Chapter 259: A Hidden Threat: Surgical Precision and Second Chances

The core team of Gastrointestinal Surgery was still mostly made up of the original Digestive Surgery group.

Some programs from Digestive Surgery had just been split off.

For example, Pancreatobiliary Surgery and Colorectal Surgery.

Overall, more specialization in departments had its pros and cons. The upside was it let doctors and nurses become real experts in their fields, striving for true mastery.

This trend was becoming standard across the entire industry.

As China grew stronger, people’s expectations for medical care only increased.

Now, everyone just goes wherever they can find the best treatment for a particular illness. Take the Oncology Department at Tuyu Affiliate Hospital—it’s become so strong it draws in cancer patients not just from all over the province, but from other provinces as well.

Zhou Can and Dr. Chi wheeled the patient into the operating room, while her family stayed outside to wait.

You could see how nervous the couple was, their faces filled with anxiety.

Inside, everything was already prepped. The anesthesiologist and surgical nurses were in place. Soon after the anesthesia started, the associate chief physician hurried in.

“Director Mu!”

Zhou Can was caught off guard; the person entering turned out to be the proud, somewhat narrow-minded Associate Chief Mu from the old Digestive Surgery team.

“Dr. Zhou, it’s an honor to operate with you today.”

Director Mu actually looked like he’d just scored a great deal, grinning as he stepped forward to shake Zhou Can’s hand.

He hadn’t always treated Zhou Can this way.

Times change, and so do people.

With Zhou Can’s remarkable potential and his growing status at Tuyu Hospital, even Associate Chief Mu had to reevaluate his attitude. Nobody would pass up the chance to get along with a rising star in medicine.

“Thank you for your trust and support, Director Mu. Really, I should be the honored one working with you.”

Zhou Can wasn’t about to take advantage of the moment.

He knew to give the other man plenty of respect, at least on the surface.

Especially with someone this thin-skinned—you had to be careful. One wrong word and it might stick.

“Old Mu, I’m really counting on you this time!” Dr. Chi clearly had a good personal relationship with Director Mu.

“Count on me? How many times have I asked you for help? It’d be rude for you to act so formal now.” Director Mu waved it off, then walked over to check on the patient.

By now, the patient was already moving into anesthesia.

Still needed a bit more time though.

“Anesthesia is complete. The patient is stable. You may begin.” The anesthesiologist was always the most solemn in surgery—methodical, strict, following every safety protocol to the letter.

Sometimes more serious even than the chief surgeon.

Understandable, since a patient’s safety rides on their shoulders. There’s no room for carelessness.

“Dr. Zhou, please!”

Director Mu nodded to Zhou Can.

“Alright!”

Zhou Can took his place as lead surgeon and began the open abdominal procedure.

In his hands, the scalpel seemed to come alive—graceful, nimble, moving exactly as he willed.

Every cut—its length and depth—was perfectly controlled.

As he opened the abdominal cavity layer by layer, Zhou Can used electrocoagulation to stop the bleeding. He avoided every major vessel with astonishing precision.

Though only at an average skill for Incision Technique, he made up for it with Rapid Surgical Technique, matching even the associate chief physician’s level. There was no worry he’d nick a vital vessel or nerve.

“We’ll help with the retractors.”

Associate Chief Mu and Dr. Chi stepped in to assist Zhou Can.

Once the abdomen was open, Zhou Can first suctioned out the blood and small amounts of fluid, then carefully began searching for the affected area.

Whether it’s abdominal surgery or chest surgery, a doctor needs a strong sense of responsibility and plenty of experience. In theory, as long as you don’t damage the organs while moving things aside, there’s no major problem.

But after surgery, those organs could easily develop severe adhesions, leading to all sorts of complications.

That’s what people usually call postoperative sequelae.

Pretty much all thoracic and abdominal surgeries come with some degree of aftereffects.

For example, after chest surgery, patients might often feel tightness in the chest or shortness of breath.

With abdominal surgery, the risk of intestinal adhesions and obstruction goes way up.

Plenty of patients who’ve had abdominal surgery say that, within six months after leaving the hospital, they’ve experienced constipation, bloating, and sometimes unexplained abdominal discomfort.

So, any responsible surgeon will thoroughly weigh the pros and cons before opening a patient’s chest or abdomen, making sure the benefits far outweigh the risks.

Zhou Can did everything he could not to shift any other organs inside the abdominal cavity. He’d already carefully mapped out his approach before the surgery.

Now, with the cavity opened, he went straight for the suspected area.

The patient’s illness was still in its early stages, so the abnormalities just weren’t obvious. Even though they’d mapped it pre-surgery and his fingers had detected small nodules, there was nothing visible even now on direct inspection.

Zhou Can had expected that.

“There’s no obvious tumor or nodule here, Dr. Zhou. When you examined her, could it have been different because she’s a young woman?” Dr. Chi asked quietly.

Before surgery, Dr. Chi had been totally confident in Zhou Can’s diagnosis.

But now, after opening the abdomen and finding nothing, he was starting to doubt.

He couldn’t help feeling a bit let down.

Mostly, he was worried about how to face the patient’s family.

“Do I look like someone who’s never seen a woman before?” Zhou Can rolled his eyes, speechless. If he were that clueless, he’d never make it as a doctor. “I know my fingers didn’t lie. If we can’t see anything after opening up, there’s just one explanation—the tumor or nodule is extremely small and hidden inside a tissue.”

Zhou Can had vast surgical experience, with plenty of tumors and nodules under his belt.

The situation was a bit unexpected, but he quickly regained his composure and started to work it out.

He’d found nothing on the first sweep because he’d been so careful, worried about injuring the abdominal tissues.

“Give me thinner sterile gloves—the thinner the better.”

He told the surgical nurse.

Everyone in Digestive Surgery knew Zhou Can and his reputation.

So even though the surgery had hit a snag, none of them seemed worried in the slightest.

The Attending Nurse hurried over to help remove his right glove, while the instrument nurse gave him a pair of ultrathin sterile gloves.

“Dr. Zhou wants to feel for the pathology with his own hands?”

Dr. Chi paused, then instantly understood Zhou Can’s intention.

With the new gloves in place, Zhou Can began gently feeling the patient’s abdominal tissues, focusing mostly on the jejunum.

“Tumors usually show up in the ileum. Are you sure you’re searching the right spot?” asked Associate Chief Mu.

Zhou Can shook his head. “The patient’s pre-op GI scans pointed to the jejunum, and when I did the pain test, that area had the strongest response. I’m pretty sure I’m in the right place.”

He didn’t want to speak too soon either.

His gaze roved, searching for tissue most likely to hide a tumor.

When he lifted part of the jejunum and focused on a spot, countless anatomy diagrams from med school raced through his mind.

“If there’s really a tumor, lymphatic tissue under the intestinal wall is the likeliest place to find it. Those lymph nodes are dense—it’s probably hidden in there.”

He felt he was closing in on the culprit.

Carefully, he started palpating those tissues.

“There it is—a nodule, hard and a bit slippery… No, this doesn’t feel like a lymph node. It feels like a tumor.” Zhou Can’s face lit up with excitement. After all this searching, he’d found it.

Tumors in this spot are always elusive and hard to catch with any conventional exam.

By the time typical screening finds it, it’s often already late-stage cancer.

“So, the tumor’s hidden underneath the intestinal wall, inside the lymphatic system. No wonder it was so hard to find!”

Lymphomas under the intestinal wall spread fast, deepening along the wall, invading the serosa and mesentery, even infiltrating the mucosa and stiffening the folds.

Thank goodness Zhou Can caught it in time. If this girl’s case had been mistaken for intestinal tuberculosis and delayed a few months, she’d definitely miss the window for surgery.

[Pathology Diagnosis experience +1.]

[You successfully diagnosed a high-difficulty hidden case. Bonus: Pathology Diagnosis experience +100.]

That hundred-point experience reward was well deserved for Zhou Can.

After all, he’d just saved a young life.

“Who’d have thought someone so young would get a small intestinal lymphoma? The death rate is brutal. What makes it tough is how hard it is to detect in these early stages. Many patients barely notice any symptoms at first.”

Associate Chief Mu wasn’t stellar in surgery, but his theory was solid.

He’d published several influential papers on the intestines.

“Dr. Zhou really lives up to the reputation. With the tumor found, we’ll have a clear answer for the family,” Dr. Chi started laying on the praise.

Just a short while ago, he’d been skeptical, even wondering if Zhou Can’s hand had slipped because he’d never touched a young woman before.

Now he realized he’d spoken too soon.

Once said, though, words can’t be unsaid.

If they’d misdiagnosed her and treated it as intestinal tuberculosis, things could have ended terribly.

It was almost eerie.

Both he and Director Mo had pressed on the patient’s abdomen, but neither had found a tumor.

Zhou Can concentrated on removing all the diseased lymphatic tissue. After triple-checking that it hadn’t spread, he finally called an end to the surgery.

[Tissue Separation experience +1. Incision Technique experience +1.]

[First time successfully removing a submucosal jejunal lymphoma! Bonus: Tissue Separation experience +100. Incision Technique experience +100.]

One surgery, three hundred surgery experience points. And all in skills that were usually extremely slow to improve.

Zhou Can was absolutely thrilled.

But even more satisfying was knowing he’d saved that girl’s life and prevented a family tragedy.

“Dr. Chi, Director Mu, the affected lymphatic tissue has been fully removed. Ready to suture and close up?”

“Go ahead and close.”

With Director Mu’s word as final, they began suturing the incision. Zhou Can stitched carefully, aiming for the cleanest result—after all, a long scar on a woman’s abdomen could be easily mistaken for a C-section or abortion scar.

That could complicate her marriage prospects for sure.

Of course, things like this can always be explained. With medical records and test results, she could prove the truth.

Still, being healthy and avoiding surgery altogether is always best.

But life rarely goes according to plan. When a malignant tumor starts growing, you do whatever it takes to survive.

However bad the scar, it’s a fair trade.

“It’s amazing—even after all those tests, the real problem never showed up. I’ve spent years in Gastroenterology, learning and practicing, but now I’m more nervous than ever. No matter how careful I am with diagnoses, mistakes and oversights can still happen.”

This anxiety hits most veteran doctors.

The better a doctor you are, the more cautious you become—like walking on thin ice, afraid to make even the smallest slip.

“Small intestinal lymphoma is just that difficult to detect. If you run into a similar case where endoscopy has ruled out upper GI or colon bleeding, try a double-contrast small intestine X-ray. The newer string test is also worth using more in practice. And if none of those turn up anything, don’t hesitate—follow Dr. Zhou’s lead and do an exploratory laparotomy.”

Associate Chief Mu shared his hard-earned experience.

He was a surgeon, but his diagnostic skills were second to none—even compared to the internists.

Nothing in the world is absolute.

Thinking internists are always better diagnosticians than surgeons? That’s just wishful thinking.

The string test is easy, noninvasive, and cheap.

It’s used at many major hospitals.

But in places aiming just to boost profits, this test is rarely used.

If a patient’s cause isn’t found, doctors are free to order every test in the book. After all those checks, the hospital easily pulls in a few thousand yuan.

As for whether the patient feels miserable during the contrast studies or if invasive exams worsen their condition—honestly, some doctors don’t care.

……

As soon as the patient was wheeled out of surgery, her parents rushed forward.

“Doctor, how’s our daughter?”

“The surgery went very smoothly. We’ve removed her small intestine lymphoma and sent it for pathology. The report will show if the margins are clean, if there’s any spread, or if the tumor’s been fully excised, as well as the nature of the tumor. Usually, the results take twenty-four hours. Once they’re in, I’ll set up the next step in treatment.”

Dr. Chi answered the family.

“It really was a tumor? Thank you, Dr. Chi, thank you, Dr. Zhou!”

The girl’s father thanked them both gratefully.

“This is Associate Chief Mu, the lead surgeon for the operation.” Dr. Chi knew that Director Mu cared about recognition and quickly introduced him.

“Thank you, Associate Chief Mu!”

The father, sensing the situation, thanked Director Mu immediately.

“Dr. Zhou did most of the work. I was more of a guide. If you’re thankful, thank Dr. Zhou. Your daughter will need to fast for about six hours after surgery, then start on liquids. Be sure to care for the incision and avoid washing the area.”

Director Mu was in a rush, so he gave the instructions and left.

Once the family learned it was mostly Zhou Can who’d performed the surgery, their gratitude for him shot up another notch.

Back in Digestive Surgery, before Zhou Can could even sit down, Luo Jingyin—working for Director Shang—rushed in.

“Dr. Zhou, if you’re not busy, Director Shang wants you in Vascular Medicine to consult on a critical case.”

She was just passing on the message.

By now, Director Shang should be at his outpatient clinic.

Zhou Can had just reached for a cup of water, ready to help out in clinic, when the request came.

“But I’m only a trainee. Isn’t it a bit much for Director Shang to have me consult in Vascular Medicine?” Lately, he’d been doing remarkably in Digestive Medicine.

Especially with those tough diagnoses, he’d really impressed Director Shang.

In fact, every doctor in the department—from chief physician down to resident—held his diagnostic abilities in high regard.

“Director Shang knew you’d say that. He told me to tell you—you’ll represent him in this consultation. He even said your skills are every bit his equal, so be confident. Don’t let him down!”

That kind of trust felt so heavy.

For Zhou Can, it was the first time stepping out of his own department as an official representative to consult in another field.