Chapter 266 - 175: Feeding from the Main Account

Chapter 266: Chapter 175: Feeding from the Main Account

The rain was getting heavier.

Jiang He closed his umbrella and wiped the soles of his shoes on the doormat.

Just as he reached the floor of the Hepatobiliary Surgery Department, he saw Feng Ye waiting for him.

"Boss!" Feng Ye’s eyes lit up as he trotted over, looking like a primary school student waiting for praise from his teacher.

Jiang He asked gently, "Did you finish it?"

"I finished it!"

Feng Ye placed his laptop on the triage desk in the hallway and flipped open the screen.

"It’s the underlying algorithm for the early multi-biomarker prediction model for SAP. I put a shell on the front end, and I’ve already programmed in all the feature value weights you gave me yesterday."

Feng Ye explained as he demonstrated:

"You just have to enter the patient’s specific values in the corresponding biochemical indicator fields, and the system will automatically run the prediction probability and generate the AUC curve."

The algorithm wasn’t actually that complex. For a future computer genius like Feng Ye, it was practically overkill.

But Feng Ye’s attitude was surprisingly excellent.

He had pulled an all-nighter, working at top speed to get it done.

’Time to repay the favor.’

Jiang He entered the values into the system interface.

He clicked run.

Three seconds later, an ROC curve appeared on the screen, and a message popped up below:

AUC = 0.915.

The prediction result was good.

"Very good." Jiang He nodded in approval.

The program was fine, but this system couldn’t be implemented clinically just yet.

He had to wait for the SAP paper to be published in the *New England Journal of Medicine*. Only with the academic endorsement of a top international journal could he take it to Dean Chen and legitimately establish a project for clinical trials at Affiliated Hospital No. 1.

"Alright, I’ll take it. Your efficiency is very high, I’m very satisfied."

Jiang He gave him a thumbs-up. "Nice work. Go back and get some rest."

"Hey, Boss!"

"What is it?"

"Are there no other work arrangements? That’s it?"

"Not for now. I’ll let you know when something comes up."

Feng Ye stood rooted to the spot, his expression extremely conflicted.

He felt incredibly uneasy.

He had already prepared to work himself to the bone, and this was it?

If he were a woman, Feng Ye would absolutely suspect that Jiang He had spent so much money just to hit on him...

"Boss, you... you have to give me more work! Anything will do!"

Feng Ye was frantic.

’I want to work, I really, really want to!’

Jiang He understood what the young man was thinking and said:

"For now, just stay at the hospital and take good care of your mother. Help her recover and catch up on some sleep yourself. Once my paper is published and the multi-center validation begins, you’ll have plenty to do. I won’t let you stay idle."

Hearing this, Feng Ye finally felt a bit better.

He nodded. "I understand, Boss. Whenever you need me, I’m on call."

"Go on."

After sending Feng Ye off, Jiang He went into the private changing room and put on his white coat.

Then he took Meng Shiyu to do rounds.

As he did his rounds, he taught; as he taught, he observed.

’Hmm, this kid, Meng Shiyu, is quite smart. He can extrapolate from one example to understand many things, which makes teaching him easy and effortless.’

However, whether or not he could bring him onto the team still required further observation.

’After all, being smart is just the first step. What’s more important is... loyalty!’

Halfway through the rounds, Xiaochen, a nurse, suddenly trotted over.

"Dr. Jiang, the emergency department just called. They said a female patient was transferred from the municipal hospital. The municipal hospital had recommended an immediate exploratory laparotomy, but the family adamantly refused, insisted on discharging her, and transferred her here. And when the family arrived at the ER, they asked for you by name."

Jiang He closed the medical chart and looked up.

It was a little later than expected, but she had come after all.

’Good thing she’s here.’

He turned to Meng Shiyu. "Inform the head nurse here to slow the IV drips for beds 17 and 19, then come find me in the emergency department."

"You got it, Teacher." Meng Shiyu didn’t hesitate and immediately did as he was told.

「Ten minutes later, in a small conference room on the third floor of the Affiliated Hospital No. 1’s main building.」

Since Yang Xu had gone to Shencheng for an emergency consultation, today’s discussion on this urgent transfer case was led by the Medical Affairs Department. Several attending physicians from Hepatobiliary Surgery, Urology, and Gastroenterology participated, with the new Vice Dean, Zhang Sui, personally presiding.

"The situation is tricky. There’s a massive retroperitoneal mass that is severely compressing the right ureter, causing moderate hydronephrosis in the right kidney. If we delay any longer, the renal damage will be irreversible."

"The patient has jaundice and abdominal pain of unknown origin, as well as bilateral submandibular gland swelling. The municipal hospital performed two biopsies, but the pathology only indicated lymphocyte and plasma cell infiltration with fibrosis. They didn’t find any cancer cells."

"But that doesn’t mean it isn’t a malignant tumor. With retroperitoneal sarcoma or advanced lymphoma, it’s very common for a biopsy to miss the core tissue. I lean toward the municipal hospital’s judgment and recommend scheduling an exploratory laparotomy as soon as possible."

"I also agree with opening her up. The retroperitoneal space is too large. With a mass that has grown to this size, regardless of whether it’s malignant, it must be removed to relieve the compression."

In the conference room, the doctors’ opinions were nearly unanimous: operate.

Given the state of medical knowledge in 2008, when faced with a massive, highly invasive mass where no cancer cells could be found, a surgeon’s first instinct was always to cut.

After listening to everyone’s opinions, Zhang Sui said, "Jiang He, give us your opinion."

Jiang He answered immediately, "I don’t recommend surgery."

The attending from Urology immediately retorted, "No surgery? What about the hydronephrosis in the right kidney? What if it’s a metastatic malignant tumor and we miss the window of opportunity? Who will be responsible?"

Jiang He said, "A retroperitoneal mass, ureteral compression, submandibular gland swelling, jaundice, plus the pathology report indicating plasma cell infiltration with fibrosis... Everyone, could we be overlooking a systemic disease?"

"What disease?"

"IgG4-related disease."

A few doctors looked bewildered, clearly unfamiliar with the term.

Meanwhile, a few other senior attendings frowned slightly.

"IgG4?" The attending from Gastroenterology was the first to react. "That’s an inflammatory pseudotumor caused by an immune system abnormality, isn’t it? But I remember the incidence rate is extremely low, it’s clinically rare. Are you suggesting we abandon the first-choice surgical option for a malignant tumor for the sake of a rare disease possibility?"

"Exactly." The senior attending from Hepatobiliary Surgery also shook his head. "If we treat it as an inflammatory pseudotumor, we’ll have to use high-dose hormones. If the diagnosis is wrong, the patient is already weak. Once the hormones are administered, her immune system will completely collapse, and we won’t even have the chance to operate anymore."

The doubts everyone raised were exactly the same as the concerns Director Xu Wenpei had brought up back at Peking Union Medical College Hospital.

Without absolute certainty, you never administer high-dose hormones.

Jiang He calmly explained:

"A while ago at Peking Union Medical College Hospital, I encountered an almost identical case: painless jaundice, a mass in the head of the pancreas, and all imaging indicators pointed to pancreatic head cancer."

"At the time, Director Xu Wenpei and Vice Dean Zhao Licheng of the Peking Union Medical College Hospital General Surgery Department also recommended an immediate Whipple procedure."

The people in the conference room exchanged bewildered glances.

Peking Union?

When did Jiang He go to Peking Union to participate in a consultation of this level?

Meng Shiyu, who had been standing behind Jiang He the whole time, was now desperately trying to suppress the mad grin spreading across his face.

’Here it comes, here it comes!’

’Brother Jiang is about to flex again!’

Jiang He continued, "At the time, I suggested the possibility of IgG4-related disease to Director Xu, so we rushed a serum IgG4 subtype test."

"As it turned out, the patient’s IgG4 levels showed a pathological increase of more than tenfold. We then proceeded with experimental hormone therapy, and within just a few days, that massive tumor had shrunk by a third."

"It’s the same for this patient. We just need to draw two vials of blood, send them to the lab to check the IgG4 levels. If they’re normal, it won’t be too late to perform the laparotomy then."

Waving the banner of Peking Union and Xu Wenpei was extremely effective!

Moreover, his plan didn’t outright reject surgery. Instead, it used a blood test to rule out a potential cause of overtreatment.

The logic was tight and irrefutable.

Zhang Sui quickly ran through the hospital’s SOPs in his mind.

Jiang He’s proposal didn’t violate any rules.

First, perform a non-invasive biochemical test to rule out a specific disease, and only then proceed with invasive surgery.

This in itself was the most standard procedure for differential diagnosis.

So, Zhang Sui made the decision.

"Jiang He has a point."

"Screening for specific indicators complies with the standard for pre-operative differential diagnosis."

"Notify the ward to draw blood immediately and run an urgent serum IgG4 test."

"If the levels are indeed abnormally elevated, then follow Jiang He’s plan. Request a consultation from the Rheumatology and Immunology Department and attempt hormone therapy."

"If the levels are normal, schedule an immediate exploratory laparotomy."

"Meeting adjourned."

Zhang Sui stood up and walked out of the conference room.

A consultation that could have escalated into a multi-departmental dispute was thus effortlessly resolved by Jiang He with just a few sentences.

Many of the attending physicians present were amazed at Jiang He’s extensive knowledge and experience.

Others believed that Jiang He was very well-connected, able to know prominent doctors at Peking Union, and thus had a boundless future ahead of him.

This outcome was completely within Jiang He’s expectations.

’My main account (Zhiyu) feeding difficult cases to my alternate account (Jiang He)... this really is a great idea.’

’My status in the hospital is skyrocketing.’

’I wonder what will happen after the commendation ceremony in the middle of the month.’

’With my teacher’s help, what rank could I be promoted to, breaking the usual conventions?’

’I have to say, I’m actually a little excited.’

He walked out of the conference room.

Meng Shiyu followed closely at Jiang He’s side, marveling, "Teacher Jiang, you’re really something else. You’re incredible."

Jiang He said, "Let’s go. We need to finish the rest of the rounds. We have a laparoscopic surgery later, so let’s go prepare early."

"Alright, but Teacher, there’s a piece of gossip. You want to hear it?"

"What is it?"

"During the meeting just now, did you notice that Vice Dean Zhang was in a bad state?"

Hearing this, Jiang He thought back for a moment.

In the conference room, Zhang Sui’s eyes had been bloodshot, and his brow was constantly furrowed. He did indeed seem a bit tired and anxious.

"True, he did look a little out of it. What’s going on?"

Meng Shiyu glanced left and right. Seeing no one in the hallway, he said, "I only found out from hearing the nurses gossiping at their station just now. Vice Dean Zhang is actually divorced and has a daughter. Custody was awarded to his ex-wife."

"I heard his daughter is especially rebellious. Last time, the two of them got into an argument over something and it got so bad they ended up at the police station. Then this morning, Xiaoliu from the Medical Affairs Department went to his office to deliver the duty roster. The door wasn’t fully closed, and from outside, Xiaoliu vaguely heard Vice Dean Zhang on the phone reporting something to the police. He sounded extremely anxious, saying he was looking for his daughter."

"Reporting a missing person to the police?"

"Yeah, they probably had another fight and the girl just ran away from home."

Meng Shiyu shook his head. "Tsk, tsk. King Zhang the Great, who treats the hospital rules as more important than heaven itself, can’t even manage his own daughter..."

At this, Jiang He suddenly stopped in his tracks, a little stunned.

In his past life, after he started working at Affiliated Hospital No. 1, he had worked with Zhang Sui for a long time.

He knew very well that Zhang Sui was a stubbornly old-fashioned leader who was protective of his own people. He also knew Zhang Sui was a workaholic and that he was divorced.

But he had never heard that Zhang Sui had a daughter.

In his memory, Zhang Sui had always been all alone.

’Huh? Where did a daughter come from?’

’Why is it that in the memories of my past life, it’s as if this daughter never existed at all?’