A New Year Spent in Agony and Anxiety

Doctor zhou January 1, 2023

I do not know how to describe these days. Every day is like a forced march; there are far too many patients, and I cannot truly rest.

I had pneumonia in high school and have had a sequela ever since: whenever I overexert, I cough incessantly. This bout of exhaustion is like nothing I have known; even during gaokao exam prep I was never this worn out.

These days I cough as if my lungs will come out. Before I even fell ill with COVID I was already coughing badly from overwork. My son says that for as long as he can remember he has never seen me cough like this; he calls it "the cough of the soul."

I actually need rest to ease the cough—for years, rest has been the thing that works better than any drug. This overwork-triggered cough needs at least three months of rest to recover, but now is obviously not the time for me to rest.

Thankfully my strength has fully returned; though I cough, my breathing is not difficult, there is no stuffiness, my oxygen saturation is high, blood pressure normal, and there is no life danger. On December 31, 2022, I carried a bucket of water from the first floor to the sixteenth; after climbing I was not even breathless and my heart felt fine. That moment I was heartened, because I knew my strength was fully back, despite the coughing.

Now I spend every day like a soldier answering patients consultations. I have always opposed assembly-line medicine, but lately I have no choice. The patient volume makes non-assembly-line work impossible; individualized care is a luxury in this emergency. Even acquaintances from home get assembly-line prescriptions from me. Of course this is not ideal, but no one can change the situation.

I have deleted everyone who just wanted to chat, because at a time like this no medical worker has time for small talk. I also deleted a large batch of strangers who for years have used me as a free family doctor with endless questions. I have no choice: dozens of consultations per minute are impossible to handle. Some still expect me to answer every little detail (things they could find on Baidu in seconds); I simply cannot.

Countless people wait for life-saving help—but in truth, for many I can only ease their most distressing symptoms, not solve everything perfectly. Patients and families cannot understand the makeshift nature of this emergency, nor that doctors have limited ability against a new disease; they want every symptom relieved. I cannot even tend to my own severe cough; how could I tend to other patients minor symptoms?

At such a moment, doctors must prioritize those in immediate life danger; everyone not at risk is set aside. However anxious or pleading patients and families are, we cannot soften; we must keep the doctor-patient boundary, because many need us more than these mild cases.

It is like a shipwreck: each doctor is a lifeguard in a small boat. The boat carries only a limited number of endangered elderly, weak and sick, and cannot fulfill every plea. If we soften and take everyone aboard, the boat capsizes and all die.

Lately several doctors have come to me for help: some fainted from exhaustion and were carted off by ambulance; the emergency doctors, finding nothing after workup, let them rest briefly, eased symptoms, and sent them home without drugs. Others keep working carrying oxygen bags, listless and coughing.

I have tried to treat them first; I know they, like me, most need rest, but they too are crushed under patients and families. Where symptoms can be eased by drugs, I help, but the burdens on their shoulders only they can carry.

I only hope this peak of severe cases ends soon; I think that is the shared wish of medical workers across China. Some hospital managers are rigid, deferential to superiors, and at a time like this still demand staff do "Xuexi Qiangguo" study or dock their performance pay—instead of letting them rest or focus their limited energy on saving patients.

Medical workers under such bosses are beyond angry; they have cursed so many people, yet cannot speak out. When will our officials become normal, humane instead of official? I hope my voice is heard, and that formalism stops. Sometimes the last straw truly breaks the camel; leaders at all levels should not just mouth "people first" and "care for medical workers"—put it into practice, not one thing said and another done.

My father has already been invited to three funerals. I agreed to the first two; I firmly refused the third. He is in his seventies, had COVID and only just recovered; attending funeral after funeral easily causes relapse. On December 31 he felt unwell and went by himself to a small clinic for an IV drip.

For one thing, egged on by the villagers, my father felt uneasy without a drip—everyone in the village was scrambling for drips, though half the village lost taste and smell after them; for another, he did not want to burden me, always fearing I was overworked beyond my body ability.

The barefoot doctor at the clinic is an old acquaintance of my father. He told my father that he himself was running fevers while giving patients drips; these days he drips patients by day and himself by night, half his life already in the King of Hell hand.

The barefoot doctor triages by pulse oximeter: he takes mild patients with good oxygen saturation and turns away those with low saturation, sending them all to big hospitals. My father oxygen saturation was good, so he dripped him.

Country folk here are superstitious about drips; the village has been saying these days that you must get a drip to flush out the toxins. My father too has developed this psychological hang-up, feeling uneasy without a drip—it has become a new superstition among rural elders.

Clinic drips have set prices: at my mother-in-law village it was 50 yuan per drip recently; the clinic my father used today charges 75 per drip, with each patient dripping several days running. My mother-in-law has not joined in, but I worry neighbors will eventually drag her off to "flush toxins." Once rural elders get this fixation, they helplessly follow the crowd—the herd effect. Irresponsible rumors spread awfully fast in this age.

Father told me firecrackers go off constantly back home; the countryside is open and villagers hear firecrackers from surrounding villages. Each volley means another death; the ongoing reports weigh heavily on the留守 elders. Indeed many have died this year; firecrackers are common at this season every year, but this year there are far more, and elders are a fragile population and easily alarmed.

So please care more for your留守 elderly family members; call them more to comfort them. If possible, buy your elders an electronic blood-pressure monitor and a fingertip oximeter so they can check themselves daily. As long as their basic vital signs are stable and non-life-threatening, these留守 elders will panic less.

I do not know how to comfort my patients, nor the many strangers messaging me for help; I have no time to read many messages. I have a horde of cancer patients to care for—they are the high-risk group in this wave. I can only hope that when people cannot reach me, they can find another doctor nearby. For those whose suffering I cannot relieve, I feel deep guilt, but I truly have no power left.

This wartime state may last until after the Lantern Festival; some frail doctors and nurses may not make it through. I long to rest and ease my cough. But my vital signs are stable; apart from the cough I have great strength and energy, and I am in my prime. In such times, how could I retreat and pass these burdens onto my elderly seniors and frailer colleagues?

Sometimes patient families press me until I am wretched, but after digesting it I must press on. Countless anxious patients and families pour their negative emotions onto us; no matter how busy, I write articles every day to ease readers and patients anxiety.

But I also hope everyone understands how hard this wartime state is on medical workers. When your own life is not at risk, do not over-occupy staff time and energy; let them rest more. A patient life is a life, and a medical worker life is a life too.

My wife second aunt has died despite rescue; another of my great-aunts and a distant relative also died despite rescue. We have not even had time to grieve, because funerals are held in nearby villages every day. My second aunt, after taking 10 doses of my herbs, was successfully rescued and is now basically normal—the most heartening news at home.

Cao Zhi of the Three Kingdoms era, writing of the Jian'an plague, said: "Every household bears the pain of the dead; every home holds weeping and lamentation." In my hometown these days, people who have not attended a funeral are probably rare. The day before yesterday my father rushed to two funerals in one day—grieved and exhausted—and afterward felt unwell.

Hospitals are now full of severe patients, and many of them will not be rescued. The first wave of sudden-death peaks has passed, but the second wave has just begun and will not settle until after the Lantern Festival. This New Year is fated to be spent in sorrow.

I make public several pill formulas I commissioned a pharmacy to make for family use. Ideally these should have been tested and verified first, but there is no time for such thoroughness now.

Baoxin Huhu Wan (Heart-Protecting Lung-Nourishing Pills): Huangqin 10 g, Qinghao (Sweet Wormwood) 10 g, Dilong (earthworm) 20 g, Xiyangshen (American ginseng) 6 g, Maidong (Ophiopogon) 10 g, Tiandong (Asparagus) 10 g, Baihe (Lily bulb) 10 g, Wuweizi (Schisandra) 10 g, Yuanzhi (Polygala) 10 g, Suanzaoren (Ziziphus seed) 6 g, Chuanxiong (Ligusticum) 6 g, Rougui (cinnamon bark) 6 g, Sheng Huangqi (raw Astragalus) 30 g, Danggui (Angelica) 6 g, Huangjing (Polygonatum) 10 g, Jiegeng (Platycodon) 6 g, Gancao (licorice) 6 g, Pipaye (Eriobotrya leaf) 6 g, Chuanbeimu (Fritillaria) 6 g, Zhuru (bamboo shavings) 6 g, Juhong (tangerine red) 6 g, Yiyiren (Coix seed) 30 g, Shanzha (hawthorn) 20 g. Powder all, bind with refined honey into soybean-sized pills; take 30–60 pills each time. For COPD patients in whom COVID has triggered persistent cough/wheeze, chest tightness and fatigue that do not resolve naturally.

Yiqi Huayu Wan (Qi-Supplementing Stasis-Resolving Pills): Sheng Huangqi 50 g, Xiyangshen 10 g, Maidong 20 g, Tiandong 20 g, Wuweizi 20 g, Dilong 10 g, Rougui 5 g, Danggui 10 g. Powder all, honey-pill to soybean size; take 20–40 pills. For constitutionally frail people who after COVID have fatigue and breathlessness.

Chai Gui Jing Fang Baidu Xiefei Wan: Guizhi 10 g, Huangqin 10 g, Renshen 10 g, Zhi Gancao 6 g, Baishao 10 g, Chaihu 25 g, Tianhuafen (Trichosanthes root) 15 g, Huoxiang (Agastache) 5 g, Peilan (Eupatorium) 5 g, Sharen (Amomum) 5 g, Qianghuo (Notopterygium) 10 g, Chuanxiong 5 g, Cangzhu (Atractylodes) 5 g, Houpo (Magnolia bark) 5 g, Zhiqiao (bitter orange) 5 g, Baizhi (Angelica dahurica) 5 g, Manjingzi (Vitex) 15 g, Fangfeng (Saposhnikovia) 5 g, Jingjie (Schizonepeta) 5 g, Pipaye 10 g, Sangbaipi 15 g, Jineijin (chicken gizzard lining) 6 g, Shanzha 15 g, Gegen 15 g, Jiegeng 10 g, Dilong 10 g, Dazao rou (jujube flesh) 25 g, Ganjiang (dried ginger) 5 g. Powder all, honey-pill to soybean size; take 20–60 pills. For post-COVID alternating heat and cold, night sweats, poor appetite, loss of taste and smell, frequent cough, body pain and stubborn headache.

Wuji Wan (Five-Aggregation Pills): Baizhi 6 g, Chuanxiong 6 g, Zhi Gancao 6 g, Fuling 6 g, Danggui 6 g, Rougui 6 g, Baishao 6 g, Fabanxia 6 g, Chenpi (tangerine peel) 12 g, Zhiqiao 12 g, Mahuang 12 g, Cangzhu 48 g, Ganjiang 8 g, Jiegeng 24 g, Houpo 8 g. Powder all, honey-pill to soybean size; take 20–40 pills. For headache, body pain, abdominal pain, chest pain, poor appetite, nausea/vomiting and menstrual irregularity caused by external wind-cold or internal cold raw food.

These formulas have not been widely verified, but most are ones I actually used effectively on COVID patients in this wave. So they should work for some patients, though I cannot guarantee they work for everyone.

I hope this is the last hard New Year. Wishing everyone a speedy recovery!

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