The Enhanced Doctor-Chapter 596 Penicillium

"Does your father grow flowers at home? How many?" Liu Banxia, who had stepped outside, asked the patient’s son.

The patient’s son nodded dazedly. "He grows lots of flowers; they’re all over the balcony."

"What kind of fertilizer does your father use for his flowers?" Liu Banxia continued to ask.

"Beer, tea, soybean water... I think he also got some farm manure from someone," the patient’s son responded.

Liu Banxia nodded. "It might be a Mucor infection. We need to perform an endoscopic biopsy in the sinus area, take several samples, and screen for Mucor." 𝚏𝗿𝗲𝐞𝐰𝚎𝕓𝐧𝚘𝘃𝗲𝐥.𝐜𝚘𝕞

"We’ll also test for sensitivity to Amphotericin B. If he’s not allergic, we’ll administer it intravenously, starting with the smallest dose. Let’s observe the patient’s condition first; I suspect this is it."

"If his symptoms improve, or if the tests confirm Mucor, we’ll need ENT doctors to debride the area around the sinuses."

"Banxia, could it really be Mucor?" Xu Hui asked. "Although the symptoms somewhat align, the patient’s blood sugar isn’t high, and he hasn’t reached the level of ketoacidosis."

"Moreover, if it were a Mucor infection, shouldn’t there be signs on the wound on his hand? There’s some inflammation, but no sign of pus."

"The wound on his hand is probably just an ordinary injury, but that’s not his dominant hand," Liu Banxia pointed out.

"The skin on the hand with the injured finger is very smooth, while the skin on his other hand is somewhat rough. Notably, there are hangnails on his fingers. We were only focused on his injured hand."

"What if he accidentally picked his nose while handling the soil in the flower pots? That could have left Mucor residue. He also had a cold, which would lower his immunity, so unfortunately, he could have gotten infected."

"However, this is just my speculation for now; we still need to wait for the lab results. But a Mucor infection does fit the current symptoms. It’s just uncommon to see rhinocerebral and pulmonary types appearing simultaneously."

Xu Hui nodded; that explanation made sense. However, they still had to wait for the lab results. If it truly was Mucor, they should be able to see mycelia in the necrotic tissue.

Culturing it would be very difficult. Although this fungus is common in everyday life, it’s often absent in necrotic tissue samples.

Even if mycelia are visible under a microscope, a standard culture will still likely come back negative.

Moreover, for the current patient, even though the microscopy results weren’t out yet, they could proceed with the sensitivity test concurrently.

With a clear direction, the examination process became much more straightforward.

Finally, the lab results came back, confirming it was mucormycosis. Further typing would require more tests, but Amphotericin B was the currently available treatment.

DING! Multiple Embolisms Mission completed.

Gained 400 experience points, 100 diagnostic skill proficiency points, and 8 Glory Points.

"Not bad, you actually diagnosed it," Chen Xuehai said, patting Liu Banxia’s shoulder.

"It was just a guess, actually," Liu Banxia said with a smile. "Initially, I was focused on the wound on his hand. I thought bacteria entered through the wound, infected his blood, and caused vasculitis."

"But then I thought, if that were the case, his symptoms seemed too mild. So I started wondering if there might be another condition. Could it also manifest on his fingers?"

"Let me put it this way: today’s diagnosis was a complete shot in the dark. I hadn’t considered Mucor at all. It only occurred to me when I saw the many hangnails on his other hand and the dark soil under his fingernails."

"However you figured it out, you’re the hero here," Peng Bo commented. "Mucormycosis develops very rapidly, especially the rhinocerebral type. If it had gotten any worse, we might have truly lost the chance to save him."

"This disease isn’t very common because Mucor needs a specific environment to thrive. It’s just that this patient’s situation was somewhat unique."

"Nowadays, homes have heating, so the temperature is right. Flowers need watering, so the humidity is there. These flower fertilizers are also very conducive to Mucor growth. He loves flowers, is always tending to them, and he also happened to have a cold... All these factors came together to cause this illness."

"Let’s see how Amphotericin B works first. If it’s not effective, we’ll have to operate. Not just the sinus area; we’ll probably need to inspect the lungs thoroughly and remove any necrotic tissue. Otherwise, Amphotericin B won’t be able to penetrate effectively."

Liu Banxia nodded. "That’s the tricky part, especially concerning the brain. For now, the necrosis seems confined to the area around the sinuses and probably hasn’t spread towards the cranium."

"Xu Yino, go and explain the situation to the patient’s family. Also, tell them to prepare for surgical debridement. As for how many areas will need debridement, we can’t determine that yet."

Xu Yino nodded and hurried out.

"Alright, everyone, back to your tasks," Liu Banxia said. "Dr. Chen, please research if lung debridement is necessary. I still need to go to the operating room and report to the Director about that case he assigned me."

Everyone chuckled. This was related to a task Zhou Shuwen had given Liu Banxia during the noon consultation, one Liu Banxia had to complete without fail. They had forgotten to check what surgeries were scheduled for the afternoon, but they were usually significant ones.

He first checked the operating room schedule when he got back. Operating Room 2: a liver cyst, with Qi Wentai as first assistant to Zhou Shuwen. It didn’t seem too complicated; he could manage.

"Director, that patient has been diagnosed," Liu Banxia said after arriving at the operating room. "It’s a Mucor infection, rhinocerebral and pulmonary types."

"Mucor?" Zhou Shuwen remarked. "Diagnosing that isn’t easy. There’s usually visible bone damage."

"Uh... Actually, it was a wild guess. We didn’t even check for bone damage," Liu Banxia said, slightly embarrassed.

"Even guessing is a skill. Come on, take over. It’s a routine cyst resection; I’m currently dissecting," Zhou Shuwen said.

Liu Banxia hurriedly approached the operating table and took over the surgery.

"Director, maybe we shouldn’t schedule so many operations this week," Liu Banxia said.

"It’s not that I want to; we’ve had many patients transferred here recently. And transfer patients can’t afford delays. You and Shi Lei should take on more cases to help share the load," Zhou Shuwen replied.

"Director, could we perhaps speak to hospital administration about getting an otolaryngologist transferred here sooner?" Liu Banxia suggested hesitantly.

"With today’s patient, a professional otolaryngologist might have become suspicious just from a nasal endoscopy. Although we can perform the procedure and make observations, we’re still not on par with specialists."

"I’ll bring it up at the next meeting," Zhou Shuwen said. "Other departments will be established in the near future. There’s no need to rush; it’s just a matter of time."

"Wang Lei, your anesthesiology department will have to hold on a bit longer. Anesthesiologists are incredibly hard to find. The hospital feels it’s better to focus on training interns for now."

"Even if we manage to recruit someone, they’re likely to be poached by another hospital after their contract ends. Anesthesiologists require years of experience. If we can’t cultivate our own talent, relying solely on external hires isn’t sustainable."

"Director, rest assured, we’ve been working hard on this," Wang Lei said. "But the workload in our anesthesiology department is indeed quite substantial."

"Our Emergency Center not only handles its own surgeries but also shares some of the load from the inpatient department. We’re actually collaborating with the inpatient anesthesiology department now; otherwise, we really couldn’t manage."

"You and Zhou Li have both contributed a great deal. Just hang in there for a few more months," Zhou Shuwen said.

"Thank you, Director. We can manage for now, but lasting a whole year like this would be really tough," Wang Lei said with a smile.

As Liu Banxia operated, he felt a wave of emotion. It seemed the real bottleneck was the anesthesiology department. He remembered Wang Lei grumbling about this back when he was still a resident. Now, the surgical caseload had effectively increased, but the number of anesthesiologists hadn’t, naturally making their workload much heavier. So many operating rooms, yet only four anesthesiologists. The past few large-scale emergency procedures had also required pulling staff from the inpatient department’s anesthesiology team. However, the Second Hospital was a public institution, and everything operated within strict regulations. Even if they wanted to offer high salaries to recruit, they didn’t have that option. Doing so would likely upset the hospital’s internal salary structure. Perhaps the only recourse would be some form of compensation tied to their positions in the future, but whether that could genuinely retain people was another question entirely. This wasn’t just an issue for the Emergency Center; it was a problem for the entire Second Hospital. Compared to pediatrics and the ICU, the anesthesiology department faced even more significant difficulties. But this wasn’t something he, as chief resident, could resolve. The problem was too high-level. He could think about it, but there was no practical solution he could offer.

This was also the first time he and Qi Wentai had formally performed a surgery together. They had long since set aside their previous animosities, and their collaboration was seamless.

Actually, this was also Zhou Shuwen’s way of assessing Liu Banxia’s current surgical proficiency. Even though Liu Banxia was his direct disciple, it had been a long time since they had last operated together.

The opportunities to assist Zhou Shuwen had mostly been passed on by Liu Banxia. It wasn’t just him; even Shi Lei rarely got the chance now, with others and the interns taking on those roles more often.

DING! Surgery complete.

Obtained 200 experience points, 100 diagnostics proficiency points, 100 suturing proficiency points, 100 dressing change proficiency points, and 3 Glory Points.

The reward wasn’t substantial, as Liu Banxia had taken over midway through the surgery. But he was still gratified, feeling he had helped Zhou Shuwen and allowed him some rest.

Being a director isn’t easy. So many issues to handle and so many surgeries to perform; it’s truly not a relaxing job. For him, Liu Banxia, all he could do now was occasionally step in. Many patients specifically came for Zhou Shuwen. Given Zhou Shuwen’s character, he wasn’t the type to just make an appearance before anesthesia and then have someone else take over once the patient was under.