Chapter 252: A Surgeon’s Instincts

Director Shang had already become wary of how this case was being handled, thinking Dr. Huang Liang’s approach of just lowering the fever and giving fluids wasn’t quite right.

After all, the patient was suffering so much, which meant whatever was brewing inside hadn’t gotten better—in fact, it was only getting worse.

Some illnesses progress alarmingly fast.

Once they reach a certain point, things unravel quickly, like a landslide—impossible to stop.

Every year at Tuyu Hospital, countless patients die—many after resuscitation efforts fail.

But the number who actually die after pulling their tubes is very few.

Hearing the severity in Zhou Can’s voice, Director Shang’s expression turned completely serious.

Others might not know Zhou Can’s abilities, but he had seen them firsthand.

On Zhou Can’s very first day in the Gastroenterology Department, he pulled the team out of a medical mishap. Since then, he’d contributed brilliantly to diagnosing and treating multiple cases.

With skills like his, all he lacked was seniority.

Otherwise, he’d already be carrying the department on his shoulders as a key member.

“Director Zheng, this patient is from your group. What’s your opinion?” Director Shang looked at Dr. Zheng Hongtao.

Zheng Hongtao was two years older than him.

But position in any workplace never comes down to age—what matters is skill, talent, connections, education and results.

Both Director Shang and Zhou Can casually ignored Dr. Huang Liang, who flushed bright red before his face shifted to a pale blue.

Being made invisible like this in front of so many doctors, nurses, family members and the patient—that had to sting.

But really, he only had himself to blame.

The patient’s condition was so severe, and yet he was still trying to stand out for himself. The fact that Director Shang didn’t scold him right there was already generous.

“Does that mean Director Shang agrees with Zhou Can’s assessment too?”

Zheng Hongtao hesitated, clearly unsure.

This patient’s illness had already grown beyond his control, and he had to admit he lacked experience with this type of case.

Honestly, even Director Shang had struggled to diagnose this one.

There’s always been a clear line between surgery and internal medicine.

They were experts in gastroenterology, but when the symptoms started to look more surgical, even they felt a little lost.

“Zhou Can, can you explain your diagnosis for everyone?”

Director Shang turned to Zhou Can.

“There are two main reasons for my diagnosis. First, the patient has been suffering persistent abdominal pain, and even after symptomatic treatment the pain hasn’t lessened—it’s actually intensified. This morning her temperature shot up—now she’s got a fever, showing symptoms leaning toward sepsis. She hasn’t caught a cold, so the fever is likely from a bowel perforation that’s led to peritonitis and inflammation throughout her body.”

Zhou Can laid out his diagnosis methodically and with composure.

He’d operated countless times in surgery, and could spot danger signs that others often missed.

As soon as the crowd heard he suspected a bowel perforation, everyone stiffened.

Especially Director Zheng Hongtao, who hadn’t been paying much attention before—now his expression was even more severe than Director Shang’s.

He was responsible for this patient. If anything seriously went wrong, he’d be the one in trouble.

Intestinal perforation is tremendously dangerous and can be fatal.

“Second, the patient’s white blood cell count is 32.08 x 10^9/L, which supports the likelihood of a bowel perforation. She’s also experiencing compensatory metabolic acidosis and low urine output—all signs that not only has a perforation happened, it’s not recent. Bowel contents have likely contaminated the abdominal cavity, triggering acute sepsis, which explains the current findings.”

Zhou Can’s reasoning was airtight and clear.

The department’s doctors had missed the risk because they’d grown complacent, and weren’t familiar enough with surgical symptoms.

Now, after hearing Zhou Can’s analysis, every face turned grave or solemn.

“Director Zheng, we should play it safe—get a GI surgeon to consult, or immediately take the patient for another abdominal CT scan.”

One of Zheng Hongtao’s associate chief physicians spoke up.

“I think so too—we need to act fast. If this really is a bowel perforation, the illness can progress at lightning speed. If she goes into shock, we might not make it in time.”

Another chief physician agreed with Zhou Can’s diagnosis.

“But… when the patient was admitted, both the abdominal ultrasound and CT scan showed nothing!”

Dr. Huang Liang was still unwilling to give in, clinging to his pride.

“Foolish! The patient was admitted yesterday—since then, a perforation could easily have developed. You’re arguing based on yesterday’s scans? That’s sheer stupidity.”

Zheng Hongtao couldn’t hold back, shouting at Huang Liang before Director Shang could even step in.

Any doctor with a conscience despises people who put their own reputation ahead of a patient’s life.

When lives are on the line, ego and personal gains should take a back seat.

Hospitals allow competition and even encourage it, but never infighting.

From day one, medical students are taught to respect life above all.

Dr. Huang Liang was publicly scolded by Zheng Hongtao, which finally snapped him out of it.

He froze for a moment, then lowered his head, shame written all over his face. “I was being foolish.”

No one pitied him, in fact everyone thought Director Zheng was right to call him out.

“Dr. Zhou, what do you think our next steps should be?” Zheng Hongtao openly asked for Zhou Can’s advice in front of everyone.

It was partly a way to thank Zhou Can for helping him avoid a major mishap just now.

But more than that, it showed the high regard he now had for Zhou Can’s diagnostic skills.

“In my opinion, the best thing would be to transfer her to General Surgery immediately for emergency intervention. But based on hospital protocol, we’ll probably need to do another CT first to clearly locate the perforation and assess the abdomen before proceeding to surgery.”

Zhou Can stated his recommendation.

Every hospital follows standard treatment procedures.

It still wasn’t absolutely certain that the patient had a perforation. If you opened someone up and found nothing, you’d have a hard time explaining that to the family.

Plus, the small and large intestines take up almost the whole abdominal cavity.

Only by pinpointing where the leak was could they make the right incision for surgery.

“Alright, get her an abdominal CT right away! Huang Liang, grab two trainees and take the patient over—move quickly, and explain to Radiology just how serious this is. She can’t afford to wait.”

Zheng Hongtao put Huang Liang in charge of the arrangements.

That was partly since he was managing this patient, and partly as a little punishment for earlier.

Otherwise, a senior resident who was almost attending wouldn’t normally handle errands like this.

Zheng quickly put in the scan order. The patient’s family, hearing that her life was at risk, was already frantic.

They followed the doctors’ instructions without hesitation.

Right now, all that mattered was saving their loved one.

“Director Zheng, I have another suggestion—it’s just a thought!”

Zhou Can didn’t get cocky after his success.

Instead, he stayed humble and unflappable as always.

“Go ahead.”

Zheng Hongtao’s tone had shifted completely when speaking with Zhou Can.

He was no longer apathetic like before.

Now, he was treating Zhou Can as an equal.

“I think the patient’s condition will deteriorate rapidly. As soon as the CT’s finished, she’ll need surgery immediately. I recommend calling General Surgery now, get them ready, so as soon as we confirm the diagnosis we can rush her over for an operation without losing a second.”

Zhou Can proposed.

Prepare before trouble strikes and you’ll never be caught off guard.

Being proactive saves precious rescue time.

“Alright, I’ll call Director Xiao now and get everything lined up.”

Zheng Hongtao agreed without hesitation, which meant he already had a good relationship with Director Xiao in Gastrointestinal Surgery.

A lot of the time, department heads would put effort into making connections, exchanging pleasantries at every chance, just so they could pull strings when something serious came up.

Zheng got Director Xiao on the phone, ironed things out in just a few words.

The doctors standing around watched with a tinge of envy.

It’s easy to get things done when you’ve got the right contacts.

Turns out Zheng had strong ties with the new GI Surgery director—something others envied.

“Director Zheng really is the big shot in our Gastroenterology Department. So many connections—how can anyone not be jealous?”

Director Shang stayed on the scene, watching Zheng handle everything.

If he saw Zheng drop the ball, he’d have stepped in himself—no way he’d let anything happen to the patient.

“Ah, my network is nothing! Director Shang knows way more people than I do. Today’s patient nearly ended in disaster if not for the help of you and Dr. Zhou.”

The whole ordeal had left Zheng Hongtao drenched in cold sweat.

The experience had changed his attitude toward both Director Shang and Zhou Can.

Sometimes, arguments really are just a battle of pride.

A little turning point is all it takes for two sides to shake hands and move on.

“We’re all from the same department—we should help each other out, Director Zheng. Don’t be so formal. If my own patients have problems I miss, wouldn’t I need to ask for your help too?”

Director Shang said with a smile.

“You’re right, we’re one team, one family.”

With that, the tension between the two directors dissolved.

Having the department’s two strongest doctors patch things up was great news for everyone else.

Sometimes, picking sides in these situations is just impossible.

“It’s getting late, let’s keep rounding on the patients.”

Director Shang led everyone onward.

When they got to Bed 79 and saw the lawyer with cirrhosis, Zhou Can reminded Director Shang to order a splenic vein imaging test for her.

Shang wasted no time, putting the order in on the spot.

That little incident also showed how much status Zhou Can now had with Director Shang.

Before they’d even finished rounds, Huang Liang—who’d taken the patient to her scan—called back.

The CT showed free air in the abdomen, severe bowel dilation and heavy fluid between the loops.

So the patient really did have a bowel perforation, and it had been there for a while.

No wonder she was in so much pain.

When it comes to suspected bowel perforation, CT is usually the first choice, since it’s more sensitive than traditional X-ray.

Plenty of older doctors still like plain X-rays better.

It’s a habit, one they developed during times of limited medical resources.

Back then, MRI didn’t exist and CTs only entered China around the late ’70s and ’80s.

Hospitals mostly relied on Doppler ultrasound and X-rays.

A lot of senior doctors grew up in that era, so they’re still attached to traditional scans.

When Zheng Hongtao learned the patient really had a perforation and was in serious danger, he felt as though he’d just dodged catastrophe.

It was all thanks to Zhou Can catching it in time.

So many chief and associate chief physicians had missed this bowel leak, but Zhou Can, just a trainee, had spotted it—thanks to his background in General Surgery and wealth of clinical experience.

That’s why top hospitals now pick their elite trainees from generalists.

Doctors with experience across every department are better diagnosticians, whether they end up in surgery or internal medicine, than those who train in just one specialty.

Those who join for a single field know only that field’s illnesses.

For anything else, they’re clueless, and once they’re on the job they won’t dare touch any patient outside their comfort zone.

“Director Shang, I need to get the patient straight over to General Surgery for emergency treatment. I’ll excuse myself.”

After the call, Zheng Hongtao hurried off to General Surgery.

Confirming the diagnosis in Bed 7 put Zhou Can in the spotlight—more and more doctors started giving this talented young trainee a second look.

While finishing rounds, several struck up conversations with Zhou Can.

It was proof that his reputation in the department had climbed to a whole new level.

…

After rounds, Zhou Can’s truly busy day kicked off.

He sent the stomach cancer patient from Bed 77 to the Interventional Operating Room, ready for an endoscopic procedure.

Director Shang himself would be the one wielding the scalpel.

The patient—a woman—was just moving from early to advanced-stage stomach cancer.

In medicine, cases are usually spoken of as more serious than the reality.

Truth is, her cancer was still early—barely even stage two by strict interpretation.

That’s why Director Shang agreed to an endoscopic surgery.

If stomach cancer actually advances to stage two, with major cell metastasis, surgery is usually no longer an option. Only interventional therapy and chemo are left.

And those only prolong life—they don’t cure.

By then, a cure is nearly impossible.

But catch stomach cancer early, operate on time, and follow up with radiation, and the outlook is usually very good.

Inside the Interventional Operating Room, the patient lay calmly on the table, prepped and ready to go.

Director Shang rushed in with Dr. Huang Xinggui and three graduate students.

Meanwhile, Zhou Can thought to himself—if he could get this surgery, he’d be first in line for future endoscopies in Director Shang’s group.

The Gastroenterology Department performed more endoscopic operations than any other.

Several of Zhou Can’s surgical skills were still only at level four. If he could upgrade them to level five during these few months in gastro, his future would brighten dramatically.

Get a head start early and you’ll always be ahead.

Especially with techniques like Incision, Tissue Separation and Anastomosis—they were notoriously hard to level up.

Each endoscopic surgery handed out 100 points of experience, making it the perfect way to grind these crucial skills.

“Director Shang, you already checked my endoscopic surgery experience before—can I take the lead on this operation?”

Before Director Shang could reach the operating table, Zhou Can pushed past his nerves and seized the chance.

Unlike traditional open surgeries, for endoscopies the main operator picks a position that’s easy to handle the instruments while watching the front screen.

“You’re really serious about this?”

Director Shang fixed his eyes on Zhou Can, exerting a pressure that made Zhou’s heart pound.

But Zhou knew this was the time to show real confidence, or Director Shang would never trust him with the procedure.

“I’m absolutely serious. If I feel unsure, I’ll stop immediately—I’d never push through at the patient’s expense. I’ve studied all her images thoroughly. I’m confident I can do it, or I wouldn’t have asked.”

Zhou spoke earnestly, his gaze steady and sincere.

A quiet confidence radiated from him.