At around 6 a.m. on January 2, before dawn, an old bicycle passed through the mottled street lights and staggered into the hospital gate. The man in the car greeted the guard and drove towards the surgical building.

Before he arrived at 6 o'clock in the morning, he received a call from Tong Miao, and something happened to Wu Zhenggen on bed 34.

After relapse of spleen rupture, Tong Miao had no choice but to undergo another open surgery to cut off the entire spleen. After pathological frozen sections during the operation, it was found that amyloid was found, and Congo red staining was positive, which was confirmed to be amyloidosis. Combined with these strange symptoms involving multiple systems in the patient, the diagnosis was very clear, which was systemic amyloidosis.

Xin Cheng was riding a bicycle, silently chanting this professional term that ordinary foreigners don’t have much contact with, and shook his head: “I didn’t expect it would be the result.”

When he stopped the car and went upstairs, Xin Cheng walked into the ward with a shout of "Director Xin, morning". Looking at Li Peide who was still lowering his head to eat breakfast, he hurriedly asked, "Old Li, you were preparing for the shift last night, let's talk about the situation."

Li Peide ate two bites of porridge and said, "Oh, don't mention it. The patient who came at 8 o'clock had three holes in his stomach. I struggled on the stage for more than four hours before he finished it. One was..."

"I'm talking about Wu Zhenggen."

"Oh, he." Li Peide dug a bite of pickles and swallowed it. "The old boy upstairs has it. I heard it is amyloid degeneration."

"You are not here when your spleen ruptures?"

"I've been to the operating room long ago. I've done night shifts in the lactation department. I must be present and they can feel at ease if I'm here."

Xin Cheng picked up the 34 chart on the table and looked at the surgical records and pathology. Each piece of content stimulated his nerves: "It seems that it is the spleen swelling caused by amyloidosis. It should have been cut off when the emergency department was sent to him."

"Oh, it wasn't enough indications at that time. Besides, you were also trying to save money for them." Li Peide comforted him, "Splenish repair is cheaper than spleen removal."

"It's not much cheaper..." Xin Cheng sighed: "Is his wife here?"

"Here I am."

"I'll go and talk to her." Xin Cheng took out the pathology report from the chart and ran out of the office.

Wu Zhenggen had just finished the operation and suffered heavy blood loss and was very weak. Liu Xianglan moved a chair and sat next to him. Although she didn't see anything on her face, the corners of her eyes turned slightly red, which might have made her feel uncomfortable this night.

"Director Xin..."

Xin Cheng stood at the door and waved to her, calling the person outside the door: "The pathology of last night has been diagnosed."

Although she had guessed that her husband was very ill, even though the director told her that her condition was not optimistic last night, Liu Xianglan still held a glimmer of hope in her heart. But when she saw the doctor in her bed nodding, her last psychological defense line finally collapsed: "Is there really no other way?"

Xin Cheng shook his head: "There is no special medicine for this disease, and we can only treat it symptomatically at present."

The peasant woman kept wiping tears from the red corners of her eyes, and her voice slowly choked up: "How long can my old man live?"

Xin Cheng briefly explained the process of amyloidosis, and then said: "We will do bone penetration as soon as possible to see which stage it has progressed. If it is only early, how many years should we last if we actively treat it."

"What if it's late?"

"We can only do our best to treat it, starting with protecting the liver and heart, and slowing down the development of the disease..."

Xin Cheng didn't expect that his surgeon director is now talking about an internal medicine disease.

After so many years of clinical practice, although he often encounters situations where surgical operations cannot be treated, as a responsible surgeon, he still has some room for trouble. Even if there is a serious injury, as long as he has a chance, he will stand on the operating table and take a try.

But now the amyloidosis in front of me slowly disintegrates the organ function from the inside of the cells, making people feel powerless and unable to start.

If only one organ is involved, it’s okay to just cut it off and abandon the car to keep the coach. But what Wu Zhenggen has suffered is the most harsh primary systemic amyloidosis in amyloidosis. Almost all organs will have this disease, it’s just a matter of time.

The calming of amyloid caused the spleen to rupture and bleeding, and also made the spleen the first piece to be abandoned in this game.

If there is no pathological diagnosis that happened this time, the next thing to be abandoned may be the kidneys that cause edema of the lower limbs, or the liver that causes jaundice, or the gastrointestinal tract that causes upper gastrointestinal tract bleeding.

The diagnosis was cruel, but at least it let the doctor know that what should be protected now is not just handsome, but all the pieces in the whole chess game.

"What we have to do now is to try to prolong Lao Wu's life as much as possible while ensuring the quality of life." Xin Cheng said, "We will formulate a treatment plan at the director's consultation later."

"Treatment plan..." the peasant woman wiped away the tears from her cheeks and said, "Will the treatment cost a lot?"

"Because it's long-term treatment, it's definitely money."

"Then we... we will not cure it." The peasant woman said lightly, but her tone was very firm and straightforward. "Our unscrupulous son has not yet made his wife pregnant. The money should be left to the couple. I heard that it costs a lot of money to cure infertility."

"But Lao Wu..."

"This is Lao Wu's last thought." The peasant woman paused and said, "Last year he felt that he was in poor health, so he kept urging them."

Xin Cheng nodded, knowing very well the wish of an old man to hold his grandson when he was at this age. However, as a doctor, he still suggested: "Even if you are pregnant now, there will be a process for ten months of pregnancy. The necessary symptomatic treatment is still necessary. As for the cost issue, someone will discuss it for you, and there should be an answer today."

"Okay." Liu Xianglan didn't know how to say it, so she could only say, "Thank you."

"Go back and accompany him."

......

The plan for the day is in the morning, and general surgery makes full use of this.

The general internal medicine ward stipulates that nurses on the night shift the day before start blood checking their body temperature at 6 o'clock, and the interns on duty also start measuring the patient's blood pressure and heart rate at this time. Other doctors need to arrive at work at 7:30 in the morning, start handing over the shift before 8 o'clock, and check rounds before 9 o'clock to get a doctor's order.

However, general surgery always understands the morning more early than other departments.

The preoperative examination must end the afternoon of the previous day. The start time of the rounds in the morning was set at 6 o'clock, and the duration was shortened to 30 minutes. Because the time was a bit early, the participants in the rounds were generally graduate students and undergraduate students.

The attending deputy director who is the real surgeon will not show his face in the ward.

They usually enter the operating room directly at around 7 a.m., change clothes and wash hands, go on stage to operate, and start the day's work.

Wu Zhenggen's serious illness is a major event for this family. But in the entire general surgery department, Lao Wu's ending does not seem to cause much trouble.

The early rounds starting at 6 o'clock are still in progress.

All graduate interns will evacuate the ward and enter the operating room before 7 o'clock, and will have a reconciliation with the surgeons in their respective groups. The first surgery they have to start before 8 o'clock.

Step by step, so when everyone heard the diagnosis of bed 34, everyone felt very sorry, but everyone couldn't keep regretting it.

What they hold in their hands is life, gastric cancer, intestinal cancer, hernia repair, abscess drainage, intestinal obstruction... After the operation on the bed is completed, they still have to consider which patients to be admitted to the hospital. They really don’t have the time and energy to care for a patient who cannot be treated surgically.

Xin Cheng and Liu Peide made a simple handover and left the ward with Wu Zhenggen's medical history.

At 8 o'clock in the morning, he and several internal medicine directors who had finished handing over the shift.

These directors did not expect that a thick stack of medical history that had been studied for several days was turned into a semi-waste before they could use it. The diagnostic discussion meeting that originally caused a sensation in the entire hospital turned into a treatment plan formulation meeting.

"Director Tong is really decisive and cut his spleen directly."

"I'll cut it too, I've broken it twice, who knows if it will break the third time?"

"After ten o'clock, the pathology department is willing to do ice cutting?" The director of the hematology department looked at the pathology report and was a little incredible. "Our biopsy is sent, and it usually takes three or four days to produce results, which is too biased."

Xin Cheng sat in the center, looked at them and said, "It was Qi Jing who advised Tong Miao to cut off his spleen, and it was also the ice cut he sent to make."

"Qi Jing? Just Lao Qi's son?" The director of the hematology department seemed to have some impression of this name.

"It's this guy again? Why are he everywhere?" Qi Rui looked at the director of the hematology department and said with a smile, "This guy has grown up again. Even the disease in your department can be diagnosed. By the way, why didn't I expect it to be amyloid degeneration? It seems that the symptoms are indeed very consistent now."

"How many times can you encounter this disease a year? You stare at the heart every day, and you've probably forgotten the diseases of other departments."

Yu Tao, who was sitting aside, put more than half of the paper in the medical history aside and only picked some important laboratory test data to see: "The patient's condition did not develop very quickly, and now it seems that there is no sign of affecting the myocardium. It should be able to be delayed for a while."

"Where is the gastrointestinal tract?" Xin Cheng asked.

"I have had gastroscopy and some ulcers, but they are not serious and there is no active bleeding." Yu Tao took out the gastroscopy that Wu Zhenggen had just finished and said, "If you are not at ease, we can use some medicines preventively. The key problem is the liver. The appearance of jaundice is a very bad signal and needs good care."

"The kidneys are also very edema, and the diuretic strength should be increased."

"The heart needs to be thoroughly investigated!" Qi Rui looked at the report and said of his expertise. "You should have a heart biopsy to see the involvement of cardiomyocytes. If amyloidosis has reached the myocardial muscle, then the condition has reached the middle and late stages, and the heart will definitely not last for a year."

"If myocardial muscle is affected, I'm afraid..."

"So we need to confirm as soon as possible. The medication must also be considered in terms of myocardial involvement. As for other aspects..." Qi Rui turned around and looked at the gate and said, "We said this is useless, but we have to look at him."

"I hope they can get a better result."

"Alas, it's said that life is priceless, but at this time, every minute and every second are linked to money, which is really ironic."

......

It was not just these directors who were surprised. Ji Guanghao, who had originally wanted to join in the fun, had never expected it. The scene of the major directors who were still thinking about the night before did not appear in front of him. This discussion meeting, which should have been verbal, ended in just 10 minutes.

Since the diagnostic problems have been solved, the next treatment will become simple.

For this chronic disease with poor prognosis, the only thing we can do is to treat it symptomatically as much as possible to slow down the development of the disease and reduce the impact of symptoms on the body. It is really because of the major directors who know the strategies of symptomatic treatment. After a while, they discussed the three options: upper, middle and lower, and the next thing is the cost.

The best method can be described as luxury. They use the best clinical drugs nowadays, which also cover all the symptoms of Wu Zhenggen. Some of the contraindications in the drugs are also avoided by them, and they are basically the best. Of course, the cost is definitely not cheap.

Although Zhongce also covers most of the symptoms, the drug has been reduced in grades and the price has been reduced a lot.

The worst-case scenario is very cheap. After fully considering Wu Zhenggen's family situation, he made various products after making compromises. A lot of medicines were deleted, leaving only the most important ones. Although it seems cruel, this medication strategy is something that patients can bear.

"Boss Ji, you have also seen that Guanghao Fund has not won the success this time."

Qi Jing sat next to Ji Guanghao, rested his head on the cushion and said, looking at the fountain: "But this is something that will happen sooner or later. As long as Guanghao Fund insists on handling it, this situation will only increase."

Ji Guanghao was used to seeing big things, but he was still not as good as the doctors who were accustomed to life and death, and he couldn't recover immediately.

The doctor who came to consult was the best and most qualified director in Quan Danyang, and the funds for the examination were sufficient. He was thinking about celebrating the doctors after the diagnosis, but he was stuck in the neck by the god of death in the end.

In just half a year, he encountered the second time when money lost its effect.

The previous time was my own misdiagnosis and I almost lost my life, but this time it was another terminal illness.

"Haha, what a joke, your Uncle Ji is not that easy to admit defeat!" Ji Guanghao laughed a few times and said, "And you also have to know that this is not considered a master's victory. Wu Zhenggen is not dead yet, and the cost that was originally intended to be used for examination can be used to treat him."

Qi Jing nodded, this was the best result he could have expected.

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