Level 1 Diagnostic Assistance AI

“Damn!” Lin Yuming cursed aloud.

Deputy Director Liu and Luo Hao remained silent in unison.

For a steady, seasoned medical director to swear like that, it was most likely a case of a medical dispute.

After the crackdown on organized crime, coordinated medical conflicts had vanished overnight, leaving only complaints related to medical grievances and occasional malpractice incidents.

Luo Hao recalled carefully—there hadn’t been any severe medical accidents recently.

Lin Yuming spoke to Deputy Director Liu, “Old Liu, do us a favor.”

“Go ahead.”

“There’s a pregnant woman diagnosed with issues—twins, and it might be impossible to save them.”

“...” Deputy Director Liu was momentarily stunned. “Is this one of your hospital’s staff?”

“No.” Lin Yuming shook his head.

“Then...”

“She’s just an ordinary pregnant woman from a nearby rural village,” Lin Yuming said in a low tone.

Deputy Director Liu gave him a strange look, staring at Lin for a full thirty seconds before quietly saying, “Lin, you keep saying you’re old... but you’re still acting like you did back in school.”

That scholarly idealism was truly hard to call ‘old.’

“Can’t help it,” Lin Yuming said as he turned the car around and explained, “A few days ago, I was at the hospital in the medical alliance next door. It was pouring autumn rain, freezing cold.”

“At the hospital entrance, there was a man in his thirties, shirtless and crouching in the rain, holding his head and crying.”

Deputy Director Liu had already guessed Lin was just soft-hearted and wasn’t surprised at all.

“That family never had children before. Suddenly, at 27 weeks, they got pregnant—with twins no less. But recent scans showed fetal malformations.”

“Malformations? Lin, isn’t your saintly heart a bit too big?” Deputy Director Liu said helplessly. “I’m just a radiologist—an expert, if you like—but let’s be honest, my skills aren’t perfect. Who can really fix fetal malformations?”

He looked toward Luo Hao.

“Dr. Luo, can your hospital handle this?”

“...”

Luo Hao was speechless.

“Listen to me first,” Lin Yuming said without waiting for Liu’s agreement, driving back. “They’ve done two ultrasounds. I stood by during the second one, and I just felt something was off.”

“But you know I’ve been out of clinical work too long to tell exactly. Recently, our obstetrics director, Sun, has been coordinating with experts in the capital for a consultation.”

“And then?” Deputy Director Liu asked.

“The mother’s mental state collapsed first. She was desperate, even suicidal at the hospital.”

This was something senior clinicians had long been accustomed to. What could one do? Only sigh.

Deputy Director Liu thought for a moment and looked at Lin Yuming.

“I’ll do an ultrasound check.”

After saying this, Liu shook his head. “Lin, recently one of my juniors was called to a parent-teacher meeting because his kid wasn’t focused and got scolded. You know how I comforted him?”

Liu didn’t beat around the bush and continued, “Teachers are usually very strict with their own kids because they’ve seen exceptional students. But doctors and nurses? Most just let things be.”

He paused, then earnestly advised, “Because at the ICU entrance, we’ve all seen parents devastated beyond words.”

“Being a doctor, too much empathy isn’t good. Even though Lin, you’re now in the medical office. Back in the day, we juniors always relied on you for help.”

“After all these years, Lin, you’re still the same temper.”

“Alas,” Lin sighed again, “I just can’t stand seeing someone pitiful and not helping when I can. How could I just watch?”

Deputy Director Liu was speechless.

He had thought the same when he was a medical student, but decades in the field had ground that youthful idealism to dust.

He hadn’t expected Lin to still have that temperament.

“Well, just take a look—Lin said so.” Though Liu thought this, he didn’t take it seriously.

He worked at the medical university doing four-dimensional ultrasounds and nuchal translucency scans and had seen countless malformed fetuses and women in tears.

At first, it was sorrowful; over time, that feeling faded. He had been numb for over a decade.

Most likely, Liu’s ultrasound wouldn’t help much, Luo Hao thought.

Then he remembered the big gift package the system had given him for completing the novice task.

Might as well open it now—if it helped at all.

With that thought, he activated the package.

Brilliant lights flashed suddenly, startling Luo Hao.

The system was a bit flashy, throwing out some fancy but ultimately useless items.

[Congratulations! You have obtained Diagnostic Assistance AI, currently at Level 1.]

Luo Hao felt like he had fallen into a deep pit.

Diagnostic Assistance AI, Level 1—a never-ending upgrade abyss.

If this were a game, the next step would be to charge money. But the system was frustrating—it didn’t ask for money!

He opened the Diagnostic Assistance AI interface, similar to ChatGPT, likely operated similarly.

“Director Lin, which pregnant woman are you referring to?” Luo Hao suddenly broke the silence.

“For what?”

“Liu and I want to study carefully, get ahead of the situation.”

Lin Yuming absentmindedly gave a bed number. Luo Hao contacted the obstetrics on-duty doctor.

Soon, the patient’s brief data was sent to his phone.

The patient was admitted one day ago at 27 weeks plus 2 days due to abnormal twin development found on ultrasound. She was a first-time mother; the early pregnancy ultrasound suggested monochorionic diamniotic twins...

The obstetrics doctor photographed the medical records and sent the images.

Luo Hao squinted and reviewed the whole medical history and examination.

At 27+2 weeks, the fetuses were big enough for recent prenatal exams to detect a significant PSV-MCA difference between twins, with the donor twin’s heart enlarged and the recipient twin’s umbilical artery blood flow PI elevated.

The preliminary diagnosis at the lower-level hospital was questionable; after arriving at the mining hospital, the ultrasound revealed more details.

His phone vibrated continuously as admission blood test reports came in.

Luo Hao studied them intently, eyes fixed on the system panel at the upper right of his vision.

While reading the history and labs, the data was simultaneously input into the system.

The system’s screen shimmered, stuttered slightly, then produced an automatic diagnosis.

Luo Hao wasn’t overly surprised.

In theory, AI systems like ChatGPT could be used for diagnosis. Clinical practice was still exploratory, but there were successful cases resolving difficult medical problems.

Yet it was all experimental, not widely implemented, with many issues remaining.

The diagnostic assistance AI from the big gift package should be more powerful than ChatGPT.

Luo Hao stared intently. Soon, a line of text appeared in the upper right corner:

[Insufficient data, unable to generate diagnosis.]

“!!!”

Luo Hao was stunned.

This was one reason ChatGPT hadn’t been broadly adopted in clinical settings.

Patient histories were subjective and often inaccurate; just having the patient’s narrative wasn’t enough for AI to reliably diagnose.

Unexpectedly, even this advanced system told him it lacked sufficient information to give a diagnosis.

This was not what Luo Hao had hoped.

Looks like he’d have to ask questions himself.

Though disappointed, Luo Hao didn’t lose heart.

*Ding dong~*

The system chimed, and a new task appeared on the panel.

[Emergency Task: Save the Patient
Task Details: The correct diagnosis remains unclear; the fetus still has a chance. Please save the fetus.
Time Limit: 3 days
Reward: 10,000 experience points.]

10,000 experience points!

Luo Hao was stunned. That seemed too little.

Compared to previous rewards for performing ten ovarian cyst sclerosis procedures, this emergency task’s reward was nearly nothing.

But he understood—the game’s newbie rewards were designed to lure players into spending money incrementally. A little “discount” was normal.

He hadn’t expected this futuristic system to be just like unscrupulous game dealers—first sweetening the deal, then revealing the true nature.

At least they could have given a 648-yuan recharge option, Luo Hao muttered to himself.

If the system had a recharge portal, paying 648 yuan for a confirmed diagnosis wouldn’t be bad. Luo Hao wasn’t short of money; he’d gladly pay for a diagnosis.

But sadly, the system offered no such function.

Damn!

“Little Luo, you drive,” Lin Yuming’s phone kept buzzing. He decided to pull over and let Luo Hao take the wheel.

Luo Hao had to pause his system research and focus on driving back to the hospital.

Along the way, Lin Yuming kept calling, instructing the obstetrics staff to comfort the patient and inform them that provincial experts were on their way for a consultation.

Deputy Director Liu understood but was unconvinced.

Every day the hospital saw all kinds of pitiful people. Social welfare agencies basically turned a blind eye. If doctors and nurses were too empathetic, they wouldn’t last long in this profession.

Lin Yuming...

Liu wondered how he had endured all these years.

Back at the hospital, Lin Yuming and Deputy Director Liu changed into white coats and formally entered the ultrasound room.

After a brief introduction of Liu’s background to the patient’s family, Liu sat at the ultrasound machine and began the color Doppler exam.

Gel was applied, the probe lowered—and within seconds, Liu’s brow furrowed.

Luo Hao sat beside him, hands poised over the keyboard, ready to record Liu’s observations.

His eyes, however, focused on the ultrasound screen, analyzing the images for useful information.

Though the system’s emergency reward was small, as a doctor he had to give his all to save the patient.

The images were complex, with red and blue hues flickering.

“Intrauterine live twins, monochorionic diamniotic, estimated fetal weights 786 and 913 grams, weight difference 14%.”

Click-clack~

As Liu recited technical details, Luo Hao rapidly typed.

“Fetus one: slightly increased hepatic echogenicity; enhanced echoes of intrahepatic portal vein and bile duct walls; umbilical artery pulsatility index elevated at 1.33; systolic/diastolic ratio 4.25; reduced middle cerebral artery peak systolic velocity at 28 cm/s; velamentous placenta with vascular insertion; placenta previa.”

“Fetus two: increased cardiothoracic ratio at about 0.37; elevated PSV-MCA at 61 cm/s; PSV-MCA difference 0.93 MoM.”

A string of professional terms flowed from Liu’s mouth. Even Director Sun of obstetrics and others looked puzzled.

Disparities in technical expertise were an objective reality.

Having test results didn’t guarantee everyone would reach the correct conclusion.

After finishing, Liu glanced at Director Sun.

“Director Sun, what’s your diagnosis?”

Sun was taken aback, unsure how to answer.

Liu’s ultrasound findings exceeded her knowledge. The mining hospital was only a provincial tertiary hospital and didn’t handle such complex cases.

“Old Liu, don’t keep us in suspense,” Lin Yuming scolded.

“I’m just a supporting department doctor,” Liu said softly.

So he wasn’t stalling but genuinely deferring to the specialist.

“...”

“...”

Indeed, Liu was responsible only for ultrasounds; diagnosis was the clinician’s domain.

Ordinary ultrasound reports might include diagnoses, but these twins were far from ordinary.

The atmosphere in the ultrasound room was heavy, only Luo Hao’s typing filled the silence.

With Liu’s ultrasound data, the system had already provided a diagnosis—Twin Anemia-Polycythemia Sequence combined with Selective Fetal Growth Restriction.

“Liu, look at this report. Have I missed anything you mentioned?”

Luo Hao handed over the report.

Liu was somewhat displeased—Luo was being overly meticulous at a critical moment. But since Luo was Lin’s nephew, Liu refrained from scolding him and took the report.

Their eyes met, and Liu’s hand suddenly stiffened.

Twin anemia-polycythemia sequence with selective fetal growth restriction!

The lengthy diagnosis hit Liu like a hammer to the chest.

Such an extremely rare diagnosis was unheard of, not only to recent clinical graduates but even to an experienced clinician like Liu.

There were definitely abnormalities on ultrasound, but Liu couldn’t give a definitive diagnosis.

Yet!

Luo Hao had given a clear diagnosis—black and white on paper.

“Doctor, I...” The pregnant woman’s eyes welled with tears as she sadly inquired.

Liu could see a glimmer of hope in her gaze and didn’t have the heart to shatter her illusions.

“We have the diagnosis, but the treatment plan will come after the expert consultation.”

“Is there hope?”

Liu didn’t answer. Instead, he started searching his mind for related information.

Suddenly, he realized he had forgotten the diagnosis’ name.

!!!

What the hell!

As a well-known provincial expert, it was understandable not to know everything, especially outside his specialty.

But forgetting a diagnosis just given by someone else was absurd.

He looked again at the report—Twin Anemia-Polycythemia Sequence combined with Selective Fetal Growth Restriction.

Damn!

A monstrous diagnosis, even more complicated than before.

Liu muttered silently.

He stared at the report, imprinting every word in his mind.

“Liu, what’s the next step?” Lin cautiously asked.

“I’ll call our obstetrics director,” Liu said, about to put down the report but his hand froze; clutching the report, he left the ultrasound room.

Lin found Liu a quiet room. Liu dialed.

“Director Li, it’s me.”

“I have a patient with imaging findings...”

Liu described the ultrasound images.

“My diagnosis is vague—something like twin anemia-polycythemia sequence combined with selective fetal growth restriction. What do you think?”

Liu stammered as he read the lengthy diagnosis from the report.

“Liu, your skills have improved! You can make such a rare diagnosis.”

Liu blushed.

“From your description, it sounds correct—quite rare.”

The expert on the line chuckled, then got serious.

“Is the cloud data available?”

Liu looked at Lin.

Lin nodded.

“Yes, wait, I’ll send the cloud files. Help me take a look.”

They ended the call and had the obstetricians send the patient’s cloud data to Liu, who forwarded it to the university experts.

After ten long minutes, Liu’s phone rang.

“Old Liu, your diagnosis is spot-on, impressive! Your NT scans have made you sharp, well done!”

“Enough with the compliments. How do we treat this?” Liu asked directly.

There was a pause, then a resigned voice: “Well, Old Liu, this can’t be treated in our province.”

!!!

!!!

Lin and Liu were deeply frustrated.

Though they knew most diseases were incurable, the helplessness still overwhelmed them like a tide, impossible to escape.

“Tell me more; maybe I can think of something,” Liu asked.

“There are three options: fetoscopic laser coagulation of placental vascular anastomoses, radiofrequency ablation for selective reduction, and intrauterine transfusion therapy. Our hospital lacks the equipment for the first two, and so does the mining hospital.”

“Only a handful of hospitals nationwide have the equipment. But the surgeries carry high risk; very few doctors are willing to perform them. The last option has some chance but is technically very difficult—very, very difficult.”

“Do you know anyone who can do it?” Liu asked under Lin’s eager gaze.

“No, these rare diseases are like malignant hyperthermia; only top-tier maternity hospitals with genetic research institutes study them.”

Liu hung up, shrugged, and stared at the ceiling.

Lin muttered quietly, “Fetoscopic laser coagulation of placental vascular anastomoses, right Old Liu?”

“Yes.”

“Radiofrequency ablation for selective reduction sounds sketchy.”

“I guess it’s about turning twins into a singleton.”

They guessed at the treatments.

No one wanted to face the patient or her family.

No doctor wanted to say, “Sorry, we’ve done all we can.”

But often, they had no choice.

“Old Liu, I heard the obstetrics director mentioned another treatment?”

“Intrauterine transfusion.”

“Is that treatment easier?”

Liu looked up at Lin. Sometimes, doctors with too much compassion seemed a little crazy to him.

“Old Lin, it’s still intrauterine!” Liu reminded.

Lin nodded, his expression steadying. He had made up his mind.

“Let’s go.”

Lin opened the door to explain the condition to the patient and family—those words he dreaded speaking.

But just as he opened the door, he saw Luo Hao standing there.

“Director Lin, what did the experts say?” Luo Hao asked.

“The diagnosis is confirmed... Little Luo, have you seen patients like this at the university hospital?” Lin asked.

“Yes, such patients have three treatment options—fetoscopic laser coagulation of placental vascular anastomoses, radiofrequency ablation for selective reduction, and intrauterine transfusion therapy.”

!!!

Lin stared at his nephew in astonishment.

For the first time, he felt Little Luo had truly grown up.

Luo’s smile was like sunlight, dispelling the shadows in Lin’s heart.

Though rationally he knew no one in the province could perform the surgeries, that smile silently told him—Luo could do it.

“The first two surgeries are difficult and require equipment we don’t have. Even in the capital, few hospitals offer them. With the current tense doctor-patient relationships, it’s hard to find doctors willing to operate.”

“Simply put,” Lin looked seriously at Luo, “intrauterine transfusion is the most suitable. It’s difficult but much less so than the other two.”

“Can you do it?”

“Locating the umbilical vein puncture, intrauterine transfusion. All three treatments have similar outcomes; there’s no consensus on the best. I think we can try.”

“Dr. Luo, don’t talk nonsense,” Deputy Director Liu said sternly. “There will be fetal movements, and the difficulty of umbilical vein puncture is immense. One slip—are you sure?”

“Liu, I believe I can do it,” Luo said confidently.

Liu was momentarily dazed.

Luo’s youthful vigor reminded him of when he first arrived at the university hospital, full of boundless confidence, convinced he could cure all patients.

“Dr. Luo, just puncturing isn’t enough. Come in.” Liu beckoned Luo inside.

“The mining hospital probably hasn’t done intrauterine punctures before, right?” Liu glanced at Lin.

Lin nodded.

“Explain the procedure. Assume you succeed in puncturing—what complications might arise next?”

Both Lin and Liu thought Luo was too young, naïvely believing calmness and steady hands guaranteed success.

They didn’t realize puncture was only the first step—the real challenges came afterward.

“The vascular connections in twin-to-twin transfusion syndrome are unique. Most placental anastomoses are tiny arteriovenous connections less than 1 millimeter in diameter. Through these small connections, only 5 to 15 milliliters of blood transfer every 24 hours to the recipient twin...”

Luo spoke without hesitation.

Liu had minimal clinical experience with intrauterine transfusion and couldn’t confirm if Luo was right or wrong.

But he also couldn’t refute him.

Recalling the ultrasound images, the placental vessels were less than 1 millimeter, so it seemed plausible.

“Transfusion speed can’t be too fast or too slow; there’s a formula to calculate it.”

Luo produced a pen from somewhere and wrote a complex mathematical formula on paper.

“This...”

“Just calculate the transfusion speed using this formula,” Luo said. “There’s about a 50% chance the fetus will survive until 32 weeks and then undergo cesarean section. The overall risk is very high, but it’s a potential treatment. Whether to proceed is up to Director Lin.”

“I’ll talk to the family,” Lin decided and walked out with a serious face.

Deputy Director Liu shook his head. “Dr. Luo, you’re still young and impulsive. Success is expected, but if it fails, the responsibility falls on you. Have you thought about how you’ll handle relentless families if things go wrong?”

“Liu, I believe Director Lin can handle that properly.”

Properly?

Handle?

Liu was skeptical but, recalling Lin’s rough yet meticulous character, felt a strange sense of hope.