Yang Ping nodded, walked to the desk, picked up the phone, dialed the Neurology Department’s number: "This is Yang Ping, the MRI results for the patient in bed 15 are out, indicating thickened meningitis. I suggest checking ANCA, ACE, antinuclear antibodies, immunoglobulin, complement, HIV, syphilis, tuberculosis T-SPOT. Perform another lumbar puncture to check the cerebrospinal fluid ACE and IgG synthesis rate. If all these are normal, conduct a whole-body PET-CT. The treatment plan is to start with methylprednisolone pulse therapy for three days, followed by oral prednisone."

After hanging up, he turned around and looked at Zhaxi: "From today onwards, you will be responsible for this patient. You need to follow up on all examinations and treatments. If you encounter any issues, feel free to come to me anytime."

Zhaxi nodded vigorously.

The following days, Zhaxi spent almost all his time on this patient. Every morning, he would visit and check the patient’s condition, conduct physical examinations, and record the progress. He reviewed a large amount of literature, studying the causes, pathology, diagnosis, treatment, and prognosis of thickened meningitis thoroughly. He also learned how to read MRI scans for this disease, determining the extent and degree of meningeal enhancement.

The patient’s test results came out one after another: ANCA negative, ACE normal, antinuclear antibodies negative, rheumatoid factor negative, immunoglobulin normal, complement normal, HIV negative, syphilis negative, tuberculosis T-SPOT negative, cerebrospinal fluid ACE normal, IgG synthesis rate normal. All secondary causes were excluded. Finally, a whole-body PET-CT was conducted, but no evidence of tumors or sarcoidosis was found.

Thus, it was idiopathic thickened meningitis.

The treatment effect was excellent, with the patient’s headache significantly alleviated after three days of methylprednisolone pulse therapy. A week later, her blurred vision improved. Two weeks later, the strength in her right limb was restored, and she was able to walk without staggering. Upon discharge, the patient’s fundus check showed that the optic disc edema had receded by more than half. She held Zhaxi’s hand and said, "Thank you, Dr. Zhaxi."

Zhaxi shook his head: "It’s not me, it’s Professor Yang."

The patient smiled and said, "Professor Yang said it was you who made the diagnosis."

Zhaxi was stunned for a moment, then smiled and said nothing.

The Neurology Department Director and the other doctors nearby were also very envious of Zhaxi because he was personally mentored by Professor Yang, and his medical career prospects were considered promising.

In the evening, Zhaxi sat in his dormitory, opened his notebook, and reviewed all the records he had written down over the past two weeks. From the initial confusion when first seeing the medical records, to the anxiety when consulting literature, to the tension when performing the MRI, until the relief upon final diagnosis. The process was akin to solving a case, finding the crucial clue among seemingly unrelated pieces of evidence, then following it step by step until the truth surfaced.

He finally understood why Professor Yang wanted him to be involved in Professor Zhou’s case. It was not about solving the case, but about learning a way of thinking, a method to find order in the chaos, a thinking approach applicable both in solving cases and diagnosing illnesses.

On Friday afternoon, Zhaxi pushed open Professor Yang’s office door with his notebook in hand and found, aside from Yang Ping, another person sitting inside: Director Liu of the Neurology Department, in his fifties, with graying hair, one of the founders of Sanbo Hospital’s Neurology Department. Zhaxi’s heart skipped a beat. Director Liu’s personal presence indicated something significant.

"Sit!" Yang Ping pointed to a chair, and once Zhaxi sat down, he continued, "Director Liu has a patient who wants you to take a look."

Zhaxi was taken aback; wanting him to take a look?

Director Liu noticed his confusion, smiled, and pulled a thick medical record from his document bag, placing it on the table. "Dr. Zhaxi, your diagnosis and treatment of the thickened meningitis patient were quite successful. We discussed it in our department, and your diagnostic approach was very clear, and your literature review was comprehensive. We’ve been struggling with this patient for half a month without figuring it out, and we would like you to take a look." 𝒻𝘳ℯℯ𝑤ℯ𝒷𝘯ℴ𝓋ℯ𝘭.𝑐ℴ𝑚

Zhaxi’s face flushed instantly, as he was merely an intern, while Director Liu was a PhD advisor, a prominent figure in the field.

He opened his mouth, intending to say something, but Yang Ping raised his hand to stop him.

"Don’t be too modest," Yang Ping’s tone was calm, "Since Director Liu is giving you a chance to practice, go ahead and take a look. If you can diagnose the issue, that’s best; if not, treat it as a learning experience."

"I’ve already informed the physician in charge. You can contact him directly, assist him with patient care, and you’re welcome to visit the Neurology Department anytime to interact with the patient and review the medical records." Director Liu was perceptive and since Professor Yang held Dr. Zhaxi in such high regard, he felt it appropriate to do him a favor by giving Zhaxi another challenging case for practice.

Zhaxi, no longer holding back, accepted the medical record. The patient was a thirty-five-year-old male, a local from Nandu, and a programmer. Chief complaint: recurrent fever, joint pain, and rash for half a year, worsening with altered consciousness for one week. He continued reading. The admission record stated that the patient began experiencing recurrent fever half a year ago, with temperatures ranging from thirty-eight to thirty-nine degrees, with no clear pattern. He also experienced symmetrical pain in his limbs’ joints, mainly the wrists, knees, and ankles, exacerbated during activities. Additionally, red rashes appeared repeatedly on his body, which weren’t itchy, and would fade within days only to reappear again after some time. He had been examined at multiple hospitals, with blood counts, liver and kidney function tests, rheumatism assessments, and autoantibodies all showing no significant abnormalities. Diagnosed with "undifferentiated arthritis," he had used non-steroidal anti-inflammatory drugs with poor effects. A week ago, he suddenly developed altered consciousness, spouting nonsense and sometimes failing to recognize family members, prompting relatives to send him to Sanbo Hospital’s Neurology Department.