns a red color when exposed to light..."
Qin Donglai quickly summarized the patient's condition and outlined the treatment plan he had been following.
"So far, we have ruled out pancreatitis, pulmonary embolism, and small intestinal effusion. The patient's pain recurs frequently and doesn't fit the profile of any conventional illness..."
After finishing his presentation, Qin Donglai looked helplessly at the four senior doctors.
Huo Yun took the floor and offered his thoughts:
"I've reviewed the patient's ECG, troponin, D-dimer, coagulation panel, liver and kidney function tests, and lactate and blood gas analysis. I can't find a specific cause for her condition. So, I'd like to ask you all to consider if this could be some other rare or complex disease."
Lin Hu flipped through the patient's file.
"Could it be a dissection? The pain is severe."
"Or a splenic infarction?"
"A mesenteric artery dissection or embolism? There's a disconnect between her symptoms and physical signs..."
"Or perhaps an internal hernia?"
After Lin Hu finished, Zhang Shuxin added a few more possibilities:
"An intestinal obstruction? Or roundworms?"
"Ketosis?"
"A ruptured pancreatic cyst?"
Huang Hong also offered some ideas:
"Could it be a pheochromocytoma?"
"Abdominal allergic purpura?"
"Any stimulus can cause abdominal pain if it reaches a certain intensity. With inflammation, tissue necrosis, ischemia, or hypoxia, tissues can release various hormones or body fluids that activate pain receptors. Could the patient's pain be caused by visceral hypoxia from various chemical mediators? Concurrently, a thrombus in the inferior vena cava obstructing the venous return below could lead to blood stasis. The resulting tension and stretching of the venous walls might also be aggravating the pain..."
As expected of three clinically experienced experts. In no time, they had all voiced their opinions and listed a wide range of possibilities.
Listening to the experts' opinions, Qin Donglai had already moved to the whiteboard at the side of the room to list each possibility.
This was how multi-department consultations worked. The experts first proposed possibilities from the perspective of their respective specialties. Then, they would go through the diagnostic criteria for each corresponding condition and rule them out one by one.
Watching from the sidelines, Wu Ting was filled with admiration for the three experts' professional capabilities.
'As expected of City First Hospital, a place of crouching tigers and hidden dragons. If I didn't have the system, I wouldn't even be able to understand what they're talking about in a consultation like this.'
'No wonder even a senior attending physician like Qin Donglai didn't dare to interject and could only listen with rapt attention. A regular resident wouldn't even have the qualifications or the ability to participate.'
'Fortunately, I have Diagnosis Skill (Purple), which is the only reason I can keep up with these experts' thought processes.'
After all the possibilities were listed, the experts began to analyze them in detail, one by one.
"Wu Ting, bring up all of the patient's physical exam results, from admission to today's latest, for the experts to analyze."
At Qin Donglai's instruction, Wu Ting immediately displayed the latest exam results.
The four directors began their meticulous analysis:
"...Temp: 36.8°C, Pulse: 75/min, BP: 120/70mmHg. Patient appears to be in pain. Skin shows no pallor, jaundice, petechiae, or edema..."
"...Abdomen is flat, no visible gastric or intestinal patterns or peristaltic waves. Abdominal muscles are not rigid. Tenderness in the periumbilical and lower abdominal regions, no rebound tenderness. Liver and spleen not palpable below the costal margin. No abnormal masses palpated. Bowel sounds are not hyperactive..."
"...CBC: WBC 7.8×10⁹/L, neutrophils 75%, hemoglobin 102g/L, platelets 123×10⁹/L..."
"...Urinalysis: Protein +2, Urobilinogen +1. Stool analysis: negative. Liver function: Direct bilirubin 12μmol/L, indirect bilirubin 20μmol/L, albumin 35g/L. Transaminase, GGT, and alkaline phosphatase levels are all normal..."
"...Kidney function and blood sugar are normal. Abdominal ultrasound, full abdominal CT, and upper GI series with barium all show no abnormalities..."
After a tense and thorough analysis, every single one of the previously listed hypotheses was ruled out.
They still couldn't find the definitive cause of the illness.
The conference room fell silent.
The four directors all had deeply furrowed brows.
"It seems this patient's condition is rarer than we imagined. We need to broaden our thinking."
Huo Yun was clearly unwilling to concede.
Seeing that even the four directors couldn't find the cause, Qin Donglai's heart sank. 'If we can't get a diagnosis,' he thought, 'we'll have no choice but to transfer her to a higher-level hospital.'
'But that would be a bitter pill to swallow. Fan City First Hospital, the largest comprehensive hospital in all of Fan City, unable to diagnose a case of acute abdominal pain.'
Just as the directors were feeling stumped, Wu Ting raised his hand toward Director Huo.
Huo Yun had a decent impression of Wu Ting, but he was still surprised. That at a consultation of this level, the young resident responsible for serving refreshments would dare to raise his hand to speak.
Although he didn't think Wu Ting could offer any valuable insights, he still appreciated the young man's courage.
"Wu Ting, what are your thoughts?"
The other three senior directors also turned to look at Wu Ting, this very young doctor.
"He's one of the residents from our surgery department. Young calves aren't afraid of tigers, as they say. Please don't mind him, Directors."
Qin Donglai was also surprised by Wu Ting's audacity and tried to explain on his behalf.
"It's no problem," Lin Hu said encouragingly. "This is a departmental consultation. Anyone with an idea should feel free to share it."
Lin Hu was encouraging toward a young person like Wu Ting; the academic atmosphere at City First Hospital was, after all, quite good.
Wu Ting went directly to the computer and opened a folder he had prepared in advance. He clicked on three image files he had ready.
They saw three pages of screenshots, all of them in a foreign language.
The senior doctors were a bit baffled.
However, their proficiency in foreign languages was first-rate, and they quickly began reading.
As they read, Wu Ting began to explain:
"Directors, I have a thought, though it's just a preliminary one. I was recently flipping through some foreign journals and came across a case that was quite similar to our patient's. I brought it up for your reference. Is it possible that our patient also has this rare metabolic disease—porphyria?"
"It's because the patient's urine changes color when exposed to light. That phenomenon is just too strange. I happened to read about a foreign case study with that exact symptom, so it left a strong impression on me."