Chapter 475: A Difficult Case in the Thoracic Surgery Ward

Since he had to help out in Cardiothoracic Surgery every day, Zhou Can figured he’d take the chance to ask Director Xueyan for some tips about postgraduate exams when he saw her.

After making his rounds in the Emergency Department, Zhou Can grabbed a quick meal in the hospital cafeteria and hurried off to Cardiothoracic Surgery.

Lately, he kept getting the unsettling feeling someone was secretly following him. Concerned for Su Qianqian’s safety, Zhou Can had asked her not to bring him meals at the hospital anymore. If he had time, he’d just go home to eat with her instead.

Stepping into the Cardiothoracic Department, he was greeted by organized chaos—staff bustled everywhere.

The high-profile publicity campaign for their medical achievements, which Zhou Can had suggested, was paying off even better than he’d imagined.

Ever since a whole group of senior experts and chief nurses had been poached, anxiety hung heavy over the department. People feared everything would deteriorate fast. But over the past two weeks, the number of outpatients and emergency cases hadn’t dropped—in fact, it kept climbing. More and more, even the complex cases found their way here.

Some patients were even being transferred from other hospitals.

“Dr. Zhou, you’re here! That’s great! There’s a patient over there complaining of chest pain and trouble breathing—could you take a look?”

A female nurse at the station brightened up at Zhou Can’s arrival, as if she’d spotted her savior.

“Is this an inpatient or someone who just arrived?”

Zhou Can asked.

Since work hours were over, it had to be an unscheduled walk-in or an emergency transfer.

Patients admitted via outpatient were typically given a bed and formally checked in after evaluation—if there were beds available.

“Emergency called and shifted the patient to us. Intern Xiao Wang brought him over, but the main doctor supervising him is still in surgery with Director Xue. I heard the operation ran into complications—no telling when they’ll finish. Neither of the two on-call doctors here dares to take on this patient.”

The nurse’s name was Luo, and rumor had it she’d be promoted to head nurse this year.

She was pretty influential in the Cardiothoracic Department, especially since three senior nurses had been poached—their departure had raised her standing a lot.

The way she casually referred to the intern as “Xiao Wang” said all you needed to know about her confidence in her status.

“Where’s the patient?”

Hearing that this was an emergency transfer, Zhou Can guessed the patient probably hadn’t been thoroughly checked yet.

After work, Cardiothoracic Surgery was usually notified about chest pain patients so their doctors could transfer the cases. The Emergency Department wasn’t set up to treat that kind of illness.

If anything happened, the fallout would be massive.

Shifting the patient indicated that the emergency doctor had evaluated them and figured surgery might be necessary.

Of course, sometimes green doctors offloaded anyone with a vague chest pain to Cardiothoracic by default.

After all, Internal Medicine had two subdepartments: Respiratory and Cardio, each handling chest complaints.

“That’s the gentleman right here!”

Nurse Luo led Zhou Can to a flat bed nearby. The patient lay there clutching his chest, staring blankly at the ceiling, his breath harsh and ragged—like air rasping through bellows.

Two women stood by the rolling bed, one older and one young.

The older woman’s face was streaked with tears, gazing at the patient with a mixture of heartbreak and terror.

The younger woman looked twenty-one or twenty-two, dressed simply and with a fresh-faced innocence—like a college student or someone who’d just graduated. Judging by their features, she must be the older woman’s daughter.

Their faces and features were strikingly similar—definitely mother and daughter.

“Where exactly does it hurt in your chest?”

Zhou Can asked directly.

But the hollow, distant look in the patient’s eyes was unnerving. That blank, indifferent gaze—like people in hypovolemic shock right before they pass out.

The patient ignored him completely.

Worried about offending the doctor, the older woman quickly urged, “Son, where does it hurt? Speak up! Don’t drive me crazy with worry!”

The patient’s mother was genuinely distraught, tears streaming the whole time.

“My brother only said his chest hurt a lot and he could barely breathe. It was scary. I was at work when Mom called, so I rushed over to bring him in with her.”

The young woman shared everything she knew.

“How did it start?”

Zhou Can examined the patient while questioning the family.

“He’s my son, twenty-eight. Not long ago, he was eating at home. I noticed that other kids his age were already married, but he hasn’t even dated. He just sleeps all day and goes out at night—I’m not even sure he’s got a real job! So I nagged him a little. Suddenly he roared back, then clutched his chest and collapsed, screaming in pain. Not long after, he even coughed up blood. I was terrified—he’s my only son. If anything happened to him, how could I go on?”

The patient’s mother spoke in a voice dripping with regret, teary-eyed as she watched her son.

Chest pain, difficulty breathing, coughing up blood—those were the symptoms Zhou Can had picked out so far.

During the check, Zhou Can tested for tenderness.

Pressing a little harder on the patient’s left chest, he saw pain flash across the man’s face and he started coughing again, fresh blood appearing in the phlegm.

But the right chest showed no obvious tenderness.

And the whole time, the patient remained silent, unmoved by doctors or mother’s pleas.

“Nurse Luo, did you take his blood pressure yet?”

Zhou Can asked.

It was custom to address experienced nurses as ‘Teacher’ when speaking in front of patients, especially for older, senior nurses. Calling her ‘Nurse Luo’ in front of everyone would have been rude.

Otherwise, it would come off as belittling the nurse just to elevate himself—never a good look.

Navigating doctor-nurse relations called for humility. Doctors had higher status, pay, and prospects—if you made nurses feel looked down on, their motivation would tank.

So many medical tasks only went smoothly with close teamwork—nurses’ roles were vital.

Patients and their families might look down on nurses and disrespect the profession, but doctors never could.

Not only should doctors respect nurses, they should do their best to look out for them.

“Blood pressure’s 115 over 79.”

Normal adult blood pressure is a systolic of 90 to 140 with a diastolic of 60 to 90. This patient’s reading was fine.

Zhou Can let out a small sigh of relief.

A normal blood pressure usually meant no life-threatening heart or cerebrovascular events.

Still, chest pain, tightness, shortness of breath, and hemoptysis—those were serious symptoms.

“Are both arms’ blood pressure readings the same?”

Just to be safe, Zhou Can did some basic checks to rule out aortic dissection or dangerous heart disease.

“Both sides are basically the same!”

Nurse Luo was clearly skilled—her attention to such details proved her worth.

Rookie nurses usually only checked one arm. That was fine for typical problems, but when there was chest pain, an experienced nurse tested both sides.

Zhou Can felt the patient’s forehead for fever—nothing abnormal.

Earlier, while examining for tenderness, he’d already started silently counting the patient’s pulse and breaths.

Pulse was about one hundred per minute—give or take, but it shouldn’t be far off.

That meant the heartbeat was normal.

So, a heart attack seemed less and less likely.

The patient was breathing roughly forty times per minute.

Healthy adults breathe sixteen to twenty times per minute at rest. Above twenty-four counts as tachypnea—and this patient was way beyond that.

Zhou Can also checked for yellowed skin or bleeding, found nothing. No swollen lymph nodes, normal facial features. The only odd thing was a faint bluish tinge around the lips.

Most likely, that mild cyanosis came from hypoxia, but it wasn’t severe.

By now, Zhou Can was feeling a little more at ease.

This patient wasn’t dying—at least, not imminently. It was almost certain he wouldn’t keel over without immediate intervention.

He then checked the patient’s pupils—both round and equal, reactive to light. Another sign his life wasn’t in immediate danger.

Shrunken, unresponsive pupils along with chest pain? That combination was a red flag.

Those cases were far more likely to be fatal.

For unknown chest pain, inexperienced interns should always call in a senior doctor. Even if it seemed simple, supervisors rarely left these cases entirely to an intern.

They’d check things first, make sure it wasn’t a lethal emergency, then hand it off for training purposes.

“Come on, let me check your neck.”

Even though the patient’s face stayed blank and cold, ignoring Zhou Can’s hands-on exam,

he still tried to build some trust. The neck, head, waist, armpits, and private areas were sensitive—strangers touching them naturally triggered wariness.

Anyone who’s dated knows that, after building trust, a woman becomes comfortable with her boyfriend’s touch—even in intimate areas. But if a strange man even pats her shoulder, let alone hugs or grabs, she’ll be alert and probably uncomfortable.

That instinct applies to everyone.

Checking the neck, he found it supple, no resistance, no sign of neck stiffness.

Surface veins weren’t engorged and the thyroid was normal, no swelling.

Playing it safe, Zhou Can checked the area over the heart—no bulge, no enlargement.

“Nurse Luo, could I borrow your stethoscope for a second?”

“Of course!”

Nurse Luo handed her stethoscope over willingly.

Zhou Can listened carefully to the heart sounds—rhythm steady, tones strong, no unusual noises.

His heart seemed fine.

That was odd. With this much pain in his left chest, but no heart issues—what else could it be?

Considering his breathlessness and mild cyanosis,

and how the symptoms started right after his mother’s scolding and his angry outburst,

Zhou Can was beginning to seriously suspect a lung problem.

He probed the patient’s abdomen—flat, soft, no tenderness or rebound, liver and spleen areas clear. So, no enlargement there.

He checked all four limbs—muscle strength and joint mobility were both normal.

Normally, he’d test other physical reactions, but the patient wasn’t cooperating, so Zhou Can avoided anything too provoking.

“Doctor, is my son’s illness serious?”

“Coughing up blood always means something serious. Young people today live with a lot of pressure—it helps to show more understanding. When I examined him just now, I noticed thick calluses on his palms. That doesn’t fit with your image of him lazing about. He works hard—and he’s exhausted.”

Zhou Can turned to the worried mother, voice gentle.

Kids often hide their struggles from their parents. Judging from appearances alone, parents could easily misunderstand them.

But a lot of kids work way harder than parents think.

“I was wrong—I’ll change.” Hearing that, the patient’s mother blamed herself even more. “Son, this is on me—I shouldn’t have lectured you. Get better soon and I’ll cook something nice for you when you come home.”

She held his hand, rubbing the thick calluses she’d come to realize he’d earned the hard way.

Thanks to Zhou Can’s words, she finally realized her son wasn’t idling his days away—he’d been working himself to the bone, not loafing around.

“Mom…”

The patient’s voice trembled, eyes red. For the first time since falling ill, he called out for his mother.

In that moment, his anger melted away. Mother and son finally opened their hearts to each other.

“My good boy—it was my fault for doubting you! Get well soon, okay? I’ll never nag you again.” The mother, overjoyed, clutched his hand tight.

His sister quietly wiped away her tears beside them.

Zhou Can had witnessed countless touching reunions like this, so he kept his emotions in check.

“The patient’s chest wall is symmetrical, no subcutaneous emphysema. There’s slight bulging on the left side, and his left lung hardly moves with breathing. Percussion yields a drum-like note on the left, and listening reveals no breath sounds there—no dry or wet crackles either. Right lung is normal. I suggest immediate chest CT.”

But since it was after hours, there’d only be one doctor covering multiple wards in the CT room.

And that doctor rotated between different departments.

On top of that, the family’s clothes gave away their rough finances—they looked like money was tight.

Plus, a CT scan could take a while.

Still, he had to get to the bottom of what was causing that bloody cough—and fast.

To save them some money and speed things up, Zhou Can changed his mind. “Let’s start with a chest x-ray. We can do a CT if it’s really needed after.”

He ordered a blood panel and a chest x-ray.

All that was left was to wait for the test results.

Zhou Can headed into the office, logged into his department account, and started looking over complex cases handed off by Director Xueyan, Director Le, and others.

For tough cases, several doctors would usually team up for a joint consultation.

That helped minimize misdiagnosis or overlooked details.

“We’ve just admitted another patient transferred from an outside hospital—this one’s post-op with severe complications. The surgery was done at Xinxiang Hospital. Looks like, after a round of recruiting, Xinxiang Hospital’s gotten much stronger!”

The first case Zhou Can was asked to consult on came from Xinxiang Hospital.

These patients were nicknamed ‘messy cases.’

Tuyu was building its rep by taking on tough cases and ‘messy’ patients, so their admission criteria had loosened lately.

That was part of Director Xueyan and the team’s response to Zhou Can’s aggressive publicity strategy.

Xinxiang Hospital hadn’t been able to perform advanced thoracic surgeries like this before, but now they’d managed a full sternal resection and chest wall reconstruction, which showed their surgical skills were rising fast.

It meant Xinxiang now had the capabilities of a major hospital.

“Director Tian’s a practical sort. After setbacks and comebacks, she’s risen from the ashes. So different from Third Hospital’s overseas branding strategy.”

Zhou Can had crossed paths with Director Tian at Xinxiang Hospital twice before.

She’d left a deep impression.

Honestly, when Director Tian tried to recruit him two years ago, Zhou Can had never dreamed Xinxiang would end up where it was today.

Back then, Xinxiang Hospital was barely hanging on—more dead than alive.

Even sending experts abroad for training hadn’t helped much, in his opinion. Those efforts just weren’t enough to turn things around.

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No one expected Director Tian to ditch conventions and aggressively poach staff from other big hospitals.

And she did it department by department—no holding back.

That brute force approach hit the mark.

No wonder even Third Hospital was starting to copy her tactics.