Liu Zhengliang whispered to her, "Your husband mentioned feeling hot when he got out of the car earlier. I detected abnormal lung sounds, and his fingers show clubbing—a sign of chronic cardiopulmonary disease. You should register for the respiratory department immediately. I even suspect his earlier fainting might be related to this condition affecting his nerves. Check his blood oxygen levels right away—don’t delay."
The patient’s family member, Su Jing, whispered back to Liu Zhengliang, "Doctor, my husband has late-stage lung cancer. He’s the only one in the family who doesn’t know—the rest of us do. We’ve been telling him it’s silicosis, caused by inhaling pollutants near the aluminum plant’s furnace. We’ve been treating it as silicosis all along. His bones have deformed all over, and he can’t move anymore. Many long-term aluminum plant workers develop this condition."
Liu Zhengliang fell silent for a moment, then said, "Currently, the patient has significant pleural effusion, rapid breathing due to hypoxia, and his heart is showing signs of heart failure. But if all these issues stem from lung cancer, there’s little I can do beyond draining the pleural fluid."
Just then, the blood test results and X-rays came in. Liu Zhengliang reviewed the lab report and told the family, "Look, his BNP level is very high—2900. Combined with the chest X-ray, this confirms heart failure. Since it’s cancer-related, the fluid will keep recurring after drainage. Each procedure weakens him further—I need to be clear about that."
Su Jing replied, "I understand. Any relief, even temporary, is worth it."
As Liu Zhengliang was about to agree, Chen Junnan stopped him and said, "Ma’am, given your husband’s condition, drainage here is quite risky. I recommend transferring him to Shenyang for ICU care—it’s safer to let critical care specialists handle it. We’re an emergency department, not respiratory or oncology, and we’re not specialized in this area. That’s the truth."
Su Jing looked confused and asked, "Would the ICU cost more?"
Chen Junnan explained, "It’s safer and more professional there, so yes, it’s more expensive—over ten thousand yuan per day. It’s fully enclosed to prevent infections, making it much safer for the patient. If we perform the drainage here in emergency, there are many potential complications. If a severe infection occurs, the responsibility would be too great for us."
Su Jing’s voice trembled with tears, "Where would we get that kind of money to buy more time?"
Liu Zhengliang asked, "Should we proceed as if it’s silicosis, admit him first, and decide on a plan based on his condition?"
Su Jing said despairingly, "We can’t. The respiratory department is full now because of all the pneumonia cases from recent colds and fevers. Even when it’s not busy, they let us stay until we’re somewhat better, then discharge us. They have a point—we don’t actually have that illness, and occupying their beds uses up the department’s medical insurance funds. If public insurance runs out, where will genuine patients get treatment? This time, respiratory won’t take us, so I thought of this idea—doctor, could you just let us stay in the emergency ward?Liu Zhengliang tentatively asked: "Can’t you go to the oncology ward?""Su Jing quickly shook her head and said, "We can't go, we can't. My husband only has about a month left. Let's not scare him to death at the last moment. Doctor, just give him some psychological comfort, make him feel that someone cares about him, that his family is thinking of him and doesn't see him as a burden. That's enough."
Liu Zhengliang called Che Mingming over and asked, "Do we still have enough medical insurance quota in our department's wards?"
Che Mingming asked, "What's the matter?"
Liu Zhengliang explained the situation to Che Mingming, who said, "You need to discuss this with Director Zhao. This could be a minor issue or a major one."
Liu Zhengliang asked, "Is this considered a big deal?"
Che Mingming replied, "Don't you know about the insurance fraud at Wanghua Central Hospital a while ago? Over 800 people were involved in hospital bed scams and drug reselling. Dozens were just sentenced. You just returned from out of town and might not know, but many small hospitals play this game. A single small hospital can embezzle over two million a year. When dozens of hospitals do it together, they bankrupted Fushun's medical insurance. Last year, for several months, our hospital didn't accept insured patients—only self-paying ones—because the insurance fund ran out. Now regulations are extremely strict. Patients must be admitted to the appropriate department for their actual condition; no bed scams are allowed."
Liu Zhengliang nodded and said to the family, "We understand your situation. Would you consider paying out-of-pocket? It's just the bed fee—seventy yuan per day for a week. I'll prescribe some medication and give some injections; it should cost around six to seven hundred yuan. I'll make an arrangement for you. I have connections in Neurosurgery—their doctors owe me favors. You can be admitted there. Given your husband's condition, other wards have more complex cases, but Neurosurgery has fewer patients and is quieter."
The patient's family agreed immediately, expressing profuse thanks.
Back in the consultation room, Liu Zhengliang continued his act for the patient, saying, "Your husband has a lot of pleural effusion, which definitely affects breathing. I suspect it's pulmonary edema, requiring long-term rest. He must avoid getting angry—it harms the lungs."
The family nodded repeatedly, tears glistening in their eyes.
Later, Liu Zhengliang arranged for a bed in the ward where Zhang Dexu's daughter was staying, squeezing in an extra spot. Seeing her husband's breathing becoming increasingly labored, Su Jing went to plead with Liu Zhengliang again.
Su Jing said, "Dr. Liu, maybe I should sell everything we have and send him to the ICU. Even a few more comfortable days would be worth it."
This statement was both a consultation and a technique families use under the weight of severe illness to deflect moral judgment. Though it might seem clever, doctors encounter it daily and are unmoved. Since she didn't want to be the one blamed, someone else had to be.
Liu Zhengliang said, "In his condition, going to the ICU would only mean losing both the person and the money. It's not worth it. He'd just be put on a ventilator, but if his blood oxygen doesn't improve, he'd need intubation, which would make him suffer more. Besides, even with intubation, how long could your family afford it? Would he be discharged from the ICU on the tenth day still intubated? That would be even more agonizing. If you sell your home and land to keep him alive for a few days, where will you live afterward? What will you eat and drink? Right now, we should focus on improving his quality of life."
After the patient was admitted to the ward, Liu Zhengliang drained the pleural fluid, prescribed some cough medicine, and arranged for hospitalization. Before leaving, he told Su Jing, "Given his current state, he definitely can't sleep lying flat. Prop him up with some pillows to reduce the pressure. Having his back at a slight incline will make him less uncomfortable."Su Jing's husband coughed every forty seconds with uncanny precision, each time followed by hacking up phlegm. His throat was like Daqing Oilfield gushing forth an endless treasure trove, going through a roll of toilet paper in a day at most. Being young, Zhang Jiao remained undisturbed by the coughing and slept soundly. But Zhang Dexu couldn't bear it—lying in his hospital bed counting sheep, he'd always reach the fiftieth sheep just as another cough erupted. Count fifty more, another cough. Since the man opposite was critically ill, he couldn't very well blame a dying man, plus he needed to maintain good relations with the family. He had to call Ai Chen first thing tomorrow—this job was definitely in the bag. Dou Liping, sleeping on her daughter's bed, was also awake. Zhang Dexu turned over and met her gaze, whispering, "We'll assign this job to Boss Ai tomorrow. At this rate, it won't take half a month."
After a long night, the patients had fallen asleep, but their family members found it impossible to rest and gathered in the hall outside the ward watching TV. Zhang Dexu, Dou Liping, and Su Jing sat in a row, listlessly staring at the screen.
Su Jing said, "Sorry for disturbing you."
Zhang Dexu replied, "Hey, we're all here for medical treatment—gotta be understanding. Watching some TV's not bad anyway. We'll go back to sleep when we get tired. Your husband works at the aluminum plant, right?"
Su Jing nodded.
Zhang Dexu said, "I reckon his lungs got damaged from long-term exposure to toxic exhaust from aluminum smelting. You could file for an occupational disease claim."
Su Jing said, "The old aluminum plant went bankrupt long ago. After the restructuring, former occupational disease cases were transferred to social security."
Late-night TV offered little decent programming, and the hospital sets had no remotes—you watched whatever channel was on. An advertisement featured an elderly woman with white hair and youthful complexion named Liu Hongbin, claiming to come from a family of medical practitioners. In the first ad, she posed as a Miao medicine heir who invented a royal ancestral secret formula using snow lotuses from Yunnan's snowy mountains, mixed with spices commonly eaten by the Miao people. She claimed the Miao never suffered from rheumatism thanks to these snow lotuses, and her medicine excelled at treating it. The second ad starred the same old woman, now as vice president of the Chinese Traditional Medicine Association's cough committee, using deeply ground goji berries from Qilian Mountains to create medicine for bronchitis. The third ad featured her again, this time as a Peking University expert developing Mongolian medicine. She claimed nomadic horse riders never developed lumbar disc herniation because Mongols eat chive flowers, and her medicine extracted essence from chive flowers to treat middle-aged and elderly lumbar issues. She was practically the deadly warrior of the elderly, the terminator of population aging, honorary chairman of the pension fund circulation association, master harvester of northeastern chives, guardian of year-end bonuses for third-tier northern city TV station employees, and market designer for kidney stones lithotripsy after herbal poisoning. If all these titles were stamped on stainless steel plates hung around this old woman's neck, it might finally satisfy Liu Zhengliang's resentment.
Zhang Dexu stared dumbfounded, saying, "How is this old woman so incredible? I've seen three ads in a row starring her. These scammers aren't even trying—how can they use the same actress every time?"His words amused Chen Junnan, who happened to be passing by.
Zhang Dexu hurriedly asked Chen Junnan, "Doctor Chen, why are TV stations broadcasting all kinds of ads these days? If I were to watch these ads one by one, I wouldn’t even realize they’re scams. But in the middle of the night, they aired three ads starring the same person like a TV series—isn’t it obvious these bastards are trying to cheat ordinary people out of their money? This woman claims to be the vice president of some cough-relief association one moment, a Peking University professor the next, then a Mongolian, and later a Miao ethnic—you can’t scam people this blatantly. And the TV station dares to broadcast this?"
Chen Junnan replied, "We’re in the internet era now. These local TV stations are struggling—no one watches their programs anymore, and advertisers aren’t willing to invest. They rely on ads for revenue, but the money’s all going to internet companies. What can they do? They have to take on ads like these. Without them, how would they pay their employees? But have you noticed why you ended up watching three consecutive ads with the same lead actor? That’s the TV director’s way of showing conscience—they’re hinting to you that it’s a scam. They can’t say it outright, though. They have superiors above them and colleagues in the ad sales department next door. They definitely don’t have the guts to refuse broadcasting, but they’re still resisting in their own way. See, you’re not even in the medical field, yet you figured it out right away. That director achieved their goal. Telling the truth comes at too high a cost—you have to be clever about it. I think that director is a real talent and will go far in the future."
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