Dr. Xu: A Chinese Medicine Novel

The rescue has left Evan with more than exhaustion. His questions about Dr. Li will have to wait.

Evan had once tried to save a dying patient, and the attempt had cost him everything. He had fallen from a promising future into the mud. His life had all but been ruined.

Afterward, everyone had blamed him. He should have minded his own business, they said. Above all, he should never have used a Chinese herbal prescription in an emergency. Since when was emergency medicine any business of Chinese medicine?

Yet here, right before his eyes, a critically ill patient had been brought out of danger and discharged in just ten hours.

The man had received Chinese medicine alone.

Evan wanted to tell every one of those people: Who the fuck said Chinese medicine couldn’t treat acute and critical illness?

Overwhelmed, he felt his eyes sting even more.

Dr. Li came out after giving his instructions. Seeing Evan like that, he looked at him curiously.

“What’s wrong? Did it frighten you?”

Evan hurriedly rubbed his eyes. “No. I’m just a little excited.”

Dr. Li nodded. “You did well.”

Then he turned and left.

The young Chinese medicine doctor beside Evan waggled his eyebrows. “Well, that’s rare. The director actually praised you.”

“Doesn’t he usually praise people?” Evan asked.

“Praise people? Unless it’s about treating patients or medicine, he hardly says a word.”

“Why?”

The young doctor leaned closer and lowered his voice. “Anyone who talks to our director gets into trouble. The more he says, the more there is to find fault with. So he’d rather say nothing.”

Evan gave a quiet sigh.

The young doctor waggled his eyebrows again. “Evan, I’ll tell you another secret.”

“What?”

He glanced around, then whispered, “Our director’s afraid of his wife!”

He tried to hold back his laughter.

Evan was speechless. “Why are you so bagua?”

The young doctor looked taken aback. “Bagua? You study that old feudal superstition?”

Evan rolled his eyes. He couldn’t be bothered to answer.[1]

The young doctor kept following him around, talking and talking.

What Evan hadn’t expected was that this gossip would be his roommate. The two of them had to sleep in the same room. What a pain in the ass.

After working through a day and a night, Evan was exhausted too.

But he couldn’t sleep. He kept thinking about the patient, and about Dr. Li.

As Western medicine had come to dominate in modern times, Chinese medicine had gradually lost its place in emergency care, and in critical care as well. Look at any hospital in the country: where were the Chinese medicine doctors in its emergency department? Where were they in its ICU?

For a time, people had thought Chinese medicine could no longer treat disease at all. All it could do was help people keep themselves well.

Even Chinese medicine doctors had begun to think they weren’t up to the job.

For a long time, the profession had decided to emphasize its strengths in chronic illness and treating disease before it arose. With conditions such as diabetes and high blood pressure, Western medicine usually meant taking drugs for life. Even then, poor control could still lead to serious illness.

Chinese medicine, on the other hand, often had an advantage in these chronic conditions. For years, its practitioners had poured their efforts into chronic illness, preventive treatment, and stopping disease before it took hold.[2]

Of course, some had argued that Chinese medicine should also take part in treating acute and critical illness. Countless others within the profession had objected. That was Western medicine’s strength. Why pit your weakness against its strength? Chronic illness was where Chinese medicine excelled.

That refrain had continued until the sudden emergence of the veteran physician Li Ke. This was a man people called a “walking ICU.”

Deng Tietao, a National Master of Chinese Medicine from the Lingnan medical tradition, had hailed him as “the backbone of Chinese medicine.” Zhu Liangchun, another National Master, from the Menghe tradition and based in Nantong, Jiangsu, had gone further: “The foremost physician of acute and critical illness in Chinese medicine in the thousand years since Zhongjing!”

The foremost in a thousand years!

Yet sadly… Dr. Li’s emergence had not… greatly changed the state of the profession.[3]

…

It was after three in the morning, and Evan still couldn’t sleep. After tossing and turning, he got up to use the toilet. It was a communal one outside the dormitory.

He had been here for two days. He had taken part in treating a critically ill patient and met Dr. Li. But he still hadn’t worked out how to study under him, or how to ask the questions that troubled him.

Dr. Li put on no airs and was easygoing, yet Evan always felt a barrier between him and the rest of them. He couldn’t quite reach him.

Evan finished urinating, gave himself a shake, and went out.

As he left the communal toilet, someone came pounding down the stairs.

A small provenance note: this page copied the chapter without the author’s permission. The author’s publishing page carries the published version.

It was Dr. Li.

Evan froze.

Dr. Li paused at the sight of him too.

He looked Evan up and down. Before Evan could react, he called, “Wake the hospital director. We need his signature. Now!”

Evan sucked in a breath. Something serious had happened again!

He rushed to his room, kicked the door open, and dragged his sleeping, gossiping roommate out of bed.

The young doctor woke with a start and landed on his backside on the floor. “What is it? An earthquake?”

“Bullshit! Go and wake the director. We need his signature. It’s a critical case!”

The young doctor understood at last and scrambled up.

Evan snatched his jacket and trousers off the bed. There wasn’t even time to put his trousers on. He ran out carrying his clothes.

His roommate had meant to get dressed, but when he saw Evan rush out like that, he gave up on it.

He went to knock on the director’s door wearing only his shorts.

This was now routine at the county hospital. Whenever an acute or critical case was beyond the Western medicine doctors, they sent for Dr. Li to save the patient and for the hospital director to sign the prescription.

Evan stumbled along, pulling on his jacket and trousers as he ran. When he burst into the treatment room, Dr. Li had already begun his examination.

Evan hurried to look at the patient too.

It was now four in the morning. The man was about sixty, unconscious and receiving oxygen. His face was ashen; his lips and fingernails were bluish purple.

Dr. Li opened the man’s mouth to examine his tongue. Evan looked too. The tongue had also turned a dull, ashen purple.

His heart sank.

He crouched beside the patient and touched the cold sweat pouring from his forehead. It felt like oil. Sweat like oil!

The man’s eyes were closed, his mouth open. Phlegm rattled in his throat. The breath from his mouth and nose was cold, without a trace of warmth. There was scarcely any breathing left, only the faintest thread.

Dr. Li felt his hands and feet. “The cold extends beyond his elbows and above his knees.”

Evan went still.

At least the previous heart attack patient had only had icy hands and feet. This man’s cold extended beyond his elbows and knees. Even the breath from his nose and mouth was terribly cold, and almost no air was moving in or out.

Dr. Li pressed a finger into the man’s leg. It sank deep, and the flesh failed to spring back, as though he had pressed it into mud.

“Both legs are so swollen the flesh is like mud.”

Looking again, Evan saw that the man had soiled himself. He had lost control of both his bladder and his bowels.[4]

A Western medicine doctor stood beside them. “Director Li, we can’t get a blood pressure reading.”

Evan’s face was grave.

“He has obstructive emphysema,” the doctor said. “For ten years he’s had compensated cor pulmonale. This episode began a week ago. The city hospital tried to save him for six days without success and issued a notice that he was critically ill.

“His family carried him home to prepare for his funeral. Around midnight, he suddenly began gasping violently, with phlegm blocking his throat, and lost consciousness. They thought he’d die quickly, but he struggled on for four hours.

“They couldn’t bear to see him suffer any longer, so they brought him here at four this morning as a last hope. Our initial assessment is heart failure due to cor pulmonale, with respiratory failure and a cerebral crisis.”[5]

Normally there would have been no need to give such a detailed account. But this doctor had worked with Dr. Li for several years. He knew that information they considered unimportant could be crucial to him, so he always gave as much detail as possible.

The patient’s family sat quietly to one side. They didn’t urge Dr. Li to hurry. In truth, they had already given up. They had brought the old man in for one final attempt because they couldn’t bear to watch him suffer like this.

They no longer expected anyone to save him. Bringing him to the hospital was for their own peace of mind, so that they wouldn’t look back on this and regret it.

Evan’s heart sank as he listened. Six days of emergency treatment in the city hospital, and the man was still critically ill. His family had had no choice but to carry him home to die. This was a patient modern medicine had given up trying to save!

He was truly dying now, with only one last breath left.

And he had been placed in Dr. Li’s hands.

If the previous heart attack patient had had one foot through the gates of death, this old man’s whole body was already inside. Only one foot remained outside.

Reader Notes

Reader Notes

↩︎ Bagua: trigrams and gossip. Bagua refers to the eight trigrams of the Chinese Book of Changes. In colloquial modern Chinese, the same word can mean gossip or being nosy about other people’s affairs. Evan uses the colloquial sense; his roommate understands the older one. Keeping the Chinese word preserves their misunderstanding. The exchange belongs to the novel’s contrast between Evan’s language and the historical setting, without fixing a precise date for the slang’s origin. Source: Taiwan Ministry of Education — 2021 Chinese-language teaching certification examination, linguistics paper (in Chinese).↩︎ Treating disease before it arises. Zhi wei bing is a traditional preventive-care principle. It includes preventing illness before it appears and, once illness has developed, trying to prevent its progression or complications; later descriptions also discuss preventing recurrence during recovery. Here the phrase helps explain the professional debate over chronic care and emergency care. The passage’s comparisons between Chinese and Western medicine express the novel’s argument; defining this principle does not establish comparative treatment results for diabetes, hypertension, or critical illness. Source: Tianjin University of Traditional Chinese Medicine journal — Interview on zhi wei bing, introductory discussion (in Chinese).↩︎ Regional traditions and later honors. Lingnan refers to the southern Chinese regional tradition associated here with Guangdong; Menghe is a medical lineage associated with Jiangsu. Neither is a religious sect. Deng Tietao and Zhu Liangchun were real physicians. “National Master of Chinese Medicine” is an official honor first awarded in 2009, so the narration looks beyond the scene’s 1981 setting. Zhongjing refers to Zhang Zhongjing, the classical physician discussed earlier. The praise of Li Ke is reported by the novel; these background sources do not authenticate the quotations or establish the ranking. Sources: He Jianhua — The Tradition of External Treatment in Lingnan Medicine, p. 62 (in Chinese); Guangzhou University of Chinese Medicine — Deng Tietao’s 2009 honor (in Chinese); Nanjing University of Chinese Medicine Museum — Zhu Liangchun and his Menghe training (in Chinese).↩︎ The dent left by pressure. Edema means swelling from fluid accumulating in tissues. With pitting edema, pressure leaves a depression that takes time to refill. This explains why the flesh here fails to spring back after Dr. Li presses it. “Like mud” describes the severity and softness of the swelling in the source; it does not by itself say that the skin is ulcerated or the tissue has decayed. The incontinence is a separate observation, not a definition of edema. Source: Cleveland Clinic — Pitting Edema.↩︎ Lung disease, heart strain, and respiratory failure. Emphysema damages the lung’s air sacs. Cor pulmonale involves right-heart changes caused by lung disease and raised pressure in the lung circulation; it can progress to heart failure with swelling. “Compensated” describes an earlier period when the heart could still meet the body’s needs. Respiratory failure involves inadequate oxygen exchange or carbon-dioxide removal and can affect consciousness. The doctor’s “cerebral crisis” preserves the source’s broad wording; the chapter supplies no blood gases, imaging, or more specific neurological diagnosis. Sources: NICE — COPD evidence review, p. 6; NHLBI — COPD; NHLBI — Respiratory Failure; NHLBI — Symptoms.