Chapter 19: Full Hospital Consultation (Part 2)

About fifteen minutes later, Lin Yuming entered, carrying an enamel cup, his face beaming as he took his seat on the podium. He scanned the tiered lecture hall; nearly all the clinical department heads had arrived. Dozens of directors, deputy directors, and attending physicians represented the core strength of the mining hospital.

With most people present, Director Li of the Gastroenterology Department sat trembling in the front row. Lin Yuming lifted the enamel cup, blew on the tea leaves, and took a sip.

“Everyone’s nearly here. Let’s begin the hospital-wide consultation,” Lin Yuming’s voice buzzed through the microphone, filling the lecture hall.

“General Surgery, please start with the patient history.”

The hall fell into a hush.

Hospital-wide consultations were common, but usually involved only three or five related departments at most. Seeing so many gathered in one place today was unusual—there had to be a catch.

Everyone knew this was more than a simple consultation and leaned forward, eager for the drama.

Chen Yong steeled himself and stood. He tried to report the history on the spot, but Luo Hao beckoned him over to the microphone on the podium.

Chen Yong hated Luo Hao in that moment.

At the microphone, clutching the medical record, Chen Yong began presenting the patient’s condition.

“The patient presents with abdominal pain and generalized jaundice…”

His hands trembled slightly—not from fear, but from excitement and adrenaline. After starting, he calmed, his body adjusting, and his voice grew steady and fluent.

His brief but precise report was competent. Since joining the hospital, Chen Yong had been mentored by Jiang Wenming, building a solid foundation.

Lin Yuming was pleased with Chen Yong’s report—concise yet thorough with clear emphasis. If all young doctors at the mining hospital were like him, the future looked promising.

“The history report is complete. Which director would like to share their opinion first?” Lin Yuming asked.

Director Li hesitated, about to rise, but saw Wen Youren stride onto the podium.

“I’ll break the ice with a few words,” Wen Youren said harshly, glaring disdainfully at Li as if she were dead.

“As you heard, the patient underwent a cholecystectomy twenty years ago,” Wen Youren raised his voice. “Twenty years! I don’t understand why Gastroenterology sent the patient to General Surgery.”

“Is the gallbladder supposed to grow back within twenty years, requiring me, Old Wen, to operate again?”

“Director Li! The hospital and the municipal health commission have repeatedly ordered that patients must not be passed around. The responsibility for first diagnosis must be upheld. How did you handle this? Ignorance of the diagnosis and casually pushing the patient to another department?!”

The tension thickened the air. Even the least perceptive doctors were stunned, staring at Wen Youren.

This was no consultation—it was a personal vendetta.

Some directors and attending physicians thought it might be excessive, but seeing Lin Yuming calmly sip tea from his enamel cup, they felt helpless.

Wen Youren sought backing from the medical affairs office, wanting to make Gastroenterology look bad.

Sigh. They were colleagues—why go so far?

“The patient has a liver abscess; I believe that’s why Gastroenterology passed the patient to me. Director Li, please sit and listen politely,” Wen Youren’s tone grew wilder.

He caught Lin Yuming’s subtle nod and took it as encouragement, becoming more brazen.

“What to do with a liver abscess? Surgery? Aren’t you afraid of postoperative sepsis? The treatment for liver abscess is puncture! Puncture! Puncture!”

“During basic skills training, every doctor must master puncture techniques. It’s not necessary to transfer the patient to General Surgery. Li Shumei, don’t say you can’t do it!”

Wen Youren named her directly.

Li’s face flushed repeatedly, almost brought to tears by anger.

“Passing the patient to General Surgery was malicious! If I operate and the patient develops a high fever and has to stay in the ICU, who is responsible—Li Shumei or Old Wen?”

“This is General Surgery, where drug costs are low. The patient likely has sepsis and other complications requiring advanced antibiotics. You’re just offloading trouble and keeping cost-effective patients in your department!”

“Shameless!”

Wen Youren’s words grew harsher, even using terms like “cost-effectiveness,” rarely heard from him, ending with outright insults.

“I…” Director Li wanted to respond but had no microphone; her voice was a mere buzzing mosquito, ignored.

“Ridiculous!” Wen Youren continued, “You’re shirking responsibility, failing to implement the municipal health commission and hospital policies. This is irresponsibility toward the hospital, the director, and Director Lin!”

Every director was dumbfounded. Everyone knew Wen Youren’s temper was bad, but no one expected him to lose control like this, backed by the medical affairs office, ignoring the patient’s condition and attacking Gastroenterology.

The long-standing tension between General Surgery and Gastroenterology was well known, but no one imagined Wen Youren would use a hospital-wide consultation to undermine Gastroenterology.

“Director Li, please explain the condition,” Lin Yuming interrupted Wen Youren.

If this went on, it would only escalate. Lin Yuming carefully controlled the pace.

Wen Youren glared contemptuously at the petite Director Li.

Li’s blood pressure rose from anger. She ascended the podium and calmed herself for two minutes.

The silence was awkward. Everyone stared. A few doctors familiar with her wanted to defend her but ultimately stayed silent.

“The patient’s condition is complicated. Ultrasound shows a liver abscess with bile duct pneumobilia. I consider it likely caused by local inflammation.”

“What inflammation?” Wen Youren shouted. “The gallbladder was removed; no stones are visible in the bile duct. Where would inflammation come from? It’s the liver abscess!”

“Moreover, if inflammation exists, it’s treatable by internal medicine, not surgery!”

His aggressive tone overwhelmed Director Li, who struggled to respond.

Luo Hao stood beside the screen, observing.

Li did not counter effectively. She apparently did not know about sump syndrome; she only suspected a link to the cholecystectomy twenty years ago based on experience.

But she could not explain why.

It was time for Luo Hao to intervene.

He looked at Lin Yuming. After a moment, seeing Li silent and Lin flushed with embarrassment, they both turned to Luo Hao.

Their eyes met; Luo Hao nodded.

Lin Yuming set the enamel cup down under the table and made a decisive cutting motion with his hand.

Luo Hao nodded seriously.

“Director Li, please rest. We are all colleagues; minor conflicts are normal. Director Wen, no need to take things so personally.”

Wen Youren looked triumphant, as if having won a great victory.

“Any other directors wish to speak? Let’s focus on the case,” Lin Yuming asked, scanning the room.

No one spoke; silence blanketed the hall.

After a few seconds, Lin Yuming nodded, lifting the enamel cup again.

“Then the Medical Affairs Office will offer their opinion for everyone’s reference.”

The directors froze.

The Medical Affairs Office providing opinions?

In a hospital-wide consultation, the medical affairs office usually only moderated, ensuring departments didn’t shirk responsibility.

How was the referee stepping onto the field?

Luo Hao ascended the podium amid murmurs.

Once, the young doctor from Peking Union Medical College had been full of promise, but nearly two years at the mining hospital had passed quietly, until recently when he had become somewhat active. Still, only Obstetrics-Gynecology and General Surgery knew much about him.

Luo Hao opened his laptop, connected the projector, and launched a PowerPoint.

The directors and attending physicians were impressed.

This was the professional style of experts at academic conferences—unexpected to see it at a hospital-wide consultation.

Time was tight for these meetings; PowerPoint was unheard of.

This was eye-opening.

“Directors, good day. I represent the Medical Affairs Office to discuss this case. Please point out any shortcomings.”

Luo Hao’s warm, sincere smile felt like sunshine breaking through the gloom.

The bitterness Wen Youren had spread was swept away.

“Dr. Chen has reported the history, so we’ll skip that.

Here is the magnetic resonance cholangiopancreatography (MRCP) performed five hours ago.”

The image appeared on the screen.

“There is communication between the proximal duodenum and common bile duct. Inside the intrahepatic and extrahepatic bile ducts are ill-defined low-signal filling defects…”

Luo Hao delved into complex imaging details, which only a few could truly understand despite being department heads and attending physicians.

He continued, summarizing:

“The MRCP shows intestinal contents at the choledocho-duodenal anastomosis.”

Intestinal contents.

An anastomosis.

The directors frowned, puzzled.

“An anastomosis? What anastomosis? The patient claimed to have had a cholecystectomy twenty years ago. Where is this anastomosis?” Wen Youren asked, surprised.

Memories flooded his mind. He sensed a problem.

“Yes, an anastomosis,” Luo Hao smiled slightly. “There was an error in your past description, Director Wen.”

Error!

Luo Hao bluntly exposed Wen Youren’s mistake.

Wen Youren’s smile froze into an icy scowl. Luo Hao’s words confirmed his suspicions.

“Impossible! The patient said he had a cholecystectomy here twenty years ago!” Wen Youren shouted.

“Director Wen, please lower your voice; this is a hospital-wide consultation,” Luo Hao said calmly.

“Since the surgery was performed here, the medical record must be in the archives.”

He clicked the screen, switching images.

Faded, yellowed medical records appeared before everyone.

Even just from the image, the audience could smell the passage of time.

Though the records sat on shelves in the archive, no one had ever checked the patient’s history, especially for a surgery twenty years ago.

Both Li Shumei and Wen Youren had overlooked this.

Most directors and attending physicians were overwhelmed, unable to grasp the volume of information.

Luo Hao scrolled to the hand-written surgical record by the senior director at that time.

“This is the surgical record personally written by our senior General Surgery director, Guo Hua.”

“I verified the handwriting is his.”

In the era of handwritten records, it took twenty minutes to write a surgical report. That the senior director wrote it himself, rather than delegating, was significant.

Luo Hao’s statement caught everyone’s attention—it was clearly important.

Especially for Wen Youren, who stared blankly at the familiar handwriting.

It was indeed the senior director’s script; no forgery.

Knowing the senior director’s meticulous nature, Wen Youren understood the surgery must have had issues or potential complications.

The senior director’s personal attention was a warning.

Wen Youren’s heart sank.

He sensed danger.

He read further.

Suddenly, Wen Youren felt as if plunged into an ice cave.

The patient did have a cholecystectomy, but due to copious muddy stones found in the common bile duct, the senior director also performed a side-to-side choledocho-duodenostomy.

If so…

Wen Youren’s hair stood on end.

“The side-to-side choledocho-duodenostomy was a common procedure then. We cannot fault the patient—non-medical people would only know their gallbladder was removed,” Luo Hao said kindly.

“The medical records are in the archive. If one has even a modicum of professionalism, one should look. Don’t you agree, Director Wen?”

Luo Hao’s smile was gentle yet firm as he looked directly at Wen Youren.

Wen Youren’s blood boiled; he was being slapped in the face—publicly—without rebuttal.

“So what if it was done? The gallbladder’s gone. What else can surgery do?” Wen Youren started to stall.

“Director Wen, speaking loudly does not make you right,” Luo Hao answered coolly.

“Let’s discuss the postoperative complications of side-to-side choledocho-duodenostomy.”

Luo Hao cut off Wen Youren’s tantrum and began his presentation.

“The diagnosis should be sump syndrome, also called blind pouch syndrome.”

“MR imaging shows food residues and stones accumulating in the blind pouch formed by the biliary-enteric anastomosis to the Vater ampulla, causing symptoms.”

“Diagnostic criteria include…”

“Differential diagnosis includes…”

Luo Hao spoke fluently and logically, methodically covering every point.

At first enraged and resentful, Wen Youren’s face drained of color; his hands shook.

Doctors must rely on professionalism.

Before becoming a “dragon of malice,” every doctor’s dream was simple: to heal and save lives.

Even the most embittered must face unassailable facts silently.

Wen Youren recalled Luo Hao’s smile and the MRCP request he had approved.

Scenes flashed before him like a dying man’s final visions.

He realized in confusion that he had fallen into a trap.

Looking at Director Lin calmly sipping tea and Luo Hao confidently wielding facts against him, Wen Youren’s mind went blank.

Both men hid daggers behind smiles. He had been duped.

“Sump syndrome is a classic surgical case. Now, treatment.

Previously, similar patients required reoperation…”

Luo Hao did not dwell on attacking Wen Youren but continued with the case.

A bloody surgical image appeared on screen.

“This is a 1995 case, published in the Chinese Journal of Surgery.”

“At that time, surgery was the treatment. But with recent advances in minimally invasive techniques, ERCP combined with EST has replaced traditional open surgery for stones in the lower common bile duct.”

“EST? ERCP?”

The acronyms appeared onscreen.

“Dr. Luo, what kind of procedures are those?” an attending physician in the corner asked, captivated.

Luo Hao seemed prepared, scrolling to related materials and briefly explaining.

Even Lin Yuming listened intently.

Luo Hao’s explanation was concise, clear, and accessible.

Five minutes later, Luo Hao smiled.

“That’s roughly it.”

He paused.

“Ahh~”

Someone in the back sighed in relief.

Some had heard of ERCP, others not, but after Luo Hao’s explanation, all understood it was a minimally invasive procedure causing much less trauma and far better results than surgery.

Luo Hao opened a new door.

Behind it, doctors glimpsed a new world.

Reoperation meant anatomical changes complicating surgery. ERCP + EST avoided this; only the sphincter of Oddi needed to be cut to retrieve stones with a basket.

The thought of simplifying complex treatment thrilled the assembled doctors.

Only Wen Youren was an exception.

His face was ashen, eyes glaring venomously at Luo Hao.

“Director Wen, did you understand? If not, I can explain again,” Luo Hao said calmly, unfazed by the murderous glare.

“!!!”

A pure provocation.

Wen Youren clenched his fists, knuckles cracking.

“Back to our patient.

Given your level, Director Wen, I don’t think surgery is feasible. The Medical Affairs Office recommends inviting experts to perform ERCP + EST.”

“Not feasible!”

Luo Hao gave Wen no face, bluntly stating the opinion of the Medical Affairs Office, which he represented.

Doctors, still dazzled by the new technology, snapped back to reality.

This case was not just a clinical dispute but a clash of old and new ideas.

Though ERCP was no longer novel, it remained high-end care at the mining hospital, which had yet to adopt it.

“On what basis do you say that?!” Wen Youren spat through clenched teeth, each word rough as gravel, grating on ears.

Luo Hao regarded him thoughtfully.

“What are you staring at?” Wen Youren slammed the chair arm and stood abruptly, fury blazing, ready to strike Luo Hao.

Everyone tensed, glancing at Lin Yuming.

As Medical Affairs Director, Lin should intervene to calm Wen and prevent chaos.

But Lin Yuming remained unmoved, sipping tea from his enamel cup, indifferent.

Luo Hao’s expression was serious.

“Director Wen, I overrated you earlier. Do you really want to know why I say this?”

The voice was quiet but the microphone carried every word clearly.

A direct challenge.

Bloodshot eyes stared back.

“Fine. I’ll tell you why. By the way, Director Wen, youth is precious—better sit down and listen. If you rush me and get beaten, everyone will remember it.”

Luo Hao paused, smiling.

“If that happens, anyone with dignity won’t stay in this hospital.”

“You…”

Wen Youren knew Luo Hao spoke truth, but it stung.

Luo Hao opened another PowerPoint.

“Let’s compare General Surgery’s surgical difficulty, completion rates, and patient complaints before and after your tenure as director.”

“People boast over drinks, but the real story behind being a provincially recognized expert is known to us doctors. Fooling the public is one thing; don’t deceive yourself.”

Wen Youren nearly bit through a tooth.

Unable to fight or argue, he was helpless.

“These data come from nearly 25 years of General Surgery records. No doubts.”

“Before 2011, when Director Wen took charge, General Surgery performed about 1,800 surgeries annually, with 45% being level-4 difficulty. Appendectomies and hernia repairs were relatively few.”

“Pancreaticoduodenectomies averaged about 30 per year.”

“After 2011, none were performed, and high-difficulty surgeries almost ceased.”

“Although total volume declined slightly, I found that abdominal punctures were counted as surgeries under your leadership.”

“I wonder how you reported surgical achievements to hospital leadership during annual reviews.”

The lecture hall was deathly silent.

Luo Hao wasn’t just slapping Wen’s face; he was pinning him to the ground, grinding his face underfoot.

Lin Yuming was pleased, sipping tea from the enamel cup with satisfaction.