CHAPTER 352: 352 PRESSURE IS ALSO A DISEASE

(Thank you to a generous friend for their reward and encouragement, and to readers 20180602234317808, ’I Love Reading Books,’ and ’Original Waiting for the Moon Tickets’ for their encouragement.)

The patient’s sudden hematemesis startled Liu Banxia. In past incidences of pellagra, there had been no symptoms of upper gastrointestinal bleeding.

"Doctor, why... why is she vomiting blood?" the patient’s husband asked in panic.

"Don’t worry too much for now. It seems to be upper gastrointestinal bleeding. The bleeding isn’t severe currently; let’s perform an endoscopy to take a closer look," Liu Banxia said.

"I’ll handle it personally," Wang Huan added.

"This is tricky. It seems that niacin deficiency isn’t her primary ailment," Liu Banxia said, frowning.

"We’ve gone in a full circle and come back to the assumption that pellagra is a complication of her main illness. If we can’t identify the main illness, I’m afraid giving her niacin long-term won’t be a cure."

"That’s the question, where did we miss the mark?" Wei Yuan also furrowed his brows.

They had just breathed a sigh of relief, and the patient’s condition had improved significantly after niacin supplementation. But then an episode of upper gastrointestinal bleeding occurred, signaling that they had taken a wrong path.

"The patient’s husband is really under immense stress," Liang Xiaolin sighed.

"They just got married and hadn’t even started enjoying marital bliss when his wife fell ill. They also bought a large apartment; I’m afraid with the mortgage payments, their quality of life won’t be very high."

"Eh? Wait a minute," Liu Banxia, who had been deep in thought, said, pinching his chin after hearing Liang Xiaolin’s words.

"President Liu, do you have a new theory?" Wei Yuan asked, a glimmer of hope in his eyes.

"I have a slight idea. We need to consider the patient’s overall situation," Liu Banxia said.

"Firstly, the patient does have pellagra, right? Normally, newlyweds have regular and healthy diets. So why did she contract this illness? She definitely didn’t have it before."

"Secondly, the patient’s blood calcium is somewhat high. Why is that? We still haven’t figured that out. So we can put a small question mark here."

"Dr. Liu, can’t you just get straight to the point?" Liang Xiaolin said helplessly.

Liu Banxia shrugged. "The patient has two diseases, and they aren’t isolated. I believe one of them triggered the other. These two diseases are very similar, which has interfered with our judgment."

"As you just said, the patient just got married; she should be enjoying her marital life right now. However, the young couple bought a big house, an investment that’s definitely a heavy burden on their lives."

"Furthermore, the patient’s husband mentioned they’re planning to have a child. Raising a child is quite expensive, isn’t it? Even Old Wang and Sister Li are just beginning to plan for it. Their income levels are decent, right? Yet, they still have to watch their spending."

"This is stress. It can take a toll on an otherwise beautiful life. The stress of daily living means spending is no longer as carefree as it used to be. The pressure of having a child, considering the substantial daily expenses required, adds to it."

"Under such pressures, it’s possible for the patient’s Celiac disease to be triggered. Over time, the condition deteriorated, becoming more and more severe."

"Celiac disease? Surely not. Isn’t Celiac disease gluten intolerance? How does it relate to her current illness?" Liang Xiaolin asked, frowning.

"Because the patient has diarrhea," Liu Banxia responded with a smile. "We simply viewed the diarrhea as a symptom of pellagra. What if it occurred before the pellagra?"

"Why did she contract pellagra? Because she couldn’t absorb enough niacin, and the organ responsible for absorbing nutrients in the human body is the small intestine. Coincidentally, Celiac disease damages the small intestine, causing functional disorders."

"Celiac disease is a genetic condition; it’s also an autoimmune disorder. Many people carry the gene for this disease, but carrying it doesn’t necessarily mean it will be triggered."

"It’s similar to urticaria. When a person is under extreme fatigue and anxiety, their immunity declines, making it possible for such diseases to flare up."

"The patient went on her honeymoon, so they must have been tired, right? Wedding expenses would have made them careful about their spending. They also have to save money for their future baby. All this adds stress and can significantly lower their immunity."

"Another piece of evidence is the patient’s high blood calcium concentration. And why is this? There could be numerous causes, but one very indicative reason is the presence of a malignant tumor."

"Unfortunately, the incidence of malignant tumors in patients with Celiac disease is over 7%. These are often gastric mucosal tumors, which would explain the patient’s stomach pain."

"Vomiting blood is also somewhat related to Celiac disease. The small intestine is damaged, leading to reduced absorption of not only niacin but also various vitamins in general. For instance, with less vitamin K absorbed, the patient’s blood coagulation time will be longer."

"During the blood test, these signs were indeed present, but they were only at the edge of the normal range, so we didn’t pay much attention."

"Of course, this is just my speculation for now. Once Wang Huan finishes the endoscopy, we should be able to get a clearer view of the condition inside the stomach, at the very least to see if there are any tumors in the lining."

"Then we can conduct stool tests and X-rays to check the small intestine. If Celiac disease can be diagnosed, all the symptoms would make sense. If not, we’ll keep exploring. Why are you all staring at me like that?"

"Teacher Liu, you’re incredible! Why is it that every time you analyze a case, it’s so clear and understandable? We can understand it when you explain, but we can’t come up with it ourselves," Miao Rui complained, his face crestfallen.

"We should thank Dr. Liang. If she hadn’t mentioned stress, I wouldn’t have thought of this aspect," Liu Banxia said with a laugh.

"Stress is often overlooked, but it can have a drastic impact on the human body. It can cause not only psychological harm but also physical harm."

"Many urticaria patients can identify their allergens, but once they recover and their health improves, these allergens no longer trigger urticaria."

"These kinds of autoimmune diseases are often triggered by excessive stress. After all, most people nowadays live fairly well and don’t suffer from a lack of basic necessities. Even if they can’t afford upscale restaurants, ordinary food is generally accessible."

"That’s why we also need to constantly adjust our moods. Being a doctor is an inherently high-pressure profession. If we can’t find a good way to manage our emotions, we could easily be overwhelmed."

"Many of the patients we see are facing life-or-death situations. Imagine the pressure. You’ve all experienced losing patients. This will only become more frequent, not less, unless you quit this line of work. That’s the only way it might ease up a bit."

"Yes... we also need to be mindful of the patients. Being ill, hospitalized, spending money, and suffering often puts them in a bad mood. So, when we’re consulting with patients or doing our rounds, we also need to control our own emotions."

The interns nodded in agreement. Liu Banxia was spot on. The reason they grew so quickly was because the pressure Liu Banxia put on them was quite significant. However, the pressure Liu Banxia applied wasn’t constant or suffocating. He often took the team out for fun during breaks and meals, frequently cracking small jokes. And so, they somehow navigated through it all, not crushed by the stressful internship, but instead significantly improving their medical skills. Reflecting on these past few months, it felt as though many things had happened, yet also as if nothing particularly memorable stood out.

After a while, Wang Huan came back, frowning. "The esophagus has slight damage, but it’s not serious and can completely self-repair. But I saw a lump in her stomach; it looks like a lymphoma. When I came back to tell you... what’s with that look in your eyes?"

He stopped midway because everyone was looking at him very strangely.

Wang Huan checked himself but found nothing wrong. What’s wrong with them now?

"Teacher Wang, we need to do a stool test and a gastrointestinal X-ray," Miao Rui said.

"Why are you getting as cheeky as Banxia? Huh? Why?" Wang Huan asked, perplexed.

"It might be Celiac disease causing these symptoms and the pellagra," Liu Banxia said.

"Damn, that might actually be it!" Wang Huan paused for a moment, then turned and ran off again.

It looked like he couldn’t wait to perform the tests on the patient.

After all, he was an internal medicine doctor and knew more about such conditions than a surgeon. Liu Banxia had needed to explain it at length just now, but Wang Huan understood the gist as soon as he heard the disease name.

"Teacher Liu, my surgery is done, and the patient has been sent to the ward," Xu Yino said, strolling back in.

"Heh, you guys were in surgery and missed Teacher Liu’s exciting diagnosis of Celiac disease," Miao Rui said.

"Psh, what’s the big deal? Anyway, Teacher Liu will definitely review this case with us later. Right, Teacher Liu? We need to review it," Xu Yino said.

Liu Banxia nodded with a smile. "Miao Rui, you can review it with them. But don’t just focus on reviewing; keep up with patient consultations and ward rounds."

"Brother Wei, you can organize the surgery for this patient; let them pick who assists. I have a liver cyst excision tomorrow. I wonder when the director will let me assist with a transplant."

"Banxia, must you make us feel so inadequate?" Wei Yuan said helplessly. "Currently, only the director, Shi Lei, and you can perform a partial hepatectomy in our emergency center. What more are you aiming for?"

"Heh, actually, I was planning to have Brother Wei assist me," Liu Banxia said, feigning seriousness. "I just wonder if there will be a celebratory meal afterward."

"Yes, yes, absolutely! Not just any meal, but a special one, a big one!" Wei Yuan hurriedly said.

Liu Banxia might be young, but he had significant experience with liver surgery. If Wei Yuan could successfully perform one under Liu Banxia’s supervision, he could then attempt more such procedures himself.

"Alright, team, are you happy? Dr. Wei is treating us to a special meal tonight!" Liu Banxia said with a wide smile.

"We must have that meal! I’ll argue with anyone who says otherwise," Wei Yuan declared with mock gravity.

After saying that, he started laughing along with them. Joking around like this occasionally was indeed quite enjoyable.