B was keen to prove himself. He had chosen this patient himself whilst Dr. Li was seeing another patient.B: "I saw a 17 year old female patient complaining of a myriad of symptoms. She is accompanied by her mother. She has a pain across her whole abdominal which she describes as being sharp in character. She states that the pain came on suddenly yesterday at around 5 pm after she had dinner and has been their constantly since then. The pain has radiated to her lower back but it is now just in her abdomen. She would scale the pain a 9/10 in severity.
She states that she does feel nauseous but has not vomited. Her stools have been more watery for the past several days and paler in colour. She last opened her bowels yesterday night and states that there was some blood mixed in with the stool.
In terms of urinary symptoms she has had an increase in frequency and urgency for the last week. There is no change in colour and there is no offensive smell, bubbles, grit or blood.
The patient reports losing 10 kg of weight in the last month; which was unintentional. She has also had night sweats. The mother reports the patient had a fever yesterday which she measured at 38.5 degrees. She also states that she feels a loss in energy and fatigued.
Past medical history: the patient suffers from severe depression and migraines.
Past surgical history: She had an appendectomy in 2000.
The patient is currently taking Prozac, prophylactic inderal and marezine. She is also taking other pain relief such as regular paracetamol and codeine. She is allergic to penicillin. The mother reports that when the patient was 5 and was treated with a penicillin for tonsillitis, the patient had a widespread rash all over her body. The patient is also allergic to the antibiotics flagyl and proloprim they caused the patient to have breathing difficulties.
Family history: The mother reports that there is a history of cancer in her family such as leukaemia, non-Hodgkin"s lymphoma and breast cancer. On the patients father"s side there is a history of stroke, heart disease and hypertension.
The patient Lives at home with her mother and father. She has a younger brother who is 10 years old. The patient doesn"t drink or smoke."
Li Xiuying: "Patient occupation?"
B: "The patient is currently being home schooled by her mother. The mother states that her daughter is too unwell and lacks the energy to attend college."
Li Xiuying: "Diagnosis?"
B: "The patient has a range of symptoms. My first concern is cancer specifically because of the patient weight loss, night sweats and reported fever which suggests some sort of lymphoma. I can"t confidently exclude some form of abdominal pathology perhaps Chrohn"s it could even be appendicitis if the appendix wasn"t fully removed. I have already sent off full set of bloods and blood smear. I have also requested a CT scan."
Li Xiuying: "Examination?"
B: "I thought it was strange that both the patient and the mother refused the examination. The Patient did allow me to take bloods and a urine sample."
Li Xiuying had a nagging feeling in the pit of her stomach. She had an overwhelming sense of déjà vu. B"s report had raised many questions in Li Xiuying"s mind.
Li Xiuying: "Name?"
B: "Wan Chao." B was overcome with joy that Li Xiuying had finally asked his name. He would no longer be a letter. His joy was short lived when he heard Dr. Li next two words.
Li Xiuying frowned: "Patient name."
B felt so embarra.s.sed: "Yu Guan-yin"
F watched B go red faced and was comforted by the fact that he wasn"t the only to feel mortified after misinterpreting Dr. Li"s words.
Li Xiuying pulled up the Yu Guan-Yin"s old records and scans on the computer.
Li Xiuying: "F, thoughts?"
F: "For a 17 year old she has been in to hospital a lot."
Li Xiuying scrolled through the list of scans. In this year alone Yu Guan-Yin had had 4 CT scans, one MRI and numerous X-rays on various parts of her body. Yu Guan-Yin"s has had numerous fractures since 2007 which included a broken arm, broken leg, broken collar bone and even a broken hip.
It was highly irregular that a young person with no evidence of bone disease or malignancy had had so many fractures. Also it was very unlikely that Yu Guan-Yin engaged in any contact sports like rugby.
Li Xiuying looked at the other investigations: Yu Guan-Yin"s has had two colonoscopies and one OGD this year. She had a bone marrow biopsy in 2009 and a liver biopsy in 2008. There were no hospital records prior to 2007.
Li Xiuying became more and more shocked as she scrolled through Yu Guan-Yin"s details.
B and F who were standing behind Li Xiuying had looks of horror on their faces.
Li Xiuying had alarm bells going off inside her mind: "Cancel the CT scan."
B: "Erm yes right away." B Quickly walked over to the phone to accomplish his task.
F: "Dr. Li, Is there something you need me to do?"
Li Xiuying: "Call the Psych team and social services."
F: "What should I report to..."
Li Xiuying: "I"ll do it."
Li Xiuying: "Take the patient and the mother to private room 3."
F hastily made his way to the patient.
Li Xiuying first port of call was to contact security.
Li Xiuying waited with the receiver to her ear. She strummed her fingers on the work top as the phone rang.
Male voice: "h.e.l.lo security."
Li Xiuying: "This is Dr. Li I"m currently in accident and emergency. I need two security guards to stand watch over the occupants of private room 3. Monitor the mother for flight risk."
Male voice turned serious: "Dr. Li I"ll send the guards now. I"ll be on standby in the control room watching the monitors. I"ll alert all the security guards of the situation."
Li Xiuying: "Thank you."
Li Xiuying then called the psychiatry team for an emergency consult.
B and F had returned to stand by Li Xiuying"s side.
Li Xiuying: "Let"s go."
The trio made their way to private room 3.
The moment Li Xiuying stepped into the room and caught sight of Yu Guan-Yin. She knew why the case sounded so familiar. In her previous life Li Xiuying had read about Yu Guan-Yin"s death in the newspaper. Yu Guan-Yin had died at the age of 22.
Yu Guan-Yin"s death had led to a full scale investigation into the widespread systemic failing of various hospitals in saving her life.
Yu Guan-Yin"s image was particularly memorable to Li Xiuying because of the photo used in the article. It was taken months before Yu Guan-Yin"s death.
Yu Guan-Yin looked weak and like she was struggling to survive. Her face was thin and her skin was tinged a sickly yellow. She had crusting lesions on her face, neck and arms. Her hair had fallen out in patches. Yu Guan-Yin had a look of hopelessness and fear in her eyes.
The article detailed Yu Guan-Yin"s life and her extensive and tragic medical history. Yu Guan-Yin was born in a typical middle-cla.s.s family. Her father was an accountant and her mother worked in IT.
Yu Guan-Yin was born premature and had breathing difficulties which resolved when she was one.
Yu Guan-Yin had been in and out of hospital from the age of 4 for a myriad of symptoms. The mother had take Yu Guan-Yin to over 10 different hospitals and medical facilities all over the country. Most of the facilities were unlicensed and would do anything if the price was right.
Yu Guan-Yin was subject to numerous investigations and operations. By the age of 21 Yu Guan-Yin had had her tonsils, appendix, part of her large bowel and her womb removed. She had even been given a dose of chemotherapy and radiotherapy.
The last hospital Yu Guan-Yin had visited and the place of her death was Emerald hospital. Li Xiuying hadn"t come across Yu Guan-Yin, she never saw anyone who wasn"t on the patient list that Chen Wei and Chen Meng had a.s.signed her.
The article stated it was the hero Li Yu Yan, a medical student who called attention to Yu Guan-Yin case. She had reported her suspicions to her seniors. The police also became involved.
Emerald hospital was commended for having such a brilliant young medical student and was praised by the public. The other hospitals and medical facilities such as Unity hospital were hated by the public and even boycotted by many.
Later news articles reported that Yu Guan-Yin"s mother had committed suicide on the first day of her imprisonment. The father was also given a jail sentence. The brother went missing and could not be found.