Chapter 2075: Chapter 1788: Get to the Bottom of It_2

Zhaxi nodded hard.

Yang Ping went on, "Also, starting this month, I plan to do individualized training for your cohort. The thirty of you come from different places, with different foundations and different needs. I can’t teach everyone with the same set of methods."

Zhaxi was stunned for a moment. "Individualized training?"

Yang Ping said, "Yes. You’re from a high plateau region—altitude sickness, spinal tuberculosis, congenital deformities, these are high-incidence diseases where you come from. Ah Yi is from Guizhou, it’s a Mountain Area there, with lots of trauma, lots of scoliosis, lots of rheumatic disease. Ely is from Xinjiang, where the territory is vast, ethnic groups are many, and hereditary diseases are common. The training direction for each person is different."

He paused, looking at Zhaxi. "I’ve already thought through your direction. After you go back, you’ll be facing not only common diseases, but also the problems unique to high plateau regions."

As he spoke, Yang Ping took a study plan sheet out of the drawer and handed it to Zhaxi.

Zhaxi sat there, staring at the densely packed plan. His mind was blank.

Yang Ping looked at him, and his tone suddenly softened. "Zhaxi, do you know why I’m so strict with you?"

Zhaxi shook his head.

Yang Ping said, "Because after you go back, you’ll be facing all the ordinary people of an entire region. They’ve been waiting for you for many years. You can’t make them wait any longer."

Yang Ping continued, "When you all return to the grassroots in the future, you’ll be doing the hardest jobs and saving the people who need help the most."

He looked at Zhaxi. "You, Ah Yi, Ely, Bilige... you who come from the grassroots are the ones I value the most."

Zhaxi stood up and bowed to Yang Ping. This time, Yang Ping did not stop him.

That night, Zhaxi sat in the dorm, staring blankly at the study plan sheet Yang Ping had given him. He read through the plan three times, and each time his scalp tingled.

Finish the basic Medicine on Clostridioides difficile in one week? Back in medical school, just microbiology alone took an entire semester.

But he knew Yang Ping wasn’t making things hard just to make them hard. Yang Ping was pushing him, forcing him to build a knowledge system of his own in the shortest possible time.

He took a deep breath, turned on his computer, and started searching for materials.

The first task of the first stage: microbiological knowledge of Clostridioides difficile.

He found a review article and started reading it from the beginning. As he read, he discovered a problem: he had already forgotten many of the basic concepts. What is a spore? What is an exotoxin? What is a cytotoxin? He had memorized them in medical school, then forgotten them right after the exam.

He hesitated a moment and sent a message to Ely, who was on duty that night: "Do you have a medical microbiology textbook over there?"

Ely replied, "Yes, an electronic version. I’ll send it to you."

Zhaxi downloaded the textbook and started from Chapter One. He read very slowly, taking notes as he went. By the time he read through the Chapter on Clostridioides difficile, it was already eleven at night. He had written more than ten pages in his notebook, turning the structure of the bacteria, the pathogenic mechanisms, and the mechanisms of action of the toxins into diagrams.

The next morning, he went to find Yang Ping.

Yang Ping was reading papers in his office. Seeing him come in, he raised his brows slightly. "So fast?"

Zhaxi handed over the notebook. Yang Ping took it and flipped through it, reading for about ten minutes.

"These diagrams are pretty good," he said. "But there are a few things that aren’t right."

He circled a few spots in the notebook with a red pen. "Here, you wrote that toxin A is an enterotoxin and toxin B is a cytotoxin. That’s not accurate. Toxin A also has cytotoxicity, and toxin B can also trigger Intestinal Tract inflammation. They act synergistically; it’s not a simple division of labor."

Zhaxi hurriedly wrote this down.

Yang Ping continued, "And here, you wrote that Clostridioides difficile is a Gram-positive bacillus. Correct, but you left out a key point: in the Intestinal Tract it exists in the form of spores. Spores are resistant to alcohol, high temperatures, and many disinfectants. That’s why this disease is easy to spread in Hospitals, and why it recurs so easily. Go back and add this in."

Zhaxi wrote that down as well.

Yang Ping handed the notebook back to him. "Not bad. Keep going. Use points to drive the whole picture. Tomorrow, start learning the gut microbiota."

Zhaxi nodded and turned to leave, but Yang Ping suddenly called out to him. "Zhaxi."

Zhaxi turned back.

Yang Ping asked, "What time did you study until last night?"

Zhaxi hesitated. "Eleven o’clock."

Yang Ping frowned slightly. "Studied until eleven and got up again at six? That’s acceptable, but don’t stay up late."

Zhaxi nodded.

Yang Ping said, "I told you before: taking good care of yourself isn’t selfishness; it’s taking responsibility for everyone. If you wear yourself out, all the things you’ve learned are useless. In bed before eleven every night—that’s an order. In Medicine, without sleep, there is nothing. You should understand that."

Zhaxi nodded again, forcefully.

That night, Zhaxi shut down his computer at eleven. Lying in bed, he tossed and turned, unable to fall asleep. His head was full of Clostridioides difficile spores, toxin A, toxin B, swirling round and round.

He picked up his notebook and read a few more pages, then turned off the light.

The next day, he started learning about the gut microbiota.

This part was even harder; he had never studied this field of knowledge before. What is the phylum Firmicutes? What is the phylum Bacteroidetes? What is the relationship between the gut microbiota and the Immune system? How do antibiotics disrupt the microbiota?

He spent two days chewing through the basic knowledge of gut microbiota, then went to report to Yang Ping.

After listening, Yang Ping asked him a question. "Tell me, why is it that after using antibiotics, some people develop Clostridioides difficile infection while others don’t?"

Zhaxi thought for a moment and said, "Probably because the composition of their gut microbiota is different. Some people’s microbiota are more resilient."

Yang Ping nodded. "Right. So how do you predict that? How do you prevent it?"

Zhaxi couldn’t answer.

Yang Ping said, "Go search the literature—papers from the last five years. See whether there are any relevant prediction models or preventive strategies."

Zhaxi went back to search again. He found a meta-analysis on probiotics for preventing antibiotic-associated diarrhea, and also a review on fecal microbiota transplantation in the treatment of recurrent Clostridioides difficile infection.

He spent a full day reading the two papers, then went to see Yang Ping again.

After hearing his summary, Yang Ping asked an even trickier question. "For fecal microbiota transplantation, how do you choose donors? What are the screening criteria? What are the routes for transplantation? Between oral capsules and Colonoscopy infusion, which has better outcomes? What about the long-term safety?"

Again, Zhaxi couldn’t answer.

But this time he didn’t panic. He had gotten used to it. Yang Ping’s way of asking questions was like peeling an onion, layer by layer. At the very end is the part you truly don’t understand.

He said, "I’ll go look it up."

Yang Ping smiled. "Go ahead. The Department of Gastroenterology at Sanbo Hospital is currently waging war on gut microbiota suppression. You can go talk to them and learn a bit."

A week later, Zhaxi completed the first stage of study. He had filled more than a hundred pages in his notebook, drawn dozens of diagrams, and read more than a hundred papers.

When he went to report to Yang Ping, Yang Ping asked him, "At this point, how much do you understand about Clostridioides difficile?"

Zhaxi thought for a bit and said, "About five percent."

Yang Ping laughed. "Not bad, that’s progress. At least now you know you only know five percent."

He paused and took out a new plan sheet from the drawer. "This is for the second stage. In two weeks, finish the Clinical Medicine part of this disease. Two weeks from now, I want you to present this case from beginning to end—explain it to me, and also to the other trainees."

Zhaxi froze. "Explain it to the other trainees?"

Yang Ping said, "Yes. The best way to learn is to teach others. Only when you’ve taught others well do you truly understand it yourself."

Zhaxi took the plan sheet. His hands were trembling slightly, but he was no longer afraid.