Chapter 546: The Silent Danger: Piercing Through the Fog of Diagnosis

When critically ill patients arrive at the hospital, their conditions often look downright terrifying.

At least, that’s how Zhou Can felt when he first started his internship in the Emergency Department. On his very first day, he received five patients teetering on the brink of death.

“I remember your name—Xie Yu, right?” Zhou Can said as he walked toward the Emergency Hall alongside a young nurse, striking up a conversation.

“I can’t believe you remembered my name! I’m so touched!” The young nurse seemed genuinely flattered, a hint of awe in her voice.

These days, everyone in the Emergency Department—doctors and nurses alike—knew Zhou Can was a heavyweight in the department. With skill, status, and a bright future ahead, he commanded respect. Even if not everyone revered him, there was a shared understanding to treat him as a key figure in the team.

“Let me tell you something,” Zhou Can continued. “Patients who look critically ill aren’t actually the scariest ones. The ones you really need to watch out for are those who don’t seem that serious. Take pulmonary embolism, for instance. It strikes fast, and death can come in just a minute or two.”

He offered this piece of advice to the newcomer with a steady tone.

In a hospital, medical staff form a tightly knit community with shared interests. Especially within the same department, one person’s mistake could drag everyone down. So even the most aloof doctors or nurses would take the chance to guide rookies when the opportunity arose.

The field of medicine endures and thrives precisely because of this willingness to teach and pass on knowledge.

“Dr. Zhou isn’t exaggerating one bit,” the young nurse chimed in. “I still remember my first year as a nurse. I was checking on a patient under observation. He was cheerful, chatty, even joking with me while his family kept him company at the bedside. I took his blood pressure, and it kept dropping. Despite him laughing and talking, showing no obvious symptoms, how could his pressure be so low? I switched arms to measure again. Then, out of nowhere, he started convulsing, collapsed on the bed, eyes rolling back. He passed away soon after. Later, we found out he had an aortic dissection that ruptured.”

Jiang Wei, standing nearby, shared her own experience from her early days.

During the formation of an aortic dissection, patients usually experience varying degrees of pain.

But some have a high tolerance for pain. They barely notice milder discomfort and easily brush it off.

Then there’s the most terrifying type of aortic dissection.

The time from formation to rupture is incredibly short. The mortality rate for this is basically one hundred percent.

Unless it’s caught early and intervention happens—like placing a vascular stent to seal the tear in the vessel wall—even the best doctors can’t save the patient.

“I’ve learned so much! I’ll be extra cautious from now on. I had no idea that patients without symptoms could be the most dangerous.”

The young nurse nodded earnestly, taking the words of her two seniors to heart.

By now, the trio had reached the triage desk. There, a man in his mid-thirties lay on a stretcher, his face pale as a ghost.

One glance told them he was an emergency case brought in by ambulance.

The patient clutched his chest tightly, his face drained of color. Sweat beaded across his forehead, dampening his hair.

His expression twisted in agony.

His breathing came in labored gasps, each one a struggle.

Spotting Zhou Can, the on-duty doctor looked relieved, as if a savior had arrived. He quickly stepped aside to let Zhou Can examine the patient.

“Where does it hurt?”

Zhou Can first checked the patient’s carotid pulse.

For patients with suspected chest pain or sudden collapse, feeling the carotid artery could reveal a wealth of diagnostic clues.

For instance, the strength or absence of the pulse could give a rough idea of the heart’s condition.

Some patients might also show neck stiffness, which could point to conditions like meningitis or neurological issues.

“Right here—it hurts so bad! And it’s like… my left shoulder and back are aching too, in waves.”

The patient’s voice was weak, sounding as if he might slip away at any moment, his words barely audible.

Hearing this, Zhou Can gently pressed on the chest area the patient indicated.

The man only groaned softly twice. The pain response wasn’t pronounced.

Some patients become so numb to pain that they can’t pinpoint where it’s coming from. They just know a large area hurts.

At times like these, a doctor must rely on experience and medical knowledge to discern the true source of the pain.

Everyone knows pain is the body’s way of protecting itself.

Wherever it hurts, that’s likely where an organ or tissue is undergoing serious distress. The more intense the pain, the more severe the condition, in theory.

Also, if the pain starts small and lingers for a while, gradually worsening, or if it comes in intermittent bursts, it often points to a chronic illness.

But when the pain hits hard right from the start, escalating from mild to unbearable in a short span, that’s a red flag.

It’s usually an acute condition, and the danger level is often sky-high.

Chest pain or tightness goes without saying, but even acute severe abdominal pain or headaches warrant extreme caution.

Common examples include strokes, brain hemorrhages, acute appendicitis, or intestinal perforations. If not treated promptly, the golden window for rescue slips away, leading to death or permanent disability.

After pressing on the patient’s chest and noting the lack of a strong pain response, Zhou Can felt more confident.

It likely wasn’t a cardiac issue.

The on-duty doctor might have panicked upon hearing about chest pain and vomiting.

Since the pain wasn’t centered in the chest, it suggested the chest discomfort was radiating pain.

When pain is intense, it can spread outward in a certain radius, sometimes even projecting to distant areas.

Take the concept of treating foot issues for headaches—sometimes a problem in the foot can manifest as head pain.

Zhou Can moved to press on the patient’s abdomen.

“Ow… it hurts! It hurts!”

When Zhou Can’s fingers pressed on the middle of the upper abdomen, just above the navel, there was little reaction at first. But as he applied slightly more pressure, the patient let out a distorted scream. His body tensed sharply, veins bulging on his neck.

“Looks like the real pain is right here. Not on the surface of the upper abdomen, but deep inside. This area corresponds to the stomach and pancreas. The stomach sits more superficially in the upper abdomen, while the pancreas is deeper, toward the back. Based on his symptoms, it’s more likely the pancreas is the issue.”

Zhou Can analyzed the patient’s condition while turning to the on-duty Dr. Xie.

“Have you checked the patient’s temperature and blood pressure?”

When examining a patient, blood pressure and temperature are two crucial indicators.

“Yes, temperature is 37.8 degrees Celsius, and blood pressure is low—systolic is around 80.”

Dr. Xie had been in the Emergency Department for over a year now. Compared to when he first started, he’d made significant progress. At the very least, he handled these basic details well after receiving a patient.

However, he was the type of doctor who struggled with flexibility. His diagnoses were rigid—plenty of textbook knowledge, but little ability to apply it creatively.

The patient’s temperature indicated a mild fever.

His systolic pressure was below 80 mmHg, no wonder Dr. Xie seemed so rattled.

Chest pain paired with low blood pressure immediately raises suspicions of an aortic dissection.

The normal range for systolic pressure is between 90 and 140 mmHg. Below that, it’s considered hypotension in clinical terms. Above it, it’s hypertension.

Relatively speaking, hypotension in a clinical setting can stem from many causes.

Things like chronic malnutrition, hypothyroidism, or even taking blood pressure medication can trigger it.

But hypotension combined with chest pain is the most alarming. Almost every emergency doctor will suspect an aortic dissection with internal bleeding as the first possibility.

Zhou Can, with his level-six Hemostasis and level-six Pathology Diagnosis skills, had a distinct edge in diagnosing internal bleeding.

After his initial assessment, he believed the likelihood of massive internal bleeding was low.

Many symptoms of an aortic dissection overlapped with this patient’s condition, but that didn’t mean it was definitely the case.

In clinical practice, diseases with overlapping symptoms are as common as grains of sand.

A doctor’s diagnostic skill is measured by their ability to quickly and accurately synthesize a range of symptoms, conduct targeted tests, rule out similar conditions, and pinpoint the true cause.

It sounds simple, but achieving this level of precision is incredibly difficult.

Almost every doctor spends their entire career striving toward this goal, constantly learning and accumulating diagnostic experience. Yet, only a fraction ever reach a truly high level of expertise.

Thanks to his system’s advantages, Zhou Can could attain in one or two years what others might take twenty or thirty years—or even longer—to achieve. That was his greatest strength.

Many doctors might spend two or three decades just to raise their Hemostasis skill to level six, but they can’t elevate multiple medical skills to that height simultaneously.

This often results in a narrow scope of expertise during diagnosis.

Zhou Can, however, broke that mold. He could push multiple medical skills to level six and beyond. It was as if he combined several chief physicians, each with over thirty years of experience, into one person. The effect was staggering.

It wasn’t just one plus one equals two—it was far greater.

Recently, his track record in the Emergency Department, Pediatrics, and Cardiothoracic Surgery spoke for itself. He’d cracked numerous complex cases that even teams of chief physicians couldn’t solve after consultation. That alone showed how powerful it was to wield multiple level-six skills.

But learning never stops.

He hadn’t let this success slow him down.

On the contrary, he was still pushing to improve every skill, aiming to reach level seven.

Once he got there, even if he couldn’t claim to be the best in the world, he’d likely have no equal in China.

Dr. Xie watched Zhou Can examine the patient, not daring to rush him, though he fidgeted anxiously in silence.

Good grief, the patient’s condition was already so critical, and the symptoms matched an aortic dissection rupture so closely. What was Dr. Zhou still mulling over?

He sure didn’t seem to be in a hurry!

Neither Dr. Xie nor the nearby nurses dared to prod Zhou Can along.

In the absence of a chief physician, Zhou Can was the undisputed authority.

He was the highest-ranking doctor on the scene.

Even if an attending doctor were present, it would be the same.

“Mild fever, low blood pressure, severe deep pain in the upper abdomen…” Zhou Can’s brow furrowed tightly. He needed to cut through the fog of uncertainty and find the real cause—fast.

At the very least, he needed a clear diagnostic direction.

If it wasn’t an aortic dissection but he treated it as such, precious rescue time would slip away.

As everyone’s patience wore thin, a family member finally snapped.

“This man is about to die, and you’re just standing there! Can’t you call in an older doctor to treat him? Young doctors have no experience. You’re dragging your feet with no results. You might not be in a rush, but we, the patient’s family, are frantic!”

The family’s emotions boiled over, their voices sharp with desperation.

“A bun’s worth isn’t in its folds. A doctor’s skill isn’t tied to age. Dr. Zhou is one of the top talents in our department. He’s focused on diagnosing your loved one right now. Please don’t disturb him. If you delay the treatment, that’s not the outcome you want to see.”

Jiang Wei stepped in once again to shield Zhou Can from the family’s frustration and anger.

She stood like a barrier, deflecting their attacks and dissatisfaction.

“Our chief is currently in the ICU saving another critically ill patient. As soon as things stabilize there, he’ll rush over. Dr. Zhou may look young, but his skill isn’t below the chief’s. Please, have a little more patience.”

Dr. Xie also spoke up in Zhou Can’s defense, upholding his image and authority.

No one teaches you how to handle these situations.

It’s a skill that comes naturally with rank. Those who master it and apply it well often rise quickly through the ranks. Those who don’t might stay at the bottom their entire careers.

After their reassurances, the family’s emotions settled somewhat.

Zhou Can remained focused on uncovering the patient’s true condition, paying no mind to the family’s outbursts.

“Do you feel thirsty?”

He suddenly asked the patient.

“Yeah, I really want some water!”

The patient answered with effort, his voice strained.

By now, his breathing had grown more rapid and heavy, heightening everyone’s concern.

“When did you start feeling unwell?”

“I think it was the morning before yesterday when I woke up. I just didn’t feel right.”

“Have you urinated today?”

“Not yet.”

“Do you feel the urge to go now?”

“I don’t think so.”

Zhou Can nodded after hearing the patient’s responses.

“His pulse is weak, heart rate is fast, he’s running a mild fever, blood pressure is low, and there’s severe, persistent deep pain in the upper abdomen that’s getting worse. It’s even radiating to his back and shoulder. Add to that thirst and reduced urine output—this points to a serious issue with his pancreas. I suspect acute pancreatitis. Draw blood immediately for a full panel and check fasting blood sugar. Then send him to the Ultrasound Room for an abdominal scan right away.”

With a diagnosis in mind, Zhou Can took command like a general on the battlefield, issuing a flurry of orders.

He moved swiftly to arrange a series of lab tests and imaging for the patient.

“It’s not an aortic dissection after all!”

Dr. Xie stood by, stunned as he absorbed Zhou Can’s conclusion.

He hadn’t expected Zhou Can’s initial diagnosis to be acute pancreatitis.

In that moment, Dr. Xie keenly felt the gap between himself and Zhou Can.

“If there are no issues, get those tests scheduled immediately. Don’t delay. Take the patient for these checks, and as soon as you have the results, find me or the on-duty chief physician.”

Zhou Can knew full well that acute pancreatitis carried a high mortality rate. He didn’t dare take any chances.