"We actually have an easier way to verify the authenticity of the pain, right?" The schoolgirl asked. "It's hard for someone who pretends to be in pain to have a heartbeat, and we can test it in Haiti. Or are you inclined to punish that addict with this thing? ”

"Well, that's a good idea, first ask them where it hurts, then press on that spot and ask if it hurts more, and then quietly continue to apply pressure. If the person is faking illness, then the person will probably not be able to feel the slight afterburner, but the person who is really in pain will be able to feel the pain intensify. Grigory nodded. But these are not infallible methods, for example, if the person is a veteran drug addict who is well-versed in medicine, and he has heartbeat-boosting drugs on hand, then these tests are difficult to succeed — which is why the detection of retired police officers is always so difficult. In contrast, I am much safer in doing this, because it is easier for the other party to retreat and know that you are not easy to mess with here. ”

The schoolgirl nodded thoughtfully, and Grigory continued to switch topics as before. "Let's go back to the second patient, Sonorous Rose, who plays volleyball – the treatment didn't work for her, in fact at least we think it doesn't. When we took blood for a lab test, we found that she had tactile hypersensitivity. And the blood routine done in the face of pain found that the blood calcium data exceeded 16 (11-digit hypercalcemia line, 15-digit hypercalcemia crisis line), can anyone give me some possible reasons? ”

"Parathyroid adenoma, kidney disuse, vitamin D poisoning......" The female student immediately began to give examples, while the male student chose one of them to say.

"I think it's most likely an adenoma?" The male student asked. "Check for parathyroid hormone and blood phosphorus, then ...... Tc-MIBI？ ”

"Well, Tc-MIBI dichronotropia imaging is the most common practice for the detection of parathyroid adenoma. However, for some reason, the doctor chose an MRI for a complete probe and found that her thyroid gland was clean, but the main problem was that she had an osteosarcoma on her thigh bone, but fortunately, the final removal did not cause lifelong disability, and the case was closed. Gregory nodded, then jumped back on the subject. After that, let's get the farmer's business out of the way now. Let me start by asking, did you learn how to announce bad news to your family in class? How do you practice, one person plays the doctor, the other plays the family member, and then you measure your level of empathy by the kindness of your words and things like that, and then give you practical points? But in fact, sometimes the more brutal questioning can lead to some unexpected results, for example, when I tell him that he is dying and that we can't do anything but help him with the pain, do you know what he says? 'What about my dog, what will happen to it?' ’”

He ...... When he himself was dying, only cared about his dog? The male student was stunned.

"yes," Grigory nodded. "If there's any truth in medicine, believe me, it's the golden rule that 'everybody lies'. Everybody lies, and that's what they're lying about – telling them about their impending death in a cruel way tends to make them panic and expose what matters most to them: what you'll find out what's important to them, and it may help you find out what they're lying about. ”

"You mean, he ...... in that dog thing" The schoolgirl reacted quickly. Are you saying that the dog that was unusually ferocious when they were looking for the snake was to blame, and that the sick farmer chose to protect the dog? ”

"You've deduced it from me, it's good," Gregory nodded. In fact, it was like this - the dog bit him, but he liked the dog very much, so he concealed the fact that he was bitten by the dog: his dog obviously had a bad history of biting other people, and once the incident was reported, it would definitely be executed, so this dog lover would really be willing to hide his illness in order to try to save his dog. In fact, in the end, we did find the culprit in the dog, streptococcus, and its attack caused the patient to be infected with necrotizing fasciitis, which eventually led to the patient's amputation and his pet dog was eventually put to death. ”

Then Grigory suddenly picked up a few pieces of chalk from the table and began to paint on the blackboard. "Let's go back to the last patient, the addict. While I understand that you want to expose his alleged drug fraud, a new situation has arisen, and that is that he has started to urinate blood, and the specific color is ...... Such! He showed the blackboard circles made of red, yellow and brown painted together. The urine is like this, tell me what is your differential diagnosis? ”

When he said this, he seemed to be in high spirits, and he was quite eager to try. "You (he pointed at the schoolgirl) your skills are obviously solid, tell me what this urine says?"

"Blood in the urine can be caused by kidney stones, while brown ...... It represents the removal of components other than normal urine and blood, that is, waste products in the body," the female student quickly replied. "It means his kidneys are failing."

"His kidneys aren't working, that's fine, but why aren't they?" Gregory reversed his previous precedent approach and began to walk up to the schoolgirl with his cane, asking in a very stern tone.

"Trauma?" The female student's answer was a little unconfident.

"The case didn't mention it, are you sure it's possible?" Gregory immediately asked again.

"Probably...... The addict himself injected Dumerol without permission," the female student suddenly thought of this result that was in line with the addict's setting. "Is that it?"

"Is there any other possibility?"

......The schoolgirl was a little nervous when she found that the most likely reason in her mind didn't seem to be approved by Gregory. Is it an infection? ”

"Well, so what do you need to do if you inject Demerol and get infected without permission?" Gregory's pace of speech increased again, and the tone of his voice took on a kind of oppressive force that suffocated everyone present. "Human life is at stake, tell me quickly!"

"Hot compresses, bed rest, and antibiotics!" The female student seemed to be a little panicked, and her voice trembled a little when she spoke.

"Is there anything else possible?" Gregory still doesn't seem satisfied with such an answer. "Hurry up! Tell me, is there anything else possible? ”

"......" The schoolgirl opened her mouth, but in the end she could only shake her head with some guilt. I do not know. ”

"You're a piece of shit!" Gregory's emotions were agitated, but he calmed down after the scolding. "Forget it, at least you know you're a piece of shit, which means you won't be arrogant at least."

At the back of the classroom, the corners of the mouth of the young man who had come with the girl twitched slightly. "This teacher is so ruthless......"

"yes, but ...... I think there's a possibility they've overlooked. The girl catered to the boy's words, but whispered something.