by Weijian Shan
I nodded my head in agreement.
“Risk!” the instructor exclaimed. “A revolutionary isn’t afraid of risks, because he is not concerned about himself. For a revolutionary doctor, the task is to treat the patient, regardless of the chance of losing the patient or humiliating himself before others. As for the technical problems, Chairman Mao guides us to the answer in his teachings on capturing the principal contradiction.” The instructor paused, creating an effect of suspense. Seeing that we were all listening, he continued, “There were many contradictions in this situation. If he didn’t open the chest with his pocketknife, the patient would surely die. If he did, there would be bleeding and infection. But if you compare death with bleeding and infection, which was the biggest problem?”
Obviously, it was death.
“The doctor, following the teachings of Chairman Mao, decided that death was the principal contradiction and other issues were secondary. Once the principal contradiction was resolved, other problems would in turn become principal contradictions to be dealt with. So he opened the chest. Once the man was brought back to life, the medical workers could tackle the problems of bleeding and infection. So you see,” he concluded triumphantly, “Chairman Mao’s teachings are sharper than a surgeon’s scalpel.”
I had to scratch my head at this feat of logic. I had been unaware that Chairman Mao’s teachings had such universal applications.
Dr. Yu taught the sessions on diagnostic techniques. I was very grateful to him, so I was extremely attentive. Dr. Yu was a rather serious person who seldom smiled. He would suddenly call out a name and ask the victim to interpret what he had discussed. Because of these surprise attacks, most people were a little afraid of him.
One day the subject was peritonitis, the infection of the peritoneal tissue that covers the inner stomach. Dr. Yu was describing some causes and symptoms. Toward the end of the lecture, he said that gastric puncture caused by an ulcer could also lead to peritonitis. Then he turned from the blackboard and asked:
“Could somebody tell me why gastric puncture can lead to peritonitis?” To my horror, he was looking at me.
I could feel the blood drain from my face. I was the only one who had never had any medical experience. Oh, please, Dr. Yu, I have no idea why gastric puncture can lead to peritonitis, I thought.
I heard my name. I searched Dr. Yu’s face for mercy, but there was only inquisitive gravity.
I stood, with a sense of despair. But suddenly a thought came to me. I heard my voice tremble, “A gastric puncture would cause gastric juice to leak out. Peritonitis could be caused by the irritation of the peritoneum by the gastric juice.”
I did not know if I had made any sense. But Dr. Yu smiled broadly and announced emphatically, “Absolutely correct.”
I grew dizzy from nervousness and relief. I was so happy that I hadn’t let him down—everyone knew that Dr. Yu had selected me for the course.
During the break, a young woman named Liu Ying came over and asked me how many years I had studied medicine. She could hardly believe I had never studied before.
“No wonder. I could see you were very nervous just now. You were trembling and your face was as pale as a piece of white paper. But how did you know the answer, then?” she asked.
When I told her it was intuition and logic, she shook her head in disbelief. I asked her how long she had been a barefoot doctor.
“Two years. But I haven’t studied medicine either.”
It was my turn to disbelieve. How could she practice medicine for two years without having studied it?
“Simple. At first, I just did what the military doctors asked me to do. After I had some experience, I could treat some minor problems. ‘Learn from practice,’ you know,” she said, quoting a line from Mao.
It was little wonder that there were so many “medical accidents” in the regiment and division hospitals. I had heard, for example, how a woman once had an operation on her stomach. After two weeks, her wound still had not healed, and more and more pus kept coming out. When she went back, the doctors found through an X-ray that they had left a pair of surgical scissors in her stomach. So she had another operation to retrieve the scissors. This time, they left a roll of gauze in her stomach. She had to be operated on for the third time. Li Baoquan once told me the best thing the doctors could do would be to install a zipper. That way they could open her stomach whenever they wanted.
We studied both Western and Chinese diagnostic techniques. While Western medicine relied heavily on instruments and lab tests, a doctor of Chinese medicine had to know how to bamai, to feel the pulse. The index, middle, and ring fingers were used to sense many things about the pulse, but it was very difficult for an inexperienced doctor to discern the very subtle differences. The doctor instructed us to feel each other’s pulses to practice.
This “practicing on each other” method of learning soon became a little scary. We had to give each other injections. I was not afraid to play doctor, but I was most reluctant to be practiced upon. The instructor recited Chairman Mao: “There must be sacrifice when there is a revolution.” This little sacrifice, we were told, was nothing in the service of learning useful skills for the revolution. We should feel happy. But whenever I was practiced upon, I cringed, closed my eyes, and “prayed” the words to myself over and over: “There must be sacrifices.”
To this day, I wonder how doctors learn all their techniques without being tortured or torturing others. I had saline injected into my buttocks numerous times, acupuncture all over my body, and blood drawn repeatedly from both arms. These were all unpleasant experiences. I, in turn, inflicted the same pleasure of learning upon my fellow medical students. There was only one exercise in which I absolutely refused to participate: intravenous transfusion. I couldn’t bear the thought of having my blood vessels loaded with saline. Fortunately, when I said that I would certainly pass out, the instructor spared me.
Acupuncture was a little better. Each of us practiced on ourselves. Everyone was given a small box containing different-sized needles. We were supposed to implant these on the correct points on our own bodies. I found this difficult to do. I was able to push the needle into my skin, but no matter how determined I was and how hard I pushed, I just couldn’t feel what the instructor told me I should. He said I was too tense. But how could I not be tense, pushing a needle into myself?
My first attempt to apply what I had learned of diagnostic techniques was on myself. I began to suffer from insomnia. I would be awakened by the slightest sound, such as the wind blowing past a window. At first I thought I was studying too hard without sufficient exercise, so I started to run long distances in the morning and stopped reading half an hour before bedtime. But I still could not sleep.
After consulting several books, I realized my insomnia was probably caused by malnutrition. Once I began my medical studies, I became a “person detached from production” for rationing purposes, meaning my rations were only two-thirds or less of what they had been when I belonged to the category of “person in an agricultural company.”
I had never felt that the ration for an agricultural worker was enough. The “detached from production” ration left me hungry almost all the time. Besides, our daily diet had consisted only of corn flour, sorghum, and pumpkins ever since I had first arrived, with no meat and few vegetables. That was certainly not enough nutrition for a 17-year-old.
Although I thought I had accurately diagnosed my problem, there was nothing I could do about it. If there was not enough food, there was not enough food. I wrote a long letter to my father and asked him to send me a package of food by mail, especially wheat flour, canned food, and chocolate.
The training course had been scheduled to run three months, but apparently the regiment leadership had decided that the training of a barefoot doctor did not require so much time. The instructors had to squeeze all the classes into five weeks. Just when I thought that I was getting a slight taste for the medical profession, the training was ove
r.
Dr. Yu arranged for me to go out on a fishing boat on the last day of my stay, since Batou was located right next to Lake Wuliangsu. It was a dinghy with a sail, manned by two boys from the Eighth Company. Their job was not to catch fish, but to ship cargo to another company.
I had never been out in a boat on the lake, although we already had spent two winters cutting reeds on its frozen surface. This was summertime and there were numerous waterfowl. I expected a fun trip.
We set out early. One boy used a pole to propel the boat, while the other held the rudder. We moved slowly through thick forests of reeds. There were throngs of mosquitoes everywhere. Fortunately, we had raincoats that we used to cover our heads and arms. I was told it would be a bad idea to swim near the reeds, for the mosquitoes could kill you.
When we cleared the reeds and moved out onto the lake, the mosquitoes disappeared. There was a vastness of calm water dotted with fishing boats. The boys raised our sail and the dinghy really started to move. I felt I had stepped into a fairy tale.
We passed a fish bag, and the boys netted out some large carp. This would be our lunch. Each one weighed 5 or 6 jin (∼5 or 6 pounds). I thought that two of them would be sufficient for the three of us, but the boys smiled and said that the way they prepared the fish, the three of us would need five.
I wanted to help cook, but they told me just to watch. To my astonishment, they cut off the heads and threw the bodies back into the water. Having been hungry so often and for so long, I could hardly bear to see such senseless waste.
The boys said the most delicious part of a carp was its head. They had to throw the bodies away because there was no way to keep them fresh. But whenever they could get hold of some cooking oil they could make dried shredded fish, which was easy to store. Once we got back, they would give me some to bring back to my “poor brothers.”
The fish heads were indeed delicious. But there was not much meat on them. The boys said I must have starved to death in my previous life, because I just could not eat enough. I told them I couldn’t remember the last time I had fish. And I had never had fish so fresh.
* * *
The training class at Batou provided but the briefest introduction to medicine. I realized there was a great deal more to learn, but “learning from practice” was the only way. Fortunately, there was an advantage to practicing medicine on a farm: There was no specialization to speak of, so I got a taste of everything. If someone was sick, I had to find out what was wrong, prescribe medication, fill the prescription, sometimes administer the medicine through infusion or injection and, occasionally, if the illness was serious, nurse the patient.
Including myself, the Fifth Company now had a rather large medical force. A Dr. Yin had recently been transferred in to replace Dr. Yu. Because Dr. Yin had been accepted into a military medical school shortly before the Cultural Revolution, he was nominally a medical school graduate, although he had not received much real medical education before his school was shut down. He was in his late twenties, tall and with a flat face. He stuttered, especially when he spoke to women.
There were two other medics. One was Wang Xinquan, a boy from Tianjin. He was taller than most boys, but his mannerism was almost feminine. He spoke softly. When he walked, his hips swayed more than a woman’s.
There was also a young woman four or five years older than me named Gao Xiaorong; she was short and somewhat overweight. To be sure, most of the young women in our company looked chubby whereas most boys looked emaciated, probably, I gathered from some readings, because all we ate were carbohydrates, which were more easily turned into sugar and fat in young women than in young men.
Dr. Yin usually stayed in the company clinic. So did Gao Xiaorong. Wang Xinquan would go to the fields with the platoons occasionally. I was the only one who went to the farm field with my platoon every day. I was truly a barefoot doctor who was not “detached from production,” although in the Gobi, unlike in the rice paddy fields in the south, nobody took off their shoes when working. I enjoyed this, because I didn’t want my “poor brothers” to think that I was now different from them.
I reported my return to the political instructor as soon as I got back from Batou. He seemed pleased to see me and asked me not to forget that this opportunity to practice medicine had been given to me by the Party. I should work hard to live up to the expectations of the Party. He did not need to mention that he represented the Party. In fact, he was the Party.
“I need acupuncture for my arthritis. Gao Xiaorong is no good. When you think you are good enough, come treat me,” he said before I was dismissed.
I knew that my acupuncture skills were limited. In the hands of a good acupuncturist, a patient should not feel it when the needle goes in, and he should feel only numbness and a sense of swelling after the needle has reached the right depth. I could not achieve this effect on myself. Perhaps, as my instructor had said, this was because I could not relax.
Li Baoquan volunteered to be my guinea pig. He said gallantly, in Tianjin ruffian tradition, that he was not afraid of “stabbing both sides of his ribs with a sharp knife for the sake of his friend.” He was true to his word. Every day after dinner he would lie on the kang allowing me to plant needles all over him. When I hurt him he would curse me for being clumsy and stupid. But I was happy to see that I was making progress with my skills every day.
Soon I had settled back to the daily routines of farm life. In the morning, I would go out with the platoon to work in the fields, carrying a first-aid bag. Every evening after dinner, while the others relaxed, I went to the company clinic. I fell in love with medicine. My work was more tiring now, but I really enjoyed being able to help those who were sick.
The clinic was where I spent all my spare time. When there were no visitors, I would write down the Latin names of all the drugs we had. Dr. Yin said it was not necessary, and besides, without knowing anything about Latin and without knowing how to pronounce the long words, it would be difficult to remember so many. But I was not discouraged. I enjoyed being able to memorize them.
I remembered my promise to the political instructor to treat his arthritis. I was flattered by his insistence and I appreciated fact that he took me, a freshman in the profession, so seriously, when he could have gone to the other two barefoot doctors. After much practice on Li Baoquan, I was ready to give it a try.
I went to consult with Dr. Yin to get a better idea of the instructor’s case. Dr. Yin was strictly a doctor of Western medicine. As far as I knew, there was no cure for arthritis in Western medicine. Aspirin could help relieve the symptoms, but it would not provide a cure. Acupuncture did not promise a cure either, but it might alleviate the problem without the irritating side effect of an upset stomach from aspirin.
Dr. Yin seemed uninterested in my inquiries about the instructor’s medical history. While listening to me, he kept his eyes fixed on the cover of a medical manual. Without raising his head, he said, stuttering, “The in . . . instructor is in excellent health. He won’t be ki . . . killed by your acupuncture. So, just do whatever you want, he’ll be fine.”
I was a little annoyed. I would not have called somebody with arthritis in excellent health. Dr. Yin did not seem serious about the matter. Could it be that he was scornful of acupuncture? After some hesitation, I said, “Dr. Yin, you know I am a neophyte at this. I really need your help. It would give me a better idea of the best way to treat him if you would tell me his medical history.”
There were no such things as medical records in our camp. The company clinic was supposed to provide only basic medical help for daily ailments. Nobody ever thought it necessary to keep a record. I would not be able to find out anything about the political instructor without Dr. Yin’s help.
He moved his stare away from the medical book and smiled his typical embarrassed smile. “I cer . . . certainly would like to help you in any way I can,” he said. “But you know that there is little I can do to help him. I have given him aspirin re . . . regularly.
But I . . . I think he throws away more than he takes. He said he was for . . . getful. It must be that his problem does not bother him much. The instructor is a man of much . . . much . . . much thunder but few raindrops. So don’t be too serious about it.”
I did not like what I heard. I thought that as medical professionals we should care deeply about someone’s medical problem. Obviously, there was nothing I could gain from Dr. Yin.
I took a rubber knee hammer and went to the political instructor’s bedroom. I found him and Company Commander Zhang playing poker with two young women. I felt uneasy about disturbing them and stood there with a silly smile on my face.
The political instructor raised his head and beckoned me closer. I reported that I had come to check on his knees. I said I was ready to treat him, but I could come back when he was free.
“Good, good,” he said, “Why don’t you sit down and have a game of poker with us? Are you good at Advantage?”
How dare I? What would people say if they knew I had played poker with young women in the political instructor’s room? Besides, I was not a poker player.
So I politely refused, saying that perhaps I should come back another time. I could see that the political instructor was not too pleased, but he turned to the others and said, “I knew that Little Shan would be a good barefoot doctor. See, he is now ready to treat this stubborn problem of mine. I would like to go to the fields every day with all the soldiers. But this damned arthritis troubles me all the time.”
“Political Instructor, at your advanced age, you should take more rest. Don’t risk your health with us young kids,” a young woman by the name of Wang Lianxi chimed in. She was with the cooking squad and was rumored to be a big mapijing, or ass-kisser.
I took a hard look at this woman. How could she be so shamelessly flattering? The political instructor was no more than 40, and she was talking about his advanced age. Then I caught the company commander resting his hand against her thigh. Noticing my glance, she brushed him away.