ROT CH 39

Chapter 39: The Standard Answer?

“I can explain,” Han Junzhou said to Xue Bingsheng. “The question you lost points on was the second essay question, wasn’t it? The case about a 20-year-old male Alpha with a suspected malignant change ^[1]in the right lobe of the gonad. After a biopsy, it was confirmed to be adenocarcinoma, and a full-body examination showed no distant metastasis. How did you approach it?”

“Complete gonad removal. That’s the textbook answer, found on page 405,” Xue Bingsheng confidently replied, even quoting the page number. His classmates looked at him, stunned by his certainty.

Han Junzhou nodded and turned to Li Wenting. “What about you? What was your answer?”

Li Wenting hesitated. “I wrote partial lobe removal followed by chemotherapy.”

“You lost two points for that, right?” Han Junzhou asked.

Li Wenting nodded, avoiding the gaze of his father, Dean Li Fan, who specialized in cancer treatment.

“And the rest of you?” Han Junzhou asked the class.

“Partial lobe removal. Three points deducted.”

“Chemotherapy. Four points deducted.”

“I wrote radiation therapy. Also lost three points.”

The answers came one after another, covering a range of treatments.

“Did anyone else write ‘complete gonad removal’?” Han Junzhou asked. Other than Xue Bingsheng, no one raised their hand.

“And did anyone get full marks on this question?” he continued. Unsurprisingly, the class shook their heads, all eyes turning to Bai Chengyu, suspecting he might be the exception.

Han Junzhou reassured them, “Actually, the essay questions toward the end of the exam were all beyond the standard curriculum. You’ve all shown great critical thinking, even addressing material outside the syllabus. Professor Chen wrote this question not just to test your ability to treat a patient—it’s still a bit early for you to focus solely on treatment…”

This is an advanced topic,” Han Junzhou explained. “The professor’s main intention was to remind you of what points you, as doctors, must focus on when dealing with patients.”

The students still looked confused. Xue Bingsheng, however, seemed more indignant, realizing he had lost the most points among his peers.

“The textbook answer is complete gland removal. Writing ‘partial lobe removal’ is simply wrong. The gonads are so small that, although divided into right, left, and middle lobes, removing just one lobe comes with significant risks. Complete removal is a safer choice to prevent the cancer from recurring,” he argued.

“But I also added chemotherapy,” Li Wenting retorted.

Before a full argument could break out, Han Junzhou raised his hand to stop them, and Yue Qi tugged on Xue Bingsheng’s arm, trying to calm him down.

“Chengyu, what was your answer?” Han Junzhou finally called on Bai Chengyu.

Bai Chengyu thought for a moment before responding, “The pathology report confirmed adenocarcinoma. Malignancy in glandular tissues like this is not extremely high. Additionally, the question specified there was no distant metastasis, which rules out stage IV cancer. My answer was this: if the patient is in stage I, I would recommend partial removal of the right lobe, followed by regular monitoring. For stage II, I’d recommend partial removal of the right lobe with adjuvant chemotherapy. For stage III, in addition to partial removal, adjuvant concurrent chemoradiotherapy (CCRT) should be arranged within six weeks.”

The surrounding students gasped. Such detailed cancer treatment protocols were usually only remembered by oncology specialists, and they were only second-year medical students. Even Li Wenting’s addition of post-surgical chemotherapy had been considered an impressive effort.

Bai Chengyu, oblivious to the astonished and admiring looks of his classmates, continued, “The patient is a 20-year-old male Alpha. Considering future reproductive concerns, I would advise sperm preservation before undergoing chemotherapy.”

When Bai Chengyu finished, Han Junzhou, Yue Qi, and Dean Li Fan all nodded in approval, while the other students silently digested both the professor’s words and Bai Chengyu’s answer.

Bai Chengyu had not only proposed treatment plans tailored to different stages of the disease but also included adjuvant therapy in line with cancer treatment guidelines. Most importantly, he had taken the patient’s age into account, suggesting appropriate measures for the patient’s future life.

“Well done,” Dean Li Fan said loudly in praise. “For a second-year medical student to think of sperm preservation shows a clear and thoughtful approach.” He glanced at Li Wenting and the other students. “You all should learn from Bai Chengyu.”

“Now, do you understand? This is the most suitable answer,” Han Junzhou said to Xue Bingsheng. “You mentioned the textbook’s standard answer on page 405. I appreciate your diligence, but have you noticed that none of your classmates chose complete removal? In fact, out of over a hundred students in the class, only eight wrote ‘complete removal.’ Do you now realize the difference between Professor Chen’s question and the one in the book?”

By now, Xue Bingsheng’s face was flushed with embarrassment, and he was speechless. He realized that his classmates hadn’t been stunned by his precise recall of the textbook’s page number but rather by his rigid choice of complete gland removal.

“In the textbook’s example, the patient was a 77-year-old, otherwise healthy Omega woman diagnosed with stage I squamous cell carcinoma of the gonads. Because squamous cell carcinoma is more aggressive and less sensitive to chemotherapy, and considering the patient’s advanced age where natural gland function has already declined…”

“…and without fertility concerns, complete gland removal is recommended to prevent the risk of recurrence or metastasis from squamous cell carcinoma,” Han Junzhou paused. “In contrast, this case presented by Professor Chen involves a 20-year-old Alpha male. Setting aside the patient’s future reproductive concerns, you went straight to a complete gland removal without considering partial preservation. Do you realize what that means for the patient? His Alpha traits and pheromones would disappear, and his hormonal balance would be entirely disrupted. While you may cure the cancer, you would essentially castrate him. His future would be irrevocably destroyed.”

Han Junzhou frowned deeply and continued, “Not only would he be unable to have a normal sexual life in the future, but the hormonal imbalance would severely weaken his body. He wouldn’t live past 30.”

“Professor Chen was kind enough to still give you five points. As a clinical physician, if it were me, I would have only given you one,” Han Junzhou said seriously. “Complete removal is technically a treatment option, so it warrants one point. However, for this patient, it is the worst possible choice among all available options.”

Xue Bingsheng lowered his head, overwhelmed with shame. He had always prided himself on being a diligent student, devoting all his time to memorizing every word in the textbooks. While he knew he wasn’t the smartest, he believed his effort and dedication set him apart.

But the truth was clear—he had fallen short.

Everyone else had considered gland preservation as the most basic measure, while he arrogantly thought that complete removal was the only and most correct answer. He hadn’t even contemplated the finer details, let alone the critical suggestion Bai Chengyu made about sperm preservation.

Noticing Xue Bingsheng trembling slightly as he hung his head in silence, Han Junzhou softened his tone, though his gaze remained firm. “Bingsheng, you can’t just see the disease. When you become a doctor in the future, before you see the illness, you must first see the person.”

(To Be Continued…)

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