Chapter 509: A High-Stakes Patient

Having a patient like this is something every department wishes for—the more, the better.

Doctors are people too. They need to eat, they need to make a living.

Whenever treating patients without insurance or with only basic rural coverage, doctors always try to save them every cent. Even if a patient has employee insurance, doctors still have to keep expenses in check.

But for legendary retired officials like this, there’s no need to hold back. Whatever gets the best results, that’s how they’ll be treated.

Zhou Can stepped into the special care ward and saw a frail old man with a bluish complexion lying on the hospital bed.

This kind of ward is expensive. At most, there are just two beds, each with a private bathroom.

Dedicated nurses and doctors provide constant care, aiming to deliver the highest quality service.

Ordinary people simply can’t afford this kind of room.

“Are you Mr. Bai Dongyang?”

“Yes, he’s my husband!”

Sitting by the bedside was an elegant-looking elderly woman, her hair pure white but her spirit remarkably bright.

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Most retired officials and their spouses are highly educated.

“How is he doing now? Is he still having trouble breathing?”

“Yes, he still feels short of breath and chest tightness.”

Zhou Can nodded after listening, his tone gentle as he told the patient, “Let me listen to your chest and lungs. Lying on your side for so long—does it feel uncomfortable?”

The patient had just undergone a complete left lung removal. No matter which side he lay on, it would tug at the wound inside.

“Lying flat is even worse…”

Just speaking took all the strength the patient had left.

He had to force every word out.

His voice was weak, barely above a whisper.

At the moment, he wasn’t on a respirator—only receiving concentrated oxygen through one nostril.

It needs to be said: rushing to put a patient on a respirator is deeply irresponsible. Especially with invasive ventilation—it’s really only for saving a life.

For patients who can still breathe on their own, even if breathing is tough but not life-threatening, sometimes they don’t even need oxygen.

In clinical practice, doctors decide breathing support based on the real situation.

Before listening to the patient’s chest, Zhou Can warmed the stethoscope head in his hands before using it.

This small gesture is to minimize any discomfort for the patient.

Cold metal pressed against a frail chest—that’s a feeling no one likes.

He listened closely to the patient’s breathing.

There were obvious crackles and bubbling sounds in the lungs.

With his entire left lung removed, the right lung was doing all the work.

Hearing those abnormal sounds, it was clear the right lung was in trouble too. No wonder the patient felt breathless and tight-chested.

Things were downright dangerous for this man—one bad turn and he might stop breathing altogether.

Zhou Can checked the patient’s records since admission. Blood pressure was 162/100 mmHg, which definitely counts as high blood pressure. Anything above 140 for systolic is considered hypertensive.

Still, sometimes blood pressure readings can be falsely high.

For example, if a patient is emotional or just ate something stimulating, the numbers can soar but usually settle down a while later.

ECG showed the patient had sinus tachycardia.

So now he had both hypertension and couldn’t lie flat.

One phrase jumped to Zhou Can’s mind: pulmonary edema.

Finding the root cause wasn’t actually that hard.

After admission, Associate Director He and another doctor from Tuyu gave a joint consult. Both agreed it was pulmonary edema.

But getting to the bottom of why it happened—the real pathology—was the tough part.

Without a definitive cause, you can’t talk about treatment.

Treating it like a post-surgery complication is far too simplistic. It wouldn’t solve anything.

After checking the patient himself, Zhou Can didn’t just leave.

Instead, he grabbed the patient’s records and post-op medication details for a closer look.

He checked everything, one item at a time.

The surgery itself had gone very well.

Pre-op testing was also thorough and complete.

Because the patient’s insurance covered almost everything, safety came first—every necessary test was done.

Nothing was skipped.

That actually worked in Zhou Can’s favor as he tried to track down the cause.

Complete left lung removal surgery was something he could do himself—he’d handled several already.

So, for every step of the medical process, Zhou Can could make spot-on judgments.

The pre-op exam results all pointed to a malignant tumor in the left lung only—the right lung was healthy. No hidden diseases.

The surgery itself was extremely meticulous.

At least from the records, this operation was a great success.

This just proved the Provincial People’s Hospital had elite surgical skills.

With the pre-op checks clear and the surgery smooth, only one possibility remained—the problem arose after the operation.

There’s a high chance this was a post-surgical complication.

It’s possible that something minor was missed during surgery, or perhaps a small mistake caused the right lung to develop edema.

But judging from similar cases Zhou Can had accepted from the Provincial People’s Hospital, their procedures were strict and responsibility for each step was clearly assigned.

And this was a retired official—a special patient receiving top-notch care.

They’d only be even more careful with his treatment.

So chances of a surgical error or post-op right lung edema caused by the operation itself were slim.

That left just one real possibility—an issue with the post-op nursing.

And this wasn’t the first time something like that had happened.

Sometimes it’s just carelessness, sometimes it’s staff lacking in skill, or maybe a mistake in the nursing process itself.

“Did his breathing problems start right after he woke up from anesthesia?”

“No! When he first came back to the ward after surgery, my husband was in decent shape. Later, a nurse came in with some medication and started an IV drip. After it finished—maybe three hours later—my husband started feeling unwell. We told the nurse right away and she said a little reaction after an IV is normal. She said it would boost his immunity, provide nutrition, and help him recover. So I didn’t argue.”

Clearly, the patient’s wife had been by his side the whole time.

Otherwise, she wouldn’t know all those details.

Growing old together, through thick and thin.

You could tell the couple was deeply bonded.

As soon as he heard about the post-op IV, Zhou Can launched an investigation.

The medication and saline used checked out fine.

But the infusion volume was a whopping 1200 ml.

That’s what you call special treatment from Lady Luck herself!

Did seeing a 100% insurance reimbursement make them eager to pump in as much fluid as possible?

To Zhou Can, that amount of medication was definitely on the high side.

But since he didn’t know the full picture, he couldn’t judge if the doctors overtreated.

“How long did the whole IV take?”

He asked.

Just earlier, the patient’s wife mentioned the whole drip took about three hours.

“Uh… I didn’t check the exact start time. I just know it finished a bit before four in the afternoon. My husband came back from surgery around one. So it shouldn’t have taken more than three hours.”

That answered his question.

The Provincial People’s Hospital was pretty sly—nursing records only listed the meds, dosages, and care given. There was no record of infusion time.

“Doctor, was there something wrong with the IV my husband got at the Provincial People’s Hospital?”

The family seemed to catch on.

They asked Zhou Can directly.

“Since I wasn’t there at the time, I can’t comment. Right now, your husband’s pulmonary edema is fairly severe. I’ll write up the orders and treatment plan right away. Is he able to urinate easily?”

Of course, Zhou Can wouldn’t criticize another hospital in front of the patient.

He’d never stir up trouble like that.

“He’s fine. He can use a urinal.”

After so many years together, talking about helping her husband use a urinal didn’t embarrass her in the least.

“Does he have any allergies to medication?”

“Not that I know of.”

“Alright, for the next few days, we’ll use diuretics. He’ll likely be peeing much more than usual. If your husband feels thirsty, don’t stop him from drinking—just let him eat and drink as normal.”

Zhou Can gave a few instructions and went ahead with the treatment orders.

He needed Associate Director He to review everything before starting treatment.

By now, most of Zhou Can’s clinical orders—whether for Associate Director He or Director Xueyan—barely got more than a glance before getting approved.

[Pharmacological Reasoning experience +1. Bonus experience +10.]

Leveling up pharmacological reasoning was a slow, steady slog. He was still only at level five; reaching level six wouldn’t be easy.

He’d mostly pinned down the cause of the patient’s postoperative right lung edema.

Drawing on his critical care experience, Zhou Can figured it was probably caused by the post-op IV being administered too quickly—maybe the nurse from the Provincial People’s Hospital wasn’t quite experienced, or maybe something unusual happened and the drip finished too fast.

Sometimes, the family fiddles with the IV and turns up the speed themselves.

That’s the most common scenario.

Some patients and families hate slow drips—they secretly open the valve wider to make it go faster.

To them, it doesn’t matter if it’s in fast or slow, as long as it all gets in.

When nurses deal with families like that, all they can do is sigh.

At best, they gently remind them not to do it again.

They don’t even dare to say it harshly.

Because if they do, some families will kick up a fuss—or even get aggressive.

Aside from families secretly adjusting the flow, sometimes emergencies arise and staff deliberately speed things up for life-saving treatment after weighing all risks.

Compared to side effects, saving the patient always comes first.

If a patient is bleeding, you need to get hemostatic meds in quickly to control the bleeding.

If you took your sweet time and let the drip run for 24 hours, the patient’s blood would be all gone.

It’s the same for anti-coagulants—they need to circulate fast.

That’s why Zhou Can never criticizes the other hospital’s nursing in front of anyone.

If you weren’t there, you can never really know what the staff were facing at the time.

He prescribed 10mg caffeine via intramuscular injection for sedation. That would ease the patient’s discomfort and help bring down his blood pressure.

If he got any more agitated, his blood pressure would rise even higher.

In addition, 20mg furosemide and 0.4mg cedilan by IV.

These treatments needed to start right away. He also ordered a long-term plan: for the next five days, continue using diuretics and digitalis drugs.

The goal was to quickly reduce the symptoms of pulmonary edema.

The lungs control water in the body. When they develop edema, the first thing to do isn’t restrict water—it’s to use diuretics.

If the patient’s kidneys were also failing, then it’s a real crisis.

When any organ fails, it’s like an ancient kingdom calling for its neighbors’ help. Other organs step in to assist.

But these calls for help require the doctor’s intervention—through medication and other methods.

So giving this patient a diuretic is like having the lungs call on the kidneys to pitch in, speeding up the removal of excess water and easing the pulmonary edema.

Diagnosing the cause and pathology earned Zhou Can 101 Pathology Diagnosis experience points.

A hundred of those were straight from the system as a reward.

Whenever you crack a tricky case, the minimum reward is 100 Pathology Diagnosis points.

Sometimes, with some luck, he’d even scored a thousand in one shot.

The Pathology Diagnosis skill was rising fast—leaving Pharmacological Reasoning in the dust. It was almost at level six.

Thanks to yesterday’s livestreamed surgery, Zhou Can had made Tuyu’s Cardiothoracic Surgery Department a rising star. Difficult cases would keep pouring in, and so would the big experience rewards.

But there’s one catch—no mistakes allowed.

Just one serious medical incident and it all falls apart.

After handling this high-profile patient, Zhou Can was ready to go back to the office to study a new tricky case.

Never underestimate what he brings to the table.

Every complex patient he helps adds prestige to Cardiothoracic Surgery. Over time, that adds up to a massive reputation boost.

“Dr. Zhou, can I speak with you for a moment?”

Director Bu waved Zhou Can over.

Zhou Can hurried into the consultation room, specially used to talk to patients and families. Two bodyguards stood out in the corridor, looking sharp and scanning every person who neared the room.

They’d memorized Zhou Can’s face long ago.

After all, their boss had come all the way from Magic City just to see Zhou Can.

Inside, Chen Zhongzhi, the patient, sat calmly.

“I just spoke with Director Bu. I understand your hospital’s policies. But for my surgery, I hope Dr. Zhou will handle it. As for appearances, do whatever you need.”

Chen Zhongzhi’s status was high, and so was the value of his life.

He didn’t want to do the aortic replacement surgery at a major hospital in Magic City—the stakes were just too high. He wouldn’t risk it.

“I’m just a resident doctor!”

Even when Zhou Can performed major level-four surgeries and was the primary surgeon, officially, he was always listed as a participant.

He’d built some trust with the patient, but there was no way he’d admit any confidential truths outright.

Some unwritten rules are understood but never spoken.

Like giving gifts to important leaders—showing up with a suitcase or a wad of cash, and you wouldn’t even get through the door.

No one can predict if you’re being secretly filmed—or if someone else is.

The risks are just too high.

It was no secret in Tuyu Hospital’s Cardiothoracic Surgery Department that Zhou Can could lead level-four surgeries. But such things were never discussed openly—nor could they ever be.