Chapter 251: Early Morning Rounds and Hidden Dangers in the Ward

After finishing up with the earlier patients, Zhou Can headed to the ward where the patient in Bed 71 was staying. Yesterday, they had already performed an esophagojejunostomy and a fistula repair for the patient.

For now, it was too soon to see how well the surgery had worked. They’d have to wait five to nine days or so, until the area basically healed, before letting the patient try liquid food.

That meant things like rice porridge or milk.

“So, how’s it going? No unusual reactions after the surgery?”

Zhou Can asked the patient’s family.

“Thank you to the hospital for giving my father the bypass surgery and repairing the fistula. Everything’s been great. We’re really looking forward to the feeding trial in a week.”

The family was genuinely friendly toward Zhou Can.

Tuyu Hospital had helped them by performing the surgery, and they were very satisfied so far.

Still, this was just temporary.

The family would only feel truly relieved when the patient could actually eat and drink again.

If the problem wasn’t fully resolved, all this would have meant was suffering yet another round of pain.

After the Bed 71 check, Zhou Can still had three new patients assigned to him to manage.

In total, he had seven patients now. Even doing basic rounds ate up over half an hour.

Every patient’s condition, their changing symptoms—he had to keep up, constantly updating doctors’ orders as needed. Then it was on to writing medical records and progress notes. Luckily, none of his current patients were about to be discharged just yet.

Otherwise, he’d have another job on his plate: paperwork for hospital discharge.

Thankfully, none of his seven patients were in critical condition.

Around 7:40, Director Shang arrived at work.

Usually, Director Shang wouldn’t come in this early.

But today, he’d shown up nearly twenty minutes ahead of schedule, all for one reason: ward rounds.

According to hospital policy, every Chief Physician had to do at least one round a week.

When it came to rounds, Chief Physicians moved in near-perfect unison—skipping out whenever they could. Plenty of top Chief Physicians personally ran a medical team, taking care of several inpatients themselves.

A serious round could easily take more than an hour.

If you ran into complicated or critical cases, it could take much longer.

That’s why most Chiefs took full advantage of the three-tiered rounding system. Interns and trainees managed the patients closely, reporting issues to the resident physician.

Sometimes, if they were short on residents, they’d use advanced trainees as substitutes.

Many of these trainees were already certified doctors from county or city hospitals—top of their class in their own institutions. Having them act as residents worked just fine.

If the resident ran into something they couldn’t handle, they brought it to the attending physician.

By the time a doctor earned the attending title, their skills and experience were strong enough to do just about everything a Chief could.

For big or small issues, the attendings could usually sort things out.

If even an attending got stuck, only then did they escalate things to a Chief Physician.

Only by splitting up responsibilities like this could Chiefs keep up with their heavy workload.

Director Shang was the lead powerhouse in the Gastroenterology Department, responsible for a lot of patients.

“Get ready, everyone. The Chiefs are about to start rounds.”

Dr. Huang Xinggui notified the doctors in their group.

Any doctor in charge of a patient needed to prep all test results, vital sign charts, and medical records, placing everything at the patient’s bedside so the Chief could check during rounds.

They also needed to know every detail about their assigned patients. When the Chief stopped at a bed, the primary doctor had to present the patient’s key info clearly and quickly.

If there was anything they couldn’t handle alone, now was the perfect chance to consult a Chief Physician.

Zhou Can quickly organized the files for his seven patients and laid them out by each bed, mentally running through everyone’s status.

Just as he finished, Director Shang, along with other Chiefs from the department, the head nurse, several associate chiefs and attending doctors—nearly twenty people—formed a massive rounding team and swept into the ward.

These ward rounds, when the Chief led the team, were called the big rounds.

It was the largest turnout of doctors and nurses for any check.

The exact day for rounds wasn’t set—it all depended on the Chiefs’ own schedule.

In the first ward, Zhou Can waited by Bed 3.

This patient was dealing with enteritis, a new case Zhou Can had only gotten yesterday.

When Director Shang’s team reached Bed 3, Zhou Can calmly introduced the patient’s condition and the tests done since admission.

Internal medicine patients tended to have lots of lab work.

Enteritis was usually acute. Unless it was chronic and particularly severe, most patients didn’t even bother coming to the hospital.

This patient’s case wasn’t especially bad either—just some food from a street stall followed by ongoing stomach pain and diarrhea. After getting pain relief, anti-diarrheal and electrolyte therapy, things had already been improving.

Honestly, with Tuyu’s level, they rarely admitted patients for simple enteritis.

Cases here were always at least somewhat challenging.

Either the condition was severe or the cause was complicated.

“Director Shang, these are the orders I wrote for the patient this morning. Could you check if I missed anything?”

Zhou Can had just revised the orders to better match the current condition.

As symptoms improved, doctors often trimmed down meds. If a case got worse, they’d ramp up doses or add new drugs.

For high fevers, patients sometimes needed ice packs to lower their temperature.

“I trust your orders completely!”

In front of all the doctors, nurses, and family, Director Shang showered Zhou Can with praise for his medical skills. Instantly, every eye turned to Zhou Can.

Honestly, since his very first day in Gastroenterology, Zhou Can had caught plenty of attention for saving a patient from a potentially fatal medical error.

“I’ve gone through your orders: the combinations, dosages, and administration routes are all spot-on.”

After complimenting Zhou Can, Director Shang still went over the medical orders personally.

Then he gave them his official stamp of approval.

“Director Shang really seems to trust this young trainee! Kid’s quite handsome too, very sharp-looking.” One short, stout male doctor chimed in with a loaded tone.

His words carried a definite undercurrent.

This was Dr. Zheng Hongtao, one of the Chiefs in Gastroenterology. He led his own team. Word was his skills rivaled even Director Shang’s.

There’d always been some rivalry between these two.

When Zhou Can joined Gastroenterology, Director Shang had taken him right away. That didn’t sit well with Zheng Hongtao.

Maybe it was all just sour grapes, but Zheng wasn’t very friendly toward Zhou Can.

For the last two days, whether in the office or elsewhere, if Zhou Can crossed paths with Zheng Hongtao, the atmosphere was always awkward and chilly.

“Dr. Zhou is steady and reliable, and his medical skills are excellent. He’s definitely trustworthy. But your own Dr. Huang Liang is just as dependable, wouldn’t you say? Outstanding young doctors pop up everywhere.”

Director Shang replied with a warm smile.

As department head, maintaining unity and harmony in his team was always a priority.

Zheng really couldn’t help having issues about Zhou Can’s transfer. Before he even joined Gastroenterology, Deputy Director Ye in Internal Medicine had made it clear they should all invest as much time and effort in his training as possible.

For Ye to personally raise Zhou Can’s case in an Internal Medicine meeting showed just how much Tuyu Hospital valued him.

Later on, Director Tan from Internal Medicine even approached Director Shang about Zhou Can in private.

Unlike Deputy Director Ye’s hints, Director Tan was refreshingly direct.

After all, they were all ‘their own people.’

Tan explained that Zhou Can’s stint in Gastroenterology would be flexible, but once he did join, he hoped Shang would personally mentor him.

With both higher-ups asking, how could Shang refuse?

If he passed Zhou Can off to Zheng Hongtao and Tan asked about it later, what could he possibly say in defense?

Tan might seem easygoing, but his status in Internal Medicine was unshakable. Everyone honestly respected him.

By emphasizing that outstanding young doctors existed everywhere, Shang hoped Zheng would stop dwelling on the matter.

But Zheng just smirked.

“Ha! Huang Liang’s already about to become an attending, but you’re putting Dr. Zhou on the same level? He must be something special indeed.”

Zheng’s words sounded complimentary, but you could hear the scorn underneath.

No doubt he was thinking, ‘A trainee measured against my attending?’

“Dr. Zhou is far more capable than me. His medical orders for this enteritis case were clear and precise. When I was a trainee, I never had that kind of nerve—even for the simplest admission order, I’d agonize for ages before daring to submit it for seniors to check.”

A young man in his mid-thirties with a buzz cut, standing beside Zheng, quickly picked up the thread.

With a tone almost identical to Zheng’s, he pretended to pay a compliment while actually poking fun at Zhou Can for being too reckless.

Trainees writing orders without a senior double-checking? Unthinkable.

Zhou Can could easily pick out their sarcasm.

He couldn’t help but feel wronged—caught in the crossfire even when he hadn’t done a thing.

He’d never even provoked these guys.

But in the world of adults, grudges often came down to tangled interests—not personal issues.

Any time you threatened someone’s interests, even if you didn’t do a thing to them, you could expect a cold shoulder, biting words, even open hostility.

Still, Zhou Can kept his head down and focused on his work.

He knew it wouldn’t be long before even these two would have to quietly accept his rise.

The rounds carried on.

As luck would have it…

In the very next ward, three patients fell under Dr. Huang Liang’s care. Beds 6 and 8 were in serious shape—one had intestinal polyps removed, the other had a duodenal ulcer.

Bed 7’s patient had come in with stomach pain, preliminarily diagnosed as an intestinal infection.

After admission, Dr. Huang started them on antibiotics, nil by mouth, IV fluids, and observation.

All three of his patients had gastrointestinal issues.

Clearly, that was his area of expertise.

“After my initial assessment and diagnosis, Bed 7’s patient has acute gastroenteritis and stress-induced hyperglycemia. Here’s the test report—abdominal ultrasound, upright abdominal X-ray, biochemistry and labs—all point to acute gastroenteritis.”

Like Zhou Can, Huang Liang worked efficiently, having everything ready for the team.

Zheng took the paperwork and flipped through it carelessly.

“What treatment plan have you started for this patient, Dr. Huang?”

“When the patient arrived, their stomach pain was bad. Even after starting initial treatment, the pain remained frequent and severe last night. By six this morning, the pain got worse and the patient began vomiting. So, I gave IV fluids to stabilize them. Also, because they started running a fever this morning, I prescribed oral antipyretics and used an ice pack for physical cooling.”

Huang Liang went over the various treatments he’d administered.

All in all, the measures were by the book—no big issues.

But to Zhou Can, it all felt a bit too conservative.

With the patient curling up from pain, face twisted, it was obvious these treatments hadn’t helped much.

Abdominal pain might be less dangerous than chest pain, but frequent, severe stomach pain was nothing to ignore—delaying treatment could end badly.

Having trained in Surgical Gastroenterology with Dr. Jia for three months, Zhou Can was quick to spot red flag symptoms.

To him, this patient looked to be in real danger.

But with so many Chiefs and seniors at the scene, it wasn’t his place to speak up as a trainee.

Besides, Zheng and Huang Liang had obvious issues with him—if he publicly challenged Huang’s treatment, he’d make things worse.

For Zheng, it would look like Zhou Can was just showing off.

Zhou Can decided to see what the senior doctors would say.

“I think Dr. Huang’s approach is solid. What do you think, Director Shang?”

There were several Chiefs in Gastroenterology.

As far as Zheng was concerned, only Director Shang was on his level.

He didn’t bother asking the others—just wanted Shang’s opinion.

“The treatment’s addressing the symptoms, but with the patient in this much pain, just fluids and stabilization might be a bit too cautious,” Director Shang gently pointed out.

This case was borderline surgical, and it seemed the internal medicine Chiefs hadn’t clocked just how dangerous it was.

Zhou Can was getting more and more anxious for the patient.

“Both the ultrasound and abdominal X-ray suggest things aren’t that bad. Director Shang, what extra treatments do you recommend?”

This time, Zheng was asking for real advice.

In his mind, they’d done everything necessary—future steps would depend on how things developed.

That’s the standard playbook in internal medicine.

Admit the patient, treat symptoms, support life functions, and then monitor and adjust based on how things went.

In that respect, internal medicine wasn’t so different from traditional Chinese medicine.

“It’s hard to say exactly what else to add yet. But with that much pain, we can’t afford to ignore it. Let me see the test reports and records.”

Even Director Shang wasn’t willing to make a snap judgement.

He wanted to do a careful review before deciding.

Chief-led rounds were, after all, meant to catch hidden dangers or any errors in diagnosis or care.

“Dr. Zhou, come pitch in with your thoughts!”

Director Shang beckoned Zhou Can, who was standing near the door.

As a trainee, Zhou Can was lucky just to avoid getting squeezed out of the room by all the more senior doctors.

“Usually, you’d call on your associate chiefs or attendings for backup, but Director Shang asked Dr. Zhou, a trainee, instead. Maybe Zhou’s got more standing than I realized!”

Zheng remarked, half in awe, half with envy.

Director Shang’s other seniors—Deputy Director Shi and Dr. Huang Xinggui—couldn’t hide their discomfort.

They respected Zhou Can’s ability, but to say he’d surpassed them? No way.

Zhou Can simply walked over, turning to Zheng: “Not at all, Director. It’s not that I’m important, it’s just that Director Shang is helping a new doctor like me learn through experience. And inside our team, Deputy Director Shi and Dr. Huang always look after me just the same. I’m lucky to have such helpful mentors.”

One sentence, and he’d smoothed things over perfectly.

Now Deputy Director Shi, Dr. Huang Xinggui, and the others were all smiles.

Senior doctors always appreciated a humble young colleague.

The way Zhou Can handled things left everyone at ease.

He took some medical records from Director Shang and began reviewing, focusing on key results.

For acute gastroenteritis, bloodwork was really important.

After scanning the labs, Zhou Can’s expression changed drastically.

Director Shang caught the shift immediately.

“Zhou Can, what’s wrong? Do you see a major problem in the test results?” He’d seen what Zhou was capable of before, but never with such a grave look.

Running a big department, what Director Shang dreaded most was a serious incident in the hospital.

So when Zhou Can’s face darkened, he tensed right up.

“It’s not good—I need to check the urinalysis results!”

Zhou Can quickly pulled up the urine test, his brow furrowing deeper and deeper, as if disaster lurked just outside the gates.

“Dr. Zhou, must you be so dramatic? You’re making everyone—patient and family—nervous,” Huang Liang objected.

And calling him ‘little Dr. Zhou’ instead of just ‘Dr. Zhou’ or ‘Zhou Can’ in front of everyone was an obvious slight.

But Zhou Can ignored him completely.

He was focused solely on the urinalysis numbers.

“Director Shang, this patient’s situation is extremely dangerous. I recommend bringing in the General Surgery team for immediate consultation. Any delay might have truly dire consequences.”

Zhou Can chose his words carefully—saying ‘truly dire consequences’ twice drove home the danger this patient was in.