Chapter 13: Notoginseng

On Monday, after a full day of outpatient appointments, the oncology department held a meeting before the end of the workday.

At a quarter past six, the small conference room was full of medical staff. Jiang Baizhi sat on the left side of the second row, with the meeting documents on the small desk beside her.

Director Liu chaired the meeting. He went over the patients admitted the previous week and raised several cases where the treatment plan was disputed. One of them was Jiang Baizhi’s patient.

“Xiao Jiang, are you sure you want to use targeted therapy?”

“The patient has advanced lung cancer. She’s already undergone three rounds of radiation and chemotherapy at Huaya Hospital, but the cancer has still spread to both lungs, her bones, and her brain. Her platelet and white blood cell counts are very low. She’s no longer a candidate for radiation or chemotherapy.”

“Old Zhang thinks we should send the patient home to take medicine and let her live out whatever time she has.”

Jiang Baizhi gently capped her pen and objected. “But we haven’t tried targeted therapy. The patient is only sixty-two and just retired. She should be at an age when she can enjoy her later years.”

Old Zhang, whom Director Liu had mentioned, spoke up. “The patient’s son wants to take her home. He doesn’t want her to keep getting treatment.”

Jiang Baizhi had a good guess what the family was after. She turned and asked, “The woman usually lives with her daughter. Her son has hardly ever looked after her. Why does he want to take her home now?”

“It’s obviously about the money. She retired from a management position at the postal savings bank and withdrew several hundred thousand from her housing fund all at once.”

“I’ll call her daughter.” Jiang Baizhi opened the patient’s file.

“Don’t get dragged into this. Let the family take her home.” Old Zhang continued to try to dissuade her. He’d had plenty of bad experiences with troublesome relatives and had been harassed by them for a long time.

Jiang Baizhi stood her ground. “Can we let the patient stay in the hospital until her condition stabilizes? Some targeted drugs are covered by insurance now. I’ll do my best to talk to her family.”

“Fine, let’s do that. Xiao Jiang, let us know if you need help.” Director Liu had been Jiang Baizhi’s mentor since she entered the profession. He knew her temperament. She seemed easygoing, but once she made up her mind, not even ten oxen could drag her away from it.

They continued discussing the other patients. Before the meeting ended, Old Zhang, the deputy director, suddenly said, “Xiao Jiang, the medical affairs office received a complaint. A patient’s family member said you had a bad attitude and refused to accept reasonable advice.”

“We’ll discuss it after the meeting. Xiao Jiang, come with me to my office.” Director Liu cleared his throat, silencing the murmurs around the room. After the meeting, he stood and left first.

Jiang Baizhi gathered her papers and headed straight for his office.

Director Liu had practiced wellness for years. The herbs in his teacup changed every few days, depending on how he felt. He took a couple of sips, then opened his eyes, which had narrowed to slits. He spoke kindly. “The family member is being unreasonable. He insists that you write him a letter of apology.”

Jiang Baizhi frowned slightly, but her voice remained calm. “Teacher, what was this ‘reasonable advice’ he gave? He read two or three articles about the medication and then questioned a doctor’s expertise.”

Director Liu waved a hand. “There’s no point arguing with him. He won’t listen.”

Jiang Baizhi, though young, remained composed. “Teacher, I’m only stating the facts. If we have to apologize to every family member, we’ll be swamped.”

“You’ve worked here for two years. How many family members have you apologized to?” Director Liu smiled. “None, right?”

Jiang Baizhi smiled back. “Teacher, I just don’t think an apology will help. People who make a scene will keep making a scene, and they may even push for more.”

“If you don’t apologize, they might take it to the Health Bureau, and that’ll be a headache. Better to keep the peace. Write it when you get home and send it to me. That’s final.”

Jiang Baizhi saw that he’d made up his mind, so she stopped arguing and nodded.

As she was leaving, Director Liu brought up one more thing. “A few interns from Yan University are coming tomorrow. We’ll split them up among us.” The oncology department had three chief physicians, each with a treatment team and an associate chief physician under them.

“I prefer to take a female intern.”

Director Liu laughed. “You have preferences when it comes to teaching students?”

“Women are more obedient.”

“I think there’s a young woman named Zhao Ruoruo.”

“Then I’ll take her. Thank you, Teacher.” Jiang Baizhi was already standing by the door.

“You only act up in front of me. The other staff all say you’re an ice queen. Go on, go on. Aren’t you married? When are you bringing your other half to meet me?”

“She’s shy.” Jiang Baizhi said it and disappeared down the corridor less than a minute later.

Jiang Baizhi lived in a row of villas at Ronghui Garden Estate, twelve kilometers from the hospital. Jiang Luhua and Sun Mingfen had bought the house for her and Qi Banxia. Jiang Luhua was busy with business most of the time, and he and his daughter rarely saw each other. They each did their own thing, and Jiang Baizhi had gotten used to living alone.

After showering, she opened her laptop in the study on the second floor. The words “Letter of Apology” appeared on the screen, but she had no idea what to write. Half an hour passed before she managed to finish it.

Dear [Redacted] Family Member,

Hello.

I am Doctor Jiang Baizhi of the oncology department at Yanyang City Hospital of Traditional Chinese Medicine. Thank you for your valuable advice. I will give it careful consideration, and I sincerely apologize for my attitude at the time.

Jiang Baizhi

Year xxxx, Month x, Day x

She emailed it to Director Liu, then sent another copy to the medical affairs office. Once she had finished organizing the day’s work, she closed her laptop.

The neighborhood was quiet. All she could hear was the wind brushing her hair. Jiang Baizhi held a glass of water. She was careful not to drink much at night, as usual, and after two small sips, she set it down.

Rain fell hard outside the balcony, and the wind was strong, too. Sitting in a hanging chair, she wore a loose white shirt that clung to her skin as if it had been soaked. Her slender arms were clearly visible.

She picked up her phone, put it down, and picked it up again. At last, she opened the chat and typed a message below the words “Good night.”

“Are you coming home on Thursday? I’ll come pick you up.”

The message sank into the sea without a trace. The next morning, she still had no reply. Jiang Baizhi pressed her fingers to her brow, scolding herself for her recklessness that night. Had she scared Qi Banxia?

Jiang Baizhi had no outpatient appointments on Tuesday, so she stayed in the inpatient department. Several interns reported to the oncology office. Old Zhang and Director Liu were seeing patients, so Jiang Baizhi held a brief meeting according to the plan. The interns would accompany the doctors on rounds.

Hospital inpatients received three levels of rounds to ensure quality of care: rounds by resident physicians, attending physicians, and chief or associate chief physicians. Director Liu had a more detailed system. In addition to leading a major round once a week, the two associate chief physicians also took available attending and resident physicians on rounds.

Internal medicine rounds took a long time. Jiang Baizhi was thorough, so it was after nine in the morning by the time she reached the last room. The patient was the same one they’d discussed at the meeting.

The woman’s daughter was feeding her banana juice. A nurse had noted that she had a poor appetite.

The family member said, “Doctor, my mother barely ate anything last night or this morning, but she keeps saying her stomach feels bloated.”

Jiang Baizhi checked the chart and asked, “Did anyone take her temperature half an hour ago?”

“They did. It was 37.2 degrees, which is normal, but it goes up again in the afternoon. Yesterday it reached 38.1.”

“That’s an inflammatory response. It’s normal. She’s only been on the medication for two days. There’s no need to rush.”

The family member said, “Doctor, my mother’s belly feels hard, like there’s something in it. Could you check?”

“How have her bowel movements been?”

“She hasn’t gone in two days. She only passed a little this morning.”

Jiang Baizhi rolled up her sleeves slightly, then carefully lifted the woman’s gown to expose her upper abdomen. “Take a breath for me, ma’am.” She pressed down gently, keeping her fingers together as she palpated.

The other doctors watched from the side.

Jiang Baizhi straightened and answered without hurry. “There’s nothing serious. She has some bloating. Give her easy-to-digest food. I’ll ask the doctor in charge to add another herb to her prescription. Once she’s finished the medicine from the last two days, you can get the next batch from the dispensary.”

“Thank you, Doctor Jiang. Thank you so much. I really appreciate it.” The family member was visibly emotional.

Jiang Baizhi glanced at the clock on the wall. “Do you have time at ten? Come to the doctors’ office so we can discuss the patient’s treatment plan.”

“I can’t make the decision by myself. I need to talk to my younger brother. He thinks we should take Mom home once her fever goes down.”

“Bring him with you, then. Any time before noon is fine, or after one-thirty this afternoon.” Jiang Baizhi gave a few more instructions before leading the doctors out of the room.

“Chief Jiang, does the patient have heat in the intestines with excess in the bowels, or dryness in the intestines due to fluid deficiency?” The young woman at the back of the group asked her.

“Zhao Ruoruo?”

“Yes.”

“Did I mention feeling a mass in the patient’s left abdomen?”

“No.” Zhao Ruoruo tapped the notebook in her hand with her pen. Then she realized. “So it’s excess in the bowels. Dry heat has built up inside, blocking the flow of qi through the bowels and causing constipation.”

“That’s right.” Jiang Baizhi walked a couple of steps. A pleased smile touched her lips as she turned to say, “Good. You know how to distinguish between patterns and ask the right questions.”

The family of the lung cancer patient didn’t come that morning. Jiang Baizhi was eating when Sun Mingfen called. She said Qi Banxia had dropped her phone in the toilet the night before and taken it in to be repaired. She’d only got it back ten minutes ago.

“Mom, did Banxia say anything else?”

“Not much. Come over for dinner Wednesday night. Banxia will be there, too.”

Jiang Baizhi quickly asked, “She’ll be back Wednesday?”

“Her flight lands at three-thirty in the afternoon. She should get here around six.”

“I’ll pick her up.”

Having accomplished what she’d set out to do, Sun Mingfen asked Jiang Baizhi a few more questions about how she was doing, then hung up.

The woman holding the phone hadn’t been in a particularly good mood, but a few words in the chat window made her heart leap.

Wednesday, 5:58 p.m.