Free Web NovelChapter 38: Chapter 38: Misdiagnosed Pancreatic Head Cancer
Back at the budget hotel.
Jiang He flopped directly onto the bed, pulling the pillow and comforter into a tight embrace.
Her scent still lingered on the comforter and pillow.
It felt just like holding her tight in his arms.
He closed his eyes, a sense of peace washing over him.
A moment later, a message arrived from her.
Shen Yu: [Dr. Jiang, are you back yet?]
Jiang He replied: [Just got back.]
She replied instantly: [Around what time should we meet up tomorrow?]
Jiang He thought for a moment, then typed: [How about dinner? I have to go to Peking Union Medical College Hospital in the morning, so I’ll come find you in the afternoon.]
Shen Yu: [Okay! Just let me know when you’re done~]
Jiang He: [Yep.]
Shen Yu: [Get some rest, Dr. Jiang. You worked really hard today.]
Jiang He: [No, no, it was nothing. Just don’t move your foot too much and let it heal properly.]
After he sent that reply, the conversation was over.
But both of them, with a tacit understanding, remained on the chat screen.
’I want to send something else... but the conversation seems to be over. If I send another message, will I seem too talkative? Will I be disturbing his/her rest?’
Thirty seconds later.
Jiang He sent: [Oh, right, what do you want to eat tomorrow night?]
Shen Yu: [Oh, right! I forgot to ask, can you eat spicy food?]
They both froze for a second, then both felt a little embarrassed. fгeewebnovёl.com
’If only I’d known, I would’ve waited for him/her to message first!’
...
...
「The next morning, at Peking Union Medical College Hospital.」
On the second floor, inside a small conference room, Lu Xiaolin was giving a presentation.
As Jiang He walked in, Director Zhang was shaking his head.
"Xiaolong, this ’cell polarity reversal’ you’re talking about, how can it be implemented clinically? When surgeons operate these days, what they need are clear tumor margins. You’re proposing a morphological indicator, but how are we supposed to make a judgment based on that from a rapid intraoperative frozen section? It doesn’t conform to clinical standards."
Lu Xiaolin explained, "Well... if we do a preoperative puncture..."
"Don’t you know how high the false negative rate is for preoperative punctures? Given the pancreas’s location, a puncture can easily cause needle tract seeding. It’s impossible to increase the patient’s risk for the sake of your inconclusive indicator."
Lu Xiaolin sighed.
’Director Zhang did have a point.’
He saw Jiang He to the side and made an introduction. "Director, this is the student from our group responsible for clinical liaison."
Jiang He bowed. "Hello, Director. I’m Jiang He, from the Class of ’06, Clinical Medicine, at Southern Medical University."
After speaking, he exchanged a look with Lu Xiaolin.
Lu Xiaolin nodded.
Jiang He got straight to the point.
"The problem Director Zhang just mentioned—the difficulty of judging intraoperative frozen sections—does indeed exist."
"Therefore, I suggest we abandon the traditional preoperative endoscopic ultrasound-guided fine-needle aspiration. Instead, after opening the abdomen, we can use an intraoperative ultrasound probe for direct guidance to perform a three-point coarse-needle core biopsy..."
Jiang He said quite a lot in one breath.
Some people at the scene raised questions.
Jiang He did his best to answer them, all while keeping the limitations of the current era in mind.
Listening from the side, Lu Xiaolin was filled with admiration.
’My junior’s academic level and ability to think on his feet are truly impressive. I really need to learn more from him. It’s a good thing I asked him to come today.’
After a smooth and fluent Q&A session,
Director Zhang nodded. "If you put it that way, it’s actually not bad."
Another doctor asked with a smile, "Xiaolong, are all the third-year students at Southern Medical University this impressive nowadays?"
Lu Xiaolin said, "Professor Yang Xu personally requested for Jiang He to join the group. He’s outstanding."
Hearing Yang Xu’s name, several of the experts nodded again.
"Alright, this proposal has some merit. Leave the documents. We’ll discuss it again at next week’s departmental meeting."
Director Zhang had spoken. The matter had passed the first hurdle.
Lu Xiaolin quickly handed over the documents.
The world of medical academia was a place where connections and social etiquette were paramount. To publish a high-level paper, besides the quality of the work itself, one often needed the endorsement of authoritative experts in the field.
To put it bluntly, Lu Xiaolin’s trip to Peking Union Medical College Hospital this time was to pay respects to the powers-that-be on behalf of his mentor.
Just as the two were preparing to take their leave, a doctor poked his head in and spoke rapidly:
"Director Zhang! The joint consultation between Gastroenterology and General Surgery is about to start! The Vice President is there too. The family is very emotional and pushing for a treatment plan. You need to get over there right away!"
Director Zhang stood up at once and asked, "Is it that coal boss from Jin City?"
"Yes, the one who was just transferred to the special-needs ward yesterday. His jaundice has worsened."
Director Zhang walked out quickly, pausing for a moment as he passed by Jiang He and Lu Xiaolin.
He looked at Jiang He and suddenly said, "Since you two are Yang Xu’s students, you should come and listen in as well."
Lu Xiaolin was stunned for a moment, then overjoyed.
’A top-tier joint consultation at Peking Union Medical College Hospital! This was the kind of learning opportunity you couldn’t find even if you searched with a lantern!’
Special-Needs Ward Conference Area.
Jiang He and Lu Xiaolin were seated in the gallery, in the furthest corner.
"What is General Surgery’s opinion?" Vice President Zhao Licheng asked.
The Director of General Surgery, Xu Wenpei, a gaunt and stern-looking middle-aged man, said:
"Based on the clinical manifestations and imaging, we’re seeing painless jaundice, a pancreatic head mass, and elevated CA19-9—a classic presentation of pancreatic head cancer. Considering the blood vessels have not yet been invaded, this is the perfect time for surgery."
"I recommend scheduling the surgery immediately to perform a pancreatoduodenectomy (Whipple procedure). The family has also made it clear that money is no object, as long as we can completely resect the tumor, use the best drugs, and the best equipment."
As he finished speaking, several experts in the conference room nodded in agreement.
"I agree with Director Xu’s opinion. Pancreatic cancer progresses extremely rapidly. If we delay any longer and the blood vessels become invaded, we’ll lose the window for surgery."
"The family is strongly in favor, and the patient isn’t too old. Although the Whipple procedure is traumatic, it’s manageable as long as the postoperative care is up to par."
"Let’s just operate. Relieve the obstruction first, then confirm with pathology."
Vice President Zhao Licheng nodded and said, "Since everyone is in agreement, let’s schedule the surgery as soon as possible. With this kind of VIP patient, we must demonstrate the efficiency and skill of Peking Union Medical College Hospital."
The discussion seemed to be settled.
In the corner, Lu Xiaolin was also quickly jotting down in his notebook: "Classic pancreatic head cancer, Whipple procedure is the first choice..."
Of everyone in the room, only Jiang He was looking at Zhao Licheng and Xu Wenpei in the front row with a complex expression.
He’d actually run into two acquaintances.
’Vice President Zhao Licheng. In his past life, the name was infamous.’
’In less than two years, he would be thrown in jail for his involvement in an egregious case of medical equipment corruption, academic fraud, and covering up a major medical malpractice incident.’
’His quick approval of the surgery now wasn’t necessarily all about saving the patient; it was more because of the family’s statement that money was no object.’
’A top-tier Whipple procedure meant a legitimate reason to use the most expensive imported consumables and exorbitantly priced postoperative drugs.’
’But the Director of General Surgery, Xu Wenpei, the one who looked so old-fashioned, was the complete opposite.’
’In his past life, this man had been the father of a bridesmaid at his wedding, a comrade-in-arms. He had spent his entire life refusing bribes from any pharmaceutical representative and fiercely criticizing the over-commercialization of medicine. Ultimately, in 2015, after a grueling twenty-hour continuous emergency surgery, he suffered a sudden myocardial infarction and died right next to the operating table.’
’His strong advocacy for surgery now was entirely because, limited by the medical knowledge of 2008, he genuinely believed it was the only way to snatch a patient’s life back from the jaws of the "King of Cancers."’
’Two completely different men, driven by entirely different motives, were pushing for the same treatment plan.’
’But... both of them were wrong.’
’This was the very field Jiang He had specialized in during his past life.’
’He was certain this wasn’t pancreatic head cancer, but rather autoimmune pancreatitis (AIP).’
’In 2008, the concept of AIP had only just recently been established internationally.’
’Clinicians in the country rarely considered it a primary differential diagnosis.’
’The surgeons’ mindset was still one of: better to kill three thousand by mistake than to let one slip through the cracks.’
’If they treated this according to the pancreatic cancer diagnosis, the coal boss from Jin City would be on the operating table by tomorrow, having his duodenum, gallbladder, a small part of his stomach, and the entire head of his pancreas removed.’
’In reality, if it were correctly diagnosed as AIP, no surgery would be needed at all.’
’All it would take was a prescription for a ten-yuan bottle of prednisone. After two weeks, the massive tumor would melt away like ice and snow, and the jaundice would subside along with it.’
’A major surgery that could be a life-or-death ordeal could, in fact, be resolved with just a single bottle of steroids.’
’This was a limitation of the era, and a blind spot in medical knowledge.’
"Good. Since no one has any objections, it’s settled." From the front row, Vice President Zhao Licheng made the final decision. "General Surgery, go talk to the family and have them sign the surgical consent form."
Xu Wenpei closed the medical file and nodded.
Lu Xiaolin started packing up his pen and notebook, ready to leave as the meeting concluded.
Jiang He remained seated, deep in thought, weighing the pros and cons.
In the conference room, the experts were already getting up, pulling back their chairs to leave.
Jiang He sighed, and finally spoke up. "Directors, please wait a moment." freewёbnoνel.com
Everyone froze.
Director Zhang turned back, his brow furrowed slightly. "...Jiang He? What is it?"
Jiang He stood in the corner and said softly, "Director, regarding the diagnosis of pancreatic head cancer, I have an idea I’d like to present. It will only take thirty seconds of your time."
