Chapter 517: A Critical Encounter in the ICU

“Sir, the patient you’re visiting is in that bed over there!”

When the nurse spotted Zhou Can entering the ward and looking around, she figured he must be searching for the person he’d come to see.

Every patient who gets admitted here has to get their hair and nails trimmed clean.

One by one, they’re all shaved bald. Some are wrapped in so many bandages that they look like mummies—it really is hard to tell them apart.

“Oh, got it!”

Zhou Can had already guessed that the bed a little farther away was probably Deputy Director Lu’s. There was a gathering of doctors and nurses around it, all scrambling to save a life. Emergency procedures were in full swing.

Chief Xiang Fei, famed as the “King of Hell’s Nemesis,” was leading the charge.

He was personally taking part in the most challenging rescue procedures.

“You can only stand to the side and watch. Whatever you do, don’t interfere with the medical staff’s work.”

The nurse, worried Zhou Can might cause trouble, offered this gentle warning before he could get too close.

“Understood.”

Zhou Can walked over.

Wearing disposable sterile protective gear, it was obvious to the medical staff that he was a family member there to visit.

Everyone was busy with their own duties, so naturally, no one paid him much mind.

Only the nurse stuck with him. Family visits always had to be accompanied one-to-one by medical staff. If a relative got careless and tampered with a ventilator, blood perfusion machine, dialysis equipment, or monitoring gear, it could put fragile patients in real danger.

That’s one reason medical staff really don’t like letting family into the ICU.

A stranger entering means a lot of unpredictable risks.

Everyone’s already overloaded with their own work—adding the job of escorting visiting relatives just gives them another headache.

As Zhou Can approached Bed 13, the nurse quickly called him back, telling him not to go any further.

Deputy Director Lu’s head had been completely shaved and a clear blood hematoma was visible on the back. His complexion was ashen and lifeless.

His right arm lay at an odd angle by his side. From Zhou Can’s clinical experience, it was obvious that the arm had been fractured.

Both legs had severe hematomas too, and it looked like both legs were broken to some extent.

From these fractures and the hematoma at the back of the head, Zhou Can could pretty much reconstruct how Deputy Director Lu fell.

His legs likely hit the ground first, then his body lost balance and toppled. The impact forced him to fall, and his right hand instinctively tried to catch himself—hence the break. When he went down, the back of his head slammed into the hard floor.

The floor itself was probably flat cement or something similar.

If it had been rocky or there were sharp corners where he hit his head, it would’ve been all too easy to end up with a cut and heavy bleeding.

Only when the surface is flat do you see these kinds of large-area hematomas.

The pooled blood gets trapped under the skin.

After tracing the stages of Lu’s fall, Zhou Can felt there was suddenly a much greater chance to save him.

Based on anatomy, the back of the skull sits closer to vital brain areas.

In fights and martial arts, you’re generally forbidden to strike the back of the head or a man’s groin—those are critical weak spots.

A hard blow to the back of the head can knock someone out or kill them instantly.

Lu’s injury seemed to be right around the occipital bone.

Even the parietal bone was affected.

The impact when he fell was probably tremendous.

Still, guessing whether his legs hit first isn’t so straightforward. Only Lu himself would know.

The cerebellum, cerebrum, even the pineal gland could all have taken a beating here. As for internal bleeding—where exactly did it happen? What caused it? There’s just no way to tell with the naked eye.

Massive, diffuse bleeding seemed a likely culprit.

But he could also have ruptured a cranial artery, with bleeding happening in one spot or multiple places.

Zhou Can’s gaze shifted to the vitals monitors, alarms blaring without pause. Lu’s blood oxygen, heart rate, blood pressure, respiration, and EEG—all out of whack.

The situation was a lot worse than he’d imagined.

A central venous line was already in, and he was on a ventilator.

Lu’s problems seemed endless, but Zhou Can knew if you could just pinpoint the real cause of his coma, most issues might unravel on their own. Focusing only on blood pressure, breathing, or blood oxygen individually? That’s missing the forest for the trees.

That’s the classic mistake for doctors below attending physician level.

Limited command of clinical knowledge makes it easy to get stuck inside a box, thinking too narrowly during diagnosis.

Chief Xiang Fei was a heavyweight in the Critical Care Department at the Provincial People’s Hospital—a true pillar.

His diagnostic skills went far beyond those of an attending.

His clinical experience was legendary.

His approach now focused on stabilizing the patient’s blood oxygen, heart rate, and blood pressure, supporting breathing—all symptomatic treatments.

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This is also the most common Western medicine protocol in emergency care.

Whichever vital sign is off, you step in and stabilize that.

In high-pressure emergencies, that’s the fastest way to see results.

But if there’s more time, there are higher-level rescue strategies.

That means peeling back layers to find the real root of the illness—and then tackling it head on.

For example, if Lu had been found to have brain bleeding, you’d have to stop the bleed and reduce intracranial pressure. Just boosting blood pressure or cranking up the ventilator alone would get you nowhere.

Zhou Can stood back, about five or six meters away. His entire diagnostic focus was centered on Lu’s coma.

Thanks to his unique experience in emergency rescue and his unconventional way of thinking, he instinctively felt the source of the coma was the key to solving everything.

There are three main causes of coma.

First: disturbance of normal consciousness due to pathological physiology. Second: microscopic changes and neurotransmitter shifts in conscious states. Third: damage to key neural structures responsible for consciousness.

In Lu’s case, damage to crucial neural structures seemed the most likely culprit.

Blunt trauma to the brain, brainstem compromised by internal bleeding—plenty of ways you could end up comatose.

Even if the blood supply to a critical brain region is disrupted, that alone can trigger a coma.

The vital neural structures are the cerebral cortex, the thalamic diffuse projection system, and the reticular activating system in the brainstem.

For this case, the first suspect would be damage to the cerebral cortex.

The cortex is divided by fissures and grooves into several gyri or lobes.

White matter nerve fibers link them, with the corpus callosum connecting the two hemispheres.

With widespread lesions, it’s all too easy to see impaired consciousness in various forms.

So for Zhou Can, the priority was to rule out trauma to the cerebral cortex.

Too bad he was only here as a visitor—no way would they let him examine the test reports or diagnostic results.

He could only see what was available on the surface.

Vitals like blood oxygen, heart rate, blood pressure, and central venous pressure.

Most family members wouldn’t even know what they were looking at. Only a pro like Zhou Can could take it all in at a glance.

“Sir, your visit time is up. Please leave. Hospital regulations don’t allow family to stay long. This is an aseptic zone—if you stay too long, you increase the risk of contamination. Thanks for understanding.”

The nurse spoke to him with genuine politeness.

After interacting, she definitely sensed Zhou Can wasn’t your average visitor.

“Chief Xiang, may I ask when the patient’s central venous pressure was first monitored?”

Just as Zhou Can was about to leave, he made a rapid, comprehensive assessment of Lu’s vital signs and visible symptoms—and came to a shocking conclusion.

Lu’s coma was probably due to multiple factors.

Given how urgent things were, a minor slip or oversight during treatment could very well have played a role.

The nurse was horrified—Zhou Can had actually questioned the highest-ranking chief in the room.

She went pale as a sheet.

She had no idea how he even knew Chief Xiang, and the question itself was scarily professional.

Right now, her only wish was to get this wild card out of there fast.

“Sir, please leave now. Don’t get in the way of the rescue.”

There was a hint of anger in her voice.

Still, she kept just enough restraint.

She’d warned him so many times, and yet he just wouldn’t listen.

Was he just making trouble for her on purpose?

Chief Xiang Fei was starting to get irritated. His usual rescue protocol wasn’t working on this patient. Maybe the injuries were simply too severe.

Saving patients who fell from great height is always a nightmare.

You just can’t quickly find all the internal bleeding or organ damage.

And that’s not even counting the chain reactions that follow such trauma.

The rescue was hitting a wall, and now, this visiting relative had stepped forward to question him, interrupting his thoughts. He felt a surge of anger.

But he’d been through countless battles.

Years of clinical practice told him not to start fights with family lightly.

He simply lifted his head and glanced indifferently at Zhou Can, then replied coldly, “If you have any questions, ask the nurse directly. Visitation is over. Please leave.”

It was clear he didn’t take Zhou Can seriously.

He’d seen plenty before—relatives with tidbits from the internet or books demanding to know why doctors weren’t following what they’d read.

Nobody in the medical field enjoys dealing with that kind of family member.

In these situations, most staff will move the patient if they can. If that’s not possible, they’ll fall back on defensive medicine to protect themselves.

Dealing with these families always cools relationships.

“Chief Xiang, I’m not trying to cause trouble. I just want to offer a diagnostic perspective. Could the decline in the patient’s vital signs be from a venous thrombosis—specifically, a central venous thrombosis? That might be worth checking.”

For better or worse, Zhou Can had to put his idea out there.

Anyone who didn’t understand would think he was nuts.

What kind of visitor dares to tell the chief how to conduct a rescue?

“Please leave! If you have questions, speak to our nurse.”

A tall young doctor working under Chief Xiang strode over and started ‘escorting’ Zhou Can out.

The doctor’s gaze was openly hostile.

If this weren’t the ICU, he probably would’ve called security straight away.

The young female doctor on the team shot Zhou Can the same look you’d give a lunatic. She was probably laughing inside—who was this random “genius” who thought he could teach the chief how to save lives?

The world really is full of strange birds these days.

“Wait!”

Chief Xiang stopped Zhou Can.

His trainees respected his authority—they immediately backed off.

But the look they gave Zhou Can was anything but friendly.

“Why do you think the patient has a central venous thrombosis?”

Chief Xiang seemed to be having a realization after hearing Zhou Can’s suggestion. No wonder nothing was working—if there really was a central venous thrombosis, that would be serious.

“I’m not certain, just suspicious. The most common reason for a central venous thrombus is air not fully expelled during puncture, or maybe air accidentally entering the system. It’s just a theory, not a criticism of the doctors’ work.”

Zhou Can rushed to explain himself.

He had no desire to provoke everyone by casting doubt on the puncture technique.

After years inside the hospital system, Zhou Can knew any doctor-patient dispute made everyone stick together.

It’s just like any bureaucracy—people rally to shield themselves from external scrutiny.

It’s ultimately about self-preservation.

Setting up a venous line is routine in emergency care—for circulatory support and for monitoring central venous pressure, dialysis, and so on.

“Are you a doctor too?”

For the first time, Chief Xiang really looked at Zhou Can.

“Yes.”

Zhou Can didn’t deny it.

“How do you know the patient?”

“He’s my colleague.”

Hearing that they were only colleagues, Chief Xiang’s attitude softened and his guard eased a bit.

“Tell me what makes you suspect a venous thrombus.”

Chief Xiang’s tone had clearly changed—there was a note of respect now.

Anyone familiar with Chief Xiang would recognize he was addressing Zhou Can with a bit more regard.

“For high-risk emergencies, you usually need two or more peripheral venous lines. If possible, a central venous catheter is even better. Whether it’s rapid infusions or monitoring central venous pressure, both need a clear line. Right now, both the monitoring and the infusions look off. With the patient’s changing vitals, I’d say the odds of a thrombosis are very high. As for why it formed, there’s no need to point fingers.”

When Zhou Can finished his analysis, he deliberately made his tone friendly.

Doctors understand better than anyone how tough this job is.

Slips and mistakes are just part of the human condition.

Everyone messes up sometime.

If Zhou Can tried to pin the blame on someone for improper technique, he’d only turn the whole team against him.

That would just make it impossible to make progress with Lu’s treatment.