Chapter 264: A Thorny Case and the Power of Trust

After the patient left, Director Zheng stood up and gripped Zhou Can’s hand tightly.

“Dr. Zhou, thank you for coming to help! This case was incredibly tough to diagnose. Once we get the results from the small intestine perfusion test, I’ll need your expertise again.”

Zheng Hongtao treated Zhou Can with such respect because he knew he needed Zhou Can’s skill for this diagnosis.

And if they could crack a disease that even the big hospitals couldn’t handle, and cure the patient, the perks for him would be huge.

An expert’s authority and reputation are built over time—on tough cases and high-impact research published bit by bit.

You have to pile up the dirt to build a high platform. A towering tree starts from a tiny sprout.

No renowned doctor rises to fame overnight.

Those so-called miracle doctors who become famous from a case or two and get called ‘divine healers’ are usually just con artists. Real miracle doctors are practically nonexistent.

People who travel miles hoping for a miracle are just paying an intelligence tax.

Of course, there are a few miracle healers with real skills—hidden masters of traditional medicine who’ve never bothered with a license, act like they don’t care about anything, and might look like total fakes.

Yet some of them truly possess lost medical arts and have genuinely relieved countless patients’ suffering.

But these miracle healers differ from fraudsters in one critical way.

They aren’t in it for the money. Their fees are low or sometimes, like old-world doctors, they won’t charge poor patients a penny. They’ll even lose money to help them just to ease someone’s pain.

Frauds, though, are all about the gimmicks—like ‘healing illnesses with special powers’ or wild claims that a secret folk remedy can cure everything.

Every single one of those is just after your money.

Even if a patient feels better afterward, it’s all in their mind.

Medically speaking, any drug that claims to cure everything is always fake—just a supplement or a scam.

From Zhou Can’s professional point of view, real medicine always comes with serious side effects.

They only treat one specific disease—not some miracle panacea.

Most are prescription meds regular people can’t just buy.

Even doctors agonize over prescriptions, weighing every detail before writing one out.

After returning from the outpatient department, Zhou Can got back to his office to write up case notes, record disease progress, and review physician orders.

As he got more comfortable writing orders on his own, he noticed his own knowledge and experience weren’t enough. So besides consulting senior doctors more frequently, he kept brainstorming ways to quickly improve his prescribing skills.

He worked hard every day to study, grabbing every chance to shore up his fundamental medical knowledge.

He’d also use his permissions to review past cases in the department, studying the orders issued by Director Shang, Director Zheng, Deputy Director Shi, and others to learn from their approach.

This method worked incredibly well.

With every case he reviewed, he’d gain 1 point each in Pharmacological Reasoning and Pathology Diagnosis.

Talk about killing multiple birds with one stone.

Near six in the evening, the patient with diarrhea and diabetes insipidus finished the small intestine perfusion test. The patient’s family brought the results to Director Zheng Hongtao, who headed straight to Zhou Can’s office with them.

After all, as a chief physician, it was a bit awkward having to keep asking Zhou Can for help in front of the family.

So he sent the family away and went to Zhou Can alone with the test results.

Complicated cases like this are always tough to analyze and diagnose.

Discussing it with Zhou Can wouldn’t make anyone laugh at him.

And besides, plenty of doctors in the department asked Zhou Can for help all the time.

Even the junior nurses started coming to Zhou Can now.

If a patient needed a catheter or IV but was too overweight for easy veins, they’d all come looking for Zhou Can.

They all came to him for help.

Pretty nurses in their twenties would sweetly call him ‘Can-ge’—and he really couldn’t turn them down.

Unless he was really busy, he’d always help them out.

He could earn experience, and win their heartfelt thanks—why not do it?

Especially with procedures like urinary or tracheal catheterization—he got 1 point in Device Implantation every time, and sometimes, if he was lucky, he’d get a 10-point bonus as a reward.

“Dr. Zhou, based on the small intestine perfusion test, the patient’s intestine is secreting abnormally high levels of water and electrolytes. We can tentatively diagnose secretory diarrhea.”

Zheng Hongtao handed him the test results.

The patient had also done stool routine and bacterial culture tests, both negative.

That ruled out chronic bacterial inflammation of the intestines.

There are four common types of diarrhea: secretory, osmotic, exudative, and those due to gastrointestinal dysfunction.

Exudative diarrhea is basically what we call inflammatory diarrhea.

Such as enteritis.

So running stool tests and bacterial cultures are crucial for diagnosis. With a negative bacterial culture, exudative diarrhea was ruled out immediately.

The small intestine perfusion test helped them zero in on secretory diarrhea.

“The patient’s stool routine shows potassium, sodium, chloride, and bicarbonate excretion are all extremely elevated. The highest levels are twenty times the norm. No wonder his body couldn’t take it.”

Zhou Can truly felt for this patient. After so many days of nonstop runs, anyone else would have suffered rectal prolapse by now.

“If he weren’t a young man in his twenties—the prime of his life—he’d already be in the ICU. Now we know what kind of diarrhea it is. Next, we have to find the cause. Dr. Zhou, any insights?”

When Director Zheng discussed the case with Zhou Can, he spoke like they were equals.

What made this patient so tricky was that every direction of diagnosis seemed blocked by invisible walls.

For example, they found hypokalemia and knew it was from alkalosis, but going further proved difficult.

Now, by changing diagnostic tracks and focusing on the diarrhea, plus the perfusion and stool tests, they’d isolated secretory diarrhea. But the underlying cause was still a mystery.

There are too many causes of secretory diarrhea.

Time for Zhou Can to sift through the fog and separate truth from noise.

The hardest part of pathology diagnosis is that with complex diseases, the true cause is like the hidden answer in a tricky math problem—only after step-by-step deduction can you possibly find it.

Possible causes of secretory diarrhea flashed rapidly through Zhou Can’s mind.

Cholera—the infamous Class A infectious disease that killed countless people in ancient times.

Even today, with advanced medicine, cholera is still deadly.

The patient’s days of relentless diarrhea matched the cholera profile.

Second disease he considered: pancreatic endocrine tumors. Pancreatic cancer’s reputation as the ‘King of Cancers’ is well earned. Its unexplained diarrhea can be so severe it leads to irreparable rectal prolapse.

During his critical care training, Zhou Can had seen patients literally pull out their own intestines while straining.

Third possibility: carcinoid syndrome, which also triggers diarrhea—again, linked to cancer.

So if someone suffers from long-term diarrhea, they must go get checked out at the hospital, because it’s often linked to cancer.

All cancers benefit from early detection and early treatment.

In developed countries, cancer rates are actually very high.

But they take checkups seriously and have a different consumer mindset from the simple, thrifty habits of many in China. Spend money and travel or buy things for fun is normal for them.

Spending in advance or on credit is just everyday life.

In China, even when people feel unwell, as long as it’s not serious, few take the initiative to get checked.

They’re afraid of the cost, or of missing work.

The fourth disease Zhou Can thought of was medullary thyroid carcinoma. The patient’s low potassium and persistent diarrhea lined up with its clinical signs.

Besides these four that cause hypokalemia and severe diarrhea, there’s also villous adenoma of the colon, which triggers intense diarrhea.

In just moments, Zhou Can had listed six or seven possibilities strongly matching the patient’s symptoms.

Which one is it? More tests are needed.

So far, they’d only done blood routine, urine and stool tests, and the small intestine perfusion. That wasn’t much to go on.

“Director Zheng, could we apply for an abdominal ultrasound for the patient?”

Zhou Can had reached the end of what he could diagnose for now.

“No problem requesting an ultrasound. What are you thinking?”

Director Zheng knew Zhou Can always had good reasons for his test suggestions.

But this time, he was curious—what exactly did Zhou Can want to look for?

“I want to check if the patient has any tumors in the abdominal cavity. Several possible causes of secretory diarrhea are related to malignancies. We don’t have enough data to go further. Maybe the ultrasound will give us new clues.”

Zhou Can answered honestly.

“Something this odd could definitely be cancer. We should check. I hope it’s not—he’s so young and comes from a single-parent family. His mom raised him into a college graduate. He just entered society and now has to face this… Trouble always seems to find the ones who’ve had it hardest.”

Director Zheng let out a long sigh.

He’d seen too many human tragedies in his years of practice.

And the more he saw, the less numb he became. Instead, he developed a compassion close to that of the Bodhisattva.

No matter who comes to pray, the Bodhisattva always stays silent.

Maybe there are no gods, but people still find faith in them.

Not for anything else, but because as people, we all face suffering and hardship and need something to keep our spirits strong.

After enduring so many moments of powerlessness, a doctor’s mindset quietly transforms. They become quietly compassionate, doing everything they can to help.

If there’s truly nothing else they can do, they learn to let things go.

“It’s already after hours. Imaging is closed for the day. We’ll schedule the ultrasound for tomorrow morning.”

Director Zheng took the test result and went to arrange the next step.

Zhou Can went to the ward to check on all twelve patients under his care. Overall, they were doing well. Three could be discharged tomorrow, two would have interventional procedures, four were scheduled for endoscopic surgery, and the last three were in maintenance care.

These twelve patients made clear that even in the gastroenterology department, most aren’t treated with drugs alone.

Many require interventions, endoscopic, or minimally invasive procedures.

Only a few can be managed with medication alone in the hospital, since those patients mostly take their medicine at home.

If a hospital stay isn’t necessary, people avoid it.

After a course of medicine, they return for checkups as needed.

After finishing rounds and handover, Zhou Can skipped dinner and rushed back to his apartment.

From a distance, he spotted Su Qianqian’s BMW parked by the curb.

“Dr. Zhou!”

Wei Fang, now professionally trained in security, had better observation skills than most. She spotted Zhou Can from afar and quickly approached.

“Come on, let’s go upstairs!”

Zhou Can’s face was practically unreadable.

“Didn’t I ask you to stop calling me Dr. Zhou? You can call me Zhou-ge, Can-ge, even just ‘big bro’ if you like.”

He was honestly pretty satisfied with Wei Fang’s work.

She was just a bit rigid—no matter how he suggested more familiar terms, she always insisted on ‘Dr. Zhou’ and never relaxed around him.

Once upstairs inside Zhou Can’s apartment, Jin Mingxi wasn’t home yet.

Unlike Zhou Can’s regular schedule, Jin Mingxi lived the life of a typical trainee, with long hours and overtime keeping him busy.

It was just as well—there was a confidential matter to discuss with Wei Fang and it was better if Jin Mingxi wasn’t around.

If Jin Mingxi was there, they’d have to talk in the car.

As soon as Wei Fang entered the room, Zhou Can closed the door.

Alone with Zhou Can, Wei Fang showed no anxiety at all, as if she never worried he’d do anything out of line.

Truthfully, Zhou Can’s character was solid.

“Sit.”

He gestured for Wei Fang to take a seat.

“Have some water.”

He poured her a cup of plain water, making Wei Fang feel both surprised and grateful. She scrambled up to accept it.

“I asked you here because I have something extremely important for you to handle. This powder has no color or taste. Tomorrow, when Qianqian meets with Hu Wei, you’ll need to slip it into his drink. Since he betrayed Jin Yu Interactive and caused so much trouble, he’s bound to be cunning. Be extra careful—don’t leave any evidence.”

Zhou Can was using every bit of his medical expertise to take care of his enemies.

“Don’t worry. This isn’t poison. As long as you leave no evidence and act with care, you won’t be at legal risk. The meeting room will be chosen purposely without surveillance, but be extra cautious. If you really can’t pull it off, just back out.”

Zhou Can had thought this decision through before trusting Wei Fang with the task.

For now, she was the only truly trustworthy person by Qianqian’s side.

“You basically saved my life. For the past two years, you’ve provided me a life better than I ever dreamed. I’d do anything for you. If you or Miss Su were ever in danger, I’d gladly take a bullet. I don’t ask for anything in return, just that if something ever happens to me, you promise to take care of my grandmother.”

Wei Fang spoke with a sincerity that she had never shown before.

Even if she hadn’t said it, Zhou Can already trusted that she’d risk her life to protect Su Qianqian.

That was just the kind of loyalty she had.

“You don’t need to worry about your grandmother’s golden years. If anything ever happens to you, I’ll care for her as if she were my own. But as your employer, I have to insist—protecting Qianqian is important, but so is protecting yourself. Your life is just as valuable as hers. Understood?”

Zhou Can’s tone became sterner.

“Understood!”

Her face barely changed, but the emotion in her eyes showed just how much Zhou Can’s words moved her.

“There are two packets of powder. If something goes wrong, you’ll have a backup. Once Hu Wei drinks it, you don’t need to worry. He won’t show any symptoms right away…”

Zhou Can had always been wise beyond his years—he took every precaution and planned ahead.

He prepared for every possible accident.

Once Hu Wei took that powder, Zhou Can would have leverage to control him.

By then, Hu Haikun wouldn’t know what hit him.