Chapter 16: Dancing in Shackles

"So much went in, so little came out; why was the blood sodium still so low? I imagine the teachers from every department were also feeling troubled and stuck on this point at the time."

Seeing the expressions on Mo Jiaoshou and Sun's faces, Ji Xiang knew the System NPC must have guessed correctly. His mood instantly improved, and he continued to repeat the System NPC's explanation in his own words.

"Back then, I thought of a formula from physiology and biochemistry—concentration = solute ÷ solution."

"That was when I found the source of the problem."

"Clinical medication to supplement sodium increased the total amount, but the blood sodium concentration still dropped—there is only one reason: there was too much water in the blood vessels, which diluted the sodium. So I estimate that the various indicators in the 24-hour urine electrolyte test also changed; that is the point."

Listening to Ji Xiang's explanation, Sun's drool flowed out unconsciously, as if he had suffered a sudden cerebral infarction.

He could understand every word Ji Xiang said, but when put together, he had no idea what it meant.

"Because the patient's hormones for regulating fluid balance were malfunctioning, it led to a series of symptoms."

"To summarize, this is a disease called SIADH, also known as Syndrome of Inappropriate Antidiuretic Hormone secretion."

"One point that especially needs attention is that Syndrome of Inappropriate Antidiuretic Hormone secretion can appear in patients with severe infections."

"Therefore, in my treatment plan, I decided to take a slightly risky approach: while administering intravenous albumin, I used Furosemide to drain the excess water from the body, which in turn caused the other diluted indicators to rise back up."

"Teacher, my line of reasoning for the answer is finished."

After finishing, Ji Xiang stood calmly before the group and bowed slightly, looking exactly like someone defending a thesis.

The conference room was quiet, without the slightest sound.

Was Ji Xiang right?

No one knew.

Although Zhao Yuanzhang, Mo Jiaoshou, and even Sun all came from clinical backgrounds and had a thorough understanding of clinical practice.

But Ji Xiang's deduction was too profound; even though he used plain and easy-to-understand language, everyone still couldn't understand it.

It wasn't that they didn't understand at all—they understood every word, and they understood a little bit about Syndrome of Inappropriate Antidiuretic Hormone secretion, but...

It was estimated that only an Endocrinology Expert or a Kidney Expert could chat with this Pre-service Trainee.

Where did this monster come from?!

To be able to guess the complex 24-hour electrolyte report just by guessing!

Many doctors in grassroots hospitals hadn't even heard of this kind of test.

Zhao Yuanzhang felt slightly dejected; how good it would be if his own son could stand before him and say these things.

Although the mix of envy and jealousy was complicated and hard to describe, Zhao Yuanzhang did not lose his composure.

He slowly stood up, walked to Ji Xiang's side, and patted his broad shoulder lightly.

"Young man, the Second Affiliated Hospital welcomes you."

"Thank you."

"Work hard in the future!"

After saying this, Zhao Yuanzhang left the conference room.

Sun suppressed the shock in his heart and chased after Zhao Yuanzhang.

But he was too hurried, accidentally bumped into the table, and stumbled.

Fortunately, Sun reacted nimbly, bracing his hands on the floor so he didn't hit his head. But in that instant, he ran out of the conference room scrambling like a dog.

Mo Jiaoshou didn't mock Sun; even if his performance was flustered, it didn't attract Mo Jiaoshou's attention. His gaze was incomparably complex as he looked at Ji Xiang.

"Mo Jiaoshou, I still have a skills exam," Ji Xiang said with slight regret.

Ji Xiang also wished he could immediately follow Mo Jiaoshou to perform surgeries; no matter how well he did on the exam, the system wouldn't give any rewards.

But performing surgery was different; for every one he performed, he gained the accumulation of one surgery.

Whether it was technique, experience, or the rewards given by the system, they were all tangible to Ji Xiang.

"Who is the chief examiner for the skills exam?" Mo Jiaoshou asked.

"Professor Deng from Orthopedics."

"I'll call him," Mo Jiaoshou said. "Come with me to perform surgery. If you can perform surgery, why take some damn skills exam."

Ji Xiang didn't know if it would work and glanced at the young staff member from the Medical Affairs Department.

"Lao Deng, it's me, Mo Chenggui," Mo Jiaoshou had already dialed the phone. "Are you in charge of the skills exam for the Standardized Residency Training today?"

"What's wrong, Mo?" Professor Deng asked from the other side of the phone.

"I have 32 Outpatient Surgeries today, and I just happened to catch a new trainee to help me," Mo Jiaoshou said with a chuckle. "His level is quite good; if you want to see the operation, come to the Outpatient Surgery Room."

"That's not good, the others..."

"Isn't it the holidays?" Mo Jiaoshou interrupted the other party. "The school kids are all rushing to get their circumcisions done now; it's swarming, and I really can't finish the surgeries."

"But..."

"Last time you asked me to help in the middle of the night and said you'd treat me to a drink, but I haven't heard a word since. Help me out with this; don't leave after work today, I'll treat you."

The person on the other side of the phone had already given up resistance.

The Standardized Residency Training exam was just a formality anyway; with Mo Jiaoshou pushing hard, this bit of face still had to be given.

"Leave is granted," Mo Jiaoshou hung up the phone and looked at the young staff member from the Department of Science and Education.

The young staff member's lips moved, but he didn't dare to object.

Not just at the Second Affiliated Hospital, almost all Attending Professors in Surgery had some connections in society. Unless arranged by higher-ups, no one in the administration wanted to offend them for no reason.

Building a bit of goodwill—who knew when one might get a stone in their Kidney and need to beg Mo Jiaoshou.

It was just a Standardized Residency Training exam, after all.

Mo Jiaoshou led Ji Xiang out of the office building. At this moment, Mo Jiaoshou had lost his previous aggressive posture and asked cautiously, "Doctor Xiao Ji, that case analysis..."

"Mo Laoshi, when I was an intern, I happened to encounter a similar patient with my teaching teacher," Ji Xiang said, his face not turning red at all while lying; he was very calm, as if it were true.

This was too coincidental!

But it only took Mo Jiaoshou 0.1 seconds to accept Ji Xiang's explanation.

This is the most logical possibility; there are no other possibilities.

Mo Jiaoshou had also heard rumors about how thorny that case was back then.

At the dinner table, he had heard Professor Deng from the Orthopedics Department mention it countless times, and every time, Deng Chaohong would speak with spit flying, looking smug.

He never expected it to be "easily" solved by a small Standardized Training Student.

Wrong!

Thinking of this question, thinking of Deng Chaohong, and thinking of Zhao Yuanzhang, Mo Chenggui had already straightened out the line of thought.

It was likely that Zhao Yuanzhang wanted to arrange for his son to go to the Orthopedics Department, to be mentored by Deng Chaohong, and to stay in the Orthopedics Department in the future. Sun had heard rumors of this, so he chose one of the cases Deng Chaohong was most proud of as the exam question.

Although it was useless, it couldn't be called gilding the lily; Mo Chenggui was not surprised that people in the administration had these little schemes.

He didn't like it, but he didn't oppose it either.

"Xiao Ji, just watch for now, don't rush to take over; we are doing a Stapler Circumcision."

"Mo Laoshi."

"Hmm?"

"The very first thing I learned was Stapler Circumcision," Ji Xiang explained.

"..."

"Compared to Manual Suturing, I am more familiar with the instruments," Ji Xiang said in a firm tone.

"!!!"

Mo Jiaoshou was stunned.

Was this something a Standardized Training Student should say?

"Mo Laoshi, there is one thing I don't understand, and I would like to ask for your guidance."

"Go ahead." Mo Jiaoshou looked at Ji Xiang with great interest.

Using instruments to perform Phimosis Surgery made the procedure simpler; he believed what Ji Xiang said was true. If that were the case, it was truly like someone sending a pillow just as one was getting sleepy.

"Why did we do Manual Suturing two days ago, but today we are doing Stapler Surgery?" Ji Xiang asked.

"Heh." Mo Jiaoshou let out a long breath after hearing Ji Xiang's question.

This question proved that Ji Xiang was just a rookie with extraordinary talent, not some legendary transmigrated old monster.

"Xiao Ji, do you know about the staffing system for doctors?"

"I know a little; doctors at our Second Affiliated Hospital should be under the Public Institution system," Ji Xiang answered vaguely.

"Correct, and also incorrect." Mo Jiaoshou didn't beat around the bush, explaining to Ji Xiang as they walked, "The Public Institution system hasn't had new spots for a long time; when one retires, that spot is gone. Now, the vast majority are third-party outsourced."

"Outsourced?"

"It saves money." Mo Jiaoshou sneered, "Let's not talk about that; let's talk about the Public Institution system. There are four categories of Public Institution staff. I won't go into the others, but hospital doctors belong to the Differential Appropriation Public Institution."

"The Differential Appropriation Public Institution is a type of Public Institution staffing where the government provides partial funding, and benefits and income are linked to a certain extent, such as in hospitals and some tourist attractions."

"But do you know, the funding... hahaha."

As he spoke, Mo Jiaoshou laughed out loud.

Ji Xiang didn't know what he was laughing at and felt a bit confused.

"The state regulations are just regulations; the actual differential appropriation that reaches the Second Affiliated Hospital is only 18-23%."

"That little?"

"That's not even the half of it," Mo Jiaoshou said. "During the public health epidemic in previous years, the city and province didn't touch the medical insurance funds, but instead asked each hospital to advance the payments, and they still haven't paid it back to this day."

"..."

"They owe our Second Affiliated Hospital 220 million, and other similar hospitals are likely owed about the same amount."

Ji Xiang was silent; he didn't quite understand what Mo Jiaoshou was talking about.

"Why don't they touch medical insurance? Because medical insurance has no money. A stapler costs 1,680; it's either paid in full or 80% is reimbursed. Just for a circumcision, if it costs that much, the medical insurance department certainly won't stand for it."

"Oh, then we just don't do it," Ji Xiang said.

"It's not that simple." Mo Jiaoshou smiled. "The common people all know about the reimbursement; it's not up to us to decide. But if there's too much reimbursement, medical insurance won't settle the accounts with us, and the extra money has to be paid by the hospital, and the hospital will deduct it from the department's funds."

"We are indeed here to heal the wounded and rescue the dying, and we can help out when we occasionally encounter poor patients. But we only earn such a pittance, and then we have to fill in the gaps..."

It was so complicated that Ji Xiang felt his head starting to ache.

The things Mo Jiaoshou was talking about didn't seem to be the same medical field he knew, and Ji Xiang instantly cast these matters aside as useless information.

"Everyone wants to be a good person and get the benefits, but doctors and hospitals are caught in the middle, making it very difficult to act," Mo Jiaoshou said.

"Then why are there still so many Stapler Surgeries today?" Ji Xiang asked.

"The patients won't have it otherwise. With consulting so developed now, we can't just tell the patients we don't know how to do it," Mo Jiaoshou said, shrugging helplessly.

"Besides, if we don't do it, other hospitals will, and if we don't do it, we'll end up with nothing to eat. Using Manual Suturing to balance it out, we are living in the cracks, dancing in shackles."

"Mo Laoshi, I heard that the profit from medical instruments is very lucrative."

"That was before centralized procurement; after centralized procurement, there isn't much money in it," Mo Jiaoshou said very calmly.

"You..."

Ji Xiang thought of the cigarettes Mo Jiaoshou smoked.

"If you want to make money, go to a private hospital; performing surgeries there is what you call making money." Mo Jiaoshou didn't show his emotions like Wang Daxiao, but said calmly, "However, you are young, don't be in a rush; practice your surgeries well first."

(End of this chapter)