Chapter 90 No Free Meals, Old Man

A distant house call takes Evan into the mountains, where Dr. Li has a question for him.

Lingshi was the narrowest county town in Shanxi. High mountains hemmed it in on both sides, with the Fen River running between them. There was scarcely a patch of level ground in the whole town.

The village they were visiting lay deep in the mountains. They set off on bicycles, jolting over such a rough road that Evan's backside was swollen and sore by the time they finally reached the foot of the mountain.

They found somewhere to hide their bicycles and began climbing on foot. Dr. Li was already middle-aged, but he moved so quickly along the mountain path that Evan, young as he was, could not keep up.

Before long, Evan was gasping for breath.

Dr. Li was still walking with ease. “You young people need more exercise,” he teased.

“Yes, sir.” Evan panted. “Do you walk these paths often?”

“I do.” Dr. Li walked on ahead. “Lingshi is all mountains. I don't walk nearly as much now that I work at the county hospital. When I was a barefoot doctor, I was on mountain paths every day.^[1]

“People would often wake me in the middle of the night, and off I'd go over the ridges under a sky full of stars to see someone. You couldn't even see the path. After a while, I learned to walk these mountains with my eyes shut.

“But this weather is easy enough. Heavy rain is what you dread. The paths get so slippery that one wrong step can send you down the mountainside. And when it snows heavily, the mountains are covered. Walking is like skating.”

“Didn't you fall all the time?” Evan asked, still panting behind him.

Dr. Li smiled. “Oh, I fell. Plenty of times. I'd often come home from a call with my clothes torn and bruises all over me. Then my wife would give me a scolding.”

He shook his head. “What else could I do? If someone comes looking for you in the middle of the night, the illness must be serious. Farmers are too poor to see a doctor for anything minor. By the time they do, it's an emergency. If they come at that hour and ask you to cross the mountains, you know it's very serious indeed. I might take a few falls. They're waiting for someone to save a life.”

Evan felt a surge of respect. For years, Dr. Li had crossed these mountains, saving lives in the scattered villages. Outsiders had no idea what it cost him.

In those days, the people who could afford to see a doctor were those whose work units reimbursed their medical bills. Farmers could barely get enough to eat. If they fell ill, they endured it until they could endure no more. Only then did they think of calling a doctor.^[2]

So by the time doctors like Dr. Li saw them, they were already critically ill.

It was different in the cities. Ambulances took critical patients straight to hospitals; doctors of Chinese medicine never got a chance to treat them. An open-minded doctor trained in Western medicine might request a Chinese medicine consultation, but that was all—a consultation.

In the countryside, many doctors of Chinese medicine dealt with critical illness day in, day out. They had no other option. They had to do what they could with Chinese medicine.

That experience had produced a number of doctors highly skilled at treating medical emergencies. Dr. Li was one of them, and one of the best known.

As he climbed ahead, Dr. Li suddenly asked, “Evan, do you really want to study medicine with me?”

Evan was taken aback, then answered at once. “Of course I do!”

Dr. Li did not turn around. “I've had a hard life. I've been imprisoned twice, and my name still hasn't been cleared. I've got black marks against my name and scars all over me. I haven't been a fortunate man.^[3]

“I never apprenticed to anyone. In those years, people heard the name Li Ke and shunned me as though I were the god of plague. I taught myself Chinese medicine. Plenty of other practitioners call my methods unorthodox. Would you still want to learn from me?”

Evan nodded earnestly. “I would!”

“My doses are often more than ten times those in the pharmacopoeia, sometimes several dozen times. Do you know what that means?”

“Save the patient, lose your license. Fail to save them, go to prison.”^[4]

Dr. Li stopped abruptly and turned, staring intently at Evan. “Aren't you afraid?”

Evan was taken aback. Then he said firmly, “Of course I'm afraid. But I know you're the one who's right!”

Dr. Li looked startled too. “You think I'm right?”

Evan nodded.

Dr. Li chuckled. “Everyone says I break with accepted practice and prescribe dangerously. And you think I'm right?”

“Because I know you're someone who truly understands Zhongjing's formulas.”^[5]

This time, Dr. Li was genuinely surprised. He looked Evan up and down several times. His lips moved as though he wanted to say something, but he held it back.

“Let's get going,” was all he said.

Evan nodded.

They set off again, keeping up a brisk pace. It was past noon when, after crossing ridge after ridge, they finally reached the village hidden deep in the mountains.

Dr. Li greeted the villagers with easy familiarity.

The patient's family led him to her room.

One look was enough. Another critical case!

Evan let out a heavy breath. Back in the city, he had seldom encountered a medical emergency. Here in the countryside of the early eighties, he saw critical cases every few days. It was opening his eyes.

The author's official posting contains this chapter, but the copy here was taken without their permission.

They went into the room.

A middle-aged woman lay on her side on the bed, vomiting repeatedly.

“Evan, examine her,” Dr. Li said.

“Yes, sir.”

Evan went over. The woman was bringing up foul-smelling, sticky fluid mixed with feces.

She lay groaning in pain, cold sweat running ceaselessly from her forehead. Her right leg was bent; she dared not straighten it even a little.

Evan lifted her clothing. Over the appendix in her lower abdomen was a raised lump the size of a steamed bun. It was red and swollen. Even the lightest touch caused her terrible pain.

He laid his hand over it. It felt burning hot, with a wave-like sensation—bursts of searing heat, one after another. Her belly was swollen round as a jar, and she had bouts of colicky pain.

Frowning, Evan felt her forehead. She was clearly feverish, yet despite the high fever she kept shivering, her teeth chattering with cold.

He opened her mouth to look. Her breath was foul, and her tongue was black, dry, and covered with prickles.

From the outward signs alone, Evan could tell that this was severe appendicitis: an intestinal abscess in which pus had already formed. It was very serious. He had treated appendicitis before, but the stubborn old man's illness seemed almost trivial beside this. At least that old man had still had the strength and spirit to argue!^[6]

Meanwhile, Dr. Li was questioning the family.

“She's been in pain for five days! She can hardly stop vomiting—even her own stool's coming up. She's in a terrible state. We didn't know what else to do, so we sent for you. Li Ke, my friend, please—you have to help my wife!” the man pleaded.

A gray-haired old man was pacing nearby with his hands behind his back.

“There's no reasoning with this family,” he said irritably. “It's obviously an appendiceal abscess with intestinal obstruction. She hasn't passed stool in three days. Not even gas. Her temperature's up to 40°C.

“I gave her penicillin, but it didn't help. She needs surgery. They just won't listen. Keep delaying and her appendix will perforate. Then it'll be peritonitis, and she'll die.

“She has to go to the county hospital for an operation. Even our township clinic can't treat this. But they won't listen. They've sent for Li Ke, as though that will help. It won't. She needs surgery!”

He was the village's barefoot doctor.

“Why haven't you taken her for surgery?” Dr. Li asked.

The man was a middle-aged farmer, his face and skin rough and dark from the sun. Ordinarily an open, cheerful sort, he was now blushing beneath his dark complexion. He clutched the ragged hem of his shirt.

“My wife, she… she's afraid to have an operation. And… and…”

Dr. Li sighed softly. He had seen this many times before.

“This isn't a question of being afraid,” the barefoot doctor said. “Calling Li Ke is a waste of time. It's an acute abdomen—an appendiceal abscess and intestinal obstruction. Either one calls for surgery, let alone both.^[7]

“Chinese medicine won't help with this. I've studied it too. I know how to dig medicinal herbs in the mountains. But Chinese medicine can't treat an acute abdomen!”

Evan had finished examining her. He stood up.

“Who says Chinese medicine can't treat an acute abdomen?”

The barefoot doctor was an older man with standing in the village. He was immediately offended that a youngster would challenge him.

“You can treat her, can you? If you can, I'll eat this table!”

Evan gave an exasperated laugh. “Trying to scrounge a free meal, old man?”

Reader Notes

Reader Notes

1. ↩︎ Barefoot doctors. This was a name for community health workers in rural China, often farmers who received short medical training and continued agricultural work alongside basic health care. It did not mean they treated patients without shoes. Their work could combine Chinese and Western medicine; the title alone says neither which system a practitioner favored nor how much experience he had. Here, Dr. Li is recalling an earlier stage of his working life. Source: WHO Bulletin — China's village doctors take great strides.
2. ↩︎ Work units and medical costs. A work unit, or danwei, was an employing organization through which some workers received welfare benefits as well as wages. Government and state-enterprise medical schemes financed care for their covered employees, while rural cooperative schemes had different funding and offered basic services. The narrator's contrast concerns the financial barriers facing these farmers; it should not be read as a precise statement that every rural resident everywhere had no coverage. No particular benefit or insurance entitlement is specified for this family. Source: WHO Asia Pacific Observatory — People's Republic of China Health System Review, historical financing discussion, p. 162.
3. ↩︎ Clearing a name. The Chinese term pingfan means reversing an unjust judgment and clearing the wrong done to someone. It concerns a judgment being overturned, rather than merely a prisoner being released. Dr. Li says this has not happened in his case. The chapter gives neither charges nor dates for his two imprisonments; the translation preserves his account without identifying a particular prosecution or political campaign. Source for the term: Taiwan Ministry of Education — pingfan (in Chinese).
4. ↩︎ The pharmacopoeia and professional risk. A pharmacopoeia is a reference setting standards for medicines. The dialogue returns to the unusually large doses discussed in the preceding chapters. Evan's terse reply expresses the consequences he fears; it does not establish an automatic legal rule. The novel does not identify the edition or relevant legal provisions here. Official information on aconite medicines also recognizes risks from excessive dosing. Sources: WHO — definition of a pharmacopoeia; Hong Kong Department of Health — Aconitum Alkaloids (in Chinese).
5. ↩︎ Zhongjing's formulas. Zhongjing is Zhang Zhongjing, the Eastern Han physician associated with the Treatise on Cold Damage and Miscellaneous Diseases. Evan is referring to the classical medical formulas associated with his work. His praise concerns Dr. Li's command of that tradition, in a conversation about learning from a teacher who is himself self-taught. This is Evan's judgment of his prospective teacher, rather than an independently verified assessment of Dr. Li's prescribing or its safety. Source: Hong Kong Baptist University — symposium on Zhongjing's academic heritage.
6. ↩︎ Intestinal abscess. Changyong, translated here as “intestinal abscess,” is a traditional disease category associated with fever, pain and contraction in the right lower abdomen, tenderness, and sometimes a palpable mass. The novel places it beside a diagnosis of severe appendicitis and states that pus has formed. Those are the judgments made in this examination scene; the traditional term itself does not establish what modern imaging or surgery would show. No such investigations have been performed in the chapter. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entry 1668, p. 227.
7. ↩︎ Acute abdomen and the surgery dispute. Acute abdomen describes a clinical syndrome of severe abdominal pain with various possible causes, not a single disease. The village doctor's insistence that either condition necessarily requires surgery remains his statement. Modern information describes surgery as the usual treatment for appendicitis, while recognizing selected antibiotic treatment and different approaches to complications such as abscesses. That background neither determines this fictional patient's treatment nor verifies Evan's counterclaim about Chinese medicine. No treatment or outcome has occurred yet. Sources: NLM MeSH — Abdomen, Acute; NIDDK — Treatment for Appendicitis, treatment and complications sections.