Liu Zhengliang had the day off and was having a drink with his grandfather, accompanied by Ai Chen.
Chen Junnan called Liu Zhengliang: "Come back as soon as you're free. We have a patient who might be having an acute myocardial infarction, but we've been studying it for a while and can't figure it out."
After hanging up, Chen Junnan returned to the consultation room to communicate with the lying patient. He asked how much alcohol the patient had drunk, and the patient said six liang. Chen Junnan thought to himself, a little over half a jin shouldn't cause vomiting like this. But if it really were an acute myocardial infarction, the patient should already be confused by now. Yet he was perfectly fine and still alert.
Liu Zhengliang planned to take a taxi back to the hospital, but Ai Chen said, "I'll drive you." The two drove west along the Hunhe River embankment road. Halfway there, Chen Junnan called again: "Old Liu, the patient is still quite alert now, talking and chatting normally. The myocardial enzyme results are out too, no changes, and blood pressure and oxygen levels are okay."
Liu Zhengliang asked, "How old is the patient?"
Chen Junnan replied, "Fifty."
Liu Zhengliang said over the phone, "At that age, with chest pain and vomiting, the first thing to consider is definitely acute myocardial infarction, and the ECG points to it clearly. But why are the myocardial enzyme indicators off? Let me think about it."
While driving, Ai Chen cautiously asked Liu Zhengliang, "Isn't a heart attack when the heart stops working? Why are you drawing blood to test for myocardial enzymes?"
Liu Zhengliang explained, "When myocardial cells stop working, some die. Once the cells die, the myocardial enzymes originally inside them flow into the bloodstream throughout the body. When we draw blood and test it, if we find them where they shouldn't be, it indicates the heart might be in trouble."
Hearing that there might be an urgent case, Ai Chen's professional instincts kicked in: "Then I'll go take a look too, in case there's work later."
Liu Zhengliang was torn between laughter and tears: "No, no, don't. If you come with me, it'll be too awkward if someone sees you. What if the patient recognizes you and gets scared?"
Ai Chen said, "What's the big deal? It's a normal occurrence. My dad's WeChat name is 'Dead Work Comes Alive,' and no family members have been upset about it. No death, no work—that's just how we make a living. If there's work, save it for me. Keep the meat in the pot, don't let it go to someone else's house."
Liu Zhengliang didn't know whether to agree or not.
Meanwhile, Chen Junnan was still verifying information with the elderly patient. The patient, Kang Shuangsheng, had done business abroad for over ten years. He had some money but wasn't extremely wealthy. He learned to drink in Russia and had half a jin every day.
Chen Junnan asked, "Which side of your chest hurts exactly? Look, is it here? Does it hurt here?" He used his hand to locate the spot on Kang Shuangsheng's chest.
"Yes, right here in the chest, exactly here."
The precordial area—that's correct.
Chen Junnan asked again, "Does it feel like a pressing sensation, as if a stone is weighing on you?"
Kang Shuangsheng replied, "Yes, yes, just like Sun Wukong being crushed under the Five Elements Mountain."
Chen Junnan pressed further, "Have you had high blood pressure before?"
Kang Shuangsheng nodded repeatedly, "Yes, I have. Two years ago, I also had a myocardial infarction and got a stent placed in Russia."Chen Junnan let out a long sigh: "That makes sense. I was wondering why the medical records were blank. Nowadays everything's connected through big data—major health issues are backed up, and local physical exam data is shared. No wonder I couldn't find any of your information."
After Liu Zhengliang entered the examination room, Chen Junnan briefed him on the situation.
Liu Zhengliang said: "Get a cardiology consultation immediately. If it's confirmed, prepare for surgery right away. If not, we'll wait a few hours for the cardiac enzymes to fully release before rechecking the myocardial enzyme panel—these indicators have a lag period anyway."
Liu Zhengliang then asked Kang Shuangsheng: "How long have you had this chest and abdominal pain?"
Kang Shuangsheng checked his watch: "About four hours. I didn't take it seriously at first, but it kept getting worse. Now my stomach's starting to feel uncomfortable too—all twisted up and painful."
Liu Zhengliang and Chen Junnan exchanged glances. Liu typed a WeChat message to Chen: "Doesn't look like acute myocardial infarction."
When Doctor Lu from cardiology arrived, he performed a thorough physical examination—palpating the abdomen, pressing the liver, checking every part of the body—but found nothing unusual. Frowning in thought, he finally said: "Run full tests for liver function, kidney function, electrolytes, and amylase."
Kang Shuangsheng protested: "I just have stomach pain, and you're ordering tests for all my internal organs like money grows on trees? Do you even know what you're doing?"
Liu Zhengliang explained: "We need to determine your actual condition. Humans can develop all sorts of ailments—we can't just diagnose by looking at your face."
Kang retorted: "But Doctor Chen said it might be acute myocardial infarction earlier?"
Liu responded: "If it were really acute myocardial infarction, your cardiac enzymes would definitely show abnormalities after all these hours."
Soon the test results for liver function, kidney function, electrolytes, and amylase all came back—completely normal.
The atmosphere turned awkward. Old Lu said: "Since there's nothing wrong, I'll take my leave."
Everything appeared normal, yet Kang kept clutching his stomach and chest in pain—how to explain that? Two hours later, repeat tests showed the cardiac enzymes remained normal. Even if cardiac enzymes were made of mercury, they should have shown up in blood tests by now.
Liu Zhengliang said: "We should focus on the digestive system. This clearly isn't related to myocardial infarction."
Chen Junnan agreed: "Makes sense—it could be acute pancreatitis, which also causes abdominal pain. Let's get a gastroenterology consult."
Liu Zhengliang decided: "Alright, we need to rule out acute pancreatitis, gastric perforation, intestinal perforation, intestinal obstruction, and appendicitis. No need to consider intussusception—this isn't pediatrics. Get both ultrasound and CT scans—full trunk imaging. Show the results to gastroenterology afterward. Emergency priority, fast-track the imaging."
When the scans came out, Deputy Director Lin from gastroenterology examined them carefully before muttering: "Just three small gallstones visible, nothing else wrong. No suppuration or swelling, pancreas is normal, digestive tract looks fine, and his appendix was already removed previously. I can't identify any issues."
Kang Shuangsheng grew frightened hearing this.
The atmosphere became even more awkward. Deputy Director Lin said: "Since there's nothing urgent here, I'll return to my other patients."They still needed to consult cardiology, and this time they had to get the department director. Director Zhang also came over after receiving the notification. Director Zhang said: "We still can't rule out acute myocardial infarction. I recommend performing coronary angiography immediately to check whether the coronary arteries are blocked or infarcted. If they are, we can proceed with stent surgery right away."
Kang Shuangsheng was genuinely angry this time: "What are you doing? I already told you I've had a stent placed before. Another stent? Are you building a subway system in my body, putting one here and another there?"
Che Mingming comforted him: "If one subway line isn't enough, you have to build two. The coronary arteries aren't just one blood vessel - there are multiple pathways. Did you think installing one stent would guarantee that all blood vessels would remain problem-free?"
When Director Zhao from the emergency department heard about a patient with unclear diagnosis, he also came to check. Director Zhao also helped persuade him: "Several departments' doctors can't figure out your condition. Given your current situation, we don't dare transfer you to another hospital. If this turns out to be acute myocardial infarction and something happens during transfer, we might as well quit our medical careers - that would be considered a major medical accident, practically criminal. Please cooperate with us and complete all the necessary examinations."
Kang Shuangsheng's wife chimed in: "The doctors definitely know better than you. Just do what they tell you and stop acting like you're so clever while everyone else is foolish. Doctor, I'll go pay for the angiography."
Director Zhang from cardiology and Director Zhao from emergency department reviewed the coronary angiography results together. The blood vessels were all in good condition - neither blocked nor narrowed, properly supplying adequate blood to all parts of the body.
The atmosphere instantly became extremely awkward.
Director Zhang from cardiology persisted: "Could it be aortic dissection?"
A family member asked: "Doctor, what does that mean? I don't understand."
Liu Zhengliang explained: "It's like a double-layered rubber tube where the inner layer ruptures while the outer layer remains intact. Long-term hypertension makes the inner tube lose elasticity until blood pressure breaks through. Blood gets trapped between the two layers, and over time it can accumulate and form blood clots within the dissection. If thrombosis occurs in the dissection, it becomes life-threatening. The questionable part is, even if it were aortic dissection, it's unlikely to coincidentally affect both chest and abdomen simultaneously. Besides, his pain pattern doesn't match the severe pain typical of aortic dissection rupture."
Emergency Director Zhao said: "Better to over-investigate than to miss something. It might be due to his age or hypertension that his pain perception isn't typical. People vary - in such situations, investigation is better than neglect. Let's do enhanced CT angiography of the aorta, carefully scanning this area for thorough examination. What if it's abdominal aortic dissection?"
Kang Shuangsheng complained: "I've been undergoing tests all afternoon, spent thousands just on examination fees without any medication or treatment. Is this how doctors should practice? Your profession makes money too easily - even wealthy families can't afford hospitals. Once you come in, you're like lambs to slaughter, letting you cut me however you want, right?"Director Zhao could only force an apologetic smile and said, "Brother, with your history of heart disease and hypertension, we have to cover all bases and rule out every possibility. We've already come this far in our investigation—like crossing the marshlands on the Long March—and we're about to get results. A CT scan costs just a couple thousand yuan. Don’t risk your health to save such a small amount."
When the results came out, the contrast-enhanced chest and abdominal CT showed nothing—the aorta was clear from the proximal end to the distal end, completely clean.
Director Zhang from the cardiology department said to Liu Zhengliang and Chen Junnan, "I’ll take my leave now. There’s nothing more I can help with here. You two carry on; I have other matters to attend to."
The atmosphere in the consultation room suddenly turned overwhelmingly awkward.
Kang Shuangsheng, now completely resigned, clutched his stomach and said to Liu Zhengliang and Chen Junnan, "Alright then, I’m all in. Whatever else you want me to check, I’ll do it all. If you don’t give me a conclusion today, I’m not fucking leaving. You can’t mess with people like this—I’ve been sent for CTs and ultrasounds multiple times this afternoon, and you’ve drawn six or seven tubes of blood from me. Let’s see if you actually know how to diagnose anything."
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