Chapter 228: Zhang Fan's first outpatient service

People would often think of the proctology department as a place to only treat hemorrhoids. This wasn't actually the case. The proctology department was focused on treating all diseases related to the last part of the digestive system. In proctology, there were still many diseases which had causes that weren't fully understood yet. Since the causes were still unknown, prevention would be highly difficult.

To give an example using hemorrhoids which many people were familiar with, there were currently two main prevailing theories for the formation of hemorrhoids. To explain the first theory simply, the blood vessels in the hemorrhoids would become obstructed from things such as sitting down for too long, constipation, gestation, an enlarged prostate, a large pelvic tumor, and so on. These all might cause the veins in the rectum to become obstructed.

There were plenty who didn't support this theory, but they were also unable to provide evidence against it. Meanwhile, another prevailing theory from western medicine, explained in a simplified manner, was that it was related to anal contractions during bowel movements, and various other reasons.

Since the exact cause of hemorrhoids was unknown, it would be quite difficult to prevent them entirely. As doctors would put it, a large number of poor habits and lifestyle choices could all potentially cause hemorrhoids.

Without discussing other matters about the proctology director, his medical skills were actually quite good. He had developed numerous proctology surgeries for the department. Amongst local hospitals in the area, Chasu City Hospital's proctology department was actually above average in skill level because of him. However, due to the problem of him taking more money for his marriage, he caused his proctology department doctors to lack any motivation.

Since the director wasn't here, only Zhang Fan himself could go and perform outpatient services. This was actually his very first time performing outpatient services, and it would be as a proctologist. He brought a water bottle and a nurse with him to the hospital's outpatient clinic.

In proctology, the number of young patients was roughly equal to the number of old patients, and since proctology would require inspection of a rather private area, it was more convenient for Zhang Fan to bring along a female nurse to help him with the female patients.

The head nurse of the outpatient clinic smiled and greeted Zhang Fan. "Doctor Zhang, you're here to perform outpatient services?"

"Yes, head nurse."

"I'll prepare a sign with your name on it then."

"Alright, thank you, head nurse," Zhang Fan answered politely.

When he turned the corner, he ran into Xue Fei from orthopedic department #1. In the orthopedic departments, Xue Fei had the best relationship with Zhang Fan. He was also the type who really valued friendship. Back when Zhang Fan was treating the injured military patient Qin Nuo, Xue Fei had risked incurring Superintendent Ouyang's wrath by specially reminding Zhang Fan about the risks involved with performing surgery on someone with a special status like Qin Nuo. Zhang Fan was quite grateful to Xue Fei for this.

However, Xue Fei was the type who was unreliable with his work. His medical skills were only average despite being an attending physician. He was far less skilled than fellow attending physician Zhou Chengfu. Back before Zhang Fan monopolized all of the surgeries in the surrounding area, Zhou Chengfu would also occasionally take surgeries at other hospitals. Meanwhile, Xue Fei spent all of his free time playing mahjong instead.

"What, Director Zhang is formally starting work today?" Xue Fei commented. Everyone in the surgical departments knew about how Zhang Fan was becoming the acting director of the proctology department for one month. Since all surgical departments were in the same large building, news would spread very quickly.

"Yeah. I'm performing outpatient services today. What, are you also on outpatient service duty today?" Zhang Fan couldn't be bothered with being serious about Xue Fei's joke that he was the director. The more serious someone was with him, the more he would joke around. Rather, he would stop joking around if Zhang Fan just admitted that he was the "director".

"I call you fat and you start panting? Isn't it just looking at anuses all day? Why are you acting so proud?" Xue Fei gave Zhang Fan a thumbs down while looking down on him.

"Heh, don't you look down on this. I'll wait for the day that you get hemorrhoids due to playing too much mahjong. I'll definitely give you a thumb examination when you do."

"Ptui! Ptui! Ptui! You jinxer, you're the one who will get hemorrhoids! Okay, I'll be serious now. Are you coming to the orthopedic department in the future or not? I'm still counting on you covering for me. You won't really be interested in the position of proctology director, will you?"

Xue Fei was now having a hard time in orthopedic department #1. Due to the new addition of orthopedic department #3, all three orthopedic departments were doing their very best to perform as many surgeries as they possibly could. However, Xue Fei's medical abilities were only average, and he was unable to perform many of the more difficult surgeries. Orthopedic department #1's Director Gao Shijun was quite dissatisfied with him because of this.

"Bro, you'll have to do the best you can by yourself. I'm performing outpatient services now." Zhang Fan went to the outpatient service section for proctology.

Xue Fei's thinking that Zhang Fan couldn't possibly become a director right now was what most doctors shared. Although Zhang Fan was indeed highly skilled, it seemed inconceivable that he would be made an actual department director with his young age.

The nurse that Zhang Fan brought with him was named Chen Xiaoli. She was a young woman who had a two-year-old child. She was one of the most skilled nurses amongst the proctology department's nurses, which was why the proctology head nurse had intentionally assigned her to come along with Zhang Fan on his first day of performing outpatient services.

Zhang Fan's first patient was someone that he was already acquainted with. The patient was Old Yu, who had been one of Shao Hua's neighbors back at her parents' old apartment. Old Yu was in his 60s. He was one of Shao Hua's father's Chinese chess buddies. He and Shao Hua's father would often argue with each other and reconcile right away. They would even miss each other after not seeing each other for a few days. Zhang Fan had met Old Yu several times already whenever the latter came over to play Chinese chess. They knew each other by sight.

Old Yu had been feeling rather uncomfortable over the past few days. Since the discomfort was about his butt, he felt too embarrassed to tell his children about it. So, he came here to get treated while only bringing his wife with him. When he came to the proctology outpatient services section and saw that Zhang Fan was the doctor here, he became excited as the doctor was someone he already knew. Old Yu started smiling, but then he started feeling awkward again.

"Sir, come in! Why stand there at the door?" Zhang Fan saw that his first patient was standing at the door, hesitating about coming in. Zhang Fan found the situation rather funny because the patient was someone he knew, but he did his best not to laugh out loud.

"Sigh! Doctor Zhang, so you're in the proctology department?"

"Yes, sir."

"Weren't you a surgeon?"

"Proctology is a type of surgical department. How are you? Where are you feeling uncomfortable?" Zhang Fan knew that he couldn't allow himself to be pulled into Old Yu's conversation. Older people were typically really chatty. It would probably take all morning and even part of the afternoon before Old Yu would talk about his problem if he was allowed to speak as he wanted.

"It's not much at all. I've just been coughing a lot recently." Old Yu really became embarrassed about being asked so directly. Due to his embarrassment, he started describing his own symptoms really vaguely.

However, his wife could no longer take it anymore. "The doctor is busy! This isn't a place for you to play Chinese chess. Doctor Zhang, I don't know what's going on with my husband, but he keeps coughing for no apparent reason, and sometimes when he coughs, part of his intestine will fall out from his butt! Just say it directly! You're so old already, yet you're still feeling embarrassed!?" Old Yu's wife instantly explained everything.

"Oh, so that's what's going on. Sir, how long have you been coughing for? Do you have any fever? Do you have any phlegm, or any other symptoms?"

"No, I'm quite fine. I just keep coughing for no apparent reason. My throat doesn't even itch. I just can't help but keep coughing."

"Oh, I see—" Right as Zhang Fan said this, Old Yu began to cough. Zhang Fan immediately could discern from the cough that this wasn't an irritable cough. This sounded more like a reflex cough caused by abdominal pressure, because this cough sounded really low, and wasn't successive.

"I think it came out again!" Old Yu's face became bright red. He acted as if he was a young boy who had done something wrong as he lowered his eyes and didn't dare to look directly at Zhang Fan or his wife.

"Your intestine came out again?" His wife had a really loud voice. She was also the dense type who didn't notice her husband's current feelings. "Why make such a ruckus! It's not like you're laying eggs. If it came out, then it came out! Why shout about it!" Old Yu became so humiliated from this that he also became somewhat angry.

"It's fine, sir. No need to worry. Could you please crawl up onto the examination table? I'll examine things for you."

The nurse Chen Xiaoli assisted Old Yu up onto the examination table as Zhang Fan put on his gloves.

"Young lady, you can go out after drawing the curtain around the table!" Old Yu told the nurse.

"Yes, sir." The nurse closed the curtain around the examination table and left.

"Sir, could you please take off your pants?"

Old Yu was getting older, so moving around wasn't that convenient for him. His wife had to assist in taking off his pants. When Zhang Fan took a look, whoa! A wad of meat was sticking out from the anus! It really resembled a meatball placed right in the middle of the butt!

This type of problem was truly awkward. When using some force during a bowel movement, the rectum would come out from the body, and then it would return to the body again after the bowel movement was finished. This would become a problem over time. Using too much force, such as with a cough, would cause rectal prolapse. Sometimes, a person might even have to hold their own anus while walking. Otherwise, the rectum would fall out!

Successful surgical treatment for rectal prolapse would obviously be the best result. If rectal prolapse wasn't treated in time, the rectum would become swollen and likely strangle its own tissue to death. This truly was such an awkward problem to have.