Chapter 118: Lessons in Duty and Discretion

Zhou Can was only responsible for applying plaster to the woman; as for her son, no matter how ungrateful he was, it wasn’t up to the doctor to intervene.

On his first day interning at Tuyu Hospital, his mentor warned the interns: a doctor only does what’s necessary.

Don’t let an overabundance of righteousness lead you to meddle in a patient’s family affairs or personal matters.

He was also told that while saving lives, a doctor must learn to protect himself.

At the time, Zhou Can couldn’t understand his mentor’s advice.

He even wondered how someone so self-serving could become a mentor.

It wasn’t until later, through his own experience, that he realized his mentor’s words were pure gold. Zhou Can recalled the first time he meddled in someone’s business—a young woman in her mid-twenties had been injured and admitted.

It was obvious she had been beaten.

Yet she claimed it was a fall, and neither the attending doctor, the nurse in charge, nor any doctor pried into the matter.

Zhou Can simply couldn’t understand why she lied.

Nor did they dig into the patient’s private affairs.

Until that evening, when he was on night duty.

He inadvertently discovered that the woman’s husband was in the ward; he had just slapped her twice and struck her head with a fist.

She sat on the bed, crying.

Seeing this ignited a fire in Zhou Can’s heart.

At last, he understood how the woman had been injured.

He rushed into the ward to stop the man from further assaulting her. The man was arrogantly warning Zhou Can not to meddle, claiming it was a family matter. Zhou Can wasn’t about to let him off; he scolded him fiercely, saying that domestic violence was illegal.

Outraged, the man shoved him.

Zhou Can, who had trained in Sanda, didn’t hold back. In a swift move, he threw the abusive man to the ground.

This only escalated the situation.

The woman cried, begging Zhou Can not to hurt her husband.

The man then called the police.

Soon, the head doctor of the ward and the hospital department leaders were all alerted.

Although the truth was plain as day, when questioned by the police, the woman sided with her husband, claiming that Zhou Can had overstepped by striking him first. The man even threatened to have Zhou Can sent to jail.

At that moment, Zhou Can felt as if his heart was bleeding.

He had only been doing the right thing, upholding justice and helping the weak.

Yet the woman not only failed to be grateful but ended up turning against him, conspiring with her husband to falsely accuse him.

The idea of a doctor attacking a family member had a tremendously negative impact.

Paying compensation was the least of his worries; he was bound to face disciplinary action from the hospital.

Fortunately, a family member had recorded the incident in the ward and secretly handed the footage over to the police, which restored the truth.

Zhou Can wasn’t punished, nor did he have to pay any fines.

But he didn’t receive any praise either.

Instead, both the department head and his mentor called him in separately to criticize him.

That incident left an indelible mark on Zhou Can.

From then on, he never meddled in others’ business again.

In his role attending to patients, he gradually learned how to protect himself.

Any document requiring a signature had to be signed by the family.

He would never agree to anything just out of pity for a patient or their family.

That, he believed, was what made a doctor truly competent.

…

Under the guidance of Dr. Hezhang, Zhou Can successfully applied plaster to the injured woman’s left arm.

It was his first time applying plaster independently.

It wasn’t flawless.

But he managed to complete the procedure successfully.

He even earned one experience point.

Following Dr. He’s instructions, after applying the plaster he observed the patient for about twenty minutes to confirm there were no issues before leaving.

During this waiting period, Zhou Can couldn’t help but glance around at the patients in the nearby beds.

There were both male and female patients, many of whom were young.

Some had already undergone surgery and were staying in for a while, while others were either waiting for surgery or enduring the pain of traction, lying in agony on their beds.

Zhou Can’s gaze finally rested on a bed next to him.

The patient was a middle-aged man, around forty, sleeping with his eyes closed. Compared to the others, he seemed remarkably calm.

Next to him, a haggard middle-aged woman lay by the bed, her face etched with worry as she watched her sleeping husband.

In moments of disaster, spouses, parents, and children are the most reliable kin.

This middle-aged couple was burdened with both elderly parents and young children.

They were the pillars of their family.

If the middle-aged man suddenly collapsed, the consequences for the family would be catastrophic. The woman must have been tormented by the thought of how they would manage if her husband didn’t recover.

During hospitalization, not only could he not earn money, but significant expenses would also pile up, compounding their hardship.

“He was hospitalized after a car accident, his lower leg crushed and fractured. I heard it was a complete (open) fracture of the tibia with some comminuted fractures. The operation took eleven hours, and they had to reconnect bones, vessels, and nerves. They only finished the surgery a bit after five this morning.”

Dr. Hezhang carefully explained the patient’s condition to Zhou Can.

“Dr. Zhou, there isn’t much more for you to do here. For now, examine the condition of the patients on ten beds. You might have to cover a shift tonight.”

This was typical of the exploitation among doctors by seniors like Dr. Hezhang.

Senior doctors would dump miscellaneous, dirty, or laborious tasks on junior doctors. Night shifts were grueling and were typically handled by residents and interns.

In a large department, having a chief resident on call at night was considered fortunate.

The Intensive Care Unit was not one of those.

In that unit, if a patient’s condition suddenly worsened and appropriate rescue measures weren’t taken within seconds, it could be fatal.

For instance, some patients might experience a sudden drop in blood oxygen or abrupt cardiac arrest.

That’s why novice nurses and doctors weren’t even qualified to be on call in the ICU.

It truly was a test of a doctor’s and nurse’s ability to handle emergencies, requiring rich experience, solid medical knowledge, and proficient rescue skills.

Nearly all elite medical staff were gathered in the ICU.

Faced with Dr. Hezhang’s pressure, Zhou Can had no room for negotiation.

He had only one option: obey.

Zhou Can went around to check on every bed.

Patients and their families were generally indifferent towards a young doctor like him.

These days, families and patients were very shrewd.

During the morning rounds, as the director and senior doctors made their inspection, the families would swarm in, knowing that authority had arrived.

They would force smiles and put on their most eager, ingratiating faces.

Answering any question they were asked.

After inspecting all ten beds, Zhou Can found that the nurse in charge, Dr. He, had already left.

The nurse in charge needed to write orders, check on the interns’ case files, write summaries, and promptly report any abnormalities to the senior doctors.

There was always so much to do.

Sometimes, if a patient had a sudden issue, a nurse or intern would call him, and he would have to rush over to check and handle it properly.

Zhou Can returned to the bed of the woman he had applied plaster to and inspected the cast.

The plaster had already set.

It felt quite hard to the touch.

The injured woman continued to grumble and claim that she felt like she was dying.

Her son only cared about the game on his phone; he neither pressed the doctors for information about the surgery nor asked for a painkiller injection for his mother.

Zhou Can shook his head and glanced at the middle-aged man on the nearby bed who had just undergone surgery.

At that moment, the middle-aged man still appeared to be resting with his eyes closed.

From the slight flutter of his eyelids and the occasional shifting of his head, it was clear he wasn’t truly asleep.

“Is he doing alright? Any discomfort post-surgery?”

Zhou Can asked out of habit.

When he was an intern responsible for a ward, he had always taken the time to check on his patients.

Every bed assigned to him received regular visits accompanied by inquiries about their condition.

“Everything’s fine, except my husband complains that his left leg feels swollen and achy,”

the woman reported to Zhou Can.

“It’s common to experience swelling, soreness, or numbness right after surgery. There’s no need to worry too much,”

Zhou Can reassured the family.

“Doctor, I feel like there’s a huge bug crawling around inside my leg. It’s extremely uncomfortable.”

The middle-aged man opened his eyes.

Perhaps due to prolonged insomnia coupled with his injuries, his eyes were bloodshot and his overall state was quite poor.

He looked visibly drained.

“Let me check your leg,”

Zhou Can said as he pulled back the blanket to examine the man’s leg. The crushed area had been operated on and was now wrapped in gauze.

This was to prevent infection at the wound site.

Although the specific surgical details were unclear, it was evident that the severed bone needed to be reconnected—possibly using a steel plate and screws—with vessels, nerves, and tendons all mended.

Damaged muscle tissue had to be removed.

One could only imagine how complex the operation was.

Below the surgical site—from the ankle down to the foot—there appeared to be more skin folds. The color was notably more pronounced than the pallid appearance of the knee and thigh above.

However, there was still some normal coloration.

This suggested that blood circulation was likely intact.

At most, it seemed that post-surgery, blood flow was somewhat diminished.

Zhou Can felt the temperature of the patient’s right foot, which was slightly below normal.

It appeared the surgery had been very successful.

Once the operation was completed, if blood flow was adequate and the temperature at the limb’s end recovered, the limb could generally be saved.

“Can you feel it when I touch your foot’s top?”

Zhou Can asked the patient.

“Yes—it just feels a bit numb,” the man replied.

Zhou Can nodded and examined the patient’s ankle closely.

He noticed some purplish spots beneath the skin.

They resembled subcutaneous veins.

At first, Zhou Can thought that was the case.

But when he touched above the ankle, he clearly felt stiffness.

From experience, that was the telltale sign of edema.

“Overall, the situation isn’t too bad. There seems to be some edema near the ankle, and I’ll check on you every two hours. Rest assured,”

Zhou Can assured the patient.

Postoperative swelling can be due to multiple factors.

It might be normal or could signal trouble.

Its duration needs to be monitored carefully.

Zhou Can decided he should report this patient’s condition to the nurse in charge.

He made his way toward the doctor’s office.

All along the way, he pondered the edema near the upper end of the middle-aged man’s operated leg and the faint purplish spots on his inner ankle.

What could this indicate?

The surgery had clearly been a success.

Blood flow was smooth and the foot’s temperature looked good.

Yet this situation wasn’t something textbooks could explain—it required personal diagnosis and reflection.

During the past three months in the emergency OR, Dr. Xu had offered him valuable guidance.

Coupled with his growing surgical experience, it significantly improved his diagnostic skills.

Zhou Can’s ability to diagnose had noticeably advanced.

“Could it be that the distal limb, having suffered prolonged ischemia, is beginning to necrotize?”

That possibility loomed.

The phenomenon of post-mortem discoloration and lividity matched the swelling and purplish spots on the patient’s left distal limb.

Moreover, ischemic necrosis is difficult to detect in its early stages.

Dr. Hezhang was busy scrutinizing the intern’s case notes.

Every issue he found, he pointed out immediately.

The intern nodded humbly, jotting down all the corrections.

Back when Zhou Can struggled with his case notes, he’d received plenty of scolding.

After patiently waiting for Dr. Hezhang to finish guiding the intern, Zhou Can finally said, “Dr. Hezhang, I noticed some abnormal postoperative reactions in the patient on bed 120.”

“What’s happening?”

Dr. Hezhang looked startled, his face tight with concern.

“During my inquiry, I learned that the patient kept complaining about a swollen, aching leg—as if a huge bug were crawling inside it!”

At Zhou Can’s report, Dr. Hezhang’s tension eased slightly and he let out a shallow breath.

This new resident was so jumpy—it nearly scared him to death.

“His leg was severely damaged after being run over by a car. Postoperative swelling and pain are generally normal. Tell the patient it should gradually improve over a few days,”

Dr. Hezhang explained.

“When I examined him, I noticed edema near the surgical site and mild purplish spots.”

Zhou Can continued to report his findings.

His diagnostic skills assured him that something was indeed abnormal with that patient.

“Let me go and check it out! How severe is the edema?”

Dr. Hezhang, not willing to take any chances, decided to inspect the patient himself.

“The swelling is mild for now, but I suspect it’s just the initial stage. It might worsen later,”

Zhou Can recalled his experience with two replantation cases.

Though replantation was not comparable to the case of the patient in bed 120, the underlying principles were the same.

Swelling in an amputated limb is a very ominous sign.

It often portends a failed surgery.

Two intern doctors, driven by both learning and curiosity, followed along to inspect.

A doctor’s skills improve not only by reading and practicing procedures but also by accumulating experience in handling complications.

The four of them reached bed 120, and upon seeing four doctors approach, the patient and his wife gratefully nodded at Zhou Can.

It showed that the young doctor had reported the situation to his superiors.

Both patient and family appreciated such responsible care.

“Are you feeling any better? I heard you mention your leg feels swollen and painful?”

Dr. Hezhang inquired of the man in bed.

“The pain comes in waves, and there’s also an ache—it’s really uncomfortable,”

the man admitted.

Dr. Hezhang nodded, then pulled back the blanket to examine the operated leg more closely.

Tuyu Hospital’s strict safety and accountability systems ensured that no doctor dared cut corners.

After all, doctors at Tuyu Hospital enjoyed comfortable careers—and a single mistake could ruin everything.

“There’s nothing major here. The upper part of the surgery looks fine, with only minor edema near the lower end. As for the subcutaneous bruising, it’s common—usually just minor bleeding beneath the skin. Given the flesh tone and the temperature of the foot, the likelihood of muscle necrosis is low.”

Don’t be fooled by Dr. Hezhang’s seemingly subordinate role—his experience and diagnostic skills were impressive.

His expertise even rivaled that of attending physicians at city hospitals.

As hospitals grow in reputation, so do the doctors—the more busy a major hospital is, the more experience its doctors accumulate.

One city hospital surgeon once confessed that although he was proficient in liver surgery, he rarely got the opportunity to perform one because patients preferred major hospitals for serious conditions.

Even a slight illness would send patients rushing to larger hospitals.

City hospitals, though already large, found it increasingly difficult to attract patients, let alone major surgical cases, compared to county or district hospitals.

Without patients, there were no opportunities to improve surgical and diagnostic abilities.

This vicious cycle ultimately made mega hospitals even stronger while smaller ones grew weaker.

After listening to Dr. Hezhang’s observations, Zhou Can still felt things weren’t that simple.

He frowned, deeply contemplating.

In times of need, one always regrets the lack of knowledge.

He cursed his own insufficient medical expertise and diagnostic skills.

Even though he knew something was off with the patient, he just couldn’t pinpoint the exact issue.