Chapter 589: The True Cause Behind the Patient’s Death

The patient’s death was linked to improper handling of the urinary catheter, meaning the Gastroenterology Department had to shoulder responsibility.

“The patient’s abdomen was swollen like a drum and her skin had turned dark, showing that urine and feces had stayed inside her body for a long time with no way to get out. The toxins then backfired, attacking her organs and likely causing major failure and death. It’s a real issue that there was no urine output from the catheter.”

Director Shi from Infection Control had come to much the same conclusion.

They were all professionals—when it came to analyzing the cause of death, they rarely missed the mark.

Both their preliminary investigations pointed toward mistakes in the Gastroenterology Department’s treatment, making the attending doctor and Director Shang instantly uneasy.

Even the nurse who’d inserted the urinary catheter looked terrified.

“Dr. Zhou, what do you think?”

Hospital Assistant Qin’s gaze turned to Zhou Can, who had yet to speak.

Director Shang, on the other hand, shot Zhou Can a desperate look, hoping he’d help lighten Gastroenterology’s share of the blame.

“The patient’s death wasn’t caused by the urinary catheter!”

Zhou Can spoke with steady confidence.

Director Shang and several staff immediately looked at Zhou Can with deep gratitude.

Zhou Can still looked out for his old colleagues.

“Hmph. Dr. Zhou is participating in this investigation as a member of Quality Control now. Don’t let old friendships cloud your judgment or let bias affect the findings.”

Director Shi from Infection Control gave a sharp grunt, clearly dissatisfied with Zhou Can’s conclusion.

He obviously knew Zhou Can had completed residency in Gastroenterology and had ties with their doctors.

A referee’s biggest taboo is to play favorites.

As members of Quality Control, they could not turn a blind eye to issues just because they were close with the department or attending doctor.

“Dr. Zhou, you need to be mindful of your stance. Get used to your new role.”

Hospital Assistant Qin gave him a quiet reminder.

“I’m not covering for Gastroenterology. My verdict is just based on my analysis. The patient couldn’t pass stool for a long time, not even after using glycerin suppositories or having her family attempt to remove it by hand. She stopped urinating at around 5 a.m. yesterday, and by 3 a.m. today, when she died, she still hadn’t peed.”

Zhou Can recited the patient’s care records.

“I’ve examined the catheter. Even though the body stiffened after death and the catheter was wedged tight, the depth and angle of insertion were both correct. I’m over 99% certain, even if you ran an autopsy, that the catheter was placed in the bladder properly.”

When it came to placement technique, both Director Ju of Nursing and Director Shi of Infection Control were outmatched by Zhou Can.

Especially after Zhou Can reached Level 6 in device implantation, his evaluations became almost frighteningly precise. Sometimes he could tell at a glance whether a catheter was positioned right.

“So why, after inserting the catheter four hours before death, was there no urine output at all?”

Director Shi challenged him, clearly unconvinced.

“Normally, no matter how little urine is produced, using a catheter at least yields some output.”

The bladder is an extraordinary organ.

The way urine forms and is expelled in the body is almost ingenious.

As blood flows through the glomerular arteries, large proteins and blood cells pass as normal, and—thanks to the filtering—return to the circulatory system unimpeded.

Most water, glucose, inorganic salts, and urea are filtered through the glomeruli and enter the bladder. The renal tubules also do some reabsorbing.

That’s how urine forms.

When a doctor checks a patient’s urine and finds albumin or blood cells, it means the kidneys are faulty.

That’s a signal the glomerular filters aren’t working.

Albumin and blood cells are crucial nutrients. If they’re expelled via urine, the body weakens, and signs like weight loss or anemia soon follow.

Sometimes patients can’t urinate because there’s simply too little urine. If the bladder isn’t full, they don’t even feel the urge.

If the amount is tiny, even patients who want to pee may be unable to.

With too little internal pressure, the urine just won’t come out.

But after a catheter is inserted, even the smallest amount usually drains out.

Of course, this depends on the doctor’s insertion skills.

Director Shi and Director Ju both believed the catheter hadn’t been placed right since it yielded zero urine for so long. They figured stool alone wouldn’t cause the abdomen to swell so dramatically.

It’s only when neither urine nor stool can exit that the belly swells up, almost like a pregnant woman’s.

Too much pressure inside the abdomen leads to a whole host of complications.

That was their diagnostic view.

“First, everyone should know that if urine stays in the body too long, it’ll get reabsorbed.”

Zhou Can began explaining his theory.

Doctors often urge patients not to hold in their urine, no matter how little the urge. Best to go every hour or two.

That’s because urine contains loads of toxins and harmful substances.

If not expelled promptly, those toxins get reabsorbed, causing real harm.

Holding it once or twice isn’t the end of the world, but doing so often paves the way for all kinds of serious problems.

People who do this often lose skin luster, turning sallow.

Their eyes get sunken and dark, their faces resembling someone with uremia.

“So you’re saying the patient’s urine got reabsorbed because she couldn’t pee for so long?” Director Shi was obviously dissatisfied with this answer.

“No, what I mean is, by the time the catheter was placed, she might have already had little or no urine. Any traces could have been reabsorbed, resulting in no output at all.”

Zhou Can answered calmly.

“So then where’d all that urine go? Her belly was huge—you’re not about to claim there was nothing in there, right?”

Director Shi’s tone dripped with sarcasm.

He was an experienced internist and now head of Infection Control, so he looked down on Zhou Can, the young doctor.

The others didn’t really buy Zhou Can’s logic either.

Even Director Shang, sitting opposite, doubted him. He figured Zhou Can was just sticking his neck out to cover for Gastroenterology and lessen their blame.

“In fact, there really wasn’t any urine in the patient’s belly. Did anyone notice this? Right before death, she suddenly vomited a lot of blood.”

Zhou Can scanned everyone’s faces.

“When I examined her a moment ago, I pressed her abdomen and found it soft. That tells me there was a lot of fluid build-up, not just feces.”

Truth is, even a week of constipation wouldn’t make someone’s belly swell like a pregnant woman’s.

That’s because stool is mostly solid.

And people with chronic constipation end up with drier stool, since water is reabsorbed over time.

That’s why doctors urge constipated patients to drink plenty of water.

Without enough water, stool gets too dry and much harder to pass.

“I suspect the patient suffered a major arterial or venous rupture, causing massive internal bleeding in a short time. That’s why the abdomen was so bloated.” That was his conclusion.

“But that can’t be! She stopped urinating before 5 a.m. yesterday, so if there’d been massive internal bleeding for that long, she’d have shown severe blood loss long before. Even Gastroenterology wouldn’t have missed signs that obvious.”

Director Shi voiced his skepticism.

“That’s exactly what puzzles me. Could it be she started off with just a slow internal bleed—not a tiny one, but not massive either? Because she was already constipated and felt constant discomfort, she ignored the pain from the bleeding.”

“Once the blood loss got worse, the body tried to maintain blood circulation by pulling water from all other body fluids, which is why she didn’t urinate for nearly a day. Later that night, the bleeding accelerated and led to vomiting blood and then death.”

Zhou Can offered his bold hypothesis.

“Even if Dr. Zhou is right, how could bleeding in the abdomen make someone vomit blood?”

Director Ju from the Nursing Department raised a new objection.

The Medical Department staff, for their part, kept silent.

Truth be told, they were hoping Gastroenterology wouldn’t be blamed either, since if a clinical department screwed up, they themselves could be faulted for lack of proper oversight.

“If a patient vomits blood, it’s usually from an upper digestive tract or respiratory source—but this patient’s bleeding was in the abdominal cavity. Normally she wouldn’t vomit blood. So only two possibilities remain: Either she also bled into the upper GI tract, or the bleeding in the abdomen actually started in the intestines. Only an autopsy could tell for sure.”

Even Zhou Can was curious about where the fatal bleeding had truly started.

What was clear was that the death was due to internal bleeding, not a misplaced urinary catheter causing urinary retention.

“The family wants a peaceful resolution and refuses an autopsy. Our hospital would also prefer to settle things quietly so the deceased can be laid to rest. Dr. Zhou, your investigation points to internal bleeding as the true cause. Do Directors Shi and Ju agree with that verdict?”

Deputy Chief Old Xiong from the Medical Department spoke up right on cue.

Zhou Can knew this Deputy Chief Xiong was friends with Director Shang.

With trouble in Gastroenterology, Xiong would be doing all he could to minimize fallout for his friend.

Making friends like this was always a good thing.

“I agree!”

Director Ju Shiman from the Nursing Department nodded in support of Zhou Can’s findings.

Director Shi from Infection Control was still a bit doubtful. “Dr. Zhou, can you really rule out bladder rupture or a misplaced catheter?”

“I’m certain. If the bladder had ruptured, the patient would have been in excruciating pain before dying. According to the family and staff, she passed away within minutes, so quickly there wasn’t even time for rescue. So I believe we can rule out bladder rupture. As for the catheter, based on my expertise, I’m sure it was positioned correctly.”

Zhou Can declared confidently.

He was right—bladder rupture is intensely painful.

No one could possibly have no reaction.

Even wild antelopes can barely move if their bladders rupture.

Older antelopes make a habit of urinating at night rather than waiting until morning.

That’s because lions and wolves usually hunt in the early morning.

Savvy predators know antelopes’ greatest weakness: After digesting all those moist plants overnight, their bladders are full come dawn.

Young, inexperienced antelopes are clueless and just sleep through the danger. They lie in late and enjoy it.

When sunrise comes and the lions suddenly let loose a thunderous roar, they spring right into the hunt.

The antelopes panic and bolt.

In their desperation to escape, a full bladder can burst from the sudden sprint, and that’s usually fatal.

Their running slows fast—pain will do that!

The next thing you know, they become breakfast for the lions.

The old antelopes have survived many a predawn ambush and learned to empty their bladders at night. That way, there’s less risk of bladder rupture if they have to run for their lives.

Plus, losing all that urine makes them lighter, so they can run even faster.

Humans are way less durable than wild animals.

If even an antelope can’t stand a ruptured bladder, then if this patient had suffered the same, her screams would’ve echoed through the whole ward.

That’s why Zhou Can was quite sure her bladder hadn’t ruptured.

Of course, if you really wanted proof, an autopsy is the gold standard.

“Alright. I accept Dr. Zhou’s findings! The patient’s death had nothing to do with how the catheter was handled.”

Director Shi finally accepted Zhou Can’s explanation.

Across from them, Director Shang and his people finally relaxed, grinning in relief.

Assistant Qin gave Zhou Can a look filled with admiration.

Word spreads fast. In just a few years, Zhou Can, with an ordinary education, had made a huge name for himself here at Tuyu Hospital. He really was something special.

The folks from the Medical Department had long known Zhou Can’s skills, so they weren’t the least bit surprised.

Director Ju Shiman from Nursing also marveled at how capable this young doctor was. She hadn’t expected him to be so outstanding.

Of course, getting into Quality Control’s first group was a huge accomplishment in itself.

Every spot in the first group was precious beyond words.

It took one tough exam after another to even get in.

“Dr. Zhou, now that you’ve cleared Gastroenterology of responsibility, that’s very helpful. But we still have to give the family an explanation. Would you be able to narrow down the exact area of the fatal injury without an autopsy? It doesn’t have to be too precise—just a general region will do.”

Assistant Qin’s reliance on Zhou Can was now crystal clear.