Chapter 107 Your First Time in the ICU?

An invitation to consult does little to ease the doubts outside the ICU.

The Chinese medicine doctors following the group felt their hearts sink at the news. It wasn't that they doubted Professor He's skill.

But he wasn't invincible. The patient had spent seven months at some of the best hospitals in the province. He had seen every kind of specialist, and none had been able to help.

Professor He was a leading provincial specialist, certainly, but those other experts knew their business too. Specialists in both Chinese and Western medicine had already consulted together.

They couldn't see how he could be better than all those experts combined.

Even the patient's wife felt the same way.

In truth, the news had shaken Professor He's confidence too. He probably couldn't do much either. But with a patient before him, refusing to try was out of the question.

He nodded solemnly. “I'll do everything I can.”

Marcus shook his hand again. “Please.”

The professor nodded. “All right… Evan, come and change with me. You're coming in.”

“All right,” Evan said.

Marcus looked taken aback. “The young doctor is going in too?”

“Professor He, we have staff inside who can assist you,” said Dr. Shi, the head of the ICU. “It's a complicated environment. We shouldn't have too many people going in.”

“Patrick, this is Dr. Xu,” Leo said.

“Who?”

“The one who cured the appendicitis…”

Dr. Shi remembered at once. “Oh, the one who identified appendicitis in an atypical location?”

Professor He turned to look at Evan. The young man had quite a reputation!

Dr. Shi now took Evan a little more seriously. Treating appendicitis in an unusual location was nothing remarkable; recognizing it was the real skill. Still, his opinion had risen only a little. After all, curing it wasn't much of an achievement.

He gave a slight nod. “Even so… I personally wouldn't recommend taking him in.”

Everyone paused in surprise.

Leo hurried over and tugged at him. “Patrick, what are you doing?”

“I'm not trying to make things difficult for you,” Dr. Shi said quietly. “First, he isn't one of our doctors. Second, he won't be any use in there. At this stage, the only option is amputation. It doesn't matter who comes.”

“Dr. Xu has already signed a consultation agreement with us. He's one of our invited specialists now.”^[1]

“What?” Dr. Shi was momentarily taken aback.

“Dr. Xu is my assistant,” Professor He added. “He has to come in.”

“Well…” There was nothing more Dr. Shi could say. He gave a rueful smile. “All right. You haven't been in an ICU before, have you, Dr. Xu? Once you're inside, make sure you follow the staff's instructions.”

The younger Chinese medicine doctors behind them exchanged glances. They had never been in an ICU either. They never got the chance. The ICU was Western medicine's territory. Even when a Chinese medicine consultation was requested, the invitation went to director-level doctors, never to them.

“All right.” Evan nodded slightly.

“Then go and change,” Dr. Shi said.

Evan and Professor He went to change.

Marcus came over to Leo. “What's the story with that young doctor?”

“Stop calling him that,” Leo said irritably. “Dr. Xu may be young, but he's very good. Show him some respect. You might need his help yourself one day.”

Marcus gave his older brother a sidelong look. “Are you telling me what to do?”

Leo had no answer.

Meanwhile, Evan and Professor He were getting ready nearby.

“Is this your first time in an ICU?” the professor asked.

Instead of answering, Evan asked, “Do you go in often, Professor?”

Professor He shook his head. “Very rarely, actually. Nowadays, emergency and critical cases generally aren't referred to Chinese medicine. Occasionally I'm invited for a consultation, and then I'll go and have a look.”

Evan gave a small nod.

Professor He put on his mask. “The people in there are critically ill. Once we're inside, don't wander around or touch anything.

“Since this is your first time, seeing so many seriously ill patients at once may make you nervous. Take a few deep breaths if you need to. Watch more, talk less.”

He was trying to prepare Evan, worried that the young man would struggle with what he was about to see.

Evan lowered his head and smiled a little. “All right.”

A source check shows an unpermitted copy; the page where the author publishes this chapter is the supportive place to read.

Wearing protective clothing and masks, they entered the ICU.

A gloom hung over the unit that was hard to describe. Everyone here had a life-threatening illness. How could the atmosphere be anything but bleak?

They followed the staff farther inside.

Professor He felt heavyhearted. He always did when he entered an ICU.

They went into the ward.

Several other patients lay there besides Gordon Gao, all groaning in pain.

The professor felt worse. He looked around at them and sighed inwardly. A sense of helplessness as a doctor came over him, deepening his distress.

He shook his head slightly and set his feelings aside. He turned toward Evan, afraid the young man would panic at his first sight of a scene like this.

Instead, Evan was even calmer than he was. While the professor was still dwelling on what he had seen, Evan had already sat down at the patient's bedside and begun asking questions. He was composed and methodical.

Professor He was astonished.

Was the young man really so unflappable?

He hurried over too.

The patient was in great distress. His chest felt tight and swollen, with stabbing pain. Even speaking was difficult.

Evan asked only a few questions. He already knew the rest of the history from the conversation outside.

He continued the examination. Both legs were ice-cold below the knees, the left worse than the right. There was an ulcer on the inner side of the left big toe, and all ten toes were bluish-purple. This was tuoju, digital gangrene.^[2]

The patient's voice trembled. “It hurts. My feet… it's like they're being shocked with high-voltage electricity, all the time… the pain… they're all numb… I can't move them. My left hand's numb too. My chest… tight…

“Swollen… like someone's sticking needles into my heart… it hurts… it hurts…”

Both doctors frowned. This was zhen xintong, true Heart pain.

The Lingshu, in its chapter “Jue Bing,” stated: “With true Heart pain, the hands and feet are cold up to the joints, and the pain is severe. If it begins in the morning, death comes by evening; if it begins in the evening, death comes by morning.”

This was a life-threatening condition. The patient could die.^[3]

He also clearly showed signs of tuoju.

His Western diagnoses were hardening of the brain's arteries, an inferior-wall myocardial infarction, and thromboangiitis obliterans in both legs.

In Chinese medicine, these were two conditions: true Heart pain and tuoju. Both were already severe.

The outlook was poor.

Professor He considered for a moment. “His arms and legs are cold and numb, especially the legs, and there's severe pain like electric shocks. In that case, we could examine…”

Before he had finished, Evan was already at the foot of the bed, examining the patient's foot arteries.

The three pulses—Fuyang, Taixi, and Taichong—were all taken along the arteries of the feet.^[4]

Professor He paused. Why did Evan seem more familiar with assessing a critically ill patient like this than he was?

After examining the feet, Evan said, “Neither dorsalis pedis pulse can be felt. There's no pulse to assess.”

The professor's heart sank. It was worse than he'd thought.

Evan went straight on to examine the pulse at the cunkou region of the wrist.

Evan had been doing all the work since they came in. The professor had been left standing beside him. For a moment he had the odd feeling that he was the one observing and learning.

Wasn't this Evan's first time in an ICU? How could he be so familiar with examining a critically ill patient on his first attempt?

The professor couldn't understand it.

After a little while, Evan finished. “Deep, thready, slow, and barely perceptible. His complexion is pale and dull, he's listless and sensitive to cold. Professor, it's quite clear now. Would you like to check the pulse?”^[5]

“I'd better.”

Professor He examined it too and reached the same conclusion.

“Shall we go outside and discuss how to treat him?” Evan asked.

“All right.” The professor nodded.

They were about to leave.

Through the pain, the patient forced out the words in a trembling voice. “I don't want an amputation. I'd rather die…”

Their hearts grew heavier still.

Reader Notes

1. ↩︎ An invited specialist. The agreement matters because Evan works outside this hospital. Leo is establishing that he has been formally invited to provide care. Chinese institutional practice distinguishes a consultation for a particular case from regularly practicing at several hospitals. Here, “invited specialist” describes Evan's consulting role, without making him a permanent employee. The later reference to “director-level” doctors conveys senior standing; it does not establish that every doctor invited is a department head. Source: National Health Commission — distinguishing outside consultations from practice at multiple institutions (in Chinese).
2. ↩︎ Tuoju. This traditional disease category concerns the fingers or toes and may involve coldness, numbness, severe pain, discoloration, and eventual tissue death. Here the narrator applies it to Gao's cold legs, discolored toes, and ulcer. The name belongs to the Chinese medicine account of his illness; his previously established vascular diagnosis appears separately below. Calling the condition tuoju does not mean that every toe has already become necrotic. Source: WHO — International Standard Terminologies on Traditional Chinese Medicine, entry 1932.
3. ↩︎ True Heart pain. Zhen xintong is the traditional name used here for a dangerous chest-pain condition. The quotation comes from “Jue Bing,” chapter 24 of the Lingshu, one part of the Huangdi Neijing. Its morning-and-evening wording conveys the classical text's grave prognosis. It is not a modern survival timetable, and the historical category is not interchangeable with every modern diagnosis of myocardial infarction. The English quotation is translated from the Chinese supplied in this novel. Source: Lingshu — “Jue Bing,” Chinese transcription.
4. ↩︎ Lower pulse sites. Fuyang, Taixi, and Taichong name traditional sites for feeling arterial pulsation, rather than three acupuncture procedures. They should not all be understood as points on one artery: Taixi lies at the inner ankle, while Fuyang is associated with the pulse on the foot's upper surface. The story's wording groups these lower sites together. Evan's next finding describes an absent palpable pulse, rather than arteries physically disappearing. Sources: WHO — TCM Terminologies, entries 855 and 919; WHO — Standard Acupuncture Point Locations, KI3, p. 137.
5. ↩︎ The wrist pulse. Cunkou is the radial-pulse region near the wrist, assessed at three adjacent positions. The four descriptions address distinct qualities: deep concerns the pressure needed to feel it; thready describes its narrowness; slow concerns its rate; barely perceptible conveys its faint strength. They preserve Evan's four-part assessment, without supplying an unreported heart rate or blood pressure. Source: WHO — TCM Terminologies, entries 856–857, 890–891, and 895–896.