Granting You A Second Life

Tuesday - Unity hospital 12:35 pm

Yao Changying was sitting across Li Xiuying as they both ate their lunch in silence.

Li Xiuying thought that she should make the first move since she had initiated this lunch time meeting. She couldn't think of how to initiate a conversation. Her only other friend was Ren Daiyu and she could speak enough for the whole of Beijing.

Li Xiuying looked at Yao Changying and noticed her earrings. Her eyes took on a sheen: "Alpaca's are cool."

Yao Changying was surprised: "I agree. I'm surprised you're able to tell that they're alpaca's. Not many people can tell the difference between alpaca's and llamas." Yao Changying had gotten her earrings specially made since only llama earnings were available commercially.

Li Xiuying:"Alpaca's are generally smaller and their ears are shorter and pointier." She was channelling her inner nature channel commentator.

Yao Changying: "Yes! Their fleece is also silkier."

Li Xiuying: "It's probably lucrative to be an alpaca farmer."

Dr. Yao: "Maybe I should leave medicine and become an alpaca farmer. There's probably less stress, less bureaucracy and less incompetence."

Li Xiuying nodded.

The two continued discussing their plans to become alpaca farmers.

At 1 pm a resident briskly walked over to Yao Changying.

Yao Changying muttered: "No rest for the wicked."

Third year resident: "Dr. Yao I need your help regarding a patient please."

Yao Changying: "Okay 52. Lead the way."

Yao Changying handed her phone to Li Xiuying: "Let's exchange numbers." At first she wasn't sure if she and Li Xiuying would get along. However, in the short 25 minutes they had been together she found that they were actually both kindred spirits and as odd as each other.

Li Xiuying also started leaving the canteen. She felt smug inside as she thought to herself 'this friend thing is easier than I thought.' She was glad that she regularly watched doc.u.mentaries about wildlife.

After the two future alpaca farmers left; the people who were sitting around Li Xiuying and Yao Changying revealed their dumbfounded expressions. They also started gossiping amongst each other.

"Did I just hear correctly? They both want to leave medicine to become farmers?"

"Do you think Dr. Li and Dr. Yao were replaced by aliens?"

"I didn't know that there were so many differences between alpaca's and llamas. OW why did you hit me? I was just saying."

...

Li Xiuying returned to the emergency department. She had started working from 8:30 am in order to have a lunch break.

Li Xiuying sat at the desk and looked at the patient waiting list. She had been scheduled to work in the emergency department at least twice every week. Although she found the medical specialties interesting she really needed to hold a scalpel in her hands.

Li Xiuying sighed internally. She really wanted to be in theaters, she was in her element when she was operating.

Li Xiuying heard someone calling her in a mousy voice. "Erm Dr. Li"

Li Xiuying swivelled around to see a small woman standing nervously behind her. Li Xiuying looked at her badge '1st year resident."

Li Xiuying then looked at the resident, waiting for her to continue.

Mousy's voice become quieter with every word she said until her voice was a whisper: "Erm. Well Dr. Li I was erm... hoping that you could erm... assess a patient that I'm currently seeing please?"

Li Xiuying: "Present."

Mousy: "I saw Chen Shu a 32 year old female who has presented with generally feeling unwell. She has a several month history of feeling lethargic, weight loss, decreased appetite, nausea, vomiting and diarrhoea.

No relevant past medical or surgical history.

She's not currently on any medication, no herbal remedies, no known drug allergies.

No relevant family history.

She is now a housewife bit was previously a gardener. She volunteers at the local park occasionally.

No smoking, no drinking, no recreational drug use."

Li Xiuying: "Examination?"

Mousey: "On examination, the patient appears listless, her skin looks slightly tanned and the creases of her palms looks slightly darkened. She also reports loss of body hair. No other remarkable findings to report. Her vital observations reveal she is mildly hypotensive and tachycardia."

Li Xiuying: "Impressions?"

Mousy sounded nervous: "I think the patient may have Addison's disease." She handed a drugs chart to Li Xiuying.

Mousy: "I've prescribed IV fluids, 100 ml of 20% dextrose to correct the patient's hypoglycaemia. A bolus of 200 mg hydrocortisone IV followed by 100 mg 6 hourly until her blood pressure is stable."

Li Xiuying: "Tests?"

Mousy: "I've requested a set of bloods including clotting screen and blood cultures. I've also ordered a CT abdomen, c.h.e.s.t and pelvis. I've requested a 9 am serum cortisol and a synacthen test for tomorrow."

Li Xiuying sensed there was something more to the story: "Any problems?"

Mousy began mumbling and looking around shiftily: "Well you see err I, erm the patient eh..."

Li Xiuying frowned as she thought 'this could take all day'.

Li Xiuying: "Results?"

Mousy looked relieved. She slanted the keyboard closer to her and typed in the patients ID number and got up the patient's blood results.

Li Xiuying scanned through the results: "Interpretation?"

Mousy breathed a sigh of relief as she read out the results: "The blood test show neutrophilia, decreased sodium, increased potassium, raised CRP, raised ESR, blood culture results are still pending. The results alongside the history and examination are suggestive of an addisonian crisis likely due to infection as indicated by the high CRP and ESR."

Li Xiuying then proceeded to look at the CT which was normal.

Li Xiuying: "Most common cause of Addison's?"

Mousy realized she had forgotten something vital: "Autoimmune. I'll request autoantibodies right away."

Li Xiuying: "Bed number?"

Mousy: "13"

After Li Xiuying and Mousy assessed the patient; Mousy went to ask the nurse to check if there were any beds available on the endocrine ward.

Li Xiuying carried on seeing patients. It was 1:50 pm. She was getting ready to leave the ward when mousy sat down at the desk. It was clear that she had been crying as her eyes were red and puffy.

Li Xiuying watched as a mousy looked at a doctor in a white coat slowly walking passed the desk. She looked away as he gave her a condescending look.

Li Xiuying quirked a brow.

Mousy noticed Li Xiuying's gaze: "It's nothing. I did something wrong and Dr. Fa was reprimanding me for it that's all. I'm being overly s.e.n.s.i.t.i.v.e."

Li Xiuying didn't inquire any further; it wasn't any of her business. She got up from her chair and as she walked behind Mousy she said: "Good catch."

Addison's disease was notoriously difficult to diagnose in the early stages. It typically presented with a range of unspecific and general symptoms. As time went on the patient will present with tanned skin and darkening of the gum line, tongue and creases of the palms. People with Addison's often die suddenly due to the severe decrease in sodium and increase in potassium.

On hearing Li Xiuying's praise Mousy no longer felt as bad. She had managed to save a patient's life and also received praise. She stood by her earlier decision even if she was reprimanded. She smiled to herself.

After Dr. Li left the emergency department, a doctor walked over to Mousy who was currently the only one at the desk.

Dr. Fa sneered: "Lin JingJing I bet you feel happy with yourself just because you managed to diagnose one patient. Don't you dare start thinking too much of yourself. You just got lucky. Next time if you ever undermine my clinical decisions in such a way you'll regret it every day that you're here." He was fuming that a little 1st year resident had completely disrespected him by ignoring his order to discharge. She had gone behind his back secretly diagnosed, treated and presented the patient to a senior colleague.

Lin JingJing didn't say anything she just looked at the keyboard. Her hands clenched into fists underneath the desk.

Dr. Fa was still angry but he tried to control his emotions: "Next time you should discuss your concerns regarding my patient with me instead of stepping on my head. Do you not know the meaning of common courtesy?" He then stormed away.

Lin JingJing took a deep breath and looked at the patient waiting list.