Reflections Brought by a Car Crash

A person's true life should be within his own heart.

— Fyodor Dostoevsky, Notes from a Dead House

On November 19, 2023, the seventeenth day after my cousin's death, I was somewhat dazed and, while cycling, again fell into deep thought over a tricky clinical problem. At an intersection, a female driver was also distracted; instead of slowing down, she was driving fast. By the time I realized a crash was inevitable, there was very little I could do. The best I could do was twist the handlebars as quickly as possible and swerve aside to avoid taking the front of her car directly.

But the tragedy happened anyway: I was hit by the car, having only dodged the hood. My bicycle was snapped in two, and I was thrown several meters. In the instant of impact my mind went blank. It was a near-death sensation; in that instant I did not know whether I was alive or dead. Only after crashing heavily to the ground and feeling pain did I know I had narrowly survived.

I was struck so that my face was covered in blood. The violent pain left me nearly numb. Then I found large wounds on my hands and knees, bleeding profusely. I had headache, dizziness, and nausea, but my consciousness was not entirely lost. My hands still worked, so I quickly photographed the crash scene and the other car's license plate. I sent photos of the crash to my wife, telling her I had been hit. Then I called 122 (traffic police); the dispatcher did not care how seriously I was hurt and wanted to resolve things remotely, refusing to send an officer to the scene.

A little impatient, I gave the location of the crash and hung up rather than waste more time, then called 120 for an ambulance. Because my mother had a history of cerebral hemorrhage, and because I had treated many stroke patients at work, I judged from my symptoms that I might have intracranial bleeding. I had enough experience in this area to know I needed absolute quiet and should not move around. So at that moment I spoke as little as possible and quietly waited for the ambulance.

The ambulance arrived quickly. I was finally able to lie on the stretcher, and the paramedic immediately took my blood pressure. My wife was on the high-speed train back to Beijing from Shanghai; she called a classmate who lived nearby and asked the couple to help me. My child happened to be home; on learning of the crash, he contacted me at once and wanted to come to the scene. But by then I was already in the ambulance, so I told him to go directly to the nearest Grade-A tertiary hospital the ambulance was taking me to and find me there.

The hospital emergency room was crowded; getting in meant a long wait. By the time I arrived, my consciousness was growing unclear; headache, vertigo, and nausea kept worsening. Once my son arrived, I sent him to a nearby pharmacy to buy Yunnan Baiyao and iodophor so he could help with the wounds. I took a double dose of Yunnan Baiyao, repeating it about every half hour—a method I commonly use for acute internal bleeding. I also took some of my own medicines for traumatic brain injury and Angong Niuhuang Wan; after taking them, I felt much better.

The hospital's brain CT showed a small amount of subdural bleeding and mild cerebral white-matter demyelination, plus a facial bone crack. My right lower back also ached badly, and urination was difficult; I knew the kidney might be injured. A later urine test at another hospital showed elevated small round cells and epithelial cells, but B-ultrasound and CT showed no serious kidney damage, and renal function was normal; only flocculent shadows around the right kidney. So the kidney damage was probably mainly contusion of the surrounding soft tissue.

Beyond that, it was all external injury, though the external injuries were severe: large-area abrasions on the body, two facial wounds needing stitches. The first hospital gave a basic diagnosis and treatment plan, gave me a tetanus shot, and an older nurse dressed the external wounds. The emergency doctor told me that for stitches and for treating the brain injury I would need to go elsewhere; their hospital could not provide those services.

The next step was my own decision. I decided first to go to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences for stitches, then find a hospital to treat the subdural bleeding. The ER doctor told me stitches should ideally be done within six hours of the crash; at the fifth hour after impact I was finally on the operating table for suturing. The surgeons were extra cautious, afraid I might have a severe brain injury and die on the suturing table; they suggested I treat the brain injury first. Only after I repeatedly emphasized my condition was controllable and saw me answer their questions basically clearly did they dare suture.

After suturing, my classmate drove me around Beijing looking for a hospital that would accept me. The first one turned me away, saying it had no neurosurgery department. The crash happened around 3:30 p.m.; I was not admitted to another hospital's neurosurgery ward until about 1 a.m. the next day—ten hours after being hit. The neurosurgeon on duty took no chances, immediately ordered intensive monitoring, required that someone stay by me twenty-four hours a day, and required complete bed rest, not even getting up to urinate or defecate.

My wife stayed with me in the hospital. I soothed her, telling her not to panic. Before coming to the hospital, I had already treated my own brain injury symptomatically; by the time I was under intensive monitoring, my symptoms were already easing, and I believed nothing too serious would happen. I also told her not to mention the crash to any relative at home until I was out of danger. If I did not make it through, the more people who knew and the more greetings she and I received, the more my life would be at risk. I needed absolute rest: no emotional fluctuations, no exertion, no phone calls. Everything had to be handled calmly. She followed my wishes and did not tell anyone.

The first night passed safely. The next bed was an elderly patient in deep coma from a severe stroke; he breathed heavily and from time to time let out pitiful cries in his coma. We could not rest well that night. The doctor temporarily prescribed painkillers and neurotrophic drugs, and the nurse came to start an IV. Perhaps I was just too exhausted; despite the noise from the next bed, I drifted off. When I woke, I had brief episodes of unclear consciousness, but they were transient and I soon cleared again. I asked the attending doctor to arrange kidney checks as soon as possible, because my lower back ached and urination was affected.

Soon an ultrasound technician wheeled a mobile machine to my bedside for a full-body exam. The result showed the right kidney had not ruptured, which was a relief, though the urine result remained concerning. I had another brain CT on admission; this one showed no obvious subdural bleeding and no reported white-matter abnormality. Not reassured, the doctors scheduled a brain MRI the next day; the MRI also found no subdural bleeding or white-matter abnormality.

Once the results were out, my attending and I both breathed a sigh of relief. I had already been observed in the hospital for three days, and vital signs had been stable. By then I wanted to leave, and the attending agreed to let me go home for observation. I wanted to leave because the neurosurgery patients were all so severe; the others in the ward were mostly comatose, in respiratory distress, crying out endlessly, and the noise kept me awake all night. On my second night I even had to sleep for a while in the corridor outside the ward, but the nurse's station was noisy too. Recovering in that environment right after the crash was worse than going home and returning if something came up.

By discharge, my lower back pain had not eased at all. One of the hospital doctors said, "Go to 301 Hospital; our facilities are too poor. After a crash, renal tubular injury is easy; acute tubular necrosis has a mortality of 10%-30%, and neurosurgeons have little experience with it." I thought that was right, so I went to 301 to rule out tubular injury. The result was inconclusive; I was sent home to continue observation.

I know that Leonurus (Yimucao) granules can treat tubular injury, so I bought some and took them at home. After taking them, urination became much smoother and the back pain eased. Over the next few days I stayed in bed at home, treating myself entirely. Although there may have been no brain bleeding, or any tiny bleed was absorbed in time, the concussion was real. With slight exertion I felt the world spinning, with headache and nausea. At discharge, the neurosurgeon told me to stay absolutely away from phone, books, computer, and TV for at least a week, and recommended a full month of rest, otherwise I would easily be left with post-crash sequelae.

In fact, in the week after the crash, various sequelae appeared. My temper became shorter than before, less gentle. I was easily angered when communicating with people. My mood swung between hyperarousal and deep depression, much like a patient with bipolar disorder. I told my family this was a very special period and asked them not to be affected by my emotions or hurt by my words. I tried to speak as little as possible, and did not read or look at my phone.

In those days, whenever I recalled the crash, I went into a state of alarm, yet I could not help recalling it again and again. The female driver's family was very unkind. I told them not to contact me for two weeks, that we would handle everything after two weeks. Not only did they not come to the hospital to visit me, they found ways to harass me and deliberately provoke me. I simply blocked all their numbers. As an experienced clinician, I knew exactly what I needed at that moment.

This was the longest period my mind had been silent since I entered university. Before, my brain had never rested. I slept as much as possible, spoke little, and when awake played with the cat or sat in a daze. Emotions surged like waves, and I tried to control them. My greatest fear was being left with post-traumatic stress disorder, unable to love those around me or control my emotions. In fact, at such times, sleeping, spacing out, and silence are the best ways to recover the brain.

After a few days of turbulence, the inner waves finally settled. Headache, dizziness, brain ringing, tinnitus, forgetfulness, and memory gaps gradually eased. After a week I could basically control my emotions normally, and I knew I was not going to be left with PTSD. Many people's personalities change after a crash, as if they had become a different person. If one day I lost the ability to love others, and was no longer gentle, tolerant, and rational, that would be a disaster—not only would my family and friends be deeply affected, my work would become impossible.

Fortunately, the medical care after the crash was professional, and the care from my closest relatives was also excellent. By the tenth day I felt as if "a light boat had sailed past ten thousand mountains." My mind was much lighter, and my reactions were as quick as before the crash.

Since the age of twenty, I have never had such a long continuous rest. The most important task of an adult male in this society is to support his family. Had this crash not happened, I think I would never have rested continuously this long until I died. I was raised too hardworking as a child, and have long held to the principle of "a day without work is a day without food."

Over the past ten days, my mind has been emptied out. I was in a state of relaxation I had never known. I reflected on why I had the crash. At first I had grievances, blaming the driver, blaming work for being too busy, blaming everything for going wrong. But gradually I realized that no one was to blame; the root cause was myself.

From small on, I was constantly "getting into trouble." At two years old I set fire to our own house; I was by nature utterly mischievous. While my mother was alive she often recalled how fearless I was as a child: at a few years old I climbed trees barehanded and, once up, imitated the "lightness skills" I saw on TV, jumping straight down to the ground, splitting my head open several times. At six or seven I began catching snakes barehanded—all sizes, venomous or not, I would catch any snake I saw, never knowing fear. And I was naturally good at it: seeing a snake, I would calmly confront it, seize the moment, grab its tail, swing it until stunned, and successfully catch it. Sometimes I brought captured snakes into the classroom to play with, making the other children scream and giving my teachers a terrible time.

I also flipped the family bench over and used it as a scooter, racing down the various slopes of the village; once I crashed into a sharp rock and nearly destroyed my left eye, with dozens of stitches at the outer corner. As a child I was frequently sent to the village clinic for stitches and tetanus shots, and earned the village nickname "Scar." People say that once the scar heals one forgets the pain, but I forgot the pain before the scar healed and went on to make new ones. I loved water too; once I nearly drowned in mid-river, but at only about ten years old I was somehow able to calm down, sink to the bottom, hold my breath, grab a large stone, and walk to the bank, saving myself.

Back in my hometown, traffic accidents happened frequently; before I was twenty I had been in no fewer than ten, large and small, and several were serious. In Beijing I have been hit by cars five times; although most were the other party's fault, each was also related to my being distracted while walking. But none of the previous accidents was as serious as this one.

I actually know I have these traits, and I keep to my home as much as possible to avoid being hit outside. Yet even at home I frequently bump into furniture, doors, range hoods, cabinets, and walls, getting hurt and bleeding often, covered in bruises. I get hurt more than five times a month, and the corners of my furniture had to be wrapped with bump guards. Recuperating at home after the crash, I have been especially careful, yet in these ten days I still got hurt three times—one of them bumping into a wound from the crash that had not yet healed. Counted this way, over forty-some years I have had at least 2,000 bumps and bruises.

Many people tell me, "If you were more careful you would not hurt yourself so easily." But the truth is, after the crash I have been extremely careful. This suggests that people like me get hurt because of something going on in the subconscious; subconscious slips are so swift that by the time you notice, it is too late to stop the injury.

I think this must be some problem in our genes, and I am surely not the only one. Under a Zhihu thread titled "Why do I always bump into things?" I found many people like me. It turns out I am not alone; many people suffer this. Interestingly, almost every answer in that thread was cheerful and optimistic—clearly a group of thick-skinned people, most answering in a self-mocking, playful way, completely different from the tone in depression threads.

I know I probably cannot change this for the rest of my life; it may be part of the hunter genes of our ancestors. In hunting, our ancestors needed this kind of fearlessness, total focus, and freedom from environmental distraction, so they naturally evolved a gene for strong concentration with insufficient vigilance to small surrounding dangers; we simply inherited it.

I am innately insensitive to pain in my own body. Covered in bruises, I feel nothing, as if it were not me. But I am very sensitive to the pain of others. After the crash, while waiting for treatment, I saw another person with a severed finger, bleeding heavily; his suffering produced an electric-shock reaction in me, while I felt nothing about my own pain. In fact, mine was worse than his at the time: two deep wounds on my face kept bleeding, and I was one of the most seriously injured in the waiting crowd.

Were it not for this insensitivity to pain, people like us would probably not develop our optimistic, calm, and unflappable personalities. In clinical practice I have seen too many patients with highly developed pain nerves and fragile hearts, suffering from depression, borderline personality disorder, anxiety, and other psychiatric illnesses, some unable to escape their suffering for a lifetime. Their overdeveloped sensitivity helped them avoid many risks, so they did not get hurt as often as I do without knowing it, but they also cannot enter the calm, peaceful psychological state as easily as I can. So every gene has both advantages and disadvantages.

In the first half of my life, I relied on quick reflexes to dodge one disaster after another. But in the second half I will not react as swiftly as I did when young—the faster one's reflexes in danger, the better the chance of escape. So after this crash I resolved to adjust my lifestyle: no more cycling. I will also minimize going out alone, and for the rest of my life live as much as possible between the National Library and my home, exercising and relaxing in Zizhuyuan Park near the National Library. If I go to grow vegetables, I will take the bus. The times I was hit by cars while walking in this life left no more than skin wounds; after all, accidents on sidewalks are minor. But the times I was hit by cars while cycling or fell on my own were several times very dangerous.

The outside world is exciting, but my genes have decided I am better off living within my own heart. The genes we inherit are not chosen, but the lifestyle we live is. Since the bustling outside world is too risky for me, I will simply keep even more to my home. Within a small room, there is also endless delight.