Surviving Cancer Requires Wisdom and Courage

For some people, staying alive is not difficult. For others, staying alive is like sailing through stormy seas, full of hardships and dangers.

Cancer patients belong to the latter group. Some are indignant at fate's arrangement after a cancer diagnosis; others are crushed in spirit after the blow of misfortune. But if one wants to keep living, one must adjust one's state of mind as quickly as possible, fully mobilize every resource available, and fight for the greatest chance of survival.

When illness comes, the first thing to do is seek medical help. But in this era of diversified medical services, choosing among many treatment options is no easy task. Choosing means we need to make a correct judgment, yet making a correct judgment is never easy. Our wisdom is often not as reliable as we imagine; the "common sense" in our heads and the various new information we receive are not necessarily correct.

Moreover, it is often hard for us to define "correct" correctly. This sounds convoluted, so let me give an example.

Galileo conducted his famous iron-ball experiment, overturning the conclusion left by Aristotle that the speed of a falling object is proportional to its mass. Before other professors and students, Galileo dropped two iron balls of different masses from the Leaning Tower of Pisa; after a moment, the two balls hit the ground at the same time. Before Galileo, people, relying on their common sense, believed Aristotle's judgment: objects of different weights fall at different speeds in free fall.

Judging by our everyday common sense, Aristotle's view is right—if Galileo had experimented not with two iron balls but with a feather and an iron ball, the feather would certainly have fallen more slowly. This kind of experience, verified countless times in real life, forged our "common sense"; whenever people make any judgment, they first turn to their "common sense."

Is common sense correct or wrong? Common sense is conditionally correct. And the correctness of scientific principles is also conditional. Two iron balls land together because the difference in air resistance is negligible for two balls of different masses. But the difference in air resistance is not negligible for a feather and an iron ball. So if you experiment with a feather and an iron ball, the feather lands more slowly. In a vacuum, however, the feather and the iron ball land together.

So it is very hard to define "correct" correctly; both common sense and scientific principles are "correct." I was born in a village in eastern Hubei and lived in my hometown most of the time until I was eighteen. In my hometown there are still many people with low educational attainment—in my own village, the proportion of people with higher education is very low, so many there still believe Aristotle's judgment. But now I live most of the time in Haidian District, Beijing, which may be the area with the highest concentration of intellectuals in China; most people here learned about Galileo's iron-ball experiment in textbooks long ago, so for them common sense says that in free fall, speed is independent of mass.

It follows that the concrete content of "common sense" differs among different groups of people, and sometimes their "common sense" is directly opposed. In the real world, our society is made up of different groups. People differ enormously in education, cultural background, personal beliefs, economic circumstances, and occupation; these differences mean that each person's "common sense" must also differ enormously.

So the world contains countless "correct views" that seem to contradict one another. Are the "correct views" in our own heads actually correct or wrong? It is extremely hard to judge. Many people, precisely because they believe themselves absolutely right, make wrong decisions and in the end forfeit their lives.

What matters more than "correct" is "wisdom"—wisdom and correctness are not the same thing. Wisdom reflects the maturity of a person's mind; only a mentally mature person can be called wise. When making choices, the mentally mature person examines the "common sense" in his own heart, sifts the information he receives rather than blindly believing and following it, listens to opinions from many sides, and then makes a relatively reasonable judgment. A wise person does not lightly judge right or wrong based on a single aspect of things; he sees the complexity of the objective world.

There is no absolute correctness in choosing among medical options. A given regimen may succeed for patient A and fail for patient B. If we happen to be patient A, we may feel our choice was successful; if we are patient B, we may feel it was a failure. Patient C, looking at A, would endorse the regimen; looking at B, would reject it.

Even so, there are things that can help us make a relatively better choice. For instance, we can compare the success rates of various regimens. Generally speaking, the higher-success-rate option should be the first choice—why I say "should be" is that the higher-success-rate option may be unaffordable for some patients.

I particularly understand those patients who, because of poor economic circumstances, have to choose a second-best option. There are always fortunate patients who, after choosing the second-best regimen, instead achieve the ideal outcomes that those who chose the highest-success-rate regimen could not. It is like how, among students at key high schools, more do get into Tsinghua and Peking University, but among students at weaker high schools there are always still some who make it.

Success depends not only on success rate but also on "luck." To beat cancer, one should of course choose the highest-success-rate regimen; but when the highest-success-rate regimen is out of reach, or when it has failed, lower-success-rate options may still work miracles. After one treatment fails, keeping an optimistic outlook and seeking another regimen may not guarantee we beat cancer, but it genuinely improves our odds.

In the process of seeking a survival strategy, we should keep an open mind and accept the reasonable side of all things; at the same time we should remain rational and prudently examine the unreasonable side of things. Lightly concluding that a regimen is wrong or unreliable easily turns us into a paranoid person.

I will quote a passage and analyze it to illustrate concretely one attitude I take toward incoming information.

The passage goes like this: "Between heaven and earth, only wind enters everywhere; if a single crevice (xia, fourth tone, meaning a crack) is not sealed, its arrival cannot be resisted. In the human body, the tight are few and the leaky many. Wind takes advantage of this: in mild cases it gives a cold; in more severe, an injury; in still more severe, a stroke. The ancients said to avoid wind as you would avoid bandits, for one must block the source to prevent disaster. The pattern of wind-stroke: sudden fainting, unconsciousness; or profuse phlegm with rattling in the throat; or a rigid tongue unable to speak. Once wind evil is exuberant, qi must rebel upward; phlegm rises with qi, lodging and blocking, causing coma and fainting—all due to phlegm. Though all five zang-organs can be struck by wind, attacking the liver channel is most common. For the liver governs the sinews and pertains to wood; wind easily enters it, each according to its kind. When the liver is struck by wind, the sinews become slack and deprived of nourishment, now slack now tight, hence the patterns of wry mouth, flaccid paralysis, hemiplegia, and slurred speech. The method of treatment is to regulate qi first. The Classic says: those skilled at treating wind govern wind through qi; when qi is smooth, phlegm is resolved. Gently regulating the wind may then bring results."

This passage comes from the most brilliant disciple of Zhu Danxi—the Ming physician Dai Yuanli's book Mishuan Zhengzhi Yaoji Ji Lei Fang (Secretly Transmitted Essentials of Diagnosis and Treatment, with Classified Prescriptions). (A note: I chose this passage not because it is especially remarkable, but simply because when writing this article the nearest book to hand was this one, and I happened to open to this page.) The gist of the passage is that, between heaven and earth, wind is the factor most harmful to the human body (TCM says "wind is the chief of the hundred diseases"), the body's ability to ward off wind evil is limited, and when wind evil attacks a person it easily causes various illnesses. Mildly, it gives a minor ailment like a cold; more severely, a wind-cold injury; still more severely, a stroke. Hence the ancients said to avoid wind as you would avoid bandits, because we must prevent trouble before it arises. He then discusses the various symptoms of wind-stroke, and how to treat the various diseases caused by wind evil.

To someone with a little common sense of both Chinese and Western medicine, Dai Yuanli's passage is like a physicist reading text claiming that objects of different weights fall at different speeds: one sees its obvious errors, but also sees what is reasonable in it.

First, the passage is almost entirely wrong in explaining the mechanism of disease. When people catch cold in windy autumn and winter, most of the time they have been infected by pathogenic microorganisms (viruses or bacteria); they have caught a common communicable disease that is spreading among people. And the serious "wind-stroke" of TCM is actually caused by a cardiovascular or cerebrovascular accident—most often a stroke—and strokes occur because of high blood pressure and vascular aging. Explaining all this as due to wind evil is certainly a grave error.

But some of the phenomena TCM observed have a certain reasonableness. On very windy days, influenza and strokes are indeed more common than usual, and people's immunity is somewhat lower in high winds. Avoiding going out on windy days keeps people away from sources of infection and also prevents cerebrovascular accidents.

So this passage has both a wrong side and a correct side. Whether in Dai Yuanli or in other TCM physicians, the medication plans they gave based on the characteristics of wind evil are the same: there is a correct side and a wrong side. If you treat a cerebrovascular accident as wind evil, you will mostly fail.

The famous Qing physician Xu Lingtai wrote in his works that, in his day, doctors treating stroke basically killed one hundred percent of their patients. Because everyone treated this disease as wind evil, using the various wind-dispelling herbs of TCM.

It was not until Wang Qingren that people realized these so-called strokes were actually problems of vascular blockage in the brain. So Wang Qingren pioneered the method of activating blood and resolving stasis to treat stroke, and we still use his methods and concepts today in treating cerebrovascular accidents. In treating the sequelae of cerebrovascular accidents, such as hemiplegia, his Buyang Huanwu Tang works very well.

The overwhelming majority of the Chinese and Western medical literature we read is just like Dai Yuanli's passage: it contains both correct and erroneous content. So studying medicine is not easy; those who have achieved anything in medicine through the ages have been both gifted and diligent.

As patients, once ill, we inevitably turn to all kinds of medical literature for hope. In reading medical information and literature, if we are not to be blinded by prejudice, we must use our wisdom. Reliable surveys show that the more educated a person is, the longer he survives after a cancer diagnosis. Even if one was not a diligent learner before, becoming an eager learner after cancer diagnosis can still greatly benefit a person. Human reason is not innate; it is forged in the process of constantly learning and correcting one's biases.

Of course, in treating cancer the patient must not only keep learning and improving his capacity for rational judgment; he must also have the courage and perseverance to fight all kinds of suffering. As a physician with rich experience in fighting cancer, over the past decade-plus I have seen too many cancer patients endure a great deal of suffering during treatment.

A patient I know with lung adenocarcinoma had all ten toes ulcerate during chemotherapy, a mass of flesh and blood too harrowing to look at. Yet even in such dire straits, this older sister still fought the illness with fortitude; with the help of both Chinese and Western medicine she survived for more than ten years.

Some patients' fortitude is moving, while others are utterly weak—minor side effects like nausea and vomiting are enough to break them. These patients are like the ones Kafka described: every difficulty defeats me, rather than my defeating every difficulty. Fighting cancer is like sailing through treacherous seas, with unexpected sufferings attacking the patient at any moment. So for cancer patients, staying alive is indeed full of hardships. A person lacking courage can hardly complete the road of fighting cancer.

To encounter such a predicament in life, perhaps only those who are neither easily blinded by appearances nor lacking in courage can, with a little luck, walk out of this difficulty.

I hope every cancer patient can beat cancer, but reality has cruelly shown me that only a few do. The qualities these few possess are worth the others' emulation and learning.