Chapter 618: A Glimmer of Hope in the Dead Zone

Aside from necrosis, nerve severance caused by spinal cord transection is also irreversible.

There’s a reason why so many doctors treat the spinal cord as a no-go area for surgery.

Electrophysiological tests have basically confirmed that this little boy’s first pair of spinal nerves are abnormal. That’s a real headache.

Let’s talk about the structure of the brainstem first.

The brainstem is known as the forbidden zone of life, a surgical no-man’s-land. Even seasoned neurosurgeons get nervous just thinking about it.

That’s because the brainstem is the very heart of the body’s nervous system—delicate and dangerously fragile.

It includes the medulla oblongata, pons, and midbrain.

Actually, those gyri and sulci you often see in textbooks are the brain—not the brainstem.

Sometimes even if you get a brain tumor or a blood vessel ruptures somewhere, as long as it doesn’t affect the brainstem neurosurgeons are pretty fearless. These days, endoscopic skull surgery is also quite advanced.

Usually, they just drill two or three small holes into the skull to complete the surgery—fast and safe.

The patient’s wounds are also minimal.

Endoscopic surgery is great for especially weak patients or those with less complicated lesions. Some people just aren’t fit for traditional craniotomy, so the only option is conservative treatment.

Which, as you’d expect, is basically waiting for the inevitable.

Tumors in the brain, cerebellum, or other cranial areas aren’t necessarily terrifying. But a little bleed in the brainstem is enough to leave doctors utterly helpless.

Of course, several top hospitals in China already have strong neurosurgery teams. The brainstem is no longer totally off-limits.

If it’s not a particularly severe brainstem injury or doesn’t involve the midbrain, they’ll take the risk.

Anatomically, the medulla oblongata links up to the pons above and the spinal cord below. It’s like the throat of the whole nervous system.

Unfortunately, the first cervical nerve is right there in the medulla.

It’s located at the junction where the medulla and spinal cord meet.

With such a critical position, Zhou Can’s surgical skills let him take a shot, but there’s no guarantee. The odds aren’t great.

If an exploratory surgery shows a complete spinal cord transection—a clean severance—he’d be helpless too.

Right now he can reconnect most nerves, but he knows he’s not yet capable of fixing a broken spinal cord.

“This kid’s lower-level central nerves are still working—at least on the left side. He’s also got pain reflexes below the neck, though they get weaker further down. That suggests a spinal cord transection is unlikely.”

Zhou Can quietly mulled over the boy’s case.

“Jiang Wei, I remember the boy’s hematoma was on the right side after his fall, right?”

He turned to ask Jiang Wei nearby.

“Yes, the injury was on the right side of his neck.”

Jiang Wei nodded in confirmation.

She might just be a nurse, but she’s got real drive to learn. Working with Zhou Can on surgeries and rounds—even tough diagnoses—has really boosted her skills.

“If the injury’s on the back-right of his neck but the left-side reflexes are normal, it means a spinal cord severance is almost impossible.”

Zhou Can muttered to himself.

According to physics, when a surface takes a hard blow, it’s often the opposite side that breaks first.

The boy’s right lower-level nerves are abnormal but not entirely gone. This points to damage in the right spinal gray matter—a good sign, since it means he didn’t sever the nerves from that fall, only suffer some injury.

If that holds true, Zhou Can has a good shot at fixing things through surgery.

“When the lab gets the spinal fluid test results, let me know right away. If there’s no infection or inflammation, then we can consider surgery. Either way, I’ll have Director Wu from neurosurgery double-check the plan.”

Zhou Can’s eyes lit up with hope.

He’d wrestled with this tough case for two days and finally saw light at the end of the tunnel.

If he could cure this kid, all the effort would be worth it.

Only Zhou Can had that kind of pull—inviting the ‘Peak Scalpel’ from neurosurgery for a consult like asking an old friend for a favor.

There are strict rules for urgent consults between departments.

When another department is asked to send a doctor for an emergency consult, if no one’s specified, the department has ten minutes to have someone in the ER. But let’s be honest, that rarely happens.

Especially when the ER used to be low on the hospital food chain, some big departments would drag their feet, showing up half an hour later—if you were lucky.

For a regular consult, again with no doctor specified, it’s supposed to be done within 24 hours.

But in reality, that usually means three days.

If Zhou Can needs a neurosurgeon and the patient’s not urgent, it’s a routine consult—apply, wait for approval, and expect a day to pass.

Once the other department gets the notification, it often takes another day to send someone over.

So you end up waiting until day three for a doctor to show up.

Everyone’s busy with their own patients. Consults are either an obligation or a personal favor.

If things go south or you’re too demanding about the consult, don’t be surprised if they just send a trainee. You’ll feel like you swallowed a fly.

Even if you complain to the Medical Department, they’ll just say, “Sorry. Our department’s overloaded, but our trainee here is actually quite capable.”

They’ll claim the trainee is excellent with tough cases.

And the Medical Department leadership won’t argue further.

After all, they’ve sent backup. If you’re still not satisfied, maybe diagnose it yourself!

That’s why patients at hospitals often hear: after a brief exam, a doctor will say, “Maybe you should cancel this appointment. Our department isn’t suited for this—you need to see another specialist.”

That’s a pretty cold way of doing things, or it means the doctor has no connections.

They’ll just bluntly push the patient to another department.

But if a doctor actually knows someone in the right department, they’ll just call them up: “I’ve got a patient I’m not sure about—could you take a look?”

Most of the time the other doctor will agree.

It’s like handing over a new patient.

Even a small case is still business.

Each extra patient treated means more income. Occasionally you catch a big case and it’s a win-win in both performance and reputation.

If the front desk staff assigns appointments or patients choose themselves, opportunities like this get missed.

Here’s a little secret about hospital registrations.

If you make an appointment online, just pick a regular doctor for minor issues. Anyone seeing patients is at least an attending physician, and even if they’re just a resident, they’re still among the best.

But if you register at the window, staff will default to giving you a specialist if one’s available.

Their priority is to assign patients to the highest-ranking doctor first.

This doesn’t include special expert appointments.

Those cost a lot—at least 50 yuan each, and the steeper ones start at 300.

A lot of people are already broke from their illness. If you stick them with a several-hundred-yuan appointment, they’ll explode on the spot.

So if you think your case isn’t serious, just ask for a regular number at the window—staff are happy to oblige.

Whether it’s the front desk, a clinic doctor, or the nurses, everyone’s just doing their job.

There’s a bit of kindness in everyone.

No one wants to make things harder for a patient, not for no reason.

Zhou Can’s connections with directors and top experts are a huge advantage.

Every patient he sees has a shot at VIP-level treatment.

His appointments are only 8 yuan but might get you a consult with elite specialists.

Experts like Wu Baihe and Director Yin have appointments you can’t even book if you try.

Still, Zhou Can isn’t careless about his resources.

Every time he asks another director for help he owes them a favor.

……

Surgery ran late into the afternoon—they didn’t finish until nearly 1 pm. So he ordered food and ate in the surgeon’s lounge.

Some level-III surgeries really are tough.

Only someone like Zhou Can can breeze through an ordinary level-III surgery like it’s nothing. For most doctors—even experienced associate chiefs—it’s a nerve-wracking walk on thin ice.

Though Zhou Can always respects his work, his skills are so strong he rarely runs into trouble.

Lately, he’s even managed to handle some orthopedic procedures.

“Boss, the test results for that kid are out.”

Jiang Wei personally brought over the results.

“There’s an infection!”

After looking them over, Zhou Can couldn’t help but exclaim.

This was the last thing he expected.

He’d thought the boy’s paralysis was all from his neck injury, but now things were taking a strange turn.

He was glad he’d sought advice from Director Yin that night.

The veteran experts have nothing but experience and composure.

Director Yin had warned him to be alert for causes other than spinal trauma.

So when he got back, just to be safe, he requested a spinal fluid test for the boy. Good thing he did.

You can never be too careful.

Today’s events really drove home the lesson: a doctor needs both caution and meticulousness.

If he’d skipped this extra test and gone straight to surgery, the consequences would have been unthinkable.

Spinal infections are sometimes barely detectable with a standard blood panel.

And this kid’s infection is the worst kind—tuberculosis.

Zhou Can was completely floored.

Tuberculosis is notorious in the clinic—hard to diagnose, hard to treat, easy to relapse.

The bacteria thrive in huge numbers and multiply quickly, making them a tough enemy for most medications.

Treating TB clinically usually means using a combination of drugs.

And you have to stay on them for a long time.

Why is tuberculosis so tough to cure?

Tubercle bacteria in the body fall into two groups.

One is the extracellular kind—mostly hiding in cheese-like lesions, nodules, or cavities. Standard anti-TB drugs can knock those out.

But since there are so many of them and they multiply so fast, if you don’t use a good combination of drugs, they’ll adapt, mutate, and become drug-resistant. That’s why relapses are so common.

The other kind is the intracellular type. These reproduce much more slowly.

Their slow metabolism means anti-TB drugs kill them far less efficiently—another big reason why treatment is so tough.

Even a straightforward case of pulmonary TB can give doctors gray hairs.

But here it’s the spinal cord that’s infected.

That’s the central hub of the entire nervous system!

If the result came from an outside hospital, Zhou Can would’ve doubted it.

But Tuyu Hospital’s lab is among the best in the country, especially at pathogen detection. With generous funding, they always take diagnostics seriously, sparing no expense.

For example, a test might cost a patient 80 yuan.

Sometimes, one try doesn’t cut it or the results are in doubt—they’ll repeat the test two, three, even four times if needed.

So if it takes four tests to be sure, the cost is 320 yuan.

Would they actually bill the patient for that?

Patients would probably tear down the payment window if they did.

The hospital just eats the cost.

Every responsible big hospital’s lab loses money this way.

It’s all about being meticulous.

Small hospitals stick to basics. If they can’t find anything with routine tests, they frankly tell the patient: we don’t have the tech or conditions, you’ll have to go elsewhere.

So patients always end up at the big hospitals anyway.

Whenever community hospitals run into tricky cases, they push them up to the major hospitals—but those can’t say no.

They just take the patient, no matter the loss, and run whatever tests are needed.

Even if it means losing money, they do it.

That’s how a hospital builds its reputation—by doing whatever it takes.

Big hospitals don’t just go all out in the lab, spending freely to get the right results. ICUs do the same for critically ill patients.

At first glance, the daily ICU cost might be twenty to thirty thousand—sometimes over a hundred thousand. Patients might think the hospital is making a killing.

But really, the hospital is quietly losing money.

Every doctor and nurse knows how well-equipped ICUs are. Treating critical patients means throwing everything into the effort: equipment, supplies, manpower—whatever it takes. ICUs run on rotating shifts too.

There are doctors and nurses dedicated to the ICU 24/7.

That level of care is expensive.

A day in the ICU costing ten thousand or more probably means they used ECMO or some special drug or consumable.

A lot of that stuff is 100% imported, which is why it’s so expensive.

In the past, imported titanium alloy staples cost over 6,000 yuan each, and domestic ones weren’t even available.

If a patient snapped a bone and couldn’t use an implant like that, they’d be disabled for life.

With it, there’s a good chance of a complete recovery.

And it can stay in the body permanently, no need to ever take it out.

Domestic products, on the other hand, trigger harsher rejection and don’t match up in corrosion resistance or strength.

So both patients and doctors always prefer imported options.

In the end, ICU doesn’t turn a profit—it earns reputation, and the success rates with critical patients.