For a third-year university student to suddenly interrupt a joint consultation at a top-tier hospital like Peking Union Medical College Hospital was, in itself, an extreme breach of etiquette.

Lu Xiaolin, beside him, broke out in a cold sweat and desperately tugged on the corner of Jiang He’s shirt under the table.

Director Zhang glanced at Vice President Zhao Licheng. He didn’t seem to mind, instead gesturing gently. "Go on."

Jiang He moved past the conference table, walked up to the light box displaying the CT scans, and said concisely:

"This CT shows no double-duct sign. The pancreas has a sausage-like appearance and is accompanied by a pseudocapsule sign... Directors, I’ve read the relevant research. These findings seem more consistent with autoimmune pancreatitis."

Everyone present was a top expert in the country; they were not completely unaware of the concept of AIP.

It was just that in 2008, AIP had only recently been established internationally, and clinical cases in the country were extremely rare.

When the emergency department faced a patient with painless jaundice and elevated CA 19-9 levels, the default line of thinking would naturally lead to the deadliest of all cancers.

"You’re Xiaojiang, correct?"

The Director of General Surgery, Xu Wenpei, turned around and voiced his opposition:

"The imaging features you mentioned do exist, and it’s not that we haven’t considered AIP. But you have to understand, the incidence of AIP is extremely low, whereas pancreatic cancer is fatal."

"The patient’s CA 19-9 levels are clearly elevated—that’s an indisputable fact. If we overturn the diagnosis of pancreatic head cancer now and treat it as AIP, we would have to immediately halt surgical preparations and put the patient on high-dose steroids."

"Once the steroids are administered, the patient’s immunity will plummet. What if we’re wrong? What if this isn’t AIP at all, but a malignant tumor with atypical imaging?"

"By then, the patient will have lost the chance for even a Whipple procedure. Who will bear the responsibility for delaying treatment?"

These were the genuine concerns of a surgeon in 2008.

Without absolute certainty, they would rather perform major surgery than risk missing a potentially fatal tumor.

Lu Xiaolin, listening from the side, nodded in agreement.

Xu Wenpei’s logic was irrefutable.

Clinical practice isn’t about writing papers; it’s about being safe and reliable.

Jiang He bowed slightly. "Your concerns are completely valid. Therefore, I suggest we don’t need to change the treatment plan immediately, and certainly not start steroids right away."

Xu Wenpei asked, "Then what are you suggesting?"

Jiang He said, "Let’s take a two-pronged approach. The General Surgery Department’s preparations can continue as scheduled; no need to stop. But before the operation, we should run an urgent blood test for the serum IgG4 subtype. While AIP is rare, a significant elevation in serum IgG4 is a specific marker for Type 1 AIP. At the same time, let’s ask the Gastroenterology Department to immediately schedule an ERCP and perhaps even try to obtain a tissue sample for a biopsy during the procedure."

Jiang He continued, "If the IgG4 levels are normal, or if the biopsy reveals cancer cells, then we proceed with the surgery as planned. But if the IgG4 shows a pathological increase of more than tenfold... we might be able to spare the patient the immense trauma of having multiple organs removed."

The conference room fell silent.

There was no risk of delaying treatment. They only needed to run an urgent blood test and an imaging procedure to rule out a potentially huge misdiagnosis.

This young man’s thinking was not only sharp but also incredibly tactful and thorough, completely taking into account the practical difficulties on the clinical front lines.

After a moment of consideration, Vice President Zhao Licheng smiled and said gently:

"Alright, let’s proceed with this plan. General Surgery, go talk to the family and get the surgical consent form signed. Keep the surgery scheduled for tomorrow. Gastroenterology, get the urgent blood draw for IgG4 done now. Perform the ERCP this afternoon. Make sure you have the results before tomorrow morning’s surgery."

"Alright." After speaking, Xu Wenpei gave Jiang He another look and then silently nodded.

They walked out of the conference area of the special-needs ward.

Lu Xiaolin grabbed Jiang He’s arm and quickly pulled him into an empty stairwell at the end of the hallway.

"You..." Lu Xiaolin’s voice was filled with lingering fear. "Do you have any idea how close that was? That was the Vice President of Peking Union Medical College Hospital and all the department heads! What if you’d been wrong?"

Jiang He stood still, looking at Lu Xiaolin’s pale face, and didn’t respond.

’In his past life, when he was a chief surgeon in hepatobiliary and pancreatic surgery, he had handled far too many typical AIP cases like this one.’

’From the imaging signs to the biochemical data, all the characteristic features were etched into his very bones. It was impossible for him to be mistaken.’

Seeing that Jiang He neither argued nor explained but just stood there calmly, Lu Xiaolin sighed helplessly. 𝚏𝕣𝐞𝗲𝐰𝕖𝐛𝐧𝕠𝕧𝚎𝚕.𝐜𝚘𝗺

He straightened up, his gaze on the third-year junior before him incredibly complex.

"But anyway, junior, you really... surprised me again today."

"How so?" Jiang He asked.

Lu Xiaolin walked to the stair railing and said with a wry smile, "This is Peking Union Medical College Hospital... To be honest, even if the same thought had crossed my mind while looking at the scans earlier, there’s no way I would have stood up and questioned the directors’ judgment."

Jiang He watched him quietly, fully understanding what Lu Xiaolin was feeling at that moment.

The medical world is a place where seniority and rank are paramount, with a strict hierarchy.

To overturn a major surgical plan decided upon by an authoritative expert on their own turf required shouldering an immense amount of pressure and professional risk that most people couldn’t imagine.

Jiang He looked at him and said softly, "Medicine, by its very nature, is born from questioning."

Hearing this, Lu Xiaolin looked up, a bit dazed.

"Only by daring to question authority and overturn old conclusions can clinical practice make breakthroughs."

Jiang He looked him in the eye, his tone steady. "Senior, isn’t the research on cell polarity reversal you’re doing now also an attempt to break with traditional pathology conventions? Don’t be intimidated by any big names. True knowledge comes only from practice. I believe in you. You can definitely succeed with this project."

Lu Xiaolin stood frozen in place.

He mulled over Jiang He’s words, an indescribable shock rising in his heart.

’Is this the kind of awareness and perspective a third-year university student can have?’

After a long moment, Lu Xiaolin gave a self-deprecating laugh. "This is unreal. I’m two years older than you and about to start my PhD, but in front of you, I feel like a goddamn greenhorn on his first day of clinicals."

Jiang He’s tone was sincere. "Don’t say that, senior. You’re already outstanding."

’Hearing this, Lu Xiaolin couldn’t help but feel like Jiang He was indirectly praising himself. What was up with that?’

He waved his hand. "Alright, stop trying to console me. Before coming to the Capital City, I heard you got a perfect score and took first place in this semester’s Clinical Pathology Reasoning Competition. I already thought you were impressive, but today, you’ve truly left me in awe."

Lu Xiaolin stepped forward, clapped Jiang He firmly on the shoulder, and said with great solemnity, "I was originally planning to praise you a lot in front of Boss Yang when we get back. But now I realize that’s completely unnecessary. You don’t need my praise. Jiang He, you are destined to shine brightly in the medical world."

Jiang He smiled slightly and nodded. "I’ll take that as a good omen, senior."

Just as he spoke, a vibration came from the pocket of his pants.

He pulled out his phone, lit up the screen, and his expression instantly softened.