Chapter 608: A Glimmer of Hope in Emergency Care

Anyone who’s studied medicine knows the knee-jerk reflex is one of the simplest nervous system responses. Only two types of neurons are involved: a sensory neuron and a motor neuron.

Thump!

As soon as the little mallet struck the trigger point on the child’s knee, his left leg jerked upward in response.

A look of relief broke across Zhou Can’s face.

The neural center for the knee-jerk reflex is a lower-level center located in the gray matter of the spinal cord. When the knee-jerk occurs, the spinal cord’s nerves also send impulses up to the brain, letting a person actually feel the tap on their knee. That’s what causes the leg to bounce.

This child has high-level paraplegia, so in theory, all nerves below the head and neck should be blocked.

But with a quick test, Zhou Can proved that the nerves connecting the lower body to the brain hadn’t been severed. There was still hope.

Even if he only stimulated the low-level neural center, that was enough to give him a boost of confidence.

It was like finding a pulse on a patient—you can almost be sure there’s a heartbeat.

But a pulse and a heartbeat aren’t exactly the same. The heart rate is the number of times your heart beats in a minute, while the pulse—also called the pulse rate—is how often you feel your arteries throb. When a surge of blood enters an artery, it bulges slightly; if that’s near the surface, you can feel the expansion—that’s the pulse.

Normally, heart rate and pulse rate match.

For some patients, though, the heart rate can be higher than the pulse.

Compared to heart rate and pulse, the nervous system is much more complicated. Now that Zhou Can had confirmed the child’s lower neural reflexes were unbroken, he knew the nerve damage wasn’t as bad as imagined.

After checking the left leg, Zhou Can tried the same test on the right.

There was still a reflex, but the right knee’s response was weaker.

After several more tests, he noticed the right knee’s reflex was much weaker than the left, but it still showed a clear reaction.

His mind drifted back to the child’s neck stiffness.

The left side of his neck was soft, while the right was stiff—a stark contrast.

Everything seemed to point to a major issue with the nerves on the child’s right side. Then again, maybe it was the left that was actually worse and the right was fine?

At least it gave him a possible direction for diagnosing the problem.

A stiff neck usually means there’s pain or some reaction, and the muscles are tense. It’s like when a doctor checks a patient’s abdomen—’soft’ and ‘hard’ mean completely different things.

A soft, flat belly typically isn’t cause for concern.

But if the abdomen is rock hard to the touch, it means the area is so painful that the patient’s abdominal muscles tense up automatically to guard it.

That’s just the body’s natural way of defending itself.

First, one thing must be clear: whether it’s abdominal muscles tightening or neck stiffness, it’s all because muscles are contracting.

And those muscle contractions all rely on nerve signals.

Without nerve signals, muscles are just flesh. They can’t move at all.

That’s the main reason Zhou Can wasn’t sure how badly the nerves on the child’s right side were affected.

He even wondered if the right neck muscle was simply tense all the time, somehow disrupting nerve transmission.

There were so many diagnostic possibilities, and each needed to be sorted out and tested.

That meant more tests—extra examinations were unavoidable.

Even though the child had had many tests at two other hospitals, Zhou Can still thought it was necessary to do more exams at Tuyu Hospital to nail down the true cause. If needed, they’d even do exploratory surgery.

Of course, most families are deeply reluctant—sometimes downright opposed—to exploratory operations.

It’s the same during emergency resuscitations. Sometimes you have to perform a tracheotomy and put the patient on a respirator, but families can be adamantly against it. Plenty of people have missed their chance for rescue because of that.

“Director Zhou, Director Zhou! They need an emergency surgery in the OR. Dr. Xu is tied up and asked if you could take over.”

A nurse came running up, breathless and flustered, asking Zhou Can for help.

Right now, only Dr. Xu and Zhou Can in the Emergency Department could handle level-three surgeries or higher.

When it came to saving lives in critical emergencies, Zhou Can had even surpassed Dr. Xu.

“No problem, I’ll head right over.”

The Emergency Department’s whole mission is to save lives, above all else.

With a new emergency patient, their investigation into the paralyzed child would have to wait.

Besides, the child’s case wasn’t going to be solved in one sitting.

“This child needs to be admitted first. Only after we find the cause can we start treatment. Are the family willing to let him stay in the hospital? Just to be clear—Tuyu Hospital will do our best, but we can’t promise a cure.”

Zhou Can turned to look at the family and the bouncy castle boss.

“Of course! Dr. Zhou, your knee reflex test on my grandson already gave us hope. We’re more than happy for him to be treated here. Please, when you’re less busy, help us save him.”

At least the grandfather knew what was what.

He didn’t dismiss Zhou Can just because of his youth.

After witnessing Zhou Can’s unique approach to diagnosing, the old man was even more confident in him.

A person’s reputation precedes them.

For someone as young as Dr. Zhou to be so well-known—even in the Imperial Capital—he must truly be exceptional.

Trust the person you choose—if you doubt them, don’t choose them in the first place.

They chose to trust Zhou Can.

“Thank you for your dedication, Dr. Zhou.”

The child’s mother, eyes brimming with tears, pressed her hands in prayer and pleaded with Zhou Can.

The grandmother felt a bit awkward. Not long ago, she’d shown off her son’s status in front of Zhou Can, which had clearly annoyed him.

“Don’t worry. I take every patient seriously. Since you’ve agreed, I’ll have the other doctors handle the admission. He might need surgery, so let’s put him in the Surgical Department’s inpatient ward.”

With that, Zhou Can looked over to the bouncy castle boss.

The poor man really was down on his luck, caught up in such a disaster. His situation now was probably as bad as Dr. Xu’s had been back in the day.

After all, the child’s father had a very special status.

His only child got hurt at the bouncy castle, and as the boss, he clearly couldn’t escape responsibility.

Doing everything possible to make up for it and help treat the boy—that was his only lifeline.

Otherwise, he’d probably already have been detained.

“Based on the tests and the knee reflex just now, things aren’t hopeless. I think there’s a slim chance for recovery—maybe 10% or a bit less. As for costs, use insurance as much as you can. When you check in, please ask Dr. Xie to help you transfer your insurance for out-of-region care.”

Zhou Can remembered the miserable aftermath of what happened to Dr. Xu, and couldn’t help but feel for the unlucky boss.

He tried to lighten the man’s burden as much as possible.

In the Imperial Capital, almost everyone had formal medical insurance, with higher reimbursements than the New Rural Cooperative Scheme or urban-rural insurance.

Of course, if the child happened to have no insurance, there was nothing they could do.

“Thank you, really! My friend said you’re renowned for your compassion, and I see it’s true. Coming all the way from the capital to find you was worth it.”

Tears filled the boss’s eyes.

Even when he was labeled the guilty party, Dr. Zhou still considered his side. At a time like this, that meant the world.

“My son bought insurance but was worried it wouldn’t work here. So glad it can be transferred for out-of-region care.” The child’s mother really was a kind and thoughtful woman.

If they pinned all the debt on the boss and crushed him, everyone would lose.

“No worries. Usually, out-of-region insurance works—the only difference is a lower reimbursement rate.”

After years in medicine, Zhou Can knew money was the biggest hurdle to treatment.

That’s the point of insurance—to help people dare to get admitted and treated when they’re sick.

Especially for big treatment plans costing hundreds of thousands or even a million, insurance makes it possible.

The bouncy castle business already had commercial insurance, on top of the child’s formal insurance, so the family shouldn’t have to pay a huge sum.

Most expenses would be for traveling here and for the child’s rehabilitation later.

Sadly, most rehab isn’t covered.

“Dr. Xie, could you help them get set up? I’ll come by after surgery to work out a treatment plan and recommend more tests if needed.”

With the child’s care settled, Zhou Can hurried off to the operating room.

“Director Zhou, the patient is in OR 3.”

The Emergency Department had three operating rooms: one cleanroom rated at Class 100, another at Class 10,000, and one very old standard OR.

Both Zhou Can and Dr. Xu usually operated in the Class 100 cleanroom, also known as OR 2.

The most recently built, Class 10,000 cleanroom was OR 3.

That’s where other attending surgeons usually operated, often with their own teams.

Most surgeries there were level-two operations.

“Why not take the patient to OR 2?”

Zhou Can frowned—he was puzzled.

If the case was so urgent he was needed as deputy chief in the OR, it must be serious.

There are real differences between the Class 10,000 and Class 100 cleanrooms.

The Class 100 room had the best equipment.

When the hospital bought expensive equipment, they always concentrated it where it’d do the most good.

No way could they outfit every OR with top-line gear.

Most of the Emergency Department’s advanced equipment was in OR 2. Of course, the new Endoscopy Room was also quite good and was starting to do various endoscopic procedures.

That was a major trend in medicine.

But honestly, endoscopic surgery will never completely replace traditional open surgery.

For serious illnesses or complex cases, open abdominal, thoracic, or brain surgery is usually better.

Whenever you do a surgery, you have to consider not just the risks, but also the odds of success and the expected outcome.

Take heart surgery—even something like right ventricular hypertrophy. Often, open surgery is more reliable.

Endoscopic techniques have their limits. They can hold back a surgeon’s skills for many operations.

That’s why endoscopic surgery will never totally take over from traditional open procedures.

“That patient was supposed to have a subcutaneous tumor removed, but during the operation she suddenly began bleeding heavily. We’re struggling to save her.”

The nurse didn’t know much more than that.

She wasn’t in the OR herself, just responsible for managing patients outside.

“You’d better get back to work.”

Zhou Can felt his heart sink. His expression grew grim.

As both vice director of the department and deputy chief in the OR, he knew any medical mishap would quickly put him on edge.

The doctor at fault would definitely be punished.

But the one in charge of the OR and the department would be implicated too. Even their department’s reputation would suffer.

He pushed open the operating room door with his foot, changed into sterile scrubs and strode toward the theater.

The moment he entered, Zhou Can felt the tense atmosphere.

Staff were moving quickly. Their faces were tight with worry.

“What happened with the patient?”

Zhou Can’s face was unreadable.

“It was just supposed to be a simple subcutaneous tumor removal—a basic level-two operation. But no one expected severe bleeding during surgery. Her blood pressure keeps dropping, and her breathing is labored… Director Zhou, what should we do?”

Tang Wangnian was the attending doctor, desperately trying for a promotion. A fiasco like this could ruin him.

He used to be nothing but defiant and restless around Zhou Can.

Now that something had gone wrong, seeing Zhou Can was like seeing his only savior.

He almost dropped to his knees to beg for help.

“What do you think? We have to keep her alive, no matter what.”

Zhou Can shot him an annoyed glare and walked straight to the operating table.

The patient was a young woman in her twenties. She had a subcutaneous tumor on her left inner thigh, and it had been growing lately. Afraid of cancer, she’d come to Tuyu Hospital for treatment.

She chose the Emergency Department because of its good reputation.

General Surgery could’ve handled this too.

Same for the OB/GYN department.

Unless it was especially tricky or risky, most surgeons could handle a subcutaneous tumor.

Logically, removing a tumor from the thigh shouldn’t lead to such heavy lower-body bleeding.

Several doctors and nurses were in the operating room. Since the patient was under anesthesia, there was no way anyone could have done something out of line.

So what was causing the bleeding?

At this point, her breathing was alarming—rapid, harsh, her chest heaving.

She was struggling for every breath of fresh air.

Her blood pressure was shockingly low, and still dropping.

Her abdomen was still flat.

Zhou Can pressed her abdomen gently. A flood of bright red blood gushed from below.

That meant the bleeding was still going, with a lot of blood accumulating inside her abdomen.

“Was she given a pregnancy test before surgery?”

Zhou Can studied the patient’s body and then turned to Dr. Tang Wangnian.

Her appearance was suspiciously similar to a pregnant woman.