Chapter 275: Professor Zaizen, Did You Really Misdiagnose?

Higashi Saeko is the daughter of Higashi Teizo, the former professor of the First Surgery Department at the Tokyo Medical and Dental University where Uesugi Muneyuki worked; she and Uesugi Muneyuki have met a few times, but they are not familiar with each other.

Before transferring to become a Forensic Pathologist, Uesugi Muneyuki was a surgical medical student and had attended some of Professor Higashi's lectures at the time, though Professor Higashi did not think much of Uesugi Muneyuki; Professor Higashi was also a graduate of the University of Tokyo Medical Department, but as everyone knows, graduating from the University of Tokyo Medical Department does not equal staying on at the Tokyo University Affiliated Hospital, and Professor Higashi was clearly a loser in the power struggle, having been defeated when running for Associate Professor at the University of Tokyo, and was then forced to transfer to the Tokyo Medical and Dental University to serve as professor of the First Surgery Department.

It was for this reason that Professor Higashi did not like Uesugi Muneyuki, and especially since Uesugi Muneyuki had a grandfather who was a professor at the University of Tokyo, he liked him even less.

However, although Professor Higashi did not like Uesugi Muneyuki, he did not really make things difficult for him or do him any wrong; this guy was just a pedantic old scholar, though it is said that the rivalry between him and Professor Zaizen was extremely intense, and by the time Uesugi Muneyuki reached his final year in surgery, the professor of the First Surgery Department had become Professor Zaizen.

Compared to Professor Higashi, Professor Zaizen was an even bigger heavyweight.

This guy Professor Zaizen has always been famous worldwide for his extremely superb medical skills, and last year he was even invited by the International Surgical Association to give a lecture in Poland and perform a public surgery, becoming a member of the association and receiving unanimous praise both domestically and abroad; however, this guy's reputation with Uesugi Muneyuki is not very good.

Ever since Professor Zaizen took office as professor of the First Surgery Department, this guy neither sees patients, nor teaches, nor writes papers; the only thing he does is perform surgery non-stop, and go around soliciting sponsorships and finding pharmaceutical representatives to make a killing; Uesugi Muneyuki was originally just barely getting by under Professor Higashi in the First Surgery Department, but after the switch to Professor Zaizen, he was quickly swept out the door.

Why was this?

Uesugi Muneyuki does not know, and he does not want to know, but thinking about it afterwards, it is truly intriguing.

"I am very sorry to disturb you." Higashi Saeko has a well-proportioned figure and clear features, her melon-seed-shaped face carrying the refined and quiet air of a sheltered young lady, yet her large eyes are filled with determination and fortitude; when she saw Uesugi Muneyuki, that resolute gaze was practically as if she wanted to pick Draven: "Are you Forensic Examiner Uesugi? We have met before."

"Yes." Uesugi Muneyuki nodded, his mood still not very good: "Speak your mind, I have things to do right now."

"Very well." Higashi Saeko said softly: "It is regarding the medical malpractice case of the patient Sasaki Yohei; you were the one in charge of the administrative autopsy, right?"

"That's right, it was me." Uesugi Muneyuki thought about it; indeed, he was the one who performed the autopsy on Sasaki Yohei's body, and then Saijo Yasue came charging over that very evening: "Is there a problem?"

"Uesugi-san! What is your take on this autopsy incident?" Hearing Uesugi Muneyuki admit that he was the one who performed it, Higashi Saeko's expression became agitated: "Please, you must tell us the truth! Did Professor Zaizen really misdiagnose him? What exactly did the deceased die of?"

"As for this, didn't I state it very clearly in the pathological autopsy report?" Uesugi Muneyuki raised an eyebrow: "The deceased did not die from the esophageal cancer surgery; in fact, Professor Zaizen's esophageal cancer surgery was performed beautifully and was of top international standard. The true cause of death was left lung infection, respiratory failure caused by cancerous lymphangitis."

"Yes, that's it!" Professor Higashi's daughter said with an agitated expression: "We have evidence showing that before the surgery, someone had already discovered signs of lung infection in the deceased! But Professor Zaizen did not accept this opinion!"

"What?"

Uesugi Muneyuki took two documents from Higashi Saeko's hands.

One was a report provided by the former Associate Professor of Internal Medicine, Satomi Shuji, in which he clearly mentioned that the possibility of infection had been discussed before the surgery; the second was the altered medical record. It was very obvious that the record of a possible pre-operative infection had been artificially altered and deleted, but under the cover of the correction fluid, one could see from the angle of light passing through from behind that a shadow had been discovered in the lower part of the left lung on the CT scan earlier.

Uesugi Muneyuki's eyebrows tightened: "This is... I didn't even know about these things."

"Uesugi-san! You are our last hope!" Seeing Uesugi Muneyuki's expression change, Higashi Saeko was agitated beyond measure, and she presented a business card: "To tell you the truth, I am now an intern lawyer at the Sekiguchi Law Firm. Our law firm has taken on the lawsuit for the deceased's family, but... Professor Zaizen's father, Zaizen Mataichi, is the Vice President of the Kanto Medical Association. Under his influence, no law firm dared to take this medical lawsuit before, and no forensic pathologist at any Medical Examiner's Office was willing to perform a second autopsy or testify in court!"

"Oh, yes, I know about this matter. It seems Associate Professor Satomi even left the hospital because of this and went to Chiba University Affiliated Hospital." Uesugi Muneyuki nodded, looking at Higashi Saeko's documents with his brow tightly locked: "So, you want me to testify in court?"

"Yes." Higashi Saeko bowed deeply: "You are already our last hope."

"Why do you think I would be willing to testify in court? Dr. Satomi has already lost his job because of this." Uesugi Muneyuki's brow remained tightly furrowed.

"Because you are Uesugi Muneyuki, a descendant of the great Uesugi Kenshin! You have said many times in front of the cameras that you are just a forensic pathologist, and all you have to do is make the facts clear!" Professor Higashi's daughter's voice trembled slightly: "I am representing a wife who has lost her husband and a son who has lost his father in asking you to tell the truth!"

"This is clearly a misdiagnosis! But everyone wants us to shut up! The Metropolitan Police Department, the Medical Association, the Medical Examiner's Office, the major law firms, and even the Tokyo Medical and Dental University Affiliated Hospital!"

"No one is willing to help us, no one wants the truth. All they have been doing is trying to make us shut up, shut up, shut up!"

"You are our last hope! I beg you! You personally performed the autopsy on Sasaki, please do not ignore a soul that died unjustly!"

After finishing, Higashi Saeko intended to perform a dogeza.

"Don't!" Uesugi Muneyuki quickly signaled for Professor Higashi's daughter to get up. He was silent for a moment, then said to Higashi Saeko: "Since I was the one who performed the autopsy on Sasaki Yohei, I will certainly see it through to the end; there is no doubt about that. But whether it is truly a misdiagnosis, I need some time to judge. You go back first and wait for my call."

"Thank you very much!"

Just as Higashi Saeko opened the door, she discovered that the entire Special Mission Unit was eavesdropping outside, and Uesugi Muneyuki immediately came out: "Mikoto, we've got work!"

"Huh?" Ishihara Mikoto did not understand.

"Let's go, to the Forensics Division!" Uesugi Muneyuki waved the materials in his hand.

Five minutes later, Metropolitan Police Department Forensics Division.

Uesugi Muneyuki and Ishihara Mikoto dug Nakado Kei, who was sleeping on the autopsy table, out of bed, then took out the autopsy report and the evidence brought by Higashi Saeko, and together they studied one most important question.

Did Professor Zaizen really misdiagnose him?

This revealed Uesugi Muneyuki's weakness—although he is known as a legendary forensic pathologist, in reality, his forensic skills are not outstanding to the point of being peerless; on the contrary, both Mikoto and Nakado have more extensive forensic experience than he does.

"No misdiagnosis." Nakado Kei, with his messy hair and sleepy eyes, looked over the entire medical record and autopsy report, then suddenly shook his head: "Indeed, before the surgery, a very small ground-glass opacity in the lung was discovered on the CT scan, but..."

"But the patient already had a long history of smoking." Ishihara Mikoto nodded; when encountering professional issues, Mikoto also became serious: "Sasaki had gastric cardia cancer, which is unrelated to the lungs. Even if there was a small amount of ground-glass opacity in the lungs, so what? The possibility of metastasis from early-stage gastric cancer is extremely small; even if there were shadows, it is more likely to be inflammation."

"What do you mean?" Uesugi Muneyuki asked accordingly.

"KUSO! Aren't you a legendary forensic pathologist? How can you ask such a KUSO question?" Nakado Kei said impatiently: "What exactly is a ground-glass nodule on the lung? How are you going to confirm it? PET and CT scans can't tell. Localized high-metabolic lesions actually cannot rule out inflammation either. In many cases, it is also observation, watching over time to see if the tumor continues to grow; only if it grows would one consider whether it is cancer. But could the patient afford to wait?"

Nakado Kei naturally admired Uesugi Muneyuki; he had always felt that Uesugi Muneyuki's forensic level was at least three or four stories higher than his own. He did not expect Uesugi Muneyuki to ask such an unsophisticated question, and could not help but feel extremely irritable.

"Yes, Nakado is right." Mikoto also added: "If you want to confirm, you must perform a biopsy, a thoracoscopic biopsy. Even for such a small lesion, a biopsy might not even be possible; you would need a lung biopsy or even a wedge resection biopsy to clarify the diagnosis. That was a cancer patient, urgently waiting for surgery. Biopsy? That's murder!"

"So... Professor Zaizen did not misdiagnose?" Uesugi Muneyuki could not help but fall into deep thought: "From the autopsy findings, the final result was lung metastasis. But it was not a common pattern of metastasis, but rather explosive cancerous lymphangitis of the lungs, so the patient passed away shortly after the surgery. I also cannot judge whether it was pre-operative metastasis or post-operative metastasis."

"Right, no misdiagnosis!" *2.

Ishihara Mikoto and Nakado Kei both gave an affirmative answer. Mikoto hesitated for a moment and added: "Uesugi, doctors are also human, and if they are human, they cannot avoid errors in judgment. Under the circumstances at the time, looking at the imaging findings combined with the patient's medical history, how many oncologists and radiologists would first consider this to be metastasis?"

"In other words, Professor Zaizen did not misdiagnose. At least, given the current level of medical science and the limits of his surgical ability, even if the CT scan captured a problem in the lungs, refusing to believe that metastasis had occurred was reasonable."

"A biopsy takes two weeks, and the deceased could not wait two weeks. In that situation, performing a lung biopsy or wedge resection would be equivalent to direct murder!" Ishihara Mikoto said softly.

"Hmm, I understand." Uesugi Muneyuki stood with his hands behind his back: "So, the most critical issue is not whether Professor Zaizen misdiagnosed."

"The most critical issue is that when he discovered there was a problem with the CT scan, he neither informed the deceased and the deceased's family, nor did he initiate a consultation, but very arbitrarily demanded surgery, ultimately leading to the patient dying of respiratory failure caused by pre-operative metastasis."

"Right!" *2

Ishihara Mikoto and Nakado Kei said almost simultaneously.

Uesugi Muneyuki's eyebrows twisted into a knot.

He felt he should not get involved in this matter, because purely from a medical perspective, Professor Zaizen did not misdiagnose.

However, from the perspective of law and medical ethics, Professor Zaizen did not allow the patient to exercise their right to informed consent, but instead decided on the surgery in an extremely arrogant manner, ultimately leading to the patient's death.

Therefore, whether he testifies in court has become the key to this case. If he testifies, then considering his influence and his status as an unquestionable authority in forensic pathology, Professor Zaizen will be in trouble.

However, if he does this, it is highly likely that he will lose his position at the Tokyo Medical and Dental University, and even lose his student status and his place in the medical world; the previously discussed enrollment and employment at the University of Tokyo would also become uncertain.

Daring to fire shots at his own alma mater and provide unfavorable testimony, the University of Tokyo side...

What if he states from a purely medical perspective that Professor Zaizen did not misdiagnose?

This way, it is good for you, good for me, and good for everyone; theoretically speaking, Uesugi Muneyuki did not tell a lie either. Strictly speaking, a patient's right to know is also a gray area in the medical field. Many people advocate for things like "benevolent lies," "appropriate concealment," and "maintaining a good mindset can give patients a better chance of recovery." Whether informing them of the truth and the risks of surgery is ethical or unethical is very vague; there is no clear boundary, and it can be interpreted in any way.

As for himself, what should he do?

Uesugi Muneyuki stood with his hands behind his back, gazing at the sky of Tokyo.

Outside Sakuradamon, the autumn sun pierced through the azure dome, wispy clouds hung like broken feathers over the spire of the Diet Building, a flock of pigeons stirred up a string of golden reflections on the glass curtain walls as they swept past, and the sky was high and distant, like translucent glazed porcelain.

His heart fell into a struggle.

(End of this chapter)