Top-tier doctoral supervisor, reborn as a first-year graduate student in standardized residency trai

Gu Lin stood in front of the stage, raised his head, and the light fell on him. His voice was not loud, but it gave people an unconditional sense of conviction.

Good afternoon, teachers.

"The case I'm reporting today is an exploration of combined treatment after surgery for high-risk, poorly differentiated gastric cancer."

"But before we talk about treatment, I'd like to address a question first."

He pressed the page-turning button, and Zhou Mingyuan's initial pathology report appeared on the screen.

Poor differentiation, serosal invasion, positive vascular tumor embolism, and positive nerve invasion.

Lymph node metastasis: 16/31.

Gu Lin looked at the report, his tone calm.

"If we only look at this pathology report, we can easily draw a conclusion."

"This is a high-risk patient with a poor prognosis and an extremely high risk of recurrence."

He paused for a moment, then switched to the next page, which showed Zhou Mingyuan's post-operative recovery curve.

"But what's really worth discussing about this patient is that his pathological risks and postoperative recovery performance did not match perfectly."

On the screen, Zhou Mingyuan's post-operative recovery curve was displayed.

Changes in body temperature, inflammatory markers, white blood cell recovery, nutritional status, and the downward trend of tumor markers.

These data, taken individually, are not particularly alarming, but when placed behind that almost terrible pathology report, they seem quite unusual.

Gu Lin didn't rush to turn the page. He stood at the front of the stage, his gaze sweeping across the screen.

"The patient's pathology results indicate that his risk of recurrence is very high. According to conventional thinking, we should of course proceed with subsequent treatment as soon as possible."

"But the problem is that his recovery after the surgery was more stable than expected."

"The inflammatory response subsided quickly, and the nutritional status recovered better than that of similar high-risk patients."

He paused slightly at this point.

"This does not mean the patient is safe, but it suggests that there may be something in the patient's physical response that warrants further observation."

The directors in the front row, who had been looking down at their documents, gradually stopped.

Gu Lin pressed the page-turning button, and the title of the next page appeared on the screen.

From "very poor prognosis" to "is there still a chance?"

Gu Lin continued speaking.

"Therefore, the focus of our discussion at that time was not to directly change the treatment principles, but to first identify a problem."

Is it possible for this patient to benefit from more aggressive treatment?

After those words were spoken, the middle-aged man from the medical department suddenly spoke up.

His tone wasn't sharp, but it carried a clear sense of caution.

"Gu, may I interrupt for a moment?"

Gu Lin stopped turning the page and turned to look at the audience.

"Please speak."

The man looked at the meeting materials in his hand, then looked up at the stage.

"You're still a resident physician, right?"

The atmosphere in the conference room suddenly became subtle. Song Zhe, sitting in the back row, slowly stopped writing.

He knew it.

This person definitely has ill intentions!

"Yes."

The man nodded.

"Then I'd like to confirm, was the subsequent treatment plan for this case proposed by you personally?"

This is a very clever question. If Gu Lin answers yes, it could easily turn into a resident physician taking the lead in treatment beyond his level.

If the answer is no, it will weaken the core value of his report.

Gu Lin was silent for a moment, then looked up.

"What I'm proposing isn't a treatment decision, but rather some doubts about the case."

The man's brow twitched slightly.

Gu Lin continued:

"I found a mismatch between the patient's postoperative condition and the pathological risk."

"Then we organized the relevant information and submitted it to Director Lin and the oncology team."

"Subsequent screening, assessment, and treatment plan discussions were all completed collaboratively by the MDT team."

He spoke calmly, without any intention of taking credit.

"I'm just asking one question: is there any opportunity for this patient beyond the routine evaluation?"

This was a solid answer; it neither evaded his role in the case's progression nor went overboard with the procedure.

The man in the medical department, who was about to press for more information, was temporarily silenced.

Lin Hanchuan then spoke calmly.

"I signed off on the treatment plan, the oncology department participated in the evaluation, and all procedures were documented."

The moment those words were spoken, most of the pressure in the conference room was relieved.

Instead of defending Gu Lin, they directly clarified the boundaries of responsibility.

Gu Lin raised concerns, the director reviewed the case, and the MDT (Multidisciplinary Team) discussed it. The process was complete, and there was no overstepping of authority.

The head of the oncology department also put down his documents and added a comment.

"It's also in our department's consultation records. At that time, the treatment wasn't adjusted directly because Gu Lin suggested it."

"In fact, after the testing was improved, there is indeed grounds for further discussion."

He looked at Gu Lin, his tone clearly showing approval.

"It's quite remarkable that a young doctor could notice this abnormality in the postoperative recovery curve."

The man in the medical department did not ask any further questions about his identity.

Gu Lin pressed the page-turning button again, and the screen displayed the reaction record after Zhou Mingyuan's first treatment.

Fever, fluctuating test results, family anxiety, and discussions about whether to suspend treatment.

"The patient developed a fever after the first treatment."

Gu Lin's voice remained steady.

"The most important thing at the time was to determine whether it was an infection or a treatment-related reaction."

"If the diagnosis is wrong, continuing treatment may increase the risks."

"But if we stop abruptly because of fever, the patient may miss the window of opportunity."

On the screen, infection indicators, blood culture results, and imaging re-examinations are displayed side by side.

Gu Lin didn't use too many technical terms; he simply explained his reasoning process to everyone in the most straightforward way.

"We ruled out obvious foci of infection, and after dynamic monitoring, the patient's overall condition did not progress toward septic shock."

"Therefore, Director Lin and the oncology department determined that the procedure could continue under close monitoring."

He cut out the next page.

CEA levels decreased, inflammatory markers declined, and follow-up imaging showed stability.

The atmosphere in the conference room changed at that moment.

Because everyone saw the result.

It's not wishful thinking, nor is it taking risks; it's about observing, judging, and verifying step by step.

The head of the pathology department was flipping through the documents when he suddenly asked a question.

"You just mentioned that this patient's postoperative recovery was inconsistent. Is it possible that this is simply due to individual differences?"

Gu Lin nodded.

"Possibly."

Gu Lin did not deny it; instead, he directly acknowledged the possibility.

Therefore, this case cannot be defined as a fixed pattern at present.

"We cannot generalize this to all patients with high-risk, poorly differentiated gastric cancer just because of one patient."

He switched to the last few pages of the summary.

"Its value lies not in proving that a certain solution is necessarily effective, but more in reminding us."

"When a high-risk patient exhibits a recovery performance that is not commensurate with their risk, should their potential treatment benefits be reassessed?"

The pathology department director's slightly furrowed brows slowly relaxed.

This response was very cautious, neither exaggerating the conclusion nor elevating a single case to general experience, which actually made the entire report more credible.

The people in the medical department were looking down at the documents, and their expressions had softened considerably compared to when they first started.

Song Zhe, sitting in the back row, finally breathed a quiet sigh of relief.

He was initially worried that Gu Lin, being young, might easily get caught up in the controversy over "who proposed the plan" when asked.

As it turned out, Gu Lin didn't panic at all from beginning to end.

We don't shy away from what needs to be acknowledged, and we draw clear lines where necessary.

Most importantly, he kept talking about the patients and never about himself, which is the most impressive thing about him.

Gu Lin turned to the last page, where there was only one sentence on the screen.

Not all high-risk cases should be abandoned prematurely.

Gu Lin stood in front of the stage, looking at that sentence.

"Zhou Mingyuan's case is currently only in a stage of stability. He still has the risk of relapse and will need long-term follow-up."

"But at least at this stage, he has shown us one thing."

Gu Lin raised his head, his voice still not loud, but clearer than before.

"The pathology report tells us about the risks, but the patient themselves can also give us new clues."

"Doctors must respect the reports, but they also cannot stop observing patients."