Some Things I Have Learned in Treating Cancer
In the blink of an eye, it has been over ten years since I devoted myself to cancer research and treatment. It began with wanting to save my own cancer-stricken mother; now she has been gone for over five years. It began with saving myself, then gradually, at the request of patients and families, saving others. And I have grown from a twenty-something youth, new to the world, into a middle-aged man of wide experience.
Treating cancer is enormously stressful work, demanding suffering ordinary people cannot bear. Just witnessing the appalling physical condition of many terminal cancer patients is more than most people can stand. I have seen cancer patients with rotting limbs; I have seen surface tumors with maggots crawling over them, a stench hitting me as I approach.
Inwardly I am very afraid to see such patients, but when they come to me in despair, referred by friends or through reading my articles, I find it hard to refuse. I cannot bear to watch patients with the same disease as my mother reach the final stage of life without a shred of hope. Even if I offer only the comfort of a last straw, it is better than their spending their remaining days in mental collapse.
When I was in high school, my older brother was studying at university in Shanghai. Once he took me to Shanghai to see a renowned urology professor. The old expert was one of the top authorities in the country in his field. I remember, at the door of his clinic, a line he had written for his students, roughly: "Patients come to us perhaps at the last stop of their long search for care. If we do not treat them well, they will sink into despair. So whether or not we can cure them, we must treat them well."
More than twenty years later, those words are still imprinted on my mind, and have deeply influenced me. So whenever patients who trust me and entrust their lives to me come to me, I try my best, even as I treat them, to soothe their exhausted hearts and bring them some peace.
Of course, my ability is very limited. However hard I try, I may not actually achieve the intended goal.
My mother was the most good-natured person I have known. All her life she did what she could to help those she pitied, yet things always went against her wishes. I was greatly influenced by her, and I also deeply felt the disappointment and pain she endured when outcomes were not good. So I dare not be too optimistic about the effects of what I do.
If the opposite of what I intend occurs, I can only, in shame, offer my profound apologies to my patients and their families.
I grew up at a time when China was rising as a technological power but declining as a humanistic one. Modern technology and economic models have dealt devastating blows to traditional culture and belief; social contradictions have grown sharper; many of the beautiful emotions between people have vanished; a new, tolerant, rational social order has not yet formed.
This broad backdrop has an especially great impact on medicine, because medicine is said to be the last line of defense of social conscience; many believe that if this line too is breached, the last dignity of our humanity will be gone.
What makes us human, in the end, is simply that we have life. Because we have life, we humans have produced such splendid culture; because we have life, we live out such colorful existences.
The doctor is the one who escorts life when it is threatened. The doctor's work is the most genuine act of humanitarian rescue.
But truly selfless humanitarian rescue exists only in the ideal. Doctors are constrained by three realities and can never fully satisfy the patients they would save: first, medicine itself is imperfect and cannot solve every patient's problem; second, each doctor's ability is limited, his art cannot reach the ideal, and he cannot solve all of the patient's problems; third, doctors must also feed their families and can hardly be entirely selfless in rescue.
For these reasons, medicine has always been a sensitive profession, in all times and places.
"A healer is a workman who treats disease," our ancients defined. From my reading of Chinese and Japanese medical history, the medical profession, in old China and Japan, was never respected by society.
Scholar-officials turned to medicine only as a last resort, and even then stressed "scholarly ambition, medical practice" (taking Confucian learning as one's ambition, medicine as one's trade), as though earning a living from the life-saving money of suffering patients were a shameful thing that needed the fig leaf of "scholarly ambition."
This relates to our Confucian cultural circle's division of people into four ranks—scholar, farmer, artisan, merchant. The physician, as a "disease-treating workman," ranked only slightly above the merchant, the lowest of the four. Our cultural genes hold physicians in low esteem.
Zeng Guofan, the great Qing statesman, explicitly said that he, for one, believed neither in witchcraft nor in medicine. Famous physicians through the dynasties have often died unnatural deaths. In present-day China, reports of doctor-patient disputes are commonplace, and internet condemnation of doctors is fierce.
Among all kinds of doctors, the cancer doctor is in the most awkward position. Most of the time, treating the patient leaves the family with nothing but both life and money lost; yet if we do not treat, patients and families beg us in hot pursuit, hoping we will help.
I am especially grateful to the families who, after a patient dies, still say thank you to me. Several families contacted me immediately after their loved ones' death, sincerely thanking me for the help given in the patient's final days. A few words from them were enough to move me to tears.
Mencius said the wise person does not stand beneath a crumbling wall. In recent years many doctors have fled this high-risk profession. Most of those who have not fled have shifted, where possible, out of oncology into other departments. Cancer is enough to shatter a doctor's confidence.
Colleagues along the way have urged me to treat curable diseases and stay away from this death-reeking field.
Yet I have, imperceptibly, gone farther and farther down this road—from initial interest to today's situation, in which my growing personal influence has left me with no way back. My mindset has not, I must say, been unchanged.
Once I disregarded my own safety and responded to every request. Now, when a situation might endanger my personal safety, I first think of protecting myself.
My teacher once hoped I would be "broadly learned in antiquity and the present, conversant with both Chinese and Western learning." Today, to my son, on those eight characters I add four more: "deeply versed in human nature."
The ancients said: "Read ten thousand books, travel ten thousand miles." Knowledge gained from reading becomes more valuable when tested in practice. Medicine has never been purely a technical trade; besides treating disease, the doctor must deal with patients, families, and the public. A doctor inevitably must be "deeply versed in human nature."
The ultimate depth of being versed in human nature, as I understand it, is forgiving all.
No matter how powerful a person thinks himself, before Death he is only a lamb awaiting slaughter. The natural laws of birth, aging, illness, and death, and the entanglements of love and hate, make even the proudest person frail before real life disaster. Each of us is the same; no one is exempt.
This universal, sorrowful reality makes all of humanity an object of pity. Buddhism advocates cultivating the heart of great compassion; the "great compassion" it promotes is precisely the spirit that pities all beings trapped in the suffering of involuntary reincarnation.
No one is truly strong enough to control his own life and death.
In a famous temple I once saw a sick monk, carried on a stretcher, anxiously raging at the bearers for fear he would not receive timely rescue—entirely lacking the calm composure expected of a great figure of the Buddhist order.
From a physician's standpoint, I approve of this behavior and do not endorse a serene attitude toward life and death when a life could be saved. Life comes but once; fearing death is no disgrace.
Five years ago, when my mother died, I bore grudges against certain people for injustices she had suffered. Three years ago, that hatred was gone. Now, when I am hurt, after brief pain I quickly stand in the shoes of the person who hurt me and think about why he did it.
Hatred no longer takes root in me, because a deep pity for the suffering hearts behind people's masks has left me unable to hate anyone. Everyone has his own difficulties; he just does not always say them aloud.
I used to criticize various faiths, but gradually I have held my tongue.
Not because I have changed my own beliefs and adopted others', but because the same compassion has shown me that not everyone has a strong inner life. Many need faith to prop up their exhausted spirits. That being so, why disturb the peace of others' hearts?
In tasting the world's pain, I have worn away the hatred and prejudice in my own heart and become a tolerant, cautious person. That is my greatest gain from treating cancer.
Another gain is that clinical practice has stripped away all my arrogance.
Once, in Wuhan, a patient came to me and asked how confident I was of curing her. I told her honestly: less than ten percent. I saw her face twitch, an expression of extreme pain, because she had come full of hope.
At that moment my own heart ached too, but I thought I should stick to the principle of truth and tell her the real situation. She did not return; I never learned what became of her. Perhaps she went looking for a more confident doctor.
Now I study mainly TCM, but I am neither a fanatic who thinks TCM superior to Western medicine, nor one of those many people steeped in scientific thinking who dismiss TCM as worthless.
I am neither superstitious about nor prejudiced against any form of medicine. Because what I have seen tells me that, before a disease like cancer, no medical approach has anything to be proud of.
We often face situations where, instead of helping the patient, we have worsened his suffering. I believe colleagues who truly work the front lines and see large numbers of patients every day know this deeply. And I believe it is not only cancer that gives us "disease-treating workmen" this feeling.
Medicine has yet to develop; humanity as a whole still must look to medical progress to free itself from dread disease. All who study medicine should bow their proud heads and admit they cannot yet solve every patient's problem.
Sometimes, in the awkward moment of being unable to solve a patient's problem, I feel that we medical people, in a sense, are little better than swindlers.
We encourage patients and families to undertake some medical experiment, only for it to backfire, leaving the patient more wretched—and then, on top of that, we charge high fees. It is not hard to understand why, in all times and places, doctor-patient relations have been tense.
The Qing-dynasty physician Xue Xue, in old age, styled himself "the old ox-herding fellow," withdrew to the countryside, herded cows, and never spoke of medicine. Years ago, when I read his writings, I did not quite understand; today I feel it deeply.
Because of my reputation, I fear I can never become that "old ox-herding fellow." Even if I withdraw to the mountains, patients will probably still seek me out for treatment.
But in my heart I have the dream of being an "old ox-herding fellow." I hope that, when I reach the age of "white-haired old man and old woman," I will no longer have to exhaust myself treating patients and enduring, again and again, the disappointment of "drawing water with a bamboo basket."
Reading early this morning, I came upon a passage in Will Durant's Story of Civilization, in Our Oriental Heritage: "In a world so inured to violence, it is difficult to think of any phenomenon more valuable than this noble curiosity, any zest more meaningful than this never-ceasing passion to know."
This passage resonates deeply with me. I can probably only encourage myself with similar words, to keep walking forward in this imperfect field of medicine. If possible, I will do some deep research on certain questions and write them into books for later generations, as my predecessors did.
Such is the series of psychological changes, the assorted trivial thoughts, and the lessons I have learned while treating cancer. Tossed together into an essay, I myself do not know why I am writing it. Since I have written it, I venture to share it with my readers.