(Thanks for the encouragement from Kafedou Bentou with monthly votes)

The morning flew by, and at lunch, Liu Banxia had a video call with Qiaoqiao as usual. This is what Xu Yino called a feast of dog food time, with no way out but to shove it into your mouth.

As he was enjoying his meal, Liu Banxia's phone rang. Seeing it was Qi Wentai calling, it gave him a fright.

"What's up? Do I need to rush back for an emergency?" he asked quickly after answering.

"I just received a patient with poor appetite, fatigue, and bloody stools," Qi Wentai said.

"OK, wait for me," Liu Banxia agreed readily.

Poor appetite, in other words, means not feeling hungry and having no appetite. Combined with symptoms of fatigue and bloody stools, this patient is very likely to have rectal cancer.

He didn't expect it; it was just such a coincidence that there was a suspected patient. Anyway, he had eaten more than half of his meal, and now there was no time to worry about eating.

Rushing back to the emergency center hall, Qi Wentai waved at him, "A male patient, 47 years old, has been feeling a poor appetite and fatigue for about half a month, with occasional bloody stools, but has hemorrhoids. I've already done the basic inquiries; just take him to the examination room."

Liu Banxia nodded, "Please come with me; we need to do some more tests, which aren't convenient to do outside."

The patient nodded, "Doctor, could this be rectal cancer? They all say rectal cancer is just like this."

"This is uncertain; hemorrhoids can sometimes also cause bleeding," Liu Banxia said.

"Don't worry yet, I see there's no family history on the record, you don't smoke and don't drink excessively. It might just be caused by hemorrhoids. Did you have a little drink at lunch?"

The patient nodded, "Just less than two ounces, my friends said I looked a bit risky, so I came to the hospital. They said if it is rectal cancer, you'd have to wear a bag, how do you live after that?"

"Don't worry yet; we still need to diagnose it," Liu Banxia reassured again.

"Now I'll do a finger examination for you, to give a general direction. Just follow the posture in the picture next to you, don't be nervous."

The patient nodded.

Earlier, Qi Wentai had told him that he needed to do such a finger examination. He was really worried and scared that it might be rectal cancer.

Before, he just thought it was hemorrhoids, but his friends said hemorrhoids wouldn't cause a loss of appetite or such fatigue. At most, it hurts when sitting during an outbreak, not like this.

Liu Banxia put on gloves, applied lubricant, and carefully performed a digital examination for the patient.

He slightly furrowed his brow, not feeling any lumps. If it were rectal cancer, the digital inspection would be the most direct. However, he did feel hemorrhoids, and it's possible that the bleeding was caused by this.

"Doctor, is it rectal cancer?" the patient asked worriedly after the examination.

Liu Banxia took off his gloves, "From the digital examination, it doesn't seem like it; I didn't feel any lumps. But I did find three hemorrhoids, and they are quite sizeable. If you have time, you should also get them checked out."

Hearing this, the patient noticeably relaxed. The most worrisome thing hadn't happened, thankfully.

"However, given your circumstances, I think we should be cautious," Liu Banxia said.

"Normally, if it's only hemorrhoids, you wouldn't have symptoms like poor appetite and fatigue. According to what you provided, these symptoms have been going on for about half a month?"

The patient nodded, "Half a month might be an understatement, it's been about twenty days. I just didn't take it seriously at first, but today my friends told me to pay attention."

"Have you had any other symptoms recently? Like changes in bowel habits, or abdominal pain?" Liu Banxia asked.

"Occasionally, there's some stomach pain, but bowel movements are quite normal," the patient thought for a moment and said.

"Well, based on your current symptoms, we should conduct a gastrointestinal examination to check for any changes in the intestines," Liu Banxia said.

"Currently, you have symptoms of bloody stools, and it's not yet determined if it's caused by hemorrhoids. The gastrointestinal exam is simple, just a rectal examination."

"But since you haven't prepared your intestines, we can only do it tomorrow. Abstain from food after dinner tonight and come back in the morning."

"Or you can do it later today, by drinking some laxative medication now, which will clear your intestines in about four to five hours, and then we can do the colonoscopy."

"Otherwise, if there's too much material in the intestines, even if we conduct the colonoscopy, we won't be able to see many places and you'll suffer in vain."

"Doctor, is doing a colonoscopy uncomfortable?" the patient hesitated to ask.

"There's a certain level of discomfort, as it's an endoscope inserted into the intestines," Liu Banxia said.

"If you're worried you can't handle it, you can opt for a Painless Colonoscopy. Once you're under anesthesia, you won't feel a thing, it's just that the cost will be a bit higher."

"Doctor, I'll just get it done today. No need for the painless option, if an average person can endure it, then I should be fine too," the patient said.

"I really can't afford to delay any longer; if I do, I won't be able to sleep. Will I know if it's cancer after the colonoscopy?"

"It's more or less like that, but the colonoscopy can only observe your lower digestive tract," Liu Banxia replied.

"Bright red blood in your stool is bleeding within the lower digestive tract. If it's upper digestive tract bleeding, it would be either vomiting blood, coughing up blood, or your stool would turn darker."

"If you didn't have blood in your stool and were worried about a colon or rectal tumor, we'd look into your loss of appetite and fatigue from an internal medicine perspective."

"I'll write you a prescription now, and then we'll prepare your bowel. This type of laxative won't harm your intestines or cause any fluid and electrolyte imbalance. Possible side effects are nausea and bloating, but that's no big deal."

"After drinking it, you'll need to drink plenty of water, about three liters, and you'll have to make a few more trips to the bathroom. If your bowels aren't very sensitive and don't clear out, we might have to do an enema as well."

"Usually that's not necessary, such cases aren't very common. Most take no more than five hours, and four hours should be enough."

The patient nodded, "Alright, please prescribe it, I'll go take the medication."

"Don't worry too much about hemorrhoids flaring up, it's normal for them to bleed," Liu Banxia added reassuringly.

The patient nodded again, his expression relaxing a bit, and headed out to pay and collect the medication.

Liu Banxia had no choice; ordinary patients wouldn't have so many questions. This gentleman was just too worried, affecting his mental state significantly.

It's pretty much ruled out rectal cancer; as for colon cancer, the colonoscopy is the gold standard.

"Teacher Liu, how's it going?" Xu Yino and the group came running in.

"It doesn't quite seem like colon cancer, but it's hard to be certain. The patient does have some weight loss symptoms, but nothing was palpable during the digital rectal exam," Liu Banxia said.

"Li Hao, prescribe the bowel prep for the patient and schedule a time with the endoscopy department. The patient insists on having the test today; otherwise, I would have scheduled it for tomorrow."

"Also, keep an eye on this patient, although it's just a laxative, it can still have some impact on the body. If it is colon cancer, I haven't decided whether to use NOSES or a conventional laparoscopy yet."

"Teacher Liu, either is feasible," Xu Yino said earnestly.

Liu Banxia rolled his eyes, "You might think so, but I don't. You all need to control your expressions, don't let the patient think we're hoping for them to be sick."

"Ah, Teacher Liu, you're underestimating us, aren't you? We'd never do that," Xu Yino responded.

"Alright, go back to your tasks. There seemed to be quite a few patients when I glanced on my way back," Liu Banxia said.

Xu Yino and the others strolled out, feeling a little bit disappointed, actually hoping to witness the NOSES surgery.

It's not that they wish for the patient to have cancer, after all, the patient is there for treatment. And for the emergency department, it's really just a matter of time.

Colon and rectal cancers are currently prevalent malignant tumors, with several cases admitted every month, sometimes more than a dozen.

What they regret is the potential postponement of watching Liu Banxia's surgical technique.

"Not rectal cancer, huh?" Qi Wentai asked when Liu Banxia walked out.

"Right, but colon cancer hasn't been ruled out," Liu Banxia replied.

"Judging from some of the symptoms the patient is showing, there are still some tumor indicators. Once the colonoscopy is done, we'll know for sure, let's see how it goes."

"Would you believe it, this guy came in and immediately told me he had rectal cancer. I thought he was already diagnosed at another hospital, turns out he self-diagnosed," Qi Wentai said.

"That's still better than ignoring everything, that's truly frightening. It's much harder to handle when it's discovered too late," Liu Banxia said.

This gentleman, even though he self-diagnosed, did play a positive role in being proactive. But if it were a tumor, it would probably be in stage two by now.

But isn't that better than advancing to stage three? Malignant tumors, each stage is a critical point. The later it is, the more dangerous it becomes, even if the prognosis after colon or rectal tumor radical surgery is generally good, that's only in most cases.

Thinking this through, since there's nothing else to do, Liu Banxia decided to check on the medical interns' debridement skills. He hadn't visited before, wanting to avoid putting too much pressure on them.

Now, after so much time, if they can't even handle the pressure of his observation, how will they ever perform surgeries on stage?