Chapter 182: A Day at Tuyu Hospital

Zhou Can preferred to conduct his rounds alone, checking on patients and reviewing test results as a resident or intern.

When following the attending physician’s rounds, his low status meant he could only listen.

He would usually stand at the foot of the bed, watching from a distance.

It was even worse when he joined the chief physician’s rounds.

With a procession of at least seven or eight doctors, plus nurses and the head nurse, amounting to over a dozen people, this trainee barely had room to stand.

During the chief’s rounds, the head nurse, responsible nurse, resident doctor, and attending are all required to be present.

Typically, the resident would introduce the patient’s case while the chief summarized briefly. The whole process resembled a runway show.

In Zhou Can’s view, making independent rounds was the quickest way to improve.

Patient 47 had been diagnosed with right upper lung cancer accompanied by pericardial effusion—one of the patients scheduled for surgery today.

It was clear that the patient was very eager for the operation.

After the nurse had ordered a no-food, no-drink rule the previous night, the patient had bathed, cleaned up, and used the restroom early this morning, ready for surgery.

“Doctor, am I scheduled for surgery this morning?”

“Yes! The surgery is set for around 9 a.m. I expect to bring you to the operating room for preoperative preparation and anesthesia around eight.”

This was a major operation, and no one could yet predict exactly how long it would take.

It was bound to be lengthy.

There were many procedures to be performed.

They had to remove the right upper lung, create a pericardial window, and possibly perform lymph node dissection. The task was immense and the risks very high, which is why he was scheduled as the first case of the morning.

Delayed surgeries involving both the heart and thoracic regions require exceptionally skilled surgeons.

Director Xue had only been promoted to chief physician for a little over a year.

For someone so young to have achieved a senior title, her academic and educational credentials must have been outstanding.

At Tuyu Hospital, chief physicians in their 40s were extremely rare—practically one in a blue moon.

Her surgical skills surely couldn’t match those veteran cardiothoracic chiefs.

Taking on both cardiac and thoracic challenges is exhausting even for veteran chiefs; many prefer to collaborate during complex surgeries.

Most cardiothoracic chiefs specialize exclusively in either thoracic surgery or cardiovascular procedures. Few are proficient in both areas.

Director Xue was likely young, talented, and confident—daring enough to attempt this high-risk operation.

Zhou Can had already reviewed all the patient’s records several times on his office computer.

He hadn’t found anything abnormal.

The patient’s physical condition met the surgical criteria.

After asking a few more questions, Zhou Can comfortably moved on to the next patient.

He hadn’t been in the team long, but Zhou Can was extremely responsible.

Director Xue and his other colleagues treated him very well.

People tend to be friendly when you perform exceptionally well and show great potential; only a few, driven by jealousy, might speak coldly.

Zhou Can didn’t check every bed—he focused on the patients in his own team.

When he reached bed 53, he noticed the patient in bed 54 clutching his cheek in pain.

That patient wasn’t even under his team’s care, so by protocol he didn’t need to attend to him.

After examining the patient in bed 53, as he was leaving, Zhou Can looked at the patient in bed 54 and asked, “What’s wrong? Is it a toothache?”

“Yes! My tooth has been acting up recently. It hurt last week, but after taking some medicine it got better. I’m scheduled for surgery now because of my heart condition, yet the tooth pain has flared up again.”

The patient was a man in his fifties.

“Doctor, do you have any medicine here for toothaches?”

“Of course, the hospital stocks toothache medicine. I see you’ve already changed into your surgical gown—preparing for today’s operation, right?”

Zhou Can inquired further.

“Exactly!”

The patient nodded.

“It’s best not to take random medications before surgery to avoid complications. Just bear with the pain for now.”

Zhou Can then casually asked,

“What kind of surgery are you having?”

“I think it’s some sort of bypass! We rural folks don’t get many details—only that a Director Le is performing the surgery. I’ve heard he’s a protégé of Hu Kan, the most renowned cardiothoracic expert, so the skills must be top-notch.”

Patients and their families are often swayed by such buzzwords.

They love to believe in famous doctors.

They assume the more renowned the doctor, the greater his capabilities.

In theory, that’s not entirely wrong.

But sometimes, putting complete faith in a celebrity doctor isn’t ideal. In his area of expertise, misjudgments are less likely; however, if the patient’s issue falls outside his specialty, his skill might not even match that of a veteran attending.

It wasn’t about belittling experts—it was simply that everyone had their specialized field.

Experts are human too.

They mainly focus on their specialty, only dabbling in other fields just enough to know a bit.

“Director Le is likely performing a cardiovascular bypass surgery on you. This is a major operation, so you really shouldn’t take random medications.”

Zhou Can casually glanced over the patient’s test results and medical record book.

The reports indicated vascular stenosis, hardening, and severe plaques.

A bypass was a good preventive measure against myocardial infarction.

The patient complained of chest tightness accompanied by chest pain.

The record stated that he had no history of chronic illnesses, no drug allergies, no recent fevers, and wasn’t on any other medications before admission.

After reviewing the records, Zhou Can briefly advised the patient and then moved on.

Once he finished his rounds, he returned to the office to check on his team’s orders.

Since he hadn’t yet received his medical license, any orders he wrote used a superior doctor’s name, and he had to request a review to avoid mistakes.

Shortly after 8 a.m., following shift handover, Zhou Can helped the resident doctor send patient 47 to the operating room.

If he was late, the anesthesiologist might scold him.

As he escorted the patient into the operating room, he saw that the patient in bed 54, scheduled for cardiac bypass surgery, was similarly being pushed into another operating room.

Tuyu never ran out of patients—the outpatient numbers were enormous.

It was common for a cardiothoracic doctor to see a hundred patients in a day.

With such high outpatient numbers, even if only 10% required surgery, the figures would be astonishing. Some departments even reported inpatient rates as high as 19%.

Every day, countless cardiothoracic patients needed to be hospitalized for surgery, making bed availability extremely tight.

Surgical volumes were also very high.

Chiefs and associate chief physicians were performing one or two major surgeries almost daily.

There were about seven or eight chief and associate chief physicians in the cardiothoracic department, so the operating rooms were very busy.

Just a few days ago, colleagues in the group were discussing plans to add an extra Class 100 laminar flow operating room to relieve the backlog.

Watching the patient from bed 54 being rushed into surgery, a flicker of doubt crossed Zhou Can’s mind.

During rounds, the patient had mentioned having a toothache about a week ago.

And after taking medicine, the pain had subsided.

What kind of painkiller had he taken?

Some medications have long metabolic cycles.

At the time, Zhou Can had checked the patient’s record but found no note of any medication history. This was a potential risk.

Perhaps the patient hadn’t deliberately hid it, but the doctor’s failure to ask in detail was an oversight. As long as nothing went wrong it would be fine—if something did, it could result in a surgical mishap.

For instance, when Zhou Can’s internship was nearing its end, there was that patient with a rubber allergy.

Sometimes, patients aren’t even aware of what they’re allergic to.

No one would expect that the single-use sterile gloves used in surgery could become a ‘silent killer’ during an operation.

“Dr. Zhou, what are you looking at?”

“Oh, nothing. I happened to notice the patient in their group with a toothache during rounds this morning—a cardiac bypass case.”

Zhou Can answered absentmindedly.

“At his age, over fifty, experiencing tooth pain is quite normal. Poor oral hygiene can easily lead to cavities; once they reach the nerve, the pain becomes unbearable.”

The resident doctor in charge, Dr. Wu, was a young doctor in his late twenties.

He got along quite well with Zhou Can.

Most resident doctors, who had only been working for two or three years, were climbing the career ladder step by step.

There was much to learn while managing patients—from admitting them to surgery, post-op care, recovery, and discharge.

Throughout the entire hospitalization process, unexpected situations often arose.

The residents learned a great deal from these experiences.

However, it was recommended that one not oversee patients for more than four years. Most would start managing patients alone after obtaining their license, usually for two or three years, to build experience before going for further studies, returning as a chief resident for a year, and then aiming to become an attending around the fifth or sixth year.

This was considered an ideal progression.

Of course, this didn’t apply to PhD students. With their inherent academic advantage, they could directly become attendings.

Master’s graduates also had a chance, typically becoming attendings in about two years.

At Tuyu Hospital, competition was fierce—after becoming an attending, one might not immediately receive an official appointment letter from the hospital but would have to wait in line.

PhD holders were different; as special talents in the hospital, they received preferential treatment in many aspects.

Thus, academic qualifications were extremely important.

For a medical graduate like Zhou Can, with only an undergraduate degree, securing a training position at Tuyu as a resident was already an achievement. Moreover, he had obtained a qualification as a general trainee—a highly valuable credential.

After his training, it was almost guaranteed he would continue working at the hospital.

Yet, his future promotions and titles would be heavily influenced by his academic background, leaving him somewhat disadvantaged.

“Dr. Zhou, Dr. Zhou…”

Dr. Wu noticed Zhou Can drifting off and repeatedly called his name.

“Ah… sorry, I was daydreaming. What painkiller do you think is generally taken for toothaches?”

Zhou Can asked.

“Ibuprofen sustained-release tablets are common, though some patients might buy their own medicine from small clinics or pharmacies. I’ve even seen cases where antibiotics were administered via IV.”

Small clinics aren’t always shady, but they often try to extract more money from patients by ensuring immediate noticeable results from medications.

There is frequent overuse of antibiotics and various other drugs.

“If the patient only took ibuprofen sustained-release tablets, it should be okay. I’m just worried if he took aspirin or acetaminophen-type drugs.”

Zhou Can was filled with concern.

If the patient had taken aspirin, surgery would be contraindicated.

Aspirin requires a week off to be safe—or at least two weeks to be on the safe side.

Besides its anti-inflammatory and analgesic effects, aspirin also functions as an anticoagulant.

Patients who have had cardiac stents or cerebral stents need to be on anticoagulants for life to prevent thrombosis.

Some patients, either worried about long-term side effects or trying to save money, stop taking them after a year or two—a very dangerous move.

Disasters can happen easily.

During his training in general surgery, Zhou Can had seen a patient with a rubber allergy who, after stopping anticoagulants for less than a year post-stent, suddenly collapsed at night.

By the time the patient was brought to the hospital, his pupils were already dilated.

For patients about to undergo surgery, it was crucial to inform the doctor if they were still on anticoagulants.

Otherwise, it could lead to a tragedy.

Sometimes, routine blood tests wouldn’t even reveal it.

Especially for patients who only took the medication occasionally, it was hard for doctors to detect.

That really made it hard for doctors to guard against.

“Let’s not worry about the patient in that group. Quickly send the lung cancer patient in—if the anesthesiologist waits too long, his face will be as long as a mule’s.”

Dr. Wu, not wanting to meddle too much, spoke up.

Everyone mostly minded their own business.

Interfering too much often led to more trouble than help.

Doctors who had worked a bit longer had learned this the hard way.

Just then, Director Le hurried over with his team of attending physicians.

“First, send the patient in. I need to speak with Director Le—if something goes wrong, it won’t be good for the patient or the department.”

Zhou Can, still new to the hospital and maintaining his inherent kindness, stepped forward to greet Director Le.

“Good morning, Director Le!”

Zhou Can greeted him proactively.

“What can I do for you, Dr. Zhou?”

Director Le’s tone was courteous, likely because the patient from the previous chest wall suturing surgery belonged to his team.

Either way, by successfully treating the patient, Zhou Can had helped Director Le out.

“The patient from bed 54, scheduled for cardiac bypass surgery—before proceeding, it might be best to investigate a bit further,” Zhou Can explained.

“What’s the issue?”

When a surgery was set, you couldn’t just cancel it on a whim.

Director Le needed to understand the situation thoroughly before making any decisions.

“This morning during rounds I noticed the patient in bed 54 was holding his cheek, so I asked if it was a toothache. He mentioned it flared up again; he had a similar episode last week and had self-medicated.”

Zhou Can recounted the incident.

“Is there really a problem?”

Director Le looked confused.

“There isn’t any other issue, but I’m worried he might have taken aspirin, which is an anticoagulant. Who knows when he stopped taking it? I’m merely offering a word of caution—the final decision is yours.”

After speaking, Zhou Can let the matter drop.

He felt he had done his duty by warning; if Director Le were stubborn and ignored the advice, there wasn’t much he could do.

Without further ado, Zhou Can made his way into the operating room. He was eager for today’s lung cancer surgery, expecting to learn a lot.

However, his hands-on experience might be limited.

Director Xue hadn’t yet fully placed her confidence in him, so she occasionally entrusted him with minor tasks like suturing skin and managing airways.