Chapter 265: A Doctor’s Difficult Truth

After sending Wei Fang off Zhou Can couldn’t help but feel a surge of anticipation about this medicine’s effects.

Whether it’s truly effective is still up in the air.

They’ll have to wait about seventy-two hours after Hu Wei takes it to see if it works. The formula itself he picked up from Director Wen of the Neurosurgery Department.

Back then Director Wen had just casually mentioned the recipe to Zhou Can on a whim. In fact the formula wasn’t Director Wen’s original research—it was passed down to him by his mentor on their deathbed, asking him to continue studying it.

One person’s offhand words became another’s inspiration.

Zhou Can found it fascinating and memorized the formula. After figuring out how to make it, he still hadn’t tried it in clinical practice yet.

Using Hu Wei as a free test subject didn’t seem like such a bad idea.

……

The next day, just past 10 a.m., the patient suffering from diarrhea and diabetes insipidus finished waiting in line for his abdominal ultrasound.

Director Zheng had already left word. He’d be performing two major endoscopic surgeries in the operating room that morning, so patients with results could go straight to the inpatient department to find Zhou Can.

This was a tough case—definitely not one just anyone could handle.

The patient’s mother came to Zhou Can, clutching the test results.

But after taking the ultrasound report and reading it over Zhou Can stayed silent for a long time.

“Dr. Zhou, can you find out what’s wrong with my son? Is his illness very serious?”

The worried look on the family member’s face said it all.

This was a mother’s love for her child. Raising her son as a single parent had been no easy road.

To her, her son was everything—the reason she kept living.

Zhou Can could clearly sense her anxiety and mounting tension.

“Based on the ultrasound results the news isn’t great. The scan shows multiple space-occupying lesions in the liver. This likely points to a pancreatic neuroendocrine tumor.”

Before the ultrasound Zhou Can had hoped there wasn’t anything seriously wrong.

But things had shifted precisely in the direction he dreaded.

Pancreatic neuroendocrine tumors can be divided into functional and nonfunctional types.

Nonfunctional tumors don’t secrete neuroendocrine substances or cause any unusual symptoms.

Clearly with diarrhea as severe as this the patient almost certainly has a functional tumor.

The exact type of tumor was still unclear.

It could be an insulinoma, gastrinoma, glucagonoma, VIPoma, somatostatinoma—any of these were possible.

There’s a reason pancreatic cancer has earned the nickname ‘King of Cancers.’ It’s truly terrifying.

“A tumor…” The patient’s mother was visibly shocked and pained. Instinctively, she pressed a hand to her forehead and temples, her body swaying as if ready to collapse.

“Please, try not to panic. At this stage we’re only suspecting a pancreatic neuroendocrine tumor. This isn’t a final diagnosis yet.”

Zhou Can could only offer comforting words he didn’t quite believe himself.

But he knew deep down the ultrasound had almost confirmed the presence of a neuroendocrine tumor—one that had most likely already spread.

At minimum, it was already at a middle stage.

That meant once the diagnosis was confirmed the patient might not even be eligible for surgery.

The King of Cancers gives no one a fighting chance.

It rarely lets doctors mount a timely rescue.

It doesn’t even allow you the hope of just slowing it down.

Quickly Zhou Can got up and helped the woman into his office chair.

He then hurried to the door and waved at the nurses’ station. “Xiao Li, if you’re not too busy could you come give me a hand?”

The nurses in Gastroenterology often asked Zhou Can for help, so he was on friendly terms with them.

Plus people liked him—young, well-off, generous, always treating the nurses to milk tea or barbecue after work.

For the record, when he treated the nurses to barbecue after hours he never went himself.

He’d just hand money to a lead nurse and reimburse her the next day.

Don’t be fooled by the pretty, highly educated nurses in the department—they still loved taking advantage of a freebie here and there.

Whenever Zhou Can was buying, they’d show up for barbecue even if it wasn’t their shift.

But they were decent people; sure they liked scoring free food, but never to the point of greed. They always found little ways to give back—being extra careful with his cases or returning the favor in small tokens.

Sometimes they’d slip him a couple cookies or a snack into his pocket.

Every time, it left him both amused and a little exasperated.

For the girls, sneaking snacks at work was a guilty pleasure. But Zhou Can? Besides the occasional piece of fruit he almost never touched snacks.

With his busy work and study schedule, plus the fact that men and women have different habits, he just didn’t want them.

Xiao Li, the nurse, came running. “Zhou, what’s up?”

“That woman in the office just found out her son might have a pancreatic tumor. She nearly fainted. Could you stay with her and help support her? If she fell or anything happened, it’d be hard to explain later.”

As a man, Zhou Can really wasn’t comfortable personally supporting a female family member.

Even though this woman was already fifty, he couldn’t ignore the optics.

Rumors ruin reputations.

These days even a doctored photo can destroy a doctor’s career overnight.

Remember that scandal not long ago? A photo went viral claiming a nurse was browsing her phone while rescuing a patient. Anyone with sense knew that in the middle of an emergency, no one would dare slack off and play on their phone.

Later it turned out the nurse wasn’t goofing off. She was actually contacting specialists and coordinating emergency supplies for the rescue—on her phone.

But the grieving family blamed her for their relative’s death, snapped a photo, and posted it online.

The uproar that followed was massive.

Thankfully the truth came out, and her name was cleared.

There are just too many sweat-and-tears stories for doctors and nurses in the real world.

When it comes to comforting people, the nurses had some real skill. With Xiao Li’s gentle words, the mother’s nerves gradually calmed. But the sorrow between her brows never lifted.

Since this patient was under Director Zheng’s care and the diagnosis had taken a big step forward, Zhou Can knew he needed to report right away.

Even if Director Zheng was in surgery, he had no choice.

Zhou Can dialed Director Zheng’s number without hesitation.

“Dr. Zhou, did you get results on the patient with the diarrhea and diabetes insipidus?”

“We still can’t pinpoint the exact cause. But the abdominal ultrasound already shows multiple space-occupying lesions in the liver!”

He gave Director Zheng a rundown of the patient’s situation.

“That’s serious trouble…”

After a few seconds of silence, Director Zheng’s voice came out heavy with a long sigh.

Sometimes a doctor’s medical predictions are as precise as scientific forecasts.

The better the doctors on a case, the more accurate their judgments.

Before the ultrasound Zhou Can had predicted the disease was probably a malignant tumor. Sure enough, it was confirmed.

“It’s truly heartbreaking. Do you think it’s necessary to do a plasma hormone level test now? Though the ultrasound isn’t promising, we’re still a couple steps away from a definitive diagnosis.”

Zhou asked Director Zheng about the next step in treatment.

“Let’s do it! Once we have the results we can determine the specific type of pancreatic tumor.”

Director Zheng agreed at once.

“Frankly, I don’t think the plasma test will hold any surprises. There’s only the slightest bit of hope left. Next we’ll need imaging to check for metastasis. If it hasn’t spread, or only reached the local lymph nodes, surgery might still be an option. I recommend a CT scan, focusing on the chest, abdomen, and neck.”

If the tumor had spread, the lymph nodes in the neck were the main places to check—they’re the richest in lymph tissue.

Organs in the chest are also easy targets for involvement.

It’s like if a neighbor’s house catches fire—nearby homes are the first to get hit.

When a tumor forms in one organ, the adjacent tissues and organs are usually the first affected.

“Alright! I’ll have Huang Liang fill out the test order and send it over right away. I’ll leave communicating with the family to you.”

Only Zhou Can and Director Zheng truly understood the patient’s situation—they’d been on this case from the start.

Huang Liang was good for paperwork and errands, but expecting him to sit down with the family was another matter entirely.

The order was filled out in no time.

Zhou Can talked with the family, and things went smoothly.

Once the plasma hormone level results came in Zhou Can saw both the VIP and SST values were shockingly elevated.

The VIP—vasoactive intestinal peptide—measured an incredible 300 to 890. For reference, a healthy person would be around 60. The patient’s results were over a dozen times higher than normal.

The SST, or somatostatin, hit a terrifying 600 to 2500 ng/l. The normal value is just 25. That’s a hundred times too high.

When Zhou Can saw these results his heart sank.

If only they’d come to him sooner.

But even if they had, he probably wouldn’t have had the experience to find the cause back then.

Now, based on the hormone levels, it was clear—the patient had a mixed VIPoma and somatostatinoma.

At last, the reason for the constant secretory diarrhea made sense.

VIP is found throughout the digestive nervous system and in the endocrine cells of the pancreas.

Its effects are manifold—relaxing smooth muscles, stimulating bile and sweat secretion, and making the intestines release water and electrolytes.

The patient’s high VIP levels were largely responsible for his watery diarrhea.

Somatostatin is mainly in the hypothalamus, pancreatic D cells, and small intestine.

Its role is mostly to inhibit digestive secretions.

With his SST a hundred times too high he’d have steatorrhea. But since he also had secretory diarrhea the effects partly canceled each other out.

Finally, the root causes of his diarrhea and diabetes insipidus were clear.

The truth was out at last.

The only hope now was that the upcoming CT scan would show the tumor hadn’t metastasized.

But luck wasn’t on their side—the CT results arrived fast.

They showed a mass in the body of the pancreas and metastatic tumors in the liver. Clinical practice confirmed the patient’s main pancreatic duct was completely blocked.

There were also abnormalities in the supraclavicular lymph nodes.

Without needing a biopsy Zhou Can could be sure—the cancer had spread to both the liver and the supraclavicular nodes.

Subsequent checks confirmed: it was a metastatic neuroendocrine tumor.

The test results were so dismal Zhou Can felt his heart go cold. Still he clung to hope and requested exploratory surgery—maybe they could still remove the tumor?

Cure wasn’t possible anymore.

But maybe they could at least buy the patient some time.

During the surgery, they found the neck and body of the pancreas were several times the normal size. The tumor had invaded nearby tissues and long since spread to the liver. The patient had lost any chance for an operation.

When the patient was wheeled out, his mother was already anxiously waiting outside the operating room.

She rushed up immediately.

“Dr. Zhou, how did the surgery go? Is my son okay?”

She already felt uneasy. Her face was pale, her hands trembled uncontrollably, almost like an old woman of ninety.

Before the surgery, Zhou Can had spelled everything out.

If surgery was possible, they’d have her sign a new consent and go straight in to remove the tumor.

But if there was no surgical option, all they could do was make her son’s last days less painful.

The surgery ended so soon—and no one came to her for a new consent. She knew what that meant.

“Take the patient back to the ward first. I’ll talk to the family about his condition.”

Zhou Can spoke to the nurses and Dr. Huang Liang.

Officially, Dr. Zheng Hongtao was in charge, but driven by a sense of duty Zhou Can had thrown himself into helping the patient.

In the end, he’d done all he could—fate just wouldn’t be changed.

Facing an advanced neuroendocrine tumor, there was nothing Zhou Can or Tuyu Hospital could do.

Modern medicine simply can’t cure someone at this stage of cancer.

Even extending a patient’s life would be a struggle.

Given the family’s situation, no ethical doctor would let them sell their home or empty their savings for further treatment. At this point, money meant nothing.

Otherwise, they’d lose everything—money and hope both gone.

When a patient is diagnosed with cancer doctors rarely tell the patient directly, sometimes even avoiding them. Whether the family chooses to tell the truth is their choice.

Zhou Can had the family sit with him on the bench in the hallway.

“Exploratory surgery showed your son’s tumor has metastasized to multiple sites. It’s late-stage cancer, which means surgery isn’t an option. All we can do is make him as comfortable as possible.”

On hearing this, the mother gripped the bench so tight her knuckles went white. Eyes closed, her face was twisted in agony.

A muffled sob welled from her throat and the tears came pouring down, running like beads along her weathered cheeks.

At fifty, lines had long since crept across her face.

A woman with an easy life and healthy habits might still look thirty at her age.

But her face was old before its time, haggard from years of hardship.

Now, her son’s diagnosis would plunge her into even deeper pain.

Watching her, it was hard for anyone not to feel wrenched.

“Dr. Zhou, how long does my son have left?”

She tried to wipe her tears but they kept coming.

No sooner had she dried them than a fresh wave would burst forth.

“If nothing unexpected happens, he should have around three months left. With advanced cancer spreading through the body’s organs, there’s unimaginable pain. Make sure he eats and drinks well. I wouldn’t recommend spending everything you have on expensive treatments—they won’t help.”

Zhou Can refused to profit off another’s desperation—not that he could say the same about all doctors and hospitals.

Some private hospitals won’t stop until they’ve squeezed every last drop from a cancer patient’s family.

It wasn’t rare for late-stage cancer treatment to cost millions.

Hospitals aren’t owned by any one person—they’re collectives. As long as families keep paying no one at the hospital would object, quite the opposite.

After all, every hospital needs to make money to stay afloat.

And a department’s success is tied to the staff’s income.

Everyone wants to live a better life.

“Just… only three months left…”

The mother’s legs almost gave out at those words.

It took a while for her to catch her breath, then she broke down, wailing into her hands.

Zhou Can wasn’t afraid of complicated medical cases, but dealing with a family member’s heartbreak left him feeling lost.

Her sobs drew the attention of others nearby.

Zhou Can grew even more uncomfortable by the moment.

In the future, he’d have to remember—these conversations belonged in his office, not the hallway.

Luckily, his good relationships paid off. A nurse hurried over.

“Dr. Zhou, what’s going on?”

“Her son was just diagnosed with late-stage cancer and given three months to live. She’s at her breaking point. Can you help comfort her?”

Right then, Zhou Can felt like he’d grabbed onto a lifeline.

All those milk teas and barbecues for the nurses had finally paid off.