Rehabilitation Medicine Deserves More Attention

Twenty years ago, my maternal grandfather passed away. Overcome with grief and complicated by hypertension, my mother suffered a sudden cerebral hemorrhage. She was rescued in hospital but left with some sequelae. She was then hospitalized in the neurology department of our county's First People's Hospital; the attending physician was a master's graduate from Tongji Medical College, a kind man, and the department head was kind as well — but neither understood rehabilitation medicine. The department head was a conservative older doctor; fearing a second hemorrhage, he ordered my mother not to get out of bed for half a month.

The only person in that department who knew anything about rehabilitation was an alumnus of my older brother's, from the same graduating class — I called him "senior brother." He told me privately that the earlier rehabilitation is started, the fewer the later sequelae.

Patients came and went on the neurology ward, many admitted long after a stroke, hemiplegic, aphasic, or markedly paranoid, with very poor quality of life. In the countryside, survivors of stroke sequelas have a hard time; over the years families grow less patient caring for them, so the patients often go about dirty and unkempt.

Seeing the condition of other patients with my own eyes, I adopted my senior brother's advice without hesitation. He drew up a plan for my mother combining acupuncture, tuina, and exercise therapy; with his help she emerged from the stroke with almost no visible sequelae. Invisible ones remained: she had hemisensory disturbance, and whenever the weather changed, one side of her body felt as if it were burning. This turned my usually cheerful, lively mother somewhat depressive.

Because of her illness, I suddenly felt that all my previous pursuits were meaningless. At the time I was a successful young businessman, under thirty, who had bought a home in Beijing and could almost have retired early. From then on I set out on the road to studying medicine.

My mother grew up during the Great Famine, when countless people starved. My grandfather had five children and, remarkably, none of them starved to death — already no small feat. But my mother and her sisters were left with lasting ailments: chronic hunger caused gastric ulcers — one of the precancerous lesions of gastric cancer — and living on wild vegetables and pickles left them with hypertension, which ultimately led my mother to both cerebral hemorrhage and gastric cancer.

Now, through my studies, I know that after her hemorrhage my mother's lentiform nucleus was damaged, causing the hemisensory disturbance; and I know her illness could have been prevented. If I had then had richer medical knowledge, she might not have had the stroke, might not have developed gastric cancer, or at least the cancer would have come years later and been caught early.

But all this is too late for regret. Today I have done extensive research on cancer and stroke sequelae, and can even solve stubborn problems that other doctors cannot, yet I can no longer ease my mother's suffering or extend her life. She passed away thirteen years ago.

The year my mother had her stroke, the best hospital in our county had no rehabilitation department, and only a handful of the best hospitals in our province even had one. Very few clinicians then understood rehabilitation medicine; my senior brother had encountered it during training at Tongji Hospital and, being especially fond of learning, had studied it on his own.

Medical education has advanced greatly in recent years; now that I am studying medicine at university, our major has a dedicated course in rehabilitation medicine. Rehabilitation medicine is an important branch of medicine, one of its four major domains, addressing functional impairment and promoting the physical and mental functioning of patients, people with disabilities, and the elderly. Survivors of stroke, spinal cord injury, infantile cerebral palsy, fractures, COPD, and coronary heart disease all need rehabilitation to recover functions lost to illness and improve their quality of life.

But the concept of rehabilitation medicine still needs wider promotion; to most laypeople the term is unfamiliar. Over the years I have met many survivors of stroke and their families, and they plainly know nothing about rehabilitation — not that it can partly or fully restore impaired function, improve patients' lives, or lighten caregivers' burden.

I enjoy this course. Our professor is knowledgeable, widely read, and warm; her classes are a pleasure. Through her I learned that even today there is a large shortage of rehabilitation physicians. After her class I felt stirred and would very much like to work in rehabilitation medicine in the future.

I also hope that patients and their families will learn something about rehabilitation. As a discipline it has matured greatly in concepts and techniques; what lags is dissemination and practice. The state now also values rehabilitation medicine, which has become a required course for clinical-medicine students.

Some diseases can never be cured, but comprehensive rehabilitation can still improve patients' quality of life. As our society ages, the number of patients needing rehabilitation will only grow. We should not stereotype medicine as merely drugs and surgery; the integrated use of physical therapy, exercise, psychological support, and assistive devices to improve functional impairment is also an essential part of medicine.