評(píng)論
打印
A few days later, when Hassen returned to the hospital for his next shift, he wondered what had happened to the man with the weakened legs. He saw that his potassium had come back to a normal level and that he had been discharged. These days, financial pressures push doctors caring for hospitalized patients to narrow their focus to identifying life-threatening conditions and addressing those enough to stabilize the patient. Patients are then sent back to their primary-care doctors to determine the hows and whys behind the conditions that sent them to the hospital in the first place. Hassen accepted this reality, and yet to him the real pleasure of medicine wasn't just identifying and addressing the serious symptoms but figuring out the cause behind the cause of the symptom. This man's weakness was caused by low potassium. But what made his potassium low?
幾天后，哈森回到醫(yī)院準(zhǔn)備下一次值班時(shí)，他想知道那名腿部虛弱的男子現(xiàn)在情況如何。他看到他體內(nèi)的鉀含量已恢復(fù)到正常水平，目前已經(jīng)出院。如今，經(jīng)濟(jì)壓力迫使看護(hù)住院病人的醫(yī)生將重點(diǎn)縮小到識(shí)別危及生命的狀況，并解決足以穩(wěn)定病人的問題。之后，病人被送回自已的初級(jí)保健醫(yī)生那里，以確定最初送他們?nèi)メt(yī)院的情況背后的原因和方式。哈森接受了這個(gè)現(xiàn)實(shí)，然而對(duì)他來說，醫(yī)學(xué)的真正樂趣不只是識(shí)別和解決嚴(yán)重的癥狀，而是找出癥狀背后的原因。這名男子的虛弱由體內(nèi)鉀含量低引起。但為何他的鉀含量會(huì)低呢？
A Striking Resemblance
驚人的相似
Hassen reviewed the notes from the patient's overnight stay. In the emergency department, he had been weak, his heart racing, his blood pressure high and his potassium low. When electrolytes were repleted, his strength returned and his blood pressure dropped. But his heart continued to race. Heart rates are often high in the E.R.: Patients are scared and sometimes sick, often in pain. But this man's heart rate stayed high even as everything else got better. That struck Hassen as strange.
哈森回顧了病人住院那晚的記錄。他在急診室時(shí)一直很虛弱，他心跳加速，血壓高而且鉀含量低。補(bǔ)充電解質(zhì)后，他的體力恢復(fù)，血壓下降。但他的心跳仍在加快。患者在急診室時(shí)心率都會(huì)很高：因?yàn)椴∪烁械胶ε拢袝r(shí)會(huì)惡心，而且通常處于痛苦中。但這個(gè)人的心率一直很高，即使其他情況都有所好轉(zhuǎn)。這讓哈森覺得很奇怪。
And so Hassen turned to the internet. He eventually found a case report that bore a striking resemblance to his patient: a young man with weak legs, low potassium and a high heart rate. That patient turned out to have something Hassen had never heard of: thyrotoxic periodic paralysis, muscle weakness where the low potassium was being caused by an excess of thyroid hormone.
于是哈森開始在互聯(lián)網(wǎng)搜索。他最終發(fā)現(xiàn)了一個(gè)與其病人驚人相似的病例報(bào)告：一名年輕人，雙腿無力，鉀含量低，心率高。那名病人患有哈森從未聽說過的疾病：甲狀腺毒性周期性麻痹，癥狀為肌肉無力，而鉀含量低由甲狀腺激素過量所引起。
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