February 3, 2003
Guangzhou Number Three Hospital, Guangzhou, China
311 Infected, 32 Dead
“WE USED FIVE HUNDRED MASKS THAT FIRST NIGHT, THREE HUNDRED gowns,” says Deng. “We ran out of supplies. But we had to continue working. We had to try to stabilize these patients. The party leadership knew we had these patients.”
At 10:00 A.M. the next day, after Deng caught a few hours of fitful sleep on his office floor, he received a call from Zhongshan Number Three Hospital. They wanted to transfer a patient to Guangzhou Number Three. “No, no,” Deng told them, “you don’t need to do that. We already have a dozen of these patients.”
“You’re the big brother hospital,” the doctor on the line told him. “We are the little brother, so he’s yours.”
Deng tried to think of an excuse. He needed a few hours’ more sleep. In fact, he says, he had never felt so tired. He was almost dozing off on the phone.
“He’s already on the way,” he heard the physician say.
When Deng put down the phone, he could see the elevator doors opening, and out came the Poison King. The patient’s look of good fortune had by now largely dissipated. His face had taken on the familiar featurelessness that Deng had seen in the earlier cases, but his skin had turned bright red, as if he had been scalded. And his eyes, despite their sag, looked angry. The man was stout, and, even supine in a hospital bed beneath sheets and pricked by IV lines, he exuded tremendous physical strength. He had been a seafood wholesaler, his forms said, running a shop at the Thousand Flavors Seafood Market in Guangdong. Deng says he had once visited the place, a sprawl of aquariums, fish tanks, and marine carcasses on ice. You could buy any form of aquatic life there, and Deng had purchased a half dozen in-season hairy crabs one year for a fair price, only to find out later that they were knockoffs of those succulent freshwater crustaceans so popular in winter months. The genuine article, raised in a special lake near Shanghai, were sweeter and less briny than those farmed elsewhere. These had been disappointingly salty.
Deng focused on the patient’s charts. Under “Diagnosis,” it just said AP, atypical pneumonia.
A handwritten note accompanied the new admittee. In it, the doctor in Zhongshan reported that he had six medical staff stricken with the same disease as this patient. Whatever the patient had, the doctor wrote, it was highly contagious. But for now, the Poison King was stable.
Deng went back to the ward, where the eleven-year-old was lying still and terrified under a mask. Deng rolled his head on his neck, trying to unknot his aches and pains. It had to be stress that was making his neck hurt. He was also shivering slightly. Probably just a cold. Anyway, he did not have time for his own touch of la grippe while he worked to stabilize Little Xu, as he called the eleven-year-old who lay on his back, mouth gaping open around his endotracheal tube. The boy had arrived with a ten-day history of fever. In addition to antiviral medication, he had been placed on a respirator and given intensive steroid therapy. He had awakened earlier that morning, the nurse told Deng, but it wasn’t clear that he understood where he was. But how could an eleven-year-old comprehend the enormity of this anyway? Patients in severe states of hypoxia and with blood oxygenation levels as low as Little Xu’s tend to be aware of only one thing: terror. Little Xu had good reason to be frightened, even in his unconscious state, with tubes rammed down his throat and into his arms and his brain now running on about 10 percent of the oxygen it required to function.
Deng continued his rounds as usual, checking in on his other patients. He found himself losing patience with those complaining of minor respiratory maladies or petty asthma cases. You live in the most polluted country on earth, he wanted to tell them, how could you expect not to wheeze or cough once in a while? You want to see a real respiratory problem, check out Little Xu. He even shouted at his ward’s business manager, a glorified clerk, really, whose job it was to quartermaster the hospital, collect money from delinquent patients, and screen any prospective new patients to assess their ability to pay for treatment—or, in some cases, determine just how much treatment they could afford. Because of the disposable gowns and masks the hospital staff had been going through treating just these patients, the business manager hadn’t been able to keep them resupplied with N-95 particle masks. “How can I do my job?” Deng recalls shouting at him.
The manager looked away from his department head and apologized, saying he would do better.
Deng went back to check on Little Xu.
He was dying, lapsing into multi-organ failure. The boy was turning yellow, a symptom of jaundice. His systemic inflammatory response syndrome, an immune reaction to the presence of whatever microbe was ravaging his respiratory system, was impeding his lungs’ ability to “load” his red blood cells with oxygen, thus robbing the liver, heart, and brain of oxygen. Deprived of precious O2 for extended periods, the organs one by one start selectively shutting down certain functions, like an overmatched chess player sacrificing rooks to save his queen. Eventually, the liver stops cleansing toxins from the blood and metabolizing red blood cells, and the brain eliminates conscious thought to ensure that involuntary synaptic functions—the beating of the heart, the processing of waste by the intestines—can continue. At a molecular level, the body’s cells stop functioning and replicating because they are lacking one of the basic building blocks required for any activity. For a doctor reading these signs, it’s like watching a windup toy sputter to a halt. To reverse this, to wind the crank even a little bit, Deng was joined by the nephrologist, and they commenced a series of four intermittent liver- and kidney-support treatments, employing dialysis machines and charcoal-and-anion exchange filters that could nourish the blood and at least keep the patient from developing sepsis as the liver stopped cleansing the blood of toxins and bacteria.
These desperate measures proved only a temporary salve, as respiratory function decreased to the point where convulsions began. Finally, late the next afternoon, Little Xu went into cardiac arrest. Deng had never seen a child succumb so quickly to pneumonia. As he and a nurse worked to resuscitate the boy, pounding on his chest to restart his heart, he cautioned the nurse not to break his ribs.
“You want a dead boy with good ribs,” he would always remember her saying, “or a live boy with broken ribs?”
As it was, at around 7:00 P.M., they had a dead boy with broken ribs.
AFTERWARD, DENG CLIMBED THE STAIRS TO HIS OFFICE, BECOMING short of breath by the time he reached his floor. He was forty-one years old, in fine shape, a regular badminton player and, in the summer, a swimmer. But now his whole body ached, and he’d had a headache for about two days. He felt irritable, frustrated, confused. He popped a digital thermometer in his ear and was surprised to see that he had a fever of 101 degrees. He swallowed a few paracetamols and phoned his wife, suggesting she take their son to her parents’ house. “I may have come down with something,” he told her. “I’m afraid it might be contagious.” When he returned home that evening, he fell into bed but could not sleep, instead lapsing into feverish visions of Little Xu and the Poison King and remembering how just before he left the hospital he had heard that one of his nurses was running a 103-degree fever. There had been the journey to Heyuan, and it was like he was back in that van, driving along the winding country highways, past the green mountains and the slow-moving placid streams. His body ached as he imagined the van driving and driving, each bump and pothole jarring his body with another bruising ache, never getting any closer to finding the source of the disease.
At dawn, he took his temperature again: 103. His phone rang. It was another doctor telling him he couldn’t make his rounds. He had a fever of 102. “I’ve got one hundred and three,” Deng said. He told the doctor to call around and see how the rest of the staff was doing.
“Four doctors are sick,” the other doctor told Deng when he called back, “including you. And four nurses.”
By then, Deng was so fatigued from sitting up in bed holding the phone to his ear that he lay back again. Eight staff down in only three days of treating this disease. And this was just one hospital. Before drifting from consciousness, he wondered about the other hospitals, the rural clinics, the villages. Who knew how many cases were out there?