Chapter 235: The Strength of Immunity

After being infected with Salmonella, just giving fluids isn’t enough. Some patients can pull through with their own immune system, but others may get worse and even die. That’s why, when medication is called for, we have to use it.

As soon as Director Shang finished speaking, the patient’s family member next to him looked terrified.

“Professor Shang, you have to save my husband! Our family can’t go on without him.” She was probably hitting herself with regret by now.

How could she have known that sneaking her husband a bowl of chicken soup would have such serious consequences?

Just thinking her husband might die, tears started rolling uncontrollably down her face.

“Don’t cry, please don’t cry! I’m just teaching my doctors how to treat this type of illness. While your husband’s condition looks bad, we caught it very early—his situation is still under control. I truly believe he’ll improve quickly after starting treatment.”

Director Shang did his best to explain things to the family and calm their panic and grief.

“Dr. Yu, I have to praise you again. Being the first to notice the patient’s abnormal symptoms and so quickly and accurately diagnosing a Salmonella infection shows not just your responsibility, but your growing skill in medicine.”

After reassuring the family, Director Shang once more praised Yu Xin.

He also meant to remind Zhou Can that there were more than just one talented trainee under his guidance.

Basically, he wanted to take Zhou Can down a peg.

Zhou Can’s performance had been a bit too dazzling lately, and his string of achievements was starting to worry Director Shang—he didn’t want Zhou Can getting cocky, which could hinder his growth.

Yu Xin looked somewhat embarrassed.

She wasn’t actually the one who diagnosed the Salmonella infection.

With her current diagnostic skills, she had no way of pinpointing such a complex cause.

“I…”

She bit her lip, ready to come clean.

Trying to bluff your way through never lasts.

“What’s wrong?”

Director Shang looked confused—Yu Xin was never this hesitant.

“Professor Shang, actually, the doctor who diagnosed my husband’s Salmonella infection was him. But Dr. Yu has also been incredibly attentive and diligent with my husband’s care.”

The family member decided to set the record straight.

Director Shang caught on right away.

Turns out it was Zhou Can who pulled it off again. He’d hoped praising Yu Xin would put a little pressure on the kid.

Now it might just have the opposite effect.

Still, as an old hand used to turbulent situations, Director Shang kept his cool and naturally turned toward Zhou Can, waiting at the foot of the bed.

“Wasn’t Dr. Yu responsible for this patient? How did you end up making the diagnosis?”

“I just offered some advice, and my diagnosis happened to match Dr. Yu’s. Actually, Dr. Yu had already figured it out; she just saw that the patient’s condition looked bad and, to be safe, copied your approach of group consultations by calling in both me and Dr. Duan Zifu.”

Zhou Can didn’t care much about credit for things like this.

So, he decided to play along and gave Yu Xin all the credit with a little white lie.

Director Shang broke into a pleased smile.

“Good work, both of you. Taking advantage of the wisdom of collective consultations is a great way to avoid mistakes or missed diagnoses.”

Yu Xin, who’d been worrying about how to offer an explanation that wouldn’t embarrass her, never expected Zhou Can to come up with such a perfect story.

Now, no matter how closely Director Shang questioned her, her contribution wouldn’t be shaken.

And she wouldn’t have to worry about being caught in a lie later.

Yu Xin shot Zhou Can a grateful look.

He just smiled and winked at her.

“Dr. Zhou, do you know the pathogenic mechanisms of Salmonella?” Director Shang asked him.

He was probably testing his basic medical knowledge.

In the past, Zhou Can might have fudged it. But now, all that cramming he did hadn’t been for nothing.

“Salmonella comes in many types. It can live in chickens, cats, ducks—domestic animals and poultry. Chickens, in particular, are a main intermediary host for Salmonella. In their bodies, the bacteria coexist peacefully. But once people eat contaminated chicken meat, Salmonella, using its impressive defenses, can withstand stomach acid.”

“Once it survives the acid and travels with digested food into the intestines, it immediately finds a perfect breeding ground. The bacteria burrow into cells of the intestinal wall, multiplying like crazy. In just two hours, any cell infected will die. The Salmonella then bursts out, spreads to neighboring cells, and repeats the process, destroying normal tissue and multiplying rapidly.”

Zhou Can had once pored over medical materials to fully understand these mechanisms.

He knew every detail about what happens once Salmonella invades and how the body tries to fight back.

“Salmonella multiplies in the body at an amazing speed. On average, it increases three to four times every hour. If a thousand Salmonella reach the intestine, within seven or eight hours, that number explodes to over a million. After one more hour—about nine hours total—the number can soar past four million. Such a huge bacterial population kills off normal cells in the gut, which triggers the body’s immune responses.”

“As those normal cells die, they give off chemical alarm signals. The immune system picks up these signals and quickly rallies the body’s macrophages to attack the invading bacteria. Macrophages can catch the bacteria and release a deadly fluid to dissolve them.”

Director Shang listened intently, nodding in satisfaction as Zhou Can explained.

He wanted Zhou Can to keep going.

Dr. Yu was equally impressed by Zhou Can’s solid grasp of medicine.

“Normally, most bacteria would be killed by those macrophages. But Salmonella has a secret weapon—it gives off its own chemical signals that make the macrophages completely useless. Or, you might say, it’s like putting on an invisibility cloak so the macrophages are blind to it.”

“When that happens, and the macrophages don’t work, the bacteria get even more aggressive. They keep wreaking havoc and multiplying. As the infection spirals out of control, more and more normal cells die, pumping out stronger alarm signals. The bowels then launch a built-in defense instinct of their own.”

“This reaction is a lot like what you’d see in enteritis. Patients feel nauseous and their stomach hurts. Stomach contents can reflux, causing breathlessness and ultimately severe vomiting that expels some of the Salmonella. At the same time, the intestines move faster, water pools in the colon, and the patient has intense diarrhea, which also helps expel some of the bacteria.”

Everything Zhou Can described matched what the patient in Bed 73 had been through.

“Doctor, if I vomit and have diarrhea, does that mean the illness will go away since I got rid of the germs?”

The patient asked weakly.

“Vomiting and diarrhea are just your body’s way of protecting itself. They get rid of some Salmonella, but there’s no way to clear it out completely. The bacteria keep multiplying, killing off healthy cells. At that point, you’ll start feeling severe abdominal pain—which shows that more and more healthy cells are dying.”

“As dying cells unleash chemical substances, they trigger the body’s third line of defense. Once these chemicals enter the bloodstream, they quickly cause swelling in muscle tissues. That’s when your helper cells sense danger and swarm out to join the fight.”

“But those helper cells can’t kill Salmonella directly, since they’re not cut out for that. Instead, they rush to the blinded macrophages, releasing a special substance that restores their activity and doubles their size. With that boost, the macrophages go into overdrive and secrete toxic compounds to wipe out the Salmonella for good.”

“So, in theory, the human body can destroy Salmonella by itself, with no need for medication. The thing is, that process usually takes two to three days.”

Zhou Can wrapped up his entire explanation of the disease progression and the body’s defense mechanisms.

He looked at Director Shang.

“You’ve only given fluids, not started antibiotics. Are you waiting for the patient’s third-stage immune response to kick in and let his own body destroy the Salmonella?”

Zhou Can had basically figured out Director Shang’s treatment approach.

“Smart!”

Director Shang smiled and nodded, eyes full of approval.

“No medication or surgery in the world compares to a patient’s own immune system when fighting disease. Over ninety percent of illnesses can’t actually be cured by doctors. In the end, it’s the immune system that does the healing.”

Zhou Can had heard of this medical philosophy before.

Anyone studying medicine knows that most diseases can only be cured by the body’s own immune system.

That makes it more effective than any drug.

It’s likely that ancient Chinese medicine practitioners already figured out these secrets.

Traditional medicine often emphasizes the balance of yin and yang.

That’s actually very close in concept to regulating the immune system in modern medicine.

“So, Professor Shang, are you saying my husband doesn’t need medicine and will get better on his own?” The patient’s family didn’t really understand all the technical details, but she got the main idea.

“It’s too early to say for sure. First, we’ll address dehydration and electrolyte imbalance. Then he needs to be carefully observed, kept warm, and get plenty of bed rest. If his own immune system can kill off the Salmonella, that’s ideal. If things get worse or take a turn, I’ll start medication right away. Please don’t worry about that.”

Director Shang set their minds at ease, wanting both patient and family to feel reassured.

Otherwise, with the patient in this condition and the hospital not giving medication, both he and his family would be anxious.

“Dr. Yu, keep a close eye on this patient. If there’s a severe chill or any major symptoms change, report to me immediately.”

Director Shang gave Yu Xin these instructions.

This highlighted how crucial trainees and interns were for attending physicians. If there aren’t enough hands, should the attending follow every patient themselves?

They’re way too busy for that—it just isn’t practical.

Now, with a trainee specifically assigned to watch a patient, the attending is free to care for others.

“And the nursing department, pay extra attention to this patient and help him pull through the next couple of days.”

Director Shang also spoke to the charge nurse.

“Don’t worry, our nursing department will treat this very seriously.” The head nurse wasn’t as authoritative as the chief nurse or director, but her attitude was solid.

She was earnest and respectful.

“Dr. Zhou, come with me to check on the patient in Bed 71.”

Director Shang led Zhou Can over to Bed 71, where he checked the patient’s condition and discussed surgical plans with the family.

Zhou Can listened quietly at the side.

The whole conversation wasn’t long.

The family’s trust in Tuyu Hospital was the key to smooth communication.

After talking, they agreed on Director Shang’s surgical plan right away.

Their exact words were, even if the surgery only lets their father drink a sip of water again, it’s worth it.

Once the family agreed, all that was left was to schedule the operation.

They set the operation for tomorrow morning, with Zhou Can following up.

“I’ll be seeing outpatients at one this afternoon. Dr. Zhou, you can join me at the clinic for some hands-on experience.”

Director Shang’s invitation made it clear that Zhou Can had passed his initial test.

Ever since Zhou Can got his medical license, he’s taken these clinics more seriously.

Following a senior doctor in the outpatient clinic is a huge help—he can learn how to answer all sorts of patient questions and see how to handle different diseases and consults.

“Got it! Thank you, Director Shang!”

Zhou Can beamed with happiness.

All the effort reviewing medical history and developing a surgical plan for the patient in Bed 71 had finally paid off.

Back in the office, as Zhou Can was writing the medical record for Bed 71, a nurse appeared at the door.

“Dr. Zhou, you’ve just been assigned another inpatient: Bed 77!”

Normally, each trainee manages at least six to eight beds.

Some particularly capable trainees handle twenty or even thirty beds. Supervising doctors tend to load trainees with huge workloads, squeezing every bit out of them they can.

They’re not even worried about anything going wrong—just admit the patient and dump them on the trainee for management.

Right now, Zhou Can was doing okay. Including the new patient in Bed 77, he was only in charge of two beds.

He had an unusually light workload.

No one knew how much it’d increase later.

The more beds you manage, the harder your life becomes.

Between dressing changes, writing records, medication orders, and documenting all their cases, you barely have time to breathe or grab a drink.

“I’ll be right there!”

Zhou Can quickly saved the unfinished medical record and hurried to the ward.

The hospital didn’t require the assigned doctor to immediately check in each new patient. It was the attending’s job to assign beds, and after a patient was moved in, the nurse would make sure everything was settled.

Doctors mainly needed to review the case, write orders, monitor reactions to medication, and report any changes.

As long as you keep your patients stable, going to the ward just once a day is fine.

When Zhou Can arrived, he saw a young woman lying in bed, her face pale and eyes red and swollen, looking exhausted. Her worn-out clothes suggested serious poverty and long-term malnutrition.

No family member was at her bedside.

“What’s her diagnosis?”

Zhou Can asked the nurse.

“Stage II gastric wall tumor. It’s not good,” replied a nurse around thirty-five or thirty-six, her face heavy with unspoken sympathy.

You could see how sorry she felt for this patient.

“Her condition’s so serious—how come no family member is around? She’ll need a long hospitalization.”

Gastric tumors have four stages. Stage II means you can’t cure it with surgery alone; you need both surgery and chemo or radiotherapy for much chance of success.

She’d definitely be in the hospital for a while.

But just as Zhou Can finished, the patient burst into tears.

He froze—completely at a loss.

He regretted even asking.

Now he’d made her cry, and that was never a good thing.

He looked helplessly at the nurse for help.

Luckily, he’d earned some respect at the morning meeting, standing out among the other trainees.

The nurse, seeing his plea, stepped in instead of walking away.

She hurried over to comfort the patient: “Miss Luo, we’ve already informed your mother. She’s very worried and will be here soon to stay with you. Don’t be sad—it’s not good for your health, you know? Tumors like these hate a positive attitude. As long as you stay optimistic and cheerful, the cancer grows very slowly. But if you get too sad or anxious, your immunity drops and the tumor spreads faster…”

The nurse was a true professional.

She really knew how to calm people down.

With her encouragement, the patient finally stopped crying, though her mood was still down.

Zhou Can was so rattled, he didn’t dare say anything else.

Instead, he picked up the patient’s chart and started reviewing her case to get up to speed.