LRAB Chapter 13 The 72 Genders of America
Chapter 13 The 72 Genders of America
Chen Yisen pretended to drink water and began to think rapidly.
Based on appearance, this person should be a male-to-female (MTF) transgender person.
Logically speaking, you can just address her as "Madam".
But the amazing thing about America is that it's not that simple.
The other person is very likely a "queer", that is, the Q (Queer) in LGBTQ+.
Refers to non-binary gender identity.
For example, armed helicopters.
Or gender identity may shift and change between men and women.
Or perhaps somewhere between a man and a woman...
In short, this is a blind box.
It's a blind box where you could be blown up if you opened the wrong one.
Chen Yisen really wants to ask a question on Quora now.
What should I do?
Waiting online, very anxious.
Fortunately, Eva Atkinson wasn't the type to be obsessed with gender, and she took the initiative to speak:
"Miss."
This shows that she is just a regular transgender person.
Chen Yisen breathed a sigh of relief: "Hello, Ms. Atkinson, is something bothering you?"
"I've been experiencing chest pain lately, and occasionally shortness of breath," Eva said, pulling a bag from an old backpack next to her. "I had a chest X-ray last month, and the doctor said it was bacterial pneumonia, but after taking medication for half a month, I still haven't gotten better. The next appointment is in seven weeks, so I thought I'd come in for a checkup..."
Seven weeks is indeed an unusually long time for a patient with lung problems.
Chen Yisen waved to the nurse behind him: "Come and check her oxygen saturation, blood pressure, and 12-lead blood pressure... She can be seated."
A very observant medical student quickly grabbed his toolbox and came over, handing the equipment to the nurse before quietly observing from the side.
He then asked, "Where exactly is the pain?"
Eva touched her upper chest, then moved a few centimeters down.
Atypical cardiogenic chest pain.
"Do you have a cough or fever?"
"Occasionally."
"Are you coughing up phlegm?"
"No."
When do you usually experience shortness of breath, before going to sleep? After exercising?
"It's mainly after exercise... not the kind of strenuous exercise, like brisk walking, that you feel it."
"..."
After a brief exchange of questions, Chen Yisen took out the X-ray film and pointed it at the overhead light.
To be honest, neither he nor the original owner had seen many physical X-ray films (they are usually digitized), and given that he was essentially a battlefield medic, he was a bit bewildered at the moment.
Even with the amazing skill of "electrical impedance tomography", you still need to figure out roughly where the problem lies first.
Otherwise, if just anyone came along and touched my whole body, I wouldn't be able to take it for long.
Fortunately, the imaging quality was good, and it was not difficult to see diffuse miliary shadows and ground-glass opacities in both lungs.
It doesn't resemble the butterfly shadow of heart failure at all, nor does it resemble pneumothorax.
The previous doctor's suspicion of pneumonia was understandable, but the antibiotics were completely ineffective, and there was no phlegm, indicating that this was not the case.
However, it is almost certain that the problem lies in the lungs.
Then you can cheat.
Chen Yisen put on his stethoscope and gestured to Eva: "Turn to the side, I'll listen to your back."
Upon hearing this, the assistant, nurse, and two medical students who were busy nearby all looked at him with shock.
Chen Yisen felt a chill run down his spine from her gaze: "What's wrong?"
The four people looked at each other, and finally the assistant summarized, "This is such a mess... Shouldn't we take the auscultation in the car outside?"
Chen Yisen never intended to actually listen to the patient's heart; he was just using it as an excuse to touch the other person's back.
Besides, in his previous life he practiced treating illnesses in complex environments, so he really hadn't paid attention to the noise of the environment.
He immediately waved his hand calmly, saying, "It's nothing, the community clinic does this every day, I'm used to it."
Then, amidst several admiring glances, he reached his hand inside Eva's clothes.
He had already tested it on himself before, and the bioelectricity emitted by the impedance tomography was not clearly perceptible. Therefore, this time he didn't even need to act. He simply held the stethoscope between two fingers and used his palm to output the detection current.
A three-dimensional model of the human chest cavity reappeared in Chen Yisen's mind.
With almost no adjustment required, he felt a distinct "filling defect" in his right pulmonary artery.
That is, there is a mass that does not flow with the blood.
Its shape is an irregular teardrop shape, with tiny gaps between it and the inner wall of the blood vessel, and it exhibits extremely high and extremely uneven electrical impedance.
Pulmonary embolism.
And it doesn't seem to have formed naturally.
Although the resistance of a thrombus is higher than that of normal blood, it is still fibrin and red blood cells, which are still water-containing biological tissues, and it is not high enough to approach the level of an insulator.
To avoid a disastrous first attempt, he aligned his palm with the mass and fine-tuned the frequency of the released current.
Sure enough, the response was completely different from that of other human tissues and was very chaotic.
Therefore, it is still a non-thrombotic pulmonary embolism.
That means there is a foreign object.
Chen Yisen's gaze immediately focused on the other person's chest.
A man with this physique can't possibly be born with it.
He pretended to move the stethoscope head a few positions, then withdrew his hand.
"Fine moist rales at the bases of both lungs, decreased breath sounds, pleural friction rub, increased P2 heart rate, S3 gallop rate in the right ventricle, tricuspid regurgitation murmur, systolic ejection sound in the pulmonary valve area..." Chen Yisen quickly recited a long string of medical terms, leaving Eva completely bewildered.
The few people around who could understand were dumbfounded. Even the resident doctor who was treating another patient turned around and looked at them with a look of disbelief.
The meaning behind that expression was very clear—
No, can you really hear me clearly?
Chen Yisen smiled nonchalantly, hung the stethoscope back around his neck, and struck a pose of a reclusive sage.
Listen carefully, of course it's impossible.
Even he could only get a rough idea of what was going on in the dreadful environment of the shelter.
Moreover, patients don't get sick according to textbooks, and even in a quiet environment, what they hear can't be completely typical.
Otherwise, pulmonologists would only need a stethoscope, so what would be the point of CT and MRI?
However, the difficulty in medicine lies mainly in deducing diseases and causes from known symptoms.
He had simply looked at the correct answer and then deduced the symptoms from it, so of course he was always right.
Fine moist rales at the bases of both lungs are caused by local bleeding, alveolar edema, and inflammatory exudation due to blockage of pulmonary capillaries.
Decreased breath sounds are caused by a concentrated mass of foreign matter in the pulmonary artery, which most likely resulted in local atelectasis or pleural effusion.
Pleural friction rub occurs because if the embolism area is close to the pleura, it can easily cause local pleurisy.
As for the heart condition, that is the core sign of pulmonary embolism, almost like reciting a memorized text.
……
After stating the results, Chen Yisen took a deep breath, his gaze sweeping across the front half of the room before finally settling on a medical student squatting to his left.
"Frank, tell me, what does all of this mean?"
In that instant, he felt completely refreshed, experiencing nothing but pure bliss.
So many years have passed.
It's finally my turn.
Finally, it was my turn to ask someone a question...
Frank, whose name was suddenly called, froze and immediately put on the Pain Mask.
"Well……"
"..."
After hesitating for a long time, he finally tentatively gave an answer: "Pulmonary edema?"
It's alright now; they didn't say it was pneumonia.
Chen Yisen certainly didn't intend to make things difficult for the young man, but rather hoped to guide everyone and make them feel that the judgment they were about to make was not complicated.
So he added, "I'd like to point out that the key points are an accentuated P2 and a subxiphoid TR murmur."
"Alveolar hemorrhage... pulmonary hypertension?"
It's not hard to see that Frank actually has a good foundation of knowledge.
However, medical students who have not yet undergone standardized residency training find it difficult to effectively utilize their knowledge to make inferences under the high pressure of the diagnostic field.
Perhaps sensing that Frank was about to faint from nervousness, the medical student next to him came to his rescue: "Dr. Chen, the test results are in."
"you say."
「血压96/58mmHg；口温37.6℃；指脉氧92%；心跳122bpm；窦性心律，律齐；电轴右偏+110°；S1Q3T3征阳性，I导联S波加深，III导联出现异常Q波及T波倒置……」
For Chen Yisen, none of these things matter anymore.
After the main indicators were reported, he looked at Eva, whose face showed some trepidation:
"Ms. Atkinson, I need to ask you some questions about your personal medical history. If you feel this involves sensitive privacy, you can talk in the car outside, but you'll have to wait in line."
"No need, just ask directly." The other party clearly saw that Chen Yisen was confident, so they were no longer in the mood to wait.
"You've had breast implants?" Chen Yisen lowered his voice, trying not to let too many unrelated people hear.
Eva nodded: "That's right."
"What about the materials?"
"Silicone, of course. I can't afford autologous fat."
Compared to Amber Zheng, Eva was quite frank about economic matters.
"This isn't right," Chen Yisen stared intently into the other person's eyes. "I'm afraid... it's not just silicone."
Silicone implants are highly pure, and even when inserted into a blood vessel, they will appear as a very cohesive mass.
The one inside Eva's body, on the other hand, was full of noise, more like a bunch of miscellaneous things that had just happened to come together in her blood.
In other words, it is highly likely to be something that does not meet medical standards.
"I'd like to offer a friendly reminder: any statements made in a medical setting will not be used as court testimony." Chen Yisen tapped the table. "So you should think carefully; this issue might affect the subsequent diagnosis..."
Eva's pupils visibly dilated, clearly indicating that her biggest concern had been addressed.
After a moment's hesitation, she nodded: "Okay, actually I attended a... uh... pump party."
This completely touched upon Chen Yisen's blind spot in knowledge.
"What is that?"
Eva covered her face in pain: "It's just... some guys who can't afford cosmetic surgery... Of course, some real women might also get mixed in. Anyway, they get together every now and then to inject each other with silicone, hyaluronic acid, or hormones..."
"..."
Now it was Chen Yisen's turn to be dumbfounded.
"what?"
No, buddy.
I've never seen anything like this before.
It took Chen Yisen several minutes to digest this somewhat incredible piece of knowledge.
Gender reassignment surgery is free in New York State.
However, this does not mean that subsequent health care and cosmetic procedures will also be free.
FTM is somewhat better, but for MTF to look decent, it requires a huge amount of money to maintain.
This "pump party" is probably some kind of cheap, high-risk alternative.
However, there are still many questions he doesn't understand.
"The silicone you're talking about... if it can be injected, you're probably referring to industrial silicone oil, uh... like polydimethylsiloxane... a liquid oily substance?"
Eva didn't understand the chemical names, but she nodded in the end, indicating that Chen Yisen's description was correct.
"Then... how do we fix it?"
Chen Yisen was genuinely curious, and also wanted to figure out what the blood clot was.
"Finally, a little bit of agent AB will be injected. Both are liquids, and they only solidify after being mixed." Eva seemed completely unaware of how incredible her words were. "Or we might use bio-glue... I'm not too sure about the specifics; I haven't administered it to anyone else..."