Heimlich's Maneuvers Page 5

  The “commercial aircraft” in which we flew to Chungking was a two-engine passenger plane, a C47 cast off by the US Air Force to the CNAC. The plane ascended rapidly and we headed over the Hump, a pass from India to China through the Himalayas. We had to climb to more than seventeen thousand feet to get over the mountains. There were holes in the windows through which we could fire a gun if attacked by a Japanese plane. I later learned that that was not unusual.

  As the air grew thinner and thinner, I began gasping for breath. This became increasingly painful, relieved only when I lost consciousness, as we all did. Only the pilot and copilot had oxygen masks. I have no idea how long we lived with limited oxygen. The next thing I remember, my eyes suddenly popped open, and I was wide-awake. I looked out the window and saw row after row of rice paddies all around the sides of the hills. We were in China.

  The plane landed in Chungking, China’s wartime capital. The “airport” was a small sand island in the Yangtze River. Upon landing, I got into a bamboo chair and lay back as two coolies (working-class Chinese), one in front and the other in back, carried me on their shoulders up steep and lengthy stone stairs leading from the river bed to street level. My five mailbags were also hauled up on the backs of coolies. When the coolies set me down, no one was there to meet me, so I stood in the street for quite a while. After an hour or so, a jeep pulled up and drove me to SACO headquarters.

  MY MISSION DISCLOSED

  The next day, I met in a small room with two US Navy officers who finally revealed to me the details of my assignment and explained a bit more about SACO’s mission.

  The organization was formed in 1943 as a top-secret military partnership between the government of Chiang Kai-shek and the government of the United States to help defeat Japan. Having received direct funding from President Franklin D. Roosevelt’s office, SACO gathered key intelligence from China and communicated it to Washington.

  The need for such intelligence was heightened after the Japanese brutally took Nanking. Commander Miles was once again sent to Chungking in western China, and the country became a patchwork of tenuous loyalties with nationalists, Communists, the Japanese, Chinese puppet generals, and assorted independent warlords all jockeying for dominance in this tumultuous area.

  Miles was advised specifically to have no communication with a particularly powerful and brutal Chinese warlord named Lieutenant General Tai Li. He was Chiang Kai-shek’s powerful head of the secret police who “recruited” villagers at bayonet point to join his guerrilla army. His mission was to protect China from the dual threat of foreign imperialism and homegrown Communism. Tai Li ruthlessly carried out Chiang Kai-shek’s instructions, eliminating political opposition and reserving for himself the fruits of illegal smuggling operations.

  Miles needed accurate intelligence gathering regarding Japanese fleet movements, but he was getting nowhere with his mission of setting up US naval bases on the Chinese coast. Then he received an interesting invitation from none other than Tai Li. He offered to take Miles on a trip through Japanese-occupied China to demonstrate that the Chinese general had access to all areas of his country due to his tight control of the police. With Miles dressed in Chinese clothes, the two traveled relatively safely down the Yangtze River on a sampan, a flat-bottomed, wooden boat. They visited Shanghai and other Japanese-occupied territories. The men formed a firm relationship, and, on July 4, 1943, they signed the SACO treaty.

  With this partnership in place, the United States could set up camps in the interior of China and report on weather conditions originating there, specifically in the far-west region of the country. These weather reports then would be radioed to headquarters in Chungking. Knowing the conditions was valuable in that it could help predict weather in the Pacific Ocean, where the US Pacific Fleet operated, three weeks in advance. US Navy and US Marine personnel set up and monitored weather stations in the Gobi Desert in Inner Mongolia. In eastern China, a network of coast watchers reported Japanese fleet movements. For example, SACO coast watchers in Shanghai frequently radioed to US submarines when a Japanese ship was leaving the dock so the Americans could intercept the ships at sea with torpedoes.

  And just what did Tai Li get out of the deal? He needed to strengthen his guerrilla forces to be ready to fight the Japanese, so US sailors and marines trained his Chinese soldiers in combat and in other areas. All told, SACO established a network of over a dozen guerrilla-training posts, many of them doubling as weather stations, throughout China.

  And that’s where I came in. I was sent to US Naval Unit Four, the one located in Inner Mongolia, which was known as Camp Four. In addition to training Chinese soldiers, Camp Four was to maintain a hospital facility behind Japanese lines not far from the coast. The clinic would serve the Allied forces that were expected to soon land in China as part of a plan to invade Japan.

  I had no way of knowing then just how the time I would spend at Camp Four would influence my worldview and the way I practiced medicine throughout my career.

  ARRIVAL IN CHINA

  Set squarely on the edge of the Gobi Desert, Camp Four was the most remote American-backed clandestine military-training base in China. It was strategically located in the Gobi Desert to support the army of a general named Fu Tso Yi. He was a powerful military leader. During the summer of 1945, the main obstacle that stood in the way of a Japanese attack on Camp Four was the presence of a nationalist Chinese army, one hundred thousand men strong, under Fu’s command.

  The day after arriving in Chungking, I ran a fever of 104 degrees and was about to collapse. The headquarters physician examined me. The diagnosis was bacillary dysentery and they immediately put me to bed in the sick bay. The vomiting and diarrhea lasted three days. Despite my suffering, I received orders to proceed to Camp Four. I was going to the Gobi Desert, regardless of my physical condition. But it was also a psychological challenge: I was a kid from New Rochelle who was going to live on the opposite side of the world from where I had been my whole life, and I had no idea how long I would be there.

  And yet, I had to chuckle. All along, the sea-lover in me had joined the navy to sail the high seas, and here I was, about to head to just about the driest place on earth.

  I was flown to Lanchow, an ancient city in Kansu Province and the gateway to the West for Chinese traders, as it had been since the days of Marco Polo. There, I was met by a US Navy lieutenant commander and three enlisted weathermen with whom I was to travel north. The lieutenant commander and one weatherman were going northwest to Tsinjiang to set up a weather station. Traveling in the back of a truck, we made our way over well-groomed, sandy roads to a walled-in city and dropped off two weathermen there. Next, we headed toward the city of Ningsia in Ningsia Province, after which time they would drop me off and I would head to Inner Mongolia.

  The warlord Ma Hongkui, known as General Ma, controlled the mostly Muslim Ningsia Province. General Ma arranged for our accommodations, and we were put up in grand style for a week. After having been on the road for several weeks, we were grateful to have excellent food, showers, and a clean bed. Wherever we went, we rode in Ma’s colonial-style carriages drawn by horses, similar to those in New York City’s Central Park. As General Ma rode in his carriage, a half dozen soldiers carrying submachine guns ran alongside.

  Figure 5.2. A prominent family: General Ma of Ningsia Province treated us navy men well.

  After a week, a truck from Camp Four arrived to pick me up. We left the comforts of Ningsia, heading north, and were ferried across the Huang Po (or Yellow Bank River). We continued on a hardened-dirt road, marked only by the tire tracks of trucks that had preceded us, toward the town of Shanpa, the capital of Suiyuan Province. The land was looking more desolate. A few trees and mud homes dotted the sandy landscape. We passed through the collection of one-story, dun-colored adobe buildings that was Shanpa.

  Small and nondescript as it was, Shanpa was a regional stronghold for Chinese nationalists. Fifty miles to the east were tens of thousands of Japanese
troops, as well as Chinese military puppets, which were Chinese armies that had gone over to the Japanese side during the nine years Japan had controlled China. Thirty miles north of the region were more puppets, more Japanese, and an Imperial Japanese intelligence office. It was not difficult to understand why this was an “extra hazardous” duty; Japanese forces were nearly all around us.

  Figure 5.3. Getting to know a strange country: I had this photo of me taken in front of a Chinese temple.

  We headed west out of Shanpa, and about ten miles later, we finally reached Camp Four. It was June 4, 1945. It had been nearly four months since I’d left Washington, DC.

  Camp Four was surrounded by huge waves of white sand that extended as far as the eye could see. In the distance, in a haze, was the mountain range the local people called the Big Blue Mountains. As we approached Camp Four, we could see tents pitched as barracks for Chinese soldiers, guerrillas who were being trained by the US Marines stationed there. High, mud walls surrounded the camp; on the walls were painted foot-high Chinese characters praising the “Nationalist cause.” Two Chinese sentries holding American rifles flanked the gate and waved us in.

  Figure 6.1. Working together: Those of us stationed at Camp Four relied on a Chinese guerrilla army for protection from Japanese forces and Chinese Communist rogue forces nearby.

  Our quarters at Camp Four had once been a Belgian Catholic mission. The buildings had glass windows, unlike all other buildings in that part of China, which had rice-paper-covered window openings. Most of the men’s beds were made with wooden frames and crisscrossed rope on which they placed their sleeping bags. I slept in a sleeping bag on a clay platform known as a kang. We had Chinese interpreters available, and every American had a houseboy to make the beds, clean up, and bring hot water for washing.

  I was one of twelve Americans stationed at Camp Four—six navy men and six marines working under the navy. “The Apostles” was our code name. I replaced another doctor who had to leave to get back to headquarters in Chungking for dental work. The main part of my job was to provide medical care to our American men, as well as to Chinese soldiers and the local villagers.

  Figure 6.2. A powerful warlord: Keeping General Fu Tso Yi on the side of the United States was critical to maintaining a stronghold in China.

  The man responsible for our accommodations and just about everything else in the camp was General Fu Tso Yi. General Fu had provided each American at Camp Four with a Mongolian pony for transportation. Getting around on a small Chinese horse was certainly not a customary activity for a young man from New York City. My first time getting on the animal was a complete disaster. The horse shied at a piece of paper blowing on the road, and it threw me over its head. After a few weeks, however, I was riding as well as anyone, galloping through dried-up irrigation ditches and racing my friends.

  General Fu’s influence extended beyond Camp Four and into the surrounding region. Fu was loyal to Chiang Kai-shek and opposed the Japanese, as well as the rogue Chinese Communist forces in the area. But US officials were not sure how long his loyalty would last. Many other Chinese military leaders had become puppets of the Japanese. The reason I was there, and the doctors before me, was to appease Fu. If we provided medical care to the local people and kept on good terms with them, the US believed it would increase the likelihood that Fu’s nationalist army—one hundred thousand men strong—would remain on our side against the Japanese and keep nearby rogue Communist Chinese forces at bay.

  Figure 6.3. A New Yorker in the desert: When I joined the navy, I had no idea I would serve in the deserts of Inner Mongolia.

  SETTING UP A MEDICAL CLINIC

  There wasn’t much of a medical clinic at Camp Four when I got there. There was no place to operate and no ready supply of sanitized water. The water came from an open well used by anyone passing by, including camel caravans. The roiling winds of the Mongolian plateau left the well water contaminated with dirt and animal dung. Camp latrines were simply holes dug in the ground, which attracted disease-bearing flies. The doctor who had been there before I arrived and the one before him were not surgeons, and they treated patients only on an occasional basis. The camp’s ample supply of surgical instruments and medication were packed away in boxes.

  I figured I would make changes to the camp so that we could treat more patients under better conditions. First on the list was setting up a rudimentary operating room that was as sanitary as possible. To clean up the water supply, I had some of the Chinese men build a wall around the cesspool and protect it with a wooden cover. Then we rigged up a hinged pole device that would lower a bucket into the well to retrieve clean water. I had the men build a wall around the latrine holes, which they covered after partially filling them with lime.

  Then I turned to surgical preparations. We had some surgical instruments, materials for bandaging up patients, and a small amount of antibiotics and other drugs. What we didn’t have was a system to sterilize water, so I engineered one. We commandeered a kettle, stuck copper tubing through a cork on its spout, and twisted it around in a spiral pattern upward and then downward so that steam condensed within it and dripped into a bottle sterilized in boiling water. Next, using a five-gallon oil drum with a tight-fitting lid and a wooden platform that we fitted inside the oil drum a few inches from the bottom, we made a field-hospital “sterilizer.” We filled the space under the platform with water, placed sheets on the platform, corked the top tightly, and put the contraption on hot coals, our serviceable steam-pressure “autoclave.” Finally, I had the Shanpa coffin maker build me an operating table. Following a sketch I gave him, he constructed a sturdy wooden table with a hinged, adjustable head and leg pieces. Once finished, he delivered it by donkey wagon to Camp Four.

  These preparations were completed none too soon. Barely two weeks after my arrival, I stepped away from the wooden operating table, looked out of the mud-walled operating room, and gazed across the sands of the Gobi desert. In the fading light of dusk, I saw a middle-aged Chinese man approaching the camp. He was bent over, carrying a young girl on his back. I had no idea how far he had come with her.

  She was his daughter, the peasant told my interpreter. “Bu whei cher fan,” the man said sorrowfully. She cannot eat. He said she had been vomiting for the past two weeks. He brought the girl into the makeshift operating room and I examined her. She was about eighteen years old, severely dehydrated, and barely conscious. Her abdomen was hugely swollen. Was it a tumor or an infection? With only a nine-month surgical internship at Boston City Hospital, I wasn’t certain of the answer.

  I could see that she would die if left untreated, and so I decided I would have to operate to figure out what was wrong. It was nearly nightfall, however, and since we had no electric lights, it would be foolhardy to begin an operation this close to dark. Instead, I treated the dehydration immediately and planned to operate in the morning. I added salt tablets to condensed steam from our “still” and injected the saline solution under her skin. I didn’t want to risk an intravenous injection because, in these circumstances, the sterility of the solution couldn’t be guaranteed, and that could destroy her red blood cells.

  It was all I could do until daylight, so I went to get some sleep. Before I did that, however, I had the corpsman sterilize some instruments in boiling water and ready some sheets from the oil-drum autoclave. I also told the father that if his daughter made it through the night, I would operate. The girl and her father spent the night in a spare room in our compound. I must admit that I had to consider letting her die rather than operate in view of my minimal surgical experience and the primitive surgical equipment. The Chinese villagers already distrusted Western medicine, perceiving us doctors as foreign devils. If the young woman died during or after surgery, the Chinese living in the area would refuse to come for medical care. We would lose face as a medical unit and would probably have to leave.

  The next morning, thanks to the saline infusion, my patient was somewhat improved. Adjusting the coffin
maker’s table, I gave the girl a spinal anesthesia, and we set to work. I painted the girl’s abdomen with iodine and placed the sterilized drape over her. Then I carefully cut through the skin into the abdominal cavity.

  When I hit the peritoneum, the abdominal lining, something amazing happened. Green and yellow pus gushed out of the incision, soaking me and the assisting corpsman standing nearby. I screamed with delight, eliciting a glance of considerable amazement from the corpsman. This meant that the cause of the patient’s distress was an infection, a huge pelvic abscess. I was joyful because I knew I could handle an infection. At Boston City Hospital, draining even a massive abscess like this one would have been considered a fairly routine procedure—although I personally had never done such an operation before. Had she had a tumor, I would not have known what to do.

  I cleaned out the abscess, inserted rubber tubing to drain the infection, and left the wound partially open to continue the drainage process. We monitored her carefully, and, bit by bit, her color and spirits returned. About a week later, the girl was well enough to travel.

  “Hsie hsie, mei gwa daifu,” her father said, bowing, as they left. Thank you, American doctor.

  GENERAL FU TSO YI

  Word of the girl’s recovery spread in Shanpa and throughout the countryside. Many saw it as a miracle. Those who had seen the girl before the operation expected her to die, and when she went home smiling a week later, my stock as a physician shot up dramatically. It seemed as if the entire scattered population of the region was suddenly converging on Camp Four. First in a trickle and soon in a stream, people who had never before had contact with Western medicine began to knock on the door of my little “clinic.” They came on foot or by horse. The wealthier ones were carried in sedan chairs. A few were so sick, they crawled in. For some, the trip had taken them many days. All wanted to be treated by the mei gwa daifu, the “doctor from the beautiful country, America.”