Chapter 85 A Truly Critical Case

A hospital lobby in another time brings Evan face to face with a question he has never been able to answer.

Lingshi County Hospital, Shanxi. 1981. 7 p.m.

Evan looked around, bewildered. He was in a hospital lobby, but this wasn't Xiyuan Hospital in Beijing. It was the county hospital in Lingshi.

He had gone back into the past again.

He looked about him with a mixture of confusion and curiosity. He had only just arrived, and the sight before him had left him too startled to take it in.

A shout soon broke through his bewilderment.

“Move! Out of the way! Move!” A group of people burst in, shouting as they pushed a wheeled bed.

“Where's a doctor? A doctor! Help! Please, help!”

Evan stared at the patient on the bed. His own breathing grew heavier, his expression dazed. He had treated emergencies before, but none of them had been truly critical. He had seen a patient this close to death only twice.

The first time, he had been fired for trying to save a life.

The second time was now.

The man's face was a ghastly blue-gray, like a demon's. His lips and fingernails were blue-purple.

Sweat poured from his whole body without stopping.

He gasped desperately, unable to get enough air. His hand clutched his chest as though he were trying to crush his own heart through it.

His face was horribly contorted with pain. It was as though something demonic had entered his body, twisting him into this horrible shape, making him look as if he were already in hell.

Watching him, Evan stopped breathing for an instant.

“The doctors are here! They're here!” someone shouted.

Several doctors in white coats hurried over, asking questions and beginning their emergency assessment.

Evan remained rooted to the spot, frightened and dazed. Once again, he seemed to see the old man lying on the ground. He, too, had been dying like this, plunged into hell, tormented as though by a demon…

“Someone save my dad! Please, I'm begging you! Please save him!”

“You killed my father! You! You butcher in a white coat! You!”

Evan's face turned deathly pale. In an instant, cold sweat soaked his clothes.

It had been a long time since he had last seen that frenzied woman screaming at him in his mind.

Until now.

After that incident, he had asked himself countless times: if another patient lay dying in front of him, would he still rush forward, whatever it cost?

He had never been able to give himself a definite answer. Since then, he had never encountered another patient like that.

Until now.

“Move!” Evan shouted, and rushed forward again.

He never even considered whether he should try, whether he dared, or what trouble he might face if he failed to save the man.

Once again, he went straight to the patient, regardless of everything else.

He seized the man's hand. Both hands were icy, the cold extending beyond the wrists. He felt the feet next. They were just as cold, past the ankles.

Evan pried the patient's mouth open to examine his tongue. Streaks and patches of bruising marked the tip and edges, and the coating was gray, thick, and greasy. He took the pulse. It was extraordinarily large.

This was bad: yin deficiency with a sudden collapse of yang.^[1]

The signs of a critical emergency, of a man close to death.

Beside him, a doctor hurriedly questioned the family.

“My… my dad was diagnosed with coronary heart disease just over a month ago,” a family member stammered. “Then at two this afternoon, his chest suddenly started hurting terribly. He held nitroglycerin in his mouth.

“It helped a little. Then at six, the pain suddenly came back. He tried nitroglycerin again, but it didn't help. Then he used amyl nitrite, and it still hurt terribly. It just kept getting worse.^[2]

“We could see how bad it was, so we brought him straight here. Doctor, you have to save him! Please, you have to save my dad!” The pleas went on and on.

In Chinese medicine, acute myocardial infarction fell within the category of zhen xintong, “true Heart pain.” The Neijing said that if it struck in the morning, the patient would be dead by evening.^[3]

The doctors receiving the patient all looked alarmed.

“Damn, it's an acute myocardial infarction. You can see how serious it is. Could the infarction be complete? Should we take him for tests right away?” one of the younger doctors asked an older colleague.

“To hell with tests!” the older doctor snapped. “Get someone from Chinese medicine!”

“What?” The younger man was taken aback.

“What are you standing there for? Get Director Li Ke from the Chinese medicine department! Now!”

“Right! Yes!” The young doctor hurried away.

At that moment, a scene so absurd it was almost eerie was unfolding in this county hospital. They were dealing with an acute myocardial infarction, one of the most unmistakably critical emergencies.

Yet here, in a general hospital, faced with a man dying of a heart attack, these two doctors trained in Western medicine had immediately called in a Chinese medicine doctor to save him.

It was something that could never happen in any other general hospital in the country.

In nearly a century since Republican times, when had emergency care ever been entrusted to Chinese medicine?^[4]

Yet here it was happening.

And everyone took it for granted. Not just the Western medicine doctors—even the patient's family seemed to think it was exactly what should be done.

Evan had finished taking the pulse and heard the family's account.

He rose quickly. The dispensary was right beside them. He rushed over, shouting, “Purified musk, 0.5, and bingpian, 0.05 g, mixed with liquid for him to swallow. Then five Suxiao Jiuxin Wan pills and one Suhexiang Wan pill.

NovelPhoenix publishes the author's chapter for readers, while this version was reproduced without their permission.

“Quick! And give me a few filiform needles!”^[5]

He took the needles and hurried back.

“Evan, what are you doing?” the older Western medicine doctor asked.

“Saving his life!”

That was all Evan said. He crouched and began needling, first applying strong stimulation at Suliao and the left Zhongchong point. Then he lifted, thrust, and rotated a needle at Neiguan on the patient's left arm, using strong stimulation.^[6]

“The medicine! Here it is!” The woman from the dispensary hurried over.

“Get it into him, quick!” Evan shouted.

For that moment, he seemed to have become the head of the emergency department, the one giving all the orders.

The family didn't hesitate. Someone was trying to save their father; they couldn't just stand there. They quickly propped him up and poured the small mouthful of medicine into his mouth.

Still rotating, lifting, and thrusting the needle, Evan said, “Now the Suxiao Jiuxin Wan and the Suhexiang Wan. Have him hold them in his mouth.” He quickly put the pills into the patient's mouth.

He continued the acupuncture. Nothing worked faster in an emergency. This patient was just as critically ill, just as close to death. But Evan was different now. He was no longer the university student he had been then.

Only now did a family member ask the Western medicine doctor, “Doctor, who is this young doctor?”

“From the Chinese medicine department,” the older man replied.

“Oh.” The family member was a little reassured, then asked anxiously, “Is Director Li here yet?”

“Here he comes!”

They all looked over.

A thin, wiry middle-aged man was hurrying toward them, his face grave. He wasn't tall or imposing, yet as he ran over, an invisible force seemed to come with him, as though he were a giant, a god.

“Director Li's here!”

“Dr. Li Ke! Thank goodness!” The family grew excited.

A group of doctors followed him. As he hurried over, Dr. Li was already calling out, “Purified musk, 0.5 g. Bingpian, 0.05 g. Mix them with liquid for him to swallow. Five Suxiao Jiuxin Wan pills and one Suhexiang Wan pill, to be held in the mouth.”

He reached the bed. “Already given? Oh? Using acupuncture to save him?”

Only then did his attention turn to Evan.

“Director Li, Dr. Xu's already given him those medicines,” the woman from the dispensary said. “Exactly the ones you just named.”

Dr. Li nodded slowly and looked at Evan's needling technique. Since his arrival, Evan hadn't turned his head toward him even once. He was concentrating on the needle, glancing at the patient from time to time.

Watching him, Dr. Li gave another slow nod.

He took the patient's other hand and began examining the pulse. On the way over, the younger doctor had already given him a full account of the case.

Five minutes had passed since Evan began treating the man with both needles and medicine. The patient's condition had already improved considerably. The chest pain had eased, and his face was no longer so horribly contorted.

Dr. Li nodded again. Evan's emergency treatment had bought him precious time to differentiate the pattern and decide on treatment. He looked once more at the way Evan was handling the needle, nodded, and continued his assessment.

Another five minutes passed. Evan had now been treating the patient for ten minutes. The man was much better, and the true Heart pain had stopped. He was still gasping and drenched in sweat. His other symptoms were unchanged, but his face was no longer contorted and his chest no longer hurt.

Evan let out a small breath of relief.

The family was excited too. “It's stopped hurting! Dad, does it still hurt?”

Evan knew these measures had only kept the man alive for the moment. He was not out of danger. His life still hung by a thread.

By now, Dr. Li had finished his assessment.

He looked at the patient, nodded slightly, and said, “Write the prescription.”

A young junior doctor already had pen and paper ready.

“The patient shows every sign of yang collapse with cold extremities and loss of vital function,” Dr. Li dictated. “A modified Poge Jiuxin Tang. Fuzi, 150 g…”^[7]

The dispensary woman's expression froze. “That needs the hospital director's signature!”

“Someone's already gone to get the director,” another person said.

Evan had finished the needling. Drained, he sat on the floor. He turned toward Dr. Li, but all he could see was a pair of feet.

Slowly, Evan raised his head. At last, he saw him…

Reader Notes

Reader Notes

1. ↩︎ Yin deficiency and yang collapse. In traditional theory, yin includes nourishing fluids, while yang is associated with warming and sustaining activity. Yang collapse names a critical failure of those functions; it is more severe than an ordinary deficiency pattern. Evan is interpreting a combination of tongue, pulse, sweating, and cold limbs. His unusually large pulse finding is retained as written, rather than changed to match a textbook example. This traditional assessment is distinct from the biomedical diagnosis discussed next. Source: WHO — Standard TCM terminologies, entries 414–415, 894, and 1093–1103.
2. ↩︎ Two medicines in the family's account. Nitroglycerin and amyl nitrite are different substances associated with relief of angina, the chest pain caused by inadequate blood supply to the heart. Nitroglycerin is described here as held in the mouth; amyl nitrite is historically an inhaled preparation, although the family does not specify how it was used. The account gives a sequence of attempted relief, without supplying doses or establishing the diagnosis through the response. Sources: DailyMed — Nitroglycerin, indications and usage; DailyMed — Amyl nitrite inhalant, description and indications.
3. ↩︎ “True Heart pain.” Zhen xintong is a traditional category of severe pain associated with grave signs. The Neijing passage is in the Lingshu's chapter “Jue Bing,” which describes intense pain and cold extremities, followed by a stark prognosis about death within the day. The novel applies that category to an acute myocardial infarction, or heart attack. The ancient description predates modern diagnostic categories; its language does not establish a fixed survival time for every heart attack. Source: Chinese Text Project — Lingshu, “Jue Bing” (in Chinese), zhen xintong passage.
4. ↩︎ Republican times and hospital roles. The Republic of China was established in 1912. The narration's “nearly a century” and its sweeping statement about other hospitals are retained from the Chinese text, rather than treated as a verified chronology or survey of emergency practice. Here “Director Li” means the head of the Chinese medicine department. The hospital director mentioned later holds a different role. These titles describe positions within this Chinese hospital. Source: National Museum of China — The provisional government's army organization orders (in Chinese), historical introduction.
5. ↩︎ Musk, bingpian, and the two pill preparations. Shexiang is the medicinal material rendered “musk”; bingpian is associated with borneol preparations, rather than literal pieces of ice. Suxiao Jiuxin Wan and Suhexiang Wan are two distinct named medicines; wan denotes a pill preparation. Chongfu means mixing the material with liquid for swallowing, unlike holding pills in the mouth. Evan's first “0.5” has no stated unit in the Chinese. Dr. Li later specifies 0.5 g. The narrative leaves the materials' precise natural or synthetic origins unspecified. These names identify the story's medicines, without verifying the rescue regimen. Sources: HKBU — Shexiang (in Chinese); HKBU — Suhexiang Wan (in Chinese); HKBU — Bingpian (in Chinese); Jinyao Darentang — Suxiao Jiuxin Wan history (in Chinese).
6. ↩︎ Point names and needle movements. Suliao, Zhongchong, and Neiguan are acupuncture point names. The text specifies the left side for Zhongchong and Neiguan. Filiform needles are slender acupuncture needles, and lifting and thrusting refers to movement along the needle's axis; rotating is a separate manipulation. These distinctions preserve what Evan actually does. The subsequent claim that acupuncture acts fastest belongs to the novel's narration. A terminology standard defines the techniques, without establishing that comparison or the effectiveness of this emergency treatment. Source: WHO — Standard TCM terminologies, entries 3012 and 3032–3033.
7. ↩︎ The interrupted prescription. Poge Jiuxin Tang is a named formula; tang indicates a decoction. Dr. Li specifies a modified version, but the chapter stops listing ingredients after fuzi, an aconite lateral-root medicine. Aconite alkaloids can cause serious poisoning, including disturbances of heart rhythm. Processing and preparation matter, yet this passage does not supply those details or the rest of the prescription. The 150 g figure and the demand for the hospital director's signature are preserved as parts of the scene, without establishing a generally safe dose or a universal hospital rule. Source: Hong Kong Department of Health — Safe use of Chinese medicines containing aconitum alkaloids (in Chinese).