Tokyo Unnatural Forensics

Chapter 269, Did Professor Zaizen really misdiagnose?
Higashi Saeko is the daughter of Higashi Satozo, the former First Surgery Professor at Tokyo Medical and Dental University Hospital. She has met Uesugi Muneyuki a few times, but they are not familiar with each other.

Before switching to forensic medicine, Uesugi Muneyuki was a surgical medical student. He had attended some of Professor Higashi's classes, but Professor Higashi didn't think much of him. Professor Higashi was also a graduate of the University of Tokyo's Faculty of Medicine, but as everyone knows, graduating from the University of Tokyo's Faculty of Medicine does not mean staying at the University of Tokyo's affiliated hospital. Professor Higashi was clearly the loser in the struggle. He lost the election for associate professor at the University of Tokyo and was then forced to transfer to Tokyo Medical and Dental University to become the first professor of surgery.

This is why Professor Azuma dislikes Uesugi Muneyuki, especially since Uesugi Muneyuki has a grandfather who is a professor at Tokyo University, which makes him dislike him even more.

However, although Professor Higashi disliked Uesugi Muneyuki, he did not make things difficult for him or wrong him in any way. This guy was just a rigid old scholar. It is said that the rivalry between him and Professor Zaizen was very fierce. When Uesugi Muneyuki was in his last year of surgery, Professor Zaizen became the professor of the First Department of Surgery.

Compared to Professor Higashi, Professor Zaizen is a much more important figure.

Professor Zaizen is known worldwide for his exceptional medical skills. Last year, he was invited by the International Society of Surgeons to give a lecture in Poland and perform open surgery, becoming a member of the association and receiving unanimous praise from home and abroad. However, Uesugi Muneyuki's opinion of him is not so good.

Since Professor Zaizen took office as the professor of the First Department of Surgery, this guy neither sees patients, nor teaches, nor writes papers. The only thing he does is keep performing surgeries and go around soliciting sponsorships and finding pharmaceutical representatives to make a lot of money. Uesugi Muneyuki was able to get by under Professor Higashi of the First Department of Surgery, but he was quickly kicked out by Professor Zaizen.

Why is this?

Uesugi Muneyuki didn't know, and he didn't want to know, but upon reflection, it was truly intriguing.

"It is with great intrusion that I have come to disturb you." Higashi Saeko was well-proportioned with clear features. Her oval face had an elegant and quiet demeanor like that of a young lady from a humble family. Only her large eyes were full of determination and fortitude. When she saw Uesugi Muneyuki, her resolute gaze was so intense that it seemed as if she wanted to take Draven by surprise: "Are you Uesugi Forensic Officer? We have met before."

"Hmm." Uesugi Muneyuki nodded, still in a bad mood: "Just say what you have to say, I have other things to do right now."

“Okay.” Higashizaeko said softly, “You were in charge of the administrative autopsy regarding the medical malpractice case involving patient Sasaki Yohei, right?”

“Yes, it was me.” Uesugi Muneyuki thought for a moment. Indeed, he was the one who dissected Sasaki Yohei’s body, and then Saijo Yasue came to kill him that very night: “Is there a problem?”

"Uesugi-san! What are your thoughts on this autopsy incident?" Higashi Saeko's expression became agitated upon hearing Uesugi Muneyuki admit to performing the autopsy. "Please tell us the truth! Did Professor Zaizen really misdiagnose? What exactly caused the deceased's death?"

“Didn’t I make this very clear in the pathology report?” Uesugi Muneyuki raised an eyebrow: “The deceased did not die from esophageal cancer surgery. In fact, Professor Zaizen’s esophageal cancer surgery was performed exceptionally well, reaching top international standards. The real cause of death was respiratory failure caused by infection in the left lung and carcinomatous lymphangitis.”

"Yes, that's it!" Professor Azuma's daughter exclaimed excitedly, "We have evidence that someone noticed signs of lung infection in the deceased before the surgery! But Professor Zaizen didn't accept this opinion!"

"what?"

Uesugi Muneyuki received two documents from Higashi Saeko.

One report was given by former associate professor of internal medicine, Shuji Satomi, who clearly mentioned that the possibility of infection had been discussed before the operation. The second report was the altered medical record. It was obvious that the record of possible infection before the operation had been deliberately altered and deleted. However, under the correction fluid, from the angle of light shining through from behind, it could be seen that there was a shadow on the lower left lung that had been found in the CT scan before.

Uesugi Muneyuki frowned: "This is... I didn't know any of this."

“Uesugi-san! You are our last hope!” Seeing the unusual expression on Uesugi Muneyuki’s face, Higashi Saeko was overwhelmed with emotion. She handed him a business card: “To be honest, I am currently an intern at Sekiguchi Law Firm. Our firm has taken on the case of the deceased’s family, but… Professor Zaizen’s father, Zaizen Matataichi, is the vice president of the Kanto Medical Association. Under his influence, no law firm has dared to take on this medical malpractice case before, and no forensic pathologist from any of the Medical Examiner’s Offices has been willing to conduct a second autopsy or testify in court!”

“Oh, yes, I know about this. It seems that Associate Professor Satomi even left the hospital because of this and went to Chiba University Hospital.” Uesugi Muneyuki nodded, his brows furrowed as he looked at Higashi Saeko’s documents. “So, you want me to testify in court?”

"Yes." Higashizaeko bowed deeply. "You are our last hope."

"Why do you think I would be willing to testify in court? Dr. Satomi has already lost his job because of this." Uesugi Muneyuki's brows remained furrowed.

"Because you are Uesugi Muneyuki, a descendant of the righteous Uesugi Kenshin, you have said many times on camera that you are just a forensic doctor, and your job is to clarify things!" Professor Dong's daughter's voice trembled slightly: "I am pleading with you on behalf of a wife who has lost her husband and a son who has lost his father, to tell you the truth!"

"This is a complete misdiagnosis! But everyone wants us to shut up! The Metropolitan Police Department, the Medical Association, the Inspectorate Medical Services, major law firms, and even the affiliated hospitals of medical and dental universities!"

"No one is willing to help us, no one wants the truth, all they've been doing is trying to shut us up, shut us up, shut us up!"

"You are our last hope! Please! You dissected Sasaki yourself, please don't ignore the soul of an innocent man who died unjustly!"

After saying that, Higashisako prepared to dogeza (bow down).

"No!" Uesugi Muneyuki quickly gestured for Professor Higashi's daughter to get up. He was silent for a moment, then said to Higashi Saeko, "Since I was the one who dissected Sasaki Yohei, I will definitely take full responsibility. There is no doubt about that. However, I need some time to determine whether it was a misdiagnosis. You go back first and wait for my call."

"Many thanks!"

As soon as Higashi Saeko opened the door, she found the entire Special Missions Division eavesdropping outside. Uesugi Muneyuki then came out and said, "Mikoto-nee, we have work to do!"

"Huh?" Ishihara Mikoto didn't understand.

"Let's go to the forensic department!" Uesugi Muneyuki waved the documents in his hand. Five minutes later, at the Metropolitan Police Department's forensic department.

Uesugi Muneyuki and Ishihara Mikoto dug up Nakado Kei, who was lying on the dissection table fast asleep, and then took out the dissection report and the evidence sent by Higashi Saeko, and studied the most important question together.

Did Professor Zaizen misdiagnose the patient?

This reveals Uesugi Muneyuki's weakness—although he is known as a legendary forensic pathologist, his forensic skills are not actually outstanding. On the contrary, Mikoto and Nakado have more forensic experience than him.

“There was no misdiagnosis.” Nakado, his hair disheveled and eyes still heavy with sleep, looked through the entire medical record and autopsy report, then suddenly shook his head: “Indeed, before the surgery, the CT scan showed very small ground-glass opacities in the lungs, but…”

“But the patient already has a long history of smoking.” Mikoto Ishihara nodded. When faced with a professional question, Mikoto became serious: “Sasaki has gastric cardia cancer, which is unrelated to the lungs. So what if there are a few ground-glass opacities in the lungs? The possibility of metastasis in early-stage gastric cancer is extremely small. Even if there are opacities, it is more likely to be inflammation.”

"How so?" Uesugi Muneyuki asked casually.

"What the hell! Aren't you a legendary forensic doctor? How could you ask such a ridiculous question?" Nakado said impatiently, "What exactly are ground-glass nodules on the lungs? How are you going to confirm it? PET and CT scans can't detect them. They're localized hypermetabolic lesions, and inflammation can't be ruled out. In many cases, it's about observation, watching over time to see if the mass continues to grow. Only if it grows will we consider whether it's cancer, but can the patient afford to wait?"

Nakado admired Uesugi Muneyuki, always thinking that Uesugi Muneyuki's forensic skills were at least three or four levels higher than his own. He was quite annoyed that Uesugi Muneyuki would ask such a tactless question.

“Yes, Nakado is right.” Mikoto added, “If we want to confirm, we have to do a biopsy, a thoracoscopic biopsy. Even for such a small lesion, a biopsy might not be possible. We need a lung puncture or even a wedge resection biopsy to make a definitive diagnosis. That’s a cancer patient, urgently needing surgery. A biopsy? That’s murder!”

"So... Professor Zaizen didn't misdiagnose?" Uesugi Muneyuki fell into deep thought. "Judging from the autopsy, the final result was lung metastasis. But it wasn't the common metastasis pattern; it was fulminant carcinomatous lymphangitis in the lungs. So the patient passed away soon after the surgery, and I couldn't determine whether it was preoperative or postoperative metastasis."

"Yes, there was no misdiagnosis!"*2.

Both Mikoto Ishihara and Kei Nakado gave affirmative answers. Mikoto hesitated for a moment and added, "Uesugi, doctors are human too, and humans cannot avoid making mistakes in judgment. Under the circumstances at the time, considering the imaging findings and the patient's medical history, how many oncologists and radiologists would have first considered that this was a metastasis?"

"In other words, Professor Zaizen did not misdiagnose. At least, given the current limitations of medical technology and his surgical skills, it is reasonable to refuse to believe that metastasis has occurred even if the CT scan shows a problem with the lungs."

“A live examination takes two weeks, but the deceased cannot wait two weeks. Performing a lung puncture and wedge resection under such circumstances is tantamount to murder!” Mikoto Ishihara said softly.

“Yes, I understand.” Uesugi Muneyuki said with his hands behind his back, “So, the most crucial question is not whether Professor Zaizen misdiagnosed the patient.”

"The most critical issue is that when he discovered the problem with the CT scan, he neither informed the deceased nor his family, nor did he conduct a consultation. He then arbitrarily demanded surgery, which ultimately led to the patient's death due to respiratory failure caused by preoperative lesion metastasis."

"Yes!" *2
Mikoto Ishihara and Kei Nakado spoke almost simultaneously.

Uesugi Muneyuki's eyebrows were even more furrowed.

I don’t think I should get involved in this, because from a purely medical point of view, Professor Zaizen did not misdiagnose.

However, from a legal and medical ethics perspective, Professor Zaizen did not grant the patient the right to know, but instead made the decision on the surgery in an extremely arrogant manner, which ultimately led to the patient's death.

Therefore, whether or not he appears in court to testify has become the key to this case. If he does appear, given his influence and his undisputed position in forensic medicine, Professor Zaizen will be in trouble.

However, doing so would most likely mean losing his position at Tokyo Medical and Dental University, and even his student status and place in the medical field. The previously agreed-upon admission and employment at the University of Tokyo would also become uncertain.

Daring to criticize their own alma mater and provide unfavorable evidence, what about the University of Tokyo...?

What if, from a purely medical perspective, Professor Zaizen did not misdiagnose the patient?

This way, everyone is happy, and theoretically speaking, Uesugi Muneyuki didn't lie. Strictly speaking, the patient's right to know is also in a gray area in the medical field. Many people advocate things like "white lies," "appropriate concealment," and "maintaining a good mindset can give patients a better chance of recovery." Whether informing the truth and surgical risks is ethical or not is very vague and there is no clear boundary. It can be interpreted in any way.

What should I do?

Uesugi Muneyuki stood with his hands behind his back, gazing at the Tokyo sky.

Outside Sakurada Gate, the autumn sun pierced through the azure dome, and wispy clouds floated like broken feathers above the spire of the Diet Building. As flocks of pigeons flew by, they created a trail of golden reflections on the glass curtain wall, making the vast sky appear like translucent porcelain.

He was torn by an internal struggle.

(End of this chapter)