Chapter 191: Diagnosis on the Edge

Based on her description, the likelihood of chronic ulcerative colitis is quite high.

There is also a risk of developing intestinal polyps and colon cancer.

Considering she’s very young—just in her twenties, at the bloom of youth—the risk of colon cancer is relatively low.

Furthermore, she was treated at a local hospital where she was diagnosed with colitis.

However, the treatment hasn’t been very effective.

Also, she has begun vomiting. Even if it really is colitis, it’s a particularly dangerous type.

“Qiu Hong, start with a physical examination for her,” he instructed.

Dr. Jia likely considered that she was a female patient, so he had the female doctor Qiu Hong perform the exam.

Yet in a doctor’s eyes, gender really doesn’t matter.

Female patients often undergo ECGs by male doctors, and many male doctors attend to breast issues. During a physical exam, female patients are asked to lift their tops for visual and tactile inspection.

According to hospital policy, a female nurse or doctor must be present.

If only a male doctor is present with a female patient, and she later accuses him of impropriety, it could be impossible to clear his name.

Additionally, female patients may be accompanied by their husband or another family member.

In the outpatient department, family members are allowed to accompany patients.

Only in the Operating Room, Examination Room, and Critical Care Department are family members prohibited.

In the Resuscitation Room, it depends; generally, family members are not allowed, but if resuscitation is complete or if the doctor deems it necessary to bolster the patient’s will to live, they are invited in.

They will be invited to join.

A physical exam is far more complex than one might imagine. It includes measuring axillary temperature, counting the respiratory rate, taking blood pressure in the right arm multiple times, and observing the patient’s complexion, development, nutrition, and bowel sounds, among other things.

It’s by no means as simple as pressing the painful spot a couple of times as seen on TV.

While Qiu Hong was examining the patient, Zhou Can picked up her report to review.

He began by checking the complete blood count.

After the onset of a disease, over 70% of conditions manifest to some degree in the blood work.

This patient’s white blood cell count was markedly elevated, whereas her red blood cell count and hemoglobin were below normal. Her hematocrit had dropped significantly, her ESR was high, mucin levels had increased, and her albumin was low.

Even just the blood test results made it clear that something was wrong.

With this many abnormal blood indicators, from a doctor’s perspective, this is no minor issue.

Colitis is generally considered a minor illness.

So, what could be more serious than colitis?

An intestinal perforation can likely be ruled out, since it is usually accompanied by peritoneal infection and far more severe symptoms.

Patients would experience unbearable pain, often with high fevers and chills.

Zhou Can then reviewed the stool test, which showed the presence of red and white blood cells as well as a positive occult blood test.

This suggests that the disease is most likely located in the intestines.

A CT scan did not reveal any obvious abscess in the abdominal cavity.

Based on these tests, the patient appears to have ordinary colitis. The treatment plan and diagnosis from her local hospital were correct.

“Zhou Can, have you found anything?”

Dr. Jia’s way of addressing Zhou Can had unconsciously changed.

He had shifted from calling him ‘Little Zhou’ to ‘Zhou Can.’

Perhaps it was because calling him ‘Little Zhou’ in front of the patient seemed disrespectful, or maybe Zhou Can had discovered a hidden disease in the patient on Bed 3, warranting extra respect.

Either way, it was a positive sign.

At least Dr. Jia referred to the beautiful doctor Qiu Hong by her proper name instead of ‘Little Qiu.’

“It’s too early to say—the examination data is too sparse. We can only surmise that the disease is in the intestines. It might be colitis, but it’s not your ordinary colitis.”

Zhou Can offered his diagnostic opinion.

Expecting him to provide a definite diagnosis would have been too much to ask.

The fact that he could continually narrow down the possibilities was already impressive.

“Not bad! Your diagnostic reasoning isn’t as impulsive as that of most young doctors—very methodical. You’re even more impressive than I expected,” Dr. Jia complimented.

It was the first time Dr. Jia had praised him.

And he did so in front of the patient.

This clearly showed Dr. Jia’s satisfaction with Zhou Can’s performance.

“To pinpoint the exact cause, we need to perform a colonoscopy,” Dr. Jia announced to the patient.

“Isn’t there a way to avoid a colonoscopy? I heard it’s terrifying. I’m afraid of the pain and even more scared that it might perforate my intestines!” the patient protested, clearly averse to the procedure.

At her local hospital, the doctor had most likely already discussed a colonoscopy with her.

“You’re scheduled for a colonoscopy, which does carry a slight risk. If you absolutely refuse, we can opt for a barium enema instead. However, I personally recommend the colonoscopy for a more definitive look,” Dr. Jia explained.

He said this to her with a firm tone.

“Oh… no, no. A friend of mine had a colonoscopy and suffered for days afterwards. Unless it’s done painlessly, I just can’t do it,” she replied in a somewhat childish tone.

She sounded a bit immature.

In reality, most girls like her are kind-hearted, driven, and cheerful.

At the very least, they take hardships in stride.

Their ability to cope under pressure far exceeds that of the average girl.

“Young lady, you’re already sick and yet still so worried about a bit of discomfort from the exam? A painless colonoscopy requires an appointment—at least a six-month wait. Your condition cannot be postponed even for a day. Besides, a painless procedure is much more expensive. What’s the point?”

Dr. Jia shook his head in exasperation.

Today’s youth have a strong sense of individuality, and their ideas differ greatly from the older generation.

Eventually, after the physical exam, Dr. Jia submitted an application for a barium enema.

The frail patient then paid and went for the examination.

It was worrisome to see her in such a delicate state, alone without any family by her side.

One couldn’t help but wonder about her family life.

Some young people, remarkably mature beyond their years, carry all their burdens alone to avoid worrying their parents.

It was both pitiful and heartbreaking.

……

Around half past ten in the morning, Qiu Hong’s phone rang.

“Dr. Tang, have the test results for the patient on Bed 3 come in yet?”

Qiu Hong asked proactively.

It turned out that the attending doctor for the patient on Bed 3 was calling.

“Ah… it really is gallbladder cancer! Our new Dr. Zhou is simply remarkable,” she exclaimed, her beautiful face registering shock at Zhou Can’s foresight in detecting the hidden disease.

【Pathology Diagnosis EXP +1】

【You successfully diagnosed a challenging hidden disease. Pathology Diagnosis EXP +100】

A total of 101 points in Pathology Diagnosis EXP were credited, which delighted Zhou Can immensely.

His hard work had finally paid off handsomely.

Currently, his pathology diagnosis level is that of a fourth-level Attending Physician. To reach the Associate Chief Physician level, he needs 10,000 EXP. If he only gained one point per case, it might take forever.

After ending the call, her gaze toward Zhou Can completely changed.

“Teacher, Dr. Tang just called and said that…” Before she could finish, Dr. Jia waved his hand and interjected, “I heard everything. That kid Zhou Can really has skills.”

After the praise, he sighed softly.

“Sigh… gallbladder cancer is known as the king of cancers, with a very poor prognosis. This patient’s condition is dire—she has likely lost her chance for surgery. Once I finish outpatient consultations, I’ll review the MRI results,” he added.

Dr. Jia expressed genuine sorrow for the patient.

Had gallbladder cancer been caught earlier, the outlook might have been better. At this stage, it has very likely metastasized.

Both pancreatic and gallbladder cancers are notoriously severe.

These two cancers are often dubbed the kings of cancers—each more perilous than the other.

They share one common trait: they easily invade surrounding vital tissues and organs.

Any delay in detection can immediately eliminate the chance for surgery.

Cancer cells replicate rapidly, enabling them to spread swiftly throughout the body. If surgery doesn’t completely remove them, they can grow uncontrollably.

From diagnosis to death, the progression is often astonishingly rapid.

Gallbladder cancer is a malignant epithelial tumor with an extremely high degree of malignancy. It can be classified as adenocarcinoma, squamous cell carcinoma, adenosquamous carcinoma, a tumor derived from mesenchymal tissue, or a neuroendocrine tumor, depending on its pathological mechanism.

Regardless of the type, the prognosis is grim.

The five-year survival rate for gallbladder cancer is generally less than 10%.

This patient is in her seventies. If her family were affluent, they might consider re-evaluating the surgical plan and its risks. Otherwise, a conscientious doctor would warn the family that treatment could cost them dearly both financially and otherwise.

“Junior Zhou, I’m really curious—how exactly did you detect that the patient on Bed 3 had cancer?” Qiu Hong’s beautiful eyes fixed on Zhou Can.

Her way of addressing him had shifted from the unfamiliar ‘Dr. Zhou’ to ‘Junior Zhou.’

At that moment, she willingly accepted that Zhou Can called her ‘Senior Sister.’

“It was sheer observation! During rounds, I noticed the patient’s complexion, eyes, hands, and facial color were all off. I immediately suspected cancer. Later, after taking leave and reviewing the reports carefully with Dr. Jia, I used the process of elimination to finally pinpoint the gallbladder as the source.”

Zhou Can generously shared his diagnostic experience.

“The main issue was that the symptoms of cancer were masked by her liver cirrhosis and duodenal ulcer. Otherwise, it would have been easy to detect.”

Stealing some of Dr. Jia’s spotlight naturally necessitated giving him a way out.

Even experts can sometimes miss details or make oversights.

“Qiu Hong, you don’t know? When Zhou Can was training in other departments, he was already quite renowned. The chief physicians highly praised him, each eager to have him join their team,” Dr. Jia informed.

Dr. Jia was remarkably well-informed.

He knew all about Zhou Can’s achievements in other departments.

It seems Zhou Can’s reputation began to rise right after his General Surgery training. Even Deputy Director Ye had taken a keen interest, which led to special consideration during his rotation in Critical Care.

Now, with Director Xueyan’s assistance, Zhou Can is frantically bridging gaps in his foundational medical knowledge.

After nearly two months, noticeable progress has been made.

His shortcomings in immunology and gastroenterology have been significantly mitigated.

Being able to precisely localize the cancer to the gallbladder of the patient on Bed 3 marks real progress.

Just then, two groups of patients entered the consultation room simultaneously.

The young female patient at the back was the one initially diagnosed with colitis.

She had just returned from her barium enema.

“Dr. Jia, the test results are in. Could you please take another look?”

She handed Dr. Jia the results and flashed an apologetic smile at another patient who had just arrived.

“The barium image shows a ‘skip lesion’ pattern… this is troublesome!”

Dr. Jia frowned deeply as he reviewed the results.

It indicated that her condition was very difficult to treat.

After reviewing the barium enema, Zhou Can’s heart skipped a beat. Her condition was very similar to colitis; however, the presence of a ‘skip lesion’ pattern strongly pointed to ulcerative colitis.

But when coupled with her electrolyte test results, this is no ordinary case—it could be the deadly Crohn’s disease.

The CT scan had already hinted at this.

The proliferative lesions spanning the intestinal wall had involved the mesentery and local lymph nodes, confined to the small intestine and colon.

The lesions were distributed in segments.

They were clearly separated from normal bowel segments, forming the characteristic ‘skip lesions.’

All signs pointed to Crohn’s disease, infamously nicknamed the ‘green cancer.’

This disease isn’t technically cancer, but with current medical technology, patients require lifelong medication—and the costs are exorbitant.

Using imported drugs, a single treatment can cost between 15,000 and 20,000 yuan.

Patients need to have an IV drip approximately every two months.

Such prohibitively high treatment costs, coupled with bi-monthly treatments, are a nightmare for an ordinary young girl.

“Just tell me straight—I can handle it,” she declared.

The girl, brave at heart, could already tell from Dr. Jia’s expression and tone that the news was not good.

Dr. Jia paused as he organized his thoughts.

Doctors generally try to be as considerate as possible when communicating with patients.

“It’s alright, just say it—I can take it. My family is practically non-existent. My parents divorced when I was very young, and I was raised by my grandparents. Now that they’re gone, even if I get cancer, there’s nothing holding me back in this world. I can accept any outcome.”

It was hard to believe such words came from a girl barely in her twenties.

Listening to her and observing her expression, Zhou Can felt an overwhelming sense of sympathy.

Sadly, his medical knowledge was still limited; no doctor has yet found a cure for Crohn’s disease.

The only recourse is lifelong medication.

Despite advances in diagnosis, surgery, pharmaceuticals, and understanding pathological mechanisms, Western medicine has, over the years, overshadowed thousands of years of traditional Chinese medicine and Western quackery.

Yet many chronic diseases remain incurable.

Statistics suggest that over 80% of chronic diseases are incurable.

Isn’t that astonishing?

Take tumors, for example—after removal, they often grow back.

In medicine, we refer to that as recurrence.

Why is early detection crucial for the possibility of curing cancer? It isn’t really a cure, but rather the body’s immune system overcoming the disease.

By the time cancer reaches an advanced stage, much like a wildfire in a forest, it becomes uncontrollable and the immune system is either destroyed or overwhelmed.

Thus, whether through surgery or chemotherapy, the final outcome is largely left to fate.

Western medicine treats the symptoms while traditional Chinese medicine aims to get to the root of the problem.

Traditional Chinese medicine is centered on restoring the balance of Yin and Yang. Perhaps one day it will be globally recognized as mainstream, with Western medicine playing just a supporting role.

But when that day comes, traditional Chinese medicine might not be the unrivaled force in China, as developed Western nations may have long recognized its value.

After all, many renowned Chinese doctors have already been lured overseas with significant sums.

This is both frustrating and disheartening.

Fortunately, these overseas moves have caught the attention of the relevant authorities, who have begun implementing policies to support the development of traditional Chinese medicine.

Compared to the severe decline and marginalization of traditional Chinese medicine from the late Qing period to modern times, its current situation has improved considerably.

“Young lady, your condition is Crohn’s disease—an idiopathic inflammatory bowel disease. Theoretically, it can occur anywhere in the gastrointestinal tract, but it most commonly affects the terminal ileum and right colon. Clinically, it presents with abdominal pain, diarrhea, and bowel obstruction, along with extraintestinal symptoms such as fever and nutritional deficiencies. Your anemia, constipation, and even the vomiting when you eat are all related to this disease,” Dr. Jia explained.

She, clearly unfamiliar with the condition, asked in a daze, “So, can this disease be treated? Is it cancer?”