Chapter 281: When Knowledge Fails: Lessons Beyond the Books

Du Leng’s theoretical knowledge was top-notch, but when it came to real diagnostic skills, he ranked near the bottom among attending physicians. His clinical ability just didn’t match up to his academic prowess.

This all came down to one thing: Du Leng never realized that true medical expertise isn’t learned from books, but forged in the heat of clinical practice, right at the patient’s bedside.

You have to gain insight through hands-on clinical diagnosis.

Real skill is never something others can teach you. You have to figure it out yourself and turn that insight into something uniquely your own.

He had an enviable PhD from a prestigious overseas university. His academic achievements were impressive, but after joining Tuyu Hospital, his pride soared. He saw himself as a cut above, never thinking to start at the ground level and hone his craft through the basics of clinical experience.

Instead, he was always eager to join director-level case conferences and take on complex, high-risk surgeries.

And that’s how Du Leng ended up making a spectacle of himself during this session with the experts.

It’s only when the tide goes out that you see who’s been swimming naked.

This time, getting thrown into the real fight at Xinxiang Maternity and Child Hospital exposed his true abilities immediately.

Now, his face had turned ashen, and his expression was dark and sullen.

You could tell he was having a rough time inside.

It made sense. He’d soared so high before—now he’d crashed, and the fall was brutal.

But in a way, maybe this wasn’t a bad thing for him.

As long as he faced his shortcomings, learned from the experience, and buckled down to train through practical basics back at Tuyu Hospital, his solid foundation meant he could become a truly skilled doctor in just a few years.

Gao Jian followed Director Jiang back to their desk.

Before leaving, Gao Jian glanced sympathetically at Du Leng. Compared to Du Leng, Gao Jian was pretty lucky.

At least Gao Jian had worked diligently and kept his feet on the ground throughout nearly two years of residency. He hadn’t chased glory or done things just for show like Du Leng.

“Zhou, I’ve got high hopes for you! You should guide Yang Chan more in the future. Aren’t you two classmates? You should really help each other out.”

Director Zhang also led Yang Chan back to her own consultation desk.

Plenty of patients were still waiting for her. Even though she was involved in the case conference here, there was already a small line forming at her desk. Patients and families quietly queued up under the nurse’s guidance.

That’s what the reputation of a top-tier doctor looks like.

Both patients and their families trusted her expertise.

As Yang Chan left with Director Zhang, she cast a lingering glance Zhou Can’s way, but quickly looked away. For the first time, Zhou Can saw something awkward about her expression.

This didn’t seem like the bold, heroic, and confident Class Monitor of 512 at all.

Had he really defeated her three times in a row and conquered her spirit?

Zhou Can wouldn’t dare think so.

In his mind, Yang Chan was always proud and never one to admit defeat. She’d definitely look for another way to beat him next time.

Once Director Jiang and Director Zhang left, their consultation table fell quiet again.

That’s just the harsh reality. Patients and families would never entrust their lives to some unknown ‘expert’.

Deputy Director Shi was still too little-known.

Time dragged on, every minute feeling longer than the last.

These idle clinic shifts were Zhou Can’s least favorite, hands down.

In his view, it was just a waste of life.

But in this setting, pulling out his phone to read would look pretty bad.

Luckily, before too long, the extremely overweight female patient returned from her tests.

Although the family had grown fond of Zhou Can and trusted him to a degree, they didn’t bring the results to him. Instead, they went straight to Director Zhang Bihua for further diagnosis.

Compared to young Zhou Can, the family clearly still placed more faith in Director Zhang.

“Dr. Zhou, Dr. Zhou, come take a look! Your diagnosis was spot on—the patient’s thyroid function really is off. And her bone scan shows osteoporosis, too.”

Zhang Bihua, after reviewing the patient’s tests, waved to Zhou Can with excitement.

Both results matched Zhou Can’s predictions almost perfectly.

It boosted Director Zhang’s trust in Zhou Can’s diagnostic abilities even further.

“Her sleep apnea syndrome can basically be confirmed as resulting from endocrine and metabolic disorders. The culprit is a thyroid problem.”

Seeing everything confirmed, Zhou Can was pretty happy himself.

“No wonder her symptoms looked so much like mixed-type SAS, yet nobody could ever figure out the real cause! Who’d have thought it would turn out to be a thyroid issue? Good—now with the right treatment, the medicine should clear it up.”

Director Zhang was just as pleased.

Successfully diagnosing a tricky case gives every participating medical staffer a real sense of accomplishment.

“Dr. Zhou’s surgical skills are exceptional and she’s got lots of experience with thyroid and breast cases. Do you think she needs surgery for this one?” Director Zhang sounded uncertain about her own proposed plan.

After all, this patient had already seen plenty of doctors, including several renowned specialists in the province, yet none could cure her.

Now the idea that a simple prescription might resolve it almost felt unreal.

“Let’s try medication first and see how it goes. If it really doesn’t work, we can consider surgery. But remember, every surgery causes irreversible damage. If we can avoid it, we should.”

Zhou Can didn’t recommend surgery for this patient.

Let’s see how she responds to meds before making any decisions.

……

Director Zhang wrote up a prescription and reminded the patient to manage her weight. Best if she could exercise every day and shed some pounds.

Being dangerously overweight can lead to all kinds of diseases, and her declining thyroid function was likely related to her obesity.

Medically speaking, there are four causes for hypothyroidism. First: inflammation or infection, including bacteria or autoimmune disorders. Second: tumors. Third: trauma, thyroid removal, or radiotherapy—even nasopharyngeal cancer treatments can damage the gland and trigger hypothyroidism. The last is well-known: insufficient iodine intake.

That’s why they add iodine to salt—to solve iodine deficiency and prevent goiter.

Poor lifestyle and eating habits, plus being extremely overweight, had also made it easy for her to become iodine deficient.

If she doesn’t keep her weight within a healthy range, she’ll put long-term strain on organs like her heart, lungs, liver, and kidneys, which could trigger a series of serious complications.

Director Zhang’s plan was to gradually supplement her thyroid hormone, correcting the deficiency, and to have her lose weight.

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Both approaches are effective treatments.

Zhou Can watched as the overweight patient left, hoping her sleep apnea would be cured after proper medication.

Not long after, the patient with a stubborn cold that lasted two years also returned from her tests.

Normally, pathological exams take three to seven days for results.

For instance, tumor tissue samples might need immunohistochemistry or molecular pathology testing, which could drag out for a week or so.

Intraoperative pathology, though, can be done as a rapid test—about thirty minutes for results.

That means the removed abnormal tissue is quickly frozen in a cryostat, sectioned, stained, and prepped; then a pathologist examines and diagnoses it under a microscope.

Sadly, tests revealed that this young female patient really did have a mass in the left pharyngeal region.

Doctors at Xinxiang Maternity and Child Hospital took tissue from the upper and upper posterior pharyngeal cords for pathology, initially suspecting non-Hodgkin lymphoma.

Director Zhang’s face grew grave when she saw the results.

Zhou Can, though he had half-expected this, couldn’t help but feel downcast. He silently mourned for the young patient.

“Dr. Zhou, now that we have the results, it really is a tumor inside her throat. And it’s lymphoma—what do we do?” Director Zhang Bihua wasn’t stumped by treatment, just saddened for the young woman.

With all her experience, she really worried that the girl’s tumor had already started to spread.

There are actually three main ways tumors can spread.

The first is infiltration into nearby tissue; this is actually the most controllable. If caught early enough, cut out all affected tissue and use chemotherapy to reinforce, and the outcome is generally good.

The second way is through blood metastasis. This one’s trickier—tumor cells have to survive the immune system in new areas and multiply wildly to become new tumors. It’s a tough process.

Think of it like a bandit trying to start a criminal gang in a strange town. Success rates are actually pretty low.

Unfamiliar with the territory, odds are he’ll get squashed by local authorities.

Tumor cells that survive the bloodstream and manage to take root, eventually forming new tumors, need time to do so.

With modern testing and experienced clinicians, it’s easier than ever to spot these.

Remove both the original site and all metastases, follow up with radiation, and there’s still a chance for a decent outcome.

The third metastatic route is through the lymphatic system. Lymph nodes are normally crucial parts of the body’s immune defenses—once tumors invade, it’s like government offices being overrun and controlled by bandits.

You can imagine how dreadful that is.

In short, it’s total chaos.

So, when lymphoma tests malignant, the prognosis is often poor.

When the girl’s mother learned it was lymphoma and saw the doctors’ somber faces, she was nearly undone. Both hands gripped the edge of the desk, knuckles trembling. Tears welled up and her breath came in short bursts, her face ghostly pale.

“Doctor… please, I beg you, save my daughter. Her father’s been working so hard away from home to give her a better life. How am I supposed to tell him about this now…”

Her voice already choked with tears.

She was only putting on a brave face for her daughter—if they weren’t together, she’d probably have broken down crying on the spot.

“Please try not to panic. This is just an initial diagnosis. First, lymphoma isn’t necessarily malignant. Second, even if it is, we can often remove it surgically. The focus now is to clarify its exact pathology, then check if it’s spread anywhere else.”

Director Zhang did her best to comfort the family.

She looked at Zhou Can again. “Dr. Zhou, I know you’ve performed multiple surgeries across several surgical departments. Your experience must be extensive. Which areas do you think should be the main focus for further testing?”

Director Zhang was humble in her inquiry—everyone has different specialties.

Most of her operations were OBGYN; she rarely handled tumor surgeries.

In the past, tumor cases always went straight to the relevant specialty.

Breast tumors went to the breast and thyroid specialists. For cervical or ovarian tumors, OBGYN doctors took the lead.

Most OBGYN surgeries focused on C-sections, curettage, ligation, and the like.

As for pharyngeal lymphoma, that was a rare sight for her.

She didn’t have much experience handling that kind of case.

“Now the patient has liver disease and hearing loss, plus confirmed lymphoma in the throat. For further testing, I’d recommend a CT scan for both ears and chest. The eardrums and lungs are top priorities for evaluation. It’s also best to do a lumbar puncture to test the cerebrospinal fluid.”

This time, Zhou Can answered without hesitation, offering his suggestions for further assessment.

Director Zhang nodded slightly and looked to the family.

Before she could even speak, the mother bit her lip and nodded hard. “We’ll do all of them. Whatever needs to be checked.”

From her reaction, it was clear—Zhou Can’s last successful diagnosis of her daughter’s tumor had been spot on, and the test results proved it. Her trust in Zhou Can was now unshakable.

She accepted all the checks Zhou Can suggested, no questions asked.

Once Director Zhang wrote up the test requests, the mother took her daughter to get them done—no need to dwell on that.

After they left, Director Zhang sighed. “If only they’d figured out the cause of her illness sooner. Two years have passed, her liver is already damaged, and multiple systems in her body are affected. The results probably won’t be good.”

“She was definitely delayed by poor treatment.”

Inside, Zhou Can was raging—quack doctors ruin lives!

Some quacks aren’t just incompetent, they’re dangerous.

That girl had just turned nineteen, the prime of her life. If they’d found her pharyngeal lymphoma two years ago, how much better off would she be?

Now, several organs and tissues were affected. There was a high chance the cancer had already spread.

At this point, chemotherapy and radiation might be the only hope.

Her outlook was likely grim.

With a case like hers, even surviving five years might be a stretch.

“Dr. Zhou, may I ask—the three tests you ordered, does that mean you already know where the cancer has spread?” Yang Chan watched Zhou Can diagnose tricky cases one after another, all confirmed by testing.

He’d been correct every time.

While she admired him, Yang Chan was also deeply curious about the patient’s illness.

At her current level, she couldn’t match Zhou Can’s precise judgment on whether and where the tumor had spread.

Driven by curiosity, she finally posed her question.

Zhou Can looked over at her, his mood still heavy, so his face was serious.

“It’s basically confirmed. Hearing loss is almost certainly because the eardrum was invaded, and now it’s diseased. Her liver condition, even the fatty liver, are likely just symptomatic. Lymphoma tends to hit the lungs next, so I wanted a chest CT. The liver is called the most silent organ—it feels little pain and has greater tolerance than most.”

To put it simply, it’s got thick defenses.

From Zhou Can’s perspective, the liver is like a heavy-armored warrior: high offense, high defense.

For example, no organ can match its detoxifying power.

That’s first-rate offensive capability.

“So why bother with a lumbar puncture?”

“That’s simple—it’s to check cerebrospinal fluid. The head sits atop the body, ruling the six yang meridians, but since her primary tumor is at the throat and neck, it’s very easy for cancer to spread up to the head. Her symptoms also suggest there could be nerve involvement in the brain or cerebellum.”

Zhou Can patiently explained things to Yang, the Class Monitor.

Back in school, she was always the one teaching others—the classic model student.

Zhou Can didn’t go to grad school only because he couldn’t pass the exams.

She, on the other hand, could’ve passed easily, might’ve even been guaranteed admission. She gave that up and went straight into the workforce after her bachelor’s, probably because her family’s situation didn’t allow further study.

A lot of girls are wise beyond their years.

They know the family can’t afford much, so they scrimp and save, hustle hard for scholarships, and even when they qualify for further study, they choose to shoulder responsibility and start working.

Yang Chan was fiercely proud. She never once talked about being poor to classmates or teachers.

To Zhou Can’s knowledge, she never once applied for financial aid.

Still, from her simple clothes to skipping class events that cost too much, the hints were everywhere. Even as class monitor, she never joined expensive outings. All those little details made it clear to Zhou Can—her family was struggling much more than she’d ever let on.