Chapter 262: A Hidden Threat: Diagnosing Beyond the Obvious

“The patient’s abdominal lymph nodes are enlarged, and along with cervical lymph node tuberculosis, I think the second hospital’s diagnosis of concurrent splenic tuberculosis is justified.”

Zhou Can spoke after a moment’s thought.

“Dr. Zhou, do you also think this is splenic tuberculosis? I feel the diagnosis holds up, and antituberculosis treatment should be continued. Tuberculosis is a tough, chronic disease. It takes a long time on medication to see improvement.”

Dr. Huang Xinggui, the attending physician, weighed in.

Many illnesses take a long time to treat. For tuberculosis, medication often stretches over half a year, sometimes even a year or two if the condition is severe.

“Well… I do think the second hospital’s findings make sense, but I don’t completely agree with the conclusion. The patient’s initial examination looked a lot like TB, but now they complain of occasional pain all over the bones and joints. That’s a red flag. During my orthopedic rotation, I saw two cases like this that ended up being malignant tumors.”

Zhou Can had rotated through several departments, always shadowing the chief physicians. The benefits of that were starting to show.

It’s true—the more you see, the wider your knowledge.

He’d worked beside chief physicians diagnosing, operating, and treating patients. All those experts had generously shared their knowledge.

He might have less than two years of residency, but he’d already built up a wealth of medical knowledge and clinical experience.

Especially with complex cases, drawing from several specialties gave his diagnostic skills a real edge. He even outpaced many associate chiefs and chief physicians.

That’s why so many chief physicians, once they make a name for themselves, still look for chances to train in different departments or even other hospitals.

They start to feel the limits of their experience in daily practice.

Gaps in certain medical fields or clinical experience can become real weaknesses that drag down their diagnostic abilities.

“Doctor, are you saying this could be cancer?”

Just like that, the patient’s nerves were stretched tight.

“Not necessarily. But I do think we should run a CT scan and check the spleen again. The last hospital’s ultrasound found multiple solid masses, and though the images weren’t clear, there should be hypo-echoic or low-density regions—just not obvious ones.”

Zhou Can explained gently.

Without solid evidence, he’d never make wild speculations to a patient.

If you say it’s a possibility, there’s nothing wrong with being cautious.

After all, diagnosing a patient means sorting through possibilities, eliminating the false, and identifying the true cause. Then you target your treatment.

Ultrasound uses sound waves to produce images, while CT scans use radiation to make detailed cross-sectional images.

Different organs absorb X-rays differently, so you get images showing varying densities. CT makes use of this to get detailed visuals of the organs, offering much more info than regular X-rays and helping with diagnosis.

Some think CT scans are just upgraded X-rays, but that’s not quite right.

X-rays scan a flat image of a body part; CT scans do continuous multiphase cross-sections. The imaging principles aren’t the same.

When you need to check for low-density zones in organs, CT is a great tool.

In practice, doctors often pick ultrasound and CT for diagnosis because they’re affordable. Using both gives a fuller picture.

“Zhou, your diagnostic skills are getting sharper! You reached the same conclusion I did. Here’s the CT request—head over, pay for it, and get the scan done. Once you have the results, skip the line and come straight to me. I won’t be here this afternoon, so if I’m gone, look for me at the Gastroenterology ward. If I’m not there either, just see Dr. Zhou instead.”

Director Shang was clearly putting Zhou Can front and center.

Zhou felt honored, though he almost wanted to protest. In the end, he just bit his tongue.

It wasn’t until he saw the scan order that Zhou understood. Director Shang had solved it already—he just wanted to test the students’ diagnostic skills.

“Thank you! Thank you, Dr. Zhou!”

The family took the request, thanked Director Shang, and separately thanked Zhou Can as well.

These family members were practical to a fault.

Dr. Huang Xinggui had helped, too, but they didn’t thank him.

People only care about what hits closest to home.

Director Shang made it clear—if he’s not around, Zhou Can would need to interpret the results.

So the family needed to stay on Zhou Can’s good side.

After they left, Huang Xinggui was still confused. “Director Shang, the symptoms and test results point clearly to tuberculosis. Why do you and Zhou Can both suspect a tumor?”

The other three residents looked puzzled, too.

Qiu Chengyu glanced at Zhou Can, his expression complicated.

He’d watched Zhou climb from a mere doorman on his first day to where he was now.

Zhou’s status had even surpassed Huang Xinggui’s.

Whether Director Shang sent Zhou to cover his shifts in Cardiology, or just told patients to go to Zhou for further diagnosis, it all showed Zhou was now a higher priority than Huang.

Before Zhou’s arrival, Huang had been Director Shang’s right hand.

Female residents Xie Lin and Luo Jingyin turned to Zhou for advice whenever they hit a tough case.

He’s close in age and easy to talk to. Plus, his explanations always solved their problems.

“Zhou, why don’t you explain it to them?”

Director Shang picked up his tea.

Teachers are experts at passing off work. If someone else can do it, why step in themselves?

Maybe it’s because history is full of cautionary tales about bosses micromanaging themselves to an early grave.

“My thought process boils down to three points. First, the ultrasound showed a low-density area in the spleen—subtle, but for a TB patient, that’s not a good sign. Second, the patient reports unexplained pain in bones and joints, also a red flag that’s often a warning sign for leukemia or malignant tumors.”

Zhou laid out his diagnostics with complete transparency.

“Finally, the bone marrow showed hyperactive proliferation. The granulocyte-to-erythrocyte ratio was 7:1—a bit above normal and easy to miss. With most cancers, this only skyrockets when things get bad. Early on, the numbers barely budge.”

He rattled off the three points, silencing everyone with his sharp reasoning.

Huang Xinggui had a sudden realization. “So that’s it. Dr. Zhou, not only do you have solid medical fundamentals, but you’re meticulous and know how to draw on experience from many fields. I’m honestly impressed.”

“Ha, Dr. Huang, your compliments are making my head spin.”

Too much humility is just as bad as arrogance.

Endlessly deferring to others can rub people the wrong way, too.

A little humor goes a long way sometimes.

Come to think of it, this might be the first time anyone called Zhou’s foundation solid.

It proved his crash-course approach to learning medicine these past two years was paying off.

Once this patient left, they moved on to the next.

Director Shang always released a set number of appointment slots. But determined patients would find ways to squeeze in extra if they learned he was around.

It was almost noon when things quieted down. That patient with the enlarged spleen rushed back after getting her scan.

“Professor Shang, the CT scan is done. Could you take a look?”

Impressive—she managed to jump the queue and get a CT in just about an hour.

Director Shang took the film. The CT results were much clearer than the ultrasound.

You could see multiple low-density spots in the spleen at a glance.

“This isn’t good. I recommend an exploratory laparotomy for a clear diagnosis. Most likely, we’ll need spleen removal to save her life.”

This time, the seriousness was clear in Director Shang’s tone.

His face was grave. At his level, you rarely tell a patient they might lose an organ unless it’s absolutely necessary.

Only if the risk is dire would he say such a thing.

“Professor Shang, what exactly does my mother-in-law have?”

The patient’s daughter-in-law looked level-headed, but the son was already gripping his mother, clearly alarmed.

“It’s almost certain there are tumors in her spleen, and more than one. They were hidden and masked by lymph node tuberculosis, so the last two hospitals missed them. It’s best to deal with them while they’re small—surgery is the safest option now. The spleen’s surrounded by vital organs and dense lymph nodes, and malignant cells can spread easily. If that happens, things get much worse.”

Director Shang tried hard to persuade the family to agree to exploratory surgery.

If necessary, they’d have to remove the spleen on the spot.

Losing the spleen would have some impact, but it’s far better than dying of cancer later.

Without this operation, in two to three years, the tumors might spread throughout the body.

By then, not only would life be painful, but surgery might not even be an option.

All they could do would be to ease her pain and make her last days more comfortable.

“I thought my mother-in-law had tuberculosis. How is it now a splenic tumor?”

The family struggled to accept it.

“Tuberculosis can trigger gene mutations that lead to cancer, especially in older patients who are more prone to mutations. Now she has both TB and lots of tiny tumors inside her spleen.”

Director Shang explained as gently as possible.

Doctors rarely say the word “cancer” straight to a patient.

They use terms like “malignant tumor” or just say things don’t look good.

Gene mutations are a key cause of cancer.

Throughout life, our cells constantly renew. Every new cell forms through DNA copying and genetic info transfer.

Humans produce over 10 billion new cells every day, and some of them inevitably carry mistakes. Some of those die off, but others mutate and gain endless life and reproduction—the source of cancer cells.

The appearance of a cancer cell doesn’t always mean you get cancer.

Our bodies have protective mechanisms, the most important being tumor suppressor genes.

Only when those genes are lost or stop working can cancer cells settle in and grow into tumors.

Why are young people less prone to cancer while older people are at greater risk?

It’s mainly because older people’s immune systems grow weaker.

Plus, the more times cells divide, the more likely mistakes happen.

No one knows exactly when this patient’s splenic tumor developed. Some cancer cells just lurk silently, biding their time—like a strategist waiting for a weakness. Once defenses drop, they strike and grow fast.

After Director Shang’s explanation, the family finally agreed to a diagnostic surgery and—if necessary—a splenectomy.

Since this involved surgery, Director Shang referred her straight to General Surgery for further treatment.

Normally, if a patient hasn’t been admitted and the treatment is beyond a department’s scope, you’d refer them straight to the right specialists.

There’s no sense in tying up resources from two departments for a joint surgery.

……

Once the clinic wrapped up, Zhou Can and his colleagues headed to the cafeteria together.

Compared to surgeons, internists are busy too, but their work isn’t quite as pace-driven. Surgeons often take turns eating or miss meals entirely.

Scenes where internists all eat together? For surgeons, that’s almost a luxury.

But surgery isn’t even the busiest department.

The most intense is Critical Care, always racing against time with critically ill patients. Doctors and nurses have to stay on high alert, sometimes all running flat out for emergencies.

Only those who’ve done it can know just how tense and exhausting that work really is.

Mid-meal, Zhou Can’s phone buzzed twice.

His phone was always on silent at work.

He took it out and saw a message from his girlfriend, Su Qianqian.

“Sweetie, Hu Wei just called. He wants to meet me at the John’s Western Restaurant.”

Ever since Zhou Can’s talk with Mr. Li, he’d checked the negative news on Su Qianqian. There was a flood of it, most of it from an account calling itself ‘Former Jin Yu Interactive Employee’.

The rest of the rumors came from attention-seekers, spreading or inventing stories just for clicks.

Public opinion can be terrifying.

It was obvious Su Qianqian was under huge pressure from all these rumors.

But she never once brought it up to Zhou Can.

Whenever they met, she’d only share the good, not the bad.

Zhou understood—she was worried telling him would mess with his work, so she chose to keep it bottled up.

Of course, Jin Yu Interactive wouldn’t stand idly by under this kind of attack.

In fact, the company had long been helping her behind the scenes, going after those who spread slander.

As her boyfriend, Zhou Can knew it was his job to protect her.

He had to stand by her when she needed it most, be her strongest support.

Just a few days ago, he’d invited her to his dorm to talk it all over.

Besides comforting her, he had a plan to help.

He told her that if the turncoat Hu Wei from Jin Yu Interactive ever called, she should let Zhou know right away.

After waiting this long, Hu Wei finally reached out.

Now Zhou could finally put his plan into action.

He was ready to play for high stakes—to take on Hu Haikun behind the scenes.

So what if he was the richest man around? If your hands are dirty and you keep throwing your weight around—even making moves on Zhou’s girlfriend—you’re bound for trouble.

Zhou was never one to start trouble, but he wasn’t scared of it either.

Now that Hu Haikun was poking the hornet’s nest, just like he’d dealt with Mr. Qian from Bei Hai Lang Xing Media, Zhou was ready to send Hu Haikun to prison.

Hu had a long criminal record—organized crime, violence, you name it. If the truth came out, he’d never see the light of day again.

“When are you meeting?”

Zhou texted her back.

“Normally, I wouldn’t see someone like that, but since you told me to go along with it, I agreed to meet him around 2 p.m. tomorrow.”

Her trust in Zhou was absolute.

After their talk, she was deeply moved. Every woman wants a boyfriend who’ll stand up for her.

Everything was going exactly as Zhou planned.

“Great. If you can, have Wei Fang come by my place—I need her help with something.”

“Okay! After work I’ll have her wait for you downstairs at the dorm.”

“When she gets there, tell her to call me. And while Wei Fang isn’t with you, don’t leave the company—Hu Haikun will stop at nothing, so be extra careful.”

Zhou reminded her seriously.

If Su Qianqian ever ended up in hands like that, he could already imagine the consequences.