Surgery Godfather-Chapter 274 - 0258: Less Than Three Hundred Cases Worldwide

Chapter 274: Chapter 0258: Less Than Three Hundred Cases Worldwide

After speaking, Teng Guihua realized her error and quickly covered up by saying, “I’m just asking, just asking.”

A fleeting look of joy on her face caught by Yang Ping, perhaps his observational skills were more enhanced than average thanks to his training with System Space.

Did he see it wrong? His patient’s condition was worsening, yet instead of worrying, even crying, why was her mother a bit happy?

“I’ll help!” Teng Guihua squeezed to the bedside to massage Fang Xiaoyun’s legs.

Chang Juan, a colleague of Fang Xiaoyun, moved aside a little, revealing a look of disgust. She thought, a weasel paying a visit to a chicken surely had no good intentions.

But after all, it was Fang Xiaoyun’s mother, and this time she had not asked for money, but merely came to visit her daughter. As a colleague, there was not much she could say.

...

The mother, dressed quite fashionably, wearing heavy lipstick, perfume so strong you could smell it through the mask.

Her hands adorned with rings and bracelets, and the necklace on her neck was not missing either.

After visiting Fang Xiaoyun, Professor Zhang cautioned Yang Ping to observe closely. He still had to go to the outpatient clinic and explain the diagnosis to another patient who was waiting for his test results.

It was past his duty hours and the old man was still explaining the disease to the patients. Truly a tireless worker.

The 80-year-old wouldn’t rest; the hospital arranged for him to conduct consultations one day a week, but he insisted on working five days a week.

After Professor Zhang left, Yang Ping pulled out all Fang Xiaoyun’s case files for study.

Any anomaly needed an explanation; otherwise, it created an unease in his heart.

While others might ignore such anomalies, Yang Ping did not want to give up easily.

“Aren’t you leaving yet?” Xiao Su placed her bag near the computer, sat down to accompany Yang Ping, and helped him massage his shoulders.

The two had agreed to have dinner together, take a walk after dinner, and then play some tennis.

“The patient’s spinal cord swelling isn’t subsiding, the duration of the peak period is too long, it’s unusual—” Yang Ping began explaining to Xiao Su.

“You take your time, I’ll stay with you.” Xiao Su sat next to him, close to him, massaging his shoulders with both hands.

As a doctor, having a supportive partner is absolutely crucial.

Otherwise, a few days of continuous emergency surgery could easily cause chaos at home.

“Pay attention to the patient, don’t mind me. My dad’s a doctor, my mom’s a nurse. I am used to situations like this.” Xiao Su said with a faint smile.

Yang Ping viewed the images intently, not overlooking any signs, inspecting each part carefully.

Sacrificing a bit of his rest time didn’t matter, had he not found the issue, it would be fine, and if he had identified the problem, it could be dealt with promptly. Any delay could impact the patient’s life.

“The pressure on the spinal cord has been completely relieved, no signs of an embolus in the supplying artery, and the spinal canal vein is slightly thicker than normal.”

Yang Ping mentioned his observation to Xiao Su as he kept looking. Xiao Su was quite interested; she loved to hear Yang Ping discuss the patient’s condition.

The slightly thicker spinal canal vein was an intuitive feeling that Yang Ping had due to seeing numerous imaging pictures in System Space.

It is impossible to find anything by the thickness or thinness of the blood vessels alone. Even a minor difference can’t prove anything.

Yang Ping examined and compared the MRI and CT images taken before the operation, on the first day after the operation, and one week after the operation.

The spinal canal vein at the same place seemed to be getting slightly thicker each time—an extremely subtle change, but still, it was captured by Yang Ping.

Furthermore, the change in the spinal canal vein positively correlated with spinal cord swelling; the thicker the vein, the worse the swelling.

If not for his monstrous training in System Space, how could he possibly notice such an insignificant change?

A spinal dural arteriovenous fistula?

No way, there were fewer than 300 cases reported worldwide. How can such a rare disease, along with tuberculosis of the spine resulting in paralysis, occur simultaneously? The probability was as low as a severe thunderstorm.

However, the more Yang Ping looked at it, the more he directed towards this diagnosis. He was almost certain.

Updat𝒆d fr𝑜m freewebnøvel.com.

If so, a spinal angiogram must be done soon. The angiography procedure is extensive and takes hours.

The spinal area has many blood vessels with complicated distribution: bilateral vertebral artery, common carotid artery, thyrocervical trunk, costocervical trunk, 12 pairs of 24 intercostal arteries, any of which could potentially form a fistula.

During angiography, the lengthy exposure to x-rays poses a major challenge for the patient and the surgeon.

The most troublesome part was that due to the complex structure of the blood vessels around the spine, if the technique was not accurate, even after conducting an angiograph for all the blood vessels, the problem might not be found.

The contrast agent also increases the risk of spinal artery occlusion, particularly the good anastomosis of the anterior spinal artery from the last operation. With a complicated situation, multiple mutually contradictory risks coexist.

If there was no full understanding and cooperation from the patient, no further examination and treatment could be done under these circumstances.

“A spinal dural arteriovenous fistula? Arrange for a DSA angiography immediately for the emergency.” Yang Ping told Xiao Su.

Dinner was off the table, and the plans for a walk and tennis fell apart.

“What do you want to eat? We can order takeout!” Xiao Su was not displeased.

Seeing Yang Ping’s determination, if the DSA confirmed the diagnosis, then an emergency surgery would need to be performed—doing the surgery together was a good idea!

Without needing any explanation, the two had a great tacit understanding, and Xiao Su immediately went to arrange for takeaway dinner.

Everyone was about to finish their work and leave the office, Song Zimo and Tang Fei said goodbye to Yang Ping, they were about to end their shift.

“Fang Xiaoyun, Dural arteriovenous fistula!”

Yang Ping responded to Song Zimo.

Song Zimo immediately paused: “Emergency DSA?”

“Yes, diagnose immediately, and then go straight into surgery. Contact the interventional operating room, we need a room capable of hybrid surgeries.”

Yang Ping took the water brought to him by Xiao Su. Xiao Su said with a smile: “Looks like nobody is going home tonight, I’ve already ordered the takeaway.”

Song Zimo and Tang Fei immediately gave up on the idea of going home. Song Zimo handed his backpack to Tang Fei: “Hold my bag for me, I’m going to call Zhang Lin, Little Five, Fatty and the rest over. We have a job tonight. A disease for which less than 300 instances have been reported worldwide…we’ve stumbled upon it, is this real?”

“It’s likely to be real, prepare for DSA and surgery.” Yang Ping got up.

The overlap of two diseases, both are capable of causing myelitis, which can lead to paralysis. One disease masks the other, what are the chances?

Zhang Lin, Little Five, and Fatty saw that Yang Ping was still in the office, and didn’t dare leave right on time, worried that there might be something requiring their attention.

Several people were “having a meeting” in the duty room when they received a call from Song Zimo. No one dared to delay and everyone came out.

They had no concept of Dural arteriovenous fistula, they had never heard of it before.

At this point, Professor Zhang called. He sounded urgent: “Xiao Yang, where are you? Please conduct a DSA of the spinal artery for Fang Xioyun in the emergency room. It might be a Dural arteriovenous fistula!”

“I’m arranging it now!”

“I’m arriving at the department right away!”

The phone wasn’t hung up in time, and the voice of an old lady could be heard from inside: “Ah – just got home, the meal is ready, why don’t you eat something before going, it’s better to fill your stomach with a few mouthfuls –”

Professor Zhang, with his wealth of experience, also thought of this rare possibility.

Song Zimo was in contact with the interventional operating room. There are a few operating rooms capable of performing hybrid surgery.

But at night, they didn’t know if there were enough personnel available to assist with the DSA. A highly skilled interventional doctor was needed to help with this.

Everyone was working separately. Xiao Su and Zhou Can needed to prepare accurate instruments, as well as a microscope, and confirm the interventional operating room so these could be sent over.

After the DSA was completed and the diagnosis was confirmed, they would go directly into surgery in the interventional operating room. Sometimes angiography was needed during surgery to find blood vessel fistulas, and after surgery, angiography was also needed to confirm whether the arteriovenous fistula had been properly managed.

Yang Ping reported to Director Han. Director Han also expressed that he would come immediately. He wasn’t worried about Yang Ping’s skills, but rather he wanted to back Yang Ping, undertaking the risk. After all, Yang Ping was the attending doctor.

After checking Zhang Lin’s informed consent forms, making minor modifications, and then printing them out, Yang Ping and Zhang Lin went to talk to Fang Xiaoyun to get her understanding and cooperation.

Teng Guihua was in the ward. Fang Xiaoyun’s colleague, Chang Juan was also there. She probably didn’t trust Teng Guihua and feared that she might do something that would harm Fang Xiaoyun.

Yang Ping felt that Fang Xiaoyun was not a problem, but her mother might be the obstacle in communication. Fang Xiaoyun was an adult and in order to save trouble, Yang Ping decided to bypass Fang Xiaoyun’s eccentric mother.

“I’m going to have a talk with the patient now. You two exit the room. Zhang Lin, call for a nurse to come in. Have her escort them out.” Yang Ping’s words were decisive.

“I’m her mother, what can’t you say in front of me?” Teng Guihua sensed something unusual.

Yang Ping dismissed her: “Leave, didn’t you hear clearly? I don’t want to delay time. Fang Xiaoyun is an adult and can make decisions for herself. We don’t need you present.”

Although these words were harsh and direct, at this time, arguing with her was simply a waste of time.

Chang Juan was more forthright: “If a doctor tells you to leave, then you leave. Why so much useless talk. Xiaoyun, we’ll leave. Listen to the doctor, don’t think too much.”

The colleague pushed her mother out. After the nurse came in, Zhang Lin closed the door. When examining a female patient, or having a private conversation, it was necessary to have other female nurses or doctors present to avoid unnecessary disputes.

“Doctor Yang, what’s going on?” Fang Xiaoyun asked a little scared.

Yang Ping said calmly: “Fang Xiaoyun, it’s been one week since your surgery, and the strength of your legs is weakening, which is unusual. We suspect that in addition to spinal tuberculosis, you also have a Dural arteriovenous fistula. This is a rare disease, with less than 300 cases reported worldwide. It may have happened to manifest right after your surgery, leading to the worsening of your lower extremity paralysis. I’m not 100% sure, but I’m 90% sure. Now, we need to conduct a spinal artery angiography. We will have to search for it blood vessel by blood vessel, we may or may not find it. But if we do, we will immediately operate to treat it. This time the surgery will be done from the back. Are you willing to trust us and cooperate with us? If it is this disease and it is not detected and treated on time, it will cause permanent paralysis.”

This disease progresses rapidly and the prognosis is poor. Venous congestion can cause irreversible spinal cord edema, followed by extensive arterial embolism.

“Don’t be afraid, you can make your own decision. Your body is your own, and you don’t need to consider other factors.” Yang Ping added, his tone was firm but gentle, and his words were clear.

Fang Xiaoyun was an ordinary rural girl. She hadn’t finished junior high school when she was reproached by her mother and sent to work. She had worked as a general laborer in the factory and later, via an introduction, she worked in a foot bath shop doing foot massage.

All the money she earned over the years went to support her family. She only bought herself cheap clothes and held onto her Redmi phone for several years, not willing to replace it.

But at the crucial moment, this girl had clear ideas. She thought about it and nodded: “Doctor Yang, I’ll do whatever you say. I’ll undergo whatever examination or surgery is necessary. Thank you for your hard work.”

“As long as you are okay with it, we can start planning immediately. Let me tell you about the details of the surgery-”

After explaining everything and having her sign the consent form, Yang Ping stood up and the nurse opened the door.

He thought it would be a great effort to persuade Fang Xiaoyun, but it turned out to be very easy. This girl was very sensible.

Maybe, her decisiveness could save herself.