Chapter 465: Delicate Balances: Diagnosis and Doubts in the Surgical Wing

“Honestly, there’s not much mystery here. I looked at the patient’s pre-op scans and the barium meal study. I figured you performed a total gastrectomy.”

Zhou Can explained this with a smile.

A barium meal is used to check the junction between the cardia and digestive tract. Usually, the patient just swallows the barium and in medical terms, we call this a barium meal.

Some patients worry a lot about swallowing it but there’s really nothing to fear—it’s basically harmless.

The barium used for digestive exams is a suspension of medical-grade barium sulfate. It doesn’t dissolve in water or fats, so it won’t be absorbed by the gastrointestinal lining and is basically non-toxic.

If you ask if it’s completely free of toxins, I can’t guarantee that.

After all, it is a chemical compound.

But honestly, the additives in the fruits, veggies and processed foods we eat daily are way more than you’d think.

The toxicity of a single barium meal is probably less than eating a spicy snack or chewing a piece of betel nut.

These checks aren’t done often—only when really needed. So there’s no reason to get too anxious.

Our bodies’ abilities to detox, resist, self-cleanse and recover are all stronger than we imagine. Most toxins or harmful substances that get inside are quickly broken down by the liver.

If the liver can’t process it, the kidneys step in to flush it out.

And our sweat glands help with detox too.

If you eat something really toxic, don’t panic. The body will immediately launch a double layer of defense—vomiting and diarrhea. First, it throws up the stomach’s contents, then whatever gets into the intestines gets pushed out quickly with diarrhea.

This shows our body sometimes cares more for us than we do for ourselves.

“You’re right, I did a total gastrectomy. To me, losing a stomach is better than losing a life. Even if it only extends her life by five years, it’s worth it. Realistically, if there’s no recurrence, her life could be extended by ten, twenty years, maybe even more.”

Director Le is considered a true veteran in Cardiothoracic Surgery.

His surgical skills are top notch.

Every surgery does some harm to the patient, but if the attending doctor believes after assessment that the benefits outweigh the risks, it’s worth doing.

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Losing the stomach, an organ central to digestion, will definitely have negative impacts on the body.

From now on, pretty much all meals have to be liquid.

It’ll lead to a lot of inconvenience. With the stomach gone, food can’t be stored, so meals have to be small and frequent. Food reflux is another struggle for these patients.

Without a stomach, it’s not just digestion and storage that drop—you also lose a crucial barrier. Stomach acid destroys most bacteria and viruses we eat.

Without it, that natural shield is gone.

So it’s vital to take good care of every organ. If you notice something wrong, go see a doctor right away.

Dragging things out only makes you miss the best treatment window.

Think of the body like a house. If a fire starts in one room, put it out quickly and you’ll barely lose anything. Overall, the house stays safe.

Wait too long until everything in the room is burned and you put out the fire then, at minimum you lose that whole room.

Every organ is like a room and has its special function.

Other rooms can rarely take its place.

If the kitchen’s gone, you can’t cook—takeout every day is your only option.

“Did you remove the stomach and connect the jejunum to the lower esophagus with a side-to-end anastomosis?”

Almost everyone here inherited Dr. Hu Kan’s style. You could guess his surgical plan pretty easily.

“That’s exactly right!”

Director Le nodded in agreement.

“Did you place the feeding tube in the distal jejunum?”

Zhou Can followed up.

“Exactly.” Director Le was honestly impressed by Zhou Can. Just from glancing at the scans, he could deduce the whole surgery. “You must already know what’s causing the patient’s symptoms, Dr. Zhou. Don’t keep me in suspense, spill it! You know I’m not patient.”

He couldn’t help but urge Zhou Can.

With what he knew about Zhou Can, he was sure Zhou Can had already reached a diagnosis.

But Zhou Can was always low-key, and wouldn’t speak up without absolute confidence.

“Heh, to be honest, I do have a preliminary diagnosis. But whether I’m right or not, we still need to run more tests to confirm it.” Zhou Can smiled—before saying anything concrete, he stressed the need for diagnostics before treatment planning.

Medication and therapy both require real care.

No matter how skilled a doctor is, unless it’s a life-or-death emergency, they can’t just judge with gut instinct.

Even in emergencies, you still need to run a few essential tests.

Say it’s a sudden cardiac arrest or a brain bleed—what then?

Even in those cases, you first do basic life-saving steps like CPR, then rush to do the essential checks. Nobody—no matter how confident—would dare administer thrombolytics or operate before the tests come back.

If you absolutely had to risk everything, say the patient’s unconscious and the doctor, based on experience, knows a certain heart vessel is blocked.

In that case, a quick interventional procedure could save the patient’s life.

But if you have to wait for a CT or an angiogram before deciding on surgery, the patient will definitely die.

So what do you do—save the patient based on the doctor’s experience, or wait for scan results?

Sadly, even if you know the patient will die waiting for tests, you still have to wait.

It’s not that doctors want to let people die; it’s just no one dares gamble their career and home. If the patient doesn’t make it and the family sues, the doctor’s basically finished.

To stay safe, the doctors wait for the results.

While waiting, they stick to very basic rescue procedures, never daring to operate or do an interventional procedure.

Even medication is handled with extreme caution.

That’s the harsh reality.

It’s not that doctors are callous or heartless—they’re just required to follow protocol exactly.

“Since the patient had a jejunal–esophageal anastomosis, I’m boldly guessing the cause is a serious postoperative complication—bile and pancreatic juices are refluxing back up.”

Zhou Can shared his diagnosis.

Director Le fell into deep thought after hearing that.

“The reflux is usually alkaline. Without stomach acid to neutralize and buffer it, the reflux harms the esophageal lining even more. So every time there’s reflux, the patient has intense pain behind the sternum, loses appetite, and over time, the body gets seriously weakened.”

He analyzed further based on Zhou Can’s conclusion.

Zhou Can just nodded in agreement.

“So how do we fix this?”

Director Le humbly asked for his advice.

They’d found the cause, and it wasn’t one of those immediately fatal ones, so there was time to treat.

Now they just needed to figure out how.

“Since the surgery’s already done, this is going to be tough. If the surgery hadn’t happened yet, there’d be a way to fix it.”

Zhou Can’s expression turned grave.

He wasn’t a miracle worker—there are some postoperative complications that are near impossible to resolve.

You can’t cook without rice.

If the previous surgeon already removed part of the patient’s organs, even knowing a solution wouldn’t help.

“So I messed up the surgery, didn’t I?”

Director Le was no fool. Even if Zhou Can didn’t say it directly, he understood.

A good doctor rarely criticizes another’s work outright.

At most, they might give a nudge, like Zhou Can just did.

You also can’t hold the prior surgeon accountable. The patient’s family always signs off before the procedure—they know the risks and consent to the surgery.

Even with the knowledge that signing brings big risks, you can’t avoid it.

When it’s time to sign, you sign.

If the family won’t sign, the operation can’t happen.

Their only option is to find another hospital.

And let’s face it, the family doesn’t know as much as the attending physician. If they start using random medical knowledge found on the internet to try and tell the doctors how to plan the surgery? Don’t make me laugh.

If a family tries that, and the doctor can’t talk some sense into them, they’ll just walk away and have the family find someone else qualified.

These days, some smart patients and families like to consult a few different hospitals and compare different proposed surgical plans. Honestly, that’s the safest approach.

Of course, this only works when it’s a chronic disease and you have enough time, money and energy to shop around.

If you pick from big hospitals, you can avoid a lot of hidden risks.

As for Director Le’s question, Zhou Can really couldn’t give a straight answer.

Even though they were on good terms, it would be incredibly stupid to admit to his face that he botched the surgery.

Maybe he’d act fine now, but privately, it would definitely change things.

If you run into one of those egotistical types, they might even turn into an enemy.

“Dr. Zhou, does this patient’s complication have any hope of treatment?”

Director Le tried asking a different way.

“Let me take a look at your surgical plan and operative notes, then while we have the chance, we should do a 24-hour bilirubin monitoring. If possible, get an endoscopy to check for bile reflux and confirm the cause.”

Zhou Can didn’t rush into making sweeping claims.

You could tell—as he gained experience and skill, he’d grown more and more cautious in his words and actions.

That’s how all good doctors evolve.

The better the doctor, the more careful they become in practice.

It’s not just about saving face—it’s about considering every angle deeply, making thorough assessments part of their routine. So they get more cautious the more skilled they become.

That careful approach lowers the odds of disaster.

Director Le handed over all the surgical records and pre-op discussion notes for Zhou Can to review.

Meanwhile, he’d already set up a second round of tests to observe for reflux and pin down the cause.

Half an hour later, Zhou Can had already finished his review and came up with an improved surgical plan.

Director Le’s test results probably wouldn’t be in until tomorrow.

Zhou Can called Director Le to say he’d wait for the test results, and then they’d consult together. Then, he hurried over to Pediatrics.

A tricky case was waiting for him there too!

He headed straight for Dr. Tang Fei’s office.

He knocked on the door. Dr. Tang Fei hadn’t left work yet—she was probably waiting for him.

When she saw Zhou Can come in, she lit up and immediately set down her pen and got up to make him some tea.

It’s worth noting—she’s the head of Pediatrics.

Zhou Can is just a resident doctor, yet he gets this level of hospitality from someone nearly next in rank to the hospital’s deputy director. That’s the benefit of true skill.

For most residents, getting a private one-on-one in Dr. Tang Fei’s office would be a huge honor.

They’d probably end up standing the whole time.

But look at Zhou Can—the treatment he gets is totally equal. Even most associate chief physicians don’t get this from Dr. Tang Fei.

“Dr. Zhou, have a seat! No need to be so polite here!”

Dr. Tang Fei smiled and invited him to sit, closing the office door with a casual motion.

Zhou Can’s smile tightened and he looked uncomfortable.

After being misunderstood by Director Xueyan’s husband, he’d developed a bit of a complex about these things. Whenever he had to meet alone with a younger, attractive female doctor or nurse, he became extra cautious.

Especially if they were alone in her office—he’d keep the door open if possible.

Otherwise, if rumors started again, it’d be bad for everyone.

“Relax, Dr. Zhou. This isn’t your first time here.”

Seeing his tense and awkward expression, Dr. Tang Fei couldn’t help but comfort him with a smile.

“Uh… it’s not that I’m nervous! But could you leave the door open? I’ve been feeling a little short of breath lately.”

He clumsily came up with an excuse.

Pfft!

Dr. Tang Fei could read his face easily and knew he was fibbing.

She burst out laughing right then and there.

Zhou Can blushed, immediately feeling more embarrassed.

“What’s gotten into you, Dr. Zhou? You seem so odd today. Did something happen?”

A woman’s sixth sense is just too sharp.

She picked up on Zhou Can’s troubles without a hitch.

“Um… well…” Zhou Can struggled with his words.

“Are you treating me like a stranger? Whatever it is, you can tell me. Maybe I can offer advice or even help you out! But if you don’t want to talk about it, that’s fine too, don’t force yourself.”

Dr. Tang Fei was always kind to Zhou Can and valued his talent immensely.

After hesitating, Zhou Can finally admitted, “I was meeting with another female doctor in her office, the door was closed and we were going over a patient’s case. Her husband found out and misunderstood. This morning he tracked me down and warned me to stay away from his wife. I’m not really scared for myself, but I’d hate to cause trouble for you ladies. Then I’d really feel guilty.”

He sighed, obviously frustrated.

Dr. Tang Fei giggled.

She laughed so hard she almost couldn’t stop.

“That’s it? I thought it was something serious! Be careful around other female doctors or nurses, sure, but here—don’t worry. My husband never cares who I meet with. He trusts me completely. He spends all day shut in his lab with research and doesn’t have the time to interfere. Honestly, he just says as long as I don’t make trouble for him, he’s happy.”

Dr. Tang Fei explained.

“You’re so beautiful—doesn’t he ever worry about you being snatched away?”

Zhou Can couldn’t help but ask.

People really are so different from one another.

Dr. Tang Fei’s husband and Director Xueyan’s husband are total opposites.

“If he ever cared, I’d probably be happy. But honestly, his scientific data is more appealing than I am.” Dr. Tang Fei was in her forties, still lovely, and her husband had zero concern about other men.

It’s actually kind of funny.