Pancreas
Tumors and Cancer
During the lunch break, the flow of people in the emergency hall slightly decreased, and only two consultation rooms were open in the ultrasound room of the emergency center.
Behind the green curtains, Lu Yinxi and Jian Qing stood side by side, while Yan Miaomiao lay on the bed, exposing her belly: “I haven’t eaten much all morning, I hadn’t even had a bite of a vegetable before Director Jian dragged me here!”
The female doctor on the noon shift applied coupling agent to her belly: “Director Yan, don’t shout. I haven’t even had a sip of water since this morning. I just took a bite of instant noodles before you dragged me here to work!”
Yan Miaomiao rolled her eyes at her: “I took good care of you when we were in the External Liaison Department, didn’t I? Now you’re reluctant to serve the people a bit, where’s your conscience? How did you do in radiology back then? Did you ever fail a course?”
The female doctor shushed a few times: “Shush, shush, shush, I never failed any courses, I passed them all. Be quiet, be quiet. I’m about to start, let me take a look at your liver, gallbladder, pancreas, spleen, and kidneys!”
The three doctors in the consultation room were all alumni from Jiangzhou University.
Working at the affiliated hospital of the school, the network of relationships keeps circling around, and you can’t avoid alumni and their friends.
The immediate supervisors might be senior students from a few years ago, the department heads might have been seniors from decades ago, and the newly recruited young doctors might be students they personally mentored…
Sometimes, when staff members of the hospital get hemorrhoids or need a circumcision, and have a minor surgery in the hospital, within a few days, almost everyone in the hospital will know. When they meet, they will greet them with a smiling and kind inquiry.
Therefore, some staff are unwilling to have surgery in the hospital and would rather go to other hospitals far away, contributing to other hospitals’ revenue, to avoid being surrounded by classmates and alumni from their own hospital, and having to take off their pants to be used as teaching material for their own students, which is incredibly embarrassing.
The ultrasound doctor operated the probe, placing it on Yan Miaomiao’s upper abdomen: “It’s just that the students are all on lunch break now; otherwise, I would have let my apprentice practice on you. Look at your liver, your pancreas—”
Speaking of the pancreas, she suddenly elongated her tone, made a sound of surprise, and then fell silent. Her teasing expression instantly turned serious. She widened her eyes, moved her head closer to the screen, and moved the probe back and forth on Yan Miaomiao’s belly with her right hand.
Yan Miaomiao lifted her head, wanting to take a look at the screen: “What’s wrong with my little pancreas?”
Jian Qing folded her arms and sternly stopped her: “Don’t move.”
Yan Miaomiao, having been scolded, lay back down muttering: “So fierce, I just treated you to a meal, how come you’re like an ungrateful wolf…”
“What little pancreas, I’m an old aunt…” The ultrasound doctor still teased with her words, but her expression was no longer relaxed. She put down the probe, “Let’s go to the ultrasound department and have Director Wang take a look at you, and do some other tests as well.”
In the emergency department, those who take turns seeing patients and interacting with them are almost all young doctors, while the department heads are stationed in the main ultrasound department.
Yan Miaomiao sat up, Lu Yinxi handed her a tissue, she thanked her and took it to wipe off the coupling agent on her belly, and asked: “What’s the issue, why do you need to call your leader to check? Are you not skilled enough?”
The ultrasound doctor glanced at Jian Qing: “Director Jian, did you see it?”
Jian Qing looked at Yan Miaomiao and calmly said: “Pancreatic head mass.”
A pancreatic head mass means there is a tumor in the head of the pancreas. It could be benign or malignant.
If it is benign, a minor surgery to remove it would suffice; if it is malignant, it is highly likely to be pancreatic head cancer.
Pancreatic head cancer is a type of pancreatic cancer.
Pancreatic cancer is known as the “king of cancers,” with a five-year survival rate of about 1% to 3%. It has a hidden onset, no obvious early symptoms, progresses rapidly, is highly malignant, has poor treatment effects, and poor prognosis. Once discovered, nine times out of ten, it is in the late stage and cannot be operated on; even with hospitalization, survival beyond six months is almost impossible; even if surgery is possible in the early to mid-stages, there is a very high probability of recurrence after surgical removal.
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Current medical methods are helpless against this cancer, and even the most popular and effective immunotherapy in recent years, which alleviates many types of cancer, has minimal effect on pancreatic cancer.
The small examination room fell into a moment of silence.
The ultrasound doctor adjusted her glasses and broke the silence by comforting, “It doesn’t look malignant to me, Director Yan, don’t scare yourself.”
These words could only be said in front of acquaintances.
In medicine, caution is always the first priority. Without seeing more examination results, no one can or should make promises or guarantees to the patient.
Whether it is malignant or not can only be confirmed by the final pathological results. Pathology is the gold standard for tumor diagnosis, while blood tests and imaging results can only be considered auxiliary examinations and auxiliary judgments.
Yan Miaomiao’s face turned pale instantly. She froze for a few seconds, then smiled and looked at Jian Qing: “Hey, old classmate, you are familiar with these, what other tests do you need to arrange? Let’s do them all at once. If it’s benign, let’s get it removed early to be done with it. If it’s malignant, then it might be pancreatic head cancer. I think mine should still be in the early stage now—no, it won’t be.” She lowered her eyelids, smiled again, and shook her head in denial, “I’m only 32 this year, don’t smoke, don’t drink, no family history of diseases; at most, I stay up late a bit too much. It can’t be cancer… Anyway, let’s do the tests first…”
Doctors know more about diseases than ordinary people.
It is precisely because they know more that they understand how terrifying it is.
She has witnessed many life-and-death situations in the emergency department. Sometimes she becomes numb to the death of patients, but knowing that a serious illness might befall her, she still cannot face it calmly and cannot be fearless in the face of life and death.
Doctors are not gods; they are also human. Humans will always fear diseases.
This is a basic instinct engraved in our genes.
Specialization in different fields is necessary; the larger the hospital, the more specialized the departments, and the more professional the expertise.
Sometimes, after staying in the same specialized position for a long time, the knowledge points of other disciplines that are not used for a long time might be less known than what a rotating doctor knows.
Emergency medicine is broad and covers a wide range of knowledge horizontally, but the vertical study is not deep. When facing specialized diseases, they still need to be treated by specialized departments.
The digestive system is also not Jian Qing’s most familiar area. She invited the digestive team from the oncology department, hepatobiliary and pancreatic surgery, gastroenterology, radiology, and ultrasound departments for a multidisciplinary consultation. Hu Jianjun, upon learning of the situation, also rushed from the vice president’s office to the MDT (Multidisciplinary Team) consultation room to lead the consultation.
Yan Miaomiao did not participate in the discussion of her own case; she chose to stay in the ward to calm down.
When you’re sick, the hardest part is waiting for the test results.
Panic, prayer, regret, reflection, self-blame, countless thoughts flood the mind.
Yan Miaomiao sat on the bed Jian Qing had arranged for her, looking back on her life of more than thirty years.
She had always excelled in her studies, was well-liked, and had friends from all over, but her family background wasn’t great. Her biological parents preferred boys over girls. Shortly after she was born, she was abandoned at the hospital. A couple who couldn’t have children took her in, raised her as their own, and supported her all the way to the best medical university in the country.
Unfortunately, while other people’s daughters were graduating from college in their early twenties and earning money to support their parents, those who studied medicine, even in the fastest eight-year program, spent several more years. In the first two years after graduation, they hardly earned any money. She chose the grueling and exhausting emergency department, which kept her away from home all year round, not even able to spend the holidays with her family.
Her adoptive parents were not highly educated and often poked her forehead while scolding her: “You’re not even as good as the cat I raised. At least the cat doesn’t stay out all night and knows to come home even after being fed elsewhere. But you, you! Your wings have hardened and now you don’t come home. You haven’t even married yet and you’re already like water thrown out!”
Despite the scoldings, her adoptive parents still brought chicken soup and dumplings to her department during the holidays, only leaving after watching her drink them.
The last time there was a drunk causing trouble in the emergency department who slapped her in the face, her adoptive mother happened to be at the hospital. She pulled her behind her like a mother hen protecting her chick, swung her arms and fought the person until they were bruised and swollen, almost getting herself locked up. After coming out of the police station, without saying a word, she dragged her to the emergency department’s leadership to demand a safer department for her daughter.
Yan Miaomiao wondered what would happen to her adoptive parents if she really had pancreatic cancer.
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How could she say it out loud? How could she bear to say it out loud? To let her parents, who are now old and gray, bury their black-haired child? To let her elderly parents take care of her instead?
Tons and tons of guilt weighed on her heart. Yan Miaomiao didn’t have time to think about herself, didn’t consider the various treatment plans. She took out her phone, opened her mobile banking app, counted her savings, and thought to herself that if she really had cancer, she might as well not get treated. After all, pancreatic cancer is hard to cure. She didn’t want to waste money and lose her life too. Her parents had had a hard life; she should leave the money for their retirement…
As she thought about it, she told herself that she wasn’t a bad person and hadn’t done anything immoral. On the contrary, she had saved many lives. How could the Heavens let her get cancer?
And the most difficult pancreatic cancer at that?
Was it from staying up too late? Was it from eating too much instant noodles? Was it inherited from her biological parents?
She swore that if it wasn’t cancer, she would live a regular life in the future, eat less instant noodles, exercise, and cultivate good living habits.
Teachers, colleagues, and students from the hospital took turns visiting Yan Miaomiao to comfort her.
Yan Miaomiao refused to show weakness in front of others. She rubbed her eyes, pulled herself together, and responded with a cheerful smile.
The work in the emergency department was very busy, too busy, so busy that there was no time for internal strife. As a result, the colleagues in the department were as close as if they wore the same pair of pants (very close-knit).
The head of the emergency department, hands behind his back, circled three times to the left and three times to the right in front of Yan Miaomiao’s bed. This nearly fifty-year-old head finally got so anxious that his eyes turned red. He sat by the bed and said, “I have delayed you!”
Yan Miaomiao shouted loudly, “Don’t say that! Your words make it sound like we have some kind of affair. What do you mean by ‘you delayed me’?”
The old director was heartbroken, “Your illness is caused by the exhaustion of working in the emergency department. I shouldn’t have kept you in the emergency department back then. You were an excellent eight-year program student with better prospects, and I—”
Yan Miaomiao interrupted her, “What’s wrong with the eight-year program? Who says those in the eight-year program can’t work in the emergency department? We’re all here to treat and save people; why make distinctions of high and low status? Back then, you won my heart with a bowl of instant noodles, convincing me to stay in the emergency department, and now you’re saying you delayed me! I’m not dead yet, so don’t get all weepy on me! Are you here to cry at my funeral?”
The old director was stunned by her outburst and slapped the bed, yelling back, “If I’m not a weepy woman, then am I a tough man?”
Yan Miaomiao still respected her mentor, so she shrank her neck, lowered her voice, and comforted the old director, “Look, our emergency department can mobilize the whole hospital. Whichever department I call, they dare not refuse. I came to the emergency department for the quick and efficient pace. I like standing on the edge of life and death, solving a case in no time. Unlike internal medicine—”
She pointed to Jian Qing, who had just entered the room, “Slowly making rounds, slowly writing medical records, slowly reviewing literature, dragging things out, nitpicking, even though their medical records are well-written, they can hardly save a few people in a whole year. I just don’t like it!”
Jian Qing’s face turned cold, “I can still save a few people.”
The old director of the emergency department defended her, “She speaks without thinking; don’t take it to heart.”
“She’s older than me,” Jian Qing still had a cold face, “Your blood chemistry, blood routine, and tumor markers are all very normal. The imaging results show that the lesion’s boundary is very clear, with calcified edges, no cystic changes, necrosis, no ascites, or enlarged lymph nodes. The preliminary judgment is a low-grade malignant or benign tumor. The MDT discussion results suggest it’s likely a neuroendocrine tumor, which can be surgically removed. Of course, it can’t be confirmed 100%, and the definitive diagnosis still depends on the pathological results. The surgical team recommends surgery, and we’ll see the postoperative pathology. You should transfer to the Hepatobiliary and Pancreatic Surgery department.”
Neuroendocrine tumors, except for nails and hair, can occur in various parts of the body, most commonly in the digestive system, with the pancreas being the most susceptible in the digestive system.
Pancreatic neuroendocrine tumors have three stages: G1, G2, and G3. Among them, G1 and G2 stages are relatively low in malignancy and grow more slowly, considered to be tumors. G3 stage has the highest malignancy and can be called cancer.
Upon hearing this, Yan Miaomiao immediately jumped up from the hospital bed, disregarding the fact that Jian Qing was wearing a white coat, and hugged Jian Qing, howling, “Old classmate, I shouldn’t have badmouthed you behind your back in school, calling you a cold-blooded, emotionless deadpan! You are simply my angel now!”
Jian Qing coldly and unfeelingly pushed her away, “Pack up your things and vacate the bed.”
In the partitioned office of the second tumor ward, Lu Yinxi borrowed the microwave to heat up food for Jian Qing.
Jian Qing had been busy taking Yan Miaomiao for check-ups all morning, without eating or drinking.
Lu Yinxi did not remember Yan Miaomiao’s role in the original novel, or rather, in her limited memory, there was no such character as Yan Miaomiao.
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Perhaps Yan Miaomiao had little to do with the male and female leads, so her role was minimal or she wasn’t included at all.
Unlike He Bei.
In the original novel, He Bei and the male lead Chu Yan were childhood neighbors. Chu Yan had a crush on her, and after her death, Chu Yan was depressed for a long time. Eventually, it was the female lead who pulled him out of the shadows and they ended up together.
Now that this part of the plot had been changed by Lu Yinxi, she was worried that if He Bei didn’t die and Chu Yan ended up with He Bei, then what would happen to the original female lead?
She changed the plot, and also the fate of others.
But regardless of the romantic drama, she believed that human life should be the most precious.
Saving a life could never be wrong.
Likewise, she prayed for Yan Miaomiao, praying that the result would not be malignant.
One flower, one world; one leaf, one Buddha. Perhaps this world truly exists in some time and space, some universe, just like the real world.
“Have you eaten?” Jian Qing pushed open the small door of the office partition and walked in, interrupting Lu Yinxi’s contemplation.