18 Hospital-Wide Consultation (Part One)

“Luo,” Director Wen said, noticing Luo Hao was present. He began to complain, “Look at the Department of Gastroenterology. What kind of state is this? The patient’s gallbladder has already been removed, and the diagnosis of a liver abscess is clear. The Medical Affairs Department has explicit regulations: liver abscess patients should be treated in Gastroenterology.”

“To have such a patient sent to me is simply preposterous! This is blatant patient-shirking. Since you happen to be here, tell me, what is the Medical Affairs Department’s stance on this?”

“Director Wen, I will report this to Director Lin immediately,” Luo Hao replied in a low voice. “For now, please admit the patient. Don’t just leave them out in the hallway.”

“This!” Director Wen’s eyes widened.

“What I mean is, let’s organize a hospital-wide consultation. We can clarify the facts in person and have the patient transferred. As for whether it can be cured, that’s no concern of General Surgery. The Department of Gastroenterology is clearly in the wrong here—shirking patients is never acceptable—but regardless, we cannot leave the patient in the corridor.”

Director Wen thought for a few seconds before calling out, “Chen Yong, go ahead and admit the patient.”

“Luo, should you report this to Director Lin, or should I do it myself?” Wen Youren asked, curling his lip and speaking in a muffled tone, clearly dissatisfied with how Luo Hao was handling things.

*Do it himself?*

Luo Hao nearly burst out laughing at the thought. Director Wen really had an inflated sense of his own importance; the term “personally” sounded quite comical.

“Director Wen, I’ll report the details first; there are many trivial matters, and Director Lin already has a general idea. Then, you can express your stance on your end and apply some pressure,” Luo Hao suggested thoughtfully.

Seeing that the director was still unsatisfied, Luo Hao smiled. “I will suggest that the hospital-wide consultation be on a larger scale. We’ll invite every relevant department, especially those related to geriatric medicine. We will clarify the situation in front of all the department heads. What Gastroenterology has done is unethical. With more people present, they’ll think twice before pulling this again.”

“Right! Call all the department heads in the hospital and let’s see what the Department of Gastroenterology is made of,” Director Wen agreed in a low voice.

Every word Luo Hao spoke resonated with him. In Wen Youren’s eyes, this was clearly a case of the Department of Gastroenterology deliberately shirking a difficult patient. They couldn't handle the tricky case, so they used the patient's gallbladder surgery from twenty years ago as an excuse to dump them onto General Surgery.

It was utterly ridiculous. What did a cholecystectomy from two decades ago have to do with a current liver abscess? Absolute nonsense!

Director Wen looked at Luo Hao with great satisfaction, thinking the young man was exceptionally bright. He had identified the core of the issue immediately and was willing to stand up for General Surgery instead of just trying to smooth things over.

“Luo, thank you for your hard work,” Director Wen said, a rare compliment.

“Director Wen, it’s no trouble at all; it’s my duty. Please go ahead with your work; I’m going to report the situation.”

Luo Hao didn't return directly to the Medical Affairs Department. Instead, he helped Chen Yong admit the patient, gathering as much information as possible. Based on his own judgment and the confirmation from the diagnostic AI, Luo Hao was certain it was "Sumac Syndrome" (also known as sump syndrome).

Knowing the gravity of the situation, he checked the patient's history and discovered the surgery twenty years ago had also been performed at the Mining General Hospital. He made a trip to the Medical Records Room. When he found that "ancient" medical file, a confident smile appeared on his face.

Back at the Medical Affairs Department, Luo Hao briefed Lin Yuming on the situation.

“The surgery was performed twenty years ago by the old department head, Director Guo Hua. I went to the records room and borrowed the file from back then.”

“Twenty years ago… back then, it was good enough to even have a record; they were mostly just scribbled by interns,” Lin Yuming asked, “Is it of any value?”

“Yes!” Luo Hao placed the yellowed file on the desk. “The general history and progress notes have no reference value, but the handwriting on the operative note is different from the rest. I believe Director Guo Hua wrote it himself.”

“Oh?!” Lin Yuming’s eyes lit up.

In the era of electronic records, department heads and surgeons rarely write their own operative notes. Back then, everything was handwritten. If the old Director Guo had written it himself, there had to be a reason.

“The patient’s condition is quite specific. Although diagnosed with cholecystitis and gallstones, Director Guo didn't just perform a simple cholecystectomy during the surgery; he also performed a high-difficulty side-to-side choledochoduodenostomy.”

“Director Guo wrote clearly that the patient had sludge-like stones in the common bile duct, which is why he performed the bypass.”

Lin Yuming turned to the page with the operative note and flipped through it gently. Time had passed, and the file hadn't been touched since it was archived. A faint, musty scent rose from the pages, silently telling the story of what happened all those years ago.

“What is the diagnosis now?” Lin Yuming asked directly.

“Sump Syndrome.”

“???” Lin Yuming looked at him with a face full of questions.

“This condition is also known as blind pouch syndrome. It’s a rare complication following a side-to-side choledochoduodenostomy. It refers to the accumulation of food debris or stones in the blind pouch formed between the biliary-enteric anastomosis and the Ampulla of Vater, causing a series of clinical symptoms.”

Lin Yuming roughly understood what Luo Hao was describing. “Does it require surgical intervention?”

“It used to, yes. But in the last decade, it’s mainly treated with Endoscopic Retrograde Cholangiopancreatography (ERCP) combined with biliary clearance.”

“Endoscopy, huh.” Lin Yuming tapped his fingers on the file. A shaft of sunlight shone in, illuminating dust motes dancing within the pages of the old record.

Lin Yuming was deep in thought. Strike at the root. He needed irrefutable evidence to bring Wen Youren down—or at the very least, make it impossible for him to hold his head high at the hospital. Beating Wen Youren was only one goal; Lin Yuming also wanted to use this opportunity to develop new techniques.

Luo Hao’s explanation sounded excellent, but the key was that Lin Yuming knew nothing about this condition. A cholecystectomy twenty years ago leading to a complication that only flared up now? He had instinctively felt it was unlikely. But his trust in Luo Hao was growing by the day.

Glancing at Luo Hao, Lin Yuming felt a momentary daze. Without realizing it, Luo Hao had grown into a fine young man. In the shifting light, he almost saw his old friend. Luo Hao looked so much like his father.

“Uncle, do you have any doubts? I think we could consult Teacher Liu. If even he isn't sure...” Seeing Lin Yuming silent, Luo Hao assumed he had concerns and offered his advice.

“What other tests are needed?” Lin Yuming asked.

“Magnetic Resonance Cholangiopancreatography (MRCP).”

“Fine. Tell me again exactly what you said to Wen Youren.”

Luo Hao repeated his conversation with Director Wen word for word.

“Take the patient for the tests. The diagnosis must be precise—absolutely no ambiguity. If you’re unsure, tell me; I’ll consult experts in the province. Of course, you can also consult your teacher,” Lin Yuming said in a low voice.

“Understood.”

As Luo Hao left, Lin Yuming looked at the A4 sheet covered in scribbles that only he could decipher. He picked up his phone and called Deputy Director Liu.

“Old Liu, you said that if there were complications from a cholecystectomy twenty years ago, wouldn't they have appeared long ago?” After a brief description, he asked.

“Boss Lin, generally speaking, the peak period for complications after a side-to-side choledochoduodenostomy is within five years. Twenty years? Well, it’s not impossible,” Liu Haisen replied. His tone shifted, and he added lightly, “Boss Lin, this diagnosis didn't come from you or the directors at your Mining Hospital, did it? It was Luo Hao, if I’m not mistaken.”

“...” Lin Yuming was stunned.

“This condition isn't common. I doubt your hospital can even perform a choledochoduodenostomy anymore,” Liu Haisen said. “If you can’t perform the surgery, let alone deal with twenty-year-old complications...”

“Luo Hao told me. I wasn't sure, so I’m asking you.”

“Doing an MRI is correct. Once confirmed, there are several solutions. It used to require surgical intervention, which is difficult and high-risk. Recently, Director Shi handled a few similar patients sent from local hospitals, and the results were quite good.”

“!!!” Lin Yuming’s eyes lit up.

“Do you have ERCP equipment there?” Liu Haisen asked.

“We do.” Lin Yuming said with a touch of irony. “A few years ago, the mining district was flush with cash. We bought almost any new equipment requested, the most advanced stuff. Those were good times—none of these petty headaches we have now.”

“Haha, it’s been nearly ten years, does it still work?”

“It should. It’s been gathering dust, but I’ve kept up with the manufacturer’s maintenance every year,” Lin Yuming said. “So, ERCP can solve this, right!”

“Yes, but the data must be complete. Look, since you don’t understand the technical side, I’ll communicate with Luo Hao.”

*Since you don’t understand.* The remark was a bit sharp, but Lin Yuming didn't take it to heart. During his university days, he’d heard worse every day. It was just daily life. Besides, it was the truth.

After hanging up, Lin Yuming drew lines across his A4 paper, mapping out the next steps like a talisman. Wen Youren? Hah! I’ll show you.

...

Luo Hao "reported" to Wen Youren, persuading him to order an MRCP for the patient. Wen Youren’s medical proficiency was limited to simple cholecystectomies, gastrectomies, and bowel resections; he was clueless regarding high-difficulty diagnosis and differential diagnosis of pancreatic and bile duct issues. He readily agreed.

A few hours later, after anti-inflammatory treatment, the patient’s pain had eased. Luo Hao and Chen Yong took the patient for the MRCP.

When the images appeared, Chen Yong frowned at the screen. “Luo Hao, there are ill-defined low-signal filling defects in the intrahepatic and extrahepatic bile ducts. There must be a foreign body.”

“Yes, likely bowel contents causing an obstruction at the choledochoduodenostomy site.”

“As I thought!” Chen Yong clenched his fist, his almond-shaped eyes narrowing at the screen. “My teacher said the patient likely had a side-to-side choledochoduodenostomy! The imaging proves my teacher was right!”

Luo Hao nodded. Jiang Wenming was truly impressive; it was a pity he had stepped away from clinical practice. But one couldn't force a man’s path.

“I told you, Director Wen must be wrong. Luo Hao, isn't the Medical Affairs Department going to make a statement?” Chen Yong asked.

“A statement? What kind of statement?” Luo Hao asked.

“In clinical practice, right is right, and wrong is wrong. It should be black and white!”

When he said “black and white,” Chen Yong’s gaze was unusually firm. He wasn't wearing three layers of masks, and his handsome face seemed to embody the very words.

“Director Wen is, after all, a director. We have to consider his reputation,” Luo Hao said vaguely.

“You guys... you’re really something else!” Chen Yong said with indignation.

*Easily angered, aren't you?* Luo Hao smiled slightly.

“As long as the patient receives proper treatment and recovers, isn't that what matters?” Luo Hao asked.

“What about the future? Director Wen’s level is so low, yet he suppresses other doctors. My teacher is a skilled surgeon, and he was forced into the outpatient clinic by him.”

“The outpatient clinic isn't bad—at least you don't have to work night shifts. Besides, don't you think you’re being a bit self-righteous? You don't seem as noble as you think.”

Luo Hao retorted and turned back to prepare the imaging data. Liu Haisen had started a group chat, bringing together himself, Luo Hao, Lin Yuming, and Director Shi. After checking all the data, Luo Hao uploaded the patient’s files to the cloud and shared the link.

[Teacher Shi, could you please take a look and see if our diagnosis is correct?]

[One moment, let me check.]

A few minutes later, Director Shi replied. After the patient was returned to the ward, Director Shi gave a definitive answer: Luo Hao’s diagnosis was correct. He recommended an endoscopic sphincterotomy combined with biliary clearance.

Whatever happened after that was no longer Luo Hao’s concern. His uncle was preparing to deal with Wen Youren; he couldn't let it slide that Wen had instigated the patient’s family to sue the hospital.

“You guys are too much,” Chen Yong continued to grumble, though his voice dropped after Luo Hao’s earlier retorts.

“It’s fine, really. At least the patient has a diagnosis now,” Luo Hao comforted him. “Director Lin is currently contacting experts from a higher-level hospital to perform the minimally invasive surgery. Rest assured, the disease can definitely be cured.”

Chen Yong’s expression softened slightly, but he still looked at Luo Hao with disdain. Luo Hao actually felt a bit of fondness for this young doctor who saw everything in black and white, even if Chen was hostile toward him.

“Come on, let’s go have a smoke. Stop being so angry,” Luo Hao said after settling the patient, pulling Chen Yong toward the fire escape.

“No smoking in the hospital!” Chen Yong replied stiffly.

“Oh, come on, I’ve seen your teacher smoke,” Luo Hao said, smiling. “Let’s go, don't be angry.”

Chen Yong glanced at Luo Hao and seemed to remember something. He “reluctantly” stood up.

As they stepped out, a beautiful woman about twenty-five or twenty-six, wearing a mustard-yellow long coat, stockings, and high heels, walked toward them. Seeing this outfit in the current weather, Luo Hao shivered. The woman’s cold resistance was truly superhuman.

“Why are you here?” Chen Yong stopped, his face stony.

“Can’t I come see you? Did I interrupt your date with a nurse?” The woman smiled sweetly. Seeing Chen Yong’s expression, she quickly softened her tone. “I brought you food.”

“...”

Chen Yong didn't reach for the insulated lunch box she offered. *Not bad, Chen Yong, someone bringing you food,* Luo Hao thought, watching the show.

“Honey, let me tell you something,” the woman said affectionately.

“Go ahead.”

“When we argue, can you not get angry? Just give me a hug, that’s all I need,” she said, her voice dripping with sweetness. “We’re lovers, not enemies. Please don't always keep such a cold face.”

“Do you have any idea how hard you are to handle, like a pig before the Lunar New Year?” Chen Yong asked.

“You!”

Luo Hao reached out and gave Chen Yong a shove from behind.

“We have to prepare the materials for the hospital-wide consultation in a bit. Hurry up,” Luo Hao whispered.

Chen Yong realized this wasn't the time for romance. He took the lunch box and whispered a few words to the woman. She beamed, turned, and left. Her mustard-yellow coat seemed to blossom like a flower.

In the fire escape, Luo Hao teased, “Not bad, someone bringing you food. I’ve been at this hospital for nearly two years and worked in clinical wards, but I’ve never had family bring me food.”

“It’s meaningless.” Chen Yong pulled out a cigarette, didn't offer one to Luo Hao, lit it himself, and sat down on the steps.

“That’s classic ‘pump and dump’ behavior, you total scumbag.”

“Nonsense,” Chen Yong replied. “I’m an honest man. I made it clear from the start: just dating, no marriage.”

“Uh...”

“She’s just greedy for my body.”

“Screw you!”

Luo Hao truly didn't know where Chen Yong got such narcissism or the courage to say that.

“That girl looks nice, though.”

“Wise men don't fall into the river of love unless they meet a wealthy woman.”

“Where did you learn to talk like that?” Luo Hao asked.

“My teacher.” When Chen Yong mentioned Jiang Wenming, his tone softened.

“...”

“My teacher says there are a few modern ways to accumulate merit: don't urge people to get married, don't urge people to have a second child, and don't stop people from getting a divorce.”

“Is he single?”

“Yeah, divorced for five or six years.”

Luo Hao thought of his uncle. By Jiang Wenming’s standards, his uncle definitely wasn't accumulating much merit.

“Write the medical records properly. Once you’re done, I’m going to review them.”

“!!!” Chen Yong looked at Luo Hao as if he were an idiot.

“You just like bullying people, don't you?” Chen Yong said with disdain. “You don't dare touch Director Wen, so you just bully junior doctors. You’re all birds of a feather.”

“It’s all for your own good,” Luo Hao smiled.

“Everything is done under the banner of ‘for your own good.’ That’s the favorite motto of those bureaucrats. What else do they say? Right: ‘Do it if you want, quit if you’re scared; the hospital won’t collapse without you.’ Try saying that in Pediatrics and see if the department can still function.”

“So many complaints.”

“Complaints? I’m just stating facts.” Chen Yong had already categorized Luo Hao as one of the bureaucrats and couldn't be bothered to say another word. He extinguished his cigarette and stumbled out of the fire escape.

Luo Hao ignored him. If Chen Yong wrote the records well, he might become invisible during the hospital-wide consultation. Otherwise, Chen Yong might be the one Wen Youren throws under the bus.

Luo Hao only had a fondness for Jiang Wenming; he had no interest in this philandering, disgruntled guy. He lit a cigarette, sat on the steps, and began to carefully deliberate on the ERCP procedure.

The Mining Hospital had never performed such a surgery; practicing it beforehand was crucial. Luo Hao cautiously utilized his system’s surgical training time.

The first run, 70% completion.

Luo Hao blinked, realizing the stone retrieval using the basket was tricky and required precision. But that was secondary. After running it once, he realized the hospital might not even have some of the necessary consumables.

After some calculation, Luo Hao took out his phone and made a call.

“Manager Yin, I recall our company invested in a medical device firm three years ago.”

“Mr. Luo, that is correct,” a deep, magnetic voice replied.

“Do you have ERCP consumables? I need them, urgently.”

After selling his Bitcoin years ago, Luo Hao had placed a portion of the funds in a long-standing trust company in Hong Kong. But rich people die in trusts. After a major trust scandal in the country caused heavy losses for high-net-worth families, Luo Hao had withdrawn 75% of his funds, putting most into fixed-term deposits and starting two companies: Luolin Real Estate and Luolin Investment. He had professional managers handling them, so he didn't need to worry. He vaguely recalled investing in a medical supply company, and now, it was needed.

Luo Hao glanced at the system panel in the top right of his vision; his luck stat of 33 was shining brightly.

“Mr. Luo, I will have the relevant details within 30 minutes...”

“No need for that level of detail. If you have the ERCP supplies, please find a way to get them to me; I need them for a surgery. If not, acquire a company or bring them through the medical supply company’s channels. Can you do that?”

The other side fell silent.

“Fine, that’s that. I’m busy here, I’ll wait for your news, Manager Yin.”

“Understood, Mr. Luo. As you wish.”

After hanging up, Luo Hao entered the system surgery room once more to train.

A few minutes later, Luo Hao left the fire escape, feeling satisfied. The surgery completion was 100%. Although it cost him all his system training time, he was very content.

Back in the doctor’s office, Chen Yong was buried in his writing, not saying a word, acting as if he didn't know Luo Hao. Luo Hao didn't mind and stood behind him to watch.

“Hey, can you not stand behind me!” Chen Yong immediately protested.

“Sooner or later, you’ll have to show me. I’m here representing the Medical Affairs Department in General Surgery,” Luo Hao said calmly.

“!!!”

Chen Yong finally understood why his teacher chose to work in the outpatient clinic. Although you still had to deal with these bureaucrats there, it was relatively less frequent.

*Damn it!* Chen Yong cursed internally and stopped acknowledging Luo Hao.

“Luo, come here for a second.”

Just as Chen Yong was feeling completely awkward, Director Wen appeared at the doorway and called for Luo Hao. For the first time, Chen Yong thought Director Wen looked somewhat agreeable.

“Luo, will there be enough people attending the hospital-wide consultation?” Wen Youren asked.

“Should be enough.”

“‘Should’? That won’t do.” Wen Youren was displeased. “The Department of Gastroenterology thinks that just because they’re an ‘upstream’ department, they can dump their difficult cases on us. This is a corrupt practice that must be stopped!”

“Director Wen, you are absolutely right,” Luo Hao smiled.

“I suggest—just a suggestion—that you mention this to Director Lin.”

“Go ahead, Director Wen.”

“I suggest we hold this consultation as a grand ward round, where every department head must attend.”

Luo Hao smiled happily; he watched as Wen Youren dug his own pit and jumped right in. Contacting Lin Yuming met with zero resistance, and the consultation was scheduled for the lecture hall.

In four hours, Luo Hao prepared a PowerPoint presentation. Despite the tight schedule, he finished everything methodically. At Wen Youren’s urging, they headed to the hall.

Most of the hospital’s department heads had already arrived. They looked solemn, sensing something was wrong—that a major event was about to unfold today.