"Mr. Yan, let me tell you what's really going on."
Yang Xuan walked to the bedside and reached out to smooth the messy hair of the woman on the bed.
"Mr. Yan, it's like this…"
"Three days ago, my younger sister, Yang Ting, suddenly started speaking nonsense. She'd cry one moment and laugh the next, saying all sorts of incoherent, jumbled things."
"She also drools…"
Yang Xuan pulled a few tissues from the box on the nightstand, wiped the drool from her sister's mouth, and continued, "Sometimes, she gets agitated and starts screaming and thrashing."
"We were afraid she would hurt herself, so we had no choice but to tie her up."
Yan Feifan asked coldly, "She's been like this for three days. Why have you kept her tied up at home instead of taking her to a hospital?"
Yang Xuan bit her lip, a look of shame on her face. "My parents and I were being selfish."
"Mr. Yan, my fiancé and I have set our wedding for May Day. If his family finds out my sister is like this…"
"They'll definitely worry that I might also…"
She paused, then said pleadingly, "Mr. Yan, I'm begging you, please take a look at my sister. Prescribe her something that will let her act normal, at least for a while."
"We're planning to take her to a psychiatric hospital out of province for treatment."
Hearing this, Yan Feifan was at a loss for words.
'So afraid of her wedding being called off that she'd imprison her own sick sister at home.'
'Some sister she is.'
He couldn't help but look back at the middle-aged couple.
The two of them averted their gaze, not daring to meet Yan Feifan's eyes.
Yan Feifan was secretly disappointed and shook his head.
'With parents like these, it's no wonder the sister turned out this way…'
He walked to the bedside and carefully observed Yang Ting. Her cheeks were flushed, her gaze was unfocused, and she was still muttering nonstop. "Have you given her any medication?" he asked.
Yang Xuan nodded and said timidly, "We gave her some sedatives, like Valium, but they didn't have any effect."
"Mr. Yan, that won't be a problem, will it?"
Yan Feifan couldn't help but snort coldly. Suppressing his disgust, he asked, "Is there a family history of mental illness?"
As soon as he asked, Yan Feifan noticed hesitation and uncertainty flicker across Yang Xuan's face.
He immediately raised his voice slightly. "Is there or isn't there?"
Yang Xuan gritted her teeth and nodded. "Yes. My paternal grandmother has schizophrenia. She's currently receiving treatment at a psychiatric hospital in the neighboring province."
'That explains it.'
The genetic probability of mental illness is quite high.
Studies show that the incidence rate of schizophrenia among relatives ranges from 4.3% to 16.4%, far higher than the 1% rate in the general population.
However, although Yang Ting's condition looked very much like a psychotic break, as a meticulous doctor, Yan Feifan had to perform a thorough examination before making his final judgment.
He reached out and touched Yang Ting's forehead.
Yan Feifan immediately noticed that her forehead was hot. Her temperature was likely between 38.5 and 39 degrees Celsius.
He looked at Yang Xuan, his expression serious. "Did your sister have a fever before this episode began?"
"Or did the fever only appear after?"
Seeing how gravely Yan Feifan asked the question, Yang Xuan didn't dare answer carelessly. She thought about it seriously and said, "Mr. Yan, I really don't know."
"When I got home that day, I just found my sister wasn't acting right."
Yang Xuan looked at her parents. "Do you two know?"
The Yang parents exchanged a glance.
Mr. Yang spoke up. "We really don't know. Tingting was very restless that night. If we took our eyes off her for a second, she'd kick off her blankets."
"Maybe she caught a cold that night."
Just then, Cai Yuanheng asked with concern, "Mr. Yan, is it really that important whether the fever came before or after the episode started?"
Yan Feifan nodded. "A fever is a warning sign from the body. It's a precursor to many illnesses."
"If her body had a fever before the episode began, then there's a certain possibility that her current symptoms aren't from a psychotic break, but are caused by something else."
"What other cause?" Yang Xuan pressed urgently.
Yan Feifan didn't want to engage with such a selfish person, so he answered perfunctorily, "There are several possibilities."
He opened his medical bag, took out a stethoscope, a penlight, and a pair of rubber gloves, which he put on.
"I'm going to perform a full physical examination on the patient."
"This process will involve touching the patient's body, including some very private areas."
Yan Feifan looked questioningly at Yang Ting's parents. "Are you…"
Mr. Yang understood and quickly replied, "Mr. Yan, you're a doctor. Please, examine her however you need to. We don't mind."
At Yan Feifan's request, Cai Yuanheng and Mr. Yang left the room, while Yang Xuan and her mother stayed.
Yan Feifan first used the stethoscope to listen to the patient's heartbeat, lung sounds, and bowel sounds. He found her heart rate was high, at one hundred and thirty beats per minute, but he didn't hear any murmurs. Her lung and bowel sounds were also normal.
Next, Yan Feifan began his examination with the patient's head and face.
He checked her head for any signs of trauma, insect bites, or parasites. He also checked her pupillary response to light, her mouth and tongue coating, and her ear canals for inflammation.
Finding no obvious abnormalities on her head or face, Yan Feifan had Yang Xuan remove the patient's pajamas.
After a visual inspection confirmed there were no bite marks from insects or snakes, nor any external injuries, he began the hands-on examination.
Yan Feifan felt the patient's neck, then moved down along her collarbones, pressing and palpating her arms and ribs.
Of course, he didn't skip examining her breasts either.
Moving past her navel, his hand pressed onto the patient's lower abdomen…
Yan Feifan had just palpated the lower-left quadrant of the patient's pelvic region and was about to move to another area when the sensation under his hand suddenly gave him an uncomfortable, incongruous feeling.
It was more of a psychological sensation, a sixth sense.
'Is there a problem here?'
Yan Feifan focused, holding his breath. He returned his palm to that spot, applied a bit more pressure, and once again used percussion, stroking, and pressing to more carefully feel the abdominal area that had struck him as odd.
Yang Xuan and her mother also noticed that Yan Feifan seemed to have found something, and they held their breath involuntarily…
After palpating it several more times, a rough projection of the internal abdomen gradually formed in Yan Feifan's mind.
He had finally found the source of the abnormal feeling.
Yan Feifan finished the rest of the examination, covered the patient with the blanket, and stood up to face Yang Xuan and her mother.
"There's a high probability that Yang Ting has a two-to-three-centimeter tumor on her left ovary."
"A tumor?"
"Cancer?"
Hearing the mother and daughter's response, Yan Feifan said flatly, "I can't be certain yet. You need to take Yang Ting to the hospital immediately for a confirmatory diagnosis."
"Also…"
Yan Feifan added, "If this tumor is confirmed, then Yang Ting's current symptoms are likely caused by it."
Yang Xuan asked in disbelief, "Mr. Yan, can a tumor cause symptoms similar to a psychotic break?"
Yan Feifan nodded and explained, "The condition is called autoimmune encephalitis."
"When the human body is infected by a virus or develops a tumor, the immune system produces antibodies to kill the invading virus or tumor."
"However, these antibodies sometimes can't distinguish between friend and foe."
"They can sometimes attack our own healthy central nervous system or brain tissue, causing neurological and psychiatric dysfunction."
"This is what leads to symptoms like Yang Ting's, which resemble a psychotic break."
Listening to Yan Feifan's logical explanation, Yang Xuan glanced at her sister, who was drooling profusely on the bed again, then looked back at him.
"Mr. Yan, what are the actual odds that my sister has this… this autoimmune encephalitis you mentioned?"
Before Yan Feifan could respond, Yang Xuan's emotions suddenly crumbled, and large tears streamed down her face.
"Mr. Yan, I've been having nightmares every single day, terrified that one day I'll end up just like my sister."
She wiped her eyes and continued, "Mr. Yan, I would rather have cancer than go crazy."
Yan Feifan sighed to himself. "I can't guarantee that your sister has autoimmune encephalitis."
"I can only say that there is a chance, and it's a relatively high one."
"Don't waste any more time. Take your sister to the hospital…"
Yan Feifan repeated his examination findings and diagnosis to Cai Yuanheng and Mr. Yang, who were outside the bedroom.
Following that, under his constant urging and subtle threats, combined with Cai Yuanheng's strong persuasion, the Yang family finally decided to take Yang Ting to the hospital right away.
Yan Feifan watched them get into their car before he started for home.
After all the commotion, it was nearly midnight by the time he got home.
Yan Ziruo was still awake, waiting for him in the living room.
"Feifan, was the patient's condition very serious?"
"It's a long story!"
Yan Feifan said with a sigh, then suddenly reached out and hugged Yan Ziruo.
"Sis, thank you for not giving up on me."
It was rare for her little brother to show his emotions so openly, and Yan Ziruo was a bit taken aback.
She instinctively raised her hand and gently patted Yan Feifan's back, then hugged him in return.
Yan Ziruo chuckled. "You're my own brother. I'd give up the whole world before I ever gave up on you…"