(Thanks to the free-spirited bookworm for the encouragement of the monthly ticket)

"Director Liu, I didn't see any vegetations on the valve."

The doctor performing the cardiac ultrasound said after a careful observation.

Liu Banxia also frowned, staring intently at the screen.

He had encountered a case of endocarditis before, and similarly, nothing was visible on the ultrasound. It was only after a long and careful observation that he discovered a tiny bit.

That patient had an infection from an inflamed wisdom tooth, and he wasn't sure if this case was similar.

"Observe for a while longer, and keep more recordings. I will review them carefully when I return, sorry for the trouble," Liu Banxia said.

"Teacher Liu, are you suspecting it's similar to the wisdom tooth infection case? Because the vegetation is so small, it needs careful discrimination?" Xu Yino asked.

"It's hard to determine right now. The heart has developed a murmur, which is a new change. Coupled with his lung infection, it's very likely that the bacteria in his body are circulating with the blood and settling everywhere," Liu Banxia said.

"The initial fever was due to bacteria in the bloodstream, but it's unclear why the white cell count didn't rise significantly. After settling in the lungs, pneumonia symptoms appeared."

"In these few hours, the bacteria may have circulated throughout the body. I highly suspect the heart is already infected. Next, it could settle elsewhere and infect other organs."

"We don't have much time left, about two hours or so. If we can't figure it out, we'll have to push him to the ICU. Li Hao, run to the lab once more to see if there are any new results."

Li Hao turned and ran; the patient's condition had become very critical.

"It's still better to check the patient's phone; we can't afford to worry about much else now," Liu Banxia said after thinking it over.

He had many concerns just now, but the patient was on the brink of a critical condition, about to be pushed into the ICU. What other thoughts could he have?

The only goal was to save the patient's life; the patient could no longer fend off the bacteria. Otherwise, it wouldn't have settled in the heart. Even if it wasn't visible on the ultrasound now, it could be because the vegetation is still very small.

It's indeed possible to wait until the vegetation proliferates more, but by that time, if it hasn't been diagnosed, what bacteria caused the infection, it would be impossible to find the right antibiotic.

By that time, the only choice would be surgical intervention, doing a valve replacement. It's a delaying tactic because the cause hasn't been found.

Such a procedure, although it could save the patient's life at the moment, would cost the patient a lot of money and cause significant harm to the body.

It's not that the patient initially presented with endocarditis, but a developing syndrome. If it could be identified in time, medication could still be effective.

Communicating with the patient's mother went smoothly; the patient's phone was fingerprint unlocked and opened easily.

Liu Banxia opened the phone album and started browsing with everyone.

The album basically could reflect a person's life habits.

For example, if your phone album is full of photos of beauties, scenery, various random pictures, it could reflect a certain aspect.

The photos in the young man's phone were also many, but it could be seen that he was very self-disciplined, with some artistic flair. Most of the photos in the album were object-focused, taken casually.

Then there were some zoo trip photos or travel photos with friends.

It also showed he liked small animals a lot; there were many photos with small animals and photos with stray cats.

"Auntie, do you have pets at home?" Liu Banxia asked.

The patient's mother shook her head, "He wanted to keep a cat before, but I didn't allow. Had I known he loved cats this much, I would have let him keep one."

Liu Banxia said nothing and continued flipping through the photos.

But nothing could be deduced from these photos for now. What if it was a bacterium transmitted from small animals? A zoonotic disease?

None of his current symptoms seemed to match, and the photos with animals were from much earlier. No one heard of stray cats carrying such a formidable bacterium, with such a prolonged incubation, so menacing.

There was a photo of him holding a lamb, but that was also quite some time ago, making brucellosis unlikely.

He had also diagnosed a patient with brucellosis before, with Wang Huan's help. But that patient's symptoms were clearly different from this one.

Brucellosis patients do exhibit flu-like symptoms, but it's mainly a low-grade fever. This patient had a high fever. This point alone could rule out this bacterium.

Parasites? Impossible too.

No parasitic eggs were found in the lung effusion examination. If it were truly a parasitic infection, with such severe lung lesions, it would definitely be visible.

Moreover, if it were a pulmonary parasite, by now, the patient should have had very obvious chest pain symptoms. The X-ray examination mostly showed cystic shadows.

All these thoughts emerging while browsing the photos were ruled out one by one by Liu Banxia.

"Teacher Liu, take a look at his social media circle. Wouldn't there be some photos he already deleted, but they're still saved there?" Xu Yino suggested.

Liu Banxia nodded, operated a bit, and then opened the patient's social media circle.

This reflected another layer of the patient's life. There weren't many posts, but regardless of which one you look at, the comments and interaction were considerable.

Judging from the photos and feedback, the patient's daily life seems disciplined, aspiring, compassionate, and slightly artistic.

"Teacher Liu, hold on."

Liu Banxia was still browsing when Xu Yino softly called out.

"What did you notice?" Liu Banxia asked.

Xu Yino embarrassingly shook her head, "I just saw a photo of him holding a lamb, no wonder he would hold it; it says below that he participated in the birth of this little lamb."

This doesn't seem very professional; she should be investigating the cause of the disease, but now she's distracted by social media.

Liu Banxia was also a bit helpless; girls' focus can be quite peculiar sometimes.

He continued scrolling down and reading the text.

But as he kept scrolling, Liu Banxia's finger paused, he reversed back and opened the picture of the lamb again.

"Teacher Liu, let's hurry and find the cause," Xu Yino said anxiously.

"Just wait a moment," Liu Banxia frowned and said.

He started carefully pondering.

The patient's life is very disciplined, and he doesn't hang out in messy places outside. So the place where he got the bacteria should be within the campus with stray cats, or the small animals outside the school.

Otherwise, such bacteria would have caused related cases around him if it occurred in crowded places.

Most cats carry parasites, which can be roughly excluded for now. As for the lamb? Lambs sometimes carry more bacteria.

Because in pastoral areas, there are often outbreaks of many zoonotic diseases. For locals, these are common symptoms. The young man might have gone there to play, and it only developed after he returned to school? This is something easily overlooked.

"Teacher Liu, what did you think of?" Xu Yino asked.

"I suspect the bacteria might have been transmitted from the lamb or pastoral area, but the disease duration seems too long? The lamb is so big now, it looks like it's half-grown," Liu Banxia said.

"Lamb, or pastoral area, with such a long incubation period. Manifested as high fever, persistent fever, recurrent..., oh my, blood sample, send to laboratory for serological Q fever antibody testing."

After saying so, Liu Banxia felt much relieved.

Although Xu Yino and others haven't figured out what's going on, with this directive, they just need to follow through.

"Ensure protective measures and isolation. If it turns out to be Q fever, it is indeed contagious, though the chances are not high," Liu Banxia continued.

"Doctor, what disease did you find?" The anxious mother of the patient asked nearby.

"We are close, we'll do a symptomatic check immediately. But also, we need to push him back to the ward. When you take care of him, make sure to wear a mask and gloves," Liu Banxia said.

"Even though the virus's human-to-human transmission probability isn't high, we still must take precautions. If confirmed, treating this disease becomes quite straightforward."

"After pushing him to the ward, discontinue antibiotics and only provide fever treatment. Notify me upon confirmation to prepare a medication plan. This whole late night wasn't spent in vain. If we truly diagnose it successfully, Xu Yino takes the top credit."

"Indeed, the patient's symptoms closely resemble Q fever pneumonia. But his endocarditis seems to have flared up rather quickly, though introductions say it might persist longer," Huang Bo said.

"Anything is possible; symptoms development varies between individuals. Often it falls within a general range, but there are patients who exhibit unique manifestations outside of this." Liu Banxia said.

"This patient has many matching symptoms, just that the incidence rate is not very high, even in pastoral areas."

"With the corresponding check, the results can come out quickly. If diagnosed, medication can then bring swift recovery. If negative, straight to ICU, as saving a life is a priority."

Liu Banxia's words sounded harsh, but this is reality.

Even now with a suspected diagnosable symptom, a genuine diagnosis hasn't been achieved yet. Only when test results are out and a true diagnosis is made, can it be considered fully accomplished.

All current results are broad-range speculations.

Liu Banxia was in high spirits; Xu Yino's suggestion was indeed timely. Otherwise, they might have continued waiting, and even valve replacement might not uncover the issue.

What kind of suffering would the patient have to endure by then? This isn't a minor issue, it involves valve replacement.