Chapter 299: The Curious Case of the Goldfish-Eating Boy

Eating raw meat and drinking blood—that was the way of early humans.

After millions of years of evolution, people have long adapted to eating cooked food and drinking boiled water. Don’t be fooled just because foreigners eat steak or grilled meat rare—sometimes barely cooked at all—or even eat raw fish on occasion. Those foods are fundamentally different from wild animal meat.

For instance, before beef hits the market, it undergoes a battery of strict inspections.

They make sure hormone, bacteria, virus, and parasite levels meet strict standards before selling.

It’s much like the white mice used in medical experiments. They’re expensive because their quality standards are incredibly high.

But for an eight-year-old boy to eat a live fish—that’s definitely pushing the bounds of mischief.

“Hey kid, what kind of fish did you eat back then?”

“It was just a goldfish from the market! My friend and I made a bet, I lost. A man keeps his word, right? So I ate a live goldfish just like we agreed.”

The boy’s voice was weak as he spoke.

Still, Zhou Can and the others couldn’t help but burst into laughter.

A kid this young already taking promises so seriously—that’s actually impressive.

“Little tough guy, where did you get that goldfish?”

Zhou Can tried to hide his amusement as he asked.

“We caught it with a net while we were at the park! We caught six total—I ate one, and the rest my friend and I brought home to keep as pets. They all died within two days though.”

The boy looked genuinely disappointed as he recalled the goldfish dying.

“When you ate the goldfish, did you chew it up first or just swallow it whole?” Zhou Can pressed on.

Honestly, either way, the goldfish didn’t stand a chance.

The question was to help figure out the risk of parasite infection.

The mouth and the stomach are totally different environments.

The mouth is a breeding ground for bacteria, while the stomach is like an incinerator for germs. Almost no viruses or bacteria survive stomach acid. The vast majority of parasites can’t either.

But there are some exceptions.

Tapeworms, roundworms, sparganum—they’re all possible.

If he chewed up the goldfish first, parasites could hide between his teeth, then sneak into his head through his nasal passages or reach his lungs through the bronchial tubes.

Parasites are tough and crafty. Even the tiniest chance to survive, they’ll take it.

“I… was scared it would wriggle inside my stomach, so I chewed it up with my eyes shut and swallowed real fast. It tasted super fishy and bitter.” Just remembering it made him uncomfortable.

That bitter taste was probably from biting into the gall bladder.

Bile is extremely bitter.

And the fish’s waste can taste bitter too.

Zhou Can finished his questions and turned his attention back to the medical records.

Ever since eating that live goldfish, the boy has suffered repeated bouts of nausea and vomiting. It usually hits seven or eight hours after a meal, often with diarrhea—up to four or five times a day.

The first hospital he went to was the local county women’s and children’s hospital.

They tested his vomit and confirmed it was stomach contents. The diarrhea was yellow and watery.

The results from the first blood test showed white blood cells at 2.2 x 10⁹/L and eosinophils at 12.3%.

These two indicators from the blood test are important reference points for doctors.

An unusually high white blood cell count means a higher risk of bacterial or viral infection. High eosinophils are a key indicator for parasite infections.

The county women’s and children’s hospital also did a gastroscopy, which revealed mild reflux esophagitis.

Turns out the hospital wasn’t half bad.

Any county-level hospital that can do gastroscopies and colonoscopies is at a decent level.

At least for its tier, it’s actually quite good.

An abdominal Doppler ultrasound showed a small amount of abdominal fluid.

Zhou Can glanced at the ultrasound report—sure enough, there was some fluid in the abdominal cavity.

He also noticed the boy’s spleen was enlarged.

Spleen enlargement usually means it’s either swollen or has a tumor.

If it’s a tumor, you can often tell by looking for areas of very low or high density.

Most tumors look different from normal organs in density.

He kept reading. Urinalysis came back with strong positive protein (+++).

That meant there was a lot of protein in his urine—signs of serious kidney damage.

That was all the testing the county hospital did. They gave him meds to protect his stomach lining and stop vomiting. His condition improved, so he was discharged.

But less than a month later, everything came back—vomiting, low fever, diarrhea.

The family probably doubted the county hospital’s skills, so they took him straight to the provincial children’s hospital this time.

Judging from the county hospital’s tests and treatments, their standard wasn’t low at all.

A lot of people assume county hospitals are always worse than provincial or municipal ones, but that’s simply not true.

Every hospital has its own strengths.

If a county hospital has a skilled doctor and builds a team specializing in a field, it might actually rival provincial hospitals in that specialty.

Reverse situations like that happen often.

Zhou Can once saw a township orthopedics clinic that was even better than a provincial hospital. Patients came from all over the country, the fees were low, and their trauma care was top-notch.

Serious injuries that big hospitals couldn’t fix, or cases needing conservative treatment, would be cured there.

These legendary township or county hospitals are rare, but they exist here and there, earning national fame with real skills.

Zhou Can moved on to the reports and treatment plans from the second hospital.

At the provincial children’s hospital, they first ran a urinalysis—it still showed three pluses for protein.

That level of proteinuria usually means lupus nephritis, glomerulonephritis, or nephrotic syndrome. It’s a big warning sign. But maybe the doctors at the county hospital ignored it or misjudged the result.

The second hospital’s doctors clearly had more experience.

After seeing three pluses for protein, they immediately ordered an ANA test. The result was negative.

ANA stands for antinuclear antibodies—a group of complex autoantibodies.

They’re used in medicine to screen for rheumatic diseases.

Like lupus, scleroderma, Sjögren’s syndrome, and rheumatoid arthritis.

Since the test was negative, rheumatism could pretty much be ruled out.

The provincial hospital’s experts were sharp—right after that, they ordered another kidney ultrasound. They must’ve suspected kidney problems.

Unfortunately, the ultrasound didn’t turn up anything obvious.

The expert kept digging and ordered another gastroscopy.

Maybe, deep down, he didn’t trust the county hospital’s scope results.

This time, they took a stomach lining biopsy—diagnosis: mild gastritis, with occasional eosinophil infiltration.

No wonder the provincial hospital had such a good reputation—even with the same gastroscopy, their approach was more detailed and targeted.

Zhou Can found it fascinating to review the boy’s outside treatment and see how other experts think through tough cases. Their strategies could help him level up his own diagnostic skills.

That doctor at the provincial children’s hospital was definitely a true expert.

You could see it just from his diagnostic thinking.

Every test he ordered had a clear reason.

He didn’t just order every possible test for the sake of it—each one mattered.

If you don’t really understand pathology, or if you don’t have deep diagnostic experience, you just can’t pull that off.

Now that Zhou Can had improved his own diagnostic skills, he could tell the caliber of other doctors just by looking at the tests they ordered. In the past, anytime he saw a doctor order a bunch of repeat tests, he’d roll his eyes and think, ‘This guy’s just out to make money.’

Why run all these tests again if the patient already had them done a few days ago and they’re still valid?

But in reality, not every doctor is like that.

Some, like Du Leng, only know the theory and have no real experience, so they just order every test under the sun with no real purpose.

Now, with his skill, Zhou Can could instantly tell which type of doctor he was dealing with.

For example, this provincial hospital doctor was definitely a top-tier specialist.

After finishing the gastroscopy, the expert ordered a colonoscopy for the patient.

No abnormalities were found.

They tried nutritional support next, but it didn’t help at all.

About a week later, the doctor saw that the treatments weren’t working and probably called in other hospital experts for a joint consultation.

And then things got interesting.

After the team consult, they ordered yet another kidney ultrasound.

Zhou Can found it strange—didn’t they just do a kidney ultrasound not long ago with nothing found? Why do it again after the consult?

But what do you know—this time, the kidney ultrasound actually revealed something.

If this hadn’t been a provincial-level hospital, Zhou Can would have thought they were just running up the bill.

Last time, the test showed nothing—how could something show up in just a few days? It sounded almost ridiculous.

But this time, the ultrasound showed mild dilation of both renal pelves, the bladder was empty, there was 2.6cm of pelvic fluid, the rectal wall was thickened, and there was a suspicious mass on the right side.

Two kidney ultrasounds, and such wildly different results.

The only explanation is that the first kidney ultrasound doctor must have gotten the job through connections and had a fake certification.

Big hospitals’ imaging departments are notorious for being packed with well-connected but less-than-qualified staff.

There really are some ‘amateur’ staff doing the job.

If you end up with one of those non-professionals for a scan, well, tough luck.

Who would expect even provincial hospitals to have non-professional sonographers?

Medical imaging doesn’t require rocket science, really. Even a mediocre student who tried a little in college can do it.

But a doctor who truly knows their stuff does imaging more professionally, and is much better at catching hidden problems.

This time, they found a mass in the patient’s right kidney area.

No doubt the experts were excited.

They immediately performed a laparoscopic surgery to remove the suspicious mass.

Pathology confirmed it was a teratoma.

The team at the provincial children’s hospital was hopeful, thinking they’d finally found the cause and removed the tumor. Surely the boy would recover now.

But according to Murphy’s Law, things often go wrong at the worst possible moment.

The mass was removed, and pathology confirmed it was indeed a tumor—but the boy’s symptoms didn’t improve. He kept vomiting and having diarrhea.

This kind of strange case was probably a first for the hospital’s expert.

So then what?

Zhou Can really admired this specialist’s grit. Despite everything, he didn’t give up. He kept on treating the kid.

Right after surgery, though, the boy suddenly developed frequent and painful urination, urgency, and now his lower back hurt too.

So, not only did removing the tumor not cure him, it also made him suffer a bunch of new symptoms.

Things were clearly getting worse. He was facing more and more problems.

The family must have started to lose faith—did they really trust this doctor?

Maybe they even doubted whether what was removed was really a tumor. Could the hospital just be making it up to save face?

Even in a top-tier public hospital, doubts crept in for the family.

But honestly, apart from trusting the doctors, what choice did they have?

Besides, this expert stayed stubborn and just kept grinding away to cure their child.

The doctor next ordered a plain abdominal X-ray.

This time, they found a gas-liquid level in the abdomen, so the doctor gave the boy sesame oil, and—amazingly—the condition improved.

After all that, they finally saw a glimmer of hope.

Or maybe it was all the new symptoms after the surgery, but once he took sesame oil, at least some symptoms eased. The expert’s spirits were lifted and he regained some confidence.

He started thinking in a new direction.

Since the boy ate a live fish, there was every reason to suspect a parasite infection.

His earlier blood test showed elevated eosinophils as well.

So, the doctor had the lab run a stool test for parasites.

With stubborn diarrhea like this, stool tests are always done when a patient’s admitted.

But this time, the expert specifically asked the lab to check for parasites in the stool.

Things like eggs, parasite bodies, or even live larvae.

But sadly, even after all that, they found nothing.

The diagnosis had reached a dead end.

The expert had used almost every trick in the book—any more, and they’d just be going in circles.

To make matters worse, the boy’s condition took another dive.

Proteinuria was still present, and now he was getting pain in his knees and elbows. The frequency and urgency of urination got even worse—he could be running to the bathroom a hundred times a day. Sometimes just a trickle, never more than 30 ml.

He was still vomiting and having diarrhea.

A low fever lingered, too.

Even worse, after so long without effective treatment, new symptoms like shortness of breath and palpitations appeared.

That meant the disease was attacking his heart and lungs, too.

At this rate, he’d walk into the hospital on his own and be carried out in a body bag.

The provincial hospital’s expert had run out of options. No one could figure out what else to try.

This was a famous big hospital, staffed by top doctors, so the expert couldn’t bring himself to suggest a transfer.

But big hospitals have their own ways of handling tough cases.

Sometimes they send medical touts undercover, pretending to be families of other patients in the ward. They’ll chat with you, seem really concerned, and hint that you’d be better off going to such-and-such specialized hospital for treatment.

Of course, after hearing this, families start thinking twice.

The hospital doesn’t even need to suggest the transfer—the family will ask for it themselves.