Chapter 273: A Child’s Crisis in the Clinic

With nothing to do, Zhou Can found himself pondering the root cause of this obese woman’s illness.

There are plenty of reasons why someone might suddenly stop breathing in their sleep. Genetic factors are one example.

If someone in the family has this condition, there’s a high chance it will be passed down. Doctors can often spot this through inspection—take an oversized tongue, for example, which people call ‘big tongue disease.’ These patients often speak with a slight stutter.

That’s the classic sign of hereditary sleep apnea.

Almost every patient with an oversized tongue is at risk for sleep apnea. Their tongues are so large, it’s easy for them to fall back and block the throat.

Small jaw deformities, enlarged uvulas, or swollen turbinates can all increase the risk of sleep apnea as well.

People with these features fall into the high-risk category.

An experienced doctor can often spot it just by looking.

Aside from genetics, people who regularly drink or smoke are also prone to this condition.

Heavy drinking makes sleep apnea symptoms much worse.

Some folks have died after passing out drunk and being left unattended, only to be found lifeless the next morning. Sadly, these stories aren’t rare.

Zhou Can replayed images of the obese woman and her parents in his mind, but he couldn’t spot any obvious physical deformities.

Their speech was clear, and there were no signs of an oversized tongue or anything like that.

He’d asked about family history, but the patient’s parents hadn’t mentioned anyone else with the same problem.

So hereditary factors could pretty much be ruled out.

Long-term smoking or drinking didn’t seem likely either—she didn’t look the part.

Airway narrowing from obesity could be crossed off as well, since she’d already had surgery for it, and her family clearly said the symptoms persisted afterwards.

That pretty much ruled out airway narrowing as the main cause.

Unless hers was a special case, maybe something other than airway narrowing was behind it.

So what could the cause be? Endocrine imbalance?

That was actually quite likely.

Metabolic disorders can also lead to sudden pauses in breathing during sleep.

Zhou Can found his line of reasoning stalling right about here. To go any further, they’d have to wait for her to finish both the bronchoscopy and enhanced CT scan.

Just then, a woman at the next table caught Zhou Can’s attention.

She was holding a toddler, maybe a year or two old, and describing symptoms to the doctor.

“Doctor, could you take a look at my son? He seems to have a cold these past couple of days. Every time he breathes there’s a strange sound, like something’s blocking his nose. His forehead’s pretty hot too.”

The woman looked twenty-three or twenty-four, dressed plainly, her skin on the darker and rougher side. Judging by her appearance, her family probably wasn’t well off.

Their education level was usually pretty low as well.

People like this already have tough living conditions. Add a lack of health awareness and little exposure to medical knowledge, and sometimes they can be extremely set in their ways.

Instead of seeing a proper doctor, they’d rather pray, use folk remedies, or believe in old wives’ tales.

If she was the one getting sick, that wouldn’t be a problem.

No matter what she did, she’d only be hurting herself.

But if she used these methods on her sick child, the one paying the price was really the kid.

One look, and Zhou Can could tell the child’s face was already turning slightly blue—a clear sign things were serious. It had taken this long for Mom to bring him in? That was some nerve.

Sitting by Zhou Can’s side was Director Dai Shan from Tuyu’s Pediatrics Department.

She looked about forty-one or forty-two.

With her short hair and average looks, she gave off a capable, no-nonsense vibe.

Becoming a chief physician in Tuyu Hospital around the age of forty is actually quite young in this field.

Though senior titles are reviewed by city officials and the top titles by the provincial department, the reality is there’s plenty of subtlety involved.

Both county-level tertiary hospital and provincial tertiary hospital chief physicians are reviewed by the province, at least in theory.

But in practice, their skill levels can be worlds apart.

Take Tuyu for example—their recruitment process screens out most candidates at the internship stage, and their requirements are insanely strict. Every successful applicant has made it through fierce competition, standing out from thousands.

Their foundation is way stronger than the average county-level hospital trainee.

The later stages of training are on another level too.

Whether it’s mentoring, research, teaching, equipment, patient flow, or experience with tough cases, provincial hospitals outclass county hospitals in almost every way.

It’s easy to imagine the gap in abilities among doctors at the same title level between the two.

Still, there are always exceptions.

Some county-level hospitals have extremely capable chief physicians too.

Conversely, a few provincial hospital chief physicians might just be average.

Either way, Dai Shan earning the title of chief pediatrician at such a young age spoke volumes about her skills.

Seated next to her was a young female doctor Zhou Can recognized.

It was Chen Jiaojiao, a trainee from his own class.

She’d gotten stellar scores on the recruitment exam and was quite the surgeon, too.

After nearly two years of training, the group of trainees was slowly starting to take part in real consultations.

Sitting alongside chief physicians like this was just the first step towards becoming fully independent doctors.

Director Dai leaned forward for a closer look at the child, her face unreadable.

“How old is your child?”

“One year and seven months.”

“Has he been weaned?”

“Long ago. He eats meals with us now.”

Kids from poorer families are weaned around a year old and eat whatever the adults do. In wealthier urban families, many children drink milk as their main food until they’re nearly three.

There’s another interesting trend too.

Female white-collar workers in big cities rarely breastfeed, since they have to work and can’t stay home. They’re also conscious about their figure, worried that nursing will lead to sagging or loss of shape.

So instead, they’re happy to spend thousands every month on formula.

In the past few years, though, frequent milk scandals and research showing that breastfed kids are healthier and smarter has made more urban professionals turn to breastfeeding.

Longer maternity leave has also encouraged this change.

This child was no longer breastfed, so he’d have to rely on his own immune system to fight off illness.

Zhou Can caught the faint sound of a high-pitched wheeze in the boy’s breathing.

It was like air rushing through a narrow tube, or the yelp of a small dog.

“This is bad. The child’s throat is definitely inflamed, and probably acutely so.”

The blue tinge to the child’s face and lips pointed to a possible high fever, along with breathing issues—his blood oxygen was probably dangerously low.

“Dr. Chen, check his temperature and run a physical exam.”

Director Dai spoke to Chen Jiaojiao.

“Alright!”

Chen Jiaojiao was petite and sweet-faced, quiet and demure.

You’d never guess that this gentle-looking young woman was a grad student at Imperial Capital Medical University and had such incredible surgical skills.

She walked up to the sick child, gave him a bright, warm smile, and spoke gently, “Be good, little one. Aunty just needs to check you, and no crying, okay?”

With practiced hands, she slid a thermometer under his arm.

Then she measured his heart rate, pulse, blood pressure, and respiration—covering all the critical vitals.

From the looks of it, this child was pretty sturdy.

His arms and neck were padded with soft baby fat.

Even his face was adorably chubby.

“Oh my—his temperature’s up to 41.3 degrees! That’s really scary!”

A moment later, Chen Jiaojiao pulled the thermometer free and went pale, exclaiming in alarm.

Anything over 39 degrees counts as a high fever.

But this kid’s temperature was already at 41.3—seriously frightening.

It meant the immune system was burning through whatever reserves it had, desperately fighting off infection.

“I’d say his glottis is swollen, badly so.”

Zhou Can couldn’t help but chime in.

Since he had nothing else to do, why not watch the pediatric chief handle this case?

Whenever the boy cried, his voice was hoarse, and each breath was punctuated by a faint barking sound.

“Dr. Zhou, you seem pretty good with pediatric cases yourself!”

Chen Jiaojiao glanced at Zhou Can.

She’d probably been paying attention to him all along, but her shy nature hadn’t given her a chance to speak with him.

Even though they were seated side by side, they’d never spoken until now.

“Nah, I’m just a dabbler, not really good at any of this. But it’s worrying to see this child’s condition. If he doesn’t get proper care soon, things could go south quickly, and the prognosis will be grim. Look, he’s already starting to show retractions.”

Truth was, Zhou Can really wasn’t well-versed in pediatrics.

But when a child’s fever was this high and he was showing retractions while breathing, his condition was taking a nosedive.

It was mostly because of the mother’s ignorance—she hadn’t rushed him to the hospital when the fever first spiked.

She’d waited until things got this bad to see a doctor.

To put it bluntly, the child was at death’s door before she even showed up. The kid was suffering horribly, and whether he’d survive was up in the air.

Retractions happen when a child’s struggling for breath. The chest muscles work overtime to suck in air, but the lungs can’t expand properly, so a vacuum forms, pulling parts of the chest, collarbones, and even the belly inward with each breath.

When you see this in a young child, don’t hesitate—get them to the hospital immediately.

By the time the child looks blue in the face, that’s already an early sign of respiratory failure. He’s starved for oxygen.

“Yeah, it’s very serious,” Chen Jiaojiao agreed. “Director Dai, what do you think we should do next?”

Hearing both young doctors call her child’s condition severe, the mother looked increasingly frantic.

Her anxious eyes darted to Director Dai, desperate for help.

When a deadly illness strikes, to most people, doctors feel like their only hope.

“A fever this high, plus retractions—do a laryngoscopy right away. If there’s pus, immediate treatment is a must. If the airway gets blocked, he won’t be able to breathe at all.”

Director Dai gave her orders for further diagnostic testing.

“Mom, you should’ve brought him here sooner! Let’s start with a laryngoscopy, then we’ll figure out the right treatment after we see the results. Sound good?”

Hidden in Director Dai’s words was a reproach toward the mother.

“I… I didn’t expect it to be so serious. He’s had colds before, and he always got better after a couple of days! His dad’s not home, and I have three kids. I couldn’t leave them alone. Even today, I had to ask a neighbor to watch the other two so I could bring him to the hospital.”

The mother was so shaken her voice trembled.

“Doctor, I’m begging you, please help my son! I finally had a boy after three pregnancies—I can’t lose him!”

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Turns out the mother was not just ignorant—she clearly favored sons over daughters too.

Though many places have moved past old ideas about sons being more valuable, plenty of families still hold onto them, thinking daughters will just marry out and ‘raise someone else’s kids.’

“Take the application form, pay first, and hurry with the tests. The two main ones are a blood panel and laryngoscopy. Bring me the results as soon as you have them.”

Director Dai reminded the mother.

The child’s illness was straightforward, with clear symptoms and an obvious source.

But treatment wouldn’t be so easy.

In the child’s current state, thick pus could easily clog his airway at any time.

……

Roughly an hour went by before a nurse came sprinting over.

“Director Dai, the little boy with the fever and breathing trouble just had a sudden scare during his tests. We need you right away.”

The nurse didn’t say what happened—maybe she worried about scaring the other patients in the room.

“Please, could you lead us there?”

Director Dai’s face clouded over as she rose, following quickly.

Chen Jiaojiao hurried after her.

If a patient died during the very first expert clinic day that Tuyu’s specialists were holding at Xinxiang Hospital, it would be a terrible start.

“Dr. Zhou, what do you think happened to that child?” Deputy Director Shi, nearby, was full of curiosity.

“That’s hard to say, but my guess is his bronchial tubes got blocked. Did you notice how blue his face looked? That means he was already short of oxygen. I suspect thick pus was clogging most of his airway during that exam. Add throat swelling on top of that and it’s even harder for him to breathe.”

Zhou Can answered, visibly worried.

Breathing problems were likely the child’s biggest issue.

If this had happened at home, he might not have survived.

In a hospital with capable doctors and lots of experience, though, things usually don’t end in disaster.

At least in Zhou Can’s eyes, if he’d been treating the child, he wouldn’t have let him die.

Director Dai and Chen Jiaojiao rushed into the laryngoscopy and bronchoscopy suite, where they found the child flat on his back, his face purple with strain and twisted in pain.

He was trying to cry but could barely make a sound.

Director Dai, with all her pediatric experience, felt her heart clench at the sight. Her face grew even more grim.

“Is his airway blocked?”

“The boy’s just a toddler. After prying open his mouth and giving anesthesia, he started breathing rapidly and had to work for every breath. We tried nebulized inhalation, but there wasn’t much improvement.”

The laryngoscopy doctor stayed impressively calm.

Their emergency responses had been quick and appropriate.

Xinxiang Maternity and Child Hospital was no slouch. Especially in gynecology, obstetrics, and pediatrics—they excelled in these fields.

“Did you check his throat with the scope?”

Director Dai shone a flashlight into the boy’s mouth, still held open with a tongue depressor. His baby teeth hadn’t even come in, but now his jaw was locked tight, and the anesthetized tongue was starting to stiffen.

He was barely breathing at all, hardly any air in or out.

“We did a basic scan—his throat was clearly red, swollen, and inflamed, with pus visible deep inside. We didn’t dare go further in, the situation was too dangerous. Should we do an emergency tracheotomy?”

A child this young facing a tracheotomy would suffer enormous harm—it’s a huge risk.

Director Dai frowned, deep in thought for a few seconds before asking, “Are you confident doing a tracheotomy here?” Her question, though reasonable, might come off as insulting to Xinxiang’s doctors and nurses.

But with a child’s life at stake, Director Dai’s concerns were understandable.

“Technically and in terms of equipment, our hospital can manage a tracheotomy. The only worry is whether we could handle the rescue work afterward. Unfortunately, our lead expert on this just left to study abroad. We don’t have anyone with that level of rescue experience right now. Since you’re the pediatric expert from Tuyu, may I ask if you’d oversee the care after the tracheotomy?”

The laryngoscopy doctor came clean about why they’d really called Director Dai over.