Chapter 98 This Prescription Won't Do

Another call sends Evan back to the hospital, this time on Clara’s pink electric scooter.

Well, Evan had taken the call, and now he was heading out again.

Clara could have cried. Why was he leaving again? There was no way she could stop him, though.

“Remember to ask them for a consultation fee. You can't do all that work for nothing.”

“I know,” Evan said, gathering his things.

“Then… come back as soon as you're done. Take my little electric scooter. It'll be quicker.”

“All right.” He took her keys and left.

Clara sighed mournfully, then turned toward Ben, who was sitting in the corner, and gave him a kindly smile.

Ben rolled his eyes. Was it too late to pretend to faint?

Outside, Evan still felt out of place. For a moment, he couldn't remember the way. But he couldn't keep the patient waiting. He took out his phone, searched for the Chinese medicine hospital, started the navigation, and set the phone on the scooter.

He climbed onto Clara's girlish pink scooter and put on her pink helmet, complete with a little yellow duck and its pinwheel. Then he turned the throttle and followed the directions.

In the old part of the county town, an electric scooter was more convenient than a car. He soon reached the hospital.

Once there, Evan called Leo.

Leo came downstairs at once, accompanied by Dr. Qi, the head of surgery.

Yes, the same Dr. Qi who had treated the Abbess's father for appendicitis.

“Ha! Dr. Xu, we meet again.” Dr. Qi smiled broadly and held out his hand.

“Hello.” Evan shook it without any change in expression.

He had long since forgotten who this man was. Leo, though, he remembered. They had met quite a few times, and Leo had treated him to a meal. Oh, Dr. Simon Liu had treated him to one too.

“Hello, Dr. Xu.” A young woman in glasses greeted him from behind Dr. Qi, her cheeks faintly pink.

She was the resident who had first suggested yesterday that the Abbess's father might have appendicitis with an atypically located appendix.

“Hello.” Evan nodded. Looking at the young doctor, he couldn't seem to place her either.

She stole a glance at him. Finding him looking at her, she blushed even more.

What was he looking at her for? Why was he looking at her?

All sorts of scenes began playing out in her head.

“I'm afraid we need your help again, Dr. Xu,” Dr. Qi said courteously. “Oh, and we've asked the hospital to prepare an agreement for bringing you in. They'll settle the fees for these consultations with you.”

“That's right,” Leo added. “We've never invited a Chinese medicine practitioner from outside the hospital system to consult before. There wasn't a precedent.

“But you've been a tremendous help these last few times. Dr. Zhong, Dr. Qi, and I spoke to the administration, and they've agreed. We'll pay the standard consultation fee. It may not be much. I hope you won't mind.”

“That's fine. The patient comes first,” Evan said politely. “Let's go. Tell me about the case.”

“Of course. We can talk on the way.” Leo gestured for him to go ahead.

They set off.

The three medical heavyweights discussed the case while the young woman hurried ahead to show the way.

“It's really me who needs your help this time, Dr. Xu,” Dr. Qi said. “We have a difficult patient, so I asked Leo to get in touch with you.”

Leo chuckled at Evan. These days, he was practically Evan's communications officer.

“What's the situation?” Evan asked.

“The patient had surgery for a bowel obstruction two years ago. Now he has another obstruction, a partial one caused by adhesions. He's been in the hospital for 20 days and hasn't been able to eat for 25. Frequent vomiting, persistent abdominal pain. Hannah, give me the chart.”^[1]

The young resident immediately handed him the folder she was carrying.

Dr. Qi took it and passed the documents to Evan. “These are his treatment records and test reports from this admission.”

Evan looked only at the symptoms and the medicines previously given. He didn't read the test reports.

They entered the elevator.

“We've tried conservative treatment, but the results haven't been very good,” Dr. Qi continued. “The patient doesn't want another operation, so we asked Chinese medicine to consult. The herbs haven't helped much either. That's why we asked you to come.”

Hannah's eyebrows rose. Their department head was certainly paying Dr. Xu a compliment.

Neither the Chinese medicine doctors nor the Western medicine doctors at their hospital could manage it, so they had called him in? Was Dr. Qi saying he was better than all of them?

She marveled to herself.

Still, she could see why they thought so highly of him. Yesterday's patient had an atypically located appendix. That was almost guaranteed to be misdiagnosed, yet Dr. Xu had identified it.

And he hadn't stopped at a diagnosis. One batch of medicine, and the stubborn old man had actually recovered. When she had gone on rounds that morning, he was nowhere to be found.

They had called and gone out looking for him, only to discover he had slipped out for breakfast. He had been quite indignant about it too. If they wouldn't give him anything to eat, couldn't he go and find some himself?

Hannah hadn't known whether to laugh or cry. He hadn't been able to eat before, and they couldn't have let him anyway. He had been scheduled for surgery and had to go without food or water.

She simply hadn't expected him to recover so quickly. Even if they had operated, he would have faced several days without food or water afterward and days recovering in the hospital before discharge. It couldn't have been this quick.^[2]

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They went upstairs to the inpatient ward.

At last, Evan saw the patient.

After 20 days in the hospital and 25 without being able to eat, the man had lost so much weight that his face was almost unrecognizable.

Evan asked about his condition. He was weak all over, unable to sit up or stand, and the slightest movement left him short of breath. He vomited frequently and had constant abdominal pain. His bowels weren't quite blocked: with great effort, he could pass a tiny amount of stool.

Evan examined his tongue. It was red, with dryness in the middle and at the root.

He took his pulse next. It felt broad, but dispersed beneath firmer pressure.^[3]

After completing his examination, Evan went out with the others.

They went to Dr. Henry Zhong's office in the Chinese medicine internal medicine department.

Dr. Zhong and Alex were both there.

“Dr. Xu.”

“Hello, Dr. Xu.”

“Hello.”

These two Evan did remember. They had come to the clinic to make trouble.

“Oh, is this the patient with a partial obstruction from adhesions after bowel-obstruction surgery?” Dr. Zhong asked.

“That's him,” Dr. Qi said.

Dr. Zhong printed out their prescription. “Although he has a bowel obstruction, this isn't an excess-heat pattern. It's a deficiency pattern. Weakness of the middle qi has caused the obstruction.”^[4]

Evan nodded slightly. Dr. Zhong did know his medicine. Not every bowel obstruction was an excess-heat pattern. This patient had a deficiency pattern. Charging in with bitter, cold purgatives regardless would cause trouble.

Dr. Zhong handed him the prescription. “I used Buzhong Yiqi Tang, treating the apparent obstruction by tonifying. The results have been rather limited.”^[5]

Evan read it, his brow creasing slightly.

“What do you make of the case, Dr. Xu?” Dr. Zhong asked with a smile.

Evan looked calmly at the prescription. He had attended countless consultations like this in that other time. He was well used to them.

“His middle qi is deficient and can no longer keep things moving. His Stomach fluids are depleted, so the Stomach can't harmonize and descend. Your general approach is right, but there are problems with the prescription.

“Tonifying the middle and replenishing qi is certainly right. But look at his tongue. His Stomach fluids have dried up, so his Stomach qi can't descend. That's why he keeps vomiting. You haven't taken that into account.”^[6]

Dr. Zhong froze.

He had only asked Evan to look at the prescription, not critique it. He had asked for his opinion of the illness. Why was he volunteering an assessment of the prescription too? Was this a buy-one-get-one-free deal?

Around him, expressions were beginning to change.

Evan noticed none of it.

“The treatment of any fullness or blockage depends on regulating qi,” he continued. “All illness arises from qi. The Spleen and Stomach are the hub of qi transformation and its rising and descending throughout the Triple Burner. This patient's qi is disordered in the middle burner. It rises but doesn't descend. That's why he's blocked below while he vomits violently above.

“You're right to replenish qi, treating the apparent obstruction by tonifying. But right now, everything is rising and nothing is descending. If you only replenish qi without guiding it downward, you can hardly expect quick results. You haven't accounted for the depleted Stomach fluids, and the doses of shen and huangqi are too low. This prescription of yours won't do!”^[7]

At that last sentence, everyone in the room was stunned.

Alex stared in disbelief.

Hannah covered her mouth in surprise.

Dr. Zhong's aging face rapidly turned red.

Evan remained oblivious. He had only just come back from that other time, and his thinking hadn't caught up yet. He had spent decades there as a leading clinical authority.

What did that mean?

He had scolded every department head in the county, whether they practiced Chinese or Western medicine!

And afterward, they had all looked as though they had learned a valuable lesson.

Evan thought he had been quite polite.

Reader Notes

Reader Notes

1. ↩︎ A partial bowel obstruction from adhesions. Adhesions are bands of scar-like tissue inside the abdomen, often developing after surgery. They can pull, bend, or compress the bowel and obstruct the passage of its contents. An obstruction may be partial or complete; the word “partial” does not mean the symptoms must be mild. Conservative treatment here means treatment without another operation. The novel does not specify which measures were used. The hospital stay, inability to eat, and response to treatment are this patient's fictional history. Source: NIDDK — Abdominal Adhesions, definitions and treatment.
2. ↩︎ Fasting and recovery. Going without food or drink before an operation relates to preparation for anesthesia. The resident's expectation of several days without either afterward is retained as her thinking in this scene. It is not a universal rule for appendectomy: the linked hospital guidance allows drinking after the operation and eating when hungry unless the team advises otherwise, and describes discharge on the same or following day in some cases. Neither that guidance nor the diagnosis establishes the novel's herbal cure or its nearly certain misdiagnosis claim. Source: Guy's and St Thomas' NHS Foundation Trust — Appendicectomy: Having surgery.
3. ↩︎ Tongue and pulse findings. In Chinese medicine, tongue inspection and palpation of the pulse contribute to pattern assessment. A “large” pulse describes a broad sensation under the fingers. A pulse may feel broad under light pressure yet become indistinct when pressed more firmly. These descriptions belong to traditional pulse assessment; they differ from a heart-rate count or an ECG finding. Evan also observes dryness in the middle and at the root of the tongue. These findings form part of the reasoning he later explains to his colleagues. Source: WHO — International standard terminologies on traditional Chinese medicine, diagnostic terminology.
4. ↩︎ Deficiency, excess, and the middle qi. These are Chinese medicine pattern terms. Deficiency concerns insufficient functional activity or bodily resources; excess concerns an obstructing or overabundant pathogenic influence. “Heat” is another pattern quality, not necessarily a measured fever. Middle qi refers here to the digestive functions associated with the Spleen and Stomach. Dr. Zhong interprets the obstruction as a consequence of weakness rather than an excess-heat pattern. “Bitter” and “cold” describe traditional medicinal properties in Evan's assessment, not the temperature or taste of a new treatment given here. Source: WHO — International standard terminologies on traditional Chinese medicine.
5. ↩︎ Buzhong Yiqi Tang and tonifying an obstruction. The formula name refers to supplementing the middle and replenishing qi; its traditional use includes weakness of the Spleen and Stomach with failure of their lifting function. Saiyin saiyong is the apparently paradoxical choice of a strengthening treatment when blockage is attributed to weakness. It means supporting the function thought unable to move things through. Dr. Zhong's actual prescription is not reproduced, and the chapter supplies no quantities. The sources explain the traditional approach rather than verify this patient's treatment. Sources: Hong Kong Baptist University — Buzhong Yiqi Tang; Jiangxi University of Chinese Medicine — He Xiaohui on saiyin saiyong (in Chinese).
6. ↩︎ Stomach fluids and the direction of qi. In this traditional account, the Spleen raises what is useful from food, while the Stomach receives food and directs it downward. The Triple Burner is a functional framework of upper, middle, and lower regions. Evan connects weakness in the middle with failed downward movement and depleted Stomach fluids. The latter is not a laboratory measurement of gastric acid. This note explains his vocabulary; his claim that all illness arises from qi remains his statement. Capitalized organ names mark the novel's traditional functional usage. Source: WHO — International standard terminologies on traditional Chinese medicine, Spleen, Stomach, qi movement, and Triple Burner terms.
7. ↩︎ Shen and huangqi. Huangqi is the medicinal material commonly called astragalus root. The Chinese text shortens the other name to shen. A standard Buzhong Yiqi Tang may contain renshen, ginseng, but a named formula does not establish every ingredient in a particular doctor's prescription. The text gives neither the full ingredient name nor the quantities here. Evan's judgment that the doses are too low is preserved without supplying a dose, preparation method, or replacement prescription. Source: Hong Kong Baptist University — Buzhong Yiqi Tang, composition.