FONG SUP (風濕) | Yue-Ting Lau

Arthritis, in a Chinese household, smells and looks like roots—twisting ginseng tendrils, golden scars worn from cooking and sewing, the white flesh of unearthing roots from the soil with scholar’s hands. It is less pain and more weariness, a forecast of rain, a sigh exchanged between women at the market as they recount the changing state of the world over carefully selected green beans. It is balms massaged into wrists and shoulders, knees creaking less beneath medicated patches carrying the scent of wet earth and drying grass.

The ED room smells like tiger balm, thick with menthol and that bitter, honeyed scent of medicine, the only kind I knew worked for arthritis growing up. Ah-yi is my very first consult of fellowship, and stepping into that room feels like recognition.

I first encountered Chinese topical medicine when I was just tall enough to wrap my fingers around a drawer handle at forehead height and pull open my grandmother’s forbidden drawer. It held toothpicks, measuring tape, needle threaders, ibuprofen and Tums, and inexplicably, White Rabbit candy and Sugus fruit squares beside Chinese white flower oil and Malaysian tiger balm. Home was inside that drawer: the amalgamation of sugar and herbs, jasmine tea sweetened with rock sugar beside broth simmered for hours. I recognized it immediately as a piece of myself.

It had been a long time since I had felt that recognition so sharply: women in my family bearing weight and setting it down again, searching for something loosening and healing. When I introduce myself in Cantonese as the rheumatologist, their joy is immediate, and at first, I think it is relief after waiting more than four hours in the ED. I hate to disappoint; at this point in my training, I barely knew the difference between gout and rheumatoid arthritis.

But it is something else entirely.

“She speaks Chinese!” Ah-yi says, crow’s feet deepening around a mostly toothless smile, Cantonese carrying the plucked cadence of Toishan underneath.

I smile back awkwardly. “Speaks Chinese” feels generous, considering how many nights during residency I sat at a computer memorizing translations for words no one would ever use in a Cantonese kitchen: “red blood cell,” “uric acid.” A far cry from my father pointing at a grocery store calendar hanging crooked over the entryway table, a massive yellow fruit on the cover, and shouting “mong-guo!” while I dissolved into laughter beside him.

She beckons me closer with a gnarled hand and clasps mine in her papery palm. Leaning in conspiratorially, she asks, “This pain is part of getting old, right?” Then she throws her arms wide in dramatic despair, just like my grandmother used to in the mornings. “Oh, but it feels like I am falling apart,” she whispers, tempting fate. “Like death. I can’t even walk or move my arms.”

Her daughter rolls her eyes, just like my mother used to before reaching for the white flower oil to hand my grandmother, and I laugh.

Her daughter tells me the pain started in her toes before spreading everywhere, one joint swelling after another. I notice the tophi along the dorsum of her hands and elbows, the taut pink skin over her toe. I tell myself to remember these findings for my attending.

“Ah-yi,” I say gently, “I think this is more than just old age. But I think we can make this much, much better quickly.”

She beams wider. “Look at this brilliant doctor. Her Chinese is so good. We are so proud of you.”

I have not even explained the diagnosis yet, but we lock eyes and she recognizes something else first: that I know this world already. The feel of Heberden and Bouchard nodes beneath my fingers long before I had names for them, while massaging my grandmother’s hands in winter. The scent of herbal oils meant to loosen pain from worn joints. How far we have come from the mountains of southern China, where my father worked as a barefoot doctor, delivering babies with no training beyond grit and responsibility to his community. Now I stand here able to prescribe a pill that can quiet years of pain.

“We are so proud of you.”

She starts prednisone, and two weeks later, when she comes to see me in outpatient clinic, she and her daughter burst into excited chatter over one another before they even sit down.

“I am a new person!”

“She’s worried you’ll order too many blood tests.”

“I can walk a million miles!”

“You should have seen how tired she was before.”

“What do you think about her blood pressure medicines?”

“Do you think she is eating too many foods that have hot chi?”

She twirls her wrists and ankles to show me how much better she can move, and her daughter laughs as she lifts her arms in a little dance while I examine her.

I can’t help but smile the whole way through, take her hands in mine, and squeeze them gently before prescribing a higher dose of allopurinol.

At the end of the visit, I hold the door open and watch the two of them lean into one another as they walk down the long hallway.

“Ah-yi!” I call after her.

They both turn.

“Keep your hands warm. Don’t forget your uric acid medicine. Come back to see me soon!”

The words leave me the same way my mother used to call across the produce aisles at 99 Ranch beneath bright yellow sale signs hanging over the mangos and kiwis.

She waves back enthusiastically and gives me a vigorous thumbs-up.

Arthritis, to a Chinese rheumatologist, grounds and grows like roots—like an answer to a millennia-old understanding of wind and water, of erosion and renewal. I think my office one day will smell like white flower oil and tiger balm beside orders in the EMR for methotrexate and secukinumab.

I startle when I feel a tap on my shoulder. I turn to find a small woman with red-purple dyed hair like the ladies selling Napa cabbage and persimmons in Chinatown.

“Did I hear you speaking Chinese?” she asks. “Are you one of the arthritis doctors here?”

I nod.

She beams.

“Are you taking patients? Can I come see you?”

Yue-Ting Lau is a rheumatology fellow at the University of California San Francisco with interests in medical education and narrative medicine. She completed both her undergraduate and residency training at UCSF. She is the website artist for The Clinical Problem Solvers, where she develops visual illustrations and diagnostic schemas to teach clinical reasoning. Her writing explores identity, memory and the human relationships shaping the practice of medicine.

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