I Am Diagnosed as a Medical Titan

Chapter 236: Chapter 158: Protect Your Screen Name

Meng Shiyu happened to return just in time to hear the entire conversation.

At first, he was just listening quietly on the side.

Until... he heard Jiang He refute the attending physician’s plan.

Meng Shiyu froze.

Bismuth type IV hilar cholangiocarcinoma with major vascular encasement.

Even at a place like Xiangya, a case like this would only have one conclusion:

Incurable. Palliative drainage or discharge recommended.

But Jiang He said it was resectable? And he said it to the patient’s attending physician?

Meng Shiyu looked down, pretending to be invisible, and chose to continue playing dead.

He couldn’t understand what the expert was saying, nor did he want to.

This was probably the most terrifying episode of his life since transitioning from medical student to clinical practice...

In the office, Lin Haibo’s brow was tightly furrowed.

"Resectable? Jiang He, I know you’ve performed exceptionally well in the emergency department, but this is different. This is hilar cholangiocarcinoma. The tumor has already completely encased the right hepatic artery, and it’s stuck fast to the portal vein. How would you resect it?"

Jiang He’s expression didn’t change. "Extended left hepatectomy combined with a total caudate lobectomy."

"And what about the blood vessels?" Lin Haibo pressed.

"The right branch of the portal vein is experiencing inflammatory adhesion caused by the obstruction; it can be dissected. The affected vessel wall can be resected and then repaired with sutures. As for the right hepatic artery, we’ll transect it, mobilize the gastroduodenal artery (GDA), and flip it up for an end-to-end anastomotic reconstruction."

"Mobilize the GDA for anastomosis..." Lin Haibo muttered to himself, then shook his head. "That’s too idealistic. Never mind how difficult the vascular reconstruction would be. Even if you reconnected it, after an extended left hepatectomy plus a caudate lobectomy, the patient’s remaining liver volume would be absolutely insufficient. Have you calculated the future liver remnant (FLR)?"

"I have. The remaining right posterior and part of the right anterior sections would have a volume of around 550 milliliters, which is 45% of the standard liver volume," Jiang He replied.

"45% is indeed sufficient, but the patient’s current total bilirubin is 385. With such severe jaundice, their liver reserve function is extremely poor. Post-op, it would absolutely lead to irreversible acute liver failure."

"That’s why before performing this extreme surgery, we first need to reduce the jaundice. We’ll start with a percutaneous transhepatic cholangial drainage, a PTCD, of the right intrahepatic bile duct. We’ll aim to lower the total bilirubin to below 100, giving the liver a one to two-week recovery period to allow its function to compensate. As long as the metrics fall within the safe window, we can proceed with the curative resection."

Lin Haibo was a little stunned.

How was Jiang He answering all his questions without a moment’s hesitation?

’Could it be... this kid has thought of everything?’

...But he had to admit, Jiang He’s plan was logically sound, and every step was interlinked.

First, precisely reduce the jaundice, then perform an extreme curative resection.

In theory, this could indeed create a slim chance of survival.

But that was predicated on the lead surgeon possessing a terrifyingly high level of skill.

The number of people in the country who could perform a surgery of this level could be counted on one hand.

A thought suddenly flashed through Lin Haibo’s mind:

’Am I looking for Yang Xu?’

"..."

After a moment of silence, he said:

"Alright. Regarding this case, we’ll bring it up again for a department-wide discussion before the afternoon handoff. As for the family, I’ll go talk to them in a bit. I will communicate the situation to them honestly and ask if they’re willing to continue treatment if there’s a chance for a cure."

"Thank you, Teacher Lin." Jiang He nodded slightly.

Lin Haibo left quickly.

Meng Shiyu, on the other hand, cautiously sidled up to Jiang He.

He had originally intended to ask a question.

But now he’d changed his mind. He decided to do some extreme damage control first, so he said:

"Teacher... Teacher Jiang."

Jiang He turned to look at him. "What is it?"

"Um... about what I said to you in the hallway today... about Director Yang... I didn’t really mean any of it. I’m just new here, feeling a bit insecure, and was just spouting nonsense. Please don’t take it to heart."

Seeing Meng Shiyu’s "walking on thin ice" expression, Jiang He found it rather amusing.

He said in a gentle tone, "It’s fine. We’re the same age and from the same cohort. No need to worry so much. Let’s look out for each other in the department from now on."

Meng Shiyu grunted in surprise, and then his eyes filled with emotion.

He had thought that a "crown prince" like Jiang He, coddled by the director, would surely have a huge temper and could easily make his life miserable during his months of rotation.

He never expected him to be so approachable.

"Thank you, Teacher Jiang! I’ll definitely work hard under your guidance from now on!"

Meng Shiyu stood ramrod straight, just short of giving a salute.

Jiang He looked away and continued to flip through the lab reports on the desk.

In fact, looking at Meng Shiyu reminded Jiang He of his own years of struggling and hustling in the clinical world in his past life.

The people he despised most were those who, after clawing their way to a bit of status in the hospital and getting promoted to associate or chief physician, would shamelessly exploit the residents under them and throw their weight around the department at the slightest provocation.

Everyone who puts on this white coat shares the same goal: to treat patients and save lives.

Some learn the path earlier than others, and everyone has their own specialization.

Some are more talented and progress quickly, while others are less gifted and move slower. But as long as they’re doing the work, why should seniority be used to bully people?

Of course, if he encountered interns who didn’t work hard, lacked ambition, and failed to do their jobs properly, Jiang He always felt they deserved a good scolding.

But until then, he was willing to give every hardworking newcomer the respect they deserved.

"Where are the charts for beds thirty to fifty?" Jiang He asked.

"Oh, right! I just came back to ask a question... I’ll go get them now!"

"It’s fine. Don’t worry about them for now. Let’s go to the wards and check on the patients."

The two of them walked out of the office and began their daily clinical routine.

There wasn’t much for newly hired doctors to do, mainly just checking on the patients’ conditions.

Bed three, suppurative cholangitis.

Jiang He walked to the bedside, lifted the blanket, and glanced at the degree of scleral icterus in the patient. Then he pressed on the upper right abdomen. "Sir, does this hurt?"

"It hurts... comes and goes."

Jiang He withdrew his hand and turned to Meng Shiyu. "Monitor his urine output and blood pressure. If we can’t get his temperature down before noon, we’ll have to push the endoscopy suite to perform the ERCP early. Go record the current color and volume of the drainage fluid."

"Okay." Meng Shiyu immediately took out a notebook to record it.

They pushed the dressing cart to bed seven.

The patient in bed seven was being treated conservatively for liver trauma.

Jiang He put on gloves, removed the gauze, and carefully observed the area around the drainage tube.

"The drainage fluid is clear, and the volume is 20 milliliters less than yesterday," Jiang He said while skillfully disinfecting the area around the incision with an iodine-soaked cotton ball. "Meng Shiyu, you’ll be in charge of changing his dressing tomorrow. Pay attention to sterile technique during the procedure, and make sure the disinfection area for the iodine is large enough."

"Understood, Teacher Jiang." Meng Shiyu stared at Jiang He’s technique without blinking.

The hallway was bustling with doctors and nurses coming and going.

Chen Jing had just finished escorting a patient back to their room when she ran into Jiang He. She immediately smiled and greeted him, "Dr. Jiang, doing your rounds? The patient in bed one just rang the bell, said his incision is a little itchy. Could you take a look while you’re at it?"

"Sure, Sister Jing. I’ll head over right now," Jiang He nodded.

A few passing interns also stopped to nod in greeting when they saw Jiang He.

"Teacher Jiang, busy as always?"

"Working hard, Teacher Jiang."

"Morning, River God."

Meng Shiyu followed behind Jiang He, taking it all in.

He became more and more certain of one thing: Jiang He’s high status at Affiliated Hospital No. 1 definitely couldn’t be explained by publishing one top-tier journal article.

This atmosphere of intimacy and trust, from his superiors all the way down to the nurses, was something he had clearly earned through sheer competence in a clinical setting.

’Latch on! I have to latch onto this thigh and never let go!’

Meng Shiyu secretly swore to himself.

Nearing noon, the two finished their rounds and were about to head to the cafeteria for a quick bite.

When they reached a fork in the connecting corridor, they saw a familiar figure standing by the nurses’ station up ahead.

The top student of the eight-year clinical program, the great Xu Chen.

Hearing footsteps, Xu Chen turned his head and saw Jiang He.

Their eyes met for a second.

Xu Chen immediately straightened up and called out, "Teacher Jiang."

Jiang He was now officially employed and had his medical license, so Xu Chen called him "Teacher" willingly.

"Here again today?" Jiang He asked.

"Mhm, I’m admitting patients with my mentor this week," Xu Chen answered properly.

Just then, the door to the treatment room next to the nurses’ station opened halfway.

A young, sweet-looking nurse with a ponytail poked her head out, holding several bottles of saline solution for IV drips, and called out:

"Dr. Bao Bing, over here~"

Xu Chen turned his head. "Oh! Coming!"

Jiang He blinked, sizing up the two of them with great interest.

Only after calling out did the young nurse notice there was someone else in the hallway.

Her gaze met Jiang He’s, and she froze for a moment, seemingly recognizing him as the famous River God who had been the talk of the hospital recently.

Then, her cheeks immediately flushed red.

"Th-that is, Dr. Xu, hurry up and get the medicine..." the young nurse stammered before closing the treatment room door.

Xu Chen gave a couple of dry coughs, his expression also a bit unnatural. Not daring to meet Jiang He’s eyes, he said, "Teacher Jiang, well... I’ll get back to work."

With that, he scurried into the treatment room as if fleeing.

Jiang He chuckled.

No wonder he’d been seeing Xu Chen around the hospital building so often lately. Everything suddenly made sense...

"Dr. Bao Bing..."

Jiang He repeated the name softly to himself and grinned.

’This kid might just be a hopeless romantic.’

"Teacher Jiang, what’s a Dr. Bao Bing?" Meng Shiyu, who hadn’t understood what was going on, asked in a low voice.

"An online handle. This story teaches us that we should protect our online handles, you know?"

"Got it!"

Jiang He was clearly just joking, but Meng Shiyu very seriously jotted it down in his notebook.

When there’s a huge gap in status between two people, even if one tells a joke, the other person won’t get it. And even if they do get it, they won’t dare to admit it.

「4:30 PM.」

In the hepatobiliary surgery department’s large demonstration room, quite a few people had gathered.

The complete set of enhanced CT scans, MRI images, and all the blood chemistry indicators for the patient in bed 42, Zhao Youcheng, were displayed on the screen.

Director Yang Xu pushed the door open and walked straight to the center seat in the front row.

Amidst the swirling smoke, he was about to ask for a light.

Then, as if suddenly remembering something, he immediately barked, "Smoke-free department! How many times have I said it! Still smoking? I can’t control you people, is that it? Put them out! All of you!"

A few of the senior attending physicians were dumbfounded.

They hastily extinguished their cigarettes.

Seeing this, Meng Shiyu said quietly, "Teacher Jiang, smoking is bad for you. Want some areca nut?"

Jiang He was speechless. He said, "And how is that stuff any better?"

Meng Shiyu gave an embarrassed smile. "Ah, my apologies, my apologies."

He actually didn’t used to chew them either; he had picked up the habit from his seniors at Xiangya.

At first, he had even asked if it was bad for one’s oral health.

His seniors replied, "We’re at Xiangya. You’re worried about oral health problems?"

Meng Shiyu had a sudden epiphany and, from then on, started down a path of no return...

Yang Xu glanced at Jiang He, then said:

"Alright, let’s begin. Tell us about this... Bismuth type IV."

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