Chapter 164: Shadows of Urgency

The origins of ICU construction abroad remain unclear; domestically, the earliest ICUs were spearheaded by anesthesiologists.

Speaking of which, let me begin by introducing the Emergency Department.

In the past, Chinese hospitals didn’t have an Emergency Department—it was established later to rescue critical patients. After a series of standardizations and discipline clarifications, it finally got the name it deserved, where every emergency patient registers.

Moreover, the Emergency Department cannot turn patients away.

Also, specialty outpatient clinics do not operate at night.

The Emergency Department staffs doctors 24/7, so no matter when you show up, you’ll have someone attend to you.

With these two golden rules in place, the Emergency Department later acquired a few additional privileges.

For example, when a car accident victim arrives without any relatives—and efforts to contact family fail—with the patient’s life hanging by a thread, hospital protocols demand a family signature and fee before treatment.

In such cases, the Emergency Department is granted a special power: during working hours, if no guardian can sign, they simply contact the Medical Department for the chief to sign on their behalf.

Even if no payment is made, if surgery or resuscitation isn’t initiated immediately, the patient would die instantly.

Problem solved!

They handle the treatment first and sort out the fees later.

Even today, despite being the department with the highest unpaid bills, the Emergency Department remains at the top.

Beyond these privileges, examinations in the Emergency Department are generally marked as urgent.

Many tests skip the queue and are prioritized.

In specialty departments, you must wait for an available bed before admission.

The Emergency Department isn’t so particular—if needed, even an observation room bed will suffice.

After all, doctors aren’t going to let a patient die right in front of their eyes, are they?

Thanks to all these conveniences and privileges, patients absolutely love the service provided by the Emergency Department.

Thus, it became the busiest department in the hospital.

Heads of specialty departments, experts, and all levels of medical staff, including nurses, were unhappy when patients began flooding into the Emergency Department.

Consequently, the inherently flawed Emergency Department evolved into a triage station.

It only handles emergencies and critical cases—and just provides initial treatment. Once patients are stabilized, they’re transferred to the relevant specialty department for further care.

This arrangement reassured the specialty departments.

It was like having an extra helping hand to perform the initial sorting and processing of patients.

By the time patients reach the specialty departments, the doctors and nurses can take over gradually.

Specialists found life much easier compared to the era before the Emergency Department.

Importantly, their revenue wasn’t reduced.

Since the Emergency Department only deals with preliminary care, they barely receive a fraction of the major treatment fees for medications, surgeries, or hospital stays.

But the workload in the Emergency Department is far heavier than that of any specialty.

They constantly endure insults—and sometimes even physical abuse—from patients and their families.

Working in the Emergency Department is both exhausting and dangerous, yet the pay remains low.

Thus, a saying has circulated in the medical community: ‘Enter the Emergency Department and beware of getting struck by lightning.’

Before long, very few doctors were willing to stay long-term in the Emergency Department, especially those with talent, who eventually moved to higher-status departments for better benefits and recognition.

Inability to retain elite doctors inevitably led to subpar resuscitation outcomes in the Emergency Department.

So, what could be done?

Eventually, the Critical Care Department emerged.

When the Emergency Department struggled to manage certain critical cases, staff from the Critical Care Department would step in and fight for the patient’s life.

In terms of life support and monitoring, anesthesiologists are undeniably the best.

This is why, in the early days of critical care, the core doctors were mostly anesthesiologists.

Later, nutritional support from Internal Medicine was integrated into critical care, combining with the life support of anesthesiology to form a nearly perfect partnership.

Gradually, more critical patients were admitted to the ICU alive rather than being carried out dead.

Increasingly, more patients were transferred alive to general wards.

Nowadays, the Critical Care Department encompasses diagnostic testing from the technical staff, nutritional support from Internal Medicine, life monitoring and support from Anesthesiology, and surgical support from Surgery—including invasive ventilators, tracheostomy tubes, urine bags, and more.

It now stands as a testament to a hospital’s overall strength.

By pooling elite medical staff from various departments, they provide the best medical resources, life support, and a range of treatments for patients.

However, despite all its developments, anesthesiologists still hold the initial advantage, remaining indispensable in the realm of critical care.

“So, Dr. Shi used to be an anesthesiologist. His quiet demeanor now makes sense. Would you say that the development of Critical Care surpasses that of Anesthesiology?”

Zhou Can was genuinely curious—he wondered which department was truly superior.

To most doctors, both Anesthesiology and Critical Care are shrouded in mystery.

They know little about the income or future prospects in either field.

“Each has its advantages. Dr. Shi’s transition to Critical Care has been remarkably successful. Though he reached the attending level in Anesthesiology, his title didn’t change after switching departments. Yet, this year he might finally be promoted to Associate Senior—something that might’ve been impossible if he had stayed in Anesthesiology.”

Achieving the Associate Senior title is a major hurdle for many attending physicians.

A provincial-level research project and three core journal-level papers can easily block many from advancing.

And the written exam for promotion is just the first, simplest obstacle.

Dr. Shi is estimated to be around 39 or 40 years old.

Some doctors with natural talent, a solid foundation, and a bit of luck might achieve it by 38, but such cases are extremely rare.

For many, earning the Associate Senior title before the age of 45 is a small miracle.

Why mention luck?

Because when choosing research topics, success can depend on having a top mentor, joining a promising project, or even just being assigned an average project to lead—all of which depend on luck and personal merit.

Such opportunities require both luck and good character.

For Dr. Shi to attain the Associate Senior title at 40—especially in a fiercely competitive hospital like Tuyu—is a truly remarkable transition.

Zhou Can gathered every bit of information he could, preparing for his own future promotion.

Family matters are best understood from within.

His lower academic degree is a significant shortcoming; the higher one climbs, the more glaring it becomes.

Although at his current pace he might overcome this limitation, one must always plan for the worst.

Collecting information now is just a proactive measure.

“Zhou Can, remember to report to the ICU at 8 a.m. for handover tomorrow. Be sure to arrive about thirty minutes early.”

Dr. Hu reminded Zhou Can as they parted.

Today was only his first day; Zhou Can spent most of his time learning how to operate various devices and getting familiar with the surroundings.

Tomorrow, he would gradually be given more responsibilities.

Even while having dinner in the hospital cafeteria, Zhou Can couldn’t shake his fixation on the patient in Bed 7—what was causing his lower gastrointestinal bleeding?

The patient’s test reports kept replaying in his mind.

Untreated intestinal bleeding can easily lead to perforation, yet despite bleeding for half a year, there was still no perforation.

This certainly wasn’t a miracle.

There had to be an unknown reason behind it.

The patient had already undergone endoscopic hemostasis; if there were any clear intestinal abnormalities, they should have been detected.

A routine stool test with occult blood was also performed.

Yet, the reports revealed no obvious cause.

Zhou Can envisioned a detailed diagram of the human digestive tract in his mind.

The human intestine is composed of the small and large intestines.

The small intestine starts at the pylorus of the stomach and connects to the cecum of the large intestine.

The entire large intestine is roughly 1.5 meters long in adults—not very long, and since the end can be reached via colonoscopy, abnormalities are more easily detected.

Zhou Can pondered that intestinal tumors, polyps, ulcers, and various types of enteritis had mostly been ruled out.

Even vascular malformations or varicose veins seemed unlikely.

This case was truly perplexing.

The gastroenterologists couldn’t be blamed for not finding the cause.

The patient’s condition was simply too complex.

In a way, it was both complicated and straightforward.

Because it was clear that the bleeding was essentially diffuse within the colon.

The colon mainly consists of the cecum, appendix, colon, rectum, and anal canal.

The appendix can be ruled out first.

If it were the culprit, the patient would be in excruciating pain and wouldn’t last for half a year.

Moreover, it would quickly deteriorate within the abdominal cavity.

The anal canal is also unlikely to be the source.

That leaves only the cecum, colon, and rectum.

Focusing on these three areas might not yield much.

His level of pathological diagnosis was average for an intern, and no matter how confident he felt, he couldn’t outshine a Chief Physician.

His repeated successes came from his unconventional diagnostic ideas.

By approaching problems from different angles, he could see blind spots that others overlooked.

That was his advantage.

“Could it be that a malignant tumor in the colon is infiltrating the surrounding tissue?”

His mind raced, considering this possibility.

The patient had already had a blood test—ruling out leukemia.

Generally, unknown bleeding cases start with screening for leukemia and other bleeding disorders.

If a malignant tumor were present, it should have been apparent on angiography.

After reviewing the angiography report again, Zhou Can preliminarily ruled out malignant tumor infiltration.

That left only one final hypothesis.

He boldly speculated: Could the source be in the small intestine?

In adults, the small intestine stretches to about 7 meters at most, with a minimum of 5 meters—it’s the primary organ for nutrient absorption.

The patient’s emaciation clearly pointed to prolonged bleeding.

Yet, it was also possible that the bleeding was merely a smokescreen.

This very possibility had led other doctors astray, trapping them in an almost unbreakable diagnostic routine.

When Zhou Can first learned that the patient had been experiencing rectal bleeding for over six months before seeking help, he instinctively attributed the weight loss to the delayed treatment.

After all, no one with six months of rectal bleeding should be able to maintain their weight.

‘Yes, we should check the small intestine,’ he thought.

The more he considered it, the more logical it became, sharpening his focus.

His unconventional diagnostic approach allowed him to break free from rigid conventions and escape the diagnostic trap.

If there was indeed an issue in the small intestine, what would be the most likely problem?

First, one condition had to be met.

When dirty fluids from the small intestine enter the colon, they can trigger colonic bleeding.

This would neatly explain why the bleeding sites in the colon were inconsistent.

Zhou Can decided to consult the attending physician about the patient’s case.

The attending in charge was Dr. Xia Ping from the Gastroenterology Department.

After finishing lunch in the hospital cafeteria, it was already 6:30.

The Gastroenterology outpatient clinic had long shut down.

However, the Inpatient Unit always had a doctor on duty.

Zhou Can was well acquainted with both Director Tan and Director Yin of Internal Medicine—top figures in that department.

At that moment, it was perfectly acceptable to visit the Internal Medicine Inpatient Unit to ask about Dr. Xia Ping.

He was a man of action; if he thought of something, he immediately got to work.

Quickly, Zhou Can made his way to the Internal Medicine Inpatient Unit.

“Hello, I’m Zhou Can, a trainee from the Critical Care Department. I’m here looking for Dr. Xia Ping from Gastroenterology.”

He could only inquire with a nurse at the station.

“Sorry, Dr. Xia is off duty. If it isn’t urgent, you can come back tomorrow.”

The nurse’s tone was quite pleasant.

She was addressed as ‘nurse sister’ since she was at least in her thirties—significantly older than Zhou Can.

If she were in her early twenties, she’d be called ‘nurse girl.’

“It’s not extremely urgent, but it concerns the life of a Critical Care patient. I’d like to speak with Dr. Xia now. Alternatively, could you give me his phone number?”

Zhou Can was genuinely worried that the patient in Bed 7 wouldn’t last much longer.

After all, during the last bowel movement, the patient almost expelled his intestines.

Moreover, the patient’s condition was extremely fragile. Finding the cause of the bleeding even one day earlier could make a huge difference.

“We don’t have doctors’ phone numbers here! You can ask a duty doctor in the on-call room.”

Nurses deal with countless family members daily.

They can be very slick; unless you’re well acquainted with the department’s doctors, don’t even think about it.

Having experienced that, Zhou Can chose not to waste any more time and headed straight for the doctors’ office.

Knock, knock, knock!

The office door was open with the light on, and a lone doctor sat with his back turned to the door.

Knocking is a sign of courtesy.

“Please come in!”

The doctor turned around to look.

“Ah, it’s you! If you’re not working in the Emergency Department, why are you coming to our Gastroenterology Department?”

This doctor was none other than Dr. Chi—the very one who had once stormed into the Emergency Department in a huff.

Dr. Chi clearly remembered Zhou Can; otherwise, he wouldn’t have recognized him right away.

“Hello, Dr. Chi!”

Zhou Can greeted him respectfully.

Last time, Dr. Chi had acted outrageously in the Emergency Department, ending up completely embarrassed.

Zhou Can naturally chose not to bring up that past mishap.

“What’s the matter?”

Dr. Chi’s expression seemed a bit uneasy—likely recalling the previous incident. The awkwardness was evident.

“I’d like to get Dr. Xia Ping’s phone number in order to inquire about a patient’s situation. Could you share it with me?”

Zhou Can lowered his tone politely.

“Dr. Xia Ping’s number? Alright, let me check. One moment, please!”

Dr. Chi didn’t make a fuss; he genuinely set aside his work to look up the number.

“Here you go. This is Dr. Xia Ping’s mobile—just give him a call. But since it’s after hours, I can’t guarantee he’ll answer.”

“Thank you!”

Zhou Can dialed the number listed on the duty roster.

Fortunately, the call connected.

Without beating around the bush, he directly inquired about the patient’s condition from his office.

“Hello, Dr. Xia Ping. This is Zhou Can, a trainee from the Critical Care Department. I’m calling to get an update on patient Guo Ziyang in Bed 7, who is suffering from gastrointestinal bleeding. Is now a good time?”

Zhou Can asked.

“Sure, go ahead,” replied the calm, resonant voice on the other end.