Chapter 102 - 0100 Difficult Patient

“Alright, let’s go on rounds!” said Yang Ping. He had asked enough questions for now.

As for Director Zeng’s subtle attitude, Yang Ping could perceive it acutely but decided not to dwell on it for the time being.

With Director Zeng accompanying him, Yang Ping led everyone on their rounds.

Twenty-one patients to check on, excluding the young man they had just seen, there were twenty others.

Six were suffering from pain in their neck, shoulders, waist, or legs and were undergoing conservative treatment. Fourteen were surgical patients: two had clavicle fractures, one humerus fracture, two radius and ulna fractures, one femur fracture, three had fractures to both the tibia and fibula, three had ruptured tendons, one had a finger fracture, and one had a pelvic fracture, which had been treated with an external fixator.

Although he was an acting head, Yang Ping wasn’t at the hospital to relax. He was there to treat and save lives, and his rounds were carried out conscientiously.

After seeing the last patient, there was one more ward. The door was shut, so it looked empty and unoccupied, which caught Yang Ping’s attention.

“That’s all,” said Director Zeng.

Suddenly, the door swung open. An old man in his seventies, wearing round, black-rimmed glasses, emerged: “Zeng Little Treasure, how can you say that I’m not a patient? You tried to kick me out to the surgical department, but I refused. I’ve moved back here.”

Wasn’t this room supposed to be locked up? How did he manage to move back in?

At this point, Director Zeng was clearly uncomfortable. His face looked as though he had just smeared it with chili oil – it was burning red.

“What’s… the situation here?” asked Yang Ping quietly. Standing at the doorway, he couldn’t avoid asking.

“This patient underwent surgery a year and a half ago and is here for rehabilitation. You should examine him as well”, Director Zeng responded reluctantly.

He then turned to the patient with a forced smile on his face: “Teacher Yan, because a single room became available in the surgical department, we arranged for you to move there. This room will soon be needed for another patient.”

“Hmph!” The patient grunted coldly.

Yang Ping led the team into the room.

“Who cares for this patient? Report his case history!” Director Zeng ordered.

Before any of the doctors could speak, the patient himself spoke out: “I have a lumbar disc herniation. My main symptom is numbness and severe pain in my right leg. It’s so painful that I’m having trouble walking. I had surgery, but it still hurts. I’ve spent a lot of money, and my suffering hasn’t lessened a bit.”

“May I examine you?” asked Yang Ping, who had already discerned that this patient was a contentious case.

“This is Director Yang from the provincial hospital. He’s here specifically to see you. Perhaps he has some ideas”, Director Zeng introduced.

“Director Yang? From the provincial hospital? Perfect. I was planning to present a petition and lodge a complaint at the provincial hospital. My surgery was performed by a professor from there, too. Even after medical insurance reimbursement, I paid over twenty thousand out of my own pocket. And my leg still hurts, and my back has worsened.” The patient’s attitude was poor, his belly filled with bitterness.

“Zeng Little Treasure, let me tell you, once my leg gets better, I will certainly present a petition and lodge a complaint against you all. What is this? You’re treating human life with utter disrespect. Do you think I don’t know? You and that Professor Zeng from the provincial hospital must be related. You’re in cahoots. There must be some unmentionable activity going on. I’ve already written my letter of complaint.” The patient rambled on and on.

Yang Ping took his hand and said: “What should I call you? Please, calm down first. Tell me what the problem is, and I’ll see how I can help.”

“Teacher Yan!” blurted out Director Zeng, clearly embarrassed.

Yang Ping said: “So, what seems to be the problem, Teacher Yan?”

The patient took out a notebook and began: “On June 17th last year, I had a CT scan here, in this very hospital. It revealed that I had lumbar disc herniation at L4/L5, L5/S1, spinal stenosis, and right-sided nerve root compression. After a month of conservative treatment, which proved ineffective, Zeng Little Treasure suggested that Professor Zeng from the first affiliated hospital in the provincial city perform surgery. The date of the surgery, let me check… It was July 28th last year. We gave Professor Zeng a red envelope with five thousand yuan. It’s all recorded here. After surgery, my right leg pain didn’t alleviate at all. After I was discharged following the removal of stitches, I was readmitted on September 20th. Since then, I’ve been constantly admitted to and discharged from the hospital. This has been happening over and over for more than a year. Now the year is almost over, and there’s been no relief. Tell me, how can this be resolved?”

The man’s thick notebook was poked and prodded with fingers wet with saliva, as he flipped through it, page by page. Then he picked up a pen and began to write: “What’s the date today? I should write it down. Zeng Little Treasure came with someone from the provincial hospital. What’s his name?”

The old man looked at Yang Ping’s ID card: “Yang Ping, Director Yang, came for rounds, noted.”

Once the old man finished writing, he closed the notebook and placed it under his pillow.

No need to introduce the patient’s history—it was even clearer than what was recorded in the medical chart. What was in the medical chart, he had; what was not, he also noted down.

“Teacher Yan, what did you teach before you retired? Can I have your permission to examine you?” asked Yang Ping.

The man lay down: “High school politics. Go ahead with the examination. I’ll cooperate. Later, don’t say that I didn’t cooperate with the doctors, which led to poor results.”

While the patient was sharing his medical history, Yang Ping was able to go through the medical chart. The patient had undergone L4/L5 and L5/S1 lumbar intervertebral disc removals, posterior decompression, intervertebral fusion, and pedicle screw internal fixation surgery.

Yang Ping did not know Professor Zeng from Fuyi Hospital, but he did know that his surgical skills were beyond question, top-notch in the province. So what was causing the issue?

He conducted a Straight Leg Raise Test on the patient’s right lower limb. It showed a clear positive result – the patient couldn’t lift the leg beyond thirty degrees. Upon testing the strength and sensation, the muscles controlled by the sciatic nerve were somewhat weak and the sensation was somewhat impaired. The right calf muscle showed atrophy.

Resistance Abduction and ‘4’ Figure Tests were also positive.

“I can’t, I can’t. It’s numb and painful, unbearable.” The patient cried.

Yang Ping had the patient lie prone. He pressed the position of the piriformis muscle which was firmer than normal. Upon pressing, the patient cried uncomfortable words and the right lower limb suffered from severe numbness and pain.

Could Piriformis Syndrome be a possibility here?

Professor Zeng was busy performing surgeries, perhaps he only looked at the radiograms. The lumbar disc prolapsed pressing severely against the right nerve and the symptoms coincided closely with the radiogram, so he rushed to operate without conducting a detailed examination. This scenario was not unheard of.

“What do you think? Do you understand now? You’re not at fault in this, and I won’t sue you. But, I will definitely sue Little Zeng.” The patient sat up.

After visiting the ward, Yang Ping organized his thoughts. Among the patients in the department, besides the chronic osteomyelitis patient earlier, this one also had problems in diagnosis and treatment.

Through his reading in the system space and his solid theoretical foundation, Yang Ping made rapid progress in terms of the breadth and depth of his knowledge.

These two cases needed to be addressed separately. If he spoke about issues directly, of course, it would damage Director Zeng’s ego. Even though Yang Ping had only been there two weeks, it was of no need to offend him.

You shouldn’t do two things to someone: disrupt their income or spoil their reputation.

Yang Ping decided it would be better to take a roundabout approach. He would speak about the dispute patient first. As Director Zeng now seemed overwhelmed by this patient, he believed there would be no problem offering him advice.

“It’s embarrassing, so embarrassing!” Director Zeng wiped his sweat.

Yang Ping casually said, “Every hospital has demanding patients. It’s no big deal.”

Director Zeng said, “Director Yang, do you have any advice about these patients?”

“No specific advice. Director Zeng, you are very experienced and spent time studying at Fuyi Hospital, your case handling is appropriate. It’s clear to see Dean Pan had full confidence to make Orthopedics an independent field.” Yang Ping made these comments in front of everyone.

Although Director Zeng had been previously embarrassed, Yang Ping’s comment restored a bit of his dignity.

“Director Zeng, shall we go sit in the office?” Yang Ping suggested.

Director Zeng had something to say and immediately nodded his head.

Once in the director’s office, Director Zeng poured a tea.

Yang Ping said, “For this lumbar disc herniation patient, I suspect there may be Piriformis Syndrome. If we can get him to have an MRI and EMG of the piriformis muscle performed, it might differentiate the conditions. If it is truly Piriformis Syndrome, another surgery can be performed to release the sciatic nerve, that should solve the issue.”

If the problem could be solved, he would be willing to kowtow in gratitude. This patient had been a major worry for him, extremely troublesome, and half of his gray hair was probably due to this man.

The patient created a nuisance several times, showed up at his office, blocked him on the way home from work, and now refused to leave the hospital, even lodging a complaint to the mayor.n/o/vel/b//in dot c//om

“The hospital doesn’t have an MRI, we’ll have to go to Shipo People’s Hospital to have it done, which is outpatient and non-reimbursable. He will definitely reject it. He hasn’t paid a cent for his current hospital stay.” Director Zeng spoke out his grievances.

“A CT and EMG can also be done; they should be enough to determine the condition. We have both a CT scan and EMG, right?” Yang Ping asked.

“Yes, we have both!” Director Zeng confirmed.

“Shall we go talk to the patient together?” suggested Director Zeng.

Yang Ping said, “Yes, it’s a good idea. It would be best if we could call him over here.”

“I’ll go get him!” Director Zeng prepared to leave.

Yang Ping stopped Director Zeng, asking him to clarify the patient’s family situation before going to invite him.

After a while, the patient came over, limping heavily, leaning on a crutch.