The Medical Profession I Both Grieve For and Devote Myself To
When I was a child, the thing I remember most vividly was my mother often vomiting acid water at our doorstep, in utter misery.
Because she was born during the great famine, my mother endured many days of hunger, which led her, before she was even married, to develop chronic stomach disease. Whenever she became fatigued, the stomach problem would flare up.
Every time my mother's stomach flared up, she not only vomited acid water but also suffered spasmodic stomach pain, with constant belching and twitching. Watching my mother endure such suffering tore at my heart.
Back then I always thought: if only I could grow up to become a specialist in stomach disease and cure my own mother's condition.
My mother saw many doctors and took large quantities of both Chinese and Western medicine, but her stomach illness always improved and relapsed, never being fully cured. It developed all the way into gastric cancer, and she eventually died of it, before she was sixty.
In the years following my mother's death, the elders in my family passed away one after another, mostly from cancer or stroke.
During those years I began to face death directly—death happening right before my eyes, taking my own closest kin. The shock of death was so great that it completely changed my view of life and made me readjust my path.
For a long time, I believed the reason my mother's stomach illness dragged on uncured was that our family was poor, with neither power nor money, and therefore could not find good doctors.
But later, although I was not especially wealthy, I earned a good deal of money through business and hired many renowned Chinese and Western medical experts for my mother; the treatment results were just as poor, and some actually made her condition worse.
Looking back now, the doctors my mother saw in her childhood were by no means all mediocrities. She went to see the locally famous stomach specialists, both Chinese and Western, and some were medical experts who enjoyed special government allowances from the State Council.
The modest family tradition of herbal folk medicine we had also did not play much of a role in curing my mother's stomach illness.
Later, when I myself studied and practiced medicine, I spent a period working in clinical rounds with a retired, re-employed teacher who had switched from Western to Chinese medicine. One day, a stomach patient came to see my teacher, and I sat in on the consultation.
After the patient left, my teacher said to me: in the future, for stomach patients, if you prescribe Western medicine—acid-suppressing agents like omeprazole—do not prescribe more than a two-week supply at a time. If a patient takes omeprazole for more than two weeks, trouble will follow.
I hurriedly asked why omeprazole should not be prescribed for more than two weeks at a stretch. My teacher told me that long-term use of this drug has significant side effects; some patients develop intestinal metaplasia, which is why doctors in Europe and America do not readily prescribe more than a two-week course.
When I heard my teacher's words, my head seemed to explode with a loud buzz. According to the prescriptions written by the doctors who had treated my mother, she had been taking acid-suppressing agents like omeprazole almost continuously for years on end.
This teacher of mine was a highly respected medical expert who, from childhood, had studied under one of China's towering medical masters. She was rich in experience and broad in knowledge, yet extremely low-profile; even I only learned of her lineage by chance.
In that clinical encounter, my teacher told me that the patient who had just left showed intestinal metaplasia on his gastroscopy report. When she pressed him about his medication history, she learned he had been using omeprazole for years. To avoid exposing other doctors to medical disputes, she had not told me this in front of the patient.
Having studied oncology for over a decade, I know that intestinal metaplasia is one of the precancerous lesions of gastric cancer.
After that, I observed many stomach patients who came to me and found that several who had progressed to intestinal metaplasia indeed had a history of long-term omeprazole use.
The reason my mother developed gastric cancer may have been related to the treatment plans those earlier doctors gave her—it was an iatrogenic carcinoma.
When I was a child, although my family was not destitute, we were quite poor. So in the past I always thought the root cause of my mother's incurable stomach illness was our poverty.
But by the time I myself had become well known in oncology circles, the accumulating evidence told me that this was not the case.
Once, at the invitation of a patient's family, I went to a prefecture-level city to see a gallbladder cancer patient. When I took the history, the family told me that the patient, a few years earlier, had been found to have a single 1.5 cm gallbladder polyp.
I asked, astonished: when this polyp was found, didn't the doctors at the hospital suggest considering surgical removal? The family told me the doctors had never even mentioned it; no one had ever told them that a single gallbladder polyp larger than 1 cm could undergo malignant transformation.
This patient's family was well-off. Her husband was a local official with good connections to the hospital leadership. Yet, unexpectedly, a disease that could have been stopped at the precancerous stage was completely ignored and allowed to progress all the way to advanced cancer.
After that, I came into contact with more and more cancer patients from affluent families. Their stories were much the same as my mother's: almost imperceptibly, they had progressed from chronic disease to advanced, untreatable cancer—and some of them were professional doctors themselves.
For a while I worked at an upscale clinic in Beijing. One of the clinic's investors was a Chinese-American physician practicing in the US, one of America's leading authorities on cardiovascular disease. His consultation fees were very high, and wealthy families in China sought him out. The single thing he did most for his patients was help them reduce their medications.
In his view, modern Chinese medicine was simply a mess. He constantly criticized the state of healthcare in China, criticizing how the medical system prevented outstanding talent from entering the profession, so that the overall quality of Chinese medicine could never rise.
Certainly his views had an extremist edge. As a developing country, China's investment in healthcare cannot, of course, compare with that of developed countries like the United States, and the economic capacity of Chinese patients is quite low; most cannot afford the fees charged by doctors in developed nations. Still, China's steadily rising life expectancy shows that its medical and health work has been progressing.
It is just that our medical profession does indeed have serious problems. Our current healthcare still falls short of safeguarding citizens' health and of saving the dying and healing the wounded.
We have a long way to go in public education about disease and in the prevention of major illness; at the same time, our medicine is increasingly becoming a form of care stripped of warmth.
Not long before writing this article, at a patient's family's request, I went to a place in Gansu to see a dying patient. By the time I arrived, the patient was already in the local ICU, his limbs ice-cold, his pupils unresponsive to light—clearly nearing the end.
Because the patient, when critically ill at a tertiary Grade-A hospital in Beijing, had once called me in for a TCM emergency rescue with striking results, the family trusted me more than any other doctor.
At the patient's final moment, I strongly urged his son to abandon all aggressive, invasive treatment, take the patient home, prepare for the end, and let him return to his roots.
When the family accepted my advice, the ICU doctors produced a pile of documents for them to sign, to ward off medical disputes. I could feel the tension in the ICU doctors; they were terrified that, after a medical accident, medical-family unrest would erupt.
I was at the patient's side when he died, because I had promised the family to accompany and escort him home alive. He stopped breathing less than five minutes after arriving home.
I witnessed the whole process of his terminal rally and death, and I witnessed the family holding his funeral. As the last professional at his side, my role at that moment was to confirm to the disbelieving family that he had indeed died, and to urge them to restrain their grief.
The family was utterly bereaved, but none of them treated me with disrespect; on the contrary, they respected and thanked me deeply. Medicine in a rule-of-law society has gradually turned cold and overly self-protective, no longer centered on humanistic care, but becoming a purely economic transaction marked by severe doctor-patient confrontation. If one day I myself face death, I hope the ones by my side are my family—and medical staff like myself.
I am past the age of being an angry young man; I already know that venting emotion does not solve practical problems. As a middle-aged person who has entered the healthcare field, what I think about more is how to participate myself, improve the state of medicine in China, and solve some of the problems in the profession.
I am not so arrogant as to unrealistically think I am a lone hero who can overturn Chinese medicine. But I know that as long as I am willing to work hard, I can make at least a small contribution to this field.
The reason I want to invest my energy and heart in advancing medicine is that I have realized: my family lives in China, and they need a better medical environment.
I now live in Beijing, an international metropolis where many things already approach the standards of developed countries—including healthcare.
Over the years I have met many people in Beijing who want to partner with me in medicine; most are business people—wine sellers, steel magnates, former coal bosses, ex-corporate consultants. When talk turns to medicine and the "greater health" industry, everyone gets excited.
Because, allegedly, at a time when China's economic growth is slowing, the healthcare industry stands alone, still expanding at over twenty percent a year.
Yet rarely do I see, in the words and demeanor of these eager investors, the humanitarian and humanistic spirit that medicine truly needs. What everyone thinks about most is: I want a bite of this juicy piece of meat as soon as possible.
Without exaggeration, people come to talk cooperation with me every month. Many feel I have great commercial value waiting to be unlocked, and that it would be a waste not to exploit it.
It is just a pity that they have not succeeded in assimilating me. Nearly forty years of life experience have long since made me a rational, calm person. I do want to achieve something in medicine, but not because of the financial returns it might bring me.
I believe that patients like my mother, in a good medical environment, could well have lived out their natural lifespans and died of old age rather than of cancer. Patients like her are countless. To reduce such deaths—deaths that need not happen—we need better medical technology and a better medical environment.
I have also gradually realized that my earlier concept of medicine was very limited. I once thought medicine was simply a discipline dealing with people's physical and mental illnesses. But in practice, I have come to see that the meaning of medicine goes far beyond that.
Medicine is, first of all, a spirit—a spirit of unyielding self-improvement that humanity has shown in its struggle against nature. It is also a humanitarian spirit developed as people care for and love one another.
In treating patients, doctors, patients, patients' families, and even society at large all play a role. Even the intellectual currents of an entire society are themselves part of what bears on a person's physical and mental health. They all belong to medicine in the broad sense.
Medicine is delicate, because its purpose is to cherish life. Life is fragile; a single illness or accident can shatter it. A crude process of providing and receiving medical technology between doctors and patients, and the simple economic transactions that arise from it, are not the way medicine should exist.
The end of life is the most helpless situation human beings face. If people could live forever, many would choose to; but such a wish is impossible to fulfill.
Medicine exists to save life and relieve suffering when human life is threatened; it also exists, when nothing more can be done, to see off the dying and comfort the living. At the same time, it ought to exist to provide health guidance to the public and prevent major illness.
Such medicine is warm medicine; it is the medicine that humans, as emotional creatures, truly need. We should develop such medicine across the land of China, rather than treating it merely as a sector of economic development.