Chapter 7: Misdiagnosis

Words : 2332 Updated : Mar 13th, 2025

Andy patted Walter on the shoulder. "Rest for five minutes, and you're ready for eight hours. Let's get moving!" An experienced doctor had to manage many beds, and patients were assigned to doctors based on their beds. As a backbone of the emergency department, Andy was responsible for many beds and, thus, many patients. Upon entering the ward, Andy instantly became the center of attention. A stylishly dressed middle-aged woman suddenly blocked his path. "Mr. Tibbert, when can my daughter be discharged?" "Bed number 6?" Andy gave the bed a quick glance. The girl was heartbroken, having self-harmed after a breakup. Her parents found her just in time, and after hours of emergency treatment, doctors managed to save her life. "Let's do a check-up first. If there are no complications, she can be discharged this afternoon. However, while the physical wounds are healed, the emotional ones are harder to treat. I recommend seeing an experienced psychologist for counseling." In the emergency department, inpatients usually stayed for a day or two. Patients who stayed more than three days were transferred to specialized departments. Tenos Hospital was a large hospital with a shortage of beds. Not only were patients eager to be discharged, but doctors also hoped to discharge them quickly to free up beds for more patients. Unlike other attending doctors, Andy didn't shirk his responsibilities. He tracked each patient throughout their stay, ensuring no time, money, or hospital resources were wasted. Approaching another bed, Andy nodded at Walter. Walter understood Andy's intent and stepped forward to examine the patient. While examining, he asked, "How did you sleep last night?" "Not well at all. I slept less than three hours in total; the wound hurt a lot!" The patient, a 20-year-old sports school student, had gotten into an argument while drinking at a food stall and was hit on the head with a beer bottle. "The anesthetic has worn off, so pain is normal." "Doctor, will there be any after-effects?" Walter didn't answer. Andy's suturing skills were top-notch, using classic interrupted sutures with meticulous attention to detail, so the wound was expected to heal quickly. However, the current situation wasn't as optimistic as expected. Walter reported to Andy, "The wound is swollen. We need to increase the medication, and he will need at least two more days before discharge." The ward fell silent. Andy's skills were well-recognized. Was Walter questioning authority? Walter pinpointed the issue, "The surgery was fine; the problem lies in post-operative care." Andy frowned. "What happened?" The nurse responsible for monitoring the ward spoke up, feeling wronged. "The patient sneaked out last night and only returned around 3 a.m." Andy was more surprised than anything. Walter had discerned the nursing error through observation alone; he clearly wasn't just an ordinary intern. "You neglected your duty!" Andy rarely spoke so sternly. Having practiced medicine for many years, the man had seen various emergencies. He calmly said to the patient, "Your life is your own. If you want to be discharged now, you can go ahead. But how you recover later has nothing to do with the hospital!" Seeing Andy about to give up on him, the patient panicked and pleaded, "I'm sorry, Mr. Tibbert. It was a special situation last night. My girlfriend and I broke up, and I spent half the night making up with her. I'll cooperate with your treatment from now on and won't cause any more trouble." Andy wasn't truly giving up on him; he just needed the patient to understand the gravity of the situation. He chose the cold treatment method and walked away toward the next bed. Following Andy on his rounds, Walter gained a new understanding of Tenos Hospital. Unlike field doctors, emergency surgery felt like an assembly line, where patients were like damaged goods and attending doctors were responsible for repairing them. As for post-operative recovery and medication, there was a standardized process. Doctors entered patient data into the computer system, and a mature system tracked each subsequent step. After rounds, a young nurse with a demure appearance approached Andy with a folder. "Andy, you have seven to eight surgeries scheduled today." Andy seemed dissatisfied. "That's a bit too few!" Doing three to four surgeries per night would be the limit for a novice. However, for an experienced expert like Andy, seven to eight surgeries were just the starting point. When the nurse's gaze shifted to Walter, Andy introduced him, "You should get to know her. She's Raina Bell, our emergency surgery room's goddess nurse." Nurses started their careers early, and Raina looked young, certainly not over thirty, but she'd worked in Tenos Hospital's emergency department for ten years. Standing at 1.7 meters, with long legs and a slim waist, she was fair-skinned with rosy cheeks; though her expression was often cold, she didn't smile much. Nurses not smiling was a professional habit, especially for pretty ones. Being too friendly could easily lead to misunderstandings with patients. There had been instances where patients fell in love with a nurse who cared for them attentively and caused trouble when their feelings weren't reciprocated. Raina seemed well-informed, addressing Walter before Andy could introduce him. "You're the new intern, Walter, right?" Andy squinted his eyes, teasing, "Isn't he handsome? Wipe your mouth; your lipstick's smudged from drooling." Raina rolled her eyes, retorting, "It's not about looks. I heard he has some skills." Walter couldn't help but chuckle wryly. "That's a refreshing assessment." Raina shrugged, raising her eyebrows. "That's Mr. Shayle's exact words. If you're not happy, take it up with him." Andy patted Walter on the shoulder, pretending to whisper, "You can ignore Pablo and me, but don't ever offend Raina. Whether your surgeries go smoothly depends on her mood." Walter looked at Raina, who rolled her eyes and quickly waved. "Don't put me on a pedestal; I might fall." She glanced at her watch. "An ambulance is about to arrive at the lobby. You should prepare for surgery." "What's the situation?" "Suspected acute appendicitis! The patient is in severe pain, and the family has agreed to surgery." Andy considered this and then asked Walter, "Want to give it a try?" The opportunity came sooner than expected, and Walter wasn't going to refuse. "Sure!" The woman mused, "It's his first day on the job, though!" Raina looked surprised, confirming with Andy, "Are you sure you want an intern to perform an appendectomy alone?" Generally, interns only perform appendectomies independently under supervision towards the end of their internship. Andy's aged face crinkled into a smile. "Hey, don't judge a hero by age. I was doing surgeries on my own at twenty. Plus, this kid's better than me, a real wolf in sheep's clothing." Walter was speechless. Was this a compliment or an insult? ***** The wheels of the surgical stretcher rattled as it left the ambulance, the sound echoing through the lobby's silence. Walter stood waiting at the entrance, quickly moving with the stretcher once it landed. Meanwhile, Walter questioned Elliott Shirvinton, who had accompanied the patient, trying to understand the situation. "How's the patient?" Elliott, a resident in the emergency surgery department who had just been promoted last year, was on emergency duty today. He was excited; appendectomies were too minor for the director, so it was an excellent chance for him to perform one independently. He quickly replied, "The patient is named Ivy, female, 22. She started feeling uncomfortable around 10 p.m. last night, initially thinking it was menstrual pain and took painkillers. By 1 a.m., the pain was unbearable, and her family called the ambulance. During the ride, I examined her; she had significant pain in the lower right abdomen with rebound tenderness. Initial diagnosis: acute appendicitis." Walter suspected it wasn't that simple without having examined the patient yet based on his experience. Entering the operating room and pulling the curtain, the patient lay on a sterile mat, clutching her abdomen and constantly crying out in pain. Then, Walter stepped forward and began examining the patient. Elliot had already learned from Raina that Walter would be performing the surgery, leaving him no chance to participate. This realization left him deeply dejected. Even so, he didn't leave. Instead, he shamelessly lingered in the operating room, holding onto a sliver of hope. After all, Walter was just an intern, and it was his first day on the job—there was a high chance something would go wrong. If that happened, he might get to step in as a substitute. Walter started by tapping on the painful area, then checked other spots. As his examination deepened, his expression grew more serious. After about two minutes, he stopped, reporting to Andy with a grave expression. "I recommend an abdominal ultrasound. The patient might not have appendicitis but cholecystitis." "That's ridiculous! How could it be cholecystitis? You can't even distinguish between the gallbladder and appendix locations, yet you dare to spout such nonsense here?" Being questioned by an intern, Elliott, usually mild-tempered, was like a cat whose tail had been stepped on, leaping in fury.

Chapter 7: Misdiagnosis

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