Chapter 300: Breaking the Diagnostic Deadlock

These days, medical scammers have seriously leveled up. Gone are the days when they’d just hang around the hospital lobby like cheap hustlers, grabbing whoever walked past. Thanks to constant news about con artists luring patients into shady clinics and ripping them off, everyone’s become a lot more cautious.

Ordinary folks aren’t idiots either.

Now, if someone suddenly strikes up a friendly chat and starts raving about some ‘miracle doctor’ or a bargain hospital, people immediately get suspicious.

To up their success rate, these scammers have learned all kinds of disguises.

It lets them stay one step ahead of security and makes it easier to win over patients and their families.

No one really knows whether this family decided to transfer hospitals on their own or if someone talked them into it. Zhou Can definitely wasn’t one to pry into a patient’s personal matters.

Right now, his focus was straightening out the patient’s case from onset to now—what exactly had happened, what treatments had been given, and what the symptoms were at present.

“He’s looking pretty thin now. Was he chubbier before he got sick?”

“He used to be a bit heavier for sure. He was almost seventy jin before, now he’s down to just fifty-nine,” the family answered.

The family member answered.

Losing eleven jin in just over two months? That’s never a good sign.

A persistent low fever is also a red flag, hinting at something seriously wrong.

Take leukemia or most cancers for instance—continuous low-grade fevers are classic early symptoms.

Zhou Can ran through all the patient’s test results again, piecing together a complete image of the case in his mind.

“Hey, buddy, let uncle give you a quick check-up. Be good, alright?”

Zhou Can stood, gesturing for Ji You to join him as he started the physical exam. What gave others a headache was exactly the sort of challenge he enjoyed.

Du Leng had only skimmed the records before pushing the patient out the door.

Zhou Can could never do that.

He insisted on following proper protocol—examining the patient carefully and filling out all the intake records.

Blood pressure and heart rate were both within normal limits.

He was thin, running a low fever at 37.9°C, and when he stood, his legs shook involuntarily. It didn’t look like joint pain—he suspected underlying weakness or maybe even a neurological problem.

And when they say nerves, they don’t just mean brain neurons. The whole body’s nervous system counts—motor nerves, sensory nerves, the sympathetic system, you name it.

“Does your neck hurt here? Any swelling?”

Zhou Can asked as he gently felt along the patient’s neck.

Palpation is one of the most basic clinical skills.

“Nope!”

The boy shook his head.

Zhou Can didn’t find any lumps in the neck either. Not one to overlook details, he checked one side of the boy’s armpit.

“Huh?”

A spark lit in his eyes.

The boy squirmed and giggled—it tickled, so he tried to pull away.

“Hold still for a second. I think I feel a lump.”

Zhou Can’s face grew serious.

On palpation, he found distinct lumps in both armpits. Most people know the neck is packed with lymph nodes—but the underarms have plenty, too.

If he was right, the swelling in both axillary lymph nodes was real.

That was a key new discovery.

Urine protein triple positive, swollen axillary nodes, a drastic weight loss, ongoing fevers… No ordinary illness could pull all that off.

When diagnosing tough cases, Zhou Can rarely sticks to convention—he likes to step outside the box and view things from unusual angles.

Even if the tests didn’t scream ‘malignancy,’ he already slapped that mental label on this patient.

Leukemia, or cancer—had to be something major.

Of course, he’d never mention that to the family yet. They’d think he was cursing their child and chew him out.

“Let’s get a CT scan of the chest, abdomen, and pelvis. With these symptoms, things aren’t looking good.”

He turned to the family.

“Alright.”

Right now, the parents just wanted an answer—and were open to any necessary tests.

The CT didn’t take long. Soon, the patient was back.

Zhou Can pored over the results—and, as expected, found a huge new clue.

Both armpits had swollen lymph nodes, and there was fluid in both sides of the chest cavity.

The spleen was enlarged, too.

Actually, the spleen had been swollen since the very first exam at the County Women’s Hospital.

Bladder wall thickening, hydronephrosis in both kidneys, and fluid buildup in both ureters.

There was fluid in the pelvis as well, and the left colon wall was thickened.

With so many serious abnormalities showing up, Zhou Can began to worry the heart might be affected, too. Just to be safe, he had the family get an echocardiogram.

Echocardiograms use ultra-short sound waves to check the heart and big blood vessels—both their structure and function.

It’s a non-invasive test.

One of the most advanced diagnostic tools in the field.

The fact that Xinxiang Maternity and Child Hospital could run these kinds of tests said a lot about its capabilities.

But a hospital’s strength isn’t just about the shiny equipment. What really matters is the doctors themselves—skills are what set the standard for care.

The echo showed an LVEF of 48% and a pulmonary artery pressure of 34 mmHg.

That pulmonary pressure was way above the normal 12-20 mmHg range.

They’d run every test that mattered. Now it was down to diagnosing the cause and pinpointing the problem.

Despite the sea of symptoms, Zhou Can suspected they all stemmed from a single underlying disease—one of those chronic, truly nasty conditions.

Dilated ureters, protein in the urine, weak heart function with pulmonary hypertension—all together made him immediately think of genitourinary tuberculosis.

Given the boy’s constant urge to pee, that suspicion only grew.

He grabbed the patient’s urine test results for a closer look.

Pro 0.3 g/l.

White blood cell count was just 2.2 x 10⁹/L—way on the low side. For adults, a healthy count should be over 4.0 x 10⁹/L.

Eosinophils at 15.1%—that was sky-high.

Hemoglobin and platelets looked fine though.

Staring at the numbers, Zhou Can realized his thought process was getting stuck in the same rut as that provincial children’s hospital expert.

Genitourinary tuberculosis?

Parasitic infection?

Those two diseases wrestled in his mind.

“Dr. Zhou, what’s wrong with my son?”

The boy’s father was starting to lose patience.

They’d run test after test, and though Zhou Can was young, he still hadn’t reached a diagnosis.

The family’s trust in him was dropping bit by bit.

It reminded him of the day Du Leng got yelled at by another frustrated family.

“Please wait a little. Dr. Zhou is working hard on your son’s case! Diagnosing something this rare and difficult takes careful reasoning and expertise. Please be patient and try not to interrupt his train of thought.”

Ji You, sitting right beside Zhou Can, played the role of a perfect assistant.

She spoke up to smooth things over and kept the parents calm.

Her explanation worked better than if Zhou Can had tried himself.

If Du Leng had such a thoughtful nurse, maybe he wouldn’t have landed in hot water either.

With the family soothed, Zhou Can could immerse himself fully in the case.

He frowned in deep concentration, eyes dark and steady, occasionally darting around as he thought things through.

Solving a tough case was often harder than the hardest test question.

Especially with cases this tricky—it took everything he had.

“Let’s run an acid-fast stain on the urine!”

After much thought, Zhou Can requested another special test.

The family started to look upset.

“Haven’t you already run all sorts of urine tests? Why another one?”

They began to question the necessity of more tests—not a good sign at all.

If he didn’t make a breakthrough soon, he’d lose the family’s trust and cooperation entirely. That’d mean there’d be no way to move forward with diagnosis or treatment.

And if there was doubt now, things would only get worse if he prescribed meds or suggested surgery.

Most doctors earn a salary, so dealing with this kind of family is always a headache. Whether they treat one more or one less patient honestly doesn’t matter much to them.

In the end, countless doctors would just send families like this away.

“This test I’m ordering is a urine sediment analysis, completely different from the routine urine test. They target different issues. Routine tests are mostly about red blood cells, protein, glucose, nitrites, and white blood cells, while urine sediment analysis looks at what’s left after spinning urine with a centrifuge and examining it under a microscope—super useful for spotting urological illnesses.”

“Based on my careful review and deeper analysis, I think we need to rule out genitourinary tuberculosis for your son.”

Zhou Can patiently explained, making sure the family felt heard.

He looked them in the eye, sincere and respectful.

That sincerity won him points with the family.

“Sorry, we misunderstood you! Please go ahead with the test—we’ll pay right away.”

The boy’s mother hurried to bridge the gap.

The father didn’t say anything, but the apology was clear on his face.

When people communicate with real honesty, you can feel the connection.

Zhou Can’s sincerity touched the family, making them feel guilty for doubting him.

Soon, the urine sediment results were in.

WBC 118.1/μl, epithelial cells 72/μl, bacteria 8317.6/μl…

Still not satisfied, Zhou Can ran a PPD skin test and checked TB antibodies—both came back negative.

At this point, genitourinary TB was basically off the table.

So what was it, then?

He couldn’t help picking up the CT scans for a fresh look.

There’d been a tumor found at the provincial children’s hospital, which was surgically removed.

But that didn’t rule out the possibility of other hidden tumors inside the boy’s body.

Many cancers are tiny when they first develop—under five millimeters—making them almost impossible to find.

In medical terms, any tumor under 1cm is called a microtumor. Honestly, doctors aren’t too alarmed about those—like ignoring ants crawling on the ground.

It all comes down to human nature and a ton of clinical experience.

Early-stage tumors rarely cause harm—they’re manageable. Only when they grow larger do they pose serious risks.

Tiny tumors are really tough to classify as benign or malignant.

You need a tissue biopsy to be sure.

Most of the time, doctors just ask patients to get regular checkups and watch for changes.

Why’s human nature involved here?

Because these tumors aren’t in the doctor’s body. While it’s still small, simply doing checkups fits medical guidelines. But if its nature isn’t clear and they cut it out…

What if surgery reveals it wasn’t even a real tumor?

Plus, biopsies mean taking a sample—which always irritates the tumor.

Some tumors are tricky to sample in the first place.

For a doctor to take that risk often leads to more trouble than it’s worth. So few are eager to do it.

Zhou Can frowned, deep in thought.

Right now, he’d hit a diagnostic brick wall.

Just then, Director Zhang finished with her own patients and came over.

She’d been secretly paying close attention to Zhou Can the whole time.

She knew he’d inherited this difficult case, after Du Leng and Director Dai had each tried to pass it off.

Taking responsibility for such a challenging case, unafraid of ‘losing face’ if he failed—that kind of courage and willingness to help was truly admirable.

“Dr. Zhou, if diagnosing this case proves too difficult, consider admitting the patient for observation—you might learn more. After all, this child spent ages at the provincial children’s hospital, and even their top experts couldn’t figure it out. That means the case is a nightmare,” she advised with a smile.

Zhang Bihua wasn’t just vouching for Zhou Can—she was also pointing out there’s no need to rush when facing cases like this.

They could admit the patient and investigate further.

Haste makes waste.

Any hospital, no matter how impressive, can’t diagnose every complicated case right in the outpatient clinic.

With hard-to-crack problems, the best bet is to admit and observe. If the answer comes, great; if not, all they can do is assure the family they’ve tried everything.

“Thanks for your concern, Director Zhang. I’ll give it one more shot. If I really can’t solve it, I’ll talk to the family about admitting him,” Zhou Can said gratefully, nodding to Zhang Bihua.

He stood, taking the records to show Director Zhang.

With her here, he knew she’d join in on the consult—no words were needed.

“At first, I thought it was genitourinary tuberculosis, but after all those tests, that’s basically ruled out. Parasitic infection’s unlikely too.”

He explained his reasoning to Director Zhang.

Director Zhang looked through the results, combined that with Zhou Can’s thinking, and pointed out, “This child’s case is incredibly complex—it’s tough to diagnose. Maybe focus on the initial symptoms—vomiting and diarrhea—and have him admitted for further study.”

Sitting atop the OB/GYN department at Tuyu Hospital as the lead, Director Zhang’s diagnostic ability was beyond question.

Her advice gave Zhou Can a sudden jolt of inspiration.

He realized that his habit of unconventional thinking had made him lose sight of the basics: the original symptoms.

The most direct path is often the best.

As martial arts masters say, sometimes ‘no move’ beats a thousand moves.

All things are connected—the logic holds true anywhere.

Medical diagnosis is like martial arts. At the start, you copy others until you master the basics. Then you blend in your own experiences and adapt.

Zhou Can’s usual offbeat approach to diagnosis was essentially that second stage.

Once you’re skilled, you add your own spin.

Eventually, you get your unique style and thinking.

Director Zhang’s pointed words were a revelation.

It was like a flash of understanding—an epiphany.

Not just a little more experience, not just a single disease better understood, but a genuine breakthrough in diagnostic mindset.

His entire approach to pathology had just reached a whole new level.

【Your approach to pathology diagnosis has undergone a fundamental transformation. Pathology Diagnosis EXP + Congratulations, your Pathology Diagnosis has leveled up to five. Current EXP: Level 5, 1/—Associate Chief Physician Junior Level.】

Last time he’d gotten a 1000 EXP reward, he thought that was unprecedented.

After all, it’s rare to get more than 100 EXP at once.

But now, he’d shattered another record.

A true leap in diagnostic thinking had pushed his skill to the next level instantly.

This was a one-of-a-kind promotion.

Even though his knowledge and experience weren’t technically at Level 5, the system had bumped him up anyway.

Epiphanies like this can’t be forced.

There might not be another for a long while.

Zhou Can felt medicine and martial arts were growing ever more alike. In ancient times, plenty of traditional doctors came from families of martial artists.

Martial arts is about technique and mindset.

Now that his diagnostic mindset had leaped forward, it was like he’d just taken that critical step in mastering martial arts philosophy.

With Pathology Diagnosis now at level five, Zhou Can found that reexamining the boy’s case brought an entirely new clarity—where things had once been murky, now everything was falling into place.