Chapter 232: A Calculated Approach

It’s like drilling a hole in a wall—no one can guarantee you’ll hit that exact mark drawn on the other side.

A misaligned hit is perfectly normal.

Moreover, the patient’s occluded anastomosis isn’t short at all.

When an occlusion occurs, prompt surgical intervention makes the challenge a bit easier. But with months having passed, the occlusion has extended far beyond its original length, making it even tougher to open.

Zhou Can ponderously worked through the surgical plan.

A bold new strategy began to take shape in his mind.

“Using endoscopic ultrasound combined with X-ray guidance might just open the occluded connection between the esophagus and the jejunum. This will require a highly skilled nurse and a lead endoscopic surgeon with top-notch endoscopic and puncture technique.”

Zhou Can’s endoscopic skills were exceptional—natural talent paired with finely honed techniques.

Puncture technique and injection technique are remarkably similar.

Mastery in injection inevitably means proficiency in puncturing as well.

Thus, with Zhou Can personally as the lead surgeon, technical hurdles were no concern.

Finding a proficient nurse to assist was hardly a challenge.

First, use endoscopic ultrasound to open the blockage; a fine needle is sufficient to puncture from the esophageal end to the jejunum. Then, deploy a covered metal stent to expand the occluded connection.

And just like that, the passage is opened.

As for addressing an esophageal anastomotic leak, conservative treatment is usually preferred when the case isn’t severe.

This patient’s condition, however, was quite critical, making fistula resection the primary choice.

Zhou Can mentally rehearsed the surgical plan several times, meticulously scrutinizing every step and potential oversight. He even hand-drew detailed diagrams of the procedure.

Once everything was in order, all that was left was to consult Director Shang.

If approval was granted, he would then discuss the plan with the patient’s family.

As long as the family trusted the hospital and agreed to the procedure, the plan could go ahead.

With plans settled, he awaited Director Shang’s arrival.

The chief physician typically arrived late—around nine o’clock in the office.

Besides, he didn’t have much else to do; being idle was no harm at all.

So, Zhou Can began reviewing other cases in their group.

He recalled the patient in Bed 73, heard humming earlier that morning, and decided to check on his details first.

The patient, a 51-year-old with a long history of heavy drinking, had been admitted for unbearable abdominal pain. Both ultrasound and X-ray tests indicated pancreatic duct stones.

Director Shang, the attending physician, had scheduled an endoscopic stone extraction.

The surgery was performed yesterday.

They had done a sphincterotomy of the pancreaticobiliary duct and dilated the pancreatic duct to extract the stones.

The procedure went off without a hitch.

Both the surgical and postoperative care records confirmed its success.

This patient should, by all accounts, be in good shape.

After reviewing, Zhou Can proceeded to look at the rest of the group’s cases.

He was most intrigued by those particularly complex cases.

Each difficult case diagnosed earned him an extra 100 points of pathology diagnosis experience.

To this day, his pathology diagnosis skill still hovered at a below-attending level.

This branch of medicine is one of the toughest to advance in among many specialties.

Pharmacological differentiation is similarly hard to upgrade, primarily because he previously lacked prescription authority.

Now, holding a practicing certificate and prescription rights in a primarily medication-based internal medicine department, his experience in pharmacological differentiation was bound to rise.

“Hey, Dr. Zhou, you’re here bright and early! Early birds really do catch the worm. No wonder your medical skills are so high—always so diligent.”

Chief Resident Luo Shengsheng greeted Zhou Can cheerfully as he returned from the wards and spotted him meticulously reviewing the group’s cases in the office.

In the spacious office were also two intern doctors and another resident.

Luo Shengsheng ignored the others and chose to greet Zhou Can first.

This clearly showed his tendency to cozy up to higher-ups.

Noticing Zhou Can’s outstanding potential and the fact that Director Shang personally mentored him, Luo Shengsheng naturally held him in high regard.

In his eyes, Zhou Can’s status even exceeded that of a regular resident.

“Don’t praise me, Chief! Compared to esteemed seniors like you, my diligence is nothing. Besides, you know what they say—early birds get eaten too. Getting here early might land me a tricky case, and then I might be completely overwhelmed.”

Zhou Can laughed in response.

“Ha! Dr. Zhou’s unconventional thinking never ceases to amaze me. Early birds get eaten—I’ve never heard such reverse logic. Speaking of tricky patients, I had one on Bed 13 last night that nearly broke me, and from six this morning until now, I’ve barely slept. By the way, has Dr. Chi arrived?”

While describing the case, Luo Shengsheng’s face wore a look of utter dismay.

It was hard not to chuckle at his plight.

Sometimes, both residents and interns do their best to avoid these challenging patients.

After all, no one wants to be stuck with a problem.

As Chief Resident, Luo Shengsheng was on duty year-round, making avoidance impossible.

Yet, serving as a resident is a necessary step before becoming an attending.

It can be seen as a form of tempering.

It indeed builds character.

After a year of training, many residents emerge completely transformed.

Their ability to handle critical patients and sudden situations—from drastic drops in vital signs to unruly family members—improves substantially.

The tricky case Luo Shengsheng mentioned was likely under Dr. Chi’s purview.

Otherwise, he wouldn’t have brought it up.

“When I arrived, I only saw the three of them—Dr. Chi was nowhere in sight,” noted Zhou Can, who had come in quite early.

“Oh! He should be arriving a bit later. I better get on with writing the progress notes!”

Luo Shengsheng sat at his computer and began drafting the progress notes.

Before long, Dr. Xia Ping and Dr. Chi walked into the office together.

They both seemed in good spirits, chatting and laughing all the way in.

“Dr. Chi, the patient in Bed 13 nearly had a major scare this morning. Since around 11 last night, his condition has been unstable. I didn’t want to disturb you after a long day—as long as it wasn’t beyond my control, I managed him all night, rescuing him six times without a wink of sleep.”

Luo Shengsheng was both venting and taking some credit.

After a long night’s work, he naturally wanted Dr. Chi to know.

“Really, you’ve worked so hard! I’ll go check on him right away,”

Dr. Chi quickly set his bag down, changed into his work clothes in a side room, and dashed to the ward to assess the patient.

As the shift started, more doctors filtered into the office.

Zhou Can, still just a trainee on his first day in the Gastroenterology Department, didn’t yet have an established position.

Noticing the influx, he wisely logged off, stood up, and yielded his seat.

Other trainees and interns, equally sensible, did the same.

Everyone was well aware that no one would dare snatch a seat from a senior doctor.

Some might not realize just how low the interns’ status is.

They don’t even have their own coat hooks.

The idea of reserving a fixed seat in the office specifically for interns or trainees is laughable.

With so many doctors covering the shift today, the office was completely packed, leaving Zhou Can puzzled.

Could it be that a disgruntled family member stirred things up, prompting the department to summon every doctor to be on standby?

No hospital is immune to family disputes.

As long as they find something unfair, they’re sure to make a scene.

Some families believe it’s perfectly normal to argue with nurses and doctors.

But when such families appear, it’s hard for doctors and nurses not to feel a twinge of anxiety—a fact they all try to hide.

Usually, they’d try to avoid confrontation altogether.

Zhou Can noticed that some senior residents had no seats left and were forced to stand like everyone else.

Only those at the level of attending or above could sit.

“Ha, everyone’s so early! Let’s get the word out—a morning meeting in the main conference room.”

The moment Director Shang entered the office, his presence dominated the room.

The previously noisy office instantly fell silent.

Zhou Can patted his head as he remembered that just yesterday, Dr. Xia Ping and Dr. Zhang nearly caused a medical mishap. Director Shang had mentioned a morning meeting today to emphasize medical safety.

No wonder every doctor in the Gastroenterology Department showed up.

One by one, the doctors left the office and headed to the conference room.

Some nurses also gathered in small groups, all making their way to the meeting.

It was clear that the whole department was holding a morning meeting.

Tuyu Hospital is notoriously strict when it comes to medical safety.

“Dr. Zhou, how is the case with the esophagus-jejunum anastomotic leak progressing?”

Director Shang abruptly called out to Zhou Can.

Trainees Duan Zifu and Yu Xin from his group glanced at him with a hint of envy.

Their eyes betrayed their admiration.

Among all the trainees, only Zhou Can had managed to capture Director Shang’s full attention.

Neither Duan Zifu nor Yu Xin enjoyed the same spotlight.

“The patient’s vital signs are stable. Here is the surgical plan I devised. It might be a bit premature, so please review it when you have time.”

Zhou Can had already drawn a clear schematic of the procedure.

Given the situation, Director Shang obviously didn’t have time for a detailed verbal report.

Handing over the diagram was a quick and efficient solution.

“You even prepared a diagram?”

Director Shang skimmed through it and his face lit up in astonishment.

“This young man not only gets the job done properly, but he’s also meticulous. The plan is almost exactly as I envisioned—it’s clear you put a lot of thought into this.”

A satisfied smile spread across Director Shang’s face.

Other doctors passing by couldn’t help but cast extra glances at Zhou Can.

It was well known that a capable trainee had joined their ranks, though few truly recognized Zhou Can’s talent.

Now, with Director Shang praising him, their respect for Zhou Can soared.

Even the usually aloof trainee Yu Xin was, for the first time, giving him a closer look.

Having trained under Director Shang for so long, she knew just how rare his commendations were.

“Thank you for your kind words. I reviewed the patient’s previous records from the other hospital. Although the esophageal leak occurred, there was no sign of abdominal infection. However, after the initial surgery, the patient’s food was leaking out—a sign of a severe leak. I believe that resecting the fistula is the best option.”

Seizing the opportunity, Zhou Can voiced his concerns.

“Hehe, that’s some deep thinking! Let’s discuss it in detail after the meeting. The fact that you gathered and thoroughly analyzed the patient’s records from the other institution shows excellent work ethic. I’m very satisfied with your efforts on your first day. Now, off to the meeting!”

Director Shang’s gaze towards Zhou Can was filled with genuine admiration.

His reputation was well deserved.

Earning praise from so many chief physicians, Zhou Can clearly had many exceptional qualities.

“Understood!”

Zhou Can quickly caught up with Duan Zifu and Yu Xin, and they all headed to the conference room together.

As members of the same trainee group, they naturally sat together during meetings.

“Dr. Zhou, you’re amazing! Just one day into training and Director Shang is singing your praises. I’ve been training for nearly a month before I got lucky enough to be noticed and assigned under him.”

Any trainee lucky enough to work directly under the chief physician was bound to be competent.

Duan Zifu must be pretty capable too.

“I wouldn’t dare compare—I just try to do my job well,”

Zhou Can replied modestly.

“I heard that your diagnostic and surgical skills are top-notch. Could you lend a hand with Dr. Yu’s case?” Duan Zifu shifted the conversation to make a small request.

Yu Xin’s face remained impassive; she said nothing.

Only her delicate brows furrowed slightly.

It seemed she had encountered a particularly tricky situation.

“Tell us what’s wrong first. My skills are limited—I might not be as helpful as you hope,”

Zhou Can did not refuse outright.

“Here’s the situation: Dr. Yu’s patient in Bed 73 underwent a pancreatic duct stone extraction yesterday. This morning during rounds, I discovered the patient was complaining of abdominal pain, and his temperature had risen. However, after checking, we couldn’t pinpoint the cause.”

Duan Zifu gave a rough account of the case.

“Could this just be normal post-anesthesia pain?”

With a wealth of surgical experience—having performed more operations than most attending physicians—Zhou Can was confident in his postoperative assessments.

His expertise with postoperative management was equally extensive.

“It doesn’t seem like typical post-op pain. The pain isn’t at the surgical site but more in the lower abdomen. Moreover, the patient is also nauseous with a fever,”

Yu Xin offered her input, breaking her usual reserve.

She seemed too timid to speak up directly to Zhou Can earlier.

Now that Duan Zifu had prompted her, she no longer held back her concerns about the challenging case.

Faced with such a tricky patient, her worry was unmistakable.

If poor management led to complications, it could ruin her prospects.

“Didn’t you report this to a senior doctor?”

Zhou Can asked again.

After a brief hesitation, she bit her lip and, with a hint of embarrassment, said, “Within our group, there’s an unspoken rule: reporting even minor issues to superiors is seen as a sign of weakness. It would count against me in Director Shang’s eyes. I want to handle this on my own before causing any trouble.”

“Fortune favors the brave,”

she added, hinting at the subtle competition among junior doctors.

It was much like the patient Zhou Can managed—a self-devised plan that significantly boosted his standing with Director Shang.

Reporting even the smallest issue immediately would label one as a ‘big baby.’

No outstanding doctor would want that tag.

Yet, lacking sufficient strength, she feared that not reporting might backfire badly.

In the end, it would be a lose-lose situation.

This delicate balance was something she alone had to navigate.