Dr. Xu: A Chinese Medicine Novel

Evan answers Dr. Li’s question about the patient he couldn’t save.

At the question, Evan’s heart grew heavy.

His thoughts went straight back to the past.

He gave a bitter smile. “It was a traffic jam.”

“What?” Dr. Li looked puzzled. “A traffic jam? Are there that many cars in the provincial capital?”

For a moment, Evan didn’t know what to say. Never mind the provincial capital—even Beijing didn’t have traffic jams in this era. There were barely any cars.

Seeing that Evan seemed unable to answer, Dr. Li said, “I haven’t been to the provincial capital in years. I’ve spent so long in the countryside. Perhaps it’s developed a great deal. Go on. I won’t interrupt.”

Evan nodded slightly.

“Perhaps it was fate. They were building the subway, and there were roadworks everywhere. There were three roads to the hospital. Two were under construction.

“On the third, there’d been a serious crash. Two big trucks had collided, spilling their sand and construction debris across the whole road.

“And it happened right at the evening rush hour. That road was badly congested every day as it was. This made it worse. There were also two events in the south of the city—a music festival and an anime festival. The traffic was completely blocked.

“The other two roads were impassable because of the construction. People were trying to get through from both directions. Everything had jammed solid. Nothing could move.

“Even the electric scooters couldn’t get through. The riders went onto the sidewalks. They were so inconsiderate at rush hour that they blocked those too.

“The cars were like stones, and the scooters were like sand, darting about and filling every gap. Every space between two cars was full of scooters. By then, even people on foot couldn’t get through.”

Dr. Li took another puzzled drag on his cigarette. He suddenly felt that he knew very little of the world. What sort of vehicle was an electric scooter? You could ride one? Weren’t bicycles the things you rode? And what kind of festival was an anime festival?

Did people eat dumplings for it?[1]

Evan slowly bent forward, supporting his head with his hands. He looked at the ground. In its darkness, he seemed to see that day’s events reflected before him.

“Perhaps it really was fate. I had the day off. I wasn’t at the hospital. I was visiting my college roommate, and his family’s little Chinese medicine clinic happened to be on that road.

“A woman came running out of a residential compound, carrying her elderly father on her back. She was looking for a doctor. She’d already called an ambulance, but it couldn’t get through. Not even a person could.

“The only medical help nearby was that little clinic. The old man had severe heart failure too. He was dying, drenched in cold sweat that lay on him like oil, gasping for breath. Soon he lost consciousness.[2]

“We couldn’t get a blood pressure reading. His heart rate had fallen to 45. His limbs were icy cold—past the elbows in his arms, past the knees in his legs. Only his chest still held any warmth. He had barely a breath left.

“My roommate’s father and the others had given him Suxiao Jiuxin Wan pills, but there was no improvement. He was getting worse, and the traffic still wasn’t moving.

“My roommate and I had just come down from the loft above the clinic. That was what we walked into. I’d never seen anyone so close to death before. My first thought was that I had to save him. My second was your Poge Jiuxin Tang.”[3]

Evan raised his head with a bleak, self-mocking smile.

“They all tried to talk me out of it. ‘Li Ke can use that formula,’ they said. ‘That doesn’t mean you can. If you fail to save him, you’ll be in serious trouble. Even a Grade A tertiary hospital couldn’t promise to save someone in that condition, let alone a Chinese medicine student who’s only just graduated.’[4]

“But no ambulance or medical worker could get there to help him. His only hope was our little clinic. So I insisted on trying. My roommate supported me.

“I took the risk and used your formula. I started with 80 g of fuzi, boiling it quickly over high heat and giving it as it brewed, hoping to save his life. But it didn’t work. His condition never stabilized.[5]

“It was very late when the traffic finally cleared and the ambulance reached us. By then he was gone. In the end, I couldn’t save him.”

Evan looked up at the stars, his face full of bitterness.

“Afterward, she came to the hospital and made a scene. She grabbed at me, fought with me, shouted abuse. A doctor she knew had told her that fuzi was poisonous and that I’d exceeded the dose.

“Fuzi’s toxicity only drops significantly after an hour of boiling. He’d been at death’s door. I’d boiled it quickly over high heat, when the poison was at its strongest.

“So she thought I’d poisoned her father. He’d already been barely alive. Perhaps, without my medicine, he’d have lasted until the ambulance arrived. After all, he hadn’t been dead long when it got there.”

Evan fell silent, despondent.

Dr. Li smoked slowly. He let out a breath of smoke.

“You didn’t poison him. The medicine was probably what kept him alive that long.”

Evan was taken aback.

Dr. Li flicked the ash from his cigarette.

This was copied from the author’s official story page without consent, while reading the chapter at that page supports the author.

“Your starting dose was simply too low. With someone that close to death, you have to start with at least 150 g. You have to go beyond the usual limits.”

Evan felt a tremor. “Could 150 g have saved him?”

Dr. Li shook his head. “I couldn’t say. With a severely ill patient, I’d be confident. But when someone’s that close to death, even if I’d treated him myself, his chances would have been sixty percent at most.

“People say I’m good with heavy doses, that I’ve saved countless lives. But there are plenty I haven’t saved. Doctors aren’t gods. With someone that close to death, the chances aren’t good no matter who treats him.”

Evan pressed his lips together.

“But if you’d used 150 g of fuzi and still failed to save him, being sent out here to a poor backwater might not have been all that awaited you. You might have…”

Evan’s face tightened.

“Chinese medicine is different from modern medicine,” Dr. Li said. “The pharmacopoeia allows them to go beyond the normal limits with their emergency drugs when they’re trying to save a critically ill patient. Sometimes they can use several times the usual dose. And they have the family sign an agreement.

“But there’s nothing like that for Chinese medicine. No one’s ever considered Chinese medicine in emergency care, so there are no rules like those to protect its practitioners. To save a life, you have to prescribe beyond the limits. And you risk bringing disaster on yourself.”[6]

Evan let out a small breath. “Teacher, how many times in your life have you faced that kind of disaster?”

Dr. Li chuckled. “It’s all… in the past.”

He said it lightly. But Evan felt the weight of those few words.

Dr. Li tossed the cigarette butt to the ground.

“What about you? If you could go back to that day, would you still try to save him? Would you use 150 g of fuzi?”

Evan paused, then nodded solemnly. “I would.”

“City people are educated. They know the law. They won’t let things go easily. If you failed to save him, do you know what you’d face?”

Evan nodded slowly. “I do.”

“And you’d still try?”

“I knew nothing then. I was just a student without any experience. But there was no one else to help him. If I did nothing, he had no chance at all.

“If I gave it everything I had, he might have one chance in ten thousand. I’d still give everything for that one chance, even if it destroyed my future and brought disaster on me.”

Evan looked at Dr. Li in earnest.

“Because I am a doctor! A physician should give everything he has, devote himself wholly to saving the patient, without weighing his own fate or guarding his own life.”[7]

Dr. Li looked at him, deeply moved. “Then I’ve entrusted all I’ve learned to the right person.”

He asked another question. “Didn’t the leaders at your old hospital try to protect you?”

Evan lowered his head.

“Evan, you’ve caused serious trouble. The repercussions have been terrible, and people throughout the hospital are very unhappy with you. But out of regard for Professor He, we’re still willing to protect you. You’ll have to be suspended for a while.”

“Director, dismiss me.”

“Why?”

“You can protect me, but who’ll protect Ryan Yao’s family clinic? I dispensed the medicine. I wrote the prescription. I was the one who insisted on trying to save him. You protect me, suspend me, and I get away. Then she’ll go after them. They can’t bear that. I can’t let them take all of this for me. I caused the trouble. Let me bear all of it myself.”

“Are you sure?”

“I am.”

Evan smiled at the hospital director. It was the only time he smiled in the six dark months that followed.

Reader Notes

Reader Notes

↩︎ A festival with dumplings? Dongman jie names an anime and comics event, but jie is also the ordinary word for a festival or holiday. Dr. Li tries to make sense of the unfamiliar event through celebrations he knows. Dumplings are associated with occasions such as the Lunar New Year. His question is an unspoken joke about the gap between his world and Evan’s, rather than a custom of anime gatherings. Source: Smithsonian Folklife Festival — New Year’s Dumplings.↩︎ Heart failure. This means the heart cannot pump enough blood to meet the body’s needs; it does not by itself mean that the heart has stopped. Evan’s account still gives a heart rate, although the patient is gravely ill. The sweating, cold limbs, loss of consciousness, and unreadable blood pressure are details of his recollection. They do not supply an independently documented clinical record. Source: MedlinePlus — Heart Failure, summary.↩︎ Two different medicines. Suxiao Jiuxin Wan is the name of a manufactured Chinese pill medicine. Poge Jiuxin Tang is Dr. Li’s decoction formula, introduced earlier in the story; tang denotes a decoction, while wan denotes pills. Their names both concern the heart, but the clinic’s use of the first and Evan’s decision to try the second are separate steps. The manufacturer’s listing identifies the pill product; it does not verify the outcome recalled here. Source: Darentang — Suxiao Jiuxin Wan product description (in Chinese).↩︎ Grade A tertiary hospital. Sanjia abbreviates a hospital’s level and assessment grade in China’s hospital system: tertiary level, Grade A. It describes the institution’s classification, rather than a doctor’s rank or the hospital’s public or private ownership. In this exchange, the comparison is to the resources of a major hospital. The grading document explains the classification; it does not establish the patient’s chances of survival. This reference occurs in Evan’s modern recollection. Source: National Health Commission — tertiary hospital assessment rules, opening page (in Chinese).↩︎ Fuzi, dose, and preparation. Fuzi is the aconite lateral-root medicine discussed in the preceding chapters. The gram quantities here concern herbal material, not isolated aconitine. Aconitum alkaloids can cause severe poisoning, including dangerous heart-rhythm disturbances. Processing, preparation, and quantity affect risk; a stated boiling time is not a universal guarantee. The account gives no complete prescription or material specification. The quantities and judgments in the dialogue belong to the story’s account, rather than an independently documented toxicology finding. Sources: Hong Kong Department of Health — aconitum poisoning alert, 16 August 2021; Department of Health — aconitum poisoning investigation, 12 June 2015.↩︎ Pharmacopoeias and protection for practitioners. A pharmacopoeia is an authoritative collection of medicine standards and quality specifications. That function is distinct from establishing every rule about emergency prescribing, consent, or legal responsibility. Dr. Li contrasts the protection he believes the two medical systems receive. The novel identifies no edition or provision for the exemption he describes, and the general source below does not verify it. His remarks belong to the 1981 conversation, while Evan’s recalled accident belongs to his later original timeline. Source: WHO — International Meetings of World Pharmacopoeias, introductory definition.↩︎ A physician’s commitment. Evan’s words echo Sun Simiao’s Dayi Jingcheng, “The Great Physician’s Skill and Sincerity,” in the opening volume of the Qianjin Yaofang. The passage urges wholehearted aid without calculating one’s own good or ill fortune or protecting one’s own life. The novel condenses and rearranges that language, translated here from its Chinese wording. This recalls the ethical teaching of Chapter 92; the classical passage does not establish the safety or effectiveness of a particular prescription. Source: Sun Simiao — Qianjin Yaofang, volume 1, Dayi Jingcheng (in Chinese).