Dr. Ai Fen Interview, published 10th March 2020

On Tuesday 10th March 2020, the Chinese magazine People (Renwu 人物) published an interview with Doctor Ai Fen, the director of the Emergency Department at Wuchang Hospital in Wuhan, Hubei province, China. In the interview, which was quickly censored, Dr. Ai detailed her censure by hospital authorities for sharing a diagnostic report on WeChat showing a patient with SARS-like pneumonia in late December.

The People article was also quickly deleted from social media sites and from People’s webpage. This is a basic English translation with my own minor amendments to make sense of certain lines.

Dr. Ai Fen

On December 16, last year, we received a patient from the Emergency Department of Nanjing Road Hospital. Inexplicably high fever, the medication has not been working and the body temperature has not gone down. On the 22nd, she transferred to the respiratory department where they performed a bronchoscopy, took alveolar lavage fluid, and sent it out for high-throughput sequencing. Later, the coronavirus was reported orally. At that time, the colleague who handled the bronchoscopy whispered several times in my ear ‘Director Ai, that person reported the coronavirus’. Later we learned that the patient was working in South China Seafood.

Immediately after December 27th, another patient came from the Nanjing Road Hospital. He was the nephew of a doctor in our department. He was in his 40s without any underlying diseases. His lungs were messed up and blood oxygen saturation was only 90%. The hospital had treated him for almost ten days without any improvement, and the patient was hospitalized in the respiratory department. Fibrobronchoscope was also taken, and the alveolar lavage fluid was taken for testing.

At noon on the day of December 30th, my classmate at Tongji Hospital sent me a screenshot of a WeChat conversation, which said: “Don’t go to South China recently, there are many people with high fever …” He asked me if it was true. Yes, at that time, I was watching a CT of a typical patient with pulmonary infection on the computer. I sent him a 11-second video of the CT and told him that this was a patient who came to our emergency department in the morning and was in South China Seafood market.

Just 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 have read the report many times and the following note reads: SARS coronavirus is a single-stranded positive-strand RNA virus. The main mode of transmission of the virus is close-range droplet transmission or contact with respiratory secretions of patients, which can cause a special pneumonia that is obviously contagious and can affect multiple organ systems, also known as atypical pneumonia.

At the time, I was scared and in a cold sweat, which was a terrible thing. The patient was admitted to the respiratory department. It should usually be reported by the respiratory department, but for the sake of insurance and attention, I immediately called and reported it to the hospital’s public health department and the hospital’s sensory department. At that time, the director of the respiratory department of our hospital happened to pass by my door. He was a person who had participated in SARS. I caught him and said, “We have a patient who has been received in your department and found this report.” He said at a glance that it was troublesome. I knew it was troublesome.

After calling the hospital, I also circulated this report to my classmates. I purposely drew a red circle on the line “SARS coronavirus, Pseudomonas aeruginosa, 46 types of oral / respiratory colonization bacteria.” It is to remind them to pay attention. I also sent the report to the doctors in the department to remind everyone to take precautions.

The word spread that night and the screenshots passed around were photos of the report with the red circles shown, including the ones that I later learned that Li Wenliang passed on to the group. At that time, I was thinking that it might be bad. At 10:20, the hospital sent a message. It was a notice passed on to the city health committee. The main point was that pneumonia of unknown cause should not be arbitrarily released to the press to avoid causing panic among the people. If panic was caused by leakage of information, people would be held to account.

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 news within the group cannot be circulated. One day later, at 11:46 pm on January 1st, the head of the hospital supervision department sent me a message to call in to see him the next morning.

I didn’t fall asleep that night. I was worried and thought about it over and over again, but I felt that there are always two sides to 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, I called in as requested.

After the interview began, I suffered an unprecedented and very severe rebuke.

At that time, the leader of the conversation said, “We can’t afford to raise our heads when we go out for a meeting. The director of XX criticizes our hospital. As the director of the emergency department of Wuhan Central Hospital, you are a professional." This is the original sentence. I have to go back to the 200-odd people in the department to speak to them one by one. We can’t send the information by WeChat or SMS. We can only talk face-to-face or call them up. We can’t say anything about this pneumonia.

I was stunned all at once. He didn’t criticize me for not working hard, but it seemed that the good name of Wuhan’s development was being destroyed by me alone. I had a very desperate feeling at the time. I was a serious and hard-working person. I felt that everything I did was done in accordance with the rules and made sense. What did I do wrong? After seeing this report, I also reported it to the hospital. My classmates and my colleagues communicated about the situation of a certain patient. Without revealing any personal information of the patient, it is equivalent to discussing a medical case between medical students. As a clinical doctor, I already knew that a very important virus has been found in patients. When other doctors asked, how could you not say it? This is your instinct to be a doctor, right? What am I doing wrong? I have done what a doctor and a person should normally do. In the case of anyone, I think I will do the same.

I was very emotional at the time, saying that I did this thing, and it had nothing to do with the rest of the people, you will just arrest me and send me to jail? I said that I am not suitable for continuing to work in this position and want to take a break. The director did not agree, saying that this was the time to test me.

I went home that night, I remember quite clearly, and told my husband after entering the door, if something went wrong, you can raise the child. Because my second treasure is still very young, only over 1 year old. He felt confused at the time. I didn’t tell him what he was being said.

On January 20th, after Zhong Nanshan told others, I told my husband what happened that day. During that time, I just reminded my family not to go to crowded places and wear masks when going out.

Peripheral department Many people worry that I am also called to admonish one of those eight people. In fact, I was not warned by the Public Security Bureau. Later, a good friend asked me, are you a whistleblower? I said that I am not a whistleblower, I am the one who sent the whistle.

But that interview hit me a lot, very big. After I returned, I felt that my whole heart was broken. I really worked hard. Then all the people asked me again, and I couldn’t answer.

All I can do is get the emergency department to focus on protection. We have more than 200 people in the emergency department. From January 1st, I asked everyone to strengthen their protection. All people must wear masks, hats, and clean their hands. I remember one day, when there was a male nurse who did not wear a mask during the shift, I immediately scolded him on the spot “don’t come to work without a mask in the future.”

On January 9th, I saw a patient coughing at the pre-examination table when I was off work. From that day on, I asked them to have the patient who came to see the patient wear a mask, one for each person. Don’t save money at this time. No one passed on, and I want to emphasize here that wearing a mask to strengthen protection is contradictory.

That time was really depressing and very painful. Some doctors proposed to wear their outer medical clothing outside. The meeting in the hospital said they would not agree to this, saying that wearing medical clothing would cause panic. I asked the people in the department to wear an isolation gown inside a white coat. This was out of specification and ridiculous.

We watched more and more patients, and the radius of the spreading area became larger and larger. First, the South China Seafood Market may be related to it, and then it spread, the radius became larger and larger. Many of the cases are family-transmitted. Among the first seven people, there was a disease in which the mother gave the son food. The clinic boss got sick, and the patients who came for the injection were passed on to him. They were all too heavy. I knew there must be someone passing on. If there is no human-to-human transmission, the South China Seafood Market will be closed on January 1. Why are there more and more patients?

Many times I was thinking, if they didn’t rebuke me like that, ask the ins and outs of this matter calmly, and then ask other respiratory experts to communicate with them, maybe the situation would be better, I can at least communicate more in the hospital a bit. If everyone was so alert on January 1, there would not be so many tragedies.

On the afternoon of January 3rd, in the Nanjing Road Hospital, doctors of urology gathered to review the work history of the old director. Dr. Weifeng Hu, who is 43 years old, is now in the rescue; on the afternoon of January 8th, the Nanjing Road Hospital on the 22nd floor, Director Jiang Xueqing organized a Wuhan Rehabilitation Party for Onyx Patients in Wuhan. On the morning of January 11th, the department reported to me that Hu Ziwei, a nurse in the emergency room of the emergency department, was infected. She would be the first infected nurse in the central hospital. As it was the first case, I called the Chief of the Medical Department to report, and then the hospital held an emergency meeting. The meeting instructed me to change the report of “two lung infections, viral pneumonia?” to “two lungs scattered infection”; even on January 16th, at a weekly meeting, a deputy dean was still saying, “Everyone must have a little medical knowledge. Some senior doctors should not scare people.” Another leader took the chair and continued, “No one can pass it on, but it can be prevented, treated and controlled.” One day later, on January 17th, [Director] Jiang Xueqing was hospitalized, and 10 days later he was intubated [placed on a ventilator] and taken to ECMO [Life Support - Extracorporeal Membrane Oxygenation which is machanical external oxygenation of the blood].

The cost of the central hospital is so large that it is related to the lack of transparency of our medical staff. If you look at the infected people, the emergency department and the respiratory department are not so many, because we have a sense of protection, and we should quickly rest and get treatment as soon as we are sick. The most important ones are the peripheral departments, Li Wenliang is an ophthalmologist, and Jiang Xueqing is a nail specialist.

Jiang Xueqing is really a very good person with high medical skills. He is one of the two doctors to be given Chinese physician awards in the hospital. And we are still neighbors. We are a unit. I live on the 40th floor. He lives on the 30th floor. The relationship is very good. However, because I am too busy at work, I can only speak to him during meetings and hospital activities. He is a workaholic, either in the operating room or at the clinic. No one will go to tell him specifically, Director Jiang, you have to pay attention and wear a mask. He didn’t have the time and energy to inquire about these things, and he must have taken care of it: “What’s the matter? It’s pneumonia.” This was what the people in their department told me. If these doctors can get timely reminders, perhaps this day will not be. Therefore, as a client, I regret it. I knew that today, I would criticize him for not criticizing me. Lao Tzu said everywhere, right?

Although he was in the same hospital with Li Wenliang, I didn’t recognize him until his death, because the hospital had so many, 4,000 people, and was usually busy. The night before his death, the director of the ICU called me to borrow a cardiac press from the emergency department and said that Li Wenliang was going to be given treatment [for the virus]. I was shocked at the news. I did not understand the whole process of Li Wenliang, but his condition was affected by the criticism. Does it matter if you are in a bad mood after being reprimanded? I will ask a question mark here, because this is the same way I feel.

Later, when things got to this point, it proved that Li Wenliang was right. I can understand his mood very much. It may be the same as my mood. It is not excitement and happiness, but regret. Regret should continue to scream loudly from the beginning. When people asked us, they continued to say. Many, many times, I was wondering if it would be time back.

On the night before the city was closed on January 23rd, a friend from the relevant department called to ask me about the true situation of emergency patients in Wuhan. I asked him if he was asking as a private person or on behalf of the public. He said as a private person. I will tell you the truth when I speak on my behalf. On January 21, our emergency department saw 1,523 patients, three times more than usual, of which 655 had fever.

During that time, the situation of the emergency department will never be forgotten by people who have experienced it, and it will even change your

If this is a war, the emergency department is at the forefront. However, the situation at the time was that the followi-on wards were saturated, and basically none of the patients were accepted, and the ICU resolutely refused to accept them. They said that there were clean patients in their wards, and they would became contaminated as soon as our patients entered. The patients kept rushing to the emergency department, and the road behind was not open, so they all piled up in the emergency department. Patients waited a few hours before seeing a doctor. We couldn't get off work at all. There is no distinction between fever and emergency. The hall was full of patients. The infusion room and the rescue room were filled with patients.

A patient’s family came and said he wanted a bed. His father was in the car, because the underground garage was closed at that time, and his car couldn’t get in. I ran to the car with people and equipment. At a glance, his father dead. What do you say, it’s difficult. The man died in the car and had no chance to get off.

There was another old man whose wife had just died at Jinyintan Hospital, her son and daughter were infected, and he was being take care of by his son-in-law. As soon as I saw that he was very ill, I contacted the respiratory department to have him admitted to the hospital. At seeing me, his son-in-law who was a very polite person, came over and asked me to thank the doctor and so on. Thanking me took only a few seconds but in that time the old man had died. This thank you sentence weighed me down.

There are still many people who send their families to the ward and it will be the last time they see their familiy, and the family will never see them again.

I remember that I came to work in the morning of the day before New Year. I said that we would take a picture to commemorate the 30th year of the New Year. I also sent to a message to a circle of friends on Wechat. No one said blessings that day. At this time, it is good to live.

In the past, if you made a mistake, for example, if you didn’t get an injection in time, the patient might complain or argue with you. Now no one is complaining, no one is arguing with you. It’s confusing. When a patient dies, it is rare to see family members crying sadly, because there were too many, too many dead. Some family members will not beg the doctor to save their family, but say to the doctor, hey, let’s get rid of the body quickly, this is the point. Because at this time everyone is afraid of being infected. It takes five hours to line up at the hot clinic every day. I saw a woman fall down in the queue, seeing her wearing a leather coat, carrying a nice bag and wearing high heels. She is a smart middle-aged woman, but no one dared to step forward to help her, and she lay on the ground for a long time. I had to call the nurse and doctor to help her.

On the morning of January 30th, I came to work. The son of a white-haired old man died at the age of 32. He stared at the doctor who gave him a death certificate. There are no tears at all, how could he cry? There is no way to cry. Looking at his clothes, he may be an outside migrant, there is no way of knowing. Without a diagnosis, his son became a death certificate. This is what I want to call for. The patients who died in the emergency department were all undiagnosed and could not be confirmed. After this epidemic has passed, I hope to give them an explanation and give their families some comfort. Our patients are very poor and pathetic.

Having been a doctor for so many years, I have always felt that there is no difficulty that would bring me down. This is also related to my experience and personality. At the age of nine, my father died of gastric cancer. At that time, I thought of growing up as a doctor to save the lives of others. Later, when I entered the college entrance examination, all my volunteers were filled in medicine, and I finally passed the Tongji Medical College. After graduating from university in 1997, I went to the Central Hospital. I previously worked in cardiovascular medicine and became the director of the emergency department in 2010.

I think the emergency department is like a child of mine. I made it so large that it united everyone and made this situation not easy, so I cherish this group. A few days ago, one of my nurses sent a message to a circle of friends saying ‘I miss the big emergency department that was busy before’ but and that kind of busyness and this kind of busyness are totally different concepts.

Prior to this epidemic, myocardial infarction, cerebral infarction, gastrointestinal bleeding, trauma and so on were the areas of our emergency department. That kind of busyness is a busy one with a sense of accomplishment. The purpose is clear. There are smooth procedures for various types of patients. They are very well-tested. And this time there are so many critically ill patients who have no way to deal with and cannot be admitted to hospital, and our medical staff are still at risk. This kind of busyness is really helpless and sad.

One day at 8am in the morning, a young doctor in our department sent me a WeChat, and it was quite personal, saying that he would not come to work today and I was not comfortable. Because we have rules here, if you are uncomfortable, tell me about the arrangement in advance. You tell me at 8 o’clock, where do I go to find someone. He lost his temper with me in WeChat and said that a large number of highly suspected cases were put back into the society by the emergency department you led. We understand that this is sin! I understand him because of his conscience as a doctor, but I was also anxious and I said ‘Can you tell me, what should you do if you are the director of the Emergency Department?’

Later, the doctor came to work after a few days of rest. He did not say that he was afraid of death and fatigue, but that he had encountered such a situation and felt very overwhelmed in the face of so many patients at once. As doctors, especially the many doctors who came to support them, they couldn’t bear it psychologically. When this happened, some doctors and nurses cried. When one is crying others are crying themselves, because everyone does not know when it is their turn to become infected.

Around mid-to-late January, the hospital’s leaders also became ill one after another, including our director of the office and three vice presidents. The daughter of the Chief of Medical Services was also ill and he was resting at home. So basically no one cares about you at that time, you just fight there, that’s the feeling.

The people around me also started to catch the virus and die one by one. On January 18, at 8:30 in the morning, the first doctor was infected. He said that I was recruited as the director, did not burn, only had CT, and the lungs had a large ground glass. Soon, a responsible nurse in charge of the isolation ward told me that he had died. At night, our head nurse was infected. My very real first feeling at that time was - luck, because she had died early, and I could get off the battlefield early.

I had been in close contact with these three people. I just work every day with the belief that I must die. Everyone in the hospital thought I was a miracle. I analyzed it myself, it may be because I have asthma, and using some inhaled hormones may inhibit the deposition of these viruses in the lungs.

I always think that the people we have in the emergency department are considerate people. In Chinese hospitals, the status of the emergency department is relatively low among all the departments, because everyone thinks that the emergency department is nothing more than a passageway. It is enough to take patients in. Already. This neglect has always existed in this fight. In the early days, the supplies were not enough. Sometimes the quality of the protective clothing assigned to the emergency department was very poor. I was angry when I saw that our nurses wore such clothes to work and got angry with Zhou Huiqun. Later, many directors gave me all the clothes they kept in the department.

There are also eating problems. When there are many patients, the management is confusing. They simply can’t think if the emergency department still has something to eat. Many departments have food and drink after work. They have a large row. We have nothing here. In the WeChat group of hot clinics, doctors complain. “Our emergency department only has nappies …”. We fought at the forefront, and as a result, sometimes I was really angry.

Our collective is really good. Everyone is away only when they are sick. This time, more than forty people in our emergency department were infected. I built a group of all the sick people, originally called “emergency sick group”, the head nurse said this was unlucky and it was changed to “emergency refueling group”. Even people who are sick don’t have a sad, desperate, and complaining mentality. They are all very positive, that is, everyone helps each other to overcome difficulties.

These children and young people are very good, just follow me and be aggrieved. I also hope that after this epidemic, the country will increase its investment in emergency departments. In many countries’ medical systems, the emergency department is highly valued.

On February 17th, I received a WeChat message from a classmate at Tongji Hospital. He said “Sorry” to me. He said, “Fortunately, you passed it out and reminded some people in time. If you didn’t pass it on, we might not have lost Li Wenliang and the eight of them, and we would probably know less.”

This time, we had three female doctors infected with the whole family. The father-in-law and mother-in-law of the two female doctors were infected with her husband, and the father, mother, sister, and husband of a female doctor were infected by five people. Everyone thinks that the virus was discovered so early, but it turned out to be so costly.

This cost is reflected in all aspects. In addition to those who died, those who were sick also suffered.

In our “Emergency Emergency Team”, people often discuss physical conditions. Some people ask if the heart rate is always 120 beats per minute. Does it matter? It definitely matters, and panic as soon as they move. This will affect them for life. Can’t heart failure? It’s hard to say. In the future, others can go hiking and traveling, they may not, and that is all possible.

And Wuhan. You said that Wuhan is a lively place. Now it’s quiet everywhere. Many things can’t be bought and we have to support the whole country. A few days ago, a nurse of a medical team in Guangxi suddenly fell into a coma while at work, and was rescued. Later, a heartbeat occurred, but she was still in a coma. If she hadn't come to work, she could have had a good time at home, and this kind of accident would not happen. So, I think we have earned everyone’s favour, really.

Having experienced this epidemic, many people in the hospital have been hit hard. Several medical staff below me have thoughts of resignation, including some key members. Everyone’s previous concepts and common sense of this profession are inevitably a little shaken - is that you work so hard, right? Just like Jiang Xueqing, he works too hard, is this good for the patient, he is doing surgery every year and the New Year . Today, someone sent a WeChat written by Jiang Xueqing’s daughter, saying that her father’s time was all given to his patients.

I have had countless thoughts myself, have I returned home to be a housewife? After the epidemic, I basically did not go home and lived outside with my husband. My sister helped me take care of my children at home. My second treasure didn’t recognize me. He didn’t feel me when he watched the video. I was very lost. It was not easy for me to give birth to this second child. He was 10 kg at birth. This time, weaned too — when I made this decision, I was a bit sad. My husband told me that he said that someone can encounter such a thing in his life, and you are not only a participant, you are also assembling a team to fight this battle which is also a very meaningful thing. When everything returns to normal in the future, it will also be a very valuable experience for everyone to remember.

The director talked to me on the morning of February 21st. Actually, I would like to ask him a few questions, such as, do you think that criticism was wrong that day? I hoped he might give me an apology. But I dared not ask. No one said sorry to me on any occasion. But I still feel that this time it is more clear that everyone still insists on their own independent thinking, because if someone wants to stand up and tell the truth, there must be someone, and the world must have a different voice, right?

As a Wuhaner, which one of us does not love our own city? We now recall with what extravagant happiness we lived the most ordinary life. I now feel that about holding the baby, going out to play with him on a slide, or going out to watch a movie with my husband, but it is not common in the past, but until now it is a kind of happiness, it is an unachievable happiness.

Barry Sharples, 2020.