【ENGLISH VERSION】 https://spark.adobe.com/page/3NqQhlPN3BP5E/
Author: Ai Fen
Translators: Charles S, TCC、freedust、InAHurry
Dr. Aifen’s Diary
A Chinese magazine, People, published an online interview with Dr. Ai Fen, the director of the emergency room at Wuhan City Hospital, China. The article used the first-person narrative to vividly record the Wuhan Coronavirus outbreak from the first patient with pneumonia of unknown cause identified on December 18. Dr. Ai Fen was the first doctor to identify this group of suspected SARS-like patients and spread the news to colleagues in the hospital. If Dr. Li Wenliang, died of Wuhan Coronavirus, was a whistleblower, Dr. Ai Fen is the original whistleblower.
This article also clearly illustrated the severity of the epidemic in Wuhan indirectly, which was far worse than those from official propaganda. Expectedly, this article quickly disappeared from the web. However, those inspired Chinese netizens have reconstructed this article in creative ways, such as traditional Chinese calligraphy, emoticons, and even “Martian text,” to reproduce it and widely spread on various Chinese social media.
Dr. Ai Fen, who had initially thought that the chief would appraise her for her excellent work, was, in fact, warned not to spread information about the coronavirus. She felt that “it seemed that she had destroyed a bright future development of Wuhan by spreading the findings.” In the article, she also shared her experiences and genuine emotions during these two months. She and her colleagues had really represented the kindness and dedication of Chinese health professionals. They are hardworking, dedicated, and passionate about their professions, and are willing to sacrifice for their patients. These thousands of thousands of kind and hard-working people have allowed China’s social system to function normally. The CCP Kleptocrats have utilized and abducted these hard-working and dedicated Chinese people to challenge the world openly!
As the CCP virus rapidly spreads around the world, the CCP has been shamelessly blaming the US for spreading the virus and strengthening its control and suppression of public opinion domestically. Any information that is inconsistent with the official media of the CCP will soon be disappeared. Because of its lack of transparency in the information and data that the virus becomes pandemic today. At present, the development of treatment and vaccines still heavily relies on its actual situation and data provided by the CCP. It is evident that the CCP is struggling to survive and wishes to drag down the whole world with it. The madness and evilness of the CCP are the real enemies of not only its own people but the entire human beings. Only to exterminate the CCP the world can really be prosperous and peaceful again!
On December 16, 2019, a patient arrived at the ER of our Nanjing Rd. Hospital. His temperature remained elevated and didn’t respond to our treatment. We transferred him to the respiratory ward on the 22nd, and a bronchoscope took the alveolar lavage fluid sample for sequencing. We got a word of mouth report it is a coronavirus. At the same time, my colleague in charge of the hospital ward also whispered to me it was coronavirus. We later learned that the patient worked in the S. China Seafood Wholesale Market in Wuhan.
Immediately after that, on December 27th, another patient arrived at the Nanjing Rd District. He was the nephew of a doctor in our department. He was in his 40s without underlying health issues. His lungs were messed up, and blood oxygen saturation (SpO2) was only 90%. The subsidiary hospital has been treating him for almost 10 days without any progress. The patient was then admitted into our respiratory ward. The alveolar lavage fluid was taken from the fiberoptic bronchoscopy for sequencing as well.
At noon on the day of December 30th, my classmate, who worked at Tongji Hospital, sent me a screenshot from a WeChat conversation: ” Don’t go to South China Seafood Wholesale Market, there have been many people with high fever …” He asked me if it were true. I was watching a CT of a typical patient with a pulmonary infection on the computer at that time. So I sent him an 11-second video of the CT and told him that it was from a patient who had come to our ER in the morning from South China Seafood Wholesale Market.
After 4 pm that day, my colleague showed me a report that said: SARS coronavirus, Pseudomonas aeruginosa, 46 kinds of oral/respiratory colonization bacteria. I read the report carefully many times, and the notes read: SARS coronavirus is a single strand plus RNA virus. The primary mode of transmission of the virus is close-range droplet transmission or contact with respiratory secretions of patients, which can cause special pneumonia that is obviously contagious and can affect multiple organ systems, also known as atypical pneumonia.
By then, my anxiety is giving me cold sweats. SARS is seriously scary stuff. According to the SOP, the respiratory ward is reasonable to report the case through the chain of command. However, I immediately called and reported it to the hospital’s public health department and the infection disease department just to make sure it is known. Coincidently, the director of the respiratory ward walked by my door. He lived through the SARS epidemic. I grabbed him and said, “This is what we found in a patient in your ward.” He took a glance and said: “That is bad.” I knew immediately it was really bad.
After calling the hospital, I forwarded this report to my classmates. I highlighted “SARS coronavirus, Pseudomonas aeruginosa, 46 types of oral / respiratory colonization bacteria.” in red to remind them to pay attention. I also sent the report to the doctors’ WeChat group in our department to remind everyone to take precautions.
That report was spread out that night, and the screenshots of the transmissions were the photos with the red circles I painted, which later I learned doctor Li Wenliang also forwarded. I thought at the time that there might be trouble. At 10:20, the hospital sent a message. It was a notice from the city health committee. The main point was that the information about the pneumonia of unknown cause should not be carelessly released to avoid public panic and the responsible persons would be held accountable.
I was very scared at the time and immediately passed this information to my classmates. About an hour later, the hospital sent another notice, again stressing that related information within the group cannot be released to the public. A day later, at 11:46 pm on January 1st, the Inspection General of the hospital sent me a message and asked to talk to me the next morning.
I couldn’t sleep that night. I was worried and thought about this over and over. Yet I felt that there are always two sides of everything. Even if it caused adverse effects, it is not necessarily a bad thing to remind medical staff in Wuhan to take precautions. At 8 o’clock the next morning, before I finished the shift, the phone rang again.
During the following interview, I was given a severe punishment I have never had.
The leader who called for the conversation said, “We couldn’t hold our heads high when we attended meetings. Director so-and-so criticized:” That ER director Ai Fen in your hospital. She’s supposed to be a professional, how could she spread rumors disregarding the rule of the Party?” These were his words. He also sent me back to correct what I sent with those 200 or so people in our department one by one in person. No WeChat, no text messages. Only phone calls or face to face conversations. We were not allowed to say anything about this pneumonia. “Not even to your husband.”……
I was stunned. He didn’t criticize me for not working hard. Instead it seemed that the good situation of Wuhan’s development was destroyed by me. I had a very desperate feeling at the time. I have been a hard-working person. I felt that everything I did was reasonable and by the rules. What did I do wrong? I saw the report, and reported it to the hospital. My classmates, my colleagues, and I exchanged information about a certain patient without revealing any personal information. It is equivalent to discussing a medical case between medical students. When you, as a clinical doctor, already know that a very important virus has been found in a patient, how could you not say it when other doctors ask? This is your instinct to be a doctor, right? What did I do wrong? I have done what a doctor and a normal person should do. I am certain anyone else would do the same.
I was very agitated, too. I told him: “I did this and it has nothing to do with the rest of the staff. You can just jail me.” I said that I am not suitable for staying in this position and wanted to take a break. The leader did not agree, saying that this was the time of challenge, and I could prove myself.
I remember quite clearly that night, after I went home and entered the door, I told my husband if something happened to me, he would have to raise our children. My 2nd baby was just one year old. My husband thought I was not making any sense, cause I didn’t tell him about scolding I just received. On January 20th, after Professor Zhong Nanshan told people about human-to-human transmission, I told him what happened that day. Before that, I just reminded my family not to go to crowded places and wear masks when they have to.
[Other departments] Many people worried that I was among those 8 people who had been summoned by the police. I was not one of them. Later, a good friend asked me if I were one of the whistleblowers? I said I was not the whistleblower; I was the one who gave them the whistle.
But that talk hurt me a lot, seriously. I felt that my whole spirit was crushed after that. I have to try very hard to concentrate on my work. I couldn’t answer any more questions after that anymore. All I can do is get the ER to focus on preventive protection. We have more than 200 people, and from January 1st, I asked everyone to strengthen their protection. All people must wear masks, hats, and use hand sanitizer. I remember one day during the shift, there was a male nurse who did not wear a mask. I immediately scolded him, “Do not come back for work without a mask.”
On January 9th, I saw a patient coughing at the triage station when I was off work. From that day on, I asked them to give masks to all patients who came here to see doctors, one for each. This is not the time to be frugal. I was emphasizing wearing a mask when others were saying there is no human transmission. It was challenging.
It was depressing and harrowing in that period. Some doctors suggested that we wear protection suits on the very outside, but the hospital management vetoed it, as it might cause panic. So, I asked people in my department to wear the gown inside their white robe. It violated the safety protocol and looked ridiculous.
We witnessed more and more patients arriving helplessly, and the radius of the infection circle became larger and larger. It might be related to the South China Seafood Wholesale Market in the beginning. Then it spread out, and the radius became larger and larger. Many of them were transmitted within family members. Among the first 7 infected, there was a son who got the virus from the lunch delivered by his sick mother. A doctor in a clinic got sick from one of his patients. They were all in serious condition. I knew there must be human to human transmission. The market had closed on January 1st, how could there be more and more patients without human-to-human transmission?
I thought so many times if they didn’t rebuke me like that. Instead, they could calmly discuss the ins and outs of this case. Then we could consult with other respiratory experts; maybe the situation will be better. I can at least communicate a bit more inside the hospital. If everyone were so alert on January 1st, there would not be so many tragedies.
At the Nanjing Road Branch of Wuhan Hospital on the afternoon of January 3, doctors in urology surgery gathered to review the work history of their former director. Dr. Hu Weifeng, 43-year-old, and one of the participants were now in the intensive care unit. On the 22nd floor of the Nanjing Road Branch on the afternoon of January 8, Director Jiang Xueqing had organized a rehabilitation party for Wuhan patients with breast prosthesis. On the morning of January 11 (3 days later), the department reported to me that Hu Ziwei, a nurse, was in the emergency department for her infection. She should be the first infected nurse in the central hospital. I immediately called and reported the chief of the medical department. Then the hospital held an emergency meeting and instructed to change the diagnosis report from “bilateral bottom-lobe pneumonia , likely to be viral pneumonia” to “bilateral diffuse pneumonia”. At the last weekly meeting on January 16, a deputy director still said, “Everyone should have some common medical knowledge. Some senior doctors should not spread information to scare others.” Another leader continued saying that there was no human to human spread, and the infection is preventable, curable, and controllable. One day later, on January 17, Director Jiang Xueqing was hospitalized and intubated 10 days later and went on the ECMO. No one passed it on; it was preventable, curable, and controllable.
The price of the central hospital was so high. This was because of the lack of transparency to our medical staff. If you looked at those severely sickened, they were not from the emergency department or the respiratory department. We had a sense of ‘protection’ and knew when to rest and be treated. All those who were severely ill were from peripheral departments, like Li Wenliang from the ophthalmology and Jiang Xueqing from the breast reconstruction. Dr. Jiang Xueqing was a very good person with high medical skills and had won one of the two Chinese Physician Awards in the hospital. We were also neighbors. We lived at the same apartment building where I lived on the 40th floor, and he lived on the 30th floor. Our relationship was perfect. Because of the busy working schedule, we only met at meetings or hospital activities. He was a workaholic, either in the operating room or at the clinic. No one would go to remind him and say, “Director Jiang, you have to pay attention and wear a mask.” He also didn’t have the time and energy to inquire about these things. Even if someone did, he would say something like, “what’s the matter? It’s just pneumonia.” This was told to me by his department.
If these doctors could get timely reminders, perhaps this day would never come. Therefore, as one of his colleagues, I regretted that I did not remind him. If I know what would happen today, I’d not care whether I would get criticized. “This old man (I)” would like to remind everyone, right? Although Li Wenliang and I served the same hospital, I didn’t recognize him until his death. This was because the hospital had 4,000 staff, and regularly we were all busy. At night before his death, the director of the ICU called me to borrow a CPR machine from the emergency department and said that Dr. Li Wenliang was in critical condition. I was shocked by the news. I did not quite understand the whole situation about Li Wenliang, but would his sickness be related to his bad mood after being reprimanded? I’m going to put a question mark here because I understood how he felt.
Later, things went on to the point that Li Wenliang was proven right. I can understand his feeling very well. His feeling would be the same as mine, not excited nor happy, but regretful. We regretted that we did not continue screaming about the truth from the beginning or continue to talk about this when people asked us. I was wondered many times if we could turn back the time.
[Staying alive is good] On the night of January 23, one day before the city was closed down, a friend from the relevant department called me and asked about the true situation of emergency patients in Wuhan. I ask him if this request was from him or his office. He said he asked for himself. I replied if this were for himself, then I would tell him the truth. On January 21, our emergency department saw 1,523 patients, three times more than our usual number, and 655 patients had a fever.
During that time, no one could forget what happened in the emergency department. This would even change your view of life.
If this is a war, the emergency department is at the forefront. However, the situation then was no other department accepting patients, and the ICU refused to accept them. They claimed that they had ‘clean (not infected)’ patients who can be contaminated whenever an infected patient moved in. The patients kept rushing into the emergency department, but no other department could triage them. So these patients all piled up in the emergency department. When patients came to see a doctor, and they had to wait for a few hours. We can’t get off work. There was no way to separate fever from non-fever other emergencies. The waiting hall was full of patients, as well as the infusion room and the CPR room.
One patient’s family came to the hospital and requested a bed. He said that my dad was very ill and stayed in the car. Because the underground parkade was full, he couldn’t get in. I cannot think a better way but run to the car with nurses and equipment. When we arrived, his dad was dead. Tell me how you feel. I was depressed and sorry for him. The man died in the car without even getting off the vehicle.
There was another older woman whose husband had just passed away at Jinyintan Hospital. Both her son and daughter were infected. She was accompanied by her son-in-law when she was given an injection. Because she was very ill, I contacted the respiratory department to admit her. Her son-in-law, an educated man at a glance, came to me and expressed his appreciation. Although this was just seconds, I urged him to send his in-law first. It was too late that she passed away before her admission to the hospital. The thank-you wording had weighed me down.
There were still many people who sent their families to the ward, and this might be their last time to see the patient.
I remember that I came to work on the morning of the 30th (Chinese New Year Eve). I said that we would take a picture to commemorate the 30th year of the New Year. No one said blessings that day. At this time, it is good to live.
I remember it was the morning ofnew year’s eve of Luna year; I recommended to take a photo to mark the day. Then I sent the picture to WeChat moments. People barely said something about blessing. In this situation, survival was everything we expected.
A few days before, if you ever made a little mistake, like not doing the injection in time, patients might have come to argue. Now there’s none, no one to contend with; everyone was shocked by the sudden strike, then depressed.
Patients died, could hardly see families crying, cause there’s too many. Some families even did not beg me to save the patient. Instead, they said, “just let it go; I don’t want him to suffer anymore”. Everyone was so frightened that he or she could be the next one to be infected.
It took 5 hours to wait outside the fever clinic every day. A woman in line fell down; she was wearing a fur coat, carrying a bag, in high heels, looked like an exquisite middle-aged woman. No one dared to come forward and helped her; she was lying down there for a long time until I called the nurses and doctor.
On the morning of Jan 30th, I came to work. A son of a white hair elderly haired old man died, who it was 32 years old. The old man just watched the doctor issuing the death certificate with no tears, even can’t find a way of mourning. Judging by his dress, he might be a migrant worker, and he had nowhere to complain. His son had gone before being confirmed, left him only a death certificate.
That’s what I want to appeal about. All patients who died in the emergency department were undiagnosed and could not be confirmed. When this outbreak is over, I hope to give them an explanation, give their family some comfort. The patients were so pitiful.
Lucy, to be a doctor for all these years, I always think that there is no difficulty in bringing me down. This has to do with my experience and personality. My father died of gastric cancer when I was 9. That’s when I wanted to be a doctor and save people’s lives. Later, during the college entering examination, all I wanted to do was studying medicine, and finally, I was admitted to Tong Ji Medical College. After graduating from university in 1997, I came to the Central Hospital. I worked in the Cardiovascular Department first, then became the director of the Emergency Department in 2010.
I consider the emergency department as a child of mine, I raised it, united the team, it’s hard to make it work well like this. I value this team very much.
Several days ago, one of my nurses sent a message on Moments and said, I miss the busy emergency department so much; that kind of busyness was different from what it is now.
Before this outbreak, such as MI, TIA, GI, trauma, these were what we as Emergency Department concerned. That kind of busy is fulfilling, purposeful. For all types of patients, there were very smooth procedures, very established — what to do next, how to do it, and which one to look for when something goes wrong. And this time, some so many critically ill patients have no way to deal with and could not be admitted to hospital. Meantime, our medical staff was at risk. This kind of busyness was helpless and sad.
One day at 8 am, a young doctor in our department sent me a WeChat message, which was quite individual, saying that he was feeling under the weather and wouldn’t come to work the day. Cause we have rules here, if you were sick, let me know about it in advance. You were telling me at 8 o’clock; I had no one to replace you. He lost his temper at me on WeChat, saying that a large number of highly suspected cases were put back into the society by the Emergency Department you led. What we were doing was committing a crime! I understood him of his conscience as a doctor, but I was also lost control, and I said to him, you could report me. But if you were the emergency department director, what would you do?
After taking rest for a few days, the doctor came back to work. He said he was not afraid of death or fatigue, but he had never encountered a situation that was dealing with so manypatients at one time, he felt depressed.
As a doctor, especially those who came to support us from outside, couldn’t stand this mentally. Shocking by the situation, some doctors and nurses couldn’t help crying for the others and themselves. Cause no one knows if he or she will be the next one infected.
About in mid to late January, The leaders of the hospital fell in ill one after another, including director of the clinical office, three vice presidents. Chief of Medical Services was resting at home, whose daughter also got sick. Therefore, no one cared about you at the time. You fought alone, that’s what I felt.
People around me also started to fall ill one by one. On January 18, at 8:30 in the morning, The first doctor was infected. He said, “director, I caught the disease, no fever.” We did a CT to him; there were big glass-like areas in his lungs. A moment later, one of the nurses in charge of the isolation ward told me that he was ill too. At night, Our head nurse also got sick. The first thought that came to my mind was that they were lucky. As soon as being infected, you could go off the battlefield.
I have had been in close contact with these three people; I just worked every day with the belief that I would fall into illness eventually. But I did not. Everyone in the hospital thought I was a miracle. I analyzed it myself; it may be the reason that I have asthmaand were using some inhaled hormones, that may inhibit the deposition of these viruses in the lungs.
I have always thought that people who chose to work in the ER are people with compassion—In Chinese hospital hierarchy, ER is considered to be relatively low status. ER is often considered to be a transitional passageway: we just take patients in. The stereotype also existed in this fight against COVID19.
At the early stage of the outbreak, there was already a shortage of supplies. Sometimes, the protective suits allocated to our ER were of deficient quality. I was angry to see our nurses had to work in such a condition, and I often lost my temper in our weekly-meeting group chat. After that, several directors of other departments gave us those protective suits they kept for themselves secretly.
There were also issues with the canteen. When the hospital is packed with patients, canteen management is in chaos. They completely forgot about the ER and never thought about if we have had enough to eat. While there was always abundant food in other departments where they could not even finish before the end of their shift, we don’t have any food. Some doctors from the section for out-patient were complaining in the WeChat group chat saying: ” at ER, the only thing we have is diapers.” We, ER doctors, are at the forefront of this battle against the virus, yet we are treated this way. Sometimes, I am burins with anger.
We are really a good team. No one is offline unless one is sick. There are more than 40 that were infected with COVID19. I created a group chat for all of them. Initially, I wanted to name it ‘ER sick group’. The head nurse did not like the idea, said it is unlucky to call the group like that. Then the name was changed into the ‘ ER cheering group.’ Even those who were infected are not sad, hopeless, or blaming others. Everyone has a positive attitude: let’s help each other and get through this together.
These kids, young guys, are all brilliant. I couldn’t give them the treatment they deserve. I hope when the epidemic is over, the State will increase the budget for the ER. ER departments are often highly regarded within the medical systems in many other countries.
【Unachievable happiness】On 17th February, I received a WeChat message. It was from a classmate that works in Tongji Hospital. He wrote, “I am sorry.” I replied: “ I am glad you let it ( information of COVID19 ) out. You have timely alarmed few.” If he didn’t get any word out on COVID19, there might not be Dr. Li Wenliang and them eight. And fewer people would have known about the virus.
Three female doctors have the whole family infected with COVID19. Two of them and their husbands and in-laws are infected. The third one, together with her parents, elder sister and her husband, have all caught COVID19. None of us would expect such an outcome this costly since the virus was spotted so early on.
The price we are paying for the epidemic is reflected in all aspects. It’s not just the ones that died paid a heavy price. Those who are sick but alive are also suffering.
In our group chat (‘ER cheering group’), we often discuss our health. Some asked: if my heartbeat remains at 120/min, is it an issue? It is an issue if one is flustered as soon as one moves around. This will have an impact on them for their entire life. Might they suffer from heart failure as they get older? The consequences are hard to predict. While others can enjoy hiking and traveling, they might not be able to do those things. This is highly possible.
And onto our city Wuhan. Wuhan used to be full of life. And now every street is so quiet. We are short on many necessary supplies, and we had to ask for help from the rest of the country. A few days ago, a nurse of the medical team from Guangxi just collapsed. She had a heartbeat again after the ER, but she is still in a coma. If she didn’t have to come here, she would still be enjoying her life back home. Therefore, I am uneasy every time I thought about the support we get from the rest of the country.
It is a big hit for many of us working in the hospital after going through this epidemic. Several medical staff, including the excellent ones, under my team, wanted to resign from their position. Everyone’s existing ideas and common sense about our profession are inevitably a little shaken – Should you be working so hard? For example, Dr.Jiang Xueqing, he always works so hard and treats his patients so well. He is doing surgery every New Year and every single national holiday. Someone reposted one of the WeChat messages from Dr.jiang’s daughter, saying her father had dedicated all his time to his patients.
I, myself, had thought about quit many times. Should I just return home to be a full-time wife? Since the outbreak, I hardly went back. My husband and I have moved out, and my sister is at home looking after our children. My little one doesn’t even recognize me anymore. I was sad when he didn’t react to me during our video call. My second pregnancy was not an easy one: I even had gestational diabetes. He weighed 5 kilos when he was born. I was still breastfeeding (when the outbreak happened), and I had to wean. I was sad when I made this decision, but my husband told me: “you have something big happening in your life now. Not only you are a direct participant (in this fight), you are a leader for the team. It is a meaningful thing. One day everything goes back to normal, you look back, it will be an experience you treasure.”
On 21st February, my superior talked with me. I had a few questions for him. For example, was I wrongly accused the other day? I hoped he would apologize to me. But I didn’t dare ask for it. No one under no occasion had apologized to me so far. However, I still believe that the whole thing tells us we must stand for our independent thinking. There must be someone to stand up for the truth. There has to be someone. This world needs different voices, right?
As a Wuhan citizen, we all love our city. The typical life we used to have is an extravaganza today. Usually, little things such as being able to carry my baby, take him to the playground on a slide or go to the cinema with my husband mean happiness to me now. It is unachievable happiness.
Edited by：【Himalaya Hawk Squad】