Super Doctor - Chapter 137

“Guillain-Barré syndrome?” Director Qu was taken aback by Xu Ze’s words. A glint flashed behind his black-framed glasses as he fixed his gaze on Xu Ze, sounding slightly surprised. “You know about this condition?”

Seeing Director Qu’s reaction, Xu Ze felt a surge of joy. Just as I thought—Director Qu is familiar with it. That saves me a lot of explanation.

He nodded lightly and handed over the medical record in his hands. “Director, take a look at this patient…”

Recognizing it as the case of the patient with unexplained weakness—one he had reviewed earlier—Director Qu paused, giving Xu Ze a deep look before finally accepting the file and examining it carefully.

He flipped through each page meticulously, taking his time to analyze. He had seen the patient earlier that day, but with so many cases to handle, he had only ordered some tests and later accepted Qian Xuebin’s diagnosis without considering this particular condition.

Yet, recalling the latest research he had come across, certain symptoms now seemed to align more closely with Guillain-Barré syndrome than the initial diagnosis of neurogenic myasthenia gravis.

After a long moment of contemplation, Director Qu looked up at Xu Ze and said slowly, “You’ve read the latest literature on this too?”

Xu Ze nodded, then added, “Director, I conducted a thorough history-taking and physical exam earlier. The patient had an infection two weeks before onset, along with limb and neck/back pain prior to symptoms—details slightly more comprehensive than Dr. Qian’s notes.”

As Xu Ze spoke, Director Qu’s eyes brightened. He motioned for him to continue.

“On examination, aside from limb weakness, absent tendon reflexes, I also noted mild superficial sensory impairment in the lower limbs—subtle but present.” Xu Ze paused briefly, seeing Director Qu listening intently, then went on, “And based on Dr. Qian’s current treatment, the response has been inconsistent—only temporarily halting progression without significant improvement. This casts doubt on the neurogenic myasthenia diagnosis.”

“Given the history and exam findings, Guillain-Barré syndrome is highly likely.” Xu Ze finished, watching Director Qu expectantly.

After considering the analysis, Director Qu nodded slowly, his expression approving. “Impressive. At your level, to have such broad knowledge and attention to detail is remarkable.”

“However,” he added cautiously, “this is a newly recognized condition domestically, with limited reported cases. We must be thorough.” Standing up, he picked up his stethoscope and reflex hammer. “Let’s re-examine the patient together.”

Xu Ze inwardly agreed—this was the prudence expected of a highly skilled specialist. Without delay, the two headed to the ward.

Watching them leave after their discussion, Zhang Qi glanced up curiously before returning to his notes.

…..

Entering the ward, they approached the patient’s bed. The family and patient recognized Director Qu from rounds that morning—the professor from the affiliated hospital, accompanied respectfully by Dr. Qian.

The family member, who had been feeding the patient congee, stood up eagerly. “Director Qu!”

Smiling, Director Qu addressed the patient. “This morning was hectic, so I didn’t get to examine you thoroughly. Now, Dr. Xu and I will conduct a more detailed evaluation.”

The patient, noticing Xu Ze beside him, responded gratefully, “Oh! Thank you both for your time!”

Director Qu repeated parts of the history-taking, much to the patient’s bemusement—why were both doctors asking these unusual questions?

Confirming Xu Ze’s findings, Director Qu proceeded with the physical exam, verifying the mild sensory impairment in the lower limbs alongside the motor deficits.

Afterward, they stepped out of the ward. Reviewing Qian Xuebin’s notes, Director Qu frowned. If only he’d taken a more detailed history, we wouldn’t have nearly missed this.

Relieved, he turned to Xu Ze. “The presentation does fit Guillain-Barré. But without domestic diagnostic criteria, we can’t be certain.”

Xu Ze smiled. “Director, one hallmark of Guillain-Barré is albuminocytologic dissociation in cerebrospinal fluid. A lumbar puncture for CSF analysis should confirm it.”

“Albuminocytologic dissociation?” Director Qu tried recalling the term from the literature—it had been mentioned, but not definitively. “Are you sure, Xu Ze? The treatments for Guillain-Barré and neurogenic myasthenia are entirely different. We can’t afford mistakes.”

Xu Ze nodded confidently—future medical knowledge left no doubt.

“Then we’ll perform the lumbar puncture immediately. No delays—we need a prompt diagnosis,” Director Qu declared.

Surprised by his urgency, Xu Ze hesitated. “Shouldn’t we wait for Dr. Qian?”

“He’s likely at lunch and won’t return until his shift resumes. We’ll proceed now.”

With that, Xu Ze nodded. “I’ll prepare the equipment.”

Though still new to the ER, with nurse Hu Xia’s assistance, Xu Ze swiftly gathered the necessary tools.

Meanwhile, Director Qu briefed the family on the suspected diagnosis and necessity of the procedure. Grateful, the family signed the consent form, especially appreciative of Xu Ze’s diligence in identifying the issue.

When Xu Ze returned with the tray, the family’s warmth toward him was almost overwhelming.

…..

In the ward, the patient, now informed, regarded Xu Ze with newfound gratitude.

Director Qu adjusted his glasses, observing Xu Ze expertly position the patient in a lateral decubitus, knees-to-chest. Does he actually know how to perform a lumbar puncture? That’s impossible—clinics don’t offer this procedure.

Yet, given Xu Ze’s earlier surprises, he decided to test him. “Xu Ze, can you perform this?”

After a brief pause, Xu Ze answered honestly, “Yes.”

“Yes?” Director Qu’s eyes sparkled with intrigue and delight. “Good. You’ll take the lead.”

“Understood.” Excited, Xu Ze prepared mentally. Though he had practiced extensively in virtual simulations, real-world application thrilled him.

Lumbar punctures were technically challenging, often requiring multiple attempts for novices. But Xu Ze was confident.

Ensuring optimal positioning—back perpendicular to the bed, head and knees flexed—he palpated the iliac crests to locate the L3-L4 interspace, the ideal entry point.

After sterilizing the site with iodine, he donned sterile gloves, arranged the drape, and assembled the equipment—each step flawlessly executed.

Director Qu watched, impressed. His technique is impeccable—like a seasoned practitioner. How does a third-year student know all this?

As Xu Ze readied the anesthetic syringe, Director Qu, playing the assistant’s role, handed him a vial of 2% lidocaine.

Just then, Zhang Qi, curious, entered the room. Seeing Director Qu assisting Xu Ze—a rookie—his jaw nearly dropped. Director Qu, assisting a newcomer? Unbelievable.