Chapter 196: Old and Young

Zhu Bing recovered nicely over the days. Since the leaders viewed him with importance, he was enjoying treatment a government official would. He had a private room and policemen to accompany him.

Lu Renjia came over every day to visit Zhu Bing as well, even though she didn't know how to cook. There were also lots of people who came to try and make a connection with Zhu Bing. He received so many presents that his patient room was unable to contain them all. This was all due to Lu Renjia's appearance, as she was the daughter of a politician. Many perceptive people noticed this. The result was that many high-ranking individuals all came to visit Zhu Bing.

Lu Renjia and Zhu Bing were truly grateful to Zhang Fan. It was likely that Zhu Bing would have died, and Lu Renjia would've regretted things for the rest of her life, if Zhang Fan hadn't been there. Cardiothoracic Director Liu already told the ICU doctor in charge of Zhu Bing that any change in the patient's condition had to be reported to Zhang Fan! Although Zhang Fan's status in the surgical departments was unshakable now, he really wanted to cry when he thought about the patient that endocrinology Director Dilibaer had given to him.

This so-called graduation exam patient that he had to take care of was incredibly difficult. His patient was a woman who had previously been a model. She was about 1.8 meters tall, with beautiful hair, an alluring figure, elegant gait, mesmerizing curves, and pretty smile. However, that was all only in the past.

She now looked almost unrecognizably different. Due to a problem with a boyfriend, the young woman suddenly gave up on taking good care of herself. She quit being a model and became a hermit at home 1who ate as much and as unhealthily as she wanted. Three years later, this formerly young and sexy woman transformed into someone far pudgier who weighed more than 100 kg.

When she sat down, she would seem like a mountain of flesh. Her formerly pretty round face had now transformed into a bun. Although her hair was still beautiful, she now gave off an oily appearance.

This female patient had finally decided to improve her condition and stop being like this. However, she had gotten addicted to eating whatever and however much she wanted. It wasn't that easy for her to lose weight, and with her body mass, it would be dangerous for her to lose weight without doing it scientifically, because her body had already gotten accustomed to her current weight. A sudden large change would definitely cause problems with her organs.

There were plenty of advertisements out there about weight loss medicine. There were also plenty of companies focused on weight loss. They would claim to have the most scientific weight loss methods out there, demanding as much money as they possibly could from people by taking advantage of their desire to lose weight. As for how safe or healthy such weight loss methods actually were? Well, the companies wouldn't care.

Losing weight properly would be especially more important for those who were considered obese. Someone obese shouldn't just try to diet and change what they ate so easily. That was because when dieting, the body would first start burning up your protein, not your fat. You would lose a large amount of protein first, but your weight wouldn't decrease. Losing so much protein would cause all sorts of problems, such as swelling, a weak heart, and so on.

Only after burning up most of the protein would the organs start burning up fat in order to preserve themselves. A large amount of decomposed fat would then enter the liver. However, the liver wouldn't be able to metabolize all of this fat, so the fat would then transform into fatty liver, which shouldn't be underestimated. The continuation of fatty liver would be cirrhosis. Without even considering the possibility of liver tumors, just cirrhosis alone would be painful enough to make people want to die.

Without even discussing jaundice or hepatic encephalopathy, just when talking about the vascular system, the liver was an organ for internal secretion as well as a highly important link of the vascular system.

What was fatty liver cirrhosis? Your soft liver would become filled with fat particles which would then block all the hepatic lobules. With the veins here blocked, the esophageal veins would then transform into esophageal varices, leading to spitting up a large amount of blood, a symptom of one's esophageal veins rupturing. This could be fatal. Thus, it was vitally important to lose weight in a scientific manner. Losing weight recklessly wouldn't be good for one's body at all.

It was basically inborn for women to love beauty. Young women would especially often pay attention to their own figure and image. They would be the most sensitive to weight loss advertisements. There were quite a few women who wanted to lose weight even though their weight was perfectly normal. As a result, such women would diet and cause havoc within their bodies. Anorexia, bulimia, and so on would often ensue. These eating disorders weren't just physical illnesses anymore. They were also mental roadblocks that could develop into more severe mental illness. This would be no laughing matter at all; there were plenty of real-life examples.

The human body had two types of fat, also known as brown fat and white fat. The difference between the two was that brown fat could be found in the entire body. Brown fat also contained far more mitochondria, and was abundant in blood vessels. It would be under the control of the autonomic nervous system. Brown fat would also contain uncoupling proteins. To explain things simply, the nervous system could help us to burn brown fat, but that wouldn't be possible for white fat.

Although it seemed simple to treat obesity, the willpower required for someone to conquer obesity would be the equivalent of what it would take to quit smoking. Therapeutic intervention would be required to help the patient improve their eating habits, exercise more, and increase physical activity. Although this all sounded simple, few people in modern society were actually capable of keeping such things up for long.

The correct thing to do would be to eat less calories, less fatty products, and eat only an appropriate amount of protein and carbohydrates. But as the classical saying went, what the doctor told you not to eat would all be delicious, while what the doctor told you the eat would be foods you didn't enjoy.

The person who named this former model had to have been a grandmaster prophet, because her name was Tang Yuan! Yuan in Chinese meant round, and Tang Yuan indeed became round, really round!

Treating this patient's obesity truly wouldn't be simple. This was because during the day, Tang Yuan would grit her teeth and claim to want to lose weight, but at night, she would secretly eat junk food under the blankets as if she was a pudgy mouse. Her favorite foods were anything oily, fried, or high in sugar!

In order to treat her obesity, it would be necessary to first instill an adamant will in her. As for how to do this? Zhang Fan had no idea. Humans could be so complex! He really had no idea how to even start. This was different from performing a surgery. In surgery, he could simply remove anything that was bad. However, this wasn't something that he could surgically remove. In that case, he could only use the plainest of ideas. He lectured his patient three times per day for half an hour each time on the dangers of obesity, telling her over and over again what she should be eating!

When Zhang Fan started managing this patient, he created a nutritional and reasonable diet for her. His diet reduced Tang Yuan's oil, salt, and sugar intake. He also told Tang Yuan to drink as much water as possible without drinking any beverages. These were the main principles of how to properly diet. As for more specific things, the diet would need to still satisfy the body's basic nutritional needs. The calorie intake would also need to be lower than the amount of calories burned per day, so that part of the fat in the body would be consumed. This was the most scientific method of losing weight. Starving oneself truly wouldn't be a good idea at all.

The size and type of the food was also really important. When dieting, it would help to eat large food that actually contained little energy. This would be easy to understand with some simple numbers. One gram of fat would provide 9,000 calories of energy. Meanwhile, one gram of protein or one gram of carbohydrates would only provide 4,000 calories of energy. Eating two broiled chicken legs would have significantly reduced caloric intake compared to eating two fried chicken legs. Most vegetables and fruits were also quite large but would contain very little energy.

Zhang Fan prepared the perfect nutritional diet for Tang Yuan that would help her to healthily lose weight gradually. However, three days later, when he weighed Tang Yuan, he discovered that her weight hadn't changed even one bit. Zhang Fan glanced over at Director Dilibaer, but she pridefully ignored him and went out for consultations without saying a single thing. Zhang Fan was left at a loss for what to do. His patient Tang Yuan was also feeling bad. She had quite a dejected expression.

"Doctor Zhang, am I unsalvageable?"

"No! Your condition is nothing at all. I've seen others who are far heavier than you!"

Maybe Tang Yuan had heard many such similar consolations before. She wasn't happy to hear this at all. She fell silent and lowered her head while returning to her patient room. Zhang Fan felt quite helpless as he watched what seemed like a mountain of flesh walk away.

Just what could he do? The simpler treatments were completely ineffective because Tang Yuan was unable to stick to the diet and exercise plan. Repeated failed treatments to cure her obesity had also caused Tang Yuan to lose most of her confidence in herself. What should Zhang Fan do here? His System still hadn't opened up internal medicine courses to him. Chasu City also didn't have any large libraries. It would be hard for him to even find a research thesis on the topic. Zhang Fan could only sigh as he took a rest on the sofa. This was the first time that he had felt completely helpless to treat a patient.

"What is it?" Shao Hua's mother asked her daughter because she was wondering why Zhang Fan seemed to be so down.

"He's worried about one of his patients!" Shao Hua answered.

The more that Zhang Fan thought about it, the more he was unable to come up with any ideas. He wasn't afraid that Director Dilibaer would actually force him to remain in the endocrinology department. It was that he was a doctor. If he didn't properly think about how he could help his patient, he felt that he would do wrong by his white doctor's coat.

He thought some more and then sat up. He then told Shao Hua and her mother who were both in the kitchen, "Ma'am, no need to make any food for me. I'm going out."

"You should leave after you eat! The food's almost ready," Shao Hua said while exiting the kitchen.

"It's alright. I don't have an appetite. I'm leaving now to go talk to someone!" Zhang Fan put on his jacket and left right after this.

Who was he going to talk to? Of course, Director Dilibaer. He figured that the person testing him had to have the answer. He didn't contact her, and instead directly drove his car to her home.

Chasu City was quite white in winter. The snow would only melt in spring of the next year. It was as if there were walls made of snow on the streetsides with how high the snow piled up.

Director Dilibaer didn't live on the hospital grounds like many other directors did. This was because she was originally from Chasu City to begin with. Her family had been here in the border province for many generations already. She lived in her ancestors' family home, which was a small dwelling with blue walls. Many trees were planted outside the home, while two large and thick trees were planted at the entrance.

Zhang Fan parked his car at the home's entrance. He could faintly see that lights were still turned on inside the home. Just as he was about to use his cell phone to call Director Dilibaer, the door suddenly opened. A middle-aged woman who was rather plump stood there, blocking the front entrance.

"Who yer lookin fer?" The middle-aged woman's Chinese was rather accented.

"Does Director Dilibaer happen to live here?" Zhang Fan asked politely.

"Yes, she does. Yer name is Zang Wan?"

"Oh! It's Zhang Fan!" Zhang Fan could only awkwardly correct his name!

"Hurry and come in! My aunt is waiting fer ya!"

Actually, Director Dilibaer had been waiting all day for Zhang Fan to visit her, ever since the morning patient checkups. However, he hadn't arrived even by the time that the day shift was over. Finally, he arrived just as she was about to disappointedly give up on him.

"You can leave us be. He's probably in no mood to eat or drink." Director Dilibaer had her niece leave them before saying to Zhang Fan, "No matter how I look at you, it doesn't seem like you're the really intelligent type. Yet, based on your professional performance, you should be a genius. Why is there such a discrepancy?"

"I wanted to research things by myself." Zhang Fan could only explain things in such an awkward manner. It felt bad for him to directly hear that he wasn't smart, but there was no helping it. His own intelligence really was just average, after all. His knowledge all came from his System that nobody else knew about.

"Haha, I suppose so. You wouldn't be able to accomplish what you have already without the desire to research and understand. Then tell me, what have you thought of now?"

"Yes. Normal treatments are already completely ineffective for Tang Yuan. It also seems that she's lost all faith in a normal obesity treatment. I kept thinking about it over and over again for any idea that I could use. In the end, I felt like since she's still so young, it's necessary to rapidly help her become thinner so that she can reenter society. That's why I would like to perform a simple gastroplasty surgery on her, which will greatly reduce her food intake."

Director Dilibaer had been drinking some water, but she almost spat out her water when she heard this. "Is this the end result that you came over to tell me at nighttime after thinking about it for an entire day?"

Zhang Fan awkwardly nodded.

"Sigh! Why are surgeons always so simple-minded? Although your medical skills are indeed amazing for a more basic hospital like ours, you still lack overall medical knowledge. This is my assessment of you after observing you for quite a while. I don't wish to understand why your medical knowledge has become so skewed towards surgery. Today, simply allow an old lady like me to give you a good lesson on internal medicine." Although Director Dilibaer was from an ethnic minority, her father had been a high-ranking city official. She was also highly educated, and had completely assimilated into Chinese culture. In fact, she viewed things such as teacher-disciple relationships even more seriously than many Chinese would.

She wouldn't teach anyone her abilities easily. She had been waiting and observing to see if Zhang Fan had the comprehension ability and character necessary to receive her skills. However, she waited all day and observed for so long, only to receive Zhang Fan who was strangely unlike any other!

Director Dilibaer had already said so much. She waited for quite a while, but Zhang Fan was still confused.

"Are you not willing to learn?"

"Oh! I'm willing! I'm willing! Teacher, please have some tea!" Zhang Fan finally understood that Director Dilibaer was someone who really valued ceremony. What she meant was that he should address her as teacher in order to receive this lesson. Although Director Dilibaer was somewhat dissatisfied with how Zhang Fan was like a block of wood, there was no helping it. She could only work with what she had. Zhang Fan still counted as rather excellent among the younger doctors. Unfortunately, she knew that Zhang Fan wasn't interested in internal medicine. Even his medical way of thinking was becoming rather heavily biased towards surgery. This all made Director Dilibaer feel rather helpless!

"Back when I was studying in the former Soviet Union, I was lucky enough to study under a medical professor there. At that time..." Director Dilibaer slowly started telling Zhang Fan about her past.

Sparks kept flying out from her home's fireplace. The old lady and young man sat next to the fireplace on this wintry night until deep into the night. The old lady taught the young man everything that she knew about internal medicine. The young man focused fully on her every word.

Time slowly passed by. Director Dilibaer's niece looked in on them through the window several times. She saw that the two had been talking for this entire time, and that the young man was continuously taking notes.

"Let's end things here for tonight! I'm getting tired!" Director Dilibaer was rather fatigued. She had just taught Zhang Fan for a bit more than three hours tonight. This brought her much mental fatigue. The questions that Zhang Fan liked to ask her were far too strange. Zhang Fan had incredibly excellent understanding of anatomy, yet his knowledge regarding all sorts of endocrinology factors was only half-complete. Yet, he was somehow able to make up for his lack of knowledge here with an astonishing amount of surgical knowledge and a surgical way of thinking.

So, for this night, Director Dilibaer had basically been trying to reestablish Zhang Fan's overall medical way of thinking by giving him proper knowledge of internal medicine.

"Um, how about I give you a massage? My massage techniques are actually really good!" Zhang Fan felt rather awkward about having an older lady sit straight for several hours while teaching him. He really did want to do something for Director Dilibaer who had been willing to help and teach him so much.

"There's no need for that. You should hurry and go back home now. It's getting quite late. Be careful on the road. If you still want to hear an old lady like me nag you, then feel free to come visit me again tomorrow. Once you truly have some medical treatment ideas for your patient Tang Yuan, you'll count as having a complete medical way of thinking of you own. See you later!"

Zhang Fan slowly left Director Dilibaer's home. He then stood there at the entrance and raised his head to look at the bright starry sky. He stretched his back afterwards. Zhang Fan was finally gaining the knowledge he had missed during college because he hadn't properly studied back then.