Chapter 650: Breakthrough in Diagnosis

These two only ended up having to talk to each other because of Zhou Can’s involvement.

Some neurological diseases just can’t be tackled without both internal medicine and surgery working hand in hand.

Zhou Can had no other choice. If he wanted the top brains of neurology and neurosurgery to consult together, he had to play messenger. Getting them both to sit down in the same meeting room? Not a chance.

With their tempers, they’d probably start a fight the moment they disagreed.

Physique-wise, Wu Baihe from neurosurgery was short but tough, while Director Yin Hua from neurology had the height but was skinny from a lack of exercise.

Honestly, if it came to blows, Director Yin would likely be the one worse off.

After coming back from the Song Family Mansion, Zhou Can had been waiting for a reply but nothing came.

Worrying wouldn’t help though. If the patient’s family refuses treatment, there’s nothing anyone can do.

Especially since the Song Family is no ordinary household.

Zhou Can’s diagnostic skills were nearly at the seventh level. To be more confident treating Mr. Song, he’d cleared his schedule to focus on tackling all kinds of complex cases.

He even cut back his daily rounds in the emergency department from twice a day to just once.

Later on, it became once every two days.

Honestly, he’d meant to let the other doctors start handling those tasks anyway.

It’s the same in every department. Once you reach deputy director level, you barely bother with daily trivialities. Letting go when the time is right is something you just have to learn.

Otherwise, you’ll burn yourself out, just like Zhuge Liang.

Trying to do everything yourself only leads to exhaustion—you’ve got to accept the reality of things.

Usually, chief physicians do their rounds once a week. Mondays tend to be the big day when all department heads do their inspections.

There’s a good reason it’s set up this way.

With more free time, Zhou Can finally had extra hours to dive into difficult cases and pick up advanced medical knowledge.

After just six days, his diagnostic skills broke through from level six to level seven.

The instant he leveled up, he felt waves of excitement. Years of effort had finally borne real fruit.

Seventh-level diagnostic skills—almost across every discipline. In the medical world, that’s practically unheard of.

[Pathology Diagnosis, Level 7, current experience 1/. Specialist grade.] Particularly skilled in pediatrics, cardiothoracic surgery, general surgery, critical/emergency care, neurosurgery, neurology, gastroenterology (internal and surgery), and orthopedics.

Just those specialties alone made for an impressive list.

You could say his achievements stacked up like trophies.

Getting to level seven meant reaching true expert status.

That’s actually above the average chief physician’s level.

He could now diagnose just about any illness with barely a second thought.

Especially within his specialties, some cases didn’t even need imaging or lab work—a single look, a few questions, and his diagnosis would be nearly spot-on.

After reaching seventh-level in pathology diagnosis, Zhou Can felt unbeatable every time he sat in for consultations.

Some of the cases he saw were quite challenging, but with him, almost every single one was nailed right away.

It was all effortless for him now.

Those tricky cases he used to rack his brain over or had to call other departments for? Now he could handle them on his own with relative ease.

He ordered fewer and more targeted tests for his patients than ever before.

Internal medicine usually starts with blood or urine tests, then zeroes in on a region of interest from the results. After that, you do imaging to confirm the cause.

Some cases still needed a biopsy, and those would do the trick.

After a full morning of seeing patients, Zhou Can realized how amazing seventh-level pathology diagnosis really felt.

He was diagnosing patients with a speed and efficiency he’d never experienced before.

Experienced doctors start with a physical exam and questions, form a preliminary opinion, then write the appropriate test requests and refine the diagnosis from the results.

The greener the doctor, the more tests they’ll order.

But honestly, that’s just the way things are.

With the current state of healthcare, extra checks mean more income for the department—and also lower the chance of a misdiagnosis.

But honestly, if your skill isn’t there, even running every test under the sun can still lead you to miss things.

That’s why expert consultations are so expensive and booked solid—there’s real value there.

Zhou Can glanced at the clock—it was already past noon.

He’d squeezed in more than twenty extra appointments.

What else could he do? His reputation was huge now. Just one clinic session, and patients from all over would come flocking in.

Some patients even arrived days early, staying in hotels, at least one family member by their side.

It wasn’t easy at all.

Zhou Can really sympathized with how much they went through.

Seeing these patients travel such distances while already ill, dealing with pain and daily expenses, he just couldn’t bring himself to turn them away.

We’re all human, after all.

Compassion—the true heart of a healer.

It was precisely this genuine empathy for patients’ struggles that kept Zhou Can’s reputation rising.

Of the patients and families he treated, at least eight out of ten would praise his superb skills and outstanding medical ethics.

“Director Zhou, there’s a patient outside complaining about hearing loss and really wants you to take a look. I explained the consultation slots were full for today, but they’re insisting.”

The triage nurse came in to let Zhou Can know.

“Add them to the list.”

Zhou Can wrote a note and handed it to the nurse.

Only the attending expert could write an add-on slip for special appointments.

The registration staff didn’t have the authority.

If they started adding appointments on their own, the consulting experts would tear into them. No one would be dumb enough to risk that.

Since Zhou Can was now an attending physician, his consultation fee had gone up to sixteen yuan.

Deputy chief consultations were twenty-one.

Specialist consultations were the priciest—fifty at the cheapest and upwards of three hundred for more sought-after experts.

Money wasn’t an issue for Zhou Can to begin with. And he naturally had a healer’s heart, always refusing the hospital’s attempts to upgrade him to specialist fees.

Even though his skills outstripped most specialists, patients only paid sixteen yuan to see him.

That price had only gone up to match his attending physician status.

Otherwise, it would’ve been even less.

Once the family added the extra appointment, they were ushered right in.

There were three of them.

The patient was a young man, around twenty, accompanied by his parents.

Zhou Can honestly didn’t consider himself an expert at treating hearing loss.

Usually, he’d send that type of case to ENT.

“Please have a seat. Has there been total hearing loss?”

Zhou Can motioned for them to sit down.

The young man was able to lip-read.

A lot of people with hearing loss can figure out what someone’s saying just from watching their lips move.

It’s a special skill you develop out of necessity.

“That’s right. When my son was a baby, his hearing was fine. Then, when he was a bit over two years old, we weren’t watching and he climbed onto the table but fell off. He only got a bruise on his head at first, nothing major. But later we noticed his hearing seemed to be going. At first, we had to shout before he could hear us.

Later, even yelling right by his ear stopped working.

I regret it every day—if only we’d kept a closer eye on him, he never would’ve climbed up. Over the years, we’ve done everything to get treatment. It’s affected his schooling, work, his whole life.

Now that he’s old enough to start dating, every introduced girl loses interest the moment they learn about the hearing issue. They don’t even want to meet him.

It’s so hard.”

The young man’s mother sighed, sharing the whole story.

Kids have no sense of danger, so it’s always on the parents to keep them safe.

So many tragedies happen in just a split second.

This couple seemed only in their forties, but both already had gray in their hair.

Since his injury, their son’s hearing loss had changed their lives.

They’d been trapped in regret, worrying about their son’s illness every day. Happiness was out of reach—the whole family was living in agony.

“Have you seen a specialist in otology?”

“We have. We’ve been to ENT, neurology, neurosurgery in the best hospitals. The doctors said there was nothing they could do. We even considered cochlear implants, but after the tests, they said my son wasn’t a candidate. Completely lost hearing, they said.”

At this point, the young man’s mother started crying.

“Don’t worry, let me take a look first. I’m guessing you’ve already had a lot of tests done?”

“A lot! We’ve got bags full of old reports at home and only brought the most recent images and results today.”

The father lifted a bulky white plastic bag filled with paperwork.

You could see it was packed with thick folders of medical records.

“Alright, let me review these. If a past test is useful, there’s no need to repeat it here.”

Zhou Can always tried to save his patients money when he could.

He took the folder and began poring through the results, focusing on the brain and ear scans.

He’d lost hearing in both ears, but it didn’t happen instantly. There was a delay after the initial injury.

That suggested the problem wasn’t immediate, but progressed over time.

There’s a specific region of the brain responsible for hearing.

Based on his clinical experience, Zhou Can guessed that his hearing nerve was likely injured in the fall, and without timely treatment, eventually lost all function.

But he’d have to rely on imaging, neuro signal, and ENT tests to be sure.

Looking at his head CT, Zhou Can saw nothing out of the ordinary.

He’d even had high-definition MRIs at two major hospitals—again, no clear findings.

No wonder so many doctors said there was nothing to be done.

Zhou Can found this case tricky himself.

“How about this, let’s do a color Doppler ultrasound for the brain. I want to check the blood flow in that area.”

After thinking it over, he discussed it with the family.

“Okay, we’ll follow your lead.”

After so many visits to so many hospitals, the family already knew how to work with doctors.

A lot of doctors, faced with uncooperative families, would practice defensive medicine or just send the patient away.

This couple had been through that before and had learned from it.

Zhou Can decided to start by looking at cerebral blood flow—a fresh approach to the diagnosis.

After all, the patient’s injury happened at age two, and he was more than twenty now. It had been almost two decades. Most physical injuries would have healed by now, rarely leaving traces.

Nerve damage is notoriously tough to diagnose.

Bones, muscles, vessels—you spot these on a scan instantly if there’s a problem.

With nerves, you usually need to run nerve conduction or electromyogram studies.

This patient had already done EEGs and nerve function tests.

For the auditory pathway, there was no nerve signal at all.

From Zhou Can’s experience, it was rare for a fall to completely sever the nerve.

The brain is protected by the skull and dura mater, plus a thin layer of cortex and some subcutaneous tissue for cushioning.

And the head itself is round.

Falling off a table and severing a nerve in the brain—almost unheard of.

He suspected a blood vessel issue was more likely.

But CT and MRI still revealed nothing. Too much time had passed—the ‘evidence’ was long gone.

After ordering the color Doppler, Zhou Can personally took the patient to the ultrasound room.

“Dr. Xing, can you stay a bit late for me?”

He knocked on the ultrasound room door and grinned at the doctor inside.

“Of course! Anything Director Zhou asks—heck, if you wanted me to stay an extra ten shifts, I’d have to do it,” Dr. Xing replied cheerfully.

“Really? That’s great, because I was about to come beg you for some extra shifts!”

Zhou Can laughed.

“Ahem… just kidding, Director Zhou, just kidding. One shift’s fine, but if you made it ten, my wife would have my head.”

Dr. Xing, in his thirties, put on a comically pained face.

Ultrasound doctors actually have a good workload—they can leave on time. When the day ends, they’re free to go.

Unlike clinical doctors and nurses, who are called back at all hours for emergencies.

And the pay in the imaging department isn’t bad either.

Not high, not low—just right.

Most importantly, the job doesn’t come with huge responsibilities.

The young man’s brain Doppler was quickly underway. Zhou Can studied the monitor, gaze sharp as a hawk.

“Hold still, right there. This spot—there’s something off about the blood flow. Take a look, am I seeing things?”

Zhou Can asked Dr. Xing for a second opinion.

Dr. Xing studied the screen for a while, then gave a wry smile. “Don’t laugh, honestly, even though I do Dopplers every day, these subtle changes in brain blood flow—I just can’t say. With my abilities, I’m lucky to earn a modest wage here in the ultrasound room. I can’t compare with your top-level skill.”

Despite staring at the scan for ages, Dr. Xing couldn’t spot any obvious problem.

“You should aim higher. Ultrasound doctors can be amazing too. Pay more attention as you work—you’ll improve.”

Zhou Can offered some advice.

It wasn’t criticism, more like encouragement.

“Print this out, will you? I’m convinced there’s something going on here. That change in blood flow probably connects to the head injury from when he was a kid.”

It seemed Zhou Can had finally found the reason for the young man’s hearing loss.

Still, he needed to study it more closely and come up with a treatment plan.

Changes in blood flow aren’t common, but they’re not unheard of either.