The Last Stop

1

During the winter break of 1997, my older brother was in his second year at Tongji University in Shanghai.

At the time I was suffering badly from a urinary system disorder and had been seeking medical help everywhere. My brother took me to a hospital in Shanghai and booked an appointment with an academician who was a urologist.

I have forgotten the academician's name. Although he did not solve my problem—the frequent urination that plagued me then still plagues me to this day—one sentence he said has stayed with me ever since.

He said: "When a patient comes to us, this may well be the last stop on their search for a cure. We must do everything we can to relieve their suffering."

I still remember him pointing at my jeans and saying to his students, with a touch of irritation: "These cheap jeans are truly harmful. They are uncomfortable to wear and do the urinary tract no good at all."

Lying on the examination couch while he palpated me, I was overcome with shame. Those were the clothes I wore to "be seen in." Because my family was poor, they were already the best trousers I could afford at the time.

In The Silence of the Lambs, the heroine Clarice as a child once watched, helpless, as lambs were led to slaughter; that scene haunted her for the rest of her life.

For me, the "last stop" remark of this academician whose name I have long forgotten has likewise shaped my whole life.

I have now myself become the last stop for many people seeking a cure. When they have run out of options, they come to me, hoping I can win for them one last sliver of hope.

At such moments I always recall the academician's words. Only, unlike his patients, mine are overwhelmingly late-stage or even end-stage cancer patients.

Treatment failure is a common occurrence in advanced cancer. So the patient's "last stop" at the same time means I may well face the reality of a patient dying while under my care.

This has even shaped my whole view of life. Someone who has long dealt with death will indeed see life differently from most people.

2

On March 21, 2019, a patient born in 1981 with advanced cervical cancer (small-cell carcinoma) came to see me from Wuhan.

Before coming, she had already received one course of chemotherapy under an academician at a certain top-tier (Grade 3A) hospital in Wuhan. She had a severe intolerance to that course of chemo, which left her body on the verge of collapse.

When she arrived she was frail. I took her pulse and found it surging, large, slippery and rapid. Her tumor had already spread everywhere. Her signs and pulse indicated a deficiency of upright qi with exuberant pathogenic evil—the hardest possible condition to treat. Her whole body gave off a strong, foul odor, and I was so alarmed that I dared not treat her.

After I measured her blood pressure, her 42-year-old husband picked up my electronic blood-pressure monitor and took his own reading; it showed a systolic pressure of 167.

I remarked in passing that the pressure seemed very high. Her husband told me that after his last cold his reading at the community clinic had been even higher, over 190 systolic; he said his hypertension ran in the family as a hereditary condition.

In that moment I felt deeply sorry for this family.

In the course of our conversation I learned that the young couple had an eight-year-old child. They had worked very hard and struggled to build a better life, yet now both spouses' bodies were in a high-risk state.

Mr. Fei Xiaotong said that, from a sociological point of view, the most important function of marriage is to enable bilateral parental care, creating the safest possible conditions for underage children to grow up.

I too have a young child. Mencius said: "Treat your elders as elders, and extend it to the elders of others; care for your young ones, and extend it to the young ones of others." Seeing this couple's eight-year-old child left in such a high-risk situation with both parents in poor health, and watching the two of them hold each other's hands, comforting each other in despair, I hesitated for a moment, then decided to take the risk and seek a way to save her.

I did not know how it would end. Perhaps she would be unexpectedly saved, perhaps not; perhaps treating her would carry risk, perhaps not.

But for a family that had truly run out of options, even if my clinic was not quite their last stop, it was not far off. When professional risk wrestles with compassion, I suppose I can only grit my teeth and face the challenge.

3

Medicine, at its essence, is not merely a natural science. No discipline that concerns human beings is ever as simple as a pure natural science.

The core of medical care is the humanitarian spirit. But medicine is a high-risk profession, and at any moment one can be pushed into a very passive position because the outcome falls short of what the patient or family expected.

So it is perfectly normal for doctors to feel apprehensive about accepting critically ill patients.

I often encounter patients who are suspicious of me, and whenever I meet such patients I try my best to avoid taking them on. Because I worry even more than they do that my treatment will fail, and that such a consultation will bring me some unforeseen disaster.

With this group of patients, turning them away carries little moral burden, because patients have the right to choose their own doctor—and they have not chosen me yet.

But how should we handle the critically ill patient who comes sincerely seeking help? That is the real question.

The patient has indeed run out of road, and the doctor does not know where the limits of his own ability lie. Perhaps with a little more effort he could save them; perhaps not.

But if we turn the patient away, they lose even this one thread of hope.

Especially when we are the patient's last stop, turning them away leaves them in utter despair.

A couple of days ago, the mother of an orbital-tumor patient I had been treating for some time came to see me. The patient was in adolescence, facing the twin pressures of a malignant tumor and the high-school entrance exam; having left school, she also faced the pressure of being marginalized, and she had developed some psychological problems as a result.

I suggested her mother seek help from a professional psychologist. The mother told me they had been to psychologists before, but had not yet found one she could trust; she did not dare hand her daughter over to them.

She and her daughter trusted me more, believing that with my body of knowledge I could help them, and so they hoped I could resolve the patient's psychological issues. I could only listen patiently to her pouring out her heart.

This patient's family was unusual. They had come to me more than a year before, but after that first visit they went off seeking care everywhere for over a year, and finally, after comparing options, chose to come back to me.

For them, perhaps there were not many roads left to take; I may be one of the few doctors they can both choose and trust.

Shrugging off one's responsibility is a simple thing, and after shrugging it off one feels light. But if we shrug off our responsibility, to whom will these patients turn for help?

4

The Medicine King Sun Simiao wrote in his chapter "On the Absolute Sincerity of the Great Physician":

"When a great physician treats disease, he must calm his spirit and fix his will, free himself from desires and cravings, and first arouse a feeling of great compassion and pity, vowing universally to rescue the suffering of all living beings. If someone in illness or distress comes seeking help, he must not ask whether they are noble or humble, poor or rich, old or young, beautiful or ugly, enemy or friend, native or foreign, fool or wise; he must treat them all equally, as though they were his own dearest kin. Nor must he look ahead and behind, consider his own fortune or misfortune, or cherish his own life. Seeing the patient's suffering should be as if it were his own; deeply grieved, he must not avoid dangers, day or night, cold or heat, hunger or satiety, fatigue, but hasten with all his heart to save them, not adopting the attitude of a craftsman or performing for show."

I used to feel, more or less, that such principles were a bit pedantic. But after standing guard over life on the front line of life and death for a long time, I have gradually come to understand that a person who truly loves medicine can only practice by following these principles laid down by the Medicine King; there is no other choice.

Having learned the art of medicine, if for any reason one refuses to save a life, it brings guilt and unease. But treating disease is not a simple matter, and medical risk is everywhere. So as the guard at life's last stop, doctors all carry a strong sense of vigilance, constantly on guard against the unexpected.

The year before last, at a family's request, I traveled to Qingyang in Gansu province to see a patient. By then he was already in the ICU, hanging by a thread.

The emergency doctors in the ICU brought out a whole stack of liability-waiver documents for the patient's son to sign. This obviously intensified the family's agitation, but it is the standard operating procedure in medicine; doctors dare not leave behind future trouble through a moment's carelessness.

In reality, though, many fierce doctor-patient disputes arise precisely this way. For when people face a threat to their own life or the life of their loved ones, their emotions easily spin out of control, and sometimes irrational acts occur.

Earlier, when this patient had been listed as critically ill at a top-tier hospital in Beijing, his family had called me for emergency help, and I had pulled him through; that is why his family trusted me so.

I did not ask the family to sign any legal document with me. Instead I told them plainly that further rescue was futile, and urged them to quickly find a car to take the patient home, so that he might return to the soil of his hometown to die.

Watching the patient's breathing grow ever more labored, though it was emotionally very hard to accept, the family respected and followed my advice. They asked me to ride along and care for the patient, trying to extend his life until they reached home.

I agreed.

On the way, the patient's son still hoped I would work a miracle and revive his father. But the patient's younger brother, when his nephew wasn't looking, gently nudged my foot with his. I understood what he meant: he wanted me to persuade his nephew to give up the fantasy and stop torturing the dying man.

In truth, the patient could certainly not have been revived. So I did what I could to give him comfort care, while telling the son that relieving his father's suffering was also a form of filial piety.

When we reached the patient's old home—a cave dwelling in the mountains of Gansu—and carried him onto his kang, in less than two minutes he breathed his last peacefully.

It was already the small hours. I stood in their courtyard, watching the family, following local custom, burn paper figures and paper horses to send the departed on his way. The courtyard was in an uproar.

Though the family was holding a funeral, all of them treated me like an honored guest, with great respect; there was no fierce doctor-patient conflict, and no one blamed me—only words of thanks.

After the bustle, they took me to the best hotel in town and settled me in.

When we have no way to save a patient's life, should we coldly follow the laws and regulations, or offer the family the most candid advice and then give them warmth and comfort? This is a question we medical workers living under the modern health-care system should ponder.

I do not know whether my way is right or safe, but I have always done my utmost to be factual, reasonable and humane, holding to the baseline that any human being should hold to.

Whether doing so will satisfy the patient and family, or bring me trouble, is something I can hardly predict.

5

After deciding to take on the advanced cervical-cancer patient from Wuhan, I talked at length with her and her husband.

I resolved to do my utmost to make a last stand for this young mother. But this also meant using many medicines that might carry risk for her and add to her financial burden. If the treatment failed, the family would face the loss of both the patient and their money.

The couple said they understood and were willing to try.

I hoped they would stay near me for a week of observation before leaving. To reduce risk, I planned to add the medicines to her gradually. Staying close let me observe her responses to each drug and make more accurate judgments.

They agreed. Following my plan, I added the herbs little by little, and after each dose they would come tell me in person how she had reacted. Over those few days by my side, I increased her medication to the maximum.

On March 25 the patient was doing well, and when she came to see me again the foul odor on her body was gone. Her husband said he had stayed by her side throughout; after taking my medicine for only two or three days, the strong odor had vanished, and she felt no major discomfort.

I too breathed a sigh of relief and was happy for her. In just a few short days we had already seen a therapeutic effect, so her illness was not entirely beyond hope.

I encouraged her to go home, to treat patiently for a month or two, and then to use the test results to assess the effect. If the tumor shrank, she should continue patiently with the current regimen.

Medicine is inherently uncertain. When a doctor prescribes based on theory and experience, he cannot know in advance whether the medicine will work. So patients or families often ask me whether I am confident in treating them. I have only one answer: "No!"—and then let them choose for themselves.

A Korean doctor once said: It is God who saves the patient; we doctors merely find a path for the patient to God.

Indeed. To treat successfully, half depends on the doctor's effort and half on the patient's luck.

6

Early last Sunday, the little girl with the orbital tumor and her mother came to see me as arranged. Before this, her mother had pleaded with me on the phone to help resolve her daughter's psychological problems.

Before they arrived, I had prepared for this consultation-and-talk. Since I had promised, I had to keep my word.

The girl had become somewhat withdrawn because of her illness, speaking little and unwilling to communicate. Untying her mental knot was no simple matter.

My own son is a year or two younger than she, and my apprentices are about her age, so I am not too unfamiliar with the psychology of children this age. My talking gradually put her at ease and made her want to keep listening.

I encouraged her to face reality, accept reality, and grow strong on her own; not to fantasize about relying on anyone, but to make her own spirit strong. I used the stories of some patients who had successfully fought cancer to inspire her confidence in defeating the disease.

I also told her that when God closes a door, He opens a window for her; that she should learn to find and develop her strengths, avoid the weaknesses in her body, and live out her own radiance.

The talk went reasonably well. The girl broke into a smile, and before leaving her confidence had returned; her attitude was positive.

Whether she would stay positive after going home, I could not know. But we agreed that if she ever felt psychologically overwhelmed, she would come back and talk with me.

I recommended a few books that would be good for her, hoping she would read them. Before she left I encouraged her to set her sights on serving patients whose fates were like her own, to study mind-body medicine well, and one day to relieve the suffering of other patients.

What she needed psychologically was a direction for her life's striving. If she could find something suited to her that she truly loved, I thought she would quickly become positive again.

But for me the war was not over. I still needed to find a way to treat her tumor, until such time as they gave up treatment with me. If the tumor were not resolved, no matter how strong her spirit, this young life would still face the threat of death.

7

A year ago, a young patient came to see me with his parents.

His mother was from Huanggang, Hubei—my own hometown.

The whole family felt especially warm toward me. Perhaps it was fate; perhaps my naturally amiable manner had left a good impression. The patient himself, upon meeting me for the first time, felt he had met his destined benefactor and firmly believed his illness would be cured through me. His trust in me exceeded that in any other doctor.

Unfortunately I did not solve his problem. After treatment failed, based on my knowledge of my TCM colleagues, I referred them to another old physician. This old doctor solved his cancer-fever problem.

At the time, another patient referred by the patient's mother came to me and responded remarkably, with the residual tumor rapidly disappearing. The whole family of three became very anxious, fearing that this old doctor I had recommended could not treat their tumor, and also fearing they had missed the chance to treat their tumor with me.

Relying on their trust in me, I vouched for the old physician's skill. I promised that if he could not cure them, I would treat the patient again myself, and told them to be at peace once they had come, and patiently wait for the effect.

After persisting for a year, they achieved a gratifying result: the tumor had almost entirely vanished. From then on the family trusted wholeheartedly in the old doctor I had recommended.

On March 11 this year, they came especially to thank me. They felt that had it not been for my referral and the words I had spoken when they were at their wits' end, they would have missed their chance of being saved—for they had already been turned away by a top-tier hospital such as the Cancer Hospital of the Chinese Academy of Medical Sciences.

At my request, they brought me the prescriptions from their 33 visits to that old doctor. The old gentleman worked within the Warm-Heat (wenbing) school of TCM. Given his advanced age, I had the patient record in detail every prescription and his reactions to each, so that after the old doctor's passing, other doctors could continue treating him with this as a reference.

I also recommended several classics of the Warm-Heat school for him to study on his own, so he could learn more of the medicine specifically relevant to his disease. That way, after both the old doctor and I were gone, when he sought care again he would not be blindly lost, and would have the discernment to judge other doctors' prescriptions.

The patient and his mother thanked me a thousand times over, and even offered to help with my own difficulties in life.

When a patient takes me as his last straw and I cannot save him, I choose to find another way out for him. My personal dignity and face are, in truth, far less important than a single life.

My life has largely gone smoothly. I believe the root cause is that my mother passed on her simple, honest nature to me. Add to that the painstaking cultivation of my beloved teacher, who nurtured me into a person of fairly broad mind.

So in how I conduct myself I am not so narrow-minded as to refuse help to the dying or to forget righteousness for profit. Over the years I have helped a number of people and saved some lives.

Adler said that discussing a person's life value in isolation is meaningless. A person's life value is embodied in the value he creates for others.

Saving patients' lives has indeed led me to evaluate my own life more positively.

8

I once did clinical work under an old physician. One day she said to me: "Don't rush. Even if you don't begin practicing independently until you are forty, and work until sixty, you can still treat and save people for twenty years. Twenty years of treating illness is enough."

My mentor's meaning was that the medical profession, practiced for twenty years, is already enough for one person to endure—because the work is truly arduous.

Another old physician, whom I deeply respect, worked at a Grade 3A hospital, and I often referred patients to him. But he always told me not to do so, because he needed to take vacations. At the time I did not understand him; only when I myself had no vacation left did I grasp his hardship.

Taking the road of studying and practicing medicine has many disappointments. High risk, heavy workload, great mental stress—these are all objective facts.

But perhaps this profession is simply inherently so, and will remain so until the day humanity vanishes, because we deal with human life. If someone who studies and practices medicine is always full of negative views about the profession, it only shows that he may not be suited for it.

As far as I know, even in the Western developed countries we so admire, there are likewise all kinds of medical problems, many thorny patients, and many other headaches for doctors.

I too have shrunk back and complained, but gradually I have understood: this is reality, the reality we ourselves must face.

When we talk with patients we often encourage them to face reality. Why can't I myself face the reality that my profession has so many difficulties? Since I have fallen in love with medicine and taken this road, I am willing to accept it all with equanimity.

This shift in mindset has changed me greatly. Now I neither complain nor wish to read any of those extreme articles that vent their authors' emotions about medicine—whether the venting comes from doctors or from patients.

Because I feel the authors of such articles are not yet mature. My life experience tells me that the only way to free ourselves from hardship is to improve ourselves.

Standing the last watch over life requires not only medical knowledge and skill, but also a mind as broad as the sea, good psychological resilience, outstanding communication skills, and a refined art of reception.

So rather than complain, better to perfect oneself.

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