Chapter 244: A Day in Internal Medicine: Challenges and Compassion

Nurses from the General Surgery Department aren’t exactly known for being easy to talk to. Zhou Can had done his training there, so he knew their temperaments inside out.

As for the doctors in General Surgery, they were all incredibly proud, their eyes fixed above everyone’s heads.

Every one of them seemed to have the arrogance of a ‘Dragon Prodigy’—impossibly self-assured.

Add in the General Surgery department’s endless workload and things got even trickier. If all you needed was a resident or attending to consult, it was doable. But this procedure needed at least an associate chief physician to operate—now, that was much harder.

They’d definitely be able to invite one over.

But if the surgeon decided to drag his feet for two or three days, no one could really blame him.

After all, this patient’s condition was chronic. Waiting an extra day or two for surgery was perfectly reasonable.

Only the Emergency Department had the privilege of summoning a department chief for a consult at any time.

That said, even people in the Emergency Department tended to get the cold shoulder when asking for favors.

“Some nurses are just like that. Don’t let it get to you.” Zhou Can realized he’d spoken out of turn and quickly tried to reassure Director Shang.

“We’ve already found the source of the problem, but now the patient’s just stuck waiting because it’s so hard to coordinate a chief from General Surgery. It’s such a waste of precious treatment time! Can you believe it?”

Director Shang still couldn’t calm down, his frustration simmering.

“Tomorrow I’m going straight to Director Wu in General Surgery to have a word. That little nurse who answered the phone was just too much. I’m still a chief and an attending in Gastroenterology, you’d think I’d at least get some basic respect.”

Once you reached the level of chief physician, even at the lowest rank, your place in the hospital was pretty solid.

Gastroenterology definitely didn’t weigh as heavily as General Surgery.

But even so, Director Shang held a certain sway. If he really wanted to make things difficult for that nurse, she probably wouldn’t come out unscathed.

If things escalated, the hospital would absolutely take Director Shang’s side.

Zhou Can let the matter drop.

After work, he grabbed dinner at the cafeteria and dropped off a meal for the stomach cancer patient in Bed 71, then headed back to the apartment to study and practice medicine. Nothing else of note.

Switching to Internal Medicine turned out to be even more stressful than working in General Surgery.

Director Shang had started to trust him, so not only did Zhou Can handle admitting new patients, he also managed their medication orders throughout their stays. Clearly, Director Shang was fully confident in him.

At this rate, Zhou Can would probably end up handling post-surgical orders too.

It was almost like he was managing the beds on his own, with most of the authority handed over.

More cautious supervisors would only let trainees write notes, record daily progress, prep discharge paperwork, or go over preoperative instructions. Most of the time, they had the trainees tag along for tests, pick up meds, fetch reports, or run documents to the Medical Department for signatures.

Some chiefs even went overboard, getting their trainees to make tea for them, mop the floors, or fetch their meals.

Even the strictest supervisors usually just gave verbal instructions and had students order some labs.

But ever since Zhou Can took over his first patient yesterday, Director Shang hadn’t interfered at all.

The admission orders went without saying. After that, all inpatient medication and care was left entirely up to Zhou Can.

For context, aside from rotating through Critical Care, all Zhou Can’s previous departments were surgical.

He’d only gotten a few days of solo practice entering orders during his last month in General Surgery.

Before that, even when attending or chief physicians trusted him and saw he was capable, Zhou Can didn’t have an actual medical license, so they never let him handle orders by himself.

Partly it was protocol, and partly it was about accountability.

If something slipped through—say, meds went wrong and the patient suffered—the responsibility would be enormous.

So to be handed full responsibility for orders right after joining Gastroenterology was a lot of pressure for Zhou Can.

It hammered home just how much he still lacked in pharmacology. Every night after work, back at the apartment, he squeezed in as much studying as possible.

…

The next morning, first thing, Zhou Can made the rounds to check on his four patients.

Before he even walked in, he noticed a gray-haired woman sitting by the bed of Patient 77.

She looked to be about fifty or so.

Deep crow’s feet marked her eyes, her smile lines were pronounced, and even her forehead was creased with wrinkles.

Aging is an unstoppable force for all of us.

Wrinkles are the most obvious sign of getting older.

As for gray hair, these days even the young are turning gray from stress, so it’s a useless indicator.

The woman in the hospital bed clearly had been crying—her eyes were still damp.

But right now her whole face was glowing with joy.

If Zhou Can had to guess, the patient’s mother had finally made it in from out of town.

“Good morning, Dr. Zhou!”

The patient greeted Zhou Can with a bright smile.

It was obvious her spirits had lifted—her eyes and face gleamed with a hope he’d never seen from her before, the kind of light only found in people with something to look forward to.

“Morning! Is this your mom?”

Zhou Can smiled gently at her.

“Yep, she got to the hospital at eleven last night.”

She looked at her mother with affection, yet regret lingered in her eyes.

There’s really no one in this world who loves you unconditionally quite like your parents.

Parents are like living saints.

No matter how tough life gets or how rebellious their child can be, their love never wavers.

“Hello, Auntie! Must’ve been tough getting here from so far away, huh?”

Zhou Can greeted the woman warmly.

“It was just a long train ride, and I lost a few hours switching lines. Otherwise, I’d have gotten here sooner. My daughter told me you paid out of your own pocket to buy her food yesterday. Thank you so much. How much was it? I’d like to pay you back right now.”

As the woman tried to rise, Zhou Can noticed she leaned on a cane.

One of her legs looked injured.

No wonder she’d stayed seated on that little stool the whole time.

“Auntie, the meals didn’t cost much. No need to pay me back. I’ve already told your daughter—she should just focus on treatment. When she recovers, she can treat me to something good next time I visit your hometown.”

Zhou Can hurriedly waved her off, not wanting the woman to feel uncomfortable.

“Of course, of course! If you ever come to Shiniu County, I’ll make sure you get the best food our area has to offer.” The woman smiled, eyes filled with gratitude for Zhou Can. “Sigh, my daughter’s always been stubborn. I raised her alone after her father and I divorced when she was just over a year old. Later, when she was seventeen, a middle-aged man tricked her into marriage. She wouldn’t hear a word of warning, insisted on marrying him anyway…”

Then the woman began sharing her daughter’s misfortunes.

“When she married him, I told her, if you do this, don’t call me ‘mom’ again. We haven’t been in touch all these years. I can’t travel easily, and I worried about causing trouble between her and her in-laws. But I never imagined her husband’s family would be so cruel. Even when she was pregnant, they mostly fed her leftovers… she was so naive.”

Her story continued between tears.

“A few days ago she called me—for the first time in four years—to tell me she had stomach cancer. I was stunned. As soon as her husband’s family brought her to the hospital, they just left. Now they’ve cut off contact and outright told her they won’t pay for her care. She’s on her own.”

In other words, she’d been completely abandoned by her husband’s family.

This young woman, so beautiful and yet married to an older man, ended up facing such a tragedy.

It was heartbreaking.

Zhou Can wasn’t the only one feeling indignant—even the other patients in the ward looked furious.

This world can have people of boundless kindness but also shocking cruelty and heartlessness.

“Did you have a marriage certificate?”

Zhou Can asked the patient.

“We did, but after I fell ill, they made me divorce him. When I refused, he and his family beat me—savagely.” When she spoke, her voice trembled and broke.

No wonder she was covered in bruises.

Her ex-husband and his family weren’t even human; monsters, all of them.

“Maybe it’s for the best. We’re just two women alone, and I’m disabled—I could never fight back. Over the years, I saved as much as I could for retirement, but now that my daughter is sick, as long as there’s hope, I’ll do everything I can. Even if I have to sell everything, I want her treated.”

The woman turned to Zhou Can as she spoke.

They really were among society’s most vulnerable—just two frail women, one of them disabled.

Even though she hated her ex-son-in-law’s family, the woman chose not to seek revenge.

It wasn’t because she didn’t want justice, but because she didn’t have the power. She just grit her teeth and endured.

Adulthood is full of these helpless compromises.

“Her stomach tumor’s still in the early stage. Surgery and follow-up chemo or radiation could give her a real shot at recovery. If you both agree, I’ll report to my supervisor and push to get her scheduled quickly.”

Zhou Can never commented on patients’ private lives.

He only discussed medical matters.

That was a rule his teachers drilled into him.

Doctors treat illness—the rest is not their business. There’s too much injustice in the world for one person to set right.

As a rule, once any cancer is confirmed and is still operable, surgery should always be done as soon as possible.

The longer you wait, the poorer your chances.

Cancer cells spread—not just to nearby lymph nodes and organs, but through the blood to far-flung parts of the body.

“We agree. Please help us arrange surgery as soon as you can.”

“Alright. When I see Director Shang, I’ll mention it and do my best to push things forward. As for costs, I’m not certain yet, but you’ll need to prepare. Before surgery, the hospital requires a deposit. Most of the treatment fees include surgery to remove the stomach tumor and post-op chemotherapy. At minimum, you’ll need about 60,000. Total costs may exceed 100,000. Insurance covers a big chunk, if you have it.”

Zhou Can made sure they knew what to expect financially.

Money is always the biggest hurdle in cancer treatment.

If the tumor’s small and surgery goes smoothly, removing a stomach cancer can cost just 6,000. But if it’s large and requires open surgery, you’re looking at at least 20,000.

Considering this girl could barely eat at her in-laws’ house and survived mostly on scraps, odds are she never paid for insurance.

Without insurance, every expense comes straight out of pocket.

That’s why buying insurance matters. If you ever get seriously ill, it keeps treatment within reach.

Serious illnesses can rack up bills in the hundreds of thousands. Even if a family can scrape together that kind of money, they might still end up ruined.

After checking on the stomach cancer patient in Bed 77, Zhou Can reviewed the case of the liver cirrhosis patient in Bed 79.

At present, the patient’s condition hadn’t changed since yesterday.

There were no obvious signs of worsening.

Zhou Can hoped Director Shang would approve a venous angiogram soon.

The sooner the cause was found, the sooner the patient could start treatment.

For patients like these whose illness wasn’t severe, chief physicians usually didn’t pay much mind.

They focused on the more serious cases.

Soon, Zhou Can would need to bring up the angiogram for Bed 79 with Director Shang again.

After finishing in that ward, he headed to the room where the Bed 71 patient was.

They’d already agreed yesterday to schedule surgery today.

Zhou Can made a point to go over pre-op instructions with the family.

He’d handle the formal briefing and sign-off later.

That wrapped up the rounds for the beds under his care.

Zhou Can then helped the other two trainees in his group check on their patients.

The patient in Bed 72 was stable enough, while, as Zhou Can had predicted, the patient in Bed 73 was improving—no more constant moaning.

Which meant their stomach pain was finally under control.

The exception was the patient’s wife—the same stubborn elderly woman—who now lay slumped against the bed, letting out a weak sob every few seconds.

Her face looked alarmingly pale.

She was as white as a sheet, completely devoid of color.

Even her groans sounded feeble, as if she barely had the energy to complain.

“Auntie, are you alright?”

Zhou Can gently nudged her.

“Ugh… My belly hurts so bad, I’m dizzy, and I keep feeling chills. Doctor, do you think you could bring me a bottle of hot water? I really can’t walk.”

She must have made dozens of trips to the bathroom last night.

Persistent, severe diarrhea would rapidly drain her strength and dehydrate her.

“Sure! This is your hot water bottle, right?”

“Yes, thank you…”

The elderly woman nodded weakly.

Zhou Can filled her bottle and poured water for both her and her husband.

Seeing her so sick, he couldn’t help but worry.

Feeling chilled is never a good sign.

From a traditional medicine perspective, that’s a sign of invading cold, causing blocked energy and blood, throwing the body’s balance off.

“You’re this ill—you really should go get checked out. Don’t put it off any longer!”

Zhou Can tried once more to persuade her.

It felt a lot like déjà vu—history repeating itself, just like the old story of Bian Que and Marquis Cai: the first visit, ignored; second, still ignored; by the third, the illness was beyond saving.

Normally, a Salmonella infection causes diarrhea, weakness, nausea, and vomiting. But the way this elderly woman deteriorated in just over a day to where she couldn’t even lift her head—that was rare.

It was almost hard to believe.

It likely meant her body’s defenses against the infection had totally collapsed.

“I’ll be fine. My health is strong, I just need to tough it out. My husband’s already much better, so I’m sure I’ll recover by tomorrow too.”

The woman still refused treatment.

Zhou Can didn’t press further. Instead, he stepped into the hallway to check up on the patient admitted last night for vomiting.

At least their condition hadn’t gotten any worse.

Still, that massive parasite inside their brain—sooner was always better when it came to treatment.

Let it fester, and bigger problems were bound to come.

If it started to move into the brainstem, the patient could need emergency care at any minute.

He’d have to see how Director Shang’s negotiations with General Surgery went.

If all else failed, Zhou Can might just have to swallow his pride and go plead for help himself.

When he got back to the office, he ran into Yu Xin and Duan Zifu.

“Good morning, Dr. Zhou!”

“Morning, everyone!”

There were already five doctors in the office—even Dr. Chi smiled at him and said hello.

All Zhou Can could do was greet them back.

“Dr. Yu, I was just in the ward and saw the elderly lady with Bed 73 had gotten worse. She can’t even lift her head. I tried to convince her to register and see a doctor, but she wouldn’t budge. I think this is seriously dangerous—you’ll need to report it to the department’s deputy chief or Director Shang. If a family member staying with a patient dies in the hospital, it’s a huge deal.”

Having worked in the Emergency Department for so long, Zhou Can had seen all kinds of bizarre incidents.

Sometimes the patient was fine, but it was the family member staying with them who suddenly died—he’d actually witnessed that before.

Once, a family member lit a cigarette in the hospital elevator. A doctor from Cardiothoracic Surgery asked them to stop, and the family member just snapped, screaming back at the doctor.

Barely a few words later, the family member clutched his chest and collapsed.

He died from a heart attack right there.

Even more absurd, his relatives ended up suing the doctor involved.