Chapter 255: Rising Stars in the Ward

By now Zhou Can had already finished checking on the patient in Bed 65 for Yu Xin and headed straight for the hallway.

He had no plans to trouble himself with Director Zheng’s group of patients.

Sometimes, when you’re too eager to help, people might not appreciate it. They may even think you’re just showing off.

“Dr. Yu, I’m heading back to the office to write case notes and progress reports. If you need anything, come find me. But after nine, you’ll have to wait until I’m out of surgery.”

He told her with a nod.

“Thanks so much!”

Yu Xin couldn’t hide her envy over Zhou Can’s special status in the Gastroenterology Department. He got to scrub in on surgeries with Director Shang or Deputy Director Shi nearly every day. Whenever Director Shang had outpatient hours, Zhou Can was always invited along.

Opportunities like that would make even a resident doctor jealous, let alone a trainee.

Take Dr. Huang Liang for example—he was already considered a standout among the residents, but he still only got one day of outpatient experience each week. And even then, he was solo. No one to supervise.

Despite the huge volume at Tuyu Hospital’s Gastroenterology Clinic, whenever these residents took their turn, their offices were completely deserted.

Even with registration for just eight yuan, hardly any patients would book with the resident doctors.

If the expert, deputy director, or attending slots filled up and patients had no choice but to get a resident appointment, they’d do so with obvious reluctance.

They’d rather scramble for pricey director-level spots than pick the cheapest resident slots.

With so few patients, there wasn’t much chance for these residents to learn.

A whole day in the clinic for them might not bring as much experience as Zhou Can got from diagnosing a single patient beside Director Shang.

Almost everyone who booked with a special-expert was a tricky or serious case. Working with patients like that was how you picked up real skills.

Zhou Can hurried back to the office and dove into his pile of medical records and progress notes.

A few cases were easy enough, but with eleven patients to write up, the workload was overwhelming. There were a lot of details to keep straight.

Every single patient’s orders needed triple-checking, and he had to make at least two rounds each day.

Every detail—from discharge times to surgeries, diagnostic tests, and prescriptions—fell on Zhou Can’s shoulders.

If all he had to do was look after these eleven patients, he could just about manage.

But on top of that, he had to carve out half a day for surgeries or to shadow Director Shang at clinic. He only had twenty-four hours in a day, but official work hours were eight.

In reality, his workdays regularly stretched beyond ten hours.

If there was a tough endoscopic surgery or complications with a patient he was responsible for, he would leave even later.

Like the other night—a patient vomiting blood got admitted just before shift ended.

The patient kept throwing up blood every so often. It was a harrowing sight.

As the primary bedside doctor, Zhou Can couldn’t just walk out under those circumstances.

Handing over a patient whose root problem wasn’t clear and whose symptoms weren’t stable to the on-call doctor? Maybe nobody would say it out loud, but inside, they’d be cursing him.

Out of pure duty, Zhou Can couldn’t clock out until he made sure the patient was okay. Otherwise, he’d lose sleep worrying.

What if the patient died overnight?

He was still in the middle of his progress notes when Duan Zifu came running over, out of breath.

“Dr. Zhou, please—you have to help Yu Xin! The elderly woman in Bed 65, her blood pressure just started dropping for no reason!”

Seeing Duan Zifu’s anxious face, Zhou Can couldn’t help but think, ‘Simp for the goddess.’

Duan Zifu clearly had a thing for Yu Xin and was always finding ways to chase after her.

But Yu Xin kept her distance, always cool with him—never even cracked a smile. Their conversations were short and to the point. That didn’t faze Duan Zifu. He kept finding chances to do her favors.

Whenever they passed in the hall, he was always first to greet her with a big grin.

Even if they worked in different wards, he’d find some reason to stop by and see her.

“The blood pressure’s dropping? What’s the old lady up to now?”

A sudden drop in blood pressure put Zhou Can instantly on high alert.

This patient had just come out of the Critical Care Department. Any setback could be fatal if handled badly.

When blood pressure crashes, it usually means things are quickly going downhill.

He hurried into the ward, where Yu Xin stood at the bedside nervously taking the elderly woman’s blood pressure.

“Dr. Zhou, her blood pressure nosedived all of a sudden and it’s still falling. Please, can you take a look?”

Yu Xin was so anxious even her forehead was breaking out in sweat.

“You didn’t change her medications, right?”

Medication errors were Zhou Can’s first suspicion.

That’s often the quickest way for a patient’s blood pressure to tank.

“No, I definitely didn’t change anything! She only just transferred from critical care—there’s no way I’d touch her orders!” Yu Xin bit her lip and shook her head in denial.

Zhou Can checked the IV bags carefully. The drug names were written with thick black marker. Everything was correct.

That ruled out medication errors or overdosing.

He glanced at the patient—her forehead was soaked with sweat.

He lifted the quilt and saw she was covered with a thick coat, the hospital blanket piled on top.

Was someone trying to sweat her out?

“When did you put that coat on her?”

He asked.

“About an hour ago, I think! Why? Is her dropping blood pressure related to all that clothing?”

The family member sounded puzzled.

“When I left earlier she wasn’t sweating. Now it’s only been about forty minutes and she’s soaked. That suggests her blood pressure crash was likely caused by excessive fluid loss from sweating in a short time.”

After a careful look, Zhou Can offered his preliminary conclusion.

Myocardial infarction, hypothyroidism, or adrenal insufficiency could basically be ruled out.

That made him even more certain that it was the over-bundling that did it.

“Wow, I really panicked and missed that. I should have thought of it sooner!”

Listening to his explanation, Yu Xin finally saw the light.

They gave the patient fluids and removed her extra layer to stop the excessive sweating.

Not long after, the elderly woman’s blood pressure recovered.

Yu Xin let out a long sigh of relief.

That emergency had really rattled her.

“All right, just a false alarm.”

Zhou Can shrugged and started to leave.

But the intern responsible for Bed 67 stepped forward, looking nervous but respectful. “Dr. Zhou, could you take a look at our patient? We still haven’t found the root cause. He had diarrhea just before but his abdominal pain hasn’t eased.”

Normally, patients with abdominal pain—especially acute enteritis—feel better after passing stool.

But this patient’s pain had persisted over fourteen hours. That had Dr. Huang Liang, who’d almost had a crisis with another patient recently, extremely on edge.

He worried the patient might have something dangerous, like an intestinal perforation.

Unlike a trainee, as a senior resident, he had much more responsibility than just looking after a bed.

He was in charge of the whole treatment process.

In short, he was the attending doctor.

Zhou Can glanced over at Bed 67 and spotted Huang Liang standing there with an awkward look, forcing a stiff smile.

Some people were really funny.

Too proud to ask for help himself, Huang Liang had sent his intern to do it for him.

“I’m just here to offer another perspective. My suggestions might not always be right.”

Zhou Can stayed modest.

He walked to Bed 67 and began observing the patient closely.

“Dr. Zhou has been diagnosing tricky cases left and right recently. Director Zheng told us to learn from you, you’re really too humble! This patient’s symptoms keep worsening—I’ve got my own suspicions, but I’d feel better if you checked too.”

Huang Liang forced himself to say that. He was praising Zhou Can, but careful not to lower himself too much.

“Can you share your diagnosis, Dr. Huang?”

Zhou Can asked.

“Given the symptoms, I’m leaning toward acute gastrointestinal perforation or perhaps acute cholecystitis.” Huang Liang offered two guesses—clearly not confident in either.

And yet he still tried to act tough in front of Zhou Can.

Zhou Can let it slide.

Instead he took the patient’s chart and began reading carefully.

The patient’s abdominal ultrasound showed no abnormal shadows. X-rays were also clear.

The patient, age 31 and in good health, had gone out drinking and eating hotpot with friends last night. Afterward he felt severe pain in his upper abdomen for hours, and only came to Tuyu Hospital’s ER when it didn’t let up. The ER tried antibiotics, but nothing worked. So they sent him to the specialty department.

He’d vomited a few times, bringing up stomach contents. The pain hadn’t moved or radiated, there was no chest pain, no fever or chills, no urgent urination, and no blood in his stool or vomit…

After reviewing all this, Zhou Can made a mental assessment—the case was urgent, but not as dire as it first seemed.

Probably an acute attack brought on by binge eating and drinking.

Hotpot is famously spicy and hot.

Add alcohol and any underlying issues can suddenly explode.

The patient’s WBC was 22 x 10^9/L, blood glucose 15.3, heart rate 85. No family history of diabetes…

Cardiac enzymes were normal.

Calcium was low, glucose and lipids high. Amylase was up too.

Cholecystitis was a possibility.

But acute GI perforation seemed unlikely.

Zhou Can pressed on the man’s abdomen—whenever he hit the upper part, the patient yelped in pain, but touching elsewhere got no reaction.

“Try pulling your knees up to your chest.”

Zhou Can instructed the man lying in bed.

The man did as told, instantly relaxing into a relieved expression.

“Hey, that actually feels better!”

His pain lessened, and he couldn’t help trusting this young doctor a bit more.

“Have you ever had anything like this before?”

With the pain eased for now, Zhou Can continued the questions.

“Never. It’s never hurt like this.”

The patient shook his head.

His girlfriend was sitting at his bedside, looking exhausted. Anyone would be after a sleepless night worrying over a loved one.

“Do you smoke?”

“Yeah.”

“Has his complexion always been this yellow?”

“Not really, I think. He used to be pretty fair.” His girlfriend answered after a pause.

“Dr. Huang, considering the symptoms and all the lab results, the mild jaundice, and the clear ultrasound and X-rays, my diagnosis is acute pancreatitis. I think his jaundice is likely caused by swelling of the pancreatic head pressing the common bile duct. The elevated amylase backs that up.”

After going over all the data and signs, Zhou Can gave his preliminary diagnosis.

“So it’s not acute cholecystitis?”

Huang Liang’s expression shifted.

He’d made two guesses, but missed both.

“Doesn’t look like it.”

Zhou Can shook his head calmly.

“When I examined him, there was tenderness in the upper abdomen plus muscle tension. The other lab findings point more toward acute pancreatitis—the main trigger is activation of zymogens inside the acinar cells, which sets off a chain reaction, and binge eating was likely what set it off.”

Zhou Can’s skills in pathology diagnosis were almost at attending level—rapidly improving.

He also had a special skill: Life-saving Insight, which boosted his diagnostic accuracy.

On top of that, his mentors were multiple chief physicians—no wonder his level outpaced even senior residents like Huang Liang.

He could see right through symptoms and labs to pinpoint the real problem.

Other doctors with less experience sometimes just saw a fog.

“But nothing obvious turned up on the earlier ultrasound.”

Huang Liang still felt reluctant.

“Let’s repeat it now. The pancreas is probably clearly swollen by this point.”

Zhou Can replied with a quiet confidence.

Ultrasound results could change as a patient’s condition evolved. With some illnesses, it was worth repeating tests more than once.

Of course, frequent repeat scans could be hard for patients and their family to understand.

That meant physicians needed to patiently explain and communicate.

So patients understood doctors weren’t just after extra fees—they were trying to pinpoint the problem and cure their pain.

Huang Liang mulled over what Zhou Can said for half a minute, then finally decided.

“You all heard Dr. Zhou. I’m going to order another abdominal ultrasound right away.” Huang Liang looked at the patient and his family.

Repeating tests like this meant getting their understanding and consent.

“Okay. I trust Dr. Zhou’s judgment.”

The patient had been sharp and alert the whole time—Zhou Can moved with the poise and confidence of a chief physician, not a mere resident.

That’s what they meant by true leadership.

It made people want to trust him without question.

Huang Liang went ahead and ordered the ultrasound. Maybe his scare with that intestinal perforation case a few days ago left him nervous, but he didn’t dare wait—he personally escorted the patient for the scan.

Usually, escorted exams meant no waiting in line.

Especially with emergency cases—Imaging staff had a duty to prioritize them.

Like chest pain patients, who could go straight through the Chest Pain Center’s green channel.

The results came back fast.

Sure enough, Zhou Can’s diagnosis was correct: the man had acute pancreatitis.

This changed the way Huang Liang saw Zhou Can. The last bit of pride dropped away—he was finally convinced. Sometimes it’s hard to separate doctors’ skill levels.

But when the gap is so wide, it’s obvious who’s on top.

In both recent cases, Zhou Can clearly outperformed him.

He didn’t need anyone to point it out: Huang Liang knew it himself.

Just then, Director Shang’s grad student, Luo Jingyin, came running over and shouted from the doorway.

“Dr. Zhou, Director Shang wants to know—are your patients all handed off? They’ll be starting the interventional surgery any minute!”

A chief physician personally calling a trainee to join surgery? That made even Huang Liang jealous.

Deep down, he admired Zhou Can more than ever.

“All done! I’ll come with you right away.”

Zhou Can had learned by now. Every morning before 8:50, he had to hand over his current patients to Chief Resident Luo Shengsheng or someone else on the team.

Because surgeries with Director Shang or Deputy Director Shi, or Dr. Huang Xinggui, usually happened around nine in the morning.