Chapter 184: Micro vs. macro, my legs hurt!

No matter how much Zhang Fan grinded, his weakness in English language department was still exposed. He had studied hard by himself over the past two years, but there really was a difference between being self-taught and having a teacher. Back at college, he could ask the teacher if there was anything that he didn't understand. This wouldn't be possible when teaching yourself. You would have to think of answers by yourself. However, self-study did have its advantage of giving you a much deeper personal understanding.

As for Zhang Fan's English? He lacked the environment to practice English in. He also hadn't cared much about English before. His successes over the past two years now had cold water poured on by Director Dilibaer. Yes, an ordinary college student graduate who managed to obtain his own house and car just two years after graduation should probably be proud of himself. But, was Zhang Fan ordinary? He wasn't ordinary at all. That was why Zhang Fan now immediately discarded his arrogance that was beginning to sprout. There was still a long path ahead of him!

Endocrinology was far too complex. Each illness would have a research direction. Endocrinology was an organized yet also scattered department. In the respiratory, gastrointestinal, or cardiology department, they would all have logical and interconnected information, focused on only a few organs. However, things were different in endocrinology. It was common that hormones would jump all over the place. Every organ and internal secretion gland would have their own unique system and functions. If described this way, it could even be said that there should be a unique department for every single organ.

Although the medical textbook that Director Dilibaer gave Zhang Fan wasn't a textbook from a top-level brand, it still contained high-level professional endocrinology knowledge. Zhang Fan really didn't have the time to finish grinding it. Language would be a big barrier for him to truly master medicine. He spent almost half his time on translation alone, not leaving him with much time left to actually learn and understand. Thanks to his experience this time with a foreign medical textbook, Zhang Fan finally became determined to master English!

Zhang Fan and Shao Hua finally took some time together this weekend to go out for three or four hours. "You're working too hard. Usually, you don't drink coffee or tea, but when I went over to your apartment yesterday, I discovered that most of the coffee and tea leaves I purchased for you were gone! This truly won't do. You're a doctor. You should understand this as well."

"Time is rather limited. This textbook is entirely in English. There really is no helping it! Sigh! I really regret things now!"

"What do you regret?"

Zhang Fan successfully changed Shao Hua's focus. He also knew that this wasn't good, but what was he supposed to do? This wasn't a matter of competing with others. This was Zhang Fan working on improving himself!

"Back in college, my school had an elective course, Medical English. I intentionally avoided that class. But now, I can't even find any highly professional medical texts on endocrinology in Chinese. All of this medical English vocabulary is so ridiculous. Sometimes, there's only two words I don't understand in a paragraph, but I'm unable to find the corresponding translation for these words!"

"Then what will you do?" Shao Hua snuggled up in Zhang Fan's embrace. The weather was now colder, which helped the two of them become even more intimate with each other. Nowadays, Shao Hua was even somewhat willing to allow Zhang Fan to touch her a little. Ahem, ahem! Imagine the rest by yourself, readers!

"There really is no good method apart from slowly researching information by myself. How about you? How are your studies going? Don't give yourself too much pressure. Take the exam if you can, but forget about it if you can't pass. I'm confident in my own ability to take care of our family." Zhang Fan inhaled Shao Hua's fragrance as he said this. She smelled like faint lavender today.

Maybe the television would usually talk about Holland or Finland when mentioning lavender as those countries had large patches of especially beautiful lavender. However, that was actually the high technical ability of the cameramen. The truly large-scale lavender patches could be found right in Chasu City. There were thousands and thousands of acres of lavender planted in Chasu City. Every year when the lavender blossomed, a blue-purple flower meadow could be seen with fresh breezes blowing past, making the lavender seem like a sea of flowers. A woman who wore a light-yellow straw hat while standing in this flower sea would seem especially beautiful! Shao Hua had such a picture of herself which made her look absolutely gorgeous. She and the scenery complemented each other perfectly. This was the border province's woman and scenery!

Although the lavender oils and fragrances from inland China might have scam component chemicals, Chasu City's lavender oils and fragrances were quite good. The neighboring -stan countries near Chasu City were big users of lavender perfume. Most of Chasu City's lavender oil and fragrance would be directly exported to other countries after being produced.

Since China's national strength had also increased a lot recently, merchants now had far more confidence in doing business abroad. Chasu City's lavender products even conquered the market in the five -stan suffix countries, kicking out Russia's lavender business! This wouldn't have been something people would have dared to even imagine before!

In the inland of any country, you wouldn't be able to sense your own country's power, but in a border province, you would be able to understand just how powerful your own country was. Large amounts of products were exported from the ports here, while the five -stan suffix countries could only exchange for Chinese products with their mining resources.

Zhang Fan didn't know very much about the import-export business, but he did know at least a little about medical products. The five -stan suffix countries imported even the most basic glucose saline from China. This wasn't because they weren't able to produce it, but rather because China's products were so cheap! China was slowly developing, but its economy was developing faster than its culture!

The women of Chasu City would often use lavender products, including pillows, blankets, perfume bags, and so on. The most miraculous part was that there was a certain ethnicity in Chasu City which would even treat guests by offering them pollen.

The first time that Zhang Fan ate pollen, he had thought that it was sesame due to the similar appearance. You would eat the pollen by dabbing a bun in oil and then the pollen. However, pollen's taste was quite different from sesame's. It would have a flowery fragrance that was especially delicious the more you chewed.

"Rest assured, there won't be much pressure for me. I'm just casually flipping through these books so that I can maintain my professional knowledge and math mind. There shouldn't be any problem for me to take the accounting exam next year!" Shao Hua said rather proudly.

Yes, studying was something where hard work and your studying method were really important. However, there really were some people who were naturally more talented at studying, so they would have superb efficiency. Meanwhile, Zhang Fan didn't have much talent for studying, but he was willing to work hard and grind!

Zhang Fan rested for all of Saturday afternoon, which finished off his weekend, since he had an appointment in another city to go perform surgery on Sunday. This time, he didn't need to go to the farther cities, and was going to closer cities instead. Typically, the elective surgeries he performed were all laparotomies.

In the past, the smaller city hospitals were capable of performing appendix surgery, gall bladder surgery, and so on. But now that laparoscopes had become commonplace, the surgical departments of smaller city hospitals basically had no more surgeries to perform. If a patient heard that they needed to perform open surgery, the patient would instantly leave and refuse to be treated at the small city hospital.

Zhang Fan performed three surgeries on Sunday morning. It was a bit past two p.m. by the time that he finished. He didn't drink even a single drop of water since he woke up. Zhang Fan hurried back to Chasu City, since Wang Yongyong was being discharged from Ma Wentao's hospital today. He had recovered quite well since he was still relatively younger, only in his mid-40s. He still had plenty of energy. Zhang Fan needed to go tell him about necessary precautions for postoperative recovery and give him one final checkup since an athlete's injury would be different from a normal person's injury, being more severe.

Although Wang Yongyong was still unable to put any pressure on his knee, the swelling had already disappeared. He sat in a wheelchair as he thanked Zhang Fan and Ma Wentao. Right now still wasn't the time for him to participate in advertisements for Ma Wentao in exchange for the free surgery fee. However, Ma Wentao had taken plenty of "before" pictures already as he planned on doing a "before" and "after" comparison advertisement of Wang Yongyong. This was an advertising technique he had learned studying abroad.

On Monday, the endocrinology department's major weekly patient checkup began. All doctors, intern, rotation, official, and so on, were led by the director and second-highest level certification doctors in checking up on the patients. This was the time that the smartest doctors looked forward to, while the doctors who were poor at studying would really fear it. The large group of doctors checked each patient one by one.

"Patient #6 is a young man who is 22 years old. He had to urinate excessively for an unknown reason, so he came to get treated at our emergency department. He was then transferred to our endocrinology department. After giving him complete checkups, the preliminary diagnosis is that this patient has diabetes insipidus," the doctor in charge of patient #6 explained the patient's situation to all the other doctors.

"Wang Xiaoyan, go give this patient a physical checkup." Director Dilibaer was beginning her tests for doctors. Wang Xiaoyan had graduated with an undergraduate degree from Tianjin Medical University. For an unknown reason, she hadn't continued her master's degree studies there. However, her foundations were really solid. Not only that, her medical license examination score had only been lower than Zhang Fan's by about 50 points last year.

When giving patients physical checkups, it would be highly important to do everything in the proper order. A physical checkup without any order would easily miss something important as well as cause more hardship for the patient. However, the physical checkup would also need to be adjusted depending on the patient's specific circumstances rather than following the instructions written in a textbook letter-by-letter.

Wang Xiaoyan's movements were highly skilled. She kept reporting as she checked up on the patient. "The patient's pupils are normal with no sign of anything unusual. There is no sign of swollen lymph nodes in his neck. Nothing appears to be wrong with his heart. No sign of rebound tenderness in the patient's stomach. Nothing appears to be wrong with his legs." Her physical examination for the patient ended after approximately five minutes.

Director Dilibaer nodded in approval because Wang Xiaoyan's physical checkup for the patient had been highly standard, with no problems at all. Wang Xiaoyan proudly glanced over at Zhang Fan as she walked back to the group. This wasn't a challenge, but just a competition of skill and one's own confidence.

"Which part of the body is in charge of the body's thirst center?" Director Dilibaer suddenly turned to ask a male rotation doctor. This doctor wasn't prepared to be asked such a question, especially a question about such an obscure topic which usually wouldn't appear on the exam.

However, this was a hospital. The doctors needed to face humans, not machines. A single misstep on a problem might cause irreparable harm to a patient. Human bodies were a complete system. No matter how obscure the information, doctors would always need to try their best to learn and understand as much about the human body as possible. It might be that one day, such knowledge would become useful for a patient with a rare condition.

"Oh! I'm sorry. I don't know." The male rotation doctor gave up on answering the question.

Director Dilibaer was slightly nicer than Superintendent Ouyang who would severely scold someone for not knowing. Director Dilibaer was instead the type who would simply ignore any lower-ranking doctor that she didn't approve of.

"Okay, just make sure to study properly," Director Dilibaer said quite simply. She didn't lecture the male rotation doctor or punish him in any way. However, the male rotation doctor felt even worse than if he had been punished! These young doctors had all graduated with undergraduate degrees. They would all want to receive attention and care from the higher-ranking doctors.

Failures at work would be quite different from failures at school. If you failed in school, you could try again with makeup tests! At work, failing once might result in permanently losing an opportunity. This male rotation doctor wouldn't have another chance to be rotated into endocrinology again, so if he failed, he would have to fail early!

"Doctor Zhang, could you answer my earlier question?" Director Dilibaer turned to test Zhang Fan.

"The hypothalamus in the brain is in charge of the thirst center."

"What is the nature of the patient's urine? How should we treat him?"

"The patient's urine is hypotonic. Give him fluid infusion and an antidiuretic. If it's necessary, perhaps also hormonal treatment."

"What are the current theories on primary diabetes insipidus?" Director Dilibaer continued to test him. This was actually a highly difficult question. Not only would it be difficult for a rotation doctor, even an attending physician in the urology department might not be able to answer this question if that doctor didn't study properly.

This was the greatest difficulty of internal medicine. The causes of many illnesses were still unclear. The expert doctors of various major hospitals would then write their own inferences, or theories, on these illnesses.

The doctors treating the patients would then give treatments according to the expert doctors' way of thinking. The expert doctors' theories were only called theories because they were still uncertain, and there was no guarantee that all patients would be the same even with the same illness.

In science's other fields, one would be able to slowly research and determine each and every little difference. However, there would be no such thing possible in clinical medicine. The doctor would have to treat the patient successfully. There was no time to do such research.

Then what could the doctors do? That would depend on the doctors' own abilities. The doctors would have to prescribe medication according to the experts' theories while determining which of the theories the patient's symptoms matched. Although an experienced doctor might still not be able to identify the reason behind the illness, they would be able to treat the illness according to the symptoms. However, it would normally take over a decade for a doctor to gain such experience in treating illnesses that would start for still unknown reasons.

"Professor Jerome P. Kassirer from the Massachusetts Medical Society has mentioned three theories. Expert Chinese doctors have categorized his theories in more detail, and they're now known as the three conditions and five clauses of primary diabetes insipidus. Currently, the prevailing theory is that primary diabetes insipidus is caused by a lack of AVP #3, an antidiuretic hormone," Zhang Fan answered.

Zhang Fan had grinded for an entire week to gain such knowledge. Not only would regular internal medicine textbooks not have such knowledge, even regular master's degree students' textbooks wouldn't contain this information, since this was about the theoretical more than practical clinical experience.

"Just listen to that English accent of yours. Your pronunciation is so terrible. I'd almost think that you were speaking Russian if I didn't listen closely to the professor's name," Director Dilibaer commented. Although she was criticizing Zhang Fan, she said this with a smile. She could tell how hardworking he had been with this. It was a definite that Zhang Fan would have skipped over this knowledge unless he studied the whole textbook that she gave him seriously, since this knowledge was on something quite minor.

Wang Xiaoyan bit her lips after Zhang Fan finished saying all this, because even she didn't know this one. Director Dilibaer wasn't favoring Zhang Fan. Rather, she really did want to test him because Zhang Fan was becoming quite famous in the hospital among all the directors.

Director Dilibaer continued asking questions to all the intern and rotation doctors as the patient checkups continued. The intern and rotation doctors didn't feel too much pressure, because Director Dilibaer was the nicer type who wouldn't scold them even if they were unable to answer the questions. However, the younger doctors still hadn't realized that this was actually a great opportunity for them! It would be of great help for their securing work in the future if they did a good job here. Any intern doctor who gave up on working in the bigger Raptor City to come to Chasu City instead meant that they would likely have to work in Chasu City in the future.

The most pressure was on the three female rotation doctors who wanted to get permanently assigned to endocrinology. They wouldn't have many opportunities to get assigned here, and they would lose the few opportunities they had if they didn't grab onto them. There were only a few such critical steps in any person's life. However, missing the right step might cause a person's future path to become far more difficult.

The morning thus passed. Zhang Fan and the three female rotation doctors really felt like time passed incredibly slowly. Director Dilibaer's questions were far too difficult. Not only did answering them require a tremendous amount of foundational knowledge, she also required you to have your own way of thinking about the problems.

What personal ways of thinking could a new rotation doctor who'd worked for only two years even have? However, the veteran Director Dilibaer was quite capable of determining how serious a doctor had been about a question from even the shortest remarks.

The questions were really difficult. Zhang Fan and the others did their best to answer. Even so, they had to give many vague answers. Endocrinology was just that difficult.

The final checkup on the last patient finished. Director Dilibaer stood at the end of the department as numerous other doctors of all types surrounded her. It was time to finish the major weekly patient checkup.

"In our endocrinology department, the most common patient problem is diabetes. Insulin has an intimate connection to diabetes. Who would like to give us a lesson on the pancreas today? Let us all learn together. But if you don't have confidence, don't offer to do it," Director Dilibaer announced while standing in the middle of everyone. It was obvious that she was fanning the flames here.

The major weekly patient checkup had lasted for several hours already. Zhang Fan and Wang Xiaoyan were the rotation doctors who performed the best—neither of them made any major mistakes. They were on par with each other.

Wang Xiaoyan had a strong personality. She was good at her studies and also highly competitive. Since she was an internal medicine specialist, she absolutely wanted to defeat Zhang Fan here since she knew that he was a surgical specialist. This wasn't because she had anything against Zhang Fan. This was simply her competitive spirit and desire to be the best among the rotation doctors. If a group of internal medicine rotation doctors were all suppressed by a surgeon instead, she wouldn't be able to handle it due to her pride.

"Director, allow me!" Wang Xiaoyan stood up after glancing over at Zhang Fan.

"Okay! Then let us all listen to Doctor Wang talking about the pancreas." Normally, Director Dilibaer addressed Wang Xiaoyan as Little Wang, but starting from today, she addressed the latter as Doctor Wang. This was because Director Dilibaer had already given Wang Xiaoyan her recognition, which equaled the assurance that the latter would have a spot in the endocrinology department! This was the specialty of a workplace where skills ruled. Skills would guarantee you a position.

When Director Dilibaer let Wang Xiaoyan take her central position, she glanced over at Zhang Fan. His personality was rather contradictory. He would be able to bring out endless courage whenever he couldn't retreat, but normally he also didn't like to stand out. This was simply his personality, with nothing right or wrong about it.

Director Dilibaer's question was quite broad. What was the pancreas? It would probably take more than an entire day for a highly knowledgeable endocrinologist to finish talking about it. Wang Xiaoyan was more than capable of talking about it for more than two hours if she had to. However, that would obviously take too much of everyone's time, so she would need to identify only the crucial points to talk about. What did Wang Xiaoyan choose to focus on? The biochemistry, pathology, and physiology of the pancreas.

"The pancreas is a complex yet simple organ. The pancreas's main cells are composed of the Langerhans cells..." 20 minutes later, Wang Xiaoyan finished describing the pathology and physiology of the pancreas in details. It was due to her high abilities that she was able to clearly explain the pancreas's functions and structure in such detail.

"Not bad at all. It's quite summarized, but it does show us how the pancreas works. Pretty good job," Director Dilibaer remarked before glancing at Zhang Fan. "Doctor Zhang, how about you also tell us about the pancreas, and share your own personal understanding of this organ?"

Wang Xiaoyan glanced at Zhang Fan with an expectant and challenging look in her eyes. She also wanted to hear Zhang Fan's talk on the pancreas, especially since she had already finished discussing the basics of the pancreas. What else could Zhang Fan even say?

'Could it be that he's just going to repeat what I already said?' Wang Xiaoyan was rather proud of herself. She was still young, after all.

"Oh!" Zhang Fan really didn't know what else he could say. Wang Xiaoyan had already done a very good job at talking about the pancreas. Zhang Fan was about to speak up and say "Doctor Wang has already done an excellent and thorough job" when he saw Director Dilibaer's expectant expression and Wang Xiaoyan's expression of challenge.

Zhang Fan gritted his teeth and went to the center to give a talk to all the other endocrinologists. When he passed by Wang Xiaoyan as she gave him the position, she whispered to him, "Don't just repeat what I said already."

Zhang Fan ignored her. He couldn't be bothered with someone like her! Besides, Zhang Fan had no intention of repeating her words to begin with. Since he had taken this on already, he wouldn't feel like a real man if he didn't at least show some skills!

"Doctor Wang did a great job and helped me learn much about the pancreas. Doctor Wang has a thorough micro understanding of the pancreas, and there's very little I can add on to that, so allow me to discuss the macro understanding of the pancreas," Zhang Fan announced.

The other doctors didn't really think much of Zhang Fan's words, but Wang Xiaoyan felt an unpleasant taste in her mouth. 'He's actually saying that my field of vision is too narrow!' This was the trait of her being a study nerd. She would always be able to over-interpret things. As for whether Zhang Fan actually meant that or not, shall we leave that up to the imagination?

Director Dilibaer was quite interested as she waited for Zhang Fan's talk. However, some of the intern doctors and rotation doctors were already becoming impatient for a rather simple reason. Some of the knowledge that Wang Xiaoyan had talked about was stuff that they didn't understand!

"The pancreas is deep within the abdomen. It's impossible to touch it through the skin. It's connected to the duodenum, and its end stretches to the left and is located close to the spleen."

'Who doesn't know about anatomy by now!?' Wang Xiaoyan was rather disappointed. This was the contradictory world of a study nerd that ordinary people wouldn't understand. She looked forward to an excellent performance by Zhang Fan, but also didn't want him to surpass her.

After a simple introduction, Zhang Fan began to describe in great detail the anatomy of the pancreas. He talked about normal blood vessel routing as well as blood vessel abnormalities. He then talked about the pancreatic duct opening and abnormal conditions that could occur in the pancreatic duct and bile duct, discussing all this in great detail.

Not only was Wang Xiaoyan surprised, even Director Dilibaer was impressed. Zhang Fan's descriptions were far too detailed. He was able to verbally describe the condition of the pancreas from its normal structure to various abnormal conditions. Zhang Fan was able to make use of almost every pancreas-related thesis he had ever read before because he was far too familiar with anatomy by now.

Of course he would be so familiar, because he had grinded general surgery for more than one year already in his System. Zhang Fan was more than skilled enough to be a college professor and give anatomy courses to medical students now.

Not only did Zhang Fan talk about regular functions and appearances, he then continued to talk about various special conditions of certain pancreatic diseases and how to treat them.

The best way to treat most pancreatic problems would be surgery as taking medicine would be useless for treating an already established organ. Zhang Fan thus began to show off his own skills here. He was unable to stop himself since he rarely went all out to show off.

Wang Xiaoyan had indeed done an excellent job with her talk about the pancreas. Zhang Fan had indeed felt like he benefited much after grinding endocrinology for one week. This was why he couldn't hold himself back anymore. He wanted to combine the knowledge he learned through his System with his own understanding and speak about it all.

As he continued speaking, fewer and fewer doctors in the group were able to understand him. Finally, when Zhang Fan reached the point of saying "There are three types of surgical removal techniques for removing diseased tumors from the pancreas. The first type is...", even Director Dilibaer was no longer able to understand him. Such a pancreatic tumor removal surgery's difficulty was actually far too high. Even very few doctors in Beijing would be able to accomplish such a surgery, much less in Chasu City.

Zhang Fan kept talking on and on. He was excited, far too excited. This was the first time that he was verbally expressing his learned knowledge gained from the System. All of his previously hazy knowledge suddenly seemed to take form and become visible to him.

This was self-improvement to another realm. This improvement was even better than with his System's assistance, since the human brain's strongest point was fuzzy thinking, a type of thinking method that was highly suitable for exploring unknown knowledge.

Once foundations were solid to a certain extent, the quality would rise and improve. Zhang Fan's understanding of the pancreas was now on par with the top experts.

Zhang Fan forgot the time because he was so absorbed in talking about the pancreas. More than two hours had passed since he began to talk. Even his teaching doctor Ren Lina, who had many years of training in standing all the time, was having difficulty standing now.

Although nobody was able to understand what Zhang Fan was saying, they could tell that he wasn't just spouting rubbish. The educated doctors all respected knowledge. Not a single person interrupted him. If only an expert pancreas surgeon could have been present to hear him, the expert surely would have been incredibly astonished.

Finally, Zhang Fan finished at the two-and-a-half-hour mark. He then suddenly noticed the time and awkwardly smiled at everyone.

All the other doctors, Director Dilibaer included, had awkward expressions as well, because they hadn't understood! Director Dilibaer coughed and cleared her throat before saying, "Good job. Doctor Zhang has a solid foundation in surgery, although he got slightly sidetracked. Pay more attention in the future. Alright, everyone is dismissed."

Director Dilibaer then returned to her office and instantly sat down on her sofa while rubbing her legs. "Sigh! My legs! I'm getting old!"