Chapter 626: A Doctor’s Weight

After being promoted to attending physician his standing in the department would take a real leap forward.

Even though he’d already proven himself, earning the approval of most of his colleagues, his low rank as a resident kept undermining his influence.

From ancient times there’s been a saying in architecture—only grand structures inspire true awe.

A hundred feet is form, but a thousand feet creates real presence.

That’s why noble estates, official residences and palaces in ancient days all sprawled over vast grounds, built to impress with their sheer grandeur.

They needed to create an air of authority in the eyes of common people—the office and home alike couldn’t be anything less.

Modern society is far more advanced, anchored in the belief that everyone’s equal.

That idea has really taken root.

But in any workplace the saying still holds: one rank higher, and the pressure crushes you.

This is just an evolution of that ancient notion—the lack of grandeur means a lack of authority.

Managers order supervisors, supervisors command team leads, team leads direct their members—it all comes together in a pyramid of hierarchy.

Each time you climb a rank your power and status climb with you.

Why did so many people oppose Zhou Can’s promotion to vice group leader in the operating room before? Simply because he was only a resident—his title too junior, and suddenly he was supposed to preside over others of higher status. That naturally stirred resentment.

But now Zhou Can’s made it: he’s officially an attending physician. Those residents who once stood eye to eye with him now have to look up. Attendings who once looked down see him as their peer.

Reaching the attending level means you finally carry some weight—even associate chiefs have to give you due respect.

Nothing is more complex than the human heart.

Why are rankings so important? Because the value behind each rank is enormous.

And the bigger the hospital the more valuable these titles become.

In small hospitals associate chiefs and chiefs often don’t live up to the title. It might impress the average person but insiders just smile knowingly.

Some small hospital chiefs may protest when they hear this.

But it’s simple—small hospital associates and chiefs often come to big hospitals for further training.

As soon as a chief steps into a major hospital he instantly becomes a trainee.

No matter how respectfully the department treats that chief, as long as he’s a trainee, his status can’t change.

Usually an attending will be assigned to mentor the trainee.

When Zhou Can was training in Internal Medicine he saw an associate chief from a county hospital come to Tuyu for training—and a regular attending chewed him out so badly the poor man couldn’t even raise his head.

If it’d been an associate chief from their own hospital, no attending would dare talk like that.

Zhou Can followed the nurse who’d passed along the message to the triage desk.

At a glance he recognized the woman waiting for him.

“It’s you!”

Zhou Can felt a twinge of surprise when he saw her.

This young woman was none other than the girl he’d run into a couple days ago while making rounds in the Pharmaceutical Division.

He’d spoken to someone on her behalf, so her leave must have gone through.

Now she’d come to see Zhou Can—was it to thank him personally?

Cheng Xiaolu watched Zhou Can walk over in his white coat, her eyes complicated.

“I honestly didn’t expect you to be Dr. Zhou Can that day! Thank you for helping me get time off.”

After asking around in the emergency department, she found out who Zhou Can really was, and the shock still hadn’t faded.

Who would’ve guessed that the young man she met that day held so much status?

Even working in the Pharmaceutical Division, she’d heard about Zhou Can’s stellar reputation.

Deputy Chief of Emergency, Vice Group Leader of the Operating Room, Quality Control member, the hospital’s youngest rising star, the new head of the Pharmaceutical Division…

All those roles together made him shine almost too brightly.

It made her feel completely overwhelmed.

“It was nothing, really. Don’t mention it. How’s your mother doing?”

Zhou Can really didn’t give the favor a second thought.

For him, it was just a tiny act of kindness.

“My mom… she had a brain hemorrhage… she’s…” She couldn’t help but sob, quickly turning to wipe away her tears.

“Don’t rush—have a seat and tell me slowly.”

Zhou Can pulled over a tall backless stool so she could sit.

They used to have plastic stools here at triage, but now with capable security, the hospital dared to switch to metal ones.

The nurse who’d brought the message smartly poured her a glass of water.

“Thank you.”

She nodded at the nurse in gratitude.

“My mom’s in a coma now. The county hospital couldn’t treat her so I called an ambulance and brought her to Tuyu. But even here, the doctors all say there’s nothing they can do.”

Whenever patients are transferred in—especially those deeply comatose—almost any hospital will feel the heat.

Passing the buck, trying to send the patient away—it’s pretty much an unwritten rule.

That’s why it’s best to find a contact at the receiving hospital and ask clearly before transferring someone in.

Otherwise, if you haul the patient to a big hospital and get ‘gently’ refused, you’ll be caught in a terrible bind.

And the transfer itself is miserable for the patient.

Some patients in critical condition might not survive the bumpy ride at all.

“Where is she now?”

“Right over there!”

She stood up and pointed not far away. There was an elderly man leaning on a crutch, watching over a patient on a gurney. A nurse and doctor who rode in with them were also there.

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The doctor was rhythmically squeezing an air bag.

That usually means either the patient can’t breathe unaided or their oxygen levels are dangerously low.

Either way, if you need to squeeze the bag during transfer, things are way more serious than they look. If she were admitted, she’d definitely be put on a ventilator.

The doctors at Tuyu are all experienced and highly skilled. If they’re unwilling to admit this patient, the risks must be enormous.

With the current climate in healthcare, nobody wants to invite trouble.

So, to protect themselves, doctors would rather avoid risky cases if they can.

Turning someone away won’t affect their pay or promotions, but if they take in a case out of kindness and get ‘bitten’ for it, that’s a price they might not want to pay. Many young doctors and nurses start off naive and kind-hearted.

But after enough ‘farmer and snake’ episodes, they have to rein in all that compassion.

“Which departments have you already asked?”

Zhou Can got up and walked toward the patient. She followed closely behind.

“Neurosurgery, Neurology, Emergency, ICU—I’ve asked all four. They all said it’s too difficult and nothing can be done, so I thought of coming to you.”

“Too difficult” is just code for “we can’t handle this—try someone else.”

She’d already tried four departments, all giving the same response.

A heavy sinking feeling hit Zhou Can.

He probably couldn’t help this devoted, unlucky girl either.

The ambulance doctor and nurse saw Zhou Can approach but didn’t greet him. Their only job was to deliver the patient—now Tuyu refused admission and they couldn’t just leave. They were fuming inside.

So, of course, they weren’t in the mood to be friendly with Zhou Can.

“Is the patient still breathing on her own?”

“Barely.”

The male ambulance doctor replied coldly.

Zhou Can checked the patient’s heart rate and listened to her heart and lungs, then took her pulse.

Normally, heart rate and pulse match up.

But that just means the numbers should be the same.

Medically, they represent totally different things.

Heart rate is the number of beats per minute—doctors use this to assess heart function.

With Zhou Can’s skill as a cardiothoracic surgeon, he could pick up subtle clues just by listening.

Like whether the patient’s heartbeat is steady, or showing signs of bradycardia, premature beats, septal defects, tricuspid or mitral valve regurgitation, or other issues—all detectable to an experienced ear.

Pulse shows how well blood is being pumped, and whether the body’s getting enough circulation.

If you feel the carotid, you can estimate the brain’s blood supply.

But this is just the initial assessment—good for a first impression and pointing the doctor in the right direction.

After checking heart rate, pulse, heart and lungs, Zhou Can lifted the patient’s eyelid.

Her pupils weren’t dilated, but her reaction to light was weak.

“When did she fall ill?”

Zhou Can asked the elderly man leaning on a crutch.

Cheng Xiaolu had told him her father was injured on a construction site and walked with a disability.

Now it was clear—one pant leg was empty.

But the amputation didn’t seem to be high up—he still had his thigh.

“Dad, this is Chief Zhou. He can help get Mom admitted.”

She spoke in their dialect so her father would cooperate.

“It was the night of the 16th. I got up in the middle of the night and something about my wife didn’t look right—her mouth was a little crooked. I didn’t think much, figured maybe it was just how she looked while sleeping. But by around five in the morning her mouth had drooped even more, her eyes were wide open, she couldn’t talk or move. I called her but got no response…”

The old man recounted what had happened.

A little bit of medical knowledge can really make a difference.

In a crisis, it might save you or a family member’s life.

If only the old man had known enough to be alarmed by the drooping mouth—could she be having a stroke?

With heart attacks, strokes, brain hemorrhages and aortic dissections, every minute counts. The sooner you recognize it and get treatment, the better the outcome.

If you act quickly, you can limit the damage.

For instance, if you have a heart attack, just three minutes without blood flow can cause irreversible harm—a huge wave of heart muscle cells start dying off from lack of oxygen.

If you can get to the hospital in time, doctors can give clot-busting drugs or perform emergency surgery, restoring blood flow quickly and minimizing lasting damage.

The prognosis is usually much better when things move fast.

But if precious hours are wasted, things can go downhill fast.

Even if you pull through, the road to recovery is long—dead heart tissue means a weak heart, leading to heart failure and other complications.

A stroke is even more devastating.

The brain is as fragile as tofu compared to the heart.

Some doctors even describe it that way when teaching.

It’s not an exaggeration at all.

“I’ve checked the situation. It’s not good. Did they do any scans at the previous hospital?”

Zhou Can asked the girl and her father.

“Yes. All the images and reports are right here.”

Cheng Xiaolu quickly handed him the test results.

Always remember to bring along all test reports when transferring a patient—if some tests are still valid, there’s no need to redo them.

It saves time and money and spares the patient extra misery.

Plus you get the fastest diagnosis and treatment.

Of course, that only works if you come across a trustworthy doctor.

If you run into the wrong kind—it’s all about their own quotas, not the patient’s needs—they’ll make you redo perfectly good tests. That’s rough.

Zhou Can once treated a difficult case where the patient had a total of seventeen MRIs and CT scans.

There were reasons for it, but the lack of ethics among the doctors was plain to see.

The patient insisted their brain was diseased. Doctors checked but found nothing wrong.

The patient and family didn’t believe the diagnosis.

So, to convince them, the doctors just kept ordering scan after scan.

And it wasn’t all done at one hospital but spread over seven different places.

Even the cheapest brain MRI costs over six hundred yuan, and the higher the resolution, the more expensive.

Just the testing fees alone racked up tens of thousands.

The most expensive MRI at Tuyu costs 5,000 yuan per scan. It’s hard to get, and there’s a queue.

It’s reserved for the most complex, puzzling cases.

Only deputy chiefs or above can order it.

Usually it’s top specialists who submit these requests.

If a department chief needs it, they can apply too, but even then it must pass the Medical Department’s approval and a waiting list.

How many hospitals can really offer resources like Tuyu does?

Most are chaotic, and for upper management, as long as you “catch mice”—bring in revenue and boost reputation—you’re golden.

What counts as “catching mice”?

Anything that helps the hospital earn money and build prestige.

If you’ve got a tricky case, first get a regular doctor’s appointment and do the necessary tests. If they can’t diagnose, don’t get mad at their skill.

Keep those test results and schedule an appointment with a top specialist.

Match the expert to the disease—no point seeing a neurologist for stomach trouble.

Here’s why you should see a regular doctor first, then a specialist.

It saves both time and money.

A specialist visit costs three hundred, even up to eight hundred yuan. If you haven’t done any tests, the expert will just send you off for them anyway.

Many test results aren’t ready the same day.

That means waiting till tomorrow, or even the next day.

When the results come in, you book a follow-up, but the original appointment’s expired.

You’ll have to book again, and there’s no guarantee you’ll get a spot.

So book a regular appointment for just a few bucks, get all needed tests done, then take those results straight to the expert. Usually they can give you a diagnosis on the spot.

After that, your admission goes smoothly.

Saves time, effort, and money.

Zhou Can took the test reports from Cheng Xiaolu, reading through them to get the full picture.