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4

My teachers—the patients

All doctors learn from their patients. If we did not do so we could never become doctors at all. Book study merely enables us to observe our patients more accurately, to detect changes we might otherwise overlook, and to utilize other doctors' practical experience. 

In China, too, I learn clinical medicine from my patients, but in addition, I learn many other things. My patients in socialist China are a living textbook of politics and history. They teach me about the struggles and oppression of the past, about events which led up to the present. They give me glimpses of what the Man of the future will be like. They teach me that human nature is not a fixed, limiting factor to Man’s development but that it can change as society changes. They teach me that the world is a fine place to live in and that it will be even better for future generations. They teach me the meaning of endurance and courage, that ideas can generate a mighty material force. 

Of the thousands of patients I have treated in China, a few spring to mind. 

The lean, brown Tibetan with straggly hair hanging down beneath his seemingly incongruous Western type hat, who hobbled into my consulting room. As he laboriously pulled off his felt boots and showed me his crippled leg he talked incessantly, pointing here and prodding there. He could speak only Tibetan and his companion, a young Tibetan girl, translated what he said into Chinese. The leg was wasted and deformed. There was a deep constricting scar below the knee and ulcers on the heel were running with pus. The toes were twisted and stiffened and he prodded sharply with his finger to indicate that the leg was numb. He lifted his leg to show the scars behind the knee. 

He talked and gesticulated as he told his story. 

He had been a serf（农奴）, owned by a Lhasa nobleman. His job when young had been to look after the nobleman’s dogs and horses, but his position in society was greatly inferior to that of his charges. They had food and shelter, while he slept in the open and fed on scraps. One night the cold was so bitter that he crept into a kennel and huddled up beside the dog. Comforted by the unaccustomed warmth he slept soundly and when his master arrived at the stables for an early morning ride, he was still dozing blissfully beside the dog. The nobleman, infuriated that a contemptible serf should soil his fine dog, lashed out wildly. The sleeping youth made the fatal mistake of trying to run away. The punishment for a serf who ran away was hamstringing（割断腿筋）. It had been so in Tibet since time immemorial, and as soon as the serf was caught, his master drew his dagger and proceeded to inflict the punishment with his own hands. He slashed the tendons behind the knee to make sure the youth would never run away again. Unfortunately for the lad, he slashed not only the tendons but also the nerves so that his leg became permanently paralysed. The wound bled profusely and, to staunch the haemorrhage(大出血), the nobleman ordered boiling butter to be poured into the wound. For good measure he chained his victim to a post so tightly that the skin below the knee sloughed away.

Slowly the wounds healed but the leg remained paralyzed. The foot became progressively more deformed and walking barefoot over stony paths caused chronic ulceration(长期的溃烂) of his anaesthetic heel.

In 1959, after the revolt of the Tibetan nobles was crushed, the serfs were freed and democratic reforms instituted. Tibet joined the rest of China on the long road out of the past and into the future.

The crippled ex-serf learned to read and write. He—who had been less than a dog—became a local leader and was elected County head. He consulted the doctors in the newly established hospital in Lhasa, and they advised him to go to Peking.

And so he had come, travelling thousands of miles across mountains and deserts with all expenses paid by the Government.

He indicated that in his opinion it would be best to cut the leg off and give him an artificial one.

His interpreter’s voice became choked and she stopped translating. I looked up and saw her eyes were brimming with tears. ‘I’m sorry’, she said, ‘I know it’s silly of me to cry—I shouldn’t do so. I’ve heard his story many times and I should be used to it by now. But he’s such a good man—and those beasts were so vicious—so brutal. . . .’ 

The Leper(麻风病患者) in the South of China whose fingers and toes had rotted away. In the sweltering heat, I was selecting suitable patients for surgical treatment. He refused to sit on the offered chair but squatted cross-legged on the earthen floor and with intense concentration and effort started to undo the laces of his canvas shoes. Without fingers it was extremely difficult for him to do so, but, almost angrily, he refused help. The sweat streamed down his face. He held the laces between his fists—he used his teeth. Eventually he removed his shoes and began to unwind the bandages. He would not be helped. He begged my forgiveness for taking up so much time saying it was really a simple job, and he had to do it himself.

At first I felt impatient and then I understood. Disease had eroded his body but not his will. His hands had lost their skill but he was determined not to become dependent on others.

So we waited while he unwound the bandages. When the task was done he wiped his brow with his sleeve and looked up with a little smile of triumph. ‘Comrade Doctor—I’m sorry I kept you waiting. I know you must be busy. But it is not pleasant for others to touch my feet.’ In the cool of the evening, I walked along the riverside. The lights of the leprosy hospital were reflected in the water. A water buffalo grazed alongside the sugar-cane(甘蔗). The air was heavy with scents of the night.

Suddenly the sound of singing rang across the river. It was a song of the Chinese revolution. Curious to know who was singing I punted across the water. The same patient was conducting a choir of his fellow lepers, leading the singing in a fine tenor voice.

When the song was finished I asked the leper if music had been his hobby. ‘No—it was never my hobby. But we know that all the people are singing songs of the revolution and though we here are physically isolated, in spirit we *ee* a great unity with all the other people. So we, too, like to sing such songs. You see, Comrade Doctor, you couldn’t know what it was like for lepers in the old days. The Japanese had a simple way with people like us— they shot lepers and threw their bodies into the lakes and rivers. The Kuomintang bandits sometimes did the same. Sometimes they just drove us up into the mountains where we starved or froze to death... Now we are cared for, and doctors come from far away to help us. Now we have hope, we can see the way ahead. That is why we like to sing songs of the revolution.’ 

As I went back across the river, the sound of song followed me on the sweet night air. The lepers were expressing their oneness with their fellow men.

The fourteen year old peasant girl in Shansi province whose leg had been burned to the bone.

Unexpectedly a message had come asking if I was prepared to leave Peking at once to see a patient. Half an hour later, feeling flattered and self-important, I was being driven to a military airfield. The machine was waiting, its engines already warmed up. Two other surgeons were at the airport. We were to fly together. None of us knew our destination—or what kind of patient we were going to see. But we assumed that it must be someone important.

The aircraft flew in a westerly direction. We shared sandwiches with the pilot in complete informality. We landed at Taiyuan airport and were driven to a military hospital. It looked as though we were indeed going to treat a VIP. But the VIP turned out to be not a high-ranking officer or a statesman but the fourteen year old daughter of a peasant.

Nearly two weeks earlier, in rescuing a shepherd and two hundred sheep from death by burning, she had sustained serious burns.

In bitterly cold weather the shepherd had driven his flock into a barn for warmth and shelter. Lambing had just finished, and the young lambs were suffering acutely from the cold. To warm his charges the shepherd lit a charcoal stove but, unfortunately, he was overcome by fumes and fell unconscious, overturning the stove. The dry timbers of the barn caught alight and the fire spread rapidly.

Just then the girl passed, on her way home from school. She heard the bleating of the terrified sheep, and the crackle of flames. She tried to open the door, but the shepherd had bolted it on the inside.

Unhesitatingly she climbed a drainpipe, smashed the glass skylight, and dropped twenty feet into the inferno. Although she had broken her ankle in landing, she forced the door open, dragged out the unconscious shepherd, drove the terrified sheep through the flames to safety and finally rolled on the shepherd to extinguish his still-smouldering padded clothes.

By the time help arrived, she herself had been badly burnt. She was taken to a military hospital since it was nearby, well equipped and well staffed. 

Military hospitals often admit civilians, for the revolutionary army has a long tradition of being closely united with the masses of the people. From the time the Red Army first came into being, its relationship with the people in the words of Mao Tse-tung, was the relationship of fish to water.

Now that the People’s Liberation Army is a mighty military force, as a matter of basic policy it unites even more closely with the masses of the people.

The girl’s early treatment had been excellent. The fracture of the right ankle had been set and immobilized and shock from the extensive burns had been prevented by scientifically controlled intravenous infusions of blood and plasma. Infection had been controlled by occlusive dressings, by strict isolation and by the use of antibiotics.

But the burn was exceptionally deep and by the fourteenth day after burning, a dangerous and perplexing condition had developed. The main part of the burn involved the left leg from just above the ankle up to the buttocks and waist. All the skin here had sloughed away revealing burnt muscle and bone. The burn was deepest around the knee joint where the charred bone and the interior of the joint was exposed. All the tendons(腱) and ligaments(韧带) crossing the knee had been destroyed and the only intact structures connecting the thigh to the lower leg were the main blood vessels and nerves. These, miraculously, still functioned but they could be seen to twist and bend with every movement.

That was where the danger lay and it was to discuss how best to handle this problem that we had been called in from Peking. If the artery(动脉), surrounded by sloughing and infected tissues, continued to be twisted and bent, it would almost certainly rupture and a fatal haemorrhage might result. Even if it did not rupture, the blood inside it would probably clot, causing gangrene(坏疽) of the limb.

With our military medical colleagues, and the junior doctors and nurses treating the girl, we discussed the problem far into the night. Finally, we settled on a course of action. We were able to agree because we all approached the problem from the common standpoint of wanting to do the best we could for the heroic young girl. We tried hard to put aside all considerations of prestige, or seniority, to be modest and open-minded and to be willing to be convinced by others’ arguments.

Some were in favour of amputating(截肢) through the thigh, because this would eliminate the danger of haemorrhage and reduce the duration of the illness. Others argued that this would expose clean tissues to the danger of infection, that no skin was available to cover the stump, and such an operation might be followed by septicaemia(败血症).

To overcome these disadvantages, others favoured amputating through the knee joint for the knee joint was already infected and since the lower leg was attached only by its nerves and blood vessels, the operation would be simple and safe. But some were against any kind of amputation because, miraculously, the foot still had normal blood supply, nerve supply and skin. Although the patient was in danger, her condition was by no means desperate. Even if the artery ruptured, provided everyone was prepared, it would be possible to stop the haemorrhage within seconds.

Eventually we decided to try and save the limb.

The next problem was to work out a method for achieving our objective. The main risk arose from uncontrolled movements at the knee joint for these constantly endangered the main artery. But to eliminate these movements was extremely difficult. We could not use external splintage(夹板固定) or a plaster cast since the skin and underlying soft tissue had been destroyed right up to the waist.

We decided on a bold plan. Even though the surface of the bone had been burnt, its deeper parts must be still living. If we sliced off the cartilage-covered(软骨覆盖的) surfaces of the bones forming the knee joint and clamped the raw surfaces tightly together, they should unite even though there was infection and even though the rim of the bone was dead. If this succeeded, the danger to the blood vessels would be eliminated and later on we could remove the dead bone around the rim and apply skin grafts(植皮) directly to the healthy bone. The function of the knee joint would of course be lost, but this was inevitable whatever we did. Our aim was to get a soundly healed limb with a stiff knee, a good hip, a good foot and a normal blood supply and nerve supply.

The next day we operated and everything turned out as planned. Within six weeks the bones had grown together and the whole limb had been covered with skin grafts. Two weeks later she began walking and was transferred to a lakeside sanatorium for convalescence.

Some years later, accompanied by the shepherd whose life she had saved, she came to see me in Peking. She said that her leg gave her no trouble and that she was able to work just like the other commune members. But the shepherd said that she was being modest, that in fact she worked outstandingly well and had been elected a model worker three years in succession.

She said that if it had not been for the solicitude shown by the Party after she had burned her leg, she would not have been able to work at all and probably would not have survived.

Remembering the care lavished on her, the special aircraft, the hours of debate, the isolation suite in the hospital, and the twenty-four hours a day nursing, I was inclined to agree with her. In New China the common people are the VIPs, and nothing is too good for them.

The girl with the smiling eyes and flying pigtails whom I first knew as a train attendant, and later as a patient.

She served tea and brought sunshine into the carriage as our train rumbled through the snow-covered countryside. We chatted about this and that until my companion, something of an expert in Chinese dialects, asked her where she came from. She named the area and my companion said, ‘I thought so. During the Anti-Japanese war, I lived in a village in that county for many months. I had been wounded and thought I was finished. A peasant woman took me into her house and nursed me back to health. At that time the Japanese were operating their “Three All” policy —“kill all, burn all, loot all”. 

But this village had worked out an answer. The people had built an ingenious system of tunnels, which honeycombed the area and not only provided a refuge for the villagers, but also enabled them to strike back at their tormentors. Side-tunnels branched off from the main system, and one of them came to the surface in the house where I had found refuge. Whenever the Japanese came, she would carry me down into the tunnel, for I was too weak to walk. She was a wonderful woman. Her husband had been killed and she was left with three children, the youngest just a little baby. But she kept the family together and fearlessly helped our Red Army men.’ As my companion reminisced, the pigtails stopped flying and the smiling eyes misted over. ‘I wonder if it’s possible,’ she asked him. ‘Could you possibly be Uncle Gao who used to play with me and make me wooden whistles? That Uncle Gao had a beard and was very thin.’

My companion, excited, gripped her hand and looked into her face. He whispered, ‘Where were you born? What is your surname?’ She replied, ‘I was born in Chen Family village—my surname is Chen. My mother was eventually caught by the Japanese.’ 

For the next two days our train chugged through frozen country and the girl train attendant frequently came to see us. She was, indeed, the daughter of the peasant woman who had saved my companion’s life.

I noticed that she limped and had a deformed foot. I asked her to see me in Peking, so that we could get an X-ray and make a thorough examination. A few weeks later she arrived. The foot had been dislocated for many years and the tendons and bones had become moulded in the dislocated position. When I asked her how it had happened, her smiling eyes again clouded over with sadness. 

‘It was so long ago, I hardly remember. And yet I can never completely forget. Not long after Uncle Gao had left us to rejoin his Army unit, the Japanese unexpectedly arrived in our village. All who could went down into the tunnels, but my mother had the children to look after and she had time only to get two of us into the tunnel when she heard the Japanese nearby. To make sure they wouldn’t find the entrance to the tunnel, she quickly covered it up, and ran out of the house towards the forest, with me on her shoulders. It was night time and she gripped my feet tight so that I shouldn’t fall off. We had nearly reached the forest when a Japanese soldier saw us and shot my mother. As she fell she seemed to grip my feet even tighter. That is when my foot must have been dislocated for it has never been right since then. 

‘My foot doesn’t really matter, Comrade Doctor. I just limp a little and occasionally it aches. In a way, it’s even a good thing because it reminds me of my mother and father and all the other comrades who suffered so much to free our land. And that makes me determined to work and study better as a way of repaying the debt I owe them.’ 

The smile had returned to her eyes. 

The two girl students from Peking University. So different and yet so alike. Cheng, slim, delicate and graceful, the only daughter of a family of intellectuals. Made much of by her brother. Never knowing want or hardship. Wu, from a poor peasant family. Tall, heavily built, with a finely chiselled face. Long before she reached maturity she had known cold, pain and hunger for she had been sold as a child bride. 

In the old days it would have been said that they had been born under different stars. But they grew up under the same star—under China’s five- pointed red star. This united them more than their different social backgrounds separated them. They shared the enthusiasm, the patriotism, the sense of dedication which is characteristic of modern Chinese youth. 

From their first day in the faculty of chemistry, they had been good friends. They argued fiercely but their arguments cemented their friendship. Cheng was a great success in the social life of the college. She sang like a lark and danced with fire and grace. Wu was more stolid. She studied diligently, assiduously helped her fellow students, was athletic and won a place in the college basketball team. Both of them joined the Young Communist League, and both were elected model students.

During the tempestuous year of the Big Leap Forward, factories became colleges and colleges became factories. They were years of experimentation, of innovation, of releasing a torrent of long pent-up creative initiative. Students in grade three of the faculty of chemistry combined their studies with the production of pure ether, needed in large quantities for a multitude of experiments, and Wu and Cheng threw themselves whole-heartedly into the work. 

One day a bottle of ether(乙醚) in the laboratory caught fire. On the same bench were nine stills, all distilling ether and nearby shelves were loaded with corrosive and inflammable chemical reagents. If the bottle of ether were to explode, the laboratory would be ablaze in a few moments, the whole building might be destroyed and loss of life might be heavy. Cheng grabbed the bottle of flaming ether and raced for the door. But Wu was there before her. She snatched the bottle from Cheng's hands and ran downstairs and out into the courtyard. By this time the bottle had become a mass of flames which splashed over Wu’s face, hands and clothes. She hurled the bottle away just as Cheng appeared carrying a blazing still which exploded in her hands, drenching her in flames and knocking her to the ground. Without a moment’s hesitation, Wu carried her to safety and with bare hands ripped off her blazing clothes. Wu herself became a ball of fire. 

The force of the explosion shattered window panes and leaping flames threatened to engulf the building. The other students formed a human wall and beat back the flames. 

Within half an hour I was helping to treat the girls in our emergency department. 

There had not yet been time for shock to develop and both girls were mentally alert. Their faces and hands were charred and dry, the hair, eyebrows and eyelashes had been burnt away. Blisters(水泡) were starting to form on their bodies, a warning that shock would not be long in developing unless active preventive measures were taken. 

Within minutes we had plasma infusions running into their veins at a rate guided by half-hourly checks on the blood pressure, the amount of urine and the degree of blood concentration. 

The girls lay on adjacent couches in the shock room. Speaking was difficult since their lips were stiffened and hot gases had scorched their throats. Nevertheless they comforted each other, each insisting that the other be treated first, both asking about the laboratory and their fellow students. 

Gradually the drugs we had given them took effect and they became drowsy. When we were sure that our anti-shock measures were effective, we removed them to separate isolation rooms where we cleansed and dressed the burns.

They remained in their separate rooms, isolated from the outside world, for many weeks. But although they were isolated, their conduct during their long ordeal was an unending inspiration and a profound education to other patients in the Burns block, to the ten thousand students in Peking University and, above all, to the nurses, doctors, orderlies, dieticians, and laboratory workers who looked after them. 

They communicated with each other by writing notes, sometimes three or four times a day. They themselves couldn’t write for their hands had been burnt, but they whispered their messages to a nurse who acted as scribe and postman.

‘My dear comrade,’ wrote Wu, ‘I can see how thin I am getting even though most of my body is bandaged up. You must be getting thin too, and you were always much slimmer than I. The doctors urge me to eat more. They tell me that I need plenty of protein food at this stage. I know they are right but I find it awfully difficult to eat. I’m just not in the slightest bit hungry. I know it must be the same with you. So let’s have a competition to see who can be the biggest glutton. Today for lunch I will eat three eggs, two ounces of rice and drink a big glass of milk. Even though I hate milk I will do it. Tell me what you will eat.’

And Cheng replied, ‘Dearest sister —I accept your challenge. Today for lunch I ate a huge meat ball with my rice and then, like you, I drank milk and finally I had an orange. You too should eat oranges. I am getting better quickly and my eyes are unharmed. The nurse tells me that your eyes too were not scorched by the flames, but maybe she is just saying that to console me. Please tell me yourself —are your eyes quite normal? I’ll believe what you say because I know how strong and principled you are.’ 

Hundreds of notes passed between them, full of encouragement, courage and mutual love.

A deputation of students came to visit them. They were not allowed into the ward because of the risk of cross-infection but they and the patients could see each other through the glass partition. They were warned not to allow their expressions to convey their horror at what they saw and after signalling their greetings, they sent in the gifts and letters they had brought. Students from the Fine Art faculty had painted a picture of Chairman Mao for each of them. The music department sent them a specially composed song. The college gardeners sent masses of flowers, fruit and fine vegetables. Their class-mates sent them a volume of poems by Mao Tse-tung. 

When the visitors left, they took with them the charred remains of the girls’ clothing.

Later, on the college campus, 10,000 students assembled to hear a report from the deputation and to receive into safe keeping the scorched clothing. As it was being handed over, something firm was felt in a pocket. It was a pocket edition of Mao Tse-tung’s article, ‘Serve the People’. Though the print was scarcely legible, marginal notes and comments could still be made out. 

The students, many of them moved to tears, left that meeting determined to become worthy school-mates of Wu and Cheng.

As the dead skin sloughed away, the raw areas were skin grafted under local anaesthesia. Though the operations were painful, both girls refused drugs because they made them drowsy and interfered with the study programme which they had decided on and rigidly adhered to. While her hands were bandaged, Wu had worked out a method of turning the pages with a chop- stick held in her teeth. Cheng improved it by attaching pieces of rubber to both ends of the chopstick. They wanted to ease the burden on the busy nurses who, for their part, considered it a privilege to help them in any way they could. 

Mainly they studied the writings of Chairman Mao and many of the notes which passed between them were about some passage in Mao’s works. 

Gradually their wounds healed and the great day came when the two friends, their friendship enriched by the long travail which they had endured in common, could be together.

Their faces were hideously distorted and before they were allowed to see each other the doctors and nurses discussed how to arrange things so as to lessen the shock, for neither of the girls had seen a mirror. In the end we decided that there was really nothing we could do. When they saw each other for the first time they stood still, looked at each other for the briefest moment and then threw their arms round each other. Wu laughed. 

‘My! You do look a sight! But I’m sure I look much worse since I was never as pretty as you.’

‘Let’s get a mirror,’ said Cheng, ‘and face up to the facts. We should be a hit as the Ugly Sisters in college dramatics even if there’s no other part for us.’ 

The doctors explained that plastic surgery could improve their appearance, but they were not greatly interested. ‘We’ve had enough surgery for the time being,’ they said. ‘First get our hands supple again and then let’s talk about our faces.’

So we started a course of physiotherapy(物理疗法,热疗、按摩等) and the function of their hands gradually improved. They argued, correctly, that the best therapy was actual work and so they did nursing and cleaning work in the wards, scrubbing the floors, serving meals, feeding patients, and reading and writing for patients who requested it. In the children’s ward, they told the children stories and helped those of school age to make up the lessons they were missing. 

One day they decided to amuse the children with a song and dance which they had composed themselves. While they were performing, a tiny tot who had just been admitted to hospital, shut his eyes tightly and called out, ‘Stop singing—stop dancing—you are ugly.’ 

An older child put his arms around the tiny tot and said to him, ‘Open your eyes, little brother. Look at them. They are not ugly. They are beautiful.’