Chapter 8 Chapter 6 Strange Patient
"It's really incomprehensible!" After diagnosing a patient, Akita couldn't help thinking.
The patient sent by the Municipal Hospital of T City, Metropolitan City was a man, about thirty-five years old, with a stout body for manual labor.
"Name: Sadaichi Tabe, 34 years old, work unit: Nippon Chemicals T Factory. He was previously poisoned by nitroethylene glycol in the factory and suffered from functional diseases in many internal organs."
Akita glanced at the medical record card and frowned.I can't help thinking that the company of my friend Da Xixiong is the area where occupational diseases are frequently in charge of.
"Symptoms?" Akita turned his attention to the medical record card again.To be precise, this is a copy of the medical record card from the Municipal Hospital of T City sent with the patient.Hospitals in various places send patients who are considered to be related to occupational diseases and cannot be diagnosed to the central clinic of the Japan Industrial Accident Prevention Association.
With the development of various modern industries, in a toxic environment, countless clinically unknown diseases have occurred, and they must be diagnosed in connection with occupations.This is Akita's mission and mission.
"Delirium, disordered thinking, hallucinations, and persecution mania. I feel that my room has become a paradise, hell, or is full of poisonous gas. Sometimes I feel that the food is poisonous and refuse to eat. I also have colorful hallucinations, similar to A short-term anesthesia state after taking hallucinogens such as muscarine, but it is difficult to detect. No extrinsic diseases such as alcoholism and other brain disorders have been seen. There is a history of renal hypertension, and it is diagnosed as caused by new chemical substances Temporary poisoning, further precise examination is required."
The patient's symptoms were indeed as described in the medical records.
"Get me out of the prison!" The patient's face twitched, crying and screaming just now due to terror; but then he showed a dazed expression as if he was intoxicated by the sound of beautiful music.
"I saw a person standing on the top of Mount Yatsugatake." "Oh! There are mice running around everywhere." "Spiders crawling on me!" These are like seeing people or some small animals running around.
This kind of environment will change, and the hallucinated image has nothing to do with the specific external stimuli, and the performance is extremely unstable, much like falling into a dream.
There are two main symptoms of hallucinations: one is disordered thinking, mainly with visual hallucinations, which is delirium;
Delirium and hallucinations often appear in alcoholism or other acute intoxication. The symptoms of delirium also appear in patients with epidemic encephalitis, acute high fever, and central brain hemorrhage.
Delirium and hallucinations are completely different symptoms, but a complication of both symptoms appeared in the patient Sadaichi Tabe.
"What's the date today?" "What time is it?" "Where are you now?" "What do you do?" "How many people are there in the family?" When Akita asked these questions, the patient didn't respond. Answer, or answer indiscriminately due to auditory hallucinations.
Tabe has a certain ability to judge the time, place, and social environment, but he has completely lost this ability.
This is a marked symptom of disturbance of consciousness, that is, insanity, due to poisoning or infection.
The above-mentioned symptoms did not show any signs of alcohol and hallucinogenic drugs, nor could they be diagnosed as neurological diseases.Therefore, just like the opinion of the municipal hospital in T city, it is believed that the unknown new toxic substances produced in the chemical industry are the root cause of the disease.
Exactly what the substance is has yet to be examined more closely.However, it is not so easy to analyze the unknown toxic substances that have been absorbed in the body in medicine.Moreover, people living in modern cities may be invaded by various harmful substances from time to time, and it is difficult to find where they have been exposed to disease-causing harmful substances.Therefore, it is necessary to take the trouble to investigate one by one from the patient's daily life environment, current occupation, and even back to the past occupational experience.
Determining a causal relationship between occupation and disease is also extremely difficult.Businesses generally go to great lengths to conceal the harmful environment within their units.
According to labor safety regulations, a sanitation management agency was established to undertake special health inspections and eliminate hidden dangers in harmful industries, but this cannot be said to have been perfected.
Fulfill legal obligations, always limited to the minimum scope.Even when occupational-related illnesses and injuries do occur, they are dealt with in-house as much as possible.But occasionally patients like Tabe slipped through the "network" and were sent to the central public medical institution, which required investigation.In this case, as long as there is not enough evidence to prove that there is a causal relationship between the occupation and the disease itself, Akita and the others have no right to conduct a compulsory investigation on the company.There is no other way than companies discovering out of conscience, declaring automatically, or waiting for a large number of patients to appear.This is also the fundamental reason for the slow progress of industrial medicine, which focuses on diagnosing and treating occupational diseases.
"That's right, it's time to ask Onishi." After sending the patient to the examination room immediately, Akita realized that the patient and his old friend worked in the same company.
Fortunately, there are no more patients in need of treatment. This is a public research unit. Unlike the public outpatient clinics of ordinary hospitals, patients will not come to seek medical treatment by themselves.
"Please pick up Onishi-kun from the special E group." Akita wanted to ask him, maybe he could get some valuable opinions for diagnosis and treatment, so he immediately picked up the direct phone in the consulting room and called the Central Research Institute of Nippon Chemical Corporation.
"Onishi just went on a business trip." The telephone operator on the other side replied in a dull, business-like tone.
"Business trip, where did you go?" "When will you be back?" In response to Akita's continuous questioning, the telephone operator's answer was a little evasive, and there were whispers on the phone that seemed to be discussing.I have called Onishi many times before, but this is the first time I have encountered this situation, and the other party will never ask so carefully like those first-rate hotels.The telephone operator of the Central Research Institute is usually very straightforward, why would he be uncharacteristically hesitant today? From this situation, Akita felt that something abnormal had happened to Onishi.
"I'm an old friend of Mr. Onishi, and my name is Akita. Please pick me up right away." Akita chased after him.
The telephone operator seemed even more hesitant. "Please wait a moment." Finally came the reply.Then I heard the voice of the phone being connected to another place, probably to ask the superior for instructions.
This is not just a business trip, but probably an important job transfer of the staff.
Soon, a hoarse voice resembling a middle-aged man came over: "What do you want to do with Mr. Daxi?"
"My name is Akita, and I'm his friend. I heard he's on a business trip. When will he be back?"
Akita deliberately concealed his identity and said it out, fearing that the other party would be wary.
"This is a relatively long business trip, and I can't tell you the exact date. However, I often go back to Tokyo due to business contacts. If you can leave your phone number, let him call you when he returns to the company. "
"Back to Tokyo? Then where did you go on a business trip?"
The other party kept asking Akita, as if he didn't know what to do, as if he regretted that he had slipped his mouth, and was embarrassed by being caught by someone.But there are many places for business trips, so why feel awkward and embarrassed?
"Would you please tell me the location of the business trip?"
To Akita's question, the other party did not answer, and after a while he said coldly: "As soon as he returns to the company, let him call back." After speaking, he hung up the phone, so that no one could ask any more questions. .
The next morning, Yoshida, the laboratory technician in the examination room, couldn't wait for Akita to go to work, so he hurried over and said to Akita, "Didn't there be a patient named Tabe yesterday?"
"How is Tabe?"
"Tabe is awake."
"It's so fast!" Akita was taken aback.Generally speaking, insanity, because the mind has been split in the original state, only if the factors that induce the disease can be eliminated, can one wake up from the absurdity.
Yoshida said that Tabe was awake, so yesterday Tabe's symptoms were very similar to the anesthesia state of alcoholism.However, he recovered too quickly.Yesterday he was completely useless, but today he is sober.It seemed that this unknown poison disappeared as easily as alcoholism.
"That's a little strange!" said Yoshida, tilting his head in thought.
"Strange? What's strange?" Akita asked.
Yoshida blinked his sleep-deprived, slightly bloodshot eyes and said: "That guy is obviously awake, but he still pretends to be confused. When asked about something important, he presumes that he can't remember, and pretends to be forgetful, just like a The suspect under interrogation refused to answer in silence. I have a feeling: Maybe he has something to say."
Yoshida spoke with a very special Kansai accent.He was born in the Northeast, and he would always bring out his Kansai dialect when he encountered something that didn't go his way.
When a person recovers from a state of insanity, there is always a part of the original situation and past events that cannot be recalled.This is called partial amnesia, and it is also an important basis for diagnosing previous symptoms.According to Yoshida's observation, Tabe seems to be pretending to be partial amnesia and avoiding clinical questions.
There are not many examples of this kind of partial forgetting by the next morning when a drunken man is "protected" in the detention room overnight.But Tabe did not suffer from the simple cause of alcoholism.
"Okay, let's go and have a look!"
As soon as Akita stepped into the consultation room, he could tell at a glance that Tabe had fully recovered.
His complexion is still quite bad, but the eyes that stared at Akita and Yoshida who walked into the room were exactly the same as those of ordinary people.With this kind of reaction, it is not a patient with schizophrenia.
"Tabe, wow!" Akita greeted with a smile.Due to etiquette, Tabe had no choice but to bow.The deranged demeanor characteristic of schizophrenic patients yesterday was gone, but when Akita came, he adopted a blunt attitude ready to deal with any questioning.Sure enough, it looks like a suspect's attitude towards the police, not a patient's attitude towards a doctor.
Yoshida gestured with his eyes, as if to say: "How about it? This guy has a trick!"
Akita tried his best to respect the other party and appear quite humble, and after a routine diagnosis, he said:
"When you were brought in yesterday, you were in a very bad condition; but now you seem to be recovering almost like a normal person. We don't think your symptoms are likely to be caused by alcohol or sleeping pills. The temporary state of confusion. In We can't say anything until the results of the close examination come out. But it can be concluded that this is a mental disorder caused by a highly toxic substance. If such a poisonous substance is placed in a place where there are a large number of people and there is a possibility of contact , This is extremely dangerous. Although we have eliminated the symptoms, we must find out what the substance is as soon as possible and determine the treatment plan. How about it, it must not bring you trouble, do you have any clues to give us? ?”
The other party was silent.
"Toxic substances like this are almost impossible to exist in the daily living environment. Of course, this cannot be taken lightly. We first suspect that this kind of toxic environment is only in the factory. There are many harmful chemicals in your factory. If, If the cause of your illness is in the factory, then your colleagues are also in danger. How about it, in order to save your partners, and to control and reduce occupational diseases as much as possible, please let us know if there is any situation ?”
Tabe still had an indifferent expression, but it couldn't conceal the wavering in his heart.
"What new substances have you been exposed to? What are they called? What do you do? What products do you make? Om? Please tell us."
"I forgot. I can't remember anything. I can't remember exactly where I got sick."
"Can't remember?"
"I can't remember, it's like being in a fog."
"Then where is the fog? Have you forgotten when?"
"I haven't been home for a long time. When I returned to Tokyo this time, I suddenly felt uncomfortable. When I regained consciousness, I was already here. Did my family send me here?"
"On vacation? I haven't been back to Tokyo for a long time! Isn't your workplace the T factory of Nippon Chemicals in T city? Or did you go on a business trip somewhere?"
Tabe showed an expression that said it was irreversible.If he returned to his own home from the factory in T city, he should not say "vacation" or "I haven't been back to Tokyo for a long time" in the same city.This is what was caught by Akita's ingenious "leading question".
"Where did you come back to 'long absence' Tokyo and feel uncomfortable? This has since clouded your memory."
"..."
"So, before you went straight back to Tokyo, it was 'that place' that put you in a fog. What's going on there? What are you doing there?"
If Tabe's statement is to be believed, then his memory was lost between the time he returned to Tokyo in "that place" and this morning.
For some reason, after a mental disorder occurs, from a certain moment onwards, it is impossible to remember what has been experienced since then, which is called amnesia.Tabe's disease also belongs to this symptom.Forgetfulness may also have psychological factors, but Tabe's symptoms are obviously caused by the intrusion of harmful chemicals from the outside world into the human body.In this way, from around a certain moment, the memory is damaged, and it can be considered that the pathogenic factor was formed at or near this moment.
Under Akita's questioning, Tabe remained silent, maintaining a high degree of vigilance against Akita's clinically induced interrogation.
"Don't hide anything. A word of yours can save many people, so say it!" Yoshida shouted, unable to hold back the anger in his heart.This only made it worse.
Immediately, Tianbe showed a timid look that was completely disproportionate to his thick physique, and suddenly became tough again.
"Don't be so scary. What danger is there? Isn't it the same as drinking too much? Sir, look, what's wrong with me? Go to the police station! I'm going to get drunk."
Tabe was still slurring his speech, and was almost on the verge of fasting for the past few days. His face was livid and thin, but his strong muscles were still faintly visible, making him look very pitiful.
It is true that, as Tabe said, it is not clear that alcoholism is the same.But what exactly makes it so is unclear.It's hard to say anything until the results of the close examination come out.At least from the appearance, apart from forgetfulness (this is also my statement), there are no serious symptoms.
Akita wanted to do some clinical research, and since the patient himself was unwilling to answer, he could no longer interrogate him.
"Doctor, please let me go home. I'm all well now, there's no other discomfort." Tabe seemed to feel Akita's vacillating attitude, and said aggressively.
"The blood pressure is still high, and there is protein in the urine." Akita always wanted to keep him for observation, and was a bit reluctant to let him go.
"It's not something that's just now, it's an old problem inherited from our ancestors." Shantou Tanabe laughed.Hypertension caused by diabetes is also a common symptom, and these alone cannot be concluded that it is affected by new harmful substances.Before the test results are fully released, I don't want to release him from the hospital.Out of professional premonition, Akita felt that from the symptoms of Tabe yesterday, it was caused by a very dangerous and harmful substance that he had never seen before.
However, this is just a hunch.A doctor has no right to detain a patient who appears to have no serious symptoms.
"I can't keep it anymore." Akita winked at Yoshida, and Yoshida smiled helplessly.
"I didn't ask anyone to take me to the hospital. My woman must be smart. She, mind your own business!"
When Tabe was about to leave, he muttered in his mouth, as if deliberately speaking to them.
"Monster!" Ji Xiang cursed in disgust as soon as Tianbe left.
"It's really strange." Akita said the same.
"Why are you so evasive and don't tell the truth? After waking up, you still insist that you don't know anything. This is the first time you have encountered this kind of patient."
"Isn't that so?"
"Before he left, this man complained that he was 'nosy'. His family only sent him to T Hospital when he was unconscious. If he was still conscious, he would not have come to the hospital. My body and mind have been damaged, but I refuse to seek medical treatment. Why? Is it afraid that people will know the cause of the damage? There must be something unspeakable hidden here." Akita murmured to himself.Suddenly, he said to Yoshida, "Yoshida-kun, how far has the detailed inspection been carried out?"
"This..." Yoshida looked ashamed, scratched his scalp and said, "I didn't expect this patient to run away all of a sudden. Yesterday, I only did a urine test, blood pressure test, and blood draw. I originally planned to do an electrocardiogram and X-ray today." Examination and fundus examination."
"Have you not had an electrocardiogram yet?" Akita said regretfully. "What items were tested with blood samples?"
"Blood counts and liver function tests."
"Very good, at least we can know the functions of the kidney and liver." Akita said confidently.
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