Chapter 492: Diagnosis Under Pressure

This patient most likely isn’t just dealing with a simple upper gastrointestinal bleed—there’s a strong chance the bleeding is also happening somewhere in the lower digestive tract.

In fact, it’s highly probable that the main source of bleeding is in the lower GI tract.

When Zhou Can first saw the patient, he used both his level six Hemostasis and Pathology Diagnosis skills to pinpoint the bleeding source as the upper digestive tract, most likely the stomach. But now, after further diagnostics, it looks like the patient may have multiple bleeding sources.

That means he missed something during the initial diagnosis.

Still, even with that oversight, he gained a lot—he got a firsthand look at the diagnostic techniques of a top-tier physician.

His Hemostasis and Pathology Diagnosis skills are still on the lower end, far from true mastery.

So, it’s not surprising a misdiagnosis happened.

But even so, being able to narrow down a bleeding source just through physical exam and patient history? That takes serious skill.

Keep in mind, he’s still just a resident doctor!

And a first-year resident at that—already this capable. With hard work and practice, it’s only a matter of time before he’s world-class.

He’s luckier than those doctors who’ve spent half their lives practicing medicine but never even reached chief physician level.

“Alright, I’ll arrange for a gastric juice test immediately. Dr. Zhou, you’ve worked hard, go grab some food! If you have any new ideas about the diagnosis, let me know anytime. Since the patient’s condition is serious, I’ll call the Gastroenterology Department for a consult as a precaution.”

Dr. Ai Li genuinely respected and cared for Zhou Can.

As a fellow doctor, no one understands the struggles of the job better.

Zhou Can had been in the operating room all morning and was still helping her diagnose patients on an empty stomach—it was a huge favor.

Dr. Ai Li wanted the Gastroenterology specialists to consult; best case they’d find the cause, and even if not, at least they could share the risk. She was very worried the patient’s condition might suddenly take a turn for the worse.

……

Sitting in the hospital cafeteria, Zhou Can was still puzzling over the patient’s condition.

If the gastric juice test came back non-bloody, they’d definitely have to investigate the lower GI tract.

Given the patient’s high fever and severe blood loss leading to shock, acute hemorrhagic necrotizing enteritis was a real possibility.

During the abdominal exam, when Zhou Can pressed beneath the sternum and around the navel, the patient had pronounced pain.

Acute hemorrhagic necrotizing enteritis often brings periumbilical or abdominal cramps, bloody watery stool, sometimes sloughing of necrotic intestinal mucosa, and the stools have an especially foul odor.

Of these symptoms, the patient only presented with GI bleeding and periumbilical pain—the rest hadn’t shown up yet.

So, acute hemorrhagic necrotizing enteritis couldn’t be ruled out, but it couldn’t be confirmed, either.

Maybe a fifty percent chance at best.

They’d need more observation and a stool test to be sure.

If it wasn’t that, then what else could it be?

At this point, Zhou Can deeply understood the feeling of wishing he’d read more when he needed it most.

He racked his brain, reviewing every GI case and key point he’d ever learned.

He was already pretty strong—at least compared to med students who have a head full of theory but blank out in real practice. There are lots of test-takers who ace exams but panic as soon as they hit the clinic.

Everyone goes through this phase.

With enough hands-on experience, you eventually learn how to put what you’ve studied to use.

After a year as an intern, three years in residency, and nearly two years as a resident, Zhou Can had plenty of real-world experience. He knew how to apply what he’d learned.

Now, another disease came to mind with symptoms similar to the patient’s.

Ulcerative colitis.

This is a non-specific inflammatory bowel disease that usually develops slowly.

The patient’s illness had escalated slowly too—it had already been over a month, which matched up.

The location fit as well.

The lower digestive tract includes the colon.

Plus, after hearing the patient had been given hemostatic drugs and a thousand milliliters of blood without the anemia improving, Zhou Can seriously suspected bleeding in the small intestine or upper colon.

Ulcerative colitis often comes with diarrhea, abdominal pain, then bloody stools, sometimes pus and blood, as well as fever and weight loss.

Among these, the patient had abdominal pain, bloody stools, fever, and weight loss—all four symptoms fit.

And it developed slowly, just like in this case.

So, ulcerative colitis was now a highly likely candidate.

Zhou Can had thought of two possible diseases, but he wasn’t about to stop there.

A true top-tier doctor keeps pushing—always expanding their diagnostic thinking to consider every possible cause.

The broader the options, the better.

Diagnosing a patient really tests the doctor’s depth of knowledge and clinical experience.

That’s why most experts stick to one specialty—a person’s energy and time really are limited.

Zhou Can had trained extensively in both the Gastroenterology Department and Surgical Gastroenterology, spending considerable time in both.

This gave him a chance to rack up way more experience diagnosing digestive tract diseases and broaden his knowledge base.

At that moment, two more possible diseases popped into his mind.

Diverticular disease of the colon—mainly happens in the sigmoid and cecum, often with fever, increased white blood cells, and signs of peritonitis.

This one can show up as periodic small bleeds or sudden massive bleeds.

Another one is Meckel’s diverticulum.

Its basic symptoms are similar but it’s more commonly found at the end of the ileum.

The patient had fever and sudden massive blood loss—those checked out.

But no signs of peritonitis were observed.

So, these two looked possible but weren’t very likely.

Zhou Can now had four possible diagnoses in mind, but he wasn’t satisfied—he kept searching for more.

“Hey, Xiaolan, eating here too?”

A man with a deep, magnetic voice snapped Zhou Can out of his thoughts.

“Yeah! It’s been busy this morning. We just finished surgery. Have you had lunch yet?”

Ma Xiaolan answered with a bright smile.

“I’ve also been caught up with work, just now coming to eat. Mind if I join your table, Dr. Zhou?”

The man, greeting Ma Xiaolan, asked Zhou Can with a smile.

“Please, sit! Dr. Du, you and Xiaolan have known each other a while?” Zhou Can hadn’t expected to run into Du Leng here.

His schedule meant meals were often ordered and eaten in the operating room; he rarely came to the cafeteria and hardly ever saw Du Leng.

Plus, Zhou Can’s career had outpaced Du Leng’s by a mile—even when they met, Zhou Can carried himself like a king.

Du Leng, on the other hand, tried to avoid any direct interaction, steering clear of him whenever possible.

Why was that?

Because Du Leng, with his overseas PhD, was getting smoked by a local university undergrad. Embarrassing, right?

Don’t be fooled by Du Leng’s gentle and refined appearance—he could rival a wily character from a martial arts drama. Not only was he fake, he cared way too much about saving face.

What stood out most to Zhou Can was that consultation they did together at Xinxiang Maternity and Child Hospital a few years back.

Zhou Can had burst onto the scene like a dark horse, while Du Leng had tumbled from his pedestal.

After that, Du Leng started keeping his distance and diligently throwing himself into basic clinical work. Rumor was, he even learned to handle patient waste, change dressings and insert catheters—doing it all from scratch.

As for how he measured up now, Zhou Can really couldn’t say.

When it came to surgical talent, even if Du Leng had wings, he still couldn’t keep up.

“I’ve known Dr. Du for about three months. Funny story: one night I was stuck at work late, it was raining and I couldn’t get a ride. Dr. Du offered to drive me home.”

Ma Xiaolan recalled the memory gratefully.

And with just a hint of shyness.

Women often feel most moved in tough times.

Whether it’s being robbed, harassed on the street, or getting sick and needing care, when a guy steps in during their lowest moments, it leaves a deep impression on their hearts.

Sometimes, special bonds are born from these little moments.

“So, are you two dating or just friends?”

Zhou Can grinned as he asked.

“Dr. Zhou, as the head of our surgical team, you sure look after your members—even care about their private lives.”

Du Leng quickly jumped in to help Ma Xiaolan out.

“Haha, everyone loves a bit of gossip—I’m no saint, Dr. Du. With your impressive background and good looks, I bet you’ve dated plenty of women. But just a heads-up: don’t let Xiaolan down, or the whole team won’t stand for it!”

Zhou Can half-joked, half-serious.

Mostly he wanted to remind Ma Xiaolan—not to let herself get played.

Du Leng didn’t have the best reputation.

He’d dated more than ten female doctors and nurses in the hospital, and to be fair, none had caused a scene after. That took some skill.

Supposedly, Du Leng only cared if a girlfriend’s looks were above average, but was especially picky about figure.

Everyone has their own preferences, after all.

Who knew how far things had progressed between Ma Xiaolan and him in the three months they’d known each other.

As the team lead, Zhou Can could only give a friendly warning—he’d never interfere in his doctors’ or nurses’ relationships. “Dr. Zhou, is that a compliment or a dig? I’m not nearly the playboy you say. I believe in being devoted to one person. If I ever find a woman who truly moves me, I’d stay loyal like a swan for life.”

Du Leng wasn’t sure if he was just worried Zhou Can would mess up his budding romance or something else.

He jumped in with an unusually serious declaration.

It felt like he was aiming his words straight at Ma Xiaolan, explaining his views on love.

He really didn’t want her thinking he was just a player.

But honestly, all that urgency just made it obvious there was something going on.

Judging by how much Du Leng cared, he probably hadn’t won her over yet. Or maybe he had, and he actually liked her—which would explain the way he acted.

Men and women both get hopelessly infatuated when they really like someone.

There’s always someone who can tame another.

“Come on, let’s eat before the food gets cold!”

Ma Xiaolan broke the awkward tension.

As they ate, Du Leng did something interesting—when they were nearly done, he got up and bought everyone a bottle of yogurt.

One for each of them.

Zhou Can found it odd—was this some sort of bribe?

“Thanks for the yogurt, Dr. Du. It’s getting late; we need to get back to the operating room. See you.”

As team leader, Zhou Can knew he had to say something.

“No problem! Honestly, I admire you. I’ve heard your surgical skills are as good as many senior chief physicians. It’s a miracle, really. You must have God’s favor.”

This time, Du Leng wasn’t just making small talk; he was actually being earnest.

“Haha, you admire me? I should say the same for you. Being an overseas grad is already impressive; only a rare few could pull that off. But I don’t believe in God. My faith is in Yan Huang.”

Zhou Can had no time for blind worship of the West.

Think about it: which is richer—foreign myths like Athena, Lady Liberty, God, Satan, or the ancient Chinese system?

The Three Pure Ones, Jade Emperor, star deities, heavenly kings, Dragon Kings of the Four Seas… China’s mythology is intricate and complete, with clear roles and hierarchy.

So, what was Du Leng’s angle, suddenly saying he admired him?

Was he trying to patch things up?

After all, they’d once been bitter rivals.

Leaving the cafeteria, and on the way back to the Emergency Department, Zhou Can was once again wracking his brain over what else could be causing the patient’s GI bleeding.

Intestinal malignant histiocytosis.

Yet another disease whose symptoms matched the patient’s filtered into his mind.

This one’s usually accompanied by fever and massive GI bleeding. Antibiotics don’t typically help.

The patient’s symptoms lined up closely with this disorder.

The best way to confirm it would be a GI tract barium study, or an emergency endoscopy.

But the patient had only just come out of shock and was still weak, with probably a lot of blood pooling in the intestines, so those tests wouldn’t yield reliable results just yet.

A bone marrow test might be a good option.

By now, Zhou Can had reached the Emergency Department lobby.

“Dr. Zhou, Director Han would like you to come to the consultation room to discuss the case.”

A nurse hurried up to tell him as soon as she saw him.

When Zhou Can arrived, he found Dr. Ai Li, Deputy Director Han, and Director Shang from Gastroenterology, along with two of Shang’s students.

“Hey, Dr. Zhou, haven’t seen you for quite a while!”

As soon as Director Shang saw Zhou Can, he stood up and warmly shook his hand.

Judging by his attitude, Shang didn’t see Zhou Can as just a resident—he treated him like an equal, like an old friend.

“Haha, it has been a while. You’re looking great, Director Shang.”

Zhou Can replied warmly, tossing in a bit of flattery.

Jiangbian Yuweng reminds you: Don’t forget to bookmark after reading.