Thank You Doctor Episode 21 Recap
> Thank You Doctor Recap
Xiao Yan convinced Bai Shu to give Little Guang more space for a happy childhood, emphasizing that Little Guang also had the right to know about his illness. Bai Shu, deeply moved and convinced by her words, reflected on their earlier conversation and admitted the truth in what she said. He recognized he had been too overprotective, micromanaging Little Guang's life and limiting his growth. They chatted agreeably on the phone, finally hanging up late.
Before doing so, Xiao Yan playfully warned him about staying up late, suggesting it could lead to baldness. After their call, Bai Shu contemplated Xiao Yan's earlier point, reinforced by the case of Yu Mingming, that children have the right to know what they are facing. Later that night, Little Guang stirred awake to find Bai Shu sitting by his bed.
Bai Shu confessed he had something he needed to apologize for, revealing he had hidden the truth about Little Guang’s illness for a long time. Little Guang, however, calmly stated that he already knew he suffered from severe thalassemia. He had even researched it online and was aware of the doctors' grim predictions when he was three and six years old.
He expressed relief at finally not having to pretend for his father's sake, admitting it had been a difficult act to maintain. Little Guang then playfully teased Bai Shu, asking who had made the "iron tree blossom," implying that Xiao Yan had convinced him to be more open. Bai Shu strongly defended himself, but in his heart, he felt a sense of relief, and then, filled with affection, simply hugged his son.
Bai Shu then called Xiao Yan, inviting her to meet and discuss the surprising outcome of his confession to Little Guang, motivated by gratitude towards her. At a café, Bai Shu shared that Little Guang had known all along, having acted for years. Xiao Yan remarked on Little Guang's intelligence, acknowledging that it would have been difficult to keep such a secret from him.
She expressed understanding for Bai Shu’s previous reluctance, noting that even doctors, outside their professional roles, are just family members when it comes to their loved ones. Bai Shu admitted that their previous disagreement over Yu Ming Ming's treatment had already made him consider telling Little Guang the truth, but facing his own family member proved challenging. He realized his excessive protection had inadvertently burdened Little Guang.
Xiao Yan reassured him, believing Little Guang must have found happiness in cooperating with him, and affirming that "some things are better when said." Bai Shu then asked why Xiao Yan had never inquired about Little Guang's mother, despite her fondness for the boy. Xiao Yan responded that everyone has secrets and they should be shared only when one is ready. Bai Shu then confided that Little Guang was his elder brother's son, born with severe thalassemia.
His brother and sister-in-law had tragically died in a car accident when Little Guang was two, leading Bai Shu to raise him as his own. When Little Guang was six, his condition worsened critically, and Bai Shu had to fight to save his life. Xiao Yan offered words of encouragement, praising Little Guang's positive outlook.
Bai Shu then jokingly asked for one of Xiao Yan's secrets in return, but she deferred, promising to tell him "when there's a chance," then thanked him for the coffee. Later, a 43-year-old female patient, Xu Han Wei, was rushed to Tongshan Hospital's Emergency Department after collapsing at home with a high fever and altered consciousness. Xiao Yan, suspecting a central nervous system infection, ordered Meropenem antibiotics and arranged for her transfer to the EICU, requesting a neurology consultation.
Due to the urgency and the family being unreachable, a lumbar puncture was performed to confirm the diagnosis, with medical administration notified. Initial reports showed a low possibility of central nervous system infection but a high C-reactive protein level, while liver and kidney functions appeared normal. A CT scan of her chest and abdomen revealed exudation around the kidneys, suggesting an infection whose source remained elusive.
Xu Han Wei’s condition rapidly worsened, with her respiratory rate increasing to 30, heart rate to 130, and blood pressure dropping to 80/40. She developed chills, indicating septic shock, and the urinary system was suspected as the infection's origin. Xiao Yan immediately ordered a 1000ml normal saline volume expansion and an increase in oxygen flow as her oxygen level dropped to 85%. With low breathing sounds and moisture rales in both lungs, acute respiratory distress syndrome was suspected.
Tang Hua was instructed to draw blood for gas analysis, and the Head Nurse prepared for tracheal intubation. Despite intubation, Xu Han Wei’s oxygen partial pressure remained low at 47, and blood oxygen saturation at 81. Her illness progressed unusually fast for typical urinary sepsis, prompting Xiao Yan to suspect infective endocarditis and order a bedside ultrasound. The ultrasound showed an ejection fraction of 50% but no valvular vegetations, still leaving the rapid deterioration unexplained.
Xiao Yan then ordered further biochemical tests, including brain natriuretic peptide, blood culture, and next-generation sequencing. The results showed extremely high inflammatory markers, and her liver, kidney, and heart functions were rapidly deteriorating. Her oxygen partial pressure remained dangerously low at 61 mmHg.
Realizing that the ventilator alone was insufficient to maintain her oxygenation due to the accelerated myocardial damage, Xiao Yan proposed placing Xu Han Wei on an ECMO machine, which required consultation with thoracic and cardiology specialists, as well as family consent. She also ordered third-line antibiotics. Xiao Yan then reported to Director Lu Ping'an, explaining Xu Han Wei's multi-organ failure, severe myocardial depression, and suspected septic and cardiogenic shock, which put her at risk of immediate cardiac arrest.
She reiterated the need for ECMO but the ongoing difficulty in contacting the family. Bai Shu, present during the discussion, advocated for prioritizing saving the patient's life. Director Lu acknowledged both their concerns, instructing them to make every effort to reach the family while he sought hospital approval for ECMO. They were tasked with maintaining the patient's vital signs in the interim. Eventually, the family was successfully contacted and gave their full consent for the ECMO procedure and aggressive treatment.
ECMO was initiated, but a subsequent bedside ultrasound revealed her ejection fraction had dropped to 25%, and her upper limb temperature was dangerously low. The ECMO machine was unable to maintain adequate blood supply to her vital organs, raising concerns about upper limb necrosis and brain damage. Xiao Yan quickly requested a consultation with cardiology for a bedside intra-aortic balloon pump.
The Head Nurse was instructed to ensure a constant supply of platelets and red blood cell suspensions, as her blood counts would decline. Tang Hua was assigned to closely monitor her invasive blood pressure, dynamic EEG, and blood coagulation. Later, Bai Shu offered Xiao Yan coffee. Xu Han Wei's husband and daughter finally arrived, thanks to Bai Shu's persistent efforts to contact them.
Xiao Yan explained the ECMO machine to them, reassuring them that their loved one’s condition had improved and she was likely to be taken off the machine within a week. The family expressed profound gratitude. Further tests, including second-generation gene sequencing of blood samples, revealed E-coli bacteria and human herpesviruses. The medical team concluded that Xu Han Wei suffered from septic shock caused by a highly independent E-coli infection of urinary tract origin.
Her long-term type 2 diabetes had severely compromised her immune system, leading to "immune paralysis," which reactivated dormant human herpesviruses in her glands, ganglions, and B cells. This triggered a fulminant human herpesvirus myocarditis, causing severe myocardial depression. The combined efforts of the thoracic surgery and cardiology departments had successfully stabilized her vital signs.
Director Lu later informed Jiang Zhongjing about the case, highlighting how Xiao Yan and Bai Shu had initially differed on the approach—Xiao Yan advocating for family consent before ECMO, and Bai Shu prioritizing immediate life-saving—but ultimately found common ground and collaborated seamlessly. He commended their growing teamwork, calling them "two strong generals" who had effectively saved the patient's life. Meanwhile, Old Pan, the caregiver for Jiang Xian Yun, was preparing his room.
He had just laundered the bedding, hoping Jiang Xian Yun would be more comfortable and have a better appetite. As he spoke, he realized Jiang Xian Yun was unresponsive in his chair, having passed away peacefully. Old Pan immediately notified Jiang Shan. Jiang Xian Yun's funeral was held, attended by medical staff from Tongshan Hospital.
During the funeral, Old Pan handed Jiang Shan a letter, explaining that Jiang Xian Yun had entrusted it to him for delivery if he ever passed away. Separately, Tang Hua's 58-year-old mother experienced sudden chest tightness and shortness of breath while dancing. She was admitted to the Emergency Department, but initial checks by Chen Zhi found her blood pressure, pulse, and respiration to be normal.
When Tang Hua arrived, concerned, all subsequent tests, including chest X-rays, ECG, ultrasound, and blood tests for anemia, yielded normal results. Her mother continued to complain of severe chest tightness. Xu Yiran suggested checking brain natriuretic peptide and D-dimer levels, but these also came back normal. Xu Yiran concluded it might be "functional chest tightness," a common complaint in older individuals, and advised against excessive worry.
While Tang Hua was attending to another patient, her mother, being looked after by Chen Zhi, began questioning him about Tang Hua's work performance and her preferences in men. Overhearing this, Tang Hua became exasperated and ushered Chen Zhi out of the room. When Xu Yiran later took over caring for her mother, the conversation quickly turned personal, with her mother inquiring if he had a girlfriend. Xu Yiran, feeling cornered, quickly excused himself.
Later, Tang Hua learned that her mother had been "scoring" the male doctors in the department. Her mother dismissed Director Lu as too old and divorced with children, and Chen Zhi as too poor and lacking in capability. She reserved judgment on Bai Shu, whom she hadn't met. However, she was highly impressed with Xu Yiran, praising his good looks, gentle demeanor, family background, connections, and successful career, despite Tang Hua's attempts to portray him as a "player" or "casanova."
Chen Zhi, having overheard these disparaging remarks, confided in Xu Yiran about his dismay. Xu Yiran, having no romantic interest in Tang Hua, decided to stage a plan to make her mother give up. He enlisted Lin Zhi to pretend to be his fiancée. Although Lin Zhi was initially hesitant due to her inexperience, Xu Yiran persuaded her. They then approached Tang Hua's mother, where Xu Yiran made a show of affection towards Lin Zhi.
Tang Hua's mother, curious, directly asked if they were dating. Xu Yiran "confessed" that Lin Zhi was his fiancée and they were planning to marry, keeping it a secret to surprise everyone. Tang Hua's mother, though clearly disappointed, wished them happiness, muttering "what a shame." Afterward, Lin Zhi expressed discomfort with the charade. Xu Yiran, however, remained focused on Chen Zhi, who was still dispirited about Tang Hua.
Xu Yiran advised Chen Zhi against being stubborn, reiterating that he and Tang Hua were not a good match and that love couldn't be forced. Chen Zhi, however, maintained his hope, arguing that compatibility could be developed over time, citing his own experience of learning to eat spicy food. Seeing his unwavering determination, Xu Yiran decided to offer genuine advice, explaining that while sincerity is common, the true secret to pursuing someone is "catering to her likes."
