Super Doctor - Chapter 135

Xu Ze observed the patient with progressive severe myasthenia in front of him. As Qian Xuebin explained the case, a memory surfaced in his mind—a virtual patient he had once diagnosed in the virtual training space. That patient’s symptoms had been strikingly similar to what Qian Xuebin was describing now. The coincidence piqued his curiosity.

“When I first took on this patient, I considered periodic paralysis as a possibility,” Qian Xuebin said with a hint of pride. “But blood tests, including potassium levels, showed no abnormalities. Later, neurological examinations revealed that the weakness was primarily in the limbs, with no other neurological deficits. Since the condition was progressively worsening, I concluded it was a neurogenic issue.”

He continued confidently, “This is clearly a neuromuscular disorder causing the myasthenia. After two weeks of ineffective treatment at Taoyuan Municipal Hospital, the patient was transferred here. By then, the weakness had already spread to the abdominal muscles. However, I managed to stabilize the condition with anticholinesterase drugs and immunosuppressants. There’s been slight improvement, and the progression has halted. With continued treatment, we should be able to control it further—maybe even achieve gradual recovery.”

The patient and his family, hearing Qian Xuebin’s words, expressed their gratitude. “We owe it all to Dr. Qian,” the family member said earnestly. “At our local hospital, the treatment didn’t help—it only got worse. Only after coming here did we see any improvement. We’ll rely on Dr. Qian’s expertise from now on.”

“Don’t worry,” Qian Xuebin replied with a self-assured nod. “Now that you’re here, we’ll do everything we can to treat you. However, this illness is quite complex. Progress tends to be slow, and long-term treatment is often necessary. You’ll need to be mentally prepared for that.”

“Of course, of course!” the family member quickly agreed. “As long as there’s a cure, we’ll follow your instructions, Dr. Qian!”

Pleased by their deference, Qian Xuebin gave a satisfied nod before turning to Xu Ze with a smirk. “Dr. Xu, would you like to examine the patient as well?”

Xu Ze smiled. He did have some doubts about this case and had no reason to decline. After nodding, he began his examination.

The patient, however, wasn’t particularly enthusiastic. The young doctor looked to be only twenty-one or twenty-two, and though Dr. Qian seemed polite toward him, it felt more like he was humoring a trainee. Still, the patient cooperated, albeit passively.

Xu Ze wasn’t bothered. Back at Huimin Clinic, patients had treated him the same way at first. Their attitudes always changed once they realized they needed him. He was used to it.

After a thorough examination, Xu Ze’s eyes narrowed slightly. The patient had mild sensory impairment in the lower limbs—not just muscle weakness or paralysis. Pure neuromuscular myasthenia gravis rarely presented with such sensory symptoms.

With a calm smile, he asked the patient, “Before your symptoms appeared, did you experience any other health issues? Like a cold or something similar?”

Though indifferent, the patient thought for a moment. “About two weeks before this started, I had a cough, but it went away after some injections.”

“Oh?” Xu Ze’s eyebrows lifted slightly at the mention of a prior infection. He pressed further, “Right before your current symptoms, did you ever feel body aches, like with a flu?”

The patient frowned in recollection. “Hmm… now that you mention it, my arms, neck, and thighs did ache for a couple of days. But it passed quickly.” He shrugged, clearly not seeing the connection. To him, the weakness in his legs had nothing to do with those transient pains.

But for Xu Ze, this confirmed his suspicion. This wasn’t a simple case of neuromuscular myasthenia—it was Guillain-Barré Syndrome (GBS).

GBS was an acute condition characterized by nerve root and peripheral nerve damage, often accompanied by elevated cerebrospinal fluid protein levels without a corresponding increase in cells. It typically struck after an infection, presenting with severe radicular pain (commonly in the neck, shoulders, lower back, and legs), rapidly progressing symmetrical limb weakness, sensory deficits, and diminished or absent reflexes. Though the condition had long been documented in Xiao Dao’s internal medicine teachings, modern medicine had only recently identified it. Xu Ze had learned about it through Xiao Dao’s online research.

The disease’s literature had just been published in national medical journals, meaning many physicians—even experienced ones—might not yet be familiar with it.

Qian Xuebin, listening to Xu Ze’s questions, frowned in confusion. He couldn’t see how these symptoms related to the diagnosis. Confident in his own expertise—after all, he was one of the rising stars of First Affiliated Hospital, with a knowledge base surpassing even many senior doctors—he dismissed Xu Ze’s line of inquiry. What could a freshly graduated rotating resident possibly spot that I missed?

Xu Ze, however, kept his thoughts to himself. Challenging another doctor’s diagnosis was a delicate matter, especially when he was technically junior to Qian Xuebin. Unless they had a strong rapport, offering unsolicited advice could come across as undermining. Since Qian likely hadn’t even heard of GBS yet, pointing it out would be futile.

After finishing his questions, Xu Ze simply nodded. “Dr. Qian, shall we move on to the next patient?”

Seeing that Xu Ze raised no objections, Qian Xuebin smirked inwardly. Trying to act profound, huh? Aloud, he said, “Sure, let’s go.”

But as they stepped out, Director Qu’s voice called from down the hall, “Xu Ze! New admission—come take a look!”

“On my way!” Xu Ze responded promptly, offering Qian Xuebin an apologetic smile before hurrying over.

Watching him leave, Qian Xuebin’s polite facade faded into a cold smirk before he followed at a leisurely pace.

…..

In the other ward, Xu Ze found the new patient—a man lying on his side, gasping for breath as nurses scrambled to administer oxygen.

Director Qu, wanting to gauge Xu Ze’s competence (despite the old director’s recommendation, he preferred to verify for himself), said, “Xu Ze, why don’t you handle this one?”

Xu Ze understood the implicit test. Nodding confidently, he took the case. He’d seen similar patients before—both in the virtual training space and at Huimin Clinic—though the virtual cases had been far more severe.

Seeing his assurance, Director Qu relaxed slightly. If Xu Ze was this self-assured, he likely had the skills to back it up. Maybe these next two months wouldn’t be so taxing after all.

After a quick history-taking with the family, Xu Ze noted the patient’s labored breathing, cyanotic lips, and inability to lie flat. A focused cardiopulmonary exam revealed fine crackles at the lung bases, an enlarged heart on percussion, and a rapid heart rate of over 120 bpm.

Coronary artery disease, cardiomegaly, Class IV heart failure—Xu Ze had his diagnosis. Still, to solidify it (and reassure Director Qu), he performed an ECG with practiced ease.

Watching him work, Director Qu nodded approvingly. His technique is polished. If his clinical judgment matches, this kid might actually be worth his salt. Now, all that remained was to see if his assessment held up.