As recently as February, Liu Xiaobo's brother dismissed reports that the imprisoned Chinese Nobel Peace laureate might be ill. Then came the bombshell on Monday that Liu has been diagnosed with late-stage liver cancer and transferred to a hospital on medical parole.
A brief video has also emerged of Liu's wife tearfully telling a friend that no treatment – surgery, radiation or chemotherapy – would work for Liu at this point.
The news has shocked and angered Liu's supporters and human rights advocates, who are questioning if China's best-known political prisoner received adequate care while incarcerated, or whether the authoritarian government deliberately allowed the 61-year-old to wither in prison.
Chinese prisons are notorious for their poor health care, lack of nutritious food and abusive conditions, and it's highly common for prisoners to re-emerge in a deeply weakened state. That may be especially true for the prison in a small northeastern city where Liu has been serving an 11-year sentence for inciting subversion of state power.
A serious illness like liver cancer could be easily missed at the prison despite checkups, although it's equally possible that Beijing has neglected care for Liu on purpose, said political dissident Hu Jia, who has served time in jail with liver issues.
"Given his influence and his massive following, it's possible that Beijing does not want him to return to society healthy, physically capable and energetic," said Hu. "Beijing considers him to be a political rival."
Hu is calling on Beijing to be open and transparent about Liu's medical care. Liu is in a hospital in the northeastern city of Shenyang and has not communicated directly with the outside.
The local prison management bureau could not be reached for comment. Police cars were seen Tuesday parked outside the China Medical University No. 1 Affiliated Hospital in Shenyang, where Liu reportedly was being treated. An Associated Press journalist could not locate Liu in the sprawling facility, and nurses on likely floors for cancer patients said they had not had a patient by the name of Liu Xiaobo.
Liu, a literary critic and essayist, was already in less than robust health when he was detained and later sentenced to 11 years in prison in 2009, recalled Liu's former lawyer Mo Shaoping. The defence team had argued for Liu to be released while awaiting trial on the basis of poor health, but was turned down, he said.
Still, Mo said he was unaware of Liu's cancer diagnosis until it was revealed on Monday.
"We would think there must be symptoms for earlier detection and that a responsible prison would not have discovered liver cancer only in the very late stage," he said.
Other than general concerns for Liu's health, there had not been alarming news until this week. In February, responding to rumours that Liu underwent computerized tomography scans for possible illnesses, Washington-based Radio Free Asia reported that Liu's brother had dismissed the rumours.
Chinese authorities have a troubling record when it comes to the treatment of political prisoners.
Untold numbers died in China's vast system of labour camps following the founding of the People's Republic in 1949. The crushing of the 1989 Tiananmen pro-democracy movement led to new rounds of repression.
More recently, Cao Shunli died in a Beijing hospital in 2014 after being detained for her human rights activism. It is widely believed she died of illness after authorities denied her medical attention.
The next year, Tibetan lama Tenzin Delek Rinpoche died in a Chinese prison while serving a life sentence. He had been denied medical parole a year earlier, and his family was refused permission to view his remains, death certificate or medical records.
When prominent rights lawyers Gao Zhisheng left prison in 2014, he could barely walk or speak a full, intelligible sentence. He has since recovered, but is still under house arrest.
In a rare interview in 2015, Gao celebrated that he's still living. "Every time we emerge from prison alive, it is a defeat for our opponents," he told The Associated Press.
Sophie Richardson, China director at New York-based Human Rights Watch, said Beijing should be held to account for letting a peaceful critic like Liu fall gravely ill.
"From those who ordered Liu's prosecution to those who denied him adequate treatment in detention ... there are many people to be held accountable for their role in this cruel travesty," Richardson said in a statement.
Supporters have called for Liu to be allowed to seek treatment overseas, although President Xi Jinping's administration has taken a hard line on refusing permission for dissidents to travel.
U.S. Embassy spokeswoman Mary Beth Polley called for Liu's release as well as that of his wife, Liu Xia, who lives under house arrest.
China should "provide them the protections and freedoms such as freedom of movement and access to medical care of his choosing, to which they're entitled under China's constitution and medical system and international commitments," Polley said.
China's foreign ministry did not directly address questions about whether Liu would be allowed to leave the country for treatment. Spokesman Lu Kang said any Chinese citizen's exit from and entry into the country is "ruled by law."
He warned that Liu's case is a domestic affair and demanded that China's judicial independence be respected. "No country shall interfere with China's internal affairs through any individual case," Lu said.
Hu, the dissident, said that for now, it's imperative that the government make public the names of the eight oncologists in charge of Liu's cancer treatment in Shenyang and that Liu is brought as soon as possible to Beijing, which has the country's best medical professionals and is his home.
"We cannot take the government's word. We must be able to judge if these eight people are truly qualified," Hu said. "We want to make sure Liu Xiaobo is seeing the best doctors in the best hospital with the best equipment possible."