Chapter 545: Rectal Fistula and the Troublesome Family

Out of caution Zhou Can kept a certain wariness toward Jiang Wei.

Something about her felt a bit unreal.

This woman was just too exceptional. For her to blindly throw her lot in with a mere resident doctor like Zhou Can didn’t quite match the high intelligence and experience she displayed.

When things seem off there’s usually a catch. Zhou Can had to stay on guard.

“That female patient is in her fifties with superficial varicose veins in both legs. The left leg is the worst. It was severely swollen before surgery so I performed a high ligation and stripping procedure. Post-op her vital signs are stable and the left leg is already under pressure bandaging. Barring any surprises she should recover quickly.”

He Hansheng’s surgical skills were always impressive.

If he said there’d be no issues there likely wouldn’t be any.

His description matched what Jiang Wei had told him.

Zhou Can couldn’t help but wonder if he was being overly cautious. Maybe she just wanted to pick up some side work for extra cash.

The next day Zhou Can headed to work. Jiang Wei was already there as usual dressed in her work uniform waiting for him.

There was no denying it—wearing the nurse’s uniform her curvy figure was perfectly outlined. Add to that her striking looks and she was quite a sight to behold.

Unlike most beauties her skin had a healthy wheat tone and her physique was incredibly well-proportioned.

Her movements were far more agile than the average woman’s.

She must work out a lot.

“Hey good morning!”

She greeted Zhou Can with a warm smile.

The moment she saw him a genuine smile bloomed on her face. It felt like a breath of spring breeze washing over him leaving him oddly at ease.

“Been waiting long?”

After yesterday’s events Zhou Can felt a bit less guarded around her.

“Not long at all. Thanks for introducing me to such a skilled doctor yesterday. I managed to earn a little side money because of it.” She took the initiative to express her gratitude.

It was also a way of giving Zhou Can some feedback.

“No need to thank me. I’ll go change first.”

After a quick greeting Zhou Can headed into the changing room inside the office to swap into his white coat.

Then he joined Jiang Wei to make the rounds.

As they checked each patient they came to one who’d undergone rectal cancer surgery. Zhou Can inspected the gastrointestinal decompression device while asking “How are you feeling? Are you adjusting to the decompression?”

The patient was only forty-six quite young for this diagnosis.

Diagnosed with rectal cancer she’d prepared for surgery over nearly three days. Zhou Can had performed the operation himself yesterday.

Rectal cancer surgery requires meticulous pre-op preparation. For instance the patient must restrict their diet to liquids for three days beforehand. To ensure nutritional needs during intestinal prep doctors often provide enteral nutrition supplements.

Typically something like Peptisorb or Ensure is used.

Additionally patients are given 10 grams of senna leaf-infused water daily to drink.

If the patient finds it bothersome they can take about 50 ml of 25% magnesium sulfate orally each evening instead.

Some patients have reservations so they find senna leaf water easier to accept since it’s like drinking tea.

“It’s manageable.”

The patient was remarkably tough a real fighter.

“Keep monitoring your condition. We’ll likely continue gastrointestinal decompression for about forty-eight hours. Once you start passing gas through the anus you can have some liquid food. A nurse and doctor will come by today to perform anal dilation. We’ll need your cooperation.”

After examining the patient Zhou Can gave her some instructions.

Post-surgery anal dilation is needed for about three to four days depending on the patient’s condition. The process can be embarrassing and painful.

All of this is to prepare for normal bowel movements after surgery.

“Jiang Wei take a look at her care plan especially the nutritional support. If there’s room for improvement feel free to adjust it.”

For critical patients like this Zhou Can often asked Jiang Wei to review medication and nutritional support plans.

“Everything else looks good but the plasma and albumin supplementation could be tweaked a bit. I’ll also put together a post-op liquid diet plan for her nutritional needs.” She offered her input after reviewing the chart.

“Sounds good.”

Zhou Can nodded in agreement.

For female rectal cancer patients this surgery carries a high risk of forming a fistula between the rectum and the urinary area. Feces can leak out from there. If such a fistula develops repairing it is often tricky with less-than-ideal outcomes.

If a simple vaginal fistula repair fails an abdominal surgery might be necessary.

This patient’s intestinal condition was poor so Zhou Can was especially worried about a rectal-urethral fistula forming. That’s the main reason he asked Jiang Wei to optimize the care plan.

…

On the third day post-op Zhou Can’s worst fears came true.

During rounds a family member reported a strong foul odor from the patient’s lower body. As soon as Zhou Can lifted the blanket the distinct stench of feces hit him. His heart sank. Upon inspection he confirmed that fecal fluid was indeed leaking from the urinary area.

Fecal fluid is teeming with bacteria. When it leaks from the urinary area it can easily trigger various inflammations in women or even lead to serious complications.

This patient had severe pelvic adhesions and poor intestinal health.

During the surgery Zhou Can already had a bad feeling.

Sadly his fears were realized—the patient had developed a rectal-urethral fistula.

This condition only affects female patients due to their unique anatomy. Simply put the posterior wall of the rectum is too close to the urethra.

This patient in particular had a history of uterine cancer and had her uterus removed.

That further increased the likelihood of a rectal-urethral fistula.

“This is definitely a rectal fistula. She’ll need a second surgery…”

After assessing the patient Zhou Can provided a detailed explanation to both her and her family. He could tell right away that the family’s expressions darkened.

It’s normal for families to be upset when issues arise post-surgery.

“Dr. Zhou I’d like to ask if this happened because something wasn’t done properly during the surgery?”

“We doctors always strive to perform the best surgery possible for every patient but sometimes unique circumstances or unexpected issues arise. Your wife had a prior hysterectomy which made her more prone to this type of rectal fistula. On top of that her pelvic adhesions were quite severe…”

“Enough I don’t want to hear your excuses. I don’t understand all that jargon anyway. Just tell me how you’re going to fix this.”

The family member rudely waved his hand cutting Zhou Can off mid-explanation.

They say harsh environments breed tough people.

This couple hailed from a remote mountainous area their worn-out clothes hinting at financial struggles. When asked to pre-pay for the surgery the husband had been reluctant haggling with doctors and nurses for a long time before finally agreeing to pay.

That issue had eventually been resolved.

But now with this post-op complication the family seized the chance to make a fuss.

Zhou Can had dealt with plenty of families like this. Their goal was usually to get the hospital to waive treatment fees.

If he gave in now they’d push for more demanding compensation from the hospital.

From their perspective if the hospital had no fault why would they compromise and reduce fees? That must mean guilt. And if the hospital was at fault it proved there was a problem during surgery.

If the surgery was botched and the hospital bore responsibility compensation seemed only fair to them.

So when dealing with such families unless the doctor made a glaring error the hospital had to stand firm and never back down.

“Sir my recommendation is to arrange a second surgery for your wife as soon as possible to prevent more severe consequences or losses. The hospital followed proper procedures and there’s no fault on our end.”

Zhou Can’s tone turned icy.

When faced with unreasonable families being too soft or polite often backfired.

For many at the bottom of society survival in harsh conditions meant following jungle rules just to get by.

Politeness and civility didn’t always apply to those in such circumstances.

Many honest decent folks couldn’t even get a sip of soup.

If you paid attention to those around you you’d notice that the ones who thrived often broke rules taking risks and pushing boundaries. Those who struggled were usually the quiet humble types.

Even when there’s just one bun left in the pot they’d watch someone else snatch it unable to bring themselves to fight for it.

With his fair share of clinical experience Zhou Can had dealt with all kinds of patients and families. He knew exactly how to handle those looking to cause trouble.

“Hmph it’s clearly your fault yet you talk about following procedures. Do you take me for an idiot? Get your hospital leader here now or I’ll file a complaint with the Health Administration Department. I’ll call in every news reporter to come judge this for themselves. Let’s see if you’re still so stubborn then.”

The man in his forties likely used to heavy labor was sturdy and strong.

His anger unleashed a fierce almost tiger-like aura that could intimidate anyone.

Of course Zhou Can wasn’t fazed by such families.

If the man dared to get physical Zhou Can wouldn’t mind sparring with him.

Having trained in martial arts and Sanda spending all day cooped up in the hospital’s operating room left him itching for a chance to stretch his muscles.

He’d welcome the opportunity to loosen up a bit.

“Complaining to the Health Administration Department won’t do you any good even if you take this to the Imperial Capital. Let me ask you—did you sign the consent form before surgery?” Jiang Wei stepped in at that moment to back Zhou Can up.

This was the first time Zhou Can saw her face down a hostile family member without a hint of fear.

Speaking of feisty nurses in the Emergency Department Ye Tingting was probably the fiercest.

When dealing with troublesome families she could outmatch their aggression.

“You wouldn’t operate if I didn’t sign!”

The family member grumbled clearly frustrated.

“Then what are you yelling about? Doctors and nurses follow the rules and guidelines set by the Health Administration Department for treatment and surgeries. Some patients have unique conditions and post-op complications are quite common. You think you can just call reporters to cover this? Do you pay their salaries? Any reasonable person would know this isn’t the hospital’s fault.”

Jiang Wei went full force scolding the family member with a ferocity that rivaled Ye Tingting.

But unlike Ye Tingting’s fiery temper Jiang Wei was more like a composed lawyer. Facing aggression or intimidation she remained cool and collected.

Her retorts struck right at the family’s weak points and vulnerabilities.

As long as the family member could still think straight they’d feel a pang of guilt their confidence wavering.

“Well uh…”

The family member stammered his earlier bravado fading fast.

“The smart thing to do is cooperate with the doctors and nurses to get your wife back to health as soon as possible. If you really push the doctors too far and they tack on extra medical fees would you even notice? If they stop treating your wife what can you do? Transferring to another hospital isn’t easy. And to be frank the best medical skills in the province are limited to just a couple of places. If Tuyu’s medical care wasn’t good enough you wouldn’t have come here.”

Jiang Wei’s words hit every point tied to the family’s interests.

Some of her remarks carried an implicit threat.

But oddly enough this approach worked on the family.

The moment he heard about potential extra medical costs he backed off in fear.

Unless you’re a professional how would you know which fees are unnecessary? Besides the power to prescribe medication and plan surgeries lies entirely with the doctors. Didn’t they call the shots?

“I got a bit heated earlier. Sorry about that. I’m just a rough guy—don’t hold it against me.”

In the end the family member softened.

He bowed his head apologizing to Zhou Can and Jiang Wei.

A potential medical dispute dissolved just like that.

Zhou Can couldn’t help but mentally give Jiang Wei a thumbs-up. This nurse was something else! The standard for a good wife is being able to shine in the hall and cook in the kitchen. For a good nurse it’s being skilled at injections dressing wounds and assisting in surgeries while also taming difficult families and patients.

In frontline clinical work the toughest part is communicating with patients and their families.

Especially with stubborn or troublesome ones—it’s often more exhausting than treating the patient.

After finishing the rounds Zhou Can gave Jiang Wei a thumbs-up unable to resist praising her. “Jiang Wei I never would’ve guessed. Not only are you a pro at nursing but you’re also top-notch at handling difficult families.”

Successfully defusing a potential conflict naturally put Zhou Can in a good mood.

“Heh I’ve been forced to hone this skill. You run into these kinds of families at every hospital. If you don’t deal with them there’s no way around it. I’ve found that being tougher than they are and overpowering them with sheer presence often resolves things.”

She said with a laugh.

“Boss Zhou since I helped you out with this mess any chance for a reward?”

“What kind of reward are you looking for?”

Zhou Can locked eyes with her trying to peer into her thoughts.

Unfortunately her eyes were like a deep pool. Beyond their captivating allure that could pull any man in he couldn’t read a thing.

“Hmm… I want to improve my surgical assistance skills. The surgeries in the Emergency Department are at most level three and many high-difficulty specialized procedures aren’t done here. How about taking me to Cardiothoracic Surgery to observe? I could assist during surgeries maybe pass you a scalpel or two. I’m confident I can handle it.”

After a moment of thought she made her request to Zhou Can.

“I’m afraid that’s not possible right now. I’d need to apply to the department leader in Cardiothoracic Surgery. Only if they approve can I bring you along.”

Zhou Can turned down her request.

Adults often don’t reject outright.

Offering a reasonable excuse is a good way to soften the blow.

“Alright I was just throwing it out there. If you can get approval that’d be great. If not no worries. There’s plenty of time ahead. I’m sure you’ll eventually lead major level three or four surgeries and I’ll naturally get the chance to grow alongside you.”

Even after being turned down she showed no displeasure or disappointment.

Instead she accepted it with understanding.

“Dr. Zhou Dr. Zhou! There’s a patient with chest pain over there and it looks serious. Please hurry over!”

A new young nurse rushed over panting and visibly panicked.

That’s just how it is in the Emergency Department. Newcomers often face a dozen scares a day. It’s par for the course.