clinical

"Good morning, this is your work uniform and temporary pass."

He Zou accepted the work uniform and work ID handed to him by the department secretary and thanked the serious-looking secretary.

After changing, she straightened her brand-new white coat in front of the mirror, looking at the temporary work permit tucked into her left breast pocket:

Kanade Yagyu, Neurologie Praktikum.

Yagyu Kazusa, a neurology intern.

Starting this semester, she will begin her clinical internship at Heidelberg University Hospital. Fortunately, her first internship department is neurology, her first choice.

He Zou took out his stethoscope and hung it around his neck. He gently placed the stethoscope against his chest and listened to his own rapid heartbeat. A sense of peace finally settled down.

"It's about to begin, Yagyu Kazuna."

She took a deep breath; the familiar smell of disinfectant calmed her heartbeat. She gave herself a bright smile in the mirror, then turned and walked toward the morning meeting point her secretary had told her about.

The handover morning meeting was characterized by German-style seriousness and efficiency.

He Zou sat quietly with the other two interns near the door, holding a hardcover notebook in his hand, listening to the night shift doctor's brief explanation while quickly taking notes.

The resident physicians reported on the patients' conditions at night, while the supervising physicians would occasionally conduct the classic "interns' interrogation" on the three new interns.

"Wolf, male, 65 years old, was admitted to the hospital with sudden onset of left-sided limb weakness and slurred speech for 12 hours. MRI showed acute infarction in the right basal ganglia region..."

Upon hearing this, He Zou paused, writing: Basal ganglia infarction, a typical case involving both neurology and neurosurgery.

"They're here."

“Melodia,” a voice, its tone neither calm nor angry, called her name.

The chorus rises.

The person calling her was the head of the department, who was also their attending physician—Professor Miller. At that moment, he was looking at her with the inquisitive gaze typical of a scholar, just as he had when she first asked him a question during his lecture.

He tapped the table with his index finger knuckle in a steady rhythm and asked a question in a calm and unhurried manner: "Based on your notes, for this case, in addition to routine antiplatelet and statin treatment, what neurological signs do you think should be closely monitored during acute-phase monitoring?"

Everyone kept their heads down, and as they looked into Professor Miller's eyes, Kanade could hear her own steady heartbeat.

This was a standard question based on standard clinical guidelines, but she didn't rush to answer. Instead, she quickly reviewed her knowledge in her mind before calmly speaking:

"In addition to continuously monitoring changes in muscle strength and speech function, I believe it is important to focus on whether patients have unilateral spatial neglect. Infarction in the right basal ganglia, especially the caudate nucleus and putamen, may affect the attentional network function, leading to perceptual impairment of the left side of space. Early identification of spatial neglect is crucial for prognosis and the development of rehabilitation programs."

Dr. Miller hummed in response, still tapping the table and watching her. This was clearly not the complete answer he was expecting.

This should have been the standard answer a medical student just starting their internship could give. But Dr. Miller was not satisfied, and no one else dared to say anything.

Seeing this, He Zou paused for a moment and added, "In addition, although the incidence is not high, large-area cerebral infarction can lead to malignant cerebral edema. Therefore, it is necessary to closely monitor the patient's level of consciousness and whether the neurological deficit symptoms are progressively worsening. Once signs of intracranial hypertension appear, a neurosurgical evaluation should be sought immediately to determine whether decompressive craniectomy is necessary."

The office was silent for a few seconds.

Several attending physicians who had been taking notes looked up at her. Her supplementary answer naturally exceeded the basic diagnostic requirements for an intern, but what caught their attention was that she was clearly very familiar with neurosurgery, and her answer was entirely from a neurosurgeon's perspective.

Rumor has it that this student was exceptionally admitted to Professor Antenberg's laboratory in neurosurgery. And it's common knowledge that their professor and Professor Antenberg are at odds.

The atmosphere became somewhat awkward. If Lin Tang were here, she would have said to He Zou on behalf of others: "He is in Cao Cao's camp but also in Han's camp."

Dr. Miller listened to He Zou's answer, his face still showing no emotion, but he stopped tapping the table and nodded: "Not bad."

He Zou humbly lowered his head, knowing that he had passed the first hurdle.

The remaining two German interns exchanged a glance—their response only elicited a single "hmm" from Dr. Miller.

After the morning meeting, the attending physician, Fisher, handed several medical record folders to the three interns and told them seriously, "These are the medical records you will be responsible for from now on. Quickly familiarize yourself with them, and then come with me on rounds in an hour."

"yes."

After the attending physicians and resident physicians followed Dr. Miller out, only three interns remained in the office.

The tall Muller clutched five medical records, slumped back onto his stool, and muttered under his breath, "This feels like sending someone to war without a map."

Another intern named Schneider, who clearly knew Muller, patted him on the shoulder to reassure him: "Hey, hurry up and look! Take some time to flip through the book."

The two tacitly ignored He Zou.

Kazusa noticed their attitudes, but she didn't initiate a conversation. She wasn't bothered by their attitudes; interns often competed for the attention and guidance of senior doctors, and the upcoming ward rounds would be the real start of the competition.

She ignored the occasional exchange of opinions between the other two, immersing herself completely in the analysis of the medical records, her lowered eyes gleaming with a burning light.

The thin sheet of paper in her hand felt strangely heavy. When she opened the medical records, her feelings were different from when she used to browse literature. She analyzed the symptoms that she was already familiar with word by word, matching them one by one with the neural pathway diagrams that were already engraved in her mind, turning them into specific people.

Time always flies when you're focused.

When Dr. Fisher returned to his office, they realized that an hour had already passed.

Dr. Fisher was also very strict in his teaching. At each patient's bedside, he would ask random questions, ranging from anatomy to physiology, from pathology to the latest clinical guidelines.

Problems came one after another, and the three of them had to draw upon all their knowledge and carefully respond to each question.

When Dr. Fisher came to the patient with basal ganglia infarction during rounds, he gestured for He Zou to come forward and said to the patient, "This is our excellent intern. She will be performing your neurological examination today."

Under the patient's slightly skeptical gaze, He Zou methodically conducted a systematic examination and made a special and meticulous assessment of whether the patient had unilateral spatial neglect.

“Dr. Fisher,” He Zou reported concisely after the examination, “when the patient’s left and right arms are stimulated at the same time, he ignores the stimulation on the left side.”

Dr. Fisher performed another examination himself. He glanced at He Zou and said to the resident next to him, "Make a note of this and arrange a consultation with the rehabilitation department."

Upon hearing that there seemed to be a new problem with his condition, the patient frowned and became visibly anxious.

Seeing this, Dr. Fisher gave Kazusa a look.

“Mr. Wolf,” Hezou spoke softly, his young voice reassuringly steady, “Recovery is a process. Your shoulder range of motion has improved since your admission. Identifying and addressing space-neglect issues is essential for achieving better rehabilitation outcomes.”

Fisher, looking down at the medical records, had a hint of satisfaction in his eyes.

Once outside the ward, Fisher, who was walking in front, instructed without turning his head: "You are in charge of following up on this patient."

The identity of "you" is self-evident.

"yes."

Amidst the complex silence of the other two, the last to walk, Hezou, calmly responded.

The morning flew by in a flurry of busy consultations, record-keeping, and learning.

During her lunch break, He Zou, carrying her laptop and iPad, a bottle of black coffee, and a bag of whole-wheat bread, went to the small garden on the rooftop. This was a good spot that she and Lin Tang had discovered when they came to "scout" the location earlier; it was relatively quiet.

She had just found a bench to sit on and was rubbing her sore neck when she heard a familiar voice behind her.

"Let me see who this is? Our future star of neurosurgery, already getting a harsh reality check on his very first day?"

Recognizing the voice, Kazusa didn't turn around. She continued tearing at the bread in her hand and said with a smile, "What brings you here?"

Lin Tang, carrying a thermos and a lunchbox, sat down next to He Zou. This semester, she was assigned to the pediatrics internship, which was in a different building from the neurology department.

As soon as she sat down, she let out a long sigh as if she had collapsed, and said with a tired look on her face, "The pediatrics department is overcrowded and noisy, giving me a headache. I came here to find some peace and quiet."

"I saw three people with fevers and coughs this morning, and one little one who refused to get a shot and cried his eyes out. I almost had to tell all the embarrassing stories from my own childhood to comfort him." Lin Tang chuckled as she spoke, then leaned closer to He Zou and asked in a low voice, "How's the neurology department? Have you encountered any difficult or complicated cases?"

Hearing this, He Zou sighed, "There are too many difficult and complicated cases... but they are indeed more vivid and more serious than those in books." She then briefly described Mr. Wolf's condition and some subtle neurological signs that she had observed.

"This case is being handed over to you?" Lin Tang burst into laughter upon hearing this. She took a couple of bites of her bento box and teased, "Then your two colleagues must be under a lot of pressure."

Being assigned complex cases is a privilege for interns; it's about trust, learning, and potential, and it's a key area of ​​competition among them. And this is only the first day; her peers must be under immense pressure.

That's how it is; Lin Tang knows all too well what it feels like to be caught in that tangled mess. He hopes those two can hold on.

"By the way," Lin Tang's eyes darted around as he asked He Zou, "Aren't your two classmates...handsome?"

He Zou swallowed the bread, smiled, and didn't answer.

Seeing her smile like that, Lin Tang knew she had asked a silly question. Compared to her boyfriend, the standard for being considered "handsome" was probably a bit too high.

As if suddenly remembering something, she asked again, "Is your 'emperor' flying to the United States this week to participate in the competition?"

She then realized just how popular tennis is; judging from the overwhelming media coverage and attention, the world's number one tennis player's influence is comparable to that of an international superstar.

Lin Tang was somewhat surprised that Hezou was not disturbed by the media. She didn't believe that this peace and quiet was not due to the efforts of Tezuka's team.

Thinking about this, Lin Tang's impression of Tezuka, who stole her best friend, improved considerably.

However, the title 'Emperor' sounds so anime-like... Oh well, I'm used to their colorful hair, so I can accept the cringeworthy title.

Unaware of her friend's inner monologue, Kazusa nodded and said, "Okay, we'll set off in two days."

"Are you going to see them off at the airport?"

"No, we've already agreed."

"It's better if you don't go, so you don't get photographed. I've witnessed the fervor of some fans online these past few days. If your guy becomes number one in the world, you'll probably have a lot of trouble," Lin Tang said sincerely.

Kanade rarely paid attention to Tezuka's social media posts and didn't say much about her friend's sentiments. After swallowing the last piece of bread, she took out her iPad and began to organize the typical cases she had encountered that morning, marking out some knowledge points that required further study.

Her "telemedicine system" model requires a large amount of clinical data to support it, which is currently far from sufficient.

With this in mind, she put the tropical medicine project, which she had canceled during the winter break, back into her summer plans.