Chapter 771 – Diagnosis and Treatment

While they were busy packing, Shi Naoren's voice carried in from outside the door: "You're all playing out of tune! He's practically dead. What good will some mystical Chinese-medicine charlatan do? By the time you've brewed the decoction, Scholar Liu will already be pushing up daisies..."

The door flew open, and Director Shi strode in, imperiously berating his subordinates—then stopped short upon seeing Liu San inside, sorting through the medical kit. He switched gears at once: "...Why wasn't Dr. Liu assigned an assistant? One person can't manage an emergency alone..."

"Director Shi... I can handle emergency care too. I studied Chinese pharmacology, but I've also studied modern medicine..."

"Oh, never mind—Chinese medicine is a form of medicine, after all," Dr. Shi said with forced heartiness. "Xiao Liu, the Executive Committee takes this very seriously. It's all on you."

"Yes, yes. I'll certainly accomplish the glorious task the organization has assigned me. But emergency medicine isn't my specialty. We still need another doctor familiar with modern medicine to assist."

This was no mere banter. Liu San had never worked in emergency care. In the old time-space, he had barely done any outpatient Chinese-medicine work either.

"All right, let Zhang Tumu go with you," Shi Naoren said.

Zhang Tumu was their only doctor who had actually worked in emergency medicine—a genuine professional. The Chengmai campaign had given him ample practice in emergency surgery. The ER at Bairen General Hospital was always busy, and under the constant stream of cases, Zhang Tumu's skills had grown ever more refined. His wound debridement and suturing, in particular, had achieved near-surgical perfection.

"No need. The ER is busy. If he leaves and an emergency comes in, that's bad. Let Zhang Ziyi go with me—a veteran nurse is worth gold."

"Fine, fine. You go first. If there's a problem, call. We'll see if a consultation is needed," Shi Naoren said. "Oh, and bring a few interns and nurses along—let them gain some experience points."

Liu San summoned Fu Wuben, plus two trainee nurses and one trainee doctor. Hearing the situation was critical, Liu San decided he and Zhang Ziyi would ride ahead with the essentials. The others would follow on foot.

At the county-town gate, Steward Zhao and several servants were anxiously watching for the approaching Australian doctor. For the Liu family, calling an Australian physician was an absolute last resort—but it was their only hope. They had all heard tales of the Australians doing "what others could not," and now they prayed for a miracle. Moreover, this Dr. Liu came on the strong recommendation of Shopkeeper Yang and was said to be a master of traditional medicine—not the Australian techniques involving knives and slicing open bellies. That gave them some comfort.

Liu San and Zhang Ziyi were met by Steward Zhao and escorted hastily into the compound. Liu San saw the veranda crammed with members of the Liu clan—and probably friends and tutors of the scholar. Some sighed; some wept. His heart sank: They look like they're preparing for a funeral. Could things really be that dire? The thought made him anxious. Scholar Liu was a flagship figure for Lingao's civil-affairs work—a "Vice Chairman of the Political Consultative Conference" who absolutely could not die. He wanted to discuss the illness with the family, but amid the crowd of people, he couldn't tell who counted as next of kin.

What alarmed everyone was not just the arrival of Dr. Liu, but the presence of a female doctor. People shrank back; others, curious, pressed forward. The scene was chaotic.

Steward Zhao, experienced enough to maintain order, quickly asked relatives and friends to step inside for a moment and not disturb the doctors with courtyard chatter. Then he led Liu San and Zhang Ziyi toward the rear courtyard.

For the past few days, to make it easier for doctors to come and go, Liu Dalin had been moved to the study. The study's courtyard was separated by only one wall from the inner quarters, from which came the muffled weeping of women—probably the Liu family's womenfolk. Steward Zhao led them into the side courtyard. Servants were bustling in and out of the study: a brazier burned on the veranda for decocting medicine; someone was fetching water. Seeing the steward arrive with two Australians, maids and female servants stepped aside to retreat.

"You lot—you're not grand ladies; what are you dodging for?!" Steward Zhao scolded. "Get back to work!" He was about to take them into the main room for the examination.

Liu San halted him. "No hurry. Please clear a room in this courtyard so we can wash our hands and change clothes before seeing the patient."

Steward Zhao had heard from his son and grandson that Australians were obsessed with cleanliness. He agreed at once, ordering a side chamber tidied up. At Liu San's request, clean porcelain basins were brought in, and the brazier was stoked to boil water.

Zhang Ziyi, the practiced nurse that she was, didn't wait for instructions. She washed her hands, mixed disinfectant, prepared instruments and medicines, then helped Liu San into a white coat and mask.

Steward Zhao led them into the main room of the study. As they approached, several women emerged, flanking a middle-aged lady. Liu San noted her clothes were not opulent but neatly tasteful—probably the scholar's wife.

A maid announced, "This is the Australian miracle doctor—" but before she could finish, the lady had already dropped into a curtsey.

Liu San quickly pulled down his mask and performed a bow in return, exchanging greetings.

Liu Dalin's wife spoke in the local Lingao dialect, which Liu San barely understood, so he offered a few polite words. Steward Zhao, who spoke New Speech, interpreted: the gist was that they begged the doctor to do his utmost. If he could save the master's life, the Liu family would reward him handsomely.

"Let's not speak of rewards," Liu San said. "However, treatment must proceed entirely under my direction. Otherwise, please ask your mistress to find another physician." He had to establish this from the start, lest they forbid this or refuse that later.

Steward Zhao murmured with the mistress, then said, "The mistress says: treat as you see fit, so long as you save the master's life."

"Good. With that assurance, we can proceed." He signaled Zhang Ziyi to produce a document—a "Family Notification" form. Per Shi Naoren's directive, all medical formalities had to be regularized from now on; the system had to be institutionalized.

For the Liu household, these were desperate times; they would pay any price to save the master. Though they didn't quite understand why such paperwork was necessary—in ancient practice, curing illness was in Heaven's hands; one didn't beat up a doctor for failure, and "malpractice" was unheard of—the mistress still signed and stamped the document as Liu San requested, however bemused by Australian ways.

Liu San and Zhang Ziyi entered the main room. Servants hovered nearby. Declaring the room too dark and the air too stale, Liu San ordered all windows opened. Only then did he approach the bed to begin his examination.

Upon careful inspection, Liu San saw the master's face flushed, his breathing rapid, a damp towel on his forehead. Obviously feverish.

Without waiting for orders, Zhang Ziyi took his temperature and blood pressure. Liu San dispensed with theatrical pulse-taking and went straight for the stethoscope.

"Temperature 39.6!" Zhang Ziyi reported. Deftly she pulled out the scholar's arm and measured blood pressure—confirming hypertension.

A bedridden person with impaired mobility was prone to a raft of complications: bedsores, electrolyte imbalance, pulmonary infection, constipation, and more. Though they couldn't yet confirm which complication was causing this, Liu San tentatively judged it an infectious flare-up. That brought slight relief—anti-infection therapy was the Elder doctors' second-greatest weapon in this time-space, after surgery.

After the flurry of preliminary diagnostics, they returned to the side chamber and summoned the attendants who cared for Liu Dalin to inquire about his condition. A diagnosis soon emerged. His case was not complicated: the primary cause was pneumonia triggered by a cold. His pulmonary infection had already become quite severe.

"He has problems all over," Liu San said cautiously. "Treating the pneumonia is easy, but the complications are tricky—they involve multiple specialties. We need a consultation. Frankly, it would be best to hospitalize Scholar Liu."

"They'll almost certainly refuse," Zhang Ziyi said. "A home-based ward, then—but we'll have to trouble other doctors to come to the Liu residence."

"No choice." Liu San considered the treatment plan. Broadly speaking, anti-infection therapy was their ace in the hole. They had ample antibiotics, and against bacteria with little drug resistance, they were highly effective. Next was lowering blood pressure. The pharmaceutical lab had trial-produced a Danshen injection, but the Lingao version's efficacy and toxicology had not been sufficiently tested. They lacked experimental animals, and unfortunately hypertension was a rare disease in this time-space—there were extremely few clinical cases among the recruited refugees. The Danshen injection had barely cleared Phase II trials.

"How about reserpine?" Zhang Ziyi asked. She knew the pharmaceutical factory was extracting reserpine from the root of a Rauvolfia species called ma san duan, grown in Guangdong. Reserpine was a traditional antihypertensive and one of the few cardiovascular drugs the factory could produce.

"The lab's reserpine has only undergone animal testing. Clinical Phase I hasn't even been done. Using it rashly on Scholar Liu might kill him. Besides, he has pneumonia—reserpine is very likely to provoke adverse reactions." After much deliberation, Liu San decided to use his own distilled Danshen injection.

By now the nurses and Fu Wuben had arrived. Zhang Ziyi assigned tasks: first, put an IV line into the scholar and administer antibiotics intravenously. Controlling the infection and fever as quickly as possible was critical for the next stage.

"Scholar Liu may also have bedsores," Zhang Ziyi said. "I'd like to give him some nursing care first. Even if he doesn't, basic hygiene should be done."

"Go ahead—but keep him warm." Liu San hopped back on his bicycle and raced to Bairen General Hospital to show Liu Dalin's case file to the Elder doctors on site.

(End of Chapter)