Dual Cancer
Nasopharyngeal Cancer and Lung Cancer
Jianqing was browsing through the webpage for viewing images while asking, “Does the director usually smoke?”
The hospital had no-smoking signs everywhere, but many office directors, and even hospital leaders, had ashtrays on their desks. Every time the Health Supervision Department came for an inspection, they had to hide them in advance.
Director Yan’s teeth and fingernails were yellow, and he always carried the smell of smoke on him. One sniff, and you could tell he was a heavy smoker.
He said, “I’ve been smoking for over twenty years.”
“I’ve been telling you to quit smoking, but you never listen! Serves you right!” Director Yan’s wife slapped his shoulder hard, her voice choked with sobs.
Her eyes were very red and swollen, as if she had been crying for a long time.
Jian Qing was used to seeing family members start crying while asking questions, so she didn’t stop to offer any comfort and focused on reviewing the imaging data.
While checking, she asked, “Any previous history of other cancers?”
Director Yan replied, “No.”
On the computer screen, black and white images scrolled by, showing a ground-glass nodule in the lower lobe of the left lung, approximately 8mm in diameter.
For lung nodules smaller than 1cm, doctors mostly advise patients to follow up with observations every 3 to 6 months and do not easily perform surgery.
Jian Qing magnified the nodules for observation and found that the nodules had a spiculated appearance, and there was a tiny blood vessel attached to the edge of the nodule.
Jian Qing waved for Lu Yinxi to come over and look, pointing at the small blood vessel and said, “This little thing is supplying nutrients to this small nodule.”
Lu Yinxi cursed it softly, “Eating inside but digging outside!”
Jian Qing gave a faint smile.
Spiculated, with blood vessels, coupled with Director Yan’s more than 20 years of smoking history, indeed suggests a higher probability of malignancy.
She reviewed Director Yan’s chest X-rays from past annual physical exams, observing the small nodule in the lower lobe of the left lung.
The clarity of X-rays is far inferior to enhanced CT scans, but it could still be vaguely seen that this small nodule existed three or four years ago and has been growing relatively slowly.
It appears unlikely to be a metastasis from the nasopharynx but rather a primary lung cancer, and possibly a slow-growing non-small cell lung cancer.
Of course, this is just an educated guess based on experience, not an actual diagnosis.
The diagnosis of cancer relies on pathological examination.
Countless cells aggregate irregularly to form a lesion.
The so-called pathological examination involves taking a tissue sample from the lesion through a biopsy or surgery, sending it to the pathology department, where the pathologist stains and slices the tissue, and then observes and analyzes the shape and differentiation degree of the cells under a microscope to determine whether the entire lesion is benign or malignant.
If cancer is the rebel army within the body, the pathological examination is akin to capturing a small group of soldiers from a suspected rebel army, imprisoning them, and interrogating them rigorously to confirm whether the entire army is indeed a rebellion.
Jian Qing asked a few more questions, then summarized, “Director, don’t overthink it. There are currently two possibilities: one is your suspicion of late-stage nasopharyngeal cancer with neck lymph node metastasis and lung metastasis; the other possibility is dual primary cancers, nasopharyngeal cancer and lung cancer, but the masses in the nasopharynx, neck, and lungs are all very small, suggesting they could be in the early stages with a high cure rate. I need to conduct further differential diagnosis. For now, let’s proceed with the hospital admission, I’ll order some tests for you, and tomorrow morning we’ll arrange a multidisciplinary consultation.”1
For someone of Director Yan’s status, her superior, Hu Jianjun, will definitely personally intervene, and the chief physicians from various departments will also lend a hand. As the primary diagnosing doctor from this hospital, Jian Qing needs to make her own judgments, but the treatment plan is not for her to decide; it will be discussed by a multidisciplinary team, and then it will be determined which department will handle the treatment.
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Director Yan and his wife stood up to express their thanks again, including for what happened yesterday.
Director Yan’s wife, Aunt Xu, hesitated and said, “Dr. Jian, how about we let Old Yan stay in Ward One instead?”
Last night, she heard from Old Yan about the criticism of Dr. Gong from Oncology Ward Two. Now that he is staying in Ward Two, facing each other every day would inevitably be awkward.
Jian Qing said, “Vice President Hu is in charge of the entire oncology center, but his most direct jurisdiction is still over Ward Two.”
Sometimes, many patients come to see Jian Qing not because of her own capabilities, but because of her famous mentor, Hu Jianjun.
Hu Jianjun’s specialist appointments are hard to get. He only consults for half a morning per week, and usually, it takes a month to get an appointment, often requiring buying from scalpers.
It’s not easy to see a famous doctor, but it is easy to see the young disciples under a famous doctor.
Getting an appointment with Jian Qing and being admitted by her, the final treatment plan will be reviewed by her superior, Hu Jianjun. If they encounter any difficult or complicated cases, he will certainly step in to oversee.
Director Yan understood his wife’s concerns and decisively said, “I have a clear conscience and am not afraid of shadows. Right is right, and wrong is wrong, nothing more to it. I came to see Dr. Jian today because I trust her. I’ll stay in Ward Two!”
Jian Qing issued the admission form and personally escorted Director Yan and his wife to complete the hospital admission procedures.
Upon entering Oncology Ward Two, the on-duty doctors and nurses were all surprised and gathered around to ask about the situation.
Jian Qing instructed Zhang Yue, “Zhang Yue, you handle the admission. First, take pictures of these documents with your phone. Teacher Hu hasn’t left yet, I’ll take them to show him.”
Zhang Yue readily agreed and brought chairs for Director Yan and his wife to sit down.
Jian Qing needed to find Hu Jianjun and it was inconvenient to bring Lu Yinxi along, so she asked her to go home first.
Lu Yinxi said, “I’ll wait for you at the hospital.”
Jian Qing said, “Then let’s go to the cafeteria for dinner first.”
Lu Yinxi responded with a hum, opened the drawer, and handed a small bread to Jian Qing, “You should eat something first too.”
Jian Qing tore open the bread package and ate while walking.
The hospital ward at night was much quieter than during the day.
Director Yan, with graying temples, sat in the chair, recounting his medical history and personal situation. His wife watched him, tears glistening in her eyes.
Lu Yinxi brought a few more small breads. Director Yan would need to have a routine blood test later and couldn’t eat anything, so she placed the bread into the arms of Director Yan’s wife, “Aunt Xu, have something to eat to fill your stomach.”
Aunt Xu wiped the tears from her eyes, “Good child, Auntie can’t eat anything right now.”
Cancer patients suffer greatly, but how could the hearts of their family members not be equally shattered?
Lu Yinxi said, “Auntie, you need to take care of your health even more now.”
Cancer is not just a hardship for the patient, but a struggle for the entire family.
The long journey of fighting cancer has just begun; this tug-of-war has only just started.
Aunt Xu was a smart person and understood Lu Yinxi’s words, so she did not decline further.
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Lu Yinxi handed her a bottle of milk and meticulously explained what items to bring from home for the hospital stay, the location of the hospital cafeteria, which secluded paths led to Oncology Ward Two, the peak times for elevator traffic, and that during these peak times security checks would be set up at the elevator entrances, requiring a medical card to be shown for access…
By the end, Aunt Xu was holding Lu Yinxi’s hand, repeatedly calling her a good child, and said, “You will certainly become a great doctor in the future. If I had more than one daughter, I would definitely want you as my daughter-in-law!”
Lu Yinxi smiled and shook her head, changing the subject.
It’s precisely because she is not a doctor now that she can offer these kindnesses so effortlessly. If she truly became a doctor and attended to every detail like this, where would she find the time? She would surely live a more exhausting life than others.
Lu Yinxi waited in the ward for an hour before Jian Qing returned from seeing Hu Jianjun.
As soon as she came back, she went to Director Yan’s bedside to discuss, “Director, there are a few empty beds in the cadre ward.2 Vice President Hu asked if you would like to transfer there?”
There were no available beds in Oncology Ward Two at the moment, so they were given an extra bed number.
In public hospitals, each department has a certain limit on bed availability. The number of beds in each area is arranged by the Health Commission. The department may have only 40 or 50 official beds, but there are hundreds of patients needing treatment. To meet the medical needs of these hundreds of people, extra bed numbers outside the official capacity are set up.
Most patients who can’t get into a ward have to make do with a bed in the corridor.
Director Yan waved his hand and said, “I’m not some high-ranking official from the province or city, why should I stay there? I can sleep in the corridor, it’s fine. Don’t discharge your patients just to make room for me. My health is holding up better than theirs.”
Jian Qing nodded in agreement.
Returning to the office, she told Zhang Yue, “Vice President Hu said that our department exceeded the rural medical insurance fund limit last month and our bed turnover rate assessment was also unqualified. We need to urge some patients with stable conditions to be discharged tomorrow.”
Zhang Yue stopped writing medical records and sighed, “Well, it’s us who get our pay docked and us who get scolded too.”
The on-duty doctor laughed self-deprecatingly and said, “Those lousy leaders at the Medical Insurance Bureau tell patients, ‘Rest assured and stay in the hospital, the medical insurance fund will cover you,’ but they tell us, ‘Control the medical insurance costs. If you exceed them, it’s not our problem; the hospital pays out of pocket.’ We try to discharge patients, and they lash out at us. Hey, all the nice words are said by those officials, and we are just the scapegoats!”
In the hospital, when bed availability is extremely tight, medical staff will urge patients to be discharged.
Patients and their families being urged to leave the hospital feel they have not fully recovered and are being forced out, which naturally leads to resentment, and this resentment is directed at the medical staff.
However, major hospitals with concentrated medical resources inevitably have to take on more treatment tasks. Limited beds and limited medical resources must be used for as many people as possible.
Many doctor-patient conflicts ultimately stem from the contradiction between the rapidly increasing demand for medical care and the severe shortage of medical resources, which gets transferred to frontline doctor-patient relationships.
Jian Qing didn’t say anything. She walked over and ruffled Lu Yinxi’s head, “Off work, let’s go home.”
Lu Yinxi was silently memorizing lines. Hearing this, she turned her head and asked about the situation, “How is it? Is it late-stage nasopharyngeal cancer with lung metastasis?”
Jian Qing said, “We can’t be completely sure, but it matches my guess. That spot in the lung could possibly be early-stage lung cancer.”
Double primary cancers are relatively rare in clinical cases, but if this possibility is ignored and a certain area is treated as metastatic cancer with the wrong treatment plan, it could seriously delay the patient’s condition.
Whether it is nasopharyngeal cancer or lung cancer determines the subsequent treatment plan, so Hu Jianjun’s primary task for her was to arrange a pathology examination.
Before a pathological diagnosis, they could only rely on imaging data and personal experience to make a judgment, which still carries the risk of misdiagnosis.
As the city lights began to shine, the streets were bustling with traffic.
From the hospital to the road across the street leading home, the two had walked this path many times.
Sometimes one walked ahead and the other followed; other times they walked side by side. Sometimes Lu Yinxi would chatter about her day, and Jian Qing would occasionally respond with a word or two. Sometimes they both remained silent, yet it never felt awkward.
Today, as they walked side by side, Lu Yinxi was chattering about Director Yan and his wife again: “I heard from Aunt Xu that she and Director Yan fell in love freely. They secretly dated in college, hiding it from their parents and the school. I remember that during their time, university students were not allowed to date…”
She spoke with great interest. Jian Qing, worried that Lu Yinxi might not watch the road while crossing, moved closer to her, shoulder to shoulder, their hands occasionally brushing. Finally, she simply held her hand to cross the street.
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“After graduation, Director Yan told his family he was dating someone and wanted to get married. His family didn’t agree with him being with Aunt Xu, saying that her ancestors were criticized as big landlords, and her family background was bad, which would affect his future career. Director Yan said, ‘I don’t care about my career; I only want to marry her,’ and he was scolded by his family for being unambitious. Can you believe it? Even someone like Director Yan was once willing to risk everything for love in his youth. What is love in this world…”
Jian Qing did not join in praising love. She thought, in just one hour, how could this kid dig up so many old stories?
She earnestly reminded, “While crossing the street, don’t chatter.”
If it were half a month ago, Lu Yinxi would have thought that the person next to her didn’t understand romance and couldn’t speak sweet words. But now, her thoughts were: if she doesn’t understand romance, it’s enough that I do; if she doesn’t speak sweet words, I’ll do it.
How can someone like another person so much? She felt that no matter what Jian Qing did, it was alright; she was willing to accept her, wholly and completely, with both her good and bad sides…
After crossing the zebra crossing, the bustling traffic was left behind.
Lu Yinxi forgot to let go of her hand, and Jian Qing glanced at her, but didn’t let go either. They continued holding hands, walking side by side back home.
The author has something to say:
Ahem, you all didn’t wait too long, did you? I fell asleep halfway through writing last night and got up early to write now. Good morning, everyone~~~
When I was writing this chapter’s emotional scene, I suddenly thought about how in the neighboring story “The Boat of Clear Dreams,” by chapter 40-something, they had already confessed, shared a bed, kissed, and were almost doing that. Meanwhile, this unproductive couple here is still just holding hands… So, being proactive and straightforward wins the beauty, while being reserved and secretly passionate means constant testing. Of course, if everyone in this world were straightforward, there wouldn’t be so many emotional confessions shared in advice columns asking, “Does this girl like me?”
Footnotes
- Multidisciplinary Consultation (多學科會診): Specialists from different fields collaborate to discuss and manage a patient’s condition.
- Cadre Ward (幹部病房): A section of the hospital reserved for government officials or high-ranking personnel.
