Chapter 229 - Diagnosis and Treatment

As they were busy packing, Shi Niaoren’s voice suddenly came from outside the door: “You’re playing the fool! He’s about to die, what’s the use of calling a quack Chinese medicine doctor? By the time the decoction is ready, Jinshi Liu will have already kicked the bucket…”

The door was pushed open with a whoosh, and Director Shi walked in, scolding his subordinates majestically. Seeing Liu San packing his medical kit inside, he was taken aback for a moment, then said loudly, “…Why haven’t you assigned an assistant to Doctor Liu? One person is not enough for an emergency…”

“Director Shi… I can handle emergencies. I studied Chinese pharmacology, and I’ve also studied modern medicine…”

“Oh, it’s fine. Chinese medicine is also a form of medicine,” Dr. Shi said in a deliberately cheerful and loud voice. “Xiao Liu, the Executive Committee takes this matter very seriously. It’s entrusted to you.”

“Yes, yes, I will definitely complete the glorious task assigned to me by the organization. However, emergency medicine is not my specialty. We still need to send another doctor familiar with modern medicine to help.”

This was not a joke. Liu San had never worked in an emergency room. In fact, he had barely even worked in a Chinese medicine clinic in the old world.

“Alright, let Zhang Tumu go with you,” Shi Niaoren said.

Zhang Tumu was their only doctor who had professionally worked in an emergency room, so he was certainly skilled. The Battle of Chengmai had thoroughly honed his emergency surgery skills. The emergency department of the Bairen General Hospital was a very busy department, and Zhang Tumu’s skills had become more and more exquisite with constant practice, especially in debridement and suturing wounds, which were almost magical.

“That’s not necessary. The emergency department is very busy. It wouldn’t be good if an injured person in need of emergency treatment came in while he was away. I think it’s better to have Zhang Ziyi go with me—an old nurse is very useful.”

“Alright, alright, you two go first. If there are any problems, call back and we’ll see if a consultation is necessary,” Shi Niaoren said. “By the way, you should also take a few intern doctors and nurses with you to give them some experience.”

So Liu San called Fu Wuben, and also two intern nurses and an intern doctor. Because he had heard that the condition was critical, Liu San decided that he and Zhang Ziyi would go first on their bicycles with the necessary supplies, and the others would follow on foot.

At the entrance of the county town, Steward Zhao and several servants were looking out from the city gate—they were all waiting for the Australian doctor to arrive. For the Liu family, calling in an Australian doctor was a last resort, but right now it was their only hope. Everyone had heard of the Australians’ many “impossible feats,” and now they were all hoping for a miracle. Moreover, this Doctor Liu was highly recommended by Shopkeeper Yang. He was said to be a master of medicine among the Australians, using traditional medical techniques rather than the Australian method of cutting open the stomach with a knife—which was somewhat reassuring.

Liu San and Zhang Ziyi were met by Steward Zhao and his men and were hurriedly led into the courtyard. Liu San saw that the corridor was crowded with the Liu family’s relatives and friends, as well as many who were probably his teachers and old acquaintances. Some were sighing, others were weeping. He was taken aback: this clearly looked like they were preparing for a funeral. Was he really that critically ill? Thinking of this, he became a little anxious. This Jinshi Liu was a signboard for the civil affairs work in Lin’gao, a vice-chairman of the Political Consultative Conference who could not be allowed to die. He was about to talk to the family about the patient’s condition, but with so many people in the courtyard, he didn’t know who was the patient’s family.

Seeing that not just one Doctor Liu had come, but also a female doctor, the crowd was startled and quickly moved aside. Some were curious and came closer to see the female doctor. The scene was chaotic.

It was Steward Zhao who took control. He quickly asked all the relatives and friends to rest in the house for a moment and not to talk in the courtyard to avoid disturbing the doctor’s diagnosis. Then he invited Liu San and Zhang Ziyi to the backyard.

For the convenience of the doctor’s comings and goings in the past few days, Liu Dalin had been moved to the study. The study’s courtyard was separated from the inner courtyard by a wall to the northeast. He could hear several women weeping in the inner courtyard; they were probably the Liu family’s female relatives. Liu San and Zhang Ziyi were led by Steward Zhao into the side courtyard. He saw several servants busy in front of the study, some tending a stove in the corridor to brew medicine, others fetching water… Seeing Steward Zhao bring in two Australians, the maids and female servants all turned aside to avoid them.

“You few, you’re not young ladies, why are you avoiding them?!” Steward Zhao scolded. “Get back to work!” With that, he was about to lead them into the main room for the diagnosis.

But Liu San said, “No hurry. Please provide a room in this courtyard for us to wash our hands and change our clothes before we proceed with the diagnosis.”

Steward Zhao had heard from his son and grandson that the Australians were extremely fond of cleanliness. He immediately agreed and ordered a side room in the courtyard to be cleaned up. He also had several clean porcelain jars brought in as Liu San had requested, and a fire was quickly started on the stove to boil water.

Zhang Ziyi was an experienced nurse. Without needing instructions from Liu San, she began to wash, prepare disinfectant, and get the medicines and equipment ready. She also helped Liu San put on his gown and mask.

Steward Zhao led Liu San and the others into the main room of the study. Several women had already come out, surrounding a middle-aged woman. Liu San saw that her clothes were not luxurious but were neat and elegant, and knew that she was probably Jinshi Liu’s wife.

A maid announced, “This is the divine Australian doctor…” Before she could finish, the woman had already curtsied.

Liu San quickly took off his mask and bowed. The two sides exchanged greetings.

Liu Dalin’s wife spoke in the local Lin’gao dialect, which Liu San did not understand well. He could only say a few polite words. Steward Zhao, who could speak the New Language, acted as an interpreter. The gist of her words was to ask the doctor to do his best to treat her husband, and that the Liu family was willing to offer a generous reward if he could be saved.

“There’s no need to talk about a generous reward,” Liu San said. “However, you must follow my instructions completely regarding the treatment. Otherwise, please find another doctor.” He had to say this in advance to avoid being told that this was not allowed and that was not permitted later on.

Steward Zhao and the mistress whispered for a while, then he said, “The mistress says: we will follow your instructions completely, as long as you can save the master’s life.”

“Good, that’s all I need to hear.” With that, he gestured for Zhang Ziyi to take out a piece of paper. It was a “Family Notification Form.” According to Shi Niaoren’s opinion, all medical procedures had to be standardized from now on, starting with the system.

At this moment, the Liu family was like ants on a hot pan. They were willing to pay any price to save the master’s life. Although they didn’t quite understand why this piece of paper was necessary—in ancient times, treating an illness was a matter of fate, and there was no such thing as beating up a doctor for failing to cure a patient, let alone medical malpractice—the mistress still signed and fingerprinted the document as Liu San had requested.

Liu San and Zhang Ziyi entered the main room. There were servants waiting by the side. Liu San found the room too dark and the air stuffy. He ordered all the windows to be opened before approaching the bed to begin his diagnosis.

Liu San examined him carefully and saw that Master Liu’s face was flushed, his breathing was rapid, and there was a wet towel on his forehead. It looked like he had a fever.

Without waiting for his instructions, Zhang Ziyi immediately took his temperature and blood pressure. Liu San also stopped pretending to take his pulse and directly used the stethoscope.

“Temperature 39.6!” Zhang Ziyi reported the reading, then skillfully pulled out Jinshi Liu’s arm to measure his blood pressure. Liu Dalin indeed had high blood pressure. People who were bedridden and had difficulty moving were prone to a series of complications: bedsores, electrolyte imbalance, lung infections, constipation, and so on. Although he couldn’t confirm which complication was the cause yet, Liu San preliminarily judged it to be an infectious outbreak. This made him breathe a sigh of relief—anti-infection was the second great weapon of the Elder doctors in this time and place, besides surgery.

After a flurry of preliminary diagnosis, they returned to the side room and questioned the servants who were personally attending to Liu Dalin about his condition. The diagnosis was soon confirmed. His condition was not complicated: the main cause was pneumonia caused by a cold. And his lung infection had already been quite severe before.

“He’s sick all over. Treating the pneumonia is easy, but the complications are difficult to handle. This involves the expertise of multiple departments. We need a consultation,” Liu San said cautiously. “To be honest, it would be best for Jinshi Liu to be hospitalized.”

“They probably won’t agree. Let’s just treat it as a home hospital. It’s just that we’ll have to trouble the other doctors to come to the Liu residence.”

“That’s the only way.” Liu San thought about the treatment plan. Overall, anti-infection treatment was their forte. They had enough antibiotics to use, which would be effective against bacteria with little drug resistance. The second was to lower his blood pressure. The pharmaceutical factory’s laboratory had trial-produced a Danshen injection, but the efficacy and toxicology of the Lin’gao version of the Danshen injection had not been sufficiently tested—there was a lack of experimental animals, and unfortunately, hypertension was a very rare disease in this time and place, with very few clinical cases among the recruited refugees. The Danshen injection had so far only barely passed the second phase of trials.

“How about using reserpine?” Zhang Ziyi knew that the pharmaceutical factory was using the root of a kind of Rauvolfia from Guangdong called “Ma San Duan” to extract reserpine. Reserpine was a traditional antihypertensive drug and was one of the few cardiovascular drugs that the pharmaceutical factory could produce at present.

“The reserpine in the laboratory has only undergone animal testing. It hasn’t even gone through phase one clinical trials. Giving it to Jinshi Liu rashly could kill him. Besides, he has pneumonia, and using reserpine is very likely to have adverse reactions.” After careful consideration, Liu San decided to use the Danshen injection he had distilled himself.

At this time, the nurses and Fu Wuben had all arrived. Zhang Ziyi then assigned the work. First, they would give Jinshi Liu an IV drip and an intravenous injection of antibiotics—to reduce the inflammation and fever as soon as possible to ensure the next step of treatment.

“Jinshi Liu may also have problems like bedsores. I want to give him some nursing care first,” Zhang Ziyi said. “Even if he doesn’t, we should still do some cleaning.”

“Okay, but be careful to keep him warm.” With that, Liu San quickly rode his bicycle back to the Bairen General Hospital and showed Liu Dalin’s medical records to the several Elder doctors who were at the hospital.