Chapter 136: Let Me Try One Last Time

While the wait continues outside the resuscitation room, Evan gets his chance to practice.

Clinical Training Room open.

Another little dark room.

Evan Xu looked around and realized he was already inside the Clinical Training Room.

The system's voice echoed through the hollow room.

Simulated patient ready. All medicinal herbs ready. All emergency equipment ready. Decoction stove and pot ready. Begin treatment.

As the announcement ended, a man suddenly appeared on the bed. Evan had seen this simulated patient many times before.

Only this time, he was in the worst condition yet.

His face was ashen blue. He was drenched in sweat, gasping, almost unconscious. Phlegm rattled in his throat, and his breathing was barely there. His limbs were icy, the cold extending past his elbows and knees. Only his chest retained any warmth. He was down to his last breath.

A textbook case of a patient at death's door.

Evan's breathing grew heavy. He rushed over to take the man's pulse. It already had the ominous sparrow-pecking and roof-leak qualities. There was a blood pressure monitor beside the bed, but it could no longer register a pressure. His heart rate was only 45 beats per minute.^[1]

A medical chart lay on the table. Evan glanced through it, then quickly closed it. There was no time now to review the man's history.

He remembered Dr. Li's teaching: when the wrist pulse could not be relied on, check the Fuyang, Taixi, and Taichong pulses for any remaining sign of life. Evan checked all three. Fortunately, he could still feel them beneath his fingers. Stomach qi had not failed completely; it could still carry the medicine's effect through the body.^[2]

Evan slowly exhaled. “He's trapped in layer upon layer of yin cold. We need to break through that cold and restore yang—batter down the gates and strike like thunder to save his life. Fuzi, 150 g.”

As soon as he spoke, 150 g of fuzi appeared on the table.

“Prepared licorice root, 60 g.” It appeared too.

“Shanzhuyu, 100 g.”

…

Evan tipped all the herbs into the decoction pot, poured in boiling water, set it on the stove, and turned the heat up high.

This was what rapid decoction over high heat meant: boiling water and a fierce boil, to release the medicine's effects quickly enough to save the patient.^[3]

After boiling it hard, Evan quickly ladled out a spoonful of the decoction and poured it back and forth between two bowls to cool it for the patient to swallow.

Once it had cooled a little, he fed it to the man.

Though almost unconscious, the patient still had a basic swallowing reflex.

Minute by minute, Evan worked to save him. The man had taken a third of the batch, but his condition still had not improved…

Simulated patient deceased. Treatment failed.

Evan's expression darkened.

With a patient hanging by a thread like this, no doctor could have much confidence.

Even so, seeing a patient die in front of him was agonizing.

Evan exhaled slowly and pulled himself together. “Again.”

Everything in the room reset, and a new simulated patient took the man's place.

Evan threw himself back into trying to save him.

Treatment failed.

“Again…”

Treatment successful.

“Again.”

Treatment successful.

“Again.”

Treatment failed.

…

Evan practiced relentlessly in the Clinical Training Room. Whether they practiced Chinese or Western medicine, doctors had to hone their skills through treating large numbers of patients.

In other words, doctors learned their craft by treating patients. Why were veteran Chinese medicine doctors so good? Because they had treated so many people.

Why could new medical graduates manage only relatively simple illnesses? For the same reason. Study medicine for three years and you dare to say there is no illness you cannot cure. Practice it for three years and you find there is no prescription you can use.

Evan's own ability had been forged through all those years inside the system.

And why were Chinese medicine doctors in Guangdong generally so good? Much of the credit belonged to the people there: they liked seeking Chinese medical treatment. You had to thank them for that.

Medical skill came from practice. Where people did not like seeking Chinese medical treatment, the overall standard among Chinese medicine doctors would not be very high.^[4]

But Evan still lacked experience with patients this close to death. Dr. Li had several more decades of practice behind him, much of it gained in the countryside.

Later, as the country developed, roads improved, medical insurance expanded, and other policies took effect. Rural people could afford treatment, and many acute and critical cases no longer came to Dr. Li.^[5]

This text was copied without the author's consent from the page where they publish, and reading the source chapter supports the writer.

For now, then, Evan had only a forty percent chance of saving a patient like this.

He had no idea how long he spent in that space. He just kept saving patients, saving patients, brewing medicine, brewing medicine, and trying to save them again.

He was nearly at breaking point. Yet his command of Poge Jiuxin Tang in clinical use kept improving, and the survival rate gradually rose.^[6]

Then the voice sounded again.

Clinical Training Room session ended.

Evan stood there, dazed.

“Ah! That hurts!”

Evan clutched his aching head. This was the drawback of the training room. Practice for too long in one stretch, and returning to the real world was miserable.

“Dr. Xu, what's wrong?” The young Chinese medicine doctors beside him were frightened. They quickly helped him sit down nearby.

The others looked bewildered too. Hadn't he been fine a moment ago? Why was he suddenly unwell?

Leo Cao hurried over. “Evan, what's wrong?”

Evan held his head. His vision kept flickering. Fighting the discomfort, he said, “I'm fine… How's the patient?”

“I don't know. They haven't come out yet.”

Evan slowly let out a breath. “Is there any water?”

“Yes. Yes, of course.” Alex Xu hurried off to get some.

The others watched Evan anxiously.

He drank some water and wiped the cold sweat from his forehead. A little color returned to his pale face, but the pain and fogginess in his head scarcely eased.

“Are you sure you're all right?” Leo asked again.

Evan shook his head. “I'm fine.”

Just then, the doctor and nurses came out of the resuscitation room.

“How is she, Doctor?” Marcus Cao hurried over.

The doctor shook his head.

Marcus went pale. “She's dead?”

Evan's face darkened too.

“No. We brought her back, but her condition warrants a critical-illness notice. She can't be questioned. She can't speak at all. Her pulmonary fibrosis is too severe.

“And… we've tried every measure available, but her condition hasn't improved.”^[7]

“Is there any chance she'll get better?” Marcus asked quickly. “Say, after some treatment—could she cooperate with questioning then?”

“Well…” The doctor looked at David Du.

Du frowned. “Tell him directly. There's no need to keep anything from Captain Cao.”

The doctor nodded and turned back to Marcus. “All right. The outlook is poor. She's not out of danger yet. She's still in a very serious condition. But I'm afraid… she may never wake up. And I think she probably has only a few days. We could transfer her to a higher-level hospital, but I doubt…”

“Damn it!” Marcus swore and stamped his foot.

The doctor knew how important this patient was to the police. He sighed. “I'm sorry. We've done everything we can.”

Everyone's heart sank. They shook their heads and sighed.

Leo felt helpless too. Human ability had its limits. Often, doctors could do little in the face of disease.

In the end, they still hadn't managed to pull her through. Who knew when the accomplices still at large would be caught, or when the trafficked women and children would be found? Every lead had been cut off…

Du's heart sank too. Yet, for some reason, he suddenly looked at Evan.

Even the habitually unsmiling Guo found himself looking at Evan, without knowing why.

Evan raised his hand. He tapped his aching head and, fighting the pain, called out, “Let me try one last time!”

Reader Notes

Reader Notes

1. ↩︎ Sparrow-pecking and roof-leak pulses. These are traditional descriptions of what a pulse feels like beneath the fingers. The first evokes several quick pecks followed by a pause; the second, widely spaced drops from a leaking roof. Classical accounts treat them as grave signs. They are not names for particular ECG rhythms. Here they describe the simulated patient's wrist pulse; the separate figure of 45 beats per minute is the story's heart-rate reading. Sources: Mai Jue Kan Wu — abnormal pulses (in Chinese); WHO — TCM terminology, entry 926.
2. ↩︎ Looking beyond the wrist. Cunkou is the customary wrist area for Chinese pulse diagnosis. Fuyang, Taixi, and Taichong refer here to pulse sites around the foot and ankle; Evan palpates them rather than inserting needles. Stomach qi describes traditional digestive and sustaining functions, not stomach gas. His inference that a remaining pulse means medicine can still act follows Dr. Li's teaching within the novel. The terminology source describes wrist and lower pulse examination, but does not establish this patient's prognosis or certify that entire three-site inference. Source: WHO — TCM terminology, entries 188, 855–856 and 919.
3. ↩︎ The medicines and the fierce boil. Fuzi is an aconite lateral-root medicine; prepared licorice root is zhigancao. Shanzhuyu is Cornus officinalis fruit; the novel calls for its medicinal flesh, shanyurou. The weights are quantities of medicinal materials. “High heat” translates wuhuo. The large amounts and hurried boiling belong to this fictional exercise. Official guidance identifies excessive amounts and insufficient preparation or boiling among causes of aconite poisoning, which can affect the heart. It does not validate the method shown here. The novel supplies no processing grade or boiling duration. Sources: Hong Kong Department of Health — Aconite (in Chinese); HKBU — Shanzhuyu; CMRO — Preparing herbal decoctions.
4. ↩︎ Confidence before experience. The contrast between three years of study and three years of practice echoes Sun Simiao's essay on the skill and integrity of physicians in Beiji Qianjin Yaofang. It warns against assuming that book learning makes medicine easy; it does not literally claim that prescriptions become useless. The narrator extends that argument to Guangdong, a province in southern China, and the opportunities patients give doctors to practice. The regional comparison is the narrator's generalization, rather than a measured ranking established by the cited classical text. Source: Shanxi University of Chinese Medicine — Da Yi Jing Cheng (in Chinese).
5. ↩︎ Changes in rural access to care. Medical insurance here refers to China's arrangements for financing care. Expansion of rural coverage is documented in WHO's account of Chinese health reforms. The passage connects roads, coverage, and greater ability to pay with a change in the cases reaching one rural practitioner. That particular account of Dr. Li's work comes from the novel. The chapter gives neither a date nor an insurance program's name, so none has been supplied in the translation. Source: WHO — Towards universal health coverage: China lessons learned.
6. ↩︎ Poge Jiuxin Tang in the training room. This continues the named decoction proposed in Chapter 134. A Chinese medicine journal account describes its use within a tradition of breaking through yin cold and restoring yang, originally directed at heart failure. That background explains the formula name and Evan's reasoning; it is not evidence for the simulated outcomes. The forty percent starting point and subsequent improvement belong to the story's exercise. No outcome for the real patient has yet been reported. Source: Tianjin University of Traditional Chinese Medicine journal — Formula background, §2.1.3 (in Chinese).
7. ↩︎ A critical-illness notice. A bingwei tongzhishu is a medical document informing a patient's family that the condition is critical. It is not a death certificate. This explains why the doctor can say she has been brought back while still describing a grave outlook. Pulmonary fibrosis is scarring of lung tissue that can severely impair breathing. The prediction about consciousness and the remaining days of life is this doctor's judgment about the fictional patient, not a prognosis that follows from the disease name alone. Sources: Health Ministry — Medical-record writing standards, article 27 (in Chinese); NHLBI — Idiopathic pulmonary fibrosis.