Chapter 532: Family Issues Arise Again, Control Infection Before Surgery

“Can a vascular stent be used for this? The experts at Provincial People’s Hospital gave the same diagnosis as you, saying it’s chronic arterial ischemia. I looked it up on some professional medical websites and found that if the issue is caused by narrowed or blocked blood vessels, a minimally invasive surgery can be done. They just place a stent inside to clear the blockage.”

Hearing this from the retired official’s daughter-in-law, Zhou Can finally understood why Provincial People’s Hospital refused to operate on the patient.

Even Zhou Can felt irritated being told how to treat a patient by a family member. The experts at Provincial People’s Hospital, all prominent figures in the medical field, must have felt the same frustration. Imagine being directed by someone who thinks they know everything after a quick online search.

Those experts, likely due to the woman’s status, couldn’t openly argue with her.

The best approach was a soft tactic.

They continued with the same ineffective treatment the previous hospital had tried, applying it to the retired official.

Seeing this, the retired official probably thought, ‘Wow, I expected the experts at Provincial People’s Hospital to be exceptional, but they’re no different from doctors at a local city hospital! Still just treating with antibiotics—will that even work?’

As long as the retired official wasn’t foolish, he’d obediently seek treatment elsewhere.

If the experts at Provincial People’s Hospital added in a serious tone, ‘We’re not entirely sure about your condition, but we could try amputation first,’

it would likely scare the retired official into demanding a transfer that very night.

Sometimes, when patients or their families think an expert isn’t skilled, it might not be true. The expert could be deliberately underperforming to make you think they’re incompetent.

“In cases like this, using a stent is quite rare. I suggest we start with a vascular angiography to get a clearer picture. Given your father-in-law’s advanced age and lack of smoking history, we should also consider the possibility of arteriosclerotic occlusion.”

Zhou Can glanced at the woman with a calm expression, patiently explaining.

Unlike myocardial infarction, chronic arterial ischemia in the limbs is rarely caused by a large plaque blocking the vessel.

It’s more likely that arteriosclerosis has caused the vessel walls to narrow over time, eventually leading to complete blockage.

“We agree to the vascular angiography. If an issue is found, we’d prefer to avoid major surgery if possible. Based on consultations with online experts, we’d like to opt for a minimally invasive interventional surgery to place a stent and resolve the problem.”

The woman remained stubbornly insistent.

In clinical practice, doctors often encounter family members or patients like this. They only trust acquaintances, online ‘experts,’ or conclusions from a quick internet search, refusing to believe the doctors treating them.

What’s worse, when the attending doctor warns them not to trust online advice and urges them to follow professional recommendations, the family often disregards it, assuming the doctor is just trying to scam them out of money.

When dealing with such families or patients, the only solution is to let them seek treatment from those so-called acquaintances.

Zhou Can stood up, exchanging a glance with Director Xueyan.

She winked at him, a subtle bitter smile flickering across her face.

If not for the presence of the family and patient, she might have shrugged helplessly.

“Take some time to think it over. If you agree, we can proceed with the vascular angiography. The patient’s condition worsens every day, so early treatment brings better results. If delayed too long, amputation might become the only option.”

Zhou Can could only say so much.

If the family and patient still refused to listen, there was nothing more he could do.

Doctors can only propose what they believe to be the most beneficial treatment plan. Ultimately, the choice lies with the patient.

“Dr. Zhou is right. My condition can’t be delayed any longer. I’ll listen to you. Can you arrange the vascular angiography now? Don’t worry about the cost. As long as it can cure me, I don’t care how much I spend.”

The retired official, seasoned by years in bureaucracy, had a wealth of experience.

He’d already picked up on subtle cues from Zhou Can and Director Xueyan’s expressions. Hearing that delaying treatment could lead to amputation—a statement identical to what the experts at Provincial People’s Hospital had said—filled him with dread.

As the saying goes, a man with a big mouth is resourceful, but a woman with a big mouth spells trouble.

His daughter-in-law was filial, no doubt, but far too overbearing.

Insisting the hospital follow her demands naturally irritated the doctors.

If their experience at Provincial People’s Hospital had felt strange,

then arriving at Tuyu Hospital without changing their mindset might lead them to encounter another set of ‘incompetent doctors.’

“Dad, don’t rush. A doctor friend of mine told me that doctors often exaggerate the severity of conditions. If they cure it, they’re hailed as heroes. If they don’t, they can just say the illness was too serious, and they did their best.”

The woman leaned in, whispering into the retired official’s ear.

“Listen to me. Let’s discuss the treatment plan with the doctors.”

Her tone was one of concern, as if worried her elderly father-in-law, naive to the world’s dangers, might be easily deceived.

After listening, the retired official lifted his head to address Zhou Can and Director Xueyan. “It’s fine. Please arrange it as soon as possible.” Then, turning to his son and daughter-in-law,

“It’s getting late. You should head back. There are caregivers here to look after me. If a signature is needed for surgery, I’ll call you.”

“A Fen, let’s head home for now!”

The retired official’s son said to his wife.

“Dad, if the test results come out, you must let us know right away! When it’s time to decide on the surgery plan, wait for us to be here.”

The daughter-in-law’s face was still full of worry.

“I know what I’m doing. Go home and take care of your mother.”

The retired official waved at his son and daughter-in-law, practically ushering them out.

Zhou Can watched all of this unfold, silently noting to himself that influential figures were indeed different from ordinary folks. This man had climbed his way up through sheer effort, and his sharp instincts were evident.

Judging by the retired official’s behavior, he’d likely figured out where the real issue lay.

Since this was a priority patient personally assigned by Director Zhu, a vascular angiography was arranged for him that very night.

Unlike cerebral or cardiovascular angiography, limb angiography carries relatively lower risks and is easier to perform.

Still, the necessary preparations couldn’t be skipped.

In the office, Zhou Can shook his head. “Sis Yan, should we first order an X-ray plain film for the retired official before moving to arterial angiography?”

This approach would allow for more targeted diagnostics.

An X-ray can reveal spotty calcification in the arteries.

Ultimately, though, arterial angiography would still be necessary.

It helps determine the location and extent of arterial blockages.

For instance, are the arteries twisted? Is there diffuse irregular narrowing of the lumen, or segmental occlusion?

Only by understanding the precise internal condition of the vessels can the most effective surgical plan be devised.

This case wasn’t particularly complex.

The real challenge lay with the patient’s daughter-in-law.

She was far too meddlesome, inevitably making doctors hesitant.

An X-ray plain film should have been done at Provincial People’s Hospital, but they didn’t even bother with it.

Even though an extra test could generate more revenue for the hospital,

the doctors there would rather forgo the income.

Doctors work for a salary. When faced with overly troublesome patients, they don’t care about treating one more or one less.

For the sake of saving one extra patient, only to be met with complaints, or even violence, lawsuits, and personal threats from families, it’s better to avoid the hassle altogether.

Director Xueyan had no objections to Zhou Can’s proposed testing plan.

She nodded in agreement with a smile.

“This patient himself is quite reasonable. It’s just his daughter-in-law who’s a handful. His wife, though, takes the cake—she’s got a mind full of schemes. I was honestly repulsed. Thankfully, she has high blood pressure and heart issues, so she couldn’t stay at the hospital for long and went home.”

Hearing this, Zhou Can couldn’t help but shudder.

The daughter-in-law alone was already tough to deal with. If the patient’s wife was even worse, treating this case might be impossible.

“When the time comes to sign for surgery, we’ll need the family’s consent. What do we do then? Should we use a gentle nudge to convince the patient to transfer? Cardiothoracic Surgery is swamped right now. We can’t afford to let one troublesome patient take up too many resources.”

Zhou Can suggested.

“Let’s see how things play out. If it really becomes unmanageable, we’ll have to find a way to get the patient transferred.”

Director Xueyan, in the end, softened.

Women often have a tender heart, after all.

But a ruthless, vicious woman? That’s a nightmare for any man.

…

By the time Zhou Can finished two surgeries in Cardiothoracic Surgery, it was already midnight.

The major operations he handled now were incredibly challenging, often lasting three to four hours, sometimes even longer.

Zhou Can increasingly felt there weren’t enough hours in the day.

Cardiothoracic Surgery had far too many high-precision, complex surgeries—many of them massive undertakings.

Sometimes, anastomosing a single blood vessel, removing a tumor, or repairing a mitral valve required extreme caution. A slew of preparatory steps were needed to ensure the surgery went smoothly.

To remove a tumor, not only did the chest have to be opened, but the pericardium also needed to be moved aside. Sometimes, extracorporeal circulation had to be established, and the heart stopped temporarily.

None of these preparatory steps could be skipped.

Each one was like walking on a knife’s edge, demanding utmost care.

Dragging his exhausted body out of the operating room, all Zhou Can wanted was to go home, shower, and collapse into bed.

He’d hoped to clock out early and work on a research paper at home.

Now, he couldn’t do anything.

Once this busy period passed, he’d have to find ways to carve out time for studying, furthering his education, and boosting his academic credentials.

Many veteran elders had warned him with hard-earned lessons that a strong academic background was crucial.

“Zhou Can, the test results for the retired official are out. I know you’re swamped, but could you take a look before you head out?” Director Xueyan called out to him after receiving the reports from the attending doctor.

If she didn’t ask Zhou Can for input now, she’d likely have to wait until after 7 p.m. tomorrow.

“Sure!”

Zhou Can didn’t refuse.

Taking the reports, he studied them carefully under the dim corridor lights.

“Huh, they even did an ultrasound. Nice touch!”

Zhou Can noticed that in addition to the X-ray plain film and arterial angiography, an ultrasound had been performed.

“When the initial results came in, I reviewed them and saw narrowing in both the popliteal and iliac arteries. So, I took the liberty of requesting an ultrasound as well.”

The attending doctor, a young physician around thirty and at the attending level, explained.

Most new doctors in Cardiothoracic Surgery held doctoral degrees, some even post-doctoral.

These individuals had a significant advantage—after just one year of work, they were promoted straight to attending level.

In terms of career advancement, compared to doctors with standard qualifications, their rise was like riding a rocket.

“That’s great. Flexibility is key.”

Zhou Can nodded, clearly approving of the attending doctor’s initiative.

In clinical practice, patient conditions are endlessly variable, requiring doctors to adapt on the fly. A rigid doctor isn’t suited for frontline clinical work.

Administrative roles or positions in the imaging department might be better fits.

Of course, many end up forced to change careers altogether.

After carefully reviewing the patient’s three test reports, Zhou Can had a clearer picture.

The color Doppler ultrasound showed significant narrowing in the patient’s abdominal aorta, iliac artery, and popliteal artery. Surprisingly, even the abdominal aorta was affected, something Zhou Can hadn’t anticipated.

This also highlighted that his diagnostic skills were still far from top-tier.

Of course, even the world’s best experts couldn’t diagnose hidden lesions solely through palpation or basic auxiliary tests.

For Zhou Can to detect issues in the popliteal and even iliac arteries just by palpation was already quite impressive.

The ultrasound also revealed no blood flow signal below the right superficial femoral artery.

No wonder the popliteal and dorsal foot pulses couldn’t be felt in the right foot.

Next, he reviewed the angiography results.

The abdominal aorta and bilateral iliac arteries showed widespread irregular narrowing. The right common femoral artery was visible, but the superficial femoral artery wasn’t.

The angiography results aligned closely with the ultrasound findings.

“Based on these results, we can basically confirm arteriosclerotic occlusion of the right superficial femoral artery.”

After reviewing the reports, Zhou Can offered his diagnosis.

In truth, most doctors present could reach the same conclusion from these tests.

What Director Xueyan and the attending doctor were really waiting for was Zhou Can’s treatment plan.

“Zhou Can, can you outline a surgical plan now? Or if you’d prefer, take the reports home and give me a plan by tomorrow morning.”

Director Xueyan didn’t hold back in front of the other staff. For key patients, she often sought Zhou Can’s input on surgical plans.

“I’ll give it now. Let’s keep the test data in the department so other doctors can refer to it for learning.”

Zhou Can felt the patient’s condition wasn’t overly complicated.

The surgical plan wouldn’t be too difficult either.

“The angiography shows contrast agent in the right deep femoral artery and the right popliteal artery above the knee, indicating there’s still a blood outflow pathway in the lower limb. During lung auscultation, I heard wet rales, suggesting a possible lung infection. If we’re to proceed with surgery, we’ll need to control the lung infection with medication first. As for the surgical plan, I propose a bypass graft between the right common femoral artery and the popliteal artery to restore blood flow to the right leg.”

Surgery requires considering all factors.

For elderly patients like this, controlling a lung infection before surgery is absolutely necessary.