Chapter 190: Hidden Ailments: A Critical Diagnosis

The ancient art of diagnosing hidden diseases through keen observation and intuition was widely practiced in olden times—every skilled traditional doctor seemed to master it.

It was known as the art of visual diagnosis.

In traditional Chinese medicine, the four basic diagnostic methods are observation, listening and smelling, inquiry, and palpation.

Observation takes precedence among these.

It is regarded as the most essential of the four diagnostic techniques.

By scrutinizing a patient’s complexion, skin, nails, tongue coating, body shape, and more, a doctor can form an immediate diagnostic impression, narrowing down the potential illnesses and guiding further targeted examinations and pathological assessments.

Zhou Can’s achievements during his three-month rotation in the Critical Care Department exceeded all expectations.

Initially, he hadn’t thought much of it, but after training in other departments he realized how invaluable those three months in Critical Care were to his medical practice.

Whether rescuing critically ill patients, making pathological diagnoses, or handling unexpected situations during surgery, it gave him an extra edge over others.

Deputy Director Ye personally extended his training in Critical Care by two additional months—a move that spoke volumes about his commitment.

For example, during a recent ward round, although even Dr. Jia had missed it, Zhou Can detected cancer in the patient on Bed 3.

Of course, this was only a preliminary diagnosis on his part.

In other words, merely a hypothesis.

Further verification was needed to confirm if the patient truly had cancer.

Zhou Can couldn’t possibly inform Dr. Jia that the patient might have cancer without any tangible evidence, could he?

After all, it was their first interaction of the day, and Dr. Jia’s trust in him was still limited.

To have his diagnostic suggestions accepted by Dr. Jia, he needed to provide solid evidence that pinpointed the affected area.

Based on his experience, diagnosing such a subtle and challenging illness would likely earn him an extra 100 points in pathology diagnostic experience.

“Dr. Zhou, I bet your girlfriend is absolutely gorgeous and irresistibly charming!” Qiu Hong suddenly said with a smile that left one baffled.

“Why would you say that?”

Zhou Can asked, clearly puzzled.

If Su Qianqian weren’t deemed beautiful, then hardly any woman would ever deserve that label.

“Judging by how distracted you look, I’m guessing you’ve been thinking about your girlfriend, right?”

Qiu Hong teased in a playful tone.

There was no malice in her words—only genuine kindness.

Earlier, when Zhou Can had responded to Dr. Jia, his tone had been somewhat offhand, and Dr. Jia’s expression revealed his displeasure.

Having worked with Dr. Jia for five years, Qiu Hong was well aware of his temperament.

She was essentially trying to help explain Zhou Can’s behavior.

And also to remind him not to get distracted.

“Haha, Senior Qiu, you do have a way with words. I wasn’t daydreaming about my girlfriend—I was analyzing the case of the patient in Bed 3. I suspect that the duodenal ulcer is far from a simple case.”

Zhou Can, no fool, instantly understood what was at stake.

Glancing quickly at Dr. Jia’s cold expression, he hurried to explain the reason behind his apparent lapse.

“That patient’s duodenal ulcer is indeed extremely severe, with a history nearing twenty years—it’s anything but straightforward!”

Qiu Hong replied.

“No, no—I mean the patient might have another underlying condition!”

Zhou Can felt compelled to voice his concerns early.

He couldn’t allow Dr. Jia to think he was a slacker or inattentive.

A seemingly trivial matter

could, however, greatly tarnish his reputation in Dr. Jia’s eyes.

One might never fully understand a person, but a single incident can drastically diminish one’s standing.

“Another condition? Dr. Jia has already diagnosed liver cirrhosis and chronic superficial gastritis!”

She asked, perplexed.

Since she had only just met Zhou Can, Qiu Hong wasn’t sure if he was merely making an excuse to justify his earlier distraction to Dr. Jia or if he truly had diagnosed an additional illness.

She leaned toward believing it was just an excuse.

Convinced that Zhou Can was simply trying to cover his tracks to avoid a poor impression.

With that thought, her opinion of him instantly plummeted.

People who try to be overly clever hardly ever win lasting favor.

“I’m referring to another condition—like cancer!”

Zhou Can was relentless in his assertion.

Dr. Jia even turned his gaze back to him in response.

Qiu Hong pursed her lips, a flash of disdain briefly crossing her pretty face. She hadn’t expected Dr. Jia’s new trainee to be so flamboyant—making excuses might be forgivable, but now he was boldly claiming the patient had cancer just to grab attention.

Luckily, the patient’s family wasn’t present; otherwise, a confrontation might have erupted.

“Dr. Jia, may I have a 20-minute break? I need to review the patient’s test reports. If it turns out the patient truly has cancer, we might need to reassess the surgical plan, given their advanced age and high surgical risk. I noticed the surgery was scheduled for 1 PM; if we wait until noon to recheck, it might be too late.”

Zhou Can explained his reasoning in detail.

His tone was earnest, his expression sincere.

Qiu Hong nearly stifled a laugh, thinking that if the new Dr. Zhou wasn’t putting on a performance, it would be a real pity.

Her favorable impression of him was now completely lost.

“Go ahead,”

Dr. Jia agreed readily.

Zhou Can wasted no time and rushed back to the Inpatient Department to check the test reports for the patient in Bed 3.

“This patient has nearly fifty years of smoking history. Their father died of typhoid 20 years ago, and the mother passed away 10 years ago due to an abdominal mass that was never properly diagnosed because no pathological exam was performed.”

In other words, it’s very likely that the patient’s mother also succumbed to cancer.

The patient had undergone standard tests such as an X-ray barium meal, endoscopy, and blood and stool analyses.

Additionally, an ultrasound of the liver was performed.

“At the sixth intercostal space on the superior liver border, the right lobe measures 13.5 cm diagonally; beneath the midclavicular line at the costal margin, there is a 2 cm thick and 1.5 cm long area; the left lobe measures 7 cm in thickness and 8 cm in length; under the xiphoid process, there is a 4 cm thick by 3 cm long region; intrahepatic hyperechoic spots are enlarged, with enhanced echo distribution appearing relatively uniform, although vascular clarity is diminished…”

The ultrasound primarily evaluates the liver.

At present, liver cancer cannot be ruled out.

After all, the liver has no pain receptors and is known as the most silent organ.

Many liver cancer patients are only diagnosed once the disease has reached an advanced stage.

Before that point, there are hardly any noticeable symptoms.

Zhou Can squinted, carefully examining the ultrasound image.

There’s no denying that Western medicine relies on comprehensive test results for diagnosis.

In this regard, traditional Chinese medicine deserves high praise.

An experienced traditional doctor can quickly assess a patient’s condition by pressing a specific point on the wrist—a method not unlike a full-body check-up in Western medicine.

These days, why are ordinary people so reluctant to enter hospitals? Once inside, whether you’re sick or not, you’re subjected to a battery of routine tests first.

And if you’re admitted, the number of tests increases further.

Before you know it, hundreds or even thousands of yuan have been spent.

After waiting in line all day, it’s considered fortunate if you receive your test results before the doctor’s shift ends.

While traditional Chinese medicine did charge consultation fees, they were often very affordable.

Many traditional doctors—renowned for their noble ethics—would even pay out of pocket for patients in dire straits.

In contrast, the Western system essentially leaves those without money to face a bleak fate.

Don’t be naive enough to think that public hospitals offer treatments on credit—treatment first, payment later.

That only applies to emergency cases.

Besides, not every emergency patient is allowed deferred payment.

If a patient or their family defaults, it’s the department’s staff who end up suffering.

From this ultrasound alone, it was difficult to determine whether the patient had liver cancer.

At least with Zhou Can’s current level of expertise, after reviewing it, he felt liver cancer was highly unlikely.

If not liver cancer, then what kind of cancer could it be?

There are countless types of cancer.

Excluding liver cancer, if a tumor were present elsewhere, the patient would likely experience pain or other abnormal symptoms.

Zhou Can reexamined the patient’s symptoms once more.

Then he asked whether the patient had experienced pain in any other area.

The patient recalled that, at the onset of the symptoms, there was occasional back pain—a type of referred pain.

At this point, with liver cancer essentially ruled out and without any other severe or unusual pain, only one possibility remained.

That is, the symptoms caused by this cancer were being masked by the duodenal ulcer.

The endoscopy had already excluded stomach cancer.

Then suddenly, Zhou Can wondered if the gallbladder might be the real problem.

There were two reasons: first, the liver and gallbladder are almost like siblings, so liver cirrhosis could affect the gallbladder; however, cirrhosis isn’t directly linked to gallbladder cancer.

Second, the duodenum is very close to the gallbladder—as if they were cousins.

If the gallbladder were malfunctioning, the patient would experience abdominal pain, and jaundice is also common.

Yet liver cirrhosis can also result in jaundice.

Thus, the symptoms coincidentally overlapped.

It was precisely this coincidence that even caused the seasoned Dr. Jia to initially overlook the issue.

Zhou Can reexamined the ultrasound—the gallbladder appeared acoustically clear, with no abnormal reflections.

However, since the scan wasn’t specifically focused on the gallbladder, he couldn’t clearly assess the gallbladder wall or the common bile duct.

Arranging a dedicated gallbladder ultrasound was tempting, but the family might object.

Moreover, Zhou Can did not have the authority to order further tests.

He would have to consult Dr. Jia or the attending physician.

“I’ll take these images to Dr. Jia for a closer look. If there’s a problem, we’ll inform you promptly.”

Zhou Can took the ultrasound report and went to see Dr. Jia.

Perhaps with Dr. Jia’s expertise, any anomaly would be uncovered.

At the very least, the gallbladder’s shape did appear slightly off.

Returning to the Outpatient Department, he found that Dr. Jia had already begun seeing patients.

Although his premium specialist appointments were limited, his reputation drew many in need of his expertise.

To avoid long waits—or patients resorting to scalpers for overpriced numbers—he often squeezed in a few extra patients.

Combined with his schedule of morning clinics and afternoon surgeries, his time was extremely limited.

Holding the report, Zhou Can stood patiently behind Dr. Jia until the current consultation was over, then showed him the ultrasound images.

“Dr. Jia, I examined the patient in the ward. They have both jaundice and abdominal pain, and there’s a noticeable abdominal mass that wasn’t mentioned. I suspect there might be gallbladder pathology—even cancer—masked by the overlapping symptoms of duodenal ulcer and liver cirrhosis.”

Zhou Can was careful not to sound too definitive.

After all, the diagnostic evidence was still insufficient.

In medicine, a conclusive diagnosis requires at least one reliable piece of evidence.

For example, ultrasound, MRI, CT, or comprehensive blood and urine tests.

In practice, doctors usually need at least two solid diagnostic indicators before offering a preliminary opinion.

A preliminary diagnosis is one that is presented with a question mark at the end.

“Gallbladder cancer?”

Dr. Jia took the ultrasound report and studied it intently for a few moments.

Then his expression grew noticeably grave as he picked up a magnifying glass and examined the image in detail.

Standing nearby, the young, attractive doctor Qiu Hong initially regarded Zhou Can’s gallbladder cancer remark with disdain, assuming he was merely acting.

But as she saw Dr. Jia’s face grow increasingly serious and him scrutinizing the report through the magnifying glass, doubts began to creep into her mind.

Could there truly be an issue?

Was this trainee really not just putting on an act?

“The gallbladder does appear abnormal. Qiu Hong, please call the ultrasound department immediately and see if they have clearer images of the gallbladder.”

Generally, all imaging results are archived.

Even if only one copy is printed for the patient, the hospital retains the originals.

Some responsible hospitals even have several archived images in the Radiology Department, even if the printed version is only one or a selection of the best ones.

Qiu Hong hesitated for a moment, “Should we suspend your outpatient work?”

“If this patient truly has gallbladder cancer, it’s a major issue. A slight delay in outpatient appointments is acceptable—in the worst case, I’ll skip my lunch break and work extra hours.”

Doctors are naturally pressed for time, especially when emergencies arise.

Patient safety always takes precedence.

“Okay, I’ll call right away!”

After speaking, she looked up at Zhou Can.

“Dr. Zhou, please inform the guide outside not to start calling numbers yet.”

Qiu Hong’s tone had clearly shifted, and Zhou Can could sense the change.

He opened the door, directed the guide nurse outside, and returned to the outpatient area.

Guide nurses, who are lower in rank and pay than departmental nurses, typically earn about 4K a month, while departmental nurses earn at least 5K.

In terms of status, guide nurses often harbor quiet discontent.

It’s much the same in any institution—for instance, auxiliary police, whose treatment and status pale in comparison to regular staff.

After Qiu Hong contacted the ultrasound department, they quickly sent over all of the patient’s images.

Sure enough, there were clear images of the gallbladder.

Dr. Jia, elated, eagerly examined the images in meticulous detail.

“The gallbladder does indeed show problems—there’s a significant chance of malignancy. We must immediately inform the attending physician and the patient’s family, and arrange for a multi-slice CT scan. If necessary, we can also add an endoscopic ultrasound examination. For now, cancel the scheduled surgery.”

Dr. Jia recognized the severity of the situation.

The patient’s condition was already poor, and now, thanks to Zhou Can’s alert, the possibility of gallbladder cancer had been unearthed.

The surgery had to be canceled immediately.

It needed to be reassessed.

“It appears the patient’s attending physician is Dr. Tang. I’ll notify him right away.”

Qiu Hong immediately phoned Dr. Tang.

After the call, she informed the guide outside to resume calling numbers.

Many of these patients had taken special leave or even traveled great distances just to seek consultation.

Canceling their appointments was not an option.

Everyone scheduled had to be seen that very day.

It was the duty and responsibility of every doctor.

Following this incident, Zhou Can’s standing improved noticeably.

Dr. Jia began to regard him with increased kindness.

Qiu Hong’s attitude toward him also shifted subtly.

True skill is invaluable—it helped Zhou Can quickly cement his position in the new department.

At that moment, a young woman with a slightly pale complexion entered the outpatient room.

Premium specialist consultations cost several hundred yuan; most patients with routine issues opt for more economical general consultations.

The woman had come alone.

“Hello, Dr. Jia. I’ve heard you’re exceptional in treating gastrointestinal diseases—even patients come from other provinces just to see you.”

“Miss, please have a seat. Dr. Jia will take very good care of you once you’re here!”

Qiu Hong reassured her in a gentle tone.

The young woman, probably in her early to mid-twenties and dressed stylishly, looked rather unwell.

“Thank you!”

Once seated, she began describing her condition.

“I haven’t really known what’s wrong lately—I’ve been suffering from persistent diarrhea, which worsened yesterday. I get nauseous and end up vomiting after eating; it’s extremely uncomfortable. At the local hospital, they suspected gastroenteritis and prescribed some medication, but it hasn’t been effective.”

She handed her test report over to Dr. Jia.

Typically, patients coming for premium specialist consultations have already been examined—and sometimes even treated—at other hospitals.

Thus, they all tend to bring in external test reports for a second opinion.

Dr. Jia carefully reviewed each report.

“Did you experience any long-term discomfort before the onset of your diarrhea?”

“Rome wasn’t built in a day.”

Serious illnesses don’t develop overnight; they accumulate slowly until they finally erupt like a volcano.

Her situation, with persistent vomiting and diarrhea, could even be triggered by a cold.

Experienced doctors systematically rule out possibilities when diagnosing.

They don’t jump to conclusions immediately.

The more skilled the specialist, the more comprehensively they consider every factor—so never doubt an expert’s capability.

Perhaps they’re just being thorough for your benefit.

“Other than that, I haven’t experienced any additional symptoms—except for long-term constipation, which has lasted for over two years. I even searched online and found that eating more fruits and vegetables might help, so I tried a dietary approach. It did offer some relief, but the constipation still persists.”

She admitted, slightly embarrassed to mention her constipation.

Dr. Jia nodded thoughtfully as he carefully recorded the details in the medical record book.

Zhou Can began to ponder what exactly this young woman might be suffering from.

Zhou Can started contemplating what illness this young patient could possibly have.