In her first decade at Sancha, Cao Chunmei never visited the Great Wall above the village. For her, the ruins belong strictly to childhood, when she used to hike to her grandmother’s house, and she sees no point in making the two-hour trek in her new home. She is a heavyset woman with a round face, and her hair is white—it started to turn when she was only a teenager. Nowadays she dyes it black, but the roots still show pale. Her left eye is blue, her right eye brown. She has a quick, gentle smile, and she always seems happiest with Wei Jia; but there is a distinct sadness behind the woman’s mismatched eyes. She’s seen the peacefulness of the countryside dissolve like a mirage, and she knows there’s nothing easy about raising the last child in a village.
I PARKED AT THE top of the dead-end road. Inside the Weis’ house, the boy lay on the kang. His face was pale and flecks of blood had dried dark around his nose. He didn’t say anything when I touched his forehead.
“It’s a lot of trouble for you to come out here,” Cao Chunmei said.
“It’s no problem,” I said. I pressed the boy’s brow—he was on fire. His eyes looked frightened but still he didn’t speak.
“Will you eat some lunch?” Cao Chunmei asked politely.
“I already ate,” I said. “I think we should go now.”
They decided that Cao Chunmei would stay behind until Wei Jia was settled in the hospital. She had prepared a change of clothes and a roll of toilet paper in the Mickey Mouse backpack. Wei Ziqi carried his son down the hill and into the backseat of the car. The boy lay with his head in his father’s lap.
The road from the village is steeply switchbacked, and I drove slowly, so the car wouldn’t bounce. After ten minutes Wei Jia said that he felt sick, and I pulled over. He made gagging noises and twin trails of blood trickled down from his nostrils. Wei Ziqi dabbed at them with the toilet paper; in the sunlight the boy looked even paler. After a minute we set off again.
Autumn is the best season in northern China, and it was a beautiful day, the sky clear and bright. The peasants had come to the final crop of the year, the soybeans, and rows of men with short-handled scythes stood bent in the fields, heads bowed like penitent monks. People threshed the haylike stalks all along the road. We had nearly an hour of rough mountain driving before the Badaling Expressway, and I tried to keep calm by focusing on the details of the countryside. We climbed out of the Huaisha River valley, across the tunneled pass, and then we descended to Nine-Crossings River. The waterway colors caught my eye—the orange-painted rails of the bridge, the dark pools of stagnant water, the white-barked poplars along the banks. At Black Mountain Stockade we had to stop again; this time the boy vomited. His nose was bleeding steadily. His father tore off fresh pieces of paper and shoved them inside to stop the flow.
The road climbed again, winding steeply through walnut orchards, and then we reached the last pass of the day. From there it’s all downhill to the valley where the Ming emperors are buried. Their tombs are scattered across the plain, each laid out to face the south, and the gold-tiled roofs shined bright in the October sunshine. We drove by the grave of Xuande, the fifth Ming ruler. According to legend he killed three Mongols with his own bow. Next we passed the tomb of his grandfather, Yongle, the great ruler who established the capital in Beijing in 1421. Just beyond that grave, Wei Ziqi asked me to stop again.
Wei Jia murmured that he had to go to the bathroom. His father took down the boy’s pants and he produced a sickly stream of diarrhea. He was completely white now and there was no expression in his eyes. We were less than ten minutes from the highway.
“I think we should keep moving,” I said.
“Give him a minute,” Wei Ziqi said.
I had pulled over in a ditch beside an apple orchard that had been recently harvested. On the road, a steady line of tour buses roared past on their way to the Ming tombs. I wondered if any tourists caught a glimpse of the scene: the parked car with its flashing lights; the father in the ditch, cradling his son. The harvested orchard, fruit picked clean, branches bare in the stark autumn light.
MIMI HAD ARRANGED A spot for Wei Jia in the children’s ward of the Peking University Health Center Number Three, where the blood specialists were supposed to be good. We registered the boy, and after he was in bed he seemed to recover some of his color. But now he was so frightened that he struggled against anybody in a white coat; when they tried to take a blood test, he bit one nurse and took a swing at another. His father and I pinned him to the bed while they performed the test. Afterward he calmed down, and a nurse said that he would be kept under close observation to see if his platelet count improved. She asked who would stay with the boy tonight.
“I will,” Wei Ziqi said.
“You can’t!” the woman said sharply. “Only female comrades are allowed to spend the night in the hospital.”
“His mother will come tomorrow,” Wei Ziqi said. “Can’t I stay with him for one night?”
“Absolutely not! Only female comrades allowed!”
“Look, they live two hours away,” Mimi said. “I’m sorry, but the only family he has here is his father.”
“The father cannot stay here! Female comrades only! You can stay if you wish, but not the father!”
The nurse was a heavyset woman in her fifties, and she had planted herself solidly in front of Wei Jia’s bed. She kept repeating that phrase—Female comrades only! The more she said it, the stranger it sounded; almost nobody used those old Communist terms anymore. The boy began to cry again, his face panicked. “I don’t want to stay here alone!” he said. “I don’t want to stay here alone!”
“Don’t worry, you’re not going to stay here alone,” Mimi said, and I turned to the nurse: “Can we talk about this outside?”
I didn’t want to get angry, because Chinese hospitals have a reputation for mistreating people from the countryside. As calmly as possible, I explained the situation, and Mimi begged the nurse to make an exception. But she was adamant—people in Chinese bureaucracies often behave this way, especially those who are middle-aged. They were educated during the chaotic years of the Cultural Revolution, and many of them have spent their entire adult lives in the work-unit system of Communist China. They essentially missed out on the Reform years, and they lack the flexibility and pragmatism that have become so common among younger Chinese. In the hospital the nurse refused to budge, and finally I decided to drive back to the village and pick up Cao Chunmei.
“You better be back here by ten o’clock!” the nurse said. “If she comes after ten, we won’t let her in. We lock the doors at night. Those are the rules!”
I called Cao Chunmei and asked her to find a motorcycle ride down into the valley, so we could save time. But half an hour later she called back: only one neighbor had a motorbike, and tonight he was already too drunk to drive. It was dark by the time I reached the dead-end road. Cao Chunmei waited with a bag she had packed for the hospital. It contained several bottles of local spring water—most villagers believe that Sancha water is healthier than anything you can buy in the city.
“It’s a lot of trouble for you,” she said, hurrying into the car.
“It’s not a problem,” I said. “Do you have everything you need?”
“I’m fine,” she said. “Have you eaten yet?”
“I already ate,” I said. In truth I hadn’t had a meal since morning, but there was something reassuring about the polite exchange. In rural China, no matter how stressful a situation becomes, you can always count on certain conversations, and Cao Chunmei’s words made me feel calmer. Driving fast through the mountains, I watched the shadowy landmarks slip past for the fourth time since dawn: the Huaisha River valley, the Nine-Crossings River, the Black Mountain Stockade. The roofs of the Ming tombs shone ghostlike in the darkness. The expressway was empty; we made it to the hospital with half an hour to spare. Wei Jia was already fast asleep, and the boy didn’t stir when I told his parents good night.
FOR MOST OF THAT week Wei Jia ran a fever. On the fi
fth day, it reached one hundred and four degrees, and his platelet count dipped beneath fifteen thousand. If it went much lower, there was a serious risk of bleeding in the brain.
Mimi and I visited daily, and every night I wrote my doctor friends in the United States. They told me that a combination of rest and good diet often stabilizes a child with ITP, but we still weren’t certain of the diagnosis. In the States, a patient in his condition would be given a blood transfusion, but the Chinese doctors hadn’t recommended it yet. And I had advised the parents that such measures should be a last resort. The blood supply in China isn’t safe; donors are in short supply and the system relies primarily on people who are paid for giving blood. At the time of Wei Jia’s illness, experts estimated that more than one million Chinese had been infected with H.I.V. The epidemic was particularly severe in Henan Province, just south of Beijing, because of unsanitary donor practices. The big cities had problems, too—I knew a Chinese-American journalist who had recently visited one Beijing donor center and was immediately offered a fake ID so she could sell her blood. Even better-run clinics usually limited their blood analysis to antibody tests, which are cheaper and less reliable than the molecular diagnostics used in developed countries.
On the seventh day Wei Jia began to bleed from his gums. That morning the doctors gave him a bone-marrow test for leukemia, and finally they decided that he needed a transfusion. Wei Ziqi telephoned me and asked to borrow nearly a thousand dollars. In China, there is no national health insurance, and city residents usually rely on their work units for coverage. Most farmers are completely on their own, which is one reason they tend to be so careful with their savings—a rural person has to be prepared to pay cash for a medical emergency. And hospitals tend to mistreat peasants as a result. Doctors are wary of getting stuck with an unpaid bill, so they always demand money up front. It wasn’t until 2009 that the central government began to take steps toward establishing some form of universal health care, although it’s still unclear how comprehensive such coverage will be.
At the time of Wei Jia’s illness, only private insurance would cover a family in the countryside. Unlike most farmers, the Weis had purchased a policy for their son. It had been offered when he entered kindergarten, and the Weis had been smart enough to buy it; now the majority of his treatment would be covered. But the hospital wouldn’t wait for reimbursement: they demanded cash now. In such situations, families usually raise money from relatives, which might take days to organize.
Mimi was preparing to leave for a work trip to Europe, so I went alone to the hospital. Wei Jia slept fitfully; his mother told me the doctors had drugged him. Dried blood had caked around his mouth—his gums were still oozing. Accompanied by Wei Ziqi, I introduced myself to the physician on duty. Her name was Dr. Zhao, and she sat in an office with another physician and three nurses. I asked if the transfusion was critical.
“Who is this?” she said sharply to Wei Ziqi. “Why is he here? Why is he asking questions?”
“He’s a writer,” Wei Ziqi said proudly.
“I’m a friend, as I just explained,” I said quickly. “I was the one who brought the boy to the hospital. I have some simple questions about what we should do.”
“This isn’t his affair!” Dr. Zhao said to Wei Ziqi. “You’re the parent, and you have responsibility. He has nothing to do with it.”
“I care about the child,” I said. “I’ve been trying to help them since he got sick. I just want us to make the right decision.”
“The decision has already been made!” With that, the woman turned her back on me. For a moment I stood in silence. In China, I was accustomed to people being more patient with me; in general they’re inclined to grant a sort of exaggerated respect to any foreigner who speaks the language. Usually this deference makes life easier, and like any long-term foreign resident I learned to play it to my advantage. But I had no illusions about what it really meant. At the root of that respect is insecurity: deep down, many Chinese, especially educated people, are slightly ashamed of the way their country might appear to an outsider. Dr. Zhao didn’t see me as a person who cared for a sick child; in her eyes I was simply a foreigner who distrusted her competence.
And she was clearly annoyed by Wei Ziqi’s faith in my judgment. Together we brought out the city woman’s worst instincts, from both sides of the spectrum: she responded to the peasant with arrogance and the foreigner with insecurity. I turned to the other women in the room. “Who can I talk to about this?” I said, but they ignored me. I repeated the question: silence. One of the nurses whispered a joke that I couldn’t hear; the others laughed. I felt my face turn red, and that was when my patience ended—I wasn’t going to listen to their laughter while the child suffered next door.
“It’s very simple,” I said. “I’m paying for this. Before I pay the money, I have to know why he needs the transfusion now. If you don’t talk to me, I won’t pay it.”
Dr. Zhao turned to me, her face tight with anger. “He needs immune globulin,” she said. “If he doesn’t get it, there’s a risk that he’ll have brain damage. Already he’s bleeding inside his mouth. We know what to do, and you don’t understand anything about it.”
“I’m trying to understand as much as I can,” I said. “If you speak slowly, it helps. I’m only asking questions because I care about the boy.”
“If you care, then let us give him the transfusion!”
“I’ve talked with other doctors who say that maybe a transfusion isn’t necessary,” I said. “They said that usually they would wait for the biopsy results.”
“How long will that be?” the woman said loudly. “We don’t even know. It could be a week. We can’t wait that long!”
“Why hasn’t he been tested to see if he has a virus that’s causing his fever?”
“We know that his platelet level is low! That’s our primary concern!”
“Have you done a test for hepatitis?”
“He doesn’t have hepatitis!”
“Have you tested for it? I was told that it’s a possibility.”
“There’s no need to test for it! Hepatitis isn’t a concern!”
“If you give him gamma globulin, is there a risk that the blood might carry some disease?”
“Of course there’s a risk!” Dr. Zhao spat out the words. “It could have H.I.V. or hepatitis or something else!”
“Don’t they test the blood?”
“You can’t test it completely.”
“I think you can,” I said.
“Believe me, you can’t!”
It disgusted me to hear a doctor say such nonsense, but I tried another approach: “Where does the blood come from?”
“How am I supposed to know?” The woman was shouting now, and I backed out of the room with Wei Ziqi. I told him that the blood supply was my main concern, and he nodded calmly. Using my cell phone, I called an American I knew who worked for a medical company in Beijing. She told me that her organization followed international testing standards for blood, and she checked to see if it was possible to arrange a sale of gamma globulin. A moment later she called back.
“They can deliver it to you,” she said. “It costs three hundred and seventy-eight dollars per unit. I think that one unit should be enough for a five-year-old, if he’s not too big.”
“He’s very small,” I said.
“That should be fine,” she said. “They’ll deliver it, but you have to get the hospital there to accept it.”
Technically it’s illegal for such an organization to sell blood, but that’s how many things work in China. I took a deep breath and returned to the doctor’s room. “If I buy clean blood, can we use that?” I said.
“There’s no guaranteed clean blood in Beijing,” the doctor said.
“There is,” I said, and then I told her the name of the organization. “They have clean blood.”
“No, they don’t,” she said. “There’s no way to test for all of these things.”
“I’m
certain they can test for H.I.V. and hepatitis,” I said.
“It’s impossible,” the doctor said. “There’s no test.”
“Forget about the test,” I said. “That isn’t important right now. What I want to know is, if I get blood from them and have it delivered here, will you give it to the child?”
“That’s impossible! They won’t sell you blood!”
“I’ve already talked to them,” I said. “They’ve agreed to sell it.”
“We won’t accept it,” she said. “It’s against hospital policy. What kind of question is this? Why do you even think of doing something like this? Who do you think you are?”
“You won’t tell me where your blood comes from, and you won’t tell me whether it’s safe,” I said. “So I’m trying to find a source that’s safe. This is the only reason I’m asking.”
“There’s no safe blood in Beijing,” she said. “You have no option other than using what we have. There’s a risk, but the risk is higher if he doesn’t get the gamma globulin. You need to make this decision right now!”
I was shaking with anger by the time I left the room. I called the American woman and explained the situation; she said that there was one more thing we could do. “I know some Chinese doctors who used to work at your hospital,” she said. “I’ll ask them to check on the blood supply. They’ll know where the blood comes from, and we can see if the donor center is reliable or not. I’ll call you back.”
I waited in Wei Jia’s hospital room with the parents. Throughout the past week, they had remained perfectly calm: no tears, no panicking, no raised voices. Life in the countryside had toughened them, and it had also taught them the meaning of Mei banfa: Nothing can be done. During my arguments with the doctor, Wei Ziqi had stood quietly in the background. He made it clear that he deferred to my judgment; he had great faith in my unseen American medical friends, and he shared none of the insecurities of the educated Chinese. For him it was simply logical: he didn’t know anything about these issues, and he had no way of gaining information, and so he trusted the foreigner with his son’s health. My own reaction was different—I was also badly out of my element, but the seriousness of the situation made me want to control it. In truth all I could do was try to get information, hoping to make the right decision, and now it was a matter of waiting for a phone call.
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