Chapter 13

Tang Feiwan’s work demeanor was nothing like her confusion in the changing room. At 8:30, after handoff, the ward physician handed her the medical records of the patient transferred from general internal medicine.

“Zhang Yan? The patient with the lung abscess?” Tang Feiwan carefully leafed through the file and headed to the EICU.

The ward physician explained, “Yes. A lung abscess caused by severe pneumonia. Starting this morning, she’s short of breath and cyanotic. Her oxygen saturation only stays at 95 with oxygen.”

Three days earlier, general internal medicine had performed a bronchoscopy. The sputum samples showed a large number of inflammatory cells, consistent with bacterial pneumonia progressing to lung abscess.

Tang Feiwan reviewed Zhang Yan’s chart and asked, “Are there CT images?”

“Here.” The ward physician pulled up Zhang Yan’s images on his phone and handed it over.

Tang Feiwan enlarged the images. Both lungs showed diffuse ground-glass opacity with reticular changes, as well as multiple round thick-walled abscess cavities with low-density interiors. A “cobblestone” sign and typical lung abscess imaging, meaning the general internal medicine colleagues’ assessment and treatment direction were completely correct. Why wasn’t it working? The patient’s fever was near 40°C, with cough, poor appetite, chest pain, muscle aches, and other symptoms unrelieved. She pursed her lips in thought, then was interrupted by a commotion nearby.

“Why can’t she be treated in a regular ward? Why does she have to be in the ICU? Are you cheating us?” Zhang Yan’s son, Zhou Wenyong, was shouting to see her primary physician.

Zhang Yan’s 17-year-old daughter, Zhou Wenyun, grabbed his flailing arm and explained, “Brother, Mom was in the regular ward for almost six days. Her condition got worse, so they moved her to the ICU.”

“Who approved this? You’re underage. Your signature doesn’t count.”

The girl muttered, “Mom wanted to save money and didn’t want treatment. I said money can be earned back, so she agreed.”

Zhou Wenyong demanded, “Do you know how much a day in the ICU costs? Your art training camp is 20,000 yuan for three months. Mom could burn through that in a few days.”

Their father had died early, so the older brother played the father’s role. Zhou Wenyun rarely talked back. “Brother, what’s more important, money or Mom’s health?”

Zhou Wenyong gritted his teeth. “You!”

“This is a hospital. What’s all the shouting?” Sun Qinhe heard the noise and came from the nurses’ station, warning, “Keep it up and I’ll call security.”

Zhou Wenyong feared the strong but not the weak. Sensing she wasn’t like the other nurses, he lowered his voice. “Who’s my mom’s primary physician?”

What a nuisance. Outside the EICU, Tang Feiwan, who hadn’t wanted to deal with him, turned and walked over quickly, her tone even. “That would be me.”

Zhou Wenyong sized her up: at most in her twenties, a female doctor. He muttered, “So young. No wonder she can’t treat the illness.”

The ward physician had a hot temper and snapped, “What did you say? The patient only transferred to our EICU this morning. Her previous primary physician in general internal medicine has been practicing for nearly ten years.” Pausing for two seconds, he added, “Moreover, Doctor Tang studied and worked at a foreign hospital. She has plenty of experience. You’re saying she can’t treat patients?”

Hearing she was a returnee, Zhou Wenyong lost his bluster. He changed the subject. “What exactly is my mom’s illness? Why is she getting worse?”

Tang Feiwan wouldn’t stoop to his level. She kept it brief. “Preliminary diagnosis is a severe lung abscess caused by bacterial infection. We’ll continue treatment and observation.” Out of the corner of her eye, she noticed the dark circles under the girl’s eyes. Combined with the man’s earlier words, she guessed he’d only just shown up at the hospital. She hinted pointedly, “Also, someone needs to stay outside the ICU. If there’s any change in the patient’s condition, we’ll communicate with the family.”

Zhou Wenyong jerked his chin at the girl. “My sister’s here.”

Tang Feiwan led him into the trap. “You said she’s underage and can’t make decisions.” Unexpectedly, Zhou Wenyong was thick-skinned. “She can’t make decisions, but she can watch over Mom. She’ll call me if anything happens.” With that, he pulled out his phone and pretended to take a call nearby.

Tang Feiwan had said all she could. She had work to do, so she turned and left.

In the EICU, patients were monitored constantly. Tang Feiwan walked to Bed 1. The nurse handed her the morning’s blood results. White cell count and neutrophil count were still high, and C-reactive protein was over 8.2 mg/L.

She asked, “Have we ruled out rheumatic and autoimmune diseases?” A patient with recurrent fever, besides infection and cancer, should be considered for less common rheumatic and autoimmune conditions. For example, lupus could present with fever, pleural effusion, alveolar hemorrhage, and even pneumonia.

The ward physician shook his head. “No, because lupus typically causes interstitial pneumonia, and the fever is usually low-grade.”

“Test for it. There are exceptions to every rule.” The patient was on low-flow oxygen with cardiac monitoring, not yet in critical condition. There was still time to find the cause.

After rounds, Tang Feiwan returned to the office and began searching for similar cases domestically and abroad. From 10 a.m. to 2 p.m., the person at the desk stared at the computer without pause. Gu Yan, passing through the office several times, finally reminded her, “Doctor Tang, aren’t you eating?”

“Mm, not hungry.” She glanced at the time in the corner of the screen: 2:03 p.m.

“As the saying goes, food is the body’s fuel. Don’t give yourself stomach problems, Doctor Tang.”

“Okay, thanks.” Tang Feiwan remembered Lin Ye saying the same thing years ago when worried about her health. She responded absently. She bent down, opened the snack cabinet, took out a cup of instant noodles, opened it, added seasoning, and poured in water. Convenient and quick. In 15 minutes, her hunger was gone.

Trash needed to be disposed of promptly. She went out to throw away the cup. Passing the EICU, she saw Zhou Wenyun curled up on a bench, drowsy. A cleaner went over and gently patted the girl’s shoulder. “Hey, hey, little girl, can’t sleep here.”

Zhou Wenyun opened her eyes slightly, coughed twice, and said, “Okay.” She forced herself to sit up, clutching her art folder, head drooping, eyes closing again.

Tang Feiwan noticed something was off with the girl’s complexion and approached. “Zhou Wenyun.”

“Mm?” The girl looked up, her red eyes gazing at her, unfocused.

Tang Feiwan reached out and touched Zhou Wenyun’s forehead. It was burning hot. Her heart skipped a beat. She said urgently, “Come with me.”

In the observation room, the girl sat in a chair with a thermometer under her arm. Seven minutes later, she handed it to Tang Feiwan. Tang Feiwan looked: 39.2°C. A high fever. Mother and daughter both with fevers. Coincidence? Ordinary bacterial pneumonia wasn’t contagious, and neither was a lung abscess. At that thought, Tang Feiwan’s frown deepened.