Chapter 6: A Dilemma

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“Director, I feel uneasy with the medical office’s team stationed in our department,” a gynecologist casually complained to Director Sun before the shift handover.

Director Sun shared the same uneasy feeling.

Clinicians most dislike bureaucrats meddling in their work. Even though Luo Haoyang from the medical office was sunny and approachable, he was still seen as an outsider—no matter how friendly his smile was, Director Sun suspected his intentions.

“When will they leave?” the gynecologist asked.

“We can’t just kick them out. If we encounter tricky cases tonight, we call them repeatedly. When they’re exhausted and fed up, they’ll leave on their own,” Director Sun whispered, sharing a knowing glance with the doctors.

Everyone understood the plan.

The office door opened, and Luo Hao entered.

Like a ray of sunshine piercing through, Director Sun squinted against the brightness.

With Luo Hao’s arrival, the previous topic abruptly ended, and they began the shift handover and patient rounds.

A busy day had begun.

…

Clinicians have complicated feelings toward the medical office.

To many, the medical office is the hospital leadership’s “lackey” or, more politely, their enforcers.

They handle everything from doctor-patient disputes and complaints to medical record audits. Over the past year, even the most complex medical insurance cases were assigned to them.

Clinicians neither want to offend the medical office nor tolerate their interference.

The gynecologists looked at Luo Hao with a mix of admiration and suspicion, as though a beauty had been forced into thievery.

That evening.

After work, Luo Hao stayed behind to write the medical record for a patient with an ovarian cyst.

“Leader, there’s a patient that seems suspicious to me. Can you take a look?” the gynecology on-duty doctor teased Luo Hao.

“Not a leader, just a donkey. Which patient?” Luo Hao asked.

“A premature birth.”

“For prematurity, we need a neonatologist. Sorry, I’ll call them now.” Luo Hao glanced at the patient, sensing something amiss, and immediately dialed the neonatology department.

“Hello, this is Luo Hao from the medical office, I’m in gynecology requesting an urgent consult with your on-duty doctor.”

“That’s me. Premature birth? I’m on my way.”

The neonatologist responded promptly and hung up.

The gynecologist’s expression was odd, which Luo Hao noticed with curiosity.

“Prepare for delivery,” the gynecologist called out to the midwife as they headed to the delivery room.

Inside, Luo Hao reviewed the chart but didn’t change into scrubs. He stood with his hands behind his back in the corridor outside the delivery room, his expression serious.

“Doctor Luo,” the gynecologist hesitated, looking conflicted.

“What’s wrong?” Luo Hao asked.

“The mother has some issues, don’t you think?”

“I sensed it,” Luo Hao said earnestly. “She’s 35 weeks pregnant, but the ultrasound shows the baby is somewhat large.”

The gynecologist gave a half-smile, half-smirk.

“The fetus has a large head and long femur. Because in later stages you can’t rely on biparietal diameter and femur length to estimate gestational age or maturity, it’s tricky to say much—but don’t you feel...”

“Enough. I know there’s probably an issue with the mother, but we need to avoid any emergencies.”

Luo Hao’s face grew serious as he addressed the gynecologist, “Inform the midwife and neonatologist—no pointless talk.”

The gynecologist squinted, raised an eyebrow, and went to change clothes before entering the delivery room.

It’s common for patients to conceal their medical history, and it’s no surprise for pregnant women to hide the date of their last menstruation.

The woman claimed 35 weeks, but the ultrasound suggested full term.

But this isn’t the hospital’s or doctor’s fault.

The gynecologist was hoping Luo Hao would show nervousness or anxiety, but he had already uncovered the truth early on—and he was even more certain than she was that the baby was not premature.

Luo Hao checked the diagnostic AI assistant; there was no indication of prematurity.

Comparing that to the ultrasound in the records, Luo Hao felt reassured.

He worried that gossip among the gynecologists, midwives, and neonatologists might upset the mother and her family, so he quietly gave instructions to each person in the hallway.

The mother was multiparous, and half an hour later, Luo Hao heard a loud cry.

The baby was healthy.

A little later, the midwife came out holding the child.

Luo Hao glanced and saw the baby was full term.

He scratched his head and treated the incident as a minor episode to forget.

The gynecologist came out after changing, removing her mask and smiling at Luo Hao.

“Xiao Luo, don’t worry. We see these cases all the time and won’t say a word.”

Luo Hao nodded and smiled.

“I didn’t expect someone so young to know so much. I thought you’d be more worried,” the gynecologist joked.

“I liked running emergencies when I was a student; my teachers chatted with me a lot.”

“Oh? Anything interesting?”

“My teacher said the emergency department with the highest divorce rate—guess what it is?” Luo Hao asked with a grin.

Divorce rates and emergency medicine seemed unrelated.

The gynecologist paused, thought a moment, then guessed, “Dermatology?”

“Nope. It’s serious. My teacher said it’s patients with urinary stones who come in at 3 or 4 a.m. during the first big cold snap in autumn—they have the highest divorce rates.”

!!!

The gynecologist was stunned.

She looked at Luo Hao, puzzled how he seemed to know more than she did.

“I’ve seen it twice—patients so pale from pain, sweating all over. The people who came with them hear it’s stones and just sit playing games, not really caring.”

“My teacher said once the stones are treated, there’s a significant chance of divorce—higher than for malignant tumors.”

The gynecologist looked at Luo Hao’s bright face, surprised this young man could rattle off clinical gossip effortlessly, with no hint of naivety.

“Don’t worry,” she said, feeling a bit embarrassed and adding, “Nothing will happen. Mainly, I kept calling the neonatologist and got weird looks, so I just bothered you. Xiao Luo, you should rest a bit; I’ll finish the notes.”

They left the delivery room together, passing by a burly man who an hour earlier had wanted to fight, now happily crying with his face covered.

Luo Hao found the scene utterly absurd.

But a doctor is a doctor, nothing else to do; he kept quiet and passed by the patient’s family.

Back in the department, the gynecology on-duty doctor found a common topic and started chatting with Luo Hao.

As for Director Sun’s subtle schemes, the gynecologist paid no mind.

No one wants to be a pawn.

Besides, Luo Hao was nice, joked around well, and if he really wanted to cause trouble, the gynecologist couldn’t bring herself to oppose him.

As they talked, the sound of a stretcher arrived, followed by a loud shout from the emergency escort.

“You go ahead, I’ll check the emergency patient.”

“Ding dong~”

The system task alert sounded in Luo Hao’s ear.

He perked up and looked at the system panel on the top right of his view.

[Emergency Task: A Difficult Choice.
Task: Treat a patient with scar pregnancy and massive bleeding.
Time Limit: 5 hours.
Reward: 10,000 experience points, 3 hours of surgical learning time.]

A task!

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Reward includes surgical learning time!

Luo Hao instantly brightened.

He was no longer satisfied with unlimited cadaver practice; the system’s surgical learning time allowed him to absorb and comprehend much more—experience points earned were 3 to 5 times greater than self-study.

Scar pregnancy...

After a brief excitement, Luo Hao’s gaze focused on the task details.

Scar pregnancy refers to women with a history of cesarean section whose embryo implants on the uterine scar in subsequent pregnancies, often causing massive vaginal bleeding and late uterine rupture—a challenging abnormal pregnancy.

This condition is extremely dangerous, second only to ectopic pregnancy in gynecology.

As for treatment...

In the past, many patients required hysterectomy after failed conservative management.

But now, Luo Hao had an idea and activated the interventional surgery skill tree. The simplest interventional catheter embolization is a level four surgery, just within his capability.

Why not try?

Try!

Embolizing the communicating artery for intrauterine twins was beyond him, but embolizing the uterine artery was doable; it was a level three surgery and not very difficult.

Luo Hao stood and left the doctors’ office.

The hospital once had an interventional department and had purchased expensive DSA equipment, performing over a thousand surgeries annually.

At its peak, they even conducted advanced procedures like TIPS, doing dozens each year.

But that was history.

Due to changes in centralized procurement policies, reduced group investment, and aggressive poaching by southern hospitals, the interventional department Luo Hao’s hospital had built for over a decade vanished in less than five years.

Now the department had shrunk to the point it couldn’t perform even basic surgeries.

Truly an emergency task, Luo Hao sighed.

A sharp metallic scent of blood hit him.

On the stretcher lay a middle-aged woman, her pants soaked through, dark red blood dripping onto the marble floor.

The vivid red blood was terrifying; the patient’s family was speechless, as if their mouths were covered, following silently with helpless, blank expressions.

“Prepare for resuscitation!” The gynecologist shouted, adrenaline surging from the blood smell.

The nurse was nervous but understood basic rescue protocols—checking blood pressure and establishing IV access.

Luo Hao helped attach ECG monitors. The patient’s blood pressure was dangerously low, 65/32 mmHg.

Diagnosed with hemorrhagic shock, time was critical to stop the bleeding.

The gynecologist called Director Sun during a moment of spare time, while Luo Hao went to the fire escape to call his uncle, Lin Yuming.

“Uncle, it’s me.”

“Why call so late? What’s wrong?”

Lin Yuming had no sleepiness in his voice. Every experienced clinician knew a midnight call meant trouble.

Luo Hao briefly explained the patient’s condition.

“Uncle, I want to do an interventional DSA surgery for the patient.”

Unexpectedly, Lin Yuming immediately refused without hesitation.

“No way!”

“Uncle, the patient...” Luo Hao started.

“Call me Director Lin!” Lin snapped.

Luo Hao was silenced for a moment.

“Director Lin, the patient’s condition demands it.”

“Bullshit demands! Since the interventional director Qian left for the south, no scar pregnancy patient here has died. Who do you think you are!” Lin cursed fiercely.

“Uncle, calm down and hear me out.”

“Hear you out? What? You think looking at images is enough for surgery? You want to expose yourself to radiation?!” Lin shouted.

“Listen, Uncle, your ideas are outdated,” Luo Hao said bluntly, knowing soft words wouldn’t work.

“At Xiehe Hospital, interventional surgery rarely uses traditional catheter methods anymore. They mainly use CT-guided radiofrequency ablation.”

“No radiation at all.”

“Many hospitals now use particle implantation surgery, which also doesn’t involve radiation.”

Silence on the other end.

Luo Hao felt a flicker of hope.

“Before pregnancy, just avoid radiation for six months. Uncle, I promise once I have a girlfriend, I’ll stop all this. But right now, it’s about saving a patient’s organ. If I can’t do it, hysterectomy is the only option. But now we can do it.”

“...”

Dead silence.

“Uncle, is our DSA machine still usable?”

“Wait for me.”

After a few seconds, Lin Yuming spoke gloomily and hung up.

Interventional surgery includes many types. Ultrasound-guided procedures are interventional surgery, but traditional catheterization uses DSA X-ray imaging.

For example, coronary interventions in cardiology.

Radiation exposure affects the operator’s health, impacting thyroid, eyes, and immunity.

Most crucially, radiation can cause birth defects in future children.

Lin’s concerns were justified; Luo Hao didn’t think his uncle’s reaction was an overreaction.

That was family. If anyone else volunteered, Lin Yuming would probably spin grand promises to fill the entire hospital cafeteria.

Director of Interventional Department, preferential insurance policies, key departments, hospital support—all the perks.

But the problem was no one genuinely wanted the job.

“You don’t want to do it? Plenty of others will,” was not true in the interventional department.

Luo Hao pondered how to convince Lin Yuming while helping with the rescue.

The patient was in poor condition, severe hemorrhagic shock, pale and cold.

Within minutes, Lin Yuming arrived hastily.

He frowned, glanced at the patient, then grabbed Luo Hao’s collar, pulling him out of the rescue room amid others’ surprise.

“Think you’re hot stuff, huh?”

“Got wings, huh?”

“You keep talking about Xiehe Hospital, do you think they know you? Who do you think you are?! If you had the skills, why not stay at Xiehe!”

Lin’s voice was low but furious.

He didn’t come at night to discuss politely but to verbally reprimand and keep a close eye on his reckless nephew to stop him from going to the cath lab.

“Uncle…”

“Who the hell calls me uncle!” Lin pointed a finger at Luo Hao’s nose. “No interventional before kids, you think I don’t know? I’m a radiology specialist—at least thirty percent of interventional doctors nationwide I know!”

“Uncle, calm down.” Luo Hao bowed, wearing a humble, flattering smile.

Lin slapped Luo Hao’s head. “Are you crazy? Ultrasound-guided surgeries aren’t enough for you to eat for a lifetime? Lao Liu said your ultrasound skills are outstanding among your peers. Even he can’t say he’s much better.”

“Uncle, but this is a patient. Without embolization, they’ll lose their uterus.”

“...”

Lin was speechless.

Luo Hao dared to mock himself!

Lin’s eyes widened like copper coins, with a hint of menace.

He knew how much his uncle doted on him—this was probably the first time Lin had ever hit him.

“Uncle, listen. I swear, just this once!”

“Once? You’re lying!”

Lin raised his hand again and slapped Luo Hao’s neck.

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“Careful of carotid intima tear—you hit me on the back of the head just now. I’m dizzy now.”

Lin’s eyes narrowed but his hand stayed raised.

Luo Hao grinned sheepishly. “Uncle, really, just this once. I’m not crazy. Wearing lead aprons in surgery is disgusting, like a puppet—I don’t want to. It’s just a transition, a transition.”

“Yeah, right.”

“Really. Uncle, listen to my teacher’s prediction of future technology. One point is puncture techniques.”

“Huh?” Lin paused. “Puncture is easy.”

“Not chest or abdominal puncture like that. In the future, nanorobots will treat cancer, implanted into lesions by puncture.”

“Isn’t it oral medication?”

“That’s generations later—science fiction, a vision. What we see now is puncture to place robots, drugs, or radioactive materials inside lesions.”

At the word “radioactive,” Lin’s face twisted.

“Uncle, I’ll find you info on particle implantation technology.” Luo Hao pulled out his phone and opened an English-heavy website looking for relevant papers.

This tech appeared in the interventional puncture skill tree. Luo Hao couldn’t perform it yet, but he could learn about it.

He tried to shift Lin’s focus, but Lin was stubborn; Luo Hao’s tricks were useless.

“I’m not looking. Say what you want.”

“Uncle...” Luo Hao swallowed, seeing Lin’s grim expression, and trimmed what he wanted to say.

He knew if he couldn’t convince Lin in three sentences, the surgery was off.

“Three points. First, we’re doctors. This isn’t just any patient, and I can do this. If I operate, the patient keeps her uterus; if not, she lives but loses it. It’s still an organ.”

Luo Hao watched Lin’s reaction closely.

“Second.”

Taking advantage of Lin’s silence, Luo Hao pressed on.

“Second, I guarantee the surgery—radiation exposure will be under 20 minutes!”

“Huh?!” Lin was stunned.

Though not a practitioner, Lin was a trained radiologist and had watched interventional doctors at the hospital.

Scar pregnancy requires embolization of the uterine or internal iliac arteries.

Previously, the hospital’s interventional director meticulously embolized the uterine artery if the patient was stable.

The uterine artery is about 2mm in diameter—small and delicate.

If skills are insufficient, embolize the internal iliac artery, which is 6-7mm—like a wide highway for interventional doctors.

A surgery under 20 minutes would mean Luo Hao planned to embolize the internal iliac artery.

This kid had some sense!

Lin snorted.

Luo Hao seized the opportunity. “Third, this is my career plan, otherwise why would I need so many practice scopes?”

“Career plan? Explain.”

“Uncle, the patient is in hemorrhagic shock, waiting for surgery.”

Lin considered, then raised a finger.

“First, actual surgery time must be under 20... no, 10 minutes. If you use more than 10, you’re not talented enough.”

“Okay, okay.” Luo Hao nodded eagerly.

“Second, this is the last time. If you insist, marry soon and have kids. Once you have kids, do whatever—then I’m an old fool, no complaints.”

Luo Hao nodded obediently.

“Third, can you really do it?”

Lin’s tone shifted from uncle to director.

Luo Hao smiled brightly.

The task was one thing, but saving the organ was what he really wanted.

“Yes!”

Lin appraised Luo Hao, furrowing his brows deeply, as if carving a crease between them.

“I’ll contact the DSA room. The interventional dept is gone, but vascular surgery still does procedures. Damn, I searched for three years for interventional docs—didn’t expect…”

“Uncle, by the way, you know plus-size women have gastric resection for weight loss, right?”

Lin nodded in confusion.

“Interventional embolization of the left gastric artery achieves the same effect with less damage.”

“Minimally invasive surgery is the future. Unless interrupted by war or disaster, by 40, current procedures will be obsolete.”

“!!!” Lin looked at his energetic nephew on his phone and sneered, “Only you believe that.”

“Once, thoracic surgery was the best surgical specialty; look at it now, beaten down by interventional surgery.”

Lin, an experienced clinician, knew this well.

The hospital once had two general thoracic and one cardiothoracic surgeons. With interventional rise, cardiothoracic surgery disappeared.

Something felt off...

Lin quickly realized Luo Hao was trying to psych him up.

Damn! Lin cursed.

“I don’t care. You either do something else or get married and have kids quickly.”

“Okay, I promise to finish the task!” Luo Hao replied without hesitation.

Lin dialed to summon people for the emergency surgery, then shot Luo Hao a stern glance before leaving the fire escape.

Back in the emergency room, the smell of blood was overwhelming.

Lin strode in, accustomed, and asked gravely, “How is she?”

“Director Lin, bleeding has temporarily stopped. Blood bank is preparing transfusion, should start within thirty minutes. Director Sun has been notified; once stable, she can go to surgery,” the gynecologist replied.

“Inform Director Sun, patient is to undergo interventional embolization.”

!!!

The gynecologist’s expression was priceless.

She paused, then smiled with relief, relaxing visibly.

“Director Lin, has Director Qian returned from the south? Or did you find someone to do interventional surgery? Amazing! You don’t know how much we’ve hoped for an interventional doctor who can perform embolizations here.”

Lin ignored her, turning back to Luo Hao.

“You handle all pre-op briefings for interventional procedures. I’ll supervise.”

“Okay.”

Luo Hao then took the patient’s family to the doctors’ office.

The gynecologist stared in amazement, slowly realizing what was happening.

Their department had ties to interventional surgery, especially for scar pregnancy patients—the best treatment is embolization.

Compared to open surgery, interventional embolization causes minimal trauma.

Sadly, with Director Qian and others gone south, these surgeries ceased.

For these patients, they could only stop bleeding first; if ineffective, hysterectomy was the only option.

Director Sun often muttered quietly about Director Qian’s greed for money when doing such operations.

But southern patients are patients, and Director Qian was just making a living.

The gynecologist anxiously wondered who Director Lin had recruited for interventional surgery, while attending the patient and urging blood bank to expedite.

Minutes later, hurried footsteps echoed down the corridor.

Bang!

The emergency room door was pushed open with such force it crashed against the wall with a loud noise.

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