The Fittest
Every step is a matter of survival of the fittest.
When Ren Jiajia returned to the office of Oncology Ward Two, she clearly sensed that the atmosphere was off.
Upon entering, the students and doctors in the office all glanced at her more or less, but tacitly remained silent. They just gave her a strange look before retracting their gaze and busied themselves with their own tasks.
Reporting a supervising teacher by name to the Medical Education Department must have already spread throughout the ward.
She was a student in the five-year clinical program, Class 1. Ever since her rotation brought her to Oncology Ward Two, their supervising doctor, Dr. Gong, had never shown them any kindness, as if they owed him millions. He would order them around like maids at every turn, teaching them nothing and making them start hands-on immediately. If they did something wrong, he would sarcastically criticize them without directly naming them.
They could still grit their teeth and endure his terrible teaching attitude, but what happened on New Year’s Eve was utterly disgusting!
On New Year’s Eve, no one went home and stayed with him on duty at the hospital. The other colleagues in the ward customarily prepared a New Year’s Eve dinner for the on-duty staff. When the food was delivered, Dr. Gong casually said to them, “Alright, go off duty for now. You can go eat something, but remember to come back to work after you’re done.”
The female students, being shy, didn’t feel comfortable staying to eat and ran outside, only to find that the cafeteria was closed and most restaurants were also shut. Hungry, they roamed several streets and finally decided to return to their dormitory to eat instant noodles.
After eating instant noodles, they returned to the hospital to continue working. Dr. Gong, picking his teeth with a toothpick, said, “Go wash the dishes in the sink.”
It was the same high-and-mighty, taken-for-granted attitude.
The interns could hardly tell whether they were at the hospital for an internship or to be treated like servants.
Yesterday, when the Medical Education Department sent out a ward round notice in the student group, Ren Jiajia discussed with her groupmates, planning to report this situation to the teachers from the Medical Education Department.
This morning, some of the students were scared and tugged at the hem of her white coat, saying, “Maybe we should drop it. What if he retaliates against us?”
Ren Jiajia said, “We won’t stay in this department in the future anyway. How can he retaliate against us?”
“What if he deliberately gives us low scores in the department evaluation?”
“Then we will continue to report to the Medical Education Department! Let them rearrange the assessment and have someone from the Medical Affairs Department invigilate us. Let’s see who gets embarrassed!”
So, when the Medical Education Department came to discuss their learning situation, Ren Jiajia took the lead in criticizing Dr. Gong for his terrible teaching attitude. Her classmates were initially silent, but after Ren Jiajia finished speaking, they heard Director Yan of the Medical Education Department, with hands behind his back, say, “This is outrageous!” They also saw Director Chen of the Continuing Education Department, with a face full of indignation, say, “We must call him in for a talk!” With the teachers’ support, the classmates began to echo Ren Jiajia’s words.
Dr. Gong had temporarily stepped out and was not in the ward. Before leaving, Director Yan, with a somber face, repeatedly assured the interns, “Don’t worry, we will definitely get to the bottom of this. The school sent you to the hospital to learn, not to wash dishes!”
Director Chen also patted their shoulders and gently comforted them, saying, “If you have any grievances, feel free to speak boldly to the teachers of the Medical Education Department. We stand on the students’ side.”
The long-lost concern brought tears to the female students’ eyes.
However, while the Medical Education Department is there to protect the students’ interests, the clinical departments may not necessarily stand on the students’ side.
Ren Jiajia returned to the office and walked up to a young doctor in the Digestive System team, quietly asking, “Teacher, I’m back. Is there anything I can help with?”
The young doctor glanced at her sideways, the keyboard clattering loudly as he typed, “How dare I ask you to do any work? Don’t report me to the Medical Education Department tomorrow as well.”
The sarcasm in his words was thick. The surrounding gazes shot over simultaneously, took a look at them, and then withdrew.
No one spoke up to help defuse the situation; everyone was busy with their own tasks.
Ren Jiajia felt her blood rushing all over her body, standing there unsure whether to move or not, like an ant being roasted over a fire.
Did she do something wrong? Clearly, she wasn’t the one at fault. Why were they all so naturally blaming her?
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Lu Yinxi blinked at Jian Qing, hinting for her to help out.
Jian Qing ignored her, watching coldly, remaining aloof.
Lu Yinxi lightly kicked her.
Jian Qing glanced at her, sat down, opened a medical record, and said to Zhang Yue, “Bed 21 needs a thoracentesis. Call the students over.”
Zhang Yue nodded, stood up, and loudly announced, “We have a lung cancer patient in our group who needs a thoracentesis. Any available students, come over to learn the procedure.”
Wei Mingming went over to pull Ren Jiajia away, “Come on, let’s go learn the procedure together.”
Although students were assigned to different medical groups, sometimes for theoretical classes or fundamental skill operations, they would be called together to learn.
The human lungs and chest wall are not completely adhered; there are two thin membranes in between. These two membranes form a closed cavity called the pleural cavity. The pleural cavity contains no gas, only a small amount of fluid.
Patients with advanced lung cancer are prone to pleural effusion, and thoracentesis is a procedure where a sterile needle is inserted through the skin, intercostal tissues, and parietal pleura into the pleural cavity.
Thoracentesis generally has two purposes: first, diagnosis. By extracting fluid through thoracentesis, it can be examined to clarify the disease. Second, treatment. One of the common complications in patients with advanced malignant tumors is pleural effusion, which can cause respiratory distress, respiratory failure, and heart failure. Performing puncture and catheter drainage of the effusion can alleviate symptoms.
In the ward, a group of people in white coats gathered around the patient’s bed. Jian Qing asked one by one about the indications, contraindications, and precautions for thoracentesis, then summarized it and named Ren Jiajia to perform the procedure.
Ren Jiajia positioned the patient correctly. Jian Qing, watching her operation closely from the side, said, “Next, select the 3rd or 4th intercostal space along the posterior axillary line as the puncture site.”
Ren Jiajia nodded and was just about to proceed, but suddenly paused in her actions and turned to look at Jian Qing.
Jian Qing, with arms crossed and a cold expression, asked, “What? Did I say something wrong?”
She looked exactly like a jade-faced King of Hell.
Ren Jiajia turned back, her heart in her throat. She looked at the patient’s back, hesitated for a few seconds, and then looked at Jian Qing again, “Teacher, I remember the book says it’s the 7th or 8th intercostal space along the posterior axillary line…”
Jian Qing’s expression remained unchanged, and she said indifferently, “Oh, I remember now. The teacher made a mistake. It is indeed the 7th or 8th intercostal space along the posterior axillary line.”
Only then did Ren Jiajia feel relieved and continued with the procedure.
Lu Yinxi watched Jian Qing and vaguely felt that she did it on purpose.
After the puncture procedure was completed, Jian Qing intermittently asked a few more questions. Then, with all eyes on her, she said, “Patients don’t fall ill according to the textbook highlights. When you get to the clinic, you have to listen, observe, think, and make your own independent judgments. You need the courage to overturn existing conclusions. What the textbook says isn’t necessarily the most comprehensive, and what senior doctors say and do isn’t necessarily always right.”
When she said the last sentence, her gaze fell on Ren Jiajia.
Ren Jiajia looked at her, and suddenly her eyes reddened.
On the walls of the hospital staircase corridor, bright signs prohibiting smoking were prominently displayed, yet every so often, someone would sit on the steps and light cigarette after cigarette.
When the hospital staff saw this, sometimes they would ignore it, and other times they would say, “Smoke less.” They always had reddened eyes, said nothing, and squeezed out a small smile to show their respect for the medical staff.
Seeing pairs of reddened eyes and the sorrow within them, no one could bear to criticize anything.
Nor could they offer much comfort; there were too many people in need of comfort in the hospital.
Today, as Lu Yinxi passed by the corridor, she heard faint sobbing.
She pushed open the door, walked over, and sat down together with Ren Jiajia, taking a pack of tissues from her pocket and handing it to her.
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“Thank you…” Ren Jiajia, with reddened eyes, took the tissues.
Lu Yinxi smiled and gently comforted her, “Once you’re in the hospital, you can’t see yourself as just a student anymore. Hmm… think of yourself as a newcomer in the workplace. Who hasn’t suffered a bit when they first started working?”
Although Ren Jiajia was still a fifth-year student, the hospital prioritized clinical work over teaching and education.
Hospitals have always had an environment that emphasizes clinical work and downplays teaching. Additionally, the continuous influx of resident trainees and visiting scholars crowds out the teaching resources available to undergraduate interns. If you happen to have an irresponsible mentor and don’t take the initiative, you’ll either be ignored or end up running errands and doing menial tasks, learning nothing substantial.
This place is accustomed to indifference, with few caring for students’ personal emotions, focusing only on the patients. Everyone has their own tasks, everyone is busy—busy with clinical work, busy with research. Interns are at the bottom of the food chain, the ones who get exploited.
Ren Jiajia wiped her tears, still somewhat indignant, “I thought I came here to learn. I don’t mind doing work; I’m willing to endure hardship. What disheartens me is their attitude. The doctors in that group don’t see us as people at all. They just see us as machines for work, free labor!”
Just stepping out of the ivory tower, everyone knows they have to be humble, but the most disheartening thing isn’t running errands and doing menial tasks, it’s the indifference from the “insiders” around you.
“Don’t worry about others’ attitudes; what’s most important is whether you’ve learned any skills.” Suddenly, a cool voice came from behind.
The two of them stood up simultaneously, and Ren Jiajia called out, “Teacher.”
Jian Qing nodded as a response and didn’t offer any more comfort. She looked at Lu Yinxi and said, “Lunch.”
Lu Yinxi responded with an “oh,” glanced at Ren Jiajia, hesitated for a moment, and said, “Don’t let one bad teacher make you lose heart in this profession or shake your determination to study medicine. Your teacher is right; you are the most important. Don’t worry about what others think…”
They went to the cafeteria for lunch and stood by the window waiting for the elevator to come up.
Lu Yinxi looked down from the window, overlooking the crowded hospital entrance below, seeing the dense stream of people flowing into the hospital.
From such a height, individual figures were indistinguishable; it just seemed bustling and crowded, with the masses resembling ants.
She asked Jian Qing, “How will the Medical Education Department handle this?”
Jian Qing, completely indifferent, replied, “I don’t know.”
She didn’t like to meddle in others’ affairs; this time she helped out only because Lu Yinxi had a soft heart.
After a moment of silence, Jian Qing turned the question back on her, “Why do you care so much about her?”
Lu Yinxi rubbed her nose and smiled, “I don’t want to see you save people only to be drowned by the river. Naturally, I also don’t want to see you being battered by storms to the point where you no longer want to be ferrymen.”
Sometimes, encountering a bad teacher can destroy a student’s faith in the entire profession.
Lu Yinxi said, “Many people’s dreams of becoming doctors are shattered during their final year of undergraduate internships.”
Jian Qing was silent for a moment and then said, “In any profession, it’s survival of the fittest.”
Lu Yinxi nodded thoughtfully.
The elevator arrived, and the two of them took it downstairs.
It happened to be rush hour, so Jian Qing pushed Lu Yinxi into the innermost corner, standing with her back to the crowd and facing Lu Yinxi, shielding her.
As the crowd pushed in, Jian Qing got closer and closer until their bodies were pressed together.
Lu Yinxi’s ears turned red, suddenly feeling like she was being taken advantage of.
Jian Qing seemed to see through her thoughts and said expressionlessly, “Can’t help it, too many people.”
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Lu Yinxi huffed lightly, turned her head away, and her face grew redder.
Jian Qing lowered her eyes and stared at her face.
Lu Yinxi glared back and whispered, “Too many people, the air is thin, not enough oxygen!”
Jian Qing then turned her gaze away, no longer staring directly at her.
On the way to the cafeteria, Lu Yinxi had a sudden thought and asked Jian Qing, “Dr. Jian, survival of the fittest—do you think I’m fit for the medical profession?”
Jian Qing asked, “Do you want to hear the truth or something pleasant?”
Lu Yinxi laughed and said, “Since you put it that way, I can probably guess what you’re going to say.”
After a moment of silence, Jian Qing revealed the truth, “You have hemophobia (fear of blood); you’re not suited to stay in clinical settings for long.”
Lu Yinxi stopped in her tracks, the smile fading from her face, “You… when did you notice?”
The author has something to say:
Guess when she noticed~~~
