The next day, the news that Zhang Lide, the head of the Department of Internal Medicine, had taken on an intern spread like wildfire throughout the entire department and even reached the ears of other departments. Many were astonished by this development, while a significant number were highly skeptical.
Typically, interns were assigned to attending physicians at most, and it was exceedingly rare for a deputy chief physician to take on such a role. As for a department head mentoring an intern, at Affiliated Hospital No. 1, this was unprecedented—let alone the head of a major department like Internal Medicine.
Thus, when the news broke, many simply refused to believe it. However, several physicians who had been on duty in Internal Medicine the previous day swore that Director Zhang had indeed brought an intern to the ward to see patients. It wasn’t a ward round; he was simply guiding the intern through patient visits.
These doctors even added mysteriously, “This intern has become quite famous in Affiliated No. 1 recently—he’s the one who performed a tracheotomy on a patient himself…”
Given their vivid accounts and corroboration from doctors in several departments, it became difficult to disbelieve the story.
Consequently, the doctors and nurses at Affiliated No. 1 grew intensely curious. Just who was this Xu Ze, who could move the notoriously aloof and demanding Head of Internal Medicine, Zhang Lide, to personally mentor him? It was a mystery.
Most of those who knew the truth about Xu Ze were the various department heads within Internal Medicine. The fallout from the earlier project competition incident still lingered, and since it involved the department’s reputation, they naturally kept Xu Ze’s situation under wraps.
The Emergency Department’s Director Qu and a few doctors there were the only ones outside Internal Medicine who knew Xu Ze’s real background. However, Xu Ze had previously worked in the Emergency Department under the guise of a rotating resident physician. Now, his official status was that of an undergraduate intern from Xingda University who hadn’t graduated yet.
No one dared to reveal Xu Ze’s true identity. If it got out that the Emergency Department had allowed an ungraduated student to pose as a rotating resident, even Director Qu could face serious trouble.
Thus, Xu Ze became a minor celebrity among the medical staff at Xingda Affiliated Hospital No. 1. Many were eager to see just who this young man named Xu was—what made him so remarkable that he could earn such special favor from the head of Internal Medicine, Zhang Lide.
The news even reached the Xingda University campus, spread by classmates who had personally witnessed Xu Ze following Zhang Lide for one-on-one mentorship.
This caused quite a stir within the university’s School of Clinical Medicine, especially among fourth-year students also doing their internships. They understood the immense privilege of being mentored by the head of Internal Medicine at such a prestigious hospital, and their respect for Xu Ze grew even more.
The top figure on the university’s “influential persons” list was indeed extraordinary; wherever he went, he seemed to attract attention.
Xu Ze, at the center of this storm, was largely unaware of the buzz. He was currently by Zhang Lide’s side, observing consultations in the internal medicine outpatient clinic.
As the head of Internal Medicine at Xingda Affiliated Hospital No. 1, Zhang Lide was a renowned figure in Xingcheng. He held expert outpatient clinics in cardiology twice a week. On those afternoons, long queues formed outside his consultation room, with over a hundred patients waiting daily for diagnosis or follow-up.
Xu Ze sat beside the esteemed expert, assisting with patient visits. His role wasn’t merely to help measure blood pressure—nurses at the door handled preliminary checks. His task was to review medical records after Zhang Lide had seen each patient, then examine the patient himself—all under the guise of “learning.”
Initially, Xu Ze was puzzled by how Zhang Lide could see over a hundred patients each afternoon. He soon understood the secret to his efficiency.
For each patient, Zhang Lide would briefly inquire about symptoms, conduct a targeted auscultation for no more than ten seconds, then issue relevant lab test requests. The patient would go for tests, and Zhang Lide would immediately move on to the next. This method naturally allowed for high throughput.
As a learner, Xu Ze took his observations seriously. While Zhang Lide was busy with another patient, Xu Ze would review the test results of returning patients.
At that moment, Xu Ze was frowning at a patient’s lab reports. The patient, who had been experiencing severe chest pain for two days, had undergone ECG and chest X-rays ordered by Zhang Lide. The results indicated myocardial ischemia, suggesting coronary heart disease, while the chest X-ray appeared normal.
However, something felt off to Xu Ze. Although the chest pain was consistent with angina from myocardial ischemia, the patient’s pain was continuous, fluctuating in intensity—unlike typical ischemic pain.
He checked the blood pressure recorded by the nurse; it seemed normal. Looking at the patient’s pale complexion, Xu Ze frowned thoughtfully. Still uneasy, he took a blood pressure cuff and measured it himself.
The reading on the left arm matched the nurse’s record: 110/70 mmHg, normal. Yet, something still nagged at him. On a hunch, he asked the patient to extend his right arm for another measurement.
The patient, growing impatient, kept glancing at Zhang Lide, waiting for his turn. Annoyed by Xu Ze’s repeated checks but unable to leave before being seen by Zhang Lide, he reluctantly complied.
Rolling up the sleeve, Xu Ze carefully measured again. This time, his eyebrows shot up. Indeed, something was wrong. The blood pressure in the right arm was significantly lower—only 90/50 mmHg, a pulse pressure difference of 20 mmHg.
This discrepancy sparked a realization in Xu Ze’s mind. It pointed toward a potentially serious condition, but he couldn’t recall the specifics. The memory was vague, and he wasn’t entirely sure.
Just then, Zhang Lide finished with his current patient. The waiting patient, now thoroughly impatient, quickly snatched his medical records and test results from Xu Ze and eagerly sat before Zhang Lide. “Director Zhang, my results are back. Please take a look.”
Xu Ze watched, wanting to speak up but hesitating. Although he suspected a problem, he couldn’t pinpoint it. He decided to observe if Zhang Lide would notice anything.
Zhang Lide took the records, skimmed through them quickly, listened to the patient’s heart, and nodded. “This appears to be coronary heart disease with myocardial ischemia. Since you’re still experiencing intermittent chest pain, I recommend hospitalization.”
“Coronary heart disease…” The patient pondered for a moment. “Director Zhang, staying here is quite inconvenient. Could you prescribe some medication instead? I’d prefer to return to my local hospital for treatment.”
Zhang Lide was no stranger to such requests. Many patients from outlying areas or nearby counties, after receiving a diagnosis at Affiliated No. 1, chose to return home for treatment—nearly half to sixty percent.
With practiced ease, Zhang Lide replied, “Your condition is relatively severe. It’s best treated here with further necessary tests. While you can return to your local hospital, it carries certain risks.”
After a moment’s thought, the patient insisted, “Director Zhang, I’d still like to go back. The People’s Hospital near me is more convenient. Now that the diagnosis is clear, treatment there should be fine.”
“Very well, it’s your choice.” Zhang Lide never forced such decisions. He jotted a few notes in the medical record, handed it back, and prepared to see the next patient.
The patient thanked him and turned to leave. Xu Ze, having racked his brain, finally remembered a severe condition that matched these symptoms. Zhang Lide, having only seen the nurse’s blood pressure reading, likely hadn’t noticed the significant difference between the patient’s arms.
Anxious, Xu Ze quickly called out, “Please wait a moment!”
The patient, already irritated by Xu Ze’s earlier examinations, turned back impatiently. “What is it, young doctor?”
As the patient paused, Xu Ze leaned close to Zhang Lide and whispered, “Director Zhang, this patient has a significant pulse pressure difference between his arms. The right arm reads only 90/50. I suspect there might be another issue.”
“A twenty-point difference?” Zhang Lide frowned slightly, then smiled. “It’s not uncommon for coronary heart disease patients to have some pulse pressure discrepancy.”
“But…” Xu Ze felt somewhat reassured by this explanation, yet unease lingered. He quickly focused on the patient standing before him, directing his gaze toward the chest area. Silently, he commanded his automated system: “Activate color Doppler B-mode ultrasound. Perform a cardiac color ultrasound scan.”
Following the command, the system’s color ultrasound swiftly scanned the patient’s chest and heart.
I hope it’s not an aortic dissection aneurysm. If it is, this patient is in serious danger! And convincing both the patient and Director Zhang will be a major hassle. Xu Ze frowned inwardly, sighing.
He hadn’t initially recalled this condition. He had encountered a similar case in the virtual training space. Such cases were extremely rare in reality, so most doctors seldom considered them.
After much thought, he remembered. Given his suspicions and his nature, Xu Ze couldn’t let the patient leave. If this was the case, the patient’s life could be at imminent risk.
On his mental display, the patient’s chest gradually revealed the heart’s image via the color ultrasound, showing blood flow through the valves. Xu Ze paid little attention to this, instead quickly tracing the aorta upward from the heart. He needed to check for an aortic dissection aneurysm. Such a significant pulse pressure difference combined with chest pain pointed strongly to this severe condition. If it wasn’t this, then there was less cause for worry.
Unfortunately, Xu Ze’s intuition was often accurate. The color ultrasound scan hinted at a faint shadow on the upper part of the aorta. However, as the aorta extended deep into the diaphragm, the scan couldn’t provide a clear view.
Nevertheless, that shadow gave Xu Ze over fifty percent certainty it was an aortic dissection aneurysm. Confirmation, however, required an MRI scan—a function his system couldn’t perform yet, being at least one or two levels beyond his current capabilities.
Combining the chest pain and pulse pressure difference increased his confidence to about seventy percent. While not absolute certainty, given the potential life-and-death stakes, Xu Ze addressed the impatient patient, “Please hold on. You need another test.”
He then turned to Zhang Lide and said quietly, “Director Zhang, I strongly suspect this could be an aortic dissection aneurysm. Should we order an MRI?”
Zhang Lide was somewhat displeased by Xu Ze’s persistent questioning. However, hearing the term “aortic dissection aneurysm” and seeing Xu Ze’s earnest concern gave him pause.
As head of Internal Medicine, Zhang Lide was familiar with this condition, though it was so rare he hadn’t initially considered it. Xu Ze’s reminder sent a jolt through him. Upon brief reflection, he acknowledged the possibility. Yet, he wondered how Xu Ze could be so certain.
Nevertheless, Xu Ze’s suggestion warranted attention. An aortic dissection aneurysm was no trivial matter; if present, the patient was indeed in grave danger.
He turned to the now-wary patient. “Yes, please wait. We need an MRI to rule out any other issues.”
The patient hesitated. “Director Zhang, is this test really necessary?”
“Yes, it’s for your safety,” Zhang Lide replied calmly.
Convinced by Zhang Lide’s tone, the patient’s impatience vanished, replaced by confusion. He took the test requisition and left for the MRI.
Watching the patient comply so readily with Zhang Lide—in stark contrast to his earlier impatience with Xu Ze—Xu Ze sighed inwardly. The difference in authority is palpable. My words carry little weight compared to Director Zhang’s.
After the patient left, Zhang Lide let out a soft sigh of relief. He hadn’t considered Xu Ze’s point earlier, and the realization sent a chill down his spine. A misdiagnosis here could have ruined his professional reputation.
Not long after, the patient returned with the MRI results. Reading them, Zhang Lide’s expression darkened. He felt a wave of relief. Thank goodness Xu Ze reminded me. This could have been a disaster.
The diagnosis confirmed an aortic dissection aneurysm. Such an aneurysm could rupture at any moment. Given that the thoracic aorta is the body’s largest artery, a rupture would be fatal.
Seeing the change in Zhang Lide’s expression, the patient grew visibly anxious. Xu Ze, glancing at Zhang Lide’s face, already knew the outcome.
He looked at the patient and sighed quietly, grateful for the fortunate timing. If he hadn’t recalled this condition, the patient would likely have faced death.
Noticing Xu Ze’s sigh and the mix of sympathy, relief, and gravity in his eyes—without even seeing the report—the patient grew even more nervous. Zhang Lide’s grim expression was alarming, but he dared not interrupt the director’s contemplation. Remembering it was this young doctor who had insisted on the test, he forced a smile and asked Xu Ze deferentially, “Doctor… what exactly is wrong with me?”
Amused by the patient’s shift from impatience to deference, Xu Ze smiled slightly and shook his head. “I haven’t seen the results yet. Director Zhang will explain.”
“But you suggested the test, you must have an idea,” the patient pleaded anxiously, now using respectful language.
Xu Ze smiled faintly, about to respond, when Zhang Lide set down the report. “Director Zhang has finished. You can ask him.”
The patient immediately turned to Zhang Lide. “Director Zhang, what’s the result?”
Zhang Lide frowned slightly, sighing as he looked at the patient. “Your condition is very serious. You need immediate hospitalization and surgery.”
“Surgery?” The patient was shocked. “Director Zhang, isn’t it just coronary heart disease? Why surgery?”
“No, it’s not simply heart disease. It’s an aortic dissection aneurysm. Surgery is mandatory,” Zhang Lide stated gravely, startling the patient. “This condition is life-threatening at any moment. Surgery is the only solution, and it must be done urgently.”
Frightened by Zhang Lide’s seriousness, the patient nodded hastily, face pale, took the hospitalization form, and left the consultation room to complete admission procedures.
After the patient departed, Zhang Lide cast a complex glance at Xu Ze beside him—a mix of admiration and contemplation.
The October breeze carried a hint of coolness. Yellowing leaves drifted slowly from the trees. Xu Ze, wearing a light yellow plaid long-sleeved shirt and carrying two books, walked along a campus path toward the parking lot.
Earlier that day, Jiang Zhibo from the Emergency Department had called, inviting Xu Ze to dinner. It had been a while since their last gathering, and everyone happened to be free.
Xu Ze knew these guys probably just wanted to get together for drinks. While not particularly keen on drinking, he felt bad declining after nearly two months without meeting them. Besides, he had a high alcohol tolerance, so a few drinks wouldn’t hurt.
After class, he headed straight for the rendezvous.
Emerging from a small path, he noticed two familiar figures ahead. Recognizing the graceful figure, he smiled, about to call out, but paused upon seeing the young man beside her. Frowning slightly, he decided against it and simply followed quietly behind.
The male figure’s back also looked familiar, but Xu Ze couldn’t place it immediately.
Then, the young man’s words caught his attention.
Hearing the voice, Xu Ze’s frown deepened. Zhang Tianyu? What’s he doing here?
“Yumeng… I truly like you. Please be my girlfriend,” Zhang Tianyu pleaded persistently, following closely behind Lin Yumeng.
Lin Yumeng seemed indifferent, continuing to walk ahead without acknowledging him.
Undeterred, Zhang Tianyu pressed on. “Yumeng, believe me… So many girls like me, but I only have eyes for you. I swear…”
Xu Ze sighed inwardly. Zhang Tianyu was not only good-looking but also a smooth talker, which explained his revolving door of girlfriends over the years.
He didn’t want Lin Yumeng to fall for Zhang Tianyu’s charms. Fortunately, Lin Yumeng appeared unmoved, which relieved Xu Ze somewhat.
