Chapter 309: Hidden Motives in the Consultation Room

Zhou Can couldn’t help but feel puzzled. This case didn’t seem all that difficult to diagnose. Why had they gathered experts from both hospitals just to discuss it?

Even with his half-baked experience, he could tell the patient was most likely suffering from a venous embolism. He just couldn’t believe the experts at Xinxiang Maternity and Child Hospital would be so clueless.

“Director Zhang, what do you think is the underlying cause of this patient’s illness?” Professor Hu Wanjun asked.

“Uh… It seems like this patient’s symptoms are related to blood vessels. To be honest, this field isn’t really my specialty,” Zhang Bihua replied, acting uncertain as she turned to a male doctor in the group. “Director Shentu, you’re the cardiovascular expert. Do you have any suggestions?”

Zhou Can immediately picked up on the strange tension in the room.

Both Professor Hu Wanjun and Director Zhang Bihua could no doubt pinpoint the cause with a single glance.

But both of them were dodging the question.

Zhou Can might come from a wealthy family, but his sense and maturity were a cut above the average.

Sensing the odd atmosphere, he kept quiet and composed, refusing to speak out of turn.

Xinxiang Maternity and Child Hospital always put on quite the show.

Back in the resuscitation room, they sent Section Chief Tang to try and poach him. That alone spoke volumes about their style.

If a doctor only knew how to treat patients, no matter how skilled they were, it was hard for them to go far.

In fact, in this field, getting by isn’t easy if you can’t handle more than just medical skills.

Beyond complicated relationships, adaptability to unexpected situations is just as important.

For example, if a doctor misses a vein the first time during treatment, they’ll need a second attempt. How cleverly they explain it to the patient or family really tests their quick thinking.

If it’s explained well, the patient might laugh it off, even thinking their own body is unique.

Sometimes, a patient is simply overweight and has layers of fat that make veins hard to find.

Others are born with veins that are naturally thin and tricky to locate.

But if the doctor just misses the vein without a word and tries again, even if the patient says nothing, you can bet they’re cursing inside.

If a doctor lacks emotional intelligence or flexibility and stubbornly insists, “I’ve been doing injections for years, never had a patient like you, your veins are simply terrible!”

Odds are, the patient will jump up and teach the doctor a lesson on manners with their fists.

Right now, Xinxiang Maternity and Child Hospital had invited the experts for a consultation, but the case itself was easy. With the odd vibes, anyone who spoke carelessly could be the one to get burned.

Director Shentu was here on behalf of the Cardiovascular Medicine Department at Tuyu Hospital.

He was in his fifties, wore black-rimmed glasses, and always looked so stern. Even when seeing patients, he was dead serious. Zhou Can had noticed that Director Shentu never smiled during a consult.

No matter the patient, his brow stayed furrowed, and his speech was perfectly measured.

“Alright, I’ll break the ice and share my humble opinion.”

Director Shentu didn’t decline.

Shentu was actually a double-barreled surname. His full name was Shentu Bao. People who didn’t know better might think he was the younger brother of the legendary immortal Shen Gongbao.

“The initial symptom for this patient was pain in the left leg, which later spread to both legs. Pain in the limbs can come from issues in the skin, muscle, nerves, blood vessels, joints, or bones. I’ve even seen cases where kidney failure led to severe limb pain. Malignant tumors can also trigger unexplained pain throughout the body.”

Director Shentu’s explanation matched his personality—meticulous and thorough.

“Neural pain follows the distribution of the nerves, often arising spontaneously and usually described as sharp, stabbing, burning, or pulling pain. On examination, you might even find nerve tenderness. These cases usually come with numbness or muscle weakness as well. Some of this patient’s pain certainly fits the description of nerve pain.”

“However, the patient mainly complains about muscle pain. Clinically, muscle pain tends to affect the fascia, it’s diffuse and spontaneous, typically dull in character, and worsens with movement. You’d often find muscle tenderness and sometimes muscle weakness or even atrophy. This patient’s pain wasn’t dull and didn’t seem clearly connected to movement. Instead, the sharp pain hit when she stood up quickly after long periods sitting or squatting.”

“Plus, for this patient, after being admitted and monitored, her latest CK, electromyography, and muscle biopsy all showed no signs of muscle damage. So, we’ve ruled out the common causes of muscle pain: spastic cramps, rhabdomyolysis, myositis, leptospirosis, dermatomyositis, polymyalgia rheumatica, and fibromyalgia syndrome.”

Every doctor has their own approach to diagnosis.

Director Shentu’s style matched his method—cautious and detailed. He leaned heavily on the process of elimination.

In clinical practice, this diagnosis method is slow and demanding, but it rarely goes wrong.

If it were Zhou Can diagnosing, he’d take a different route—using the symptoms, the ultrasound results, and personal experience, he’d pinpoint a vascular issue right away. He’d even zero in on a venous embolism.

When it comes to efficiency, there’s no doubt Zhou Can’s approach gets faster results.

But fast doesn’t mean inaccurate. Zhou Can hadn’t had a misdiagnosis yet.

Of course, missed diagnoses do happen. Limited knowledge and clinical experience mean it’s nearly impossible to catch every detail.

Director Shentu’s exhaustive approach makes missed diagnoses less likely, though it’s still possible.

Give him a patient with multiple issues and you can bet he’ll be scratching his head all day, completely frazzled.

That’s why it’s not about one method being superior. Both have their strengths and weaknesses.

As the saying goes, it doesn’t matter if it’s a black cat or a white cat. Catching the mouse is what counts.

“Looking at the supporting tests, especially the ultrasound, there’s a high chance of deep vein thrombosis. That points to pain caused by vascular disease. These include acute arterial blockage, arteriosclerosis narrowing the arteries, thrombotic phlebitis, deep vein thrombosis, thromboangiitis obliterans, and Raynaud’s syndrome, among others.”

“If it were an arterial problem, you’d see intermittent claudication in the affected limb, eventually progressing to resting pain. In cases of sudden, complete arterial blockage, the limb will be in excruciating pain, turn pale, feel cold to the touch, with relentless pain and no relief. Gangrene can even set in…”

Director Shentu could really talk. One embolism diagnosis turned into an entire lecture.

But everything he said was relevant to the case and its possible complications.

Some love the process of elimination, but to Zhou Can, it’s just exhausting.

Still, it showed just how deep Director Shentu’s medical knowledge and diagnostic experience ran.

Anyone lacking real substance simply couldn’t analyze a case like this.

Even Zhou Can knew he couldn’t do it yet.

Maybe in ten or twenty more years, Zhou Can could match Director Shentu, citing references and running through all the causes. But honestly, he had no desire to work that hard. It was simply too much.

“A deep vein thrombosis in the lower limbs can cause pain and swelling. Sometimes, there might not be any symptoms at all. The pain can be intermittent. This patient’s symptoms fit deep vein thrombosis but a firm diagnosis can’t be made yet. I recommend further tests, starting with a vascular color Doppler ultrasound, to confirm if there are arterial or venous abnormalities.”

After all that careful exclusion, Director Shentu strongly suspected deep vein thrombosis—but he still refused to make a definitive call.

Instead, he called for additional tests.

Ordering a Doppler ultrasound for the patient was something Zhou Can fully supported.

Both B-mode ultrasound and Doppler sonography are types of ultrasound exams, but they’re actually used for different things.

A lot of patients don’t understand, thinking doctors are just being greedy—first ordering a B-scan, then a color Doppler. Feels like they’re just trying to squeeze more money out, right?

That’s really not the case.

A B-mode ultrasound is a 2D image for checking tumors, organ shifts, or atrophy. It can precisely show the size, shape, and position of organs and tissues.

Color Doppler, on the other hand, displays blood flow direction and relative speed in real time. It’s invaluable for diagnosing the speed and direction of blood flow and tissue movement in abnormal tissues.

Many believe color Doppler is even more efficient for blood flow studies than expensive MRI or CT angiography.

Of course, for checking deep arteries, angiography is still the gold standard. That’s one weakness of color Doppler.

In short, when a doctor orders both ultrasounds, there’s usually a good reason.

Any doctor with a bit of ethics isn’t just padding the bill. They’re trying to use the most affordable methods possible to find the cause.

It’s a tough balance—doctors need an accurate diagnosis without errors or omissions, all while keeping costs low for their patients.

But sometimes, even with their best efforts, they still get cursed at or even assaulted by patients or their families.

From Zhou Can’s perspective, everyone who chooses to become a doctor or nurse must have a heart full of compassion.

Just look at the thousands of healthcare workers who charged into the pandemic. They left their own families behind to battle the virus at the frontlines.

If they had the choice, who wouldn’t want to stay safe at home with their loved ones?

Who wouldn’t want to enjoy the warmth of family?

But when their country and people needed them, they volunteered without hesitation. That’s the kind of devotion few possess.

“Have the imaging department work overtime. Get that patient a color Doppler ultrasound right away.”

Professor Hu Wanjun gave the order.

She seemed perfectly calm about Director Shentu’s diagnosis, as if she’d expected it all along.

Zhou Can observed everything, growing even more convinced that Xinxiang Maternity and Child Hospital had every skill needed to identify the patient’s condition.

So if they could diagnose it themselves, why invite Tuyu’s specialists over? Inviting outside help was a bit of an admission of weakness.

What game were they really playing?

Zhou Can quietly waited for their motives to reveal themselves.

He kept his composure, while Director Zhang Bihua sat beside him, calm as still water.

Even Du Leng, who usually loved showing off, sensed something strange. Head bowed, he silently fiddled with his slender, almost feminine fingers and long nails.

Du Leng wasn’t lacking in intelligence or emotional awareness.

He had smooth sailing since childhood, always top of his class, his academic achievements miles beyond his peers. No wonder he was so proud.

But pride can lead to setbacks. Sometimes, it makes people act rashly.

After being repeatedly outdone by Zhou Can, Du Leng felt frustrated and longed for a comeback. It was only natural he would clash head-on with Zhou Can.

Plus, Yang Chan kept a close relationship with Zhou Can but always maintained her distance from Du Leng. That stung him even more.

A genius like him had never been suppressed like this before.

Let alone by someone whose academic background was so much less impressive.

And let’s face it, those who study abroad for years usually come from well-off families.

Overseas tuition and living expenses are no small burden.

We’re talking hundreds of thousands a year. Not something an ordinary family could ever manage.

A wealthy prodigy at the peak of his academic game—his arrogance was even greater than ordinary geniuses.

The showdown between him and Zhou Can was definitely not over.

After so many defeats, he should start learning from his mistakes, trying to play to his strengths instead of competing with Zhou Can in arenas where he isn’t as skilled.

“Director Zhang, thanks to Director Shentu from your hospital, we’ve pretty much nailed down a diagnosis for this patient with leg pain. The experts from Tuyu Hospital really live up to their reputation!”

Professor Hu Wanjun praised the Tuyu specialists with a smile.

“You’re too kind! The doctors at Xinxiang Maternity and Child Hospital are just as capable. We all have our particular strengths.”

Director Zhang Bihua replied, ever cautious.

“I’m guessing it’ll be a while before the patient’s Doppler results come back. Since we’re just sitting here, would it be alright to ask your experts to weigh in on a few more difficult cases we have on hand?”

Professor Hu Wanjun finally let her true intentions show.

It was clear now—the previous case was just a lure to get Tuyu’s specialists here; the harder cases were what they truly needed help with.

You had to admire their half-transparent, half-hidden tactics.

It’s just human nature—the less you have, the more self-conscious you get.

After scandal after scandal, Xinxiang Maternity and Child Hospital’s once-proud reputation was in a tailspin.

These days, everyone at the hospital seemed weighed down by insecurity.

Doctors are the backbone of any hospital—the equivalent of engineers in a major factory.

Anyone working in a technical field is bound to have pride in their expertise.

For someone like Professor Hu Wanjun to come right out and ask others to help with a stack of tough cases—it simply wasn’t something she could do easily. But with pressure from Director Tian and hospital management, they saw this joint meeting as a chance to solve their backlog of difficult cases.

Their goal: boost treatment quality and improve their reputation.

Backed into a corner, they devised what they thought was a less humiliating plan.

Director Zhang Bihua just smiled, “Of course! Since we’re all just waiting anyway, might as well go over some other cases while we’re here.”

No wonder he’s the leader of Tuyu’s Obstetrics Department. His poise and grace truly impressed Zhou Can.

He saw right through their little tricks but chose not to call them out, instead doing everything he could to preserve their dignity.

That’s real maturity.

Some people fail to understand the ways of the world. They do others a favor but make them lose face—or even expose their shortcomings in public. That’s a major taboo.

Or, worse yet, asking for something in return when one’s down on their luck. Also foolish.

If you won’t help, then just don’t. But if you do, do it generously.

Just look at Han Xin in ancient times—what a tragic end.

When Liu Bang’s army was losing to Xiang Yu and on the brink of destruction, he turned to Han Xin for help. But Han Xin seized the chance to make demands—wanting territory and a king’s title.

Liu Bang nearly flipped the table in anger, pounding it so hard he nearly cursed Han Xin’s ancestors. His advisor Xiao He had to frantically kick him under the table, shooting him warning glances.

In the end, Liu Bang managed to control himself. He’d already slammed the table and couldn’t take it back.

So what did he do?

He burst out laughing, telling Han Xin, “Your demands are too modest. You’ve done so much for me. Isn’t asking for so little looking down on me, Liu Bang?”

Right then and there, Liu Bang promised Han Xin even more land and greater rewards.

Years later, with Han Xin’s help, Liu Bang defeated Xiang Yu and cleared the way to secure his throne. But that’s when he started settling scores with Han Xin.

Most people only knew that Han Xin was killed by Liu Bang’s wife, Empress Lü. But the real reason was that, at a critical moment in the struggle with Xiang Yu, Han Xin feigned illness and made demands before agreeing to help. He violated one of the cardinal rules between ruler and minister, sealing his own fate.

Modern times are even more competitive than the past.

Anyone who rises to a high position has the intelligence, temperament, and emotional intelligence to match.

By preserving the dignity of Xinxiang Maternity and Child Hospital’s doctors, Director Zhang Bihua set an excellent example.

“Director Zhang, and all the experts from Tuyu, take a look—this pregnant woman has a severe respiratory infection. After she was admitted, we started her on antibiotics. Here are her lab tests, and right now her fetal heart rate is dropping.”

As Professor Hu Wanjun described the patient’s situation, her face grew solemn and her voice heavy.

The atmosphere had turned completely different from the previous case.

Zhou Can could tell right away—this was a serious and particularly tricky situation.

“She’s already 37 weeks along! Such a mature pregnancy, but with the mother so badly infected, that could get dangerous real quick!” Director Zhang Bihua flipped through the files, his frown deepening.

“Exactly. She’s only been here two days and the fetal heart rate keeps dropping. We’re terrified of a stillbirth. Do you have any suggestions?”

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Professor Hu Wanjun sincerely asked for their advice.