DSMIS CH25

Chapter 25: The Consultation

The post-snow sunlight was sharper and more piercing than usual, making the outpatient clinic feel several shades brighter.

Holding his registration slip, Jiang Lin sat down beside the desk. Golden light poured through the window mullions, washing over half his body. From Shen Xing’s vantage point, the edge of Jiang Lin’s dark hair seemed to catch fire with light. Since the day they met, this was their very first time sitting opposite one another as doctor and patient. Shen Xing swallowed the routine “Where does it hurt?” that rose to his lips, letting his eyes fall instead upon Jiang Lin’s bulky down coat:

“Aren’t you warm? Take off your coat.”

Obediently, Jiang Lin pulled the zipper down, draped the coat over an empty chair nearby, and sat back down. He wasn’t quite sure how to begin, but fortunately, Shen Xing spared him the trouble:

“Roll up your left sleeve.”

Beneath the coat, Jiang Lin wore a dark gray crewneck sweatshirt. Lowering his head, he pushed the fabric up past his elbow. Across his lean, corded forearm ran a prominent, curved surgical scar that was impossible to ignore. Shen Xing knew at a glance that this was the remnant of an elbow joint reconstruction and brachial plexus nerve anastomosis. Pushing off with his long legs, Shen Xing rolled his swivel chair right up beside Jiang Lin, his fingertips lightly pressing along several key anatomical landmarks on his arm:

“What do you feel here?”

“A bit of pain. And… a little numb.”

“Flex your arm for me.”

Jiang Lin complied. Shen Xing closely tracked the recruitment and contraction of the muscles. The two were seated so close that the subtle, clean scent of Shen Xing’s shampoo drifted clearly into Jiang Lin’s senses.

“Bare the other arm too. Flex both at the same time.”

Jiang Lin rolled up his right sleeve. Separately, the disparity wasn’t stark, but placed side by side, his left arm was noticeably more atrophied and slender than his right. Still, judging by the flexion movement, the motor recovery of his brachial plexus was reasonably sound.

Shen Xing looked up, pushed against the tiled floor with his shoe, and rolled his chair back behind the desk. Reaching into a drawer, he retrieved a digital hand dynamometer and passed it across:

“Squeeze with your right hand first.”

Jiang Lin’s right index finger and the webbing of his thumb bore rough, hardened calluses. His fingers were long and well-proportioned; as he gripped the device, the muscular definition and veins along the back of his hand tightened in sharp relief.

Shen Xing pulled a pen from his breast pocket, ready to record the number. True to his background as an elite narcotics officer, Jiang Lin’s right-hand grip strength far exceeded the average for a healthy adult male:

“Now switch to the left.”

Jiang Lin transferred the device to his left hand. Pursing his lips, he drew a steady breath and began to apply force. The digital readout climbed at a noticeably slower pace, peaking far lower than the right. Shen Xing kept his gaze fixed on his hand. After just a few seconds, Jiang Lin’s wrist began to quiver with fine tremors. His fingertips blanched pale, the tendons across the back of his hand jumping violently as the digital numbers wavered. Yet he refused to release his grip. Seeing this, Shen Xing immediately clamped a hand over his wrist:

“Alright. That’s enough.”

The moment Jiang Lin let go, his entire palm shook uncontrollably, his fingers trembling with early signs of localized cramping. Shen Xing took Jiang Lin’s hand in both of his own, using his thumbs to knead firmly along the palm and fingers, helping the overtaxed muscles and strained nerves unwind before a full spasm could set in.

Dr. Shen’s hands were exceptionally handsome—nails trimmed neat and flat, fingers slender yet possessing an unmistakable surgical precision and strength. As the dull, burning ache in his palm mingled with the soothing rhythm of the massage, Jiang Lin felt his heart skip a beat, fluttering entirely out of rhythm for an instant.

Only when the trembling in the palm gradually settled did Shen Xing release his hold. He jotted down the reading from the dynamometer, comparing it with the baseline from the right. The left hand’s grip strength had reached 57% of the right.

Having reviewed Jiang Lin’s files, Shen Xing knew he had suffered a complete transection of the ulnar nerve—a catastrophic tier of peripheral nerve trauma. For an injury of that severity, claw-hand deformities and permanent loss of function were common; to recover more than half his baseline strength was nothing short of miraculous.

“Does your left hand feel abnormal during daily activities?”

Jiang Lin took two deep breaths before finding his voice:

“It aches after exertion. Occasionally goes numb at night. Weak grip when trying to hold objects. Can that still be improved?”

Meeting Jiang Lin’s searching gaze, Shen Xing suddenly felt the cold cruelty of medical reality. Sensing his hesitation, Jiang Lin let out a faint chuckle:

“Dr. Shen, my mental fortitude is very solid.”

“You suffered a complete ulnar nerve transection,” Shen Xing said plainly. “Under typical circumstances, patients don’t even regain half the grip strength of the healthy side, and it’s frequently accompanied by claw-finger contractures. Your functional recovery is already remarkably close to ideal. Pushing for further gains will be difficult.

“The soreness after exertion stems from neuromuscular fatigue; having survived such severe trauma, this arm exhausts far more easily than a normal limb. Going forward, avoid maximal gripping and heavy lifting. As for the nighttime numbness, we’ll run an electromyogram (EMG) in a moment to evaluate conduction velocity. That symptom can generally be managed with pharmacological adjustments.”

Jiang Lin showed no hint of disappointment. In truth, he had understood the permanent ceiling of his recovery back when he was discharged.

Shen Xing suddenly remembered Jiang Lin changing his spare tire on the highway using practically one arm. Back then, he had thought the man was just acting cool. Remembering it now, a heavy, quiet ache settled into his chest.

“Lie down on the examination bed over there. Let me see your leg.”

Compared to his arm, the lower limb had taken the brunt of the catastrophic damage.

Jiang Lin stood up and walked over to the examination table. Shen Xing rose and followed him:

“Lie flat.”

Jiang Lin reclined against the paper-lined cushion. Over the past seven months, he had been examined by countless doctors, yet none of those visits had made him this nervous. A silent Dr. Shen, dressed in a crisp white coat with lips pressed tightly together, left him feeling utterly ungrounded.

Shen Xing pushed up the cuffs of Jiang Lin’s trousers, rolling the thermal underwear up past his knee. Even having braced himself mentally from the operative recordings, the sight of the bare left leg still made Shen Xing draw a sharp breath.

There was virtually no unmarred skin across the entire limb. It was pitted, scarred, and furrowed—the brutal aftermath of shrapnel retrieval and radical debridement. Lightly pressing his fingertips against several points, Shen Xing found the calf not only freezing to the touch, but visibly edematous.

He rolled up the other pant leg for comparison. Hidden under loose trousers, the difference was invisible; exposed side by side, the disparity in circumference was jarring. The left leg displayed severe muscular atrophy, while the skin temperature on the right was distinctly warmer:

“Is it always this cold?”

“It’s probably because of the recent cold front.”

Shen Xing offered no response to the transparent excuse, asking instead:

“Does it swell like this every day?”

“No. It swells after walking around during the day. If I prop it up at night, it goes down by morning. It doesn’t happen every day—probably just the cold weather lately…”

Shen Xing lifted his gaze, his voice flat:

“Everything comes down to the cold weather, does it?”

Jiang Lin wisely closed his mouth.

Shen Xing palpatated several diagnostic reflex zones, monitoring Jiang Lin’s reactions. Over two specific points, Jiang Lin blanched pale with pain, cold sweat instantly beading along his temples. Shen Xing lifted his hands away immediately, smoothed the trouser legs back down, and braced Jiang Lin by the elbow:

“Can you sit up?”

Jiang Lin pushed himself up into a sitting position, his face noticeably paler than before, his breathing heavier, though he maintained an easy facade:

“Of course I can, Dr. Shen. Not crippled yet.”

Shen Xing waited until Jiang Lin stood steadily on both feet before returning to his desk, pulling up Jiang Lin’s most recent diagnostic imaging on the monitor:

“Has the neuropathic pain in your leg improved at all since you were discharged?”

Smoothing down his sweatshirt, Jiang Lin sat down opposite him:

“It improved during the first month after discharge. Later on, the pain flared up again. The follow-up didn’t show anything new, so they just prescribed some meds.”

Glancing at the alarming stack of analgesics listed on the Baoshan records, Shen Xing’s voice turned cool:

“Just prescribed some meds, did they?”

Jiang Lin held his breath and didn’t utter a peep. Old Man Xu must have called Shen Xing and lodged a massive complaint against him.

Clicking his mouse, Shen Xing typed out diagnostic orders:

“We’ll run routine blood panels, two EMGs, and an MRI. You didn’t get an MRI at your last follow-up, so we’ll do one today.”

“Okay.”

Jiang Lin nodded like an obedient student, raising zero objections to any of the tests.

Shen Xing printed the requisitions and handed them over:

“The pain improved and then relapsed; I need to rule out recurrent nerve compression and soft tissue adhesions. I also added a musculoskeletal ultrasound. Once you finish the laboratory tests and imaging, come straight back here. I’ll perform the ultrasound myself.”

The ultrasound technicians at the county hospital primarily handled abdominal and pelvic scans; they rarely encountered post-reconstructive trauma cases of this complexity. Fearing critical findings might slip through the cracks, Shen Xing preferred to evaluate the tissues directly.

“Understood.”

Clutching the stack of requisition slips, Jiang Lin stood up and exited the room.

The moment the door clicked shut, Dr. Luosang, who had been sitting quietly on the other side of the room, snapped his head up, his eyes gleaming with curiosity:

“Director Shen, do you know who that was?”

Shen Xing took a sip of tea, not even bothering to look up:

“Isn’t his name Jiang Lin? Patient number three.”

Luosang leaned closer:

“I have a cousin working at the county police bureau. That was Captain Jiang! Word has it that before his assignment here, he was deputy chief of the narcotics brigade in Jin City—a rank equivalent to a deputy bureau chief in our county!”

Admiration dripped from Luosang’s tone; Jiang Lin was only four years older than him, yet already held such an esteemed rank in their region. Shen Xing took another slow sip of tea—he had already gleaned that when looking him up days ago:

“Oh.”

Luosang was deeply impressed by Shen Xing’s unflappable composure. A specialist from the big city truly was built different. Then, scratching his head, Luosang added:

“Though… why did I get the feeling Captain Jiang was kind of terrified of you?”

Luosang had spotted Jiang Lin around the hospital grounds a few times before. The man was always stern and unapproachable, carrying an immense aura of authority, especially in uniform. Yet just now, in front of Dr. Shen, he had been as meek and compliant as a lamb. Shen Xing’s cup paused midway to his lips:

“I’m wearing a white coat. Which patient isn’t afraid of their doctor?”

Luosang mumbled under his breath:

“I’m wearing a white coat too…”

Why hadn’t Captain Jiang looked the least bit intimidated by him?

“Alright, call the next patient.”

After paying the cashier and completing his blood draws and imaging, half an hour had passed. Seeing a patient inside the consultation room, Jiang Lin waited quietly outside the door. Spotting him through the glass, Shen Xing gestured for him to come in and take a seat:

“I’ll do your ultrasound once I finish with the remaining patients.”

“Take your time.”

Luosang’s eyes darted back and forth between the two of them before he discreetly turned his head away.

Patient volume was light, mostly comprising chronic arthritis patients coming in for prescription refills. By 10:30 AM, the queue was clear. Shen Xing pulled up Jiang Lin’s fresh MRI scans on his monitor, reviewed the cross-sections, and rose to his feet:

“Come on. Let’s get your ultrasound done.”

This time, Jiang Lin locked onto ‘auto-follow’ mode right behind Shen Xing. Arriving at the ultrasound suite, Shen Xing exchanged a few words with the technician on duty, who smiled and gladly surrendered the probe. Shen Xing patted the examination bed:

“Hop on up, Officer Jiang.”

Shen Xing squeezed a generous dollop of clear coupling gel onto the scarred calf:

“Don’t be nervous. It won’t hurt.”

Jiang Lin cracked a wry smile:

“Are you coaxing a kindergartener?”

Shen Xing let out a brief chuckle before pressing the transducer against the skin, spreading the gel across the muscle belly as his eyes locked onto the monitor. The room fell into total silence, save for the rhythmic clicking of keys as Shen Xing logged measurements. Ten minutes later, he lifted the probe, tore off several paper towels, and carefully wiped the cold gel from Jiang Lin’s leg:

“All done.”

Jiang Lin straightened his clothing and followed Shen Xing back to the clinic.

“So, Dr. Shen… am I still salvageable?”

Seeing that he still had the nerve to crack jokes, Shen Xing shot him a sharp glare:

“Comparing your MRI with the previous scan, the recovery of your nerve damage has plateaued. I noticed that before your discharge from the military hospital, you were receiving therapeutic laser treatments. That promotes axonal regeneration and microvascular circulation. But on your recent records, that therapy disappeared entirely.”

“The county hospital doesn’t have laser therapy equipment. To get it, I had to travel all the way to Baoshan. It was too inconvenient.”

Shen Xing’s brows knit. Low-level laser therapy was critical for Jiang Lin’s current pathology. Suddenly, he remembered that at the end of this month, a shipment of donated aid equipment from Yuetan Hospital was scheduled to arrive in Fulan County. He recalled his department chief mentioning laser and ultrasound units.

“Hold on.”

Jiang Lin nodded obediently. Shen Xing placed an immediate call to Chief Lin Ke, inquiring in detail about what orthopedic equipment was included in the manifest. Three minutes later, he hung up with complete satisfaction:

“You’re in luck. The shipment arriving at the end of the month includes laser units. High-intensity laser therapy paired with functional electrical stimulation (FES)—you are sticking with this, non-negotiable.”

“Okay.”

“Furthermore, the ultrasound revealed localized fibrous adhesion in your deep tissue. Your chronic neuropathic pain stems from two culprits: persistent nerve damage and soft tissue entrapment. Addressing the adhesions offers two paths: the conservative route relies on targeted physical therapy to see if the bound tissue can remodel and release on its own; the more aggressive route involves surgical scar tissue release.”

“Which one do you recommend?”

“The adhesion isn’t catastrophic yet. We can start with conservative physical therapy first. That will simultaneously address your poor venous return and the swelling.”

“Alright. I’ll do whatever you say.”

Sitting across the room, Luosang listened to the exchange and couldn’t help marveling at what a textbook, dream patient Captain Jiang was. If only all his future patients followed orders this readily! He had no idea that far away in Beijing, Vice President Xu had nearly suffered an apoplectic stroke from this very same patient.

Faced with Jiang Lin’s meek compliance, Shen Xing found his lingering frustration evaporating. Still, he drove the point home:

“Beyond clinic treatments, the single most critical rule is that you cannot subject that leg to sustained physical strain, and you absolutely cannot let it get chilled.”

Jiang Lin nodded again.

Shen Xing suddenly gave a wry smile:

“Agreeing so quickly… you aren’t playing the obedient patient to my face while doing whatever you want behind my back, are you?”

Jiang Lin lowered his eyes, his lips curling with a faint, gentle smile:

“I wouldn’t dare.”

“Good.”

“Also, don’t expect me to hand out painkillers as freely as your previous doctors did. You cannot rely on analgesics to mask the progression.”

“Mm. I’m already cutting back.”

Shen Xing knew full well how agonizing neuropathic flare-ups were:

“I’m not going to leave you to white-knuckle through it either. I’ll design a comprehensive multimodal pain management plan for you.”

Today was too rushed; while he was an expert in surgical interventions, tailoring a non-operative regimen required conferring with colleagues in physical rehabilitation and pain medicine.

“Alright. Is Dr. Shen ready to clock out?”

Shen Xing glanced at the clock on the wall—it was indeed noon:

“Already?”

“Not fast at all. I’ve been starving for hours. Have some pity on a hungry man who skipped breakfast and gave up vials of blood, Dr. Shen. How about mutton hotpot for lunch?”