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Tuesday, July 8, 2008

The Bet (A Medical Parable)

An acupuncturist and a Western doctor walked into a bar. They bought drinks for one another; each bragged constantly that he could treat any disease, however rare. While they were having their drinks, the bartender disclosed to them that his identical twin daughters were very ill. Furthermore, the daughters seemed to be suffering from the same mysterious illness. The bartender said that their temperatures, symptoms, and attitudes changed at the exact same time. Both physicians became very interested in the case, and they decided that each would treat one of the daughters. In good humor, they placed a bet on who would be able to cure the illness.

"I bet I can cure it the fastest," said the Western doctor.

"I bet I can cure it so that it will not return," said the acupuncturist. Each gave the bartender their share of the bet money, so he could return it to the winner.

The physicians followed the bartender to a loft over the bar, where his daughters were sleeping. The twins were so identical that they were even breathing in time with one another. Their skin was very pale except in their cheeks, which were slightly flushed. They seemed to be breathing more quickly and shallowly than normal, but the bartender assured them that the girls had not experienced any cough.

He said that a few days ago, his daughters arrived home from a party feeling so fatigued that they could not speak. For two days, they could barely leave the house. They did not want to eat, but at night, they had difficulty sleeping. They had not spoken a word since they arrived home from the party, so the bartender was not sure what had happened. He explained that his daughters were normally very talkative and active; they often helped him in his work at the bar. Their mother had died eight years before from an unknown illness. The bartender, becoming very sad, explained that he was unable to raise enough money for his wife's treatment.

After the bartender finished his story, the two healers explained their plans to him. The acupuncturist marked his sleeping patient's right hand with a red dot, and the Western doctor placed a red dot on his patient's left hand. The healers knew that they were smart enough to remember their patients this way.

"I believe your daughters caught a disease when they went to the party," said the Western doctor. "I will search for this disease as carefully as I can. Once I find it, I can find a way to eliminate it." The Western doctor performed a detailed examination on one of the daughters. Her respiration rate and pulse were rapid, supporting his suspicions about the disease. "See," he told the acupuncturist, "You can cure any disease if you can look closely enough to find it." With that, he took a vial of the girl's blood and left to analyze it.

The acupuncturist did not leave the loft for many hours. First, he felt the other daughter's pulse. It seemed soft, but rapid, and very slippery. It was even soggy in the first position. Gently, he woke her and asked her to stick out her tongue. At first sight it seemed fairly normal with a slightly red tip. As he looked closer, he could see that the tongue coating was slightly greasy. Since his patient was awake, he asked her a series of questions. She could only shake her head or nod, but they were able to communicate. The acupuncturist discovered that she felt nauseated, slightly bloated, and hot. She was having loose, foul-smelling stools, and she felt very fatigued. While she had some abdominal cramping, she had very little pain otherwise.

Turning to the bartender, the acupuncturist explained his perspective. "Your daughters have indeed caught a disease, but I believe it was from something they ate, instead of from a person. It will take me a few days to remove this illness from one daughter, and then we will see how my friend fares with the other."

The acupuncturist performed a series of treatments on the bartender's daughter. After he placed the first needle (LU 6), she began to speak, very slowly and hesitantly. "I…had…to…find…" She fell asleep before she could say more. The acupuncturist placed the rest of the needles while the girl was still sleeping, and she did not move for some time. Once the treatment was finished, he gave her an herbal tea to sip constantly. She took a sip, and then cringed. "It… tastes… terrible…" she managed. Her father broke in, "At least you're speaking again!" He kissed her on the forehead, and she quietly continued sipping her tea.

For three days the acupuncturist treated one daughter, while the other one lie still in her bed. The acupuncturist's patient continued to gradually improve, and he gave her several treatments per day, while still managing to eat, sleep, and see a few other patients. As she improved, he made adjustments to her herbal prescription.

Her twin's condition did not worsen, as her father reported with relief to the Western doctor, who arrived on the third day looking both tired and winded. He had tested his patient's blood and had finally worked out a beneficial cure. He gave his patient an injection, and she awoke within six hours. She still felt groggy and tired, and was unable to speak for a day or so, but the Western doctor assured the bartender that he was confident in his treatment, and left to get some much-needed sleep.

On the seventh day, the physicians met in the bar once again to discuss the outcome of their bet. They asked the bartender to show them up to see their patients. When they arrived in the loft, the daughters were playing a card game. The bartender said, "Now, about your bet. I will give the money to whichever one of you can identify his patient." The physicians did not expect the bartender's challenge; they took the daughters' hands, and found that the bartender had marked both of their hands with red dots. The Western doctor did a physical examination, while the acupuncturist used all of his clinical skills to tell the difference; both could find no difference in their improvement, or even enough to tell them apart.

The bartender laughed. "You are both very competitive and very competent at your practice. Your patients come into my bar and talk to me, and they all want different things from you. Often, your treatments are successful – only occasionally do they fail. I must be honest. My daughters are very special; even I do not know how to tell them apart. If you choose to ask, they will tell you which one you treated."

One of the girls looked up from her hand of cards to the acupuncturist. "I'm so thankful to you for treating me," she said. "I feel like I suffered a lot through the treatment. I had to drink that disgusting tea, and I struggled because I was awake and aware for most of my illness. However, I feel that through my hardship, I learned much about myself. I was also the first to speak again, and I thank you for that."

The other girl turned to the Western doctor. "And it was you who helped me. While I was sleeping, you discovered the cure to my disease, as though you came from a dream. I know that you will tell others how to cure this disease in other areas of the world. I slept for so long that I wasn't sure when I would awaken. My sister was awake before me, but once I awoke, I recovered faster. I can't thank you enough."

The physicians grinned at each other. To reward his cleverness, they allowed the bartender to pocket the bet money, and he vowed to build a proper memorial for his wife. As they exited the bar, the Western doctor jokingly asked the acupuncturist, "So, who do you think won?" The acupuncturist shrugged and said, "I think we both did."

*I wrote this passage as an essay assigned to describe the differences between diagnosis and treatment in Chinese and Bio medicine. I don't think this is what Dr. Wu was expecting, but he seemed pleased.
**I find it ironic that, last weekend, an epic bet was placed on Wimbledon that resulted in Renae being dubbed 'high priestess of tennis.'