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The improvement in Mao's health was fleeting.

When his edema cleared up, it was obvious he had lost weight. Mao had dropped from his normal 180 pounds to 154, and his whole body seemed to have shrunk. His face had lost its fullness and become sharper rather than round, and his big belly had disappeared, the skin now sagging. The muscles in his hands—the right one, especially—had atrophied, and his calves were flabby and thin.

Mao thought that exercise would improve his health, but he was too weak for any vigorous activity. He could walk only slowly and with support, and his arms and legs sometimes trembled. I noticed that his production of saliva had increased, and he often drooled.

He began to complain about his eyesight. Everything looked hazy, he said, and he had to use a magnifying glass to read. We increased the magnification, but he still did not see well.

I was worried in particular about the muscular atrophy and involuntary trembling and suspected some new disease. I wanted Mao examined by both a neurologist and an ophthalmologist. But Mao did not want to see another doctor. Only after repeated urging did he finally consent to see an ophthalmologist.

We invited Zhang Xiaolou, the president of Beijing's Tongren Hospital, to examine Mao's eyes. Mao insisted that the exam be conducted in his study, and there was no room for Dr. Zhang's ophthalmological equipment. He had to conduct the examination with only an ophthalmoscope and a set of optometry lenses.

Zhang was nervous meeting Mao, as nearly everyone was, and was not sure how to proceed. Mao engaged the doctor with his usual banter, asking him about the characters that made up his name. Xiaolou means “small building,” and Mao assured him that the Tongren Hospital would have a very large building if the doctor treated him successfully.

Zhang's examination was methodical and meticulous, and he was soon drenched in sweat. He discovered a slight corneal nebula on Mao's right eye and suspected cataracts. But he needed a more thorough examination, with more sophisticated instruments, to be certain. He suggested a further examination.

Mao was impatient. “It has already taken too much time,” he complained. He did not want to be examined again.

But Zhang could not determine appropriate treatment until his diagnosis was certain. He needed to examine Mao's retina. He could not just abandon his patient.

When I could not persuade Mao to be examined again, I called Zhou Enlai to enlist his help. But Zhou had been so badly stung by Jiang Qing's accusations against him during Mao's last illness that he did not want to get involved again. He urged me to be patient and to continue reasoning with Mao.

Mao remained adamant. There was nothing I could do. Dr. Zhang was not called back.

Mao was spending most of his time with Zhang Yufeng. Since his illness in January, the two of them usually ate together, and she had now begun to control access to the Chairman, making it difficult for both Jiang Qing and other top leaders to see him. Jiang Qing came to rely on her to learn what Mao was doing and used her as a conduit for her own messages to the Chairman. Jiang Qing began courting Zhang's favor, showering her with gifts—watches, Western-style clothes, expensive fabrics—as a way of persuading the young woman to speak well of her to Mao, convince him to support her latest political moves, and persuade the Chairman to meet with his wife now and then. Zhang was accommodating, but because she did not understand politics or the factional tensions still rending the leadership asunder, her communications were often muddled.

Zhang and I never got along, and as her control over the Chairman increased, our relations grew more strained. She began giving Mao a small cup of fiery maotai liquor with his meals, to which I, as his doctor, objected, fearing that the high alcohol content might lead to fits of coughing. But Mao insisted that since he had given up smoking and had not drunk much in the past, a little maotai could not harm him now. Besides, he thought the maotai might help him sleep. With Zhang's influence over the Chairman growing, haggling with her about a little maotai seemed pointless. Zhang was too fond of liquor to stop.

Then Zhang Yufeng became pregnant. By the end of 1972, everyone in Group One knew of the pregnancy, and some speculated that Mao was the father. I knew, of course, that Mao had long since lost his reproductive capacity and that a seriously ill man approaching eighty could not possibly father a child.

Both Zhang Yaoci and Wang Dongxing wanted Zhang Yufeng to have the best medical care and asked me to make the arrangements. I thought the state-run hospital used by the Railroad Administration's special services unit, where Zhang Yufeng's treatment would be free, was fine and was reluctant to make special arrangements. But Zhang Yaoci insisted that Zhang Yufeng had told him Mao wanted her to have special care and would pay for all expenses.

I gave in and arranged for the baby to be delivered at Peking Union Medical Hospital. Knowing my own connection to Mao, the ranking administrators there naturally assumed that Zhang Yufeng was also highly connected and put her in a private room on a special ward reserved for high-level leaders. Zhang Yufeng's husband, Liu Aimin, visited his wife during her period of confinement, and so did many important people. Zhang Yaoci and Jiang Qing both came, bearing gifts, special foods, and diapers. Jiang Qing urged her to recover quickly and return to work. Zhang's younger sister, Zhang Yumei, was filling in for her during her period of confinement, but the sister was too young and ill-informed to serve as an intermediary between Jiang Qing and her husband. Jiang Qing needed Zhang Yufeng back for her own political ends.

Mao was not the only top leader whose health was declining. The founders of the Communist party, the survivors of the Long March, were aging. Mao was approaching eighty, and so were many of his associates.

Kang Sheng was the first of the politburo members to become ill. Kang was despised, widely regarded as sinister and cruel, and even many members of the party elite held him responsible for the deaths of innocent people. When Kang's sister-in-law, Su Mei, committed suicide in 1967, more than fifty people had been arrested and charged with her murder, including the emergency-room doctor at Beijing Hospital who had tried to save her life. The doctor was accused of putting poison in the stomach pump, and a number of Red Guards were arrested for conspiring with the doctor. The doctor was imprisoned for thirteen years before being found innocent and released. Few would miss Kang Sheng or mourn his death.

In mid-May 1972, Zhou Enlai informed me that a recent lung X ray and urinalysis indicated that Kang was probably suffering from bladder cancer. He wanted me to go with him to break the news to Mao. I hesitated, thinking Mao should not be informed until the diagnosis was certain. Zhou agreed.

A subsequent cystoscopic examination revealed that the doctors' suspicions were correct. Bladder cancer. They wanted to operate.

It was an unwritten rule that no politburo standing committee member or any member of Mao's staff could undergo major surgery without permission from the Chairman. Zhou Enlai was responsible for arranging for Kang's medical care, but Mao's approval was necessary for the surgery.

Mao refused to allow the operation. His old medical prejudices remained. Cancer—of anything but the breast—cannot be cured, he claimed. The more cancer is treated, the sooner the person will die, Mao insisted. He did not believe in telling the patient he had cancer, either, because he was certain that the anxiety of knowing would result in an earlier death. “Don't tell the patient, and don't perform surgery,” were his instructions. “Then the person can live longer and still do some work.”

But Kang Sheng already knew that he had cancer, and his doctors had urged immediate surgery. He was desperate.

Finally, Kang and his doctors compromised. The treatment would not be “major” and hence could be performed without Mao's permission. Rather than invasive surgery, they performed a local cauterization, going into the bladder through the urethra to remove the tumor.

Kang Sheng's plight had prompted Zhou to have a physical exam himself. He had a lung X ray and a urinalysis and urged Mao to do the same.

Mao refused the X ray. He only allowed us to do a urinalysis. He had no faith in doctors or in medicine. Medicine is good only for diseases that can be cured without intervention, he thought. If the disease is serious, the patient will die with or without medicine.

Mao's tests were normal, but Zhou's urine revealed the presence of cancerous cells.

First, Wang Dongxing and Zhang Chunqiao took the news to Mao. Mao did not believe them. He accused the doctors of looking for disease because they had nothing better to do. Doctors keep themselves busy doing nothing, he insisted. He brought me in to ask how it was possible to tell from looking at someone's urine that he had bladder cancer. Zhou looked perfectly healthy to him, Mao said.

I was finally able to convince Mao that Zhou Enlai really did have cancer and that the diagnosis had not been the figment of the bored doctors' imaginations. But Mao wanted the tests on Zhou Enlai stopped and refused to allow him to be treated. Cancer cannot be cured, he insisted, and treatment only causes pain and mental anguish and does the patient no good. “Leave the patient alone and let him live out his life happily,” Mao said. “If I have cancer, I definitely will not have it treated.”

He insisted we stop testing him as well. “You test here, you test there, always looking for some new disease,” he said. “Who knows if the test results are accurate? You doctors just like to stir things up and you won't stop until you get everyone upset. I don't want you to run any more tests on me. A simple checkup will do.”

Mao was adamant. From then on, he refused anything more than the most perfunctory exam—no electrocardiograms, no chest X rays, no blood tests.

Despite my personal feelings about Zhou, I, like many others in Zhongnanhai, was extremely concerned about his health. Zhou was exceptionally energetic, working long hours, sleeping little, managing the affairs of party and state. The party's best leaders had been purged. Aside from Zhou, only incompetents remained, and they spent most of their time in factional struggles. Zhou's responsibilities had consequently expanded, taking a great burden off Mao. No other leader had Zhou's experience and stamina. Mao was too weak and sick to take over Zhou's tasks.

Wang Dongxing was less concerned about Zhou's health. Only Mao was indispensable. The death of Zhou—the death of anyone—could not matter much so long as Mao was alive. Wang Dongxing urged me not to worry. Mao would have no difficulty managing.

By early 1973, Mao was having difficulty speaking. His voice became low and guttural, and his words were hard to understand, even for those of us who knew him well. The slightest physical activity took his breath away, and his lips would turn gray. We set up oxygen tanks in his bedroom and study and administered oxygen when he overexerted himself. Mao was no longer mobile, and because his eyesight was failing, he read less. Jiang Qing suggested that his study be set up to show films, and Mao began watching movies imported from Hong Kong, Japan, and even the United States. Gongfu martial arts films were his favorites.

But Mao's mind remained clear. He would not give permission for Zhou Enlai's surgery, but he would find someone to replace him. The time had come to reinstate Deng Xiaoping.