The Confusing and Daunting Business of Treating Cancer Patients

When I open my news app, every day I am flooded with reports of the latest, most heartening medical breakthroughs. My instant-messaging tools keep pushing all kinds of medical news that other people have seen and sent to me.

Over time I have grown tired of all this. Having fought cancer for more than a decade, I have become numb; now most days I do not even have the will to open the links.

Equally tiring is the ever-growing number of cancer patients. The patients are endless, and my daily work feels as if it has no end.

Now I have to politely decline most patients who seek me out and turn away many consultations, because my energy and time are simply insufficient.

Why are there so many patients? How much help does medicine actually bring them? These are questions I constantly turn over in my mind.

In 2012 an older physician advised me to devote more of my energy to tackling the causes of stubborn diseases like cancer and to preventing cancer at its source. He felt this would be more meaningful for society as a whole, because patients can never be treated to the very last one.

His wish was a noble one. But one person's ability is very limited. Faced with the surging tide of cancer, we are like a small boat tossing in a violent storm; whatever we can contribute is trivial.

I think almost every doctor must feel the same way.

On the very day I am writing this, the oncology department chair at a military hospital in Lanzhou, a Western-medicine oncology specialist at a well-known Shanghai hospital, and a specialist at a Beijing cancer hospital each sent patients of theirs to see me.

At the same time, I was myself referring patients who came to me to other doctors at various hospitals, so that those doctors could help solve their problems.

On that very same day, a breast-cancer patient who had failed treatment in Japan and the United States and had repeatedly failed treatment under renowned specialists at famous hospitals in China turned up at my door on her own.

These are the most ordinary fragments of our doctors' daily lives. In fact, every day, all over the world, I—and the doctors who refer patients to me, and the doctors to whom I refer my patients—are doing much the same thing.

We helplessly face one group of supplicants after another. Sometimes we have so little confidence in our own treatment that we do our best to persuade patients to go elsewhere for other regimens, sharing the pressure weighing on our minds and shoulders.

Few people can remain unmoved when their own kind faces the threat of death. A powerful will to live makes patients and their families place impossibly high expectations on doctors; those expectations press down on us until we can barely breathe. That is why we turn away so many supplicants for one reason or another.

We have to admit that sometimes referring patients back and forth among ourselves is a way of escaping reality. It is true that we harbor a faint hope that other regimens may help—that a different doctor might achieve a better outcome. But more often than not, it is simply that we ourselves cannot bear to face the cruel reality that the patient is about to die.

My biological clock is unusual. I generally fall asleep very early and wake around three in the morning; after that I read medical literature until dawn. Those hours are utterly silent and ideal for quiet reflection.

Often, after waking, I look back on the patients I have treated. Many of them now lie beneath the earth, and I keep asking myself whether medicine brought them help or harm.

We surgeons cut into them, slicing away piece after piece of tissue. We turn to all kinds of devices and drugs to treat them; while briefly arresting the progress of their disease, we also impose great injury and burden on their organs. Patients exhaust their savings, their bodies and spirits worn to a shadow, only soon to face the cruel reality of recurrence.

I often meet advanced cancer patients and family members who deeply resent doctors. I understand their feelings; a large part of oncologists' own depression stems from exactly this.

Once, patients and their families held us in high esteem and trust. In the end we deliver disappointment and despair. After such an experience, their resentment and disillusionment are not hard to understand.

One patient's daughter, after consulting a Western-medicine surgical oncology specialist at the Cancer Hospital of the Chinese Academy of Medical Sciences, came to me. She told me that the specialist had said to her that the longer he practiced medicine, the less he felt he knew how to cure disease.

That surgeon's words struck a chord in me. Sometimes my mind too goes blank, at a loss before a patient with a complicated condition.

The regimen that produced a gratifying result in the previous patient may, applied to the next, hasten that patient's death. Meanwhile, a regimen we had little faith in has worked miracles in some patients.

In the end we are forced to wonder: how much of the medical theory we have learned is actually reliable? And how much of our so-called experience is truly of value?

I once treated an elderly Western-medicine specialist's lymphoma with TCM. As I wrote the prescription I felt deeply uneasy. I said to her, "Doctor Li, I feel as though I am conducting an experiment on a human being."

This physician, who had practiced clinical medicine her whole life, said that she herself had spent a lifetime in clinical experiments. The doctor's work, at bottom, is a clinical trial; without the courage to run such trials, one cannot be a doctor. So she encouraged me to treat her as my laboratory rabbit.

In essence, a doctor's work is no different from a gambler's. Only when the lid is lifted do we know whether we have won or lost.

That is why I always urge my patients to undergo regular checkups during treatment, tell me the results promptly, and let me assess efficacy. If the treatment is not working, they should as soon as possible seek a better doctor, so as not to delay their care.

But I increasingly feel that this too is just another form of escape. A lung-cancer patient I saw today had shown no improvement after more than a month of my treatment; I hoped her family would consider chemotherapy.

In fact the patient had already tried chemotherapy for years. Coming to me was simply her way of refusing to repeat the old path. Asking myself honestly, when I turn away such a patient, perhaps I too am escaping reality—it is that I myself cannot bear to face the final failure.

When I recommended CyberKnife to that patient who had been treated in Japan and the United States, to address her diffuse liver metastases, she made another choice of her own.

She had already despaired of Western medicine and no longer wanted any of it. She hoped I could use pure TCM to maintain her quality of life. She no longer feared death; she only wished to die without so much pain.

Her husband, meanwhile, was in Beijing tracking down the most famous breast-cancer Western-medicine specialist they had once consulted. A firm believer in modern medicine, even though he had already run into a wall, he still wanted his wife to continue the Western "standard treatment" that caused her such pain and despair.

But that Western specialist, in truth, had run out of options too. I know that, like me, he was inwardly tormented by such a situation.

Was the patient's own choice right? Was my advice right? Or was the husband's insistence right? I cannot judge.

The confusion and dread I feel toward medicine—and the dread of taking on seriously ill patients—grows by the day. This afternoon, the daughter of a critically ill liver-cancer patient voluntarily sent me a red envelope, hoping I would give her some advice on her mother's condition. After offering some professional suggestions, I declined the red envelope.

I am not at all aloof or high-minded. It is not that I do not need or love money. It is simply that I cannot and dare not take it. Facing such a gravely ill patient, I have to weigh whether my remote help is harming her or helping her.

In the early evening another patient's family invited me to travel elsewhere for a house call to treat a relative. He asked me, "Can you tell me what results you can achieve?" I told him honestly that I did not know. Such an answer is a blow to a patient's family.

Over the last two or three months I have politely declined many invitations to make house calls, simply because I feel I may truly be unable to help these critically ill patients who are too frail to come to Beijing.

Among the cancer patients I have seen who did best, quite a few were not cured by doctors at all; they cured themselves by taking folk remedies.

I once followed up in Penglai, Shandong, on the family of a gastric-cancer patient who had dug up kushen (Sophora flavescens) root and steeped it in water to drink. In the patient's hometown, his family led me to the very herb they themselves could not name; the only thing I could do better than them was identify the material and tell them its formal name.

When this patient underwent an exploratory laparotomy, the surgeons saw that his entire abdomen was filled with tumor, decided not to resect it, sewed him up, and sent him home. By all conventions he would not live half a year.

After returning home and drinking water steeped with this herb kushen, he lived another five and a half years. Before he died he had another operation; the tumors in his abdomen had by then disappeared entirely, but his liver was filled with metastases, and it was those that killed him.

Another ovarian-cancer patient, after developing ascites, was likewise guided by a local folk herbalist to dig up xiao-ji root and stew it with pork ribs; in less than a week the ascites cleared completely. My role, again, was only to help identify the root they had dug and tell them its formal name.

There is a folk saying: "Wild punches can fell a master." Another says: "Prescriptions from the seaside confound famous physicians." I have to admit that had I treated these patients, I could hardly have done better.

And not only I. Throughout the world, in the medical systems of both developed and developing countries, no doctor—whatever his degree or title—could necessarily have done better.

We ceaselessly explore, believing that because our medicine is advancing we can solve these problems. In reality, countless medical workers may be tracing a detour that simply exhausts patients.

Many patients, by exercising to burn off excess sugar and fat, by adopting a more disciplined lifestyle, and by seeking only moderate symptom relief and a little functional treatment, achieve a quality of life and survival that may be better than what we obtain by beggaring them.

When the world's medical systems all prioritize economic returns, our medicine is inevitably dragged into a situation that may conflict with the plain facts.

Over-treatment for financial gain, and excessive coddling of patients, are weakening the primal instinctive strength people draw from nature, leading them into an endless dead end—and dragging the doctors themselves into the abyss.

We laugh at primitive peoples who relied on shamanism to heal. Yet facing terminal illness, we seem no more capable than those shamans.

We have woven an entire discourse out of medical jargon, and the public is deeply frightened within it. They are superstitiously convinced that illness must be treated through some fixed, habitual regimen.

We have only to reflect that the doctors of a century ago did the same work, that patients a century ago felt much as our patients do today, that the regimens of a century ago were utterly different from ours—and that our own regimens will look utterly different a century hence. Then we cannot help but be astonished at how terrible the herd instinct is in matters of medicine.

One stubborn human flaw is excessive self-confidence. Few pause to consider that our so-called confidence merely comes from the mental habits forged by our education; at bottom it is not that we are confident, but that we are superstitious about certain ways of thinking already established in society.

Whether doctor or patient, before going further, it would perhaps do no harm to pause and reflect quietly.