Chapter 550: Uncovering the Cause: From Doubt to Belief

Inside the ultrasound room Zhou Can stood right beside the ultrasound technician.

An echocardiogram often refers to the use of ultrasonic short-wave ranging principles. Pulsed ultrasound waves pass through the chest wall and soft tissues to measure the periodic activity of the heart walls ventricles and valves beneath. These movements are displayed on a monitor as curves showing the relationship between each structure’s activity and time recorded as images by a device.

It provides an excellent assessment of the heart’s size valve function and left ventricular ejection fraction.

Right now Zhou Can was focused on checking the left ventricular ejection fraction.

“LVEF down to EF 39%.”

The ultrasound technician reported the numbers to Zhou Can.

“It’s about the same as the results from the other hospital.” Zhou Can nodded before turning to the patient. “Alright try bending your foot. Put some strength into it.”

The patient followed his instructions.

“What’s the ejection fraction now?”

“52%.”

The ultrasound technician’s face was full of disbelief.

An ejection fraction of just 39% was on the low side. Not critically severe but definitely not mild either.

A normal ejection fraction ranges between 50% and 70%.

For the patient’s left ventricular ejection fraction to jump from 39% to 52% in an instant was nothing short of astonishing.

If this state could be maintained the patient might return to normal.

“Good job. Relax now relax!”

Zhou Can felt a growing confidence in his assessment as he guided the patient to ease up.

“Bend your calf!”

He instructed the patient once more following his directions.

“What’s the score this time?”

“46%.”

“Not bad.” At this point Zhou Can was almost certain of the root cause of the patient’s condition. “I’m going to press on your calf. Bear with it.”

After signaling the patient to stretch and relax both legs again Zhou Can began to apply pressure to the patient’s calf muscles.

“What’s the reading?”

“43%… 42%.”

These were the test results from pressing on the left and right legs respectively.

“Alright that’s enough. Thanks for your hard work! Print out the report. We’re done here.”

Zhou Can turned to the ultrasound technician.

“Dr. Zhou is the cause of my condition really in my legs?”

“Yes it’s definitely in your legs. I’ll explain more when we’re back in the ward.”

They couldn’t keep occupying the ultrasound department’s resources.

It was already past closing hours and the ultrasound staff were being forced to work overtime.

Unlike clinical departments the working hours in imaging departments were strictly adhered to. They could clock in and out on time and even rest on weekends. However due to the high demand for services like ultrasound and CT there was a shift rotation system in place.

Moreover in major hospitals like Tuyu Hospital the ultrasound departments for obstetrics and cardiothoracic surgery weren’t managed by the general imaging department. Instead they fell under the direct control of their respective specialties.

If someone aspired to be an ultrasound technician joining the departments for obstetrics or cardiothoracic surgery was widely regarded as the most promising path.

Ordinary ultrasound technicians couldn’t break through the barriers. They were often stuck in the small circle of the imaging department. Their income was decent slightly above average but there was little room for significant advancement.

Clinical department doctors on the other hand had it tougher. Their work was exhausting and even after hours or during vacations a single call from the hospital could drag them back for overtime.

Even off duty they had to worry about the patients under their care praying nothing went wrong.

If a patient they managed passed away or something similar they’d have to bear the responsibility.

This responsibility wasn’t about compensating families or losing their license but rather an evaluation system that heavily impacted a doctor’s career.

If a doctor’s patients died too frequently—say two in three days—not only would their superiors reprimand them but they’d also keep a close eye on that doctor. Eventually the doctor might be sidelined no longer given significant responsibilities in clinical settings.

In short their words would lose weight. Any medical orders they issued would need approval from a superior. Certain clinical interventions would require consulting higher-ups or even following directives from peers of the same rank.

And forget about being considered for any awards or recognition.

Zhou Can held significant authority in the Emergency Department. During clinical rescues even the Associate Chief Physician had to follow his lead.

At the temporary bedside in the corridor Zhou Can held the echocardiogram report explaining the cause of the patient’s heart failure. Director Xueyan had rushed over upon hearing the news.

“You actually figured out the cause! Impressive!”

Director Xueyan’s face was all smiles.

Every time a highly complex case was successfully diagnosed or a patient was discharged cured she felt an immense joy.

As the Department Head she naturally hoped for her department to keep improving.

A department’s reputation and prestige were built partly on handling routine cases but the real impact came from tackling difficult and rare conditions.

“I still don’t get it. How is my heart failure related to my legs?”

The patient was brimming with curiosity.

Brother Wei who had been hired by the patient’s family stood by the hospital bed his face full of disbelief.

He had initially thought Zhou Can was just making things up. But now after the tests it seemed the legs were indeed connected to the heart failure.

“Your legs have several powerful muscles called the calves. Most people might not know their importance but to us doctors we consider them the body’s second heart. Ever since our human ancestors learned to walk upright our bodies developed a major flaw. The heart became far from the ground making it incredibly hard for blood in the lower limbs to flow back to the heart.”

“At the same time blood pumped by the heart struggles to reach the extremities of the lower limbs. Over countless years of evolution the calf muscles in our legs developed a secondary heart-like function. Each time they move they squeeze the blood in the legs pushing it back toward the heart. When they relax they create a natural suction force drawing blood in. Through this cycle they mimic the heart’s pumping action.”

Zhou Can explained the connection between the legs and the heart to the patient.

Both the patient and Brother Wei were amazed by this revelation.

Director Xueyan along with the nurses and other doctors looked at Zhou Can with admiration. Everyone had learned this knowledge from textbooks. Some forgot it over time while others remembered but couldn’t apply it flexibly in clinical practice.

Zhou Can however could use this knowledge effortlessly adapting it to real-world scenarios.

His clinical diagnostic thinking left every medical staff member present in awe.

“So our legs are like a second heart? That’s incredible! But there’s nothing wrong with my legs. How could they cause heart failure?”

The patient a high school sophomore was quite studious and likely well-versed in many subjects.

Yet Zhou Can’s explanation still left him stunned opening up a whole new perspective.

“This is where your habits come into play. You spend entire days sitting while studying or reading barely moving at all. Plus you’re at a critical stage of physical growth. Your lower limbs severely lack exercise and training leading to loose and atrophied muscles. You’ll need to commit to daily exercise to gradually bring them back to a normal state. Once that happens your second heart will regain its function.”

“Don’t underestimate the role of this second heart. When it works properly it significantly reduces the workload on your actual heart improving overall blood circulation. But when it malfunctions the heart ends up doing the work of two. Over time it becomes overworked and exhausted. In such a state it can’t handle the double load anymore leading to a left ventricular ejection fraction below normal.”

“Because this wasn’t corrected in time and the true cause remained undiscovered your heart has been operating in this abnormal state for too long. Eventually it led to full heart failure.”

Zhou Can sometimes treated patients like wayward children.

He felt both pity and frustration.

Doctors often felt this mix of sorrow and exasperation. Seeing a patient sick or even on the brink of death weighed heavily on their hearts. Yet some patients when healthy couldn’t care less. Tell them to smoke less drink less or avoid staying up late and they wouldn’t listen.

They’d dismiss doctors as alarmists.

Only when they fell ill did they realize the advice was genuine. But by then it was often too late.

“So… can my condition be treated?”

The patient now saw Zhou Can as a miraculous healer. His trust in Zhou Can had soared to an unprecedented level. Finding the true cause of his illness gave him hope for a cure.

At least he finally understood why this strange illness had struck.

“Yes it can be treated! I’ll devise a treatment plan for you focusing mainly on exercise. But if you can’t stick to it and keep neglecting your health for studies I’m powerless to help. Being diligent in your studies is great but you must balance work and rest. While learning take care of your body too. Understand?”

Zhou Can didn’t think treating this condition was particularly difficult.

The real challenge was the patient not cooperating or failing to persist with exercise.

“Don’t worry I’ll definitely follow your advice this time. Falling ill has delayed my studies and made me realize that rushing won’t get me anywhere. I’ll take this lesson to heart. Even after graduation and starting work I’ll always remember this experience.”

The patient made a firm promise to Zhou Can.

This young man had determination and perseverance. If he said he’d do it he likely would.

Zhou Can nodded with relief before heading back to the office with Director Xueyan to discuss the young man’s treatment plan.

The treatment plan was finalized overnight. Medication was minimized with a focus on physical therapy. However due to the severity of the patient’s current heart failure necessary drugs couldn’t be avoided.

Only as the patient gradually recovered could they slowly reduce the medication.

All drugs carried some toxicity especially Western medicines many of which contained hormones. Their side effects on the body were significant and long-lasting.

It was easy to develop a dependency on them.

Moreover prolonged use of the same drug could lead to resistance. This would reduce the body’s absorption of the drug and drastically lower its effectiveness.

The next morning Zhou Can finished his rounds in the Emergency Department early and made a special trip to Cardiothoracic Surgery to check on the young man’s treatment progress.

For now a specific electric compression tool was being used on the patient’s calf muscles to assist with continuous contraction and relaxation. It was akin to massaging the calves.

The patient’s complexion had visibly improved. His breathing was no longer as rapid or labored.

These were all positive signs.

Even without further tests Zhou Can could sense that the patient’s heart failure symptoms had greatly eased.

“In a bit you can get out of bed and walk downstairs. Have Brother Wei accompany you. Where is he?”

Zhou Can had been there for a while but hadn’t seen Brother Wei.

Not staying by his employer’s side for so long—could the guy be stuck in the bathroom?

“Uh… Brother Wei asked for some time off. He’s gone to queue for a check-up.”

The patient hesitated for a few seconds but ultimately didn’t lie to Zhou Can telling the truth.

“Wasn’t he fine just yesterday? How did he suddenly fall ill?”

Zhou Can’s brow furrowed slightly. This patient couldn’t be left without someone to assist him.

“Well the day before yesterday didn’t you suggest he get a liver check-up? At the time he might’ve thought you were too young and doubted your skills so he brushed it off. But after seeing you successfully diagnose my condition yesterday he started to fully trust your expertise. Worried about his own health he bought me breakfast this morning took care of my washing up then rushed to queue at the Hepatology Department.”

The patient might’ve felt a bit uneasy sharing these embarrassing details about his bodyguard.

But he couldn’t lie to Zhou Can either so his words came out a little awkward.

“So that’s how it is.” Zhou Can couldn’t help but chuckle. “Since you don’t have anyone to assist you right now don’t leave this area on your own. You can walk around near the bed to move your legs and build up the strength in your calf muscles.”

Brother Wei was quite the character. Two days ago Zhou Can had urged him to get his liver checked and he ignored it.

Now he was up bright and early queuing for an appointment.

People could be so pragmatic sometimes.

“Got it! Dr. Zhou do you think Brother Wei’s liver really has an issue? How did you figure out there was something wrong with his liver? I’m just curious. Medicine feels so fascinating especially your skills. They’ve truly opened my eyes.”

The patient asked with genuine interest.

“There’s nothing particularly remarkable about it. The first time I saw him I noticed signs of liver palm on his hands. Then I spotted red spider nevi on his neck—and not just one. So I concluded that his liver likely had a problem.”

Zhou Can didn’t think his abilities were anything extraordinary.

“Many medical skills that seem miraculous to ordinary folks are just the result of accumulated experience. Since we deal with a large number of patients daily and build on the knowledge passed down through generations of doctors we develop the ability to spot whether someone has an obvious illness with just a glance.”

“I see! Thank you for patiently explaining this to me. Coming to Tuyu Hospital for treatment was probably one of the best decisions I’ve made. I’ve learned so much and most importantly my illness finally has hope for a cure.”

The patient expressed heartfelt gratitude to Zhou Can.

“You mentioned if I had gone through with a heart transplant would it still not have cured me?”

This was a tricky question to answer as it involved considering the face of the experts from the Imperial Capital. Those experts had been at their wits’ end before suggesting a heart transplant.