Chapter 800: Promotion

A few hours ago, Ji Xiang finished his surgery and went off duty to the Emergency Department.

Today was Meng Qingfei's night shift, and Ji Xiang had long since grown accustomed to this rhythm.

Arriving at the Emergency Department, he ran into an Emergency Internal Medicine Doctor, who paused after seeing Ji Xiang, said something to the Patient beside him, and then pulled Ji Xiang aside.

"Doctor Xiao Ji, I heard that Old Meng is going to the Medical Affairs Department?"

"Huh?!" Ji Xiang was also taken aback.

Meng Qingfei was going to the Medical Affairs Department?! Ji Xiang hadn't heard a whisper of this news.

But seeing the Emergency Internal Medicine Doctor's expression, he instantly guessed something.

"Yeah, Director Bai specifically came to discuss it with the Director a few days ago. You actually didn't know?"

"I didn't." Ji Xiang looked innocent.

The Emergency Internal Medicine Doctor said mysteriously, "I heard that once he goes over, he'll be promoted directly to a full section-level position."

"Teacher, that's impossible, right? To be promoted to a full section-level, you need at least 2 years as a deputy section-level. Meng Laoshi is just a regular Clinical Doctor; doing that seems a bit against the rules."

"3 years, it takes 2 years to go from deputy division-level to full division-level." The Emergency Internal Medicine Doctor corrected him, "You didn't know Old Meng is a Deputy Director of Emergency Surgery?"

"..."

Ji Xiang shook his head.

"Sigh, they call it Deputy Director, but it's actually just a title for the benefits, so he can earn a bit more money. In this dump of an Emergency Department, how many directors come through just to get a rank boost, and leave after 2 years at most? Old Meng worked to get that position years ago; I thought it was useless, but looking at it now, tsk tsk."

This meant nothing to Ji Xiang, so he just smiled.

"So he was playing a long game."

The Emergency Internal Medicine Doctor looked deeply at Ji Xiang and said the words "long game," but he had more to say that he left unsaid, then went off to get busy.

Ji Xiang arrived at Emergency Surgery, and less than 3 seconds after he poked his head in, a set of keys flew over.

After catching the keys to go change his clothes, Ji Xiang began helping Meng Qingfei get busy.

This was the time when there were the most Patients, and Ji Xiang became increasingly proficient, until a little past 6 o'clock when there were slightly fewer Patients.

"Meng Laoshi, the Internal Medicine teacher said you are going to the Medical Affairs Department?" Ji Xiang only had time to ask at this moment.

"I reckon Director Bai is going to be promoted to Vice President this year, and is stocking up on human resources for the Medical Affairs Department." Meng Qingfei said indifferently, "I have to manage Medical Records and complaints; it's a headache."

"Congratulations."

"Nothing to congratulate. If it's just Medical Records, it's easy to turn a blind eye, but once a Medical Malpractice case happens, it's a huge pot to carry; not only do you offend people, but you also bear the responsibility. As for complaints, I'll have to stock up on some blood pressure medication."

"It won't come to that, it won't come to that." Ji Xiang waved his hand.

"Won't come to that?!" Meng Qingfei said with disdain, "Let me tell you a story."

Taking advantage of the lack of Patients, Meng Qingfei got up to wash his hands; he didn't use paper towels, instead wiping his hands vigorously a few times on the seat of his White Uniform.

The black smudge in that spot was incredibly obvious, but Ji Xiang was already used to it and didn't even see it.

Arriving at the Duty Room, Meng Qingfei lit a cigarette.

"Take a break, the drunks will be coming up soon." Meng Qingfei made a gesture to throw a cigarette to Ji Xiang, but was refused by Ji Xiang.

"A few years ago, I saw a question online—it said that when his mother came to the hospital, she was perfectly fine, but in the time it took to park the car, she was dragged into the ICU for intubation and resuscitation."

"Oh, there are quite a few similar people." Ji Xiang answered very calmly, "I don't think that's a problem."

"I knew what was going on just by reading the title. If these people have even one part of a reason, they can make it sound like ten. Even if they are in the wrong, they still have to argue for three parts." Meng Qingfei said, "When you go to the Medical Affairs Department later, you'll be facing all these kinds of people."

"It won't come to that, it won't come to that." Ji Xiang laughed and repeated that it wouldn't come to that.

"How could it not?" Meng Qingfei glared at Ji Xiang, but soon smiled and said, "One advantage of our hospital is that the leaders all have Clinical backgrounds. Let me test you on a question, Xiao Ji."

"What is the advantage of hospital leaders having Clinical backgrounds?" Ji Xiang asked.

Meng Qingfei nodded.

"First of all..." Ji Xiang said two words, thought for a long time, but couldn't clearly explain what was going on.

This question was too far removed from Ji Xiang.

"Hahaha." Meng Qingfei laughed, "Let me tell you something. The Medical Affairs Director at the hospital next door was originally from a Clinical background, just like Director Bai, and could be considered shrewd and capable. Later, a cadre who transferred from the military came over, and the Medical Affairs Director moved up half a step to become Vice President."

"At the time, I didn't think much of it, but in less than 2 years, that hospital was in a mess. The good hospital was visibly losing people who could actually work, and even those who stayed were pushing Patients to private hospitals."

"Oh? How did that happen?" Ji Xiang asked.

"A hospital is like a big, broken ship. If you don't push it, the ship can still drift along. Once you exert force, especially if an outsider exerts force, the ship breaks."

Ji Xiang didn't quite understand, but Meng Qingfei didn't explain much more to him and continued, "I was having a meal with a friend from the hospital next door, and I heard them complain about one thing."

"In the Internal Medicine diabetes clinic, a Patient's blood sugar was not responding well to adjustments, and the Doctor wanted to admit them, but the Patient and the Family Member disagreed. Later, the Doctor ordered a full abdominal CT for the Patient, preparing to check carefully."

"The Family Member got angry as soon as they saw it—it was a checkup costing nearly a thousand yuan that had nothing to do with diabetes—and took the order form to file a complaint. You have to say, that cadre who transferred from the military was truly dedicated to serving the people."

Meng Qingfei laughed mockingly, "He was also very angry when he saw it, called the Endocrinology Doctor over and lectured them, using language that was unbearable."

"Oh, if blood sugar adjustments aren't working, it might be that the Doctor lacks experience, but one still needs to rule out the possibility of a Tumor. I don't think there's anything wrong with ordering a CT."

Meng Qingfei looked at Ji Xiang with an appreciative gaze, and after a few seconds, said faintly, "After scolding the person, he refunded the money and made the Endocrinology Doctor apologize to the Patient, and that was the end of it."

"The Family Member didn't say much else and took the Patient to a private hospital nearby to adjust their blood sugar. The effect seemed okay, after all, they were hospitalized. But a few months later, the Patient's condition got worse and worse; they came to the hospital for a checkup and it was late-stage Pancreatic Cancer, missing the best time for surgery."

Ji Xiang shook his head, not knowing how to evaluate this matter.

"Xiao Ji, I'm asking you, if Director Bai were handling this, what would he do?"

"He probably wouldn't think it was the Endocrinology Doctor's problem; Director Bai is very professional, after all."

"Right. Other positions in a hospital can have outsiders—and there are actually quite a few outsiders—but key positions like the Medical Affairs Department must be held by Doctors with Clinical backgrounds. Otherwise, they'll do bad things with good intentions, or manage things blindly without understanding anything."

"A bit..."

"Are you saying what I said is a bit excessive?" Meng Qingfei laughed, "Let me tell you an even more excessive example."

Ji Xiang pricked up his ears.

"At the hospital in my hometown, when I went back for the New Year, a relative was sick. I went to take a look and chatted with their duty Doctor for a few words. That person had been transferred from a lower-level hospital; perhaps they had a deep background, and they became the Director of the Neurology Department directly."

"She didn't know how to do anything; it is said that her most proficient skill was Party building."

"..." Ji Xiang was speechless.

"At first I didn't believe it, but after flipping through the Medical Record, I discovered there was no three-tier ward round system at all."

"There isn't one?!" Ji Xiang was startled.

The three-tier ward round refers to the daily medical activities performed by the attending physician, the physician-in-charge, and the chief physician during a Patient's hospitalization.

It is a basic medical system that must be followed by physicians of all levels when performing medical work, an important link for improving medical quality and implementing rules and regulations at all levels, and also an effective way to train young physicians.

Regardless of whether it was useful or not, when Ji Xiang first came into contact with Clinical work, the three-tier physician ward round system was already in place, and it had been implemented for who knows how many years.

That a department director wouldn't conduct ward rounds made Ji Xiang somewhat surprised.

"I asked why, and when the ward-managing doctor saw that I was a colleague from the Provincial Hospital, they complained to me, saying the director had no professional ability at all and was afraid of taking responsibility if something went wrong, so they found an old comrade who was about to retire to be responsible for that workload."

"And when checking the Medical Record, it was explicitly stated that unless the director was leading the round, one could not write that such-and-such director conducted the ward round."

Ji Xiang completely didn't know how to comment on this matter; life was truly absurd to the Extreme Point, so much so that doctors wouldn't even believe it if told.

The three-tier ward round is generally just for show; every morning after the shift handover is finished, the director leads people on rounds.

Provided there is no deep-seated hatred between the Attending Professor and the director, the director basically sees the Patient every day.

If it's that kind of highly dignified grand director, or a grand Internal Medicine director, there is also a grand Internal Medicine ward round or something similar every month.

The so-called three-tier ward rounds are all scribbled by junior doctors; the actual number of times rounds are conducted is definitely higher than what is written.

But for the one Meng Laoshi mentioned, who doesn't conduct rounds themselves and doesn't allow others to write that the director conducted rounds, it was very speechless.

"Then doesn't their Medical Affairs Department check?"

"Heh." Meng Qingfei looked at Ji Xiang and smiled, noncommittal, then changed the subject and continued, "At the time, a relative of mine had a cerebral infarction, accompanied by severe Heart Failure. I took a look at the treatment, and it just happened to be when the director had an opinion, guess..."

"Forget it, you definitely couldn't guess such a bizarre thing." Meng Qingfei said directly, "The restlessness caused by Heart Failure was called anxiety disorder by their director, and they were given a large amount of sedatives."

"!!!"

Heart Failure patients often have restlessness, agitation, anxiety, fear, and a sense of impending death; if systolic blood pressure is lower than 70mmHg, inhibitory symptoms can appear, gradually developing into confusion or even coma.

Judging such a serious illness as anxiety disorder... it really is outrageous enough.

Ji Xiang sighed.

"Damn it, my relative was sitting on the bed and couldn't even lie down, and she still called it anxiety disorder. Once I saw it, it was truly unreliable. Treating the illness there, the more it was treated, the more it failed, so I simply had them come directly to the Provincial Hospital."

"There aren't many directors like this, right?" Ji Xiang asked.

"Not many, but they exist. What were we talking about that brought this up?" Meng Qingfei asked.

Ji Xiang looked at Meng Qingfei in surprise.

Usually, Meng Laoshi was organized in his speech and actions, and it was extremely rare for him to forget what he had said before.

Could it be that he was sick?

Ji Xiang looked at Meng Qingfei with some astonishment.

"Hahaha, I just don't really want to go." Meng Qingfei laughed, "What are you thinking about?"

"Why don't you want to go?" Ji Xiang asked.

"It's all those lousy things." Meng Qingfei said, "The Medical Affairs Department is the worst place, and you end up offending people. Let me give you another example. Do you know about the kickbacks from before the centralized procurement in previous years?"

"I know." Ji Xiang nodded.

"I had just arrived at the hospital at that time and saw a doctor using levofloxacin for a 15-year-old female Patient with Appendicitis."

"Uh..."

Without Meng Qingfei needing to say it, Ji Xiang knew it was wrong.

Levofloxacin can be used in the conservative treatment of Acute Appendicitis, but the problem is that the drug's instruction manual clearly states that its safety for adolescents under 18 has not been established, and when used in several young animals, it can cause arthropathy.

Therefore, it is not suitable for children and adolescents under 18.

Although Ji Xiang didn't know what kind of arthropathy would occur, he just needed to know it couldn't be used.

Clinical knowledge is as vast as the sea; even with the System Panel cheat, it was impossible for Ji Xiang to be omniscient.

"The key is that the dosage given by that doctor was also the extreme limit, the extreme limit for an adult."

"!!!" Ji Xiang was surprised.

"Although nothing happened in the end, I couldn't stand it." Meng Qingfei said with disdain, "There aren't many doctors like this in Clinical, but you encounter them often. Usually, out of sight, out of mind, but if you go to the Medical Affairs Department, you tell me whether I should manage it or not."

"If I manage it, I offend people. When I was a junior doctor back then, plenty of people tripped me up." Meng Qingfei sighed, "So I wasted so many years, and half my head has turned gray. But you say if I don't manage it, I indeed don't offend anyone, but I can't get past it in my heart."

"The Medical Affairs Department is really not a good place." Ji Xiang shook his head.

Meng Qingfei's hesitation and emotion lasted only for a moment, then he suddenly beamed, "It's useless for me to tell you these things. Do you know why I'm going to the Medical Affairs Department?"

This question was asked out of the blue.

"Xiao Ji, your level is high, I don't envy that point; there are plenty of geniuses, and I haven't not seen big shots in their twenties sweeping through their own fields. The current you has a bit of a look, but compared to those monsters... it's not that you're worse, I just always feel you lack their sharpness."

"What I envy most is your luck."

Ji Xiang glanced at the number on the System Panel.

"Having ability is one thing, and how to face the jealousy of countless people is another. Society, you know, is intricate and complex; one wrong step is an abyss."

As he spoke, Meng Qingfei puffed out his chest.

"Just like your Meng Laoshi, I used to think of myself as a genius, sometimes feeling I was a genius among geniuses. But what happened? I didn't stay at Peking Union Medical College Hospital, didn't get a turn to go abroad, and returned to the Provincial Hospital thinking I'd show my skills, only to be pressed to the ground and ground until sparks flew."

"Your prostate even got ground until it's enlarged, and later it'll split like a showerhead." Ji Xiang added.

"You guys in the Urology Department are all stinky hooligans." Meng Qingfei didn't mind, laughed out loud, and said with disdain, "Learn something good."

"Heh."

"I really don't know when you gained the favor of Bai Chuzhang." Meng Qingfei said, "Director of Medical Affairs, it looks like just that, basically unable to speak on matters within the hospital, belonging to a 'clear water yamen'—lots of work, messy affairs, and heavy responsibility; no one is willing to do it."

"But if the Director of Medical Affairs really wants to help you, it will make your Clinical path smooth sailing. At the very least, what others dare not do, you dare to do; this is a huge advantage."

Speaking of this, Shen Ke raised his head and looked directly into Ji Xiang's eyes.

"Meng Laoshi, what's wrong?" Ji Xiang asked.

"Heh." Meng Qingfei chuckled, "Dean Shen has kept Bai Chuzhang in the Medical Affairs Department all along; I reckon if he is promoted to Vice President this year, he will still be in charge of the Medical Affairs Department. Do you know why?"

"It couldn't be that he wants to build up enough prestige among the Clinical department heads, could it? Whether or not one becomes the big Dean depends on other factors; the opinions of Clinical department heads don't really matter." Ji Xiang scratched his head.

"Looking back 20 years, Dean Shen was afraid Bai Chuzhang would make mistakes; that's the first reason. Look at our Provincial Hospital, how many retired big Deans have ended up in prison? Secondly, while the opinions of Clinical department heads indeed have nothing to do with whether one can become the big Dean, once you are in the position, having that background makes future work much easier to carry out."

"Dean Shen is a man of sentiment."

Sentiment—this word was used in a baffling way.

"When I first arrived, I caught the '98 flood. At that time, the military was sending unit after unit, and they needed medical teams. Dean Shen said he would go even if it meant death."

"Oh?" Ji Xiang was taken aback; he hadn't expected that Dean Shen was once a hot-blooded youth.

It was true, though; who hadn't been young, and who hadn't been full of hot-blooded passion?

"He was only in his thirties back then, an Attending Professor," Meng Qingfei said. "The Lao Zhuren tried to dissuade him for a long time, but in the end, Dean Shen drew his own blood and wrote a blood letter, insisting on going to the front line."

"Drew his own blood?"

"Biting his finger to write a blood letter—that's not something a doctor should be doing. Drawing 20ml of blood is enough for you to write a whole 'Preface to the Orchid Pavilion'."

"Hahaha."

"Looking back now, it might seem like nothing, but at the time, who knew if the dam would collapse? At the most dangerous moments, military trucks loaded with stones would drive one by one to the required spots and sink directly into the water." Meng Qingfei slowly recounted the events of the past.

"And the drivers?"

"The drivers would leave the truck in gear and jump out at the very last second before the vehicle hit the water. If they could get out, they might be covered in injuries, but they could live. If they couldn't get out, they sacrificed themselves."

"..." Ji Xiang was speechless.

"Never mind that. My point is that Dean Shen still has sentiment; he still wants the hospital to be a little better," Meng Qingfei said. "But the fact that Bai Chuzhang's gaze could fall upon a Standardized Training Doctor—you have to admit, you're lucky."

"As for me, I reckon it's because you're always running over to my side, and my seniority, level, and temperament are all sufficient; Bai Chuzhang is thinking of having me look after you after he moves up."

"That's too convoluted, isn't it?"

"Indeed, it would take at least three to five years, and I'm too old. The only advantage is that you always run over to my side; we two brothers are quite compatible," Meng Qingfei said with a smile. "Don't cause me any trouble when the time comes."

Ji Xiang smiled; he hadn't expected that Meng Qingfei being transferred to the Medical Affairs Department had such a purpose.

Bai Chuzhang really was attentive toward him; he truly didn't know what he was after.

When a Patient arrived, Meng Qingfei stubbed out his cigarette, and the two went to treat the Patient. After another hour of busyness, a girl not yet 20 years old came into the Consultation Room, hunched over, her walking posture extremely strange.

"Doctor, my stomach hurts," the girl said in a low voice.

Just from that one sentence, one could tell she was enduring intense pain; her body was extremely weak.

Meng Qingfei stood up, "Lie down, let me take a look."

The Patient lay on the examination bed, and the moment Meng Qingfei's hand touched her skin, his brow furrowed.

"Xiao Ji, go get a thermometer, a mercury one."

"Alright."

Ji Xiang ran out to get the thermometer.

Meng Qingfei didn't trust infrared thermometers; it was said that more than a decade ago, when they first appeared, they were inaccurate. One Patient would measure 36.5 degrees Celsius every time, but when measured later with a mercury thermometer, it turned out to be 39.1 degrees Celsius.

Even though infrared thermometers had been updated and their accuracy greatly improved since then, Meng Qingfei still had a shadow in his heart; whenever he encountered a serious Patient, he firmly refused to use them.

Ji Xiang felt Meng Qingfei was a bit retro, much like a G-Wagon—the main selling points were off-roading, simplicity... and showing off.

Returning to the Consultation Room with the thermometer, Meng Qingfei had already finished the physical examination. Ji Xiang handed the thermometer to the Patient and heard Meng Qingfei ask, "How long has it been?"

"The pain has been there for about a month, and the fever for half a month."

"Why didn't you come sooner?" Meng Qingfei was a bit displeased.

"It's just appendicitis; the doctor at the clinic nearby gave us a diagnosis, and it wasn't a big deal," the Patient said softly.

Meng Qingfei was very displeased, but he didn't say anything, merely ordering an Ultrasound of the lower right abdomen and other relevant examinations for the Patient.

"Go quickly and come back quickly." While speaking to the Patient, Meng Qingfei pushed out a wheelchair for her to sit in, then called for an escort to follow the Patient, whispering instructions to the escort about what to look out for.

After finishing, Meng Qingfei sighed, "Appendicitis, every day it's appendicitis."

"She's had a fever for half a month; could it have perforated?"

"I reckon it's already suppurated and perforated," Meng Qingfei said. "A few years ago, there was a girl in Nanhe with a similar situation; she ended up in the ICU for half a month and died."

"The media headlines were shocking, and the articles mentioned that the police had come several times. A perfectly fine girl was just gone like that; it was very regrettable. One hopes the hospital can give the Family Member an explanation, let the deceased rest in peace, and let the parents find some comfort."

"Xiao Ji, this matter is very tricky, but we are Emergency Department doctors; at worst, we'll find the Chief Resident of Gastrointestinal Surgery for a consultation and push the trouble onto them."

Pausing, Meng Qingfei asked, "Now, suppose you are the Chief Resident of Gastrointestinal Surgery, what would you do?"

"Complete the relevant examinations, confirm the diagnosis, communicate with the Family Member, and then perform surgery."

"What if there's sepsis after the surgery?"

"Appendicitis can kill people too; given the limitations of current medical conditions, there's nothing I can do," Ji Xiang said helplessly.

"But the Patient and the Family Member don't think appendicitis can kill. Many people feel that appendicitis is just a minor ailment and that going to a clinic for an IV drip will fix it."

Ji Xiang scratched his head.

Meng Qingfei smiled slightly, "Consider this an assignment; tell me the answer before the Patient returns."

To be honest, the things Meng Qingfei was discussing with Ji Xiang now were already outside the realm of medicine and couldn't be considered part of their professional scope.

Yet, did it really not matter?

Coupled with the things Meng Qingfei said while smoking, Ji Xiang felt a stir in his heart; he found an excuse to go to the Duty Room, held his breath, and entered the System Space.

After greeting the system NPC, Ji Xiang explained his confusion.

The system NPC laughed.

"You're just lucky; the real difficulties have never been in the medical side of things," the system NPC said calmly.

"Teacher, I want to experience Empathy." Ji Xiang said.

"From what perspective?"

"The most difficult perspective."

"Fine, then go take a look." The system NPC led Ji Xiang to the adjacent Operating Room; light and shadow flickered, and Ji Xiang immediately felt his lower right abdomen.

In just an instant, Ji Xiang froze.