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0denseOh, one thing I got polished up for public consumption! Actually, this was an assignment -- we had a few options to demonstrate our understanding of materials alongside the formal exam, and obviously I took the creative writing route. That being said, I only had 1250 words max to demonstrate a minimum of 30 technical elements, and you would be surprised how quickly that wordcount sneaks up on you! So pacing was a necessary casualty. Also, this one is NOT properly representative of absolutely any known legal system lmao, I took the general idea of "NiF, but it's also modern' that a buddy made strides in elsewhere and ran off with it, careening off the walls on my way! But I love love love the ministers and their cultivation-work <3 so here they are fighting the good fight for clarity in some ambiguous post-canon contemporary-ish setting
Ministers Shen Zhui and Cai Quan for the Defense
Word count: 1239
Caveat lector for: clinical description of offscreen character death by stroke, with complications.
Cai Quan flipped through the deposition transcript and cleared his throat before reciting, “I know I can’t ask more questions here, but I do wish I could pick the brain of whatever doctor this was. This patient would’ve been dead years ago otherwise. Why are you investigating this? Give him a medal instead.”
Shen Zhui paused, and then gave him a highlighter. “That needs to be in our closer.”
“That’s what I thought, too.”
“Alright.” Zhui closed his notepad. “Tell me like I don’t know what we’ve been doing for all these weeks.”
“From the top?”
Zhui nodded, and Quan took a deep breath before reciting.
“On December second, while dispatched to Great Yu alongside Commander Meng Zhi, Mei Changsu, known professionally as Su Zhe, died of a cerebrovascular accident. He was found in distress due to the CVA by his attending physician, Lin Chen, who attempted intervention and sent aide-de-camp Fei Liu for assistance. Commander Meng arrived shortly with Dr Lu Chenxi, who announced Mr Su dead after only a little longer.
“Our question is if Dr Lin’s actions at this time, and his preceding treatments, were appropriate.”
Zhui held up a folder decorated with the army’s stamps and release stickers, and Quan took the prompt.
“Dr Lu’s first guess, due to Mr Su’s prior condition - namely, infirm - was that it was probably a thrombotic incident, and was initially concerned that Dr Lin hadn’t attempted any anticoagulant therapy. But on autopsy, she found that he had instead suffered a burst aneurysm along the basal ganglia, and agreed that tPA, would not have been appropriate for the hemorrhage. So that’s an intracerebral hemorrhage. She also called his final ICP 'incompatible with life’ at 36 mm-hG. The report goes on to hypothesize that Mr Su’s chronic liver problems were the likely cause of the stroke. But, that leaves us with the question of the liver problems, and Mr Su’s general care leading up to the stroke.”
“Right,” Zhui agreed, stopping him there. “And so we’ve had months now of finding specialists for all of Mr Su’s problems, and asking them to check Dr Lin’s work. But apart from the liver problems and that quote we’re keeping for closing statements, what else did this last neurologist say?”
“Well, I’m definitely going to be using Dr Zhuang Shu in the opening statements too, because he explained it all in one place, finally. When Dr Lu said she thought Mr Su might’ve been experiencing the thrombotic kind of stroke, it was because those usually have a longer onset, and he might’ve been displaying the kind of lack of coordination that comes with a blood vessel slowly closing up in the wrong place. But he wasn’t slurring his speech or drooping on one side in particular earlier in the day, and he was also known to have poor balance, according to both Fei Liu and Commander Meng.
“Speaking of Fei Liu, this isn’t medical testimony, but he did also mention the other kind of stroke that Mr Su didn’t have: in an embolic stroke, a blood clot floats in and blocks a cerebral vein or artery, Dr Zhuang said. This kind of stroke is usually the fastest, so it wasn’t a bad guess on Fei Liu’s part.”
“He’d been Mei Changsu’s assistant for eight years,” Zhui shrugged. “He had to have picked some things up.”
“That’s very fair,” Quan agreed, moving the stamped folder to a clear patch of table and pulling out a report with a clear plastic sleeve. “Dr Zhuang was saying. Hemorrhagic stroke. Usually, patients are older men, or have atherosclerosis causing coronary artery disease, or another reason for hypertension leading to the vessel breaking. Mr Su, on the other hand, was only in his 30s, had extremely low cholesterol, and chronic low blood pressure as well.”
“Due to his many other problems.”
“Due to his many other problems, yes. And due to the liver issue too, because if we usually think of liver disease as causing higher cholesterol, in this case it meant his blood wasn’t forming enough coagulating factors.” He flipped through the report again, finding a small neon flag stuck to the middle of a paragraph and read, “‘Thrombocytopenia occurs when the body does not have enough platelets to prevent excessive bleeding. While a normal healthy adult has between 150,000 to 450,000 platelets per microliter of blood, this patient had approximately 50,000 platelets per microliter.’” He looked up from the report. “To confirm, that’s a third of the low side of the margin.”
Zhui grimaced, and Quan nodded grimly, turning the page, but Zhui put a hand on the table. “I thought blood was made in bone marrow. What does the liver have to do with it, then?”
“Oh, I asked that same question. Apparently the liver makes a hormone that actually tells the body to make blood in the marrow. So, liver damage from years of problems, less, uh, thrombopoietin, less clotting factors. Less clotting, more bleeding, a weak vessel in the wrong place, and a stroke.”
Zhui nodded. “Next obvious question, then. Why couldn’t they see this coming, if it all makes this much sense in retrospect?”
“Well, to be fair to Dr Lin and the rest of them, they were looking.” Quan cast about and found the binders from Dr Two - Dr Yan, Quan was sure, who had looked after Mr Su when Dr Lin wasn’t available, but it was the principle of anonymity, at least. “We have a chart of coagulation tests over time, and also all sorts of blood results in a table. But a real diagnostic test for bleeding in the brain needs a CT or MRI scan, and they couldn’t give him those monthly like a blood test.”
“And even if they had seen something,” Zhui agreed, “there are only so many things that can be done about it.”
“There are. There’s an operation to remove fatty plaques that could be making a blockage, but he didn’t have that in the first place. Carotid endarterectomy,” he found it in Dr Zhuang’s report. “Or cholesterol reduction, or keeping blood pressure down and blood vessels flexible enough, but you can’t get a vaccine for it, or anything like that.”
Zhui smiled wanly. “Wouldn’t it be nice if there was?”
“Wouldn’t it just. Even if it could cross the BBB. No, a lot of the specific treatments turn out to come after the stroke, depending on how much damage the brain has taken, even by a short TIA. The goal is regaining function, not some cure that can undo everything that’s happened. That’s where fall prevention rehab and nerve damage treatment come in. It’s a real disappointment for someone to survive the stroke, and then have another TBI from a fall two weeks later.”
“It is,” Zhui agreed, “but unfortunately Mr Su won’t have to worry about that.”
Quan sighed. “No. He did briefly have some paresthesia, and then the migraine and paresis and ataxia that Dr Lin flagged.”
“But no meningitis, no tumors causing extra edema. No other causes of the bleed.”
“No, Dr Lu took his CSF and biopsies. No MS, either, though he did generally swing between levels of ability and inability.”
“And Dr Zhuang agrees with all of this?”
“Everything we have so far,” Quan closed the folder and pushed it down the table. “So I really hope the emperor doesn’t mind not having someone to blame.”
extra: works originally cited, for funsies:
(and actually I do have context, I just didn't have space to fit it in: considering that the new emperor's advisor of mysterious provenance has died abruptly, under the primary care of 1) a doctor who is not a citizen but does represent a well-regarded neighboring entity, and 2) a physician who happens to be the emperor's own mother, it would actually behoove Jingyan to be able to independently state that there was nothing untoward going on. This is a formality, but it's not unreasonable for SZ and CQ to have some anxieties about how their report will be received, considering the previous administrations) (also, yes the other doctor's names are eastereggs for Jin Dong's other projects :D)
Ministers Shen Zhui and Cai Quan for the Defense
Word count: 1239
Caveat lector for: clinical description of offscreen character death by stroke, with complications.
Cai Quan flipped through the deposition transcript and cleared his throat before reciting, “I know I can’t ask more questions here, but I do wish I could pick the brain of whatever doctor this was. This patient would’ve been dead years ago otherwise. Why are you investigating this? Give him a medal instead.”
Shen Zhui paused, and then gave him a highlighter. “That needs to be in our closer.”
“That’s what I thought, too.”
“Alright.” Zhui closed his notepad. “Tell me like I don’t know what we’ve been doing for all these weeks.”
“From the top?”
Zhui nodded, and Quan took a deep breath before reciting.
“On December second, while dispatched to Great Yu alongside Commander Meng Zhi, Mei Changsu, known professionally as Su Zhe, died of a cerebrovascular accident. He was found in distress due to the CVA by his attending physician, Lin Chen, who attempted intervention and sent aide-de-camp Fei Liu for assistance. Commander Meng arrived shortly with Dr Lu Chenxi, who announced Mr Su dead after only a little longer.
“Our question is if Dr Lin’s actions at this time, and his preceding treatments, were appropriate.”
Zhui held up a folder decorated with the army’s stamps and release stickers, and Quan took the prompt.
“Dr Lu’s first guess, due to Mr Su’s prior condition - namely, infirm - was that it was probably a thrombotic incident, and was initially concerned that Dr Lin hadn’t attempted any anticoagulant therapy. But on autopsy, she found that he had instead suffered a burst aneurysm along the basal ganglia, and agreed that tPA, would not have been appropriate for the hemorrhage. So that’s an intracerebral hemorrhage. She also called his final ICP 'incompatible with life’ at 36 mm-hG. The report goes on to hypothesize that Mr Su’s chronic liver problems were the likely cause of the stroke. But, that leaves us with the question of the liver problems, and Mr Su’s general care leading up to the stroke.”
“Right,” Zhui agreed, stopping him there. “And so we’ve had months now of finding specialists for all of Mr Su’s problems, and asking them to check Dr Lin’s work. But apart from the liver problems and that quote we’re keeping for closing statements, what else did this last neurologist say?”
“Well, I’m definitely going to be using Dr Zhuang Shu in the opening statements too, because he explained it all in one place, finally. When Dr Lu said she thought Mr Su might’ve been experiencing the thrombotic kind of stroke, it was because those usually have a longer onset, and he might’ve been displaying the kind of lack of coordination that comes with a blood vessel slowly closing up in the wrong place. But he wasn’t slurring his speech or drooping on one side in particular earlier in the day, and he was also known to have poor balance, according to both Fei Liu and Commander Meng.
“Speaking of Fei Liu, this isn’t medical testimony, but he did also mention the other kind of stroke that Mr Su didn’t have: in an embolic stroke, a blood clot floats in and blocks a cerebral vein or artery, Dr Zhuang said. This kind of stroke is usually the fastest, so it wasn’t a bad guess on Fei Liu’s part.”
“He’d been Mei Changsu’s assistant for eight years,” Zhui shrugged. “He had to have picked some things up.”
“That’s very fair,” Quan agreed, moving the stamped folder to a clear patch of table and pulling out a report with a clear plastic sleeve. “Dr Zhuang was saying. Hemorrhagic stroke. Usually, patients are older men, or have atherosclerosis causing coronary artery disease, or another reason for hypertension leading to the vessel breaking. Mr Su, on the other hand, was only in his 30s, had extremely low cholesterol, and chronic low blood pressure as well.”
“Due to his many other problems.”
“Due to his many other problems, yes. And due to the liver issue too, because if we usually think of liver disease as causing higher cholesterol, in this case it meant his blood wasn’t forming enough coagulating factors.” He flipped through the report again, finding a small neon flag stuck to the middle of a paragraph and read, “‘Thrombocytopenia occurs when the body does not have enough platelets to prevent excessive bleeding. While a normal healthy adult has between 150,000 to 450,000 platelets per microliter of blood, this patient had approximately 50,000 platelets per microliter.’” He looked up from the report. “To confirm, that’s a third of the low side of the margin.”
Zhui grimaced, and Quan nodded grimly, turning the page, but Zhui put a hand on the table. “I thought blood was made in bone marrow. What does the liver have to do with it, then?”
“Oh, I asked that same question. Apparently the liver makes a hormone that actually tells the body to make blood in the marrow. So, liver damage from years of problems, less, uh, thrombopoietin, less clotting factors. Less clotting, more bleeding, a weak vessel in the wrong place, and a stroke.”
Zhui nodded. “Next obvious question, then. Why couldn’t they see this coming, if it all makes this much sense in retrospect?”
“Well, to be fair to Dr Lin and the rest of them, they were looking.” Quan cast about and found the binders from Dr Two - Dr Yan, Quan was sure, who had looked after Mr Su when Dr Lin wasn’t available, but it was the principle of anonymity, at least. “We have a chart of coagulation tests over time, and also all sorts of blood results in a table. But a real diagnostic test for bleeding in the brain needs a CT or MRI scan, and they couldn’t give him those monthly like a blood test.”
“And even if they had seen something,” Zhui agreed, “there are only so many things that can be done about it.”
“There are. There’s an operation to remove fatty plaques that could be making a blockage, but he didn’t have that in the first place. Carotid endarterectomy,” he found it in Dr Zhuang’s report. “Or cholesterol reduction, or keeping blood pressure down and blood vessels flexible enough, but you can’t get a vaccine for it, or anything like that.”
Zhui smiled wanly. “Wouldn’t it be nice if there was?”
“Wouldn’t it just. Even if it could cross the BBB. No, a lot of the specific treatments turn out to come after the stroke, depending on how much damage the brain has taken, even by a short TIA. The goal is regaining function, not some cure that can undo everything that’s happened. That’s where fall prevention rehab and nerve damage treatment come in. It’s a real disappointment for someone to survive the stroke, and then have another TBI from a fall two weeks later.”
“It is,” Zhui agreed, “but unfortunately Mr Su won’t have to worry about that.”
Quan sighed. “No. He did briefly have some paresthesia, and then the migraine and paresis and ataxia that Dr Lin flagged.”
“But no meningitis, no tumors causing extra edema. No other causes of the bleed.”
“No, Dr Lu took his CSF and biopsies. No MS, either, though he did generally swing between levels of ability and inability.”
“And Dr Zhuang agrees with all of this?”
“Everything we have so far,” Quan closed the folder and pushed it down the table. “So I really hope the emperor doesn’t mind not having someone to blame.”
extra: works originally cited, for funsies:
- "Most common site of bleeding in the brain at 50% of hemorrhagic strokes" Chen S, Zeng L, Hu Z. Progressing haemorrhagic stroke: categories, causes, mechanisms and managements. J Neurol. 2014 Nov;261(11):2061-78
- Schwab S, Aschoff A, Spranger M, Albert F, Hacke W. The value of intracranial pressure monitoring in acute hemispheric stroke. Neurology. 1996 Aug;47(2):393-8. doi: 10.1212/wnl.47.2.393. PMID: 8757010.
- Unnithan AKA, M Das J, Mehta P. Hemorrhagic Stroke. [Updated 2022 Sep 30]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559173/
- Peck-Radosavljevic M. Thrombocytopenia in liver disease. Can J Gastroenterol. 2000 Nov; 14 Suppl D:60D-66D. doi: 10.1155/2000/617428. PMID: 11110614
(and actually I do have context, I just didn't have space to fit it in: considering that the new emperor's advisor of mysterious provenance has died abruptly, under the primary care of 1) a doctor who is not a citizen but does represent a well-regarded neighboring entity, and 2) a physician who happens to be the emperor's own mother, it would actually behoove Jingyan to be able to independently state that there was nothing untoward going on. This is a formality, but it's not unreasonable for SZ and CQ to have some anxieties about how their report will be received, considering the previous administrations) (also, yes the other doctor's names are eastereggs for Jin Dong's other projects :D)
