My Journey to Becoming a Doctor: Striving for Perfection on an Imperfect Path

Anyone who has spent time in an oncology clinic understands that, in a sense, it is a very depressing place. Perhaps the most telling sign is young residents who constantly tell their colleagues: "I don't want to be an oncologist, because every patient we treat ends up dying." This way of thinking is incorrect; caring for cancer patients is an enormous privilege. But in the process, doctors must draw on every resource in their knowledge treasury to help patients — emotional, psychological, scientific, and epidemiological. They must also use laboratory science, history, clinical trials, and palliative care to help patients. In short, every aspect of medicine is involved. The impact an oncologist has on a person's life is enormous; we appear at the most turbulent and fearful period of a person's life, and being able to help them during this time is a very unique and intense life experience.

— Excerpted from The Emperor of All Maladies by the American physician Siddhartha Mukherjee

I am the son of a cancer patient, and my original intention in studying medicine was to care for my own mother, who had stomach cancer. I may differ from most doctors in that I hold no prejudice against any kind of medicine. As long as it is beneficial to my mother — medical knowledge that can prolong her life and relieve her suffering — I am willing to accept and learn it. As the son of a cancer patient, I refuse to be brainwashed by anyone holding a dogmatic medical ideology, and I refuse to give up any opportunity that might help my mother. I sought help from many doctors, treating each with great respect; in the face of stubborn illness, they were equally helpless, but they did their best, and I am deeply grateful to them.

I also had to care for my mother in daily life, as she suffered from the dual torment of stroke sequelae and cancer, and she was already emotionally depressed by her illness. So I studied TCM, Western medicine, psychiatry, psychology, and religion simultaneously to relieve my mother's physical and mental suffering.

Moreover, to avoid the emotional impact on my mother caused by disputes among family members, I also tried every means to mediate conflicts among my relatives. Therefore, I have a personal understanding of the "biopsychosocial medical model" described in medical textbooks. A person's suffering is not only physical but also mental. What causes suffering, besides disease, is the surrounding social environment. As a son, I earnestly longed to create every condition for my mother to live a happy life.

As a family member of a patient, I also experienced the heart-wrenching separation of life and death, watching my mother pass away before my own eyes. In this process, I experienced not only the pain of an oncologist as an observer, but also the intense grief of a son losing his mother. Every struggle that oncology families go through, and every spiritual ordeal that oncologists experience, I have lived through. It can be said that all these experiences are ones I hoped never to experience, but which I nonetheless experienced helplessly.

When I recently discussed life with someone, I said that both fate and personal striving are important to a person. Some things in fate are beyond our control, while others can be changed through our efforts. Everyone, consciously or unconsciously, accepts what cannot be changed while striving to change what can. We all have no essential difference on this issue, only differences in emphasis. Mr. Shi Tiesheng said that in the face of incurable disease, there are hardly any atheists; perhaps he was expressing the same idea. Fate is an existence we must acknowledge; no one subjectively wants to encounter cancer, but when misfortune strikes, we realize we cannot escape it. Strong people may alter their fate, while the weak are inevitably conquered by it.

Now I finally understand the difficulty of being a doctor. There is so much knowledge we need to learn — medicine, biology, psychology, psychiatry, sociology, philosophy, religion; in short, all knowledge related to human life and the soul, all knowledge that can relieve patients' physical and mental suffering. In principle, doctors should learn all of it. Because when we deal with patients, they place high expectations on us, hoping we can relieve their physical and mental pain. Therefore, due to the nature of the profession, a doctor who demands perfection of himself will eventually become a learned scholar.

The knowledge we learn updates very quickly; medical textbooks are revised every few years. As of when I wrote this article, the popular tome Practical Internal Medicine has been updated to its 15th edition. Biology, closely tied to medicine, is the same; university biology textbooks must be revised frequently because, with the development of modern biology, scientists continually discover that many previously accepted biological viewpoints are wrong. In the life sciences, there is no immutable truth; all correctness is only provisional. The life sciences cannot, like physics and mathematics, build theoretical systems through logical reasoning. The most important means of studying the life sciences are observation and experimentation. We grope for experience in clinical practice, and in clinical practice we overturn conclusions previously thought correct; medicine continually progresses in this process. Only intellectually lazy doctors superstitionsly worship authority and refuse to advance.

Public understanding and expectations of medicine are somewhat disconnected from reality, and we need to explain to them what medicine can and cannot do in order to gain their understanding. If we fail in this popular science and communication work, we will incur misunderstanding from patients and their families; sometimes this misunderstanding escalates into serious conflict, and in rare cases this conflict even endangers doctors' lives. I believe every experienced doctor speaks cautiously, because we must consider the consequences of every word we say.

We must also learn to adjust our emotions under occupational pressure, and when questioned or verbally abused by agitated patients and their families, learn to restrain our emotions and avoid escalating conflicts. The grievances and frustrations suffered at work can sometimes crush an experienced clinician; doctors are a high-risk group for depression.

I often encounter consultants who pay nothing but endlessly consume my time; these people break their promises again and again, and sometimes their words are full of insults. Once my reply fails to satisfy them, they abuse me through various means — this is part of daily life for the vast majority of doctors. Another part of our daily life is doing everything possible, only to have the patient we very much hoped to save unfortunately pass away, with treatment ending in failure. No one can comfort us except ourselves, and some harsh family members even blame us. Most people think that doctors who have experienced so much life and death should be able to take it all in stride; few sympathize with doctors, so many doctors have walked into despair and themselves become patients with depression.

Practice has taught me that besides learning to treat disease, I must also learn to care for myself. Doctors have a saying from experience: being a doctor requires some hobbies; don't focus all your attention on medicine. We must learn to release our pressure through hobbies. We must also learn to comfort ourselves, learn to control our workload, and not be crushed by work and life. Most doctors do end up strong-willed, because without inner strength, we cannot endure to the end in this imperfect profession.

I have always known that I have many shortcomings and too many knowledge gaps to fill; I have never felt that I have reached a state of perfection. I also know that we humans are still only standing at the foot of the mountain of medicine; when we might reach the summit, and whether we can reach it at all, is still unknown. Therefore I never dare stop learning. If I go more than three days without reading literature and thinking about writing, my heart panics, feeling as though I am neglecting patients' lives, and waves of guilt rise within me. Because human life is at stake, others have entrusted their lives to me, and I have an obligation to do my utmost to stop the Reaper from invading them.

Perfection may not exist in this world, but we still cannot give up pursuing it, especially in medicine. Who does not hope to escape the torment of disease and the threat of death? Doctors are the bearers of this unrealizable human dream. We have no choice but to plow, like pioneer oxen, in one old and new field after another, until death.