A patient’s friend has been consulting me on Weibo since December 23rd, a patient with acute promyelocytic leukemia (M3 for short), saying that she has been ill for 10 days with bleeding and fever and wants to go to Los Angeles for treatment. I urged her not to go to the United States and to stay in China for early treatment. But in vain, the patient had already gone to the interview. But early this morning, she told me that the patient died of hyperthermia and hemorrhage. I wish she was teasing me, it would be so strange if it was true! Acute promyelocytic leukemia was once considered to be the most aggressive and rapidly progressive leukemia. However, since Professor Wang Tingdong discovered the obvious efficacy of arsenious acid (arsenic) on this type of leukemia (M3 type) during the Cultural Revolution, and Academician Wang Zhenyi discovered the unique role of all-trans retinoic acid in inducing differentiation, and combined traditional Chinese medicine arsenic with Western medicine for treatment, the “five-year disease-free survival rate” of acute promyelocytic leukemia patients has jumped from about 25 percent to 95 percent. In recent years, China has continued to design large-scale clinical trials that have demonstrated satisfactory outcomes with oral arsenic and retinoic acid alone, rewriting the NCCN treatment guidelines in the United States. It is no exaggeration to say that China has the highest level of treatment for M3 and is the pride of the Chinese hematology community! Even so, there is still a certain amount of early mortality in M3 patients, especially high mortality without timely treatment. Since I became a specialist, I have seen dozens of M3 patients, which initial treatment was not a race against time and a thrill? The director gave us a deadly order, which was also requested by academician Lu Daopei, that no M3 patient should die after 48 hours of admission! It may sound unkind, but in fact it is because the late treatment of M3 is so good that the director always reassures patients that M3 is as good as a cold. So every doctor who admitted M3 was under great pressure and on thin ice, and this deadly order greatly improved our level of M3 treatment. In a recent study in the United States, it was analyzed that the primary mortality rate of M3 was 15%, mainly due to bleeding events caused by DIC, and it occurred mostly on holidays and Saturdays. I have treated dozens of M3 patients, including those with severe DIC hemorrhage, those with high white, those with vincristine syndrome, those with massive pericardial effusion, those with severe infection, those with multiple organ failure, and those with combined influenza A. M3 is indeed prone to accidents on holidays, and the countermeasure is to keep an eye on the changes day and night! Among these patients, there was only one case of initial death, which is still fresh in my mind. It was a young construction worker who fell on a construction site and suffered a brain hemorrhage because of the heavy DIC and hit his head when he fell. We really did our best to save him, but we were at our wits’ end. When the neurosurgeon said that such a serious DIC could not be opened and could not be drained, so we had to watch him bleed and herniate and have a Cushing reaction, and when his life slipped from my hands, I was still ashamed! So much so that when the director asked him how long he had been in the hospital, I casually and exhaustedly said three or four days! Fortunately, the sister from the other team carefully calculated that it was only 40 hours (it really felt like three or four days to me), so I was saved from being scolded by the director. But later, when I met his wife, who was eight months pregnant, I still felt speechless. Another impressive patient is a relapsed TCM doctor, 30 days of persistent granular deficiency after chemotherapy, high fever, drug-resistant bacteria infecting the lungs, progressing to lung abscess, cavity formation, daily hemoptysis, and a week of oxygen saturation of 70-80 percent. I am a Chinese medicine doctor, she did not want to be intubated, she sat in bed day and night, high fever, coughing and hemoptysis… I tried everything I could, I thought for several times that I could not keep her, but she was very tenacious until the bone marrow remission white blood cells recovered. I urged her not to give up, but every time I thought back to the frightening days and nights of her rescue, I couldn’t even say the words that came out of my mouth. A year later, I miraculously received a thank you letter from her, and although I knew her contact information, I couldn’t find the courage to ask her, hoping for a miracle and all is well. Last night this patient depressed me again, it is not an exaggeration to say that the experience of doctors is accumulated with blood and tears and life. In the era of lack of trust between doctors and patients in China, what else can we do as doctors? “The moon is fullest in America”, such a ridiculous reason to cripple this young life! Finally, please note that acute promyelocytic leukemia is very dangerous when it first starts and requires prompt medical attention and timely chemotherapy, with a very good long-term prognosis after the first course of remission. I hope tragedy never happens again!