Chapter 627: A Bleak Diagnosis

After reviewing the brain CT scan, Zhou Can’s expression turned instantly grave.

The patient’s condition was worse than he’d expected.

Shadows appeared in both the thalamus and caudate nucleus, even showing signs of a slight water-clearing effect. This meant the bleeding originated in the thalamus, and the volume was definitely far beyond five milliliters.

There are two main types of intracranial hemorrhage. One is cortical, such as bleeding in the cerebral gyri and grooves—these spots aren’t too critical, even if the volume exceeds five milliliters. As long as the bleeding is kept under control, surgery is usually unnecessary. The patient can often absorb the blood on their own and eventually recover.

In fact, neurosurgeons sometimes encounter rare cases—malignant tumors or unusual injuries—which leave patients missing up to a fifth of their skulls.

Even so, some of these patients survive and are able to care for themselves.

That’s why the specific location of the hemorrhage determines just how dangerous it is.

For this patient, the bleed was in the thalamus. What worried Zhou Can most was the possibility that the brainstem might be bleeding as well.

Most people think the thalamus is the brainstem. That’s not the case.

The thalamus is part of the diencephalon, split into two halves on either side of the third ventricle, joined together by clumps of gray matter.

Medically, the thalamus is the sensory relay hub. All signals from the body’s sensory receptors pass through the thalamus before heading to the cerebral cortex.

Earlier, Zhou Can had checked on the patient and found she was completely unresponsive, showing no signs of consciousness—deep in a coma.

That was what unsettled him the most.

A thalamic hemorrhage is serious in its own right, but this patient was not only comatose—she also had respiratory and heart failure. That made him suspect the bleeding extended beyond just the thalamus.

Zhou Can wasn’t strictly a neurosurgery specialist, but he knew much more than most neurosurgeons.

After all, when he trained in neurosurgery, he shadowed the chief physician and assisted with many major intracranial surgeries. His hands-on experience and clinical exposure spoke for themselves.

Even after his formal neurosurgery training, he was often asked to help with endoscopic procedures or consult on tricky cases.

Even Wu Baihe had discussed such issues with him more than once.

So his neurosurgical skills were actually quite solid.

The best way to analyze thalamic hemorrhage is by its three common sequelae.

First are the physical symptoms—patients feel severe, unmistakable headaches. Most people can’t bear such agony, so they often develop gastrointestinal problems, too.

Nausea and vomiting are common examples.

Some people even experience hemiplegia or weakness on one side of their body.

If limb paralysis appears, it means the thalamic hemorrhage is dire.

That’s a bad sign and usually leads to a poor prognosis.

The second major aftereffect is sensory disturbance.

The thalamus is the gray-matter relay center, passing all sensory signals from the body’s nerves to the brain.

Sensory signals from the body and nervous system are first ‘translated’ by the thalamus, then sent to the cortex.

So you can see the thalamus plays an absolutely crucial role in processing sensory information.

If it malfunctions, the resulting impact on the nervous system and brain can be catastrophic.

Think of it like constructing a massive dam.

If raging floodwaters slam directly into it, the dam can quickly collapse. Smart engineers add buffer zones to lessen the force of the current and protect the dam.

That way, the dam stays much safer.

There was a massive dam built in India that failed the very day it was completed. Corruption and lack of technical expertise were both to blame.

The thalamus is both translator and buffer.

Once it’s damaged, patients may suffer decreased or lost sensation. Commonly their limbs go numb or lose most, or all, pain sensitivity.

Recently, many COVID-19 patients lost their sense of taste and smell, most likely because of thalamic involvement.

When the thalamus is affected, even strong odors—normally unbearable—might go completely unnoticed.

Or, they might detect only a faint trace.

Of course, sense of smell is also tied to the nose and olfactory bulb, among other organs.

It takes thorough consideration—you can’t blame thalamus trouble for every loss of smell.

Third, there’s altered consciousness.

Almost any injury or disruption in the brain can lead to impaired consciousness.

Some structures won’t cause it directly but can have an indirect effect.

For instance, a hematoma can compress the skull’s cavity or sharply raise intracranial pressure.

When the thalamus is damaged, the most frequent outcomes are drowsiness, restlessness, confusion or deep sleep. Full-blown comas, though possible, are less common.

More often, you’ll see a drop in alertness, sluggish responses or even psychosis. In rare cases, patients might lose all awareness.

After analyzing the three major sequelae of thalamic damage, it’s possible to deduce which regions have been affected based on the patient’s symptoms.

That was exactly why Zhou Can felt the case was more serious than he’d first thought.

Scenario one: if the thalamus alone caused her deep coma, then the damage to the thalamus must be severe.

Scenario two: if the coma isn’t caused by the thalamus, then the brainstem is almost certainly bleeding, too.

Either way, it’s extremely tricky.

Doctors in other departments probably refused to admit her because of such overwhelming risks.

If they accepted her and she died, what would happen if her family started trouble or filed a lawsuit?

From birth, people instinctively avoid danger and seek benefit.

Doctors can be kind at heart, but when handling clear risks against themselves, most simply won’t take the chance.

Otherwise, they’d seem naive.

Zhou Can kept studying the patient’s records.

The small county hospital had actually performed an MRI on her.

Those MRI machines cost a fortune. At the very least, they’re twenty million yuan or more—usually closer to thirty million.

Nothing imported comes cheap.

Foreign companies make a killing selling this kind of technology.

First they rake in huge profits selling the machines, then they continue making money on maintenance and repairs.

They won’t even let us watch when they come to install the equipment.

Many business owners who have bought imported equipment have fallen for this trick—you bring the machine in, but still have to hire two foreign technicians to oversee everything. They get free room, board, travel expenses and hefty salaries, treated practically like royalty.

Every step of installation, adjustment and troubleshooting depends on those two foreign engineers.

Being strangled by dependence on outside technology frustrates countless people in China.

But back then, that was simply reality.

All they could do was grit their teeth, bide their time and work to catch up. Once the country advanced enough, it could shake off these technological shackles.

Any county hospital with an MRI scanner isn’t a small one.

Otherwise, no hospital leader would ever get approval for such an expensive machine, however much they wanted it.

Zhou Can thought to himself: There really are talented doctors even in county hospitals.

Their doctors clearly realized, after consulting with each other, that this case was anything but simple.

Most likely, it wasn’t just a thalamic hemorrhage.

CT scans are quite precise—but nothing is perfect at everything.

Each medical imaging tool has its own strengths and limitations.

MRI is currently considered the most accurate kind of imaging available.

Still, not all MRIs are created equal.

The best machines can achieve millimeter-level precision.

Even Tuyu Hospital has just one.

Appointments are extremely hard to come by—it’s normal to wait a week or more.

Zhou Can studied the MRI scan of the patient’s head closely. After checking, he finally felt sure of himself.

“Cheng Xiaolu!”

“Yes?”

“Your mother’s brain bleed is severe. Conservative treatment offers almost no hope. In her situation, critical care is necessary. Daily costs in the ICU will be astronomical.”

Zhou Can deeply empathized with how tough life could be for ordinary families.

Her father had been disabled in a construction accident. Her mother farmed and sometimes did odd jobs—their income was meager.

Still, they’d supported her through college and even grad school, exhausting every bit of their savings.

After graduation she worked in Tuyu Hospital’s Pharmaceutical Division.

But that department hadn’t turned a profit in years, and research salaries weren’t high—barely average for the industry, just enough to keep key people from quitting.

If she chose conservative management, her mother would definitely need ICU care. In her mother’s state, she’d have to be on a ventilator—the daily bill alone would exceed ten thousand yuan.

Honestly, it was almost impossible for her to move out of intensive care after just a day or two.

Two weeks would be the bare minimum.

And that was the best-case scenario.

The patient only had coverage under the New Rural Cooperative Medical Scheme, and those who understand know the limitations there.

If she’d been treated at a rural clinic near home, she’d get a higher reimbursement. At Tuyu Hospital, well… The insurance does help a little, but it’s hardly enough.

The best reimbursement is actually for urban employees’ medical insurance.

And of course, the gold standard is the retired officials’ policy.

But that’s only for a select few. For most, nothing beats urban employees’ insurance. Twenty-five years of payments get you lifetime coverage—that’s a valuable thing.

Most ordinary people don’t get sick while they’re young. It’s only when age comes knocking that all sorts of ailments begin piling up.

That’s simply the way of life and death.

As people age, their metabolism slows, their cells barely regenerate and every function declines—immune systems weaken, too.

A mild cold barely fazes a child—a night’s sleep and they’re fine.

For the elderly, though, even a simple illness can be fatal.

“My recommendation is surgery. Total costs would probably stay under fifty thousand yuan, but there are huge risks, including complications during or after the operation. And with her current status, neurosurgery may refuse to do it.”

Zhou Can only gave this advice out of deep sympathy—it was truly in the patient’s best interest.

Still, there’d be a pre-surgical risk assessment first.

Her current state most likely wouldn’t pass, and that was a major hurdle.

There was no way Zhou Can could force neurosurgery to admit her and operate. Even if he had that much sway, the result would only backfire.

“Dr. Zhou, I know you’re a good man. If you can save my mother, I’d be willing to spend my life repaying you, no matter what that took.”

She worked in the pharmaceutical division, so even if she didn’t know the whole system, she understood some of the basics.

After Zhou Can’s recommendation, she felt a wave of hopelessness she’d never known before.

Looking at her unconscious mother, she realized that without timely treatment in Tuyu Hospital, her mom might not survive more than a few days.

In ancient times, she would have willingly sold herself to Zhou Can as a servant if it meant saving her mother.

“Don’t do this—please get up!”

He didn’t dare physically help her, so he just kept gesturing for her to rise.

Thankfully, the young nurse was quick-witted and came over right away to help her up.

You could see she was already sobbing.

For struggling families, facing a merciless illness and harsh reality, there’s often nothing left but tears.

“Let’s do this—you wait here a moment. I’ll talk to the department heads. If it’s possible, we’ll first admit your mother to the Emergency Department and I’ll try to invite Director Wu from neurosurgery for a joint surgery. But this will be incredibly complex, and your family needs to be fully cooperative and trusting.”

There was one thing Zhou Can couldn’t bring himself to say.

If the surgery failed and the patient died, the family couldn’t cause trouble.

Human nature is unpredictable like that.

Tuyu Hospital has a dedicated legal team. When difficult cases arise, a professional lawyer steps in to sign an agreement with the family, so even if a patient dies, no one stirs up trouble.

Major hospitals really do manage medical disputes much better than smaller ones.

Not just county hospitals—even city or regional hospitals usually turn away high-risk patients or opt for conservative management.

Zhou Can went to report to Director Lou and Dr. Xu.

After discussing it, Director Lou was hesitant about admitting the patient. But when Zhou Can described the family’s struggles, he fell silent.

As a department head, he had a duty to ensure the safety and development of his ward. Compassion alone wasn’t enough.

Sometimes, he simply had to turn people away.

But he could tell how much Zhou Can wanted to help this family.

So he didn’t put up a strong objection.

Dr. Xu might look strict, but he actually has a kind heart.

Whenever he can help, he’ll always find a way.

Even after a medical mishap left him struggling, his good intentions never changed.

“Zhou, strictly speaking, I should oppose this. But as long as the family risk can be controlled, I’ll leave it to you. At worst, our Emergency Department’s mortality rate will go up a bit, but that’s a price we can manage.”

After a moment’s thought, Director Lou gave his decision.

As head of the Emergency Department, his word was final.

“Thank you, Director Lou! I’ll talk to the family and—if they agree—we’ll admit her right away.”

With Director Lou’s approval, Zhou Can instantly felt a huge weight lift off his shoulders.