Chapter 64: Within the Heart

The general surgery rotation was finally over. A few surgeries had been performed, but they fell short of Zhang Fan's goals. It was a regret; he hadn't even gone home in order to rack up surgical volume, making the loss outweigh the gain.

Upon leaving the department, Zhang Fan rotated into the Department of Cardiology. Originally, he wanted to continue in surgery, but the Medical Affairs Office had assigned him to internal medicine, leaving him with no choice. It made no sense to bother Ouyang over a minor issue like this.

Certainly, Ouyang would not give the Medical Affairs Office a heads-up beforehand just for Zhang Fan, or else her position as hospital president would carry no weight.

The Department of Cardiology was located in the internal medicine building, directly opposite the surgical building. Occupying two full floors, it was the largest department in internal medicine. Ouyang herself had started in cardiology, which also encompassed interventional medicine, bringing in an overwhelming number of patients.

In the Northwest region, the local diet was high in fat, resulting in a massive baseline population of patients suffering from hyperlipidemia, hypertension, and hyperglycemia. The department also boasted a large staff of over twenty doctors. The current head of the department was one of Ouyang's protégés.

Also a female director in her forties, Ren Li was the only holder of a master's degree in the entire hospital. It was said she had previously worked at a large provincial hospital, but due to intense departmental infighting and dissatisfaction with the work environment, she was eventually poached by Ouyang for the municipal hospital.

Ren Li possessed formidable professional skills and was quite attractive; her only drawback was a slightly lacking emotional intelligence and an inability to schmooze. After she became the director of cardiology, the department experienced a leap in development.

The number of doctors sent out for external training was the highest among all internal medicine departments, and her new medical techniques and published papers were top-tier. Junior doctors admired her as well. She was not possessive of her authority, letting competence dictate success, and tied doctors' incomes directly to their abilities. She was considered a fairly impartial director.

Within the hospitals of Chasu City, the cardiology department of the municipal hospital was the most authoritative. Ouyang supported her vigorously. Back during Old Huang's tenure, Ouyang had practically abandoned all other internal medicine departments.

She kept a tight grip on cardiology alone, frequently engaging in fierce debates with Old Huang to secure more resource allocation. In fact, the establishment of the interventional medicine department was tailor-made specifically for cardiology.

That year, the city government approved a special health fund. Old Huang intended to establish an orthopedics research center, but Ouyang vehemently opposed it, proposing instead the creation of an interventional department.

Over this matter, the two took their dispute all the way to the municipal party committee. After half a year of wrangling, Ouyang ultimately emerged victorious, and the funds were used to establish the interventional department. Old Huang always harbored resentment and consistently refused to equip the interventional department with reserve personnel.

Yet Ouyang was equally unyielding, successfully leading Ren Li and the others to develop both cardiology and interventional medicine. Once interventional medicine flourished, revenues skyrocketed, and many young doctors eagerly sought to join cardiology.

Ren Li specifically instituted an entrance examination for the department. Without passing the test, applicants were strictly rejected. Backed by Ouyang, the hospital administration had no effective countermeasure. In a technical institution, technique is king; if you aren't good enough, you can't get in—they simply don't want you, and there is genuinely nothing anyone can say.

As soon as Zhang Fan stepped into the department, his scalp went numb. Cardiology was nothing like surgery; while surgery had older patients too, cardiology was almost exclusively populated by the elderly. People leaning on crutches, sitting in wheelchairs, being supported by family, wobbling precariously—it looked dangerous just to watch.

Surgery and internal medicine operated almost as two entirely separate systems. Though housed in the same hospital, aside from clinical consultations, they rarely interacted. Zhang Fan had spent every day soaking in the operating rooms and was largely unfamiliar with the internal medicine doctors.

While his reputation in surgery was soaring, almost no one in internal medicine knew who he was. Here, he was just a junior doctor, a rotating resident. His surgical privileges were gone, and speaking of respect was out of the question.

The system had not yet unlocked the internal medicine branch for him, so he had to rely entirely on his own grinding efforts. Two female doctors were rotating into cardiology alongside him—one from gynecology and one from pediatrics. Both were slated to pursue internal medicine careers.

Zhang Fan was assigned to Ye Jing, an attending physician in her thirties who maintained a low profile in the department. In any department, the backbone staff could only be so large, and the promotional slots were limited; without striving and struggling, there were simply no opportunities.

Ye Jing's husband was a civil servant with a decent income. She had no grand professional ambitions; for her, it was just a job. Her primary focus was on her family—taking good care of her children and serving her husband constituted her ultimate pursuit.

This was entirely understandable. They were ordinary folks, which reflected the mindset of the majority. However, in a technical institution, if you didn't push yourself, you would inevitably end up marginalized. Zhang Fan was a doctor designated for surgery, merely passing through internal medicine to check a box, so he couldn't be counted on. Consequently, he was assigned to her.

On his very first day in the department, he encountered the president's grand ward round. Doctors, nurses, visiting physicians, intern students, and personnel from the Medical Affairs Office totaled nearly fifty people.

Even so, many nurses could not participate because a large volume of intravenous medications needed to be prepared, leaving them no choice.

Ward rounds in internal medicine were nothing like those in surgery. Surgical cases were straightforward: perform the required surgery, and if a diagnosis remained elusive, proceed with an exploratory laparotomy. The discussions centered primarily on surgical approaches and who would act as the primary surgeon.

In internal medicine, however, one first had to discuss the underlying mechanisms, disease grading, and medication categories. Which specific drug was superior? For how long? At what dosage? Were there any contraindications?

Even after becoming president, Ouyang had not abandoned clinical practice and continued to study diligently. During ward rounds, she would pop quiz attending physicians, rotating doctors, interns, and visiting physicians right at the bedside. The primary physician was also responsible for reporting the patient's condition. The treatment plan—whether appropriate or not—had to be debated on the spot.

If found unsuitable, a revised treatment plan had to be custom-tailored immediately, making it impossible to finish rounds within a single morning.

And since rounds could not simply be halted midway, they would push straight through into the midday hours. Doctors with weaker constitutions simply could not endure it. They couldn't even stand steadily, let alone find a spare moment to update that day's medical orders.

Zhang Fan was mostly fine, but several medical students and visiting physicians were cracking under the strain. They had never encountered such high-intensity ward rounds before and would occasionally sneak a lean against the wall while clutching their armloads of medical charts. Though made of plastic, a stack of a dozen charts was remarkably heavy.

Ouyang's questioning was professional and meticulous, frequently leaving junior doctors speechless and unable to answer. She was quite strict, demanding immediate answers from the senior physicians on the spot. If the senior doctor failed to answer, she would immediately flip through reference books, showing zero favoritism.

During her rounds, the doctors were scared half to death. Being reprimanded by her in the hospital ward, right in front of the patients, was genuinely agonizing.

Fortunately, Ouyang did not quiz Zhang Fan during today's rounds. Since Zhang Fan was slated for surgery, he might not have known the answers. Unaware of the relationship between Zhang Fan and Li Xia, she spared him to save face for Li Xia, preventing Zhang Fan from being put on the spot.

Old Ouyang wasn't very tall, but she radiated the aura of a hospital president, exerting immense pressure on everyone. Combined with her strict demeanor, it left the rotating doctors trembling with apprehension—her presence was utterly intimidating.

Once the ward rounds concluded, a mountain of progress notes awaited recording. Because it was a grand ward round day, primary and junior doctors had carried notebooks with them to record Ouyang's verbal orders on the spot.

These then had to be reflected within the medical charts. Internal medicine charts had vastly higher standards than surgical ones. For instance, an orthopedic case involving a traffic accident was straightforward: a car crash caused a fracture in a specific bone. Time, location, personnel, and degree of injury—done.

Internal medicine was different. It required distilling the case from the onset of symptoms: had treatment been administered previously? What kind? What were the effects? Had the condition worsened? Were there complications? Had the patient been taking medication regularly?

Internal medicine charting demanded rigorous precision in phrasing and tone. Words like "fair," "tolerable," and "good" were used in entirely different contexts. Use the wrong one, and Ouyang would tear you apart with the tip of her finger.

Medication regimens were also complex. Surgical drug administration relied on just a handful of categories: antibiotics, hemostatics, vasoactive drugs, and occasionally albumin, plasma, or energy supplements, administered according to metabolic loss.

Internal medicine allowed no such shortcuts. Even within the same drug class, individual patient responses varied wildly; a medication suitable for one person might be completely wrong for another.

A superficial grasp of internal medicine was easy enough; three months in the department was usually enough for a resident to get by. But striving for mastery was exceptionally difficult. First, one needed a rock-solid foundation, from physiology to pathology, from embryology to biochemistry, all memorized and mastered to the point of immediate recall.

If a doctor had to flip through books upon encountering a disease, they were merely a beginner. A truly skilled internal medicine physician could deduce a patient's physical condition from subtle cues in their speech, or gauge their health with a single glance at their complexion.

To reach that level of proficiency in internal medicine without a dozen years of rigorous study, deep contemplation, and summarization was utterly unimaginable.