151: Chapter 151 A phone call from the provincial government?

After finishing her meal, Shen Xiaoning packed up her lunch box and returned to the Yellow Zone.

Lu Chen continued reading his book.

At two in the afternoon, Director Li Sen arrived.

"Lu Chen, come over here. Let's talk in the office."

Lu Chen followed Director Li Sen into the doctors' office next to the Red Zone.

Director Li Sen closed the door and sat down.

"Did you receive the papers?"

"I received them, two copies of the sample journal."

"Good. Keep those safe; they'll be useful for your professional title evaluations in the future."

"Understood."

Director Li Sen looked at him.

"I didn't come to talk about the papers today; I wanted to tell you about a situation."

Lu Chen sat up straight.

"Please, go ahead."

"I received a call this morning from the provincial level."

"The provincial level?"

"It's not convenient for me to tell you exactly who called, but the message was clear: an important patient will be transferred to our Hospital tonight or tomorrow, and they specifically requested to stay in the Emergency Department's Red Zone."

Lu Chen frowned slightly.

"What's the patient's condition?"

"Decompensated liver cirrhosis, Massive upper gastrointestinal bleeding, complicated by hepatic encephalopathy and Coagulation dysfunction."

Lu Chen quickly ran through the information in his mind.

Decompensated liver cirrhosis, Esophageal and gastric variceal bleeding, combined with hepatic encephalopathy and Coagulation dysfunction.

This was an extremely severe case of end-stage liver disease.

"How old is the patient?"

"Forty-six years old, male."

"Where were they treated previously?"

"At the Provincial People's Hospital. They underwent conservative internal medicine treatment for a while, but the results weren't good. Recently, the bleeding has become more frequent, and the internal medicine department is reaching its limit."

"Why transfer to our Hospital?"

Director Li Sen glanced at him.

"Don't ask about that. It involves some higher-up relationships and arrangements."

Lu Chen understood.

This patient had a significant background.

"What is the patient's current liver function grade?"

"Child-Pugh Class C, MELD score of 32."

Lu Chen calculated mentally.

Child-Pugh Class C, MELD 32.

This was already very severe liver failure.

The one-year survival rate was very low.

"What did the Provincial Hospital say?"

"The Provincial Hospital's opinion is that conservative internal medicine treatment has reached its limit. The only curative solution is a Liver transplantation."

"Is there a liver source?"

"Not for now. They're on the matching database waiting list, but finding a suitable donor takes time—anywhere from a few weeks to several months."

"If it's several months, the patient won't make it."

"Correct."

Director Li Sen paused for a moment.

"So, another option is currently being discussed."

"Living Donor Liver Transplantation."

Director Li Sen nodded.

"The patient has a son who just turned eighteen. He has proactively offered to donate part of his liver."

Lu Chen fell silent for a few seconds.

Eighteen years old.

A child who had just reached adulthood.

"Has the Department of Hepatobiliary Surgery evaluated him?"

"Not a formal evaluation yet. This is still in the discussion stage. A provincial expert team is arranging the pre-operative demonstration. But regardless of which path is taken, maintaining the patient's life and pre-operative stability is the top priority."

"How long can the patient's current condition remain stable?"

"The Provincial Hospital's view is that if the bleeding isn't controlled well and another massive hemorrhage occurs, combined with the already poor coagulation function, there might not be a next time."

Lu Chen understood.

The patient was coming to Central Hospital partly because of higher-up arrangements and partly because they needed an environment that could provide high-quality emergency monitoring and life support.

If they ultimately took the living donor transplant route, pre-operative stability would need to be maintained for at least several weeks.

During these weeks, the patient could re-bleed at any time, their hepatic encephalopathy could worsen at any time, and their coagulation function could further collapse at any time.

Every sudden incident would be a brush with death.

"Director Li, are you informing me of this because you want me to participate in this patient's management?"

"Not just participate."

Director Li Sen looked at him.

"I want you to be primarily responsible for the patient's daily monitoring, assessment, and emergency handling of sudden situations while they are in the Red Zone."

Lu Chen looked into Director Li Sen's eyes.

"Why me? The Red Zone has Wu Fan and Sun Ji. In terms of seniority, they are both more experienced than me."

"Seniority doesn't equal ability. You know that better than anyone."

Director Li Sen lowered his voice slightly.

"This patient's condition is extremely unstable; something major could happen at any moment."

"I need someone with the fastest reactions, the most precise operations, and the most accurate judgment to keep watch."

"In my view, currently only you in the Red Zone are capable of this role."

Lu Chen didn't speak.

"Of course, if issues arise that require cross-departmental handling, Professor Feng from the Department of Gastroenterology and the team from the Department of Hepatobiliary Surgery will cooperate with you. I will also be there as backup at any time, but you must handle the daily first-hand monitoring."

"I understand."

Director Li Sen stood up.

"The patient is expected to arrive around eight o'clock tonight. Get prepared ahead of time."

"Okay."

Director Li Sen stopped at the door for a moment.

"One more thing."

"What is it?"

"Do not mention this patient's identity or background to anyone, including Shen Xiaoning."

"I understand."

"As long as the news doesn't leak, just focus on treating the patient with peace of mind. Vice President Zeng and I will handle everything else."

Director Li Sen left.

Lu Chen returned to his workstation.

He took out a piece of paper and began listing the key points of the patient's condition and the things that needed to be prepared in advance.

Decompensated liver cirrhosis.

Esophageal and gastric variceal bleeding.

hepatic encephalopathy.

Coagulation dysfunction.

Possible Living Donor Liver Transplantation.

Any one of these four problems would be difficult to handle alone; stacked together, they were a mountain.

What was the role of the Emergency Department?

Stabilization.

To stabilize the patient's vital signs, suppress the complications like bleeding, infection, and encephalopathy that could erupt at any time, and buy time for the liver transplant surgery.

This process could take a week, two weeks, or even longer.

During this time, Lu Chen would be the patient's first line of defense.

He finished writing the preparation list and handed it to Meng Yan.

"Sister Meng, a critically ill patient is coming tonight. Please help me prepare Resuscitation Bed No. 1."

"Set up the full suite of monitoring equipment, and prepare hemostatic drugs, Fresh frozen plasma, and Prothrombin complex concentrate."

Meng Yan took the list and glanced at it.

"Lu Chen, these specifications are very high. What kind of patient is it?"

"Decompensated liver cirrhosis, complicated by gastrointestinal bleeding and Coagulation dysfunction."

Meng Yan's expression immediately became serious.

"How old?"

"Forty-six."

"How bad is the coagulation function?"

"PT is prolonged to more than twice the normal range, and the INR is greater than 2.5."

"Then they could re-bleed at any time."

"Yes, so we need to have all possible hemostatics and blood products ready."

Meng Yan nodded.

"I'll go arrange it right away."

"Thanks, Sister Meng."

...

During the rest of the afternoon, Lu Chen handled the daily emergency patients while repeatedly reviewing emergency knowledge related to liver cirrhosis in his mind.

The pathophysiology of Portal hypertension, medication and Sengstaken-Blakemore tube compression for Esophageal and gastric variceal bleeding, the grading and treatment of hepatic encephalopathy, and the monitoring and replacement therapy for Coagulation dysfunction.

He had studied this knowledge before, but he needed to go over it again to ensure every detail was clear.

At dinner time, Shen Xiaoning came over again.

"Dr. Lu, are you not going back tonight?"

"Yeah, a critically ill patient is coming tonight, and I need to keep an eye on them."

Shen Xiaoning looked at his expression.

"Is it a very serious patient?"

"Yes."

"Then should I stay on the night shift to accompany you?"

"Weren't you on the day shift today?"

"I can swap shifts with Sister Fang. She can just take my morning shift later."

Lu Chen glanced at her.

"No need, just work your normal shift. I can handle it myself."

"But it'll be very tiring for you to watch alone."

"It's not tiring. There's Sister Meng and the night shift Nurses."

Shen Xiaoning's lips moved as if she wanted to say something, but she ultimately didn't.

"Alright, then you must make sure to rest tonight. Don't push yourself too hard."

"I know."

After Shen Xiaoning left, Lu Chen finished his meal and continued reading.