Chapter 165: A Breakthrough in Diagnosis

Dr. Chi initially paid little attention because Zhou Can was just a trainee.

He assumed that some doctor from the Critical Care Department had called Zhou Can over to review the patient’s treatment.

“When examining the patient, we discovered intestinal bleeding. Could you describe the details?”

“We performed a vascular angiography at the time. The bleeding was primarily localized in the colon, with multiple, diffuse hemorrhages,” Dr. Xia Ping explained the situation.

He was not only the attending doctor but also the primary physician who knew the patient best.

Diffuse bleeding is usually the most dangerous when it occurs intracranially.

It spreads like smoke, with bleeding emerging from multiple sites simultaneously – a common occurrence in chronic cases. This type of bleeding is often associated with superficial capillary disorders or dilation, or, most commonly, sepsis.

“What about the other intestinal segments? Any signs of bleeding?”

Zhou Can pressed on with his inquiries.

That phone call yielded a wealth of information.

At the very least, he got a preliminary rundown of the details he needed.

“There was almost no bleeding in the cecum. The rectum showed slight blood traces, and no bleeding was observed in the anorectal region. Later, after persistent pleading from the family, I took the risk to perform a colonoscopy. Its findings concurred with those from the angiography – the bleeding was mainly concentrated in the colon, with a small amount in the rectal segment. We tried thrombin and cryotherapy, but neither treatment was effective.”

“By comparing observations, I also noticed that the bleeding points seen during endoscopy did not coincide with those during angiography. I’m convinced that the patient’s bleeding sites are constantly shifting.”

Dr. Xia Ping detailed all of his findings.

After hearing him out, Zhou Can became even more convinced that the problem lay within the small intestine.

The detailed information obtained from Dr. Xia Ping was extremely valuable.

“Do you think the bleeding could be due to malignant tumor infiltration of the intestinal wall?”

Zhou Can was making his final exclusions.

If he could rule out malignancy, he would further narrow down the diagnostic scope.

“The chance of malignancy is extremely low. At the very least, colon or rectal cancer can be essentially ruled out,” Dr. Xia Ping said, maintaining a cautious tone.

Dr. Xia Ping spoke in a notably conservative manner.

This was the practiced rhetoric of an experienced doctor, honed under constant pressure.

Only a doctor with exceptional capability and full confidence in his specialty would speak so definitively.

Otherwise, a cautious, back-and-forth approach was the norm.

“Dr. Zhou, may I ask who your superior is? Did they instruct you to inquire about the patient’s condition?” Dr. Xia Ping, sensing something amiss, began turning the questions back on Zhou Can.

“My superior is Dr. Hu Yi Ba from the Critical Care Department. He isn’t aware of this; I took it upon myself to learn more about the patient, and that’s why I reached out to you.”

Zhou Can was careful not to say anything indiscreet.

After all, the doctors in the hospital knew each other well, and any inquiry would quickly reveal the truth.

He dared not bear the burden of dishonesty.

“Is that so? Well, I’m rather busy here. If there’s nothing else, let’s end our conversation,” Dr. Xia Ping said shortly as he sensed that the inquiry had been initiated by Zhou Can’s own volition, his tone instantly turning cold.

Senior doctors often have to deal with novices like Zhou Can, who ask endless questions like a curious child.

They may exercise some patience with trainees under their own guidance, but for others they tend to be curt.

“Could you also elaborate on the specific treatments administered to the patient?”

Zhou Can sought further details,

specifically about the treatments used by the attending physician and the subsequent patient responses.

Such data were invaluable in helping him better diagnose the patient’s condition.

Why are some difficult cases so hard to diagnose?

It’s because once all the common causes have been ruled out, the treating physician must venture into uncharted territory like a youngster testing the waters on a narrow stream.

“You can review the treatments directly in the medical records. I have something to attend to – goodbye.”

Before Zhou Can could say another word, the call ended abruptly with a busy tone.

Dr. Xia Ping was as pragmatic as ever.

Zhou Can was left speechless.

At least he had gathered several key pieces of information from this call.

“It’s good for a novice to be inquisitive, but you must learn moderation. Our attending physicians are often very busy, and few are willing to spend their spare time addressing trivial questions,” Dr. Chi warned Zhou Can.

His words were more of a caution than a rebuke.

Simply put, he was telling Zhou Can not to recklessly disturb senior doctors, as such behavior was highly frowned upon.

Zhou Can didn’t argue; he merely thanked him and left promptly.

Now, he was fairly certain that the patient’s lesion was in the small intestine.

As he progressively ruled out each possibility, a sudden idea flashed through his mind.

Could it be parasites? And perhaps this parasite lurks in the small intestine rather than the colon?

[Pathology Diagnosis Experience +1]

The experience points were credited, confirming that his deduction was correct.

To reach a final diagnosis, further tests on the patient were necessary.

Zhou Can felt a surge of excitement.

Hard work was finally paying off—this patient’s diagnosis had advanced a significant step.

At this moment, the cause of the bleeding was nearly clear.

The patient’s small intestine was under the influence of a parasitic invasion.

As for the exact mechanism, further analysis was needed.

Routine stool tests had been conducted, and if a parasite were present, eggs would typically be detected.

However, since neither parasites nor their eggs were found in the stool sample, it suggested that the parasite was likely hidden in the small intestine, simultaneously absorbing the patient’s nutrients and releasing substances that caused bleeding in the colon.

It could be a larva or possibly a hormone-like harmful substance that irritates the colon.

Considering that the patient experienced diffuse bleeding specifically in the colon,

Zhou Can leaned toward the idea that the parasite was lurking in the small intestine, absorbing essential nutrients from the intestinal fluids and then excreting an irritant that caused bleeding in the colon.

Once the small intestinal fluid entered the colon, the cecum, being quite short and functionally similar to the small intestine, only allowed the fluid to reside briefly.

In contrast, the colon spans approximately 1.1 meters. As food passes from the stomach through the small intestine to the colon, it secretes alkaline substances to protect the mucosa and lubricate the passage while absorbing water, sodium, and other electrolytes.

With continued peristalsis, the remnants gradually form stool, which is eventually excreted through the rectum and anus.

Thus, the intestinal fluid from the small intestine spends the longest time in the colon segment.

During this process, the harmful substances that cause intestinal bleeding are absorbed by the colon wall, leading to capillary dilation and diffuse bleeding.

By this point, the diagnostic reasoning was clear and decisive.

These irritants cause a condition resembling colonic capillary ectasia.

Possibly due to the relatively mild nature of the irritation, only slight chronic bleeding occurs.

[Congratulations on successfully diagnosing an extremely challenging case – Pathology Diagnosis Experience +100]

At last, the truth was laid bare.

Zhou Can clenched his fist and raised his arm in triumph.

His heart filled with exhilaration.

Not only did he receive 100 points in pathology diagnosis experience, but he also had the chance to save a life.

This accomplishment was incredibly meaningful.

Since the diagnosis pointed to a parasitic infection in the small intestine, administering an anti-parasitic should swiftly halt the bleeding in the patient on Bed 7.

Even though the cause had been identified, convincing his superior remained a challenge.

Senior doctors are extremely cautious with medication—especially when the patient is already extremely weak. No one wants to shoulder the responsibility if complications arise.

He decided to call his superior, Dr. Hu Yi Ba.

Being new to the Critical Care Department, Zhou Can only had a limited acquaintance with Dr. Hu.

He fished out his phone, grateful that he had saved Dr. Hu’s number after work.

He dialed the number directly.

After just a couple of rings, the call was answered.

“Who is this?”

It seemed Dr. Hu hadn’t saved his number.

That in itself revealed how little respect some doctors had for so-called ‘connections’.

Zhou Can felt that he was far superior to those background-dependent individuals.

After all, he had earned his position through the mentorship of Deputy Director Ye.

However, in Dr. Hu’s eyes, his status was still very low.

“Hello, Dr. Hu. I’m Zhou Can, the trainee just assigned to your team today,” he introduced himself humbly.

Dr. Hu’s tone remained gentle: “Oh, you must be Xiao Zhou. What’s the matter?”

“After much deliberation and consultation with my superior, I believe I’ve found the cause of the bleeding in the patient on Bed 7,” Zhou Can explained.

Aware of his limited experience, he refrained from exaggerating his connection with higher-ups to impress Dr. Hu.

“So fast? Explain it to me,” Dr. Hu replied, clearly not taking him very seriously.

It almost seemed as if Zhou Can was being overly eager to make a name for himself right on his first day in the Critical Care Department.

The patient on Bed 7 had been consulted on by several physicians from the Gastroenterology Department, including those at the chief level. After admission to the ICU, Dr. Hu, Dr. Shi, and even the head physician of our department had all reviewed the patient’s condition.

Not one of them had discovered the cause of the bleeding.

And yet, on his very first day in the Critical Care Department, Zhou Can claimed to have found it.

Dr. Hu looked at him with a mix of exasperation and immaturity – clearly, he thought Zhou Can’s reasoning was too superficial.

Of course, he didn’t spell it out directly.

“I gathered the relevant information from the attending physician, Dr. Xia Ping. The patient exhibited diffuse, extensive unexplained bleeding in the colon, with the bleeding sites shifting each time. We can rule out the common causes of gastrointestinal bleeding. Through our investigation, we believe that the true lesion may lie in the small intestine and could be due to parasites releasing excretions that lead to capillary ectasia in the colon…”

Zhou Can could tell that Dr. Hu was not taking his diagnosis seriously.

He continued to explain his reasoning, even mentioning that he had consulted with Dr. Xia Ping.

“I’ll consider your diagnostic suggestions. It’s already after hours—if you have any further questions, we can discuss them tomorrow,” Dr. Hu said, clearly offering a dismissive platitude.

“Given the patient’s critical condition, an early diagnosis with proper treatment would be significant. Do you think this matter can be addressed today?”

Zhou Can, swallowing his anxiety, pressed on.

Judging by Dr. Hu’s tone, it was clear he wasn’t taking the matter seriously.

After finally identifying the cause, it was disheartening that his superior wouldn’t trust him, leaving the follow-up treatment in limbo.

Zhou Can was deeply frustrated.

His experience points had been credited – his diagnosis was undoubtedly correct.

Yet, he found himself stuck at the gate of senior approval.

“Xiao Zhou, as a newcomer, you must avoid being overly hasty. Every patient in the ICU is critically ill. Based on your assessment, you might need to use anti-parasitic drugs. However, all anti-parasitics have side effects. A healthy person might tolerate them without notable symptoms, but even minor adverse effects could be magnified in a critically ill patient,” Dr. Hu cautioned gently.

“Saying that parasites might be lurking in the small intestine is just a hypothesis. It needs to be scientifically validated. Prescribing anti-parasitics solely on conjecture is irresponsible, and no doctor can shoulder the potential consequences.”

Dr. Hu’s words, though logical, were also steeped in a rigid adherence to procedure, which could delay lifesaving treatment.

“That said, your spirit of inquiry and determination is commendable. We can revisit the Bed 7 case tomorrow. For now, all the routine departments have closed. Get some rest,” he concluded before hanging up.

Zhou Can stood there, stunned.

His elation and excitement had been doused like a bucket of cold water.

Taking a couple of deep breaths to steady himself, he resolved to press on without turning back.

He decided to head straight to the duty room in the Critical Care Department to find the reticent Dr. Shi.

It took a lot of courage, as he knew it might end in failure and humiliation.

After all, reputation mattered.

No doctor wanted to be seen as wasting effort for little reward.

Zhou Can had always been somewhat ‘naive’ when it came to treating patients.

He made his way to the main door of the Critical Care Department and rang the doorbell.

The door was quickly opened by a nurse, someone he recognized.

Although nurses in the ICU work 12-hour shifts, they often exceed 13 hours.

Even though Zhou Can was off duty, the nurse hadn’t handed over her shift.

“Dr. Zhou, aren’t you off duty? Did you forget something?” the nurse asked with a smile.

“I need to speak with Dr. Shi about the situation with the patient on Bed 7,” he replied.

“Dr. Shi is in the duty room. Change into your protective gown and go see him,” she instructed.

“Thank you,” Zhou Can replied.

After donning his isolation gown, he entered the duty room.

A few doctors and nurses were already there, discussing the patient’s treatment and condition. Dr. Shi appeared to be writing orders for a patient, his face creased in concentration as he worked on the computer.

Zhou Can’s entrance barely drew any attention.

“Dr. Shi, may I disturb you for a moment?” he asked, approaching him.

Dr. Shi glanced up, recognizing him immediately.

“Aren’t you the trainee under Dr. Hu? What do you need from me?”

His tone was cold and devoid of any warmth.

Gritting his teeth, Zhou Can nervously explained the situation regarding the patient on Bed 7.

Dr. Shi listened silently, his expression unreadable.

A trainee sitting next to him sneered subtly, as if thinking Zhou Can was merely stirring up trouble.

After hearing Zhou Can out, Dr. Shi’s expression remained unchanged – his eyes still icy and his demeanor grave.

Zhou Can stood anxiously by, uncertain whether to stay or leave; lingering felt even more awkward.

It was as if Dr. Shi regarded him as invisible.

After a long seven to eight minutes, Dr. Shi finally finished entering the orders.

The wait felt like pure torment for Zhou Can, as other doctors and nurses occasionally cast disapproving glances his way.

He felt like a clown on display for everyone’s amusement.

“Are these diagnoses all your own ideas?” Dr. Shi suddenly addressed him, having not forgotten his earlier inquiry.

“Yes,” Zhou Can admitted, unable to hide the truth as Dr. Shi’s piercing gaze seemed to see right through him.

Any hint of dishonesty would only complicate matters further.

Swallowing his pride, he confessed.

“I could tell it was your own deduction. Why did you feel the need to involve non-existent superiors? Experienced doctors typically base their diagnostic process on data or clinical signs at every step. Your reasoning resembles the erratic doodles of a child.”

Dr. Shi’s cold, scrutinizing look sent a chill down Zhou Can’s spine.

A bead of sweat trickled down his back.

“But it’s precisely this unconventional, rule-breaking approach that gives me a glimmer of hope,” Dr. Shi continued. “I urgently need to attend to a patient. I’ll be done in about half an hour to an hour. If you’re willing, wait here and we’ll have a proper discussion about the patient on Bed 7 then.”

Dr. Shi concluded.