Chapter 613: A Closer Look Reveals the Truth Beneath the Surface

On the very day she was admitted, the patient started having headaches again. Both sides of her forehead and temples throbbed so badly she eventually threw up from the pain.

When pain is so intense it causes vomiting, you know it’s severe.

When she was admitted, her temperature was 38.4°C, so there was definitely a fever.

After she was admitted, the hospital put her on IV antibiotics. That’s standard for most patients, especially those in gastrointestinal surgery. Glucose or saline drips, plus antibiotics, are basically a cure-all here.

People love to blame small clinics for overusing antibiotics, but big hospitals aren’t always innocent, either.

It’s just that major hospitals have stricter controls on antibiotic dosages.

Small clinics, in pursuit of the best results, tend to up the dosage.

After this female patient started antibiotics, by her third day in the hospital her temperature was already back to normal.

You have to admit—antibiotics really are effective.

That’s why both doctors and patients like them so much.

The patient records carefully track her progress. On her third day, her fever had gone down and even her headache had eased a bit, but her condition overall hadn’t actually improved.

Because on that third day, she experienced a brief loss of consciousness and convulsions.

Every time it happened, the symptoms didn’t last long—just seven or eight seconds, then they stopped by themselves.

At this point, Zhou Can felt that the patient’s condition was getting more and more complicated. It was hard to piece together what was really going on.

When symptoms alone can’t pinpoint the cause, doctors rely on test results to help figure things out.

Her current stats are: temperature 36.9°C, pulse 74 per minute, breathing rate 29 per minute, blood pressure 84/146 mmHg.

All four vital signs are basically normal.

In other words, when she’s not having an episode, her body seems almost completely healthy.

No wonder she ended up in Neurology.

With symptoms like this, the first thing to suspect would be a neurological disorder.

Given what she’s experiencing, there’s a good chance her central nervous system has a problem. It could be a brain issue, or maybe even epilepsy.

She’s well nourished. No signs of jaundice, her complexion is good, and there are no bleeding spots or spider nevi. Her thyroid’s normal, chest looks fine, clear breathing, and her lungs sound normal—no abnormal dry or wet crackles.

Heart rate 74, rhythm regular, and no abnormal sounds over any valves.

Her abdomen is soft when pressed, no tenderness or rebound pain, no lumps. Spine and limbs are all normal, no deformities.

All these physical exams show her body is basically healthy. No obvious signs of disease anywhere.

Diagnosis keeps circling back to the central nervous system.

And the brain is the prime suspect.

The first attending physician and Director Yin both gave her brain an initial check.

They talked with her—she was alert, had clear thinking, normal speech, memory, calculation, understanding, and judgment. All intact.

Her vision and visual field were normal too.

Aside from seeing double, headaches, and limb spasms during attacks, nothing else seemed off.

Director Yin did a thorough check of the optic nerves. The left eye moved normally in all directions, but the right couldn’t look up or out properly—restricted movement and clear double vision.

When tested with both eyes centered and trying to focus with the right eye, the double vision was especially obvious.

Zhou Can couldn’t help but think of that boy with the spinal cord injury. After his fall, he also had clear differences between the sides of his body.

Maybe cracking this case would give him some inspiration.

The two cases are very different, but since both are neurological, there has to be something to learn from each other.

Zhou Can decided to go see the patient for himself.

No matter how detailed the records, test reports, or notes are, nothing beats a doctor seeing the patient in person.

Ever since ancient times, visual diagnosis has been one of the doctor’s fundamental skills.

In fact, it’s ranked first among the four classic diagnostic techniques in traditional Chinese medicine.

While not the core of TCM diagnosis, it’s always the doctor’s first instinct after meeting the patient.

Like they say: The day’s plan starts in the morning, the year’s in the spring.

Visual diagnosis is the springboard for everything else.

It’s got a huge impact on how the rest of the case is judged.

The real core of TCM diagnosis is pulse reading.

Western medicine came thousands of years later and borrowed some of TCM’s habits, too.

Even now, Western doctors rely on visual diagnosis, right alongside physical examination.

But as for pulse reading, Western medicine doesn’t buy into the whole meridian theory—they think pulse diagnosis is basically superstition or way too mysterious. Maybe it’s just too complex, so they developed their own replacements.

That means things like ultrasound scans, lab tests, CTs, MRIs, endoscopies, and so on.

Doesn’t matter if it’s a black cat or a white cat—as long as it catches mice, it’s a good cat.

Pulse reading in traditional Chinese medicine is incredibly powerful. A skilled doctor can find out as much with a few touches on the wrist as you’d get from a full hospital checkup. Sometimes, even when fancy machines find nothing, the pulse will reveal a clue.

But pulse reading is tough to master. It takes real talent, plus years and years of practice to get good.

Training that kind of specialist takes too long.

And with traditional Chinese medicine falling out of favor, there aren’t many old masters left who really understand pulse reading—making it even harder to find the next generation.

Western medicine, on the other hand, is much easier to spread. Any smart student can learn it.

That’s why med schools in China use test scores to pick out their future doctors.

Which is why Western medicine basically rules the scene now. There’s talent everywhere.

And if you don’t know how to use one of those machines, just follow the manual—it’s all right there.

Following all the details in her case file, Zhou Can made his way to the inpatient ward where she was staying.

Neurology, Bed 37.

A gentle-looking young woman lay in bed, and sitting by her was a woman in her late fifties or early sixties. Most likely the patient’s mother.

When a woman gets married and falls ill, the family member staying by her side is usually either her parents, her spouse, or her children.

Very few mothers-in-law or fathers-in-law come take care of their daughter-in-law in the hospital.

“Excuse me, are you Ms. Zhao Caixiu?”

“Yes, that’s me.”

Seeing the doctor arrive, she quickly sat up.

“No need to get up. I just wanted to ask a few questions about your condition. You can stay lying down.”

Zhou Can quickly reassured her.

You want patients with neurological issues as relaxed and natural as possible—otherwise, tension can bring on an attack.

“Let’s check your eyes.”

“Okay.”

She agreed readily.

Most patients are more than happy when a doctor wants to examine them or shows concern for how they’re doing.

Zhou Can studied her eyes and could clearly tell her right eye had trouble moving and had trouble looking up.

“Look at my finger. Don’t move your head.”

He said, then held up a finger and moved it around in front of her—up, down, left, and right.

Her right eye was slower to follow than her left.

Zhou Can covered her left eye and then held up two fingers.

“How many fingers do you see?”

“Looks like four!”

Yup, her right eye really was seeing double.

He covered her right eye and asked again: “How many fingers now?”

“Two!”

Her left eye was seeing normally.

But Zhou Can wasn’t done yet. Other doctors had already run these tests—he just wanted to double-check and observe the way her eyes moved.

“Did your right eye hurt when you moved it just now?”

“It did hurt a bit. Moving my right eye feels like it’s tugging on a nerve, and there’s a little bit of pain in my head.”

She answered honestly.

“Alright. I’m going to touch your face a bit, just relax.”

He gently touched both sides of her face, especially her cheeks and cheekbones—no obvious issues.

“Do you ever chew gum?”

“Sometimes, but not much.” She sounded a little embarrassed.

“Alright, I’ll give you a piece. Just chew normally with your eyes open, and I’ll watch your eyes a bit more closely.”

Zhou Can took a piece of Green Arrow Chewing Gum from his pocket and handed it over.

This unique check-up instantly caught the attention of the other patients and family members. Everyone was watching out of curiosity.

She unwrapped the gum and popped it in her mouth, starting to chew.

She still didn’t know why, but she thought this young doctor’s exam was really different and interesting.

As Zhou Can watched her, he saw that her corneal reflex was unusually slow.

But her chewing was strong and steady.

“Now close your eyes.”

She obeyed, and Zhou Can gently tried to lift her eyelids. He could tell she was shutting her eyes with noticeable strength.

Looking closely at her face, he saw no droop at the corners of her mouth, her nasolabial folds were even, and there was a sheen of soft fuzzy hair above her lips.

Women don’t have beards, but they do get peach fuzz—totally normal.

Sometimes, women have a surge of male hormones during certain periods, making that peach fuzz longer and thicker—almost like a real mustache. Many women get scared by this, but there’s really no need. It’s just a natural process.

It’s especially common for older women after menopause.

Just face it with confidence.

If you can’t stand the look or worry others will laugh, you can always use some depilatory cream to get rid of it.

Here’s a tip for the guys—if you want to figure out if a woman has a strong personality, look at her upper lip. If the fuzz is dense and long, she’s probably got a forceful character. If you marry her, get ready for a strong wife at home.

Of course, marrying such a woman can actually be a real blessing.

Women like that are pretty ambitious, love fiercely, and while their tempers might flare, they’re often great to their husband and kids.

If she doesn’t get along with your parents, just don’t live together. Simple as that.

“Okay, spit out the gum and try drinking some water for me.”

The test still wasn’t over.

She wrapped the gum in a tissue before tossing it in the trash—shows she was pretty considerate.

She picked up a cup and took a sip.

Zhou Can noticed she seemed to struggle a little when swallowing. In fact, he’d spotted something off when she was chewing gum too.

Her swallowing reflex was very pronounced.

But she didn’t choke.

“Stick out your tongue. Open your mouth a bit wider.”

Zhou Can kept going with the exams.

Luckily, her husband wasn’t there. Exams like this can easily make a patient’s husband misunderstand.

Doctors are just looking for the cause of illness—nothing more.

He saw that her tongue stayed centered with no tremors or signs of wasting.

“Good, we’re done with that part.”

He moved on to other checks.

Her limbs had normal muscle tone and strength—no involuntary movements. Coordination and sensation were normal. All her reflexes were normal.

But the Babinski sign was positive on both sides.

That was something new he hadn’t found before.

This test involves the patient lying on their back, legs straight. The doctor holds the ankle and uses a blunt metal stick to stroke the outer sole from heel to pinky and then toward the big toe—that’s the Babinski test.

Normally, toes curl downward—that’s negative.

But this woman’s response was abnormal—initially, her test was positive.

Guess it really does pay to check the patient yourself.

If he hadn’t come to the ward for a thorough exam, there’s no way he’d have caught all these details.

Looking at her records and scans, you’d think that unless she was having an episode, she was totally healthy.

Who’d guess so many hidden problems were lurking under those normal results?

“Let me check your neck. Try to relax—you don’t need to tense up.”

He gently palpated her neck. Her skin was smooth as silk.

But he could feel obvious stiffness.

“It’s okay, relax your neck. If you clench up, my exam won’t be accurate.”

He spoke gently to reassure her.

“Alright.”

She closed her eyes and did her best to relax.

But the neck stiffness was still there.

Zhou Can ran the Kernig and Brudzinski tests—she scored a mild positive on both.

Nothing too severe.

“Okay, thank you for cooperating. If we make any new breakthroughs in your diagnosis, we’ll let you know.” Zhou Can had learned a lot, and while he wasn’t one hundred percent clear yet on what was causing her issues, with all her tests and scans, they’d probably be able to find it.

“Are you her mother?”

He looked at the older woman by the bed.

“Yes! I’m her mom.”

“If she has another episode, please try to lay her on her side—preferably her left. That’s the safest position for her.”

“Okay, thank you.”

Her mother nodded, taking his advice seriously.

Most family members listen carefully when a doctor gives instructions.

Of course, there are always a few skeptical relatives—or those who think they know some medicine themselves—who might doubt the doctor’s guidance.

But in the end, not listening to doctors often leads to suffering.

Sometimes the consequences can be serious.

Zhou Can headed back to Director Yin’s office and found him already there.

“Thought you’d run off! So, did you check out the female patient’s information?”

Director Yin asked.

“When have I ever run off?”

Zhou Can rolled his eyes. Director Yin looked serious, the classic strict academic type, but once you got to know him—especially after earning his respect—he could be surprisingly easygoing in conversation.