Chapter 229: A New Chapter in Medical Trials

“Of course, nothing is absolute; we can’t let fear of the unknown paralyze us. Sometimes the cause of a disease is clear but its pathological mechanism remains a mystery—or only the symptoms are evident, making it hard to pinpoint the cause. In such cases, symptomatic treatment is a useful stopgap measure. It can relieve the patient’s suffering while preserving life as much as possible. In practicing medicine, one must avoid being dogmatic.”

Director Shang, possibly worried that Zhou Can might become as unresponsive as a block of wood, added,

“Diagnosis and treatment is an intricate process; one must learn to apply knowledge dynamically.”

“Doctors who only follow formulas and copy rigidly simply aren’t cut out for this job.”

“The cause, the pathological mechanism, the syndrome, the symptoms—these are different perspectives of understanding a disease. This demands that physicians tailor treatment by analyzing causes, distinguishing diseases, and integrating syndrome differentiation in order to apply symptomatic care flexibly.”

“Understood!”

Zhou Can nodded to show his understanding.

He had never been one to act in an inflexible manner.

“There are no special requirements for trainees under my supervision. Just maintain a conscientious and responsible attitude. If you can add initiative and diligence on top of that, even better.”

Director Shang’s seemingly modest requirements were, in fact, rather high.

Being conscientious and responsible alone is extremely challenging—and adding initiative and diligence makes it even tougher. It’s like being expected to do the work of a trainee while also shouldering the concerns of a director.

“Later, you’ll have access to the department login account. You can check on the patients in our group at any time. When you have free moments, you can even review cases from other groups in the department. If you have any questions, feel free to ask me.”

This benefit essentially became the standard package for Zhou Can as he joined the new department.

For most trainees, merely exchanging a few words with the chief physician would be a cause for prolonged celebration.

But Zhou Can had the privilege of consulting directly with the chief physician whenever needed.

“Now, let me talk about your daily tasks. For now, you’ll be responsible for checking nursing records, reviewing test results, writing case histories, issuing medical orders, and conducting rounds—the usual procedures. As a trainee, you’re expected to take on more responsibilities than those fresh interns. For instance, if a new patient is admitted to the group, they will be randomly assigned to you or another outstanding intern for individual management.”

Interns usually aren’t given too much work.

Their superiors won’t casually let them manage patients on their own, mainly out of fear of mishaps.

After all, interns are mostly fourth-year medical students who have just finished their four years of theoretical studies. Medical undergraduates typically begin internships in their fifth year.

Tuyu Medical College is a top-tier medical university that is closely linked with Tuyu Hospital.

Some of its outstanding seniors gain the privilege of interning at Tuyu Main Hospital.

Those with slightly lower performance might end up at Tuyu Affiliate Hospital or other hospitals—the school essentially arranges the internship placements.

New intern doctors are basically greenhorns when they start at a hospital.

Mentors often pay little attention to the interns under their charge. Some interns complete a year of training without even knowing what their supervising chief physician looks like. This isn’t nonsense—it’s the reality.

Those in charge of interns are mostly residents or the Chief Resident.

A few exceptional cases might get paired with a seasoned attending who will take them under his wing.

In any case, an intern will never be left alone with patients as soon as they step into the hospital.

When did that change?

Once a superior starts letting you write case histories on your own, it’s a clear sign that you’re about to be entrusted with independent patient management.

Zhou Can, as a trainee who has already obtained his medical license, was now required to manage patients on his own.

However, since he had just joined the Gastroenterology Department, they would at least give him a couple of days to adjust!

Increasing fame also brings its downsides.

Director Shang didn’t bother to ask if he was ready—he simply assigned him the task.

And judging from the tone, managing patients on his own was just the basic level of responsibility.

“I oversee several trainees, interns, residents, and attending physicians. If you want to earn more advanced opportunities—like participating in interventional procedures, joining consultations, or even engaging in research projects—you’ll have to strive and perform well. Whoever excels, I’ll give them more opportunities to grow, fairly and justly.”

Fair competition was something Zhou Can relished.

Competing with ordinary interns and trainees was usually a lost cause.

Even residents found it hard to match up to him.

Perhaps only an outstanding attending could stand a chance against him.

At least that was the case in almost every surgical department. Now, having moved to Internal Medicine, he dared not boast.

After logging into the department system, Zhou Can obediently began reviewing the case files within his group.

By examining the case progress notes written by others, one could easily gauge a doctor’s expertise.

“Dr. Zhou, patient from bed 71—someone who had undergone a radical total gastrectomy—has been admitted. Director Shang said you’d be responsible for managing this case.”

The nurse who greeted him was strikingly beautiful, with porcelain skin and a sweet smile.

“Alright, I’ll be there right away.”

On his first day at work, he was already assigned a patient for independent management—a move that Director Shang likely intended as a test.

These chief physicians were all seasoned veterans.

Earning their respect was no easy feat.

No matter how illustrious his reputation in other departments, switching to a new ward or working under a different chief physician meant he’d have to prove himself all over again.

In the eyes of Dr. Jia and Mr. Liu, Zhou Can already enjoyed a highly regarded status.

But under Director Shang, his treatment was only slightly above that of a regular trainee.

Quickly reaching bed 71, Zhou Can found three family members gathered around the patient’s bed—a frail elderly lady with white hair, a middle-aged woman who resembled her, and a nondescript yet imposing middle-aged man.

Their attire exuded class and taste.

It indicated that the patient came from a well-to-do family.

Yet, once in the hospital, no amount of wealth could alter the fact that disease renders everyone equal.

If it’s a malignant tumor, even vast riches can’t buy you a life if it spreads.

“Hello, I’m the attending for bed 71. My surname is Zhou. If there’s any issue during the patient’s stay, please feel free to come to my office. Should you have any needs or updates on the patient’s condition, you can always let me know.”

Back when Zhou Can was an intern, he often felt intimidated by family members.

Now, he carried himself with confidence and openness, no different from doctors with years of experience.

The less confident, hesitant, and unsure a doctor appeared, the more the family would look down on him. This negatively affected patient management and communication during the hospital stay.

If the family thought you were just an intern, they wouldn’t take you seriously.

They believed that talking to an intern wouldn’t get anything done.

So they would bypass you and wait for the senior doctor during rounds to report their concerns.

In turn, the senior doctor would wonder, “What’s wrong with the attending? How can such minor issues escalate to the point that the family feels the need to complain during rounds?”

This would leave a very poor impression of the attending intern or trainee in their eyes.

Zhou Can had learned this lesson the hard way through many setbacks and gradually mastered how to handle both the family and the patients.

“Dr. Zhou, when will your hospital start treating my father?” asked the woman politely.

“From the moment we admitted the patient, treatment had already begun. The inspections, basic vital checks, and medication regimens are all essential preparatory steps before any treatment.”

Zhou Can answered her questions while continuously reviewing the patient’s records.

This was to ensure he had a full grasp of the situation.

“He had a total gastrectomy half a year ago, right?”

“Yes! At that time, they discovered my father had stomach cancer. After evaluation, they determined that removing his entire stomach was the only way to save his life.”

The woman explained.

“However, after the surgery, whenever my father ate, the food would turn into liquid and flow out directly through the abdominal drainage tube. He couldn’t eat at all and had to rely on nutritional infusions to survive.”

This patient’s misfortune was indeed profound.

A total gastrectomy itself brings complications; postoperatively, food leaking from the esophagus to the jejunum usually indicates a problem with the anastomosis.

“So the patient developed an esophagojejunal anastomotic leak after surgery?” Zhou Can deduced from his experience.

“Exactly, exactly. The doctors mentioned something about a leak—we didn’t really understand the technical terms. Essentially, the connection between the esophagus and jejunum went awry. Initially, we were told to observe for a while, but after two months there was no improvement. We were really frustrated. It meant the surgery wasn’t well done. We lost confidence in that hospital’s capabilities and took my father to a much-reputed large hospital for a second operation.”

Her voice carried a mix of anger and despair as she recalled the ordeal.

Yet, Zhou Can’s clear explanation of her father’s condition bolstered her confidence in Tuyu Hospital’s medical expertise.

After all, not just any young doctor managing a ward could exhibit such high proficiency. Could Tuyu Hospital’s standards really be poor?

Little did she know, this attending was among the very best in his class.

Generally, doctors with multiple surgical skills achieving deputy chief level and a level-four proficiency in pathology diagnosis wouldn’t be relegated to behind-the-scenes ward management.

They would be placed on the front lines, performing surgeries and consultations.

Hospitals are eager to send their best doctors to directly confront illnesses—diagnosing causes and pathological mechanisms through their hands-on expertise. For patients needing surgery, those with superior surgical skills perform the procedures.

Only doctors with less star power or limited experience are assigned to manage wards, handling tasks like rounds, dressing changes, assisting in surgeries, and writing case histories.

“After the second surgery, was the problem resolved? An esophagojejunal anastomotic leak is notorious for being tricky—even a second surgery might not fix it.”

Zhou Can’s surgical insights were honed during his time in Gastrointestinal Surgery.

Dr. Jia had once told him that while a total gastrectomy wasn’t difficult, the real challenge lay in connecting the esophagus to the jejunum. Once issues arose, they became extremely tricky.

Moreover, multiple open surgeries in the abdominal or thoracic cavities lead to serious internal adhesions.

Such invaluable surgical lessons are rarely found in textbooks.

Zhou Can engraved Dr. Jia’s guidance in his mind.

Since then, he had embraced a new surgical philosophy: avoid surgery if possible, and never open the chest or abdomen unless absolutely necessary.

Postoperative adhesions in the chest or abdomen not only complicate future surgeries, but also significantly affect the patient’s recovery.

“Sigh! You’ve hit the nail on the head! After my father’s surgery, not only did the anastomotic leak persist, but he still couldn’t eat. New complications arose—swallowing became extremely difficult. He even had to spit out his own saliva. Not even water could be taken in. We were nearly at the end of our rope. What kind of hospital is this? Why does every surgery end up worse than the last?”

The woman’s tone and eyes were filled with utter despair as she recounted the second surgery.

The other two family members, though silent, wore similarly despondent expressions.

Even with modern advances in medicine—where kidney, liver, lung, and heart transplants are routinely performed—there remain many problems that even the best medical science cannot remedy.

Doctors often felt helpless in the face of such insurmountable challenges.

In nearly two years of Tuyu’s training, Zhou Can had encountered too many cases that defied medical intervention.

Some patients could only be watched helplessly as they slipped away, with no viable treatment in sight.

What left the deepest mark on him was a very young female patient—a mother of only six months old’s child—who was already in late-stage breast cancer. In the Critical Care Department, she tearfully pleaded with the doctors to let her live a few more months just to hear her child call her ‘mom.’

But despite the doctors’ best efforts, the aggressive cancer cells continued to spread and devastate her body.

In advanced stages, cancer not only wrecks the immune system but also damages and exhausts vital organs.

Eventually, that young mother never lived long enough to hear her child call her ‘mom.’ One gloomy morning, she departed this sorrowful world, burdened by endless regrets.

Zhou Can, a grown man, felt profound sorrow witnessing that scene.

Had medical science advanced just a little further, that mother would have lived longer—to hear her child call her, to watch her child grow up, perhaps even to see her child married or have children of her own.

But now, she would never see any of that, her eyes permanently closed.

The patient before him was in his sixties—a relatively long life. At least his children were grown and married.

After all, even a lowly insect clings to life; moreover, being human, none would easily choose death.

“Has the patient developed an esophagojejunal anastomotic stricture after the second surgery?” Zhou Can asked, unable to bear the sorrow in her eyes.

“Yes! You’re absolutely right,” she replied, biting her lip and nodding emphatically.

“Doctor, do you think there’s any hope for my father’s recovery?”

After two failed surgeries, each worse than the last, she had lost faith in surgical solutions. Yet, seeing her father in pain, she was desperate to try again.

“That depends on the test results. I suspect the surgery will be extremely challenging. With so much time passed, the anastomosis might have already matured. He can’t even drink water—I’m just speculating, so please don’t take my words the wrong way. I think his anastomosis might be completely obstructed. It’s like two hollow metal pipes that, due to faulty welding or some other reason, end up with the joint turning solid.”

To help her understand, Zhou Can offered a comparison.

“And you’re right again. After the local hospital’s examination, the doctors had planned to perform an esophageal dilation procedure to resolve the feeding issue. But upon checking, they discovered that the anastomosis was entirely blocked. The local doctors simply shook their heads in resignation, saying no further surgery was possible.”

The woman’s face was etched with bitterness, despair, and profound helplessness.

Sometimes, family members wouldn’t tell the doctor the entire story—omitting details like which hospitals had been visited and what the results were—each harboring different concerns.

Some feared that admitting they’d been to other hospitals might displease the doctor, while others sought to gauge the new hospital’s competency.

Zhou Can’s accuracy in predicting the situation only further bolstered the family’s confidence in Tuyu Hospital.

“Director Shang’s decision to admit the patient shows that it isn’t the worst-case scenario. They will definitely try something. As long as there’s a glimmer of hope, endless possibilities remain.”

Zhou Can reassured the family and patient, helping them maintain some trust in the treatment process.

This reassurance was critical.

“The patient’s test data is very scant, and his medical history isn’t as comprehensive as you’ve described. Do you still have all the examination and surgical records from the other hospitals?”

After a cursory review of the patient’s records, Zhou Can felt that they were woefully incomplete.

The patient’s condition was exceedingly complex.

He had both an esophagojejunal anastomotic leak and an obstruction.

The local hospital in question was unlikely to be a small facility; it was at least a mid-sized tertiary hospital.

For their doctors to be so hesitant about performing surgery indicated a severe case.

The surgical difficulty would be surprisingly high, and the risks equally daunting.

“All the examination records are kept there. I’m worried that the necessary documents might be in the car. If needed, I’ll go to the underground garage and retrieve them immediately.”

She asked for Zhou Can’s advice.

“Bring everything along! I suspect Director Shang will want to use them during the departmental discussion about your father’s case.”

Zhou Can understood deep down that Director Shang likely intended for him to take a leading role in managing this patient.