Part 29: Episode 29: Doctor and Patient

This update covers:

Gabriel Cunningham 5 - The Simplest Truth (Part 1 of 2)

Both videos in this update are on Youtube, but Viddler is telling me something like "yeah we might finish encoding these sometime this year." Check 'em if you like; the links should go to the right videos whenever they are finished. Also Starkclamp, I'm trying to think of what changed that would suddenly make the videos do something different for a phone and I have no clue. If I come up with anything I'll try it, because I cannot rest while there is a mystery to solve.

Intro Video




Gabe: Yeah. Hello, Joshua.

Joshua: Uh, Doctor? I don't hurt at all.

Gabe: ...? That can't be. I received a report from your nurse. Let's check you out. If I can't find anything, I'll let you go back to your room.

Joshua: Okay! I'm sorry, Doctor!

Huh. Alright, well... we'll just question him.



Joshua: I'm just here because the nurse said I had to be examined. But I feel just fine! You think she mistook me for some other kid? Oh, but don't blame her! She's real nice! She's always worried about me and does a lot. I wonder... maybe I did something bad. She was real worried about me.

There was... nothing in that one. There's nothing to be found with the stethoscope, either. There isn't even anything on the EKG.

Gabe: What the heck? He doesn't have a single symptom I can find.



Joshua: Oh, I'm sorry. It's just a cough!

Gabe: That looked rather strenuous, but it's "just a cough?" RONI, the patient is hiding something. I'm continuing the exam.



He still isn't giving us anything, but it's obvious something is wrong. Since he coughed, it makes sense to check the heart and lungs again.

Auscultation Video
Viddler
Youtube



Sure enough, tachypnea and tachycardia have appeared.

Gabe: It seems that earlier attack is causing symptoms to appear.

Joshua: *cough* *cough*

Gabe: There it is again... Hey, show me the hand you covered your mouth with just now.

Joshua: Huh? I-it's nothing! C'mon...

Gabe: Jeeze. He's going to try and hide as much as he can from me, huh? I need to get him to use his hands somehow.

This is a fun little puzzle. We just need to examine his midsection. Since Joshua will use his hands to lift up his shirt, we can find out what's on them. When you return from examining him...



The stain is visible under the marker, there. It's not huge, but it's not to miss, either.

Gabe: He still had blood on his hands when he lifted his clothes up. The boy coughed up blood a moment ago, and tried to hide it. RONI, make a note that the patient has hematemesis.

RONI: New Symptom: "Hematemesis."

Gabe: Hey, kid! Why are you trying to hide your symptoms from me?



Gabe: I know you coughed up blood earlier. It's on your clothing.

Joshua: Oh... I-it's just some blood! I'm full of the stuff! I'm fine!

Gabe: *sigh* Seriously, who'd he inherit this attitude from? Well, we're done talking. I need you to undergo some tests for me. RONI, get approval for an X-ray.

We've been through all this before, but hey: take it away, RONI.

RONI: This image was taken using an X-ray scan with a contrast medium. It shows the patient's stomach.

Gabe: I know what a stomach looks like, thank you.

X-RAY_01

Patient:



Sample:



X-RAY_02

Patient:



Sample:



X-RAY_03

Patient:



Sample:



X-RAY_04

Patient:



Sample:










There's just one thing we need to find, and it's in the second image.






Gabe: There's a cave-in in the gastric wall. The contrast medium has settled in it. This is definitely proof. He can't make excuses anymore.

RONI: New Symptom: "Caved-in Gastric Wall." Doctor, why not try informing the patient of these abnormalities? That may be useful in making him admit to false statements he has made.

Gabe: That's pretty devious of you. I wonder where you picked that up from?



Joshua: ...Urgh...

I'm going to take that as a yes.



Joshua: Yeah, I don't feel like eating when it hurts. What's wrong with that? Everyone keeps making a fuss about it, but it's nothing! Really! Doctor, I'm okay! Seriously!

And here we have it. First-up, stomachaches.

Gabe: What an idiot... I bet they hurt a lot, too. Well, RONI, he's finally coming clean with us. You writing this down?

RONI: Yes, Doctor. New symptom: "Stomachache."

Secondly, a lack of appetite accompanying the pains.

Gabe: Given your stomache's condition, I'm not surprised. RONI, note it.

RONI: New symptom: "Lack of Appetite."

Gabe: Now, is there anything else you're hiding? Now's your chance.

Joshua: I'm not hiding anything. I really am okay!

Gabe: Man, that little runt. Time to go back to the office and continue with the diagnosis.



Joshua's got some kind of stomach problem. It's our job to determine what it is.

Symptom List:
Lack of Appetite
Stomachache
Caved-In Gastric Wall
Hematemesis
Tachycardia
Tachypnea

Malignant Lung Tumor:
[snip]

That's just stupid.

Malignant Stomach Tumor:
A condition in which the balance of acids and protective mucus of the gastric wall is lost, causing acid to damage the gastric wall. Symptoms include an increased heart rate, hematemesis, rapid breathing, stomachaches, and lack of appetite. An X-ray exam will show a caved-in gastric wall, known as a niche. A tissue test of the lesion site will confirm the presence of malignant tumor cells.

This one is a little dumb, because we never did that test for tumor cells. Still, we just have to accept that this isn't quite it.

Gastric Ulcer:
[Exactly the same as the tumor, except the test shows no malignancy. Even the wording is the same]

THIS is what we want.



Gabe: That's odd. Joshua already had endoscopic surgery recently. There's gotta be a reason for the relapse. RONI, let's continue the diagnosis.



Gabe: There must be an underlying disease. I just hope there's no other complications.

RONI: That would be very beneficial, Doctor. Should we begin?

Gabe: Mm hm. Let's do it.



Gabe: Why do you keep trying to hide your symptoms from me?

Joshua: Th-there's nothing wrong with me. I really didn't notice it.

Gabe: Just stop it! There's no way you're alright! I don't know why you're pretending to be fine, and I don't care why! But the more you keep this up, the more you make everyone around you worry about you!

Joshua: ...But...

Gabe: There's no need to explain. If you don't want to talk about it, that's fine. I've gotten permission from Lisa--I mean, you're mother--already. RONI, get the examinations ready. If he's not going to talk, then I'll find out myself!

RONI: Understood. Doctor, please calm down.

Gabe: Oh, sorry.

The X-ray, CT, and analysis exams are now available! We got out of having to sift through numbers last time, but not anymore. The following values are off:

Serum Amylase: A digestive enzyme excreted when the pancreas breaks down sugars. High levels can indicate pancreatic disorders. Normal level 60 ~ 200. Patient level 370.0

Gabe: That seems unusually high. RONI, add it to the list.

RONI: New symptom: "High Serum Amylase Level."

Serum Lipase: An enzyme created by the pancreas to digest fats. High levels in the blood can indicate pancreatic disorders. Normal level 11 ~ 53. Patient level 124.0

Gabe: That's a bit higher than I'd like it to be. Record that.

A bit? It's more than double the upper limit.

RONI: New symptom: "High Serum Lipase Level."

Elastase: An enzyme that breaks down elastin, used in asterial walls and tendons. Large quantities can indicate pancreatic disorders. Normal level 70 ~ 430. Patient level 735.0

Gabe: His elastase level is elevated. Got that, RONI?

RONI: New symptom: "High Elastase Level"

Alright. Now, the fun part. We have X-ray and CT exams to look at. For starters, the X-ray.

X-RAY_01

Patient:



Sample:



The large, sinister-looking shadow in the upper-right is very easy to spot.

Gabe: There's an abnormal break in bowel gas. RONI, record that.

RONI: New symptom: "Abnormal Bowel Gas in Intestine."

Okay, now the CT. It's a bit harder!

CT_01

Patient:



Sample:



CT_02

Patient:



Sample:



CT_03

Patient:



Sample:



CT_04

Patient:



Sample:



CT_02

Patient:



Sample:





Well, to start with, there's a medal in image 4. Look at the top, and you can see Joshua's layer of fat is very thin.

Gabe: ...Is it possible his disease has been ongoing?

RONI: Doctor, I would like to remind you that it is still within the normal range.

Gabe: I know. I just want to cure him before he gets any thinner...

Moving on, our symptom is in image number 3. The pancreas, which takes up most of the middle of the image, is way huge in Joshua.

Gabe: This isn't normal. His pancreas is swollen. RONI, make a note of that.

RONI: New symptom: "Swollen Pancreas."

Gabe: We've got a lot more to go off of, now.

RONI: Doctor, we will need the patient's cooperation for any further examinations.

Gabe: Yeah, you're right. I should try talking to him again.



Gabe: I wasn't being professional. But you also--

RONI: Doctor?

Gabe: I know. Just be quiet! Anyways, I want to cure you completely. And... everyone is worried about you. Joshua, will you please cooperate with the exams?

Joshua: ...Sorry.

Gabe: Huh?



Gabe: Hey, it's alright. Don't cry!

Joshua: *sniff* But it's all my fault. I didn't want my mom... or that nurse... to worry about me. I'm really sorry. I just made everyone worry even more. I won't hide anything anymore. I wanna get out of this hospital! So, please!

Gabe: Yeah, I understand.

Joshua: Um, actually, my tummy feels a little weird. Can you check it out, Doctor?

Gabe: Of course. Leave it to me. Are you ready, RONI?

RONI: Yes, Doctor. I am fully prepared.

Gabe: Let's continue the exam!



Holy shit what the hell is this

Next time: What the hell that is. And also the conclusion.