Chapter 590: Uncovering the Cause

Now that the patient has passed away, figuring out the cause of death without an autopsy makes diagnosing things a whole lot harder.

Zhou Can already finds it challenging to diagnose the living—this is his first time ever trying to diagnose the dead.

Facing Hospital Assistant Qin’s hopeful gaze, Zhou Can finally decided to give it a try.

“I’ll do my best. But as you know, after the patient’s gone, there’s really not much meaningful diagnostic data left. So, please don’t get your hopes up too high.”

With that, Zhou Can accepted the daunting task.

After death, all symptoms disappear—blood pressure, breathing, heart rate, body temperature—they’re all gone. There’s nothing concrete left to work with.

It’s a massive disadvantage for diagnosis.

All he can do now is piece together the nursing records, x-rays, symptom descriptions, and whatever details were observed right before and after death to make the best guess possible.

“I get it! Let’s just do all we can. And if the family can’t accept our findings, we’ll have to recommend the legal route with a proper autopsy.”

Hospital Assistant Qin nodded.

Director Shi from Infection Control gave Zhou Can a meaningful look.

“Whenever our First Group encountered these tough cases before, we could always pinpoint the cause of death quickly. But ever since Old Song left, that knack vanished. Now you’ve taken over his role. I hope you’ll keep building this skill.”

Zhou Can’s curiosity was piqued at the mention of Old Song.

“Who exactly is Old Song?”

He asked the question without thinking.

“He was a seasoned attending doctor, later moved into our Quality Control Office. Started as a regular in the Fifth Group and eventually worked his way to the First Group.”

Director Shi spoke about Old Song with real admiration.

From his words, it wasn’t hard to realize: within Quality Control’s five teams, the First Group has the highest status and the Fifth the lowest.

As for Team Leader Zhong Hui, who gave Zhou Can a hard time before—he wondered which team Zhong had belonged to.

To be a team leader and to have Department Head Xin Wanshan show him such respect—he had to be someone important.

Now Zhou Can worked in the same department as Zhong Hui. He wondered if running into each other would be awkward.

But those things happened long ago, and Zhou Can wasn’t the type to hold a grudge.

No way he’d keep dwelling on it.

He was new to Quality Control, and plenty of hospital leaders were surely watching him. If he started seeking revenge against old foes right from the start, he’d only be ruining his own future.

“After Old Song joined Quality Control, he taught himself forensic medicine and later spent some time interning with the police. When he returned, his skill in forensics really shined—he focused on finding the cause of death for patients who died during clinical treatment, unlike the criminal investigations the police handle. Whenever a patient in the hospital died, he’d be called in to look things over. Nine times out of ten, he got to the bottom of things in no time.”

“At first, families didn’t trust his conclusions. But whenever they requested an autopsy, the results matched his exactly. So Old Song became the hospital’s forensics expert. Whenever a patient died in our hospital, or even outside hospitals, people would pay big just to have him take a look. You’ve got great clinical talent yourself—you could consider studying forensic medicine and following his path. Now that you’re in Quality Control, it’s only right to take this job seriously.”

Director Shi was eager for Zhou Can to take the same forensic path—at least, the ‘hospital version.’

Whether it was truly a good or bad suggestion was hard to say.

But Zhou Can had his own dreams. No way he’d give all that up just to stick with Quality Control.

The thing he feared most was being half-hearted in everything.

He always believed being a clinician had far more promise than being the hospital’s in-house medical examiner.

Forensic doctors figure out why people die.

Clinical doctors, on the other hand, save the living, pull people back from the brink, and actually relieve their pain. That feels way more meaningful.

“Thank you for the suggestion, Director Shi. I’ll give it some thought.”

Zhou Can gave a standard, noncommittal reply.

He didn’t waste any more time and started carefully combing through the patient’s medical records and test results one by one.

Honestly, he’d already gone over them once outside.

But this time he was being extra thorough.

And this time, his focus had changed.

While checking in the ward before, he’d mainly looked for any irregularities in how Gastroenterology’s staff had managed the case. Now, he was zeroing in on the cause of death itself.

Before admission, the patient’s stool test was done and showed no blood.

So, gastrointestinal bleeding could be pretty much ruled out.

But right before he died, the patient suddenly vomited a massive amount of blood, and his belly swelled up like a drum. Those were all classic signs of GI bleeding.

And chances were, it was an upper GI bleed.

“Did the patient have a bowel movement before he died?”

“No, he already had a hard time going. He needed a laxative and even then, the nurse had to help manually.”

The attending doctor answered matter-of-factly.

Nurses truly deserve the utmost respect; they’re the unsung heroes of the hospital. When patients recover, the doctors get all the credit—few people ever mention the nurses.

But during a patient’s stay, all kinds of care and their medications come from the nurses.

Only the occasional prescription is actually given by the attending doctor.

Nurses are like loyal ministers; doctors are the king.

When it comes to ‘manual extraction’ for bowel movements, if there’s a male nurse available, he’ll usually handle it. But male nurses are a rare breed, and plenty of departments don’t have any at all.

So all the tough and messy nursing jobs fall to the women.

Over time, these women turn into real strong heroines.

In the wards, they help lift patients onto flatbeds for surgery or important tests. In the ICU, they feed people, turn them over, and take care of bedpans—while injections and bandages are just part of their usual routine.

Now that the patient had died, the nurse on duty was called in for questioning.

Zhou Can looked at the young nurse across from him—her eyes brimming with tears, her face anxious—and couldn’t help feeling sorry for her.

Especially after hearing that she’d had to manually help the patient with his bowel movements.

That took courage—she was a true hero.

“Were you the one taking care of the patient the whole time?”

Zhou Can’s gaze shifted to the nurse.

“Yes.”

She bit her lip and nodded hard.

Tears threatened to spill from her eyes at any moment.

She looked at Zhou Can with obvious gratitude.

At first, Director Ju Shiman from the Nursing Department and Director Shi from Infection Control both thought it was a botched catheterization that caused the patient’s death.

It’s true—not being able to urinate for too long can kill someone.

But with modern medical tech, that’s hardly ever the case now.

If someone can’t pee, they show up at the hospital before a day’s out. Doctors can figure out what’s wrong and get the bladder emptied in all kinds of ways.

It’s not always about inserting a catheter; sometimes they even make a small incision in the waist to insert a drainage bag.

If a male’s catheter gets blocked or collapsed by inflammation, doctors might try using a dilator.

They come in all sizes.

It’s an agonizing process, but it gets the job done.

When Zhou Can ruled out catheter issues as the cause of death, he cleared the nurse’s name. No wonder she was so grateful.

“Don’t be afraid. You did a fantastic job caring for the patient—especially going above and beyond to help with those difficult moments. That took guts and real dedication.”

He gave her the credit she deserved.

She breathed a sigh of relief.

And nodded again, even more firmly.

“Thank you! Thanks for saying that about me!”

“What’s your name?”

“Luo Xiao.”

“Ms. Luo, do you remember when the patient last had a bowel movement?”

Doctors usually call nurses ‘Teacher’ or ‘Ms./Mr.’ as a sign of respect if they don’t hold lead or senior titles. But lately, the title has gotten some flak because online, Japanese AV actresses get called that too.

Nursing is a special job, so misunderstandings can happen.

A lot of hospital directors dislike being called ‘Teacher’ for this very reason.

That’s part of it, but mostly it’s just about pride—being called ‘Director’ sounds more impressive than ‘Teacher’.

“Um… I think it was two days before he passed—on the evening of the 19th. He complained of chest tightness and severe abdominal pain, so I helped him go manually.”

Nurse Luo Xiao recalled.

That got Zhou Can thinking.

As a cardiothoracic surgeon, he’s especially alert to symptoms in his field. Chest tightness might not register for other staff, but it made his ears perk up.

Combining that with the patient vomiting blood right before death—and the fact that the medical team never had time to save him—he started to form a theory.

Could this have been a cardiovascular issue?

Like an aortic dissection—the ascending type is the most dangerous. Or maybe even an aortic aneurysm.

But even if the aorta ruptures, the blood usually pools inside the chest and abdomen. You don’t see people suddenly vomiting it out.

Most people suffering an aortic dissection present with sudden, agonizing chest pains.

The pain can feel like cutting, stabbing, or ripping—so severe that even opioid medication hardly helps.

Still, the chest tightness is a key clue.

“Ms. Luo, were you present at the time of death?”

“Yes, I was on the night shift. The family called for help, and I rushed in. The patient’s blood pressure was dangerously low, so I called the doctor and phoned Dr. Wang, the attending.”

She grew nervous as she relived the scene.

Even seasoned medical staff feel real pain seeing a life slip away.

Female staff, in particular, take it harder than most.

Watching a patient die hits them the hardest.

“Was his blood pressure low at the time?” Zhou Can followed up, suspecting it could have been due to aortic rupture and major bleeding. “Did you notice anything about his appearance? Was he pale, sweaty, or clammy like someone in shock?”

He pressed on.

Usually, with an aortic dissection rupture, patients show shock-like symptoms but die so quickly they never reach that stage.

Most people pass away in a matter of minutes.

It’s like they’re dead before shock even sets in.

“Um… he was definitely pale, but I didn’t pay attention to whether or not he was sweating. His arms did feel a bit clammy when I took his blood pressure, but honestly, I was so nervous I missed a lot of the little details.”

She seemed embarrassed.

Most young staff panic when a patient crashes—all they think about is saving the person.

Scared a life will be lost on their watch.

Zhou Can only learned to keep his cool after several months in Critical Care, facing emergencies day in and day out.

When he trained in Critical Care, Deputy Director Ye personally arranged for him to stick around longer, and it paid off in his doctoring career.

Among the hospital leaders, Zhou Can’s closest connection wasn’t Director Zhu or Deputy Director Bai, but Deputy Director Ye.

It’s hard to explain, but in all kinds of small ways, it was clear that Deputy Director Ye truly cared about him.

“Did the patient have any abdominal CT scans on file? Can we pull them up now?”

“No problem—I’ll get in touch with Imaging right away.”

Director Shang was happy to help.

Back in the day, Zhou Can studied under him as both student and subordinate.

Now those tables had turned—Zhou Can had overtaken him.

With his administrative role, he was technically a leader.

Even if the title was mostly in name.

After all, he was still a regular member of Quality Control, not a proper manager.

“Dr. Zhou, did you make a big discovery?”

Deputy Chief Xiong from the Medical Department chimed in.

“Kind of. I suspect the cause of death was massive bleeding due to an aortic rupture.”

But even Zhou Can wasn’t sure yet—too many pieces still didn’t add up.

“Aortic rupture and massive bleeding? That doesn’t really fit, because the patient vomited blood before dying. Sounds more like an upper GI bleed,” Director Shi countered.

“That’s normally true. But every body is unique. Most people’s hearts are on the left, but every now and then you find someone with a right-sided heart. Once, I even treated someone whose heart was in their abdomen. So, anything is possible.”

Zhou Can spoke with calm authority.

Experience has made him more confident at handling tricky cases like these.

The more you see, the less you’re limited by conventional thinking.