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In July 1974, we learned that Mao was going to die.
His eyesight had continued to deteriorate, and by early 1974 he could not see a finger in front of his face. He could only tell light from dark. His speech had become so muddled that even those who knew him well could no longer understand him. It was as though he had lost control of his tongue, and he seemed unable to close his mouth. The muscular atrophy in his arms and legs was worse, especially on the right side of his body.
Mao's antipathy toward the medical profession continued, and even as I urged him to be examined by specialists, he continued to rail against doctors. Finally, he agreed to see an ophthalmologist and a team of neurologists. Zhang Yufeng had heard good reports about the ophthalmology department at Sichuan Medical College and suggested bringing in specialists from there. I was delighted. So long as Mao agreed to the exam, the rest was easy. Through the Ministry of Public Health, I invited a doctor named Fang from my alma mater, West China Union University Medical School, now renamed the Sichuan Medical College, and another named Luo, also from my alma mater and now at Sichuan Provincial Medical Hospital, to Beijing. They stayed in the 305 Hospital, seeing patients and performing operations, waiting for Mao's call.
In the meantime, two neurologists examined Mao—Huang Kewei, the director of the neurology department at the 301 Hospital, and Wang Xinde, the director of the neurology department at Beijing Hospital.
After examining Mao separately, the two doctors asked to consult with each other before discussing their conclusions with Mao. Mao asked for a written report. He did not want to see the doctors again.
I met with the two neurologists to discuss their findings. Their initial impression was that Mao had Parkinson's disease or had suffered a minor stroke. But as they discussed the test results and weighed the medical evidence, they now saw something else. They suspected that Mao had an extremely rare motor neuron disease, amyotrophic lateral sclerosis, known colloquially in the West as Lou Gehrig's disease. The illness involved the deterioration and eventual death of the motor nerve cells in the medulla and the spinal cord which control the muscles of the throat, the pharynx, the tongue, the diaphragm and intercostal muscles, the right hand, and the right leg. They wanted another medical opinion before making a final diagnosis, however, and suggested inviting Zhang Yuanchang, the director of the neurology department of the First Medical College of Shanghai, to Beijing.
Zhang Yuanchang came. After reviewing the results of the tests, he agreed with doctors Huang and Wang. Mao was suffering from amyotrophic lateral sclerosis, an illness so rare that Dr. Zhang had seen only two cases in his thirty years of clinical experience. The cause of the disease was unknown and there was no effective cure.
We discussed the prognosis. The doctors had had so little experience that they turned to foreign medical journals. Experience in the West suggested that the paralysis of Mao's right side would progress and he would become increasingly immobile. Once the disease spreads to the motor nerve cells of the throat, the pharynx, and the tongue, most patients die within two years. Mao had already reached that stage. In the final two years, as the throat, pharynx, and tongue become paralyzed, the patient experiences extreme difficulty swallowing and must be fed through a nasal tube. Otherwise, the patient runs a constant risk of choking, suffocation, and recurrent lung infections. With swallowing increasingly difficult, food and liquid often enter the trachea and lodge in the lungs, leading to infection and, often, pneumonia. In the last stages, swallowing is impossible. The diaphragm and intercostal muscles governing respiration also become paralyzed, and finally the patient is unable to breathe. With no effective cure, treatment could prolong the patient's life, but not for long. The use of a nasal tube for feeding could prevent food from lodging in the lungs. A respirator could aid breathing. Any physical activity had to be monitored carefully, because it was easy to fall and break a bone.
I was stunned. Mao's death was certain and probably only two years away. Wu Jie and Hu Xudong, still part of Mao's medical team, were also shocked. How could we write the medical report? Explaining the disease in language comprehensible to Mao and the other ranking leaders was almost impossible. And we could never tell Mao that he would die within two years.
We talked first with Wang Dongxing. But Wang knew nothing about modern medicine and could not understand what we were trying to say. He wondered how the Chairman could possibly have contracted such a bizarre disease and could not believe that Mao had only two more years to live. Mao was still able to eat and drink. The muscles of his throat were not paralyzed. He did not believe that there was a disease without a cure. He could not believe the doctors' prognosis. “After all your examinations, this is what you produced?” he asked. “This will not do. You have to do something else.”
The next day, we met with Marshal Ye Jianying, using models of the human body to show him how the eyes, the brain, and the spinal cord worked. He followed our presentation closely, asking questions, examining our models intently, attempting to understand. Ye Jianying had always trusted doctors, and he understood our presentation better than most of the other leaders. Mao's eye problem, he agreed, was less serious than the motor neuron disease. If his blindness was due to cataracts, an operation might help. If the eye problem was something else and the blindness proved incurable, the worst was that Mao would no longer be able to see. But the motor nerve cell problem, he agreed, was serious. He suggested setting up medical task forces in major metropolitan areas to treat other patients with amyotrophic lateral sclerosis. We could then use the most successful procedures to treat Mao.
Then we informed Zhou Enlai. Zhou had no difficulty understanding the problem and knew immediately how serious it was. His own health was declining. He knew he needed surgery but was still waiting for Mao's approval. New tests had revealed severe hematuria (blood in the urine)—some 100cc a day—and Zhou's physicians were insisting on immediate surgery. Zhou, too, wanted the operation performed, but he was not willing to go ahead without Mao's consent. Zhou's wife, Deng Yingchao, finally intervened. Mao had been charmed by the young female lab technician Li, who was a member of our medical team and in frequent contact with the Chairman. Since she was not a doctor and therefore could not be accused of trying to scare her patient, Deng decided to ask the young woman to talk to Mao and make the case for her husband's operation. Only after talking to Li did Mao finally agree. On June 1, 1974, Zhou Enlai checked into the 305 Hospital, where urologists Wu Jieping, Xiong Rucheng, and Yu Sungting performed a simple cauterization. Knowing the severity of his own illness, Zhou had no trouble understanding that Mao was also seriously ill. He was concerned.
He wanted us to keep looking for a cure and suggested that the Chinese delegation to the United Nations in New York be asked to gather information about Western treatment for amyotrophic lateral sclerosis. When we told him that the United States had no effective treatment either, he said, “So the case is terminal.”
We were all silent. No doctor wanted to say that the Chairman's death was inevitable.
“Then you must use the available time to find a way to deal with the problem. If you really cannot cure the disease, then at least you should try to prolong Chairman's life,” Zhou said.
On July 17, 1974, I met with the medical team in the 305 Hospital to discuss possible treatment procedures. We needed to review everything that could go wrong during the course of Mao's illness. Each specialist was asked to outline procedures for dealing with every possible problem in his area of expertise and submit a written report detailing his plans.
Xu Yingxiang, the president of Beijing's Tongren Hospital, and his colleague Li Chunfu, the director of the ear, nose, and throat department there, joined us to discuss the effects of paralysis of the throat and pharnyx and to work out procedures for dealing with that problem. The doctors agreed with what was widely known: that the only way to prevent food or liquid from entering the trachea was to feed Mao through a nasal tube. Zhang Yuanchang, the Shanghai neurologist, was particularly concerned about paralysis of the intercostal muscles, which control breathing. We would need a respirator and had to be prepared to perform cardiopulmonary resuscitation. In the long term, respiration was the most serious problem. If Mao could not talk, he could still write, and if he could no longer swallow, we could feed him through a nasal tube. But there was no way to keep him alive if he could not breathe.
The politburo was meeting even as we were discussing the Chairman's health. I learned later that it was during this meeting that Mao lashed out against Jiang Qing, separating himself from her politically and warning her, Zhang Chunqiao, Wang Hongwen, and Yao Wenyuan against forming a Shanghai faction of four. From warnings such as this came the later epithet Gang of Four.
The politburo meeting concluded while we were still working out our plans, and Zhang Yaoci called us shortly after to inform us that Mao had decided to take a trip. He would be leaving in two hours, and Wang Dongxing had directed that Wu Jie, Hu Xudong, and I, as well as the two ophthalmologists from Sichuan, accompany Mao. The neurologists were to return to their hospitals and await further notice.
I was aghast. Mao's condition could turn critical at any time. We had not finished our discussions, and the doctors had yet to write their reports. We had not yet decided how to handle all the possible medical emergencies. Nothing could stop Mao from leaving, but he needed a whole team of specialists along. The neurologists were critical to our work, and so was an ear, nose, and throat specialist. We needed an internist, too, plus special emergency rescue equipment and a trachial tube in case Mao had difficulty breathing. I explained this to Zhang Yaoci.
But Zhang was implacable. Mao's health was not his concern. He had his orders. “Wang Dongxing has ordered you to stop your discussions,” he said. The decision about who was to accompany Mao had already been made. There was nothing Zhang could do. “We have to follow orders,” he said.
Wu Jie, Hu Xudong, the two ophthalmologists, and I began packing immediately, taking as much emergency equipment as we could. We left with Mao by train for Wuhan.
We were there for two months.
Mao's condition worsened. His throat and pharynx, as we had feared, were becoming paralyzed, and swallowing was becoming more difficult. Mao could no longer swallow solids and had to be put on a semi-liquid diet—a thick broth of beef or chicken. He would lie on his left side while his attendants—usually Zhang Yufeng or Meng Jinyun—fed him, letting the liquid slide down his throat and into the esophagus. Food occasionally spilled into his trachea, causing lung infections. But he refused medical care. He refused even to see me or the other doctors. Wu Xujun, who saw Mao occasionally, kept me informed. She, in turn, passed messages from me to Mao, urging him to let us see him and emphasizing that he needed treatment.
Mao refused.
Finally, I wrote a full medical report, spelling out his problems in great detail and using diagrams to illustrate what was wrong, and asked Zhang Yaoci to submit it to Mao. He gave it to Zhang Yufeng, who gave it to Mao. The only thing I did not reveal was the prognosis. Few doctors in China informed their patients that a disease is likely to be terminal. We believed that the anxiety such knowledge provoked could actually shorten the patient's life. With hope for recovery, the patient's life could be prolonged. Certainly, no doctor would take responsibility for telling the Chairman that his disease was fatal. But it was my job to prolong his life, and we could only do that if Mao agreed to treatment.
Mao finally met with me after reading the report. He did not like what I had said. He never liked to hear bad news about his health and always suspected a plot. He pointed out again, as he had so many times before, that doctors are too pessimistic and refuse to see the bright side. Doctors scare both their patients and themselves, he said. Mao did not believe he was seriously ill. He had had laryngitis in 1965 and was convinced that his current problem was nothing more than that. When I tried to convince him otherwise, he refused to listen. But he agreed to see the ophthalmologists.
Mao cracked his usual jokes when the ophthalmologists came, and he tried to be cordial. But his speech was so muddled that no one could understand what he was saying.
The ophthalmologists confirmed that Mao had cataracts. When Mao wondered if they had found anything else, they said they would have to remove his lenses surgically before drawing further conclusions. Mao was irritated that his questions could not be answered without surgery. When I met with him after the ophthalmologists left, he was still irritated, complaining that they could do him no good. He asked me to send them away. From then on, he refused to see any doctors—even me.
But I was still in charge of his health and would be held responsible if anything went wrong. I was becoming desperate, sleepless, unable to eat, constantly worried. I saw myself as a doctor devoted to the Chairman's health. He saw me as an enemy. I explained my dilemma to Wang Dongxing, emphasizing that the doctors Mao had brought with him were not specialists in motor neuron disease and might not be of much use in an emergency. We needed other doctors too, especially neurologists and specialists in ear, nose, and throat diseases. We also wanted an orthopedist to join the team in case Mao fell and we had to set a bone. Wang agreed only to ask the Hubei provincial revolutionary committee in Wuhan to set up an emergency rescue team. I never met the Wuhan medical team. They never came to Mao's villa and never saw the Chairman.
Many people close to Mao had difficulty believing he was ill. When Wang Hairong and Nancy Tang accompanied Li Xiannian and Imelda Marcos, wife of the Philippine president, to visit Mao in Wuhan, they could see that Mao was having difficulty talking and often drooled, but they found his spirits still high. They were amazed when I told them that Mao was seriously ill. “Chairman is such a strange person and has such a strange disease,” Nancy Tang said.
Jiang Qing remained in Beijing during Mao's stay in Wuhan. Her campaign against Zhou Enlai was giving her a new sense of power, and she had begun comparing herself to the only empress in Chinese history—the Tang dynasty's Wu Zetian, remembered by the Chinese people as an evil and wicked woman. Articles praising the empress had begun appearing in the press, and everyone knew that Jiang Qing fancied herself a modern-day Wu Zetian. In honor of her own meeting with Imelda Marcos, Jiang Qing's tailors had made several costumes fashioned after those of the empress. When she saw the elaborate imperial gowns, even Jiang Qing realized how inappropriate they were. She never wore them. What role Mao had in dissuading her, I never knew. But Wang Hairong and Nancy Tang told Mao about her gowns, and from Mao's silence I knew that he disapproved.