Chapter 1454: The Patient Family’s Distrust

Chapter 1454: Chapter 1454: The Patient Family’s Distrust

(Thank you to atuola, baochong, Wang Lintai1, I Love Fruit Paradise, Clever Bookworm, Lazy Monthly Ticket Encouragement)

"Teacher Liu, the patient and family chose PTCD. They are also worried that further drainage might be needed, which would be tough."

After a while, Su Wenhao came over.

"Has the MRI film come out?" Liu Banxia asked.

"It has, but like the CT, it shows a clear mass, and we can’t rule out the possibility of bile duct cancer," Su Wenhao replied.

"I also explained this situation to the patient’s wife, and she’s currently calling the children to come over. We still need to wait for the marker screening, should we consider doing the drainage first?"

"Alright, go ahead and prepare, I’ll be over in a moment," Liu Banxia nodded.

For this patient, the likelihood of bile duct cancer is already very high. After all, the two main causes of bile duct obstruction are stones and tumors.

Neither ultrasound, CT, nor MRI has found stones, so what’s left but a tumor?

The patient’s bile duct obstruction is already so severe that drainage is a necessary procedure.

"Uh... Teacher Liu, we still have to wait a bit. I just got a call from the patient’s son, saying he wants to discuss it with us when he gets here."

Liu Banxia was about to head to the operating room when Su Wenhao came over looking awkward.

Liu Banxia smiled and nodded, "Alright, there’s nothing much this afternoon anyway. So, do you think you can handle his son?"

"Teacher Liu, it’s nothing we can’t handle. The patient’s condition is very clear, regardless of whether the mass is a tumor, drainage needs to be done," Su Wenhao said.

"Even if it wasn’t at our hospital, at another hospital with more expert hepatobiliary specialists, the current situation would still require drainage first. Other issues will be discussed after the patient’s inflammation has subsided somewhat post-drainage."

"Teacher Liu, let me ask you. If this patient really has bile duct cancer, is there still an opportunity for surgery? Many bile duct cancer surgeries end up being unnecessary suffering," Su Wenhao asked.

"How to put it, it ultimately depends on what’s happening inside the bile duct," Liu Banxia thought for a moment and said.

"Currently, there’s just a clear mass, and the tumor marker screening results aren’t out yet. We’ll see what CA19-9 shows, as many bile duct cancer patients will have elevated this indicator."

"However, surgical intervention opportunities exist in the early stages of bile duct cancer, but for mid-to-late stages, the risk is too great, and we can only consider conservative treatment."

"It’s really because of the critical position of this organ, with so many surrounding tissues and organs. If it truly is a malignant tumor, the invasion to nearby areas would be severe."

"We can’t sample each one, we have to wait for the results before proceeding. We must consider things more conservatively, preventing any potential risks, so the patient doesn’t relapse or suffer again."

"Sigh... actually, I was hoping to reassure them, but I don’t even know what comforting words to say," Su Wenhao sighed.

"Our industry is like this, you need a heart of stone. With more consultation time, we’ll encounter more similar patients," Liu Banxia said.

"Better think about how to deal with the patient’s son next, it seems he has his own thoughts. Although these won’t be on future exams, they’re important issues to handle well."

Su Wenhao nodded; he had personally taken the patient’s son’s call and could sense it from his tone.

Liu Banxia stretched his neck; it’s always something every day. But he could understand the patient’s son’s feelings since this case is somewhat special.

Sitting by the computer, he pulled up the patient’s MRI results again. Like the CT, there was a mass, but it wasn’t very clear.

After waiting a bit more, Liu Banxia made a round to the laboratory, bringing back the patient’s tumor marker screening results.

He was a bit puzzled, as the CA19-9 value wasn’t very high. Could the patient be in a very early stage?

"Teacher Liu, this is the patient’s son from earlier, who has some concerns about my explanations."

At this moment, Su Wenhao led a young man over.

"It’s not that I have concerns, it’s just that I didn’t really understand. Does my father have bile duct cancer or not? Why are you recommending that endoscopic examination method? People say such examinations or drainage are prone to problems," the patient’s son said.

"Please have a seat, perhaps you’re too anxious and didn’t hear clearly," Liu Banxia said.

"No way, didn’t you say it had to be done that way?" the patient’s son replied.

"Okay, let me ask you, if you had an intestinal obstruction right now, would you choose open surgery or laparoscopic surgery?" Liu Banxia retorted.

"I’d definitely choose laparoscopy," the patient’s son answered without a second thought.

"If you choose laparoscopic surgery, the cost is definitely much higher than open surgery. What if you currently face financial difficulties and can’t gather the money?" Liu Banxia asked.

"Even the poorest people aren’t short of that bit of money, right?" the patient’s son said.

"Yes, for many people, thousands or tens of thousands might not be a problem. But for some patients, hundreds can be a significant challenge," Liu Banxia said.

"So when we introduce options to patients, we explain all the possible choices, and in the end, it’s up to the patient and family to decide."

"Your father’s condition is already very severe now, with bilirubin levels extremely high, more than ten times the normal value. If we don’t perform drainage soon, the next developments could lead to more severe infections, resulting in high fever and shock."

The patient’s son frowned, seemingly misunderstanding something.

"What about bile duct cancer? Is it confirmed?" the patient’s son asked again.

Liu Banxia shook his head, "Not confirmed."

"Then how could you tell my mom it’s bile duct cancer? My dad has guessed it too; it’s not a good disease, and he’s terribly frightened," the patient’s son said, his tone slightly agitated.

"You can go back and ask your mother how exactly we informed her," Liu Banxia said calmly.

"I understand your feelings, as it’s your father. The test results aren’t good right now, so your mood won’t be good, but that’s not a reason to shout at us here."

"It’s not just the doctors at our hospital; basically, all hospital doctors nationwide won’t give a definitive diagnosis to patients or their families without a clear confirmation."

"To prevent your parents from worrying too much, we checked the images on the computer before developing the films in the imaging department. Our diagnosis is an obvious mass at the lower segment of the common bile duct, not ruling out the possibility of bile duct cancer."

"For a definitive cancer diagnosis, the only accurate result comes from a biopsy. However, for your father, this is not the most urgent matter at the moment."

"Regardless of whether it’s a tumor, his bile is significantly congested right now. If we don’t perform drainage, it could become very dangerous."

"If the drainage is effective and his inflammation reduces somewhat, we can consider doing endoscopic ultrasound to check the condition of the common bile duct. Do you understand my explanation?"

The patient’s son frowned; he seemed to have received some incorrect information.

"Doctor, how is this endoscopic ultrasound done?" the patient’s son asked, his tone now much softened.

"The term means a combination of endoscopy and ultrasound. However, since it’s internal, it allows us to see more clearly," Liu Banxia said.

"Take some time to consider whether to do ERBD or PTCD. For your father, the sooner the drainage, the better. The bile has probably been congested for a long time."

"Of course, you can also consider checking at another hospital. We won’t insist; our suggestion is to perform drainage quickly."

"By the way, there’s a new test result. The tumor marker screening just came out, and the CA19-9 value isn’t very high. This indicator corresponds to bile duct cancer, so even if it is bile duct cancer, it should be in the early stage."

"Doctor, does this mean my dad doesn’t have bile duct cancer, and it was a misdiagnosis?" the patient’s son quickly asked.

"I need to correct you. We have not made a definitive diagnosis yet; we just haven’t ruled out the possibility of bile duct cancer," Liu Banxia said.

"To confirm any cancer, tissue sampling and pathology are required. That’s the gold standard; other equipment checks are merely for auxiliary judgment."

"For example, with rectal cancer, we can touch the tumor through digital examination and see its position with rectal MRI. But to determine the development stage, or whether it’s benign or malignant, we can only rely on pathology."

"Unless it’s already at a late stage, with very obvious infiltration and clear metastasis, which reduces the need for pathology, but then surgery would generally not have much significance."

After saying this, Liu Banxia nodded and sat to the side.

He could tell that the patient’s son wasn’t completely ignorant about medical matters, but he didn’t know much either.

He was worried his parents might be misled into undergoing unnecessary surgery here.

All necessary explanations were provided, and the choice now was up to them.

Even if they found the diagnosis here very "suspicious" and decided to be discharged and checked again at another hospital, that was within their rights.

"Doctor, please wait a moment, I need to make a call first."

The patient’s son said to Su Wenhao, then stepped aside to make a call.

Liu Banxia chuckled; it seemed the son had a friend who studied medicine, at least he was informed on this matter. Now that he understood the situation, he sought their opinion.

Su Wenhao felt a bit embarrassed; he hadn’t handled such a small matter well, and it needed Liu Banxia to step in.