Grown Up, Yet Still a Child

"Where is Dr. Luo?" Lin Yuming asked the intern.

"He's in the emergency room attending to a patient. We had an elderly patient whose blood pressure completely bottomed out..." the intern rambled on. Lin Yuming didn't have the patience to listen and strode directly into the emergency resuscitation room.

Luo浩 stood beside the resuscitation bed, his eyes fixed on the numbers and waveforms on the ECG monitor, deep in thought.

"Dr. Luo," Lin Yuming said in a deep voice.

"Director Lin? Why are you here?" Luo Hao turned around and saw it was Lin Yuming. "With roads this slippery, driving isn't safe. What are you doing here?"

Although it sounded like a complaint, every word was filled with genuine care.

Lin Yuming felt a warm surge of gratification.

The child had finally grown up, learning to show concern for others instead of being as clueless as he used to be.

Having someone handle the miscellaneous chores while he commanded from the center, especially for matters requiring his personal influence and standing, was the ideal situation. In the past, Lin Yuming had never enjoyed such treatment.

Although the medical administration department didn't need to strive for absolute perfection and coasting by was an option, Lin Yuming knew that he was dealing with one vibrant human life after another; whenever possible, he had to give it his all.

By being a bit more diligent, perhaps a person could be saved. He considered it a good deed that would accumulate merit for himself and bring a little fortune to his son.

While saying this sounded terribly unmaterialistic, medical and nursing staff survived on a breath of immortal energy, which in itself was entirely unmaterialistic and deeply metaphysical.

Now, with Luo Hao around, the emergency department was running in immaculate order. Even if he were to take command hastily himself, he wouldn't be able to achieve this level of efficiency. Lin Yuming was quite satisfied with this.

Good.

Extremely good!

Lin Yuming smiled.

Today, he had felt somewhat restless inside, his heartbeat accelerated, with a persistent feeling that something was bound to happen. That was why he had rushed over.

Seeing Luo Hao handle everything so clearly and methodically, Lin Yuming felt that his worries had been for nothing.

"Director Lin, the orthopedic department is still busy, and then there's the intensive care unit. It would be great if we could have doctors on standby at all times," Luo Hao offered a word of comfort before immediately making a request.

Lin Yuming nodded. "I'll arrange it. What is going on with this patient?"

The patient's family members were at the orthopedic department getting a cast put on and were not present, which made it much easier for Luo Hao to speak freely.

After briefly reporting the medical history, Luo Hao continued, "I suspect the patient has an aortic dissection and urgently needs a 64-slice CT scan."

Lin Yuming looked at the energetic Luo Hao, feeling a complex mix of emotions.

If Luo Hao weren't his own biological nephew, and any other staff member under his supervision—or even any department head—dared to say something like that, Lin Yuming would have definitely slapped them across the face.

Then he'd drag them outside to look at the ground. Under these road conditions, how on earth was he supposed to get people to come in for overtime?

And that was just a preliminary diagnosis.

Lin Yuming frowned. "Is there any other way?"

Luo Hao also knew that dragging people from their homes to perform a 64-slice CT scan in this kind of weather posed risks. He scratched his head. "Director Lin, I know how to operate the machine myself."

"!!!" Lin Yuming was left speechless.

Luo Hao's meaning was very simple: even if there was no staff, as long as he was given authorization, he could do it himself.

As for his qualifications, Luo Hao's intermediate professional certificate had been processed by Lin Yuming's own hands, so Lin Yuming knew his capabilities crystal clear.

"Director Lin, the patient's condition is quite critical and extremely tricky. Even if we make a definite diagnosis, our Mining General Hospital still can't perform the surgery."

"Then what should we do?" Lin Yuming asked.

"Call in reinforcements," Luo Hao said matter-of-factly. "I'll have my senior fellow apprentice fly over to perform it. If the diagnosis is correct, the patient will need an elephant trunk procedure, which I doubt our Mining General Hospital has ever done."

Damn it!

Lin Yuming cursed out loud.

Treating illnesses and saving lives was one thing, but no one treated patients the way Luo Hao did.

The "elephant trunk procedure" was the doctors' colloquial term; officially, it was much simpler—termed the elephant trunk technique, also known as total aortic arch replacement.

Because the shape of the aortic arch closely resembled an elephant's trunk, it earned this moniker.

This surgery was the single biggest procedure in cardiothoracic surgery, without exception, and the industry considered its difficulty to surpass almost every other heart surgery.

Let alone the Mining General Hospital, nobody in the provincial capital right now would dare pat their chest and guarantee a 100% success rate.

Luo Hao wanted to perform an elephant trunk procedure at the Mining General Hospital?

What would happen if the patient died on the operating table? Nowadays, medical-patient disputes were so fierce that it was better to avoid trouble than to invite it.

Lin Yuming felt a headache coming on, his mind buzzing.

"Director Lin."

While Lin Yuming was lost in thought, Luo Hao continued, "The patient's condition has stabilized slightly now. I'd like to take him for a lung CT scan first to assess the situation."

Lin Yuming sighed.

He had just praised Luo Hao for growing up, only for the kid to immediately drop a massive bomb on him.

What kind of mess was this?

Lin Yuming nodded, and Luo Hao began summoning people to transport the patient.

He called four male interns to tag along, forming a robust and formidable contingent—completely devoid of the understaffed look usually plaguing the emergency department—and marched triumphantly all the way to the CT room.

On the way, Luo Hao leaned close to Lin Yuming and whispered, "Uncle, I have a feeling the patient has an aortic dissection. The condition is critical and cannot be transferred; we have no choice but to invite an expert to perform the surgery."

"Hmph!" Lin Yuming let out a cold snort, expressing his dissatisfaction with Luo Hao's "meddling."

"Uncle, my senior fellow apprentice has a very high success rate with this kind of surgery."

"Very high?" Lin Yuming seized on Luo Hao's loose phrasing. "Is that a 60% success rate or a 70% success rate?"

"Heh." Hearing Lin Yuming's displeasure, Luo Hao stopped pushing the subject.

Regardless of how high the success rate was, the mortality rate for this type of surgery far exceeded that of almost any other.

In the era of 3.0 medical-patient disputes, avoiding trouble was better than courting it, and Lin Yuming naturally leaned toward transferring the patient.

A kind-hearted doctor would contact a superior hospital and ensure no time was wasted, fulfilling their duty to the best of their ability. Why deliberately invite trouble for oneself?

This little rascal Luo Hao—he regretted praising him just moments ago for growing up and learning to care for others.

In the blink of an eye, this fellow had dug up a massive problem for him.

Arriving at the CT room, Lin Yuming kept a gloomy expression throughout.

Luo Hao instructed the interns to lift and handle the patient with utmost care, placing them onto the machine for the examination.

Once the scan was complete, Lin Yuming squinted at the images.

After all, he was among the earliest cohorts of domestically trained professionals graduating in medical imaging and possessed a wealth of clinical experience.

At a single glance, Lin Yuming couldn't help but smile; even a dog of a fellow like Luo Hao could occasionally make a misdiagnosis.

"Luo Hao, how on earth did you diagnose an aortic dissection?" Lin Yuming said in a relaxed tone. "Anyway, I don't see any imaging of an aortic dissection here. Come, come, teach me."

The patient's CT scans were quite clear: pericardial effusion, right-sided pleural effusion, right obstructive pneumonia, and atelectasis.

Although a pulmonary CT scan could not directly diagnose an aortic dissection, an experienced doctor could always find some subtle clues within a lung CT. (Note)

The lung CT of the patient whom Luo Hao claimed would die without an elephant trunk procedure showed no major abnormalities; symptomatic treatment was all that was primarily required.

Lin Yuming firmly believed the patient did not have an aortic dissection.

"Uncle, a lung CT can't confirm it definitively. Why don't you discuss it with the head of the CT room? Turn on the machine and run a 64-slice scan? An aortic dissection cannot tolerate any delay, and besides, if surgery is needed, we have to invite someone to fly over. Every hour saved counts," Luo Hao cajoled with a cheeky, smiling face.

At this moment, Luo Hao was humble to the extreme, bearing no resemblance to his usual bright, upright young self.

He acted like a weathered scoundrel of society; although his attitude was humble and his words gentle, Lin Yuming was certain that if he refused to do as told, Luo Hao might very well lie down on the floor, roll around, and play dead.

He would stop at nothing to achieve his goal.

Who on earth did he learn this from?! Lin Yuming felt helpless inside.

"Uncle, I have three options—upper, middle, and lower..." Seeing Lin Yuming remain silent, Luo Hao continued to scheme.

"Get lost!" Unable to contain his anger any longer, Lin Yuming swore angrily. "To hell with your three options! Who do you think you are?"

Giving only one treatment plan meant that if it ultimately failed, the responsibility fell entirely on the person who provided it.

However, offering three options meant that if it failed, the responsibility fell on the person who chose the plan.

The smooth and covert tactic described in books had actually manifested in Luo Hao—something Lin Yuming hadn't expected at all.

The kid was growing up truly fast; Lin Yuming immediately found a point to praise Luo Hao.

After all, he was family, so praise was still due when earned.

"Uncle, we really have to do the 64-slice aortic CT," Luo Hao said respectfully.

Although his expression was respectful, his tone was exceptionally resolute, wearing him down through sheer persistence, as if the routine CT hadn't already ruled out any issues entirely.

"Luo Hao, you're crossing the line!" Lin Yuming said sternly.

"Running an extra test is a minor matter, and I'll go talk to the patient's family," Luo Hao said shamelessly. "But once we drop our guard and a patient who could otherwise be saved suddenly dies unexpectedly, I'm just worried you'll be the one facing trouble."

"Stop with the 'you're' and 'yours.' Whenever you use formal pronouns with me, I know nothing good is coming of it," Lin Yuming chided. "The imaging is right here. Tell me, where is the aortic dissection?!"

Faced with Lin Yuming's reprimand, Luo Hao fell silent.

Yet he didn't give up, pleading with his eyes instead.

I really can't take this... Looking at Luo Hao's resentful and pleading gaze, Lin Yuming felt a pang of softness.

For a fleeting second, Lin Yuming thought of Luo Hao's father, his own departed old friend.

The father and son had the exact same stubborn temper, damn it! Lin Yuming cursed inwardly.

"Uncle, just this once. If there is no aortic dissection, I'll let you have the final say on everything from now on." Luo Hao pleaded in a low voice.

"Don't you dare. That stuff isn't easy to digest." Realizing there was a glimmer of hope, Luo Hao quickly chimed in, "Then let me thank you on behalf of the patient."

"The patient?"

"No, no, no, I thank you myself."

Lin Yuming felt utterly helpless.

Perhaps Luo Hao was still going through his rebellious phase; fine, fine, let him do as he pleased.

With a gloomy face, Lin Yuming went to call the head of the CT room.

Although the medical administration department was the superior governing office, the proper respect still had to be shown.

Furthermore, the person operating the machine this time wouldn't be a professional CT doctor; dealing with the resulting complications would be no less troublesome than performing an elephant trunk surgery.

As long as human beings were involved, nothing remained purely simple.

After a full half-hour of negotiation, Lin Yuming finally "persuaded" the head of the CT room to unlock the doors of the 64-slice CT suite.

The machine whirred into motion. Luo Hao acted as both doctor and nurse, communicating with the patient's family, inserting the IV needle, administering contrast agents, and conducting the examination—all by himself.

Watching Luo Hao shoulder every single task single-handedly, Lin Yuming's emotions grew even more complex.

Luo Hao was genuinely capable, but he was perhaps a bit *too* capable, always stirring up trouble.

Taking advantage of the interval before the scans were developed, Lin Yuming spoke in an earnest, advisory tone, "Little Conch, did you know that the county hospital down in Libo County was smashed up yesterday?"

"Why?"

"A patient drank alcohol after taking antibiotics, suffered an acute allergic reaction, and couldn't be resuscitated at a small clinic before being sent to the county hospital. They performed a tracheotomy and tried everything, but the person still died."

Luo Hao focused intently on operating the machine, chatting casually with Lin Yuming as he worked.

"That's quite normal, isn't it? Are the family members unwilling to accept it? What's there to make a fuss about? Drinking after taking antibiotics is basically asking for death," Luo Hao remarked.

"The family filed a complaint with the Health Commission, claiming that a minor ailment was sent to the hospital, but due to medical malpractice by the doctors, they cut the patient's windpipe." Lin Yuming used the real-life example to warn Luo Hao.

"!!!"

"I acknowledge that the vast majority of people are good and do understand medical staff. But imagine this scenario—as long as you express dissatisfaction and file a complaint, there is a potential payout. At the very least, you get your hospital expenses waived; at best, you secure compensation of tens of thousands, hundreds of thousands, or even millions."

"If you were in their shoes, what would you think? Would you be tempted?" Lin Yuming asked.

"It's not like I'm short on money," Luo Hao said casually, his eyes fixed on the machine's monitor.

"Smack~"

Lin Yuming slapped the back of Luo Hao's head.

"Uncle, hitting me back there is a good way to make me stupid," Luo Hao complained, rubbing the back of his head.

"Take this seriously. You are very likely to encounter situations like this in your future career."

"Well, there's nothing that can be done about it," Luo Hao said helplessly, glancing sideways at his luck value in passing.

Honestly, he wanted to boost every single attribute: stamina, mental focus, and luck.

The few attribute points granted by the system were simply never enough.

If he could, Luo Hao would max out all his stats.

With such a high luck bonus escorting him, he figured he shouldn't run into unreasonable family members, Luo Hao mused to himself.

"It's better to avoid trouble than to invite it. Even if you want to fulfill your responsibilities as a doctor, you have to assess the situation."

"This patient's family seems quite reasonable. Don't worry, Uncle, I know what I'm doing."

Lin Yuming's persuasion was once again batted right back by Luo Hao.

You rascal. I'll just let reality educate him instead. No matter what reasoning he presented, Luo Hao always had ten retorts waiting.

Lin Yuming decided to let facts speak for themselves.

And the first fact would be Luo Hao's misdiagnosis.

An aortic dissection, my foot! Having made up his mind, Lin Yuming looked over the regular CT images once more.

Based on his many years of clinical experience analyzing scans, the patient did not have an aortic dissection.

He couldn't wait to see what Luo Hao would say once the scans came out, Lin Yuming thought viciously to himself.

"Uncle, there's a problem!"

Luo Hao's voice interrupted Lin Yuming's train of thought.

"A problem? Where?" Lin Yuming turned his gaze to the screen displaying the 64-slice aortic angiography.

"Right here," Luo Hao pointed directly at the screen. "Right where the ascending aorta exits the heart—there is an aortic dissecting aneurysm! A regular CT couldn't catch it; only the 64-slice scan can reveal it."

Lin Yuming stared blankly at the spot where Luo Hao's finger rested.

Sure enough, there was a somewhat atypical image of an aortic dissecting aneurysm right there.

It really was there!

Lin Yuming felt no shame over his earlier words. In front of his own nephew, whatever was said previously didn't matter; it wasn't like Luo Hao would dare mock him anyway.

Upon spotting the vascular aneurysm of the aorta, Lin Yuming felt a numbness creeping into his hands.

A tricky patient indeed.

Aortic dissections came in several types, with Type I being the hardest to handle. Unlike other types where dropping a large stent would likely resolve the issue—something the vascular department could handle—the patient before them belonged to the most difficult category of Type I aortic dissections.

The dissection occurred right where the vessel exited the heart; even if surgery were attempted, the level of surgical difficulty would skyrocket.

Luo Hao had dug up a massive problem for him.

Lin Yuming even harbored a small, dark thought: sometimes discovering such a patient was worse than never finding it at all.

If it went undiscovered and the patient suffered sudden death, it would at most result in a medical dispute.

But once discovered... what then?

Perform an elephant trunk procedure?

Forget the Mining General Hospital today; even the Mining General Hospital in its prime years back then couldn't have pulled it off.

Let alone the Mining General Hospital, how about the hospitals in the provincial capital? Even for them, the elephant trunk procedure was far from a routine operation.

Explaining the harsh reality to the family—if they happened to be reasonable, fine; but if they were difficult, the probability of facing a medical accident or dispute would instantly shoot past 80%.

Just as Lin Yuming was standing there in a daze, he suddenly heard Luo Hao's voice.

"It's me, your godfather."

"It's business. Who is the teacher with the highest success rate for elephant trunk procedures at your hospital?"

"Hah, I'm just staying true to my original intentions—I called him teacher before, and I still call him teacher now. Unlike you, who used to call me godfather, but now that you've become a deputy director, you're trying to change your tune."

What on earth was all this chatter about? Lin Yuming listened in utter confusion.

"I have a Type I patient here. I'll forward the imaging data to you shortly. The patient's condition isn't looking too good; we need to hurry and perform the surgery—the sooner, the better."

"Ah, Teacher Han? It's not that I was shy about troubling him. I just figured finding you would be more straightforward... Oh well, let me ask Teacher Han instead."

"Hang up now."

With that, Luo Hao disconnected the call.

"Who did you just contact?" Lin Yuming asked.

"Director Cui Mingyu from Anzhen Hospital."

Damn it!

Luo Hao addressed a department head at Anzhen Hospital with terms like "godfather" and "godson"? Recalling Luo Hao's words just moments ago, Lin Yuming felt the numbness in his hands spread further.

"Uncle."

Luo Hao leaned close to Lin Yuming and asked in a low voice.

"What mischief are you plotting now? Out with it if you have something to say." Lin Yuming had a bad premonition.

"The patient's condition is critical. To perform an aortic arch replacement, we need to prepare at least 20 units of red blood cells and 1,500 milliliters of plasma. As for platelets and the like, having them on hand would be ideal."

He knew Luo Hao hadn't brought any good news, and Lin Yuming glared fiercely at him.

"I'll contact the expert, and I'll communicate with the patient's family; those are minor issues. But there are some major problems that require you, Uncle, to step in personally to resolve. Look..."

The moment Lin Yuming heard Luo Hao address him formally as "you," a wave of throbbing headaches washed over him.

...

...

"Comrade, I am Wen Youren, head of the Department of General Surgery at the Mining General Hospital. I am lodging a real-name report against Director Lin Yuming of the Medical Administration Department and Luo Hao, an officer of the same department."

Carrying a thick stack of documents, Wen Youren arrived at his destination.

Upon entering the room, before he even had time to warm up from the cold, he stated his purpose outright.

Wen Youren was well-practiced in this routine because he had done it before.

Many years ago, an old department head who enjoyed the same renown as Wang Guohua had always looked down upon Wen Youren, breeding deep resentment within him.

After retiring, that old head didn't return to the Mining General Hospital but instead joined a private clinic, using his technical expertise and personal connections to siphon away quite a few patients.

The private hospital's anesthesiologist happened to be his wife, who lacked the legal scope of practice for anesthesia.

That had been Wen Youren's breakthrough. Patiently accumulating documentation on dozens of surgeries, he ultimately filed a real-name report, completely knocking down the old head who had wronged him and stepping on him a few extra times for good measure.

In Wen Youren's eyes, the old head back then had acted tyrannically, going so far as to let his wife administer anesthesia at a private clinic purely to boost his income—a blatant violation of medical principles.

He viewed himself as standing on the side of justice.

And right now felt just like back then.

For selfish gains, Luo Hao had engaged in off-label medication use, administering iodized oil to a patient despite the package insert failing to list intravenous administration as an approved route.

This kind of person was a pest in the medical field! A destructive worm! He had to be purged.

Tucked within those thick pages were the package insert for iodized oil, along with Luo Hao's surgical records and medication logs—complete and in order.

Wen Youren had spent a long time gathering these materials, keeping his actions under wraps precisely to deliver a thunderous blow today.

A real-name report! Even if someone wanted to protect Luo Hao, they wouldn't be able to shield him!

Clutching those documents, Wen Youren wore a smile on his face.

Yet his cheeks had been frozen stiff by the cold, making his imagined smile look somewhat ferocious, akin to a starving wolf in winter.

...

...

Luo Hao's cell phone rang.

Answering the call, he found it was from a nurse in the emergency department.

The patient's critical value report had come in. The reason it was delayed was that the laboratory department initially thought the numbers were too absurd and ran a repeat test to be sure, which wasted time.

Hemoglobin: 38g!

Before even starting surgery, they needed to transfuse blood first.

This time, not just Lin Yuming, but even Luo Hao felt a splitting headache coming on.

The hemoglobin level needed to be raised to at least 70 before surgery could proceed, causing Luo Hao to scratch his head incessantly.

"I'll go talk to the patient's family," Luo Hao sighed.

Since he was the one courting trouble, he had no one else to blame.

The patient's family member indeed had a broken limb; with a plaster cast suspended before his chest, he sat anxiously in the emergency resuscitation room waiting.

When Luo Hao returned, he called the family member outside.

"Your mother's condition is as follows," Luo Hao briefly outlined the patient's status before continuing, "Her hemoglobin is currently far too low, and she needs a blood transfusion."

Upon hearing about the blood transfusion, the family member's eyes lit out brightly.

"Doctor, I have 12 blood donation certificates!" the family member said eagerly. "That means free blood transfusions! That shouldn't be an issue."

Damn it!

Luo Hao cursed internally.

Could it really be that simple? You must be joking.

Yet the simpler they thought it was, the harder it would be to explain things to them.

Luo Hao watched the system task progress bar inching forward slowly. Wouldn't it have been better to just win effortlessly? Why on earth did he insist on treating a patient with such staggering difficulty?

The thought flashed through Luo Hao's mind, only to dissipate just as quickly.

If the patient still possessed a glimmer of survival, that thread was undoubtedly tied to him.

Throughout the entire Mining General Hospital, the only person who could promptly invite someone capable of performing such a high-difficulty elephant trunk procedure was himself.

Forget it, Luo Hao heaved a deep sigh.

"Here is the situation..." Luo Hao began to explain.

...

Note: Speaking of which, I still have to wail a bit here.

While on duty a few days ago, another patient was vomiting blood. During the emergency response, we had to rouse the department head from home to coordinate centrally, communicating with the gastroenterology department to step in for bandaging and hemostasis at a moment's notice.

After the patient's condition stabilized, while smoking and chatting with the department head, he mentioned that 80% of the patients vomiting blood in the department always seemed to land on my shifts.

Shrugging, palms turned upward, looking up at the sky.

Nothing to be done; this is metaphysics.

Back when I was in cardiothoracic surgery in 2015, all eight patients with rib fractures complicated by aortic dissections were received on my shifts.

Misdiagnosing such a rare complication is practically equivalent to a death sentence. I've never seen patients with rib fractures suffer sudden death elsewhere, so I can basically confirm it.

Fortunately, I diagnosed all eight patients, relying entirely on regular CT scans.

In one case where it wasn't obvious, I leveraged my personal standing in the middle of the night to consult the CT doctor I trusted most to review the scans together before finally securing a definitive diagnosis.

There's truly no alternative. Perhaps once I retire, the number of emergency cases at our hospital might actually decrease a little.

Regrettable.