Chapter 260: A Test in the Cardiovascular Department

“Alright, I’ll head over right away! But let your boss, Director Shang, know—if things go south, you can’t blame me.”

By now, Zhou Can and Luo Jingyin were pretty familiar with each other, so he felt comfortable joking around.

It’s common for graduate students to refer to their advisor as ‘boss.’

In formal settings, they usually address their advisor as Professor or Director, but in private, ‘boss’ is the go-to nickname.

Graduate students often feel more like unpaid long-term assistants than actual students.

It’s all about the needs of both sides.

Advisors hold a lot of power over their students’ futures. There have been cases where a student crossed the wrong advisor—one who held grudges and refused to write them a recommendation letter.

That was enough to ruin a student’s prospects.

“Heh, if you don’t want Director Shang to scold you, you’d better show us what you’ve got! I believe you’ll leave the doctors in Vascular Medicine amazed.”

She covered her mouth as she laughed.

“Aren’t you all just throwing me into the deep end? I’m just a trainee—how can you expect me to fill in for a chief physician!” Zhou Can was speechless.

Having a supervisor like Director Shang meant Zhou Can was always thrown into the spotlight, never treated with kid gloves.

He couldn’t tell if that was lucky or not.

If you were talking about raising kids, Director Shang’s approach of giving students freedom to grow would be great. But for doctors, there’s no room for error in real clinical practice.

If anything goes wrong, it won’t just be Zhou Can’s neck on the line—Director Shang will be in deep trouble too.

How could he be so trusting?

Resigned, Zhou Can steeled himself and headed alone toward the Vascular Medicine Department.

Technically, this should be called the Cardiovascular Medicine Department—a combination of the departments for cardiac, thoracic, and vascular medicine.

If the pilot program splitting General Surgery into multiple subspecialties worked out, Cardiovascular Medicine would probably be broken up too. Vascular Medicine alone could be divided into several subfields.

And Cardiothoracic Medicine could also split into Cardiology and Thoracic Medicine.

The two top powerhouses of Internal Medicine are Cardiovascular Medicine and Neurology.

Cardiovascular Medicine asking Gastroenterology for a consult was a first. Judging by the department’s overall reputation, they were top-tier—brimming with talent.

Zhou Can was somewhat familiar with Neurology but knew little about Cardiovascular Medicine.

His impression of their doctors was similar to those in Neurosurgery—they were prideful, looking down on other departments.

Whether during his one-month rotation there as an intern, or later when he called them for an Emergency Department consult, their attitude had always left a bad taste.

Many Cardiovascular doctors literally looked down their noses at colleagues from other departments.

Director Shang sending Zhou Can for the consult this time seemed deliberate—maybe to give those Cardiovascular doctors a little lesson, so they’d stop looking down on others.

“Excuse me, miss—which room is the Cardiovascular consult in?”

Zhou Can approached the nurses’ station and asked one of the nurses.

Three young nurses were sitting in a row—all of them lively, all quite pretty.

“Are you here for the consult too?”

The nurse with the oval face, sitting on the end, looked Zhou Can up and down in surprise.

The other two nurses also glanced up curiously at the young doctor from another department.

“Yeah, I’m a trainee doctor from Gastroenterology.” Zhou Can nodded.

“Where’s your supervisor? Director Luo and the rest have been waiting in the consult room for Director Shang.” Nurses may only seem to handle mundane tasks, but they’re always in the loop.

There’s hardly anything that goes on in a department they don’t know about.

Maybe it’s just part of being a woman—they love a good bit of gossip.

If anything even minor happened in the department, the nurses would have it whispered around and known to everyone before long.

“Director Shang really can’t get away at the moment, so he sent me over to attend instead.”

Zhou Can answered honestly.

“Did I hear that right? The patient’s got a cerebral infarction—almost all our chief physicians are here discussing the case. Director Shang should at least send a chief physician, even if he’s busy!”

The nurse eyed their surroundings, then lowered her voice.

“You’d better hurry back and fetch a chief physician, or Director Luo will definitely lose his temper. He’ll tear into you for sure!”

This was a tough situation—a patient this complex, and Gastroenterology only sent a trainee? That was playing with the patient’s life.

You could tell this nurse had a good heart.

Zhou Can, however, looked completely calm. “It’s alright. I’ll go in and check first. If it’s beyond me, there’s still time to get Director Shang.” He then asked:

“Where’s the consult room?”

“See, go down this hallway, it’s the fourth room on the left. Most of our department’s chief physicians are in there already—good luck!”

Realizing she couldn’t change his mind, the nurse let it go.

“Thanks!”

Zhou Can didn’t look the least bit worried about getting yelled at and headed straight for the consult room.

Knock knock knock!

He rapped on the door.

“Hello, directors. I’m the doctor sent by Gastroenterology for the consult. My supervisor, Director Shang, is tied up and couldn’t make it, so he sent me in his place.”

The moment Zhou Can stepped in, all eyes in the consult room turned to him.

He took the opportunity to introduce himself.

“Are you kidding? Director Shang sent a trainee to this consult?”

A man in his forties with a ruddy face and sharp eyebrows lost his temper immediately.

“Easy, Director Jiang—don’t be so quick to get angry. I know this trainee, he’s Zhou Can—the hottest name in our hospital right now.” Someone stepped in to speak up for Zhou Can.

That helped ease the tension.

“He’s the one both Internal and Surgical want to recruit?” Director Jiang wasn’t just blunt—he didn’t care how Zhou Can might feel about his comments.

He was just one person—how could he openly call Zhou Can a “hot commodity” to his face?

Granted, it was a compliment.

But it still came across as a little disrespectful.

“Ahem… I’m just an ordinary, run-of-the-mill trainee. No need to exaggerate,” Zhou Can cleared his throat as he walked in.

His gaze fell on the abdominal X-ray displayed on the screen.

The patient’s basic information was also up for everyone to see.

Female, age 66, diabetic, gallstones, hospitalized for lacunar cerebral infarction.

The specific treatment plan was unclear for now, but for elderly patients with cerebral infarction, thrombolysis is usually the first choice.

Surgical risks are high—no one chooses that option unless absolutely forced.

What’s on screen now is the abdominal X-ray, which probably isn’t relevant to the stroke.

Zhou Can suspected the stroke had already been dealt with, and now complications had cropped up—thus the urgent call for Gastroenterology.

“Zhou Can, no matter how promising you are, you’re still a trainee—both your skill and experience are limited. Better call Director Shang and get him here in person. This time we’ve brought not just Gastroenterology but also Endocrinology. Director Hong here is from Endocrinology, and they care more than you guys, clearly.”

Director Jiang’s tone was full of frustration.

He saw sending a trainee as a sign of disrespect to Cardiovascular Medicine.

“Let me give it a shot first. If I’m not up to it, I’ll call Director Shang in. He’s really busy right now.” Zhou Can kept a straight face.

“Fine—next time Gastroenterology needs us, we’ll just send over a trainee too.”

Director Jiang was so angry his face looked like iron.

“So you want to try? That’s the patient’s abdominal film up on the screen. Why don’t you tell us—what’s the diagnosis?”

There were several chief physicians in the room, but only Director Jiang was airing his temper.

He didn’t hold back and fired one testy question after another at Zhou Can.

“If you could diagnose something just by looking at an abdominal film, I’m sure you all in Cardiovascular would already have the answer and wouldn’t need a consult from another department. I’m here to help, not to be berated. Director Jiang, I understand you’re anxious for the patient, but please give me at least basic respect.”

Zhou Can’s voice was steady—without a hint of anger.

But it was enough to make Director Jiang blush in shame.

“Director Jiang, why don’t you relax for a bit? I’ll brief Dr. Zhou on the case.” The chief physician who had spoken up for Zhou Can was at least in his fifties.

He looked kind, hair completely white, thin and wiry—his eyes, though, still sharp and bright.

They glimmered like stars at night.

“Please, Dr. Zhou, have a seat. Here’s the patient’s chart and medical records. Take a look at her background, and feel free to ask if anything’s unclear. Oh, by the way, I’m Luo—I’m the department chief here.”

So this was Director Luo—much friendlier than expected.

“Thank you!”

Zhou Can accepted the records and began reading intently.

Physical examination showed mild tenderness in the right upper abdomen, but no palpable mass. Gentle percussion over the liver region elicited obvious pain.

At present, the patient was suffering chills, high fevers, and jaundice.

Her bilirubin was markedly elevated.

She’d undergone a battery of tests—bloodwork, ultrasound, CT scans.

Given her history of gallstones, the initial suspicion among the Cardiovascular doctors was a stone-obstructed common bile duct causing the jaundice.

But her ultrasound showed no dilation of intra- or extrahepatic bile ducts, the pancreas looked fine, and her serum amylase was not significantly elevated.

Based on that, Zhou Can could basically rule out the possibility of jaundice from common bile duct obstruction.

When dealing with jaundice, you should focus your attention on the liver and gallbladder.

Those two organs are as close as brothers.

CT imaging showed her lungs were clear when she first arrived—no signs of inflammation.

But today’s follow-up CT showed abnormal findings in the chest.

Both lungs now had patchy, fluffy-looking infiltrates.

What did that mean?

Zhou Can immediately suspected a lung abscess.

Meanwhile, the Cardiovascular chiefs kept debating the case, combing through every possible cause.

The Endocrinology chief wasn’t much help.

The case just didn’t intersect with his specialty, so there was no way for him to contribute anything useful.

He’d probably been pulled in just because the patient had diabetes.

Diabetes care is typically Endocrinology’s turf.

But at this point, the patient’s symptoms had almost nothing to do with her diabetes.

All the Endocrinology chief could do was sit quietly. But since they hadn’t found the cause, and the discussion wasn’t over yet, he couldn’t just leave.

Zhou Can kept reviewing her other tests.

Follow-up ultrasound showed a huge solid lesion in the right lobe of her liver.

The initial ultrasound, before the cerebral infarction treatment, showed her liver was basically normal.

Which meant lesions in the lung and liver had developed only after she started treatment for her stroke.

No wonder Director Jiang was practically hopping mad.

Any doctor would panic if their patient in treatment suddenly developed so many serious problems.

These sorts of complications could quickly turn fatal.

Especially for elderly patients with multiple underlying conditions.

“May I share my diagnosis?”

Zhou Can raised his hand.

Director Jiang looked surprised. He hadn’t expected Zhou Can to reach a diagnosis so quickly, though he still wasn’t holding out hope.

How high-level could the diagnosis of a trainee be?

Director Luo also turned to Zhou Can: “Go ahead.”

“I’ve reviewed all the records and have a few ideas. First, given the patchy infiltrates in both lungs, I suspect a lung abscess. I recommend taking a sputum sample for bacterial culture. Second, the large solid lesion in the right liver lobe also seems like an abscess. I suggest an ultrasound-guided aspiration, and if needed, I can perform it myself.”

Zhou Can was confident that if he performed the aspiration himself, he’d likely gain a 100-point experience reward.

“The sputum culture is already in progress—a result should be out soon. I have to say, Dr. Zhou, you really know your stuff.” After hearing Zhou Can’s findings, Director Luo couldn’t help but praise him.

None of the other chiefs dared take Zhou Can lightly now.

“You’ve suggested targeted testing, which shows you’re on the right track systematically. So, what’s your diagnosis? We’ve already identified the abscesses. What we need now is the actual cause—so we can treat her precisely and fast.”

Director Jiang’s tone was still proud, but he’d clearly changed his manner.

At least now he was showing genuine interest in Zhou Can’s assessment.

“It’s most likely that the patient’s blood was infected by bacteria, leading to sepsis. Because medications weren’t started in time, her case worsened to septicemia.”

That was Zhou Can’s diagnosis.

Actually, this wasn’t as tricky to diagnose as people thought.

Was it really that none of the Cardiovascular chiefs could figure it out, or was there something more going on?

“At first, I also suspected sepsis after she started anti-thrombotic therapy for her diabetes. But both her blood and IV fluid cultures came back negative, so we’ve ruled it out.”

Director Hong from Endocrinology was the first to object.

As he spoke, Zhou Can suddenly understood.

No wonder none of the chiefs had found the real cause.

If you dismiss a line of investigation just because an initial result was negative, you’re hurting your own chances.

Sometimes the first round of tests turns up nothing, but rechecking in a day or two reveals the problem.

Zhou Can had seen plenty of tough cases like that.

The worst thing a doctor can do is stick rigidly to convention.

It blinds you to important clues.

You have to be willing to question test results and let the facts overturn them, otherwise you end up with ‘diagnostic blind spots’.

“I read the culture reports, and they were done four days ago. The patient developed fever and chills not long after starting anti-thrombotics. At that point, the infection might have been too new for any culture to pick up yet.”

Zhou Can stated his position.

“Since the sputum culture is already being done, they’ll find the real cause soon anyway, even without a Gastroenterology consult.”

If the sputum culture points to a lung infection, the diagnosis of sepsis will follow.

“Of course I was worried the patient would die! Her condition has worsened every day for the last four—how could I not be anxious?” Now Director Jiang was explaining himself.

He even opened up about why he was so high-strung.

But Director Hong from Endocrinology stubbornly insisted, “We still can’t be sure it’s sepsis. Other diseases can look similar in the liver and lungs. I’ve seen liver cancer patients with almost identical symptoms.”

That kind of stubborn denial was pretty feeble.

It was just a way to save face.

There are plenty of older doctors like Director Hong in hospitals—they get used to being flattered all day. Compliments pile up until they grow calluses on their ears.

Over time, it’s easy to get a big head.

Once you’re on that pedestal, it’s hard to step down.

Director Hong was a perfect example. Even knowing Zhou Can’s diagnosis was probably right, he still argued—just to save face.

“Of course other illnesses can present this way. But Director Luo, could we arrange a liver aspiration for a definitive diagnosis?”

Zhou Can tried to make things as easy as possible for Director Hong.