Chapter 325: A Day in the Pediatric Clinic: Diagnoses and Dilemmas

“Dr. Zhou, what kind of cold does my granddaughter have? Why aren’t the medicines working at all?”

She directed her question at Zhou Can, who was busy checking the little girl’s vital signs.

As she spoke, she pulled out the cold medicine and handed it to Zhou Can for him to take a look.

“Do you think this could be fake medicine? She got sick at night so I bought it from the nearest small clinic.”

Whenever medicine doesn’t work, patients love to wonder if what they bought is counterfeit.

There is a small chance of that happening.

Especially nowadays—many pharmacies boost profits by stocking up on lesser-known brands from small manufacturers. The quality just can’t compare to the big brands.

After all, building up a brand is tough. Major companies can’t afford mistakes, so they stay cautious.

Small manufacturers, just trying to stay afloat, might cut corners or even pull off some shady moves.

Zhou Can took a careful look at the cold medicine the patient had used.

“The medicine here is fine—it’s from a reputable manufacturer and the type matches the symptoms.”

If the owner of that little clinic overheard him, they’d probably thank him on the spot.

A lot of small clinic owners and pharmacists actually studied pharmacology or even were medical students before switching paths. Some just longed for freedom and didn’t want to deal with all the hospital drama, so they struck out on their own.

So, these folks really do know their stuff.

And when it comes to selling medicine, they can’t afford to mess around.

If a patient gets harmed from the medicine, the clinic or pharmacy would be in serious trouble.

“Your granddaughter has a fever and a racing heart. Judging by her symptoms, it does look like a cold but it could be something else too. Has she been using the bathroom normally these past two days?”

“I’m really not sure,” the grandmother admitted, shaking her head.

Her granddaughter was already eight years old, so grown-ups rarely check about bathroom habits anymore.

The little girl could feel both her grandma and the doctor staring at her, and ducked her head, embarrassed. “Just a little diarrhea, but everything else is fine!”

Diarrhea happens to be one of the most common cold symptoms.

After getting a pretty good grasp of the basics, Zhou Can started thinking about what tests to order.

For her situation, both blood and urine tests were a must.

No need for a chest X-ray yet. Zhou Can decided to wait for the test results before considering more advanced labs. He quickly sorted through his diagnostic approach in his mind.

Now he finally understood why the Health Department sets daily patient limits for ER and outpatient doctors.

When you see too many patients in a day, your brain just becomes a mess.

See over a hundred patients in one shift and there’s no way to remember who had what problem. Sometimes it’s just a quick chat and a test before sending people off.

It’s no wonder care quality takes a nosedive under these conditions.

Inpatient units and operating rooms suffering from crazy overwork is an open secret—especially for interns and trainees. It’s like a disaster zone.

He just hadn’t expected outpatient clinics to struggle with overload too.

That’s never a good thing.

Doctors and nurses get worn down, patients don’t get good care, money’s spent, time is wasted and nobody gets better.

When doctors are too tired, it’s all too easy to misdiagnose or miss something important.

Zhou Can could say for sure: if a hospital ever solved those problems, their competitiveness would leave everyone else in the dust.

“Let’s do a blood test and a urine analysis first. Once I see the results, I’ll know more.”

After covering the basics, Zhou Can filled out the paperwork for the tests.

“Okay! Now that we’re here, we’ll do as you say.”

The grandmother agreed without hesitation.

With the order in hand, she led her granddaughter out of the office.

This was actually the first tricky case Zhou Can had run into during today’s shift.

He hadn’t even had time for a sip of water before the door swung open again—a new patient arrived.

He had no choice but to shake off the fatigue and get ready for another case.

This was already the fifth patient of the morning, and it had barely been an hour.

Clinic’s off to a strong start today!

Seems that working at Tuyu Hospital, thanks to home-field advantage, means the outpatient numbers are on a whole different level compared to Xinxiang Maternity and Child Hospital.

The fifth patient was a boy about nine with a dislocated left arm—already over 1.7 meters tall.

Zhou Can was very comfortable treating bone injuries like this.

It was so much easier than handling those complicated tricky cases.

Still, he asked plenty of questions about how it happened and checked everything thoroughly to avoid missing anything. Sometimes little injuries that seem harmless can be life-threatening if overlooked.

You hear stories in the news about car accident victims settling privately, feeling fine at the time, only to die suddenly days later.

Scary as those stories sound, most of the time they’re preventable.

If only accident victims saw a doctor in the hospital right away, hidden injuries could be caught and treated early, avoiding tragic endings.

Thanks to Dr. Xu’s strict teachings, Zhou Can always took patient safety seriously.

No matter how routine the illness, he stayed vigilant for any risk.

After a full checkup on the tall boy and finding no hidden problems, Zhou Can ordered an X-ray and sent him off.

Right after that patient and his family left, two more walked in at the same time.

One was a new face, but the other was his very first patient of the day—the girl who’d hurt her foot dancing.

“Dr. Zhou, we’ve finished her tests.”

The girl’s mother handed over the results.

“Could you all wait a moment? They were my first patient this morning. I’ll help them first, then see to you.”

Zhou Can explained things to the family of the new patient.

“Of course! They came first, they should be treated first.”

That family was easygoing and quite understanding.

Once they were settled, Zhou Can turned back and calmly began reviewing the little girl’s scans.

“Young lady, next time you dance, don’t be so bold! You’ve managed to dislocate your right ankle joint this time. The good news is, no broken bones—that’s the silver lining.”

Having read her X-ray, Zhou Can already knew what to do.

Since there was no open wound, no fracture, just a dislocation, manual reduction would work perfectly.

“Did you hear Dr. Zhou? Your body’s your own—don’t be so reckless in dance classes next time.” The mother’s words were equal parts scolding and love, more tenderness than blame.

After her gentle chiding, she turned to Zhou Can, worry showing in her brow.

“What should we do about her injury, Dr. Zhou?”

“I’ll try a manual reduction. Much better than surgery. But she does need plenty of rest. I’ll also prescribe some anti-inflammatories and painkillers.”

Zhou Can offered his treatment plan.

“Absolutely, we’ll follow your lead. We only came to you because we were worried she’d need surgery. Looks like we picked the right doctor!” The mother finally released a huge sigh of relief.

For the family, avoiding surgery meant lower costs and a lot less suffering for their child.

Surgery carries higher risks. If something went wrong and her right foot was left permanently damaged, the regret would be unbearable.

“Don’t get your hopes too high. Manual reduction isn’t always one hundred percent successful—there’s still a chance it might not work. All I can promise is I’ll do everything I can to choose the most effective and affordable plan.”

Maybe he hadn’t noticed, but Zhou Can was starting to pick up the communication skills of a chief physician—especially in how he talked to families.

He made sure to give the best impression possible, earning trust and gratitude along the way.

“Sit tight! A manual reduction will hurt a bit, but don’t be scared—the pain only lasts a moment.” As he spoke, Zhou Can knelt down and got to work.

To play it safe, he glanced at the mother.

“Better if you hold her steady.”

“Okay!”

The mother walked over and held her daughter in place.

The little girl didn’t dare watch Zhou Can’s hands.

She turned her head away, eyes squeezed shut.

As Zhou Can started to adjust the joint, the pain made her cry out again and again.

He stayed focused, ignoring her cries as he lined up the joint, then gave it a gentle push forward.

“Click!”

A loud pop echoed in the room, making the girl scream from pain.

“You’re okay! Pain is normal. Now, try pulling your right foot up toward your toes.”

Zhou Can offered some encouragement.

The whole thing only took a blink—he’d already completed the manual reduction.

The girl tried flexing her right foot.

“Wow—look, Mom, I really can move it now!” Her eyes lit up in delight.

“That’s wonderful! Dr. Zhou, your skills are amazing—the joint’s back in place!” her mother beamed with relief and gratitude. She turned to Zhou Can. “Thank you, Dr. Zhou. Thank you so much!”

“No need to thank me! Our job as doctors is to save lives and heal. To be honest, I’m even happier than anyone else I could help her avoid surgery. If such a young girl needed an operation, she’d have had scars and a long recovery. Now both of us can breathe easier.”

After carefully checking that the joint was in place, Zhou Can finally sat down again.

“I’ll prescribe her some medicine. Celecoxib will ease the pain and stop inflammation…” With his level four pharmacological skills, Zhou Can found such cases easy.

His skill let him choose the perfect medication in just the right dose every time.

It might look simple, but many residents only master this after years of struggle—sometimes not even by the time they become attending physicians.

Even senior residents are extra cautious with prescriptions, double-checking resources and consulting specialists. It’s prescribing that’s the tough part.

One mistake with medication can make a patient’s condition spiral out of control.

Too high a dose? Drug toxicity. Too low? No effect. Even the way a drug’s delivered matters.

Take IV infusions, for example. Most new doctors don’t know that some patients need the fluids warmed to about thirty degrees Celsius.

Zhou Can only learned about advanced IV techniques after three months of training in critical care.

Some patients end up in the ICU due to severe health issues—poor circulation, heart failure—and can’t maintain their body temperature without burning through energy reserves.

Cold fluids into the veins are okay if slow, but a fast infusion could stop a weak heart instantly.

Several senior doctors mentioned this during his time in critical care.

Even Dr. Feng from anesthesia brought it up.

With the medicine prescribed, the girl with the ankle injury was all set.

It’s rare for an outpatient clinic doctor to perform manual reduction in person.

Because that already counts as a special skill.

Simply put: most doctors just can’t do it.

Usually, patients needing manual reduction have to go to Orthopedics and visit the specialized room for the procedure.

Zhou Can doing it himself right in Pediatrics was a bit out of the ordinary—he wondered if he was breaking protocol.

But from the patient’s perspective, this all-in-one service felt like a huge win.

Otherwise, families would have to rush to Pediatrics for a check, then queue up again at Orthopedics with their test results.

The young mom and her daughter left, full of thanks.

She was thrilled with how things turned out.

Zhou Can gained another loyal fan.

Reputation is built just like this—a grain of sand at a time, every drop counts.

“Dr. Zhou, you’re a miracle worker! Could you take a look at my nephew? He’s been saying both his legs hurt, especially his knees.”

So the poised woman in her mid-thirties wasn’t actually the boy’s mother.

There are all kinds of reasons for pain in both legs—ranging from leukemia and tumors to simple juvenile arthritis or rheumatism.

After a detailed history and exam, Zhou Can wrote up orders for three tests: bloodwork, an ultrasound, and an X-ray. Each served a specific purpose.

That way, he could quickly zero in on what was going on.

…

By then, the boy named Lele with macrodactyly had finished his tests too.

Looking at the results, Zhou Can was pretty sure it was type 2 neurofibromatosis macrodactyly. This genetic disease occurs in about one in three thousand children and is inherited as a dominant trait.

Most kids like this die before birth, or the anomalies are found in the womb and the pregnancy is terminated.

Years ago, the rate of babies born with disabilities in China was extremely high.

Many kids were born with intellectual disabilities, missing limbs, or severe congenital diseases. It wasn’t until recent advancements in medical technology and more prenatal screening—along with banning close-relative marriages—that the number finally dropped.

Most moms who’ve ever been pregnant have heard of Down’s screening and 4D ultrasounds.

For instance, Down’s screening is used to check for what’s also called Down syndrome.

It’s a disease caused by an extra chromosome. Babies with this have an extra copy of chromosome 21. Sixty percent are miscarried early in pregnancy, and survivors have intellectual disabilities, distinct facial features, stunted growth, and multiple birth defects.

It’s best to screen for Down syndrome at around 12 weeks pregnant.

Once found, the pregnancy can be terminated, saving families from much heartache. Think about it—raising a child with severe intellectual disabilities is a lifelong burden for any family.

Even couples who were once deeply in love can be torn apart when faced with a responsibility like that.

“I need to take off his clothes to check his body,” Zhou Can told the boy’s grandmother.

Multiple tests can confirm neurofibromatosis.

So far, Lele had only received an X-ray and an ultrasound.

X-rays make it easy to see abnormal bones and striped streaks—their signatures of neurofibromatosis.

During the Schug test, Zhou Can had seen a café-au-lait spot on the boy’s neck.

He didn’t give it much thought then, figuring it was a simple birthmark.

But with the test results in hand, he realized it might mean something else.

With the boy’s shirt off, he spotted several more café-au-lait spots, all in different sizes.

The biggest was over four centimeters wide.

Usually, just having six of these café-au-lait spots is enough to suspect neurofibromatosis—though it’s just a surface-level clue, not a definitive answer.

Genetic tests detecting NF1 or NF2 mutations make the final call.

Still, X-rays, ultrasound, CT, and MRI scans can lend diagnostic proof.

For example, this boy’s X-ray revealed bone deformities and stripe-like imaging—a definite sign.

Getting to the real root cause is always like this: collect clues one by one, run every check, and finally make a diagnosis based on all the evidence.