CHAPTER 365: 365 RABBIT FEVER?

(Thanks to my friend Yuanqi Yuanyue Yuanzi for the encouragement, and to my friend Shuibuxing for the monthly ticket encouragement)

Liu Banxia had a great time at the Zhou Family’s dinner last night. He had performed excellently, so naturally, he was very satisfied with the meal. However, for Wang Xiaoyan, this wasn’t necessarily a good thing.

They had agreed to continue eating barbecue when they got back. However, she and Tang Dou ended up being the main ones eating. Wang Xiaoyan had nagged Liu Banxia and Qiaoqiao about it, but the two of them, with their thick skins, didn’t care at all.

"Chao, did we admit any critically ill patients yesterday?" Liu Banxia asked after changing his clothes.

"Yesterday was relatively calm. There was one car accident and two heart attacks. The car accident victims only had minor injuries, and the heart attack patients were also successfully resuscitated," Wang Chao replied.

"However, this year’s flu is quite rampant. Many people come to our department for IV drips every day. I wonder when the numbers will start to go down."

"The temperature this year is a bit abnormal, cold one day and hot the next. Plus, there hasn’t been much snow, which is indeed a concern," Liu Banxia commented.

"We still have to remind everyone to pay attention to personal protection. Wearing a mask for a long time is indeed uncomfortable, but it’s necessary. Especially for the nurses who are frequently in contact with patients, disinfection work must be done meticulously to avoid cross-infection."

"Don’t worry, everyone is very careful about this. How many surgeries do you have today?" Wang Chao asked.

"Three: two colostomies and one inguinal hernia repair," Liu Banxia responded.

"If there’s nothing urgent, I’ll take them into the OR. I just reviewed the preoperative examination results; everything looks good. I’ll try to finish quickly so I can come back and help out."

"Go ahead. If I have time, I’ll come and observe one of the colostomies, alright?" Wang Chao inquired.

"Sure, manage your own time. Alright, kids, let’s get to work!" Liu Banxia called out.

If it were in the past, interns like Xu Yinuo would certainly have been ecstatic. But now, having assisted Liu Banxia in surgery multiple times, they weren’t as thrilled as before.

However, this only meant they weren’t *as* excited; they still cherished every opportunity to join Liu Banxia in the operating room.

After all, they had been interning with Liu Banxia for quite some time. Even though they nominally had other supervising physicians, the six of them were pretty much under Liu Banxia’s guidance.

Based on their experience during this internship period, as long as Liu Banxia approved of them, they would have many opportunities to participate in surgical procedures.

This was extremely precious. Normally, interns could only observe surgeries like colostomies. But Liu Banxia was different; he gave them opportunities to practice, which was invaluable experience.

Liu Banxia’s surgical speed was very fast, and his operating times at the Second Hospital were among the shortest on average. Even so, he only managed to perform one colostomy and one inguinal hernia repair that morning.

The colostomy scheduled for the afternoon was somewhat more complex because the patient had rectal cancer, which involved the issue of sphincter preservation. If possible, they had to do their utmost to preserve the patient’s anus.

"President Liu, I admitted a patient this morning who is emotionally unstable and excessively sleepy, with enlarged lymph nodes," Wang Huan said, approaching with his meal tray.

The interns eating with Liu Banxia immediately pricked up their ears. They loved it most when people sought Liu Banxia for a consultation. It was like solving a puzzle and very interesting.

"Brother Wang, you really should have waited until I finished eating. I just got out of surgery," Liu Banxia said with a wry smile.

"I timed my visit specifically for this. You eat your food; I’ll tell you about it," Wang Huan said.

"At first, I thought she might be showing signs of depression. However, the blood test results showed an elevated erythrocyte sedimentation rate, indicating inflammation. The patient also has a fever."

"We then suspected a possible brain tumor and performed an MRI, but the results were negative. We also considered parasites, but blood and cerebrospinal fluid tests were negative for those as well."

Hearing Wang Huan’s description, Liu Banxia became interested. "Can hypersomnia be ruled out?"

Wang Huan nodded. "It can be. Besides, the blood test results for hypersomnia aren’t like this. Currently, we still don’t know the primary cause of the fever and inflammation."

"How many hours does she sleep each day?" Liu Banxia asked casually.

"It varies. According to her husband, at least fourteen hours. Some days it’s more, possibly up to seventeen or eighteen hours," Wang Huan replied.

"And unlike some people who sleep in segments, she sleeps straight through. When she wakes up, her mood is terrible, and she sometimes loses her temper if she talks too much."

"We’re currently considering whether it might be paraneoplastic syndrome, but the cerebrospinal fluid examination results don’t quite align. She’s already been admitted. Would you take a look after you finish your meal?"

Liu Banxia nodded. "Alright, but don’t count on me. You guys have surely held consultations on this already. This case is indeed quite interesting."

"By the way, have you done any tests related to pellagra? Didn’t we encounter a patient with similar symptoms not too long ago? Although that patient didn’t sleep nearly as much as this one."

"We checked that too. They have a good standard of living and no apparent stress in their lives. Their child also got into a fairly good university this year, and the couple’s income is quite decent," Wang Huan explained.

Liu Banxia nodded. While he continued eating, his mind was already working on the case. This is genuinely tricky, he thought. So many tests have been done, yet no cause has been found.

At that moment, Wang Huan’s phone rang again. After answering, his expression turned serious. "Okay, I’m heading up now."

"What’s wrong?" Liu Banxia asked.

"You’d better eat later. The patient just had a brief seizure, and after recovering, she started experiencing hallucinations," Wang Huan said.

"Alright, let’s head up and take a look first. Miao Rui, ask Zhou Qiang to keep our food warm for us," Liu Banxia said, then followed Wang Huan towards the Emergency Center.

He’d barely had a few bites; it would be a real waste to throw it all away. They could eat it when they got back. Besides, this kind of interruption was normal in the hospital.

"Teacher Wang, we’ve administered 5 mg of haloperidol to the patient. Her condition has stabilized for now," Zhou Shangkai reported.

Wang Huan nodded, handing the patient’s chart from the bedside table to Liu Banxia.

Liu Banxia read the chart carefully. The patient was forty-one years old, and all relevant test results were negative.

"Doctor, can we do any other tests?" the patient’s husband asked.

"Are there any other symptoms she exhibits at home? Please try to recall carefully. Since it’s not convenient for us to question the patient directly right now, even the slightest detail could be important," Liu Banxia instructed.

"For instance, regarding her emotional and physical state when the illness first started, did the emotional instability appear before or after the hypersomnia began?"

"Initially, she just seemed a bit out of sorts and would occasionally have a slight headache. Later, she started sleeping more, both at night and during the day. After waking up, she’d be listless and bad-tempered," the patient’s husband said.

"At first, we thought she was bewitched or something, so we found a traditional healer. After two days of trying things with no effect, we came to the hospital. Now, she’s sleeping more and more."

"Does she usually sleep this soundly, whether it’s day or night?" Liu Banxia pressed.

"Well... initially, she tossed and turned a lot at night. It got so bad that I eventually had to move to another room," the husband admitted.

"I really didn’t think much of it at first. I assumed it was a cold, and don’t cold medicines make you sleepy? I’ve told Doctor Wang all of this already; I really can’t think of anything else."

"Her current state is exhausting for me too. When I get home from work, I have to tiptoe around, afraid of waking her. If I do, she’ll pick a fight," he added.

"Do you have any pets at home?" Liu Banxia asked after a moment of thought.

"Yes, we do. We got a pet cat just this year," the patient’s husband replied.

"Initially, she adored it, doting on it constantly. But now, in her current state, she doesn’t even pay attention to the cat, and the cat doesn’t dare approach her to be affectionate anymore."

"President Liu, do you suspect this might be an infection transmitted by the pet?" Wang Huan asked, frowning in thought.

Liu Banxia shook his head. "It’s still hard to say for sure. Right now, we can only consider multiple possibilities. Could it be tularemia? The high fever and swollen lymph nodes are consistent."

"The patient initially thought it was a cold, so she might have overlooked symptoms like general body aches. However, it doesn’t quite align with her hypersomnia. For now, it’s just a hypothesis."

"Okay, I’ll arrange for targeted lab tests immediately. Hmm... both of them should be tested, for comparison," Wang Huan nodded.

"Is it really an infectious disease?" the patient’s husband asked anxiously.

"That’s just our current hypothesis. Your wife’s symptoms aren’t very clear-cut, so we’re using a process of elimination. We’ll also need to do a simple blood test and a skin test on you shortly," Wang Huan explained.

The patient’s husband glanced at his wife lying on the bed, then nodded.

"Brother Wang, can we try administering streptomycin while we wait for the test results? It will take too long to get them back," Liu Banxia suggested.

Wang Huan nodded. "We’ll do a skin test for streptomycin allergy on the patient first. If there’s no reaction, we’ll give her a 500mg intramuscular injection and observe the effect."

Although some symptoms didn’t quite fit, tularemia seemed the most plausible diagnosis at the moment. Moreover, streptomycin is effective against many bacteria, so it was worth trying.

This was the plan for now. Whether it would be effective would depend on the test results and the patient’s response to the medication.

After dealing with the situation upstairs, Liu Banxia and his group returned to the canteen to finish their meal.

"Dr. Liu, what are you thinking about?" Qing Kewa asked curiously.

"It’s still about that last case. Something just doesn’t feel right, especially the hypersomnia. We still can’t find a reasonable explanation for it," Liu Banxia confessed.

The interns didn’t know what to say. It was true. They knew about tularemia, but it typically didn’t cause hypersomnia.

However, the other symptoms matched very well. It was also possible that the hypersomnia was a complication arising from tularemia, but this was still uncertain.