Cancer is now the primary cause of death in Beijing, and air pollution is a major factor in this grim reality. The capital’s dangerous smog caused an “airpocalypse” this January, leading one public health expert to call the menace “worse than SARS.” Beijing made significant improvements to its measure of air quality in January 2012, more than a year after the U.S. embassy infamously tweeted that the city’s air was “crazy bad.” This is only the first step to solving an enormous public health crisis.

In a March issue of China Weekly, reporter Gong Xi tells the story of two women whose lives have been turned upside down by the smog.

The Beijing Patient

Capital city of smog.

“I don’t know how, but I got lung cancer.”

Mother Qin, 49, pale, and emaciated, is lying on a bed in Wangjing Hospital, Beijing. You have to pay close attention to hear her voice. Her daughter, Tongtong, is sitting next to her, firmly grasping her mother’s hand, glaring at the slowly dripping IV solution.

The ward is crowded with an endless stream of family and friends visiting patients. Only Mother Qin’s bed is quiet. Next to her bed, there are no flowers or fruit baskets, only a meal tray and a bowl of pears boiled in rock sugar.

The nurse on duty lifts the half-closed curtain. But there is no sunshine.

Beijing is shrouded in heavy smog. Looking out the glass on the 18th floor, everything is white. In January 2013, Beijing has already had 25 days like this.

Lifting her eyelids and looking through the window, Mother Qin can’t help but let out two coughs.

Cancer from Heaven

Mother Qin had been a normal Beijinger, living a very normal life. She spent her days mostly at home, her work unit, the vegetable market, and the supermarket.

She lived very close to her work unit, only a ten-minute walk away. She worked in the mail room and was in charge of delivering newspapers, documents, and other easy tasks. Everyday during the noon break, she went to the vegetable market near her home to buy the day’s fresh vegetables and cook her lunch. She seldom ate out.

“My mom is just a normal women. She doesn’t have a lot of education or a high emotional quotient. She’s just a very common woman, a normal housewife,” her daughter Tongtong says. Mother Qin didn’t have any particular hobbies. Her main pastime was going to supermarket. She could ride her bike to three or four supermarkets in one day.

Every day after dinner, as long as it wasn’t raining or snowing, she would go out for a walk. She held onto this habit for nearly ten years. Those ten years also saw a rapid growth of lung cancer patients in Beijing.

In 2011, one after another report on air pollution appeared. Beijing’s air pollution index topped the nation. The capital city of China was gradually turning to “the capital city of smog.” More and more, air pollution far exceeded safe levels. But at the time, neither 2.5 micrometer particular matter (PM2.5) measurements nor the air pollution index had official standards. Mother Qin never thought about the air quality when she took her walks.

“At home,” Mother Qin says with a weak voice, “I would watch TV dramas and such, and rarely cared about the news. When I took walks, I never used any protection. Nobody wore face masks when they went out in the evening.”

In 2012, Mother Qin starting to feel a tingling in her chest and sometimes could hardly breathe, but she didn’t take it seriously. At the beginning of March, Mother Qin was sorting newspapers in the mailroom when she suddenly felt pressure in her chest and difficulty breathing, as if a heavy object was pressing on her back. The feeling continued for the whole day. Back home in the evening, Tongtong saw that her mother was not feeling well and took her to the nearby hospital. Her blood pressure had already jumped to 110/180. It was past 10 p.m., and the outpatient department was closed for the day. Mother Qin could not have a comprehensive check at that time. She could only control her blood pressure for the time being.

The next day, Tongtong took Mother Qin back to the hospital for a CT scan of her chest. The doctor found excessive fluid in both lungs, which had to be immediately extracted by pleural tap. The doctor asked that Mother Qin be hospitalized to run further tests.

March and April are peak season for respiratory diseases. All the hospitals were already full, and there was no chance to get a bed. After several rounds of turnovers, Mother Qin was finally able through personal connections to find space at Navy General Hospital.

After she checked in, doctors at Navy General Hospital ran comprehensive tests and found cancer cells in the fluid built up in her lungs. As Mother Qin went to the restroom, the doctor told Tongtong the diagnosis–lung adenocarcinoma, and it was late stage. The cancer cells had already spread from the lungs to the parietal pleura, the lung tissue attached to the chest cavity.

One Who Cannot Escape

Tongtong was stunned. She never expected her mother would ever get lung cancer. She knew that the most significant cause of lung cancer was smoking, but Mother Qin never smoked. And the  adenocarcinoma she had was the type least related to smoking.

Wang Fang, the doctor in charge of Mother Qin’s case, is an oncology specialist at Wangjing Hospital. “The patient doesn’t smoke,” she explains. “She was not in a second-hand smoke environment, either. She doesn’t have bad living habits or a family history of the disease. There are many causes of cancer. Although we cannot pinpoint the specific reason for her case, air pollution definitely plays a major role.”

Dr. Wang remarks that “genetic defects are a contributing factor to cancer. In Chinese traditional medicine, this is called ‘inner weakness.’ Some patients who are susceptible to respiratory diseases have this ‘inner weakness’ manifest in their heart and lungs. When they breathe polluted air for extended periods of time, they will inevitably get sick. Such stimulus can trigger cancer. Mother Qin is this kind of a patient. It might take five to ten years for a cancer cell to develop into a tumor. During these five to ten years, the environment has changed, she she has been breathing the kind of air which can lead to cancer. So the air pollution can be seen as the catalyst for her cancer.”

Doctor Wang Fang usually suggests that patients whose conditions are stable to stay with family and friends in the suburbs or beyond, in order to avoid the heavily polluted air of Beijing. This will extend the lifetime of the patient. She has two colleagues who also have lung cancer, both of whom learned they had the disease in the late stage. After their symptoms were under control, they fled downtown Beijing and rented a farmhouse in the suburb of Shunyi. Their symptoms have been very stable so far.

Zhong Nanshan, an academic at Chinese Academy of Engineering, has said, “Beijing has seen a 60% increase in lung cancer in the past ten years. The smog has a significant impact on the respiratory system because the air pollution permeates the whole environment, both outside and indoors. For every ten micrograms of PM2.5 in one cubic meter of air, the hospitalization rate for respiratory diseases can increase up to 3.1%. If the smog increases from 25 micrograms to 200 micrograms, the daily fatality rate can increase up to 11%. This is much worse than SARS. SARS can be isolated, but no one can escape air pollution.”

Mother Qin is one who “cannot escape.”

The White Lie

Once she learned her mother had cancer, 24-year-old Tongtong decided not to tell her mother the truth. Tongtong cried alone in the corridor for a long time. Then she wiped her tears, went back to the patient’s room, and smilingly told her mother, “Ma, the doctor just told me that you have tuberculosis. No need to worry. As long as we follow the treatment, it will go away.”

Tongtong just graduated from college last year. When she was 12, her father passed away in a car crash. Afraid that the child could not take the reality of losing her father, Mother Qin didn’t tell her daughter the truth at first.

12 years had past. Now sad news once again hit the family. This time, it was the daughter who chose to keep a secret. “When I was a kid, she kept the truth from me. Now I’m keeping the truth from her.”

Two types of treatment were presented to Tongtong: one was chemotherapy, the other an imported treatment called molecularly targeted therapy. Chemotherapy kills and controls the growth of tumor cells, but at the same time kills normal cells and immune cells. Targeted therapy is a new kind of anti-cancer medicine which blocks tumors from certain molecules necessary for their development into cancer cells.

Although her father passed away early, Tongtong grew up under her mother’s tender care. This was the first crucial decision of her life, and it concerned her mother’s life. Tongtong was helpless. She had no one to talk to. She couldn’t find anyone to talk to.

That night, Tongtong thought it through. Considering that chemotherapy would add to her mother’s physical and psychological burdens, Tongtong chose the more conservative treatment: targeted therapy.

The doctor told Tongtong that Mother Qin could take targeted therapy at home; no need to stay in hospital. If her situation got worse, she could come back for treatment. At the end of March 2012, Tongtong checked her mother out of the hospital.

After leaving Navy General Hospital, Tongtong stayed at home with her mother. Ignorant of her illness, Mother Qin was in a good mood. She believed that her health would soon be restored. Tongtong had to keep the secret. She put the cancer treatment capsules one by one into another medicine bottle. Mother Qin took the medicine everyday. Her health was gradually getting better. For nearly half a year, Mother Qin was in good shape. She could still go to the supermarket, cook, and sometimes go out to take a walk. Life was returning to normal. What was different from before was that Mother Qin would wear a face mask every time she went out.

When she was checking out of the hospital, the doctor warned Mother Qin that the air pollution was severe, that she should take protective measures when she went out, and should try her best to breathe fresh air. Tongtong bought an air purifier for the house. Mother Qin became attuned to news about air quality and air pollution. “The government can’t change the air pollution, never mind us,” Tongtong thought. “What I can do is to make my mom feel more comfortable. The air outside is bad, so the only thing we can do is to go out less often.”

The good times didn’t last long. In November 2012, Mother Qin’s symptoms worsened. She got weaker and weaker. She felt tingling in her back and fatigue from head to toe. She became irritable and lost her appetite. Mother Qin started to doubt her illness. She often asked Tongtong if she really had tuberculosis. Tongtong comforted her mother, saying that she ought not to have such a heavy heart; all medical treatment requires such a process.

At the end of December, the drugs Mother Qin normally took could not control the spread of the disease. Pungent smells made her cough violently, and her phlegm was speckled with blood. She ached so much that she couldn’t swallow food. She could only ingest liquid.

Regular painkillers could no longer alleviate Mother Qin’s pain. One day at the end of December, Tongtong went to the hospital to get clinical-grade painkillers for her mother. She was nervous all the way back, feeling that something was about to happen. When she got home, she saw Mother Qin lying on the sofa, hair unkempt, sweat drenched through the shirt from pain. Tongtong immediately poured a glass of hot water for her mother take the medicine. Mother Qin could hardly breathe. She mustered the strength to lift her arm and shoved the glass back into Tongtong’s hand. “Tell me, just what am I sick with?” Her daughter could keep the secret no more. Her eyes filled with tears, Tongtong said in one breath, “lung cancer.”

“Whaaa…” Mother Qin cried.

Mother Qin thought of quitting treatment several times. She thought late-stage cancer was incurable; all efforts were a waste of time. But under Tongtong’s persuasion, she went once again to Wangjing Hospital.

January 2013 was a smoggy month in Beijing. Mother Qin was very sensitive to changes in the weather. When the air was bad, she would cough, have trouble breathing, and feel unbearable pain all over her body. Now she had to take painkillers every day.

Targeted therapy loses its effect after one to two years of use. Mother Qin had poor immunity, so her health was on a fast decline.

When she was hospitalized, experts at Wangjing Hospital had a consultation about Mother Qin’s symptoms. Upon examination, they found the cancer cells had corroded her lymph. A large lump was growing on one of her lymph nodes. They decided to deploy a combination of Chinese and Western medicine in one final battle. They would administer injections primarily to kill cancer cells, and use Chinese medicine to help Mother Qin expand her trachea, eliminate phlegm, invigorate her blood and qi, and enhance her immunity. Now Mother Qin has to undergo transfusion five to six hours every day. Pin pricks dot the back of her boney hands.

A Concern Come Too Late

The fees for Mother Qin’s cancer treatment are huge. Excluding hospitalization, the medicine alone costs more than 10,000 yuan (about US$1,613) a month. The targeted drug she used to take when she was still at home cost 4,600 yuan for seven pills. Taking one pill per day meant a monthly cost of 20,000 yuan (about US$3,225). Most cancer treatment is not covered by medical insurance, and Mother Qin’s family finances are precarious. She has lost the ability to work. Tongtong just graduated and has no job. She has to rely on their limited savings for her mother’s  treatment. Yet this will barely make a dent.

Tongtong wishes she were a carefree little girl who could go shopping after work and come home to meals cooked by her mother. This normal and happy life has vanished. “I have to be tough. A somber day is still a day, a happy day is still a day. It’s worth it to spend whatever amount of money it takes to make my mom a little bit happier.”

In the hospital, Mother Qin’s mind wanders far and wide. She says to Tongtong, “My daughter, your dad passed away early. You have had a bitter life since you were young. You’ve finally grown up, and now Mom has this illness. Mom is encumbering you.”

“Mom, I’m still young. I’m not married and I don’t have kids. I only have you. As long as you are well, I am well, too. You took care of me the in the past few decades, and I will take care of you in the coming decades.”

Mother and the daughter can’t tell how many times they have had this conversation.

For convenience, Tongtong stays in her relative’s home near the hospital. Every day she gets to the hospital at 7 a.m. sharp to stay with her mother, and leaves at 9 p.m. These happen to be the two times of day when the air is at its worst. Every time she sees a smoggy sky, Tongtong puts on a face mask.

Doctors remind Tongtong and Mother Qin, “Right now the air quality  is very bad. Try not to go outside or open windows for ventilation. Breathe more oxygen to relieve pressure on the lungs.”

Sometimes, when there are patients ready to leave the hospital, the doctors will have them wait until the air quality has improved before releasing them.

Tongtong has also started to worry about the air. She regrets that her concern has come too late. “Before I was not too concerned. I just heard on the news that there are this many or that many breathable particles in the air, and reminders to take care. But the sky was clear and we couldn’t see or touch the particles, so we didn’t pay attention to the warnings. Now I can see with my own eyes. Everywhere the air is cloudy white. Honestly, I regret that I didn’t make my mom pay attention to it earlier.

“Even though it’s in the news every day, the government isn’t doing anything to address the issue. It hasn’t announced any policies or improved its ability to monitor air quality. It’s all just useless work. For an individual, no matter how hard he tries to strengthen his own environmental awareness, there’s almost nothing he can do about it. Not to mention that it’s only the very few who have this awareness. I recognize the seriousness of the air pollution because my mom got sick. But for those people who haven’t gotten sick, can they understand? Normal face masks can’t filter out PM2.5; we have to buy professional masks. Now it’s PM2.5, who knows what will come afterwards. Will we wear biosafety masks in the future?”

Tongtong asked the doctor to let her mother go home for Spring Festival. It’s hard to feel the holiday spirit from a hospital bed. The doctor observed Mother Qin for a few days, then agreed to Tongtong’s request.

On the second day of the holiday, the Spring Festival Gala was still replaying on TV. Their relatives were gathered at home. Mother Qin wore an oxygen mask, watching the sparkle of firecrackers through the window from her bed. Smoke from burning fireworks mingled with the smog in the air. Mother Qin furrowed her brow.

“Tomorrow will be another smoggy day.”

Mother Qin and Tongtong are pseudonyms.

Via CDT Chinese. Translation by Mengyu Dong.