Chapter 413: A Hidden Clot, A Life-Saving Night

“Doctor, I finished my rounds in the ward just now.”

“Good work.”

“That patient who just had debridement for gangrene mentioned a symptom to me. He said that ever since his right leg was injured he gets this strange, intermittent throbbing pain that seems to move around. Based on his description and what I saw during debridement, I suspect he might have an arterial embolism. It’s likely a localized blockage in the artery that led to the gangrene in his leg.”

Zhou Can laid out his reasoning and all the evidence behind it.

After listening to his report, Dr. Xu fell silent for almost half a minute before speaking. “If it really is a local arterial thrombosis in the right leg, then it needs to be removed tonight. Do a Doppler ultrasound first. If needed, I’ll contact Interventional to get a vascular angiography set up.”

As a surgeon with decades of experience, Dr. Xu instantly grasped how dangerous the situation was.

The worst risk with an arterial clot is if it breaks off and travels to the heart or brain—it can be fatal.

Most of us probably remember our parents warning us as kids—never leave sewing needles lying around, or if one sticks you and enters a vein, it’ll travel straight to your heart or head and kill you.

That risk does exist, but in reality, it’s extremely rare.

Parents are mainly worried kids will scatter needles around, especially on beds or couches, and someone will get stabbed if they sit down.

With Dr. Xu’s approval, Zhou Can went straight to the Emergency Department’s duty room, borrowed the attending doctor’s computer, logged in, and ordered a Doppler ultrasound for the patient in bed 22.

At night, many tests can’t be done.

But the Emergency Department has an advantage—even at 1am, you can get urgent tests done.

Specialty outpatient and imaging departments usually only work during the day. Some exam rooms only open once a week.

The test results came back quick.

Sure enough, the patient’s leg showed suspicious signs of a vascular embolism.

Zhou Can was just about to call Dr. Xu when Dr. Xu arrived, having rushed back by taxi.

“A thrombectomy by interventional surgery would probably work best. You’re great at both interventional procedures and endoscopy. Can you handle this one?”

He looked at Zhou Can.

“I’m about seventy or eighty percent confident.”

Zhou Can didn’t dare promise too much.

“I’ll call an interventionalist to open the door for us. We need to get this clot out tonight. No wonder the patient’s wound just wouldn’t heal—turns out we finally found the hidden cause. If we hadn’t, there’s no way he’d have been able to keep that leg.”

Dr. Xu breathed a heavy sigh.

You really never know what kind of situation you’ll run into. Even with decades of surgical experience, Dr. Xu hadn’t figured out what caused this wound to worsen. Everyone’s first guess was that the debridement and suturing at the small clinic was poorly done. And since the patient chose to recuperate at home to save money, infection set in.

Who would’ve guessed—the culprit was actually an arterial blood clot.

If that artery had been completely blocked, it would’ve shown up right away—the lack of blood would’ve caused the limb to die fast.

Luckily, in this case the clot wasn’t a complete blockage—it blocked about ninety percent of the vessel.

That meant the artery still carried blood, but at a drastically reduced flow. Only about ten percent of normal got through. Healing the wound under those conditions? That would’ve been a true miracle.

There was just enough blood to keep the limb alive, which also made it nearly impossible for doctors to spot the clot.

No one even thought to look for it.

Inside the intervention room, Zhou Can put his skills to work and successfully removed the true culprit that had tormented the patient for days—a clot roughly one centimeter long.

Judging by the appearance, it looked like it had formed from blood coagulation.

Didn’t seem like a fat embolism.

Clots like this have a lot of causes, but trauma is a big one. Sometimes, if a nurse reuses an IV catheter and isn’t careful, a clot can form.

Experienced nurses using reused catheters typically pull back with a 10ml syringe until they see blood before they start the infusion.

A rookie mistake is starting the infusion without checking for blood.

Then they find the catheter put in yesterday is already clogged.

And a careless nurse might just flush it with saline right away.

What they don’t realize is that the blockage is often due to blood refluxing into the needle after placement. Overnight, that blood coagulates.

If you forcibly flush that out with saline, you could be pushing a blood clot right into a patient’s vein.

A blocked IV catheter might also be caused by residual infusion fluids crystallizing inside—an even riskier situation.

Either way: if you force something into the vein, it could be lethal.

If the IV catheter is blocked, there are three safe ways to deal with it.

First, figure out why. Then you can try gently drawing back with a 10ml empty syringe to remove the clot.

Or, if the patient’s condition allows, you can clamp the catheter and infuse 10ml of 0.9% saline mixed with heparin sodium (25u/ml) or urokinase (100,000u/ml) for five minutes, then try drawing back again. If there’s still no blood, repeat once. If still blocked after two tries, remove the IV right away.

Basically—you need to use a fresh IV catheter.

After Zhou Can successfully removed the clot, he couldn’t help feeling a cold sweat. If they’d missed it, the patient’s wound would’ve only gotten worse. By tomorrow, there’s a good chance they’d have to go through with an amputation just to save his life.

For that family, it could’ve been a crushing blow.

Once a leg is lost, the patient might not be able to work. His wife would be pushed into financial crisis, her husband crippled, unable to accept the outcome. Family conflict could explode into divorce.

And the husband himself could spiral into despair.

But it’s always the little boy who ends up suffering the most.

He’s just a kid.

And I heard there’s a teenage daughter too, in junior high.

Two underage kids—who’d raise them then?

[Pathology Diagnosis: +1 EXP. EXP reward: +100]

[Debridement Technique: +1 EXP. EXP reward: +1000]

[Special Medical Skill: Benevolent Heart +1 EXP. EXP reward: +100]

Zhou Can never expected that simply removing a clot would earn him so much experience in medical skills.

Especially the Benevolent Heart skill—it’s notoriously hard to level up.

Getting 100 points in one go felt as lucky as hitting the jackpot. Yet, even now, this special skill still hasn’t upgraded.

No one’s figured out what it truly does, either.

From Zhou Can’s experience, the harder a skill is to level, the more powerful its effects.

For example, once Pathology Diagnosis or Pharmacological Reasoning reaches level 4, you’re genuinely on par with an attending physician in Internal Medicine. At level 5, you’re at associate chief level.

Right now, both those skills are at level 5—solid associate chief standard.

That’s why, during later residency training, Zhou Can often outshone even the department’s associate chiefs. After training in Gastroenterology, this advantage became even more obvious.

He’s regularly invited by attending or even chief physicians to join in on case consultations.

Put politely, it’s ‘consulting together.’ Be blunt, and really, they just want his help.

Pharmacological Reasoning at level 5 shows up most in how he writes medical orders.

Whether it’s a temporary order, an emergency order, a hospital admission, or post-op order, Zhou Can earns trust—and gets the right to write first and inform later.

What does that mean?

It means that when treatment’s urgent, he can act first, save the patient, and let superiors sign off after.

“Funny, why did my Debridement Technique gain experience too? And a huge reward of a thousand on top of that!”

Earning one hundred experience in Pathology Diagnosis makes sense.

After all, he’d pieced together subtle clues to identify a hidden arterial clot. None of the initial clinic, the Provincial People’s Hospital, Tuyu General Surgery, or the Emergency Department found it.

That discovery was a breakthrough, a big step forward in diagnostic skill.

But debridement and thrombectomy don’t seem connected at all!

Thinking for a moment, Zhou Can realized something. Sure, taking out the clot and performing debridement seem unrelated, but if the arterial clot isn’t removed, even the best debridement work would be pointless.

It’s a lot like what entrepreneurs say—your health is the ‘1’ in front of all the zeros you earn.

Lose your health, and all those zeroes mean nothing.

This clot was directly stopping the wound from healing.

Debridement might look unrelated—but the outcome depends on it.

Reaching skill level 5 isn’t just about better technique anymore. It’s about understanding deeper causes, body-wide mechanisms.

He got the feeling that by level 6, even a minor illness would force him to consider the lesion, blood flow, and all major systems—everything.

The human body is one integrated whole.

A small problem in one spot can affect the entire system.

This shift in thinking is like being pushed to see the bigger picture, not just a single lesion or even the system it hurts.

Peeling off the heavy lead vest, Zhou Can stepped out of the intervention room, a genuine smile lighting his face.

Nothing beats the feeling of saving a patient’s life.

……

The next morning during rounds, he made sure to check in on that patient.

According to the patient, the nagging pain in his leg was completely gone, and his wound showed obvious improvement. Things were finally looking up.

After rounds, Zhou Can dropped by Cardiothoracic Surgery.

“Hey, Dr. Zhou, welcome!”

“Good morning, Dr. Zhou!”

The staff greeted him with the same warmth as always, but the air felt heavy, stifling even.

It also looked like there were far fewer patients than before.

The signs all pointed to what was once a star department rapidly falling into decline.

It was a dramatic contrast to the Emergency Department, which was booming.

Watching it unfold left Zhou Can with a dull ache deep inside.

Director Hu Kan, his mentor, poured his heart into building up the top-notch Cardiothoracic Surgery Department. Now, with no strong successor, it’s fading fast.

“Has Director Xue arrived yet?”

“She didn’t go home last night. Looked pretty down. You might want to check on her—she’s in the office!”

Guilt nipped at Zhou Can’s heart.

After hearing about her surgery setback yesterday, he should have called her right away.

Locking herself away in the office… There’s no doubt she’s hurting.

“Well, well, look who’s decided to visit! It’s been a while, Little Zhou!” Associate Director He strolled by with two of his junior doctors, brimming with satisfaction.

His smile was about to burst off his face.

‘Little Zhou’—that was a slight, a way to show off seniority and put Zhou Can in his place.

‘Our department’ was another signal—Cardiothoracic Surgery wasn’t Zhou Can’s turf.

This old fox was still bitter about losing out on the chief position last time.

Now that Director Xueyan was in trouble, he wasn’t pitching in. In fact, he looked like he was about to break into a happy tune. Annoying, but typical.

With a rival’s misfortune, of course he was thrilled.

If Director Xueyan lost her post, the job might land right back in his lap.

“It has been a while! Looks like you’re glowing, Director He!”

Zhou Can was quick to flatter—to those you can’t avoid, you play along.

When dealing with guys like this, you still have to keep up appearances.

“Oh, you’re too kind!” Director He laughed in delight.

“But…” Zhou Can dragged out the word, looking like he stopped himself from saying more.

“But what?”

Director He couldn’t help but ask.

“It’s nothing. Just… I’d recommend you get a checkup when you have time.” Zhou Can replied blandly.

“What are you getting at?”

Director He was suddenly tense.

He knew very well what Zhou Can could do. In this department, whenever Zhou Can said a patient needed more attention, their condition was always quickly proven.

And now, his comment clearly implied Director He was ill.

With such a grave tone and look, Zhou Can made it sound serious.

How could Director He not start to worry?

“Oh, it was just a well-intentioned reminder. No need to take it too seriously, Director He. If you have time get that check done. I need to see Director Xue about something and then head back to Emergency. We’ll talk again later.”

He raised the issue, then let it go like nothing.

It was all about leaving Director He dangling.

He truly despised people who turned against their own like this.

When the nest falls, not a single egg survives.

If Cardiothoracic Surgery collapsed, how could Director He escape?

How can there be a home when the country is gone?

Yet, some folks are just that shortsighted. Obsessed with petty self-interest and blind to the bigger picture. Director Hu Kan never handed him the department for a reason—he could see right through Director He’s nature.

Put a department in the hands of someone like that, and it’s bound to fail.

“Hey, wait, don’t go! What’s wrong with me?”

Director He called after him in a panic.

Zhou Can stopped but didn’t turn. He only shot an inscrutable smile back at Director He.

“It’s your body. If something’s wrong, I’m sure you know best.”

The art of sowing doubt—been working on people for thousands of years.

Once someone suspects they’re sick, it’s trouble. Even a healthy person will worry themselves into illness.

Back in medical school, whenever the professor described some disease, Zhou Can always thought he had it, too. Most med students know that feeling.

Once you start doubting, you’re stuck until you get a firm answer.

It’s like a man convinced his wife is cheating—see her chatting with a male coworker and he jumps to conclusions. Why did Old Li suddenly start giving her rides home? Must be something shady.

Then she brings home a bigger bonus this month, he’ll wonder if the manager has a crush on her. Why else would only she get a bonus?

……

In the end, suspicion eats away at him until he’s neurotic, hypersensitive, and divorce is almost inevitable.

Now Zhou Can planted a seed of doubt in Director He’s mind—hinted he was ill, but didn’t say where.

Intentionally making Director He guess for himself.

At his age, with the usual aches and pains, he’ll probably live in anxiety from now on. ‘What part of me is sick?’ He’ll curse Zhou Can forever.

If he gets a stomachache, he’ll wonder if it’s colon cancer.

Then he’ll try every way to line up a colonoscopy and abdominal CT scan.