While scrambling to raise funds, Chen Junnan referred him to his first surgery—this was how Liu Zhengliang got dragged into this dubious business. He had done the math: five thousand, eight thousand, or even ten thousand per surgery, performing two or three procedures over a weekend. In about a year, he could save up that one million yuan.
This time, Chen Junnan had squeezed in an urgent case at the last minute, offering thirty thousand due to its urgency. That amount could buy another tile's worth of space in his apartment in Huilongguan, Beijing's suburbs. Liu Zhengliang had no reason to refuse.
Chapter 3
Anyone who has studied medicine knows that most of what you learn in school is general knowledge. The real skills are acquired in the hospital, under the guidance of department heads and professors. In other fields, a Ph.D. graduation confers significant academic authority, but in medicine, a doctorate is merely the entry ticket. During his doctoral studies, Liu spent his days talking in outpatient and emergency departments, following rounds and taking notes, busy from morning till night. Yet patients coming to their Heping Hospital were from all over the country, seeking solutions for complex illnesses that local hospitals couldn't handle. As the final safeguard of Chinese medical science, these patients were naturally unwilling to let students perform surgeries—especially in neurosurgery, Liu Zhengliang's department. So, during his training, observing more and operating less was inevitable. Still, Liu had persevered to become an attending physician, with several years of experience in interventional neurosurgery, though he had never independently performed a surgical procedure.
The human brain requires stable blood pressure and volume to function properly. Your genes determine your ability to clot blood effectively after trauma, partly thanks to fibrin. But if fibrin one day slacks off and quits, and your ability to dissolve it is inadequate, it turns into a thrombus. Chronic carotid artery thrombosis, over time, narrows the once robust artery from the neck to the brain into an extremely tight passage, colloquially called "a slit of sky," which is very likely to trigger cerebral infarction.
Insufficient blood flow to the brain leads to cerebral infarction, while excessive blood causes cerebral hemorrhage. For instance, the patient Chen Junnan mentioned over the phone had subarachnoid hemorrhage and was diagnosed with an aneurysm.
As soon as Liu Zhengliang got off the train, he headed straight to the hospital. The previously scheduled surgery could wait; urgent cases took priority. The first order of business was to assess the patient's family. Without reading their expressions and preparing in advance, he might accidentally run into medical dispute instigators. When he arrived, there were no teahouses or restaurants nearby, so he met them directly at a Korean cold noodle shop across from the hospital. After a brief chat, they seemed like Filial Son and Virtuous Grandson types, nodding at everything Liu said, which put his mind at ease.
This surgery was different from previous thrombectomy procedures. It wasn't that local doctors lacked skill; rather, Chen Junnan had raised the stakes. It was like hiring a university professor to teach a course that a primary school teacher could handle. This time, it was subarachnoid hemorrhage—not particularly difficult, but dangerous.
Liu Zhengliang asked, "Has your attending physician explained the condition and treatment plan to you?"
Filial Son replied, "The doctor said we've missed the optimal treatment window and need to wait for stable physiological indicators before surgery. So, our family thinks he's not competent. If the indicators are stable, why would we need surgery? It's precisely because they're unstable and there's an illness that surgery is necessary."Western doctors have a particular quirk: when explaining pathology, they strive for precision with everyone as if conducting a debate. Every word from their mouths is scientifically rigorous, so even when family members ask questions, they never get the simple cause-and-effect relationships or timelines they want.
For example:
Doctor, how long does my father have to live?
Doctor, was his cerebral thrombosis caused by drinking?
Doctor, after this surgery, will my son definitely survive?
These are questions Western doctors never know how to answer. They might have a rough guess, but they don’t want to share it with you. Once they do, it becomes unprofessional—because doctors aren’t fortune-tellers. Yet when these serious, non-fortune-telling doctors present statistical data, ordinary people are unwilling to believe cold, hard statistics. If they tell you there’s a ten percent chance of recovery but it’ll cost seven or eight hundred thousand, and leave the decision to you, you’ll feel the doctor is ruthless. Because they’ve placed you in the defendant’s seat of a moral trial: spending nearly a million to treat your father with only a ten percent success rate. It’s a math problem, a philosophical dilemma, a social issue, and an ethical quandary.
This problem is too difficult; most people can’t solve it.
Would you have a good impression of someone who gives you such a tough problem?
Liu Zhengliang thought for a moment and said, "The reason we don’t dare operate now is because we’re afraid your father’s blood vessels might spasm. Think of an aneurysm rupture like the dike of Poyang Lake bursting. How do you fix a burst dike at Poyang Lake? Can you just repair the Poyang Lake embankment and call it done? Does the Yangtze River flooding affect Poyang Lake? Absolutely. So we have to wait. Wait for what? For the Yangtze River water level to drop a bit."
Soon, four bowls of cold noodles were served. Actually, since Liu Zhengliang had just gotten off the train and arrived well past mealtime, none of them were particularly hungry. They just felt obliged to order something since they were occupying the space to talk. In Fushun’s cold noodles, besides slices of pear, they also add a bit of watermelon. Liu Zhengliang called the owner over and asked, "Do you still have any watermelon in the shop?"
The owner said, "There’s half left. I’ll cut it for you."
Liu Zhengliang quickly stopped him and said, "No need to cut it, just bring it as it is."
The owner said, "Alright, then I’ll charge you five yuan for it. It’s about five or six jin."
When the watermelon was brought over, Liu Zhengliang took a spoon from the utensil cabinet. The two patients’ family members and Chen Junnan watched him, thinking he was going to eat the watermelon.
Liu Zhengliang used the spoon to stir the watermelon flesh, pressing down hard to squeeze out the juice. He said to the others, "The arachnoid is on the shallow surface inside the skull. Bleeding there is just a superficial phenomenon—like cutting open a watermelon and stirring the flesh with a spoon. A lot of juice comes out, which is water released from the ruptured cells of the watermelon flesh. That’s just the surface. The underlying cause is the spoon compressing the watermelon cells; the pressure is too great, and the cells burst. For a patient with subarachnoid hemorrhage, the underlying cause is that the cerebral aneurysm couldn’t withstand the high pressure and ruptured."
Virtuous Grandson asked again, "Dr. Liu, then where does the danger lie in my grandfather’s surgery? Can’t we just stop the bleeding? With medicine so advanced now..."Liu Zhengliang said, "Let's continue with the flood-fighting analogy. Now that the breach in Poyang Lake's dam has been plugged, the water level remains above the warning line, and there's still a risk of piping and dam collapse at any moment. Currently, there are two surgical approaches."
He took out his phone, opened Gaode Maps, searched for Poyang Lake, found Hukou County, and pointed at the lake's outlet, saying, "See? One method is to build a dam here, sealing it off so that Poyang Lake and the Yangtze River have no connection, turning them into two separate systems. Poyang Lake would no longer be Poyang Lake but a small fishpond by the Yangtze. No matter how much the Yangtze floods, the water level in Poyang Lake wouldn't change, eliminating the risk of dam collapse. That's one surgical option. The other method is to fill Poyang Lake with soil—if the lake disappears, there's no worry about dam failure. These two surgeries are called aneurysm neck clipping and aneurysm embolization. Understand? Both treatment options have their pros and cons. Say you block the lake's outlet, clipping the fistula—what if the fistula is too large to seal? That's one issue. And is filling the lake with soil absolutely safe? Not really. Because reclaiming land from the lake involves filling from the edges inward, pushing the water out, and the land becomes dry. But the coils we insert are placed inside the blood vessels, equivalent to throwing large rocks into the lake. The total water volume decreases, reducing pressure on the dam, but some pressure remains. So the prognosis—oh, meaning after surgery—even if successful, there's still risk."
The Filial Son and Virtuous Grandson seemed to gain a long-missing intellectual resonance from Liu Zhengliang, their expressions shifting from stern to slightly relaxed. They also built trust in him through this folksy, popular science style of explanation. Most people hold the belief that truly exceptional individuals not only communicate with other experts but also use everyday language to connect with the masses—being able to make the least educated person understand you is real knowledge and great talent. But they didn't know that medicine is a scientific technology, not pedagogy; medicine has no obligation to educate patients' families and thus doesn't waste time cultivating this ability in doctors. If not for Liu Zhengliang's lifelong immersion in xiangsheng and Northeast Errenzhuan, he wouldn't have mastered this unique skill.
Liu Zhengliang added, "This condition is extremely dangerous. Even if I operate and it seems successful initially, there's still a relatively high chance of re-bleeding within ten days to half a month. Even after discharge, if the patient suddenly develops high blood pressure, bleeding could recur, and if it does, it's very hard to save him. You, the family, should discuss this one last time and let me know your decision. Don't feel pressured—if you agree, I'll operate; if not, I'll proceed with the previously scheduled surgery, and it won't delay my other commitments."
The Filial Son's face turned bright red, and he hurriedly asked, "Dr. Liu, look—if, I mean if, if this surgery is done, the money is spent, and the old man isn't saved, then how would the surgical fees be handled?"Hearing this, Liu Zhengliang was quite displeased, as Chen Junnan should have already handled such preliminary groundwork instead of waiting until now to play the good cop and bad cop routine. In "Capturing and Releasing Cao Cao," Chen Gong simply released Cao Cao outright—why waste time with incessant chatter and probing? If you hadn't rambled on, wouldn't things have proceeded more smoothly? Wouldn't the Lü Boshe family have avoided slaughtering pigs in the dead of night? Wouldn't the entire Lü family have been spared? Liu Zhengliang glanced at Chen Junnan but didn't respond.
Chen Junnan cut in: "What we're dealing with here is surgery. The risks involved have already been explained to you beforehand, right? Surgery isn't like buying watermelons at the market—guaranteed ripe and sweet, where if you cut one open and it's unripe, they'll just swap it for another. Various unexpected situations can arise during surgery, and it's hard to completely avoid them all. But the doctors have put in their effort, so you still need to pay them."
Virtuous Grandson, who clearly seemed well-read, added: "Risk disclosure is between the hospital and the patient. But you've brought in specialists from Beijing for this surgery, and we've paid extra—quite a substantial amount. Shouldn't there be at least some minimum guarantee? We don't want to end up losing both the patient and the money."
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