Based on the patient's symptoms, the first thing to consider was the possibility of an acute abdomen.
An acute abdomen is a condition primarily characterized by sudden, severe abdominal pain, and it's a common complaint in the emergency department.
Common examples that many people are familiar with, like acute appendicitis, acute cholecystitis, and acute pancreatitis, are all types of acute abdomen. Beyond those, it could also be abdominal bleeding or an intestinal obstruction.
Wu Ting carefully reviewed the patient's prior diagnosis. Initially, Dr. Qin had considered pancreatitis, but after blood and urine tests, the results showed no abnormalities.
When the patient was admitted, his abdominal pain was severe, and he was completely restless. However, the examination revealed no rebound tenderness. None of the common types of acute abdomen could explain the source of the patient's pain.
Dr. Qin had also ordered a plain CT scan to check for fluid in the small intestine and an abdominal vascular examination, which ruled out the possibility of a pulmonary embolism.
'So what exactly is the cause?'
Wu Ting suddenly recalled the suspicious urine—the phenomenon where it turned red upon exposure to light.
After a moment of thought, Wu Ting went to speak with the patient again.
"Dr. Wu, this abdominal pain has been recurring for seven years. Before, the county hospital treated me for gastritis. The medication helped, but the pain came back multiple times whenever I was hungry, tired, or emotionally agitated."
The patient pointed to the area of his pain. It was all paroxysmal pain in his middle and lower abdomen, sometimes accompanied by nausea and vomiting, but the episodes were short and would resolve on their own.
"My urine is a normal color right after I go, but if it's exposed to sunlight for more than thirty minutes, it changes color and turns red."
"I've also had issues with insomnia and vivid dreams before."
The patient sounded extremely frustrated and depressed as he spoke.
After hearing everything, Wu Ting offered a few words of comfort. Under his Diagnosis Skill (Purple), an idea really did begin to form.
'However, based on my deduction, this is an extremely rare disease. There are very few clinical records of it in the country.'
Wu Ting thought for a moment longer, then decided to search foreign journals for corresponding case studies.
'Fortunately, I previously obtained Cheng Feng's scholarly foreign language ability (Yellow), which gives me the basic skills needed to search cutting-edge journals.'
Before, with his own foreign language proficiency, this would have been impossible.
With a preliminary idea in mind, Wu Ting rushed to the office and began searching online. He had to admit that for many rare diseases, foreign research was far more extensive than domestic research.
Soon, in a few foreign journals, Wu Ting found three similar cases. They had all gone through numerous twists and turns, with misdiagnoses that had tormented the patients for years.
Porphyria is a rare metabolic disorder that is difficult to diagnose. The average time to a clinical diagnosis is as long as 5-15 years!
A hospital like Fan City First Hospital would rarely encounter such a patient, so whether it was the Emergency Department, the Pain Management Department, or the General Surgery Department, none of them would typically disseminate knowledge about Porphyria.
Only major hospitals in places like Xiao City, Jinggang University Affiliated First Hospital, or the higher-level hospitals in Xianglin City and Qinghe City would have some experience diagnosing it.
'It looks like the patient's condition really might be this rare Porphyria!'
Wu Ting took screenshots of these relevant case files, printed them out, and prepared to discuss them at the multi-department consultation that afternoon.
While Wu Ting was preparing the consultation materials, Dr. Luo Ming came over.
"Wu Ting, come with me for a moment. Ma Weiguo, the patient you were in charge of, is having a bit of a situation. I need you to come along."
Luo Ming sounded somewhat helpless as he spoke to Wu Ting, glancing at the documents he was printing.
Seeing that they were all original foreign-language texts filled with professional terminology, Luo Ming was a bit surprised. He scanned them but couldn't make sense of them.
He sighed internally. 'The resident doctors these days are so competitive. I already knew Cheng Feng's foreign language skills were impressive—he'd even earned praise from Director Huo—but I never expected Wu Ting to start trying to read original foreign journals too.'
'But can he really understand it?'
However, Luo Ming wasn't about to discourage Wu Ting's ambition.
Being willing to spend time shoring up one's weaknesses was always a good thing.
"A problem came up with Ma Weiguo after the surgery?"
Wu Ting put down his work, confused. He had just checked on him that morning, and his recovery was going quite well.
Luo Ming said, looking a bit awkward, "It's not a post-op complication. Ma Weiguo is refusing to let me remove his stitches or conduct his post-op physical therapy."
"Huh? Wasn't Ma Weiguo very cooperative? And he was so satisfied with the surgery. Why would he refuse physical therapy?"
Wu Ting frowned and followed Luo Ming to the patient's room.
As they approached, they heard Ma Weiguo's stubborn voice: "If Dr. Wu doesn't come, I'm not getting my stitches out, and I'm not doing any physical therapy."
The nurse's face was flushed. "Uncle Ma, we have a schedule for removing stitches and for physical therapy. You need to follow the doctor's orders. Right now, Dr. Luo is in charge of your stitch removal and therapy. Dr. Wu has other duties."
"Dr. Luo is also a very experienced doctor. You need to trust us."
The young nurse explained patiently.
But Ma Weiguo wouldn't budge, insisting on waiting for Wu Ting.
"Uncle Ma, what's the problem? Is your hand hurting again?"
Wu Ting hurried over.
Seeing Wu Ting, a smile finally appeared on Ma Weiguo's face. "Hey, Dr. Wu, you're finally here! I only trust you. I'll only get my stitches out if you say so. And I'll only start my physical therapy if you confirm it's okay."
Hearing Ma Weiguo's words, Wu Ting finally understood. It turned out that Ma Weiguo only trusted him and was wary of all other doctors.
The money-saving, time-efficient surgical plan that Wu Ting had specially designed had completely won Ma Weiguo over, convincing him that Wu Ting was the only good doctor who truly had his best interests at heart.
He was afraid the other doctors would trick him into spending money on unnecessary procedures, which was why he insisted on waiting for Wu Ting.
Luo Ming shrugged helplessly, a little envious inside. After all, earning a patient's trust is an honor for any doctor.
When the young nurse saw that Wu Ting had arrived, she admonished Ma Weiguo:
"Uncle Ma, look, Dr. Wu is here now. Can we proceed with the stitch removal and physical therapy?"
Ma Weiguo looked at Wu Ting for his opinion, and Wu Ting nodded.
"Uncle Ma, removing stitches and starting physical therapy follow a strict schedule. You must follow the doctor's orders. As for who is in charge, our hospital has a rotation. But you need to understand one thing: all of our doctors are professionals. Dr. Luo Ming is much more senior than I am. Plus, I have other work to attend to, so you absolutely must cooperate. Understand?"
Wu Ting had no choice but to try and persuade him.
"If it were my turn on the rotation, I would definitely handle your physical therapy and stitch removal personally, but right now, it's Dr. Luo's shift."
The old man was just stubborn and fixated on one idea.
He had decided Wu Ting was a good doctor, and so he would only trust Wu Ting.
Hearing Wu Ting put it that way, Ma Weiguo finally nodded, though he was still a bit disappointed that it wouldn't be Wu Ting himself.
"Alright, since Dr. Wu said so. I trust you. I'll cooperate."
"Uncle Ma, come with me to get your stitches out, then. After that, we'll arrange a set of small-range active and passive flexion and extension exercises."
Luo Ming took Ma Weiguo to have his stitches removed and then to the rehabilitation room to complete his exercises.
After leaving the patient's room, Wu Ting went back to preparing his materials for the consultation.
That afternoon, it was finally time for the multi-department consultation.