Zhang Dexu said, "The leg's fine now—they set the bone and put in steel pins."
Zhang Jiao had finally made it through the critical period without becoming vegetative, which was a great encouragement to Liu Zhengliang. Overjoyed, Liu Zhengliang invited Zhang Dexu to grab a meal together. Zhang Dexu insisted on treating, but Liu Zhengliang insisted it was his treat. So after work that evening, the group headed to a Korean barbecue joint. Each with a bottle of Tianhu beer, the three men plus Che Mingming gathered around the grill, dipping meat in sauce and chatting as they cooked. Liu Zhengliang told Chen Junnan that the first time he pulled someone back from the brink of death was during his general practice internship with his mentor, when he handled a young woman with a thymic microadenoma. She had been diagnosed with Cushing's syndrome at Shenyang Medical University First Hospital, but they couldn't pinpoint where in her body the problem was—she'd been tested over and over.
Che Mingming asked, "What's Cushing's syndrome?"
Chen Junnan laughed and said, "Old Liu, we've been in clinical practice too long, just focusing on the same common diseases every day. If you ask me to perform CPR, I can press for an hour without moving, but don't talk academics with me. In our small hospital, where would we ever see that kind of condition? Tell me, in this Second Hospital, from the director down to the nurses, who writes papers? Who can get published in a top-tier journal?"
Liu Zhengliang said, "You must have forgotten—this is all from our undergraduate textbooks. Symptoms are usually due to hypothalamic-pituitary dysfunction, excessive corticotropin secretion, leading to obesity, acne, hypertension, secondary diabetes, and some people even get osteoporosis."
Liu Zhengliang continued, "Shenyang China Medical University First Hospital checked her out and found three suspicious areas: the pituitary gland, the adrenal glands, and the thymus. Most cases of Cushing's syndrome are caused by pituitary or adrenal issues. The university hospital could only do major thymus surgery, but the young girl didn't want a 30-centimeter scar on her neck, so they went to Heping Hospital instead. When she first arrived, she was still fairly active, but within a few days, she had trouble breathing and was on oxygen by the time of the surgery."
Liu Zhengliang went on, "The surgery itself was nothing—just a minimally invasive thymoma removal, taking out the tumor and that was it. But post-op, she immediately had severe respiratory failure, myasthenia gravis, and Pneumocystis infection. Looking at her CT scan back then, her lungs were like frosted glass. Her family was wealthy, so she stayed in the ICU for over forty days. You tell me, here in Fushun, in our ICU, how many people can afford even ten days?"
Although Zhang Dexu had heard Liu Zhengliang mention the ICU a few times—saying he wouldn't let his daughter stay there to save money—he still didn't know exactly how expensive it was, so he asked, "Dr. Liu, why is the ICU so costly?"Chen Junnan quickly responded, "Take your daughter for example. She should have been in the ICU from the start. Dr. Liu saw your family couldn’t afford it. Even if you gritted your teeth and managed to get her in that day, what would you do two or three days later? No matter how much you adore your daughter, even if you sold your house and land, you wouldn’t be able to sustain it. In our small town, many facilities aren’t available, yet it still costs thousands a day. In top-tier hospitals in big cities, with all the equipment and medications, it’s ten to twenty thousand a day—and that’s not even including surgeries or treatments. Just lying there costs that much, pricier than a five-star hotel. For severe infections, if it’s fungal or viral, the medication alone can run over a thousand a day. Some patients can’t eat; your daughter is still being fed juice, but that’s a makeshift solution. Proper treatment means IV fluids or inserting a feeding tube for nutritional supplements, which cost hundreds a day—perfectly reasonable. If they need globulin or plasma, that’s another one or two thousand a day. Non-medical expenses like blood tests are just side dishes; things like intubation or feeding tubes cost tens each time, but if you need a nutrition pump, that’s more money. For us healthy folks, breathing, eating, even excreting seem trivial, but in there, every basic physiological need comes with a price tag. If a patient has respiratory failure and low blood oxygen, prolonged lack of treatment leads to multiple organ failure and death. So, to save them, they need ECMO—a machine that exchanges oxygen and carbon dioxide for you. Tell me, with the little money your family has, you wouldn’t last three days. Before seeing any improvement, you’d be forced to give up treatment, losing both the person and the money."
Zhang Dexu said, "You know, it’s really something about this country. Life-saving treatments—why can’t they be cheaper? Treating an illness, I’m not saying it should be free, but if common folks could spend three to five hundred and cure any disease, how great would that be? Back when the factory hadn’t shut down, medical care was free, and any medication was reimbursed."Chen Junnan teased him for being uncultured, saying, "How could you not understand this? I bet only a bookworm like Liu Zhengliang wouldn't get it. How could we people from Fushun not know? Back in the days of public healthcare, weren't there plenty of people faking illness? They'd just get a prescription and a sick note, skip work for years, and live off their basic salary and selling medication. Which factory didn't have dozens or even hundreds of such people? Back then, Fushun's factories managed everything, so you didn't pay for medical care, but the factories' operating costs were high. That's why the factories went under and the workers were laid off. Besides, pharmaceutical companies work hard to develop a drug to make money. If you force them to sell it for one yuan a box, who would bother researching new drugs? Everyone would just scrape by. Like thirty years ago, no matter what was wrong with you, the clinic would prescribe penicillin sodium or tetracycline—broad-spectrum antibiotics flooding your system, cheap, ten yuan a shot. People eat all kinds of food, and their ailments vary. For example, if tens of millions out of 1.4 billion people are prone to a certain condition, the medication for it is especially cheap because the state regulates it. Take gout—buying a box of colchicine to treat it, even in this day and age, costs only 2.5 yuan. The state won't allow such drugs to increase in price; they have to be cheap. Why? Because many people have this condition, so the cost is shared, the pharmaceutical company still makes money, and no one is overburdened. Look at nitroglycerin for heart disease—just over thirty yuan for a hundred tablets, that's only 0.3 yuan per tablet. With China's large population, there are always millions with blood issues or heart problems, but not millions needing a Zebra Guidewire and full 3D imaging. It's impossible for millions to have severe car accidents requiring punctures. Few people need these things, but the medical companies producing them can't go out of business, so they have to be expensive. That's why your daughter's surgery is so costly—the equipment and medications are pricey."
"The state is like an old farmer in a vegetable garden. If your seedling wilts, he'll give it extra water, but he can't squat by it every day watching over you. If all the money is spent on your car accident, what happens when a few cancer patients show up in a few days and the state has no funds to treat them? Should they be turned away? Of course not. This isn't a business transaction; it's like the Taiji diagram, balancing yin and yang—neither extreme works. Neither extreme is the optimal solution, and neither can be sustained long-term. So what do we do? We go for a suboptimal solution. A perfect score of 100 is impossible, but can we maintain 80? Yes, so that's what we do. Maintaining 80 points year after year isn't easy, but if you keep it up for decades, looking back historically over hundreds or thousands of years, that's a perfect score. Remember, maintaining 80 points for decades is definitely a full mark."
Zhang Dexu felt he had gained a lot of insight, but Che Mingming was unwilling to listen to Chen Junnan's clichés and asked, "So how did you treat that little girl?"Liu Zhengliang continued, "Long-term high hormone levels led to an extremely compromised immune system, almost like an HIV patient. Even the ventilator wasn't working well, and her blood oxygen saturation kept dropping. Later, the girl's mother even offered to donate her organs and body. My mentor said, 'Since you're willing to sign this, I believe in your family's integrity. Your family wouldn't engage in fraudulent claims, so I'll take a risk for you. I'll try the latest method from international literature.' For PCP pneumonia, long-term hormone use is definitely not feasible, but if you interrupt the hormone treatment midway, the patient's condition deteriorates immediately. There's only one second-line drug available, not even enough to switch between. Everything relies on the doctor's judgment—using hormones intermittently, supporting with the second-line drug in between. We treated her like this for three and a half months, just like reeling in a giant grouper weighing over ten pounds. Do you think you can just yank it up once it's hooked? You have to wear it down gradually, sometimes letting out the line, sometimes waiting it out, struggling against the King of Hell. When the King of Hell is exhausted from being dragged, you give one final pull to bring the person back and save them. After that, I was truly convinced."
Zhang Dexu sighed, "How much money would it take to cure this illness?"
Liu Zhengliang said, "At least a million."
Che Mingming downed a glass of beer and said, "How many ordinary Chinese people can come up with that much money? If a regular person gets this disease, even selling their house and land wouldn't be enough to buy their life. Don't you think those foreign pharmaceutical companies are profiting off us? Can't we, as the customers, pressure them to lower prices? If that doesn't work, can't we just produce generic versions ourselves? If everything were domestically made, it would be cheaper."
Chen Junnan, who spent his days working and trading stocks, was known as the stock god of Fushun's medical circle. He had perfectly timed the merger of China North and China South Railways, buying in at eight yuan and selling at twenty-four. Unlike bookworms like Liu Zhengliang, he understood economics.
Chen Junnan chuckled beside them and said, "Why do you think developed countries enjoy such comfortable lives? Their pharmaceutical giants occupy the upper echelons of the industry through intellectual property rights, allowing them to sit back and collect money. Since China joined the WTO, Chinese manufacturing can sell globally, but that also means we must respect intellectual property rights and can't casually produce generic versions of their drugs. We can only import them. If you dare to make counterfeit drugs, they can kick you out of the WTO. What would happen to the millions of people working in manufacturing then? You have to choose between two options: employment for hundreds of millions or affordable counterfeit life-saving drugs for hundreds of thousands. If you lose your job, even the cheapest drug becomes unaffordable. Besides, these are life-saving drugs—take it or leave it. If you don't buy them, others will smuggle them in. No matter how big your market is, it's hard to force them to comply. There was this American pharmaceutical company that developed an anti-cancer drug specifically for lung cancer, but during clinical trials, it showed little effect in North America. Guess what? The drug couldn't target the common cancer mutations in Caucasians, and the company almost went bankrupt. Later, they discovered that East Asians with lung cancer had genetic mutations that the drug could effectively target, saving the company. But did they lower the price for you? No, they've got you cornered and will bleed you dry. You want to live; I want money. If you try to bargain with me, we're not even at the same negotiating table. You're the hostage—what right do you have to negotiate?"As the conversation turned to Liu Zhengliang, Chen Junnan asked if he was still in touch with that girlfriend. Upon hearing they had broken up, Chen Junnan immediately recommended Che Mingming. Che Mingming declared, "Either we don't date at all, or there's no breaking up—only bereavement. 110 will take me away, 120 will take you away. I'll make the legal news, and you'll get removed from the household registry."
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