A Grandmother's Economic Dilemma and Attitudes Toward Life and Death

Interview location: Family waiting area of the emergency room, a major hospital in Beijing

Date: March 26, 2023, evening

While I was chatting with my previous interviewee, an elderly grandmother overheard the mention of my school, Renmin University High School ICC, and eagerly joined our conversation. Her emotions ran high as she spoke with me for about an hour, passionately expressing her thoughts.

Before I could even ask a question, she began to speak.

Grandmother:“What does this scene remind you of?” she asked, gesturing toward the entrance of the emergency room. “To me, it looks like something straight out of a play. There’s nothing subtle about it. Three meters from the door, there are four large payment windows—almost as if they were designed specifically for this space. Sometimes, I feel awkward just sitting here. The loudspeaker keeps calling for us to pick up documents and pay the bills. Honestly, if you don’t pay, they’ll stop the treatment immediately. Every step, every treatment, it's all about ‘paying money and pulling strings.’ The money collection system is so convenient, yet all other treatments and tests are incredibly complicated.”

She sighed deeply, pausing only briefly before continuing.“You’re young. You’re seeing all of this now, and I hope you can make a difference. Our country is the second largest economy in the world, but we still have a system where it’s ‘pay before you’re treated.’ There’s no such thing as getting treated first and paying later. You see this?” she asked, pointing around her, “This shouldn’t be happening.”

What if a family member misses the announcement to pay?I asked her.

“Then the treatment inside will stop until the payment is made,” she replied. “They’ll keep announcing it until you hear and pay. Only then will they continue.”

Does insurance cover any of this?I inquired, trying to understand the situation more.

“Insurance covers part of it,” she said, “but I still spend 10,000 yuan a day in the emergency room. Big bills—two of them alone were 8,000. My mother had two blood filtration procedures, but the rest, I can’t even remember. Each bill is at least in the hundreds, and some of my insurance doesn’t apply here because it’s tied to a lower-tier hospital.”

She paused again before adding, “I’ve heard that in Japan, citizens get 5,000 yuan directly for treatment, and they don’t need personal caregivers. But here, the caregiver fees alone cost 9,000 yuan a month, 300 yuan a day, and that’s not covered by insurance.”

Have you ever witnessed someone’s treatment being stopped because they couldn’t pay?

“I haven’t personally seen it,” she said, “but when a person is on the verge of dying, the whole family will likely sell everything they have to pay. You wouldn’t easily see someone unable to pay in a situation like that. If they can’t afford it, they might just give up on treatment altogether.”

How do you feel about the doctors here?I asked gently.

“They can only handle typical cases,” she replied. “If the patient’s condition is even slightly unusual, they don’t consider it. They give you a vague explanation, and it feels like they’re just going through the motions. Honestly, they’re like skilled workers. Train me for three months, and I could do the same job,” she laughed bitterly. “I may be a humanities student, but I know enough. Their judgments? Not reliable at all.”

Could you give me an example?I probed further.

“Sure,” she nodded. “After my mother had her blood filtration, she passed some blood in her stool. The doctors immediately said it was a gastrointestinal bleed. Ridiculous! It wasn’t that—it was because the blood filtration wasn’t done properly. Too much fluid was removed. For someone her weight, it should have been no more than 1.2 liters, but they took 3.3 liters out. At first, they admitted it was 3.3, but then they reduced the number to 2.3. The doctors just wouldn’t acknowledge their mistake. They wanted to treat her as if it was a gastrointestinal bleed. I argued with them until they finally gave in and didn’t administer the unnecessary medication.”

Was that the opinion of your primary doctor or a specialist?

“Just the primary doctor,” she replied. “There’s been no specialist consultation because they’re too busy.”

The conversation flowed freely as the grandmother continued, expressing her frustrations and anxieties. She had been at the hospital for five days, rotating shifts with her husband to stay by her mother’s side.

She reflected on her mother’s illness.“She’s been sick for two years,” the grandmother said. “The first time she was here, she was in the ICU for 60 days. Then, we went to another hospital for dialysis, but she developed breathing difficulties, and we rushed back here.”

Her voice trembled with emotion. “I know my mother’s condition better than these doctors. They just handle the surface-level emergencies—stabilizing breathing, adjusting blood pressure. It’s all just basic first-aid skills. If I had the equipment, I could do it myself.”

In those quiet moments, the grandmother shared her views on life and death.“When the end is near,” she said softly, “we should have the courage to say goodbye to the world on our own terms. I think being at home, in peace, in a room by yourself, is better than going through the agony of tubes and machines. At least you can signal to those around you what you need, and someone will respond. That’s the way it should be.” As our conversation came to an end, she left me with one last piece of advice,“If you ever get a chance to contribute to society, to improve healthcare, do it. That’s the most important work anyone could do.”

In those moments, I saw a grandmother, not just waiting for news of her ailing mother, but fiercely determined to improve the system that seemed so impersonal and mechanical. Her words carried both frustration and hope for a future where healthcare could be more humane, more compassionate, and less of a transactional burden.

Reflecting on this encounter, I was moved by her resilience. It’s easy to dismiss her frustrations as harsh or overly critical, but beneath her words lay a deeper truth—our healthcare system, while advanced in many ways, still has a long way to go. Her concerns may reflect just one story, but they echo the voices of countless others.

I hope her mother finds peace and recovery, and that her words inspire change in the hearts of those who can make it happen.