Patient, heal thyself
One man’s journey into Chinese health-care hell — with a hacksaw
DONGZANG, CHINA— His shroud had already been purchased when, on April 14, 2012, Zheng Yanliang, 48, summoned the last of his strength to lean out of his bed and reach for his tool box. He took out a hacksaw. Then he wrapped the handle of a back-scratcher in a piece of material, which he stuck in his mouth so that he could bite on it. He did not hesitate. He had thought about his options and concluded that he had only one choice, this unthinkable, monstrous deed. He placed the saw against his right leg, a hand’s breadth below his hip, and began to saw.
Zheng would have died in 2012 were it not for a miracle, his life having spanned the entire period of China’s opening to the world, and of the great Chinese economic miracle. Zheng diligently contributed to his society’s high-speed transformation, as both a farmer and a migrant worker, as did millions upon millions of his fellow Chinese, in a country where progress for the masses is everything and the fate of the individual means nothing.
His story shows what can happen when someone falters in this relentless pursuit of prosperity. We are only aware of his story because he did something unimaginable to survive.
Zheng is sitting in his bed in a room in Beijing. He wants to get up, but he can’t do it without the help of his wife, Zhonghong. “Zhonghong, give me the rag,” he says. She hands him a thin piece of white gauze material. He pushes up the two trouser legs, looks at what is missing and feels what is still there. “The flesh is too soft,” he says, “too little strength, too little muscle.”
He wraps the material tightly around the stump. Then he presses the stump into the cup of the prosthesis and his wife screws it into place. He now has a leg made of plastic and metal, with a knee consisting of nine hydraulic joints in the middle, a lower leg and foot encased in an orange Nike shoe.
And now the left leg, which Zheng also lost, later on, when his name was already in Chinese newspapers and doctors could no longer refuse treatment, leaving him to his tool box. His left was properly amputated. He ties a wide belt around his hips and stomach to support his upper body. Then Zhonghong bends down, hugs her husband firmly and lifts him up. Zheng teeters for a moment, but then he stands up. Zheng Yanliang, undefeated, is standing up straight and smiling. “Give me the cane,” he says to his wife.
It took Zheng seven months to learn how to stand up again. He spent seven months living with his wife in this small room on a deafeningly loud arterial road on the southern edge of Beijing, unable to sleep at night and spending torturous days with other physically disabled people in a rehabilitation centre. Today is his last day in Beijing. It’s the day he and his wife will travel back to their village, just a few hours to the southwest of the Chinese capital.
Zheng’s martyrdom has shaken the Chinese. The story was reported in newspapers and shared thousands of times on the Internet. “What happened to this man, that he was forced to do something like this?” one blogger asked. “Where was our government? Where was the Red Cross?” another wanted to know. “All praise to socialism,” a third blogger wrote with bitter irony. “Those who live in capitalism have no idea how good we have it here in China.”
Many refused to believe Zheng’s story at first. But it’s true. And it can no longer be ignored. In the meantime, says one of Zheng’s caretakers, even Xi Jinping, president of the People’s Republic of China and general secretary of the Communist Party, has asked about the condition of this patient, this one man in a country of1.3 billion people. The caretaker says: “Zheng Yanliang is a sensitive case.” His is the story of a man who sawed off his own leg because he had no other choice. It signifies how the state abandons its citizens and how the country’s health-care system leaves patients in the greatest possible distress to fend for themselves.
Zheng’s trip home in a minivan passes through the suburbs of Beijing and out into industrial Hebei Province.
Hebei has a population of 70 million and produces twice as much steel as the United States. Those who live there are always in a hurry. Hebei’s inhabitants are busy doing everything they can to increase the modest affluence they have managed to accumulate in the last 30 years. Many of them have no time to be sick, nor do they have any money to get well.
Zheng was 10 years old when Mao died and 15 when the Chinese economy embarked on its real Great Leap Forward. As the only boy of four children, he helped out in the wheat and corn fields the party had assigned to his father. But the farm did not produce enough income to feed the family, so Zheng began working on a construction site.
For years, his life — a life like that of millions of other Chinese — consisted of working in construction for 10 months every year, followed by two months at home. When he married in 1998, the country’s one-child policy had been in place for many years. Besides, he wouldn’t have been able to support more than the one daughter Zhonghong gave birth to a year after they were married. Zheng later took a job in one of the brick factories in Hebei, where the sky is filled with hundreds of smokestacks. Zheng made, loaded and delivered the bricks that were used to urbanize China.
The minivan bumps along dirt roads and past empty fields to his village, Dongzang, where the streets are empty. His wife unlocks the iron gate. A pile of corncobs are spread out to dry in the courtyard.
While he was in Beijing, a neighbour built a concrete ramp in front of the main door, and now his wife pushes him up it in his wheelchair. Then Zheng rolls into the room where his calamity began three years ago. From there, he embarked on a journey of agonies through the Chinese health-care system, an odyssey that involved travelling hundreds of kilometres and in which he was examined in several hospitals by several doctors, all of whom recognized the danger but did not take the steps needed for him to heal. And it was to this room that he eventually returned, after receiving no treatment, to die.
“It was the sixth day after the Chinese New Year’s festival, Jan. 28, 2012,” Zheng recalls. “I was sitting on this green sofa here, playing poker with a few friends. When I stood up, I suddenly felt a terrible pain right here.” He touches his groin.
Half an hour later, he could hardly move his leg. There is no doctor in the village, only an infirmary with a paramedic, Zheng Kexin, who examined him that day. The same paramedic is on duty today, three years later. As the paramedic speaks, people are constantly knocking on the door — fathers and mothers asking him to go to the room where their sick children are moaning in pain. Of course he remembers Zheng.
“I gave him some painkillers and sent him back home. I didn’t like the way he looked. But I have 20 to 30 patients every afternoon. When my wife isn’t there, I am responsible for almost 3,000 patients. The cellphone rings day and night.”
Zheng was taken back home, but when his leg became cold and pale, he began to lose sensation and his toes started to turn blue, his friends loaded him into a car and rushed him to Baoding, the provincial capital. There is no ambulance service in rural areas. Zheng’s wife took along all the money she could find. The Chinese give each other money for the New Year’s festival, and the couple had 3,000 yuan, or about $600 (Canadian), in the house.
The Hebei University Hospital is one of three large hospitals in Baoding, with 1,500 beds and more than 20,000 surgeries a year. The building is slightly dilapidated and houses many more patients than it should. In the general surgery on the 11th floor, where Zheng ended up that night, there are patients lying in beds in the hallways and on mats in the stairwell. It smells of cigarettes and urine.
At 11:10 p.m., an emergency room doctor examined Zheng and referred him to the surgeons. According to his medical record, Zheng had strong pain in both legs and had had his appendix removed three months earlier. “No other abnormalities,” the record reads. Blood work was done and he was given painkillers.
During that night, Zhonghong watched as her husband’s lower legs became more and more discoloured and his feet began turning outward in a grotesque way. She dragged her husband to the toilet several times. The next morning, he was given an ultrasound and an MRI. Then, finally, a diagnosis was prepared. Arterial thrombosis had formed in both of the patient’s legs, wrote Dr. Li Riheng, and Zheng’s condition was “complicated and critical.” Nevertheless, the university hospital discharged the patient and transferred him to Military Hospital 301in Beijing.
The blood vessels supplying blood to Zheng’s legs were clogged, in a condition called acute arterial occlusion. If treated early, the prospects of recovery are good. “But if surgery is delayed by more than 12 hours,” reads the professional literature, “there is a risk of loss of the extremity.”
Zheng couldn’t understand why the doctors did not operate, despite the obvious diagnosis, and why, 20 hours after the initial onset of symptoms, they transferred him to Beijing, 160 kilometres away.
“Why do you ask about that?” asks Dr. Zhang Aimin, 50, the chief resident in the general surgery department, when he is queried by a reporter about the transfer. Yes, he says, he does remember this patient. “The man is morally deficient,” he explains. “He is just telling people his story to make money.”
Military Hospital 301 is administered by the People’s Liberation Army and is one of the country’s biggest and best hospitals. It has more than 4,000 beds, provides outpatient care to 3.8 million people and treats 110,000 hospitalized patients a year. According to its website, the hospital is “responsible for the medical care of the leaders of the Central Committee of the Communist Party, the Central Military Commission, the General Staff of the People’s Liberation Army and the troops stationed in Beijing.” If the Chinese president were to suffer from arterial occlusion in the legs, or even a less serious condition that required in-patient treatment, he would be taken to Hospital 301.
The vascular surgeon who treated Zheng sent him directly to the orthopedics department. He noted that the patient’s right leg could no longer be saved through vascular surgery and asked his colleagues to review the conditions for amputation.
Zheng spent the night either being examined or lying on a stretcher in the hallway. Zhonghong had borrowed 10,000 yuan from friends to pay for treatment. A doctor took his wife aside and explained that an amputation was only the first step in a lengthy course of treatment, which, all told, would cost about 300,000 yuan, or $60,000 — a sum the couple could not even have raised if they had sold everything they owned.
Besides, said the doctor, an amputation was not possible at that time, because it would require a “clear line” in Zheng’s tissue to develop. According to the doctor, this “clear line” would indicate the point at which the leg could be amputated. If they wanted to have the operation done in Beijing, the doctor said, they would have to increase their deposit. The couple’s 10,000 yuan had already been used up on the pre-
vious evening, he explained.
Zheng didn’t want to leave Military Hospital 301, and he didn’t want to die. But he had no choice. He had reached the end of what the health-care system had to offer him, a man with a potentially fatal condition.
At 8 a.m. the next day, one of China’s leading hospitals discharged Zheng Yanliang. The patient was aware of his situation, the doctor on duty wrote in the file, and yet he refused to remain in the hospital. According to the file, Zheng was “informed that he would be responsible for the consequences if treatment were delayed.” Zheng paid 11,000 yuan for his night in Beijing, and another 1,800 for the ambulance that took him back to Baoding.
Booming China has long ignored the health of its citizens. The Communist health-care system collapsed when it was privatized at the beginning of China’s economic reforms. That health-care system had almost doubled Chinese life expectancy from 35 to 68 and reduced child mortality by 80 per cent — one of the few major achievements of the Mao years.
Then came Deng Xiaoping and the Chinese became more affluent, but their health did not improve significantly. Only civil servants and government employees remained insured and continued to receive medical care, while farmers and migrant workers were left to fend for themselves.
Families and relatives were left to fill the gap left by the government. In Zheng’s case, it was a gap that could not be filled.
“I hadn’t slept for two days,” says Zhonghong. “We had used up all our money. We had gone into debt. And still the money wasn’t enough for an operation. I had to make a decision. I told my husband: ‘We’ll go home, and you’ll get better.’“She thought she was taking him home to die.
It was February 2012 and Zheng was lying in his bed. He was being given Tramadol, a painkiller, by injection every 12 hours, but then the intervals were reduced to four hours and finally two. After three days, he began to hallucinate and saw ghosts flying around the room. His leg was getting blacker and blacker. Zhonghong was changing his adult diapers, but they were soon unnecessary because he had stopped eating. Zhonghong sat with her husband, waiting for him to die. His sister came to visit him and said she had bought the shroud. This was where Zheng’s story ought to have ended. But Zheng didn’t die. His leg was already dead. When he woke up one morning, after 11 weeks in a semiconscious state, he no longer felt any pain in his right leg. It was April 12, 2012. But the leg smelled, because the process of decay had already begun. Zheng couldn’t stand the sight of it. Two days later, he asked his wife to hand him the saw in a tool box under his bed. “Help me saw off the leg,” he said. Zhonghong refused. They argued and she stormed out of the room, leaving him alone. He took the saw and began cutting, but there was hardly any blood. The bones were brittle and the tissue was infested with maggots. Zheng bit so hard on the piece of wood between his teeth that he broke a molar. When his wife returned to the room and saw what he had done, she collapsed.
To this day, a serious illness like Zheng’s can ruin a family financially. After the turn of the millennium, nine out of 10 Chinese had no health insurance and, even as the urban elites became more prosperous, doctors’ salaries remained low. Underpaid, overworked and repeatedly exposed to attacks by helpless and aggressive patients, China’s doctors are in despair over their profession. One in four doctors suffers from depression.
The party is trying to correct the problem. In early 2003, China began introducing health insurance for the rural population. It aims to increase the number of doctors from 1.5 to two per 1,000 residents by 2020. Officially, almost all Chinese now have health insurance, an achievement recognized by the World Health Organization. But it’s a staggered system. Patients who visit a local infirmary get 70 to 80 per cent of their expenses reimbursed. The reim- bursement drops to 60 per cent in district hospitals, and in modern facilities like Hospital 301 in Beijing, the average reimbursement is only 30 per cent. And no matter where a patient is treated, the costs must be paid in advance.
Now that he had sawed off his leg, Zheng was suddenly no longer at death’s door.
He began to eat again. Zhonghong poured iodine on the wound. The neighbours, who hadn’t entered the house in weeks, began visiting again. Zheng began to recover.
His sister bought a wheelchair and the government approved a disability pension of 129 yuan a month. Instead of going to college, his daughter took a job in a shoe factory, but the money still wasn’t enough. He could have continued living in poverty like this, from one day to the next, for years to come. Perhaps he would have died soon of the thrombosis in his other leg, of his damaged kidneys or of an infection. The fact that it didn’t end this way is yet another miracle in a life at the very bottom in China.
In the summer of 2013, after more than a year had passed since his self-amputation, he hit upon the idea of telling his story to a newspaper. The local paper, the Baoding Evening News, sent a reporter to Dongzang, who took photos and wrote a report. It caused a sensation.
One of his visitors was Dr. Han Bin, the head of Hospital No. 2 in Baoding. He looked at Zheng’s left leg and said he wanted to take him to the hospital immediately. Zheng told him he couldn’t afford the operation. But the doctor said: “We’ll take care of that.”
His left leg was amputated. Zhonghong had it wrapped up and placed it with the other leg in a clay jar in the farm’s courtyard — Zheng wanted the legs saved so he could be buried whole when he dies.
One of the journalists posted Zheng’s account number on the Internet. About 320,000 yuan in donations were paid within a few days.
In the spring of 2014, the Baoding invalids’ association found a rehab centre in Beijing that admitted Zheng and had two prosthetic legs made for him. Zheng shared the costs with the association and the rehab centre. Of the 320,000 yuan in donations, he still had 18,000 left in the end.
Asked if he thinks there’s a villain in this story, Zheng shrugs his shoulders. He can only think of a hero. His wife. “I was poor when we met,” he says. “And I’m still poor today. She helped me. I think she is very fond of me.”
Li Zhang, the village mayor, says: “We provided Zheng with his disability pension. What else could we have done?”
Dou Dashun of the local government says: “If I had been in Zheng’s place, I would simply have waited to die. I would not have caused pain to my family and would not be sponging off my country.”
Dr. Xu Yongle, a vascular surgeon at Hospital 301 in Beijing, who examined Zheng three years ago, classified him as an emergency case and sent him to the orthopedics department, says: “If a patient ends up lying in his bed at home and saws off his own leg, there is something wrong with our system.”
Zheng, supported by his crutches, is now standing in his house, looking out the window at the courtyard and the clay jar that holds his dead legs, or what is left of them — dust and bones, relics of himself.
Zheng’s legs have preceded him into the afterlife, to a place where he refused to follow them. Zheng Yanliang is standing in his living room, alive, a man in full.
“The man is morally deficient. He is just telling people his story to make money.”
DR. ZHANG AIMIN WHO TRANSFERRED ZHENG RATHER THAN TREAT HIM