Chapter 616: The Subtle Diagnosis

Because surgery on the spine carries enormous risks, operating on vertebrae is like messing with the main support beam of a house. Doctors and patients alike need to be extra cautious—the consequences are as severe as removing a load-bearing wall during a home renovation.

Zhou Can determined that the boy’s neurological decline mainly started at the medulla oblongata. His mind quickly recalled the intricate anatomy of the nervous system.

Each section of the spinal cord sends out a pair of spinal nerves—31 pairs in total.

There are 8 pairs of cervical spinal nerves.

For this case, just checking the cervical spinal nerves should be enough.

The remaining 12 thoracic, 5 lumbar, 5 sacral, and one coccygeal nerve pairs aren’t worth checking right now.

Speaking of the coccygeal nerve, here’s an interesting tidbit.

Most people have just one pair of coccygeal nerves, but a few have two. That bumps their total spinal nerves up to 32 pairs.

It’s kind of like how some folks only have 8 molars while others have 12.

Those extra 4 teeth are called wisdom teeth, but in function they’re basically just more molars. People with 12 molars chew more powerfully.

It might not sound like much, just a slight boost in chewing ability.

After all, people with only 8 molars still manage to eat just fine.

But actually, those with 12 molars gain several advantages. Their teeth are sturdier, they grind up more food in the same amount of time, and the bits are much finer.

All this takes pressure off their digestive system.

Both traditional and modern medicine recommend eating slowly and chewing thoroughly. It’s all about protecting the digestive organs.

Especially when it comes to our stomach.

The stronger the digestive function, the healthier the person—at least on paper, they absorb nutrients more efficiently than people with just 8 molars.

Having an extra pair of spinal nerves doesn’t make someone a freak.

Some scientists think this is a leftover from incomplete human evolution. That extra pair of coccygeal nerves may have once helped control a tail, but humans lost their tails a long time ago.

Theoretically, people with 32 spinal nerve pairs might enjoy more agile and powerful lower limb movement.

At least, that’s what the theory says.

This little boy can’t speak, can’t move his head, and can’t move his body either.

To pinpoint which cervical spinal nerve is damaged, EEGs and body nerve conduction tests usually aren’t precise enough.

Anatomically, the spinal cord contains gray matter, white matter, the central canal, anterior and posterior columns, spinal ganglia, and spinal nerves.

The gray matter is the low-level control center for human reflexes.

Reflexes like the knee jerk, urination, bowel movements, sweating, and sexual responses all depend on gray matter in the spinal cord.

Many patients with lower body paralysis lose control of their bladder and bowels—signs that these low-level neural centers are affected.

When Zhou Can performed a knee-jerk reflex test on the boy, he was checking for issues in the lower-level nervous centers.

The right leg’s knee-jerk reflex was weak, while the left was normal. That means the spinal cord’s gray matter is definitely involved.

That gave him a solid lead for a diagnosis.

He went to Director Yin for advice, hoping to use this clue as a breakthrough—maybe Director Yin would have more clinical experience to share.

Director Yin did offer several invaluable clinical insights, but they didn’t quite mesh with Zhou Can’s approach.

You could say the two ways of thinking weren’t on the same wavelength.

That’s not to say Director Yin’s suggestions were useless, they just didn’t apply to Zhou Can’s point of focus.

This is pretty common among senior experts.

Their clinical experience is so vast that their approach can get a bit set in its ways—less flexible than young doctors.

If you had to spell it out, senior specialists tend to be steady with their diagnoses while younger doctors are sharper and sometimes come up with wild ideas. That can mean a misdiagnosis, but sometimes that fresh perspective finds the real cause.

You sometimes see this at major hospitals: the old hands shake their heads and sigh, convinced a patient can’t be cured.

Then a young doctor steps in—and cures the patient.

Of course, when it comes time for the hospital to promote its success, they’ll protect the reputation of the senior specialists. The chief physician gets most of the credit, while the young doctor is rarely more than a footnote.

It’s no wonder many young doctors feel frustrated about this sense of injustice.

But from the hospital’s perspective, it makes sense.

The senior doctors are the hospital’s pride—they can’t risk tarnishing that.

Most industries honor their seasoned professionals. Even abroad, in societies focused on profit, respect for seniority prevails.

In some developed countries, doctors and nurses’ salaries are largely determined by age.

No matter how hard the young doctors work, they still earn less than the veterans.

Things are a bit better here in China.

In well-managed major hospitals, pay tends to reward hard work, but there’s no such thing as perfect fairness.

The senior specialists paid their dues—they’ve earned a larger share when it comes to success bonuses.

It’s a bit like a sales manager getting a percentage of their sales team’s performance, even if they barely lift a finger—it’s just part of the way things work.

Zhou Can wondered privately—if the child’s spinal gray matter is damaged, and he can find the specific site, wouldn’t that pinpoint the location of the injury?

Since the boy can’t move anything below his neck and his sense of touch is weaker the lower you go, it’s clear the problem extends beyond just gray matter.

It’s like in a battle—if you capture the enemy’s scout, odds are the main force isn’t far off.

X-rays at Imperial Capital Renhe Hospital had already shown no obvious spinal cord injuries.

Clinically, X-rays are a standard way to look for spinal injuries.

They check not only for fractures or abnormalities in the bones but can also identify many spinal cord injuries.

Sometimes, they even reveal the precise degree of spinal cord damage.

Since the X-rays didn’t show clear spinal cord issues, the last two hospitals didn’t order MRIs for the boy.

His condition is severe, so his doctors are all at least chief-level physicians.

By that point in their career, they’re no longer worrying about putting food on the table.

Their ethics are generally impeccable, too.

MRI scans are expensive and not a routine clinical test. Chief physicians won’t order them without a good reason.

Having mapped out his next step, Zhou Can turned to look at the boy’s mother.

Their eyes met. He saw hope burning amid thick anxiety, and even a hint of fear and uncertainty.

If her son couldn’t be cured, how would she face her husband?

What about the boy’s future?

Her own future might collapse too.

A lifetime spent caring for every need, the weight of mounting medical bills—all crushing burdens.

She saw how hard this young doctor was working, making regular visits and calling in other specialists for consultations.

Even though Zhou Can’s youth made her doubt his skills a little, it didn’t stop her from trusting him.

“If there’s anything you need to ask, go ahead,” she said. “And if you have any ideas for treatment, I’d like to hear them.”

She was the first to speak up.

It was clear this woman had plenty of life experience and a smart, perceptive mind.

Just a glance told her Zhou Can wanted to ask something.

“Are you the one who mainly looks after your son?”

“Yes. Since he was born, he’s been with me all the time. When I’m at work during the day, his grandparents watch him.”

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“Before the fall, did your son have any issues? Like trouble gripping things, or choking a lot while nursing?”

Questions like that can make families defensive.

No parent likes to admit there might have been something wrong since birth.

“Uh… his grip seemed fine. On day three, I noticed his hands were especially strong. But if you want something different—my son used to have a habit of raising his head just a little. I’m not sure if that’s normal.”

As she spoke, she mimicked her son’s old habit by tilting her slender neck upward.

“Could he lower his head normally?”

“Seemed normal. He looked down for things just like any other child.”

“After birth, or during pregnancy, did you or your child have any serious illnesses? Not including colds.”

Zhou Can pressed on.

Colds are usually just viral. But some severe viral infections can be life-threatening.

Still, when doctors review medical histories, colds rarely raise concern.

Unless a person keeps getting them in quick succession.

Plus, doctors and regular people don’t always see colds the same way.

Most people think of a cold as a routine illness you just get over. To doctors, though, it’s a symptom that can have over a thousand causes.

“No serious illnesses. I was a little weaker during pregnancy and got sick sometimes, but it was just a cold. Since he was born, my son’s been healthy. Whenever he did catch a cold, he’d bounce back in a day or two.”

She thought carefully about her answer.

“Any family history of major health problems for your son’s father, or his grandparents?”

“His grandfather has heart disease. Grandma has diabetes and high blood pressure. That’s it as far as I know. My husband’s job is very secretive; he sometimes only comes home once or twice a year, so I don’t know his details. But he’s never said he had anything serious.”

Hearing her talk, Zhou Can really felt her hardship and remarkable endurance.

Only seeing her husband once or twice a year—most women couldn’t accept that kind of life.

“Alright, I don’t have any more questions for now. I’m going to request a somatosensory evoked potential test to find out exactly where the spinal cord problem is. All signs point to an abnormality in the low-level neural centers in his spinal cord’s gray matter. But if it’s just the gray matter, paralysis this severe is rare. We still need more answers. To be safe, I’ll also draw some spinal fluid for lab tests to check for infections or other issues.”

Whenever he orders these uncommon tests, Zhou Can always explains things clearly to the family.

It’s part of being a responsible doctor.

For standard tests, there isn’t time in a busy day to explain everything to every patient—doctors see dozens every day.

“No problem. I trust you. I can feel you’re working overtime to help my son. I’m really grateful.” She gave Zhou Can a deep bow.

“Don’t mention it. This is my job. As long as your family works with us and trusts us, we’ll do our absolute best. That’s all anyone can promise.”

Zhou Can answered calmly.

Most people have never even heard of somatosensory evoked potential testing. It’s a powerful and accurate way to diagnose spinal cord nerve injuries, even pinpointing the exact site of damage.

The main goal now is to check which pair of cervical spinal nerves is affected.

There’s also a chance it’s just one side.

The idea to test spinal fluid for infection was inspired by guidance from Director Yin Hua.

Sometimes, the info doctors get from family members isn’t entirely reliable.

Some might even deliberately hide parts of the medical history, like risky behavior.

Others just forget important details.

So running a spinal fluid lab test is a smart precaution.

Neither of the last two hospitals did this, since they focused on the high spinal cord injury caused by the boy’s serious fall. They never thought to consider infection.

……

That night, lying in bed with Su Qianqian in his arms, Zhou Can was still turning over the boy’s case in his mind.

He was one of those doctors who worked tirelessly and selflessly for his patients.

National Day was approaching, which made Zhou Can even more eager to solve the case and cure the little boy.

Because he and Su Qianqian were deep in the hectic preparations for their wedding.

A huge milestone in his life.

Su Qianqian knew how busy he was, so she took on almost all of the planning herself.

She even joked with Zhou Can that it felt like she was marrying herself off.

Su Qianqian’s uncle and aunt deserve a mention too.

The night Zhou Can fought two men to help Su Qianqian get away, it seemed like they were done with her uncle’s family for good—no contact, no forgiveness.

But Zhou Can had underestimated just how shameless people can be.

Auntie actually called Su Qianqian in tears, begging for forgiveness, saying she knew she was wrong and cursing herself for her past behavior.

Luckily, Zhou Can was right there.

He knew Su Qianqian was so kindhearted that she might forgive too easily.

So Zhou Can took the phone and told the sobbing woman on the line, “If regret could fix everything, what use would we have for the police? Call again, and I’ll make sure your son spends the rest of his life behind bars.”

No matter that he’d hurt Auntie’s son that night—the guy had attacked first. Zhou Can only acted in self-defense.

With his own legal team and resources, it would be simple to charge them with trying to lock up Su Qianqian and snatch the thirty thousand cash he’d brought. Robbery is no joke—if the evidence holds up, he’ll rot in jail.